Question

A 44- year old, 179Ib corporate executive, James, was admitted to the hospital complaining of chest pain. After evaluating James, the Cardiologist determined that he was experiencing a mild heart attack.

He was immediately taken to the catheterization lab, where he was diagnosed with a significantly blocked left circumflex artery. A PTCA (angioplasty) was performed. A follow- up echocardiography test reported an ejection fraction of 55%, indicating that James had NOT suffered major heart damage. Prior to his MI, James had no health issues and was physically fit, as he was involved in a regular fitness program.

Two weeks later, James was referred to you for an exercise prescription in a phase II cardiac rehabilitation program. His only medication is a daily aspirin. A maximal treadmill exercise test taking James to volitional fatigue after his PTCA revealed the following information:

- ECG: normal sinus rhythm

- Maximal heart rate: 156 bpm

- resting HR: 62 bpm

- Peak exercise blood pressure: 150/ 90 mmHg

- resting blood pressure: 120/ 70 mmHg

Bases on the above data, choose an intensity range using the %HRR method, and determine the TIME per exercise session and the NUMBER sessions per week. His goal is to expend at least 1, 000 calories per week.

- To reach is target HR, he must jog on treadmill at 4mph @ 3% grade. use the running equation to calculate his VO2.

- calculate his NET calories burned

- Determine the number of exercise sessions per week he would need to burn at least 1,000 calories per week.

- discuss the guidelines for a phase II cardiac rehab program.

- discuss the indications and the contraindications to exercise.

- are there any other physical limitations for this patient?

- what are your recommendations for this patient with regard to diet and resistance training?

- how would you guide him with regard to tips for resistance training?

Answer 1

the heart rate reserve (HRR) formula..... your HRmax and subtract your resting heart rate (RHR).

156- 62 = 94 is hrr

intensity range,, ist find the maximal heart rate target which = 220 - age (in years)

220-44= 176

moderate intensity exercise, max heart rate should equal 176. (50-70% of max heart rate = 80- 120 beats per minute).

50% intensity is required for the person

According to cardiac rehab session should run for 30- 40 mints. 5-6 exercise sessions are recommended for cardiac and obese pts

Calculation of running vo2 we need horizontal testing and vertical components

Convert mph into m. Mint = 4×26.8 = 107.2

Horizontal component = speed × 0.1 =107.2×0.1= 10.72

Vertical component = grade ×speed× 1.8= 0.03×107.2×1.8=5.7888

Resting oxygen = 3.5ml/kg/mint

Total VO2= h+v+r = 10.72+5.788+3.5=20ml/kg/mint

If VO2 is to convert into METs then divide VO2 by 3.5

Calorie burned per hour = METvalue ÷ wt in kg

( 20÷3.5)× 81.1kg(179ibs)= 467.428571 this much calorie is burned / hr

For burning 1000calorie a week he needs 3-5 exercise session per week

The guidelines for cardiac phase 2 programme focuses on ,,Smoking cessation ,Lipid management , Diet modification and Weight control ,Blood pressure control ,improved exercise tolerance , adherence to medications

Contraindications for exercise include unstable angina, heart failure,arrhythmias, pulmonary arterial hypertension, thrombophlebitis, severe obstructive cardiomyopaties. Indications for exercise are obesity, high Cholesterol, recent heart attack, heart surgery

Recommendatiins related to diet that the ptbis already obese he should avoid the fatty foods and switch to veggies, fruits , drinking more water etc related to exercise ... . He should regularly do the resistance exercise that will help him to increase cardiac output and maintain the health of the heart.

Tips for resistance exercise....... Start slowly,Proper technique is essential. ....Safety and precautions are needed so use safe and well-maintained equipment. ...Don't hold your breath. ... prevent injury through incorrect technique learn correct techniques, perform full range of motion exercises.