CRF - FITT
5 days per week: 150min moderate exercise - 40 - 59% VO2R/HRR.
3 days per week; 75min vigorous exercise - 60 - 89% VO2R/HRR.
3 - 5 days per week - mix of moderate + vigorous exercise.
Step ups - 1 min x 5.
Sit-to-stand 1 min x 5.
10 minutes total x 5 days per week = 50 minutes/150minute total = 100 min left.
Walking - 20 minutes x 5 days per week = 100 minutes.
Meets 150 min total.
During CRF, warm-up before conditioning.
Cool down - walk around clinic room.
Stretching before letting patient go.
Can monitor intensity via RPE scale. Educate them on how to use it, monitor at the set RPE (12 - 13 for moderate, 13- 17 for vigorous). Give them a copy for their reference at home.
Ensure that there are no overcompensatory movements when doing exercise - sit-to-stand, ensure there's no hovering. Chair securely against wall to prevent sliding. Also make sure is cushioned/comfortable for patient. Ask for feedback - give verbal encouragement + eye-contact while respecting personal space.
Monitor intensity via talk-test, if they are able to talk while sounding a bit breathless - within acceptable parameters. Unable to talk suggests intensity is too high. Check for perspiration.
Can progress intensity by increasing speed. Increasing height of steps/decreasing height of chair. Increasing duration of exercises - incrementally by minutes. 150min goal is a a minimum goal - advantageous effects if they can do double that.
Regress by doing the opposite of above.
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FITT- strength + endurance (isometric + dynamic):
strength - ability of a muscle to exert maximal force against resistance.
endurance - ability of a muscle to exert submaximal force for extended duration of time.
Isometric:
Strength:5 d/w, 100% MVC. Hold for 5s, 5 - 10 reps. 4wk programme.
Endurance: 5 d/w - 60% MVC. Hold until fatigued - 1 per session. 4wk programme.
Dynamic:
Strength: 2 - 3 d/w, 60 - 80% 1RM. 8 - 12 reps, 2- 4 sets. 2 - 3 min rest between sets. 48hr rest between sessions. 8WK programme.
Endurance: 2 - 3 d/w. > 50% 1RM. 15 - 20 reps, >2 sets. 2 - 3 min rest between sets. 48hr rest between sessions. 8 WK programme.
Can progress exercise by increasing reps + sets or increasing resistance/weight, colour of theraband.
Progress by decreasing these things.
If there's any pain, may be prudent to regress as well.
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Flexibility - ROM of a joint that is pain-free.
ROM - osteokinematic action of a joint to perform movements that are functional or otherwise, with or without assistance.
Static:
2 - 3 d/w. Hold for 10 - 30s to the point of slight tightness or discomfort, but not pain. Total stretch time = 60s. Programme between 3 - 12 weeks long.
Aim to use passive (external force) stretches to increase ROM - can use yoga-strap, gravity, body weight or other weights.
Must hold the joint in the target ROM in order to perform a stretch. To increase elbow flexion - flex elbow with a weight in-hand and hold - stretching the elbow extensors.
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