Aerobic Exercise for Patients with Cardiopulmonary Compromise

August 23, 2018

Heart disease is the leading cause of death in the United States, while chronic lower respiratory disease (primarily COPD) is the third leading cause of death (CDC, 2020). With advancing age, an individual undergoes cardiovascular and pulmonary changes resulting in the fundamental physiological problem of reduced oxygen delivery to skeletal muscle.

Aerobic exercise provides benefits in the geriatric population such as decreased cardiac output at a set work load (improving task efficiency and energy conservation) and elevated mood, as well as reduced risk of chronic disease, functional limitations, disability, and premature mortality. Aerobic exercise may include walking and cycling with or without functional electrical stimulation added.

General Guidelines for Aerobic Exercise
Adults, including those with chronic conditions who are able, should do at least 150-300 minutes per week of moderate-intensity or 75-150 minutes per week of vigorous-intensity aerobic physical activity spread throughout the week (U.S. Department of Health and Human Services, 2018).

Considerations:

Monitor Vital Signs:	Heart Rate (HR), Respiratory Rate, Blood Pressure, O2 Saturation, Rate of Perceived Exertion (RPE), and Dyspnea Scale.
Assess Vital Signs:	at rest, during exercise, and after exercise completion.
Review Medications:	Beta Blockers blunt heart rate response to exercise; recommend Rate of Perceived Exertion for moderate intensity.
Calculate Target Heart Rate:	using Heart Rate Reserve formula (Karvonan method); Target HR = [(220 – age) – HRrest] x (% intensity) + (HRrest)
Progress Exercise Workload:	as patient demonstrates improvement.

Recommendations for Special Populations (ACP, 2020)

*For severe disease states start with lesser intensities, initial exercise duration of 5 to 10 minutes, and with the individual in the seated position.

References:
Accelerated Care Plus. (2020). Recommendations for Special Populations (table) referenced from ACP Accelerated Clinical Practice Courses – Aerobic Exercise for Aging Adults, Chronic Obstructive Pulmonary Disease, Chronic Heart Failure & Rehab, Stroke Recovery.
Centers for Disease Control and Prevention. (2020, January). NCHS Data Brief: No. 355. Mortality in the United States, 2018. https://www.cdc.gov/nchs/data/databriefs/db355-h.pdf
U.S. Department of Health and Human Services. (2018) Physical Activity Guidelines for Americans, 2nd edition. U.S. Department of Health and Human Services.
https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf

MRK 0419 (3)