the elderly with heart disease internship project

By : J i ny eob K i m

The Elderly with Heart Disease and Exercise

Facts About Heart Disease

Cardiovascular Disease (CVD) is more common among men than women in every age group.

In the United States, a quarter of the total deaths (each year) is attributed by heart disease. With about 66% of these heart disease deaths

occurring within the population of 75 years old and older.

About 83.6 million Americans have some kind of heart disease. With about 42.2 million out of this population is 60

years old and older.

Facts About Heart Disease

The most common type of heart disease is the Coronary Heart Disease (CHD) – attributes to more than 370,000 deaths each year in the United States. With about 80% of CHD deaths occurring within the

population of 65 years old and older.

What Causes Heart Disease?

Although the term - heart disease – may relate to various problems associated with the heart and blood vessels, the term generally refers to the damage of the heart or blood vessels caused by atherosclerosis. Atherosclerosis is the most common cause for heart

disease.

Atherosclerosis refers to the fatty plaque buildup within the arteries. The plaque buildup causes clotting and hardening of the artery walls. Thus, progressively narrowing the inside of the artery. Therefore, the plaque buildup may cause an obstruction of blood flow from the arteries to the organs and tissues.

Atherosclerosis

Heart Disease Risk Factors

About half of the American population diagnosed with heart disease tend to have at least one of these primary risk factors: High blood pressure High LDL cholesterol Smoking

Other risk factors that may also attribute to higher chances of heart disease: Excessive alcohol consumption Poor diet Diabetes Overweight/Obesity Physical inactivity

Range of Motion Exercises and Heart Disease Recovery

Patients should have a meeting with a exercise physiologist, physical therapist, or nurse clinician every day during the recovery process.

Stretching or range of motion (ROM) exercises of upper- and lower- extremity highly recommended for inpatients. Myocardial infarction (MI) patients highly recommended to begin

stretching exercises as early as 2 days after MI. Coronary artery bypass graft (CABG) surgical patients highly

recommended to begin stretching exercises as early as 24-hours after the surgery. The CABG surgery may damage the soft tissue and bone of the chest

wall, and result in the deterioration of muscle function without ROM exercises.

Range of Motion Exercise

A new ROM inpatient program, focusing on the recovering patients, should include the following: ROM exercises performed once a day during the meeting with a

physician. Each ROM exercise session should target both the upper- and

lower- extremities. Upper-Extremity include:

Shoulder flexion, abduction, and internal and external rotation Elbow flexion

Lower-Extremity include: Hip flexion, abduction, and internal and external rotation Plantar flexion and dorsiflexion Ankle inversion and eversion

1 set of 10 to 15 repetitions should be performed for each exercise within the ROM exercise session.

Exercises should feel light to somewhat hard (RPE: 11 to 13).

Maintenance Exercise and Heart Disease

The types of exercises that are beneficial for heart disease patients should focus on strengthening the muscular and cardiovascular systems of the body. These are: Endurance training (Aerobic exercise)

This type of exercise improves the heart’s functional capacity.

Includes: cycling, walking, running, swimming, and etc. Resistance training (Anaerobic exercise)

This type of exercise improves neuromuscular function and increases lean body mass. Also, the increase in muscle strength is related to the decrease in blood pressure and heart rate, while lifting.

Includes: “pumping iron,” or exercises that improve muscle strength and endurance.


A study has shown that an exercise-based cardiac rehabilitation for heart disease patients is linked to a significantly lower risk of mortality, within a 5-year follow-up.

Exercise in heart disease patients has been shown to improve functional capacity by 10% to 60% within the first 12 weeks of training.

Exercise in heart disease patients has been shown to reduce myocardial work during workloads by 10% to 25% within the first 12 weeks of training.


CABG surgery and sternotomy patients is to avoid sternum-pulling resistance exercises for the first 3 months.

MI patients is to avoid resistance exercise for the first 2 to 3 weeks.

Prior to beginning either endurance or resistance training, the patient should meet a healthcare professional for an evaluation.

Resistance Training

A new resistance training program, focusing on the elderly with heart disease, should include the following: Resistance exercises performed 2 to 3 days each week. Each resistance exercise session should include 8 to 10 various

exercises that target the major muscle groups. Include: leg press (quadriceps), leg curls (hamstrings), calf raises

(calves), lower back extensions, pull downs (upper back), chest press, shoulder press, triceps extensions, and biceps curls

1 set of 10 to 15 repetitions should be performed for each exercise within the resistance exercise session.

Exercises should be performed at a lower-intensity level to prevent injuries (RPE: 12 to 13).

Weight machines are recommended, and free-weights are discouraged. The elderly tend to have a lack of balance, lower-back pain, poor vision

and a higher tendency to drop weights unintentionally.

Resistance Training

Variable Resistance Training EffectBone mineral density level Moderate increaseBody fat percentage/Lean body mass

Slight decrease/Moderate increase

Muscle strength Great increaseInsulin response to glucose/Insulin sensitivity

Moderate decrease/Moderate increase

LDL cholesterol Slight decreaseResting blood pressure (Systolic/Diastolic)

No effect/Slight decrease

VO2max Slight increaseResting heart rate/Stroke volume

No effect/No effect

Endurance Training

A new endurance training program, focusing on the elderly with heart disease, should include the following: Endurance exercises performed 3 to 5 days each week. Each endurance exercise session should attempt to incorporate both the

lower- and upper- extremities. Upper-Extremity include:

Arm ergometry Lower-Extremity include:

Walking, stairclimber, and jogging/running Combined include:

Rowing, cross-country ski machine, combined arm/leg cycle, swimming, and aerobics

A duration of 6 to 30 minutes should be performed within the endurance exercise session.

Exercises should be performed at about 55% maximum heart rate (HR) or at about 40% peak oxygen uptake (VO2).

Seated machines are recommended, and standing machines are discouraged. The elderly tend to have a lack of balance.

Endurance Training

Variable Endurance Training EffectBone mineral density level Moderate increaseBody fat percentage/Lean body mass

Moderate decrease/No effect

Muscle strength No effectInsulin response to glucose/Insulin sensitivity


LDL cholesterol Slight decreaseResting blood pressure (Systolic/Diastolic)

Slight decrease/Slight decrease

VO2max Great increaseResting heart rate/Stroke volume


References

Go A. S., Mozaffarian D., Roger V. L., et al. (2013). Older Americans & Cardiovascular Diseases. American Heart Association. Retrieved from:

http://www.heart.org/idc/groups/heartpublic/@wcm/@sop/@smd/documents/downloadable/

ucm_319574.pdf

Pollock, M. L., Franklin B. A., Balady G. J., et al. (2000). Resistance Exercise in

Individuals With and Without Cardiovascular Disease. AHA Science Advisory, 101, 828-833. Retrieved from:

http://circ.ahajournals.org/content/101/7/828.long

Shephard R. J. & Balady G. J. (1999). Exercise as Cardiovascular Therapy. Clinical Cardiology: New Frontiers, 99, 963-972. Retrieved from:

http://circ.ahajournals.org/content/99/7/963.long

the elderly with heart disease internship project

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