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Running head: Post Cardiac Surgery: The Effects of Cardiovascular Exercise
Post Cardiac Surgery: The Effects of Cardiovascular Exercise
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Running head: Post Cardiac Surgery: The Effects of Cardiovascular Exercise
I. Introduction
Cardiac surgeries are procedures conducted by specialist on patients who have suffered
from cardiovascular disease. The surgeries are performed in order to treat complications
resulting from cardiovascular disease. One major cardiovascular disease that leads to a cardiac
surgery is coronary artery disease (CAD). Cardiac surgery patients should be carefully looked
after, as they are vulnerable and susceptible to infection, are affected by the slightest change in
diet, and they are most likely to suffer from hypersensitivity. (NHS, 2014)
Coronary heart disease (CHD) results from the narrowing of arteries in the heart from
an accumulation of fatty deposits on the internal walls. The result of this is a reduced blood
supply that puts a limit on the oxygenated blood that can reach myocardial cells which can
cause a heart attack if left untreated. The most common sign of CHD is angina, or a chest pain
the could feel like a squeezing of the chest. Another common symptom is shortness of breath
due to a buildup of fluid in the lungs that can’t be cleared with the heart not pumping
effectively (NHLBI, 2016).
The prevalence of coronary heart disease usually refers to the estimated population of
people who are suffering from coronary heart disease at a certain point in time. The term
'incidence' of coronary heart disease refers to the annual diagnosis rate, or the number of new
cases of Coronary heart disease diagnosed each year.
The American Heart Association (2004) documented that the prevalence of coronary
heart disease is at almost 13.2 million people, which is about 4.85% of American population
(Prevalence and Incidence of Coronary heart disease, 2016). There are approximately 1.2
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Running head: Post Cardiac Surgery: The Effects of Cardiovascular Exercise
million recurring occurrences of coronary heart disease in America. Approximately 2.3 million
citizens are living with CHD today. In the UK, coronary heart disease is responsible for 73,000
annual deaths. Studies also show that CHD is more prevalent in men than women and that 1 in
every 6 men die whereas 1 in every 10 women die as a result of CHD (NHS, 2014).
Records show, however, that the mortality rate of CHD in older individuals has
reduced significantly since the 1960s (Fang, Shaw, & Keenan, 2010). This can be a result of a
change in individual lifestyles, bringing more awareness through campaigns to reduce risk
factors such as obesity, high-blood pressure, tobacco use, lack of physical activity or high
cholesterol. (NHLBI, 2016)
The most significant causes for early onset CHD
are; having high blood pressure, diabetes, high cholesterol levels, which include low density
(LDL) and high-density (HDL) lipoprotein, cigarette smoking, obesity and genetics. Another
cause of CHD could be left ventricular hypertrophy, estrogen replacement therapy, and family
history of CHD. (Wilson, aD’Agostino, Levy, Belanger, Silbershatz and Kannel, 1998)
Aerobic exercise can have an impact on individuals that suffer from coronary artery
disease. For example, there are many different factors which include the individual’s heart rate
(HR), their blood pressure (BP), how much blood is being pumped (cardiac output, Q) and
how much oxygen it is consuming in a single contraction. Aerobic exercise puts a large strain
on an individual's heart. The heart rate during different exercise intensities can tell us a little
bit about how strong the heart muscle is. Typically professionals will look at the individuals
recovering heart rate to see the strength of the heart. An individual with a faster recovering
heart rate typically is in better shape physically. If an individual has a recovering heart rate
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Running head: Post Cardiac Surgery: The Effects of Cardiovascular Exercise
<12 Beats per minute (bpm) at 1 minute while walking and <22 bpm while laying down, they
usually have a higher mortality rate. (Jolly, 2011)
Individuals with coronary heart disease (CHD) may have different side effects
affecting their blood pressure. Some individual’s BP may react to exercise normally which
typically has a slight rase due to the oxygen demand by the muscles. For others, such as
individuals with CHD, their BP can increase/decrease in an abnormal manner. However, any
type of exercise is good for the heart. Participating in regular physical activity will help
decrease your blood pressure, and studies have shown that it takes about 3 months of regular
exercise for it to actually affect your blood pressure (BP).
Exercise can also affect individuals with cardiac disease depending on their cardiac
output and oxygen uptake. Typically people with CHD have a lower max VO2 and is harder to
reach due to their disease. Their cardiac output usually reaches a little over 50% compared to
healthy individuals. Because of their low cardiac output and the inability to distribute blood
flow in an efficient and proper manner, their ability to transport and use oxygen is also
reduced. However, regular exercise can help increase peak VO2 by approximately 15%-30%
in patients with coronary artery disease. (Hambrecht, 1995)
Physicians recommend that individuals with CHD participate in physical activity in
order to help reduce the effects of the disease, improve their ability to return back to their
activities of daily living and maintain a healthy lifestyle. Although, the disease itself may
impact the individual’s ability to exercise due to some of the complications that can arise
during training. Individuals with CHD tend to have higher risk for cardiovascular events such
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angina, ST-Segment depression, arrhythmias and transient left ventricular dysfunction. Prior to
participating in physical activity these individuals need to be cleared by a physician to ensure
that they can handle the added stress that exercise can exert on the heart. Once cleared, they
can participate at an intensity of forty to eighty percent of their Heart Rate Reserve (HRR)
starting on the lower end and gradually increasing the intensity with time, with longer warmups and cool downs to ensure that they are gradually returning to their resting Heart Rate (HR)
and blood pressure (BP). Longer cool downs also can reduce the likelihood of
hypotension/dizziness post exercise.
Individuals with CHD sometimes will undergo a Coronary Artery Bypass Graft
(CABG) which is a procedure that allows for the blood to flow and patients who have had the
CABG can begin cardiac rehabilitation within the first seventy-two hours post-operation.
Fourteen days post surgery, patients can continue cardiac rehabilitation exercises under the
guideline previously mentioned, keeping upper body exercises to limited ranges of motion and
light resistance activities. (Schelkum, 1992)
The first risk of exercise observed is shortness of breath (dyspnea). Difficulty breathing
has multiple causes including cardiovascular disease and heart failure. It is a result of the heart
becoming less efficient at filling and emptying (Parshall, Schwartzstein, Adams, Banzett, and
Manning, 2012). As a consequence, blood vessels around the lungs build up pressures, producing
the sensation of having difficulty breathing. With a depreciated heart, reaching a vigorous
exercise intensity would demand too much of the heart and would not allow working muscles
and organs to fulfill their oxygen demands.
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Another observable risk of exercise is fainting (syncope). This is attributed to inadequate
oxygen delivery to the brain (Olshansky, Raviele, and Dubner, 2014). The pressure created by
the heart may be too high or too low. As a result, symptoms such as chest pain and nausea may
occur. It is vital to contact emergency medical services and start CPR if the person does not
regain consciousness (Colucciello, Murphy, Martin, Radeos, and Cantrill, 2001). The fall itself
could pose a major risk since the person fainting could drop to the floor in many positions and
strike multiple parts of their body.
Although exercise is encouraged with high blood pressure medication, it can still pose a
risk if not done properly. A type of medication used to treat high blood pressure in patients after
surgery is a beta blocker. Beta blockers work by blocking the effects of the hormone
epinephrine, which in turn, causes the heart to beat slower and with less force (Chrysant,
Chrysant, and Dimas, 2008). People exercising while on beta blockers have a difficult time
judging their exertion. The Beta blockers inhibition of the sympathetic system makes for a submaximal heart rate at maximal intensity which can result in unexpected fatigue and dizziness.
The person could be exercising at a vigorous intensity and not notice. It is recommended that the
Borg Scale be used to evaluate their perceived exertion (Borg and Kaijser, 2006). The scale
works by picking a number from six through twenty, where six is effortless and twenty is
maximal effort, and multiplying that chosen number by 10 to give the perceived heart rate.
II. Literature Review
There are many studies that show some of the effects of aerobic training on individual
that have undergone cardiac surgery. In a study performed by Moholdt (2009) a group of 59
postoperative CABG patients underwent aerobic interval training at 90% of maximum heart rate
Running head: Post Cardiac Surgery: The Effects of Cardiovascular Exercise
or moderate continuous training at 70% of maximum heart rate for 5 days/week. In this study
short term aerobic training(4 weeks) at intervals or moderate continuous training showed an
increase in VO2 peak with insignificant difference between the two. Long term training (6
months) showed aerobic interval training to produce a higher peak VO2 over moderate
continuous training. It also showed an improvement in heart rate recovery for a period of 6
months after completing the formal program. This study shows that interval aerobic training
should be performed for in planning a long term training program.
Research by Hermes et al. (2015) shows there is evidence of significant increase in the
strength of respiratory muscles, their functional capacity as well as quality of life as a result of
short-term inspiratory muscle training program. This program consisted of 3 sets of 10
repetitions using inspiratory muscle training threshold equipment set to 30% of maximal
inspiratory pressure. Patients were in phase II cardiac rehabilitation. The literature also
indicated that adding inspiratory muscle training regardless of how short the period is, can
enhance and complement the effects of the combination of both resistance and aerobic
training. It could result in a non-complex and standard treatment, consequently improving the
effectiveness of phase II cardiac rehabilitation. Although this program also had a strength and
flexibility program, including a inspiratory training program with only an aerobic training
program shows to still beneficial.
Recent research by Mendez,Simões, Costa, Pantoni, and Di Thommazo-Luporini
(2014) on Disability and Rehabilitation, also contributed to widening the study on the effect of
aerobic training on individuals post-cardiac surgery. The research findings show that physical
exercise during the inpatient cardiac rehabilitation that is performed by post-coronary artery
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Running head: Post Cardiac Surgery: The Effects of Cardiovascular Exercise
bypass graft (post-CABG) patients with left ventricular function normal (LVFN) group trigger
a more attenuated response in the cardiac autonomic in comparison to patients with left
ventricular function reduce (LVFR) group. It implies that there is a significant benefit of
exercise prescription in times of acute rehabilitation phase since it helps in titration in
accordance to left ventricular function (LVF). Therefore, by increasing the volume of exercise
in the proposed protocol would give better outcomes in patients with LVFN. However, most of
these literature has not been able to establish a standardized exercise prescription for these
patients thus leaving some gaps for a further study.
In a study performed by Bilińska et al.(2013), a group of 100 men 15-18 weeks post
CABG surgery underwent a six month moderate intensity aerobic exercise routine. The routine
consisted of exercising on a cycle ergometer 3 times per week for 6 weeks. The exercise load
was applied in intervals of 4 minutes exercise bout with 2 minutes recovery until a heart rate of
70-80% of maximal heart rate was acheived. Max heart rate was determined using a
CPET(cardiopulmonary exercise test). At the end of the 6 week program there was a positive
response in neuro-hormonal and hemodynamic response to a head up tilt test and a sympathetic
vagal balance at rest and after exercise. This shows that patients who underwent one hour on a
cycle ergometer for three days a week gained quicker and more precise responses from the heart
to adapt to changes in pumping force required.
A study performed by Hirschhorn, Richards, Mungovan, Morris, & Adams (2008)
involved 93 participants in Phase 1 cardiac rehab from a first time CABG. They were separate
randomly into 3 groups consisting of gentle mobilization, walking exercises, or
walking/breathing exercises. After 4 weeks post-surgery an assessment was done to determine
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distance walked in 6 minutes, plus an assessment on vital capacity and health related quality of
life. Results showed there was a significant improvement in the 6 minute walking distance with
walking exercises and walking/breathing exercises (444+/-84 m, 431+/-98 m, respectively) over
the gentle mobilization group (377+/-90 m). Although there was little difference between the two
exercise groups, other studies looked at show breathing exercises can complement and improve
effectivenemsss of Phase II aerobic exercise. There was insignificant difference on vital capacity
and health related quality of life between standard intervention of gentle mobilization and the
two exercise groups. This study shows that added breathing exercises did not significantly
increase or decrease the 6 minute walking distance, although gentle mobilization exercises had
the worst effect after four weeks of recovery.
A study done by Cox (2003) on the length of stay in the hospital post-operation was a
mean of 7.68 days. With a goal of discharge from the hospital within five days only 30.9% of the
population tested met that goal. There were a couple of variables noted that can be predictors of
whether or not a patient will be able to meet a 5 day discharge, with age being the most
prominent followed by hypertension and gender with females having a later discharge date. The
mean age of CABG surgeries has risen from 60.5 years in 1993 to 62.7 years in 1998.
In a study done by Inge D van der Peijl et. al (2003) he approached a pool of 246 patients
and randomly divided them into two different exercise groups. One of the groups was given a
low demanding exercise program of once a day, not including the weekends. The second group
was given a high intensity exercise plan which included twice a day, seven days a week. This
study took place the first day after surgery and continued over 360 days with standardized test to
monitor progress alternating groups every thirty days, over a 12-week time limit. Both exercise
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programs included activities that looked at range of motion (ROM), muscle strengthening, and
coordination exercises such as walking and stair climbing. Results show that between the two
groups, the group that had the high demanding exercise program reached functional milestones at
a faster rate and the patients were more satisfied with their results, which lead to an earlier
release from the hospital. However, the group with the low intensity program also hit their
functional milestones within a reasonable time, so other than them being in the hospital for a
longer amount of time, the low intensity program would not be a bad way to go either.
In another study performed by Romualdo Belardinelli (2012) they showed that having a
long term plan of exercise for chronic heart failure (CHF) patients improves functional capacity
and the individual’s quality of life. They did this study on a group of 123 individuals who were
stable for the previous three months who had already suffered from CHF. The trained group of
individuals went through a supervised exercise training at 60% of their peak VO2 consumption
two times a week over a time span of ten years. The constant group did not have any planned
exercises. Results showed that the trained individuals had a peak VO2 higher than 60% of their
age-gender predicted max. The untrained individual’s VO2 decreased over the years. In addition
to VO2, the quality of life was scored to be higher in the training group as well, and there were
less hospital readmissions within the trained group compared to the untrained.
About 90% of all CABG patients who undergo surgery will develop postoperative
pulmonary complications. The most prevalent being atelectasis, occurring 97.5% of the time.
Atelectasis is a condition in which one or more areas of the lung collapse or do not inflate
properly. It is thought that as CABG patients undergo surgery, complications develop from
compression of the lungs during the procedure, accumulation of air or gas in the abdomen, chest
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wall alteration, and diaphragmatic dysfunction. The basis of deep-breathing exercises is to
encouraging patients to inspire deeply to open collapsed alveoli and prevents atelectasis and
pulmonary dysfunction disease.
In a study done by Westerdahl, Lindmark, Eriksson, Friberg, and, Hedenstierna (2005), a
sample of 112 patients undergoing CABG surgery participated. 57 were randomly chosen to
perform deep-breathing exercises postoperatively and a control group of 55 performed no deepbreathing exercises. The deep-breathing exercises were started one hour after the patients were
taken off mechanical ventilation devices (extubation). While the patient was awake during the
daytime, they were encouraged to perform 30 deep breaths once per hour for the first 4
postoperative days. The patients would perform the exercises in a sitting position, if possible,
and complete 3 sets of 10 breaths with a 30 to 60 second pause in between each set. Results were
recorded for each day. After looking at all four postoperative days, it was concluded that deepbreathing exercises helped reduce atelectasis in the basal and apical levels by half when
compared to the control group. However, the study also concluded that both the experiment and
the control group had similar results when comparing the ability to perform the exercise,
pulmonary capacity, and time spent in ICU.
In a similar experiment performed by Westerdahl, Tenling, Hedenstierna, Lindmark, and
Larsson (2004), a total of 314 patients who had CABG surgery participated in a study conducted
within a time span of about 7 years. Study I included 113 men and 24 women. Study II consisted
of 25 patients that had already participated in study I to undergo pulmonary function tests four
months after surgery. Study III included 65 new patients, with 12 other patients belonging to a
control group. Study IV was 112 new patients within the last year of experimentation. Study I,
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III, and IV used a deep breathing technique, a blow bottle technique, which provided expiratory
pressure as the patents blew into the bottle, and inspiratory resistance- positive expiratory
pressure, which uses a device that can provide variable inspiratory and expiratory resistance. The
data concluded that there was no significant difference as to which technique was used. All
techniques led to a decrease in atelectasis. Nonetheless, further clinical verification is required
due to the same period and sample sizes that were observed.
III. Methods
For our aerobic exercise routine, we will use the mean age of of cardiac artery bypass
graft surgery patients provided earlier and select a 62 year old male who is beginning Phase I of
cardiac rehabilitation. Since our CABG patient has a history of cardiovascular disease he can still
be at risk for other complications so in order to begin the aerobic exercise routing the client must
complete the proper paperwork associated. This paper work will include a pre-exercise health
questionnaire and consent forms to participate in the prescribed aerobic exercise testing. The
health questionnaire will help determine the level of aerobic fitness the client is in as well as
identify the risk factors that could result in contraindications. Some criteria that would exclude
someone from this program are inability to exercise or lack of patient’s consent.
In order to obtain baseline measurements for our clients aerobic capacity we will
Phase I of the aerobic cardiac rehabilitation program will begin in hospital. An hour after
the client is taken off of mechanical assisted breathing, breathing exercises begin and are
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repeated every hour thereafter for the first four days. Breathing exercises consist of being in a
sitting position and performing 3 sets of 10 deep breaths with 30 to 60 seconds of rest between
sets.
Phase II of the aerobic cardiac rehabilitation program will begin when the client is
released from the hospital. Phase II will still consist of monitored exercises, but the client is well
enough to return to most of his activities of daily living. Breathing exercises with resistance at
30%MAX inhalation pressure, remains 3 sets of 10 with 30 to 60 seconds of rest between sets.
Phase III of the aerobic exercise routine will consist of 60 minutes of interval aerobic
exercise, 3 days per week and at an intensity reaching 70-80% of the clients max HR
-Description of measurements, rationale for selection of measurements, schedule of
measurements.
IV. Prescription
Warm-up and Cool-down Exercises
Running head: Post Cardiac Surgery: The Effects of Cardiovascular Exercise
This exercise routine uses a combination of exercise and slow walking.
1.
Neck Stretch (turn head side to side)
2.
Elbow Circles
3.
Arm raises
4.
Bends (hold 10 seconds)
5.
Ankle pumps
6.
Knee extension and flexion
7.
Calf Stretch (hold 10 seconds)
8.
Reach
9.
Slide reach (wide stance –reach arm across body)
This first seven weeks recovery exercise plan aim to wean short to longer exercise duration by
minimizing numbers of exercise bout each number of days.
Walking Schedule – on the flat surface
Recovery Week
Distance
Length of Time
Times per day
1
2 blocks (1/4 mile)
3-5 minutes
6-8
2
2 ½ blocks
5-10 minutes
4-5
3
4 blocks
10-15 minutes
3-4
4
¾ mile
15-20 minutes
3
5
1 mile
25-30
2
6
1 mile
30-45
3
7
1 miles
60
1
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The following weeks may focus walking on any surface and change surface on the hills or
inclines cut distance back to ½ miles. Continue to increase the distance walked.
Week
Distance
Length of Time
Times per day
8
½ mile
10-15 minutes
2-3
9
¾
15-20 minutes
2-3
10
1 mile
25-30
2-3
11
1 miles
15-20 minutes
3-4
During this time walking may increase the pace.
Week
Distance
Length of Time
Times per day
12
1 ¼ mile
25-30 minutes
3-4
13
1 ½ mile
30-35
3-4
14
1 ¾ mile
35-40
3-4
15
2 mile
40-45
3-4
To continue to usual activities:
Week 1-2
Weeks 6 after
Continue activities of weeks 1-6
Light housekeeping
●
●
Dusting
Setting the table
(you should be able to tolerate more)
Return to work part-time
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●
●
Wash dishes
●
●
Potting plants
Folding clothes
Light gardening
Trimming flowers/plants
Walking
Treadmill
Restaurants
Movies
Church
Attend sports event
Passenger in car
Stationary bike (without movement of arms)
Shampooing hair
Needlework
Reading
Cooking meals
Climbing stairs
Small mechanical jobs
Shopping
Playing cards and board games
Heavy housework
●
●
●
Vacuuming
●
●
Mowing lawn
Sweeping
Laundry
Heavy gardening
Raking leaves
Ironing
Business or recreational travel
Fishing
Light aerobics (no weight > 25 pounds)
Walking dog on leash
Driving
Boating
V. Expected Outcomes
The goals is to return our client to normal activities of daily living with sustainable
solutions. Our client should see reduced pain, quicker and more precise neurological control of
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the heart and respiratory function, as well as receive education on lifestyle changes to help
prevent a repeat incidence.
VI. Informed Consent
INFORMED CONSENT FOR PARTICIPATION IN A HEALTH AND FITNESS TRAINING
PROGRAM
NAME: _____________________________ DATE: ____________________
1. PURPOSE AND EXPLANATION OF PROCEDURE
I hereby consent to voluntarily engage in an acceptable plan of personal fitness training. I also
give consent to be placed in personal fitness training program activities which are recommended
to me for improvement of dietary counseling, stress management, and health/fitness education
activities. The levels of exercise I perform will be based upon my cardiorespiratory (heart and
lungs) and muscular fitness. I understand that I may be required to undergo a graded exercise test
prior to the start of my personal fitness training program in order to evaluate and assess my
present level of fitness. I will be given exact personal instructions regarding the amount and kind
of exercise I should do. A professionally trained personal fitness trainer will provide leadership
to direct my activities, monitor my performance, and otherwise evaluate my effort. Depending
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upon my health status, I may or may not be required to have my blood pressure and heart rate
evaluated during these sessions to regulate my exercise within desired limits. I understand that I
am expected to attend every session and to follow staff instructions with regard to exercise, stress
management, and other health and fitness regarded programs. If I am taking prescribed
medications, I have already so informed the program staff and further agree to so inform them
promptly of any changes which my doctor or I have made with regard to use of these. I will be
given the opportunity for periodic assessment and evaluation at regular intervals after the start of
the program. I have been informed that during my participation in the above described personal
fitness training program, I will be asked to complete the physical activities unless symptoms
such as fatigue, shortness of breath, chest discomfort or similar occurrences appear. At this point,
I have been advised that it is my complete right to decrease or stop exercise and that it is my
obligation to inform the personal fitness training program personnel of my symptoms, should any
develop. I understand that during the performance of exercise, a personal fitness trainer will
periodically monitor my performance and, perhaps measuring my pulse, blood pressure, or
assess my feelings of effort for the purposes of monitoring my progress. I also understand that
the personal fitness trainer may reduce or stop my exercise program when any of these findings
so indicate that this should be done for my safety and benefit. I also understand that during the
performance of my personal fitness training program physical touching and positioning of my
body may be necessary to assess my muscular and bodily reactions to specific exercises, as well
as to ensure that I am using proper technique and body alignment. I expressly consent to the
physical contact for the stated reasons above.
2. RISKS
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It is my understanding and I have been informed that there exists the remote possibility during
exercise of adverse changes including, but not limited to, abnormal blood pressure, fainting,
dizziness, disorders of heart rhythm, and in very rare instances heart attack, stroke, or even death.
I further understand and I have been informed that there exists the risk of bodily injury including,
but not limited to, injuries to the muscles, ligaments, tendons, and joints of the body. Every
effort, I have been told, will be made to minimize these occurrences by proper staff assessments
of my condition before each personal fitness training session, staff supervision during exercise
and by my own careful control of exercise efforts. I fully understand the risks associated with
exercise, including the risk of bodily injury, heart attack, stroke or even death, but knowing these
risks, it is my desire to participate as herein indicated.
3. BENEFITS TO BE EXPECTED AND ALTERNATIVES AVAILABLE TO EXERCISE
I understand that this program may or may not benefit my physical fitness or general health. I
recognize that involvement in the personal fitness training sessions will allow me to learn proper
ways to perform conditioning exercises, use fitness equipment and regulate physical effort.
These experiences should benefit me by indicating how my physical limitations may affect my
ability to perform various physical activities. I further understand that if I closely follow the
program instructions, that I will likely improve my exercise capacity and fitness level after a
period of 3-6 months.
4. CONFIDENTIALITY AND USE OF INFORMATION
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I have been informed that the information which is obtained in this personal fitness training
program will be treated as privileged and confidential and will consequently not be released or
revealed to any person, to the use of any information which is not personally identifiable with me
for research and statistical purposes so long as same does not identify my person or provide facts
which could lead to my identification. Any other information obtained, however, will be used
only by the program staff to evaluate my exercise status or needs.
5. INQUIRIES AND FREEDOM OF CONSENT
I have been given an opportunity to ask questions as to the procedures. I have read this Informed
Consent form, fully understand its terms, understand that I have given up substantial rights by
signing it, and sign it freely and voluntarily, without inducement.
Participant’s Signature__________________________________________________________
Participant’s Name (Printed) _____________________________________________________
Witness’s Signature ______________________________ Date: ______________
VII. Screening Questionnaire
Do you have any allergies?
Do you have any previous medical problems?
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Have you had any previous surgeries/procedures?
What medications are you currently taking?
Are you able to perform your own ADL’s?
Do you have any help performing your ADL’s?
Do you use oxygen or CPAP?
How much exercise do you do everyday?
How well do you tolerate exercise?
Do you experience any of the following during exercise:
-Shortness of Breath
-Unusual fast heart rate
- Dizziness/fainting
-irregular heartrate
- paplpitations
Do you ever experience any of the following:
(list of cardiac heart failure (CHF)
-swelling of feet
-swelling of ankles
-shortness of breath
Do you ever feel anxious or depressed?
Do you ever have thoughts of harming or killing yourself?
Do your heart symptoms ever interfere with your sex life?
Have you gained/lost an abnormal amount of weight recently?
Do you have a good appetite?
Describe your normal diet.
Describe who your support systems are?
-do you have a religious preference?
Are you financially able to pay for your medications?
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Do you have medical insurance?
How do you describe your quality of sleep?
-very good -good -poor -very poor
How many pillows do you sleep on? (Heart failure=more pillows because of the fluid buildup in
their heart)
Do you have regular dental cleaning?
Do you see a dentist regularly? (gum disease is a link to myocarditis)
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17(2), 129.
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