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Exercise Prescription Resources 

 

 

EP’s and Nurses use this risk stratification sheet above to create a proper exercise prescription. This risk sheet brings together the medical history of a patient and stratifies them as low, moderate, or high risk when it comes to exercise.  Those at high risk may not be able to work at the same loads of watts and or METS as an individual who is of low risk.  

 

Considerations for initial exercise prescription

  • Stress test—functional capacity

  • Diagnosis

  • Medical history

  • Risk stratification

  • Orthopedic limitations

  • Angina or Dyspena

  • Ejection Fraction

  • Pulmonary function

  • GOALS!! 

Exercise specialists most importantly have to keep in mind the medications that patients may be taking.  EP’s and RN’s have to stress to their patients the importance of taking their medications correctly every day at the necessary times.  While monitoring a patient we are able to see the response of medications when looking at ones heart rate and or blood pressure/glucose levels.  Certain medications help keep those measures in their proper rangers.  Certain drugs like a statin for instance may cause leg cramps in some patients.  For example,  in a situation like this we may be able to put the medication at blame but it is the job of the physician to make any medication adjustments.  Refer to the last column on the chart to see how each drug works.  We are trained to know about most medications but it is not our job to prescribe or administer any sort of medication.    

When creating an exercise prescription, and after we have reviewed patient's medical history, risk stratification, and medications, its time to build an exercise plan for the patient.  The EP’s and RN’s at this facility refer to the AACVPR’s (American Association of Cardiovascular and Pulmonary Rehabilitation) clinical assessment tools that help them prescribe the proper amount of METS to a patient.  This tool lists 700 exercises and ADL’s, and computes the corresponding MET value to that activity.  METS and watts help both the patient and exercise specialist create an intensity and workload that is appropriate for the patient at hand. The sheet above is a sample 6-minute walk test conversion table.  EP’s and RN’s administer walk tests to their patients.  Using the results from their test they can use the table above to compute the METS that is appropriate for that individual. Walk test can give us METS where a GXT can help give us a target heart rate range.  

 

 

Considerations for progressing Exercise

  • RPE

  • Target Heart Rate

  • Oxygen saturations

  • Change in clinical status (Symptoms/orthopedics)

  • Ejection Fraction

  • Blood pressure

  • Blood glucose

  • GOALS 

Volume of Exercise

  • Cardiovascular Benefit

    • 120-200 minutes per week

    • 10,000 steps per day

    • 750-1200 cals per week

  • For weight loss

    • 200-300 minutes

    • >12,000 steps per day

    • 1200-2000 cals per week 

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