We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy

Check Writers' Offers

What's Your Topic?

Hire a Professional Writer Now

The input space is limited by 250 symbols

What's Your Deadline?

Choose 3 Hours or More.
Back
2/4 steps

How Many Pages?

Back
3/4 steps

Sign Up and Get Writers' Offers

"You must agree to out terms of services and privacy policy"
Back
Get Offer

LIA Written Assessment: Class Design

Paper type: Assessment
Pages: 13 (3207 words)
Categories: Design
Downloads: 21
Views: 7

EXERCISE PROGRAM

Daily Health questionnaire:

  1. Where you are on the breathlessness scale?
  2. Do you have any unusual pain that the exercise leader should know about?
  3. Are you coughing more than usual? Remember cough etiquette, Cover your mouth Use tissue provided, Throw tissues in bin.
  4. Take your puffer if necessary
  5. If you were sick (diarrhea, vomiting etc.) this morning, please go home
  6. Are you more tired than normal for you?
  7. Work at your own pace

Lungs in Action classes can be beneficial both with and without equipment.

The minimum equipment needed includes: Resistance bands, resistance tubing or Therabands, Hand weights and Aerobic stepper. If clients use oxygen at home, they should use oxygen to exercise. Oxygen flow rates are always low – never adjust the flow rates, the client will know what they have. Exercise to a level of 2 to 4 on the Borg Scale.

Group Warm Up:

  • (20min) –
  • Walking (timed and measured)
  • Aerobic and resistance exercises:
  • (30- 40min) –
  • Heart failure patients may perform an additional 10 min on exercise bike
  • Heart failure patients may perform an additional 10 min on arm ergometer
  • Bicep curl 3 sets of 12 reps
  • Sit to stand 3 sets of 12 reps
  • Chest press 3 sets of 12 reps
  • Lunges 3 sets of 12 reps (supported)
  • Overhead Press 3 sets of 12 reps
  • Standing hip side kicks 3 sets of 12 reps each side
  • Lateral raises 3 sets of 12 reps
  • Standing hip kickbacks 3 sets of 12 reps each side
  • Wall push-ups 3 sets of 12 reps
  • Step ups 3 sets of 12 reps each side – toe taps may be acceptable for people with falls risk
  • For those with balance issues the following may be suitable replacements for exercises.

  • Calf raises 3 sets of 12 reps
  • Tandem “heel-toe” walking 2 sets of 10 reps

Group Cool Down:

  • (5-10min) –
  • 5min balance/ pelvic floor/ stretching (including neck stretch, shoulder circles, side stretch, glute stretch, hamstring stretch, and calf stretch)
  • 5min walking
  • Exercise Modifications/ Individual Considerations

Class 1:

Judith Peters (77YO F, Nil) – does not need any individual modifications to exercise with her comorbidities, just make sure her age and condition are considered when prescribing weights, reps and rest breaks. Modify if needed.

Wayne McDougall (84YO M, angina):

Increased chest pain or angina more than normal contraindicates exercise or indicates that they need to stop exercising and follow their angina management plan. Participants should rest and take their GTN spray and wait 5 minutes. If they still have chest pain, take the medication again and wait another 5 minutes. If they still have chest pain call 000 for an ambulance. Participants should only resume exercise once they have followed the safety protocols and symptoms have resolved.

Peter Marshall (76YO M, Heart Failure) – Clients symptoms will vary from day to day therefore they will need to be assessed every session and ask clients to monitor for changes in weight, shortness of breath, chest pain and palpitations. Isometric exercises and breath holding should be avoided in clients with heart failure. Clients should also avoid gripping too tightly during resistance training. Clients will need to perform about 30 minutes of aerobic exercises in a session to meet the heart failure guidelines. Exercise Intensity should be 9-13 on Borg scale or 2-4 on the modified scale. If their HR is above 100BPM or their systolic BP is above 160mmHg at rest, they should weight 5min before retesting. If they are still too high, they may have to be turned away from exercising for the day.

Kit Wong (79YO M, Osteoporosis) – In cases where a client may have musculoskeletal pain due to a co-morbidity such as osteoporosis, it may be necessary to either modify the exercise to have a pain free range of movement or avoid the exercise altogether. Clients should be warned that if pain occurs, they must tell you, the exercise leader. You should then adapt the exercise to produce a pain free result or avoid the exercise and offer another alternative. For osteoporosis, exercises that increase bone loading in weight bearing positions are beneficial.

Rudolf Mitsevski (87YO M, Nil) – does not need any individual modifications to exercise with his comorbidities, just make sure his age and condition are considered when prescribing weights, reps and rest breaks. Modify if needed.

Ahmed Ali (79YO M, Nil) – does not need any individual modifications to exercise with his comorbidities, just make sure his age and condition are considered when prescribing weights, reps and rest breaks. Modify if needed.

Athena Litsis (73YO F, Arthritis) – In cases where a client may have musculoskeletal pain due to a co-morbidity such as osteoarthritis, it may be necessary to either modify the exercise to have a pain free range of movement or avoid the exercise altogether. Clients should be warned that if pain occurs, they must tell you, the exercise leader. You should then adapt the exercise to produce a pain free result or avoid the exercise and offer another alternative. For osteoporosis, exercises that increase bone loading in weight bearing positions are beneficial.

Jane Bowen (75YO F, Nil) — does not need any individual modifications to exercise with her comorbidities, just make sure her age and condition are considered when prescribing weights, reps and rest breaks. Modify if needed.

Milton Rix (73YO F, Nil) – does not need any individual modifications to exercise with her comorbidities, just make sure her age and condition are considered when prescribing weights, reps and rest breaks. Modify if needed.

Doreen Greenan (79YO F, Panic attacks) – If client becomes more breathless than normal or appears to be having a panic attack – they must inform you. Speak in a calm and balanced tone and have them: Stop what they are doing, assume a comfortable position, use the recovery positions, do relaxed breathing and slow the breathing down or do pursed lip breathing, in most cases they will get their breath back. If there is any doubt about the client call 000 for assistance.

Class 2:

Dimitri Petrov (76YO M, Diabetes) – Diabetes sufferers will benefit from metabolic conditioning from both aerobic exercises and resistance exercises. Ask if they have had breakfast and if they have had their medication this morning. Ask if they have checked their BGL and if known to have unstable diabetes you may have to check this for them. In the case of a hypo, the client may need to be given something sugary, such as jelly beans, to bring their BGL back up.

Jason Fernandez (84YO M, Nil) – does not need any individual modifications to exercise with his comorbidities, just make sure his age and condition are considered when prescribing weights, reps and rest breaks. Modify if needed.

Charles Smithfield (76YO M, Nil) – does not need any individual modifications to exercise with his comorbidities, just make sure his age and condition are considered when prescribing weights, reps and rest breaks. Modify if needed.

Elizabeth Perkins (79YO F, Incontinence) – Clients with incontinence may need to be referred to a specialist as this is a sensitive issue and may not always be appropriate to discuss and/or deal with in the LIA class. However, Pelvic floor exercises may be taught at the end of the session in the cool down time which teaches individuals how to tighten their pelvic floor muscles: Have your clients sit or lie comfortably with the muscles of their thighs, buttocks and abdomen relaxed. Then you can guide them through contracting the pelvic floor by cuing closing the front and back passage for women or cutting off the stream of urination. For men drawing up the testicles or cutting off the stream of urination can also work. Remind patients to pull up, not push down or hold their breath and that these exercises take time and not to give up, they do work if done properly.

Andrew Smith (86YO M, Nil) – does not need any individual modifications to exercise with his comorbidities, just make sure his age and condition are considered when prescribing weights, reps and rest breaks. Modify if needed.

Yianni Constanopoulos (76YO M, Sleep Apnoea) – People who suffer from obstructive sleep apnoea slow or stop breathing for short periods while sleeping. This can happen many times during the night. It results in poor sleep with excessive sleepiness, reduced activity and lethargy during the day. Following tests, patients may use a Continued Positive Airway Pressure (CPAP) machine during the night to assist their breathing. During exercise it may be useful to regularly check their SpO2 and observe their level of breathlessness or lethargy. If they are becoming exhausted quickly offer regular rest periods to reduce the amount of time spent recovering from exercises.

Roula Onassis (73YO F, Nil) – does not need any individual modifications to exercise with her comorbidities, just make sure her age and condition are considered when prescribing weights, reps and rest breaks. Modify if needed.

Brooke Campbell (84YO F, Osteoporosis) – In cases where a client may have musculoskeletal pain due to a co-morbidity such as osteoporosis, it may be necessary to either modify the exercise to have a pain free range of movement or avoid the exercise altogether. Clients should be warned that if pain occurs, they must tell you, the exercise leader. You should then adapt the exercise to produce a pain free result or avoid the exercise and offer another alternative. For osteoporosis, exercises that increase bone loading in weight bearing positions are beneficial.

Stephen O’Mara (73YO M, depression) – There are a variety of reasons people feel depressed, maybe they have always had an active lifestyle and now because of the effects of COPD not able to enjoy many of the activities they once enjoyed. People may feel self-conscious about their oxygen or chronic cough and become more reluctant to go out into public. It may be useful to remind them that they are not alone in the class and provide some time at the end of the session for them to talk about it with you or the class, if they feel comfortable doing so. Exercise can help to reverse some of the deconditioning resulting from the chronic disease cycle, improve mood and sleep quality which is important to this client group who often suffer from anxiety and depression.

Hoi Deng (75YO F, anxiety) – The strong relationship between anxiety and COPD has long been established. The symptoms of anxiety include rapid and difficulty breathing, sweating and palpitations. Anxiety is created by the unpredictable nature and fear-arousing symptoms of respiratory distress. This distress is closely allied to a panic attack (discussed later in this section) where the person may interpret COPD related breathing difficulty as life-threatening suffocation or harmless chest pains as a heart attack. Speak in a calm and balanced tone and have them: Stop what they are doing, assume a comfortable position, use the recovery positions, do relaxed breathing and slow the breathing down or do pursed lip breathing, in most cases they will get their breath back. If there is any doubt about the client call 000 for assistance.

Margaret Goodman (75YO F, asthma) – The clinical features and pathophysiology of COPD can overlap with chronic bronchitis, emphysema and asthma. Long-standing or poorly controlled asthma can lead to chronic, irreversible airway narrowing even in non-smokers. Sufferers need to stop exercising and sit down. Practice relaxed breathing and follow their asthma management plan if symptoms do not resolve. Take medication 1 spray with 4 inhales, repeat at least twice and up to 4 times if needed. If after 5 minutes the patient is becoming more distressed call 000. If they have recovered they may continue in the class.

Site appropriateness

The group fitness room is appropriate for the cardio-pulmonary rehab demographic as the walking area is flat, there is no passing traffic other than other clients and it is a wide enough area that they can overtake. The circular circuit minimises the number of turns needed. It is indoors in a controlled environment, as some clients are sensitive to heat, cold, humidity and dry, dusty weather. There is an emergency plan displayed by the gym, air conditioning, adequate lighting and water fountains nearby. The equipment is laid out around the room where it is easily accessible and not a tripping hazard. The chairs around the circuit allow the clients to rest if necessary. All standing exercises have seated versions offered. No smoking is allowed around the site of exercise.

Safety and risk management plan

To ensure the class is safe the correct procedures should be put in place and the clients made aware of the site’s emergency plan. To ensure safety the class is safe to start observations are taken (HR and SpO2). For Heart failure patients this involves BP and weight each session. They will be asked if they have taken their medication, if they are feeling short of breath or excessively tired, and if they have been feeling unwell or had any chest pain. For diabetic patients their BGL can be checked if it has not been checked independently and ask them whether they have eaten breakfast today. During the session chairs are provided to allow the clients to rest regularly when needed to reduce the risk of longer recovery times. Encourage frequent rest periods at a minimum of 2 minutes. Insufficient rest time will result in early fatigue. Encourage clients to work at their own pace

Relaxed breathing technique and pursed lip breathing are taught to minimize breathing problems and panic attacks. If a person’s COPD or Heart failure symptoms do resolve quickly with medication, then the patient may continue with the class. If they do not resolve quickly, they need to follow their management plan as discussed earlier.

Chest Pain can be caused by a number of factors including musculoskeletal, pleural or cardiac causes. In an exercise setting with no medical back up ask the following questions.

How bad is the pain?

  • Rate between 0-10 with 10 being highest pain level
  • Is it normal for you? (Do you take prescribed medication for this)
  • Follow the Heart Foundation’s “Will you recognise your heart attack?” guidelines
  • If the pain does not settle call the ambulance

The emergency plan for this site will involve: 1 person call 000, notify them of the problem and stay on the line until told otherwise. 2nd person notify front counter staff at the gym and have someone flag down ambulance/paramedics to direct them to person in need of help.

Person 3 or group leader will need to stay with individual to begin first aid or CPR (DRSABCD) as required – someone may need to be sent to request Defibrillator from bowls club (nearest known location). The rest of the group needs to be kept calm and instructed what to do. It may be necessary to assure them that it is okay to return to the next session. Document incident and follow up with client if able.

Major diversities between COPD and heart failure exercise programming

COPD and CHF are both chronic diseases that both cause shortness of breath and make it difficult to exercise. Both will have a cough that is usually dry but can produce sputum or blood. Heart Failure programs involve at least 25-30min of aerobic activity plus resistance exercises that are tolerated by the individual.

In terms of exercise programming, the Lungs in Action program is quite appropriate for heart failure patients. The substantial walking component required for respiratory clients is suitable for heart failure patients, but it is important to remember the exercise guidelines should be prescribed by an exercise physiologist to align with the individual’s exercise capacity.

The main differences between COPD and heart failure exercises program are the changes in observations made at the beginning of the cardiac rehab which involve blood pressure, heart rate, SpO2 and weight (which should not change more than 1.5-2kg per day, they may be on fluid restrictions for this reason), the medications may be different, however Heart failure and COPD patients will often have the other as a comorbidity. While aerobic exercise time will generally be longer for cardiac rehab the resistance training guidelines will be strictly following the BORG scale to ensure that they do not show symptoms of exercise intolerance or angina.

Additional safety considerations and contraindications when exercising those with heart failure

Heart failure patients exhibit limitation to exercise due to reduced cardiac output. Cardiac Output depends on Stroke Volume and Heart Rate and this will generally increase during exercise in a healthy person to supply oxygen to working muscles. Breathlessness due to underlying lung conditions will also impact on their ability to exercise due to respiratory muscle fatigue and weakness. When muscles and organs in the body cannot get enough oxygen, they will fatigue quickly giving the patient a feeling of breathlessness. This will be further complicated if they have a lung disease as a co-morbidity.

Peripheral factors related to the disease process such as loss of skeletal muscle mass and reduced skeletal muscle blood flow also limit exercise. Deconditioning and wasting of muscles such as quadriceps will impact on their ability to exercise. This also contributes to exercise intolerance due to fatigue and shortness of breath. Fatigue can also be due to the reduced blood flow resulting in muscles not receiving as much oxygen and nutrients. Additional weight gain from fluid retention can make exercise uncomfortable or more difficult.

They must weigh themselves daily, adhere to fluid restrictions if required, quit smoking, follow low sodium diets, limit their alcohol intake and take their medication as prescribed by their doctors. They must also exercise within specific guidelines. Always exercise below the symptom limited threshold such as angina, excessive breathlessness or muscle fatigue. Isometric exercises and breath holding should be avoided in clients with heart failure. Your clients should also avoid gripping too tightly during resistance training.

Do NOT exercise if:

  • Weight has changed by more than 1.5-2kg over 2 days, or daily weighing has not been conducted
  • Forgot to take medication or have changed medication significantly
  • Angina that is new, changed or even different in the last couple of days
  • Excessively tired
  • Increased shortness of breath
  • Increased swelling in the ankles, feet or tummy
  • Increased palpitations
  • Dizziness Nausea/Vomiting
  • Fever or unwell in the week prior to class
  • More unsteady than usual After a large meal
  • If a client experiences any of the following during a Lungs in Action class they must STOP EXERCISING AND REST
  • Excessively or unusually tired
  • Increased shortness of breath
  • Increased chest pain or increased angina to normal
  • Palpitations or irregular heart rate
  • Dizziness or light-headedness,
  • Excessively sweaty
  • Cold/Clammy
  • Unsteady on feet
  • Nausea or vomiting

If BSLs are <5mmol/L thenpt should probably have something to eat prior to exercise if they haven’t had breakfast and if they are >14mmol/L (unexplained) and they have ketones then they should probably be excluded from exercise until BSLs are stable.

If BP very low (and not within pts normal range) and pt is symptomatic, as well as when v high, then pt should probably be excluded from exercise.

Weight change alone is not enough to exclude, but if pt symptomatic (more breathless than normal, oedema and high BP) as well then yes exclude from exercise.

Cite this essay

LIA Written Assessment: Class Design. (2019, Dec 16). Retrieved from https://studymoose.com/lia-written-assessment-example-essay

How to Avoid Plagiarism
  • Use multiple resourses when assembling your essay
  • Use Plagiarism Checker to double check your essay
  • Get help from professional writers when not sure you can do it yourself
  • Do not copy and paste free to download essays
Get plagiarism free essay

Not Finding What You Need?

Search for essay samples now

image

Your Answer is very helpful for Us
Thank you a lot!