Assessment One: Written Clinical Assessment
For this assessment task you are required to:
Critically review literature pertaining to one of the clinical or special populations offered (each student will have a different condition). This includes reviewing and describing the pathophysiology of the condition, common medications prescribed, and exercise in relation to the clinical condition.
· It is recommended that you allocate ~35 hours from the recommended 111 directed study hours to this assessment task.
· Learning outcomes assessed in this task are 1.0
Assessment Requirements Your report must incorporate the following components:
· An introduction
· A Review of the clinical condition/special population that will include the o Epidemiology and, Pathophysiology and, Common medications prescribed
· A Review of Exercise in relation to the clinical condition/special population including o Benefits and, o Contraindications and/or risk and,
· Exercise prescription guidelines and recommendations for the condition
Ensure to perform a thorough literature search. You are expected to include information from peer reviewed journal papers, conference presentations or proceedings and other sources such as the Internet (no more than THREE web based) to support your project material. All referencing should start on a new page and be formatted according to APA 6 th style.
Allowable content are tables, graphs, pictures, deterministic models etc.
Review of exercise
Review of exercise (exercise prescription)
Myocardial infarction is commonly known as heart attack, caused owing to blockage in blood vessel to the heart. Plaque, substance that usually known as cellular waste products, cholesterol and fat when builds up, it causes blockage. Imbalance of oxygen demand and supply usually results from MI. Blockage resists blood flow which results in damage to the heart muscle (Piepoli, et al., 2016).
The report can be segregated into three major sections, first section identifies pathophysiology, epidemiology of Myocardial infarction and common medications that are prescribed to patients with the particular health condition. Second section of the report explains benefits and risk factors of exercise associated with Myocardial infarction and the third section shows recommendations and guidelines for exercise prescriptions for the patients of Myocardial infarction. The report aims at developing an understanding the major causes, preventative measures and medications of Myocardial infarction. The report further has highlighted how patient health condition can be improved and related mortality risk can be minimised post Myocardial infarction, through well planned exercise programs that are developed based on individual patient’s fitness, physical condition, and muscular condition.
Different risk factors associated with myocardial infarction are obesity, diabetes, high blood pressure, high cholesterol, family history, increasing age, and smoking. Occurrences of MI is higher in male than female. Rate of heart attack was double the rate of women as 476 men when compared with 213 women per 100,000 people were affected (Australian Institute of Health and Welfare , 2011).
Rate of heart attack among Indigenous people had diminished between 2007 and 2015 and the number of people affected in the mentioned year were 1048 and 908 per 100,000 people respectively. In 2015, rate of heart attack was 339 per 100,000 people between the age group of 35 and 84 years, which was decline of 37% than the rate in 2007 that was 534 people in 100,000 people. Aboriginal and Torres Islander Australian population are more likely to be affected by MI when compared with other groups of Australian populations because of higher rates of risk factors (Heart Foundation, 2015).
Mortality rate due to MI among Aboriginal and Torres Islander Australian in the year 2009-2010 was double than that of other Australian peoples (Australian Institute of Health and Welfare, 2018). It is estimated that 400,000 Australians have had a heart attack in their life and every year approximately about 57 thousand Australians suffer MI. 12% of deaths of Aboriginal and Torres Islander Australian population were caused due to MI in 2017. Compared to other Australian population, Aboriginal and Torres Islander Australian population are 70% more likely to die caused by circulatory illness. Above 20% of Aboriginal and Torres Islander Australian population aged more than 18 had uncontrolled or unmanaged high blood pressure (Australian Bureau of Statistics 2018).
Six million of adult Australians aged more than eighteen in the year 2014-2015 reported that they have high blood pressure for which they take medications (Heart Foundation, 2015). 5.6 millions of Australians in the year 2011-2012 who aged higher than 18 years had found higher cholesterol. Mortality and morbidity that occurs in Australia is caused by smoking the single most important factor. One in 7 people who aged 15 and above used to smoke cigarette inn 2014-2015 (Australian Bureau of Statistics 2018, 2017). More than 65% of adult Australian population aged more than 15 perform little or no physical exercises in the same year. Additionally more than 63% of population included 36% overweight and 28% obese, aged more than 18 years (Heart disease in Australia, 2015). In 2017, 7813 people died of heart attack and this is the major cause of hospitalization in 2016-2017, the number is 57,000 (Australian Institute of Health and Welfare , 2011).
Some of the common medications that are prescribed in the treatment of MI are Aspirin, diminishes blood clotting, Thrombolytic, helps in dissolving blood clot that hinders blood flow to heart and blood-thinning medications such as Heparin is injected. Pain relievers such as morphine, Nitro-glycerine to treat chest pain or angina that helps in blood flow, platelet aggregation inhibitors to stop developing new blood clots, betablockers that helps relax heart muscle and ACE inhibitors that minimise stress and controls blood pressure (Contractor, 2011).
Patients who were physically active throughout the first year of post‐myocardial infarction had shown diminished risk of mortality compared to those who were physically inactive. Similarly, outcomes recorded from a group who decreased their physical activity after being active for 6 to 10 weeks after MI also have worse medical condition when compared with the people who remained physically active all through the year (Ekblom, Ek, Cide, Hambraeus,, & Börjesson, 2018). A research study that was presented at EuroPrevent 2018, establishes that becoming more physically active post heart attack minimises the risk of mortality. The study included 22 thousand participants who increased their rate of exercise after their heart attack and reported to have minimise their risk of death to fifty percent within four years. The research further has shown that physically active people are less likely to have heart attack and have higher life expectancy (Zhang, Cao, Jiang, & Tang, 2018).
Although significant evidences are there that demonstrate that regular exercise is linked with minimised risk of cardiac illness and death. However, articles published in New England Journal of Medicine have also established that vigorous exercise can lead to sudden cardiac arrest and death due to MI. Recommendations for participating in sport for competitive as well as leisure activities have been made in a paper published recently by European Heart Journal, the Sports Cardiology Section of the European Association of Preventive Cardiology (EAPC) for coronary artery disease. While exercising, myocardial ischaemia occurs due to imbalance between oxygen demand and supply. High intensity workout may heighten heart rate, workload as well as blood pressure and hence increases the risk of MI (Josef, et al., 2018).
Patients with coronary artery illnesses must be demonstrated with potential risks alongside benefits of exercise that are linked their engagement in competitive sports. People who have coronary artery illnesses are recommended to engage in leisure time exercises. Patients who have low risk for cardiac events post their heart attack can take part in all forms of competitive sport. However, certain exercises or activities that demand highest cardiovascular power and older patients are restricted to individuals depending on their health condition.
Risk of death caused by sudden cardiac arrest is higher in men aged above 60 during enduring activities. Cardiac rehabilitation guidelines of the European Society of Cardiology recommends that all patients post their acute myocardial infarction should take part in an exercise program. However the intensity and duration of exercise should be increased gradually. Progression of exercise depends on the daily assessment of patient’s health (Contractor, 2011).
Vigorous exercise when compared with sedentary lifestyle increases risk of myocardial infarction while the activity is 2 to 10 fold. This risk is significantly high in patients who initiate vigorous exercise but chronically used to follow a sedentary lifestyle. Hence, patients with recent incidence of myocardial infarction should be restricted from vigorous exercise training until they have a stable health condition. Patients who recently have suffered from heart attack should be referred to a rehabilitation programmed supervised by medical professionals and should undergo testing of exercise stress to identify if any abnormalities with any exercise program (Kureshi, et al., 2016).
Cardiopulmonary stress tests should be conducted to determine ventilator thresholds. Detection of prevailing cardiac situations should be conducted for sedentary patients. Treadmill testing should be carried out according to recommendations of The American College of Cardiology and American Heart Association for men above 45 years old, patients with diabetes and women above 55 years of age (Wilkins, 2019). Preparation exercise testing should be included before they start with any exercise regime (Thomas, Metkus, Kenneth, & D., 2010).
Aerobic and dynamic exercises are recommended to engage in symptom-limited exercise testing before joining any exercise program. Patients should be referred to supervised exercise sessions where they can perform 3 exercise, three times a week for 30 minutes as well as warm up and cool down. The exercises can be conducted at 70 to 85% of the intensity which is standard for majority of the training sessions. However less fit patients are benefitted by lower intensity programs while high intensity exercise will benefit more fit individuals.
Patients who do not have any lower limb issues should include brisk walking as their main exercise program for a minimum of 30 minutes daily that can be increased gradually. Target heart rate while exercising will be 120 to 130 per minute while highest heart rate is 160 per minute. Obese or overweight patients are recommended to exercise 40-60 minutes for achieving ideal body weight. It is recommended that exercise program is should be designed as per individual patient’s aerobic/anaerobic fitness, physical condition, and muscular condition (Doll, et al., 2015). Low impact exercise is recommended to heart attack patients to avoid musculoskeletal injury which can be increased gradually over time. Strength training is important for weakest patients who may experience problems in performing aerobic exercises owing to their weakness.
Patients who are not into any supervised programs also should engage themselves into some resistance exercises such as toe raises, bicep curls, bent knee pushups, shoulder shrugs, quarter squats and abdominal crunches into their daily exercise regime, if patients do not have any orthopaedic issues. These exercises should be done two times a week with each exercises of 12-15 repetitions (Anderson, et al., 2016).