Understanding Your Target Heart Rate
Nearly all exercise is good. But to be sure youre getting the most fromyour workout yet staying at a level thats safe for you, you can monitorhow hard your heart is working.
Aiming for whats called a target heart rate can help you do this, says Johns Hopkins cardiologist;Seth Martin, M.D., M.P.H.;Think of it as the sweet spot between not exercising hard enough and overexerting.
Safety Considerations And Contraindications
To ensure appropriate responses to potential adverse events during exercise testing, facility emergency procedures need to be clearly defined and basic emergency equipment such as an automated external defibrillator should be readily available in the testing area., The tester and support staff should have a minimum of basic cardiac life support certification. A physical therapist who may independently evaluate patients in the high risk category should strongly consider advanced cardiac life support certification.
Key New Publications On Oxygen Since 2008
The dangers of hypoxaemia are well documented, the most recently published studies on oxygen therapy focus on the dangers of hyperoxaemia which is a more controversial area, with many clinicians still believing that more is better.
Three large studies have been performed in critical care settings which have produced conflicting results. De Jongeet al. performed a retrospective observational study on oxygenation in the first 24 h after admission to the ITU in 36 307 consecutive patients who were mechanically ventilated. The results showed that in-hospital mortality was increased with both abnormally low and abnormally high oxygen levels. However, multicentre observational data from Australia looking at the worst ABG in first 24 h following admission, suggested that supranormal oxygen levels did not predict hospital mortality after multivariate analysis , although this study confirmed the finding of a higher mortality rate in hypoxaemic patients.
The third study was an observational study, based on a database of 6326 adult patients from 120 ITUs admitted after resuscitation from cardiac arrest. This study showed that arterial hyperoxaemia was independently associated with increased in-hospital mortality compared with either hypoxaemia or normoxaemia and that there was a dose-dependent association between supranormal oxygen levels and the risk of in-hospital death .
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Heart Rate Tips To Keep In Mind
- Start at your beginning.;Before getting overly concerned about your heart rate, Martin says, its best to simply get moving. If you havent exercised much before, start where youre comfortable and gradually exert yourself more over time.
- Listen to your body.;Your body provides other indicators of how hard its working that you need to consider along with heart rate. Pay attention to how hard youre breathing or sweating, and stop if you feel very uncomfortable, Martin says. Devices recording your heart rate have been known to malfunction, for exampleanother reason listening to your body is important.
- Remember that target heart rate is just a guide.;Dont get overly fixated on numbers, Martin says. Ideally, they just push you to work a little harder.
Oxygen Prescribing Is Poor
Despite being a drug, oxygen is often not prescribed appropriately, signed for on drug charts or regularly reviewed. The 2008 national oxygen audit showed that, in UK hospitals, less than one-third of patients receiving oxygen had any written prescription, in only 10% of cases was consideration given to a target saturation range and in only 5% of cases was oxygen signed for to indicate it had been administered .
The British Thoracic Society Emergency Oxygen Guideline, published in 2008, addresses many of the issues surrounding the use and prescribing of oxygen, specifically regarding target saturation ranges . The recommendations aim to guide clinicians, encouraging levels of oxygenation that are appropriate for each patient, based on a combination of what is believed to be safe and normal or near-normal.
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How Does Training Affect Vo2max
Training results in an increase in the efficiency of oxygen transport within the body. By lowering the resting heart rate , and the HR at sub maximal loads, the heart pumps more blood with every heart beat. This, in addition to other physiological changes, increases the oxygen extraction capability. When an individual is tested before and after training while performing exercise at the same load, a lower HR is shown after training because more blood is delivered in each heart beat. Such HR differences during exercise can be used to predict aerobic fitness.;; The % of increase in VO2 max is dependent on many variables and differs considerably from individual to individual, ranging from 5-30%. In general, individuals who are the least fit see the largest changes and individuals who are highly fit see the smallest changes.
Summary Of Key Points
Physical activity is crucial for general health maintenance. An exercise evaluation includes a comprehensive patient history, physical examination, exercise testing, and exercise prescription. The SXTT provides important clinical data that form the foundation for an effective and safe exercise prescription. Observations obtained during the exercise evaluation will identify at-risk patients who should undergo further medical evaluation before starting an exercise program. Two case examples of SXTTs administered to individuals with multiple sclerosis are presented to demonstrate the application of these principles.
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There Are Common Misconceptions Regarding The Safe Use Of Oxygen And Many People Are Unaware Of The Dangers Of Hyperoxaemia
It is widely believed that that supplemental oxygen relieves dyspnoea in the absence of hypoxaemia . No evidence of benefit exists for administering oxygen in patients who are normoxaemic or very mildly hypoxaemic . Dyspnoea can occur for many reasons other than cardiorespiratory disease, including metabolic acidosis, anxiety and pain, and treatment with oxygen is not indicated in these cases.
Another common misconception is that one cant give too much oxygen and there is general lack of appreciation for the dangers of hyperoxaemia . Historically, high levels of oxygen were given to all patients with dyspnoea and critical illness . It is well established that severe hypoxaemia results in rapid organ failure and death. Oxygen saves lives when used appropriately to correct hypoxaemia and is an essential component in resuscitation of the critically ill; however, there is little evidence that supra-physiological levels of oxygen have a clinical benefit in most instances. Evidence does exist, however, that inappropriate use of oxygen can be detrimental.
High-flow oxygen is commonly used in intensive therapy units and hyperoxaemia is common in these wards . Studies in critical care have shown that in cardiac arrest survivors and in patients receiving ITU care , hyperoxaemia is linked to worse outcomes than normoxaemia.
Measuring Your Heart Rate By Taking Your Pulse
- Take your pulse before you warm up.
- Take your pulse again when youve been exercising for about 5-10 minutes.
- Continue taking your pulse at regular intervals.
- Put the first three fingers of one hand against the inner wrist of the other hand just below the thumb.
- Lightly press your fingers into the hollow next to the tendon on the thumb-side your artery lies just beneath the skin.
- Using a watch with a second hand, count your pulse for 15 seconds. Multiply this figure by four to get your beats per minute.
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See A Graph Of Your Heart Rate Data
Open the Health app on your iPhone.
Tap Browse at the bottom right, tap Heart, then tap Heart Rate.
To add Heart Rate to your Summary, swipe up, then tap Add to Favorites.
You can see your heart rate over the last hour, day, week, month, or year. Tap Show More Heart Rate Data and you can also see the range of your heart rate during the selected time period; your resting, walking average, workout, and breathe rates; and any high or low heart rate notifications.
How Are Results Incorporated Into Training
VO2 max values cannot be used in every day training, but follow-up VO2 tests can be used as a measure of progress. However, since heart rate, speed and/or power is typically measured during a VO2max test, various heart rate, speed and/or power levels can be garnered from testing and then associated to appropriate training zones, which are then applied to everyday training. Other information such as VO2 economy can also be extracted from the data, compared to subsequent tests and against performance norms.
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Receive Irregular Heart Rhythm Notifications
You can receive a notification if Apple;Watch has identified an irregular heart rhythm that appears to be atrial fibrillation .
Open the Settings app on your Apple;Watch.
Tap Heart, then turn on Irregular Rhythm Notifications.
You can also open the Apple;Watch app on your iPhone, tap My Watch, tap Heart, then turn on Irregular Rhythm.
Exercise Prescription And Activity Recommendations
The exercise prescription for cardiovascular conditioning includes the following exercise parameters: mode, intensity, duration, and frequency. The exercise prescription needs to be individualized to the respective physical therapy client based on the data obtained in the exercise evaluation and clinical diagnosis, history, current health status, risk profile, exercise history, and the client’s goals and preferences. A comprehensive, long-term ârehabilitation and wellness programâ should also include resistance and flexibility exercises and, if indicated, functional mobility and balance training. However, a discussion of these areas is beyond the scope of this paper and the discussion in this article will be limited to cardiovascular conditioning or aerobic training.
Custom Pedal with Straps for Combined Arm/Leg Ergometer
PATIENT CASE EXAMPLE 1
Submaximal Clinical Exercise Tolerance Test – Case Example 1
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Updating The Current Guideline
The next version of the BTS emergency oxygen guideline will be titled: BTS guideline for oxygen use in adults in healthcare and emergency settings and there will be a separate guideline on emergency use in children. The key principles will remain that oxygen is a treatment of hypoxemia and that oxygen should be prescribed to a target range. The target ranges specified in the 2008 guideline are likely to remain unchanged. The new children’s guideline will provide comprehensive guidance on the emergency use of oxygen in paediatric healthcare and the adult guideline has been extended to include first responders and palliative care settings. Use of oxygen in continuous positive airway pressure ventilation systems, heliox and nitrous oxide mixtures, procedures that require conscious sedation, the peri-operative period and in track and trigger warning systems will also be included. Publication is anticipated in 2014.
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How Was The Guideline Implemented
Copies of the guidelines were sent to all hospital chief executives, medical directors, nursing heads and to all primary care and ambulance trusts, as well as to education leads in medical and nursing schools.
Local oxygen champions were identified to review local oxygen policy in accordance with the national guidelines, arrange staff education, and ensure oxygen prescription and monitoring could be achieved on drug and observation charts. Lectures, teaching material and example documentation were made available through the BTS website. Local oxygen champions were also instrumental in re-auditing after the initial implementation of the policy.
How Is Aerobic Fitness Assessed
Aerobic fitness is assessed by having the subject perform exercise at increased loads, for 12 to 15 minutes, while breathing into a mouthpiece which collects information on inspired and expired air. A treadmill, personal bike on a Computrainer, or a stationary bicycle are typically used. The test starts with an easy-moderate work load which is maintained for a 1-2 minutes. The load is increased gradually every 1-2 minutes until reaching the maximum level that the subject can tolerate and/or until physiological parameters such as heart rate, oxygen consumption, f… have hit a peak or plateau. This is done by increasing the cycling resistance or the speed and/or grade of the treadmill. The oxygen uptake, heart rate, speed and/or watts are measured at the ventilatory threshold and at maximal load, the latter would be the subject’s VO2 max.
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How To Find Your Target Heart Rate
First, it helps to know your resting heart rate, Martin says. Find your pulse . Then count the number of beats in a minutethats your resting heart rate. The average resting heart rate is between 60 and 100, he says. The more fit you are, the lower your resting heart rate; for very fit people, its in the range of 40 to 50 beats per minute.
Target heart rate is generally expressed as a percentage of your maximum safe heart rate. The maximum rate is based on your age, as subtracted from 220. So for a 50-year-old, maximum heart rate is 220 minus 50, or 170 beats per minute. At a 50 percent exertion level, your target would be 50 percent of that maximum, or 85 beats per minute. At an 85 percent level of exertion, your target would be 145 beats per minute. Therefore, the target heart rate that a 50-year-old would want to aim for during exercise is 85 to 145 beats per minute.
But theres an easier way to figure it out if you want to skip the math: Wear a fitness tracking device, or exercise on a treadmill or other machine that calculates target heart rate for you, Blaha suggests.
What The Experts Do
Monitor Heart Rate for Motivation
For Johns Hopkins cardiologist Michael Blaha, M.D., M.P.H., most workoutstake place on an elliptical trainer in his home. His machine has electrodeson which he can place his hands to automatically see his heart rate. Itgives me a sense of how hard Im working, he says.
Blaha also uses his targeted heart rate to guide the course that heprogrammed into the machine, so that he works up to where he wants to be interms of exertion. Knowing your target heart rate and trying to achieve itcan be very motivating, he says.
Stay on Top of Your Heart Health
If you have a new or existing heart problem, it’s vital to see a doctor. Our heart health checklist can help you determine when to seek care.
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Receive Low Cardio Fitness Notifications
Apple;Watch can estimate your cardio fitness level by looking at your heart rate while you walk or run outdoors, and notify you if its low. Depending on your age and sex, your cardio fitness will fall into one of four ranges: Low, Below Average, Above Average, or High. If your cardio fitness level falls in the Low range, youll receive a notification on your Apple;Watch. If it stays low, youll receive a notification every four months.
Note: This feature may not be available in all regions.
In the Health app on your iPhone , tap Browse, tap Respiratory, then tap Cardio Fitness.
Follow the onscreen prompts to turn on Cardio Fitness notifications.
You can also look in the Cardio Fitness section of the Health app to see your cardio fitness measurements and the range they fall into. Tap Show All Cardio Fitness Levels.
Note: For best results, the back of your Apple;Watch needs skin contact for features like wrist detection, haptic notifications, blood oxygen level measurements , and the heart rate sensor. Wearing your Apple;Watch with the right fitnot too tight, not too loose, and with room for your skin to breathekeeps you comfortable and lets the sensors do their job. For more information, see the Apple Support articles Wearing your Apple Watch and Your heart rate. What it means, and where on Apple Watch youll find it.
What Is Aerobic Fitness
Aerobic fitness is the bodys ability to deliver oxygen to your muscles, which allows them to do work or engage in activity.The lungs take in oxygen from the air we breathe where it gets perfused into the blood stream; the heart and blood vessels deliver it into the working muscles; and the skeletal muscles utilize that oxygen to execute muscular contractions and produce work. A cardiovascular assessment is a good tool to measure the efficiency of the aforementioned physiological functions.
While there are numerous methods for evaluating aerobic capacity, in most instances treadmill walking/running is appropriate for the majority of individuals. Normative data correlates time on the treadmill with aerobic fitness. VO2 is an index of the bodys efficiency at producing work. It is expressed in milliliters of oxygen consumed per minute, and adjusted for body weight in kilograms: ml/kg/min. There are many factors that can influence VO2max, e.g. heredity, training, age, gender, and body composition. Generally, VO2max declines with age and males typically have a greater oxygen consumption value than females. Nevertheless, the trend is that a higher VO2max allows one to produce more energy, thereby performing more work. With this in mind, VO2max is the “gold standard” measure of overall fitness.
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Oxygen Is An Essential Part Of Resuscitation And Patient Stabilisation In Critical Illness
Pulse oximetry should be recorded in all patients as the fifth vital sign and further assessment with arterial blood gases performed, if indicated .
All patients with severe hypoxaemia , acute breathlessness, severe sepsis and any other critical illness should be given high-concentration supplemental oxygen in the initial stages of the resuscitation process. Once the patient is stable, formal assessment of the need for oxygen should be made, guided by pulse oximetry plus ABGs if required.
Arterial blood gases are recommended in:
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All critically ill patients