Cardiovascular and Pulmonary Systems
Monitoring and intensity
Know the baseline numbers: resting heart rate roughly 60–100 beats per minute, and an orthostatic drop of about 20 mmHg systolic or 10 mmHg diastolic when moving from supine to standing. Estimate maximal heart rate as 220 minus age, then apply 60–80 percent for training range, or use the heart rate reserve (Karvonen) method for greater precision. Perceived exertion scales: Borg 6–20, where 11–13 is light to somewhat hard, and the 0–10 scale, where 3–4 is moderate. Metabolic equivalents help translate activities: sitting about 1 MET, walking 2–3, stair climbing 4–8.
When to stop
Terminate exercise for chest pain, dizziness, marked dyspnea, pallor, a falling systolic pressure with rising heart rate, arrhythmia, or abnormal heart rate response. Teach clients to avoid the Valsalva maneuver; exhale on exertion.
Pulmonary techniques
Pursed-lip breathing prolongs exhalation and reduces air trapping in obstructive disease; diaphragmatic breathing reduces accessory muscle use. Airway clearance uses postural drainage, percussion, vibration, huffing and autogenic drainage. Incentive spirometry targets prevention of atelectasis after surgery. Patients with COPD are usually limited by airflow, while restrictive disease limits volumes.
Traps
Questions conflate the Borg 6–20 with the 0–10 scale, ignore beta-blocker blunting of heart rate, and assume Trendelenburg is always safe; it is not for uncontrolled hypertension or recent head injury.
Worked example: a 60-year-old using 70 percent of age-predicted maximum: 220 − 60 = 160; 0.70 × 160 = 112 beats per minute target.