Episode 2 - Exercise Post Cardiac Transplantation

During an exercise session, a physical therapist monitors exercise intensity with a patient post cardiac transplantation. Which method is the MOST appropriate for the therapist to use?

1. Metabolic equivalents
2. Perceived exertion scale
3. Pulmonary function tests
4. Target heart rate range

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders Team with the opportunity to explore challenging multiple choice examination questions with students actively preparing for the licensing examination.

My name is Scott Giles and I will be your host for today’s journey.

Today our question deals with a patient following a heart transplantation. This reminds me of a funny moment. My friend once said to me out of the blue….If I ever needed a heart transplant, I would want Nancy’s since it has never been used. Nancy was his ex-girlfriend and as you may have guessed it didn’t end well. I softly chuckled but then just felt awkward and became silent.

Back to business! Ready? Let’s go! 

During an exercise session, a physical therapist monitors exercise intensity with a patient post cardiac transplantation. Which method is the MOST appropriate for the therapist to use?

1. Metabolic equivalents
2. Perceived exertion scale
3. Pulmonary function tests
4. Target heart rate range

Exercise Intensity
There are a variety of subjective and objective methods available to monitor exercise intensity. The most appropriate method for a given clinical scenario is influenced by a number of variables including measurement purpose, medical status, medical history, patient’s abilities, setting, and equipment available.

Cardiac Transplantation
The surgical procedure required for cardiac transplantation results in several relevant anatomical and physiological changes that must be carefully considered when designing an exercise program. 

The medical management of a patient following cardiac transplantation focuses on controlling immune system rejection while minimizing potential side effects. For several months after the transplant, the transplanted heart fails to respond normally to sympathetic nervous stimulation. By one year after surgery, approximately one-third of patients will exhibit a near normal heart rate response to exercise.

Let’s explore each of the options:

Option 1 - Metabolic equivalents
Metabolic equivalents (METs) are not an objective means of monitoring exercise intensity, although they may be useful to select appropriate exercise activities. Once the patient’s appropriate MET levels for exercise are determined, activities with the desired aerobic requirement can be selected from a published table of MET values.

Option 2 - Perceived exertion scale
Patients can utilize a perceived exertion scale, such as Borg’s Rating of Perceived Exertion Scale, as a subjective means of rating the intensity of exercise. This is particularly useful following cardiac transplantation since the transplanted heart fails to respond normally to sympathetic nervous stimulation resulting in an abnormal heart rate response to exercise. 

Option 3 - Pulmonary function tests
Pulmonary function tests do not measure exercise intensity. Pulmonary function tests are performed to measure lung volumes and capacities at different times in the respiratory cycle.

Option 4 - Target heart rate range
Target heart rate range is an objective means of monitoring exercise intensity. Heart rate increases with increasing intensity of exercise. As a result, intensity can be quantified as a percentage of maximum heart rate. Target heart rate range is less valid for a patient following cardiac transplantation due to the abnormal heart rate response to exercise.

The correct answer is Option 2.

Let’s explore the all student data:

6% of students selected Option 1, Metabolic equivalents
70% of students selected Option 2, Perceived exertion scale, the correct response
2% of students selected Option 3, Pulmonary function tests
22% of students selected Option 4, Target heart rate range

System Classification
The question is a Cardiovascular and Pulmonary Systems question which represents approximately 14% of all exam items.

Content Outline Classification 
The question is a Physical Therapy Examination question which represents approximately 24% of all exam items.

Level Classification 
The question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Academic Focus Area 
Looking to review related academic content? Pages 427, 442-443, 446-447, 458, and 460 from our review book PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast. See you next week! 
 

Watch the video version of this Q&A episode on YouTube - https://youtu.be/ECuoPtT-yL0?si=JTN79DkZ2kQibtB1.