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A physical therapist in an outpatient cardiac rehabilitation program is instructing a patient in proper lifting technique. Which recommendation would be the MOST helpful to assist the patient to avoid the Valsalva maneuver?

1. Inhale during the lifting (concentric phase) and exhale during the lowering (eccentric phase)
2. Exhale during the lifting (concentric phase) and inhale during the lowering (eccentric phase)
3. Inhale during both the lifting (concentric phase) and lowering (eccentric phase)
4. Exhale during both the lifting (concentric phase) and lowering (eccentric phase)

Transcript

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.

Ready? Let’s go!

A physical therapist in an outpatient cardiac rehabilitation program is instructing a patient in proper lifting technique. Which recommendation would be the MOST helpful to assist the patient to avoid the Valsalva maneuver?

1. Inhale during the lifting (concentric phase) and exhale during the lowering (eccentric phase)
2. Exhale during the lifting (concentric phase) and inhale during the lowering (eccentric phase)
3. Inhale during both the lifting (concentric phase) and lowering (eccentric phase)
4. Exhale during both the lifting (concentric phase) and lowering (eccentric phase)

Valsalva Maneuver
The Valsalva maneuver, defined as an expiratory effort against a closed glottis, should be avoided during resistance training. During the maneuver, intra-abdominal pressure increases, which forces blood from the heart and temporarily increases blood pressure. 

This maneuver and subsequent increase in blood pressure is especially risky for patients with a history of cardiovascular disease. The therapist should instruct patients on proper breathing patterns to utilize while engaging in resistance training.

Let’s explore each of the options:

Option 1 - Inhale during the lifting (concentric phase) and exhale during the lowering (eccentric phase)
While it is important for the patient to breathe rhythmically during resistance exercise, the exhalation should occur during the more strenuous phase (i.e., concentric phase), while inhalation should occur in the less strenuous phase (i.e., eccentric phase).

Option 2 - Exhale during the lifting (concentric phase) and inhale during the lowering (eccentric phase)
To avoid the Valsalva maneuver, the patient should exhale during the more strenuous lifting phase (i.e., concentric phase) and inhale during the less strenuous phase (i.e., eccentric phase). This rhythmical breathing pattern will prevent the patient from holding their breath.

Option 3 - Inhale during both the lifting (concentric phase) and lowering (eccentric phase)
Teaching the patient to inhale during both phases of a lift would require the patient to hold their breath for too long and result in the Valsalva maneuver. Breath holding should be avoided during resistance exercise.

Option 4 - Exhale during both the lifting (concentric phase) and lowering (eccentric phase)
The same rationale stated for option 3 being incorrect is true for option 4. The only difference is that in option 4, the patient is exhaling instead of inhaling on both the lifting and lowering phases of lifting.

The correct answer is Option 2

Let’s explore the all student data:
33% of students selected Option 1, Inhale during the lifting (concentric phase) and exhale during the lowering (eccentric phase)
59% of students selected Option 2, Exhale during the lifting (concentric phase) and inhale during the lowering (eccentric phase), the correct response
2% of students selected Option 3, Inhale during both the lifting (concentric phase) and lowering (eccentric phase)
6% of students selected Option 4, Exhale during both the lifting (concentric phase) and lowering (eccentric phase)

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

Content Outline Classification
This question is an Interventions question which represents approximately 29% of all exam items.

Level Classification
This 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? Check out page 404 in PTEXAM: The Complete Study Guide.

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