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Cardiac Pathologies > Cardiac Rehab, exercise physiology, exercise testing > Flashcards

Cardiac Rehab, exercise physiology, exercise testing Flashcards

1
Q

which stress test can be used to rule out cardiac problems or ischemia

A

modified Bruce Protocol

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2
Q

Resting Metabolic Rates and Basal Metabolic Rates tends to be 5-10% lower in women than in men because…

A

women have more adipose tissue (lower level of metabolic activity)

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3
Q

1 MET =

A

3.5 mL 02/kg/min

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4
Q

true or false: MET is actually and index number and not an energy unit

A

true

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5
Q

Aerobic cellular respiration occurs in the

A

mitochondria

(Krebs Cycle, uses carbs, fats and proteins)

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6
Q

from age 25 and up → peak VO2 decreases ____% per decade in sedentary people

A

9%

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7
Q

social security uses VO2 max criteria of______ considered disabled

A

<18

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8
Q

What is the test score in the Balke Protocol?
What can you do with that score?

A
  • the time taken to perform the test in minutes
  • the test time can be converted to an estimated VO2 max score using specific formulas
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9
Q

The Bruce Protocol has established norms for oxygen consumption and functional impairment based on

A

the duration of exercise

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10
Q

Who decides whether to perform a maximal or submaximal exercise test on a patient?

A

the MD

Test based on patient’s history and symptoms

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11
Q

The Full Bruce Protocol stress test is a maximal or submaximal exercise test?

A

maximal test

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12
Q

during exercise, resistance to blood flow increases or decreases?

A

decreases

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13
Q

The Bruce Protocol has ___ to ___% error in estimating VO2

A

10-20

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14
Q

Useful measure for creating proper intensity of exercise program
for endurance athletes/sports

A

Lactate threshold AKA anaerobic threshold

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15
Q

Mean values for women are _____ % lower than men

A

10-20%

due to smaller lungs and reduced muscle mass

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16
Q

The modified Full Bruce Protocol stress test is a maximal or submaximal exercise test?

A

sub-maximal / low level graded exercise test

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17
Q

advantages of treadmill tests

A
  • functional
  • mm don’t fatigue as quickly → greater dx benefits
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18
Q

Exercise-induced ST depression of > 2mm is the most valuable indicator of prognosis post…

A

MI

they are having ischemia

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19
Q

true or false: everything involved with O2 transport is affected by exercise

A

true

CO, SV, HR, RR increase

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20
Q

Anaerobic cellular respiration uses ________ as main energy source, which is stored in ________

A
  1. creatinine phosphate
  2. skeletal muscle
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21
Q

which cellular respiration system is more efficient, aerobic or anaerobic?

A

aerobic

yields 36-38 ATP + water and CO2

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22
Q

intensity: calculating Mx HR

A
  • Calculate Max HR:
    • Age method: 208 - (0.7 x age)
    • Heart Rate Reserve method: HRmax - HRrest
    • Direct method: maximal exercise test
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23
Q

the minimal amount of oxygen used in order to support life

A

Basal Metabolic Rate

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24
Q

a patient walks 365 meters in the 6-minute walk test, what is the VO2 Max?

A

≈ 15 (mod to severe compromise)

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25
Q

when is the modified Bruce Protocol test stopped?

A

at predetermined en point (% of patient max HR) unless symptoms occur first

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26
Q

Product of maximal CO and arterio-venous O2
difference; and is closely related to the functional capacity of the heart

A

VO2 MAX

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27
Q

true or false: lactate threshold can be increased with training

A

true

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28
Q

Bruce Nomogram

A
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29
Q

advantages and disadvantages of bike tests

A
  • Adv:
    • does ot take a lot of room
    • easier to take BP
    • less expensive
    • safer for those with poor balance
  • Disadv:
    • Not functional (unless you bike every day)
    • increased mm fatigue (mm not trained for bike)
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30
Q

Aerobic cellular respiration yields…

A
  • 36-38 ATP
  • H20 and CO2
  • (O2 ​required)
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31
Q

“Field” Tests

A
  • Walk velocity tests (10 meter walk test)
  • TUG
  • 6 min walk test
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32
Q

most popular submax bike test to estimate VO2

A

YMCA Cycle Ergometer

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33
Q

a patient walks 546 meters in the 6-minute walk test, what is the VO2 Max?

A

≈ 20 (none to mild compromise)

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34
Q

the 6-minute walk test can be used to prescribe exercises by estimating

A

VO2 Max

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35
Q

the volume of extra oxygen consumed after exercise

A

oxygen debt

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36
Q

The Balke Protocol was initially developed for clinical purposes for determining VO2 Max in

A

cardiac patients

37
Q

Current phases of cardiac rehab:

A
  • Phase 1: during hospitalization
  • Phases 2 and 3: supervised ambulatory outpatient program
  • Phase 4: lifetime maintenance phase
    • Physical fitness and risks factor reduction
    • minimally supervised or unsupervised
38
Q

true or false: the Balke test is recommended for cardiac patients since the elevation in workload is moderate and therefore considered safe even for patients with severe left ventricular dysfunction

A

true

39
Q

components affecting VO2 Max

A
  • Genetics/Heredity
  • Age
  • Gender
  • Altitude
40
Q

indicative of what?

a patient with CHF walks less than 300 meters in 6-minute walk test

A

not good, indicative of subsequent death with mild to mod CHF

41
Q

Calculated by the difference of O2 inspired and O2 exhaled

A

oxygen consumption

42
Q

Chemical stress test

A
  • When pt cannot complete stress tests due to back pain, stroke, or other diagnosis
  • Uses medication that increase the HR and have a short half life
  • Uses IV, EKG, and ECHO
  • ECHO before and after meds
43
Q

variations in Resting Metabolic Rates and Basal Metabolic Rates are due to…

A
  • Body size
  • Gender
  • Lean body mass
  • Endocrine function
44
Q

the 6 minutes walk test have norms for different populations:

A
  • Elderly
  • COPD
  • CHF
45
Q

what is the hallmark of aerobic fitness?

A

the ability to continue to consume oxygen at high levels of exercise

46
Q

🚨

Reasons for immediately stopping a 6MWT include the following:

A
  • Chest pain
  • Intolerable dyspnea
  • Leg cramps
  • Staggering
  • Diaphoresis (sweating profusely)
  • Pale or ashen appearance
47
Q

1 MET is close approximation of

A

resting metabolic rate

48
Q

when do you take the HR in the YMCA Cycle Ergometer Test?

A

between the last 15-30 sec of the 2nd and 3rd minute of each stage

49
Q

Bruce Protocol instructions

A
  • Begin at 1.7 mph and 10% grade
  • Change speed and grade every 3 minutes until exhaustion
    • Large increase in intensity at each stage 2-3 METS)
50
Q

LE protocols result in _______ VO peak than exercise tests for the UE

A

higher

51
Q

Indications for the 6 minute walk test

A
  • Pre and post post-treatment comparisons:
    • COPD, CHF, lung transplant/resection/rehabilitation
  • Functional status (single measurement)
    • COPD, CHF, predictor of morbidity and mortality, primary pulmonary HTN
52
Q

Bruce Protocol not used if patient is:

A
  • Decreased anginal threshold
  • Elderly
  • Deconditioned
  • Immediately post-MI
53
Q

If VO2 max below 16-18

A

most likely could not be independent in the community

54
Q

Cardiac rehab components

A
  • medical evaluation
  • prescribed exercise program
  • cardiac risk factor modification
  • education and counseling
55
Q

factors that can affect a longer distance in the 6-minute walk test

A
  • Taller height
  • Male
  • High motivation
  • repetition of the test
  • medication for a disabling disease
  • oxygen supplementation
56
Q

when do stop the test in the Bruce Protocol?

A

Patient’s max HR or symptoms

57
Q

Bruce Protocol and modified Bruce Protocol stress tests are

A

direct and indirect measurement of peak O2 consumption allowed via exercise testing

58
Q

1970’s cardiac rehab phases:

A
  • Phase 1: acute hospital inpatient
  • Phase 2: convalescent stage following discharge
  • Phase 3: extended, supervised endurance training
  • Phase 4: ongoing maintenance
59
Q

Outcomes Assessments of cardiac rehab

A
  • Health Assessments: morbidity, mortality, QOL
  • Clinical Assessments: physical, psychological, medical utilization
  • Behavioral Assessments: compliance, recognition and reporting
  • Service Assessments: patient satisfaction, financial
60
Q

What do you monitor/measure during before and after exercise testing

A
  • Continous EKG
  • Patient Symptoms
  • Heart and lung sounds
  • VO2 via open circuit spirometry
  • Expired gas analysis
  • Periodic BP and HR
61
Q

a person’s aerobic potential

A

VO2 max

(best indicator of aerobic fitness)

62
Q

essential components of exercise prescription

A
  1. Mode: type
  2. Intensity: % of maximum capacity
  3. Duration: 30 min
  4. Frequency: 5 days mosts days
  5. Progression
63
Q

Basal metabolic rate measures work of resting basic body functions such as

A
  • work of breathing
  • heart, renal, and brain function
  • Thermal regulation
64
Q

anaerobic glycolysis is effective for ____ minutes, then lactic acid levels begin to decrease muscle function

A

2

65
Q

Average VO2 Max values

A
  • Men 20-25% more than women
  • Sedentary ≈ 35
  • Elite athletes: > 60
  • Elite endurance athletes: ~70
66
Q

can you determine whether a patient needs home oxygen using the 6-minute walk test?

A

yes

  • Monito O2 Sat during test
  • If bellow 88% on room air, home O2 is indicated.
  • May need to titrate O2 to maintain SaO2 at a specific parameter,
67
Q

Anaerobic cellular respiration occurs in the:

A

cytoplasm

(uses only carbohydrates)

68
Q

modes of exercise testing

A
  • Steps
  • Stationary Bike
  • UBE (Upper Body Ergo)
  • Treadmill
69
Q

Advantages of the Bruce Protocol

A
  • Short: non-conditioned people might complete to stage III = 9 minutes
  • Begins with sub-max exertion: safe
  • Dynamic exercise for large mm groups
  • Established norms for oxygen consumption and functional impairments based on duration
70
Q

muscles produce more lactic acid than they can metabolize

A

Lactate threshold AKA Anaerobic threshold

71
Q

Still the most used test protocol for treadmill

A

Bruce Protocol

72
Q

definition

exercise intensity when lactic acid starts to accumulate in the blood stream:

A

Lactate threshold AKA anaerobic threshold

73
Q

this type of cellular respiration is used for activity that lasts up to 30 seconds

A

anaerobic

after 30 sec glycolysis begins

74
Q

YMCA Cycle Ergometer Test instructions

A
  • 2-3 minutes warm up
  • 3 minutes stages, HR monitored near the end of the 2nd and 3rd min of each stage
  • BP monitored at the end of each stage
  • RPE monitored at the end of each stage using the 6-20 scale or 1-10 scale
  • test terminated when subject reaches 85% of age predicted maxima HR
    • or symptoms
  • Appropriate cooldown
  • HR, BP, RPE, and S & S monitored for at least 4 min of recovery.
75
Q

Modified Bruce Protocol can be done on what type of equipment and what type of patients?

A
  • treadmill or bike
  • Used to rule out cardiac problems or ischemia
  • Pulmonary patients with SOB
76
Q

Bruce Protocol is the most widely used because

A

it gives normative data and allows for the calculation of functional aerobic impairment

77
Q

factors that can affect a shorter distance in the 6-minute walk test

A
  • Shorter height
  • Old age
  • Obesity
  • Female
  • impaired cognition
  • Shorter walking corridor
  • COPD
  • Interstitial lung disease
  • Angina, MI, CHF, stroke
  • TIA
  • PVD
  • Arthritis
78
Q

VO2 & HR

when does the lactate threshold approximately occur (is considered to be at…)?

A
  • b/t 85-90% of max HR
  • ~55% of peak VO2
  • value of ~4.0 mmol/L of blood lactate accumulation
79
Q

difference between peak and max oxygen consumption

A
  • Peak: when you “had enough”
  • Max: max amount of O2 that an individual can use during intense exercise
80
Q

The Balke Protocol is mainly used as a cardio endurance test by ________

A

athletes

but can be used by non-athletes as well

81
Q

are there other tests developed by Balke?

A

field tests: 15-minute run test and the Balke Step Test

82
Q

how are the first two stages of the modified Bruce Protocol test?

A
  • STAGE I: at 1.7 mph and 0% grade
  • STAGE II: at 1.7 mph and 5% grade
  • STAGE III: 1.7 at 10% grade (continues with the regular Bruce Protocol)
  • STAGE IV: 2.5 mph at 12% grade
83
Q

Balke Protocol instructions

A
  • Subjects walk on a treadmill until exhausted
  • Treadmill is set at a constant speed while gradient is increased
    • Men: 3.3 mph, gradient increased by 2% after one minute, the 1% ea min thereafter.
    • Women: 3 mph, gradient increased by 2.5% every 3 min.
84
Q

The Balke Protocol is a maximal or submaximal test?

A

maximal

85
Q

Cardiac rehab goals:

A
  • ↑ activity level
  • ↑ QOL
  • ↑ ADL performance level
  • Return to work
  • Function independently
  • ↓ anxiety and/or depression
  • ↓ recurrence of cardiac events
86
Q

Anaerobic cellular respiration yields:

A
  • 2 ATP
  • Lactic acid
  • (No O2 needed)
87
Q

true or false: the 6-minute walk test can be a predictor of morbidity and mortality

A

true

88
Q

💡types of mode

mode of training

A
  • Aerobic
  • Flexibility
  • Resistance/Strengthening
  • Functional training

Cardiac Pathologies (13 decks)

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