Cardiac Rehab, exercise physiology, exercise testing Flashcards
which stress test can be used to rule out cardiac problems or ischemia
modified Bruce Protocol
Resting Metabolic Rates and Basal Metabolic Rates tends to be 5-10% lower in women than in men because…
women have more adipose tissue (lower level of metabolic activity)
1 MET =
3.5 mL 02/kg/min
true or false: MET is actually and index number and not an energy unit
true
Aerobic cellular respiration occurs in the
mitochondria
(Krebs Cycle, uses carbs, fats and proteins)
from age 25 and up → peak VO2 decreases ____% per decade in sedentary people
9%
social security uses VO2 max criteria of______ considered disabled
<18
What is the test score in the Balke Protocol?
What can you do with that score?
- the time taken to perform the test in minutes
- the test time can be converted to an estimated VO2 max score using specific formulas
The Bruce Protocol has established norms for oxygen consumption and functional impairment based on
the duration of exercise
Who decides whether to perform a maximal or submaximal exercise test on a patient?
the MD
Test based on patient’s history and symptoms
The Full Bruce Protocol stress test is a maximal or submaximal exercise test?
maximal test
during exercise, resistance to blood flow increases or decreases?
decreases
The Bruce Protocol has ___ to ___% error in estimating VO2
10-20
Useful measure for creating proper intensity of exercise program
for endurance athletes/sports
Lactate threshold AKA anaerobic threshold
Mean values for women are _____ % lower than men
10-20%
due to smaller lungs and reduced muscle mass
The modified Full Bruce Protocol stress test is a maximal or submaximal exercise test?
sub-maximal / low level graded exercise test
advantages of treadmill tests
- functional
- mm don’t fatigue as quickly → greater dx benefits
Exercise-induced ST depression of > 2mm is the most valuable indicator of prognosis post…
MI
they are having ischemia
true or false: everything involved with O2 transport is affected by exercise
true
CO, SV, HR, RR increase
Anaerobic cellular respiration uses ________ as main energy source, which is stored in ________
- creatinine phosphate
- skeletal muscle
which cellular respiration system is more efficient, aerobic or anaerobic?
aerobic
yields 36-38 ATP + water and CO2
intensity: calculating Mx HR
- Calculate Max HR:
- Age method: 208 - (0.7 x age)
- Heart Rate Reserve method: HRmax - HRrest
- Direct method: maximal exercise test
the minimal amount of oxygen used in order to support life
Basal Metabolic Rate
a patient walks 365 meters in the 6-minute walk test, what is the VO2 Max?
≈ 15 (mod to severe compromise)
when is the modified Bruce Protocol test stopped?
at predetermined en point (% of patient max HR) unless symptoms occur first
Product of maximal CO and arterio-venous O2
difference; and is closely related to the functional capacity of the heart
VO2 MAX
true or false: lactate threshold can be increased with training
true
Bruce Nomogram
advantages and disadvantages of bike tests
-
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)
Aerobic cellular respiration yields…
- 36-38 ATP
- H20 and CO2
- (O2 required)
“Field” Tests
- Walk velocity tests (10 meter walk test)
- TUG
- 6 min walk test
most popular submax bike test to estimate VO2
YMCA Cycle Ergometer
a patient walks 546 meters in the 6-minute walk test, what is the VO2 Max?
≈ 20 (none to mild compromise)
the 6-minute walk test can be used to prescribe exercises by estimating
VO2 Max
the volume of extra oxygen consumed after exercise
oxygen debt
The Balke Protocol was initially developed for clinical purposes for determining VO2 Max in
cardiac patients
Current phases of cardiac rehab:
- 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
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
true
components affecting VO2 Max
- Genetics/Heredity
- Age
- Gender
- Altitude
indicative of what?
a patient with CHF walks less than 300 meters in 6-minute walk test
not good, indicative of subsequent death with mild to mod CHF
Calculated by the difference of O2 inspired and O2 exhaled
oxygen consumption
Chemical stress test
- 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
variations in Resting Metabolic Rates and Basal Metabolic Rates are due to…
- Body size
- Gender
- Lean body mass
- Endocrine function
the 6 minutes walk test have norms for different populations:
- Elderly
- COPD
- CHF
what is the hallmark of aerobic fitness?
the ability to continue to consume oxygen at high levels of exercise
🚨
Reasons for immediately stopping a 6MWT include the following:
- Chest pain
- Intolerable dyspnea
- Leg cramps
- Staggering
- Diaphoresis (sweating profusely)
- Pale or ashen appearance
1 MET is close approximation of
resting metabolic rate
when do you take the HR in the YMCA Cycle Ergometer Test?
between the last 15-30 sec of the 2nd and 3rd minute of each stage
Bruce Protocol instructions
- 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)
LE protocols result in _______ VO peak than exercise tests for the UE
higher
Indications for the 6 minute walk test
-
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
Bruce Protocol not used if patient is:
- Decreased anginal threshold
- Elderly
- Deconditioned
- Immediately post-MI
If VO2 max below 16-18
most likely could not be independent in the community
Cardiac rehab components
- medical evaluation
- prescribed exercise program
- cardiac risk factor modification
- education and counseling
factors that can affect a longer distance in the 6-minute walk test
- Taller height
- Male
- High motivation
- repetition of the test
- medication for a disabling disease
- oxygen supplementation
when do stop the test in the Bruce Protocol?
Patient’s max HR or symptoms
Bruce Protocol and modified Bruce Protocol stress tests are
direct and indirect measurement of peak O2 consumption allowed via exercise testing
1970’s cardiac rehab phases:
- Phase 1: acute hospital inpatient
- Phase 2: convalescent stage following discharge
- Phase 3: extended, supervised endurance training
- Phase 4: ongoing maintenance
Outcomes Assessments of cardiac rehab
- Health Assessments: morbidity, mortality, QOL
- Clinical Assessments: physical, psychological, medical utilization
- Behavioral Assessments: compliance, recognition and reporting
- Service Assessments: patient satisfaction, financial
What do you monitor/measure during before and after exercise testing
- Continous EKG
- Patient Symptoms
- Heart and lung sounds
- VO2 via open circuit spirometry
- Expired gas analysis
- Periodic BP and HR
a person’s aerobic potential
VO2 max
(best indicator of aerobic fitness)
essential components of exercise prescription
- Mode: type
- Intensity: % of maximum capacity
- Duration: 30 min
- Frequency: 5 days mosts days
- Progression
Basal metabolic rate measures work of resting basic body functions such as
- work of breathing
- heart, renal, and brain function
- Thermal regulation
anaerobic glycolysis is effective for ____ minutes, then lactic acid levels begin to decrease muscle function
2
Average VO2 Max values
- Men 20-25% more than women
- Sedentary ≈ 35
- Elite athletes: > 60
- Elite endurance athletes: ~70
can you determine whether a patient needs home oxygen using the 6-minute walk test?
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,
Anaerobic cellular respiration occurs in the:
cytoplasm
(uses only carbohydrates)
modes of exercise testing
- Steps
- Stationary Bike
- UBE (Upper Body Ergo)
- Treadmill
Advantages of the Bruce Protocol
- 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
muscles produce more lactic acid than they can metabolize
Lactate threshold AKA Anaerobic threshold
Still the most used test protocol for treadmill
Bruce Protocol
definition
exercise intensity when lactic acid starts to accumulate in the blood stream:
Lactate threshold AKA anaerobic threshold
this type of cellular respiration is used for activity that lasts up to 30 seconds
anaerobic
after 30 sec glycolysis begins
YMCA Cycle Ergometer Test instructions
- 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.
Modified Bruce Protocol can be done on what type of equipment and what type of patients?
- treadmill or bike
- Used to rule out cardiac problems or ischemia
- Pulmonary patients with SOB
Bruce Protocol is the most widely used because
it gives normative data and allows for the calculation of functional aerobic impairment
factors that can affect a shorter distance in the 6-minute walk test
- Shorter height
- Old age
- Obesity
- Female
- impaired cognition
- Shorter walking corridor
- COPD
- Interstitial lung disease
- Angina, MI, CHF, stroke
- TIA
- PVD
- Arthritis
VO2 & HR
when does the lactate threshold approximately occur (is considered to be at…)?
- b/t 85-90% of max HR
- ~55% of peak VO2
- value of ~4.0 mmol/L of blood lactate accumulation
difference between peak and max oxygen consumption
- Peak: when you “had enough”
- Max: max amount of O2 that an individual can use during intense exercise
The Balke Protocol is mainly used as a cardio endurance test by ________
athletes
but can be used by non-athletes as well
are there other tests developed by Balke?
field tests: 15-minute run test and the Balke Step Test
how are the first two stages of the modified Bruce Protocol test?
- 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
Balke Protocol instructions
- 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.
The Balke Protocol is a maximal or submaximal test?
maximal
Cardiac rehab goals:
- ↑ activity level
- ↑ QOL
- ↑ ADL performance level
- Return to work
- Function independently
- ↓ anxiety and/or depression
- ↓ recurrence of cardiac events
Anaerobic cellular respiration yields:
- 2 ATP
- Lactic acid
- (No O2 needed)
true or false: the 6-minute walk test can be a predictor of morbidity and mortality
true
💡types of mode
mode of training
- Aerobic
- Flexibility
- Resistance/Strengthening
- Functional training
