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
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)
3
Q
1 MET =
A
3.5 mL 02/kg/min
4
Q
true or false: MET is actually and index number and not an energy unit
A
true
5
Q
Aerobic cellular respiration occurs in the
A
mitochondria
(Krebs Cycle, uses carbs, fats and proteins)
6
Q
from age 25 and up → peak VO2 decreases ____% per decade in sedentary people
A
9%
7
Q
social security uses VO2 max criteria of______ considered disabled
A
<18
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
9
Q
The Bruce Protocol has established norms for oxygen consumption and functional impairment based on
A
the duration of exercise
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
11
Q
The Full Bruce Protocol stress test is a maximal or submaximal exercise test?
A
maximal test
12
Q
during exercise, resistance to blood flow increases or decreases?
A
decreases
13
Q
The Bruce Protocol has ___ to ___% error in estimating VO2
A
10-20
14
Q
Useful measure for creating proper intensity of exercise program
for endurance athletes/sports
A
Lactate threshold AKA anaerobic threshold
15
Q
Mean values for women are _____ % lower than men
A
10-20%
due to smaller lungs and reduced muscle mass
16
Q
The modified Full Bruce Protocol stress test is a maximal or submaximal exercise test?
A
sub-maximal / low level graded exercise test
17
Q
advantages of treadmill tests
A
- functional
- mm don’t fatigue as quickly → greater dx benefits
18
Q
Exercise-induced ST depression of > 2mm is the most valuable indicator of prognosis post…
A
MI
they are having ischemia
19
Q
true or false: everything involved with O2 transport is affected by exercise
A
true
CO, SV, HR, RR increase
20
Q
Anaerobic cellular respiration uses ________ as main energy source, which is stored in ________
A
- creatinine phosphate
- skeletal muscle
21
Q
which cellular respiration system is more efficient, aerobic or anaerobic?
A
aerobic
yields 36-38 ATP + water and CO2
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
23
Q
the minimal amount of oxygen used in order to support life
A
Basal Metabolic Rate
24
Q
a patient walks 365 meters in the 6-minute walk test, what is the VO2 Max?
A
≈ 15 (mod to severe compromise)
25
when is the modified Bruce Protocol test stopped?
at predetermined en point (% of patient max HR) unless symptoms occur first
26
**Product of maximal CO and arterio-venous O2
difference;** and is closely related to the functional capacity of the heart
**VO2 MAX**
27
true or false: lactate threshold can be **increased** with training
true
28
Bruce Nomogram
29
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)
30
**Aerobic** cellular respiration yields...
* **36-38 ATP**
* **H20 and CO2**
* (O2 required)
31
**“Field” Tests**
* Walk velocity tests (10 meter walk test)
* TUG
* 6 min walk test
32
most popular submax bike test to estimate VO2
YMCA Cycle Ergometer
33
a patient walks **546 meters** in the 6-minute walk test, what is the VO2 Max?
**≈ 20** (none to mild compromise)
34
the **6-minute walk test** can be used to prescribe exercises by estimating
**VO2 Max**
35
the volume of extra oxygen consumed after exercise
**oxygen** **debt**
36
The **Balke Protocol** was initially developed for clinical purposes for determining VO2 Max in
**cardiac patients**
37
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
38
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**
39
components affecting VO2 Max
* Genetics/Heredity
* Age
* Gender
* Altitude
40
# 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
41
Calculated by the difference of O2 inspired and O2 exhaled
**oxygen consumption**
42
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
43
variations in Resting Metabolic Rates and Basal Metabolic Rates are due to...
* Body size
* Gender
* Lean body mass
* Endocrine function
44
the 6 minutes walk test have norms for different populations:
* Elderly
* COPD
* CHF
45
what is the hallmark of aerobic fitness?
**the ability to continue to consume oxygen at high levels of exercise**
46
# 🚨
Reasons for immediately stopping a 6MWT include the following:
* Chest pain
* Intolerable dyspnea
* Leg cramps
* Staggering
* Diaphoresis (sweating profusely)
* Pale or ashen appearance
47
1 MET is close approximation of
**resting metabolic rate**
48
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
49
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)
50
LE protocols result in _______ VO peak than exercise tests for the UE
**higher**
51
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
52
Bruce Protocol not used if patient is:
* Decreased anginal threshold
* Elderly
* Deconditioned
* Immediately post-MI
53
If VO2 max below 16-18
most likely could not be independent in the community
54
Cardiac rehab components
* medical evaluation
* prescribed exercise program
* cardiac risk factor modification
* education and counseling
55
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
56
when do stop the test in the Bruce Protocol?
Patient's **max HR** or **symptoms**
57
**Bruce Protocol** and **modified Bruce Protocol** stress tests are
direct and indirect measurement of peak O2 consumption allowed via exercise testing
58
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
59
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
60
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
61
a person's aerobic potential
**VO2 max**
| (best indicator of aerobic fitness)
62
essential components of exercise prescription
1. **Mode:** type
2. **Intensity:** % of maximum capacity
3. **Duration:** 30 min
4. **Frequency:** 5 days mosts days
5. **Progression**
63
Basal metabolic rate measures work of resting basic body functions such as
* work of breathing
* heart, renal, and brain function
* Thermal regulation
64
**anaerobic glycolysis** is effective for ____ minutes, then lactic acid levels begin to decrease muscle function
**2**
65
Average VO2 Max values
* Men **20-25%** more than women
* Sedentary ≈ 35
* Elite athletes: \> 60
* Elite endurance athletes: ~70
66
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,
67
**Anaerobic** cellular respiration occurs in the:
**cytoplasm**
| (uses only carbohydrates)
68
**modes** of exercise testing
* **Steps**
* **Stationary Bike**
* **UBE** (Upper Body Ergo)
* **Treadmill**
69
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
70
muscles produce more lactic acid than they can metabolize
**Lactate threshold** AKA **Anaerobic threshold**
71
Still the most used test protocol for treadmill
**Bruce Protocol**
72
# definition
exercise intensity when lactic acid starts to accumulate in the blood stream:
**Lactate threshold** AKA **anaerobic threshold**
73
this type of **cellular respiration** is used for activity that lasts up to 30 seconds
**anaerobic**
after 30 sec glycolysis begins
74
**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.
75
**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
76
Bruce Protocol is the most widely used because
it gives **normative data** and allows for the calculation of **functional aerobic impairment**
77
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
78
# 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
79
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
80
The **Balke Protocol** is mainly used as a cardio endurance test by \_\_\_\_\_\_\_\_
**athletes**
but can be used by non-athletes as well
81
are there other tests developed by Balke?
field tests: **15-minute run test** and the **Balke Step Test**
82
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
83
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.
84
The Balke Protocol is a maximal or submaximal test?
**maximal**
85
Cardiac rehab **goals**:
* ↑ activity level
* ↑ QOL
* ↑ ADL performance level
* Return to work
* Function independently
* ↓ anxiety and/or depression
* ↓ recurrence of cardiac events
86
**Anaerobic** cellular respiration yields:
* **2 ATP**
* **Lactic acid**
* (No O2 needed)
87
true or false: the 6-minute walk test can be a predictor of morbidity and mortality
**true**
88
# 💡types of mode
**mode** of training
* Aerobic
* Flexibility
* Resistance/Strengthening
* Functional training
