Cardiopulm Unit 3 Exercise Training and Prescription

Question 1

What are the Indications for Exercise Stress Test?

Answer 1

Question 2

What is the purpose of Exercise Testing for PTs?

Answer 2

• Evaluate activity limitations
• Establish safety for physical activity/exercise participation
• Collect the necessary information to write an appropriate physical activity/exercise prescription that is less likely to be under- or over-dosed
• Collect baseline data for outcome assessment

Question 3

What is VO2?

Answer 3

A measure of oxygen consumption

HR x SV x (aO2 - vO2)

(HR x SV = Cardiac output)

This chart is basically saying during work output during exercise, as oxygen consumption goes up so does cardiac output (pretty much parallel)

aO2: oxygen in arteries (pre-capillary)
vO2: oxygen in veins (post-capillary)

Question 4

From rest to maximal exercise, how much does Cardiac output, HR, SV, a-VO2 and VO2increase? When a person is ~40% of maximum work, what happens to their SV?

Answer 4

• Cardiac output can increase ~4x
• HR can increase ~3x
• SV can increase ~1.5x
• By ~40% maximum work, rate of increase in SV tapers and remainder of increasing CO is due to HR
• a-VO2 difference can increase ~3x
• The body can account for increase ~12x between rest and maximal exercise

Question 5

What can having a “Normal” VO2 mean, and how is this important?

Answer 5

Having a “Normal” VO2 (around >85% predicted for your age, gender etc.) essentially rules out significant cardiovascular and pulmonary disease

The greater the amount of oxygen consumed at peak exercise, the more fit the individual

Question 6

Is HR more useful for Aerobic or Anaerobic exercise training?

Answer 6

Aerobic

Question 7

What is the normal HR response to incremental exercise?

Answer 7

There is an increase with progressive workloads at a rate of ~10bpm per 1 MET

MET: A unit that describes how much oxygen someone is consuming at rest

For ex: If a person is doing an exercise at 2 METS of intensity, this means that the exercise is having the person consume twice the amounnt of oxygen as they perform at rest

Question 8

What makes heart rate a reliable indicator for exercise intensity during an incremental exercise test?

Answer 8

Heart rate is a reliable indicator because it has a linear relationship with %VO2max, enabling accurate assessment and prescription of exercise intensity.

Question 9

Exercise intensity is directly associated to what?

Answer 9

Both the amount of improvement in exercise capacity and the risk of adverse events during exercise

Question 10

HR responses to exercise provide information to what?

Answer 10

The fitness of the individual where exaggerated responses suggest relatively less fitness

Exercise training promotes a decreased HR responseto submaximal workload

Question 11

What is the normal BP response to exercise?

Answer 11

• Systolic BP (SBP): Gradual rate of rise (~10mmHG/MET) until reaching steady state
• Diastolic BP (DBP): Increases or decreases withing 10mmHG

Question 12

What is a Hypertensive Response to exercise?

Answer 12

• A SBP ≥ 210 mmHG in men and ≥ 190 mmHG in women during exercise is often considered a hypertensive response
• A DBP ≥ of 110 mmHG is often considered a hypersensive response

Question 13

What is a Hypotensive Response to exercise? What is this often associated with?

Answer 13

• A decrease of SBP by > 10 mmHG with or without a preliminary increase is considered abnormal and often associated with myocardial ischemia, left ventricular dysfunction, and an increase risk of subsequent cardiac events

This is a serious concern

Question 14

What does the term “Regular Exercise” mean?

Answer 14

Performing planned structured physcial activity for at leat 30 minutes at a moderate intensity at least 3 days per week for the last 3 months

Anyone who does not meet that criteria is said to not be a regular exercise participant

Question 15

What is considered Light-Intensity Exercise?

Answer 15

30-39% HRR or VO2R, 2-2.9 METs, RPE 9-11. An intensity that causes slight increases in HR and breathing

(HRR: Heart Rate Reserve), (VO2R: Oxygen uptake reserve)

Question 16

What is considered Moderate-Intensity Exercise

Answer 16

40-59% HRR or VO2R, ≥ 3-5.9 METs, RPE 12-13. An intensity that causes noticible increases in HR and breathing

Question 17

What is considered Vigorous-Intensity Exercise?

Answer 17

≥60% HRR or VO2R, ≥ 6METs, RPE ≥14. An intensity that causes substantial increases in HR and breathing

Question 18

Pre-Exercise Screen

What is recommended for a person that does not participate in regular exercise and does not have CV, metabolic, or renal disease AND no S/S suggestive of CV, metabolic or renal disease?

Answer 18

• Medical Clearance is not necessary
• Light to moderate-intensity exercise recommended
• May gradually progress to vigorous-intensity exercise follwing ACSM guidelines

Medical clearance is approval from a healthcare progessional

Question 19

Pre-exercise Screen

What is recommended for a person that does not participate in regular exercise and has Known CV, Metabolic, or Renal disease and Asymptomatic?

Answer 19

• Medical Clearance Recommended
• Following medical clearance, light to moderate-intensity exercise recommended
• May gradually progress as tolerated following ACSM guidelines

Question 20

Pre-exercise Screening

What is recommended for a person that does not participate in regular exercsie and has any S/S suggestive of CV, metabolic or Renal disease (regardless of disease status)?

Answer 20

• Medical Clearance Recommended
• Following medical clearance, light-moderate intensity exercise recommended
• May gradually progress as tolerated following ACSM guidelines

Question 21

Pre-exercise Screen

What is recommended for a person that does participate in regular exercise and does not have CV, metabolic, or Renal disease and S/S suggestive of CV, metabolic or renal disease?

Answer 21

• Medical clearance is not necessary
• Continue moderate or vigorous-intensity exercise
• May gradually progress following ACSM guidelines

Question 22

Pre-exercise Screen

What is recommended for a person that does participate in regular exercise and has Known CV, Metabolic, or Renal disease and Asymptomatic?

Answer 22

• Medical clearance for moderate-intensity exercise NOT necessary
• Medical clearance (within the past 12 months if no change in S/S) recommended before engaging in vigorous-intensity exercise
• Continue with moderate-intensity exercise
• Following medical clearance, may gradually progress as tolerated following ACSM guidelines

Question 23

Pre-exercise Screen

What is recommended for a person that does participate in regular exercsie and has any S/S suggestive of CV, metabolic or Renal disease (regardless of disease status)?

Answer 23

• Discontinue exercise and seek medical clearance
• May return to exercise following medical clearance
• Gradually progress as tolerated following ACSM guidelines

Question 24

What is a Symptom (Sx) Limited/Max Exercise Test (ET)?

Answer 24

Exercise terminated at maximal exertion or clinical limitation

Question 25

What are the Common Indications of doing Sx-Limited/Max Exercise Test (ET)?

Answer 25

• Dx suspected myocardial Ischemia/CAD
• Risk stratification, prognosis, assessing medical therapy and cardiopulmonary reserve
• Assessing Cardiorespiratory Fitness (CRF), the ability of the circulatory and respiratory systems to supply oxygen to skeletal muscles during sustained physical activity. These may or may not utilize ventilatory gas analysis (Cardiopulmonary Exercise Test [CPET])