Cardiopulmonary exercise testing Flashcards
NOT CV Compromised
12 minute run
- Beep test
- Arm Ergometer
- YMCA
- Step Test
CV Compromised
- 6 minute walk test (6MWT)
- Incremental shuttle walk test (ISWT)
- IUULEx
EXERCISE CAPACITY TESTS
Require less expensive equipment, less skill and faster to administer
Dependent on an individuals motivation – not a VO2max ‘test’, but
requires maximal effort
12 MINUTE RUN - procedure
- Explain the test requirements – objective is to cover as much distance in 12 mins as possible. Encourage patient to pace themselves.
- Dynamic warm up
- Record laps during the test 0 it is ok to walk, but running is preferable
- Monitor the patient for signs and symptoms that would stop the test
- Notify participant of elapsed time regularly – count down last minute
- At 12 minutes blow whistle – ask participant to stop and walk to nearest marker and then march on spot
- Record distance covered
- Allow 5 minutes walking around track/stretches
12 min run
Use distance covered to calculate estimated VO2max (ml/kg/min) using the following equation:
Note: Cannot predict VO2max if distance covered is less than 1.71km
Use distance covered to compare to normative values:
12 min run advantages
Able to test many people at once
• Limited equipment needed
• Can estimate VO2max
12 min run disadvantages
Requires maximal effort – motivation may influence results
• Unable to monitor BP and HR individually
• May be unsuitable in sedentary individuals (minimal distance to cover)
6 min walk
Test involves walking continuously around a 60m circuit with the aim to
cover as much distance as possible in 6 minutes.
If the patient stops during the test:
• Measure SpO2 and HR
• Ask patient why they stopped – eg breathlessness, tired, leg pain
• Give the following instruction “Begin walking as soon as you feel able” – repeat every 15 secs as needed.
Outcome measure: Distance walked. This can be expressed as absolute distance or percent predicted (%).
6 min walk advantages
Easier to administer, more reflective of ADL activities than other tests
• Can be used for patients with respiratory and cardiac condition (self-paced)
• Familiar activity – walking
• Minimal clinically significant difference – 54 m
• A distance walked of <350m is associated with increased mortality in patients with COPD, chronic heart failure and pulmonary arterial hypertension (Rasekaba et al.)
6 min walk dis.
Can be influenced by many factors – need to standardise testing protocol (tester instructions/encouragement, track set up, medications, other typical pre-test criteria)
• Learning effect – need to have at least 2 attempts.
• Does not calculate VO2max (other than in those awaiting lung transplant)
MULTISTAGE SHUTTLE RUN TEST (MSRT)
Valid estimate of VO2max in children and youth, although less accurate in older individuals
• Can predict VO2max but equations need to be specific for gender and age – so will not be used in this practical.
• Run between markers in time with recorded beeps from a CD (or App)
• Starts 8.5km/hour – increases by 0.5 km/hr each minute
MULTISTAGE SHUTTLE RUN TEST (MSRT) procedure
• Subjects must have one foot on or behind the starting lines before
the beep to complete a shuttle.
• If not, they are given one attempt to catch up with the pace.
• If the beep is missed on two consecutive shuttles, the test is stopped.
• Record the level/shuttle reached
MULTISTAGE SHUTTLE RUN TEST (MSRT) advantages
- Externally paced
- Minimal equipment needed
- Suitable for very fit individuals
- Suitable for large groups
MULTISTAGE SHUTTLE RUN TEST (MSRT) disadvantages
Need the recording
• Area
• Not suited for CV compromised individuals – test to exhaustion
• Requires self-motivated individuals
INCREMENTAL SHUTTLE WALK TEST (ISWT)
When you hear 3 beeps, instruct the patient to “increase your speed now”
• Stop criteria are similiar to beep test – 2 consecutive shuttles missed
INCREMENTAL SHUTTLE WALK TEST (ISWT) - advantages
- Externally paced
- Correlated with VO2max
- Can use in CV compromised patients, although this would be a level up from a 6MWT
INCREMENTAL SHUTTLE WALK TEST (ISWT) - disadvantages
- Need 2 tests to allow for learning effect
* Equipment needed - CD
Submaximal tests
- Treadmill
- Cycle ergometer
- Step test
- Arm tests
Exercise capacity tests
12 Minute Run Test
- 6 Minute Walk Test
- Incremental Shuttle Walk Test
- Beep Test
OUTCOME MEASURE
is the result of your exercise test.
• It is the value that you will compare between multiple tests to evaluate
whether change has occurred.
• It is the end-point value – i.e. after all equations have been used
It is NOT your pre- or post-test measures
Bruce protocol
Protocol can be used for maximal or submaximal testing
• For submaximal testing – testing is stopped when 85% age predicted
HRmax is reached.
• Incremental exercise test with increasing workloads at pre-determined
speeds/treadmill inclination
Workload (speed and inclination) is increased every 3 minutes until 85% HRmax is reached. Record the time taken to reach target HR.
Outcome measure = estimated VO2 max
treadmill benefits
Can be used with both maximal and submaximal tests
• Estimates VO2max
treadmill negs
Cost/equipment required
• Requires participant to have sufficient dynamic balance to walk/run at pre-
determined speed
• Can only test one individual at a time
• Difficult to take physiological measures if required during test e.g. BP
YMCA Cycle Ergometer Test
estimates VO2 max which is compared to normatives
YMCA benefits
Can be used with both maximal and submaximal tests
• Predicts VO2max
• Easier to take physiological measures if required
YMCA negs
Cost/equipment required
• Activity not necessarily matched to daily living
• Equipment requires regular calibration
• Can only test one individual at a time
QUEEN’S COLLEGE STEP TEST
bens and lims
Benefits: • Very cheap and portable • Limited equipment needed • Short duration of testing • Can test many people at once Limitations: • Difficult to monitor physiological measures during the step (movement and large number of people typically) • Requires moderate-high level dynamic balance
UPPER LIMB TESTS: ARM ERGOMETRY TEST
Participant should be in a seated position in front of the ergometer
• Ergometer/participant should be positioned so that the fulcrum of the ergo is at
the participant’s shoulder height
• Instruct patient cycle at 50-60 rpm, starting at 0 W for 3 mins (warm up)
• Increase worked rate every 3 minutes by 10 W
• Test is stopped when patient reaches 85% HRmax
UPPER LIMB TESTS: ARM ERGOMETRY TEST bens and negs
Able to be used with participants where lower limb tests cannot be used
• Cardiovascular assessment with upper limb effort
• Indication of performance during functional tasks (ADL’s)
Limitations:
• Difficult to monitor some physiological measures if required (movement and large number of people typically)
• UL CV tests typically result in lower estimations of VO2max
• This is due to higher HR, BP and O2 consumption with UL resisted exercise
Incremental Unsupported Upper Limb Exercise Test IUULET
Used to assess upper limb exercise tolerance in a manner that resembles functional tasks, using an unsupported activity.
• Test specifically designed for patients with respiratory disease (Takahashi et al 2003)
Additional precautions:
• shoulder pain, shoulder impingement and/or surgery as test involves
repetitive, weighted and incremental increases in bilateral shoulder flexion
Outcome measure: Time (min) taken to reach 85% HRmax
IUULET pros and cons
Benefits:
• Upper limb exercise tolerance
• Usually activities involving unsupported upper limbs cause dyspnea –
reproduces symptoms
• Highly repeatable, no practice test required
• More functional movement than arm ergometry
Limitations:
• Equipment required
• Lower VO2peak achieved compared to supported upper limb exercise testing
