Cardiopulmonary Exercise Testing Flashcards
What are 3 examples of indications for CPET?
- Determining causes of dyspnea, chest pain, and exercise intolerance
- Exercise prescription
- Evaluate level of functional impairment
Do you need to rely on predicted values for exercise prescription after you have performed a CPET?
NO
We have a large physiological reserve and therefore our ability to perform ADL’s only _________ when there is a major reduction in physiological capacity.
decreases
Resting measurements do not always reflect physiological capacity (T/F).
TRUE
_______ may reveal abnormalities at an earlier stage of the cardiopulmonary disease process.
CPET
CPET is not effective for objectively quantifying the effectiveness of different therapies (T/F).
FALSE
______ helps determine the mechanism of improvement.
CPET
CPET provides an index of how well the pt will respond to ____.
stress
Pre-operative peak VO2
50-60
Can CPET be used to assess the disability for workers compensation?
yes
What are 3 components of an effective CPET protocol?
- Large muscle mass exercise to sufficiently stress the cardiorespiratory system
- Should involve measurements of metabolic, cardiovascular, ventilatory and pulmonary gas exchange variance from rest to max/peak exercise
- Should involve fixed increments in work rate (magnitude and duration) up to peak exercise
______ specificity for athletes is critical if using CPET for exercise prescription and monitoring training adaptations.
sport
What two exercise modalities are recommended for CPET protocol?
- Cycle ergometer
2. Treadmill
Rest phase of CPET protocol?
> or equal to 3 minutes
Warm up phase of CPET protocol?
1-3 minutes at very low intensity for patients (athletes will require longer and more intense warm up)
Exercise phase of CPET protocol?
Fixed work rate increments (5-25 Watts) and duration (1-2 mins) and continue until patient could no longer continue
Cool down phase of CPET protocol?
3 minutes at low intensity
Test duration for CPET should be > or equal to __ minutes and < or equal to ___ minutes in duration.
6;20
____ work rate increments and ____ duration risk early fatigue and mainly test muscular strength and anaerobic processes.
large; short
_____ work increments and ____ duration risk boredom and suboptimal performance, and mainly test aerobic processes.
small; long
What are the 3 components of the Jones approach?
- choose standardized increments (10 W in disease, 25 W in health)
- 1-2 minute stages
- Goal is to have a total test duration of 10-20 min for most individuals
What is the formula for work rate increments?
(estimated peak VO2 - estimated VO2 of unleaded pedalling) / 100
What is the formula for estimated VO2 of unloaded pedalling (mL/min)?
150 + (6 x body mass in kg)
What is the formula for estimated peak CO2 (mL/min)?
(height in cm - age in years) x 20 for sedentary men and x14 for sedentary women
What are 3 effort sensations that can help you measure symptom intensity from rest to peak exercise?
- Breathing discomfort
- Muscle fatigue
- Chest or muscle pain
Symptom evaluation is often considered to be ________, however, the intraclass coefficient is > ___ during cycle exercise.
unreliable; 0.75
Dyspnea grade __: only breathless on strenuous exertion.
I
Dyspnea grade __: breathless when hurrying on the level or walking up a straight hill.
II
Dyspnea grade __: have to walk slower than most people on the level.
III
Dyspnea grade ___: stop for breath after walking about 100 yards on the level.
IV
Dyspnea grade __: too breathless to leave the house or breathless after undressing.
V
The reason for stopping ________ provides inside into physiological factors contributing to exercise intolerance.
exercise
What are 3 possible reasons for stopping exercise?
- Dyspnea
- Leg fatigue
- Combination
________ descriptors of dyspnea provides insight into the causes of dyspnea and exercise intolerance.
qualitative
What are 6 measurements taken during CPET?
- External work
- Metabolic gas exchange
- Cardiovascular
- Ventilatory
- Pulmonary gas exchange
- Symptoms
Peak ____ and work ____ ultimately reflect the integrated response of several physiological systems.
VO2; rate
Reductions in peak VO2 and work rate are indicators of reduced _______ _______.
exercise capacity
Values
80-85
What is the best evidence of VO2 max?
Clear plateau in VO2 with increasing work rate
What is usually used as an estimate of VO2 max in clinical populations?
VO2 peak
Reduced VO2 peak reflects problems with what 6 factors?
- O2 transport
- pulmonary limitations
- O2 extraction
- Neuromuscular limitations
- Musculoskeletal limitations
- Effort
Reduced ____ ______ is the starting point in the evaluation of reduced exercise intolerance.
VO2 peak
What is the equation for VO2?
Q x (arterial-mixed venous difference)
Q = ?
Heart rate x stroke volume
What is O2 carrying capacity of arterial blood determined by?
- Hb [ ]
- Partial pressure of O2 in arterial blood
- Affinity of Hb for O2 (O2 dissociation curve)
What does muscle O2 utilization/distraction depend on?
- Capillary density
- Mitochondrial density and function
- Tissue perfusion and diffusion
In health arterial-venous difference _______ as VO2 increases, reflecting O2 extraction.
widens
Increases in VO2 are due to an increase in what two things?
- Q
2. Arterial VO2 diff
In health, HR increases _______ with increasing VO2 and work rate.
linearly
What is the formula for heart rate reserve?
predicted HR max - HR max
What are two formulas for predicted HR max?
- 220-age
2. 210 - (age x 0.65)
HR max is _______ in many patients with cardiorespiratory disease due to the disease itself of because of medication use./
reduced
If a pt reaches his/her predicted HR max then this may suggest what two things?
- maximal or near maximal effort
2. that cardiovascular function may have contributed to exercise limitation
What is the normal HR response at max?
- HR max > 90% predicted
2. HRR < 15 bpm
SV ______ near end exercise.
plateaus
What 3 things determine SV?
- EDV or pre load
- myocardial contractility
- mean arterial blood pressure or after load
What is the formula for O2 pulse?
VO2 / HR
What can be used to estimate SV?
O2 pulse
And increase in O2 pulse during exercise is ________ and reflects an increase in both SV and arterial venous difference.
hyperbolic
A low, unchanging O2 pules may reflect _____ SV and/or ______ arterial venous difference due to abnormal O2 extraction/utilization.
decrease; decrease
Abnormalities in O2 are common (T/F).
FALSE
How does SBP change with exercise?
increases from 120mmHg - 180-200mmHg
If SBP does not increase then there is probably a CV limitation or abnormality of sympathetic control of BP (T/F).
TRUE
The _______ ________ represents the upper limit of exercise intensity that can be accomplished aerobically and the onset of metabolic acidosis during exercise.
anaerobic threshold
Anaerobic threshold is usually expressed as a % of predicted _____ ____.
VO2 max
Generally, the AT should be > ___% of predicted VO2 max.
40
Is AT reached in all populations?
No; often not in people with severe CR disease/exercise intolerance.
What is the formula for RER?
VCO2/VO2
______ can be used to estimate fuel utilization because CHO and fat differ in the VO2 and VCO2 during oxidation.
RER
RER > ____ is often used as an indicator that the pt gave a good or near maximal effort during the test.
1.10
_______ _______ is tightly coupled to metabolic demands
minute ventilation
Tidal volume plateaus at ~ ___-___% of vital capacity.
60-70
Further increase in Ve after the Vt plateau is driven by an increase in _________ _________.
breathing frequency
What are two formulates for ventilatory reserve?
- Ve max/MVV%
2. MVV - Vemax (L/min)
______ is the maximum amount of air that can be inhaled and exhaled within 60 s.
MVV
What are two ways to estimate MVV?
- FEV1 x 35
2. FEV1 x 40
A Ve max/MVV > ___-___% or MVV-Ve max < ___L/min = ventilatory limitation.
80-85; 11
Would a pt with COPD have a large or small ventilatory reserve?
small
_____ _______ = acute increase in end expiratory lung volume and is a compensatory strategy to overcome the flow limitation.
dynamic hyperinflation
Would dynamic hyperinflation lead to an increase of decrease in IRV?
decrease
Vd/Vt is an index of gas exchange efficiency of ______/______ mismatching.
ventilation/perfusion
As Vd/Vt increases, gas exchange efficiency ________ and vice versa.
decreases
Normal Vd/Vt at rest is ___-____.
0.3-0.4
Vd at rest (mL)?
150mL
Vt at rest (mL)?
500mL
Normal Vd/Vt at peak exercise?
< 0.28
Vd/Vt _____ during exercise before Vt increases more than Vd.
decreases
Vd/Vt is _______ at rest and during exercise in cardiac and pulmonary disease vs. health.
higher
Ve/VCO2 (ventilatory equivalent for CO2) is an index of _________ efficiency.
ventilatory
Ve/VCO2 is closely related to what other variable?
Vd/Vt
In health, Ve/VCO2 _____ early in exercise and then _______ near end exercise.
decreases; increases
In health, Ve/VCO2 is
32-34; 36-40
An increase in Ve/VCO2 at the AT or at peak exercise = incase in Vd/Vt = _____/_______ mismatch.
ventilation/perfusion
Perceptual responses to exercise are ______ in women vs. men for any given submit exercise intensity.
higher
Patient’s with COPD have a greater perception of effort at any given work rate compared to normal controls during exercise (T/F).
TRUE
Strong individuals with a respiratory disease can go to higher work rates than a weak normal individual (T/F).
TRUE
Normal criteria for VO2 and cycle work rate?
> 80-85% predicted
Normal criteria for AT or CT threshold?
> 40% predicted VO2 max
Normal criteria for HR ?
> 90% age predicted
Normal criteria for HRR?
< 15 bpm
Normal criteria for O2 pulse?
> 80% predicted
Normal criteria for ventilatory reserve?
> 11L/min or <80-85% of MVV
Normal criteria for breathing frequency?
< 60 breaths per min
Normal criteria for Ve/VCO2 ratio at AT and at max?
<32-34 and < 36-40
Normal criteria for Vd/Vt?
< 0.28
Normal criteria for SaO2?
> or equal to 95% or < or equal to 4% from baseline
