Cardiopulmonary Exercise Testing & Questionnaires Flashcards
What should a subjective assessment for cardiopulmonary rehab include?
- History of respiratory/cardiac condition
- Other medical/surgical history
- Smoking history
- Medications (including O2)
- Home ventilation
- Dyspnoea status (MMRC scale, Modified Borg)
- Social history
- Exercise tolerance
- Patient’s goals
- Identification of risk factors
What are 3 important factors that can be assessed with questionnaires?
- Depression
- Anxiety
- Heath related QOL
What are some of the questionnaires used to assess HRQOL in pulmonary rehab?
- St George’s respiratory questionnaire
- Chronic respiratory disease questionnaire
- Medical outcomes study short form 36 (SF-36)
What does the St George’s respiratory questionnaire consider?
- Cough, dyspnoea, 6MWT, FEV1
- Divided into symptoms, activity, impacts
- Lower score is better
What does the Chronic respiratory disease questionnaire consider?
- Dyspnoea, fatigue, emotional function, mastery of disease
- Scored out of 7
What does the SF-36 questionnaire consider?
- Physical functioning
- Bodily pain
- Mental health
- Vitality
- Role physical
- Social functioning
- Role emotional
- General health
What are some of the questionnaires used to assess HRQOL in cardiac rehab?
- MacNew
- Minnesota living with heart failure questionnaire
What does the MacNew questionnaire consider?
- Reliable & valid for patients with ischaemic heart disease
- Angina/chest pain, SOB, fatigue, dizziness, aching legs in last 2 weeks
What does the Minnesota questionnaire consider?
Patient’s perceptions regarding how CHF symptoms impact on their life during the preceding month
What are some of the other investigations required for cardiopulmonary assessment?
- Respiratory function tests
- ABGs
- CXR
- Angiograms
- ECGs
- Stress tests
What should an objective assessment for cardiopulmonary rehab include?
- Observation
- Palpation
- Auscultation
- Sputum clearance
- Pulse oximetry
- Heart rate
- Spirometry
- BMI
What are the 3 stages of COPD?
I - Mild: FEV1/FVC < 0.7 & FEV1 60-80% predicted
II - Mod: FEV/FVC < 0.7 & FEV 40-59% predicted
III - Severe: FEV1/FVC < 0.7 & FEV1 < 40% predicted
What are the benefits of field tests (submax)?
- Ease of application
- Provide useful info
- Sensitive to change
- Incremental or endurance
- E.g. 6MWT, ISWT
What are the benefits of lab tests (max)?
- Gold standard
- Incremental or endurance
- Measure ventilation, HR, VO2, CO2
- E.g. treadmill, cycle
What are the reasons for assessing exercise capacity?
- Determining level of functional impairment & activity limitation
- Limiting factors of exercise capacity
- Guiding exercise prescription
- Identifying O2 saturation & need for supplemental O2
- Evaluating effectiveness of rehab
What are the 8 absolute CIs to exercise?
- New/uncontrolled arrhythmia
- Resting/uncontrolled tachycardia
- Uncontrolled HT (resting SBP >180 or resting DBP > 100)
- Symptomatic hypotension
- Unstable angina
- Unstable/acute heart failure
- Unstable diabetes
- Febrile illness
What are the criteria for ending an exercise test?
- Onset of angina or angina-like symptoms
- Signs of poor perfusion
- Patient request
- Severe fatigue
- Development of abnormal gait pattern
- Tachycardia
- SpO2 <85% (precaution)
- Failure of HR to increase with exercise
What are the submax, max & functional cardiopulmonary tests?
- Submax: 6MWT, ISWT
- Max: Stress test, CPET
- Functional: TUG, strength tests, balance & flexibility
What are some of the safety issues associated with the 6MWT?
- Staff training including CPR
- Resuscitation equipment
- Emergency procedures
- Supplemental O2
- Use of walking aids
What are the limitations to exercise in pulmonary & cardiac conditions?
- Ventilatory (normal)
- Cardiac (normal)
- Circulatory (normal)
plus: - Muscle
- Metabolic
- Nutritional
- Psychological
What are the ventilatory limitations to exercise?
- Mechanical (kyphoscoliosis, pulmonary fibrosis, post-polio)
- Alveolar (V/Q mismatch, decreased drive to breath)
What are the cardiac limitations to exercise?
- Cardiac pump (heart failure)
- Inadequate CO
- Ischaemic heart disease (co-morbidity)
What are the muscle, metabolic & nutritional limitations to exercise?
- Muscle: Respiratory & peripheral
- Metabolic: Hypoxaemia, lactate production
- Nutrition: Energy consumption > supply
What are the 4 components of the cycle of inactivity & breathlessness?
- Increased breathlessness
- Fear of exertion
- Avoidance of activity
- Decreased fitness
What should be considered to determine if a limitation to exercise is cardiac or peripheral?
Cardiac:
- Is HR < predicted max?
- Does the patient complain of angina?
- Is there evidence of ST segment depression on ECG
Peripheral:
- Does the patient complain of muscle fatigue?
- Is the RPE score > Borg score?
- Are there any other peripheral symptoms?
What are the exercise benefits in COPD?
- Improves O2 uptake by increasing aerobic capacity
- Decreases minute ventilation, hyperinflation & dyspnoea
- Reduces decline in FEV1 (slow disease progression)
- Improves cardiac function
- Decreases anxiety
- Improves independence & QOL
- Reduces social isolation
- Lowers BP
- Positive effect on co-morbidities
What are the structural metabolic muscular adaptations associated with exercise?
- Hypertrophy of type 1 muscle fibres
- Increased capillaries
- Increased myoglobin
- Increased mitochondrial number/size
- Increased oxidative enzymes
What are the functional metabolic muscular adaptations associated with exercise?
- Increased cardiorespiratory fitness
- Increased endurance capacity
What is the effect of increased supply & extraction of oxygen associated with increasing fitness?
Delays the onset of anaerobic metabolism & reduces blood lactate levels
Why might exercise training in PR not result in large changes in peak exercise capacity?
Can make changes at a muscular level, but can’t change their lung function (still have underlying pathology)
What are the metabolic effects on cholesterol?
- Increased lipoprotein lipase on capillary endothelium causing
- Increased HDL cholesterol
- Decreased VLDL & LDL cholesterol
What are the structural cardiac adaptations associated with exercise?
- Myocardial hypertrophy
- Increased elastic recoil & cardiac contractility (decreased ESV)
- Larger plasma volume (increased EDV)
What are the functional cardiac adaptations associated with exercise?
- Increased stroke volume
- Increase CO & VO2 max
- Decreased resting HR
What are the structural haematological adaptations associated with exercise?
- Increased plasma volume
- Increased RBCs
- Plasma volume increases more than haemoglobin
What are the functional haematological adaptations associated with exercise?
- Increased cardiorespiratory fitness (VO2 max)
- Decreased blood viscosity
What are the structural vascular adaptations associated with exercise?
- Increased capillaries
- Resting vasodilation
What are the functional vascular adaptations associated with exercise?
Decreased total peripheral resistance = decreased resting BP
