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CI2 > Cardiopulmonary Exercise Testing & Questionnaires > Flashcards

Cardiopulmonary Exercise Testing & Questionnaires Flashcards

1
Q

What should a subjective assessment for cardiopulmonary rehab include?

A
  • 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
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2
Q

What are 3 important factors that can be assessed with questionnaires?

A
  • Depression
  • Anxiety
  • Heath related QOL
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3
Q

What are some of the questionnaires used to assess HRQOL in pulmonary rehab?

A
  • St George’s respiratory questionnaire
  • Chronic respiratory disease questionnaire
  • Medical outcomes study short form 36 (SF-36)
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4
Q

What does the St George’s respiratory questionnaire consider?

A
  • Cough, dyspnoea, 6MWT, FEV1
  • Divided into symptoms, activity, impacts
  • Lower score is better
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5
Q

What does the Chronic respiratory disease questionnaire consider?

A
  • Dyspnoea, fatigue, emotional function, mastery of disease

- Scored out of 7

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6
Q

What does the SF-36 questionnaire consider?

A
  • Physical functioning
  • Bodily pain
  • Mental health
  • Vitality
  • Role physical
  • Social functioning
  • Role emotional
  • General health
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7
Q

What are some of the questionnaires used to assess HRQOL in cardiac rehab?

A
  • MacNew

- Minnesota living with heart failure questionnaire

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8
Q

What does the MacNew questionnaire consider?

A
  • Reliable & valid for patients with ischaemic heart disease
  • Angina/chest pain, SOB, fatigue, dizziness, aching legs in last 2 weeks
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9
Q

What does the Minnesota questionnaire consider?

A

Patient’s perceptions regarding how CHF symptoms impact on their life during the preceding month

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10
Q

What are some of the other investigations required for cardiopulmonary assessment?

A
  • Respiratory function tests
  • ABGs
  • CXR
  • Angiograms
  • ECGs
  • Stress tests
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11
Q

What should an objective assessment for cardiopulmonary rehab include?

A
  • Observation
  • Palpation
  • Auscultation
  • Sputum clearance
  • Pulse oximetry
  • Heart rate
  • Spirometry
  • BMI
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12
Q

What are the 3 stages of COPD?

A

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

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13
Q

What are the benefits of field tests (submax)?

A
  • Ease of application
  • Provide useful info
  • Sensitive to change
  • Incremental or endurance
  • E.g. 6MWT, ISWT
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14
Q

What are the benefits of lab tests (max)?

A
  • Gold standard
  • Incremental or endurance
  • Measure ventilation, HR, VO2, CO2
  • E.g. treadmill, cycle
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15
Q

What are the reasons for assessing exercise capacity?

A
  • 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
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16
Q

What are the 8 absolute CIs to exercise?

A
  1. New/uncontrolled arrhythmia
  2. Resting/uncontrolled tachycardia
  3. Uncontrolled HT (resting SBP >180 or resting DBP > 100)
  4. Symptomatic hypotension
  5. Unstable angina
  6. Unstable/acute heart failure
  7. Unstable diabetes
  8. Febrile illness
17
Q

What are the criteria for ending an exercise test?

A
  • 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
18
Q

What are the submax, max & functional cardiopulmonary tests?

A
  • Submax: 6MWT, ISWT
  • Max: Stress test, CPET
  • Functional: TUG, strength tests, balance & flexibility
19
Q

What are some of the safety issues associated with the 6MWT?

A
  • Staff training including CPR
  • Resuscitation equipment
  • Emergency procedures
  • Supplemental O2
  • Use of walking aids
20
Q

What are the limitations to exercise in pulmonary & cardiac conditions?

A
  1. Ventilatory (normal)
  2. Cardiac (normal)
  3. Circulatory (normal)
    plus:
  4. Muscle
  5. Metabolic
  6. Nutritional
  7. Psychological
21
Q

What are the ventilatory limitations to exercise?

A
  • Mechanical (kyphoscoliosis, pulmonary fibrosis, post-polio)
  • Alveolar (V/Q mismatch, decreased drive to breath)
22
Q

What are the cardiac limitations to exercise?

A
  • Cardiac pump (heart failure)
  • Inadequate CO
  • Ischaemic heart disease (co-morbidity)
23
Q

What are the muscle, metabolic & nutritional limitations to exercise?

A
  • Muscle: Respiratory & peripheral
  • Metabolic: Hypoxaemia, lactate production
  • Nutrition: Energy consumption > supply
24
Q

What are the 4 components of the cycle of inactivity & breathlessness?

A
  • Increased breathlessness
  • Fear of exertion
  • Avoidance of activity
  • Decreased fitness
25
Q

What should be considered to determine if a limitation to exercise is cardiac or peripheral?

A

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?
26
Q

What are the exercise benefits in COPD?

A
  • 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
27
Q

What are the structural metabolic muscular adaptations associated with exercise?

A
  • Hypertrophy of type 1 muscle fibres
  • Increased capillaries
  • Increased myoglobin
  • Increased mitochondrial number/size
  • Increased oxidative enzymes
28
Q

What are the functional metabolic muscular adaptations associated with exercise?

A
  • Increased cardiorespiratory fitness

- Increased endurance capacity

29
Q

What is the effect of increased supply & extraction of oxygen associated with increasing fitness?

A

Delays the onset of anaerobic metabolism & reduces blood lactate levels

30
Q

Why might exercise training in PR not result in large changes in peak exercise capacity?

A

Can make changes at a muscular level, but can’t change their lung function (still have underlying pathology)

31
Q

What are the metabolic effects on cholesterol?

A
  • Increased lipoprotein lipase on capillary endothelium causing
  • Increased HDL cholesterol
  • Decreased VLDL & LDL cholesterol
32
Q

What are the structural cardiac adaptations associated with exercise?

A
  • Myocardial hypertrophy
  • Increased elastic recoil & cardiac contractility (decreased ESV)
  • Larger plasma volume (increased EDV)
33
Q

What are the functional cardiac adaptations associated with exercise?

A
  • Increased stroke volume
  • Increase CO & VO2 max
  • Decreased resting HR
34
Q

What are the structural haematological adaptations associated with exercise?

A
  • Increased plasma volume
  • Increased RBCs
  • Plasma volume increases more than haemoglobin
35
Q

What are the functional haematological adaptations associated with exercise?

A
  • Increased cardiorespiratory fitness (VO2 max)

- Decreased blood viscosity

36
Q

What are the structural vascular adaptations associated with exercise?

A
  • Increased capillaries

- Resting vasodilation

37
Q

What are the functional vascular adaptations associated with exercise?

A

Decreased total peripheral resistance = decreased resting BP

CI2 (17 decks)

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