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Exercise Prescription > Cardiovascular Fitness > Flashcards

Cardiovascular Fitness Flashcards

0
Q

Cardiorespiratory fitness is a good measure of…

A

the heart’s ability to pump oxygen-rich blood to the muscles

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1
Q

Cardiorespiratory fitness AKA

A

cardiovascular or aerobic fitness

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2
Q

Cardiorespiratory fitness: the ability…

A
  • of the heart to serve as good functioning “pump”
  • of the lungs to “load” O2 and “blow off” CO2
  • of the blood to accept and carry/transport O2 and CO2
  • of the working tissue (muscles) to extract and utilize the O2 delivered
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3
Q

Aspects of the CR system

A

Heart, vessles, blood, lungs, muscles

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4
Q

CR fitness usually expressed in:

A

Absolute terms: (L/min)
Relative terms: (mL/Kg*min)
Standard Units: multiples of METs

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5
Q

Absolute measure of CR fitness

A

L/min

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6
Q

Relative measure of CR fitness

A

mL/kg*min

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7
Q

standard units of CR fitness

A

multiples of METs

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8
Q

CR fitness best measured…

A

in laboratory setting

using O2 uptake (VO2)

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9
Q

Resting measures

A

HR, EKG, BP, Ventilation, O2 consumption
some (less value in knowing these measures)
important because “if there’s a problem at rest, the person has a REAL problem”

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10
Q

measures during submaximal and maximal GXT

A

HR, EKG, BP, ventilation,O2 consumption
PROVIDES DYNAMIC MEASURE OF CR FITNESS
best measure of CR fitness

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11
Q

GXT

A

graded exercise test

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12
Q

What is the best measure of CR fitness?

A

Sabmaximal or Maximal GXT

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13
Q

Why Test CR fitness? (4 reasons)

A
  1. Determines physiological responses at rest and during submaximal or maximal work
  2. provides a basis for exercise programming
  3. screening for CHD and pulmonary disease
  4. determining a person’s ability to perform a specific work task
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14
Q

Factors to determine which test is appropriate to use

(4 factors)

A

Client’s age
Client’s fitness level
Client’s known health problems
Client’s risk of CHD

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15
Q

Testing Sequence of Testing and Activity prescription

A

Informed Consent –> Health History –> Screening –> Resting CRF, body comp, and psychological tests –> submaximal CRF tests –> test for low back function –> beginning of light activity program –> tests for muscular strength and endurance –> maximal CRF tests –> activity program revision (include games and sports here) –> periodic retest (and activity revision)

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16
Q
  1. Informed Consent
A

participants should be informed volunteers

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17
Q
  1. Health history
A

helps determine appropriate testing protocols and activity recommendations

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18
Q
  1. Screening
A

helps determine risk-benefit ratio and contraindications to testing and training

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19
Q
  1. Resting CRF, body comp and psychological tests
A

helps determine if abnormalities requiring further medical attention exist

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20
Q
  1. submaximal CRF tests
A

helps determine if it is OK to begin light activity

used to estimate maximal functional capacity

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21
Q
  1. test for low back function
A

flexibility (particularly low back function) is tested

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22
Q
  1. maximal CRF test
A

if no problems occur up to this point

max GXT provides info to select fitness activities

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23
Q
  1. activity program revision
A

include games and sports here
“variety is the spice of life”
keeps client interested and reduces repetition injuries

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24
Q
  1. periodic retest
A

after client achieves a minimum, fitness level program needs to be revised
increase challenge to improve results/performance

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25
Q

Maximal VO2 obtained?

A

O2 consumption plateaus with increasing workload
<= 150 mL/min increase with increasing workload

not relative to body weight
most people do not achieve this criteria

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26
Q

Peak VO2 Criteria

A

Predicted maximal HR achieved/exceeded (failure of HR to increase in exercise intensity)
Venous lactate [ ] exceeds 8 mM/L
RER greated than 1.15
RPE greater than 17 on Borg 20 pt scale

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27
Q

If max or peak VO2 not obtained?

A

measure of functional aerobic capacity

For CHD screening and classification, bring client to 85% of age-predicted max HR

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28
Q

RER equation

A

volume CO2 produced / volume O2 consumed

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29
Q

RER (fat vs carb burning)

A

mostly fat burned, RER ~ 0.7
mostly carbs burned, RER ~ 1.0

RER 1.15 is VERY ANAEROBIC

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30
Q

VO2 max reflects…

A

capacity of heart and lungs to transport O2 to working muscles
utilization of O2 by the muscles during exercise

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31
Q

VO2 max used to…

A

classify the cardiorespiratory fitness level of client
evaluate progress of client
set realistic goals for client (when periodic retest is performed)

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32
Q

VO2 expressed in absolute terms

used to…

A

L/min or mL/min
provides a measure of energy cost FOR NON WEIGHT BEARING ACTIVITIES
(ex. leg or arm ergometry)
directly related to body size
issue: cannot compare people who are different weights

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33
Q

Relative expression of VO2

A

ml/kg/min or ml/kg FFm/min or ml/kg MFL/min
used to estimate the energy cost of WEIGHT BEARING ACTIVITIES (ex. walking, running, aerobic dance, stair climbing, bench stepping)
used to compare people of different sizes
used to estimate CR endurance that is independent of body weight changes

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34
Q

Scaling Vo2 to an exponential function

A

because the relationship between VO2max and body mass is strong (r=0.86) but not perfect, some investigators use scaling to avoid under or over classification of a client’s fitness level
oftentimes used for children to control for maturation differences

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35
Q

body mass exponents used for scaling VO2 to an exponential function

A

Body mass exponent of 0.67 for individuals of similar height, weight, and training status (mL/kg^0.67/min)

body mass exponent of 0.75 to compare heterogeneous groups (young vs old, trained vs sedentary) (mL/kg^0.75/min)

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36
Q

Gross VO2

A

represents the total rate of oxygen consumed
reflects the caloric cost of BOTH rest and exercise
Gross VO2 = Resting VO2 + Exercise VO2
can be expressed in absolute or relative terms

37
Q

Net VO2

A

can be expressed in absolute or relative terms
represents the rate of O2 consumption in excess of resting VO2
USED TO DESCRIBE THE CALORIC COST OF EXERCISE
Net Vo2 = Gross Vo2 - Resting VO2

38
Q

What describes the caloric cost of exercise?

A

net Vo2

39
Q

ACSM recommends a MAXIMAL GXT before beginning VIGOROUS (>60% VO2max) exercise program for: (4 populations)

WILL NEED TRAINED MEDICAL PROFESSIONAL PRESENT FOR MAX GXT

A

Older men (>=45) and older women (>=55)
Individuals of any age with moderate risk (2 or more CHD risk factors)
high risk individuals with one or more signs/symptoms of cardiovascular and pulmonary disease
high-risk individuals with known cardiovascular, pulmonary, or metabolic disease

40
Q

ACSM recommends a SUBMAXIMAL GXT before beginning a MODERATE (40-60% VO2max) exercise program

A

low risk and moderate risk individuals

41
Q

Factors for selection of maximal or submaximal GXT

A

your client’s age and risk stratification (low, moderate, or high risk)
your reasons for administering the test (fitness testing vs clinical testing)
availability of equipment and qualified personnel

42
Q

Maximal or Submaximal VO2 testing - requirements

A

multi-stage, graded test (increase in intensity)

most require 3 minute stages

43
Q

why 3 minute stages are important for GXT

A

stage length is esp important for measuring lactate levels in the blood. Lactate must travel from legs, where most of the work is being performed, to the arms where blood is being drawn)

44
Q

Procedure for administering a GXT

A
  1. Measure the client’s resting BP and HR IN EXERCISE POSTURE
  2. begin GXT with 2-3 min warmup
  3. monitor client’s HR, BP, and RPE at regular intervals
  4. discontinue GXT if test termination requirements are met
  5. Active, low work rate recovery or passive cooldown
    MONITOR CLIENT’S APPEARANCE AND SYMPTOMS AT ALL TIMES
45
Q

When measuring client’s resting BP and HR in the exercise posture, measures may…

A

increase. “thoroughbred response”

let client know that this is perfectly normal

46
Q

Warm up for GXT allows for…

A

familiarize client with the equipment

prepare client for 1st stage of GXT

47
Q

Test termination requirements for GXT

A

client requests to stop (remember they are always considered a volunteer)
indications for stopping test are present

48
Q

Recovery post GXT

A

active low rate (not exceeding 1st stage intensity) recovery
continue measuring HR, BP, and RP every 1-2 mins for a minimum of 5 minutes

if client has had signs of discomfort or emergency, use a passive cool down, still measuring vital signs for at least 5 minutes

49
Q

General Indications for stopping a GXT

A
  1. Onset of Angina or angina-like symptoms
  2. Drop >= 10mmHg in SBP from baseline BP despite increase in intensity
  3. Excessive rise in BP, SBP >= 250 or DBP>115
  4. shortness of breath, wheezing, leg cramps, or claudication
  5. signs of poor perfusion (ataxia, dizziness, pallor, syanosis, cold or clammy skin, nausea)
  6. failure of HR to rise with increased exercise intensity
  7. noticeable change in heart rhythm
  8. subject desires to stop
  9. physical or verbal manifestations of severe fatigue
  10. failure of testing equipment (ex. ECG lead falls off)
50
Q

What is considered to be an excessive rise in BP/hypertensive response?

A

SBP >= 250mmHg

DBP > 115mmHg

51
Q

Absolute indications for stopping GXT

A
  1. moderate to sever angina
  2. drop >= 10mmHg in systolic BP from baseline BP despite an increase in workload, when accompanied by other evidence of ischemia
  3. increasing nervous system symptoms (ataxia, dizziness, or near syncope, etc)
  4. signs of poor perfusion
  5. ST elevation in leads without diagnostic Q waves (other than V1 or AVR)
  6. sustained ventricular tachycardia
  7. subject desires to stop
  8. failure of testing equipment
52
Q

Relative indications for Stopping GXT

A
  1. drop >= 10mmHg in SBP from baseline BP despite an increase in workload, in the absence of other evidence of ischemia, or failure of SBP to increase with increasing workload
  2. hypertensive response (SBP >250 DBP >115)
  3. increasing chest pain
  4. fatigue, shortness of breath, wheezing, leg cramps, or claudication
  5. arrythmias other than sustained ventricular tachycardia, including multifocal preventricular contractions (PVCs), supraventricular conduction delay that cannot be distinguished from ventricular tachycardia
  6. development of BBB or intraventricular conduction delay that cannot be distinguished from ventricular tachycardia
  7. ST or QRS changes such as excessive ST segment depression or marked axis shift
53
Q

PVC

A

multifocal preventricular contractions

54
Q

arrythmias other than sustained ventricular tachycardia

A

PVCs (multifocal preventricular contractions), supraventricular conduction delay that cannot be distinguished from ventricular tachycardia

55
Q

What is so important to do when conducting a GXT?

A

MONITOR CLIENT’S APPEARANCE AND SYMPTOMS AT ALL TIMES

56
Q

General principles of exercise testing

A
  • Calibrate equipment
  • 2-3 min warmup
  • initial intensity considerably lower than anticipated maximal capacity
  • intensity gradually increased
  • closely observe for contraindications for testing and indications of stopping
  • monitor HR at least 2 times per stage, no stabilization then extend stage by 1 minute
  • measure BP and and RPE once per stage (latter portion of stage)
  • submaximal GXT termination: 70% HRR or 85% HR max (unless protocol indicates otherwise
  • cool-down minimum of at least 5 minutes (monitor HR and BP each min)
  • testing area should be quiet and PRIVATE
  • thermoneutral room
57
Q

warm up duration for GXT

A

2-3 minutes

58
Q

intensity increased by …. each stage during GXT

A

0.5 METs - 2 METs at a time

59
Q

intensity increases for GXT for older individuals

A

should be smaller

0.5 - 1 METs

60
Q

how many times should you monitor HR during each stage of GXT?

A

2

if there is no stabilization (+- 5 or 6 bpm), extend stage by 1 minute

61
Q

when should you measure BP and RPE during GXT

A

once per stage, during latter portion of stage

62
Q

submaximal GXT termination

A

70% HRR
85% HR max
(unless protocol specifies otherwise)

63
Q

cool down for GXT should be… and HR and BP monitored every

A

minimum of 5 minutes

HR and BP monitored each minute

64
Q

active recovery vs passive recovery

A

active recovery: workload should be no more than that used for 1st stage GXT

passive recovery: used in emergency when client cannot actively cool-down

65
Q

exercise tolerance should be estimated in… or assess …. if measured directly during GXT

A

estimated in METs

assessed in O2 uptake if measured directly

66
Q

thermoneutral

A

room temp 70-72 deg F

humidity < 60%

67
Q

considerations for protocol selection

A

age, sex, health and fitness status of the client
ergometry type or field test
reason for testing
type of training you areprescribing, monitoring and evaluating

68
Q

types of ergometry used in GXT protocols

A

treadmill, bike, arm crank

69
Q

examples of field tests used in GXT protocols

A

step test, mile walk/run

70
Q

types of protocols (3)

A

continuous protocol
continuous ramping protocol
discontinuous protocol

71
Q

continuous protocol

A 
no rest between work increments
2-3 min stages
2-3 MET increases 
workload may be increased linearly or nonlinearly 
8-12 min duration
72
Q

which is the “classic” protocol

A

continuous protocol

73
Q

continuous ramping protocol

A

10-20 sec stages
MET increments much higher
10 minutes in duration

74
Q

discontinuous protocol

A

client rests 5-10 minutes between workloads
5-6 min stages
typically takes 5x longer to administer than continuous protocol

75
Q

reasons for GXT testing

A

clinical evaluation or fitness evaluation

76
Q

bike protocols

A

typically VO2max 6-11% lower than treadmill protocol
people quit sooner due to local discomfort and fatigue
exception is trained cyclists

77
Q

bike protocols typically …. lower than treadmill protocols

A

~10% lower VO2max

78
Q

treadmill protocols issues to consider

A

balance
orthopedic issues
BP more difficult to measure
calf and lower back pain

79
Q

Testing with bicycle ergometers

A

calibrate the bicycle
release tension on belt between tests
establish pedal frequency prior to setting workload
check load setting frequently during test (belt warming)
set metronome
adjust seat height so knee slightly flexed at max extension
ensure proper client position

80
Q

setting metronome for bicycle ergometry GXT

A

1 revolution = 2 beats

metronome 120 = 60 rpm

81
Q

adjust seat height so knee is slightly flexed at max extension, approx …deg
(bicycle ergometry)

A

5deg

82
Q

proper client position for bicycle GXT

A

upright
seated
hands properly positioned on handlebars

83
Q

modifications for standard GXT

for older adults

A

extend warm-up to more than 3 minutes
set initial intensity to 2-3 METs
work increments should be 0.5-1 METs
adjust (Reduce) the treadmill speed to the walking ability of client when needed
extend duration of each stage (at least 3 min) allowing steady state achievement
select treadmill protocols that increase speed, instead of grade
select protocol likely to produce total test time of 8-12mins
bike protocols with clients with poor balance, poor neuromuscular coordination or impaired vision

84
Q

protocol best for older adults

A

bicycle ergometry

85
Q

protocol time range for older adults GXT

A

8-12 minutes

86
Q

for older adults, GXT protocol should increase… instead of ….

A

increase speed, not grade

87
Q

older adults GXT should extend warm up, stages

A

warm up - more than 3 minutes

stage length - at least 3 minutes so steady state is reached

88
Q

GXT for children

A

bike not typically recomended

89
Q

why bike protocol not recommended for children

A 
volitional effort to maintain cycling cadence
cycle size (seat height, handlebar height and position)
90
Q

height requirement for most cycle ergometers

A

125 cm (50 inches)

Exercise Prescription (5 decks)

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