CEP test Flashcards
What is VO2?
The volume of oxygen the body consumes.
What is VO2 max?
The highest volume of oxygen the body can consume.
The volume of blood the heart ejects with each beat is known as __________
Stroke volume
How does stroke volume increase with workload?
Similar to heart rate, it increases as workload increases, but only up to 40-60% of the Vo2 max.
What happens to resting heart rate as stroke volume increases?
It decreases as more blood being pumped per beat allows the heart to beat less often
A measure of blood pumped per minute is ___________. It is also the product of stroke volume and heart rate
cardiac output
What does the diastolic blood pressure do during exercise?
Remains stable or decreases slightly
____________ serves as a estimate of myocardial oxygen demand. It is the product of heart rate & systolic blood pressure.
Rate pressure product
What is the gold standard to measure cardiorespiratory fitness?
VO2 max during circuit spirometry
How does a submax exercise test work?
It estimates the VO2 max from the heart rate response to submaximal single stage or graded exercise
________ oxygen consumption is the raw volume of consumed oxygen by the body
absolute oxygen consumption
________ oxygen consumption is the volume of oxygen consumed relative to the body weight. *Useful to compare fitness levels between individuals.
Relative oxygen consumption
What are the 5 health related physical fitness components?
- cardiorespiratory endurance
- body composition
- muscular strength
- muscular endurance
- flexabilty
What are the 6 performance related physical fitness components?
- agility
- coordination
- Balance
- Power
- Reaction time
- speed
________ is the ability of the circulatory system & respiratory system to supply O2 during sustained physical activity
cardiorespiratory endurance
________ is relative amounts of muscle, fat, bone & other vital parts of the body
body composition
_________ is the ability of muscle to exert force
muscle strength
________ is the ability of muscle to continue to preform without fatigue
muscular endurance
________ is range of motion at a joint.
Flexibility
_______ is the ability to change position of the body in space with speed and accuracy
Agility
_______ is the Ability to use the senses together with body parts to preform tasks smoothly and accurately
coordination
________ is the maintenance of equilibrium while stationary or moving
balance
_________ is the time elapsed between stimulation & the beginning of the reactions to said stimulus
reaction time
Vigorous intensity RPE = __________
RPE > 14
What is used as a pre-participation screening tool by a professional for cardiac rehab & other medical fitness facilities?
Risk stratification assessment
What are the 4 lowest risk components during exercise test & recovery?
- no complex ventricular dysrhythmia
- No angina or other significant symptoms
- Normal hemodynamics
- Functional capacity > 7 mets
What are the 6 lowest risk components during rest? * Must have all of these to be considered low risk*
- no complex ventricular dysrhythmias
- Resting EF> 50%
- Uncomplicated MI or re-vascularization
- No congestive heart failure
- No signs or symptoms of post event/ procedure ischemia
- no clinical depression
What is ejection fraction to be classified as low risk?
> 50%
Who is at most risk for sudden cardiac death?
Sedentary individuals performing infrequent exercise
What BMI is considered a risk factor for CVD (Obesity)
BMI > 30 kg/m2
What is used as a pre-participation health screen in absence of professionals help?
The 2014 Par-Qt , physical activity readiness questionnaire for everyone
What are some signs and symptoms of CV, renal & metabolic disease
- pain/discomfort in neck, chest, jaw & arm
-SOB at rest with mild exertion
-dizziness or syncope
-orthopnea or paroxysmal nocturnal dyspnea
-ankle edema
-Palpitations or tachycardia
-intermittent claudication
-known heart murmur
-unusual fatigue or SOB with usual activities.
Metabolic disease consist of at least 3 of these things/symptoms
-increased weight circumference (m >40in, W >35in)
-increased triglycerides >150 mg/dl
-decreased HDL (m<49 mg/dl, W<50)
-increased BP (SBP >130 or BPB >85)
-increased tasting glucose >100 mg/dl
<3 mets is defined as __________ level of physical activity
light
3-6 mets is defined as _________ level of physical activity
moderate
> /= 6 mets is defined as _________ level of physical activity
vigorous
What is 1 met mean?
1 met= the relative oxygen consumption at rest, or 3.5ml per Kg/per min.
Why do we use mets?
It is an easy way for the general public to gauge their exercise intensity. Also it used to calculate energy expenditure overtime.
What is a kilocalorie? What is it also known as?
A calorie
Estimate of energy cost that can be directly related to physical activity & exercise.
Weight gain, loss & maintenance can be estimated by __________
3500 kcal = 1lb fat
Is the ACSM’s weekly recommended physical activity sufficient to prevent weight gain in the typical american lifestyle?
No, they have to go beyond the weekly recommendations.
What is the Par-Q limitation?
A minimal standard for entry into moderate-intensity exercise programs.
-allows individuals to gauge their own medical readiness to participate.
-Does not screen well for those at low to moderate risk
What is a pre participation screening questionnaire?
Useful for clients to assess their health readiness more comprehensive & recognizes signs and symptoms of CVD & other risk factor thresholds.
What are the ACSM coronary artery risk factors?
-age (men 45 & older, women 55 & older)
-family history
-smoker
-sedentary
-obesity
-hypertension
-pre-diabetes
-Dyslipidemia (elevated fat/cholesterol)
What is the negative risk factor for coronary heart disease?
HDL-cholesterol value great than or = to 60
** This is the reverse cholesterol transport & reduces the risk of CVD
__________ is the term for shortness of breath
Dyspnea
_________ is when a patient has trouble breathing while lying down
orthopnea
_________ is difficulty breathing while sleeping
paroxysmal nocturnal dyspnea
What classifies a patient as low risk?
<2 risk factors, asymptomatic
What classifies a patient as moderate risk?
2 or more risk factors & asymptomatic
What classifies a patient as high risk?
Symptomatic or known CVD, CPD, renal or metabolic disease
What is the exception to missing risk factor information?
pre-diabetes is counted as a positive risk factor only if the person is 45 or older OR the bi is 25 or more ( and they have additional risks for pre-diabetes)
What is contraindication?
Individuals characteristics that make physical activity more risky?
What is absolute contraindications to exercise?
absolute cannot participate in any physical activity program and/or assessment & should consult with their doc first.
What is relative contraindications to exercise?
- The benefit of exercise outweighs the risk of testing.
- heart issues, most disorders exacerbated by exercise, chronic infections disease, AV block, mental impairment.
Exercise testing is recommended for individuals and what risk?
High risk
What BP is considered prehypertension?
80-89 DBP
BP for stage 2 hypertension
160 + SBP
_______
100+ DBP
BP for stage 1 hypertension
140-159 SBP
__________
90-99 DBP
Normal BP range
<120/<80
Optimal LDL
<100
Optimal HDL
<40
Optimal triglyceride levels
<150
Optimal total cholesterol
<200
3 assessments for muscle endurance
- bench press
- curl up
- push up
When a motor unit is stimulated by a single nerve impulse it is known as a _________
twitch
Motor unit stimulated constantly is known as ________
tetanus
A motor unit that has more than 1 stimulus is known as a __________
summation
What is the “SAID” Principle? What is it dependent on?
The specificity principle
-specific exercise elicits specific adaptions, creating specific training effects.
-Dependent on the type & mode of exercise
7 ways to determine exercise intensity
- heart rate reserve method
- peak HR methods
- Peak VO2 method
- peak Mets method
- VO2 reserve method
- Talk test method
- RPE method
(HRR) heart rate reserve method karvonen formula
- The difference between max HR & resting HR.
HR max - Resting HR x % exercise intensity (in decimal form, divide by 100) + HR rest
Target HR formula
Target HR = max HR x % intensity desired (in decimal form, divide by 100)
Peak HR method formula
220-age = Max HR ——-> low estimate
210- (age x 5) = Max HR ——-> high estimate
Target VO2 formula
Target VO2= VO2 max x % intensity desired
Target mets formula
Target mets= (% intensity desired)
_______ is the difference between VO2 max and VO2 rest
VO2 reserve
Target VO2 reserve formula
Target VO2 reserve= (VO2 max- VO2 rest) x % intensity desired + VO2 Rest
The talk to test method Differentiates between moderate & vigorous activity. How can you tell?
If they can talk but not sing, it is moderate. If they are unable to say more than a few words without pausing for a breath it is vigorous.
On the Borgs RPE scale, what level is recommended to improve cardiorespiratory fitness?
11-16 To improve CRF
Borgs RPE scale ranges from levels ____ to ______
6 to 20. No exertion at all to maximal exertion.
What is the CR-10 scale of exertion? (Borgs category ratio scale)
-scale from 0-10
-0 is sitting & 10 is max effort
-5-6 moderate
7-8 vigorous
What symptoms identified during an exercise test should require the test to be stopped?
- Drop in SBP 10 or below
- Rise in BP above 250 & or 115
- Failure of HR to increase
- Failure to test equipment
What is rate pressure product?
serves as an estimate of myocardial oxygen demand product of HR & systolic BP.
Equation: HR X SBP
____________ is an inadequate blood supply to an organ or part of the body, especially the heart muscles.
Ischemia
AACVRP moderate risk components during exercise test and recovery are:
-Angina or other symptoms only when >7 mets.
-Mild-moderate silent ischemia
-Functional capacity <5 mets
If a patient has angina or significant symptoms, what qualifies them at moderate risk? What qualifies them at high risk?
Moderate- only occurring at high levels of exertion or during recovery (>7 mets)
High Risk- occurring at low levels of exertion or during recovery (<5 mets)
What are considered significant symptoms by the AACVRP?
-angina
-Unusual SOB
-Dizziness
-Light headedness
What amount of silent ischemia qualifies a clinical patient for moderate risk? What about high risk?
Moderate: mild-moderate silent ischemia (ST depressions <2mm)
High risk: High levels of silent ischemia (ST depression > 2mm)
What functional capacity qualifies a clinical patient for moderate risk?
< 5 mets
AACVPR moderate risk ejection function = ________
ejection function 40-49%
AACVPR high risk components during exercise test & recovery
-complex ventricular dysrhythmias
-Angina or other significant symptoms at <5 mets
-abnormal hemodynamics
(i.e. flat or drop in SBP with
-high levels of silent ischemia (ST depressions > 2mm)
Patient has a complex ventricular dysrhythmia during an exercise test, what is the risk category?
High risk
Patients SBP does not respond to increased meds, what risk category?
high risk
At what resting ejection function does a patient qualify as high risk?
<40%
When is age risk factor for CVD?
men > 45 yr
women > 55 yr
What weight CF is a risk factor for CVD (obesity) ?
Men > 40in (102 cm)
Women > 35in (88cm)
vigorous intensity mets =
> 6 mets
Vigorous intensity VO2 or HRR =
> 60% HRR or VO2 reserve
Moderate intensity RPE =
RPE 12-13
Moderate intensity mets=
3-5.9 mets
Moderate intensity HRR or VO2R=
40-59% HRR or VO2 reserve
Light intensity RPE=
RPE 9-11
Light intensity mets=
2-2.9 mets
Light intensity VO2R & HRR =
30-39% HRR
Ability to perform a movement with a short period of time is known as _____
speed
ACSM’s weekly/daily physical activity recommendations
150 minutes moderate physical activity per week (30 min or more most of the days the week), 75 minutes of vigorous intensity.
Can most sedentary individuals safely begin a low to moderate intensity PA program without the need for baseline testing or medical clearance?
yes
Most common musculoskeletal injuries occur in what area of the body?
lower body- particularly knee and foot
Active versus sedentary
Active- exercised for at least 30 min / day, 3 day/week, for the last 3 months
Patient is active, known CV, metabolic or renal disease has signs or symptoms is medical clearance recommended at what intensity?
Discontinue exercise and seek clearance before continuation
Patient is active, known CV, metabolic or renal disease, no signs or symptoms. Is a medical clearance recommended? At what intensity?
Medical clearance is not necessary for light to moderate, but necessary before vigorous
Patient is active, no known CV, metabolic or renal disease. No signs or symptoms. Is medical clearance recommended? At what intensity?
Medical clearance not necessary, light to vigorous intensity.
Patient is sedentary. Known CV, metabolic or renal disease, has signs and/or symptoms. Is medical clearance recommended & at what intensity ?
Medical clearance is recommended. Light to moderate, progress to tolerated
patient is sedentary. No known cv, metabolic or renal disease, no signs or symptoms, is medical clearance recommended at what intensity
Medical clearance is not necessary, light to moderate, progress to vigorous.
patient is sedentary. Known cv, metabolic or renal disease. No signs or symptoms. Is Medical clearance recommended? or what intensity?
Medical clearance is recommended, light-moderate, progress as tolerated
What is used as pre-participation health screening tool by a professional for the general (non-clinical) population?
The ACSM algorithm
any bodily movement produced by contracting skeletal muscles, with an increase in energy expenditure.
physical activity
small amounts of CP are stored within each cell. Simple one to one trade off that allows for the rapid production of ATP. Only for use during short bouts of exercise, less than secs. What system is this?
Creatine phosphate system
What are the 3 metabolic pathways the body uses to create ATP?
- creatine phosphate
- Anaerobic glycolysis
- Oxidative system
Pain in the leg induced by exercise, usually because of an artery obstruction is known as _________
Claudication
No oxygen required, next most immediate energy source is _______.
-Breakdown carbs into pyruvate.
-used during medium duration exercise.»_space; No more than 90 seconds
anaerobic glycolysis
Attributes or characteristics that individuals have achieved that related to their ability to perform physical activity
physical fitness
Pt case:
1.5 mm of ST depression
Functional capacity is 4 mets
No symptoms
What risk category according to AACVRP
moderate
Which of the following procedures provides the least sensitivity & specificity in the diagnosis of coronary artery disease?
A) coronary angiography
B) Echocardiography
C) Electrocardiography
D) Radionuclide imaging
C) electrocardiography
-Least sensitive & specific of all of these test.
-Directly visualization of the coronary arteries using coronary angiography provides the highest sensitivity & specificity.
Which of the following is the thickest, middle layer of the artery wall that is composed predominantly of smooth muscle cells & is responsible for vasoconstriction & vasodilation?
A) endothelium
B) intima
C) Media
D) Adventitia
C) Media
The media contains most of the sooth muscle cells, which maintain arterial tone.
The _______ comprises a single layer of cells that forms a tight barrier between blood and the arterial wall to resist thrombosis, promote vasodilation & inhibit smooth muscle cells
endothelium
The ________ is the very thin innermost layer of the artery wall & is composed mainly of connective tissue with some smooth muscle cells.
intima
The _______ is the outermost layer of the arterial wall & consists of connective tissue, fibroblasts & a few smooth muscle cells.
- Highly vascularized & provides the media & intima with oxygen & other nutrients.
Adventitia
Orthopnea is ____________.
Dyspnea at rest in a recumbent position that is relieved by sitting upright or standing.
_________ ____________ dyspnea refers to dyspnea that begins usually 2-5 hr. after the onset sleep, which may be relieved by sitting on the side of the bed or standing to get out of bed.
—-> symptom of left ventricular dysfunction.
Paroxysmal nocturnal dyspnea
What condition is characterized by an inflammation & edema of the trachea & bronchial tubes, hypertrophy of the mucous glands that narrows the airway, arterial hypoxemia that leads vasoconstriction of smooth muscle in the pulmonary arterioles & venules & in the presence of continued vasoconstriction results in pulmonary hypertension.
bronchitis
___________ ____________ is a mean pulmonary artery pressure at rest >25mm hg or >30mm hg with exercise.
pulmonary hypertension
Which of the following statements concerning the surgical treatment of coronary artery disease is true?
A) a coronary artery stent carries a lower rate a re-vascularization than does PTCA.
B) Atherectomy is a prerequisite requirement for PTCA.
C) Venous grafts are significantly superior to arterial grafts in terms of potency.
D) Long term outcome of laser angioplasty is unknown and thus rarely used.
A) A coronary artery stent carries a lower rate of re-vascularization that does PTCA.
Which of the following is not true for an individual who suffered a cerebral vascular accident & wishes to return to work?
A) patients should be educated on avoidance & precautions
B) Assessments of muscular strength & endurance are needed.
C) they should not be encouraged to return to work.
D) Exercise programs should be specific to occupational requirements
C) they should not be encouraged to return to work
Which of the following is a reversible pulmonary condition caused by some type of irritant & characterized by bronchial airway narrowing, dyspnea, coughing & possibly hypoxia & hypercapnia.
A) emphysema
B) Bronchitis
C) Asthma
D) pulmonary vascular disease
asthma
During a medical emergency, which of the following medications in an endogenous catecholamine that could be used to increase blood flow to the heart and brain?
A) lidocaine
B) oxygen
C) atropine
D) epinephrine
Epinephrine.
Epinephrine is an endogenous catecholamine that optimizes blood flow to the heart and brain by increasing aortic diastolic pressure and preferentially shunting blood to the internal carotid artery.
what category of meds reduces myocardial ischemia by lowering myocardial oxygen demand, is used to treat typical & variant angina, but has not been shown to reduce post myocardial infarction mortality?
Nitrates:
Nitrates relax peripheral venous vessels, which decrease preload, oxygen demand & alleviate ischemia.
___________ blockers reduce myocardial ischemia by lowering myocardial oxygen demand.
Beta Adrenergic (beat agonist)
___________ is a parasympathetic blocking agent used to treat brady arrthymias
atropine- cam be useful for treating symptomatic sinus bradycardia and may be beneficial for any type of AV Block at the nodal level.
___________ is an anti-rythmic agent that can decease automatically in ventricular myocardium as well as raise the fibrillation threshold
lidocaine- injection
Which of the following medication does not affect exercise HR response?
angiotensin- converting enzyme (ace) inhibitors and angiotensin 2 blockers
Ace inhibitors & angio-tension 2 receptors blockers do what to the heart rate?
Level heart rate
Calcium channel blockers do what to the heart rate?
Raise or level heart rate
Beta blockers do what to the heart rate?
Lower heart rate
Thyroid meds do what to the heart rate?
Raise the heart rate
Medications may directly alter the ECG response during exercise & result in false positive tests. Assuming no change in underlying disease status, the drug most likely to have this effect is_________
Digitalis (Lanoxin)
_________ can modify the ST-T contour & Slow AV conduction
Digitalis (lonoxin)
Compared with data obtained during a previous graded exercise test when no medications were taken, a new patient now taking propranol (inderal) would have what response to submaximal exercise intensity during a second test.
___________ is the process where fatty streaks develop causing the artery wall to thicken while reducing luminal diameter (plaque build up)
atherosclerosis
____________ defines complete obstruction of blood flow to the cardiac myocardial tissue. Heart attack & results in tissue death or narcosis.
Myocardial infarction
____________ is defined as rapid beating or fluttering of the heart
tachycardia
__________ is defined as pain and or cramping in the lower leg due to inadequate blood flow to the muscles
claudication
_________ is defined as shortage of oxygenated blood flow to the heart myocardium
ischemia
___________ is defined as fainting & dizziness during exercise that may indicate poor blood flow to the brain because of inadequate cardiac output from a number of cardiac disorders
syncope
__________ is defined as the ability of the circulatory and respiratory system to supply oxygen during sustained physical activity
cardiorespiratory endurace
What effect do anti-arrhythmic agents have on a person with an arrhythmia?
All anti-arrhythmic agents may cause new or worsened arrhythmias
What effect does bronchodilators have on a person?
HR:
BP:
ECG:
Ex capacity:
HR: the same at rest and exercise
BP: The same at rest & exercise
ECG: the same at rest & exercise
EX capacity: the same VO2 max for patients limited by bronchospasm
What effect does alpha blockers have on a person?
- same cardiac output
- increase or the same HR
- Decrease BP
-increase resting HR/exercise HR
-Decrease exercise ischemia
-increase exercise capacity for patients with angina and CHF; the same for patients without angina
____________ is defined as shortness of breath
dyspnea
_________ is ability of a muscle to continue to perform without fatigue
Muscular endurance
Before exercise testing, what vitals and info needs to be taken from the patient?
Resting HR, resting BP, height & size weight and body composition done first
_________ is the ability of muscle to exert force
muscular strength
________ is defined as relative amounts of muscle, fat, bone & other vital parts of the body
Body composition
What is the blood pressure response to exercise?
SBP: progressive increase, typical 10 +/- 2 mmHg/MET with a possible plateau at peak exercise.
DBP: no change or slight decrease
__________ is a technique used to express or validate how hard a client feels he/she is working during exercise
The rating of perceived exertion (RPE)
