CVR Evaluating exercise capacity

Question 1

what is exercise?

Answer 1

Purposeful, structured activity that involves gross muscular activity to improve physical condition (e.g. jogging, stretching)

Question 2

what is physical activity?

Answer 2

A holistic term that includes all (purposeful and incidental) muscular activity of all intensities (e.g. walking, stairs)

Question 3

what are Activities of daily living?

Answer 3

Basic independent self-care tasks done on a daily basis that require coordination, strength and range of motion

Question 4

what does efficient gas exchange need to match?

Answer 4

maximum coupling between ventilation and perfusion

Question 5

3 tests for evaluating exercise capacity

Answer 5

1. cardiopulmonary exercise test
2. six minute walk test
3. incremental shuttle walk test

Question 6

what is involved in a cardiopulmonary exercise test?

Answer 6

• Uses a cycle ergometer or treadmill
• Intensity is incremental
• Undertaken under close clinical supervision in a controlled environment
• ECG, ventilation, O2 and CO2 routinely measured

Question 7

what are the outputs for a cardiopulmonary exercise test?

Answer 7

Peak VO2 usually the primary outcome

ECG changes monitored throughout

Question 8

advantages of cardiopulmonary exercise test (3)

Answer 8

Quantifies performance in relation to metabolism
Precise and reproducible
Continuous monitoring for safety

Question 9

disadvantages of cardiopulmonary exercise test (3)

Answer 9

Requires skilled technical support (calibration)
Very expensive (initial & ongoing costs)
Needs dedicated space

Question 10

what is involved in a six-minute walk test

Answer 10

• Uses a 20-30 m flat course (e.g. corridor)
• Objective is to cover greatest distance as possible in six minutes
• Externally timed by assessor
  Sub-maximal test

Question 11

What are the outputs for a six-min walk test?

Answer 11

• Primary outcome is total distance walked in six minutes

- Secondary variables may be ‘perceived exertion’ scales, heart rate and pulse oximetry

Question 12

advantages of six min walk test

Answer 12

Patient-driven pace – speeding up, slowing down & rest OK
Cheap to deploy
Validated in many clinical populations

Question 13

disadvantages of six min walk test

Answer 13

Requires a significant unobstructed course, it often undertaken in a public hospital corridor
The pace is not reregulated

Question 14

Incremental shuttle walk test involves what?

Answer 14

Uses a 10 m circuit
Externally paced by an audio recording (like bleep test)
Each minute has one extra length than the previous minute (e.g. minute 1 = 3 lengths of 20s; minute 2 = 4 lengths of 15s)

Question 15

Incremental shuttle walk test outputs?

Answer 15

Primary outcome is total distance walked before volitional end
Secondary variables may be ‘perceived exertion’ scales, heart rate and pulse oximetry

Question 16

advantages of the incremental shuttle test?

Answer 16

Cheap to deploy
Validated in many clinical populations
The external pacing helps some to achieve maximum levels

Question 17

disadvantages of the incremental shuttle test?

Answer 17

Requires an unobstructed course, it is often undertaken in a public hospital corridor
For some the incremental nature is difficult (min. speed 1.8km/hour)
Ceiling effect of 1020 m
Patient can be penalised for poor pace management

Question 18

what scale is used to measure dyspnoea?

Answer 18

MRC dyspnoea scale

Question 19

what is pulmonary rehabilitation?

Answer 19

a multidisciplinary programme of care for people with chronic respiratory impairment. It is individually tailored and designed to optimise each person’s physical and social performance and autonomy.

Question 20

what might a lower rate of O2 consumption indicate?

Answer 20

Impaired oxygen transport

circulatory impairment