exercise capacity

Question 1

What is exercise?

Answer 1

Purposeful, structured activity involving gross muscular activity to improve physical condition. Eg. Jogging, stretching

Question 2

What is physical activity?

Answer 2

Holistic term including all (purposeful & incidental) muscular activity of all intensities (walking, stairs)

Question 3

What are activities of daily living?

Answer 3

Basic independent self-care tasks done on daily basis requiring coordination, strength and ROM

Question 4

What happens to the body during exercise?

Answer 4

Adrenaline rises so HR increases, capillaries in muscles widen to increase blood flow, breathing rate gets faster and deeper to get O2 in and CO2 out.
Blood diverted from gut to muscles

Question 5

What is ventilation perfusion matching? What happens during mismatch?

Answer 5

For efficient gas exchange we need good ventilation & perfusion matching.
-Any inadequacy either in ventilation or perfusion impact removal of CO2 and oxygenation of blood and therefore in mismatch, exercise capacity is reduced

Question 6

What systems can exercise limitation be caused by?

Answer 6

Neurological (motor control, coordination), respiratory (ventilation, pulmonary perfusion, gas exchange), CV (heart pumping to body, ability to receive blood from lungs), muscular (local perfusion, muscle cell enzymes)

Question 7

How do CV & resp diseases limit exercise?

Answer 7

Often have breathlessness, especially during activities of daily living

Question 8

Why are exercise tests used for people with CV & resp diseases?

Answer 8

To monitor disease severity & progression, and response to treatment

Question 9

What can supplemental O2 help?

Answer 9

Can help exercise capacity but not always relieves breathlessness

Question 10

How is output of a CPET/CPEX represented? What is it useful for?

Answer 10

Represented at 9-panel chart showing relationship between key measured and derived variables. Helpful to see maximal or peak cardiopulmonary performance & anaerobic threshold.

Question 11

What is the cardiopulmonary test? What is its output?

Answer 11

• Uses cycle ergometer or treadmill with intensity incremental. Done under close clinical supervision in controlled environment. ECG, ventilation, O2 & CO2 measured.
• Outputs: lots of data with peak VO2 (VO2 max is max amount of O2 body can utilize during exercise - higher= better) as primary outcome & ECG change monitoring.

Question 12

What are advantages + disadvantages of cardiopulmonary test?

Answer 12

• Advantages: quantifies performance in relation to metabolism. Precise and reproducible. Safe - continuous monitoring.
• Disadvantages: needs skilled tech support, expensive, needs dedicated space

Question 13

When is exercise unsustainable?

Answer 13

When CO2 production is at greater rate than O2 consumption

Question 14

What is the six-minute walk test? What are the outputs?

Answer 14

• Uses 20-30m flat course with objective to cover greatest distance possible in 6 minutes (externally timed).
• Outputs: total distance walked in 6 minutes. + maybe perceived exertion scales, HR, pulse oximetry

Question 15

What are advantages + disadvantages of the 6-minute walk test?

Answer 15

• Advantages: patient driven pace, cheap, validated in clinical populations.
• Disadvantages: requires unobstructed course, pace not re-regulated

Question 16

What is the incremental shuttle walk test? What are outputs?

Answer 16

• Uses 10m circuit, externally paced by audio recording (like bleep test). Each minute has 1 extra length than previous one.
• Outcome: total distance walked before volitional end. + perceived exertion scales, HR, pulse oximetry.

Question 17

what are advantages and disadvantages of the incremental shuttle walk test?

Answer 17

• Advantages: cheap, validated, external pacing helps some achieve maximal levels.
• Disadvantages: unobstructed course needed, incremental nature can be hard, ceiling effect of 1020m, patient may be penalised for poor pace management.