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 is meant by “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 are the different ways you can evaluate exercise capacity in clinical populations?

Answer 4

• Cardiopulmonary exercise test
• Six-minute walk test
• Incremental shuttle walk test

Question 5

What is involved in the Cardiopulmonary exercise test?

Answer 5

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

Question 6

What are the outputs of the Cardiopulmonary exercise test?

Answer 6

• Peak VO2 usually the primary outcome
• ECG changes monitored throughout

Question 7

What are the advantages of the Cardiopulmonary exercise test?

Answer 7

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

Question 8

What are the disadvantages of Cardiopulmonary exercise test?

Answer 8

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

Question 9

What is involved in the Six-minute walk test?

Answer 9

• 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 10

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

Answer 10

• Primary outcome is total distance walked in six minutes
• Secondary variables may be ‘perceived exertion’ scales, heart rate and pulse oximetry

Question 11

What are the advantages of the six-minute walk test?

Answer 11

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

Question 12

What are the disadvantages of the six-minute walk test?

Answer 12

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

Question 13

What is involved in the Incremental shuttle walk test?

Answer 13

• 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 14

What are the outputs of the Incremental shuttle walk test?

Answer 14

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

Question 15

What are the advantages of the incremental shuttle walk test?

Answer 15

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

Question 16

What are the disadvantages of the incremental shuttle walk test?

Answer 16

• 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 1020m
• Patient can be penalised for poor pace management