Exercise prescription and Testing (New one) Flashcards
Pre-Test Considerations
Major CAD risk factors and signs/symptoms should be used to stratify patient risk and to determine the level of medical supervision for the test.
The patient should be advised to refrain from food, alcohol, caffeine, or tobacco within 3 hours of testing
Patients should continue any prescribed medications unless otherwise instructed by MD
Pre-Test Considerations
Major CAD risk factors and signs/symptoms should be used to stratify patient risk and to determine the level of medical supervision for the test.
The patient should be advised to refrain from food, alcohol, caffeine, or tobacco within 3 hours of testing
Patients should continue any prescribed medications unless otherwise instructed by MD
Exercise Test Selection when to use submaxial when to use maximal??
The specific test should be selected based on the purpose of the test: Exercise prescription Eg submaximal test Maximal exercise capacity Maximal testing Symptom limited exercise test
Purpose (principles) of Exercise Test
To increase total body and myocardial oxygen demand in safe increments within a reasonable time period
This requires dynamic exercise that uses major muscle groups, permiting a large increase in the cardiac output, oxygen delivery and gas exchange
Exercise Test Selection when to use submaxial when to use maximal??
The specific test should be selected based on the purpose of the test: Exercise prescription Eg submaximal test Maximal exercise capacity Maximal testing Symptom limited exercise test
Purpose (principles) of Exercise Test
To increase total body and myocardial oxygen demand in safe increments within a reasonable time period
This requires dynamic exercise that uses major muscle groups, permiting a large increase in the cardiac output, oxygen delivery and gas exchange
Modes of Testing (Lab) think like how do we test patients for things like VO2 max testing what things do we use to test them
Common modalities used for testing include cycle ergometers, treadmills, arm ergometers, steps, and chemical agents.
Bicycle ergometers and treadmills are the most commonly used exercise testing modalities
Field tests what are these think like not treadmill how would you judge distance
Field tests are those that are administered by generally measuring time and distance. They do not utilize discreet workloads but rather estimate the oxygen consumption based on regression equations for a given population
Eg 6 minute walk test; shuttle walk test; Cooper 12 minute run/walk
Pharmacological Testing does meds every interfere with exercise
Various agents…they do not necessarily provide the same hemodynamic responses that one would expect with exercise, so they can be difficult to use for exercise prescription, but are often better at diagnosing disease
Example is Dipyridamole (Persantine) which creates a cardiac “steal” condition by lowering the blood pressure
Would a maximal test be appropriate for a ‘limiting patient’ what about a gradual increase test would that be appropriate for a patient who is an endurance athlete.
The selection of an exercise protocol is influenced by the purpose of the exercise test.
For example, a demanding protocol with large increases in metabolic equivalents will not be appropriate (or informative) for a severely limited patient; just as a very gradual protocol may not be accurate for an apparently healthy individual
Who is sub maximal exercise testing good for and what does it help a PT to determine???
Appropriate for pre-discharge evaluations, especially in patients who have suffered an acute myocardial infarction
Testing has been shown to be effective for risk stratification, activity recommendations, assessment of medical therapy, &/or to determine the need for further intervention
Submaximal predischarge testing seems to predict future events as well as a symptom-limited test within a month following an MI.
The endpoints for submaximal testing are traditionally arbitrary, but should always be based on sound judgement
What is the HR and MET requirement for someone under the age of 40 when doing Submax test?
What about over the age of 40?
When is Borg Scale Used Patients using what Medication??
How long should a PT wait after an MI for Maxial exercise testing.
A heart rate limit of 140bpm and 7 METs are often used in patients who are younger than 40
A heart rate limit of 130bpm and 5 METs are often used for patients over 40.
Borg scale is used in patients taking beta-blockers, “hard” is a conservative endpoint
Maximal testing is more appropriate when conducted at least a month after an MI occurs
Measurement Techniques and Sequences
What are some Objective and Subjective Measures we use to estimate level of exertion during exercise testing???
ECG Blood Pressure Oxygen Consumption/Gas Exchange Data Subjective Assessments Angina: Typical vs Atypical Dyspnea Rate of Percieved Exertion
ECG/ EKG
How many leads should be recorded at the end and how at least how many should be read during exercise testing?
Skin Preparation and precise electrode placement are key to obtaining accurate ECGs
Most commonly the 12 Lead Mason-Likar placement is used for exercise testing; however, this placement can result in changes in amplitude and axis
At least 3 leads should be monitored continuously and a 12 lead ECG should be recorded at the end of each stage
Blood pressure when should this be taken during an exercise test and in what to two postions
What is a met
How used at rest
How many used during vigrous activites
Blood pressure should be taken at rest and during exercise to ensure patient safety and to obtain important diagnostic and prognostic information
BP should be taken both supine and standing prior to the exercise test to assess for postural hypotension
BP should be taken during the last minute of each stage of the test protocol
MET or simply metabolic equivalent, is a physiological measure expressing the energy cost of physical activities and is defined as the ratio of metabolic rate (and therefore the rate of energy consumption) during a specific physical activity to a reference metabolic rate, set by convention to 3.5 ml O2·kg−1·min−1
House hold choirs 2-3.
Vigrous - 8.
Rest - is a at 1.
Gas Exchange Measures
What is VO2 Max
What is an good indicator of survivial
What about for an CHF patient?
VO2 max defines the upper limits of cardiorespiratory function (ie the ability to increase heart rate, SV, and oxygen extraction by active muscles)
Exercise capacity is one of the most significant prognostic indicators of survival
In CHF, peak VO2 is one of the best predictors of survival and is widely used to determine the timing of cardiac transplantation
What is the equation for VO2 Max walking???
Running ??
Leg ergometry???
Walking (1.9 to 3.7mph)
VO2 = (.1 x speed) + (1.8 x speed x grade) +3.5
Running (5mph or greater)
VO2 = (.2 x speed) + (.9 x speed x grade) + 3.5
Leg Ergometry
VO2 = {(10.8 x watts)/mass} + 7
Power = load x distance x frequency
1watt is approximately equal to 6 kgm/min
Typical Angina
Atypical Angina
Exercise induced angina indicates what better than any other exercise response
Angina
Typical angina is the pain that is consistent in presentation and location, is brought on by physical or emotional stress and is relieved with rest or NTG
Atypical Angina refers to long term pain in an unusual location with inconsistent precipitating factors
Exercise induced typical angina confirms the presence of CAD better than any other test response.
Angina Rating Scale give me steps 1-4
Anginal rating scale
1 Onset of discomfort, you notice the sensation
2 Moderate Discomfort, you feel the pain increasing
3 Moderately Severe, the discomfort would cause you to rest or take NTG
4 Severe Discomfort
Dyspnea can be a sign of CAD in diabetics however, what is it usally a sign of?
Dyspnea can be the predominant symptom is some patients with CAD (diabetics), but is more often associated with impaired left ventricular function and COPD
Borg Scale
When to stop an exercise test. Just think you have to respect the wishes of the patient.
ACSM termination criteria
Patient states they can no longer exercise due to fatigue, dyspnea, or other symptoms
Any patient requesting to stop the test
Post Exercise Recoridings
When to test a patient in the sitting position patients with what kind of issues
Active vs Passive Recovery
For diagnostic purposes, the supine position may be most valuable
Patients with symptom limiting angina/dyspnea may have greater discomfort in the supine position so a seated or semi-recumbent position may be best
A passive standing recovery should be avoided due to the potential complication of venous pooling
Post Test Considerations
How long should you monitor a patient after the test has ended???
For a non diagnostic test, active recovery at low workloads may be safer and more comfortable.
Regardless of the protocol, the recovery period should be monitored for at least 5 minutes.
The recovery period should be extended to resolve symptoms or abnormal hemodynamic/ECG responses
How do you determine the exercise prescription for a patient based on what findings think Vitals
individual is determined from an objective evaluation of that individual’s response to exercise, including observations of HR, BP, RPE, subjective response to exercise, ECG, The optimal exercise prescription for an and when possible direct measures of gas exchange during an exercise test.
What is the purpose of Exerciset prescription
Prevent what?
FMDIP?
Designed to enhance physical fitness, promote health by reducing risk factors for chronic disease (eg HTN, glucose intolerance), and ensure safety during exercise participation
The essential components of a systematic, individualized exercise prescription includes the appropriate mode, intensity, duration, frequency, and progression of physical activity.
What is a successful exercise prescription defined as???
The art of exercise prescription is the successful integration of exercise science with behavioral techniques that result in long term program compliance and attainment of the individual’s goals.
What to consider when dealing with exercise “intensity”
Factors to consider before determining intensity
Level of fitness
Medications
Risk of cardiovascular and orthopedic injuries is higher with higher intensity exercise programs
Individual objectives
Describe the “direct” method of calculating TRR
Is estimating max HR using the (220-age) good?
%HRmax Estimating HR max using 220-age is not good for clinical populations due to the high degree of error Direct Method: Plot HR against measured VO2 Allows you to prescribe below the point of adverse signs/sx Heart Rate Reserve TRR = %I (HRpeak – HRrest) + Hrrest HRR= (HRpeak – HRrest)
How to calculate VO2R and MET???
VO2R = % I (VO2peak – 3.5) + 3.5 MET = %I (METpeak –1) +1
How long should the “Duration” of an exercise be according to the ACSM??
Increase duration before Fatigue
The duration of exercise interacts with the intensity to result in sufficient energy expenditure (can be measured calorically)
The total volume of exercise recommended by ACSM is 20-60 minutes of continuous or intermittent aerobic activity throughout the day
Increases in exercise duration should be made as the individual adapts to training without evidence of undue fatigue or injury
Frequency
How many times a week in general
How many times a week for someone who can only do 3-5 mets without becoming fatigued.
What is a met.
Although very deconditioned individuals may improve with BIW exercise, optimal training frequency appears to be 3 to 5 workouts per week
Patients with very low functional capacities (less than 3 METs) may benefit from multiple daily exercise sessions; 1 to 2 short exercise sessions per day are most appropriate for those with 3-5MET functional capacities
What things need to be determined before progressing an exercise
The recommended rate of progression in an exercise conditioning program depends on the functional capacity, medical and health status, age, and current tolerance to level of training
How much weight should be lifted how about cardio to what percent should the patient exercise during the ‘inital stages” aka first month.
How long dose the “improvement” stage last???
Initial Conditioning Stage should include light muscular endurance exercises and moderate level of aerobic activities (I 40-60%), exercises that are compatible with minimal muscle soreness.
This stage may last up to 4 weeks but the length depends on the adaptation of the individual to the exercise program
May begin with 15-20minutes duration
Initial Conditioning Stage should include light muscular endurance exercises and moderate level of aerobic activities (I 40-60%), exercises that are compatible with minimal muscle soreness.
This stage may last up to 4 weeks but the length depends on the adaptation of the individual to the exercise program
May begin with 15-20minutes duration
Improvement Stage: goal of this stage is to provide gradual increase in exercise stimulus to allow for significant change in fitness
This stage progresses at a more rapid rate and the stage typically lasts for 4-5 months.
The frequency and magnitude of the increments are dictated by the rate of adaptation at each stage of conditioning
Deconditioned individuals should be permitted more time to adapt
The maintenance stage. When does this stage begin?? This stage should exceed what caloric. thereshold
Maintenance Stage: goal of this stage is long term maintenance of fitness developed during the improvement stage
Usually begins after 5-6 months of exercise training
During this stage the participant may be no longer interested in increasing the conditioning stimulus.
The exercise program should meet and preferably exceed the minimal caloric thresholds (1000kcal/wk
What test should be used if the person can’t perform the normal exercise testing procedures
Duke Activity Status Index
VO2peak = 0.43 x DASI score + 9.6
