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.
