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Cardio Pulmonary > Exercise Principles/Testing > Flashcards

Exercise Principles/Testing Flashcards

1
Q

define physical activity

A

a broad term used to describe all forms of large muscle movements including sports, dance, games, work, lifestyle activities and exercise for fitness

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2
Q

define exercise

A

any activity designed to develop or hone a skill or ability. Physical activity intended to improve, fitness and specific athletic skills

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3
Q

benefits of aerobic exercise (aka reconditioning)

A
  1. enhanced pulmonary performance
  2. enhanced cardiac performance
  3. enhanced blood flow
  4. enhanced ability of tissue to extract and to utilize the delivered O2
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4
Q

what is an indirect assessment of aerobic capacity?

A

VO2 max

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5
Q

what is VO2 max?

A
  • maximal oxygen consumption → refers to the max amount of O2 that an individual can utilize during intense or maximal exercise
  • this measurement is generally considered the best indicator of cardiovascular fitness and aerobic endurance
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6
Q

T/F: Vo2 max is the gold standard for determining cardiorespiratory fitness

A

TRUE

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7
Q

list factors that influence VO2max

A
  1. gender
  2. family history
  3. age
  4. body composition
  5. training status
  6. altitude
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8
Q

T/F: after the age of 50 peak VO2 max declines by 10% per decade?

A

TRUE

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9
Q

1 MET is equivalent to what?

A

3.5 ml/kg/min

ADL range is between 10.5-17.5 ml/kg/min

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10
Q

list alternative methods for assessing submaximal exercise capacity

A
  1. 6-min walk test
  2. fixed workload tests
  3. submax treadmill test
    1. preset HR
    2. symptom limited
  4. step test
  5. cycling test
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11
Q

Other methods for determining/assessing aerobic fitness

A
  1. paper and pencil → Duke Activity Scale
  2. Weekly Activity levels
    1. Grodin Leisure Time Questionnaire
    2. Comparison against recommended amounts of weekly activity
  3. Wearables
    1. FitBit and step couting
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12
Q

what can we do with an estimate of VO2 peak?

A
  1. describe the max aerobic capacity/max fitness status of an individual
  2. use it to write exercise prescription
  3. use it to demo improvements in exercise capacity associated with reconditioning (PT)
  4. develop treatment goals
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13
Q

List physical benefits of CV exercise

A
  1. can reduce body fat
  2. increase aerobic capacity
  3. increases lung volume
  4. reduces the demands on the heart
  5. lowers BP
  6. reduces risk factors for numerous diseases
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14
Q

Mental benefits of CV exercise

A
  1. reduces anxiety
  2. improves mild to moderate depression, self-esteem, and mood
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15
Q

list determinants of strength/anaerobic fitness

A
  1. number of motor units recruited
  2. frequency of motor unit firing
  3. quality of motor unit synchronization
  4. muscle fiber type
  5. cross sectional area and strength
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16
Q

list assessments of anaerobic fitness

A
  1. MMT
  2. 1-rep max
  3. 8-10 max test
  4. hand-held dynamometer
  5. isokinetic testing
  6. power testing
    1. wingate test
    2. stair test
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17
Q

List some benefits of improved anaerobic capacity

A
  1. increased strength
  2. greater balance/reduced fall risk
  3. muscle strength but not mass independently associated with physical function in older adults
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18
Q

describe muscle decline associated with aging

A
  1. sarcopenia
    1. muscle decline associated with aging
    2. reduced muscle mass (usually Type II fibers)
    3. can be helped w/strength training
  2. reduction in capillary blood supply → can be helped w/endurance training
  3. fewer satellite cells
    1. increased myostatin production
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19
Q

incidence of frailty with aging

A

10% in those over 65

50% in those over 85

20
Q

describe the frailty-phenotypes

A
  1. recent weight loss → 10 lbs in previous yr, BMI <18.5
  2. self reported exhaustion → felt unusually tired or weak in the previous month
  3. weakness → <20% of age predicted grip strength
21
Q

strength considerations: frailty

A
  1. slow walking speed
    1. >5 sec to walk 4m or 4.57 >15 ft
  2. decreased physical activity
    1. >270 kcal per week of activity
  3. prefrail = 1-2 criteria
  4. frail = 3 or more criteria
22
Q

how can you assess for fraility?

A

Carolina Frailty-Index

includes ADL and physical function questions

predictive of all-cause mortality in older adults w/cancer

23
Q

how do you define power

A

amount of work produced per unit time

power = Force x Velocity

reflects a combo of strength and endurance

24
Q

what is the relationship between power and functional capacity?

A

Bassey and colleagues demonstrated that among frail nursing home residents, leg muscle power is more important than strength for performing daily activities such as stair climbing, rising from a chair, and walking

25
Q

List some tests for power

A
  1. Peak cycling test
  2. stair climbing test
  3. 30 sec repeated STS
  4. strong man competition
  5. gait speed (BW x distance/time)
  6. TUG, TUDs, 5x/30sec STS, inclined board
26
Q

describe the acute CV response to exercise

A
  1. increased HR
  2. increased CO
  3. increased SV
  4. increased SP (MAP)
  5. or no change in DP
  6. decreased TPR
27
Q

BP responses to exercise that signal reevaluation/stop exercise

A
  1. if SP fails to increase or drops below resting levels → stop exercise
  2. if DP increase more than 10 mmHg → reevaluate
  3. remember that BP should start to fall immediately after exercise stops
28
Q

what is exercise testing?

A

a noninvasive procedure that evaluates an individual’s capacity for dynamic exercise

29
Q

who should be tested?

A
  1. Men >45 and women >55
  2. family hx of CVD
  3. cigarette smoking
  4. sedentary lifestyle → not meeting exercise guidelines for previous 3 months
  5. obese
  6. HTN
  7. dyslipidemia
  8. prediabetic → fasting 100 mg/dL < glucose < 124 mm Hg
30
Q

list absolute contraindications to participating in exercise testing

A
  1. recent sig change in resting ECG
  2. unstable angina
  3. uncontrolled cardiac dysrhythmias causing symptoms or hemodynamic compromise
  4. uncontrolled symptomatic HF
  5. acute PE or pulmonary infarction
  6. severe symptomatic aortic stenosis
  7. acute myocarditis or pericarditis
  8. suspected or known dissecting aneurysm
  9. acute systemic infection, accompanied by fever, body aches, or swollen lymph
31
Q

relative contraindications to participating in exercise

A
  1. left main coronary stenosis
  2. moderate stenotic valvular heart disease
  3. HCM
  4. high degree AV block
  5. tachy/bradycardia
  6. electrolyte abnormalities (K<3.5)
  7. severe untreated arterial HTN (at rest)
    1. SBP >200
    2. DBP >120
  8. uncontrolled metabolic disease (diabetes)
  9. advanced or complicated pregnancy
  10. abnormal increase in body mass in previous 2 days in pts with stable HF
32
Q

absolute contraindications for STOPPING an exercise test

A
  1. onset of angina or angina-like symptoms
  2. suspicion of an MI
  3. drop in SBP >10 with an increase in work rate or if SBP falls below the value obtained in the same position prior to testing
  4. SBP >250 and/or DBP>115
  5. serious arrhythmias
  6. sig pulmonary HTN
  7. Signs of poor perfusion → pallor, cyanosis, cold and clammy skin
  8. SOB, wheezing, leg cramps, or claudication
  9. technical inability to monitor the ECG
  10. pt request
33
Q

what is wheezing?

A

continuous adventitious lung sounds with a constant pitch and varying duration

usually heard on exhalation/airway obstruction

34
Q

relative contraindications to STOPPING an exercise test

A
  1. failure of HR to increase with increasing exercise intensity
  2. change in heart rhythm
  3. severe fatigue
  4. failure of testing equipment
  5. ventricular aneurysm
35
Q

Exercise safely considerations

A
  1. assess cardiovascular risk
    1. pre-participation screening
    2. self guided (self-report)
      1. physical readiness activity questionnaire
      2. PAR-Q
    3. professionally guided
      1. physician clearance, exercise/health fitness professional
36
Q

briefly describe the PAR-Q

A

7 questions

if a pt responds to any of them w/yes the recommendation is that the pt be referred back to a physicain

37
Q

exercise testing and current guidelines

A

no exercise testing required before walking, flexibility, or resistance training. Follow ACSM guidelines for exercise testing before moderate to vigorous aerobic exercise training

38
Q

describe a submaximal exercise test

A
  1. pt achieves a predetermined submax exertional level and then test is stopped
  2. may be symptom limited or have a predetermined end point (85% HRmax)
  3. these tests tend to be ramped, progressive protocol
  4. no expired gas analysis performed
  5. VO2max or VO2peak is typically extrapolated from the results of the test
39
Q

what is included in physiological monitoring during a functional exercise test?

A
  1. HR
  2. BP
  3. O2 sat
  4. RPE
40
Q

what info can be derived from the Bruce Protocol if expired gases are not analyzed?

A
  1. stage completed
  2. exercise duration (min and sec)
  3. HR/RPE/Dyspnea at fixed workloads (i.e. at the end of a given stage)
    1. each stage = a fixed work load
  4. estimation of VO2 peak
41
Q

T/F: HRR provides the best available approximation of VO2 max?

A

TRUE

HRR = estimated HRmax - HR rest

42
Q

when to stop a Modified Bruce Protocol?

A
  1. achieved pre-determined HR → 85% of HRmax
  2. volitional fatigue or symptom limited
  3. pt choice
43
Q

what measurements should be made during a 6 MWT?

A
  1. Physiological
    1. BP (pre and post exercise)
    2. HR (pre and post exercise)
    3. RPE (pre and post exercise)
  2. Other
    1. RPE (during and at end of exercise)
    2. rating of breathlessness
    3. arterial O2 sat
44
Q

what is the MCSD for the 6MWT?

A

between 54 and 80m

or

177-262 ft

45
Q

list other submaximal exercise testing

A
  1. single-stage submax treadmill walking test
  2. Astrand and Ryhming Cycle Ergometer Test
  3. 2 min walk test; 12 min walk test
  4. modified shuttle walking test
  5. bag and carry test
  6. physical function ICU test
46
Q

predicting 1 RM

A
  1. 1 RM = weight than can be moved 10x resulting in fatigue/0.75
  2. there is a near linear relationship between the number of reps to fatigue and the % of max load
  3. select a weight, do an exercise to fatigue, count the reps, use the number of reps to define 1 RM
47
Q

importance of determining power

A

peak muscle power was superior to muscle strength and aerobic capacity in determining functional status and independently predicted functional dependency even after accounting for additional neuropsychological and health status indicators

Cardio Pulmonary (21 decks)

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