Exercise Testing Flashcards
Who should go through exercise testing?
- men > 45
- women > 55
- smokers
- sedentary lifestyle
- obese
- HTN
- dyslipidemia
- prediabetic
Absolute CI to participation in exercise testing
- recent significant changes in resting ECG
- unstable angina
- uncontrolled cardiac dysrhythmias
- uncontrolled symptomatic HF
- acute PE or pulm infarct
- severe symptomatic aortic stenosis
- acute myocarditis/pericarditis
- symptomatic severe aortic stenosis
- suspected or known dissecting anuerysm
- acute systemic infection w/ fever, body aches, or swollen lymph nodes
Relative CI to exercise
- L main coronary stenosis
- electrolyte abnormalities
- mod stenotic valvular heart disease
- severe untreated arterial HTN
- HCM
- uncontrolled metabolic disease
High deg AV block - tachy/bradycardia
- advanced/complicated pregnancy
- abnormal increase in body mass previous 2 days w/stable CF
severe arterial HTN at rest
SBP: > 200 mmHg
DBP: > 120 mmHg
Absolute CI when indicate you should stop exercise testing
- onset of angina
- suspicion of MI
- drop in SBP >10 w/increase in work rate
- SBP falls below prior testing
- SP > 250 and/or DP >115
- serious arrhythmias
- significant pulmonary HTN
- Poor Perfusion: pallor, cyanosis, cold/clammy skin
- SOB, leg cramps, claudication
- Patient Request!!
- tech inability to monitor ECG
Relative CI indicating you should stop exercise testing
- failure of HR to increase
- change in heart rhythm
- severe fatigue
- failure of testing equipment
- ventricular aneurysm
submax exercise testing
- patient achieves predetermined exertional level, then stop
- ramped, progressive protocol
- no expired gas analysis performed
- VO2 max or VO2 peak can be extrapolated from the test
how long is each stage of the bruce protocol?
3 minutes
during the bruce protocol, when are physiological measurements taken and then gradient is elevated?
last 30 seconds of each stage
Bruce Protocol: What info can be derived if expired gases are NOT analyzed?
- stage completed
- exercise duration
- HR/RPE/Dyspnea at fixed work loads (stage)
How to estimate VO2peak from Bruce Protocol in Women
(4.38xTime) - 3.9
How to estimate VO2peak from Bruce Protocol in men
(2.94xtime) + 7.65
Tanaka estimation for age specific HR
207 - (.7 x age)
Estimating HRR
HRR = (estimated HRmax - HRrest)
When to stop modified bruce protocol
- achieved pre-determined HR
- 85% of HRmax
- Volitional fatigue
- Patient choice
Bruce Protocol: What should be measured at each stage
HR
RPE
BP if possible
6MWT:
physiological measurements that need to be made during assessment of exercise capacity
- BP (pre and post)
- HR (pre and post)
- RR (pre and post)
- RPE (during and post)
- Rating of breathlessness (during and post)
- arterial O2 saturation
MCSD for 6MWT must be between
54 and 80 m
Examples of Submax exercise tests
- single stage submax treadmill walking test
- astrand and rhyming cycle ergometer test
- 2MWT
- mod shuttle walking test
- bag and carry test
- physical function ICU test
Methods of assessing strength
- MMT
- 1 rep max
- hand held dynamometer
- isokinetic machines
1 rep max
- max weight person can lift 1 time through FULL ROM with GOOD FORM
- make sure to ask RPE and use to assess subjective effort
- increase weight for next trial by 4-6 lbs
- 30 sec between trials and alternate UE and LE
- over when patient can’t complete ROM
predicting 1 rep max
10 reps resulting in fatigue / .75
power
amount of work produced per unit of time
P=force x velocity
Power tests
- peak cycling
- stair climb
- 30 sec repeated STS
- TUG
- TUDS
- 5xSTS
- stair climbing power test
