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PM Exam 7 > Exercise Testing > Flashcards

Exercise Testing Flashcards

1
Q

VO2 Max untrained and trained female

A 
UT = 38
Trained = 55
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2
Q

VO2 Max untrained and trained male

A 
UT = 44
Trained = 71
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3
Q

VO2 max as estimate for performance

A

Measuring maximal oxygen uptake
Is good but not perfect estimate
Varies with body size

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4
Q

Avg increase in VO2 max with training

A

1% per week for 20 weeks –> 20%

A lot of variability with this

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5
Q

Highest value reported for VO2 max

A

94 ml O2 * kg bw * min

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6
Q

As people age

A

VO2 max declines

Even if active throughout life, will decline just not as quickly

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7
Q

Incremental Exercise to Exhaustion AKA

A

Graded exercise test

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8
Q

Protocols for Incremental Exercise to Exhaustion

A

Mostly ramp & 8-12 min in duration
Treadmill (Bruce = standard)
Cycle (YMCA, Astrand)
Arm Ergometry

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9
Q

Treadmill vs Cycle
Which is easier for BP and ECG monitoring
VO2 Max
Systolic BP

A

Cycling is better for monitoring
VO2 Max 5-10% lower in cycle
Systolic BP is higher in cycle

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10
Q

Arm Ergometry as Protocol

A

If subject cannot do leg exercise

VO2 max values are about 60-70% of treadmill values

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11
Q

Contraindication to Arm Ergometry

A

Hypertension

Only arm exercise –> will inc blood pressure

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12
Q

Purpose for Incremental Exercise to Exhaustion

A

Diagnose CAD or Pulmonary disease
Prognosis for Post MI, Transplant decisions, Post procedure
Functional Capacity/Exercise Prescription

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13
Q

Safety of Incremental Exercise to Exhaustion

A

Mortality Rate =

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14
Q

Variables to monitor during testing

A 
RPE
HR
BP
ECG
Expired Gases
Echocardiography
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15
Q

RPE

A

Rating of perceived exertion
Borg Scale
0-10 Likert Scale
Angina Scale

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16
Q

Borg Scale

A

Reflects subjective sense of exercise difficulty

Surprisingly good gauge of exercise intensity

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17
Q 
Detail of Borg Scale
#s
A 
From 6 (No exertion at all) to 20 (maximal exertion) 
If add a zero to their RPE you will likely have their HR
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18
Q

RPE

A

Very light

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19
Q

RPE 12-13

A

Somewhat hard

60% VO2 Max

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20
Q

RPE > 16

A

Very heavy

85% VO2 Max

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21
Q

RPE 19/20

A

Probably hitting VO2 Max

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22
Q

METs

A

Multiples of the resting metabolic rate

1 MET = 3.5 mlO2 kg min = resting metabolic rate

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23
Q

Bowling

A

2-4 METs

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24
Q

Cycling 10 mph

A

7 METs

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25
Q

Fishing

A

3.7 METs

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26
Q

Golf (walking)

A

5.1 METs

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27
Q

Downhill Skiing

A

5-8 METs

28
Q

Soccer

A

5-12 METs

29
Q

Swimming

A

4-8+ METs

30
Q

Tables available that characterize activites based on METs useful for what

A

Prescription

Based on VO2 while doing these specific activities

31
Q

12 min/mile pace running

A

8.7 METs

32
Q

Subject VO2 max = 42 mlO2 = 12 METs

Desired intensity 70%

A

0.7 * 12 = 8.4 METs

12 min/mile running as prescription

33
Q

Problem with test being too hard

A

Safety

34
Q

Problem with test being too easy

A
  1. Functional capacity - could be underestimated
  2. Diagnosis - could get false negatives
  3. Prognosis - overestimate severity if not getting a true max
    Max exercise capacity (METs) is one of the best prognostic indicators
35
Q

Prognosis is correlated with exercise capacity

Index: HR

A

Age predicted max HR is poor criterion for assessing maximal effort
There is a lot of error around prediction of HR max

36
Q

Chronotropic Incompetence

A

When HR during exercise is excessively attenuated
Max HR corresponds with max workload = no incompetence
But if tachycardia at low workload –> low SV –> poor prognosis and yes to incompetence

37
Q

Prognosis is correlated with exercise capacity

Index: RPP

A

Rate Pressure Product
Index of myocardial O2 demand
HR * systolic BP

38
Q

If you have RPP

A

Poor prognosis

39
Q

What can make RPP information less informative

A

Chronotropic Incompetence

40
Q

Prognosis is correlated with exercise capacity

Index: METs

A

Maximum workload achieved

Should be indicator of choice

41
Q

Stopping an exercise test

A
  1. Subject is at maximal effort based on symptoms or indices of maximal effort
  2. Subject meets exercise test termination criteria (absoulte or relative indications)
42
Q

Symptoms of being at maximal effort

A 
RPE
HR
RPP
VO2 plateau
RER (greater than 1 at your max)
43
Q

Absolute Indication to Stop Test

A
  1. Exercise induced hypotension (Dec in systolic 10 mmHg with Inc in workload) with other signs of ischemia
  2. Moderate to severe angina (# of fingers 1-4 for pain)
  3. NS symptoms (dizziness, ataxia, near syncope)
  4. Poor perfusion (cyanosis, pallor)
  5. ECG/BP technical problems
  6. Subject desire to stop
  7. Sustained ventricular tachycardia (run of 3+ PVCs)
  8. ST segment elevation (> 1 mm in leads - small box) or new Q wave
44
Q

Relative Indications to Stop test

A

Need to use clinical judgment in context of exercise purpose

  1. Exercise induced hypotention (dec systolic 10 mmHg with Inc workload - no other sings of ischemia
  2. ST or QRS changes - ST segment depression (> 2mm or downsloping) or axis shift
  3. Arrythmias (other than sustained V tach) - PVCs, Supraventricular tachycardia, heart block, bradycardia
  4. Fatigue, shortness of breath, wheezing, leg cramps, claudication
  5. Inc chest pain
  6. Hypertensice response (systolic > 250 mmHg and Diastolic > 115 mmHg)
45
Q

Exercise Induces Hypotension

A

Dec systolic BP > or equal to 10 mmHg with Inc workload

High risk exercise response –> Preceeds V tach and fibrillation

46
Q

Possible Causes for exercise induced hypotension

A

Left ventricular dysfunction (post MI)
Ischemia
Exercise induced mitral regurgitation
Peripheral VD response

47
Q

Exercise induced hypotension predicts

A

Poor prognosis

High risk coronary artery disease (CAD)

48
Q

ST segment elevation

A

Absolute indication = > or equal to 1 mm (a small box)
- Transmural ischemia
- Arrythmogenic
ST elevation with Q waves: transmural infarction

49
Q

ST segment depression

A

Relative indication = > 2mm or downsloping (1mm may indicate ischemia)
Classic indication of myocardial ischemia = T-P elevation = entire reading is elevated - you are not getting complete repolarization

50
Q

Angina Scale

1 =

A

Onset of discomfort

51
Q

Angina Scale

2 =

A

Moderate discomfort

52
Q

Angina Scale

3 =

A

Moderately severe; pain = level for nitroglycerine - STOP TEST HERE

53
Q

Angina Scale

4 =

A

Severe

54
Q

Prognosis for CAD

A

Max exercise capacity is a good indicator

or equal to 10 = excellent survival

55
Q

Prognosis for Heart Failure

A

VO2 peak 14 ml = survival –> transplant recipient –> can defer transplant

56
Q

Prognosis for Post MI

Pre discharge eval (4-6 days post MI)

A

Can terminate at submax levels

Used to determine safety of ADLs (Symptoms at

57
Q

Sub Max Exercise Testing

A

Predict VO2 Max based upon HR response to exercise at different power outputs

58
Q

Assumptions you are making when you do sub max exercise testing

A

Achieve steady rate HR at each power
Linear relationship btw HR and power
Max HR = 220-age
Mechanical efficiency (VO2 at given power) is same across people

59
Q

Types of Submax Tests

A

Cycle Ergometer
Treadmill
Step

60
Q

Cycle Ergometer - Submax testing

A

Keep HR below 85%
Take BP and RPE once per stage
Inc to next stage if at steady HR
Plot HR from 2nd, 3rd, 4th stages vs. power
Extrapolate to power at estimated max HR
Convert power to VO2

61
Q

Treadmill - Submax testing

A 
Keep HR below 85%
Inc to next stage if at steady HR
Take BP and RPE once per stage
Plot HR vs speed/grade
Extrapolate to estimated VO2 at est. max HR
62
Q

Step - Submax testing

A

Keeping step and muscle fatigue can be an issue

Some tests account for height others do not

63
Q

Measure Gas Exchange

A

Improved accuracy over estimating peak METs based on terminal exercise stage

64
Q

Prognostic power - measuring gas exchange

A

Improved prognostic power, especially for heart failure

  • Greater peak VO2 accuracy
  • Other indices: anaerobic threshold, Ve/VCO2 slope, O2 uptake kinetics, VO2 recovery
65
Q

Oxygen Pulse

A

VO2 beat
Normalizes O2 consumption for HR
Often used as a surrogate for SV

PM Exam 7 (2 decks)

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