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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
Fishing
3.7 METs
26
Golf (walking)
5.1 METs
27
Downhill Skiing
5-8 METs
28
Soccer
5-12 METs
29
Swimming
4-8+ METs
30
Tables available that characterize activites based on METs useful for what
Prescription | Based on VO2 while doing these specific activities
31
12 min/mile pace running
8.7 METs
32
Subject VO2 max = 42 mlO2 = 12 METs | Desired intensity 70%
0.7 * 12 = 8.4 METs | 12 min/mile running as prescription
33
Problem with test being too hard
Safety
34
Problem with test being too easy
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
Prognosis is correlated with exercise capacity | Index: HR
Age predicted max HR is poor criterion for assessing maximal effort There is a lot of error around prediction of HR max
36
Chronotropic Incompetence
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
Prognosis is correlated with exercise capacity | Index: RPP
Rate Pressure Product Index of myocardial O2 demand HR * systolic BP
38
If you have RPP
Poor prognosis
39
What can make RPP information less informative
Chronotropic Incompetence
40
Prognosis is correlated with exercise capacity | Index: METs
Maximum workload achieved | Should be indicator of choice
41
Stopping an exercise test
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
Symptoms of being at maximal effort
``` RPE HR RPP VO2 plateau RER (greater than 1 at your max) ```
43
Absolute Indication to Stop Test
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
Relative Indications to Stop test
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
Exercise Induces Hypotension
Dec systolic BP > or equal to 10 mmHg with Inc workload | High risk exercise response --> Preceeds V tach and fibrillation
46
Possible Causes for exercise induced hypotension
Left ventricular dysfunction (post MI) Ischemia Exercise induced mitral regurgitation Peripheral VD response
47
Exercise induced hypotension predicts
Poor prognosis | High risk coronary artery disease (CAD)
48
ST segment elevation
Absolute indication = > or equal to 1 mm (a small box) - Transmural ischemia - Arrythmogenic ST elevation with Q waves: transmural infarction
49
ST segment depression
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
Angina Scale | 1 =
Onset of discomfort
51
Angina Scale | 2 =
Moderate discomfort
52
Angina Scale | 3 =
Moderately severe; pain = level for nitroglycerine - STOP TEST HERE
53
Angina Scale | 4 =
Severe
54
Prognosis for CAD
Max exercise capacity is a good indicator | or equal to 10 = excellent survival
55
Prognosis for Heart Failure
VO2 peak 14 ml = survival --> transplant recipient --> can defer transplant
56
Prognosis for Post MI | Pre discharge eval (4-6 days post MI)
Can terminate at submax levels | Used to determine safety of ADLs (Symptoms at
57
Sub Max Exercise Testing
Predict VO2 Max based upon HR response to exercise at different power outputs
58
Assumptions you are making when you do sub max exercise testing
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
Types of Submax Tests
Cycle Ergometer Treadmill Step
60
Cycle Ergometer - Submax testing
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
Treadmill - Submax testing
``` 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
Step - Submax testing
Keeping step and muscle fatigue can be an issue | Some tests account for height others do not
63
Measure Gas Exchange
Improved accuracy over estimating peak METs based on terminal exercise stage
64
Prognostic power - measuring gas exchange
Improved prognostic power, especially for heart failure - Greater peak VO2 accuracy - Other indices: anaerobic threshold, Ve/VCO2 slope, O2 uptake kinetics, VO2 recovery
65
Oxygen Pulse
VO2 beat Normalizes O2 consumption for HR Often used as a surrogate for SV

PM Exam 7 (2 decks)

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