Exercise Testing and Prescription Flashcards
Training
Series of practices, the object of which is to render a man or animal as completely and quickly as possible, fit for the performance of a given work
Physical Activity
Bodily movement produced by skeletal muscles that result in energy expenditure
Exercise
Subset of physical activity that is planned, structured and repetitive and has a final or an intermediate objective the improvement or maintenance of physical fitness
VO2 Peak
Limited by subject tolerance, which may or may not be physiological max
ACSM Recommendation
30 min of moderate physical activity on most/all days of week
4/10 adults work in light activity jobs (US spend 70% of their time sitting)
Total screen time > 8 hr/day
Excuses for Physical Activity (Young)
Time Fatigue Active at work Lack of results Cost Lack motivation
Excuses for Physical Activity (Older)
Fear of falling Inertia/never tired Negative affect Time Physical ailments
Excuses for Physical Activity (Universal)
Fear of looking stupid
Being watched
Physiologic changes
Getting Patients Physical Activity
Education: disease/dx/disability
Prescription: FITT
Testing: medical eval, submax test
Pre-Exercise Assessment
Risk classification - high needs med eval
Exercise limitation/modification - HR/BP, blood sugar, orthopedic/neuro issues
Baseline for comparison
Test or not to test: sub vs max, sensitive vs specific, not necessary to low/mod activity
Graded Exercise Testing
Monitor HR, BP, EKG, VO2 while incrementally increasing workload
GXT Outline
- Assess resting values
- 1-2 min warm up
- Measurements at regular intervals
- Extend stage to reach steady stat if necessary
- Cool down until close to baseline
GXT Normal Responses
Linear increase with SBP and HR proportionate to workload Min change in DBP Shortened QT interval Reduced R wave amp ST-segment elevation
GXT Abnormal Responses
No increase in HR or SPB with increasing workload SBP > 250, DBP > 120 ST segment depression (MI?) Increased R wave amp V-tach or multiple PVC
Treadmill vs Cycle Ergometer vs Stepper for GXT
Treadmill yields higher VO2, higher risk of falling
BW has decreased effect on cycle ergometer
Sub-Max Testing Assumptions
Linear relationship between HR and VO2 Max HR at give age is uniform HR at given workload varies according to fitness level Steady state HR obtained at each level Mechanical efficiency is uniform
Sub-Max Advantages
Safe Controlled pace Not population specific Quick Easily to administer Inexpensive
Sub-Max Disadvantages
Indirect measure of VO2
Estimation of max HR may be inaccurate
Sub-Max General Rule
Under predicts older/deconditioned subjects
Over predicts younger/well-conditioned subjects
Sub-Max Cycle Ergometer Tests
YMCA (3-4 3 min stages, 110-115 HR at 2 workloads)
ACSM bike test
Astrand rhyming (6 min, single stage)
Sub-Max Treadmill Tests
Submax Bruce - larger work increment, appropriate for young/healthy subjects
Balke-Ware - smaller work increments (
Direct Calorimetry
Measures heat expenditure to determine EE
Ambient air - expired air = oxygen consumption
Indirect Calorimetry
Uses RER to calculate EE
RER
Ratio between CO2 release and O2 consumed 0.7 - primary fuel from fat 1 - primary fuel from carbs 0.78-0.8 - resting 1.05-1.15 - max