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Pulm > Exercise Testing and Prescription > Flashcards

Exercise Testing and Prescription Flashcards

1
Q

Indications for Exercise Testing in Pulmonary Patients

A

Understand severity of dyspnea

Understand O2 sat at rest and with activity

Determine exercise/activity tolerance

Provide information for exercise prescription

Evaluate for heart disease

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2
Q

PRIOR to ex testing

A 
History
Screening
Lab values
Physical exam
Resting physiological measurements
PAR-Q and You
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3
Q

PAR-Q

A

Physical Activity and Readiness Questionnaire

Good to add to any outpatient intake form to ID reasons to send pt back to physician prior to commencing an ex program

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4
Q

Risks with Exercise Testing

A 
Mm soreness
Diaphoresis
SOB/SOA
Angina
MI
Stroke
Death
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5
Q

Safety with Exercise Testing

A

CPR certification
Emergency procedures in place
Monitoring equipment well maintained and available

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6
Q

ACSM ABSOLUTE C/I to Ex testing/training

A 
Unstable angina
Uncontrolled cardiac dysrhythmia
Critical aortic stenosis (symptomatic)
Uncontrolled symptomatic heart failure
Acute PE
Acute myocarditis/pericarditis
Known dissecting aneurysm
Acute systemic infection
Significant EKG suggesting ischemia
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7
Q

ACSM RELATIVE C/I to Ex testing/training

A 
Moderate stenotic valvular heart disease
Electrolyte abnormalities
Severe HTN
Tachy or brady dysrrhythmias
Neuromm, musculoskel, or RA d/o exacerbated by exercise
High degree (3rd) heart block
Uncontrolled metabolic disease
Chronic infection disease
Mental or physical impairment leading to inability to exercise adequately
Orthostatic BP drop with symptoms
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8
Q

Severe HTN

A

SBP > 200 mmHg

and/or

DBP > 110 mmHg at rest

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9
Q

Orthostatic BP drop

A

SBP drop > 20 mmHg

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10
Q

Upper Limits for Exercise Intensity

A

Plateau or decrease in SBP (> 10 mmHg), SBP > 240 mmHg, DBP > 110 mmHg

Onset of angina or other symptoms of cardiovascular insufficiency

Increase frequency of ventricular arrhythmias

Onset of other significant EKG changes (2 or 3 degree AVB, a-fib, SVT, ventricular ectopy)

Radionuclide evidence of Left vent dysfunction or onset of moderate to severe wall motion abnormality during exercise

Other signs and symptoms of ex tolerance

Pt request to stop

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11
Q

Other signs and symptoms of exercise intolerance

A

Blah blah ask PT Fam

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12
Q

HR Max

A

208 - 0.7(age)

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13
Q

How do you monitor a pt during ex testing?

A 
HR
BP
RR
O2 sat
RPE
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14
Q

When to use Borg Scale/RPE

A

Pts on meds that blunt HR response…

Betablockers
Digoxin
Calcium channel blockers
ACE inhibitors

Correlated well with HR if multiply rating by 10 (using 6-20 RPE scale)

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15
Q

Ratings of Dyspnea

0

A

No dyspnea

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16
Q

Ratings of Dyspnea

1

A

Mild dyspnea (mild, barely noticeable)

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17
Q

Ratings of Dyspnea

2

A

Moderate (bothersome)

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18
Q

Ratings of Dyspnea

3

A

Moderate severe (very uncomfortable)

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19
Q

Ratings of Dyspnea

4

A

Severe/intense - you need to stop!

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20
Q

Why Choose Max vs Submax ex testing

A

Maximal you are working someone to their MAX levels – it’s a hard test

Submax

Why?…

Lack of supplies
Don’t need to know

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21
Q

Max Exercise Testing

A

To diagnose disease
To determine max aerobic capacity and establish ex protocols
Assess medication levels
Exercise prescription
Assessment of ex/endurance training (outcome measure)

Increased sensitivity in CAD, especially asymptomatic

Better estimate of VO2 max/peak bc you will have a direct measurement of that

Make sure you have medical supervision and emergency equipment

Open circuit spirometry

Metabolic cart measures the gasses that are being released

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22
Q

What are you looking at during a max ex test?

A

HR plateau
SBP plateau
Amt CO2 produced causes sudden increase RR (signals anaerobic work)

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23
Q

RER

A

As it’s reaching 1, you’re maximized and using glucose for fuel

If it’s below 1, you’re using fat and carbs

Measured on metabolic cart

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24
Q

Commonly used symptom limited graded exercise tests (GXT)

A

Bruce Protocol - treadmill

Astrand-Rhyming protocol - cycle

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25
Q

Bruce Protocol vs Astrand-Rhyming

A

Higher VO2 with Bruce

Less expensive with UEE

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26
Q

Sub max ETT

A

Assess cardiorespiratory fitness

Determined HR response to 1 or more submax work rates

Results used to predict VO2 peak/max

Can give additional information (re: subject’s response to exercise)

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27
Q

Graded exercise tests

A

Cycle
Treadmill
Low Level Graded Exercise Test

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28
Q

Field tests

A

Individual dictates intensity

6MWT
Shuttle WT
1 mile walk
1 mile run

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29
Q

General Guidelines Before Exercise Testing

A

Avoid recent activity

Wait 2 hours after eating

2 hours after smoking or caffeine (can affect HR)

30
Q

6MWT

A

Regression equations for calculating VO2 and distance walked

Prescribe exercise by estimating VO2 max/peak

Determine need for supplemental O2 (if O2

31
Q

What if we stop the 6MWT due to non pulmonary/cardiac reason - can we still use these results (HR) for exercise prescription?

A

No because the HR is not indicative of a max HR

32
Q

6MWT Facts

A

Men tend to walk further than women

Taller walks further than shorter

As we get older, we tend not to walk as far

33
Q

6MWT VO2 max regression

A

Elderly - predicts VO2 max

COPD - Predicts VO2 max, need for transplant

CHF - predicts VO2 max, mortality, need for transplant

34
Q

Can’t walk at least 200 m?

A

Indicators of suboptimal surgical results

35
Q

Rockport 1 Mile Walk Test

A

Have pt walk briskly

Measure HR last quarter mile

36
Q

1 Mile Jog

A

Should take 8-9 min

HR should not exceed 180 at end of test

37
Q

Cross an intersection

A

Need to walk at over 0.8-1.22 m/sec

38
Q

Community ambulation

A

Requires 50-122 cm/sec or 0.5-1.22 m/sec

39
Q

Walk Velocity Test

A

6m, 10m, etc

Great way to tell if someone is able to be a community ambulator

40
Q

Step Tests

A

Estimate VO2 max from direct HR response after stepping up and down step with specified time frame or at set frequency

Compare HR response to norms to give idea of fitness

Astrand-Rhyming
3-min YMCA Step Test
Harvard Step Test

41
Q

Duke Activity Status Index (DASI)

A

Self-administered questionnaire

Sums of weights for “yes” replies

You would use this if a person can’t get up AT ALL

Right after cardiac surgery
Someone who is too weak
Someone who is unstable

42
Q

Max Score on DASI

A

58.6

43
Q

MET

A

VO2/3.5

Avg adult has around a 10 MET level activity tolerance

***IF VO2

44
Q

Goals for Ex Training

A 
Increase activity tolerance
Increase function
Increase QOL
Central hemodynamic adaptations
Peripheral adaptations to exercise
45
Q

Factors to Consider When Designing a Exercise Program

A 
Exercise goals
Primary and secondary medical dx
Medications
Physical condition at baseline
Activity preferences/personal goals
46
Q

Essential Components of ExRx

A

Mode
Frequency
Intensity
Duration

47
Q

Mode

A

Type of exercise

Focus on large mm groups

Try to match the exercise Rx with your pt’s interests and goals

Principle of specificity
Overload principle
Reversibility

48
Q

Frequency

A

days per week the exercise will be performed to achieve goal

5 days or MOST days of the week!

49
Q

Intensity

A

% of maximum capacity

ACSM - 50% for most pulm pts

AACVPR - 40% for most pulm pts

50
Q

Duration

A

Time required for exercise on a given day

Much controversy, ACSM recommends 30 min a day or 150 min/wk at moderate intensity

51
Q

AHA Guidelines

A

Ex 3-4 days a week

30-60 min

40-60% VO2 max

52
Q

FITT

A

Freq
Int
Time
Type

53
Q

Specificity

A

Training effects are specific to ex performed and mm used

54
Q

Overload principle

A

To show functional improvement, system must be exposed to higher load than is usually accustomed to

55
Q

Reversibility

A

Detraining occurs when stop training

56
Q

HRR

A

HR max - HR rest

57
Q

Karvonen method

A

Target HR = (% intensity)(HRR) + (HR rest)

58
Q

VO2 reserve method of target VO2

A

Target VO2 = (% ex intensity)(VO2R) + (VO2 rest)

59
Q

Intensity considerations

A

Age
Habitual physical activity level
Physical fitness level
Health status

60
Q

Cardiopulm endurance

A

70-85% HRmax

61
Q

Weight loss

A

55-65% HRmax

62
Q

Deconditioned individuals

A

40-50% HRR

55-65% HRmax

63
Q

When should pts reach their ventilatory threshold?

A

50-60%

64
Q

RPE

A

11-13 on 6-20 scale

ACSM recommends 12-16 for physiologic adaptations

65
Q

Stages of an Ex Session

A

Warm up: 5-10 min

Conditioning phase: 20-60 min

Cool down: 5-10 min

Recovery: time to return to baseline

66
Q

Long, slow distance

LSD

A

Approx 70% VO2max
Approx 80% HRmax

Test intensity with the talk test

67
Q

Pace/Tempo (Lactate Threshold Training)

A

Steady pace ex for 20-30 min

68
Q

Interval

A

3-5 min with work:rest ratio 1:1

69
Q

Repetition

A

30-90 sec with work:rest ratio 1:5

70
Q

Fartlek

A

Combo of…

LSD
Pace/tempo
Interval
Repetition

71
Q

Strength Training

A

Focus on low wt, high rep for endurance training

Use baseline 10 rep max test vs. 1 rep max due to risk of injury

Avoid valsalva to prevent vasovagal response

72
Q

Flexibility

A

Minimal 2-3 days/week

Ideally 5-7 days/week

Static stretch of all major mm groups

Pulm (10 decks)

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