Exercise Testing and Prescription Flashcards
Indications for Exercise Testing in Pulmonary Patients - steps? (5)
- Understand severity of dyspnea
- Understand oxygen saturation at rest and with activity
- Determine exercise/activity tolerance
- Provide information for exercise prescription
- Evaluate for heart disease
What questionnaire should you give prior to exercise testing? It’s a good?
- Physical Activity and Readiness Questionnaire
- exercise tolerance screen to determine which exercise is best
Risks with Exercise Testing? (7)
Muscle soreness Diaphoresis (cold sweat) SOB/SOA Angina MI Stroke Death
Safety with Exercise Testing? (3)
CPR certification
Emergency procedures in place
Monitoring equipment well maintained and available
Contraindication to Exercise Testing/Training? (9)
- Unstable angina
- Uncontrolled cardiac dysrhythmia
- Critical aortic stenosis (symptomatic)
- Uncontrolled symptomatic heart failure
- Acute PE
- Acute myocarditis/pericarditis
- Known dissecting aneurysm
- Acute systemic infection (with fever, body aches, swollen lymph nodes)
- Significant EKG changes suggesting ischemia
Upper Limits for Exercise Intensity? (14)
Plateau or decrease in SBP (>10mmg), SBP >240, DBP > 110
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 ventricular dysfunction or onset of moderate to severe wall motion abnormality during exercise
Patient requests to stop!
- BP and O2 sats drop dangerously
- reached ventilatory threshold
- NS problems (ataxic, dizzy)
- cyanotic
- severe fatigue
- SOB
- new lung sound
- leg cramps
EQuation for HR max?
HR max = 208 - .7 x age
How do you monitor a patient during exercise testing? (5)
HR BP RR Oxygen Saturation (O2 Sat) Rate of Perceived Exertion (RPE)
When to use Borg Scale/Rate of Perceived Exertion? Correlated well with?
- Patients on medications that blunt HR response (betablockers, digoxin, calcium channel blockers, ace inhibitors)
- Correlated well with HR if multiply rating by 10 (using the 6-20 RPE scale)
6 on RPE = ? 13 = ?19 = ?
nothing
somewhat hard
very, very hard
Subjective Ratings of Dyspnea - 0-4 = ?
0 – No dyspnea
1 – Mild dyspnea (light, barely noticeable)
2 – Moderate (bothersome)
3 – Moderately severe (very uncomfortable)
4 – Severe/intense – you need to stop!
You should take a pt to around?
3
Why do you choose max vs submax exercise testing?
Most can’t handle max, also look at why you’re doing it. Just gotta see how hard they’re working or don’t have equipment
Max Exercise Testing is used to? (5)
To diagnose disease
To determine max aerobic capacity and establish exercise protocols
Assess medication levels (how well they’re working)
Exercise prescription
Assessment of ex/endurance training (outcome measure)
Max exercise testing has an increased sensitivity why in coronary disease?
Bc you have a direct measure of VO2max and peak
Max Exercise Testing looks at? (5)
HR plateau, SBP plateau, amt CO2 produced causes sudden increase RR, signals anaerobic work
Commonly used symptom limited graded exercise tests (GXT)? (3)
Bruce Protocol – treadmill
Astrand-Rhyming protocol - cycle
RER
RER looks at? How do you know when you’re anaerobic?
RER- co2 to O2. As you approach 1, you’re reaching max level. Below one its. Fats and carbs, 1 or higher is mainly glucose (anaerobic threshold)
Sub Max ETT assesses? Determine? Results used to? Can give?
- Assess cardiorespiratory fitness
- Determine 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
Types of Exercise Testing: Sub Max ETT? (2)
Graded exercise tests
Field tests – individual dictates intensity
Examples of Graded exercise tests? (3)
Cycle
Treadmill
Low Level Graded Exercise Test
Examples of field tests? (4)
6 min walk test
Shuttle walk test
1 mile walk
1 mile run
General Guidelines - Before exercise testing? (3) Then? Choose a test how?
Avoid recent activity
Wait 2 hours after eating
2 hours after smoking or caffeine (can affect HR)
Repeat tests – 2nd test more accurate
Choose a test that relates to the training you will select for the patient
6 Minute Walk Test uses? Prescribe exercise how? Determine? When is home O2 indicated?
- Regression equations for calculating VO2 and distance walked
Prescribe exercise by estimating VO2 Max/Peak
Determine the need for supplemental O2
- If O2
6 Minute Walk Test predicts what in elderly? COPD? CHF? >200 m?
- Elderly Predicts VO2 max - COPD Predicts VO2 max, need for transplant - CHF Predicts VO2 max, mortality, need for transplant - mortality/hospitalization
(Rockport) 1 Mile Walk Test looks at? (5)
- Weight: pounds
- Age: years
- Gender: 0 for female, 1 for male
- Time: mile walk time in minutes
- HR: at end of test (during last ¼ mile –should be > 120 if given good effort)
1 Mile Jog- must tke at least? Hr must be Looks at? (4)
- 8-9 mins
-
1 Mile Walk/Run looks at? (5) More for?
- VO2 peak
- Time in minutes
- Age in years
- Gender: female 0, male 1
- BMI: kg/m2
- youth, young adults
Walk Velocity Test - setup?
Set up ramp up and ramp down distance (1m, 3m), then time how long it takes to walk a set distance (6m, 10m, etc)
Community ambulation requires? Cross an intersection?
NOTE: Community ambulation requires 50-122 cm/sec or 0.5-1.22 m/sec
NOTE: Need to walk at over 0.8 – 1.22 m/sec to cross an intersection
Step Tests - estimate? Compare? Tests? (3)
Estimate VO2 max from direct HR response after stepping up/down step (heights vary test to test) within specified time frame or at set frequency
Compare HR response to norms to give idea of fitness
Astrand-Rhyming (has a nomogram to determine VO2max)
3-minute YMCA Step Test
Harvard Step Test
Duke Activity Status Index (DASI) = ? (2) VO2 Peak fomula? How do you get MET level? When would you use this?
- DASI – sums of weights for ‘yes’ replies
- Self administered questionnaire
- VO2 Peak = (0.43 X DASI) + 9.6
- Divide VO2/3.5 to get MET level of activity
- Unstable and too weak
Measures of Aerobic Capacity - formula for MET? VO2? Avg adult has what MET tolerance? If VO2
MET = VO2/3.5
VO2 = MET level x 3.5
Average adult has 10 MET level activity tolerance (VO2 approximately 35 mL/kg/min)
If VO2
Goals for Exercise Training? (5)
Increase Activity Tolerance
Increase Function
Increase Quality of life
Central hemodynamic adaptations
Peripheral adaptations to exercise
Benefits of exercise? (12)
Decrease body weight Decrease type II diabetes Decrease cholesterol Increase HDL Improve overall endurance (VO2 ) Higher anaerobic threshold Higher functional capacity Greater independence Decrease some cancers Decrease depression Decrease osteoporosis Decrease risk for CAD, Heart dz, stroke, MI
Factors to Consider When Designing an Exercise Program? (5)
Exercise goals
Primary and secondary medical dx
Medications
Physical condition at baseline
Activity preferences/personal goals
Essential Components of Exercise Prescription - MOde =? Focus on? Frequency =? How many? Intensity = ? How much for pulm pts? Duration = ? ACSM rec?
Mode – type of exercise
Focus on large mm groups
Frequency – # days per week the exercise will be performed to achieve goal
5 days or MOST days of the week!
Intensity – % of maximum capacity
ACSM: 50% for most pulmonary patients
AACVPR: 40% for most pulmonary patients
Duration – time required for exercise on a given day
Much controversy, ACSM recommends 30 min
Mode - Try to match? Three other things you should consider?
the exercise prescription with your patient’s interests and goals
Principle of specificity
Overload principle
Reversiblity
Target HR = ? Used for? Not necessarily? HR max = ?
Target HR = (exercise intensity %)(HRmax)
used for younger, healthy people
NOT necessarily a good method for a clinical population!
HR max = 208 - .7 x age
% Heart Rate Reserve Method (Karvonen): Target HR = ? HR max can be?
(ex. intensity %)(HR max - HR rest) + (HR rest)
HR max can be from an exercise test or estimated
% VO2 Reserve Method: Target VO2 = ?
(ex. intensity %)(VO2 max - VO2 rest) + (VO2 rest)
VO2 rest = 3.5 mL O2/kg/min (1 MET)
What intensity do you choose - take into consideration? (8) Intensities for endurance, weight loss, and deconditioned individuals?
Take into consideration
Age, habitual physical activity level, physical fitness level, health status
Cardiopulmonary Endurance
70-85% HRmax
Weight loss
55-65% HRmax
Deconditioned Individuals
40-50% HRR or 55-65% HRmax
Training Window for Pulmonary Patients - When may the patient reach their ventilatory threshold? AACVPR recs?
- 50-60%
- AACVPR recommends 40%-59% for individuals with pulmonary dysfunction in order to keep intensity below the ventilatory threshold
Rate of Perceived Exertion rec? ACSM rec for physiologic adaptation?
Recommend 11-13 rating ‘light to somewhat hard’ for initial exercise prescription
ACSM recommends 12-16 for physiologic adaptation to exercise
Stages of an Exercise Session and times? (4)
Warm up: 5-10 min
Conditioning phase: 20-60 min
Cool-down: 5-10 min
Recovery: Time to return to baseline
Cool down is for?
Improvement of venous return, which can reduce HTN and dizziness
Types of Aerobic Training - Long, slow distance (LSD) = ? Test intensity with?
- ~70% VO2max or 80% max HR
- Test intensity with the “talk test”
Types of Aerobic Training - Pace/Tempo (Lactate Threshold Training) = ? Interval? Repetition? Fatlek?
- Pace/Tempo (Lactate Threshold Training) Steady pace ex for 20-30 min - Interval 3-5 min with work: rest ratio 1:1 - Repetition 30-90 sec with work: rest ratio 1:5 - Fartlek Combo of all of above
Examples of 3-6 MET Activities?
3: walking 2.5 mph
4: biking
Strength Training - focus on? Use? Avoid?
Focus on low weight, 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
What would you want to train in SCI? COPD?
- abs
- accessory and arm mm
Flexibility - min? Ideally?
Minimal 2-3 d/wk
Ideally 5-7 d/wk
