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Pulmonary Dx > Exercise Testing and Prescription > Flashcards

Exercise Testing and Prescription Flashcards

1
Q

Indications for Exercise Testing in Pulmonary Patients - steps? (5)

A
  • 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
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2
Q

What questionnaire should you give prior to exercise testing? It’s a good?

A
  • Physical Activity and Readiness Questionnaire

- exercise tolerance screen to determine which exercise is best

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3
Q

Risks with Exercise Testing? (7)

A 
Muscle soreness
Diaphoresis (cold sweat)
SOB/SOA
Angina
MI
Stroke
Death
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4
Q

Safety with Exercise Testing? (3)

A

CPR certification

Emergency procedures in place

Monitoring equipment well maintained and available

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5
Q

Contraindication to Exercise Testing/Training? (9)

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 (with fever, body aches, swollen lymph nodes)
  • Significant EKG changes suggesting ischemia
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6
Q

Upper Limits for Exercise Intensity? (14)

A

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
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7
Q

EQuation for HR max?

A

HR max = 208 - .7 x age

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8
Q

How do you monitor a patient during exercise testing? (5)

A 
HR
BP
RR
Oxygen Saturation (O2 Sat)
Rate of Perceived Exertion (RPE)
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9
Q

When to use Borg Scale/Rate of Perceived Exertion? Correlated well with?

A
  • 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)
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10
Q

6 on RPE = ? 13 = ?19 = ?

A

nothing
somewhat hard
very, very hard

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11
Q

Subjective Ratings of Dyspnea - 0-4 = ?

A

0 – No dyspnea
1 – Mild dyspnea (light, barely noticeable)
2 – Moderate (bothersome)
3 – Moderately severe (very uncomfortable)
4 – Severe/intense – you need to stop!

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12
Q

You should take a pt to around?

A

3

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13
Q

Why do you choose max vs submax exercise testing?

A

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

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14
Q

Max Exercise Testing is used to? (5)

A

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)

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15
Q

Max exercise testing has an increased sensitivity why in coronary disease?

A

Bc you have a direct measure of VO2max and peak

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16
Q

Max Exercise Testing looks at? (5)

A

HR plateau, SBP plateau, amt CO2 produced causes sudden increase RR, signals anaerobic work

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17
Q

Commonly used symptom limited graded exercise tests (GXT)? (3)

A

Bruce Protocol – treadmill
Astrand-Rhyming protocol - cycle
RER

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18
Q

RER looks at? How do you know when you’re anaerobic?

A

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)

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19
Q

Sub Max ETT assesses? Determine? Results used to? Can give?

A
  • 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
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20
Q

Types of Exercise Testing: Sub Max ETT? (2)

A

Graded exercise tests

Field tests – individual dictates intensity

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21
Q

Examples of Graded exercise tests? (3)

A

Cycle
Treadmill
Low Level Graded Exercise Test

22
Q

Examples of field tests? (4)

A

6 min walk test
Shuttle walk test
1 mile walk
1 mile run

23
Q

General Guidelines - Before exercise testing? (3) Then? Choose a test how?

A

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

24
Q

6 Minute Walk Test uses? Prescribe exercise how? Determine? When is home O2 indicated?

A
  • Regression equations for calculating VO2 and distance walked

Prescribe exercise by estimating VO2 Max/Peak

Determine the need for supplemental O2
- If O2

25
Q

6 Minute Walk Test predicts what in elderly? COPD? CHF? >200 m?

A 
- Elderly
Predicts VO2 max
- COPD
Predicts VO2 max, need for transplant
- CHF
Predicts VO2 max, mortality, need for transplant
- mortality/hospitalization
26
Q

(Rockport) 1 Mile Walk Test looks at? (5)

A
  • 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)
27
Q

1 Mile Jog- must tke at least? Hr must be Looks at? (4)

A
  • 8-9 mins

-

28
Q

1 Mile Walk/Run looks at? (5) More for?

A
  • VO2 peak
  • Time in minutes
  • Age in years
  • Gender: female 0, male 1
  • BMI: kg/m2
  • youth, young adults
29
Q

Walk Velocity Test - setup?

A

Set up ramp up and ramp down distance (1m, 3m), then time how long it takes to walk a set distance (6m, 10m, etc)

30
Q

Community ambulation requires? Cross an intersection?

A

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

31
Q

Step Tests - estimate? Compare? Tests? (3)

A

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

32
Q

Duke Activity Status Index (DASI) = ? (2) VO2 Peak fomula? How do you get MET level? When would you use this?

A
  • 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
33
Q

Measures of Aerobic Capacity - formula for MET? VO2? Avg adult has what MET tolerance? If VO2

A

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

34
Q

Goals for Exercise Training? (5)

A

Increase Activity Tolerance

Increase Function

Increase Quality of life

Central hemodynamic adaptations

Peripheral adaptations to exercise

35
Q

Benefits of exercise? (12)

A 
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
36
Q

Factors to Consider When Designing an Exercise Program? (5)

A

Exercise goals

Primary and secondary medical dx

Medications

Physical condition at baseline

Activity preferences/personal goals

37
Q

Essential Components of Exercise Prescription - MOde =? Focus on? Frequency =? How many? Intensity = ? How much for pulm pts? Duration = ? ACSM rec?

A

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

38
Q

Mode - Try to match? Three other things you should consider?

A

the exercise prescription with your patient’s interests and goals

Principle of specificity

Overload principle

Reversiblity

39
Q

Target HR = ? Used for? Not necessarily? HR max = ?

A

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

40
Q

% Heart Rate Reserve Method (Karvonen): Target HR = ? HR max can be?

A

(ex. intensity %)(HR max - HR rest) + (HR rest)

HR max can be from an exercise test or estimated

41
Q

% VO2 Reserve Method: Target VO2 = ?

A

(ex. intensity %)(VO2 max - VO2 rest) + (VO2 rest)

VO2 rest = 3.5 mL O2/kg/min (1 MET)

42
Q

What intensity do you choose - take into consideration? (8) Intensities for endurance, weight loss, and deconditioned individuals?

A

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

43
Q

Training Window for Pulmonary Patients - When may the patient reach their ventilatory threshold? AACVPR recs?

A
  • 50-60%
  • AACVPR recommends 40%-59% for individuals with pulmonary dysfunction in order to keep intensity below the ventilatory threshold
44
Q

Rate of Perceived Exertion rec? ACSM rec for physiologic adaptation?

A

Recommend 11-13 rating ‘light to somewhat hard’ for initial exercise prescription

ACSM recommends 12-16 for physiologic adaptation to exercise

45
Q

Stages of an Exercise Session and times? (4)

A

Warm up: 5-10 min

Conditioning phase: 20-60 min

Cool-down: 5-10 min

Recovery: Time to return to baseline

46
Q

Cool down is for?

A

Improvement of venous return, which can reduce HTN and dizziness

47
Q

Types of Aerobic Training - Long, slow distance (LSD) = ? Test intensity with?

A
  • ~70% VO2max or 80% max HR

- Test intensity with the “talk test”

48
Q

Types of Aerobic Training - Pace/Tempo (Lactate Threshold Training) = ? Interval? Repetition? Fatlek?

A 
- 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
49
Q

Examples of 3-6 MET Activities?

A

3: walking 2.5 mph
4: biking

50
Q

Strength Training - focus on? Use? Avoid?

A

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

51
Q

What would you want to train in SCI? COPD?

A
  • abs

- accessory and arm mm

52
Q

Flexibility - min? Ideally?

A

Minimal 2-3 d/wk

Ideally 5-7 d/wk

Pulmonary Dx (5 decks)

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