exercise testing and prescription for pulmonary patients

Question 1

what are the two main types of exercise testing

Answer 1

cardiopulmonary exercise testing and 6 minute walk test

Question 2

what type of test is a cardiopulmonary exercise test?

Answer 2

highly sensitive, non invasive, max stress test

Question 3

what type of testing is a 6 minute walk test?

Answer 3

general, non invasive, sub maximal testing

Question 4

what does the 6 minute walk test measure

Answer 4

Measures the maximal distance that patients can walk at a comfortable pace in 2 or 6 min

*Assesses global functional capacity *

Does not provide specific information on the individual systems involved in exercise capacity
Cardiac vs pulmonary vs hematologic vs musculoskeletal
Does not assess patient effort

Question 5

who is a 2 or 6 minute walk test indicated for?

Answer 5

preoperative and postoperative evaluation of patients

monitor response to therapeutic interventions and pulmonary rehabilitation

predict mortality and morbidity in patients with cardiac and pulmonary vascular disorders

Question 6

what are the reasons for performing a CPET or Cardiopulmonary exercise test

Answer 6

Reasons for performing a cardiopulmonary exercise test
Early detection & diagnosis of disease or subclinical disease
Assess fitness and suitability for planned surgery
Assess cause of poor exercise tolerance
Evaluate Symptoms - characteristics of SOB
Evaluate Dysfunction – arrhythmias, cardiac ischemia,
Information that distinguishes cardiac and respiratory disease
Monitor athletes
Monitor response to therapeutic intervention and guide prescription
Evaluation of prognosis in cardiac and pulmonary disease
Selection of candidates for cardiac transplantation

Question 7

what is CPET or Cardiopulmonary exercise test

Answer 7

Computerized test provides a breath-by-breath analysis of respiratory gas exchange and cardiac function at rest & during a period of maximal exercise
intensity of exercise is increased incrementally until symptoms are provoked
Information on respiration, oxygen consumption, carbon dioxide production, and heart rate are collected
Exercise is done on a treadmill or on a bicycle ergometer
Determines whether patients have normal or reduced maximal exercise capacity (VO2max) compared to age and gender matched norms

Question 8

what are some reasons for performing a cardio pulmonary exercise test?

Answer 8

Early detection & diagnosis of disease or subclinical disease
Assess fitness and suitability for planned surgery
Assess cause of poor exercise tolerance
Evaluate Symptoms - characteristics of SOB
Evaluate Dysfunction – arrhythmias, cardiac ischemia,
Information that distinguishes cardiac and respiratory disease
Monitor athletes
Monitor response to therapeutic intervention and guide prescription
Evaluation of prognosis in cardiac and pulmonary disease
Selection of candidates for cardiac transplantation

Question 9

Limitations to CPRT testing are

Answer 9

limitations to exercise may be caused by exercise induced hypoxia, hypertension and cardiac arrhythmias

for most COPD patients SOB is the limiting factor which leads to hypoxia and hypoxemia

Question 10

exercise testing provides information on what ? how should exercise testing change the way patients prescription is? Is exercise benefical in stopping sob?

Answer 10

baseline and exercise tolerance over time
exercise prescriptions can be set on these baselines

exercise has be shown to be an effective innervation for SOB and the further implications - oxygen implementation does show an increase in exercise tolerance

Question 11

what should you monitor for CPRT and Exercise prescription?

Answer 11

maximal testing is safe with appropriate monitoring
stationary bike Orr treadmill testing can be used

monitor the patients response to therapeutic interventions

a constant work rate protocol on a cycle or treadmill can be repetivily used to measure physiological responses to exercises

Question 12

in a Cardiopulmonary Exercise Test what does intensity mean? what does recovery mean?

Answer 12

maximal effort and symptoms are provoked

recovery- continued monitoring until symptoms and vitals reach baseline

Question 13

what is a 2 or 6 minute walk test

Answer 13

submaximal test that assess walking endurance and aerobic capacity

6MWT- good realizability and moderate validity and significant ability to predict functional abilities of patients with CHF who can not walk greater than 490 meters

helps to guide a treatment plan for cardiopulmonary patients

6MWT - is developed as an alternative for a standard CPET

Question 14

what is the preferred test when initially gathering data for an exercise prescription?

Answer 14

two or six minute walk test

Question 15

what is the rate of perceived exertion?

Answer 15

the preferred method in monitoring a patients perception of exercise intensity

patients are unable to achieve training heart rate can still show signs of physiological improvement

barriers to measuring just hr would be those patients on beta blockers- use roe scale with these patients

Question 16

Rate of perceived exhaustion scales?

Answer 16

Borg scale
6-20 6 is no exertion and maximum is effort is a 20.
the scale correlates with HR if you add a 0, that is the patients expected HR

indication of how hard the patient feels as if they are working

Modified RPE scale
0-10
0= no effort
10= full effort
used for patients SOB symptoms

Question 17

spirometry is used for what?

Answer 17

exhalation and volume rate

common office test used to assess lung functions

used to assist diagnostics and differentiating diseases

Question 18

what is a 1 rep max?

Answer 18

the most weight a patient can lift at once for a muscle group.

Question 19

resent research has shown that what type of training is effective for increasing aerobic capacity in pulmonary patients

Answer 19

High intensity with small bouts of exercises has been found effective for increasing the aerobic capacity of patients with pulmonary disease

Question 20

what other workout did research show was effective in patients with pulmonary disorders?

Answer 20

resistance training has be found to be effective for patients with pulmonary disorders. these exercise prescriptions should look like the

Question 21

research has shown that a main contributor to exercise intolerance is what muscle weakness

Answer 21

inspiratory weakness

Question 22

pulmonary rehabilitation is accepted for what type of patients

Answer 22

early detection and treatment for patients with pulmonary disorders

Question 23

what are the outcomes for pulmonary Rehabilitation programs include?

Answer 23

symptom improvement
functional and exercise gains
education
health related quality of life outcomes

Question 24

what are some types of settings and programs for pulmonary patients

Answer 24

inpatient programs
subacute programs
outpatient programs

Question 25

what type of goals should be made during pulmonary rehabilitation

Answer 25

individualized disease specific goals :
patient assessment and goal setting
exercise prescription
self-management education
nutritional interventions
psychological supports

Question 26

what is the first component of a PFT report and what does it provide?

Answer 26

spirometry and measures the flow
defines if someone has an obstructive disease
FEV1 is measured and shows the maximum exhale in one second

FEV 1/FVC ration- <70% in abnormal and obstructive

Question 27

what are the rates of FEV1/FVC RATIO

Answer 27

> 80% normal
70%-79% mildly abnormal
60%-69% moderately abnormal
50%-59%moderately to severely abnormal
35%-49% severely abnormal
less than 35% is very severely abnormal

Question 28

specifically for obstructive the fev 1/fvc ratio is

Answer 28

<70% mild obstruction
<60% mod obstruction
<50% severe obstruction

Question 29

what do lung volumes look like in the different lung diseases

Answer 29

total lung capacity- TLC

restrictive lung disease = decreased lung volume- reduction in the total lung capacity
for most patients this is usually about 80% of the predicted TLC. The worse the restriction the lower the TLC
residual lung volumes will decrease proportional to the decrease in generalized lung volume

obstructive lung disease=
reduced ability to exhale and a larger residual volume will a low fev1
hyperinflation

Question 30

restrictive lung disease volumes for total lung capacity and their level of restriction

Answer 30

80%-70% mild restriction
70%-60% moderate restriction
60% severe restriction

Question 31

what is FEF and what is used for?

Answer 31

Forced Expriratory Flow
the flow rate of air coming out of the lung during the middle portion of a forced expiration

Question 32

what are the differences in FVC, FEV, FEV/FVC, FEF,RV, TLC for patients with obstructive vs restrictive lung disease

Answer 32

obstructive:
FVC normal to decreased
FEV1 decreased
FEV1/FVC decreased
FEF decreased
FRC normal to increased
RV normal to increased
TLC normal to increased

restrictive:
FVC decreased
FEV1 decreased
FEV1/FVC normal to increased
FEF normal increase or decrease
FRC decreased
RV decreased
TLC decreased

Question 33

DLCO

Answer 33

Second most common type of PFT
Measurement to assess the lung’ ability to transfer gas from inspired air to the blood stream
Carbon Monoxide high affinity for hemoglobin and it follows the same pathway as Oxygen
Full inhale of CO, 10 second hold, exhale, quantity of CO measured
Convenient and easy for patients to perform