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Exercise Testing and Rx Flashcards

1
Q

Defn: Physical Activity

A

any bodily movement produced by skeletal muscles that results in energy expenditure

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2
Q

Defn: Exercise

A

a subset of physical activity that is planned, structured, and repetitive and has a final or an intermediate objective of the improvement/maintenance of physical fitness

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3
Q

what percent of adults 18+ dont do any physical activity

A

40%

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4
Q

what percent of adults participate in vigorous activity

A

22%

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5
Q

how long are ppl generally sitting throughout the day

A

70%

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6
Q

Risk Stratification Categories

A

Low
Moderate
High - need to do medical eval

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7
Q

what is the acsm recommendation for Rx before exercise testing

A

most individuals can perform low-mod exercise safely

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8
Q

What do you monitor in GXT

A

HR, BP, EKG, VO2 max with incremental workload.

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9
Q

which machine yields higher vo2max

A

treadmill

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10
Q

the normal responses to GXT (6)

A
  • linear increase in SBP proportionate to workload
  • linear increase in HR proportionate to workload
  • little change in DBP
  • shortened QT-interval
  • decreased R-wave amplitude
  • upsloping ST-segment
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11
Q

what are abnormal responses to GXT (7)

A
  • no increase SBP
  • no increase HR
  • SBP > 250; DBP > 150
  • ST-segment depression
  • increased R-amplitude
  • V-tach
  • multiform PVC
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12
Q

Absolute Termination Criteria (8)

A
  • MI indication
  • mod-severe angina
  • > 20mmHg drop SBP with increasing workload
  • onset arrhythmia
  • severe SOA
  • diaphoresis
  • dizziness, blurred vision, confustion
  • subject requests to stop
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13
Q

Relative Termination Criteria (6)

A
  • EKG changes from baseline
  • increasing chest pain
  • wheezing
  • leg cramping
  • abnormal SBP or DBP
  • mod SOA
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14
Q

Assumptions with Sub-Max testing (5)

A
  • linear relationship b/n HR and VO2
  • max HR at a given age is uniform
  • HR at given workload varies according to the fitness level of subject
  • a steady-state HR is obtained each workload
  • mechanical efficiency is uniform
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15
Q

Submax will under-predict in what population?

A

older, deconditioned

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16
Q

Submax will over-predict in what population?

A

younger, conditioned

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17
Q

YMCA Cycle Ergometer Test

and ACSM Bike Test

A

3-4 consecutive 3-min cycles

prediction based on HR of b/n 110-150bpm, elicited at two dif workloads

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18
Q

Astrand-Rhyming

A

6-min, single stage

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19
Q

Treadmill Tests - Submax Bruce Protocol

A

relatively large workload increments

more appropriate for younger, healthy subjects

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20
Q

Balke-Ware Protocol (treadmill)

A

employs smaller workload increments (

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21
Q

Max Ex: Direct Calorimetry

A

measures heat expenditure to determine energy expenditure

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22
Q

Max Ex: Indirect Calorimetry

A

uses respiratory exchange ratio (RER) to calculate energy expenditure

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23
Q

Max Ex: Indirect Calorimetry Method

A

ambient O2 (21%) -> volume air inhaled -> volume air exhaled -> volume O2 in expired air -> volume O2 consumed

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24
Q

Respiratory Exchange Ratio (RER)

A

ratio b/n CO2 released and O2 consumed

VCO2/VO2

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25
RER of 0.7 indicates
fat primary fuel source
26
RER of 1.0
carbs primary fuel source
27
Resting RER
.78-.80
28
What happens to VO2 at max effort with increasing workload?
plateaus
29
what happens to RER at max effort
RER >= 1.15
30
what happens to blood lactate at max effort
>= 8mmol/L
31
Max Ex Principles (6)
- individuality - specificity - reversibility - progressive overload - hard/easy - preiodization
32
3 steps in exercise Rx
warm-up 5-10min conditioning cool-down 5-10min
33
General Frequency of Exercise
3-5days/week
34
Light intensity %
30-40% HR or VO2 reserve
35
Moderate Intensity %
40-60% HR or VO2 reserve
36
Vigorous Intensity %
60-90% HR or VO2 reserve
37
General Time of Exercise
30-60min/day moderate | 20-60min/day vigorous
38
Type/Mode
aerobic and/or resistance
39
General Volume of Exercise
150min/week 5400-7900 steps/day 500-1000 METS/week
40
General exercise progression
increase time 5-10 min every 1-2 weeks the first 4-6 weeks
41
Target HR main equation
(220 - age) * % intensity
42
Target HR alternative equations
[208 - (0.7 * age)] * intensity | [(HR max - HR rest) * intensity] + HR rest
43
Mod RER
12-13
44
Vig RER
15-16
45
What does 1 MET equal
3.5 mL/kg*min
46
What should you do for mus strength
1-RM max force
47
what is muscles power formula
= (force * velocity) / time | rate work performance
48
what is muscle endurance
ability to sustain repeated contractiona
49
frequency of resistance training
2-3 non-consecutive days/week
50
resistance training intensity for a beginner
40-50% of 1-RM
51
resistance training intensity for a novice
60-70% of 1-RM
52
resistance training intensity for an expert
>= 80% of 1-RM
53
what resistance training for endurance
54
what resistance training for power
20-50% of 1-RM
55
resistance training repetitions and sets for power and strength
8-10 reps | 2-4 sets
56
resistance training repetitions and sets for older or novice
10-15 reps | 1 set
57
resistance training repetitions and sets for endurance
15-20 reps | 1-2 sets
58
pattern resistance training
2-3min intervals b/n sets | 48 hour rest interval
59
Flexibility frequency
>= 2-3 days/week but ideally everyday
60
Flexibility Intensity
to point of tightness or slight discomfot
61
Flexibility Time Static
10-60sec
62
Flexibility time PNF
2-6sec contration at 20-75%MVC | 10-30sec assisted stretch
63
Flexibility Type
all major muscle groups | static, dynamic, PNF
64
Flexibility Volume
60sec total stretching time/activity
65
Flexibility Pattern
warm-up prior to stretching | 2-4 reps each activity
66
goals in exercise prescription in older adults (3)
``` healthy aging (disease prevention) maintain ADL's maintain mental health ```
67
Who tends to have better cognitive function in aging?
more active individuals
68
What happens to muscle after age 50
- mus mass declines 1-2% each year | - mus strength declines 1.5% each year
69
what happens to muscle after age 60?
- mus strength decreases up to 3% each year
70
About what percent of muscle is lost in adults 65yo+?
25% | increases to 30-50% after 80yo
71
Sarcopenia
aging disease that affects changes in body composition and function
72
What is the primary factor underlying age and gender related strength difference?
muscle mass
73
at what percent of lean body mass loss is there a great incidence of mortality? severe risk mortality?
40% | 60%
74
the ratio muscle strength to muscle mass
muscle quality
75
Specific Torque Example
elbow flexor-extensor PEAK TORQUE (Nm) to arm lean mass (kg)
76
Specific Force Example
grip strength (kg) to arm lean mass (kg)
77
Mus strength is lost at a greater or weaker rater than lean mass with aging
greater
78
Frequency Elder Adults
>= 5 days mod activity >= 3 days vig activity 3-5days/wk (shorter duration, less vigorous generally)
79
Intensity Elder Adults
50-80% Max HR (mod-vig) | uses Karvonen maybe
80
RPE 6-20 scale rate of 13-15
moderate exertion
81
RPE 6-20 scale rate of 16-18
vigorous exertion
82
RPE 0-10 scale of 5-6
moderate exertion
83
RPE 0-10 scale of 7-8
vigorous exertion
84
Talk Test
aproximates ventilatory threshold on both treadmill and cycle at point where speech first becomes difficult, exercise intensity was almost exactly equal to VT
85
Duration/Time in Elderly
30-60min mod --> 150-300min/wk | 20-30min vig ---> 75-100min/wk
86
Type/Mode in Elderly
any that doesn't impost orthopedic stress and is client goal oriented
87
Progression in elderly
increases in intensity, frequency, and duration limited to 10% increase per week
88
Resistance Training in Elderly: Core Exercise
recruit large muscle areas typically multi-joint priority of training
89
Resistance Training in Elderly: Assistance Exercise
recruit small muscle areas typically single-joint "prehab" type
90
what to focus on with elderly beginners
whole body 2-3x/week
91
what to focus on with elderly mod-advanced
split routines 3-6x/week
92
Volume
= (total # reps) * (weight lifted each rep)
93
Order of exercise in elderly adults
power -> strength (1-2reps 80-90% 1-RM --> single-joint Alt upper and lower body Alt push and pull core --> assistant
94
how long should you rest between power/strength exercises (elderly)?
2-5min
95
how long should you rest b/n hypertrophy exercises (elderly)
30sec to 1.5min
96
how long should you rest b/n endurance exercises (elderly)
97
What are the health benefits of exercising in the elderly/older population (5)?
- improve resting BP - decrease risk colon cancer - decrease risk/severity DM2 - maintain skeletal integrity - decrease muscle loss/sarcopenia
98
what is required with every exercise (especially older population)
cool-down
99
What are the problems with AIDS (5)
- increasing susceptibility to infection - decreased food consumption - loss lean body mass - advanced tissue healing - death
100
Stage 1 AIDS
Asymptomatic Seropositive HIV | exercise capacity is unaffected
101
Stage 2 AIDS
Early Symptomatic HIV | reduced VO2 peak and VT
102
Stage 3 AIDS
AIDS dramatically reduced VO2 peak high intensity levels may elicit nervous and endocrine abnormalities
103
Complications with AIDS (8)
- cardio and metabolic abnormalities - fatigue - depression - chronic diarrhea - anemia - mus wasting - pneumocystis pneumonia - peri neuropathy
104
Aerobic Training AIDS FITT
F: 3-5d/wk I: 40-60% VO2 or HR T: 10 min initially, progress to 30-60min/day T: individually dependent
105
what is the intensity to exercise AIDS pt's at?
40-60% HR or VO2
106
what do you do if osteopenia is a concern with AIDS
weight baring exercises
107
what should be avoided in AIDS exercise?
avoid high risk and high contact
108
what is the goal in AIDS intervention?
improve aerobic capacity over 3-6months
109
Resistance training AIDS FIT
F: 2-3day/wk I: 2-3 sets of 10-12 reps @ 60% 1-RM T: free or machines
110
what is the goal in resistance training with people with AIDS?
improve mus strength, power, and/or endurance over 3-6months
111
what SCI levels are at risk of AD
T6 and up
112
SCI aerobic FITT
F: 3-5d/wk I: initially 40-60% VO2 reserve -> progress 60-80% T: 30-60 min -- initially 5-10 min mod intensity alternated with 5-min recover periods --> progress to 10-20min vig with 5-min recover
113
resistance training with SCI
F: 2-4d/wk I: 2-3 sets of 8-12 reps
114
hyperglycemia
blood glucose > 120
115
Macrovascular complications with DM
cardiovascular disease cerebrovascular disease PVD
116
Microvascular complications with DM
neuropathy nephropothy retinopathy
117
Benefits of exercise with ppl with DM
- improves insulin sensitivity, - improves lipid profiles, - reduces blood pressure, - promotes weight loss, - increases strength, - improves well-being
118
how do you start exercise with high risk DM pt's
start with short duration, low intensity
119
ACSM Guidelines for GXT with DM
>35yo Type I > 15 yo Type II > 10 yo
120
Aerobic ex FITT DM
F: 3-7d/wk I: 40-60% VO2 reserve or RPE 11-13/20 T: 150min/wk bouts >10min T: emphasize large mus groups
121
what do you do with a DM pt who had improved glycemic control?
>60% intensity
122
what should you closely monitor in DM?
BS | no ex if BS > 250 or
123
Chronic Kidney Disease
permanent loss kidney fxn due to injury or disease
124
GFR in CKD
GFR
125
End Stage Renal Disease (ESRD)
GFR
126
what do more than 45% of ppl with ESRD typically have
DM, sedentary, possess low fxnal capacity
127
Complications of CKD
- metabolic acidosis - hypertension - left ventricular hypertrophy - anemia - secondary hyperparathyroidism - peri neuropathy - mus weakness - autonomic dysfxn - increasing LDL, decreased HDL
128
Complications ESRD
- CHF - cardiomegaly - accelerated atherosclerosis - pericardial effusion - dysrythmias - renal osteodystrophy - persistent anemia - peritonitis
129
Management of CKD
maintenance therapies
130
what are the meds for those in CKD
anti-hypertensives erythropoietin phosphate-binding agents
131
exercise response of CKD
- low tolerance VO2 peak
132
Aerobic FITT CKD
F: 3-5d/wk I: 40-60% or RPE 11-13/20 T: 20-60min/day but can be in bouts of 3-5min T: walk, etc.
133
how do you progress CKD exercise pt
increase duration 3-5min weekly
134
resistance training CKD
F: 2-3 days/wk I: >= 1 set 10-15 reps @ 70% RM T: free or machines
135
recommendations for timing of CKD therapy
aviod right after dialysis spontaneous avulsion fx's may occur w/ long-standing renal bone diseases --> use 3-RM or higher (10-12RM) for strength assessment 8-day post transplant if approved by doc

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