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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
Q

RER of 0.7 indicates

A

fat primary fuel source

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26
Q

RER of 1.0

A

carbs primary fuel source

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27
Q

Resting RER

A

.78-.80

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28
Q

What happens to VO2 at max effort with increasing workload?

A

plateaus

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29
Q

what happens to RER at max effort

A

RER >= 1.15

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30
Q

what happens to blood lactate at max effort

A

> = 8mmol/L

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31
Q

Max Ex Principles (6)

A
  • individuality
  • specificity
  • reversibility
  • progressive overload
  • hard/easy
  • preiodization
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32
Q

3 steps in exercise Rx

A

warm-up 5-10min
conditioning
cool-down 5-10min

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33
Q

General Frequency of Exercise

A

3-5days/week

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34
Q

Light intensity %

A

30-40% HR or VO2 reserve

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35
Q

Moderate Intensity %

A

40-60% HR or VO2 reserve

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36
Q

Vigorous Intensity %

A

60-90% HR or VO2 reserve

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37
Q

General Time of Exercise

A

30-60min/day moderate

20-60min/day vigorous

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38
Q

Type/Mode

A

aerobic and/or resistance

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39
Q

General Volume of Exercise

A

150min/week
5400-7900 steps/day
500-1000 METS/week

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40
Q

General exercise progression

A

increase time 5-10 min every 1-2 weeks the first 4-6 weeks

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41
Q

Target HR main equation

A

(220 - age) * % intensity

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42
Q

Target HR alternative equations

A

[208 - (0.7 * age)] * intensity

[(HR max - HR rest) * intensity] + HR rest

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43
Q

Mod RER

A

12-13

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44
Q

Vig RER

A

15-16

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45
Q

What does 1 MET equal

A

3.5 mL/kg*min

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46
Q

What should you do for mus strength

A

1-RM max force

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47
Q

what is muscles power formula

A

= (force * velocity) / time

rate work performance

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48
Q

what is muscle endurance

A

ability to sustain repeated contractiona

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49
Q

frequency of resistance training

A

2-3 non-consecutive days/week

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50
Q

resistance training intensity for a beginner

A

40-50% of 1-RM

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51
Q

resistance training intensity for a novice

A

60-70% of 1-RM

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52
Q

resistance training intensity for an expert

A

> = 80% of 1-RM

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53
Q

what resistance training for endurance

A
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54
Q

what resistance training for power

A

20-50% of 1-RM

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55
Q

resistance training repetitions and sets for power and strength

A

8-10 reps

2-4 sets

56
Q

resistance training repetitions and sets for older or novice

A

10-15 reps

1 set

57
Q

resistance training repetitions and sets for endurance

A

15-20 reps

1-2 sets

58
Q

pattern resistance training

A

2-3min intervals b/n sets

48 hour rest interval

59
Q

Flexibility frequency

A

> = 2-3 days/week but ideally everyday

60
Q

Flexibility Intensity

A

to point of tightness or slight discomfot

61
Q

Flexibility Time Static

62
Q

Flexibility time PNF

A

2-6sec contration at 20-75%MVC

10-30sec assisted stretch

63
Q

Flexibility Type

A

all major muscle groups

static, dynamic, PNF

64
Q

Flexibility Volume

A

60sec total stretching time/activity

65
Q

Flexibility Pattern

A

warm-up prior to stretching

2-4 reps each activity

66
Q

goals in exercise prescription in older adults (3)

A 
healthy aging (disease prevention)
maintain ADL's
maintain mental health
67
Q

Who tends to have better cognitive function in aging?

A

more active individuals

68
Q

What happens to muscle after age 50

A
  • mus mass declines 1-2% each year

- mus strength declines 1.5% each year

69
Q

what happens to muscle after age 60?

A
  • mus strength decreases up to 3% each year
70
Q

About what percent of muscle is lost in adults 65yo+?

A

25%

increases to 30-50% after 80yo

71
Q

Sarcopenia

A

aging disease that affects changes in body composition and function

72
Q

What is the primary factor underlying age and gender related strength difference?

A

muscle mass

73
Q

at what percent of lean body mass loss is there a great incidence of mortality? severe risk mortality?

74
Q

the ratio muscle strength to muscle mass

A

muscle quality

75
Q

Specific Torque Example

A

elbow flexor-extensor PEAK TORQUE (Nm) to arm lean mass (kg)

76
Q

Specific Force Example

A

grip strength (kg) to arm lean mass (kg)

77
Q

Mus strength is lost at a greater or weaker rater than lean mass with aging

78
Q

Frequency Elder Adults

A

> = 5 days mod activity
= 3 days vig activity
3-5days/wk
(shorter duration, less vigorous generally)

79
Q

Intensity Elder Adults

A

50-80% Max HR (mod-vig)

uses Karvonen maybe

80
Q

RPE 6-20 scale rate of 13-15

A

moderate exertion

81
Q

RPE 6-20 scale rate of 16-18

A

vigorous exertion

82
Q

RPE 0-10 scale of 5-6

A

moderate exertion

83
Q

RPE 0-10 scale of 7-8

A

vigorous exertion

84
Q

Talk Test

A

aproximates ventilatory threshold on both treadmill and cycle
at point where speech first becomes difficult, exercise intensity was almost exactly equal to VT

85
Q

Duration/Time in Elderly

A

30-60min mod –> 150-300min/wk

20-30min vig —> 75-100min/wk

86
Q

Type/Mode in Elderly

A

any that doesn’t impost orthopedic stress and is client goal oriented

87
Q

Progression in elderly

A

increases in intensity, frequency, and duration limited to 10% increase per week

88
Q

Resistance Training in Elderly: Core Exercise

A

recruit large muscle areas
typically multi-joint
priority of training

89
Q

Resistance Training in Elderly: Assistance Exercise

A

recruit small muscle areas
typically single-joint
“prehab” type

90
Q

what to focus on with elderly beginners

A

whole body 2-3x/week

91
Q

what to focus on with elderly mod-advanced

A

split routines 3-6x/week

92
Q

Volume

A

= (total # reps) * (weight lifted each rep)

93
Q

Order of exercise in elderly adults

A

power -> strength (1-2reps 80-90% 1-RM –> single-joint
Alt upper and lower body
Alt push and pull
core –> assistant

94
Q

how long should you rest between power/strength exercises (elderly)?

95
Q

how long should you rest b/n hypertrophy exercises (elderly)

A

30sec to 1.5min

96
Q

how long should you rest b/n endurance exercises (elderly)

97
Q

What are the health benefits of exercising in the elderly/older population (5)?

A
  • improve resting BP
  • decrease risk colon cancer
  • decrease risk/severity DM2
  • maintain skeletal integrity
  • decrease muscle loss/sarcopenia
98
Q

what is required with every exercise (especially older population)

99
Q

What are the problems with AIDS (5)

A
  • increasing susceptibility to infection
  • decreased food consumption
  • loss lean body mass
  • advanced tissue healing
  • death
100
Q

Stage 1 AIDS

A

Asymptomatic Seropositive HIV

exercise capacity is unaffected

101
Q

Stage 2 AIDS

A

Early Symptomatic HIV

reduced VO2 peak and VT

102
Q

Stage 3 AIDS

A

AIDS
dramatically reduced VO2 peak
high intensity levels may elicit nervous and endocrine abnormalities

103
Q

Complications with AIDS (8)

A
  • cardio and metabolic abnormalities
  • fatigue
  • depression
  • chronic diarrhea
  • anemia
  • mus wasting
  • pneumocystis pneumonia
  • peri neuropathy
104
Q

Aerobic Training AIDS FITT

A

F: 3-5d/wk
I: 40-60% VO2 or HR
T: 10 min initially, progress to 30-60min/day
T: individually dependent

105
Q

what is the intensity to exercise AIDS pt’s at?

A

40-60% HR or VO2

106
Q

what do you do if osteopenia is a concern with AIDS

A

weight baring exercises

107
Q

what should be avoided in AIDS exercise?

A

avoid high risk and high contact

108
Q

what is the goal in AIDS intervention?

A

improve aerobic capacity over 3-6months

109
Q

Resistance training AIDS FIT

A

F: 2-3day/wk
I: 2-3 sets of 10-12 reps @ 60% 1-RM
T: free or machines

110
Q

what is the goal in resistance training with people with AIDS?

A

improve mus strength, power, and/or endurance over 3-6months

111
Q

what SCI levels are at risk of AD

112
Q

SCI aerobic FITT

A

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
Q

resistance training with SCI

A

F: 2-4d/wk
I: 2-3 sets of 8-12 reps

114
Q

hyperglycemia

A

blood glucose > 120

115
Q

Macrovascular complications with DM

A

cardiovascular disease
cerebrovascular disease
PVD

116
Q

Microvascular complications with DM

A

neuropathy
nephropothy
retinopathy

117
Q

Benefits of exercise with ppl with DM

A
  • improves insulin sensitivity,
  • improves lipid profiles,
  • reduces blood pressure,
  • promotes weight loss,
  • increases strength,
  • improves well-being
118
Q

how do you start exercise with high risk DM pt’s

A

start with short duration, low intensity

119
Q

ACSM Guidelines for GXT with DM

A

> 35yo
Type I > 15 yo
Type II > 10 yo

120
Q

Aerobic ex FITT DM

A

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
Q

what do you do with a DM pt who had improved glycemic control?

A

> 60% intensity

122
Q

what should you closely monitor in DM?

A

BS

no ex if BS > 250 or

123
Q

Chronic Kidney Disease

A

permanent loss kidney fxn due to injury or disease

124
Q

GFR in CKD

125
Q

End Stage Renal Disease (ESRD)

126
Q

what do more than 45% of ppl with ESRD typically have

A

DM, sedentary, possess low fxnal capacity

127
Q

Complications of CKD

A
  • metabolic acidosis
  • hypertension
  • left ventricular hypertrophy
  • anemia
  • secondary hyperparathyroidism
  • peri neuropathy
  • mus weakness
  • autonomic dysfxn
  • increasing LDL, decreased HDL
128
Q

Complications ESRD

A
  • CHF
  • cardiomegaly
  • accelerated atherosclerosis
  • pericardial effusion
  • dysrythmias
  • renal osteodystrophy
  • persistent anemia
  • peritonitis
129
Q

Management of CKD

A

maintenance therapies

130
Q

what are the meds for those in CKD

A

anti-hypertensives
erythropoietin
phosphate-binding agents

131
Q

exercise response of CKD

A
  • low tolerance VO2 peak
132
Q

Aerobic FITT CKD

A

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
Q

how do you progress CKD exercise pt

A

increase duration 3-5min weekly

134
Q

resistance training CKD

A

F: 2-3 days/wk
I: >= 1 set 10-15 reps @ 70% RM
T: free or machines

135
Q

recommendations for timing of CKD therapy

A

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

825 (5 decks)

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