Exercise Testing & Prescription Flashcards
Pre-Exercise Testing
Purpose & Includes (5)
Purpose: To sccreen for patients at risk of adverse effects with exercise who require further assessment prior to starting an exercise program
Pre-exercise Testing may include:
1. Detailed history
2. Physical Examination
3. Laboratory Tests
4. Risk stratification processing
5. Test selection
Risk Stratification
High risk (3), S/S & CV RF
Review Flow Chart on pg. 92
Guidelines for test selection - possible supervision level
HIGH RISK:
1. Cardiovascular: CVD, PVD, cerebrovascular
2. Metabolic: diabetes or renal disease
3. Pulmonary: COPD, asthma, cystic fibrosis or interstitial lung disease
S/S
1. Pain in: chest, neck, jaw, or arm
2. SOB or SOBOE
3. Dizziness/syncope
4. Orthopnea/ nocturnal dyspnea
5. Ankle edema
6. Palpitations/tachycardia
7. Intermittent claudification
8. Heart murmur
9. Unusual fatigue or SOB w/ usual activities
Risk Factors - LOW RISK:
1. Age
2. Family Hx
3. Smoking/ Alcohol
4. Sedentary life style
5. Obesity
6. HTN
7. Prediabetes
8. Dyslipidemia
Review Flow Chart on pg. 92
RF: Age
Criteria
Men: > 45 years old
Female: > 55 years old
RF: Family Hx
Criteria
Sudden death, MI, or coronary revascularization
- Before 55 years od in father/brother
- Before 65 years old in mother/sister
** Immediate family
RF: Physical Activity Level
Criteria
Not engaging in at least 30 minutes of moderate physical activity least 3 x/week in the last 3 months
“any exercise that causes shortness of breath but still allows you to talk comfortable”
RF: Obesity
Criteria
BMI > 30 kg/m2
Waist Circumference:
- Male: > 102 cm
- Female: > 88 cm
** Muscle vs carrying fat
Need to take both as BMI can give a false (+)
RF: Pre-Diabetes
Criteria
- “Any Hx of diabetes”
- “Any blood tests looking into your glucose levels”
- ** If patient is unaware count as a risk if:
- > 45 years old
- BMI: > 25 kg/m2
RF: Dyslipidemia
Criteria
LDL: > 130 mg/dL - bad cholestrol
HDL: < 40 mg/dL (if it is >60 then it counts for a negative risk factor)
Patient is on Statin medication
Total hypertension medication
RF: HTN
Criteria
Systolic BP > 140 mmHg & Diastolic BP > 90
Taking hypertension medications
RF: Stress / Psychosocial
Criteria
Depression / anxiety / stress levels
SF-36: QoL
Beck Depression Inventory: Depression
RF: Smoker
Criteria
Current smoker
Quit within last 6 months
Exposure to second hand smoke (tobacco or work environment)
Alcohol Consumption
Criteria
Male: >14 drinks/week
Female: > 9 drinks/week
RF: Diet
Criteria
N/A - Poor diet = risk factor
Risk Stratification: Screening Requirements
LOW Risk - Does NOT require medical screen prior to exercise, exercise test prior to exercise, or MD supervision of exercise test
MOD Risk - Requires a medical screen prior to exercise (VIGOROUS)
HIGH RISK - Requires a medical screen, exercise test, and MD supervision of exercise test prior to MOD & VIG exercise
Risk Stratification: Exercise Intensities
Mod & Vig
MOD Exercise:
- Intensity is 40-60% VO2 or 2-6 METs or intensity causing noticable increase in HR & breathing
VIG Exercise:
- >60% VO2 or >6 METs or intensity that causes substantial increase in HR & breathing
Exercise Testing: Indications
(3)
- Diagnostic
- Prognostic
- Prescription
More related to scope of practive & pt we may see
More details on pg. 94
Contraindications to Exercise Testing:
ABSOLUTE
(9)
- A recent significant change in resting ECG suggesting significant ischema, recent myocardial infarction (w/in 2 days), or other acute cardiac events
- Unstable angina
- Uncontrolled cardiac dysrhythmias causing symptoms or hemodynamic compromise
- Symptomatic severe aortic stenosis
- Uncontrolled symptomatic heart failure
- Acute pulmonary embolus or pulmonary infarction
- Acute myocarditis or pericarditis
- Suspected or know dissecting aneurysm
- Acute systematic infection, accompanied by fever, body aches, or swollen lymph nodes
Contraindications to Exercise Testing:
RELATIVE
Supersede if benefits > adverse event that could occur
- Left main coronary stenosis
- Moderate stenotic valvular heart disease
- Electrolyte abnormalities
- Severe arterial hypertension at rest
SBP > 200 mm Hg
DBP > 110 mm Hg - Tachydysrhythmia or bradydysrhythemia
- Hypertrophic cardiomyopathy & other forms of outflow tract obstruction
- Neuromotor, MSK, or rheumatoid disorders that are exacerbatde by exercise
- High-degree atrioventricular block
- Ventricular aneurysm
- Uncontrolled metabolic disease (DM)
Do require a pre-screening - could have other comorbidities - assess risk - Chronic infectious disease (HIV < would benefit from exercise)
- Mental or physical impairment leading to inability to exercise adequately
Maximal Exercise Testing
(3)
Also known as a stress test
Administered by Physicians (not in scope)
Graded Exercise Tests
- used to predict Vo2max - predictor
- Treadmill Tests (ie Bruce protocol)
Submaximal Exercise Testing
May be administered by a PT
Evaluative (Performance) Submaximal Exercise Tests
- Used as a mesure of endurance & exercise capacity
6-minute Walk Test (6MWT):
- The distance covered by the client walking at a comfortable pace for 6 minutes
- Subject is allowed to take breask as needed during testing
- 2 practice trials are required (learning effect < not worried about skill rather endurance & capacity)
2MWT, 10MWT, 12 MWT
** ^MWT = most validated for various populations
Predictive Submaximal Exercise Test:
- Used to predict VO2max
- Not taking patients ot complete exhaustion
Treadmill Test: Modified Bruce Protocol
Cycle Ergometer Tests: Astrand-Rhyming Cycle Ergometer Test
Indications to Prematurely Terminate an Exercise Test
General S/S (4 + 7) & Cardiovasc S/S (6) & Other (2)
General S/S:
- Fatigue (physical & verbal manifestations)
NOT good - too tired & cannot continue = STOP EXERCISE
- Signs of poor perfusion:
1. Lightheadness
2. Confusion
3. Ataxia
4. Pallor
5. Cyanosis
6. Nausea
7. Cold & clammy skin
- Shortness of breath
- Wheezing
Cardiovascular S/S:
- Onset of angina or angina-like symptoms
- Leg cramps or claudication (intermittent)
- Drop in SBP:
>10 mm Hg with an increase in work rate
Drops below the value obstained in the same position prior to testing
- Excessive increase in BP:
SBP > 250 mm Hg
DBP > 115 mm Hg
- Failure of HR to increase w/ increasing exercise intensity
- Noticeable change in heart rhythm by palpation or auscultation
Other:
- Subject requests to stop (autonomy)
- Failure of testing equipment
Coulf put someone at risk & test is no longer valid
Exercise Prescription: Components
(5)
- Exercise Selection
- Parameters
- Monitoring
- Safety
- Indications to stop exercise
Standard Intensity Ranges & High Risk Intensity Ranges
Standard Intensity = 60-85%
High Risk Intensity = 50-75%
Percentage of Maximum Heart Rate
(HR Max)
Measured (out of scope) vs Predictive
The most common method to calculate HR max is though the predictive equation:
HRmax = 220-age
Target HR = HRmax x %intensity desired
** Predictive equations may overestimate or underestimate measure HR max
ISCHEMIC HRmax = whenever pt get ischemia = STOP test & consider that their ischemic max HR THEN use that to prescribe exercise
