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Cardiorespiratory > Exercise Testing & Prescription > Flashcards

Exercise Testing & Prescription Flashcards

1
Q

Pre-Exercise Testing

Purpose & Includes (5)

A

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

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2
Q

Risk Stratification

High risk (3), S/S & CV RF

Review Flow Chart on pg. 92

A

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

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3
Q

RF: Age

Criteria

A

Men: > 45 years old
Female: > 55 years old

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4
Q

RF: Family Hx

Criteria

A

Sudden death, MI, or coronary revascularization
- Before 55 years od in father/brother
- Before 65 years old in mother/sister
** Immediate family

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5
Q

RF: Physical Activity Level

Criteria

A

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”

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6
Q

RF: Obesity

Criteria

A

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 (+)

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7
Q

RF: Pre-Diabetes

Criteria

A
  1. “Any Hx of diabetes”
  2. “Any blood tests looking into your glucose levels”
  3. ** If patient is unaware count as a risk if:
    - > 45 years old
    - BMI: > 25 kg/m2
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8
Q

RF: Dyslipidemia

Criteria

A

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

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9
Q

RF: HTN

Criteria

A

Systolic BP > 140 mmHg & Diastolic BP > 90
Taking hypertension medications

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10
Q

RF: Stress / Psychosocial

Criteria

A

Depression / anxiety / stress levels
SF-36: QoL
Beck Depression Inventory: Depression

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11
Q

RF: Smoker

Criteria

A

Current smoker
Quit within last 6 months
Exposure to second hand smoke (tobacco or work environment)

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12
Q

Alcohol Consumption

Criteria

A

Male: >14 drinks/week
Female: > 9 drinks/week

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13
Q

RF: Diet

Criteria

A

N/A - Poor diet = risk factor

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14
Q

Risk Stratification: Screening Requirements

A

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

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15
Q

Risk Stratification: Exercise Intensities

Mod & Vig

A

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

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16
Q

Exercise Testing: Indications

(3)

A
  1. Diagnostic
  2. Prognostic
  3. Prescription

More related to scope of practive & pt we may see

More details on pg. 94

17
Q

Contraindications to Exercise Testing:
ABSOLUTE

(9)

A
  1. A recent significant change in resting ECG suggesting significant ischema, recent myocardial infarction (w/in 2 days), or other acute cardiac events
  2. Unstable angina
  3. Uncontrolled cardiac dysrhythmias causing symptoms or hemodynamic compromise
  4. Symptomatic severe aortic stenosis
  5. Uncontrolled symptomatic heart failure
  6. Acute pulmonary embolus or pulmonary infarction
  7. Acute myocarditis or pericarditis
  8. Suspected or know dissecting aneurysm
  9. Acute systematic infection, accompanied by fever, body aches, or swollen lymph nodes
18
Q

Contraindications to Exercise Testing:
RELATIVE

A

Supersede if benefits > adverse event that could occur

  1. Left main coronary stenosis
  2. Moderate stenotic valvular heart disease
  3. Electrolyte abnormalities
  4. Severe arterial hypertension at rest
    SBP > 200 mm Hg
    DBP > 110 mm Hg
  5. Tachydysrhythmia or bradydysrhythemia
  6. Hypertrophic cardiomyopathy & other forms of outflow tract obstruction
  7. Neuromotor, MSK, or rheumatoid disorders that are exacerbatde by exercise
  8. High-degree atrioventricular block
  9. Ventricular aneurysm
  10. Uncontrolled metabolic disease (DM)
    Do require a pre-screening - could have other comorbidities - assess risk
  11. Chronic infectious disease (HIV < would benefit from exercise)
  12. Mental or physical impairment leading to inability to exercise adequately
19
Q

Maximal Exercise Testing

(3)

A

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)

20
Q

Submaximal Exercise Testing

A

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

21
Q

Indications to Prematurely Terminate an Exercise Test

General S/S (4 + 7) & Cardiovasc S/S (6) & Other (2)

A

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

22
Q

Exercise Prescription: Components

(5)

A
  1. Exercise Selection
  2. Parameters
  3. Monitoring
  4. Safety
  5. Indications to stop exercise
23
Q

Standard Intensity Ranges & High Risk Intensity Ranges

A

Standard Intensity = 60-85%
High Risk Intensity = 50-75%

24
Q

Percentage of Maximum Heart Rate
(HR Max)

A

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

25
Q

Percentage of Heart Rate Reserve (HRR)

A

This method gives an equivalent exercise intensity to the VO2R

HRR is calculated using the Karvonen Equation
- Target HE = [(HR max - HR rest) x % intensity desired] + HR rest

26
Q

Percentage of Maximal Oxygen Uptake
(VO2 max)

A

Target VO2max = VO2max x % intensity desired

27
Q

Percentage of Maximal Oxygen Uptake Reserve
(VO2R)

A

This method gives an equivalent exercise intensity to the HR Reserve

Target VO2R = [(VO2max - VO2 rest) x % intensity desired] + Vo2 rest

Similar to Karvonen equation

28
Q

Percentage of Meximal Metabolic Equivalents
(METs max)

A

1 MET is defined as the amount of oxygen consumed while sitting at rest

1 MET = 3.5 ml/kg/min

Target MET = (Vo2max/ 3.5 ml/kg/min) x % intensity desired

29
Q

What equations are the more accurate predictors to use (determine intensity)?

A

VO2R & HRR

30
Q

Time (duration) Recommendations?

A
  • Accumulate 30-60 minutes of moderate-intensity exercise per day
  • > 150 m/week
  • Accumulate 20-60 minutes of vigorous-intensity exercise per day
  • > 75 min/week
31
Q

Canadian Physical Activity Guidelines

A

Adults should accumulate at least 150 minutes of moderate-to-vigorous intensity aerobic physical activity per week, in bouts of 10 minutes or more to achieve health benefits

It is also suggested to add muscle & bone strengthening activities using major mm groups, at least 2 days/week

32
Q

Safety

(4)

PCE TIP

A
  • Appropriate screening & testing should take place prior to beginning an exercise program
  • All contraindications for exercise testing also apply to exercise training
  • All patients should refrain from using a Valsalva manuever
  • Upper body exercises may increase SBP, hypertensive individuals should be cautious when performing any UPPER body exercises & avoid high intensive upper body exercises
    INC BP > degree compared to L/E

** May avoid strenuous exercise (rowing) if you are dealing with someone w/ a INC risk > especially if it comes up on a vignette if UE & LE exercises - then cross out UE answers

33
Q

Indications to Terminate Exercise Session

S/S (6) + Abnormal Responses (4)

A

S/S:
1. Moderately severe or increasing angina
2. Marked dyspnea (respiratory distress)
3. Dizziness, light-headedness, or ataxia
4. Cyanosis or pallor
5. Excessive fatigue
6. Leg cramps or claudification

Abnormal Responses: Canot see or have ppl tell you
1. Failure of SBP to rise as exercise continues
2. Progressive fall in SBP of 10-15 mm Hg
3. Hypertensive BP response (SBP >200 mm Hg &/or DBP > 110 mmHg)
4. Significant change in cardiac rhythm detected by palpation or ECG (ie arrythmias, ST-T wave change elevation)

Cardiorespiratory (13 decks)

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