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Clinical Pop > Lecture 1 > Flashcards

Lecture 1 Flashcards

1
Q

Testing for Clinical Populations

A
  • Medical Evaluation
  • Resting ECG
  • Resting echocardiogram
  • Graded Exercise Test
  • —ECG
  • —ECG + Open Circuit Spirometry (measure expired gases)
  • —ECG + Nuclear Imaging
  • Pharmacologic Stress Testing: medication to increase HR
  • Cardiac Imaging: picture of the Heart
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2
Q

Indications for GXT

A
  • Diagnostic
  • Prognostic
  • Therapeutic
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3
Q

Diagnostic

A
  • used to diagnose Coronary Artery Disease

- often conducted with patients off medications

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4
Q

Prognostic

A
  • disease progression and prognosis

- improved with expired gas analysis

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5
Q

Therapeutic

A
  • Effectiveness of therapy
  • Functional capacity determination (peak METs)
  • Conducted with patients on medications
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6
Q

Can we do something to improve the prognosis?

A
  • increase METs (workout)

- medication (decrease ST seg depression)

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7
Q

Contraindications to GXT

A

ABSOLUTE

  • absolute concern
  • potential of serious complications

RELATIVE

  • possible medical concern
  • evaluation of risks and benefits
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8
Q

Who can perform Exercise Tests?

A

TRAINED PROFESSIONALS

  • clinical exercise physiologist
  • nurse
  • physical therapist
  • physicians

DOCTORS

  • might need to be present with high risk patients
  • in clinical settings (usually in near proximity)
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9
Q

Risks of GXT

A

incidence of death of major event requiring hospitalization

—-1-10 per 10,000 tests

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10
Q

Risks of Vigorous Exercise

A

-higher risk of sudden cardiac death or myocardial infarction in people with diagnosed or occult cardiovascular diseases than healthy people

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11
Q

Modalities

A 
TREADMILLS
LEG CYCLE ERGOMETER
-electronically braked (preferred)
-mechanically braked 
ARM ERGOMETER
OTHER ERGOMETER
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12
Q

Protocols

A 
ESTABLISHED PROTOCOLS
-e.g. Naughton, Cornell, Bruce, Ramping Bruce
CUSTOMIZED INDIVIDUALIZED PROTOCOLS
-usually ramping
SOUND PROTOCOL SELECION IS KEY
APPROPRIATE PROTOCOL
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13
Q

Appropriate Protocol is one that:

A
  • fits the individual
  • produces true VO2 peak (without premature fatigue)
  • takes about 8-12 minues
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14
Q

Most common protocol

A

ramping

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15
Q

Ramping Protocol

A

Work rate is gradually increased

  • ramping bruce
  • individualized

Avoid large changes in workload

Cycle Ramp Protocols

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16
Q

Prior to GXT

A
  1. Medical Evaluation
  2. General Interview
  3. Test Explanation
  4. Written Informed Consent
  5. Instructions Prior to GXT
17
Q

GXT Procedures

A 
ECG PREP
-good prep is essential
RESTING ECG
-supine and standing
MONITOR PATIENT THROUGHOUT
END OF EACH STAGE
-ECG, BP, RPE, pain, other scale
END OF TEST
-ECG, BP, RPE, immediately before test stops
-ECG and BP immediately after
RECOVERY
-active and passive
-ECG, BP, and symptoms
18
Q

Placement of Electrodes

A
  • RA and LA electrodes should be placed just below the right and left clavicle
  • RL and LL electrodes should be placed on the lower edge of the rib cage, or at the level of the umbilicus at mid-clavicalar line
19
Q

GXT Termination

A
  • should not be premature
  • criteria for achieving maximal effort
  • indications
  • —absolute
  • —relative
20
Q

Data from GXTs

A
  • Functional capacity
  • RPE
  • HR & BP
  • ECG
  • Rate-pressure product (RPP)
  • other scales for symptoms
21
Q

Evaluation for Functional Capacity

A

against expected exercise capacity
-use available equations or nomograms

functional aerobic deficit
-actual vs.expected Functional Capacity

22
Q

GXT Report

A

ELEMENTS

  1. Angina Status
  2. ECG findings pertaining to ischemia
  3. ECG findings pertaining to arrhythmia
  4. Functional capacity
  5. HR Response
    - –Exercise
    - –Recovery
  6. BP Response
    - –Exercise
    - –Recovery
23
Q

Exercise Training

A
  • Science
  • Art
  • Same as for Non-Clinical Populations
  • –but with special considerations
  • —-these vary by morbidity
24
Q

Goal Setting

A

The 1st Step

  • Patient and Exercise Physiologist work together
  • Must be realisitic

Goals

  • Improve Health
  • Improve Prognosis
  • Manage Symptoms
  • Improve Fitness
  • Improve Capacity for Activities for daily living
  • Improve psycho-social well-being
  • Improve Appearance
  • Other specified by patient
25
Q

Principles of Exercise Prescription

A 
SPECIFICITY OF TRAINING
PROGRESSIVE OVERLOAD
-Manipulate by changing FITT
-product yields volume
-3 stages of progression
----1. Initial
----2. Improvement
----3. Maintenance
REVERSIBILITY
-Importance of maintenance stage
26
Q

2008 Physical Activity Guidelines for Americans

A
  • published by the department of health and human services
  • guidelines for americans 6yr and older to improve health through physical activity
  • complement Dietary Guidelines for Americans
  • primary audiences
  • –policymakers
  • –health professionals
27
Q

Key Components of 2008 Guidelines

A
  • everyone can attain health benefits from physical activity
  • benefits of physical activity outweighs risks

explicit guidlines for

  • children and adolescents
  • adults
  • older adults
  • women during pregnancy and postpartum
  • individuals with disabilities
  • safe physical activity
  • messages for
  • –people with chronic medical conditions
  • —–benefits, safety, proper guidance/supervision by professionals
28
Q

Exercise for Cardiorespiratory Fitness

A

FREQUENCY

  • typically 3 times per week
  • varies by training stage

INTENSITY SET BASED ON GXT RESULTS

  • VO2 or MET & HR training zones
  • –reserve method
  • –straight % method
  • Actual workload
  • varies by training stage
  • –40-85% VO2 reserve and Heart Rate Reserve (HRR)
  • below level of symptoms

TIME

  • varies by training stage
  • continuous or interval

TYPE
-large-muscle rhythmic movement

29
Q

Reserve Method vs Straight Percentage

A 
RESERVE METHODS
take into account resting values
-assume a cardiac patient on HR controlling medication
HR peak=130 bpm
HR rest=70bpm
60% of HRpeak=78 bpm

HRR or VO2R METHOD

  • same general formula
  • [(peak-rest)] x percent as fraction] + rest
  • 60% of HRR for the patient alone

[(130-70) x 0.6] + 70 = 106bpm

30
Q

High Intensity Interval Training

A

-popular among athletes

research in clinical population

  • promising results
  • safety, not fully evaluated
31
Q

Muscular Fitness

A

MUSCULAR STRENGTH
-maximum ability to develop force by muscle

MUSCULAR POWER
-ability to apply force at any given velocity

MUSCULAR ENDURANVE

  • ability to maintain sub maximal force over extended time
  • not discussed in guidelines
32
Q

General Recommendations

A
  • lift through ROM
  • maintain neutral position
  • control movements
  • avoid valsalva
  • monitor BP
  • assess signs/symptoms
33
Q

FITT

A

FRQUENCY

  • 1-3 times per week
  • across stages of progression

INTENSITY AND DURATION

  • 60-80% of 1RM or 8-12 RM
  • 1-3 sets
  • ~2 rest
  • exercises for major muscle groups
  • –usually 8-10 exercises
  • circuit weight training
  • maintenance important
  • –reversibility
34
Q

Flexibility

A

ability to move a joint through a full range of motion

ASSESSMENT

  • goniometers
  • flexometers
  • inclinometers
  • indirect
  • —sit and each
  • —back scratch
35
Q

Stretching for Flexibility

A
  • PNF (Proceptive Neuromuscular Facilitation)
  • Ballistic
  • Static
  • –2-3 days per week
  • –exercises for whole body
  • –hold stretched for 10-30 sec

Clinical Pop (6 decks)

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