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EXCI 455 > LECTURE SEVEN: Laboratory-Based Physiological Assessment of older Adults > Flashcards

LECTURE SEVEN: Laboratory-Based Physiological Assessment of older Adults Flashcards

1
Q

What major system components does Cardiorespiratory Function (CRF) refer to?

A
  • Heart and blood vessels

- Lung and airways

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2
Q

What are 3 synonyms of Cardiorespiratory Function (CRF)

A
  1. Aerobic fitness
  2. Aerobic endurance
  3. Cardiorespiratory endurance
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3
Q

What are TWO good reasons for testing a person’s cardiorespiratory function (CRF)

A
  1. Provides baseline values prior to commencing a fitness program
  2. Is a key determinant of maintaining independent living (Basic ADL’s and Instrumental ADL’s)
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4
Q

What two methods are used to measure cardiorespiratory function in a lab setting?

A
  1. Direct method.

2. Indirect method

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5
Q

When measuring cardiorespiratory function directly, WHEN are the measurements taken?

A

Measurements of CRF are taken during MAXIMAL INTENSITY exercise tests.

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6
Q

What are 2 advantages of using the direct method to measure cardiorespiratory function ?

A
  1. More accurate (typical error = 3-5%)

2. Better estimation of desired exercise intensity

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7
Q

What are 3 disadvantages of using the direct method vs. the indirect method to measure cardiorespiratory function?

A
  1. Require expensive and sophisticated equipment
  2. Higher risk of adverse events (increase stress on participants)
  3. Physician supervision can be required.
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8
Q

Measuring for cardiorespiratory function, Is the direct method more appropriate for younger, healthy people and athletes or is it better for measuring Older Adults?

A

Using the Direct method to test for cardiorespiratory function is more appropriate for younger healthy people or athletes.

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9
Q

Measuring cardiorespiratory function (CRF) using the INDIRECT method does not require the use of _______________ _________________; instead, ____________ are used to estimate VO2 level.

A

Measuring cardiorespiratory function (CRF) using the INDIRECT method does not require the use of SOPHISTICATED EQUIPMENT; instead, EQUATIONS are used to estimate VO2 level.

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10
Q

What are Four advantages of using an indirect method to measure cardiorespiratory function (CRF) over using a direct method?

A
  1. Shorter to perform
  2. Lower risk for technical issues
  3. Easier to take measurements
  4. Less expensive
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11
Q

What is the disadvantage of using an indirect method to test for cardiorespiratory function (CRF) ?

A

Less accurate: Typical error = 10-20% in CRF max prediction

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12
Q

What are four common equipment used for submaximal cardiorespiratory function (CRF) testing?

A
  1. Treadmill test
  2. Leg Cycle ergometer
  3. Recumbent stepper
  4. Arm cycle ergometer
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13
Q

Why would a treadmill test be appropriate to use for submaximal cardiorespiratory function (CRF)?

A

The treadmill is a functionally relevant activity. (e.g. walking)

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14
Q

What are 4 disadvantages to using a treadmill test for submaximal cardiorespiratory function (CRF)?

A
  1. Expensive
  2. Not portable
  3. More difficult to measure BP accurately ( vs. leg ergometer)
  4. May not be appropriate for older adults with balance, gait or weight problems
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15
Q

What is the preferred equipment to use when submaximally testing older adults with gait/balance/weight problems for cardiorespiratory function (CRF)?

A

The leg cycle ergometer and recumbent stepper are preferred to the treadmill for older adults with BALANCE, GAIT, OR WEIGHT PROBLEMS ( ex. Recumbent bike, NuStep)

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16
Q

What are 2 advantages to using a Leg cycle ergometer test (vs. treadmill or nustep) for submaximal cardiorespiratory function (CRF) in OAs with gait/balance/weight problems?

A
  1. Easy to obtain BP, HR measurements

2. More portable than either treadmill or nustep

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17
Q

What are 2 disadvantages to using a Leg cycle ergometer test for submaximal cardiorespiratory function (CRF)?

A
  1. Not necessarily functional exercise

2. Can develop localized muscle fatigue (could be more difficult for some OA)

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18
Q

For non-initiated OA, what is more likely the limit to the CRF test; The use of the equipment? Or their aerobic capacity?

A

The use of the equipment

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19
Q

What is the % difference in VO2 max between the treadmill or leg ergometer when submax CRF testing?

A

VO2max is about 10% lower on the leg ergometer then when using the treadmill

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20
Q

What equipment is preferred for submaximal testing for cardiorespiratory function (CRF) of older adults with impaired motor coordination in upper or lower limbs? (ex: SCI, stroke, MS, Parkinson’s etc.)

A

The recumbent stepper (NuStep)

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21
Q

What are 4 disadvantages to using the recumbent stepper for submaximal tests for cardiorespiratory function (CRF)?

A
  1. Not necessarily functional exercise
  2. Expensive and NOT portable
  3. Difficult to take BP during test
  4. Recently –> Limited exercise protocols for testing.
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22
Q

Can you design your own testing protocol for OA’s?

A

Yes, especially for submaximal effort.

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23
Q

Which equipment is preferred for submaximal testing for cardiorespiratory function (CRF) of older adults who have difficult in ambulation?

A

Arm Cycle Ergometer

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24
Q

What are 3 advantages to using an arm cycle ergometer for submaximal testing for cardiorespiratory function (CRF) in older adults?

A
  1. Ideal for OA’s with difficult in ambulation (e.g. wheelchair or bed restrictions : stroke, SCI’s, MS etc.)
  2. Portable
  3. Inexpensive
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25
Q

What are 3 disadvantages to using an arm cycle ergometer for submaximal testing for cardiorespiratory function (CRF) in older adults?

A
  1. Localized muscle fatigue in smaller arm muscles (vs. larger leg muscles)
  2. Lack of functional specificity
  3. Difficult to take BP during test
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26
Q

Are there many protocols available using the recumbent stepper for submaximal CRF testing?

A

No, there is ONE protocol for the recumbent stepper

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27
Q

What type of test (max. vs. submax) is recommended when testing CRF in OA’s?

a) What kind of measurement is it (direct/indirect?)
b) what %APHRmax should they reach?

A

Submaximal tests are recommended

a) Indirect measurement of the volume of O2 consumed per min.
b) Participants must reach +/- 75% of max age-predicted HR

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28
Q

How accurate is submaximal testing for predicting VO2 max?

a) What is the assumption made?
b) What is the % error?

A

It’s not completely accurate;

a) Based on assumption that HR increases at the same rate as WORK rate
b) Error of 10-20%

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29
Q

When using submaximal testing to determine VO2 max, is it better to compare workload (or VO2) achieved at a given HR from test to test, or is it better to extrapolate to the maximum?

A

best = WORKLOAD achieved at a given HR

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30
Q

What submaximal equipment is most appropriate for OA with good ambulation? (although has also been successfully used in participants with stroke and Parkinson’s)

A

The treadmill

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31
Q

What is the name of the CRF test that the ACSM recommends for OA?

Describe it’s:

  • method & timeframe of increasing intensity
  • population it’s best for
  • how to modify for fitter OAs
A

The Modified Balke-Ware treadmill test:

  • slow/constant walking speed with small increases in grade every minute
  • best for those with good ambulation, as well as some with Parkinsons, Stroke
  • modify to increase walking speed and/or grade increments to better suit fit person
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32
Q

What are 9 reasons for stopping submaximal exercise test?

A
  1. Angina like symptoms (chest pain, pressure or discomfort)
    Participant :
  • is not sweating
  • Feels light-headed
  • Feels confused or unsteady
  • Looks pale
  • Has blue lips
    2. BP drops below 20 mmHg from rest
    3. No increase in systolic BP with increase exercise intensity
    4. Excessive rise in systolic BP > 260 mmHg and/ or rise in diastolic BP > 115 mmHg
    5. HR does not rise with increase in exercise intensity
    6. Participant has a noticeable change in heart rhythm (arrythmia)
    7. Participant requests to stop
    8. Participant shows physical or verbal signs of severe fatigue
    9. Failure of the testing equipment
33
Q

What is 75% max HR for 21 y/o? (if 65 bpm is normal bpm)
What is 75% max HR for 72 y/o?
And what is the clinical significance between the two results?

A

21 y/o : Predicted target HR at 75% of max = [220-21 x .75 ] -65bpm
149bpm-65bpm = increase of 84 bpm to reach 75% Max

72 y/0 : Predicted target HR at 75% of max = [220-72 x.75 ] -65bpm
111bpm-65bpm = increase of 46 bpm to reach 75% Max

Clinical Significance: CRF tests for OA do not have to be as rigorous and demanding as with YA, especially for the deconditioned OA. {Although the same amount of effort is represented}

34
Q

Who is the modified Blake-Ware treadmill test recommended for? (4)

A
  • Healthy OAs
  • Frail OAs
  • Participants with cardiac problems
  • Participants with chronic diseases and disabilities
35
Q
  1. What speed does the Balk Ware test start?

2. How do you increase the intensity?

A
  1. Slow walking speed: 3.2 km /h = 0.9 m/s

2. Slow Increase in treadmill grade

36
Q

Which treadmill protocol for VO2max is recommended more to older adults and people with chronic diseases and disabilities or cardiac problems

A

The modified Blake-Ware treadmill test is recommended over the Bruce Protocol

37
Q

What are 3 important measures/equations/guidelines to establish with the older adult client before the Modified Balke-Ware Treadmill Submax test is performed?

A
  1. Record the baseline HR and BP
  2. Calculate and record predicted HRMax ( 207-0.7 x age) and 75% of HRMax
  3. Let the client get used to walking on the treadmill. Instruct the client to:
    - Straddle the belt while holding on to the railing
    - Start the belt moving at 2 miles (3.2 km/hr)
    - Let one foot get the feel of the belt speed while holding on to the railings, step on with both feet, stand tall, and look forward;
    - Try to walk heel to toe with a normal gait pattern
    - Use fingertip support on the handrails until comfortable on the treadmill
38
Q

What are 5 important things to consider and perform during the Modified Balke-Ware Treadmill Submax test?

(speed, grade/time, measurement timing, stopping criteria)

A
  1. Set the treadmill speed to 2 miles (32.km/hr)
    [better conditioned OA: 2.5 - 3 miles (4-4.8 km/hr)]
  2. Increase the grade by 1% every minute
    (2% for better conditioned clients)
  3. Record HR and RPE near the end of every minute. BP every 2nd minute. Monitor clients condition (physical appearance, facial expressions and symptoms)
  4. Stop the test when:
    - Client reaches 75% of HRMax
    - Client requests that the test be stopped, or
    - Any indications for stopping an exercise test are apparent
  5. Record the HR and RPE immediately upon stopping the test
39
Q

What is important to remember to do after the Modified Balke-Ware Treadmill Submax test?

A
  • Reduce the grade to 0%; client keeps walking comfortably for 4 minutes
  • Monitor the client closely.
  • HR and RPE end of every minute
  • BP end of 4th minute
  • if test terminated early due to health remove client immediately from the treadmill and assess their vital signs
  • If HR and BP are still near exercising levels at the end of the 4th minute, extend cool down by another 4 minutes.
40
Q

What is the typical walking speed of OA? (km/h)

A

4.5 to 4.8 (km/h)

41
Q

Specific studies have found pedestrian walking speeds ranging from _____ km/ hr to ______ km / hr for OA and from ________ km/h to __________ km /h for younger adults.

A

Specific studies have found pedestrian walking speeds ranging from 4.5 km/ hr to 4.8 km / hr for OA and from 5.3 km/h to 5.4 km /h for younger adults.

42
Q

What is the typical walking speed of Young adult?

A

5.3-5.4 km/h

43
Q

What is the resting O2 consumption?

A

3.5 ml / kg/ min

44
Q

Calculate the predicted maximum HR of a 75-year-old man? What is this value needed for?

A

(207 – 0.7 x age) x %maxHR = (207-0.7x75)x0.75 = 116 bpm

Target HR = 116 bpm is needed to know when to stop the Balke -Ware Treadmill test

45
Q

If target HR is 116 bpm and is reached at a grade of 8%, 16% and 24% and a speed of 2 miles / hour:

  1. Calculate speed in m/min:
  2. Express grade as a decimal fraction
  3. Calculate VO2 for each grade:

VO2 = 0.1 X speed +1.8 X speed X grade + 3.5 =

A
  1. Calculate speed in m/min:
    a. 2 miles /h(26.8) = 53.6 m/min
  2. Express grade as a decimal fraction 8% grades = 0.08 / 0.16 / 0.24
  3. Calculate VO2 :
  4. 1 X speed +1.8 X speed X grade + 3.5 = (….)

for 0.08 = 16.58 ml/kg/min
for 0.16= 24.3 ml/kg/min
for 0.24= 32.0 ml/kg/min

46
Q

How do you interpret your participants VO2 result? (2)

A
  • Compare result with VO2 needs (or METs) for performing ADL’s
  • Pretest-post-test comparison after exercise training
47
Q

During pretest and post-test comparison after exercise training what will normally change as a result of the training? (3)

A
  • Increase in speed
  • Increase in grade
  • Increase in VO2
48
Q

What does the increase in VO2 over time to the same HR level indicate?

A

This indicates that your participant is improving

49
Q

Why is muscle strength testing important in OA?

A

To help avoid sarcopenia

50
Q

Is the 1 RM test recommended for the HEALTHY older adult?

A

Yes

51
Q

When is a sub-maximal alternative used to the 1 RM test when testing older adults?

A

For frail OA or participants with physical impairments and disabilities

52
Q

What are Two important points to consider about the 1-RM test?

A
  1. Avoid multiple reps

2. Decrease risk of injury

53
Q

What is the objective of the 1 RM test?

A

The objective of the 1 RM test is to find the maximum weight a person can lift once, without creating undue fatigue during the assessment

54
Q

How many cycle of adding weight are recommended during a 1 RM test?

A

Only 3 to 5 cycles of adding weight are recommended.

55
Q

Which value of what attempt will be recorded as the 1 RM value during the 1 RM test?

A

The weight lifted during the LAST SUCCESSFUL ATTEMPT is recorded as the 1 RM value

56
Q

When is a spotter necessary during the 1 RM test?

A

A spotter to control the weight is necessary when the person reaches a failure point in the test

57
Q

What are the 3 steps to the 1 -RM test?

A
  1. Instruct the client to warm up with light weights (about half the predicted maximum – which can be determined through prior familiarization sessions with the test equipment)
  2. Allow a 1-minute rest, light stretching; Instruct the client to complete three to five repetitions with a higher weight (60 percent to 80 percent of perceived maximum)
  3. Allow a 1-minute rest, light stretching; if the exertion observed in step 2 was near max, a small amount of additional weight (2.5 – 5 pounds or 1.1 – 2.3 kg) is added, and a lift attempted. Success - , no need for assistance, add more weight as before and after a 3- 5-minute rest period, the lift is attempted again. This continues until no more than 1 rep with good form .
58
Q

When would a submaximal alternative to the 1 RM test be used?

A

There are contraindications to max intensity like osteoporosis, hypertension, frailty etc.

59
Q

How can a submaximal test be used instead of the 1-RM?

A

It can be REPEATED in time to MEASURE the effect of a training program.

Ex: 6- RM for arm curls:
pretest = 10 kg
post-test = 15 kg

60
Q

What is the main purpose of balance testing in OAs?

Name 4 types of balance tests.

A

To PREVENT falls and TARGET problem areas using tests like…

  • Reactive balance
  • Static balance
  • dynamic balance
  • sensory integration organization
61
Q

How is balance testing defined?

A

The ability to control the body’s CENTRE OF MASS relative to the BASE OF SUPPORT (BOS), whether that base is stationary or moving

62
Q

How is the limits of stability (LOS) defined?

A

The MAX DISTANCE an OA can move beyond a centred position WITHOUT ALTERING the BOS is referred to as the limits of stability

63
Q

What are the four measurements of balance?

A
  1. Static Balance
  2. Dynamic Balance
  3. Reactive balance
  4. Sensory integration organization
64
Q

How is static balance defined?

A

The ability to maintain the Centre of mass (COM) directly over the Base of Support.

65
Q

Movement over a person’s base of support is measured as what?

A

Postural sway.

66
Q

How is static balance assessed?

A

Stand still for a designated period of time (20-30 sec)

67
Q

What are the different standing positions when assessing static balance?

A
  • Eyes open or closed
  • Feet heel to toe
  • One legged stance
68
Q

What does the force plate measure during a static balance assessment?

A

MAGNITUDE and VELOCITY of the postural sway

69
Q

How is dynamic balance defined?

A

The ability to control the COM while leaning through or moving beyond the LOS

70
Q

What happens when we move beyond our LOS?

A

We take a step to restore balance

71
Q

What is measured during dynamic balance assessment? (3)

A
  • Distance reached forward, backward, laterally and diagonally
  • Time of reaction
  • Movement accuracy
72
Q

Measuring the limits of stability is mainly used for what? (2)

A
  1. Testing

2. Training

73
Q

How is reactive postural control defined?

A

The ability to respond automatically to a loss of balance

74
Q

How is reactive postural control tested? (3)

A
  • Perturbation is elicited through a moving (motorized) force plate which can move forward and backward.
  • Someone with good balance will respond quickly with a counter-movement opposite to the direction of plate movement
  • Force plate measure TIME and MAGNITUDE OF REACTION TO THE PERTURBATION
75
Q

How is sensory integration and organization defined?

A

The ability to INTEGRATE and ORGANIZE sensory information provided by the visual, somatosensory, and vestibular systems

76
Q

What does the sensory integration and organization test measure? ( 2)

A
  1. How well each sensory system is functioning

2. How well the participant maintains upright balance when the information coming from the 3 systems is not in agreement

77
Q

What are the 3 sensory systems that contribute to postural control?

A
  1. Somatosensory
  2. Vestibular
  3. Visual
78
Q

The Sensory Organization Test (SOT) protocol is comprised of SIX Sensory conditions:

A
  1. Eyes - open, stable support, stable surround (All accurate)
  2. Eyes - closed, stable support (Vest./somato accurate – no vision)
  3. Eyes – open, stable support, sway surround (vest. / somato accurate – vision inaccurate)
  4. Eyes - open, sway support , stable surround (vest. / vision accurate – somato inaccurate)
  5. Eyes - closed, sway support (vest accurate – no vision, somato inaccurate)
  6. Eyes – open, sway support, sway surround (vest accurate, vision and somato inaccurate)
eyes closed = no vision 
sway support = somatosensory inaccurate
sway surround= vision inaccurate 
*vestibular always accurate with SOT
*hardest condition has vision and somato inaccurate
79
Q

In the Nashner postural study / aging, participants ≥ 65 years old were found to fall more often when during which two sensory conditions?

A

Condition 5 : No vision, inaccurate somatosensory and accurate vestibular.

Condition 6 : Inaccurate vision and somatosensory, accurate vestibular

EXCI 455 (13 decks)

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