Midterm 2 Flashcards
1
Q
______ over ______
A
process of proctocol
2
Q
4 components of the cardiovas system
A
- arterial system: highly pressurized distribution circuit
- venous system: low pressurized collection circuit
- lungs: exchange system
- heart: pump
3
Q
what occurs in the oxygen transport cascade
A
- ventilation
- pulm diffusion (gas exchange)
- convective 02 delivery
- skeletal muscle diffusion
- skeletal muscle o2 utilization
4
Q
what are the types of energy formation
A
- metabolic pathways (aerobic and anaerobic):
- ATP-CP (alactic)
- anaerobic glycolysis (lactic)
- oxidative phosphorylation (gly, krebs, ETC)
- lipid metabolism (beta oxi)
- protein metabolism
5
Q
what does aerobic testing test and what are the considerations
A
- cellular resp,02 final e- acceptor
- 02 must be delivered to mito (extracted from capillaries, transported to the cell, then mito)
1. how is 02 going to be delivered to cells?
2. how is 02 going to be extracted by cells?
6
Q
power capacity relationship
A
- uses aerobic or cardiovascular testing
- goal is test different pathways and what limits they have
- all systems working all the time
7
Q
aerobic power
A
- 02 fuels aerobic ATP
- delivery and utilization depends on integrated and coordination of 02 transport
- ability to consume 02 at high levels requires all systems
- cardiopul system delivers 02 to muscles
8
Q
VO2 peak def
A
peak rate (power) at which 02 is being consumed, transported and used for muscular work (energy)
9
Q
02 pathway def
A
volume of 02 consumed/min (vo2)
10
Q
02 consumption and what the flux is and coordination adaptation
A
02 consumption = delivery x utilization
- capacity and effectiveness at each step delivering and utilizing 02 may limit maximal aerobic power
- the capacity for 02 to flow (flux) down the cascade will be limited by one or more steps, which limit overall 02 consumption
- dysfunction, disease, reduced perf will influence flux
- coordinated adaptation: without incr of flux, other systems will adapt to the decr in flux
11
Q
gas exchange
A
- 02 enters the 02 cascade from the atmosphere via pulm system
- chest, abdomen, diaphragm incr and decr volumes and pressure to create airflow
- connective transport via pulm system enters lungs and diffuse across alveoli
- 02 transported to peripheral tissues binds to hemoglobin
- amount and rate of gas exchange facilitated by pul min vent (respiration rate and Tidal volume-TV)
- all regulated by NS
12
Q
gas transport
A
- gas carrying blood is transported via vasc system via flow from the cardiac system
- as energy incr at muscles, the heart incr blood flow to redistribute blood flow demands
- incr heart flow and delivery by incr Q
- cardiac cycles (S,D) shorten creating more frequent HR
- electric signals initiated by the SA node, conducted to ventricles
- regulated by ANS (PNS, SNS)
13
Q
stroke volume (SV) and what preload/afterload has to do with it
A
- amount of blood pumped per beat
- influenced by volume returning to atria (preload) and the peripheries resistance against flow (afterload), the strength of ventricular contraction (contractility), and ANS
14
Q
relationships between HR and SV vs Ex
A
- HR linear incr
- SV incr then plateaus
15
Q
what is the fick equation
A
V02 = (SV x HR) x (a-vO2 diff)
- both central and peripheral mechanisms
- 10 folds incr in normal VO2 from rest to max, 23 folds for endurance athletes
- incr due to SV
16
Q
arterial pressure and tissue perfusion
A
- maintaining perfusion pressure requires pressure from the vasc system
- pressure generated from Q and vascular TPR
- when tissues are active-> more blood flow is needed to meet metabolic demands
- resistance in nonactive tissues incr via vasoconstriction
- vasodilation overall total body peripheral resistance decr
17
Q
physiological factors affecting VO2 max
A
18
Q
cardioresp (aerobic) Ex testing
A
- performing dynamic work with major muscles groups to challenge delivery and utilization of energy
- tests lasting >2min challenges aerobic metabolism
- delivery is challenged via o2 cascade, limiting rate of o2 consumption (vo2)
19
Q
vo2 vs vo2 max
A
- vo2: amount of o2 consumed per min at given a given intensity
- vo2 max: maximal amount of o2 consumed per min
20
Q
what to measure during cardioresp testing
A
21
Q
cardioresp response to acute aerobic ex
A
22
Q
HR, SV, Bp, Q, TPR, VO2, a-vO2 diff graphs
A
23
Q
HR and how to find max HR
A
- incr linearly with work rate and o2 uptake in dynamic ex
- incr due to decr diastolic
- affected by age, body position, fitness, modality, disease, medications, BV
- to find max HR= 220 - age
24
Q
SV
A
EDV - ESV (normal is 60-100 at rest, max is 100-120)
- EDV function of HR, preload, ventricle compliance
- ESV function of contractility, afterload
- incr curvilinear with ex intensity –> due to frank starling mechanism
- incr contractility from SNS activation around 50% vo2max
25
ejection fraction (EF)
EF = (SV/EDV) x 100
- normal about 65%
26
Q
SV x HR
- incr linearly with work rate
- rest: 5L/min, max: ~20L/min
- at intensities up to ~50% vo2max, Q incr due to HR and SV
27
blood flow
- at rest 15-20% of Q distributed to skeletal muscles
- in ex, myocardial BF may incr 4-5x
28
BP and pulse pressure and MAP
- SBP: linear incr with incr intensity (max ~ 190-220 mmHG) (keep <250mmHg)
- DBP: may decr slightly
- pulse pressure (SBP - DBP) generally incr in direction proportion to INT
- MAP (Q x TPR)
29
a-vO2 diff
- o2 extraction by tissues reflects diff between CaO2 and CvO2
- rest: ~5mL O2/dL, max: ~ 15mL O2/dL
30
pulm ventilation
- VE ~ 6L/min at rest, max: 15-25x
- at mild-mod INT VE incr due to incr VT (tidal volume)
- incr linearly with VCO2 (and VO2) up to a point then incr
31
cardiovasc drift
- steady state upright ex shows progressive decr SV, MAP, and incr HR
32
goals of testing
- evaluate strengths and weaknesses
- evaluate health status
- identify cause of symptoms
- identify coronary artery disease (CAD)
- inform ex prescription
- evaluate effectiveness of program
- provide ergogenic aid
- identify talent
- develop knowledge of sport/activity
33
factors to consider when to test or not
- what is a CRF going to tell me about the indiv and what am I going to do with the results
- will the test result be beneficial to their long term healthy fitness/prognosis/QOL
- what tools will incr safety/reduce risk
- indiv perception of ex and motivation
- is education needed about the risk/benefits
34
pros and cons of lab tests of CRF testing to assess VO2 max
pros:
- better test quality
- controlled environment
- better monitoring/risk reduction
- produces more data
cons:
- equipment needs
- trained personnel
- inorganic environment
- psychological impact
35
types of lab tests (submax and max) of CRF testing to test VO2 max
Maximal:
- direct: VO2max, CPET, GXT --> measures expired gases
- indirect: graded --> doesn't measure expired gases
Submaximal:
- direct: ventilatory threshold test, symptom limited test, stress test
- indirect: graded (YMCA), single stage (ebbling), lactate threshold test
36
pros and cons of field tests for CRF testing to test VO2max
pros:
- high practicality
- familiarity
- group testing
- mod-high correlation to VO2 max
cons:
- monitoring challenges
- assumptions
- prediction of VO2
- environmental issues
37
types of field tests (maximal and submax) for CRF testing to test VO2 max
maximal:
- direct: douglas bag, time trial with portable gas analysis
- indirect: beep, legar test
submaximal:
- direct: training session with portable gas analysis
- indirect: 1-mile walk, 6-min walk, step test
38
contradictions if CRF testing
39
pros and cons of predictive indirect and direct tests
indirect:
- pros: practical/accessible, reduced cost, incr client comfort, less specialized personnel, incr group size, good test quality
- cons: assumptions, decr validity, affected by medications, rigid procedures, often created for specific pop, reliant on predictive variables
direct:
- pros: highly valid/reliable, criterion measure, more usable data, not reliant on assumptions, flexible protocol, use across all pop, less reliant on predictive variables
- cons: specialized equipment, trained personnel, inorganic environment, client comfort
40
pros and cons of submaximal tests
pros:
- incr safety
- decr risk
- incr client comfort
- larger groups
- less specialized staff
- shorter duration
cons:
- decr test quality
- reliant on predictive variables
- based on assumptions
- less data for ex pr
- predictive max values
- limited diagnostic capability
41
pros and cons for maximal tests
pros:
- incr validity
- more data for ex pr
- incr diagnostic capability
- clinical effectiveness
cons:
- incr risk, incr monitoring
- specialized personnel
- incr test time
- decr client comfort
-- limited to indiv testing
42
modality considerations- treadmill, arm ergometry, bike, others (step test, rower)
43
other considerations for CRF testing
- age, demographic info, ability
- modality
- test quality
- number of indiv to test
- estimated fitness level
- current health status
- CVD risk factor
- time
- practicality
44
constant load CRF testing
- purpose is to measure phsyio response needed to support work at a pre-determined workload
- external work rate is constant
- internal work rate is varied
45
intensity dependent def
whether a steady state is achieved
- diff for each variable
46
constant load test, single stage test graph
47
ramp test with small incr in workload graph
48
incremental test, step test, gxt test graph
49
non fixed load or time trial, functional threshold power (FTP) test graph
50
what is the Cardiopulm Ex test (CPET)- graded and what are the limits
- incr int, measure body response to load by expired air (gas content)
- limited by o2 delivery
51
what to monitor for best practices
- variables should always represent workload (ECG, HR, BP, signs and symptoms, rating of perceived exhertion-RPE)
52
why do we measure CRF and why
- safety: HR, BP, ECG
- external workload: speed, grade, power
- internal workload: phsyio response
- subject of perception: fatigue, pain, discomfort
53
other monitoring scales and when symptom limited test would be terminated
- angina scale: chest pain
- dyspnea scale: difficulty breathing
- intermittent claudication scale: leg pain
tests would be terminated when scales report to 3-4 (scales are out of 4)
54
test termination for all CRF testing
physiological:
- pain/ discomfort
- dyspnea
- dizziness/syncope
- pallor/ cyanosis (poor perfusion)
- unable to maintain cadence, speed, etc
- unusual fatigue
- request to stop
equipment:
- failure
- obvious calibration error or problem with data
- safety issue
predetermined/test specific criteria:
- 3 of 4 disease specific scales
- <88% SPO2
- 85% HRmax
55
indications for terminating a symptom limited maximal test
56
electrical conduction system of the heart and the order of depolarization
- has a pacemaker
- sinoatrial node (SA node) is near the right atrium and has "leaky ion" channels that causes spontaneous depolarization
1. SA node
2. atria
3. AV node
4. AV bundle (bundle of his)
5. right and left bundle branches
6. purkinje fibres
7. ventricles
57
ECG def and what it does
records electrical activity near the heart as a voltage via electrodes on the skin
- gives info of irregular activity in the cardiac cycle
- time frame of electrical activity from various views
58
how to measure HR from an ECG
measures the R-R interval
1. 1500 method:
- used when r-r intervals are irregular
- count number of small boxes between two r waves
- divide 1500 by the number of boxes
2. instantaneous HR method:
- count number of small boxes then times by 0.04s (1 small box = 0.04s)
- divides number of seconds in a min by the time elapsed for the r-r interval
59
ECG readings on paper
- thin lines every 1mm
- thick lines every 5 mm
x axis: time
- 1 small box = 0.04s
- 1 large box = 0.20s
y axis: voltage
- 1 small box = 0.1 mV
- 1 large box = 0.5 mV
- 2 large boxes = 1.0 mV
60
normal ECG wave form
1. atrial depolarization
- p wave
- followed by PR segment
2. ventricular depolarization
- QRS complex
- Q = negative deflection
- R = positive deflection
- S = negative deflection
- followed by ST segment
3. ventricular repolarization
- T wave
4. terminal ventricular repolarization
- U wave
- only sometimes
61
normal ranges for ECG parameters
62
how to tell if there is a normal sinus rhythm (NSR)
- originates at the SA node
- r-r is constant
- general rate is between 60-100 bpm
63
bradycardia vs tachycardia
bradycardia:
- rate <60 bpm
- often not clinically significant
tachycardia:
- rate >100bpm
- can have clinical significance
64
12 lead ECG
- 4 limb leads: RA, LA, RL, LL -->gives vertical plane
- 6 chest leads: V 1-6 --> gives horizontal plane
- negative pole: zero reference
- positive pole: point of view
- line: line of sight, electrical activity
65
chest leads
- are unipolar
- 6 chest leads provide views from horizontal plane
- act as positive polls
- avg of the 3 limb leads taken as a negative reference
66
augmented limb leads
- record voltage from one positive electrode only
- takes the negative electrode as an avg of the two remaining limb leads
- sometimes unipolar or bipolar
67
views and types of augmented limb leads
68
what leads associated with what ares of the heart
69
positive deflection vs negative deflection in an ECG reading
- positive deflection: depolarization towards a lead
- negative deflection: depolarization away from a lead
70
importance of ECG in CRF testing
- diagnoses risk of CVD
- can detect acute myocardial infraction (MI) via ST segment changes
71
what does predictive testing rely on
rely's on the known relationship between o2 consumption and other variables to estimate
72
predictive maximal vs submaximal test
- maximal: assess an endpoint and converts it to vo2
- submaximal: assess a submaximal endpoint, convert it to vo2 then extrapolate to a predicted endpoint
73
HR and predicted vo2 relationship for a submaximal test
74
how to calculate energy cost - leg ergometry
75
key assumptions we make in submaximal tetsing that lead to error
- steady state is achieved at each submaximal workload
- a linear relationship exists between HR and workload
- a linear relationship exists between vo2 and workrate
- mechanical efficiency is consistent for all indiv
- maximal hr decr with age
76
what can effect hr
- pre test instructions
- anxiety/nervousness
- medications or other substances
- equipment/ measurement error
- looking at or thinking about hr
77
how to find age predicted maximal hr (APMHR)
1. 220- age
2. 208 - (0.7 x age)
- have large error estimates between 10-15 bpm
78
goals of hr response in predictive testing
- collect hr data from minimum two stages where hr is between 85-110% hrmax
- must be steady state
- hr close to 85% are considered more valid and produce better quality (SV plateau)
79
how to find hr from a graph
80
HHR
HHR = HRmax- HR rest
81
fixed distance test
- walk or run is predetermined in the shortest amount of time
- at a constant speed
- converts walking or running speed to vo2
- uses a regression equation to predict vo2 max
82
fixed time tests
- walk or run a maximal distance in a set time
- converts walking or running speed to vo2
- uses a regression equation to predict vo2 max
83
types of submaximal tests
- fixed distance
- fixed time
- multistage
- YMCA cycle ergometer
- single stage
- step test
- ebbeling
84
multistage tests
- cycle ergometer, treadmill, or step test
- uses incremental ex to incr hr to 85-110% hrmax, getting steady state at each stage
85
single stage tests
- cycle ergometer, treadmill, step tests
- uses hr response to a single workload to predict vo2 max
- steady state hr is 50-70% hhr
86
step test
- used a fixed stepping rate and high height to predict vo2
- single or multistage
- can be individualized
- good for large groups
- skill and familiarity
87
ymca cycle ergometer test protocol
- 25 W (0.5kg) increments
- 50 rpm
- 85% hrmax
- minimum two consecutive steady state stages
- predefined starting/warm up stage
- measure hr, rpe, and signs and symptoms each min
- measure bp each stage (every 3 min)
88
test termination - ymca
- when hr reaches predicted 85% hrmax
- look for hr to be within 10 bpm of 85% hrmax, finish the stage then go to recovery
89
how to calculate energy cost ymca - multistage equation
90
monitoring for ymca
91
general test termination
92
ebbeling protocol
- single stage
1. 4 min warm up at 3.4-4 mph and 0% grade (goal is to get hr 50-70% hrmax)
2. 4 min at 5% grade same speed as warm up
3. test ends after 4 min or other test termination
93
estimated vo2 max equation - ebbeling
94
how to use a nonogram to predict vo2 max
- two known data points are connected with a line to predict a third unknown value
- place marks on hr scale at steady state hr and workload scale
- connect with line to determine vo2
- connected with age
95
purposes of maximal testing
- assess potential for endurance perf
- diagnosis
- prognosis
- evaluation of the acute ex response
96
types of direct maximal tests
- cpet
- stress test
- symptom limited test
- graded ex test (GXT)/incremental
- maximal aerobic power
- sport specific testing
97
cpet testing
- using expired gas analysis and a range of other measures: ECG, o2 stats, scales, arterial blood gases
98
stress test
- a cardiac test and insinuates ecg monitoring
- may or may not measure expired gas
- similar to cpet
99
symptom limited test
- similar to cpet
- endpoint is dictated by symptoms
100
GXT/incremental test
- workload is incr in increments
- asssess energy requirement per workload
101
maximal aerobic power testing
- any test that requires maximal aerobic effort
102
skills required for supervising tests
103
physiological factors determining vo2 max
104
unphsyiological factors affecting vo2 max
- genetics
- age
- sex
- modality
- training
- environmental factors
105
physiological adaptations for improving vo2 max
- incr sv
- decr hr
- incr blood volume and hemoglobin
- incr capillary to fibre ratio
- incr mito size and number
- incr enzyme activity
106
limits to vo2 max
1. metabolic :
- factors limiting oxid phosphorylation
- enzyme concentration
- mito factors
- % type I fibres
2. o2 supply:
- factors limiting o2 transport
- sv
- blood volume
- blood flow
3. muscle o2 extraction
107
metabolic measurement carts (MMC) - what variables
1. VE (min ventilation):
- measured by pneumotach
- barometric P
- humidity
- room temp
2. FEO2 and FECO2 (concentration of O2 and CO2):
- gas analyzer
108
how does the MMC measure how much o2 is consumed
109
how is vo2 max measured
vo2 max = Q x (a-vO2 diff)
vo2 = ViO2 - VeO2
110
VE def
min ventilation (L min-1)
- tidal volume x breathing frequency
111
FiO2 def
fraction of inspired o2
- constant 0.2093 = 21%
112
FiCO2
fraction of inspired co2
- constant 0.0003 = less then 1%
113
FiN2 def
fraction of inspired n2
- constant 0.7904 = 79%
114
FeO2 def
fraction of expired o2
- depends on metabolism
- at rest ~ 16-18%
115
FeCO2 def
fraction of expired co2
- depends on metabolism
- at rest ~ 4%
116
FeN2 def
fraction of expired n2
- constant 0.7904 = 79%
117
vo2 def
amount of consumed o2
118
vco2 def
amount of co2 produced
119
rer def
respiratory exchange ratio
- = vco2/vo2
120
VE/VO2 def
ratio of min ventilation and o2 consumption
121
VE/VCO2 def
ratio of min ventilation and co2 production
122
how to calculate Vi
123
goal of cpet/maximal aerobic power testing and what it measures
- maximum amount of o2 that can be consumed per unit time by a person during progressive test to exhaustion
- measures the power of the cardioresp system (maximal rate at which o2 is taken in and transported for muscular work)
124
vo2 max and peak relationship with cpet maximal aerobic power test
vo2 max:
- with an incr in workload, no further increase in consumption (plateau)
- <150 mL/min incr in vo2
vo2 peak:
- no plateau
- volitional fatigue
- RER > 1.10
- blood lactate>8-10 mmol/L
- achievement of max HR within 10 bpm
125
what to do when choosing a protocol and what are the components of a protocol for direct max testing
- return to goals of testing
1. long warm up
2. starting between AT and ANT
3. 1% grade to stimulate outdoor terrain
4. incr of 1.0 kph every two min until max
126
modified bruce protocol
- clinical setting and stress test
127
vo2 max protocols - direct testing
- all have gradual incr in int from submaximal to maximal ex
- recommended time to exhaustion 6-12 min
- dynamic ex involving large muscle groups
128
cycle ergometer protocol
- rpm 60-70 (untrained), 70-90 (trained)
- initial resistance 75W (F) or 100W (M)
- incr resistance by 0.5 kg (25W) every two min until volitional fatigue or vo2 max attained
129
treadmill protocol
- warm up 10-15 min at self pace
- starting speed 7mph (F) and 8mph (M)
- starting at 0% grade incr WL every 2 min by 2% grade until vo2max or volitional fatigue attained
130
monitoring recommendations for graded ex testing
- spo2/pulse ox
- angina scale
- dyspnea scale
- leg pain scale
131
pre test information steps for vo2 max
- prescreen
- gather background info
- determine goals
- determine monitoring
- check equipment operation/calibration
- informed consent: introduce equipment, review mouth piece, non-verbal consent
- warm up
132
technical skills to run a safe and effective test
133
how to execute a vo2 max test
134
the script
