Révision ASCM Flashcards
Unités cibles cholestérol en mg/dL:
LDL < 130 mg/dL (3,4 mmol/L)
HDL > 40 mg/dL (1,04 mmol/L)
Cholestérol total < 200 mg/dL (5,2 mmol/L).
Tour de taille cible en pouces:
Femme: < 34 po
Homme: < 40 po
Glycémies diagnostic DB:
-BG à jeun: >= 126 mg/dL (7,0 mmol/L);
-Aléatoire ou OGTT: >= 200 mg/dL (11,1 mmol/L);
-HbA1C: 6,5%
Impaired fasting glucose (en mg/dL):
100-125 mg/dL
Algorithme de l’ACSM pour la clairance médicale:
Sédentaire:
-No CV, metabolic or renal disease AND no signs or sx –> medical clearence not necessary –> light to moderate exercice recommended, may gradually progress to vigorous.
-Known CV, metabolic ou renal disease AND ASX –> medical clearence recommended –> after medical clearence, light to moderate exercice recommended, may progress to vigorous.
-Signs or sx of CV, metabolic ou renal disease (regardless of disease status) –> medical clearence recommended –> after medical clearence, light to moderate exercice recommended, may progress as tolerated.
Actif:
-No CV, metabolic or renal disease AND no signs or sx –> medical clearence not necessary –> continue moderate to vigorous exercice.
-Known CV, metabolic ou renal disease AND ASX –> for light to moderate intensity, medical clearence not necessary, medical clearence for vigorous intensity recommended –> continue with moderate exercice, following medical clearence may progress to vigorous.
-Signs or sx of CV, metabolic ou renal disease (regardless of disease status) –> discontinue exercise and seek medical clearence –> may return to exercise following medical clearence, gradually progress as recommended.
Définir:
-Light intensity;
-Moderate intensity;
-Vigorous intensity.
Light:
-30 à < 40% HRR ou VO2R
-< 3 METS
-RPE 9-11/20.
Moderate:
-40 à <60% HRR ou VO2R;
-3 à <6 METS
-RPE 12-13/20.
Vigorous:
-60% et + HRR ou VO2R;
-6 METS et +;
-RPE 14 et +.
Combien de kcal = 1 lb?
3500 kcal
Équations ACSM pour calculer VO2 à la marche, course, step et vélo:
Marche:
VO2 = 3,5 + (0,1 x vitesse) + (1,8 x vitesse x pente)
Course:
VO2 = 3,5 + (0,2 x vitesse) + (0,9 x vitesse x pente)
Stepping:
VO2 = 3,5 + (0,2 x steps/min) + 1,33(1,8 x hauteur step x steps/min)
Vélo:
VO2 = 3,5 + 3,5 + (1,8 x travail)/poids corporel
-Vitesse: m/min
-Hauteur step: m
-Travail: kgm/min (résistance en kg x 6m x rpm)
-Masse corporelle: kg
Conversion cm en po:
2,54
Conversion mile en km:
1,6
Conversion mph en m/min:
26,8
Conversion W en kgm/min
6,12
VO2 absolu en kcal/min:
5
Signes et sx de MCV, métabolique ou rénale:
-Dlr, inconfort (ou autre équivalent d’angine) dans la poitrine, cou, mâchoire, bras et autres régions qui peut résulter d’ischémie;
-Dyspnée de repos ou à faible intensité;
-Étourdissements ou syncope;
-Orthopnée ou dyspnée paroxystique nocturne;
-Œdème aux chevilles;
-Palpitations ou tachycardie;
-Claudication intermittente;
-Souffle au cœur connu;
-Fatigue ou dyspnée inhabituelle lors d’activités habituelles.
Facteurs de risques de la MCV:
Âge:
-Hommes 45 ans et +
-Femmes 55 ans et +
ATCD fam:
-IDM, revascularisation ou mort subite avant 55 ans chez père ou frère ou avant 65 ans chez mère ou soeur.
Tabagisme:
-Fumeur actuel ou ayant abandonné dans les 6 derniers mois ou exposition à fumée secondaire.
Sédentarité:
-Ne rencontre pas la recommandation de 500-1000 MET-min/sem d’AP modérée à élevée ou 75-150 min d’AP modérée à élevée/sem.
Obésité:
-IMC > 30 kg/m2
-TT hommes: > 102 cm (40 po)
-TT femmes: > 88 cm (35 po).
HTA:
-TAS >= 130 mmHg ou TAD >= 80 mmHg confirmée par mesures sur au moins deux occasions séparées OU
-Rx HTA.
DLP:
-LDL >= 130 mg/dL (3,4 mmol/L) OU
-HDL < 40 mg/dL (1,04 mmol/L) chez les hommes ou < 50 (1,3 mmol/L) chez les femmes OU
-Chol non-HDL >= 130 mg/dL (3,37 mmol/L) OU
-Rx DLP;
-Si seulement chol total dispo: >= 200 mg/dL (5,18 mmol/L).
BG:
-BG à jeun >= 100 mg/dL (5,5 mmol/L) OU
-BG OGTT >= 140 mg/dL (7,7 mmol/L) OU
-HbA1C >= 5,7%.
FDR négatif:
-HDL >= 60 mg/dL (1,55 mmol/L).
Est-ce que les individus atteints d’une maladie pulmonaire sont automatiquement référés chez le Md pour autorisation médicale avant programme ex’s?
Non.
-Les maladies pulmonaires n’augmentent pas nécessairement le risque de complication CV fatale ou non-fatale durant ou après l’effort.
Qu’est-ce qu’un patient à haut risque:
Présente au moins 1 ou plus des critères suivants:
-FEVG < 40%;
-Survivant d’arrêt cardiaque ou mort subite;
-Arythmies ventriculaires complexes (TV, multiform premature ventricular complexes (PVC) fréquentes) au repos ou à l’exercice;
-IDM ou chirurgie cardiaque compliquée par choc cardiogénique, IC chronique et/ou signes ou sx d’ischémie post-procédure;
-Hémodynamie anormale à l’exercice, surtout TAS flat ou qui diminue, ou incompétence chronotrope avec charge de travail qui augmente;
-Ischémie silencieuse significative (dépression ST >= 2 mm) à l’exercice ou au RAC;
-Signes/sx incluant angine, étourdissements, dyspnée à faibles efforts (< 5 METS) ou en récup;
-Capacité maximale fonctionnelle < 5 METS;
-Dépression clinique significative ou sx dépressifs.
Qu’est-ce qu’un patient à risque modéré?
À risque modéré s’il ne rencontre pas de critères à risque élevé ou faible:
-FEVG 40-50%;
-Signes/sx angine à niveaux modérés d’AP (60-75% de la capacité maximale fonctionnelle) ou en récup;
-Ischémie silencieuse faible à modérée (dépression ST < 2 mm) à l’exercice ou en récup.
Qu’est-ce qu’un patient à faible risque?
À faible risque si TOUS les facteurs sont présents:
-FEVG > 50%;
-Pas d’arythmie complexe au repos ou à l’exercice;
-IDM, CABG, angioplastie ou pose de tuteurs non-compliquée;
–Absence d’IC ou signes/sx indiquant ischémie post-intervention;
-Hémodynamie et ECG normaux à l’effort et en récup;
-ASX à l’effort ou en récup, incluant absence d’angine ;
-Capacité fonctionnelle maximale >= 7 METS;
-Absence de dépression clinique ou sx dépressifs.
Classification TA:
Normale:
-TAS < 120;
-TAD < 80.
Élevée:
-TAS 120-129;
-TAD < 80.
HTA stade 1:
-TAS 130-139;
-TAD 80-89.
HTA stade 2:
-TAS >= 140;
-TAD >= 90.
Classification cholestérol et TG:
Non-HDL:
-Desirable: < 130;
-Above desirable: 130-159;
-Borderline high: 150-189;
-High: 190-219;
-Very high: >= 220.
LDL-C:
-Desirable: < 100;
-Above desirable: 100-129;
-Borderline high: 130-159;
-High: 160-189;
-Very high: >= 190.
HDL-C:
-< 40 (hommes): bas;
-< 50 (femmes): bas.
TG:
-Normal: < 150;
-Borderline high: 150-199;
-High: 200-499;
-Very high: >= 500.
Méthode standardisée plis cutanés:
Procedures:
-All measurement should be done on the right side of the body with the individual standing straight;
-Caliper should be placed directly on the skin surface, 1 cm away from the thumb and finger, perpendicular to the skinfold, and halfway between the crest and the base of the fold;
-Pinch should be maintained while reading the caliper;
-Wait 1-2 sec before reading caliper;
-Take duplicate measures at each site and retest if duplicate measurements are not within 1-2mm;
-Rotate through measurement sites or allow time for skin to regain normal texture and thickness.
Abdomen:
-Vertical fold;
-2 cm to the right side of the umbilicus.
Triceps:
-Vertical fold;
-On the posterior midline of the upper arm, half-way between the acromion and olecranon processes, with the arm held freely to the side of the body.
Biceps:
-Vertical fold;
-On the anterior aspect of the arm over the belly of the biceps muscle, 1 cm above the level used to mark the triceps site.
Chest/pectoral:
-Diagonal fold;
-One-half the distance between the anterior axillary line and the nipple (men) or one-third of the distance between the axillary line and the nipple (women).
Medial calf:
-Vertical fold;
-At the maximum circumference of the calf on the midline of its medial border.
Midaxillary:
-Vertical fold;
-On the midaxillary line at the level of the xyphoid process;
-Alternate method: horizontal fold taken at the level of the xyphoid/sternal border on the midaxillary line.
Subscapular:
-Diagonal fold (45 degree angle);
-1-2 cm below the inferior angle of the scapula.
Suprailiac:
-Diagonal fold;
-In line with the natural angle of the iliac crest taken in the anterior axillary line immediately superior to the iliac crest.
Thigh:
-Vertical fold;
-On the anterior midline of the thigh, midway between the proximal border of the patella and the inguinal crease (hip).
Quelle est la recommandation d’AP en MET-min/sem? et en kcal/sem?
500-1000 MET-min d’AP d’intensité modérée à élevée / sem.
1000 kcal/sem
Décrire Astrand-Rhyming test:
-Cycle ergometer test;
-Single stage test lasting 6 min;
-Pedal rate set à 50 rpm;
-Goal: obtaining HR values between 125 and 170 bpm, with HR measured during the 5th and 6th min of work;
-Average of the two HRs used to estimate VO2max;
-Suggested work rate is based on sex and an invidual’s fitness:
–Men, unconditionned: 300 or 600 kgm/min (50-100 W);
–Men, conditionned: 600 or 900 kgm/min (100-150 W);
–Women, unconditionned: 300 or 450 kgm/min (50-75 W);
–Women, conditionned: 450 or 600 kgm/min (75-100 W).
-HR value must be adjusted for age by multiplying by a correction factor.
Décrire le modified YMCA protocol:
-Multistage submaximal cycle ergometer test;
-2-4 3 min stages of continuous exercise;
-Constant pedal rate of 50 rpm;
-Monark ergometer;
-Stage 1: 0,5 kg of resistance (25 W; 150 kgm/min);
-Stage 2: based on the steady state of HR measured during the last minute of the initial stage:
–HR < 80 bpm: change resistance to 2,5 kg (125 W, 750 kgm/min);
–HR 80-89 bpm: change resistance to 2,0 kg (100 W, 600 kgm/min);
–HR 90-100 bpm: change resistance to 1,5 kg (75 W, 450 kgm/min);
–HR > 100 bpm: change resistance to 1,0 kg (50 W, 300 kgm/min).
-Use stages 3 and 4 as needed to elicit two consecutive steady state HRs between 110 bpm and 70% HRR (85% HRmax);
-For stages 3 and 4, te resistance used in stage 2 is increased by 0,5 kg (25 W, 150 kgm/min) per stage.
Décrire 1.5 mi run/walk test et Cooper 12-min test:
1.5 mi walk/run test: cover the distance in the shortest amount of time.
-VO2max = 3,5 + 483/1.5 mi time.
Cooper 12-min test: requires the individual to cover the greatest distance in the allotted time period.
-VO2max = (distance in m - 504,9)/44,73
Décrire le Rockport One-Mile Fitness Walking Test:
-Individual walks 1 mi (1,6 km) as fast as possible;
-Test preferably on track or level surface;
-HR is obtained in the final min;
-Alternative is to measure 10s HR and x6 immediately on completion of the 1 mi (but can overestimate the VO2max).
Quel est le seuil de distance au 6 min de marche qui indique un mauvais pronostic de survie?
Les individus qui complètent moins de 300 m démontrent une plus faible survie à court terme comparativement à ceux complétant plus de 300 m.
Paramètres Queen’s College Step Test:
-Population: young adults;
-Step height: 41,3 cm;
-Step rate:
–Men: 24
–Women: 22;
-Lengnt: 3 min.
Désavantages des step tests:
-Protocols with fixed stepping rates and step heights tend to produce less accurate CRF values compared to individualized protocols;
-Special precautions for people with balance problems or are extremely deconditionned;
-Some single step tests require an energy cost of 7-9 METS, which may exceed the maximal capacity of some individuals.
Contre-indications absolues au test à l’effort:
-Acute myocardial infarction within 2 d;
-Ongoing unstable angina;
-Uncontrolled cardiac arrythmia with hemodynamic compromise;
-Active endocarditis;
-Symptomatic severe aortic stenosis;
-Decompensated heart failure;
-Acute pulmonary embolism, infarction, or deep veinous thrombosis;
-Acute myocarditis ou pericarditis;
-Acute aortic dissection;
-Physical disability that percludes safe and adequate testing.
Contre-indications relatives au test à l’effort:
-Known obstructive left main coronary artery stenosis;
-Moderate to severe aortic stenosis with uncertain relation to symptoms;
-Tachyarrythmias with uncontrolled ventricular rates;
-Acquired advanced or complete heart block;
-Recent stroke or transcient ischemia attack;
-Mental impairement with limited ability to cooperate;
-Resting hypertension with systolic > 200 mmHg or diastolic > 110 mmHg;
-Uncorrected medical conditions such as significant anemia, important electrolyte imbalance, and hyperthyroidism.
Caractéristiques du Naughton:
-Paliers de 2 min;
-La vitesse ne change pas, seulement la pente;
–Vitesse de 2 mph.
Décrire:
-Angina scale;
-Claudication scale;
-Dyspnea scale.
Angina scale:
-0: no pain;
-1: mild, barely noticeable;
-2: moderate, bothersome;
-3: moderately severe, very unconfortable;
-4: most severe or intense pain ever experienced.
Claudication scale:
-0: no pain;
-1: definite discomfort or pain, but only at initial or modest levels (established, but minimal);
-2: moderate discomfort or pain from which the patient’s attention can be diverted (ex: by conversation);
-3: intense pain (short of grade 4) from which the patient’s attention cannot be diverted;
-4: excrutiating and unbearable pain.
Dyspnea scale:
-0: no shortness of breath;
-1: light, barely noticeable;
-2: moderate, bothersome;
-3: moderately severe, very uncomfortable;
-4: most severe or intense dyspnea ever experienced.
Critères absolus d’arrêt de test maximal:
-ST elevation (> 1 mm) in leads without preexisting Q waves because of prior MI (other that aVR, aVL or V1);
-Drop in SBP of > 10 mmHg, despite an increase in work-load, when accompanied by other evidence of ischemia (AVEC SX);
-Moderate to severe angina;
-CNS symptoms (ex: ataxia, dizziness, or near syncope);
-Signs of poor perfusion (cyanosis or pallor);
-Sustained ventricular tachycardia or other arrythmia, including second or third-degree atrioventricular block, that interferes with normal maintenance of cardiac output during exercise;
-Technical difficulties monitoring the ECG or SBP;
-The individual’s request to stop.
Critères relatifs d’arrêt de test maximal:
-Marked ST displacement (horizontal or downsloping of > 2 mm, measured 60-80 ms after the J point in an individual with suspected ischemia);
-Drop in SBP > 10 mmHg (persistently below baseline) despite an increase in workload, IN THE ABSENCE of other evidence of ischemia;
-Increasing chest pain;
-Fatigue, shortness of breath, wheezing, leg cramps, or claudication;
-Arrythmias other than SVT, including multifocal ectopy, ventricular triplets, supraventricular tachycardia, and bradyarrythmias that have the potential to become more complex or to interfere with hemodynamic stability;
-Exaggerated hypertensive response (SBP > 250 mmHg or DBP > 115 mmHg);
-Development of bundle-branch block that cannot be distinguished from ventricular tachycardia;
-SpO2 <= 80%
Réponse hypertensive à l’effort homme vs femme:
Hommes: TAS >= 210 mmHg;
Femmes: TAS >= 190 mmHg.
Critères de test maximal (test VO2max):
-Plateau in VO2 (or failure to increase VO2 by 150 ml/min) with increased workload;
-Failure of HR to increase with increases in workload;
-Postexercise venous lactate concentration > 8,0 mmol/L;
-RPE at peak exercise > 17 on the 6-20 scale or > 7 on the 0-10 scale;
-Peak RER >= 1,10.
Causes de faux négatifs test à l’effort:
-Failure to reach an ischemic threshold;
-Monitoring an insufficient number of leads to detect ECG changes;
-Failure to recognize non-ECG signs and sx that may be associated with underlying CVD (ex: exertional hypotension);
-Angiographically significant CVD compensated by collateral circulation;
-MSK limitations to exercise preceding cardiac-abnormalities;
-Technical or observer error.
Causes de faux positifs au test à l’effort:
-ST segment depression > 1,0 mm at rest;
-Left ventricular hypertrophy;
-Accelerated conduction defects (ex: Wolff-Parkinson-White syndrome);
-Digitalis therapy;
-Nonischemic cardiomyopathy;
-Hypokalemia;
-Vasculoregulatory abnormalities;
-Mitral valve prolapse;
-Pericardial disorders;
-Technical or observer error;
-Coronary spasm;
-Anemia.
Sensibilité et spécificité du test à l’effort avec ECG:
Sensibilité: 68%
Spécificité: 77%
Objectif de pas/jour recommandé?
7000-8000 pas/jour avec au moins 3000 pas à un ‘‘brisk pace’’ (3 METS)
Intensité muscu pour débuter:
60-70% 1RM, 8-12 reps
Réponse physiologique des enfants à l’exercice en aigu:
-Absolute oxygen consumption
-Relative oxygen consumption
-HR
-CO
-SV
-SBP
-DBP
-Respiratory rate
-Tidal volume
-Minute ventilation
-RER
L = lower, H = higher
-Absolute oxygen consumption: L
-Relative oxygen consumption: H
-HR: H
-CO: L
-SV: L
-SBP: L
-DBP: L
-Respiratory rate: H
-Tidal volume: L
-Minute ventilation: L
-RER: L
Special considerations for exercise testing in older adults:
-Initial workload should be light (ie., < 3 METS) and workload increments should be small (ie., 0,5-1,0 METS) for those with low work capacities;
–The Naughton protocol is a good example;
-Cycle ergometer could be preferable to treadmill for those with poor balance and neuromotor coordination, impared vision, impaired gait patterns, weight-bearing limitations and/or orthopedic limitations;
-Adding treadmill handrail may be necessary (reduced balance, muscular strength, etc.)
-Many older adults exceed the 220-age predicted HR (tends to underpredict).
Absolute contraindications for exercising during pregnancy:
-Hemodynamically significant heart disease;
-Incompetent cervix, cervical insufficiency, or cerclage;
-Intrauterine growth restriction;
-Multiple gestation at risk for premature labor;
-Persistant second or third trimester bleeding;
-Placenta previa after 26-28 weeks of gestation;
-Preeclampsia or pregnancy-induced hypertension;
-Premature labor during the current pregnancy;
-Restrictive lung disease;
-Ruptured membranes;
-Severe anemia;
-Uncontrolled or poorly controlled hypertension;
-Uncontrolled thyroid disease;
-Uncontrolled T1DM;
-Unexplained persistant vaginal bleeding, such as in second or third trimester;
-Other serious cardiovascular, respiratory or systemic disorder.
Relative contraindications to exercising during pregnancy:
-Anemia or symptomatic anemia;
-Cervical dilation;
-Chronic bronchitis, mild/moderate respiratory disease or other respiratory disorders;
-Eating disorder;
-Extreme morbid obesity;
-Heavy smoker;
-History of extremely sedentary lifestyle;
-History of spontaneous premature birth, premature labor, miscarriage, or fetal growth restriction;
-Malnutrition or extreme underweight;
-Mild/moderate cardiovascular disease;
-Orthopedic limitations;
-Poorly controlled seizure disorder;
-Poorly controlled T1DM;
-Reccurent pregnancy loss;
-Unevaluated maternal cardiac arrythmia;
-Other significant medical conditions.
Warning signs to stop exercise during pregnancy:
-Amniotic fluid leakage or other vaginal fluid loss including rupture of the membranes;
-Calf pain or swelling;
-Chest pain;
-Dizziness, syncope, or faintness that does not resolve on rest;
-Headache;
-Muscle weakness or muscle weakness affecting balance;
-Regular painful uterine contractions;
-Shortness of breath prior to exertion or that is persistant and excessive that does not resolve on rest;
-Vaginal bleeding.
Glycémies cibles pour le contrôle du DB chez une personne diabétique:
-HbA1C: 7%;
-À jeun: 80-130 mg/dL (4,4-7,2 mmol/L);
-Aléatoire (post-prandial): < 180 mg/dL (10 mmol/L).
Valeurs d’hypoglycémie en mg/dL:
Adrénergique: 3,9 mmol/L = 70 mg/dL;
Neuroglycopénique: 3,0 mmol/L = 54 mg/dL.
Glycémies et HbA1C normales, pré-DB et DB en mg/dL:
Hb1AC:
-N: <= 5,6%
-Pré-DB: 5,7-6,4%
-DB: >= 6,5%
BG à jeun:
-N: < 100 mg/dL (5,6 mmol/L);
-Pré-DB: 100-125 mg/dL (5,6-6,9 mmol/L);
-DB: =>126 mg/dL (7,0 mmol/L).
OGTT:
-N: < 140 mg/dL (7,8 mmol/L);
-Pré-DB: 140-199 mg/dL (7,8-11,0 mmol/L)
-DB: >= 200 mg/dL (11,1 mmol/L).
Branches de la coronaire gauche:
-Left circumflex coronary artery;
-Left anterior descending.
Structure particulière irriguée par la CD:
Nœud SA
(Parfois irrigué aussi par la Cx).
Débit cardiaque au repos:
5 L/min (adulte)
