Week 6- Exercise Testing

Question 1

PART 1

Answer 1

PART 1:

Question 2

What is exercise testing?

Answer 2

A noninvasive procedure that evaluated an individual’s capacity for dynamic exercise.

Question 3

Outcomes of Exercise Testing Information Provided:

• _______/________ information
• Define exercise/functional __________.
• Provides _______/________ data.
• Provides guidance in ______________.

Answer 3

• diagnostic/prognostic
• exercise/functional capacity
• baseline/follow-up
• directing exercise training program

Question 4

• At what age should men and women be exercise tested?

- Who else should be be exercise tested?

Answer 4

-Men >45, Women >55

• Family Hx of CVD
• Cigarette Smoking
• Sedentary Lifestyle (not meeting exercise guidelines for previous 3 months)
• Obesity
• HTN
• Dyslipidemia
• Prediabetic

Question 5

Exercise Testing ABSOLUTE Contraindications. (9)

Answer 5

• Recent significant change in resting ECG***
• Unstable angina***
• Uncontrolled cardiac dysrhythmias***
• Uncontrolled symptomatic HF
• Acute PE or pulmonary infarction***
• Severe symptomatic aortic stenosis
• Acute myocarditis/pericarditis
• Suspected/known dissecting aneurysm
• Acute systemic infection***

Question 6

Exercise Testing RELATIVE Contraindications. (10)

Answer 6

• L main coronary stenosis
• e- imbalance
• Moderate stenotic valvular heart disease
• Severe untreated arterial HTN (SBP >200, DBP >120)
• HCM
• Uncontrolled metabolic disease (DM)
• High degree AV block
• Tachy/bradycardia
• Advanced/complicated pregnancy
• Abnormal increase in weight in past 2 days with stable HF

Question 7

ABSOLUTE Contraindications to STOP Exercise:

• Onset of _______.
• Suspicion of ________.
• Drop in SBP >___mmHg with increased work rate.
• SBP >____mmHg and/or DBP >____mmHg.
• Serious _________.
• Significant _________ HTN.
• Signs of poor ________ including pallor, cyanosis, cold and clammy skin.
• SOB, wheezing, leg cramps, or claudication.
• Technical inability to monitor ECG.
• Patient request.

Answer 7

• angina or angina-like symptoms
• MI
• SBP >10mmHg
• SBP >250mmHg and/or DBP >115mmHg
• serious arrhythmias
• pulmonary HTN
• poor perfusion

Question 8

What are some signs of poor perfusion? (3)

Answer 8

• pallor
• cyanosis
• cold and clammy skin

Question 9

RELATIVE Contraindications to STOP Exercise:

• Failure of _______ to increase with increasing exercise intensity.
• Change in heart _______.
• Patient request.
• Severe fatigue.
• Failure of testing equipment.
• Ventricular aneurysm.

Answer 9

• HR

- heart rhythm

Question 10

“No exercise testing required before walking, flexibility, or resistance training. Follow ACSM guidelines for exercise testing before _______-________ ________ exercise training.”

Answer 10

-mod-vig aerobic

Question 11

Submaximal Exercise Test:

• Patient achieves a predetermined _________ exertional level and then test is stopped.
• May be symptom limited or have a predetermined end point (___% HRmax).
• These tests tend to be ______, ________ protocol.
• No expired gas analysis performed.
• VO2max OR VO2peak is typically _________ from the results of the test

Answer 11

• submaximal
• 85% HRmax
• ramped, progressive protocol
• extrapolated

Question 12

PART 2: BRUCE PROTOCOL & 6MWT

Answer 12

PART 2: BRUCE PROTOCOL & 6MWT

Question 13

• What is the Bruce Protocol?

- Is it a direct indicator of VO2max?

Answer 13

• The Bruce Protocol is a standard test in cardiology and is comprised of multiple exercise stages of three minutes each.
• No, but we can ESTIMATE peak VO2.

Question 14

What information can we derive from the Bruce Protocol Test if expired gases are not analyzed? (4)

Answer 14

1. ) Stage completed
2. ) Exercise duration
3. ) HR/RPE/Dyspnea at FIXED WORK LOADS (each stage = a fixed work load)
4. ) Estimated VO2max

Question 15

What are (3) methods to estimate age specific HR?

Answer 15

Traditional Method
-220-age

Tanaka Method
-207-(0.7*age)

Inbar Method
-205.8-(0.685*age)

Question 16

• What provides the best available approximation of VO2max?

- How is it calculated?

Answer 16

• Heart Rate Reserve (HRR)

- HRR = Estimated HRmax-HRrest

Question 17

What are the (3) instances where the Bruce Protocol is stopped?

Answer 17

1. ) Achieve age-predetermined HR (85% HRmax)
2. ) Volitional fatigue
3. ) Patient choice

Question 18

What (3) things at measured at each stage of the Bruce Protocol?

Answer 18

1. ) HR
2. ) RPE
3. ) BP

Question 19

What is another exercise test commonly used?

Answer 19

6MWT

Question 20

What (6) measurements need to be made during an assessment of exercise capacity?

Answer 20

• BP
• HR
• RR
• RPE
• Rating of breathlessness (during and at end)
• Arterial O2sats

Question 21

Are there age matched healthy normals for the 6MWT?

Answer 21

Yes (males and females)

Question 22

What is the purpose of the 6MWT?

Answer 22

Used to establish status and to set goals.

Question 23

What was the 6MWT originally developed for?

Answer 23

Functional capacity

Question 24

What is the MCSD for the 6MWT?

Answer 24

54-80m

Question 25

PART 3: STRENGTH AND POWER

Answer 25

PART 3: STRENGTH AND POWER

Question 26

What are some ways to measure strength? (4)

Answer 26

- MMT - 1RM - Hand-held dynamometer - Isokinetic machines

Question 27

Power: - Power = _____ * ______ - Reflects a combination of _______ and ________. - Tests will have a _______ and ______ component.

Answer 27

- Power = Force * Velocity - strength and endurance - force and time

Question 28

What are some tests utilized to measure power? (3)

Answer 28

- Peak Cycling Test - Stair Climb Test - 30s Sit to Stand

Question 29

Which is better in determining functional status and independently predicted functional dependency even after accounting for additional neurophysiological and health status indicators? (Power, Strength, Aerobic Capacity)

Answer 29

POWER