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Health & Wellness > Exercise Testing and Prescription > Flashcards

Exercise Testing and Prescription Flashcards

1
Q

What is the purpose of health-related physical fitness testing?

A
  1. Collecting baseline data & educating patients about current CRF status
  2. Assist in designing the Exercise Prescription (ExRx)
  3. Monitor progress through evaluation of serial measures
  4. Motivation
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2
Q

List the pretest instructions to gather prior to initiating cardiorespiratory fitness (CRF) test

A
  1. Informed consent
  2. Preparticipation health screening - PAR-Q+
  3. Medical history and CV risk factor assessment
  4. Provide participant instructions
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3
Q

What are participant instructions prior to performing a physical fitness test?

A
  1. Refrain from food, alcohol, caffeine or tobacco within 3 hours of testing
  2. Participants should be well-rested
  3. Clothing should not limit performance
  4. May need someone to drive them home after due to fatigue associated with testing
  5. Continue prescribed cardiovascular medications
  6. Participant should provide a list of current medications
  7. Drink ample fluids to avoid dehydration
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4
Q

What is CRF?

A

Ability to perform large muscle, dynamic, moderate-to-vigorous intensity exercise for prolonged periods of time

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5
Q

Why is CRF a health-related component of physical fitness?

A
  1. Poor CRF is associated with premature death from all causes, especially from CVD
  2. Increased CRF is associated with decreased rates of death from all causes
  3. High levels of CRF are associated with higher levels of habitual PA, which has many health benefits
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6
Q

What is VO2 max?

A
  • The criterion measure of CRF– or the unit for how CRF is expressed.
  • Typically expressed in mL/kg/minute
  • Closely related to functional capacity of the heart
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7
Q

What does a plateau in VO2 max indicate during exercise testing?

A

The true physiologic limit of the central circulatory dynamics.
- Not commonly observed in testing situations

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8
Q

How is VO2max different from VO2 peak?

A

VO2peak represents the peak (or highest observed) oxygen consumption observed during testing.
- Often if another condition is limiting participation in exercise testing (i.e. strength, range of motion, pain), VO2peak (rather than VO2max) will be observed.

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9
Q

VO2max can only be observed during which type of exercise test?

A

maximal exercise testing

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10
Q

What is the primary difference between maximal and submaximal exercise tests?

A
  • Maximal tests require volitional fatigue– which is not appropriate for all indvicduals.
  • Submaximal testing allows for ESTIMATION or PREDICTION of the VO2max based on HR response during submaximal testing.
  • Mode of testing should be consistent with the client’s primary exercise preference, if available
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11
Q

What elements must be achieved to allow for accurate estimation of the VO2max based on submaximal testing?

A
  1. Steady state HR at each exercise work rate (or stage) of the submaximal test
  2. Linear relationship between HR and work rate
  3. Minimal difference between actual and predicted HRmax
  4. Mechanical efficiency is the same for everyone
  5. The subject is not taking medications that alter HR response to exercise
  6. The subject is not using high amounts of caffeine, ill, or in a high-temperature (>72 degrees) environment
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12
Q

What should you measure to establish a baseline for exercise testing?

A
  1. Heart Rate
  2. Blood Pressure
  3. Rate of Perceived Exertion (RPE)
  4. Presence of dyspnea
  5. Presence of angina
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13
Q

What are the indications for stopping an exercise test?

A
  1. onset of angina or angina-like symptoms
  2. drop in SBP of >/= 10 mmHg
  3. SOB, wheezing, leg cramps, or claudication
  4. Signs of poor perfusion: light-headedness, confusion, ataxia, pallor, cyanosis, nausea, or cold and clammy skin
  5. Failure of HR to increase with increased exercise intensity
  6. Noticeable change in heart rhythm by palpation or auscultation
  7. Subject requests to stop
  8. Physical or verbal manifestations of severe fatigue
  9. Failure of the testing equipment
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14
Q

Measurement of heart rate by what means is recommended to maintain accuracy?

A

Stethoscope or ECG

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15
Q

Performance may be impacted by which factors?

A
  1. Environmental (heat, humidity)
  2. Dietary
  3. Behavioral (anxiety, smoking status, and/or previous physical activity)
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16
Q

What are the advantages of submaximal testing?

A
  1. Gives a general reflection of the level of fitness
  2. Potentially reduces risk associated with fitness testing
  3. Requires less time and effort for the participant
17
Q

How is low CRF defined?

A

by age and gender-specified normative values

18
Q

What are the risks of low CRF?

A

Low CRF is defined as being in under the 25% for age- and gender-predicted norms.

  • Risks = Two- to fivefold increases in CVD or all-cause mortality
19
Q

What the purpose and indications of graded (clinical) exercise testing?

A
  1. Diagnosis of heart disease, especially ischemic heart disease (IHD) - Current evidence does not support routine use of GXT for this purpose in those with a very low, low, or high probability of IHD
  2. Prognosis (or risk) for an adverse cardiac event
  3. Evaluation of physiologic response to exercise
  4. Assessment of pulmonary disease, exercise intolerance and unexplained dyspnea, exercise-induced bronchoconstriction, exercise-induced arrhythmias, pacemaker or heart rate response to exercise preoperative risk evaluation, claudication in peripheral arterial disease, disability evaluation, and physical activity (PA) counseling
  5. Useful in guiding recommendations for returning to work following a cardiac event
  6. Useful in developing an ExRx in those with known heart disease
  7. Maximal Exercise Testing is the gold standard to objectively measure exercise capacity
20
Q

Who can perform an graded exercise test?

A

Shift from physician to allied health professionals:

  1. Clinical Exercise Physiologists (EP-C)
  2. Nurses
  3. Physical Therapists
  4. Physician Assistants
  • overall supervision is the responsibility of a physician
21
Q

What mode of exercise most accurately reports VO2peak in GXT?

A

Treadmills

- Bruce treadmill protocol is most widely utilized

22
Q

What variable should be monitored throughout GXT?

A
  1. Electrocardiogram (ECG)
  2. Heart Rate
  3. Blood Pressure
  4. Signs & Symptoms
  5. Rate of Perceived Exertion
23
Q

What are absolute indications for terminating a symptom-limited maximal exercise test?

A
  1. ST elevation (>1mm) in leads without preexisting Q waves from prior MI
  2. Drop in SBP > 10 mmHg when accompanied by other evidence of ischemia
  3. Moderate-to-severe angina
  4. CNS sx (ataxia, dizziness, near syncope)
  5. Signs of poor perfusion
  6. Sustained ventricular tachycardia or other arrhythmia, that interferes with normal maintenance of CO during exercise
  7. technical difficulties monitoring the ECG or SBP
  8. Subject requests to stop
24
Q

What are relative indications for terminating a symptom-limited maximal exercise test?

A
  1. Marked ST displacement (horizontal or downscoping of >2mm, measured 60 to 80 ms after the J point in a pt with suspected ischemia)
  2. Drop in SBP >10 mmHg in the absence of other evidence of ischemia
  3. increased chest pain
  4. fatigue, SOB, wheezing, leg cramps or claudication
  5. Arrythmias other than sustained Vtach, including multifocal ectopy, ventricular triplets, SV tach, or bradyarrhytmias that have potential to become more complex or to interfere with hemodynamic stability
  6. exaggerated HTN response (SBP >250 mmHg or DBP >115 mmHg)
  7. development of BBB that cannot be distinguished from Vtach
  8. SPO2 = 80%
25
Q

What should the HR response be with clinical exercise testing?

A
  1. Generally, with one MET increase, 10 bpm increase in heart rate is expected.
  2. With termination of the test, HR should decrease by 12 bpm in the first minute or 22 in the second minute. Failure to do so represents poor prognosis.
26
Q

What should the BP response be with clinical exercise testing?

A
  1. Increases in 10 mmHg with increase of 1 MET is expected
  2. With termination of the test, SBP typically returns to preexercise levels or lower within 6 minutes of recovery. Failure to do so represents poor prognosis
27
Q

What is Rate- Pressure product? what is normal peak RPP?

A

RPP=HR x SBP
- Represents the ischemic threshold

Normal Peak RPP=25,000-40,000 mmHg/bpm
- Record Peak for Clinical Exercise Test

28
Q

What is the ECG expected response to exercise testing?

A
  • P-wave: increased magnitude among inferior leads
  • PR segment: shortens and slopes downward among inferior leads
  • QRS: Duration decreases, septal Q-waves increase among lateral leads, R waves decrease, and S waves increase among inferior leads

Health & Wellness (11 decks)

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