Cardiopulmonary Exercise Testing & Questionnaires Flashcards
What should a subjective assessment for cardiopulmonary rehab include?
- History of respiratory/cardiac condition
- Other medical/surgical history
- Smoking history
- Medications (including O2)
- Home ventilation
- Dyspnoea status (MMRC scale, Modified Borg)
- Social history
- Exercise tolerance
- Patient’s goals
- Identification of risk factors
What are 3 important factors that can be assessed with questionnaires?
- Depression
- Anxiety
- Heath related QOL
What are some of the questionnaires used to assess HRQOL in pulmonary rehab?
- St George’s respiratory questionnaire
- Chronic respiratory disease questionnaire
- Medical outcomes study short form 36 (SF-36)
What does the St George’s respiratory questionnaire consider?
- Cough, dyspnoea, 6MWT, FEV1
- Divided into symptoms, activity, impacts
- Lower score is better
What does the Chronic respiratory disease questionnaire consider?
- Dyspnoea, fatigue, emotional function, mastery of disease
- Scored out of 7
What does the SF-36 questionnaire consider?
- Physical functioning
- Bodily pain
- Mental health
- Vitality
- Role physical
- Social functioning
- Role emotional
- General health
What are some of the questionnaires used to assess HRQOL in cardiac rehab?
- MacNew
- Minnesota living with heart failure questionnaire
What does the MacNew questionnaire consider?
- Reliable & valid for patients with ischaemic heart disease
- Angina/chest pain, SOB, fatigue, dizziness, aching legs in last 2 weeks
What does the Minnesota questionnaire consider?
Patient’s perceptions regarding how CHF symptoms impact on their life during the preceding month
What are some of the other investigations required for cardiopulmonary assessment?
- Respiratory function tests
- ABGs
- CXR
- Angiograms
- ECGs
- Stress tests
What should an objective assessment for cardiopulmonary rehab include?
- Observation
- Palpation
- Auscultation
- Sputum clearance
- Pulse oximetry
- Heart rate
- Spirometry
- BMI
What are the 3 stages of COPD?
I - Mild: FEV1/FVC < 0.7 & FEV1 60-80% predicted
II - Mod: FEV/FVC < 0.7 & FEV 40-59% predicted
III - Severe: FEV1/FVC < 0.7 & FEV1 < 40% predicted
What are the benefits of field tests (submax)?
- Ease of application
- Provide useful info
- Sensitive to change
- Incremental or endurance
- E.g. 6MWT, ISWT
What are the benefits of lab tests (max)?
- Gold standard
- Incremental or endurance
- Measure ventilation, HR, VO2, CO2
- E.g. treadmill, cycle
What are the reasons for assessing exercise capacity?
- Determining level of functional impairment & activity limitation
- Limiting factors of exercise capacity
- Guiding exercise prescription
- Identifying O2 saturation & need for supplemental O2
- Evaluating effectiveness of rehab
What are the 8 absolute CIs to exercise?
- New/uncontrolled arrhythmia
- Resting/uncontrolled tachycardia
- Uncontrolled HT (resting SBP >180 or resting DBP > 100)
- Symptomatic hypotension
- Unstable angina
- Unstable/acute heart failure
- Unstable diabetes
- Febrile illness
What are the criteria for ending an exercise test?
- Onset of angina or angina-like symptoms
- Signs of poor perfusion
- Patient request
- Severe fatigue
- Development of abnormal gait pattern
- Tachycardia
- SpO2 <85% (precaution)
- Failure of HR to increase with exercise
What are the submax, max & functional cardiopulmonary tests?
- Submax: 6MWT, ISWT
- Max: Stress test, CPET
- Functional: TUG, strength tests, balance & flexibility
What are some of the safety issues associated with the 6MWT?
- Staff training including CPR
- Resuscitation equipment
- Emergency procedures
- Supplemental O2
- Use of walking aids
What are the limitations to exercise in pulmonary & cardiac conditions?
- Ventilatory (normal)
- Cardiac (normal)
- Circulatory (normal)
plus: - Muscle
- Metabolic
- Nutritional
- Psychological
What are the ventilatory limitations to exercise?
- Mechanical (kyphoscoliosis, pulmonary fibrosis, post-polio)
- Alveolar (V/Q mismatch, decreased drive to breath)
What are the cardiac limitations to exercise?
- Cardiac pump (heart failure)
- Inadequate CO
- Ischaemic heart disease (co-morbidity)
What are the muscle, metabolic & nutritional limitations to exercise?
- Muscle: Respiratory & peripheral
- Metabolic: Hypoxaemia, lactate production
- Nutrition: Energy consumption > supply
What are the 4 components of the cycle of inactivity & breathlessness?
- Increased breathlessness
- Fear of exertion
- Avoidance of activity
- Decreased fitness
