Cardiovascular Fitness Flashcards
(91 cards)
0
Q
Cardiorespiratory fitness is a good measure of…
A
the heart’s ability to pump oxygen-rich blood to the muscles
1
Q
Cardiorespiratory fitness AKA
A
cardiovascular or aerobic fitness
2
Q
Cardiorespiratory fitness: the ability…
A
- of the heart to serve as good functioning “pump”
- of the lungs to “load” O2 and “blow off” CO2
- of the blood to accept and carry/transport O2 and CO2
- of the working tissue (muscles) to extract and utilize the O2 delivered
3
Q
Aspects of the CR system
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Heart, vessles, blood, lungs, muscles
4
Q
CR fitness usually expressed in:
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Absolute terms: (L/min)
Relative terms: (mL/Kg*min)
Standard Units: multiples of METs
5
Q
Absolute measure of CR fitness
A
L/min
6
Q
Relative measure of CR fitness
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mL/kg*min
7
Q
standard units of CR fitness
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multiples of METs
8
Q
CR fitness best measured…
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in laboratory setting
using O2 uptake (VO2)
9
Q
Resting measures
A
HR, EKG, BP, Ventilation, O2 consumption
some (less value in knowing these measures)
important because “if there’s a problem at rest, the person has a REAL problem”
10
Q
measures during submaximal and maximal GXT
A
HR, EKG, BP, ventilation,O2 consumption
PROVIDES DYNAMIC MEASURE OF CR FITNESS
best measure of CR fitness
11
Q
GXT
A
graded exercise test
12
Q
What is the best measure of CR fitness?
A
Sabmaximal or Maximal GXT
13
Q
Why Test CR fitness? (4 reasons)
A
- Determines physiological responses at rest and during submaximal or maximal work
- provides a basis for exercise programming
- screening for CHD and pulmonary disease
- determining a person’s ability to perform a specific work task
14
Q
Factors to determine which test is appropriate to use
(4 factors)
A
Client’s age
Client’s fitness level
Client’s known health problems
Client’s risk of CHD
15
Q
Testing Sequence of Testing and Activity prescription
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Informed Consent –> Health History –> Screening –> Resting CRF, body comp, and psychological tests –> submaximal CRF tests –> test for low back function –> beginning of light activity program –> tests for muscular strength and endurance –> maximal CRF tests –> activity program revision (include games and sports here) –> periodic retest (and activity revision)
16
Q
- Informed Consent
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participants should be informed volunteers
17
Q
- Health history
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helps determine appropriate testing protocols and activity recommendations
18
Q
- Screening
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helps determine risk-benefit ratio and contraindications to testing and training
19
Q
- Resting CRF, body comp and psychological tests
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helps determine if abnormalities requiring further medical attention exist
20
Q
- submaximal CRF tests
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helps determine if it is OK to begin light activity
used to estimate maximal functional capacity
21
Q
- test for low back function
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flexibility (particularly low back function) is tested
22
Q
- maximal CRF test
A
if no problems occur up to this point
max GXT provides info to select fitness activities
23
Q
- activity program revision
A
include games and sports here
“variety is the spice of life”
keeps client interested and reduces repetition injuries
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11. periodic retest
after client achieves a minimum, fitness level program needs to be revised
increase challenge to improve results/performance
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Maximal VO2 obtained?
O2 consumption plateaus with increasing workload
<= 150 mL/min increase with increasing workload
not relative to body weight
most people do not achieve this criteria
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Peak VO2 Criteria
Predicted maximal HR achieved/exceeded (failure of HR to increase in exercise intensity)
Venous lactate [ ] exceeds 8 mM/L
RER greated than 1.15
RPE greater than 17 on Borg 20 pt scale
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If max or peak VO2 not obtained?
measure of functional aerobic capacity
| For CHD screening and classification, bring client to 85% of age-predicted max HR
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RER equation
volume CO2 produced / volume O2 consumed
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RER (fat vs carb burning)
mostly fat burned, RER ~ 0.7
mostly carbs burned, RER ~ 1.0
RER 1.15 is VERY ANAEROBIC
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VO2 max reflects...
capacity of heart and lungs to transport O2 to working muscles
utilization of O2 by the muscles during exercise
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VO2 max used to...
classify the cardiorespiratory fitness level of client
evaluate progress of client
set realistic goals for client (when periodic retest is performed)
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VO2 expressed in absolute terms
| used to...
L/min or mL/min
provides a measure of energy cost FOR NON WEIGHT BEARING ACTIVITIES
(ex. leg or arm ergometry)
directly related to body size
issue: cannot compare people who are different weights
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Relative expression of VO2
ml/kg/min or ml/kg FFm/min or ml/kg MFL/min
used to estimate the energy cost of WEIGHT BEARING ACTIVITIES (ex. walking, running, aerobic dance, stair climbing, bench stepping)
used to compare people of different sizes
used to estimate CR endurance that is independent of body weight changes
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Scaling Vo2 to an exponential function
because the relationship between VO2max and body mass is strong (r=0.86) but not perfect, some investigators use scaling to avoid under or over classification of a client's fitness level
oftentimes used for children to control for maturation differences
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body mass exponents used for scaling VO2 to an exponential function
Body mass exponent of 0.67 for individuals of similar height, weight, and training status (mL/kg^0.67/min)
body mass exponent of 0.75 to compare heterogeneous groups (young vs old, trained vs sedentary) (mL/kg^0.75/min)
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Gross VO2
represents the total rate of oxygen consumed
reflects the caloric cost of BOTH rest and exercise
Gross VO2 = Resting VO2 + Exercise VO2
can be expressed in absolute or relative terms
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Net VO2
can be expressed in absolute or relative terms
represents the rate of O2 consumption in excess of resting VO2
USED TO DESCRIBE THE CALORIC COST OF EXERCISE
Net Vo2 = Gross Vo2 - Resting VO2
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What describes the caloric cost of exercise?
net Vo2
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ACSM recommends a MAXIMAL GXT before beginning VIGOROUS (>60% VO2max) exercise program for: (4 populations)
WILL NEED TRAINED MEDICAL PROFESSIONAL PRESENT FOR MAX GXT
Older men (>=45) and older women (>=55)
Individuals of any age with moderate risk (2 or more CHD risk factors)
high risk individuals with one or more signs/symptoms of cardiovascular and pulmonary disease
high-risk individuals with known cardiovascular, pulmonary, or metabolic disease
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ACSM recommends a SUBMAXIMAL GXT before beginning a MODERATE (40-60% VO2max) exercise program
low risk and moderate risk individuals
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Factors for selection of maximal or submaximal GXT
your client's age and risk stratification (low, moderate, or high risk)
your reasons for administering the test (fitness testing vs clinical testing)
availability of equipment and qualified personnel
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Maximal or Submaximal VO2 testing - requirements
multi-stage, graded test (increase in intensity)
| most require 3 minute stages
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why 3 minute stages are important for GXT
stage length is esp important for measuring lactate levels in the blood. Lactate must travel from legs, where most of the work is being performed, to the arms where blood is being drawn)
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Procedure for administering a GXT
1. Measure the client's resting BP and HR IN EXERCISE POSTURE
2. begin GXT with 2-3 min warmup
3. monitor client's HR, BP, and RPE at regular intervals
4. discontinue GXT if test termination requirements are met
5. Active, low work rate recovery or passive cooldown
MONITOR CLIENT'S APPEARANCE AND SYMPTOMS AT ALL TIMES
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When measuring client's resting BP and HR in the exercise posture, measures may...
increase. "thoroughbred response"
| let client know that this is perfectly normal
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Warm up for GXT allows for...
familiarize client with the equipment
| prepare client for 1st stage of GXT
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Test termination requirements for GXT
client requests to stop (remember they are always considered a volunteer)
indications for stopping test are present
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Recovery post GXT
active low rate (not exceeding 1st stage intensity) recovery
continue measuring HR, BP, and RP every 1-2 mins for a minimum of 5 minutes
if client has had signs of discomfort or emergency, use a passive cool down, still measuring vital signs for at least 5 minutes
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General Indications for stopping a GXT
1. Onset of Angina or angina-like symptoms
2. Drop >= 10mmHg in SBP from baseline BP despite increase in intensity
3. Excessive rise in BP, SBP >= 250 or DBP>115
4. shortness of breath, wheezing, leg cramps, or claudication
5. signs of poor perfusion (ataxia, dizziness, pallor, syanosis, cold or clammy skin, nausea)
6. failure of HR to rise with increased exercise intensity
7. noticeable change in heart rhythm
8. subject desires to stop
9. physical or verbal manifestations of severe fatigue
10. failure of testing equipment (ex. ECG lead falls off)
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What is considered to be an excessive rise in BP/hypertensive response?
SBP >= 250mmHg
| DBP > 115mmHg
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Absolute indications for stopping GXT
1. moderate to sever angina
2. drop >= 10mmHg in systolic BP from baseline BP despite an increase in workload, when accompanied by other evidence of ischemia
3. increasing nervous system symptoms (ataxia, dizziness, or near syncope, etc)
4. signs of poor perfusion
5. ST elevation in leads without diagnostic Q waves (other than V1 or AVR)
6. sustained ventricular tachycardia
7. subject desires to stop
8. failure of testing equipment
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Relative indications for Stopping GXT
1. drop >= 10mmHg in SBP from baseline BP despite an increase in workload, in the absence of other evidence of ischemia, or failure of SBP to increase with increasing workload
2. hypertensive response (SBP >250 DBP >115)
3. increasing chest pain
4. fatigue, shortness of breath, wheezing, leg cramps, or claudication
5. arrythmias other than sustained ventricular tachycardia, including multifocal preventricular contractions (PVCs), supraventricular conduction delay that cannot be distinguished from ventricular tachycardia
6. development of BBB or intraventricular conduction delay that cannot be distinguished from ventricular tachycardia
7. ST or QRS changes such as excessive ST segment depression or marked axis shift
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PVC
multifocal preventricular contractions
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arrythmias other than sustained ventricular tachycardia
PVCs (multifocal preventricular contractions), supraventricular conduction delay that cannot be distinguished from ventricular tachycardia
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What is so important to do when conducting a GXT?
MONITOR CLIENT'S APPEARANCE AND SYMPTOMS AT ALL TIMES
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General principles of exercise testing
- Calibrate equipment
- 2-3 min warmup
- initial intensity considerably lower than anticipated maximal capacity
- intensity gradually increased
- closely observe for contraindications for testing and indications of stopping
- monitor HR at least 2 times per stage, no stabilization then extend stage by 1 minute
- measure BP and and RPE once per stage (latter portion of stage)
- submaximal GXT termination: 70% HRR or 85% HR max (unless protocol indicates otherwise
- cool-down minimum of at least 5 minutes (monitor HR and BP each min)
- testing area should be quiet and PRIVATE
- thermoneutral room
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warm up duration for GXT
2-3 minutes
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intensity increased by .... each stage during GXT
0.5 METs - 2 METs at a time
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intensity increases for GXT for older individuals
should be smaller
| 0.5 - 1 METs
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how many times should you monitor HR during each stage of GXT?
2
| if there is no stabilization (+- 5 or 6 bpm), extend stage by 1 minute
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when should you measure BP and RPE during GXT
once per stage, during latter portion of stage
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submaximal GXT termination
70% HRR
85% HR max
(unless protocol specifies otherwise)
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cool down for GXT should be... and HR and BP monitored every
minimum of 5 minutes
| HR and BP monitored each minute
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active recovery vs passive recovery
active recovery: workload should be no more than that used for 1st stage GXT
passive recovery: used in emergency when client cannot actively cool-down
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exercise tolerance should be estimated in... or assess .... if measured directly during GXT
estimated in METs
| assessed in O2 uptake if measured directly
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thermoneutral
room temp 70-72 deg F
| humidity < 60%
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considerations for protocol selection
age, sex, health and fitness status of the client
ergometry type or field test
reason for testing
type of training you areprescribing, monitoring and evaluating
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types of ergometry used in GXT protocols
treadmill, bike, arm crank
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examples of field tests used in GXT protocols
step test, mile walk/run
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types of protocols (3)
continuous protocol
continuous ramping protocol
discontinuous protocol
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continuous protocol
```
no rest between work increments
2-3 min stages
2-3 MET increases
workload may be increased linearly or nonlinearly
8-12 min duration
```
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which is the "classic" protocol
continuous protocol
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continuous ramping protocol
10-20 sec stages
MET increments much higher
10 minutes in duration
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discontinuous protocol
client rests 5-10 minutes between workloads
5-6 min stages
typically takes 5x longer to administer than continuous protocol
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reasons for GXT testing
clinical evaluation or fitness evaluation
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bike protocols
typically VO2max 6-11% lower than treadmill protocol
people quit sooner due to local discomfort and fatigue
exception is trained cyclists
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bike protocols typically .... lower than treadmill protocols
~10% lower VO2max
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treadmill protocols issues to consider
balance
orthopedic issues
BP more difficult to measure
calf and lower back pain
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Testing with bicycle ergometers
calibrate the bicycle
release tension on belt between tests
establish pedal frequency prior to setting workload
check load setting frequently during test (belt warming)
set metronome
adjust seat height so knee slightly flexed at max extension
ensure proper client position
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setting metronome for bicycle ergometry GXT
1 revolution = 2 beats
| metronome 120 = 60 rpm
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adjust seat height so knee is slightly flexed at max extension, approx ...deg
(bicycle ergometry)
5deg
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proper client position for bicycle GXT
upright
seated
hands properly positioned on handlebars
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modifications for standard GXT
| for older adults
extend warm-up to more than 3 minutes
set initial intensity to 2-3 METs
work increments should be 0.5-1 METs
adjust (Reduce) the treadmill speed to the walking ability of client when needed
extend duration of each stage (at least 3 min) allowing steady state achievement
select treadmill protocols that increase speed, instead of grade
select protocol likely to produce total test time of 8-12mins
bike protocols with clients with poor balance, poor neuromuscular coordination or impaired vision
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protocol best for older adults
bicycle ergometry
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protocol time range for older adults GXT
8-12 minutes
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for older adults, GXT protocol should increase... instead of ....
increase speed, not grade
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older adults GXT should extend warm up, stages
warm up - more than 3 minutes
| stage length - at least 3 minutes so steady state is reached
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GXT for children
bike not typically recomended
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why bike protocol not recommended for children
```
volitional effort to maintain cycling cadence
cycle size (seat height, handlebar height and position)
```
90
height requirement for most cycle ergometers
125 cm (50 inches)
