Discussion 3: Exercise Testing Protocols and Termination Criteria Flashcards Preview

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Flashcards in Discussion 3: Exercise Testing Protocols and Termination Criteria Deck (17):
1

What considerations are made when performing a GXT?

  • Mode
  • Protocol
  • Procedures
  • Termination criteria

2

Define mode.

Type of exercise equipment to be used during the GXT

3

What modes will be used in this lab?

  • Treadmill
  • Bicycle ergometer
  • Arm bike

4

What are the advantages and disadvantages of using a treadmill as a GXT mode?

Advantages:

  • Familiar movement
  • Engages large amount of muscle mass
  • Generates a greater CV response
  • Workload can be adjusted thru speed and incline to be appropriate for a wide range of abilities

Disadvantages:

  • Motion artifact on ECG
  • Safety concerns if person is prone to tripping or loss of balance
  • Orthopedic conditions may prevent some individuals from being able to perform weight-bearing exercise

5

What are the advantages and disadvantages of using a bicycle ergometer as the mode of a GXT?

Advantages:

  • Familiar movement
  • Very little artifact on the ECG
  • Workload is highly adjustable thru changes in cadence or resistance
  • Not weight-bearing for those w/ orthopedic concerns
  • Very safe w/ minimal risk of falling

Disadvantages:

  • Engages a smaller amount of muscle mass
  • Takes longer to reach CV end points
  • Limited by localized muscle fatigue rather than CV responses

6

What are the advantages and disadvantages of using an arm bike as the mode of a GXT?

Advantages:

  • Good alternative for individuals w/ conditions that prevent the from using their lower body

Disadvantages:

  • Uses a very small amount of muslc emass limited to the upper body
  • Movement is less familiar
  • Excessive movement artifact on ECG
  • DIfficult to measure BP
  • Limited by localized muscle fatigue rather than CV responses

7

Define protocol.

Design of the GXT

8

Describe the protocol for a GXT. What determines duration? Workload?

  • Multiple stages of increasing workload that are 2-3 mins in duration
    • Duration long enough to allow individual to reach steady state
    • Each increase in workload needs to be small enough to prevent severe hemodynamic challenges and avoid muscle fatigue, but large enough to ensure that the individual will reach the chosen test termination point in under 20 mins

9

What comprises the procedures of a GXT.

  • How a test is administered
  • What is being measured
  • How it is measured
  • When it is being measured

10

What will be measuring in this lab?

  • ECG activity
  • BP
  • RPE
  • Changes to subject's appearance
  • Workload

11

During exercise, what sound do we use to denote diastolic BP?

4th Korotkoff sound: the point at which the tappings sounds become severely muffled

12

What is RPE?

Rating of Perceived Exertion = subjective measure of the amount of work the subject feels they are doing

  • Can be measured using the conventional 6-20 Borg Scale or a simplified 1-10 scale

13

What indicates steady state during exercise?

Chagne in HR < 5 bpm per min b/t measurements for a given workload

14

When does a GXT end?

When the individual reaches a pre-determined end point of demonstrates any of the termination criteria

15

What are some common end points of a GXT?

  • Reaching a particular HR (usually determined as a percent of predicted HRmax or HRreserve)
  • Reaching a particular workload (certain MET or metabolic equivalent)

16

What will be using as our GXT end point in this lab?

85% of the age predicted max HR (220 - age)

17

List the termination criteria of a GXT.

  • Individual requests to stop
  • S/Sx of poor exercise tolerance
    • Dizziness, light-headedness, ataxia, staggering
    • Nausea
    • Dyspnea or wheezing
    • Severe fatigue
    • Confusion or lack of responsiveness
    • Claudication or pain
    • Cyanosis, pallor, or clammy skin
  • Onset of angina
  • Drop in BP > 10 mmHG despite increase in workload
  • Excessively high BP (SBP > 250 mmHG, DBP > 115 mmHg)
  • Failure of HR to increase w/ increasing workload
  • Bradycardia or unexplained drop in HR
  • ECG changes:
    • ST segment elevation > 2 mm (in leads other than V1 and aVR)
    • ST segment depression > 2 mm, downsloping depression, or axis shift
    • Sustained ventricular tachycardia
    • High frequency PVCs, multifocal PVCs, bi- or trigeminy PVCs
    • Onset of heart block of bundle branch block
    • Supraventricular tachycardia, atrial flutter, atrial fibrillation
  • Equipment failure or inability to assess ECG activity or BP