Exercise testing and prescription

Question 1

What are the uses of exercise testing?

Answer 1

Diagnostic
Prognostic
Prescription

Question 2

What are the absolute contraindications for exercise testing? (SHADECAMP)

Answer 2

1. Systemic infection with fever, body aches or swollen lymph glands
2. Heart failure (uncontrolled symptomatic)
3. Aortic stenosis (symptomatic severe)
4. Dissecting aneurysm (suspected or known)
5. ECG (significant resting change)
6. Cardiac dysrhythymias (uncontrolled)
7. Angina (unstable)
8. Myocarditits or percarditis (acute)
9. Pulmonary embolus or Pulmonary infarction

Question 3

What are relative contraindications for exercise testing? (VALVENHH)

Answer 3

1. Ventricular aneurysm
2. Arterial hypertension at rest (severe > 200SBP , > 120 DBP)
3. Left main coronary stenosis
4. Valvular heart disease (moderate stenotic)
5. Electrolyte abnormalities
6. Neuromotor, MSK, or rheumatoid disorders that are exacerbated by exercise
7. Hypertrophic cardionmmyopathy and other forms of outflow tract obstruction
8. High-degree atrioventricular block
9. Tachydysrhythmia or bradydysrhythymia
10. Chronic infectious disease (HIV)
11. Uncontrolled metabolic disease (i.e DM)
12. Mental or Physical impairment leading to inability to exercise adequately

Question 4

Is maximal exercise testing in PT scope?

Answer 4

NO, must be done by physician

Question 5

Is a graded Exercise test a maximal exercise test?

Answer 5

Yes

Question 6

What types of exercise tests should PTs do?

Answer 6

Submaximal exercise testing
6MW test (distance client walks comfortably in 6min, subject can take breaks, 2 practice trials are required)

Predictive submaximal exercise testing
Used to predict VO2 max
- treadmill tests (modified bruce)
- cycle ergometer (Astrand-Rhyming cycle)

Question 7

General signs and symptoms to prematurely end the exercise test?

Answer 7

1. Fatigue
2. Signs of poor perfusion (lightheadedness, confusion, ataxia, pallor, cyanosis, nausea, cold clammy skin)
3. Shortness of breath
4. Wheezing

Question 8

Cardiovascular signs and symptoms to prematurely end exercise test?

Answer 8

1. Onset angina
2. Leg cramps or claudication
3. Drop in SBP (> 10mmHg with increase work rate, drops below value obtained in the same position prior to testing)
4. Excessive increase BP (SBP > 250, DBP > 115)
5. Failure of HR to increase with increasing intensity
6. Noticeable change in heart rhythm by palpation or ausc

Question 9

What are other miscelaneous signs and symptoms for prematurely ending exercise test?

Answer 9

1. Failure of testing equipment
2. Subject asks to stop

Question 10

What are the exercise prescription variables?

Answer 10

1. Exercise selection
2. Parameters
3. Monitoring
4. Safety
5. Indications to stop exercise

Question 11

What is exercise selection based on?

Answer 11

Goals, ability, patient preference and safety

Question 12

What are the parameters for exercise? (FITT)

Answer 12

Frequency, intensity, type, time`

Question 13

What is frequency?

Answer 13

Number of days/week dedicated to exercise
AEROBIC EXERCISE RECOMMENDED 3-5 DAYS at moderate to vigorous intensity

Question 14

What is Intensity?

Answer 14

The level of difficulty of a given exercise or exercise session

Question 15

What are the measures used for intensity?

Answer 15

1. RPE
2. % HR max
3. % HR reserve
4. Maximal oxygen uptake (VO2 max)
5. % maximal oxygen uptake reserve (VO2R)
6. Percentage of maximal metabolic equivalents (METs max)

Question 16

What are the standard intensity ranges?

Answer 16

60-85% max measures used for intensity
does not include RPE

Question 17

What are the high-risk intensity ranges?

Answer 17

50-75% max measures used for intensity
does not include RPE

Question 18

What are the BORG and modifed BORG values?

Answer 18

6-20 = BORG (number * 10 = HR)
0-10 = Modified BORG

Question 19

HR max equation?

Answer 19

220 - age = HR max

Question 20

Percentage of maximum HR equation?

Answer 20

Target HR = HR max (220-age) x % intensity required (i.e 0.5 or 50%)

example: 50-year-old
(220-50 = 170 HR max x 0.50 = 85
Target HR = 85 BPM

Question 21

Percentage of HR reserve equation?

Answer 21

The method gives an equivalent exercise intensity to the VO2R
Target HR = [(HR max - HR rest) x %intensity desired] + HR rest

Example: 50 year old
[(170 - 70) x 0.50] + 70
120 = HR reserve

Question 22

Percentage of VO2 max equation?

Answer 22

Target VO2 max = VO2 max x % intensity desired

Question 23

Percentage of Maximal Oxygen Uptake Reserve equation?

Answer 23

Target VO2 max = [(VO2 max - VO2 rest) x % intensity] + VO2 rest

Question 24

Percentage of the Maximal METS equation?

Answer 24

1 MET is amount of oxygen consumed at rest
1 MET = 3.5 ml/kg/min
Target MET = (VO2max/3.5ml/kg/min) x % intensity desired

Question 25

What is time used for in exercise prescription?

Answer 25

A measure of the amount og time or the reps/sets of physical activity of the exercise session is performed Recommended adults

Question 26

Recommended moderate exercise amount for adults?

Answer 26

30- 60 min moderate intensity exercise per day > 150 min/week moderate intensity continuously or intermittently

Question 27

Recommended vigorous exercise amount for adults?

Answer 27

20 - 60 min vigorous exercise/day > 75 min/week vigorous intensity continuously or intermittently

Question 28

Types of exercise?

Answer 28

Aerobic (walking, jogging, running, swimming, biking) Anaerobic (resistance training, free weights, machine, body weight)

Question 29

Canadian Physical Activity Guidelines?

Answer 29

150min/week moderate to vigorous activity in 10min bouts or more + 2 days bone and muscle strengthening

Question 30

What variables should be monitored during exercise?

Answer 30

HR, BP, SpO2, dyspnea and other signs and symptoms of respiratory distress

Question 31

Should a patient be supervised if they are at risk of adverse effects from exercise? What about stable patients?

Answer 31

Yes. Stable patients should be trained and educated on self-monitoring, maintaining the intensity of exercise within appropriate limits, and keeping record of details of exercise sessions prior to carrying out an exercise program independently.

Question 32

What are the safety measures and tips for exercise programming?

Answer 32

Appropriate screening and testing should be done prior to exercise program All contraindications for exercise testing apply to training All patients should refrain from usingthe Valsalva manoeuvre Upperbody exercise may increase SBP, hypertensive individuals should be cautious when performing upperbody exercise

Question 33

Indications to terminate exercise selection?

Answer 33

1. Moderately severe or increasing angina 2. Marked dyspnea 3. Dizziness, lightheadedness, or ataxia 4. Cyanosis or pallor 5. Excessive fatigue 6. Leg cramps or claudication 7. Failure rise SBP as exercise intensity increases 8. Progressive fall in SBP of 10-15mmHg 9. Hypertensive BP response (> 200 SBP, and or > 110 DBP) 10. Significant change in cardiac rhythm detected by palpation or ECG

Question 34

What puts a patient at high risk for exercise?

Answer 34

Cardiovascular: CVD, PVD or cerebrovascular Metabolic: Diabetes or renal disease Pulmonary: COPD, asthma, cystic fibrosis or interstitial lung disease Pain in: chest, neck, jaw or arm, SOB, or SOBOE Dizziness/syncope Orthopnea/nocturnal dyspnea Ankle edema Palpitation/tachycardia Intermittent claudication Heart murmur Unusual fatigue or SOB with usual activities

Question 35

What is required if a patient is at high risk for exercise?

Answer 35

A medical screen is required prior to exercise An exercise test is required prior to exercise MD supervision of the exercise test, if necessary

Question 36

CV risk factors?

Answer 36

1. Age - (men > 45, women > 55) 2. Family Hx - sudden death, MI or coronary revascularisation (before 55, father brother, before 65, mother sister) 3. Physical activity level - not engaging in at least 30 min phys act 3x/week in the last 3 months 4. Obesity - BMI > 30, waist circumference > 102 male, > 88 female 5. Pre-diabetes - any Hx DM, any blood tests looking at glucose levels, risk if older 45 and BMI > 25 6. Dyslipidemia - LDL > 130, HDL < 40 (if > 60 counts neg risk factor), statin medication, total serum cholesterol > 200mg 7. Hypertension - SBP > 140, DBP > 90 8. Stress/psychological - depression/anxiety/stress levels, SF-36 QOL, beck depression inventory 9. Smoker - current smoker, quit within last 6 months, exposure to second-hand smoke 10. Alcohol consumption - male > 14 drinks, female > 9 drinks

Question 37

What is low risk and moderate risk?

Answer 37

Low risk = < 2 risk factors + no signs and symptoms of CV/metabolic/pulmonary disease Moderate risk = > 2 risk factors + no signs and symptoms of CV/metabolic/pulmonary disease

Question 38

What is the purpose of a pre-exercise screen?

Answer 38

To reduce the risk of adverse effects of exercise, patients may require further assessment prior to starting an exercise program