Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pulm > Exercise Testing and Prescription > Flashcards

Exercise Testing and Prescription Flashcards

1
Q

Indications for Exercise Testing in Pulmonary Patients

A

Understand severity of dyspnea

Understand O2 sat at rest and with activity

Determine exercise/activity tolerance

Provide information for exercise prescription

Evaluate for heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

PRIOR to ex testing

A 
History
Screening
Lab values
Physical exam
Resting physiological measurements
PAR-Q and You
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PAR-Q

A

Physical Activity and Readiness Questionnaire

Good to add to any outpatient intake form to ID reasons to send pt back to physician prior to commencing an ex program

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Risks with Exercise Testing

A 
Mm soreness
Diaphoresis
SOB/SOA
Angina
MI
Stroke
Death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Safety with Exercise Testing

A

CPR certification
Emergency procedures in place
Monitoring equipment well maintained and available

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ACSM ABSOLUTE C/I to Ex testing/training

A 
Unstable angina
Uncontrolled cardiac dysrhythmia
Critical aortic stenosis (symptomatic)
Uncontrolled symptomatic heart failure
Acute PE
Acute myocarditis/pericarditis
Known dissecting aneurysm
Acute systemic infection
Significant EKG suggesting ischemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ACSM RELATIVE C/I to Ex testing/training

A 
Moderate stenotic valvular heart disease
Electrolyte abnormalities
Severe HTN
Tachy or brady dysrrhythmias
Neuromm, musculoskel, or RA d/o exacerbated by exercise
High degree (3rd) heart block
Uncontrolled metabolic disease
Chronic infection disease
Mental or physical impairment leading to inability to exercise adequately
Orthostatic BP drop with symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Severe HTN

A

SBP > 200 mmHg

and/or

DBP > 110 mmHg at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Orthostatic BP drop

A

SBP drop > 20 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Upper Limits for Exercise Intensity

A

Plateau or decrease in SBP (> 10 mmHg), SBP > 240 mmHg, DBP > 110 mmHg

Onset of angina or other symptoms of cardiovascular insufficiency

Increase frequency of ventricular arrhythmias

Onset of other significant EKG changes (2 or 3 degree AVB, a-fib, SVT, ventricular ectopy)

Radionuclide evidence of Left vent dysfunction or onset of moderate to severe wall motion abnormality during exercise

Other signs and symptoms of ex tolerance

Pt request to stop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Other signs and symptoms of exercise intolerance

A

Blah blah ask PT Fam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

HR Max

A

208 - 0.7(age)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you monitor a pt during ex testing?

A 
HR
BP
RR
O2 sat
RPE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When to use Borg Scale/RPE

A

Pts on meds that blunt HR response…

Betablockers
Digoxin
Calcium channel blockers
ACE inhibitors

Correlated well with HR if multiply rating by 10 (using 6-20 RPE scale)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Ratings of Dyspnea

0

A

No dyspnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ratings of Dyspnea

1

A

Mild dyspnea (mild, barely noticeable)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Ratings of Dyspnea

2

A

Moderate (bothersome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Ratings of Dyspnea

3

A

Moderate severe (very uncomfortable)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Ratings of Dyspnea

4

A

Severe/intense - you need to stop!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why Choose Max vs Submax ex testing

A

Maximal you are working someone to their MAX levels – it’s a hard test

Submax

Why?…

Lack of supplies
Don’t need to know

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Max Exercise Testing

A

To diagnose disease
To determine max aerobic capacity and establish ex protocols
Assess medication levels
Exercise prescription
Assessment of ex/endurance training (outcome measure)

Increased sensitivity in CAD, especially asymptomatic

Better estimate of VO2 max/peak bc you will have a direct measurement of that

Make sure you have medical supervision and emergency equipment

Open circuit spirometry

Metabolic cart measures the gasses that are being released

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are you looking at during a max ex test?

A

HR plateau
SBP plateau
Amt CO2 produced causes sudden increase RR (signals anaerobic work)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

RER

A

As it’s reaching 1, you’re maximized and using glucose for fuel

If it’s below 1, you’re using fat and carbs

Measured on metabolic cart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Commonly used symptom limited graded exercise tests (GXT)

A

Bruce Protocol - treadmill

Astrand-Rhyming protocol - cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Bruce Protocol vs Astrand-Rhyming
Higher VO2 with Bruce | Less expensive with UEE
26
Sub max ETT
Assess cardiorespiratory fitness Determined HR response to 1 or more submax work rates Results used to predict VO2 peak/max Can give additional information (re: subject's response to exercise)
27
Graded exercise tests
Cycle Treadmill Low Level Graded Exercise Test
28
Field tests
Individual dictates intensity 6MWT Shuttle WT 1 mile walk 1 mile run
29
General Guidelines Before Exercise Testing
Avoid recent activity Wait 2 hours after eating 2 hours after smoking or caffeine (can affect HR)
30
6MWT
Regression equations for calculating VO2 and distance walked Prescribe exercise by estimating VO2 max/peak Determine need for supplemental O2 (if O2
31
What if we stop the 6MWT due to non pulmonary/cardiac reason - can we still use these results (HR) for exercise prescription?
No because the HR is not indicative of a max HR
32
6MWT Facts
Men tend to walk further than women Taller walks further than shorter As we get older, we tend not to walk as far
33
6MWT VO2 max regression
Elderly - predicts VO2 max COPD - Predicts VO2 max, need for transplant CHF - predicts VO2 max, mortality, need for transplant
34
Can't walk at least 200 m?
Indicators of suboptimal surgical results
35
Rockport 1 Mile Walk Test
Have pt walk briskly Measure HR last quarter mile
36
1 Mile Jog
Should take 8-9 min HR should not exceed 180 at end of test
37
Cross an intersection
Need to walk at over 0.8-1.22 m/sec
38
Community ambulation
Requires 50-122 cm/sec or 0.5-1.22 m/sec
39
Walk Velocity Test
6m, 10m, etc Great way to tell if someone is able to be a community ambulator
40
Step Tests
Estimate VO2 max from direct HR response after stepping up and down step with specified time frame or at set frequency Compare HR response to norms to give idea of fitness Astrand-Rhyming 3-min YMCA Step Test Harvard Step Test
41
Duke Activity Status Index (DASI)
Self-administered questionnaire Sums of weights for "yes" replies You would use this if a person can't get up AT ALL Right after cardiac surgery Someone who is too weak Someone who is unstable
42
Max Score on DASI
58.6
43
MET
VO2/3.5 Avg adult has around a 10 MET level activity tolerance ***IF VO2
44
Goals for Ex Training
``` Increase activity tolerance Increase function Increase QOL Central hemodynamic adaptations Peripheral adaptations to exercise ```
45
Factors to Consider When Designing a Exercise Program
``` Exercise goals Primary and secondary medical dx Medications Physical condition at baseline Activity preferences/personal goals ```
46
Essential Components of ExRx
Mode Frequency Intensity Duration
47
Mode
Type of exercise Focus on large mm groups Try to match the exercise Rx with your pt's interests and goals Principle of specificity Overload principle Reversibility
48
Frequency
days per week the exercise will be performed to achieve goal 5 days or MOST days of the week!
49
Intensity
% of maximum capacity ACSM - 50% for most pulm pts AACVPR - 40% for most pulm pts
50
Duration
Time required for exercise on a given day Much controversy, ACSM recommends 30 min a day or 150 min/wk at moderate intensity
51
AHA Guidelines
Ex 3-4 days a week 30-60 min 40-60% VO2 max
52
FITT
Freq Int Time Type
53
Specificity
Training effects are specific to ex performed and mm used
54
Overload principle
To show functional improvement, system must be exposed to higher load than is usually accustomed to
55
Reversibility
Detraining occurs when stop training
56
HRR
HR max - HR rest
57
Karvonen method
Target HR = (% intensity)(HRR) + (HR rest)
58
VO2 reserve method of target VO2
Target VO2 = (% ex intensity)(VO2R) + (VO2 rest)
59
Intensity considerations
Age Habitual physical activity level Physical fitness level Health status
60
Cardiopulm endurance
70-85% HRmax
61
Weight loss
55-65% HRmax
62
Deconditioned individuals
40-50% HRR 55-65% HRmax
63
When should pts reach their ventilatory threshold?
50-60%
64
RPE
11-13 on 6-20 scale ACSM recommends 12-16 for physiologic adaptations
65
Stages of an Ex Session
Warm up: 5-10 min Conditioning phase: 20-60 min Cool down: 5-10 min Recovery: time to return to baseline
66
Long, slow distance LSD
Approx 70% VO2max Approx 80% HRmax Test intensity with the talk test
67
Pace/Tempo (Lactate Threshold Training)
Steady pace ex for 20-30 min
68
Interval
3-5 min with work:rest ratio 1:1
69
Repetition
30-90 sec with work:rest ratio 1:5
70
Fartlek
Combo of... LSD Pace/tempo Interval Repetition
71
Strength Training
Focus on low wt, high rep for endurance training Use baseline 10 rep max test vs. 1 rep max due to risk of injury Avoid valsalva to prevent vasovagal response
72
Flexibility
Minimal 2-3 days/week Ideally 5-7 days/week Static stretch of all major mm groups

Pulm (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions