Exercise testing and prescription

Question 1

Why would a therapist perform an exercise test?

Answer 1

1. Understanding severity of dyspnea.
2. Understanding O2 saturation at rest and with activity.
3. Determine exercise/activity tolerance.
4. Provide information for exercise prescription.
5. Evaluate for heart disease.

Question 2

Prior to exercise testing…

Answer 2

1. History
2. Screening
3. Lab values
4. Physical exam
5. Resting physiological measurements.
6. PAR-Q and You

Question 3

Good to add to any out-patient intake form to identify reasons to send patient back to physicians prior to commencing an exercise program.

Answer 3

Physical Activity and Readiness Questionnaire.

Question 4

Risks with exercise testing:

Answer 4

• Muscle soreness.
• Diaphoresis (abnormal amount of sweating).
• SOB/SOA.
• Angina.
• MI.
• Stroke.
• Death.

*Remember you are going to screen patients prior to exercise testing

Question 5

Safety with exercise testing

Answer 5

• CPR certification
• Emergency procedures in place.
• Monitor equipment well maintained and available.

Question 6

Subjective rating of dyspnea

Answer 6

0 = no dyspnea
1 = mild (light barely noticeable)
2 = moderate (bothersome)
3 = moderately severe (very unconfortable)
4 = moderate / intense – you need to stop!

Question 7

The American College of Sports Medicine recommend taking a pulmonary patient to what level of the subjective rating of dyspnea?

Answer 7

Level 3 moderately severe (very uncomfortable)

Question 8

ACSM guidelines ABSOLUTE contraindications to exercise testing:

Answer 8

1. Unstable angina
2. Uncontrolled cardiac arrhythmia.
3. Symptomatic critical aortic stenosis.
4. Uncontrolled symptomatic heart failure.
5. Acute PE.
6. Acute myocarditis/pericarditis.
7. Known dissecting aneurysm.
8. Acute systemic infection.
9. Significant EKG changes suggesting ischemia.

Question 9

In terms of blood pressure, what are the upper limits of exercise testing? (reasons to stop an exercise test)

Answer 9

Plateau or decrease in SBP > 10 mmHg

SBP > 240 mmHg

DBP > 110 mmHg

Question 10

Upper limits for exercise intensity:

(Reasons to stop exercise test)

Answer 10

1. Plateau or decrease in SBP > 10
2. SBP > 240
3. DBP > 110
4. Onset of angina or other symptom of cardiovascular disease.
5. Increased frequency of ventricular arrhythmias.
6. Onset of significant EKG onset.
7. Radionuclide evidence of LV dysfunction or onset of moderate
8. Other signs and symptoms of exercise intolerance.
9. Patient request to stop!

Question 11

Determination of HR max:

Answer 11

HR max = 220 – age (boards)

HR max = 208 – 0.7 X age

Question 12

When to use Borg Scale/Rate of Perceived Exertion?

Answer 12

Patients on medications that blunt HR response (beta blockers, digoxin, calcium channel blocker, ace inhibitor)

Question 13

The 6-20 RPE scale correlates well well with _____ if multiplied x 10.

Answer 13

HR​

Question 14

Types of exercise testing:

Answer 14

1. Maximal Exercise testing
2. Submaximal Exercise Testing

Why choose one over another?

• Do I have the necessary equipment available?
• Reason to do the test.
• The right person.

Question 15

What is maximal exercise testing used for?

Answer 15

• To diagnose a disease
  
  • Sensitive for coronary artery disease in asymptomatic individuals
• Assess medication levels
• Exercise prescription
• Assessment of ex/endurance training (can be an outcome measure)

Question 16

How is maximal exercise testing performed?

Answer 16

• HR plateau,
• SBP plateau
• amount of CO2 causes sudden increase in RR, signal anaerobic work.
• Must have emergency equipment and personnel available.

Question 17

Commonly used symptom limited graded exercises test:

Answer 17

• Bruce protocol: treadmill. More functional. Pt may achieve higher VO2 max.
• Astrand-Rhyming protocol: cycle. SCI, amputee.

Question 18

to assess cardiorespiratory fitness:

Answer 18

Sub maximal Exercise Tolerance test (ETT)

Question 19

Type of submax exercise test

Answer 19

• Graded Exercise Test
  
  • Cycle
  • Treadmill
  • Low Level Graded Exercise Test: whe you stop ex at a predetermined point. Ex. Stop afeter 10 min of ex.
• Field test
  
  • Individual dictates intensity
  • 6 minute walk test
  • Shuttle walk test
  • 1 mile walk
  • 1 mile run
  • 100 ft walk
  • Etc.

Question 20

General guidelines, before exercise testing…

Answer 20

• Avoid recent activity
• Wait 2h after eating
• 2 hours after smoking or caffeine.
• Repeat test: 2nd more accurate.
• Choose a test that relates with the training you will select for the patient.