Lecture 1 Flashcards
(35 cards)
1
Q
Testing for Clinical Populations
A
- Medical Evaluation
- Resting ECG
- Resting echocardiogram
- Graded Exercise Test
- —ECG
- —ECG + Open Circuit Spirometry (measure expired gases)
- —ECG + Nuclear Imaging
- Pharmacologic Stress Testing: medication to increase HR
- Cardiac Imaging: picture of the Heart
2
Q
Indications for GXT
A
- Diagnostic
- Prognostic
- Therapeutic
3
Q
Diagnostic
A
- used to diagnose Coronary Artery Disease
- often conducted with patients off medications
4
Q
Prognostic
A
- disease progression and prognosis
- improved with expired gas analysis
5
Q
Therapeutic
A
- Effectiveness of therapy
- Functional capacity determination (peak METs)
- Conducted with patients on medications
6
Q
Can we do something to improve the prognosis?
A
- increase METs (workout)
- medication (decrease ST seg depression)
7
Q
Contraindications to GXT
A
ABSOLUTE
- absolute concern
- potential of serious complications
RELATIVE
- possible medical concern
- evaluation of risks and benefits
8
Q
Who can perform Exercise Tests?
A
TRAINED PROFESSIONALS
- clinical exercise physiologist
- nurse
- physical therapist
- physicians
DOCTORS
- might need to be present with high risk patients
- in clinical settings (usually in near proximity)
9
Q
Risks of GXT
A
incidence of death of major event requiring hospitalization
—-1-10 per 10,000 tests
10
Q
Risks of Vigorous Exercise
A
-higher risk of sudden cardiac death or myocardial infarction in people with diagnosed or occult cardiovascular diseases than healthy people
11
Q
Modalities
A
TREADMILLS LEG CYCLE ERGOMETER -electronically braked (preferred) -mechanically braked ARM ERGOMETER OTHER ERGOMETER
12
Q
Protocols
A
ESTABLISHED PROTOCOLS -e.g. Naughton, Cornell, Bruce, Ramping Bruce CUSTOMIZED INDIVIDUALIZED PROTOCOLS -usually ramping SOUND PROTOCOL SELECION IS KEY APPROPRIATE PROTOCOL
13
Q
Appropriate Protocol is one that:
A
- fits the individual
- produces true VO2 peak (without premature fatigue)
- takes about 8-12 minues
14
Q
Most common protocol
A
ramping
15
Q
Ramping Protocol
A
Work rate is gradually increased
- ramping bruce
- individualized
Avoid large changes in workload
Cycle Ramp Protocols
16
Q
Prior to GXT
A
- Medical Evaluation
- General Interview
- Test Explanation
- Written Informed Consent
- Instructions Prior to GXT
17
Q
GXT Procedures
A
ECG PREP -good prep is essential RESTING ECG -supine and standing MONITOR PATIENT THROUGHOUT END OF EACH STAGE -ECG, BP, RPE, pain, other scale END OF TEST -ECG, BP, RPE, immediately before test stops -ECG and BP immediately after RECOVERY -active and passive -ECG, BP, and symptoms
18
Q
Placement of Electrodes
A
- RA and LA electrodes should be placed just below the right and left clavicle
- RL and LL electrodes should be placed on the lower edge of the rib cage, or at the level of the umbilicus at mid-clavicalar line
19
Q
GXT Termination
A
- should not be premature
- criteria for achieving maximal effort
- indications
- —absolute
- —relative
20
Q
Data from GXTs
A
- Functional capacity
- RPE
- HR & BP
- ECG
- Rate-pressure product (RPP)
- other scales for symptoms
21
Q
Evaluation for Functional Capacity
A
against expected exercise capacity
-use available equations or nomograms
functional aerobic deficit
-actual vs.expected Functional Capacity
22
Q
GXT Report
A
ELEMENTS
- Angina Status
- ECG findings pertaining to ischemia
- ECG findings pertaining to arrhythmia
- Functional capacity
- HR Response
- –Exercise
- –Recovery - BP Response
- –Exercise
- –Recovery
23
Q
Exercise Training
A
- Science
- Art
- Same as for Non-Clinical Populations
- –but with special considerations
- —-these vary by morbidity
24
Q
Goal Setting
A
The 1st Step
- Patient and Exercise Physiologist work together
- Must be realisitic
Goals
- Improve Health
- Improve Prognosis
- Manage Symptoms
- Improve Fitness
- Improve Capacity for Activities for daily living
- Improve psycho-social well-being
- Improve Appearance
- Other specified by patient
25
Principles of Exercise Prescription
```
SPECIFICITY OF TRAINING
PROGRESSIVE OVERLOAD
-Manipulate by changing FITT
-product yields volume
-3 stages of progression
----1. Initial
----2. Improvement
----3. Maintenance
REVERSIBILITY
-Importance of maintenance stage
```
26
2008 Physical Activity Guidelines for Americans
- published by the department of health and human services
- guidelines for americans 6yr and older to improve health through physical activity
- complement Dietary Guidelines for Americans
- primary audiences
- --policymakers
- --health professionals
27
Key Components of 2008 Guidelines
- everyone can attain health benefits from physical activity
- benefits of physical activity outweighs risks
explicit guidlines for
- children and adolescents
- adults
- older adults
- women during pregnancy and postpartum
- individuals with disabilities
- safe physical activity
- messages for
- --people with chronic medical conditions
- -----benefits, safety, proper guidance/supervision by professionals
28
Exercise for Cardiorespiratory Fitness
FREQUENCY
- typically 3 times per week
- varies by training stage
INTENSITY SET BASED ON GXT RESULTS
- VO2 or MET & HR training zones
- --reserve method
- --straight % method
- Actual workload
- varies by training stage
- --40-85% VO2 reserve and Heart Rate Reserve (HRR)
- below level of symptoms
TIME
- varies by training stage
- continuous or interval
TYPE
-large-muscle rhythmic movement
29
Reserve Method vs Straight Percentage
```
RESERVE METHODS
take into account resting values
-assume a cardiac patient on HR controlling medication
HR peak=130 bpm
HR rest=70bpm
60% of HRpeak=78 bpm
```
HRR or VO2R METHOD
- same general formula
- [(peak-rest)] x percent as fraction] + rest
- 60% of HRR for the patient alone
[(130-70) x 0.6] + 70 = 106bpm
30
High Intensity Interval Training
-popular among athletes
research in clinical population
- promising results
- safety, not fully evaluated
31
Muscular Fitness
MUSCULAR STRENGTH
-maximum ability to develop force by muscle
MUSCULAR POWER
-ability to apply force at any given velocity
MUSCULAR ENDURANVE
- ability to maintain sub maximal force over extended time
- not discussed in guidelines
32
General Recommendations
- lift through ROM
- maintain neutral position
- control movements
- avoid valsalva
- monitor BP
- assess signs/symptoms
33
FITT
FRQUENCY
- 1-3 times per week
- across stages of progression
INTENSITY AND DURATION
- 60-80% of 1RM or 8-12 RM
- 1-3 sets
- ~2 rest
- exercises for major muscle groups
- --usually 8-10 exercises
- circuit weight training
- maintenance important
- --reversibility
34
Flexibility
ability to move a joint through a full range of motion
ASSESSMENT
- goniometers
- flexometers
- inclinometers
- indirect
- ---sit and each
- ---back scratch
35
Stretching for Flexibility
- PNF (Proceptive Neuromuscular Facilitation)
- Ballistic
- Static
- --2-3 days per week
- --exercises for whole body
- --hold stretched for 10-30 sec
