Respiratory Diseases Flashcards

Question

Cardiopulmonary exercise testing: incremental protocols

Answer 1

Intensity is gradually increased over time in steps, or at a constant rate Last between 8-12 minutes (test duration of 5 minutes is sufficient for analysis in unconditioned patient) A routine for estimating one-minute step workload increases needed to achieve a cycle ergometer test that is approximately 10 minutes long is available Short stages, starting at 1.0 MPH and 0% grade Treadmill-based protocols are also recommended

Answer 2

Warm up at a very low workload for 2-3 minutes then increase workload abruptly above critical power and the patient continues until fatigue or test is terminated Constant load tests are superior to incremental tests

Answer 3

Peak oxygen consumption rate Ventilatory equivalents for oxygen and carbon dioxide (V̇E/V̇O2 and V̇E/V̇CO2) Anaerobic threshold (extremely low) Dead space to tidal volume ratio (VD/VT) Respiratory exchange ratio (RER) Alveolar minus arterial oxygen and carbon dioxide difference (P(A-a)O2) (how well we perfuse O2 and eliminate CO2) Arterial minus end-tidal carbon dioxide difference (P(a-ET)CO2) (how well we eliminate CO2) Oxygen saturation Breathing and heart rate reserve

Answer 4

Lower than expected peak work rate and a v̇O2 peak that is below age-predicted norms RER may exceed 1.0 at rest (a problem because they are always in an anaerobic state) or it may not increase above 1.0 during exercise because exercise is terminated prior to reaching the anaerobic threshold Anaerobic threshold is usually at the lower end of normal but may be absent (due to the individual already being in the state of anaerobic) Maximal voluntary ventilation is decreased As exercise progresses, breathing reserve is typically exhausted Cardiovascular response is mostly normal unless the cardiac or pulmonary vascular disease is also present

Answer 5

6-minute walk test Incremental shuttle walk test (ISWT) -12 stage test to exhaustion Endurance shuttle walk test -Test at 85% of maximum sustainable walking speed until breathlessness or fatigue ensues (good for looking at the function of their daily living)

Answer 6

Static maximal isometric strength Dynamic testing

Answer 7

Strength over the ROM 1-RM is widely used; an alternative is an estimation of 1RM from 2RM to 10RM Testing is generally contraindicated in those meeting the contraindication criteria for exercise testing in addition to those with musculoskeletal conditions or injuries that may be made worse by exerting maximal effort

Answer 8

Perform an MVC Low risk Measure force with a strain gauge, cable tensiometer, force platform, or force transducer

Answer 9

Fundamental component of pulmonary rehab and the most effective method for reducing exercise intolerance Each exercise prescription should be individualized

Answer 10

To improve capacity to perform external work

Answer 11

Long warm-up is important for these patients 5-10 minutes beginning at low intensity (< 40% of the V ̇O2 reserve) and increasing to training intensity Activities similar to those used in the conditioning phase Mobility, ROM, and flexibility exercises should have purpose and thus need to be structured into the warm-up session appropriately

Answer 12

Long cool down is important for these patients 5-10 minutes gradually decreasing whole-body aerobic exercise (< 40% of the V ̇O2 reserve) Help prevent venous pooling May prevent bronchospasm Static stretching and other flexibility exercises can be performed after the patient has sufficiently recovered from the conditioning exercises, but they should not be used as the primary cool-down activity

Answer 13

3-5 d/wk (obese patients up to 7 d/wk) Consider using multiple short bouts per day for those with lower fitness 1 session per week supervised by CEP

Answer 14

Use of exertion scale may be helpful when exercise testing is not practical/possible; also dyspnea and breathlessness scales Maintain oxygen saturation at ≥ 88% Varying for patients with chronic respiratory disease -Recommended aerobic training intensity for those with COPD ranges from 50% to 80% of the peak work rate and is likely suitable for patients with other chronic respiratory conditions

Answer 15

Ideally 20-60 min during each training session If deconditioned or moderate/severe disease may not be able to sustain interval training may be useful

Answer 16

Commonly used: walking or cycling Arm cycling to improve unsupported arm capacity but may produce dyspnea and distress due to fatigue of accessory muscle of inspiration Be aware that cold may exacerbate symptoms Both continuous and interval-training protocols improve exercise capacity and quality of life in patients with COPD -Decisions should be guided by client preference, symptoms, and willingness to adhere to the program as well as by the therapeutic goals

Answer 17

Consistently improves strength in COPD patients despite wide variation in training program characteristics A higher-functioning patient would benefit from a combined program that could potentially improve strength and aerobic capacity to a greater degree than a unimodal program Patients who are severely limited in their ability to undertake continuous or interval aerobic training may be better served initially by completing resistance training due to its lower demand for oxygen and lower dyspnea scores Muscle dysfunction contributes to exercise intolerance, and it is a significant contributor to the severity of symptoms experienced by those with COPD

Answer 18

8-10 whole-body exercises that involve all of the major muscle groups (i.e., arms, shoulders, chest, abdomen, back, and legs) 1-3 sets of 8 to 12 repetitions on 2-3 days each week Usually, 2-3 min of recovery between sets; total time about 30-40 min Various types of resistance elements: machine or free weights, elastic resistance bands, weighted grocery bags or other common items, or the patient’s own body mass While inspiratory muscle training is effective, it should be considered an adjunct therapy to other forms of exercise training Periodization of the program is recommended

Answer 19

Important given that impaired posture can affect ventilation and increase the work of breathing No specific guidelines for pulmonary rehabilitation: apply general recommendations: -Minimum 2-3 days/week, to the point of tightness, 10-30 seconds and 2-4 repetitions

Answer 20

Medication use Once symptoms are controlled, recommendations and guidelines are the same for individuals with asthma and healthy individuals Start with a lower intensity progressing gradually Avoid: scuba diving, swimming, exercise in cold, outdoor exercise

Respiratory Diseases Flashcards

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