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60 Cards in this Set
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- Back
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Purpose of Fitness Testing |
1. Collect baseline and follow-up data for evaluation of progress 2. Diagnose/Detect ischemic heart disease 3. Educate participants fitness status vs standards of age and gender norms 4. Motivate participants by establishing attainable goals 5. Provide data for developing exercise prescription 6. Stratification risk |
CDEMPS |
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What is a Pre-Discharge Exercise Test after MI? And what does it evaluate? |
It is a sub-maximal test. It is used to evaluate medications and detect ECG or hemodynamic abnormalities |
Heart and blood flow |
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What is a Post-Discharge Exercise Test after MI? When is it performed? What does it evaluate? |
It is a sub-maximal test. It is conducted prior to admittance to a Phase 2 program. It evaluates patient's condition, medication, and is a basis for exercise prescription. |
Progress and rehabilitation |
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What are PTCA and CABG? When are they performed? |
Both are sub-maximal tests to determine exercise prescription, adjust medication, and evaluate symptoms. Administered 3 weeks post event |
Rehabilitation, medicine and signs |
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What are the 3 reasons for performing exercise tests Post-MI or surgery? Where should it be conducted? |
1. Determine level of disability 2. Establish safe levels of exercise 3. Evaluate pharmacological treatment Conducted in a clinical setting |
DEP Disability Exercise Pharmacy |
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What is being identified by the Pre-Participation Health Screening? |
1. Identify and exclude individuals with medical contraindications to exercise 2. Identify individuals at high risk for disease due to Age, symptoms, and risk factors who should seek medical evaluation and exercise testing 3. Identify persons with clinically significant disease who should exercise under medical supervision 4. Individuals with other special needs |
Contraindications Increased risk for disease need medical clearance Clinically significant disease Special needs |
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What is an Example of a Pre-Participation Health Screening? |
PAR-Q |
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What are the 5 components of the Health History Questionnaire? |
1. Medical Diagnosis 2. Previous physical exam findings 3. History of Symptoms 4. Recent illness, hospitalization or surgical procedures 5. Orthopedic problems |
Diagnosis Exam findings Symptoms Recent illness Orthopedic |
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What are the 5 components of the Health Fitness Questionnaire? |
1. Medications, drug allergies 2. Habits (tabacco, alcohol, recreational) 3. Exercise history 4. Family history 5. Work history |
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What are 6 Absolute Contraindications to exercise testing? |
1. Recent significant change in resting ECG suggests significant Ischemia 2. Recent MI 3. Other acute cardiac event 4. UNSTABLE angina 5. Uncontrolled cardiac arrhythmias causing hemodynamic compromise 6. Severe aortic stenosis |
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Name 5 contraindications to exercise testing. |
1. Uncontrolled symptomatic heart failure 2. Acute pulmonary embolus or infarction 3. Acute myocarditis or pericarditis 4. Suspected or know dissecting aneurysm 5. Acute infections |
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Name Relative contraindications. |
1. Left main coronary stenosis 2. Moderate stenosis valvular heart disease 3. Electrolyte abnormalities Hypokalemia or hypomagnesemia 4. Severe arterial hypertension Systolic > 200mmHg and Diastolic > 110 mmHg at Rest 5. Tachyarrhythmia or bradyarrhythmia 6. Hypertrophic cardiomyopathy 7. Neuromuscular, musculoskeletal, or rheumatoid disorders that are exacerbated by exercise 8. High-degree atrioventricular block 9. Ventricular aneurysm 10. Uncontrolled metabolic disease Diabetes, thyrotoxicosis, myxedema 11. Chronic infectious disease Mononucleosis, hepatitis, AIDS |
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Define "Low Risk" |
Younger individuals Asymptomatic No more than 1 risk factor |
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Define "Moderate Risk". |
Older individuals (men>45, women>55) OR Meet 2+ risk factors |
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Define "High Risk". |
1+ sign/symptom OR Known CVD, pulmonary disease or Metabolic disease |
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Risk Factors considered in Health screening |
1. Age 2. Cigarette smoking 3. Dyslipidemia 4. Family history 5. Hypertension 6. Obesity 7. Prediabetes 8. Sedentary lifestyle |
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Risk factors for Age |
Men > 45 Womens > 55 |
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Risk factors for Family History |
MI Coronary revascularization Sudden death before age 55 in father or other male 1st-degree relative OR age 65 in mother or other female of 1st-degree relative |
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Risk factors for Cigarette Smoking. |
Current smoker Those who quit with previous 6 months Exposure to environmental tobacco smoke |
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Risk factors for Hypertension |
CONFIRMED Systolic BP > 140 mmHg or Diastolic BP > 90 mmHg OR On anti-hypertensive medication |
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Risk factors for Hypercholesterolemia |
Total cholesterol > 200mg/dL Men- HDL < 40mg/dL Women- HDL < 50mg/dL On lipid-lowering medication (statins) LDL > 130mg/dL |
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Risk factors for Impaired Fasting Glucose |
CONFIRMED Fasting Glucose of > 100mg/dL |
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Risk factors for Obesity |
BMI > 30 Waist girth Men- > 40 in or 102cm Women- > 35 in or 88cm |
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Risk factors for Sedentary Lifestyle |
Not participating in regular exercise Not meeting minimal PA recommendations from U.S. surgeon general |
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Sole offsetting Risk factor |
High serum HDL cholesterol > 60mg/dL |
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True or False a person of MODERATE risk should get a current medical examination and exercise testing prior to participation in MODERATE and VIGOROUS exercise. |
False. They only have to do so for participation in vigorous activities |
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True or False a person of HIGH risk should get a current medical examination and exercise testing prior to participation in MODERATE and VIGOROUS exercise. |
True. |
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True or False a person of MODERATE risk should have physician supervision during SUBMAXIMAL and MAXIMAL testing. |
False. They only need it during maximal testing |
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True or False a person of MODERATE risk should have physician supervision during SUBMAXIMAL and MAXIMAL testing |
True |
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Rationale for Informed Consent |
Provide client with sufficient information so they can fully evaluate risks and benefits associated with testing protocol |
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6 components of informed consent |
1. Explanation of test and language patient understands 2. Full disclosure of risks and discomforts as well as benefits of test 3. Explanation of patient responsibilities 4. Inquiries 5. Freedom of consent voluntary nature of testing 6. Confidentiality |
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3 other components of informed consent |
1. Specificity 2. Questions should be answered prior to signing 3. Signed informed consent doesn't absolve you from legal responsibility for untoward events |
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What should you do before testing? |
1. collect medical history 2. collect informed consent 3. have patient instructions 4. have paperwork ready 5. equipment calibrated |
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What are the instructions given to patients prior to exercise testing? |
1. no food, caffeine or tobaccos 3 hours prior 2. no exercise day of test 3. dress appropriately: freedom of movement, running shoes, short sleeved blouse with buttons down front, no restrictive undergarments |
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True or false if tested for diagnostic purposes it may be helpful for patients to discontinue prescribed cardiovascular medications but only with physician approval |
True it may be helpful for patients to discontinue prescribed medications |
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True or false antianginal agents don't alter the hemodynamic response to exercise and don't significantly reduce the sensitivity of ECG changes for ischemia |
False antianginal agents do alter hemodynamic response to exercise and they do significantly reduce the sensitivity of ECG changes for ischemia |
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True or False patients taking moderate to high dosage of the B-blocking agent may be asked to taper their medication over two to 4 days. In order to minimize hyper adrenergic withdrawal response |
True patients taking intermediate or higher dosage of the B-blocking agents should taper two to four days prior to test in order to minimize the hyperadrenergic withdrawal response |
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True or false patients shouldn't continue their medication regimen on their usual schedule so that the exercise response will be consistent with responses expected during exercise training |
False patients should continue their medication regimen on the normal schedule in order to see the effects of exercise |
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True or false it's not necessary for a patient to bring a list of their medications including dosage and frequency of administration to the assessment and they don't have to report the last actual dose taken |
False patients should bring a list of their medications including dosage and frequency of administration to the assessment and should report the last actual dose taken. |
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General Test Sequence |
Resting measures such as heart rate, ECG, BP and body composition, cardiorespiratory fitness, muscular strength & endurance, flexibility |
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Sequence of measures HR, BP, RPE and ECG during PRE-TEST |
1. 12-lead ECG in supine and exercise postures 2. BP measurements in supine position and exercise posture |
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Sequence of measures for HR, BP, RPE and ECG during EXERCISE |
1. 12-lead ECG recorded during last 15 seconds of every stage and peak exercise 2. BP measurements obtained during last minute of each stage 3. RPE taken at the end of each stage |
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Sequence of measures for hrbp RPE and ECG during POST-TEST |
1. 12 lead ECG immediately after exercise and every 1 to 2 minutes for at least 5 minutes 2. BP measurements obtained immediately after exercise and every 1 to 2 minutes until stabilized near baseline 3. Symptomatic ratings should be obtained using appropriate scales as long as symptoms persist after exercise |
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Pre-test instructions for Cycle Ergometry |
1. Adjust seat height so knee is slightly flexed 5 - 10 degrees when foot is at bottom of pedal swing 2. Keep pace with metronome 3. Don't hold handlebars tightly and release when BP is taken |
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Pretest instructions Treadmill |
1. Straddle belts 2. Paw belt with one foot for speed 3. Step on, keep eyes straight ahead, back erect, arms relaxed and swinging at side 4. Hold on if needed with fingertips only |
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What are the pros and cons of submaximal vs maximal protocols? |
Submax test -generally safer -don't require physician supervision -only estimate vo2max -resulting in some error Max test -place greater stress on person being tested -are more likely to reveal underlying disease -more accurate for determining vo2 max |
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True or false GXT protocols are one-size-fit-all |
False GXT protocols aren't one-size-fits-all |
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A protocol that is too aggressive can result in overestimation or underestimation of a VO 2 max? |
Overestimation |
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Ideally a maximum of GXT should last how long? |
8-12 minutes |
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What is the name of the GXT protocol and proper Mets for young physically active individuals? |
Astrand start at 6 METS and increase 2 to 3 METS per stage |
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What are the names of the GXT protocols and METS for normal but sedentary individuals |
Ellestad, Bruce, Balke. Start at 3 - 4 METS and increase 1 to 2 METS each stage |
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What are the names of the GXT protocols Animax for elderly or questionable health fitness patients? |
Naughton, modified Naughton, Ramp. Start at 1-2 METS and increase 0.5 - 1 MET each stage |
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What are the general procedures for submaximal testing of cardiorespiratory endurance using a cycle ergometer? |
-Exercise should begin with a 2 to 3 minute warmup -Protocol consists of 3-minute stages with appropriate increments in work rate -Clients needs should be 5 degrees of flexion at full leg swing -Heart rate should be monitored at least 2 times during the stage at the end of the second and third minutes of each stage -A heart rate greater than 110 beats per minute and steady-state heart rate within 6 beats of each other should be reached before work rate increased -BP should be taken at the later of portion of each stage -RPE should be taking at the end of each stage -Clients appearance and symptoms should be monitored regularly -An appropriate cool down should be initiated consisting of pedaling at work rate equivalent the first stage or passive cool down if signs of discomfort occurs -All physiological observation should be continued for at least 4 minutes of recovery unless abnormal responses occur |
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What are the 5 criteria for a true vo2max test? |
- Failure of HR to increase with increased intensity -Plateau of oxygen consumption with increased workload -Respiratory exchange ratio greater than 1.15 -Lactic acid concentration of more than 8 millimoles -RPE of 17 or greater |
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Reasons for stopping exercise test for low risk adults |
1. Angina or angina like symptoms 2. Significant drop of 10 millimeters mercury in systolic blood pressure or failure of systolic blood pressure to rise with increase intensity 3. Excessive rise in blood pressure systolic pressure greater than 260 millimeters of mercury or diastolic pressure greater than 115 millimeters of mercury 4. Signs of poor perfusion 5. Failure of heart rate to increase with increased intensity 6. Noticeable change in heart rhythm 7. Subject requests to stop 8. Physical or verbal manifestations of severe fatigue 9. Failure of testing equipment |
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What are signs of poor perfusion? |
Light-headedness confusion ataxia Pallor cyanosis nausea cold and clammy skin |
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Absolute indications for terminating exercise test |
Dropping systolic blood pressure greater than 10 millimeters of mercury from baseline blood pressure despite increased workload Moderate to severe angina Increasing nervous system symptoms Signs of poor perfusion Technical difficulties monitoring ECG or systolic blood pressure Subjects desire to stop Sustained ventricular tachycardia ST elevation greater than 1 millimeter without diagnostic Q waves |
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Relative indications for terminating an exercise test |
-Systolic blood pressure drops greater than equal to 10 mmHg from baseline blood pressure -ST or QRS changes -Excessive ST depression -Arrhythmias -Multifocal PVCs, triplets of PVCs, supraventricular tachycardia, heart block, Brady arrhythmias -Fatigue, shortness of breath, wheezing, leg cramps, claudication -Bundle branch block or intraventricular conduction delay -Increasing chest pain -Hypertensive response |
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Angina scale |
1. Light, barely noticeable 2. Moderate bothersome 3. Severe very uncomfortable 4. Most severe pain ever experienced in the past |
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Dyspnea Scale |
1. Mild noticeable to patients not to observer 2. Some difficulty noticeable to observer 3. Moderate difficulty but can continue 4. Severe difficulty patient cannot continue |
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