PET 4551Exercise Testing and PrescriptionStudy Guide Exam 21. Know exam 1 material. 2. What are some of the benefits of regular physical activity?Health benefits of aerobic exercise-Blood pressure-Cholesterol-Blood sugar-Body fat-Risk of coronary heart disease-Risk of diabetes-Risk of some cancers-Risk of stroke-Stress-Depression and anxietyFitness benefits-Increase in:-VO2 max-Speed-Agility-Coordination-Technique-Performance3. When should you stop a stress test?INDICATIONS for STOPPING a TEST:- Drop in SBP of > 10 mmHg with INC in workload- Onset of angina or angina-like symptoms- Failure of HR to INC- Excessive rise in BP: SBP > 250 mmHg, DBP > 115 mmHg- Shortness of breath, wheezing leg cramps, claudication- Noticeable changes in heart rhythm- Signs of poor perfusion: light headiness, confusion, pallor, nausea, cold and clammy skin, cyanosis- Technical difficulties- Subject's desire to stop- ST segment elevation (+1.0)- INS NS symptoms (dizziness, panic attack)4. What are some field tests that we use to measure cardiorespiratory fitness?- Queens College Step Test- 1 mile walk test- 1.5 mile run test- 12 min walk-run test5. What are some of the advantages and disadvantages of submaximal testing?Sub-maximal Tests Advantage- Inexpensive- Personnel require minimal amount of training- Allow for mass testing- Test itself is shorter in duration- Safer since it does not require maximal exertion- NO physician needed if LOW RISK- VO2 max can be estimated!- Heart rate and BP are monitored- Useful in documenting changes due to intervention programs! Sub-maximal Tests Disadvantages- Maximal HR, BP, RPP are NOT measured - VO2 max not DIRECTLY measured- Limited diagnostic value errors range from 10-20%- True max HR is not obtained for exercise prescription6. Identify sources of errors that are involved in submaximal testing.Need to try to follow standardized conditions: a) NO exercise 24 hours priorb) NO caffeine, drugs, nicotine 3 hours priorc) Light meal 3 hours earlierd) Comfortable exercise appropriate clothese) Same time pre-test and post testsf) Good night sleepg) Thermoneutral environmenth) Specificity of training7. What are the four assumptions we make when doing submaximal testing?- A steady state HR is obtained for each exercise work rate - A linear relationship exists between HR and work rate- The maximal HR for given age is uniform- Mechanical efficiency is similar for everyone8. What is meant by steady state?(HR does NOT change by > 5 bpm between exercise sets...)9. What is the Rating of Perceived Exertion Scale?The Borg Rating of Perceived Exertion (RPE) scale will help you estimate how hard you’re working (your activity intensity). Perceived exertion is how hard you think your body is exercising. Ratings on this scale are related to heart rate (how hard your heart is working to move blood through your body).10. Know general procedures for submaximal testing cycle and bench step.BENCH STEP TEST- Metronome- Bench- Stopwatch (3 min)- NO RESTS period allowed- Stop subjects standing, find pulse within 5 sec, take a 15 sec HR, and then multiply by 4!!- TAKE BP!!!**FIT PERSON WILL RECOVER QUICKER!!!!Cycle Ergometer- Proper position on cycle- 50 rev/min (rpm) ***MUST MAINTAIN TO REACH SUBMAX HR- Pre exercise BP and HR- Warm-up no resistance-Follow flow chart!! (DO NOT HAVE TO MEMORIZE)**ALL MONARKS have flywheel distances of 6 m/rev!! Work Output = Resistance (kp) × Rev per min (rpm) × Flywheel distance (m × rev-1)Cycle Ergometer Work Output = (6 m/rev)(50 rev/min)(Resistance in KG/KP)**GOAL of Cycle Ergometer: to get 2 sets of steady state HR's at 2 different workloads that fall between 110-150 BPM (range of HR that demonstrate linear relationship between HR and VO2)- Test requires at least 2 and possibly 4 stages of exercise (3 min in duration) - All subjects starts with a 150 kg.m.min workload (Work output = resistance x rev per min x flywheel distance)- Check for steady state HR at 1st, 2nd and 3rd minutes of each stage; BP and RPW at 3rd minute after HR - If not within 5 bpm, continue with stage for 1 additional minute!!- RPE based off HR (RPE x 10 = HR)! Taken at end of each stage! (Perceived exertion)- STOP test when 2 steady state HR’s between 110-150 bpm is reached!- Have patient COOL DOWN following test11. Know systolic, diastolic, and mean arterial pressure. Know how to calculate MAP, PP, and RPP.Systolic BP: maximal pressure in the arteries during contraction of the heart (measured by the onsetof sound). Diastolic BP: minimum pressure in arteries during the relaxation of the heart (complete disappearance of sound).1. Pulse Pressure = (SBP - DBP) Exercise? = INC PP!!**Systolic BP INC while diastolic remains the same or DROPS!2. Direct measure of MAP: MAP = CO x TPR (Total peripheral resistance) Indirect measure of MAP:HR < 100 b/min MAP = (1/3(SBP - DBP)) + DBPHR > 100 b/min MAP = (1/2(SBP - DBP)) + DBP 3. Rate Pressure Product: RPP = (HR x SBP)/100**Should INC with exercise! (INC HR & INC SBP) 12. Know how to calculate the heart rate reserve from the Karvonen Formula. Be able to calculate intensity or target heart rate.Target Heart Rate = ((max HR − resting HR) × % Intensity) + resting HR example13. Know how to calculate relative or absolute VO2.**Absolute (L/min) = Relative? Divide by BODY WEIGHTConverted to mL (x 1000 mL)Ex) 3.2 L/min x (1000 mL/1L) / KG (body weight) = RELATIVE**Relative = METS??Divide relative VO2/3.5 ml.kg/min/met = 11.2 METS14. Know the different ECG leads chest leads, limb leads, precordial, and extremity, unipolar, bipolar.12 LEAD EKG (12 different pics of heart)- 6 extremity/limb leads - measure in the frontal plane{I, II, III, aVr (augmented voltage right arm), aVl (left arm), aVf (foot)} - Bipolar extremity leads - I, II, III- Unipolar extremity leads - aVr, aVl, aVf- 6 chest/precordial leads - measure in the horizontal plane{V1, V2, V3, V4, V5, V6}ALL UNIPOLAR! (9 total unipolar leads!) 15. Know how to calculate heart rate.(*MUST write formulas on exam!)Choose RR interval and count boxes between them: 1. Small Box method = 1500/# small boxes2. Large Box method = 300/# large boxes3. 6-Second method find 6-sec interval (3 hash marks on rhythm strip) and count MAX # of QRS complexes found within the interval (shift complexes accordingly)! **START COUNTING ATZERO HR = # QRS complexes × 1016. Know how to calculate work load in kg.m/min or watts. Watts = [(kg)(m/rev)(rev/min)] / 6.1217. Know equation for VO2max and
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