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Slide 1Exercise Testing ModalitiesWho do we conduct Fitness Tests?Maximal Oxygen Uptake (VO2 Max) TestingSubmaximal TestsMass TestingAdvantages to Submax TestingDisadvantages to Submax TestingContraindications to Exercise Testing AbsoluteContraindications to Ex testing RelativeIndications for Stopping a TestAssumptions Made in TestingA linear relationship exists between HR and work load…More Individualized TestsCycle Ergometer ProcedureEctopic RhythmsHow to Identify an Ectopic RhythmArrhythmiasFour Basic Types of ArrhythmiasArrhythmias of Sinus OriginEctopic Supraventricular ArrhythmiasFour Types of Sustained Supraventricular Arrhythmias1. Paroxysmal Supraventricular Tachycardia (PVST)2. Atrial Flutter3. Atrial FibrilationAnother Example of Atrial FibrilationSlide 274. Multifocal Atrial Tachycardia (MAT)Slide 29Ectopic Ventricular ArrhythmiasPremature Ventricular ContractionRules of MalignancyVentricular TachycardiaVentricular FibrillationsAccelerated Idioventricular RhythmTorsade de PointesMuscular StrengthIsometricConcentric ContractionFactors that Determine the Rate and Strength GainsOverloadReversibilityHypertrophyTime Course of Strength TrainingACSM Guidelines for Strength Benefits for Healthy AdultsStrength TestingEndurance TestingFlexibilityBenefits of FlexibilityTypes of StretchingFlexibility TestingBody Composition MeasurementUnderwater WeighingError with Body Composition MethodsSkinfold MeasurementSkinfold SitesBioelectrical Impedance AnalysisAnthropometric MeasurementsNew Criteria for Waist CircumferencesSlide 60Slide 61TEST TWOExercise Testing Modalities•Treadmill •Cycle •5-25% less than treadmill•Arm ergometer •20-30% less than treadmillWho do we conduct Fitness Tests?•To educate participants about their fitness levels•To get data that will provide in the development of exercise prescriptions•To obtain baseline data so comparisons can be made at a later date•As a motivation tool for establishing goals•To use as a stratifying risk-diagnostic toolMaximal Oxygen Uptake (VO2 Max) Testing•Functional capacity•Equipment to conduct the test is expensive•Trained personnel required•It is time consuming •Need motivated subject•Moderate and High Risk individuals NEED A PHYSICIAN PRESENT!Submaximal Tests•Field Tests (Walking or Running)•Can tests a greater amount of people at one time•Cycle Ergometers•More individualized•Use for those at MODERATE RISK•Bench Test•Can be individualized•Heart Rate and BP not taken during test, ONLY AFTERMass Testing•Endurance Runs •Mile run, 12 minute run•Walks•Rockport Walking Test•6 minute or 12 minute walk•Stepping •Queens College Step TestAdvantages to Submax Testing•Inexpensive•Personnel required need a minimal amount of training•Allows for mass testing•The actual test is a shorter duration than maximal exercise testing•It is safer because it does not require maximal exertion•Do not need a physician if LOW or MODERATE risk•Vo2 Max can be ESTIMATED•HR and BP are monitored•Useful in documenting changes due to intervention programsDisadvantages to Submax Testing•Maximal HR, BP, and RP are not measured•VO2 max is NOT DIRECTLY measured•Limited diagnostic value errors range from 10-20%•True max HR is not obtained for exercise prescriptionContraindications to Exercise Testing Absolute•Change in resting ECG•Ischemia, MI, already had a heart attack•Unstable Angina•Cannot test until angina is controlled•Uncontrolled arrhythmias•Aortic Stenosis•Cant get blood flow out of thick aorta•Uncontrolled symptomatic heart failure•Swelling in ankles, shortness of breath, dizzy•Acute pulmonary embolus•Dissecting aneurysm•Acute myocarditis or pericarditis•Infection in the heart•Acute systemic infection•Fever and infections… wait until they get betterContraindications to Ex testing Relative•Left main coronary stenosis (thickening of L artery)•Moderate stenotic valvular heart disease•Electrolyte abnormalities (diabetes/dialysis/kidney probs)•Severe arterial hypertension at rest•SBP >200, DBP >110•Tachyarrhythmia or bradyarrhythmias (irregular HRs)•Cardiomyopathy (can lead to heart failure)•Neuromuscular, rheumatoid disorders •High-degree AV block•Ventricular aneurysm•Uncontrolled metabolic disease (diabetes)•Chronic infectious disease (AIDS, hepatitis)Indications for Stopping a Test•Drop in SBP of >10 mmHg w/ increase of workload•SBP = indirect measurement of CO so if SBP drops so does CO•Onset of angina or angina-like symptoms•Failure of HR to increase with workload increase•Excessive rise in BP•SBP >250 mmHg or DBP >115 mmHg•Shortness of breath, wheezing, leg cramps, claudication•Noticeable change in heart rhythm on EKG•Signs of poor perfusion•Light-headiness confusion, pallor (pale), nausea, cold and clammy skin, cyanosis•Technical difficulties (can’t get BP or HR, if EKGs are falling off)•Subject’s desire to stop •ST segment evaluation (+1.0 mm)•Can mean ischemia or lack of BF •Increasing nervous system symptoms (dizziness)•Having a panic attack, sympathetic activationAssumptions Made in Testing•A steady state HR is obtained for each exercise work rate•Steady state = HR doesn’t deviate from more than 5 bpm•A linear relationship exists between HR and work load•Discussed further on next slide•Maximal HR for a given age is uniform (220-age)•Mechanical efficiency is similar for everyone•Can differ among people as far as efficiency•Short people on bench test need to expend more energy than someone taller to step up and down•Less coordinated people expend more energy to do the same thing•Test people on equipment they’re used to•Assuming the person comes in with a normal HR, they had a good nights sleep, and are not taking medications.A linear relationship exists between HR and work load…•Before 110 bpm: SV is increasing (40-50% Vo2 SV is maxed out, or plateaued)•After 110 bpm: HR causes increase in VO2•During 110-150 bpm: VO2 and HR will increase evenly•After 150 bpm: exponential increase in HR but VO2 increases much more slowly•Linear relationship between HR and VO2 only btween 110-150 bpm.•Not before 110 bpm because CO=HRxSV and VO2=CO*(a-vo2)More Individualized Tests•Cycle, treadmill, step test•Measure HR and BP•Need to standardize conditions•No exercise 24 hrs prior•No caffeine, drugs, nicotine•Light meal 3 hours prior, comfortable


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