03 21 2012 First day after Test 1 Exercise Testing Modalities Treadmill Cycle 5 to 25 less than treadmill Arm ergometry 20 30 less than treadmill Exercise Protocols Treadmill Bruce most common when have stress tests in clinic Very good as far as eliciting a heart problem Ellestad Naughton Balke Ware Test should last 8 12 minutes Contraindications to Exercise Testing Absolute Box 3 5 Change in resting ECG ischemia MI Unstable Angina won t test until angina is controlled Uncontrolled arrhythmias Aortic stenosis can t get blood flow out Uncontrolled symptomatic heart failure swelling in ankles shortness of breath Acute pulmonary embolus Dissecting aneurysm Acute myocarditis or pericarditis infection Acute systemic infection If patient presents with any of these DO NOT DO STRESS TEST Contraindications to Exercise Testing Relative Box 3 5 Up to Physicians discretion Weighing benefits of doing stress test and not doing one Left main coronary stenosis Moderate stenotic valvular heart disease Electrolyte abnormalities usually see with diabetes dialysis people with kidney problems Severe arterial hypertension at rest SBP 200 DBP 110 Tachyarrhythmias or bradyarrhythmias Cardiomyopathy Neuromuscular rheumatoid disorders painful for patient High degree AV block Ventricular aneurysm Uncontrolled metabolic disease diabetes Chronic infectious disease AIDS Indications for stopping a test Box 4 5 2 Drop in SBP of 10 mmHg with increase in workload Onset of angina or angina like symptoms Failure of heart rate to increase Excessive rise in BP SBP 250 mmHg or DBP 15 mmHg Shortness of breath wheezing leg cramps claudication Noticeable change in heart rhythm Signs of poor perfusion light headiness confusion pallor pale nausea cold and clammy skin cyanosis Technical difficulties can t get BP or HR Subject s desire to stop ST segment elevation 1 0 mm that can mean ischemia or lack of BF Increasing nervous system symptoms dizziness or having a panic attack Clinical Stress Testing Diagnostic Exercise Testing Exercise Testing for Disease Severity and Prognosis Exercise Testing after MI Functional Exercise Testing aerobic capacity can look at stress test for severity of asthma Purpose of Fitness Testing Educating participants about their fitness levels 3 Get data that will provide in the development of exercise prescriptions To obtain baseline data so comparisons can be made at a later date Motivation tool for establishing goals Stratifying risk diagnostic tool Order of Tests did this earlier in a previous class Fill out paper work informed consents health history PAR Q Maximal Oxygen Uptake what we did in Ex Phys Functional Capacity Equipment is expensive Trained personnel Time consuming Subjects need to be motivated Older individuals and individuals at risk will need a physician present adds to cost Submax tests good alternative gives us good data not as good but less expensive Submaximal Testing what we are doing at the track during lab Field Tests walking running more mass amount of people Cycle ergometers more individualized use for mod risk Treadmill more individualized use for mod risk 4 Bench can be individualized but HR and BP not taken during just after test Submaximal Tests Advantages common sense Inexpensive Personnel require minimal amount of training Allow for mass testing Test itself is shorter in duration compared to Max test 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 Submaximal Tests Disadvantages Maximal HR BP RPP are not measured VO2max not directly measured Limited diagnostic value errors range from 10 20 True max HR is not obtained for exercise prescription Assumptions Made in Testing A steady state HR is obtained for each exercise work rate Steady state HR Doesn t increase more than or 5 bpm 5 A linear relationship exists between HR and workrate The maximal HR for a given age is uniform 220 age Mechanical efficiency is similar for everyone this can differ among people as far as efficiency Ex Short people on bench test need to expend more energy than someone taller to step up and down Another Ex Less coordinated people expend more energy to do the same thing also HR x axis vs VO2 y axis linear relationship but this only happens between 110 and 150 bpm Why doesn t it happen before 110 bpm B C CO HR x SV and VO2 CO a v So what we are looking at is relationship between CO and VO2 and 40 50 of VO2 max SV stops increasing So major reason VO2 is increasing is due to increase in HR 110 150 HR is major influence on VO2 Once past 150 bpm HR takes off more than what VO2 will increase so get exponential increase of HR So after 150 don t get good relationship between HR and VO2 so has to be in that range to be accurate predictor of a persons VO2 max 6 Exam 1 Going over it Oxygen uptake is determined by a v O2 difference x CO If the duration of the p wave is extended in lead 2 and lead v1 this is diagnostic of left atrial enlargement An increase in SV from frank startling mech is due to a better alignment of actin and mysosin From rest to exercise dbp should decrease or remain the same Which is a negative RF HDL Mose desirable ldl less than 100 Exercise training can improve the relative risk except decreasing high density lipoproteins The term strain is used to describe changes in the ST segment and T wave that accompany ventricular hypertrophy When recovering from exercise greater than 100 b min what facilitates the decrease in heart rate decrease in sympathetic activation 7 What is primary reason for increase in SBP during exercise Increased cardiac output Which is a precordial lead v6 All are unipolar except II A clinical exercise stress test would recommended for which of the following people A 44 year old woman with symptoms of heart disease starting a mod Ex program An accurate resting HR is take for 30 sec Dbp during exercise is most affected by TPR WHICH of the following is true about anatomy of heart Tricuspid valve is between the right atrium and right ventricle In lead aVr the p wave should have a Negative deflection SV is lowest in which position Standing 8 All of the following parameters increase after endurance training except max Hr Which of the following adaptations occur at rest as cons Of endurance training Increased symp Increased vasocon Increased catechol Increased parasym increased hr Exercies training can improve the
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