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CP Exam II
Exercise Testing
| Term | Definition |
|---|---|
| Purpose | diagnosis prognosis identify cause of functional or exercise capacity limitations establish baseline or assess progress |
| "Stress" Testing: Graded Exercise Testing | graded exercise testing - asses pts functional capacity & response to exertion - assess pts risk of inducing ischemia or arrhythmia during exertion -> EKG abnormalities & provoking arrhythmias (hypoxia or stimulants) |
| "Stress" Testing: Pharmacological Testing | - dipyridamole & adenosine induce coronary vasodilation as would happen during exercise - dobutamine increases myocardial oxygen demand |
| Contraindications: Absolute | - acute MI - unstable angina - uncontrolled cardiac arrhythmias - endocarditis, myocarditis, pericarditis - severe aortic stenosis - decompensated heart failure - acute PE or PI - acute aortic dissection - physical disability that precludes safe |
| Contraindications: Relative | - L coronary artery dissection - mod-sev. aortic stenosis - tachyarryhthmias w/ uncontrolled ventricular rates - acquired advanced OR complete heart block - recent stroke/TIA - mental impairment - resting severe HTN - uncorrected med. condition |
| Potential Complications: Cardiac | - bradycardia & tachyarrhythmias - acute coronary syndrome - heart failure - hypertension, syncope, & shock - death |
| Potential Complications: Non-Cardiac | - MS trauma - Soft tissue injury |
| Potential Complications: Miscellaneous | - severe fatigue - dizziness & fainting - body aches - delayed feelings of illness |
| Indications for Terminating Exercise: Absolute | - ST segment elevation > 1mm - drop in SBP (S > 200, D > 110) - mod/sev angina - increase CNS symptoms - sustain VT, 2nd or 3rd AV block impairing CO - technical difficulties - patient requests to stop |
| Indications for Terminating Exercise: Relative | - ST segment elevation > 2mm - fatigue, SOB, wheezing, leg cramp, claudication - increasing chest pain - signs of poor perfusion - other arrhythmia's - exaggerated hypertensive response (S > 250, D > 115) - SpO2 < 85-88% |
| Exercise Test Examples | Equipment - treadmill tests - LE ergometer test - Recumbent stepper - UE ergometer test No Equipment - over-ground walking test - step test |
| Treadmill Test: Step Test | - increase speed & grade every 3 minutes - can use modified bruce or bruce protocol |
| Treadmill Test: Ramp Test | - speed remains the same, grade increases every minute - use Balke Protocol Ramp Test |
| LE Bike Test: Step Test | - cadence is kept consistent throughout the test - failure to maintain the cadence is reason to stop the test - workload increases over ever 3 minutes |
| LE Bike Test: Ramp Test | - cadence is kept consistent throughout the test - failure to maintain the cadence is reason to stop the test - workload increases over ever 1 minute |
| METS | "Metabolic Equivalent" - 1 MET = 3.5 mLO2/kg-1/min-1 - difference physical activities are expressed interns of multiples of the MET unit - if cannot work at 5 METS - sign of being out of shape - healthy person can work around at least 7 METS |
| VO2 Max | - Aerobically impaired (social security): less than 17 - Sedentary: 30's is decent - Normal Healthy Adult: 50's is decent/normal - World Class Endurance Athlete: 70's - Cross Country Skiers (highest reported): low 90's |
| Normal Response to Progressive Treadmill Exercise in Healthy Subjects | - diastolic needs to remain the same to keep perfusion levels the same - ANS: driver of this response - Post-Exercise Hypotension: total peripheral resistance drops due to capillary beds vasodilating, may take min-hours for tone to return to normal |
| Interpreting Exercise Test Results | SBP: increases 10 ± 2 mmHg per MET of workload DBP: normal response is ± 10 mmHg HR: increase 10bpm per 1 MET of increased workload & should fall > 12 bpm during the 1st minute of recovery |
| Vital Signs: Response to Increase Workload | BP: increase HR: increase RR: increase SpO2: same or increase Dyspnea on Exertion (DPE): increase RPE: increase |
| Vital Signs: When Should I Take Them During Exericse? | - rest, prior to exercise - rest, in position of exercise - prior to each increase in workload - just prior to or within 10-15 secs of stopping exercise - 3-5 minutes during recovery |
| Dyspnea on Exertion | Shortness of Breath Modified Dyspnea Scale 0 = northing at all 2 = slight 3 = moderate 4 = somewhat 5 = severe 7 = very severe 9 = extremely severe 10 = maximal |
| Angina | Symptoms that indicated myocardial ischemia - varies from person to person & gender to gender - males present with more common symptoms - silent angina common in patients with diabetes - can include any abnormal sensations above the waist - Use RPP |
| Rate Pressure Product | - vital signs threshold where angina begins - considered to be an indicator of myocardial oxygen demand - RPP = HR x SBP - Change before & after exercise: heart is becoming more efficient after you are aerobically fit (oxygen demand is increasing) |
| Exercise: Stable Angina | - Know RPE or RPP & use RPP for end-point of exercise intensity - create exercise program at 60-80% of RPP - goal: decrease workload of any given activity to increase angina threshold |
| Exercise: Post-Myocardial Infarction | - submaximal test to patient tolerance - avoid maximal exercise testing during acute healing stage (4-6) *takes heart 6-8 weeks for scar tissue to form *can cause cardiac tamponade - intensity < 70% HR max or < 5 METS for 4 weeks - no resist exercise |
| Exercise: Post-Myocardial Infarction pt. 2 | - after acute period -> gradually return to recommendations for non-diseased patients - increased aerobic capacity & decrease risk of death with exercise with cardiac rehabiliation post-MI |
| Exercise: Post Sternotomy or Thoracotomy | - if no pre- or peri-operative MI, no restricts with aerobic conditioning - consider postural exercise to tolerate (increase TE & expansion - evidence of future risk reduction if pt.'s begin exercise or cardiac program - consider sternal precautions |
| Exercise: Post-Operative | - consider hematocrit & hemoglobin levels & activity tolerance - adequate pain control to allow optimal performance - consider post-op changes: incision, edema, etc. |
| Exercise: Post Transplant | - Heart is de-innervated (no autonomic input) - aerobic exercise: importance of warm-up & cool down, same workload parameters as before - Resistance Exercise: combat muscular changes associated with heart failure, myopathy with immunosuppressive meds |
| Exercise With Claudication | - may exhibit hypertension @ rest & w/ exercise due to increased SVR - =interval training with short rest periods to increase aerobic capacity - use claudication scale for subjective rating of pain levels (try to exercise @ 3 to increase circulation) |
| Claudication Scale | 1 - definite discomfort or pain, but minimal 2 - moderate discomfort or pain, attention can be diverted with ease 3 - intense pain, attention can only be diverted by catastrophic events 4 - excruciating & unbearable pain |
| Pulmonary Hypertension | - abrupt onset w/ increased workload - RV hypertrophy due to increase pulmonary resistance (often due to right sided heart failure) - jugular vein distension - signs & symptoms: due to combination of vasoconstriction & increase in vascular symptoms |
| Pulmonary Hypertension: - signs & symptoms | - hypoxia during exercise due to increase pulmonary vasoconstriction - increased R LV workload -> RV SV decreases - reduced blood volume from R side caused reduced volume on L side - decreased L sided CO - pt with decreased peripheral oxygen & BP |
| Effect of Medication | - Beta Blockers: blunt heart response to exercise - Vasodilators: lower BP, dilate peripheral vasculature w/ exercise - Diuretics: hypertension, keeps BP lower - Beta 2 Agonists: increase HR & contractility - D-Nase: mucolytics, loosening of secretion |
| Recommendations for Increasing Patient Adherence | - begin a new exercise program slowly to avoid injury - rest if pain or swelling - consider exercising @ the same time each day to establish a routine - wear comfortable clothes & supportive shoes - exercise w/ others for motivation |
| Recommendations for Increasing Patient Adherence pt. 2 | - keep exercise log & provide self-rewards when goals are met - vary exercise program to avoid boredom - choose activities that you enjoy - avoid extremes of temperature (hot or cold) |
Created by:
Cummings226134
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