Day 5

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the expected change in diastolic blood pressure (DBP) during an exercise test?

It should remain completely unchanged.

It should increase significantly.

It should decrease slightly or remain unchanged. (correct)

It should fluctuate wildly.

What is considered a normal increase in diastolic blood pressure during exercise?

A decrease of 5 mm Hg.

An increase of 20 mm Hg.

Less than 10 mm Hg. (correct)

More than 15 mm Hg.

At what diastolic blood pressure should an exercise test be stopped?

105 mm Hg

115 mm Hg (correct)

110 mm Hg

120 mm Hg

What is a hypertensive response in terms of SBP during an exercise test?

A significant increase in SBP. Signup and view all the answers

What physiological mechanism primarily causes the slight decrease in diastolic blood pressure during exercise?

Vasodilation in the vessels of the exercising muscles. Signup and view all the answers

What should be done if there is chest pain during exercise testing?

Record a baseline to identify differences for the client. Signup and view all the answers

What does the presence of peripheral pain in the leg usually indicate?

A potential complication during exercise. Signup and view all the answers

Which of the following is NOT a recommended action during an angina attack?

Encourage the client to push through the pain. Signup and view all the answers

What is the main goal of monitoring during exercise testing?

To see significant changes in the exercise capacity. Signup and view all the answers

What should be a priority when testing a client who experiences chest pain?

Document the onset style and characteristics of the pain. Signup and view all the answers

What is the normal heart rate response to incremental exercise per MET?

~10 beats·min-1 Signup and view all the answers

Which of the following factors can affect the maximal heart rate (HRmax)?

Age Signup and view all the answers

What is the expected change in systolic blood pressure (SBP) per MET during exercise?

~6-10 mmHg Signup and view all the answers

What might influence the interindividual variability of HRmax estimates?

Genetic factors Signup and view all the answers

Which method is commonly used to estimate HRmax?

220 minus age formula Signup and view all the answers

What is an expected cardiovascular response in patients on β-adrenergic blocking agents during exercise?

Decreased SBP response Signup and view all the answers

Why is it important to understand aerobic power assessment tools?

To determine their advantages and disadvantages Signup and view all the answers

Which statement about VO2 measurement is accurate?

It reflects aerobic fitness levels. Signup and view all the answers

What systolic blood pressure level prompts a recommended follow-up with a healthcare provider for men during dynamic exercise training?

≥ 210 mmHg Signup and view all the answers

What is the threshold for systolic blood pressure during exercise that the ACSM recommends keeping below?

210 mmHg Signup and view all the answers

What does a systolic blood pressure of > 250 mmHg during exercise testing suggest?

Increased arterial stiffness Signup and view all the answers

Which blood pressure threshold during exercise training indicates possible resting hypertension risk?

Systolic BP > 210 mmHg Signup and view all the answers

What is a significant action recommended for a systolic blood pressure greater than 250 mmHg during interventional exercise testing?

Follow-up with a healthcare provider Signup and view all the answers

What is suggested when diastolic blood pressure reaches 115 mmHg during exercise testing?

Increased arterial stiffness Signup and view all the answers

What systolic blood pressure threshold should be monitored during dynamic aerobic exercise training for women?

≥ 190 mmHg Signup and view all the answers

What potential risk is indicated by a systolic blood pressure increase of > 140 mmHg above a standing resting value during exercise testing?

Increased risk of future resting hypertension Signup and view all the answers

What should you do if discomfort persists after applying Nitro for the first time?

Wait 5 minutes before using another spray. Signup and view all the answers

What is a crucial precaution regarding the use of Nitro?

It should not be used if Viagra, Cialis, or Levitra were taken within 24 hours. Signup and view all the answers

How should Nitro be administered if discomfort does not resolve after two sprays?

Call 911 if discomfort persists after the third spray. Signup and view all the answers

What types of activities might trigger angina in Class 2 of the Canadian Cardiovascular Classification System?

Physical activities such as walking rapidly or uphill. Signup and view all the answers

What is the recommended first response if someone experiences angina discomfort?

Have them sit down immediately. Signup and view all the answers

What does the ischemic score represent in the exercise test scoring?

The combination of ST depression and angina presence Signup and view all the answers

How is the ischemic score balanced according to the Duke Index?

Number of METs achieved during exercise Signup and view all the answers

What physical activity is likely to trigger angina in Class 3?

Climbing one flight of stairs. Signup and view all the answers

What should be avoided after using Nitro to ensure safety?

Driving independently to seek help. Signup and view all the answers

What is the purpose of drawing a line between the ischemic score and the exercise score?

To determine 5-year survival or average annual mortality Signup and view all the answers

What threshold of 5-year survival predictions may suggest trying medical/behavioral therapy as the first-line therapy?

Greater than 95% Signup and view all the answers

What test protocol is used to assess the duration of exercise in the context of the Duke Index?

Bruce treadmill protocol Signup and view all the answers

In the development of the ischemic score, which of the following factors is NOT taken into account?

Resting blood pressure readings Signup and view all the answers

What aspect of a patient's condition is assessed during the exercise test to contribute to the ischemic score?

The presence and character of angina Signup and view all the answers

Study Notes

Course Information

Course Title: KIN 3110 | Advanced Fitness Assessment
Instructor: Robert Gumieniak, Ph.D.
Institution: University of Guelph-Humber

Plan for the Day

Recap of previous class/lab
Assigned reading material
Introduction to Aerobic Fitness Assessment
Measurement of VO2
Pros and cons of different assessment approaches

Key Questions

How is aerobic power represented?
Why are current methods used to represent aerobic power?
What are the typical aerobic power norms, including exceptional levels?
What tools are used to measure aerobic power?
What are the advantages and disadvantages of each tool?

Interpreting the Clinical Exercise Test

Heart rate response to incremental exercise typically increases by ~10 beats per minute per 1 MET
Maximum heart rate (HRmax) decreases with age and is affected by beta-blockers
Various equations are used to estimate HRmax, but estimates have high inter-individual variability (standard deviations of 10 bpm or more)

Blood Pressure Response

Normal systolic blood pressure (SBP) increases by ~6-10 mmHg per 1 MET
Diastolic blood pressure (DBP) typically remains the same or decreases slightly during exercise
Hypertensive, hypotensive, or blunted responses to exercise are possible
SBP greater than 250 mm Hg, DBP greater than 115 mm Hg, or significant drops in blood pressure during exercise should warrant stopping the test.

Exaggerated BP Responses to Dynamic Exercise

Systolic BP ≥ 210 mmHg (men) or ≥ 190 (Women), systolic BP > 220 mmHg and/or diastolic BP > 105 mmHg during exercise, systolic BP > 250 mmHg and/or diastolic BP > 115 mmHg during exercise, systolic BP > 250 during peak or >140 increase above a standing resting value during exercise testing should be evaluated by medical personnel.

Preparticipation Screening Process

Monitor electrocardiogram (ECG), heart rate, blood pressure, signs, and symptoms continuously or periodically throughout the exercise test and subsequent recovery
Use rating of perceived exertion (RPE) scales as needed.
Monitor and record adverse symptoms or abnormal ECG changes and blood pressure and heart rate during exercise

Indications for Stopping the Test

Absolute: Significant drop in blood pressure, moderately severe angina, increasing neurological symptoms, signs of poor perfusion (cyanosis or pallor), technical problems monitoring the ECG or blood pressure, sustained ventricular tachycardia, ST elevation (≥ 1.0 mm) in leads without diagnostic Q waves (except V1 or aVR), subject's desire to stop, sustained ventricular tachycardia
Relative: Significant drop in blood pressure, ST or QRS changes, arrhythmias beyond sustained ventricular tachycardia, fatigue, shortness of breath, wheezing, leg cramps, claudication, increasing chest pain, hypertensive response (SBP > 250 mm Hg and/or DBP > 115 mmHg)

Signs of Angina

Chest pain (uncomfortable pressure, squeezing, or pain in the center of the chest)
Unusual shortness of breath
Seemingly sudden decrease in physical capacity to perform exercise
Palpitations, "skipped beats", fast or irregular heart rate
Syncope or near syncope
Pain spreading to shoulders, neck, or arms
Light headedness, sweating, nausea, shortness of breath

Monitoring and Test Termination

Numerical scales exist for assessing angina, claudication, and dyspnea (shortness of breath)
Monitoring is important as exercise capacity increase with test, onset of chest pain shouldn't be as early as baseline

Angina Attack—What to Do

Always ensure subjects are seated when using nitroglycerin (Nitro)
Do not use Nitro if Viagra, Cialis, or Levitra have been ingested within the prior 24 hours.
Take Nitro as directed if prescribed
Discomfort should resolve with a spray.
Wait 5 minutes.
If discomfort persists, use another Nitro spray.
Wait 5 minutes.
If discomfort is still unresolved, seek immediate medical attention and do not drive oneself.

Canadian Cardiovascular Classification System

Categorizes different levels of physical activity that can trigger angina pectoris.

Scoring the Exercise Test (e.g., Duke Index)

Ischemia score is created by drawing a line between the maximal degree of ST depression and the presence and character of angina during exercise
Balance ischemic score with duration of exercise, using the Bruce treadmill protocol as a guide and then determine the computed 5 year survival or average annual mortality
Findings from this index are helpful to identify which treatment options may be appropriate

Post-Test

Obtain maximum blood pressure (BP), heart rate (HR), rate of perceived exertion (RPE), and ECG readings after maximal exercise.
Decrease workload until near resting values and monitoring until symptoms have resolved.

Clinical Exercise Testing Indications

Evaluating the causes of exercise symptoms (angina, dyspnea, leg pain) suggestive of cardiopulmonary disease.
Identifying coronary artery disease (CAD) in those at high risk.
Stratifying patients after myocardial infarction
Identifying surgical risk for patients with suspected CAD
Assessing therapeutic interventions' efficacy
Developing exercise prescriptions
Evaluating physical demands of a job
Ruling out myocardial infarction in emergency patients

Cardiorespiratory Fitness (CRF)

Ability to perform moderate-to-vigorous-intensity exercise with large muscle groups in a dynamic and continuous manner.
Dependent on the cardiorespiratory, musculoskeletal, and nervous systems.
High CRF levels are associated with reductions in all-cause mortality

Economic Burden of Low CRF

Direct and indirect costs of low cardio respiratory fitness in Canadian adults.
Data includes costs attributable to low, direct and indirect costs.

Maximal aerobic power increases during childhood and adolescence
This increase is followed by a plateau, and then a gradual decline with age.
Sedentary individuals experience approximately 10% decline per decade between 20 and 69 years old.
Active individuals experience a smaller (~5%) decline.
Highly fit individuals show a ~2% decline per decade.

Exercise Capacity and Mortality

All-cause death rates across categories of cardiorespiratory fitness (CRF) in men and women.
Patients with lower levels of fitness (lower CRF) show higher death rates compared to those who had high levels of exercise capacity

Relative Risk According to CRF Categories Across the Age Spectrum

Cardiorespiratory fitness is strong for mortality prediction.
Individuals with low CRF have higher mortality risk regardless of age
Individuals with a level of CRF of 8-10 mets or higher have lower mortality.

VO2 Training Response

Distribution of maximal oxygen uptake (VO2 max) training responses from a health, risk factors, exercise training and genetics study

VO2 Peak vs VO2 Max

Plateau in oxygen consumption ("super max" workload)
Not always a plateau (16-94% incidence)
Highest rate of O2 consumption, plateau or not
Measured at maximal exertion
Valid index of VO2max

Measurement Methods Comparison

Summary of advantages and disadvantages of direct measurement methods (Douglas Bags, Tissot Tank) and indirect measurement methods (MET cart, full tube, sampling, portable)

Accuracy of Respiratory Gas Variables from 15 CPET Systems

Accuracy of various measurement systems.

Summary of CRF

CRF is an essential component of health-related physical fitness.
Submaximal tests provide alternative methods when maximal tests are not necessary
Appropriate precautions and procedures must be followed when assessing CRF using non-gold standard tests.

Review Questions

Identify common measurements during maximum exercise testing
Explain heart rate's role in determining VO2 max
Explain how hemodynamic responses change in progressive graded exercise testing
Given the energy cost of a 7 mph run for a 162 lb man calculate absolute VO2, kcal/min and kcal/30 minutes.

Next Class

Upcoming topics and readings (Aerobic Fitness Protocols, Chapters 4 to 6)

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers key concepts regarding diastolic and systolic blood pressure responses during exercise tests. It includes normalized responses, hypertensive reactions, and appropriate actions during chest pain episodes. Ideal for students and professionals in exercise physiology and health monitoring.