Day 5

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.

Age-Related Decline in VO2max

• 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)

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.