Exercise Testing & Functional Assessments

This presentation covers various tests for evaluating exercise capacity and functional abilities.
Heidi Tymkew, DPT, MHS, a board-certified clinical specialist in cardiovascular and pulmonary physical therapy, is the presenter.

Vital signs (HR, BP, SpO2) are assessed before, during, and after exercise.
Rate Pressure Product (RPP) and Rating of Perceived Exertion (RPE) are also monitored.
EKG and observation of the patient (skin color, coordination, alertness/cognition, lightheadedness/dizziness) are key monitoring aspects.
Angina is a significant indicator.

Graphs display the typical responses of healthy men during treadmill exercise, including heart rate and blood pressure.
Normal values for heart rate, systolic blood pressure, and diastolic blood pressure are provided across different age groups.

Excessive or flat/decreasing heart rate responses to exercise are considered abnormal.
Hypertensive blood pressure response (SBP > 210 mmHg and/or DBP > 110 mmHg) is also abnormal.
A progressive decrease in SBP (systolic blood pressure) by 10-15 mmHg with activity is abnormal.
Failure of SBP to increase with increased activity is atypical.
Significant changes in cardiac rhythm are abnormal.

Moderated or increasing angina is a potential indicator of exercise intolerance.
Marked dyspnea (difficulty breathing) is also a possible sign of intolerance.
Dizziness, lightheadedness or ataxia (loss of coordination) can signify intolerance issues.
Cyanosis (bluish skin discoloration) or pallor (pale skin) may indicate intolerance.
Excessive fatigue and leg cramps or claudication (pain in the legs) are additional symptoms of possible intolerance.

Heart rate recovery is a crucial measurement of heart function after exercise.
Good heart rate recovery is 12 to 18 beats per minute (bpm) or higher
A recovery rate below 12 bpm suggests a higher risk of coronary artery disease (CAD) and cardiovascular (CV) death.

The 6MWT objectively measures functional exercise capacity in various patient populations.
Use guidelines from the ATS (American Thoracic Society) 2002 article for proper instructions.
A 100-foot hallway is commonly used.
Normal values for healthy adults range from 400 to 700 meters.
The 6MWT can be useful for predicting mortality and hospital readmission in heart failure patients.
A reduced 6MWD (<300 meters) in heart failure patients is a poor prognostic indicator.
If the 6MWD is less than 200 meters, the patient has an increased risk of death .

The 2MWT is similar to the 6MWT.
Patients with low endurance may tolerate the 2MWT better.
Limited research with this test in patients with cardiovascular (CVP) impairments.
5.5-meter MID for people with Chronic Obstructive Pulmonary Disease (COPD); (Johnston, 2017).
Provides normative values based on age and sex. (Bohannon, 2015)

Measures endurance and exercise capacity.
Involves raising each knee midway between the patella and iliac crest for 2 minutes.
Scored based on the number of times the knee reaches the target.
Participants are allowed to use assistive devices.
Normative values for step counts are available by age and gender (Rikli & Jones, 1999).
Normative values for heart failure patients by NYHA class (Wegrzynowska-Tedorczyk, 2016); and a cut-off score of <60 steps for lower functional capacity (Poncumhak, 2023) are also provided.

Gait speed is often measured with a 4- or 5-meter walk test.
Different functional tasks (e.g., self-care, household activities, carrying groceries), that correlate with gait speed are analyzed.
Normative values for walking speed based on Metabolic Equivalents of Tasks (METs) are provided.

Gait speed < 0.7 m/s indicates poor exercise capacity.
Gait speed < 0.80 m/s associated with increased risk of hospital readmission.
Slow gait speed in patients after cardiac surgery ( < 0.83 m/s) associated with unfavorable outcomes, increased mortality, surgical morbidities, longer ICU and hospital stays.

Measures aerobic capacity in individuals unable to stand.
Conducted while the patient is seated.
Involves alternating steps, focusing on different heights (6, 12, and 18 inches) over 3-minute intervals, with progressively increasing upper extremity activity at the end.
The procedure tracks maximum HR (heart rate) at each stage.

Measures lower extremity (LE) strength and power.
Involves repeatedly sitting and standing from a chair.
The score represents the time taken to complete the test.
Arms should be folded across the chest during the transfers; if arms are needed to assist with standing the test is stopped.

The SPPB is a battery of tests (balance, gait speed, and chair stand) to assess physical performance.
It helps identify physical impairments in older adults. Provides cutoff points to gauge frailty and other impairments in patients with heart failure.
MCIDs for the SPPB (minimally clinically important differences) in older cardiac rehabilitation patients is greater than 1 point.
Individuals with lower scores are more likely to have more severe heart failure symptoms and higher risks of adverse events.
Cutoff norms exist to gauge frailty (non-frail; mild frailty; severely frail) in the patient population.

Hypoactivity syndrome is characterized by decreased endurance due to insufficient body movement.
This impacts ability to perform prolonged activity; this is a poor prognostic indicator.
Treatment strategies focus on increasing movement and activity to enhance endurance.

Various tests, their scores, and reference equations are presented to evaluate exercise capacity and predict outcomes (e.g., risk of death) for several conditions (heart failure, coronary artery disease, or cardiac surgery).