Exercise Testing in Physical Therapy

Study Notes

This presentation outlines various exercise tests and functional assessments used in physical therapy, particularly focusing on cardiovascular and pulmonary patients.
The tests are designed to evaluate exercise capacity and identify potential cardiac or pulmonary issues.

Vitals signs: Pre-exercise, during, and post-exercise monitoring of heart rate (HR), blood pressure (BP), and oxygen saturation (SpO2) is crucial.
Rate Pressure Product (RPP): A key indicator of cardiac workload during exercise, calculated by multiplying heart rate and systolic blood pressure.
Rating of Perceived Exertion (RPE): A subjective measure of the patient's perceived exertion level during exercise. This helps gauge intensity.
EKG: Electrocardiogram to evaluate electrical activity of the heart.
Angina: Chest pain due to reduced blood flow to the heart.
Observe the patient: Monitor skin color, coordination, alertness, and cognitive function, along with any signs of dizziness or lightheadedness.

The presentation includes graphs that show the typical response curve of heart rate and blood pressure to exercise/treadmill work.
These curves show normal responses to exercise in healthy men.
Includes various age ranges with metrics recorded for each response curve (heart rate/blood pressure).

An excessive increase in heart rate during exercise can be a significant concern.
A flat or decreased heart rate during exercise is another potential red flag.
Hypertensive responses (systolic blood pressure >210 mmHg, diastolic blood pressure > 110 mmHg) during exercise are considered abnormal.
A significant drop in systolic blood pressure during exercise might indicate underlying issues.
Changes in cardiac rhythm (e.g., abnormal heartbeats) during exercise should be carefully noted.

Angina: Presenting as moderately severe or increasingly painful.
Dyspnea: Marked shortness of breath.
Dizziness/Lightheadedness/Ataxia: The patient experiences dizziness, lightheadedness, or a lack of coordination.
Cyanosis/Pallor: Bluish discoloration or paleness of the skin.
Fatigue: Extreme tiredness or lack of energy.
Leg cramps/claudication: Leg muscle pain or cramps with exercise.

Heart rate recovery is a critical measure of cardiac function following exercise completion.
Good heart rate recovery is between 12-18 beats per minute or greater.
A heart rate recovery of under 12 beats per minute is considered abnormal, signifying potential risk of cardiac issues (CAD and CV death)

An objective assessment of functional exercise capacity.
Instructions for conducting the 6MWT can be found in the ATS 2002 article.
Applicable for various patient populations and ideal for measuring functional capacity.
Normal values (in healthy adults) for distance covered range between 400-700 meters.
Valuable for assessing efficacy of rehabilitation programs, with particular use in predicting mortality and hospital readmissions in heart failure patients.

Similar to the 6MWT for assessing functional capacity.
Patients with limited endurance may find this easier to tolerate compared to the 6MWT.
Limited research regarding the test with patients who have cardiac or vascular impairments.
Normative values are described for healthy adults of various age groups and gender.

Measures endurance and exercise capacity.
The test involves ascending a 12-inch step (or other predefined height) for a two-minute interval.
Score is based on the number of times the knee reaches a pre-determined target height.
A variety of supporting devices are helpful for maintaining balance.
Multiple phases involve altering the height of the step.
Normal scores are available for healthy adults based on age.
Specific normative values for patients with heart failure exist.

Assessment of lower extremity strength and power.
Measures time it takes to complete 5 repetitions of sitting and standing motions.
The test is also useful for other functional capacity assessment (e.g., frail individuals).

A multi-item assessment of functional mobility.
Consists of balance, gait speed, and chair stand tests.
Provides an evaluation of physical impairment and frailty.
Lower SPPB scores are associated with more severe heart failure symptoms, for example.

Often determined using a 4- or 5-meter walk test.
Measures walking speed/pace and is related to functional tasks like self-care and household activities.

Characterized by principal movement impairment and decreased endurance due to insufficient movement.
Individuals are unable to maintain activity for a prolonged period.