Exercise Testing Overview

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Questions and Answers

What is a primary reason submaximal exercise testing is preferred over maximal testing in clinical settings?

  • It is less likely to cause adverse events. (correct)
  • It requires medical supervision.
  • It requires ECG monitoring.
  • It only tests cardiovascular fitness.

The original Borg Scale for perceived exertion ranges from 0-10.

False (B)

What should be documented at the time of assessment during submaximal exercise testing?

All medications

The Borg Scale for perceived exertion is used to monitor and prescribe exercise intensity, with its original range being from ______ to ______.

<p>6, 20</p> Signup and view all the answers

Match the following conditions with their indications for exercise testing:

<p>Cardiovascular disease = Diagnostic and prognostic indication Pulmonary diseases = Diagnostic and prognostic indication Unexplained Dyspnea = Diagnostic and prognostic indication</p> Signup and view all the answers

What characteristic defines a maximal exercise test?

<p>Heart rates greater than 85% of age-predicted values off medication (D)</p> Signup and view all the answers

The cardiopulmonary exercise test (CPET) can help identify cardiovascular compromise only at low levels of exercise.

<p>False (B)</p> Signup and view all the answers

What additional analysis does a CPET include compared to a regular exercise stress test?

<p>Ventilatory gas analysis</p> Signup and view all the answers

A systolic blood pressure (SBP) of _____ mm Hg is considered hypertensive.

<p>250</p> Signup and view all the answers

Match the following aspects of CPET with their descriptions:

<p>VO2 peak = Maximum oxygen consumption during exercise analysis Rating of Perceived Exertion = Borg scale used to gauge exercise intensity Cardiovascular compromise = Indication of potential heart strain during activity Maximal exercise test = Test where HR exceeds 85% of age-predicted values</p> Signup and view all the answers

What does the respiratory exchange ratio (R) primarily indicate?

<p>The ratio of carbon dioxide output to oxygen consumption (B)</p> Signup and view all the answers

The stroke volume decreases during intense exercise.

<p>False (B)</p> Signup and view all the answers

What typically happens to systemic blood pressure as exercise intensifies?

<p>It increases due to a rise in cardiac output.</p> Signup and view all the answers

During upright exercise, stroke volume is estimated using the _________.

<p>Oâ‚‚ pulse</p> Signup and view all the answers

Match the physiological response to exercise with its expected behavior:

<p>Respiratory exchange ratio (R) = Increases with exercise intensity Stroke volume = Increases initially, levels off later Systemic blood pressure = Rises significantly during peak exercise Tidal volume (VT) = Increases until reaching the ventilatory threshold</p> Signup and view all the answers

Which of the following factors does NOT need to be considered when deciding on an exercise test?

<p>Age of the patient (D)</p> Signup and view all the answers

Tidal volume tends to level off at about 40% of the individual's vital capacity during exercise.

<p>False (B)</p> Signup and view all the answers

What is the typical rise in systolic pressure at peak exercise in normal individuals?

<p>Into the 200 mmHg range</p> Signup and view all the answers

What is the minimum important distance (MID) for patients with coronary artery disease (CAD) in the six-minute walk test (6MWT)?

<p>25m (A)</p> Signup and view all the answers

The Incremental Shuttle Walk Test (ISWT) is more frequently used in cardiac rehabilitation programs compared to the six-minute walk test (6MWT).

<p>False (B)</p> Signup and view all the answers

What percentage change in distance is calculated in the six-minute walk test (6MWT)?

<p>Percentage change = (post-program distance - pre-program distance) / pre-program distance x 100</p> Signup and view all the answers

The sit to stand test (STST) is valuable for _____ activities and requires minimal equipment.

<p>daily functional</p> Signup and view all the answers

Match the following tests with their descriptions:

<p>Six-Minute Walk Test (6MWT) = Self-paced walking test measuring endurance Incremental Shuttle Walk Test (ISWT) = Externally paced test with auditory cues Sit to Stand Test (STST) = Measuring functional capacity with minimal equipment Cardiac Stress Test = Monitors heart while at rest and during exercise</p> Signup and view all the answers

What is the purpose of giving medication during the cardiac stress test?

<p>To increase heart rate (A)</p> Signup and view all the answers

The six-minute walk test (6MWT) can be done outdoors without any standardization.

<p>False (B)</p> Signup and view all the answers

In the Incremental Shuttle Walk Test (ISWT), what is one criterion for test termination?

<p>Reaching 85% max heart rate</p> Signup and view all the answers

What is the primary purpose of exercise testing?

<p>To evaluate cardiovascular and ventilatory responses (A)</p> Signup and view all the answers

VO2 max is the amount of oxygen consumed at peak exercise.

<p>True (A)</p> Signup and view all the answers

What does the Fick equation help to calculate?

<p>VO2</p> Signup and view all the answers

The average sedentary male achieves a VO2 max of about _____ mL/kg/min.

<p>35 to 40</p> Signup and view all the answers

Which system is NOT directly evaluated during exercise testing?

<p>Digestive system (A)</p> Signup and view all the answers

Oxygen consumption is solely dependent on age and gender.

<p>False (B)</p> Signup and view all the answers

Name one factor that affects VO2 max.

<p>Fitness level</p> Signup and view all the answers

What is the primary purpose of a CPET in patients with heart failure?

<p>To assess prognosis and stratify for cardiac transplantation (A)</p> Signup and view all the answers

A pharmacologic stress test involves physical exercise.

<p>False (B)</p> Signup and view all the answers

What is the maximum VOâ‚‚ during rest for the measured patient?

<p>242 ml/minute</p> Signup and view all the answers

A nuclear stress test uses _______ dye to show blood flow to the heart.

<p>radioactive</p> Signup and view all the answers

What is the heart rate of the patient at maximum exercise?

<p>153 bpm (A)</p> Signup and view all the answers

Match the following stress test types with their main characteristics:

<p>CPET = Measures work and oxygen consumption during exercise Pharmacologic stress test = Simulates exercise through medication Nuclear stress test = Uses radioactive dye to evaluate blood flow</p> Signup and view all the answers

What is the lactate level at maximum exercise according to the data provided?

<p>3</p> Signup and view all the answers

The patient's oxygen saturation level was lower at maximum exercise compared to rest.

<p>False (B)</p> Signup and view all the answers

Flashcards

Submaximal exercise testing

A type of exercise testing that uses a less strenuous approach than maximal testing, often done in clinical settings.

Rating of perceived exertion (RPE)

Measure of how hard someone feels they are working during exercise - usually assessed using the Borg Scale.

Original Borg Scale

A scale used to measure RPE, ranging from 6 to 20, originally designed to correlate with heart rate.

Modified Borg Scale

A modified version of the Borg Scale, using a 0-10 scale, designed for easier use and understanding.

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Diagnostic exercise testing

A type of exercise testing used to diagnose potential cardiovascular or pulmonary issues.

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Exercise Testing

The evaluation of the cardiovascular and ventilatory systems' responses to controlled exercise stress.

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VO2 Max

The maximum amount of oxygen that your body can utilize during peak exercise.

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Gas Exchange

The ability to move oxygen from the air to the blood and carbon dioxide from the blood to the air.

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Ventilation

Delivering oxygen to the tiny air sacs in your lungs (alveoli) and removing carbon dioxide.

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Oxygen Consumption (VO2)

The amount of oxygen your tissues use per minute.

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Oxygen Delivery

The process of moving oxygenated blood from the heart to the muscles and returning carbon dioxide to the lungs.

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Oxygen Extraction

The process of cells using oxygen to create energy (ATP).

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Fick Equation

The equation that calculates VO2 max using cardiac output, arterial oxygen content, and mixed venous oxygen content.

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Cardiopulmonary Exercise Test (CPET)

A test that measures heart and lung function during exercise, pushing the patient to their maximum capacity.

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Peak VO2

The highest level of oxygen uptake achieved during an exercise test.

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Maximal Exercise Test

An exercise test that is designed to take you as close as possible to your maximum effort.

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Submaximal Exercise Test

A test where your effort is limited to a specific level, often less intense.

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Volitional Exhaustion

A test where the patient reaches their maximum effort and may experience symptoms such as chest pain or shortness of breath.

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Respiratory Exchange Ratio (R)

The ratio of carbon dioxide output to oxygen consumption (VCO2 / VO2). It reflects the balance between fat and carbohydrate metabolism during exercise.

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Stroke Volume

The amount of blood ejected from the heart with each heartbeat.

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Systolic Blood Pressure

The pressure in the blood vessels during the contraction of the heart.

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Diastolic Blood Pressure

The pressure in the blood vessels during the relaxation of the heart.

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Tidal Volume (VT)

The volume of air inhaled or exhaled in a single breath.

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Ventilatory Threshold

A point during exercise where the body starts relying more heavily on carbohydrates for fuel.

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Vital Capacity

The capacity of the lungs after a maximal inhalation.

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Exercise Test

A test that measures various physiological responses to exercise. It helps assess cardiovascular fitness, risk factors, and exercise tolerance.

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What is a CPET?

A test used to assess the heart's ability to function during exercise, often to determine prognosis in heart failure patients or to stratify patients for transplantation.

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What is VO2/kg?

A measurement of the maximum volume of oxygen the body can consume during exercise, expressed in milliliters per kilogram of body weight per minute.

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What is FEV1?

The maximum amount of air that can be forcibly exhaled after a full inspiration, measured in liters.

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What is a pharmacologic stress test?

A stress test that simulates exercise by using medication to increase heart rate and blood flow, often used in patients unable to exercise physically.

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What is a nuclear stress test?

A stress test involving radioactive dye and imaging to evaluate blood flow to the heart both at rest and during stress.

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What is VO2/VT?

A measure of how efficiently the body utilizes oxygen during exercise, calculated by dividing the amount of oxygen consumed (VO2) by the volume of air breathed (VT).

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What is blood pH?

A measurement of blood acidity, indicating the balance of acids and bases in the blood.

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What is PaCO2?

A measure of the partial pressure of carbon dioxide in the blood, reflecting how effectively the lungs exhale carbon dioxide.

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Cardiac Stress Test

A cardiac test that uses a radioactive dye to show blood flow during rest and exercise.

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Six-Minute Walk Test (6MWT)

A self-paced walking test measuring the distance covered in six minutes.

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Absolute Change in 6MWT Distance

The difference in distance covered during 6MWT before and after a rehabilitation program.

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Percentage Change in 6MWT Distance

The percentage change in 6MWT distance, calculated as (post-program distance - pre-program distance) / pre-program distance x 100.

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Incremental Shuttle Walk Test (ISWT)

An externally paced walking test where you walk between two markers at increasing speeds until you reach a stop criterion.

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Sit to Stand Test (STST)

A test that measures how quickly you can stand up from a seated position.

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Ceiling Effect

A ceiling effect occurs when a test is too easy for a patient, making it difficult to measure further improvements.

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Borg Scale RPE

A measure of perceived exertion based on a scale of 1 to 10, where 1 is no exertion and 10 is maximal exertion.

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Study Notes

Introduction to Exercise Testing

  • Presented by Dr. Sherif Osama Elabd, lecturer at physical therapy, faculty of physical therapy, May University.
  • Date of presentation: 11/26/2024

What is Exercise Testing?

  • Exercise testing analyzes how the cardiovascular and ventilatory systems respond to exercise stress.
  • It's used to assess both the diagnostic and prognostic aspects by evaluating the pulmonary, cardiovascular, hematopoietic, neuropsychological, and skeletal muscle systems.
  • Exercise testing assesses exercise performance, functional capacity, and exercise intolerance.
  • It helps identify exercise-related symptoms.

Cardiac and Respiratory Response to Exercise

  • Ventilation delivers oxygen to alveoli and removes carbon dioxide.
  • Gas exchange moves oxygen from alveoli to blood and carbon dioxide from the blood to alveoli.
  • Hemoglobin helps transport oxygen to tissues.
  • Exercising tissues receive oxygenated blood and carbon dioxide is delivered to the lungs.
  • Muscles use oxygen to generate ATP for contraction.

Maximum Oxygen Consumption (VO2max)

  • VO2max measures oxygen use by tissues per minute at peak exercise.
  • The Fick equation calculates VO2max (VO2 = Q × (CaO2 - CvO2)).
  • CaO2 is arterial oxygen content, while CvO2 is the mixed venous oxygen content.
  • Q is cardiac output.
  • Average VO2max varies based on age, gender, and fitness level.
  • Sedentary males typically have a VO2max of 35-40 mL/kg/min, while females have approximately 27-30 mL/kg/min.

Metabolic Equivalent (MET)

  • MET is defined as oxygen consumption during rest, equal to 3.5 ml Oâ‚‚ per kg body weight per minute.
  • Various activities have corresponding MET values.
  • Values vary based on activity intensity, age, and fitness.

Maximum Heart Rate

  • Maximum heart rate is the highest heart rate during maximal exercise (estimated using age).
  • Target heart rate zones for moderate and vigorous exercise intensities are explained.

Exercise Responses in Normal Individuals

  • PaCO2 (partial pressure of carbon dioxide) remains relatively constant during exercise until the ventilatory threshold.
  • PaO2 (partial pressure of oxygen) remains relatively stable.
  • Arterial pH decreases slightly as exercise progresses.
  • Other exercise-related responses such as cardiac output, heart rate, minute ventilation, oxygen saturation (SaO2), and oxygen consumption (VO2) increase.
  • Respiratory exchange ratio (R) increases.

Exercise Testing Considerations

  • Primary purpose of the test needs to be considered.
  • Clinical risk profile of the patient.
  • Evaluation setting of the test.
  • Research or service evaluation requirements.

Indications of Exercise Testing

  • Diagnostic and prognostic assessment for cardiovascular and pulmonary diseases, unexplained dyspnea, exercise prescription, assessment of therapeutic intervention efficacy.

Contraindications for Exercise Testing

  • Absolute contraindications involve conditions where testing is unsafe (e.g., recent MI).
  • Relative contraindications indicate caution and that the test should be performed with extreme caution (e.g., unstable angina, high-degree heart block).

Types of Exercise Tests

  • Exercise stress test (EST)
  • Cardiopulmonary exercise test (CPET)
  • Pharmacologic stress test
  • Nuclear stress test
  • Six-minute walk test (6MWT)
  • Incremental shuttle walk test (ISWT)
  • Sit-to-stand test (STST)

Procedures, preparation, and protocol for each test are also included

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