Kin 3534: Exam 1

BRFSS: In 2009, what percentage of people were inactive? ______%

24

Submaximal Tests- Lab tests: Assumptions of submaximal prediction of CRF- -A cadence of _____ revolutions per minute (rpm) is typically considered comfortable and mechanically efficient in most individuals.

50

BRFSS: In 2009, what percentage of people met the physical activity recommendation? ______%

51

____1___ -____2___% of VO2 or Heart Rate Reserved is considered moderate physical activity

(1) 40 (2) 60

Atherosclerotic CVD Risk Factor Assessment: Risk Factor: Age - Men > __1___ years - Women > ___2__ years

(1) 45 (2) 55

Atherosclerotic CVD Risk Factor Assessment: Risk Factor: Family History - Myocardial Infarction, coronary revascularization, or sudden Death before ___1___ yrs in father (or other male first-degree relative) or before ___2___ yrs in mother (or other female first-degree relative)

(1) 55 (2) 65

2008 Federal Physical Activity Guidelines: When you lose weight (1 kg) by aerobic training like running = 1(60/40)% fat loss, 2(60/40)% muscle loss

(1) 60 (2) 40

2008 Federal Physical Activity Guidelines: When you lose weight (1 kg) by calorie restriction = 1(60/40)% fat loss, 2(60/40)% muscle loss

(1) 60 (2) 40

Risk Stratification: VO2R HHR% Vigorous intensity = __1___ to < __2__%

(1) 60 (2) 85

Lipids: NCEP ATPIII LDL Cholesterol: - Optimal = < _____1______ - Very high = >____2_______

(1) 100 (2) 190

NCEP/ATP III Criteria: Body Weight (Waist Circumference) - Men > ___1____ cm - Women > ___2___ cm

(1) 102 (2) 88

Blood Pressure Classifications: Prehypertension: - SBP = ____1____ - ___2___ - DBP = ____3___ - ___4____

(1) 120 (2) 139 (3) 80 (4) 89

Blood Pressure Classifications: Normal: - SBP = < ____1____ - DBP = < ____2___

(1) 120 (2) 80

Atherosclerotic CVD Risk Factor Assessment: Risk Factor: Pre-Diabetes/Diabetes - Fasting Plasma Glucose (diabetes) > ___1___ mg*dL-1 - Oral Glucose Tolerance Test (OGTT) > ____2___ mg*dL-1 - HbA1C > ____3____%

(1) 126 (2) 200 (3) 6.5

Atherosclerotic CVD Risk Factor Assessment: Risk Factor: Dyslipidemia - LDL > ___1___ mg*dL-1 - HDL < ___2____mg*dL-1 - On lipid-lowering medication - Total Serum Cholesterol > ___3___ mg*dL-1

(1) 130 (2) 40 (3) 200

NCEP/ATP III Criteria: Elevated Blood Pressure - >____1___or >_____ mmHg

(1) 130 (2) 85

Risks of PA and Exercise: Absolute annual risk of exercise-related death among high school and colleges: - One per ______1_____ men - One per ______2_____ women

(1) 133,000 (2) 769,000 (It should be noted that these rates, although low, include all sports-related nontraumatic deaths. Of the 136 total identifiable causes of death, 100 were caused by CVD.)

Blood Pressure Classifications: Stage 1 Hypertension: - SBP = ____1____ - ___2___ - DBP = ____3___ - ___4____

(1) 140 (2) 159 (3) 90 (4) 99

Atherosclerotic CVD Risk Factor Assessment: Risk Factor: Hypertension - Systolic BP > ___1___ mmHg - Diastolic BP > ___2___ mmHg or on antihypertensive medication

(1) 140 (2) 90

Lipids: NCEP ATPIII Triglycerides: - Normal= < _____1______ - Very high = >____2_______

(1) 150 (2) 500

ACSM Recommendation: - _____1___ min of moderate intensity per week - ____2____ min of vigorous per week

(1) 150 (2) 75

Blood Pressure Classifications: Stage 2 Hypertension: - SBP = > ____1____ - DBP = > ____2___

(1) 160 (2) 100

Risk Stratification: VO2R HHR% Light intensity = __1___ to < __2__%

(1) 20 (2) 40

Lipids: NCEP ATPIII Total Cholesterol: - Desirable = < _____1______ - High = >____2_______

(1) 200 (2) 240

Concept of VO2max: Estimating VO2max from submaximal testing assumes: - It normally takes ___1___-___2___ minutes to reach steady state heart rate

(1) 3 (2) 4

Atherosclerotic CVD Risk Factor Assessment: Risk Factor: Obesity - BMI > ___1___ kg•m^-2 - Waist Girth > ___2___ cm in men - Waist Girth > ____3____ cm in women

(1) 30 (2) 102 (3) 88

Atherosclerotic CVD Risk Factor Assessment: Risk Factor: Physical Inactivity - Not participating in at least ___1___ mins of moderate intensity on at least 3 days of the week for at least ___2___ months

(1) 30 (2) 3

Measurement of HR and BP: •Pre-measurement indications -NO food, caffeine, smoking, or strenuous exercise for __1___ minutes -Room temperature 65-75°F -Explain procedures thoroughly; sit quietly for 5 minutes -Measurements on ___1___ arm unless there is a medical reason

(1) 30 (2) right

NCEP/ATP III Criteria: Dyslipidemia --> HDL - Men <____1___ mg*dL-1 - Women <____2___ mg*dL-1

(1) 40 (2) 50

Lipids: NCEP ATPIII HDL Cholesterol: - Low= < _____1______ - High = >____2_______

(1) 40 (2) 60

Risk Stratification: VO2R HHR% Moderate intensity = __1___ to < __2__%

(1) 40 (2) 60

Submaximal Tests- Treadmill: Many tests to choose from: •The same endpoint (__1___% HRR or 85% of age-predicted maximal HR) is used. •The stages of the test should be ____2___ min or longer to ensure a steady state HR response at each stage. •The HR values are extrapolated to age-predicted maximal HR.

(1) 70 (2) 3

Transient Ischemic Attack (TIA) F.A.S.T- F- ___1_____ A- ___2_____ S- ____3____ T- ____4____

(1) Face (facial droop) (2)Arms (unilateral weakness, raise both arms to see which one is weak) (3) Speech (slurred speech= tell them to say a phrase "you cant teach old dog new tricks) (4) time (mark down the time)

The 2008 federal physical activity guidelines recommend that every adult should do: When you lose weight (1 kg) by resistance training like lifting weights = 100% 1(fat/muscle) loss, and 0% 2(fat/muscle) loss

(1) fat (2) muscle

Diastolic blood pressure determines the ______1______ going to the muscles and the ___________2__________ of the muscles

(1) fluid (2) contractility

Benefit to Risk Ratio: - Must always determine the ______1_____ of the program and weigh the ______2______ vs. _______3________

(1) goals (2) benefits (3) risks

NCEP/ATP III Criteria: Insulin Resistance/Glucose - >______ mg*dL-1d

110

VO2max without plateau can still mean you've reached the peak if... 3) RER > ______ (NEED 2/3 to determine that you have reached VO2max)

1.1 (normal range is 0.7-1.0) (0.7 metabolize all fat ; 1.0 metabolize all carbs) (respiratory exchange of VCO2 and VO2) (produce CO2 from metabolic process or from hyperventilation)

When to Stop the Test: - Onset of angina or angina-like symptoms - Drop in SBP of ≥____ mm Hg with an increase in work rate or if SBP decreases below the value obtained in the same position prior to testing

10

2008 Federal Physical Activity Guidelines: - 500 to _______ MET minutes/week

1000 (MET minute/week = intensity x time/week)

2008 Federal Physical Activity Guidelines: - _______ minutes/week of moderate intensity exercise

150

NCEP/ATP III Criteria: Dyslipidemia --> Triglycerides - >______ mg*dL-1

150

Submaximal Tests- Cycle Tests (Astrand-Rhyming Ergometer Test: 35 year old female, 150 bpm, 600 kpm/min, 70 kg How do you find VO2max? Start with chart and find on the right hand side the chart that has workload (make sure its on the woman line), and go to 600 and make a dot. Then make a dot on the left hand side chart that has the pulse rate (make sure its on the woman line), and go to 150 bpm. Then draw a line connecting the 600 and ______. The line goes through 2.6 VO2max. On the right hand chart with near the work load, there is a line that is just VO2 level which is 1.5 L. Then convert 2.6 L to mL kg/min - 2.6 L/min * 1/70 kg * 1000 mL/L = 37.1 mL/kg*min Then to find Percent VO2max: 1.5/2.6 * 100 = 57.7%

150

BRFSS: (2000/2009) BRFSS- adults with 30+ minutes of moderate physical activity five or more days per week, or vigorous physical activity 20+ minutes 2 or more days per week Problems: - the bar is set low and people lie, they changed the question which appears to increase activity levels

2009

Measurement of HR and BP: Blood Pressure- •Stethoscope placement •Lightly press head of stethoscope on marked artery •Inflate cuff to ______ mmHg

180

VO2max without plateau can still mean you've reached the peak if... 2) RPE of ______ (NEED 2/3 to determine that you have reached VO2max)

19 (or 20)

_________ first time in the US that the government recognized that nutrition is important to health (4 food groups)

1940's

2008 Federal Physical Activity Guidelines: - Muscle-strengthening activities _____ days/week that involve all muscle groups

2

Additional Risk Stratification according for CVD: Highest Risk- •High level of silent ischemia (ST-segment depression ≥____ mm from baseline) during exercise testing or recovery •Presence of abnormal hemodynamics with exercise testing (i.e., chronotropic incompetence or flat or decreasing systolic BP with increasing workloads) or recovery (i.e., severe postexercise hypotension - low blood pressure)

2

Measurements during the CV testing: Time Points: •Baseline (supine and exercise posture) •Final minute of each stage (Box 21-13 RM) •Every 1-___ minutes in recovery

2

BRFSS: (2000/2009) BRFSS- adults with 30+ minutes of physical activity five or more days per week Problems: - the bar is set low and people lie

2000

__________ is the first time in the US that the government recognized that exercise is important to health

2008

Interpretation of CV Tests: - Male, 40 years old - A-R cycle test = 35 mL·kg-1·min-1 - Predicted METs = 12 (83% of average METs) Normative data = Poor condition; ~_____%ile

20 (20th percentile based on chart, meaning 80 % of the people have a better VO2max)

When to Stop the Test: - Excessive rise in BP: systolic pressure >______ mm Hg and/or diastolic pressure >115 mm Hg - Shortness of breath, wheezing, leg cramps, or claudication

250

2008 Federal Physical Activity Guidelines: (Weight Loss) - Greater than _______ minutes/week moderate physical activity

250 (•Dose response across studies over a 12 week to 18 month period with weight loss ≤3kg •~2000+ kcal per week)

2008 Federal Physical Activity Guidelines: (Weight Maintenance after Weight Loss) - Greater than ______ minutes/week moderate aerobic physical activity

250 (•Typically concluded as "more is better". •~2000+ kcal per week)

BRFSS: In 2000, what percentage of people met the physical activity recommendation? _____%

26

BRFSS: In 2000, what percentage of people were inactive? _______%

28

ACSM Frequency: - _____+ days per week of exercise for at least 3 months

3

Participant Instructions: - No food, alcohol, or caffeine or tobacco products within ____ hours of testing. - No vigorous exercise for 24 hours. - Wear loose fitting, comfortable clothes. - The exercise test may be fatiguing, do they need a ride home?

3

VO2 max can be estimated from ___________________ tests

submaximal

ACSM Duration: - ________ minutes per day

30

Additional Risk Stratification according for CVD: Highest Risk- (nonexercise) •Rest ejection fraction <____% •History of cardiac arrest or sudden death •Complex dysrhythmias at rest •Complicated myocardial infarction or revascularization procedure

40

Risks of PA and Exercise: - The physically active or fit adult has about 30%-______% lower risk of developing CVD compared to those who are inactive

40 (People who are more fit have a lower risk of suddenly dying, and also people who are younger have a lower risk of suddenly dying)

Additional Risk Stratification according for CVD: Moderate Risk- (nonexercise) •resting ejection fraction 40% to _______%

49

BRFSS: Physical Activity in US 2000 and 2009 - According to phones and fitness trackers only _____% of people reach the recommended activity levels

5

Korotkoff Sounds: Phase (1/4/5) is the first silence after the last audible sound

5

Additional Risk Stratification according for CVD: Lowest Risk- (Non-exercise test) •Resting ejection fraction ≥____% •Uncomplicated myocardial infarction or revascularization procedure •Absence of complicated ventricular dysrhythmias at rest (cant have anything wrong with ventricle)

50

Atherosclerotic CVD Risk Factor Assessment: Risk Factor: Smoking - Current smoker or those who quit within the previous ____ months or exposure to environmental tobacco smoke

6

Benefit to Risk Ratio: Risks of Exercise Testing- - Data suggest that the risk of exercise testing is low, with approximately ______ cardiac events per 10,000 symptom-limited maximum tests.

6

Atherosclerotic CVD Risk Factor Assessment: Negative Risk Factors: HDLs - HDLs > _________ mg*dL-1

60

2008 Federal Physical Activity Guidelines: - _______ minutes/week of vigorous intensity exercise

75

VO2max without plateau can still mean you've reached the peak if... 1) >______% at HR max (NEED 2/3 to determine that you have reached VO2max)

90

When to Stop the Test: - Signs of poor perfusion: ______________, confusion, ataxia, pallor, cyanosis, nausea, or cold and clammy skin - Failure of HR to increase with increased exercise intensity

lightheadedness

Laboratory Safety: Clinical exercise testing laboratories- -Supervision by appropriately trained staff member with ________ certification. -AHA has established minimal competencies for physicians who supervise and interpret exercise tests.

ACLS (advanced cardiac life support (place IVs, can read EKGs, know how to administer life saving drugs))

Screening: The purposes of the pre-participation health screening include the following: - Recognition of individuals with clinically significant disease(s) or conditions who should participate in a medically _____________ exercise program or exercise testing

supervised

High degree ______ block = BAD (absolute indication) - only one or few QRS complex but many P waves - need a doctor note, its bad because ventricles aren't actually contracting and cardiac output is way down

AV

(Relative/Absolute) VO2: - mL of O2/min (milliliters/min)

Absolute

Laboratory Safety: Potential Life-Threatening Emergencies - ____________: pain/pressure in chest, neck, jaw, SOB; sit or lie down, check vitals, consider nitroglycerine and O2 - activate EMS or physician oversight

Angina

Laboratory Safety: Potential Life-Threatening Emergencies - ____________: stop activity, assess vitals, give O2, and identify arrhythmia, check perfusion - activate EMS or physician oversight

Arrhythmia (•V-tach can lead to death (if these people are exercising vigorously and have v-tech you need to slow them down before having them stop or all the blood will go to the legs and they will feel lightheaded and almost pass out))

For someone who has TIA, what should you NOT give them? - ___________

Aspirin (blood thinner and makes stroke worse)

_____________ is not an accurate representation because it doesn't account for muscle mass, body mass (across different races), height, etc.

BMI

The percent of U.S. adults who are obese or who have diagnosed diabetes was determined by using data from the ____________. An ongoing, yearly, state-based telephone survey of the non-institutionalized adult population in each state, the BRFSS provides state-specific information on behavioral risk factors for disease and on preventive health practices.

BRFSS (Behavioral Risk Factor Surveillance System)

Physical Activity, Obesity, and Diabetes Trends: ______________- is a survey that collects six behavioral health risk factors: smoking, alcohol use, physical activity, diet, hypertension, and safety belt use

BRFSS (Behavioral Risk Factor Surveillance System) (these were all associated with the leading causes of death in the US)

Measurements during the CV testing: Minimal Measurements: •HR - palpation, auscultation, monitor (ex. Polar) •EKG - 12 lead (VO2 max, cycle tests, treadmill) •BP - manual or automatic( Use TRUE DBP if you can hear it) •Subjective ratings (RPE, angina, dyspnea) •RPE - _______ (6-20) or category scale (0-10)

Borg

Laboratory Safety: Potential Life-Threatening Emergencies - ____________: "asthma attack", assist with medications (bronchodilator) - EMS if no relief

Bronchospasm

Risks of PA and Exercise: Examples of causes of sudden death in young men and women- - _________ ___________ - Overheated/Hyperthermia - Stroke - Hypothermia

Cardiac Arrest

Additional Risk Stratification according for CVD: Highest Risk- (nonexercise) •EJ% < 40% means? Highest risk something is wrong with the heart and it cannot push blood out of the heart effectively ___________ __________ is low

Cardiac Output (Q) (Oxygen levels in organs, muscles and tissues are low)

Recommended Lab Tests for Low/Moderate Risk: - Fasting Total ___________, LDL, HDL, and Triglycerides - Fasting glucose (if >45 yrs or BMI > 25) - Thyroid Function - Risk factors for Type 2 Diabetes

Cholesterol

Korotkoff Sounds: Phase 5 is also known as?

Clinical Diastolic Blood Pressure

Submaximal tests: What test do you use? •Length of the test •Willingness of the participant •________of the test to administer •What personnel needed (i.e., qualifications)

Cost

Interpretation of CV tests: __________-________ standards: - Considered desirable to achieve based on external criteria (Gold standard measure) - Open to subjective interpretation - Men; predicted METs = 18 - 0.15*age - Women; predicted METs = 14.7 - 0.13*age

Criterion-referenced

What type of exercise testing makes it easier to measure blood pressure and ECG?

Cycle Ergometers

Concept of VO2max: Estimating VO2max from submaximal testing assumes: •HR vs. workrate (Watts, speed/grade, etc) is __________ •HRmax can be estimated accurately

linear (-HR max estimated accurately -220-age standard deviation = +/- 12 -That means 68% at age 40 will have max HR between 192 and 168 with only 1 standard deviation -2 standard deviations makes the range 204 to 156 -Gives range of HR for this estimate to measure max intensity -Miss estimate HR max, gives a lot of error in intensity)

Submaximal Tests- Lab tests: Assumptions of submaximal prediction of CRF- - A ___________ relationship exists between VO2 and HR within the range of 110-150 bpm. It is at this point that SV has reached a plateau (approximately 40%-50% of max), and the HR and oxygen consumption track linearly.

linear (straight line)

Laboratory Safety: Clinical exercise testing laboratories should have similar emergency equipment - Crash Cart - Oxygen - _________________ - Established emergency plan with regular staff practice

Defibrillator (AED)

________________ blood pressure stays the same as intensity increases and may decrease slightly when you stop exercising

Diastolic

How do we lower LDLs? ________

Diet

Contraindications to Exercise Testing: For conditions that prevent diagnostic ECG information, the exercise test may still provide useful information on: - Exercise Capacity - Subjective Symptomatolgoy - Pulmonary Function - ____________ - Hemodynamic responses to exercise

Dysrhythmias (RPE (ratings of perceived exertion) - how hard do you think you are working (0-10 scale) •Angina- chest pain or chest pressure (0-4 scale) •Dyspnea- how hard your breathing (0-4 scale) •Claudication - leg pain (0-4 scale))

Additional Lab Tests for High Risk: - Cardiovascular tests - _________, angiography - Ultrasound of carotids and other peripheral sites - C-reactive protein (chronic inflammation), cholesterol subspecies, CBC, comprehensive blood chemistries

EKG

Laboratory Safety: Develop an emergency Care Plan- •Who provides care, how to direct ________, what equipment is available, what training is required, emergency procedures are posted in the laboratory, etc.?

EMS

Purpose of Exercise Testing: - _____________ participants about their present health/fitness status relative to health-related standards and age and sex matched norms

Educating

Common Errors with HR and BP: •Heavy pressure with stethoscope •Use of __________ to hold stethoscope against arm •Measurement over clothing •Stethoscope in the ears the wrong direction

thumb

Atheorsclerotic CVD Risk Factor Assessment: • CVD risk factor assessment in combination with the determination of the presence of various cardiovascular, pulmonary, renal, and metabolic diseases is important when making decisions about- - level of _________ ___________ - need for exercising testing - level of supervision for exercising testing and exercising program participation

medical clearance

Frequency Intensity Time = Volume (MET = minutes per week, multiple equivalent task which equals Resting Metabolic Rate (RMR) •___________= number of session per week •Intensity = METs •Time = Minutes per day

Frequency

ACSM Preparticipation Screening Algorithm: 1) No exercise 2) Signs/Symptoms of disease 3) Yes medical clearance 4) Intensity of exercise? (Moderate/Vigorous/Discontinue and seek medical clearance)

moderate

Frequency Intensity Time = Volume (MET = minutes per week, multiple equivalent task which equals Resting Metabolic Rate (RMR) •1 MET = RMR = 3.5 mL O2/kg per min •2 MET = 2 x RMR •3 MET = 3 x RMR (cut point for _____________ intensity exercise) (3.0 mph walk)

moderate

Low-Density Lipoprotein ratio of fat/protein is? - (more/less) fat than protein

more

Guiding Principles of Exercise is Medicine: 3) ___________-______________ efforts to bring a greater focus on physical activity and exercise in health care settings are to be encouraged (hospitals, to gyms, to universities)

multi-organizational

True or False: In order to have metabolic syndrome, you need to have 4 or more of the risk factors.

False (3 of the 5 criteria) (Suggestive of an elevated risk for CVD Criteria often used in research to define a study sample.)

True or False: Can a test be valid and not reliable?

False (a test cannot be considered valid if it is not reliable)

Examples of Exercise Testing: - Cardiorespiratory Fitness (aerobic fitness) - Muscle Fitness (strength/power/endurance) - _______________ - Body Composition

Flexibility

Exercise Prescription is based on? - Health status and __________

Goals

Atherosclerotic CVD Risk Factor Assessment: Negative Risk Factors are (HDL/LDL)

HDL

Submaximal Tests- Lab tests: Assumptions of submaximal prediction of CRF- - The HR at two separate work outputs can be plotted as the HR-VO2 relationship and extrapolated to the estimated ___________.

HRmax

Cardiac Signs/Symptoms: - _______ __________: unusual heart sounds and valves don't close correctly

Heart Murmur

________________: appropriate increases and decreases in heart rate and blood pressure with increasing workloads and recovery

Hemodynamics

Laboratory Safety: Potential Life-Threatening Emergencies - ____________: shaky, pupils dilated, weak, lightheaded, give 5-20g of glucose, juice; repeat every 15 min until glucose rises - EMS if unconscious

Hypoglycemia

Laboratory Safety: Potential Life-Threatening Emergencies - ____________: lightheadedness, syncope; lie down, elevate feet, give fluids - EMS if unresolved

Hypotension

Types of Validity: ________ validity- degree to which a measure obviously involves the performance being measured - ex. using a ruler

Logical Validity

Contraindications to Exercise Testing - RELATIVE (WEIGH RISK TO BENEFIT RATIO): •Ventricular __________ •Uncontrolled metabolic disease (diabetes, thyrotoxicosis, or myxedema) •Chronic infectious disease (e.g., HIV, Hep C) •Mental or physical impairment leading to inability to exercise adequately •Advanced pregnancy

aneurysm

Contraindications to Exercise Testing: ABSOLUTELY DO NOT TEST IF- •Acute myocarditis or pericarditis - inflammation of the heart •Suspected or known dissecting __________ •Acute systemic infection, accompanied by fever, body aches, or swollen lymph glands

aneurysm

_______________ of exercise is hard to understand because there are multiple factors that affect it

Intensity

Cardiac Signs/Symptoms: - ____________ _____________: pain in the legs during exercise which is caused by peripheral artery disease

Intermittent Claudication

Cardiac Signs/Symptoms: -____________: low blood flow (anginal events like heart attack is driven by ischemia, blockage of blood flow)

Ischemia

Additional Risk Stratification according for CVD: Lowest Risk- •Absence of complex ventricular dysrhythmias during exercise testing and recovery •Absence of _________ or other significant symptoms (e.g., unusual shortness of breath, light-headedness, or dizziness, during exercise testing and recovery)

angina

Measurement of HR and BP: Blood Pressure- •Deflate ~2 mmHg/sec (resting ~2 mmHg/heart beat) •Listen carefully for __________ sounds

Korotkoff

CRF Testing: Maximal Testing •Maximal estimated ________or maximal time on treadmill - these values have to do with speed and grade on treadmill or power output on the bike

METS (Speed/grade and work rate --> METs --> maximal work rate)

Contraindications to Exercise Testing: ABSOLUTELY DO NOT TEST IF- •A recent significant change in the resting electrocardiogram (ECG) suggesting significant ischemia, recent MI, or other acute cardiac event •Unstable _______ (chest pain, pressure, and the heart rhythm starts getting very weird) •Uncontrolled cardiac dysrhythmias causing symptoms or hemodynamic compromise- low blood pressure or cardiac output

angina

____________: Maximal ability of the body to transport and utilize oxygen to produce ATP necessary for muscle movement, etc. Direct measurements can be made by a metabolic cart along with assessment of ventilatory threshold (VT).

Maximal oxygen uptake, utilization, and maximal cardiorespiratory fitness

Submaximal Tests- Lab tests: Assumptions of submaximal prediction of CRF- - _____________ ________, which must be predicted for submaximal ergometer testing, can be estimated or predicted as a function of age

Maximum HR (HRmax) (HRmax = 220 - age).

Concept of VO2max: Estimating VO2max from submaximal testing assumes: •__________ ______ is equal across individuals (VO2 at a given workrate) -Amount of chemical energy that is translated into mechanical energy, body going forward... the rest goes to friction (heat energy)

Mechanical efficiency (-Fuel is broken down to produce mechanical energy (movement) -Our efficiency is 25-30% range based on the activity -When we start to run, we produce heat energy à fuel turns to mechanical and heat energy -Constant power output and how much oxygen a person is using -Not everyone will have same energy output to work -Lower in trained than less trained in fuel rate needed)

___________________ is the #1 drug used for people a risk for diabetes or for people who have diabetes

Metformin

Exercise is Medicine: - ___________ is the number one drug prescribed for prediabetes

Metformin (•Over 4 years it has increased to 40% in 4 years for the placebo (400 became type 2) •Over 4 years it has increased to 30% in 4 years for the Metformin (300 became type 2) •Over 4 years it has increased to 20% in 4 years for the lifestyle modification (200 became type 2))

Informed Consent: •___________ require legal guardian sign •Must indicate how the data will be used and who will see the data. •Approved by legal counsel or Institutional Review Board •Tell how emergencies will be handled •Signed by participants and staff

Minors (<18 years)

ACSM Preparticipation Screening Algorithm: 1) Exercise 2) Known disease 3) No medical clearance 4) Intensity of exercise? (Moderate/Vigorous/Discontinue and seek medical clearance)

Moderate

ACSM Preparticipation Screening Algorithm: 1) No exercise 2) Known disease 3) Yes medical clearance 4) Intensity of exercise? (Moderate/Vigorous/Discontinue and seek medical clearance)

Moderate

_________________________ is up to 6 times higher when testing is conducted in facilities without the ability to manage cardiac arrest

Mortality rate (Around 1 per 10,000, if you are in a facility without AED's you are 6 times more likely to die)

Submaximal Tests- Cycle Tests (Astrand-Rhyming Ergometer Test: •Typically a 6 minute single-stage test •Pedal at 50 RPM on cycle ergometer •Measure HR for 10 to 15 sec (multiple by 4) each minute •Measure BP after 3 minute HR is taken •Steady-state achieved? - 6 bpm difference between minutes 5 and 6 - < 6bpm, test done - ≥ 6bpm, continue another minute •HR between 125 and 170 bpm (YES/NO), continue another 6-min at higher workload

NO

ACSM Preparticipation Screening Algorithm: 1) Exercise 2) No sign of disease 3) Medical clearance necessary? (Yes/No)

No

ACSM Preparticipation Screening Algorithm: 1) No exercise 2) No sign of disease 3) Medical clearance necessary? (Yes/No)

No

If you do not participate in regular exercise and no diseases, no signs, or symptoms, do you need medical clearance? (Yes/No)

No

Atherosclerotic CVD Risk Factor Assessment: Risk Factors are- - ___________ - Hypertension - Dyslipidemia - Pre-Diabetes/Diabetes

Obesity

Screening Methods: - Self-guided Method = 2017 _______-____

PAR-Q+

Cardiac Signs/Symptoms: - Intermittent Claudication is caused by? __________ ________ _________

Peripheral Artery Disease

Cardiac Signs/Symptoms: -_________ ______ _________: heart skips a beat due to a spot in the ventricle that gets agitated

Premature Ventricle Contraction

Cardiac Signs/Symptoms: - PVC stands for?

Premature Ventricle Contractions

Cardiac Signs/Symptoms: - ankle _____________ which is swelling of the ankles, accumulation of blood in the legs

edema

Fick's Equation: VO2 = ________________ difference or VO2 = (HR*SV) * (CaO2-CvO2)

Q * a-vO2 (Q = cardiac output) (Q = heart rate x stroke volume) (A-VO2 difference = CaO2 - CvO2)

(Relative/Absolute) VO2: - mL of O2 per minute/kg of body weight (milliliters/kg*min)

Relative

Korotkoff Sounds: Phase 1 is also known as?

Systolic blood pressure

How do you change HDLs? ___________ __________

Resistance Training

Additional Risk Stratification according for CVD: Moderate Risk- •Silent Ischemia: when the ____-segment is > 2 mm from the baseline

ST

________ segment- is there enough oxygen in the heart muscle to successfully repolarize the heart muscle (need ATP)

ST

__________ segment depression- significant sign of ischemia in the heart muscle at rest

ST

_____________- bubble ST elevation myocardial infarction (evolving MI)

STEMI

Atherosclerotic CVD Risk Factor Assessment: Risk Factors are- - Age - Family History - ____________ - Physical Inactivity

Smoking

Concept of VO2max: Estimating VO2max from submaximal testing assumes: •_________ ________ HR is obtained at each workload

Steady state (-Eventually reach plateau and slow creep up (cardiac drift) -Steady state is at 100 W, HR will stay here at a long time, is the cardiac stress associated with this intensity -Athletes have a steeper increase in 1-2 minutes -Older adults take longer to get up to steady rate)

______________ blood pressure increases as intensity increase and decreases to normal quickly when you stop exercising

Systolic

Cardiac Signs/Symptoms: - Multiple PVCs (premature ventricle contractions) may mean that your heart is not getting enough _________________

oxygen

In a HbA1C, having a higher level of glucose in the blood (> 6.5%) means? - There is a higher percentage of hemoglobin with glucose attached to it which makes ___________ delivery worse

oxygen

Korotkoff Sounds: Phase 4 is also known as?

True Diastolic Blood Pressure

Laboratory Safety: Potential Life-Threatening Emergencies - __________ __________ __________: -lack of O2 to brain - activate EMS, note time symptoms started

Transient Ischemic Attack (TIA)

Additional Risk Stratifications according to the CVD: True or False: - you need to have ALL of the characteristics to remain in a certain risk.

True

Risks of PA and Exercise: True or False- Men carry a higher risk of death due to exercise-related activities than women (high school/college athletes)

True

True or False: Exercise Preparticipation Health Screening Questionnaire for Professionals helps assess health status.

True

True or False: For people with diabetes, the lower the LDL number is, the better.

True

True or False: Post-menopausal women or people who have diabetes won't feel the effects of cardiac signs/symptoms.

True

True or False: When LDL > 130 (risk factor), the body delivers fat, but fat escapes and goes in blood, arteries, or the heart.

True

True or False: Knowing if you have a disease is better than having the signs/symptoms.

True

Benefit to Risk Ratio: Risks of Exercise Testing- - Symptom-limited maximum tests: ________ _________ test (eventually limited by symptoms like chest pain or shortness of breath as the intensity increases, or muscle pain etc. )

VO2 max

CRF Testing: Maximal Testing •__________- maximal oxygen uptake, maximal oxygen utilization, maximal cardiorespiratory fitness, etc •NOTE: Some field tests will elicit a maximal response!

VO2max

ACSM Preparticipation Screening Algorithm: 1) Exercise 2) Known disease 3) Yes medical clearance 4) Intensity of exercise? (Moderate/Vigorous/Discontinue and seek medical clearance)

Vigorous

ACSM Preparticipation Screening Algorithm: 1) Exercise 2) No sign of disease 3) No medical clearance 4) Intensity of exercise? (Moderate/Vigorous/Discontinue and seek medical clearance)

Vigorous

ACSM Preparticipation Screening Algorithm: 1) No exercise 2) No sign of disease 3) No medical clearance 4) Intensity of exercise? (Moderate/Vigorous/Discontinue and seek medical clearance)

Vigorous (light to moderate intensity exercise recommended and may gradually increase to vigorous!!!!)

Possible Test Order: •Questionnaires (Allow acclimation time) •Physicals** •___________(Resting BP and HR) •Body Composition •Cardiorespiratory Fitness •Muscular fitness •Flexibility **Performed by physician (Possible Laboratory Tests included)

Vitals

ACSM Preparticipation Screening Algorithm: 1) No exercise 2) Known disease 3) Medical clearance necessary? (Yes/No)

Yes

ACSM Preparticipation Screening Algorithm: 1) No exercise 2) Signs/Symptoms of disease 3) Medical clearance necessary? (Yes/No)

Yes

ACSM: Example: Do they meet the requirements of being physically active? - 4 days/week - Moderate Intensity - 30 mins/day - At least 6 months

Yes

If you do not participate in regular exercise and have a known disease and are asymptomatic, do you need medical clearance? (Yes/No)

Yes

If you participate in regular exercise and have known disease and are asymptomatic, do you need medical clearance? (Yes/No)

Yes

If you participate in regular exercise and have signs and symptoms, do you need to get medical clearance? (Yes/No)

Yes (and discontinue exercise until you seek medical clearance)

ACSM Preparticipation Screening Algorithm: 1) Exercise 2) Signs/Symptoms of disease 3) Medical clearance necessary? (Yes/No)

Yes (discontinue exercise and seek medical clearance) (may return to exercise following medical clearance)

Korotkoff Sounds: - First, initial sound of faint, repetitive and clear tapping sounds. The maximum pressure that occurs near the end of systole of the left ventricle a) Phase 1 (SBP) b) Phase 4 (true DBP) c) Phase 5 (clinical DBP)

a (Phase 1)

Contraindications to Exercise Testing - RELATIVE (WEIGH RISK TO BENEFIT RATIO): ___________________- the PR interval is greater than 0.2 seconds (SA node is firing normally but AV node is waiting to long to contract) a) First degree block b) Second degree block c) High degree secondary block

a (first degree block)

Metformin is an _________________

antidiuretic

Risks of PA and Exercise: - Absolute risk of sudden cardiac death during vigorous intensity, physical activity has been estimated at one per year for every 15,000-18,000 previously (symptomatic/asymptomatic) individuals.

asymptomatic

Contraindications to Exercise Testing - RELATIVE (WEIGH RISK TO BENEFIT RATIO): •Tachydysrhythmia or bradydysrhythmia •Hypertrophic cardiomyopathy and other forms of outflow tract obstruction •Neuromotor, musculoskeletal, or rheumatoid disorders that are exacerbated by exercise •High-degree _______________ _________

atrioventricular block (2nd degree)

Korotkoff Sounds: - Sounds become muffled and are less distinct and less audible. Sounds may be described as soft or blowing a) Phase 1 (SBP) b) Phase 4 (true DBP) c) Phase 5 (clinical DBP)

b (Phase 4) (4th phase is the true diastolic blood pressure (muffled) --> you want this during exercise, where the vessel is wide open at rest)

HDLs < 40 is (good/bad)

bad

Concept of VO2max: Estimating VO2max from submaximal testing assumes: • Absence of medications, supplements, and intervening life events or environmental conditions that alter HR responses - _________ _______ will block SNS, causing HR to be lower

beta blockers

Measurement of HR and BP: Blood Pressure- •Palpate and mark the ______ artery •Wrap cuff on arm about 1 inch above AC fossa •Legs uncrossed and feet flat on floor

brachial

Korotkoff Sounds: - Complete disappearance of sound that usually occurs 8-10 mm Hg from phase 4 a) Phase 1 (SBP) b) Phase 4 (true DBP) c) Phase 5 (clinical DBP)

c (Phase 5) (5th phase is clinical diastolic blood pressure (no sound) --> 120/80, such low pressure on artery that it can freely expand how it wants to = laminar blood flow)

Contraindications to Exercise Testing - RELATIVE (WEIGH RISK TO BENEFIT RATIO): ___________________- the PR interval, 3 firing of SA node and then only one firing of AV node) (4 cardiac cycles, 1 contract) a) First degree block b) Second degree block c) High degree secondary block

c (high degree secondary block)

Contraindications to Exercise Testing - RELATIVE (WEIGH RISK TO BENEFIT RATIO): ___________________- the PR interval, drop a QRS complex while heart is beating (4 cardiac cycles, 3 contract) a) First degree block b) Second degree block c) High degree secondary block

c (second degree block)

Prevention of Events: - Know the pathologic conditions associated with exercise-related events - Active individuals should know __________ symptoms and seek medical care if symptoms develop (Table 2.1)

cardiac

Laboratory Safety: Potential Life-Threatening Emergencies - __________ __________: Activate EMS, start CPR/AED

cardiac arrest (after an emergency don't forget to close the loop! = document occurrence)

Participant Instructions: - For diagnostic purposes, discontinue prescribed ______________ medications, only with physician approval. They can mask symptoms. - For functional or exercise prescription (ExRx) purposes, patients should continue their medication regimen on their usual schedule so that the exercise responses will be consistent with responses expected during exercise training.

cardiovascular (CV)

Types of Validity: Criterion validity ________ validity- degree to which a measuring instrument is correlated with a criterion that is administered concurrently or at the same time (type of criterion validity)

concurrent (-at the same time measures -Take height on two scales and plot data point -Poor concurrent validity does not follow linear pattern)

Additional Risk Stratification according for CVD: Highest Risk- (nonexercise) •Presence of ____________ heart failure •Presence of signs or symptoms of postevent/postprocedure ischemia •Presence of clinical depression

congestive

Additional Risk Stratification according for CVD: Lowest Risk- (Non-exercise test) •Absence of __________ __________ failure (fluid accumulates in lungs because blood flow to lungs is impaired) •Absence of signs or symptoms of postevent/postprocedure ischemia •Absence of clinical depression

congestive heart

Guiding Principles of Exercise is Medicine: 1) Exercise and physical activity are important to health and the prevention and treatment of many _________ ___________.

chronic diseases

Types of Validity: ________ validity- degree to which a test measures a hypothetical construct; usually established by relating test results to some behavior -ex. Step tests differentiate between fit and unfit people

construct (based on marker of fitness and line between fit and unfit - The cut point is not clear)

Types of Validity: ________ validity- degree to which a test adequately samples what was covered in a course - ex. an exam or test

content

Pre Screening Take Home Messages: •Exercise testing of individuals at high risk can be supervised by nonphysician health care professionals if the professional is specially trained in __________ _____________ testing with a physician immediately available if needed. Exercise testing of individuals at moderate risk can be supervised by nonphysician health care professionals if the professional is specially trained in clinical exercise testing, but whether or not a physician must be immediately available for exercise testing is dependent on a variety of considerations.

clinical exercise

Types of Validity: ________ validity- degree to which data points are related to recognized standard criterion - ex. UWW is the (blank) measure for skin-folds

criterion (continuous measure)

Metabolic Syndrome Criteria is from the? a) NCEP/ATP III b) IDF c) WHO d) All of the above

d (all of the above) (NCEP/ATP III is what we need to memorize)

Laboratory Safety: Prevention of Emergencies- •Include proper screening strategies prior to testing . •Use appropriate exercise tests and equipment •Educate participants prior to exercise tests •Develop exercise prescriptions based on collected ___________

data

Cardiorespiratory Fitness: - Low levels of CRF have been associated with a markedly increased risk of premature ________ from all causes and specifically from cardiovascular disease

death

When you stop exercise, your heart rate (increases/decreases) quickly and then ________________ decreases to normal

decreases (;) gradually

Test Environment: •The room should be equipped with a comfortable seat and/or examination table to be used for resting BP and HR and/or ECG recordings. •The ________of personnel should be one of relaxed confidence to put the subject at ease. (Confidence in eyes of ppt; calm demeanor) •Testing procedures should not be rushed, and all procedures must be explained clearly prior to initiating the process.

demeanor

Prevention of Events: - Young athletes should be screened by qualified professionals prior to participation - Health care facilities should ensure they have trained staff to manage emergencies and have access to appropriate _______________ (increases 6 fold if you don't have these things)

equipment

Test Organization: Before the client/participant arrives- - Ensure that all forms, score sheets, tables, graphs, and other testing documents are organized and available - Calibrate all ___________ (e.g., metronome, cycle ergometer, treadmill, sphygmomanometer, skinfold calipers) according to manufacturers' specifications; and document in a designated folder.

equipment

Atheorsclerotic CVD Risk Factor Assessment: - Provides health/fitness, clinical experience, and healthcare professionals with important information for the development of a client or patients ____________ ____________

exercise prescription

Screening: - Detection of individuals at increased risk for disease because of age, symptoms, and/or risk factors who should undergo a medical evaluation and/or _________ __________ before initiating an exercise program or increasing the frequency, intensity, or duration of their current program

exercise testing

Cardiac Signs/Symptoms: - unusual _______________ or shortness of breath with usual activities

fatigue

When to Stop the Test: - Physical or verbal manifestations of severe _________ - Failure of the testing equipment

fatigue

__________ __________: VO2 = Q x (a-v)O2diff

fick equation

Participant Instructions: - Bring a list of their medications including dosage and frequency and report the last actual dose taken. Participants may wish to bring their medications with them for the exercise testing staff to record. - Drink ample _________ over the 24-hour period preceding the test to ensure normal hydration before testing.

fluids

Measurement of HR and BP: Blood Pressure- •Find midpoint of the __________ •Measure the arm circumference on the bare arm •Position arm-bend of elbow at heart level, palm up

humerus

What does having a Hb1Ac of 6.5% mean? - 6.5% of the hemoglobin in your blood has _________ attached to it

glucose

Purpose of Exercise Testing: - Motivating participants by establishing reasonable and attainable health/fitness _________

goals (keep moving and motivated, different depending on population)

Guiding Principles of Exercise is Medicine: 2) More should be done to address physical activity and exercise in __________ _________ settings

health care

Principles and Guidelines for Testing: - Give an example of a valid measure

height

Additional Risk Stratification according for CVD: Lowest Risk- •Presence of normal _____________ during exercise testing and recovery (i.e., appropriate increases and decreases in heart rate and systolic blood pressure with increasing workloads and recovery) •Functional capacity ≥7 metabolic equivalents (METs)

hemodynamics

Pre Screening Take Home Messages: •Routine exercise testing is recommended only for individuals at _____risk including those with diagnosed CVD, symptoms suggestive of new or changing CVD, diabetes mellitus, and additional CVD risk factors, end-stage renal disease, and specified lung disease.

high

Contraindications to Exercise Testing - RELATIVE (WEIGH RISK TO BENEFIT RATIO): ______________ ____________- seen an elevated risk of this in athletes

hypertrophic cardiomyopathy

Contraindications to Exercise Testing - RELATIVE (WEIGH RISK TO BENEFIT RATIO): ______________- low potassium in the blood

hypokalemia

Contraindications to Exercise Testing - RELATIVE (WEIGH RISK TO BENEFIT RATIO): ______________- low sodium in the blood

hyponatremia

Cardiac Signs/Symptoms: - ____________: low oxygen in the blood (in the muscle, low blood flow to tissue, shortness of breath, dizziness)

hypoxia

As you increase in intensity, blood pressure (increases/decreases)

increases

As you increase in intensity/workload, your heart rate (increases/decreases) linearly until max

increases

Cardiorespiratory Fitness: - (Increases/decreases) in CRF are associated with a reduction in death from all causes.

increases

____________ ______________: exchange on oxygen for carbon dioxide on exhaled air (5% exchange)

indirect calorimetry (Inspired = 21% O2) (Expired = 16% O2 and 5% CO2)

Purpose of Exercise Testing: - Providing data that are helpful in development of ____________ exercise prescriptions to address all health/fitness components

individualized

In Type 2 Diabetes, the body produces ______________, but it does not work properly to lower blood sugar

insulin

2008 Federal Physical Activity Guidelines: Panel of 13 on the Advisory Committee- some physical activity is better than none (additional benefits if ________, time, or frequency increase)

intensity

Exercise _______________ is the most difficult thing to understand

intensity

Cardiac Signs/Symptoms: -_________________ _____________= someone that exercises and their legs hurt (throbbing and very painful), when you stop the pain goes away, its a symptom of peripheral artery disease

intermittent claudication

Additional Risk Stratification according for CVD: Moderate Risk- (any one or combination of these) •Presence of angina or other significant symptoms (e.g., unusual shortness of breath, lightheadedness, or dizziness occurring only at high levels of exertion [≥7 METs]) •Mild to moderate level of silent ___________during exercise testing or recovery (ST-segment depression <2 mm from baseline) •Functional capacity <5 METs

ischemia

Cardiac Signs/Symptoms: - pain, discomfort, or other anginal equivalent in the chest, neck, jaw, arms, or other areas that may result from _________________

ischemia

Submaximal Tests- Lab tests: Submaximal exercise testing can be a valid and reliable method for predicting CRF when done in a ______________ setting.

laboratory

High-Density Lipoprotein ratio of fat/protein? - (more/less) fat than protein

less (Lots of protein and low fat)

Laboratory Safety: Emergency Plans and Equipment- •Based on _______ of exercise testing (hotel to cardiac rehab)

level

Exercise is Medicine: - The incidence of Type 2 diabetes is lower in (Lifestyle/Metformin)

lifestyle (•Over 4 years it has increased to 40% in 4 years for the placebo (400 became type 2) •Over 4 years it has increased to 30% in 4 years for the Metformin (300 became type 2) •Over 4 years it has increased to 20% in 4 years for the lifestyle modification (200 became type 2))

VO2 max versus VO2 peak: VO2 (max/peak)= the test stops and the person has reached their max intensity (there should be a plateau on the graph)

max

VO2max: VO2 ________- maximal graded test, do not know if actually meet VO2 max because you do not know what you will hit next

max

CRF Testing: Submaximal Testing - some of the sub-max tests will give __________ response if done properly, due to injury or age or higher risk individuals - field tests - cycle ergometers - treadmill tests - step tests

maximal

Some field test will elicit a ________________ response

maximal

Principles and Guidelines for Testing: If a test is reliable it means it gets the exact same _________ every time

measure

Screening: The purposes of the pre-participation health screening include the following: - Identification of individuals with __________ contraindications that require exclusion from exercise programs until those conditions have been abated or controlled.

medical

Submaximal Tests: Why choose a submaximal test?? •Submaximal takes less time to perform, is less expensive, and may not require physician supervision. •Submaximal may be ________ for those with established disease. - Gives the best view of cardiovascular system based on EKG (use in stress tests)

safer

Cardiac Signs/Symptoms: - known heart _____________

murmur

Test Organization: Before the client/participant arrives- - Maintain room temperature between 68° F and 72° F (20° C and 22°C) and humidity of <60%. - Organize equipment so that tests can follow in sequence without stressing the same ____________ group repeatedly. Careful of your testing order.

muscle

HDLs 40 - 60 is (normal/abnormal)

normal

Interpretation of CV tests: ___________ standards: - Based on previous performances by similar groups - based on frequency distribution (bell-curve) - CV testing -Table 4.9 in GETP - 20th percentile based on chart, meaning 80 % of the people have a better VO2max

normative

2008 BRFSS: Areas with high rates of diabetes also have high rates of _____________ and physical inactivity

obesity

Screening: - Screening should optimize _______________ during exercise testing and aid in the development of a safe and effective exercise prescription

safety

Cardiac Signs/Symptoms: - ________________ or paroxysmal nocturnal dyspnea which is difficulty breathing during sleep; shortness of breath during sleep is a sign of pulmonary issues

orthopnea

VO2 max versus VO2 peak: VO2 (max/peak)= they stop the test without letting the person reach their max intensity

peak

VO2max: VO2 ________- have not determined actual VO2 max, when VO2 max no longer increases after increased intensity, VO2 will never change once it plateaus

peak

Submaximal Tests: Why choose a submaximal test?? •Maximal provides the best assessment of safety of exercise and disease presence. •Maximal provides best data (e.g., true _________ ________) for exercise prescription purposes.

peak HR

Exercise is Medicine: Diabetes Prevention Program - __________ __________ program was effective and easier to be maintained than just having an overall weight loss goal

physical activity (150 minutes a week)

Cardiorespiratory Fitness: - High levels of CRF are associated with higher levels of habitual _________ ___________, which in turn are associated with many health benefits.

physical activity (PA)

Cardiac Signs/Symptoms: - _________ __________: an edema where when you poke it then take your finger off, there is still an indentation of where your finger pressed

pitting edema (this is very bad)

Exercise is Medicine: What are the 4 huge risks for diabetes? (include commas)

plasma glucose, obese, sedentary, family history (usually on moms side)

Submaximal tests: What test do you use? •What equipment and facilities are needed for the test •Whether physician supervision is needed •Whether there are any ___________ concerns •Needs to be met to preserve accuracy of the data being collected (Safety assumptions; baseline testing you see the assumptions follow up is looking for change in VO2 max then test becomes valid)

safety

(pre-testing/post-testing): helps tell people about current status of health and physical activity

pre-testing

Types of Validity: Criterion validity ________ validity- degree to which scores of predictor variable can accurately predict criterion scores (type of criterion validity) - ex. Risk factors have been validated over time as people develop CAD

predictive (-linear relationship between gold standard and tool testing with -Take current data and predict future outcomes -Risk factors and predict how long you will live)

Purpose of Exercise Testing: - Collecting baseline and follow-up data that allow evaluation of _____________ by exercise program participants

progress

HDLs are __________________ proteins which will absorb extra fat lying around in the blood

scavenger

Screening: - Potential participants should be screened for the presence of signs, symptoms, and/or risk factors for various cardiovascular, ________________, and metabolic diseases and other health issues (pregnancy, orthopedic injuries)

pulmonary

Contraindications to Exercise Testing: ABSOLUTELY DO NOT TEST IF- •Symptomatic severe aortic stenosis (narrowing of blood vessels) •Uncontrolled symptomatic heart failure •Acute __________ ___________ (blood clot) or pulmonary infarction

pulmonary embolus (blood clot)

Measurement of HR and BP: Heart Rate- - Locate peripheral pulse = _______, brachial, carotid - Measure for at least 30 seconds (± 2 bts/min)

radial (When measuring from radial artery you start with the number 0 then go up (counting the number of cardiac cycles))

Principles and Guidelines for Testing: ______________: the degree to which a test or instrument measures what it purports to measure; can be categorized as logical, content, criterion, or construct (blank)

validity

Cardiorespiratory Fitness: - The assessment of CRF is an important part of a primary or secondary prevention and _____________ programs.

rehabilitative

Principles and Guidelines for Testing: ______________: consistency or repeatability of a measured

reliability

A test must be _______________ in order to be valid

reliable

Common Errors with HR and BP: •Inappropriate cuff size •Inadequate _______ period before measurement OR allowing participant to talk, cross legs, etc •Deflating cuff too fast •Improper arm level with respect to heart

rest

When to Stop the Test: - Noticeable change in heart __________ by palpation or auscultation - Subject requests to stop

rhythm

Pre Screening Take Home Messages: •All individuals wishing to initiate a physical activity program should be screened at minimum by a ______-___________ medical history or health risk appraisal questionnaire. The need and degree of follow-up is determined by the answers to these self-guided methods.

self-reported

Cardiac Signs/Symptoms: - _________________ of breath at rest or with mild exertion

shortness

Additional Risk Stratification according for CVD: Moderate Risk- •_________ _____________: slow to make ATP and ST-segment depression is < 2mm from the baseline

silent ischemia

Submaximal Tests- Lab tests: Assumptions of submaximal prediction of CRF- - _______ ________ heart rate (HRss) can be achieved in 3-4 min at a constant, submaximal work output.

steady state

Contraindications to Exercise Testing - RELATIVE (WEIGH RISK TO BENEFIT RATIO): •Left main coronary ___________ •Moderate stenotic valvular heart disease •Electrolyte abnormalities (e.g., hypokalemia or hypomagnesemia) •Severe arterial hypertension (i.e., systolic blood pressure [SBP] of >200 mm Hg and/or a diastolic BP [DBP] of >110 mm Hg) at rest

stenosis

Cardiac Signs/Symptoms: - ______________: temporary loss of consciousness

syncope

Cardiac Signs/Symptoms: - dizziness or ____________

syncope

Cardiac Signs/Symptoms: - Palpitations or ___________________= where the heart skips beats or there is an irregular heart rhythm

tachycardia

Test Environment: •Test anxiety, emotional problems, food in the stomach, bladder distention, room temperature, and ventilation should be controlled as much as possible. •To minimize subject anxiety, the _________ _________should be explained adequately, and the test environment should be quiet and private.

test procedures

CRF Testing: Maximal Testing Tested with a graded exercise test (GXT) on a ___________, cycle, or basically any modality that elicits a maximal response.

treadmill

2008 Federal Physical Activity Guidelines: True or False- Resistance training can alter body composition

true

True or False: There is no validity without reliability

true

True or False: You can have reliability but no validity

true

Additional Risk Stratification according for CVD: Highest Risk- •Presence of complex _____________ ______________ during exercise testing or recovery •Presence of angina or other significant symptoms (unusual shortness of breath, lightheadedness, or dizziness at low levels of exertion [<5 METs] or recovery)

ventricular dysrhythmias

Benefit to Risk Ratio: Risks of Exercise Testing- - The risks of various cardiac events include acute MI, _____________ ______________, hospitalization, and death.

ventricular fibrillation

Informed Consent: •Provides ethical and legal considerations for the participant - it is a binding agreement between the tester and testee •Participants understand the purposes, risks and benefits •Procedures should be __________ explained •Participant should have opportunities to ask questions •Participant free to withdraw at ANY time

verbally

If you are not physically active, you should not start off with ________________ intensity activity

vigorous

Risks of PA and Exercise: - More recent available research has confirmed a higher rate of sudden cardiac death and acute MI among adults performing _____________ intensity exercise when compared to their younger counterparts.

vigorous (•As you increase the intensity you have a higher amount of risk (in normal asymptomatic individuals) risk goes up by 10 fold)

Frequency Intensity Time = Volume (MET = minutes per week, multiple equivalent task which equals Resting Metabolic Rate (RMR) •6 MET = 6 x RMR (cut point for __________ intensity exercise) (4.5 mph jog)

vigorous (6> is vigorous) ( Example = 3 days a week + 6 METS + 30 minutes per day = 540 METxmin/week [recommended 500-1000] )