DNE test 2
What is absolute VO2? Relative VO2?
- Absolute does not consider a person's weight and relative does. - Provides a measure of energy cost of non- weight bearing activities - Directly related to body size. - Absolute: L/min, ml/ min - Relative: ml/kg/min, ml/kgFFM/ min 1 met= 3.5 ml/kg/min
what 2 factor determine blood pressue
- Blood volume and peripheral resistance. - Flow and resistance
What are variables that you should measure throughout a max test? When should you measure them?
- Bruce protocol - Strengthens: 3 min stages - Weakness: large increments of increase VO2 from stage to stage - Balke (balki) protocol - Strength: smaller increments - Speed remains excepte for grade
What factors affect resistance in the body?
- Distance travel- viscosity - Peripheral resistance - Plaque build up - Radius of diameter of vessel - Nemver of vessesl open.
exercise prescription for cardiorespitory fitness
- Frequency >3 days/ week - intensity: 40-50%- 85% VO2 max R---40-50%-85% HRR. ---55/60% - 90% HR max RPE= 12-16; somewhat hard to hard lower threshold probably dependent on fitness level. - Time- 25-60 min - Mode- Aerobic activities FIT: 150-400 kcal/ wk--- 1000-2000 kcal. wk. in excess of 2000 kcal/wk for short and long term weight control.--- 450- 750 MET- min/wk or 7.5-12.5 MET- hrs/ week.
FIT= kcal
- Frequency x intensity x Time - Intensity x Time= Kcal > intensity need to be expresses as VO2 > for every 1L O2 consumed, 5 kcal burned
How can we estimate VO2max from a maximal treadmill test?
- From speed and grade of the treadmill - Use a test protocol and equation that has been validated. - Create your own protocol and check with validated protocol for speed and grade. Must be in steady state for this to work. - ** heart rate tells us about their exertion not about VO2max. It is estimation. VO2 max determine by work load.
How to estimate VO2 max from a max test? Estimating VO2 max from submax test
- From speed and grade of treadmill * use a test protocol and equation that has been validated * Make your own protocol and estimate from published equations for speed and grade. Must be insteady state for this to work. - From peak Watts on the bike + use a test protocol and equation that has been validated. + Make your own protocol and estimate from published equations for speed and grade. Must be in steady state for this to work. - Calibration of equipment is extra important. - No holding on in TM test
Filed tests for estimating VO2 max
- Graph time to run 1.5 miles vs Vo2max put Vo2 max on x axis put 1.5 mile time on y axis - what are strengths and weaknesses of something like 1.5 mile run to estimate Vo2-- strength: relalistic environment during competition. weakness- motivation , environment conditions, pacing % fat, running economy,, lacte threshold.
What is the difference between gross and net VO2? When we measure VO2 are we measuring gross or net? When might we want to use net VO2?
- Gross- reflect cost of both rest and exercise VO2 - Net- reflects the rate of oxygen uptake in excess of the resting oxygen uptake - Describes the caloric of the exercise (you get this by subtracting the resting compent from the gross) net = gross- resting component.
How do you know if someone has maxed out?
- Hr does not increase for a specific amount of time, despite the increase in work a rate
4. How would you rank the accuracy of aerobic tests from most accurate to least accurate?
- Lab max direct - Lab max estimate - Submax field - Or lab test, field, non- exercise
(deep squat) factor cause poor performance
- Limited mobility in upper torso can be attributed to poor glenohumeral and thoracic spine mobility. - Limited mobility in lower extremity. - - poor closed- kinetic chain dorsiflexion of the ankles - - poor flexion of the hips may also cause test performance
What are some maximal aerobic tests?
- Measure oxygen uptake= the max oxygen that you can use during exercise- VO2 = (O2 in) - (O2 out) • Cycle ergo meter • Treadmill • Step • Running
Popular Protocols: Bruce
- Men VO@ (ml/kg/min)= 14.76 - 1.379 x time + 0.451 * time 2 - 0.012 * time3 - Women: Vo2 max ( ml/kg/min) = 4.38x time - 3.90 Example of a woman going 9 min (3.4/14%) - Vo2 max = 4.38 x 9- 3.90= 35.5 ml/kg/min. large increment of 8.5 ml/kg/min - each stage is 3 min, 2% grade increase after each stage, start at 10% grade after warm up- big jump at 4.2-16% to 5.0 to 18%
popular protocols: Balke
- Men- Vo2 (ml/kg./min) = 1.444 x time + 14.99 -Women - Vo2max (ml/kg./min)= 1.38 x time + 5.22 example of someone going 9min Vo2max= 1.444 x 9 + 14.99= 28 ml/kg/min Long test & extreme grade for high fit people- can create low back pain.
Joe has developed a new max treadmill protocol. It involves increasing speed or grade every minute. VO2max is then estimated from the speed and grade at the end of the test using accepted formulas for estimating VO2 from speed and grade. Do you think this would be a good test? Why or why not? If you don't think this is a good test, how would you change it?
- No, increase every minute- will not give the body adequate time to reach steady state to give accurate measure. Fatigue easily. I would increase the speed and grade for every 3 minute- given extrea until the heart rate is at 5bpm different between the last 2 state.
When conducting a maximal test, what is the primary variable we are measuring or estimating
- Oxygen uptake, ventilation
What is oxygen uptake? What is maximal oxygen uptake? How is it measured?
- Oxygen uptake- ventilation inspired and expired - Maximal oxygen consumption - Rate or amount of oxygen used to produce energy during maximal aerobic exercise. Lab, maximal with the estimation of oxygen uptake Expired oxygen and carbon dioxide Estimate VO2 max by Bruce protocol
(Hurdle step) Clinical implications
- Stance- leg stability of ankle, knee and hip as well as maximal closed - kinetic chain extension of the hip. - Step- leg open - kinetic chain dorsiflexion of the ankle and flexion of the knee and hip. - Adequate balance bz the test imposes a need 4 dynamic stability. - poor performance due to: + poor stability of the stance leg + poor mobility of the step leg. + imposing maximal hip flexion of one leg while maintaining hip extension of the opposite leg requires the athlete to demonstrate relative bilateral, asymmetric hip mobility. + suspect hip mobility issue do? Thomas test.
FIT protocol
- Start at 1.8 mph; 6% grade - Every min increase by 0.4 mph or grade by 2% - When grade reaches 14% increase speed by 0.4 mph each min. (slow and take longer)
You're testing someone and they want to stop, but you don't think they've maxed out yet. What should be you do?
- Stop, because we have to ensure the safety of the client - Do communicate and ask for reason why they want to stop Set a goal for them depending on reason for stopping.
A 100 lb person and a 200 lb person are walking on the treadmill at the same speed and grade. How does their absolute VO2 compare? Why? How does their relative VO2 compare? Why?
- Their absolute of 200lb is more because it take more energy to maintain his body activity. Their relative VO2 is the same because- the amount energy/ body weight= the same. • Weight dependent test.
A 100 lb person and a 200 lb person are cycling at the same power output (watts). How does their absolute VO2 compare? Why? How does their relative VO2 compare? Why?
- They will have the same absolute VO2 ( cycle take out the weight factor- same power out out= same O2 consume). - The smaller people will have higher relative VO2 because same energy/ smaller weight = larger VO2 - Rest VO2 does not change bz same energy is needed to be alive no matter the training process.
What are advantages and disadvantages of using the treadmill vs the bike in aerobic fitness testing?
- Tread mill give higher value than bike or other test. - With the bike you don't get a cardio respitory max, bz local fatigue occurs first > about 15% lower on the bike. Prefer treadmill unless they are cyclist or have joint problem - Advantage of treadmill- more familiar form of exercise, you can increase HR and VO2, because during the ergometer you get local fatigue before you reach your true cardiorespitory max.
How can we estimate VO2max from a maximal cycle ergometer test?
- Use peak power output - Use test protocol and equation that has been validated.
Metabolic equation
- Used to estimate oxygen cost of exercise during steady state, submaximal conditions. - Linear relationship between VO2 and workload and caloric expenditure - No handrail Holding - Intersubject variability (7%) - Accuracy not affected by environemental temperature (HR affected) - Gait abnormalities, mechanical efficiency, And walking/ running surface will affect the accuracy
LAB CASE REPORT
- Walking at 60% of VO2 max for 1k gross kcal/ week; Walk at 4 mph at a BLANK % grade BLANK days/ week for BLANK minute/ exercise session. HR should be about BLANK bpm. VO2 max = 40 x 60%= 24 ml/kg/min; Hrmax= 200bpm; 4 mph= 107.2 m/min; weight = 80 kg % grade calculation 24 ml/kg/min= (0.1 x 107.2) + (1.8 x 107.2 x B) + 3.5 ml/kg/min 24= 10.7 + 193.B + 3.5 ml/kg/min 9.7= 193x X = 0.199 or 19.9% grade. Minutes Calculation 24ml/kg/min x 80 kg= 1.92 L/min x 5= 9.6 kcal/min 1000 kcals/ 9.6= 104 min/wk 3 times 35 min = 105 4 times/ 26 min= 104 5 times 21 min= 105 HR calculations: 60% VO2 max- 70%- 75% Hrmax 200 b/min x 0.7= 140 b/min
Shoulder Mobility
- assess bilateral shoulder range of motion, combining internal rotation with adduction and external rotation with abduction. Also requires normal scapular mobility and thoracic spine extension. - Determine the hand length by measuring the distance from the distal wrist crease to the tip of the third digit in inches. - make a fist with each hand, placing thumb inside the fist. - assume a maximally adduced, extended and internally rotated position with one shoulder and a maximally abducted, flexed and externally rotated position with the other. - hands should remain in a fist and they should be place on the back in one smooth motion. - tester measured the distance between two closest bony prominence.
What are the different purposes for graded exercise testing?
- diagnostic - Functional (maximum oxygen uptake) - Exercise prescription (determine activities that are appropriate) - Improvement.
Resistance
- directly proportion to length and viscosity - inversely related to radius of vessel to the 4th power - Resistance= length x viscosity/ radius ^4th - reduce radius by 1/2 will increase resistance by 16- 2^4= 16 - primary factor regulating blood flow through the body is the radius of blood vessel.. blood can be diverted to one organ or another or to muscles by vasoconstriction and vasodilation - greatest vascular resistance is in the arterioles.
As aerobic exercise intensity increases what happens to flow during systole? Why? What happens to resistance during systole? Why? What happens to systolic blood pressure?
- flow increase, because the increase cardiac output to keep up with demand. - Resistance decrease- body vasodialate - increase amount of blood to tissue to meet demand.
As aerobic exercise intensity increases what happens to flow during diastole? Why? What happens to resistance during diastole? Why? What happens to diastolic blood pressure?
- flow will increase bc there is more blood in vein- resistance will decrease or stay the same bc the vein dilate to accommodate for the amount of blood need to get back to the body. - diastolic pressure stay the same bz the flow increase and resistance decrease with equal magnitude.
exercise intensity Vs VO2 max relationship
- intensity on x and vo2 on y - Vo2 incre linearly with increase intensity - untrained and trained Vo2 are about the same at same intensity - Vo2max is higher in the trained person, therefore, maximal intensity or workrate is higher in trained state.
Clearing test (shoulder mobility)
- not scored it is simply performed to observe a pain response. - if pain is produced, a score of zero is given to the entire shoulder mobility test. - Clearing exam is necessary because shoulder impingement can sometimes go undetected by shoulder mobility testing alone. - the individual places his/her hand on the opposite shoulder and then attempt to point the elbow upward. - if there is pain associated with this movement, as score of zero is given.
(inline- lunge) Clinical implications
- requires stance leg stability of the ankle knee and hip as well as apparent closed kinetic- chain hip abduction. - requires step-leg mobility of hip abduction, ankle dorsiflexion, and rectus femoris flexibility. - adequate balance due to the lateral stress imposed. Poor performance due to: - hip mobility may be inadequate in either the stance leg or the step leg. - Stance leg knee or ankle may not have the required stability. - An imbalance between relative adductor weakness and abductor tightness in onve or both hips - limitations may also exist in the thoracic spine region which may inhibit the athlete from performing the test properly.
Testing with a bike
- set height of the bike, a slight (5-10 degree) bend in the knee or leg is straight- - handle at comfortable height. if possible calibrate the bike. - watch the cadence carefully with a friction braked bike (monarch) Power= F x D/t= F x 6 x rpm/ min - = 2 kg x 6 mx 50 rev/ min= 600 kg-m/ min
How could we estimate VO2 max from a submax test>>
- submaximal exercise tests for estimation of maximal oxygen uptake Similar to maximal tests except - terminate at a predetermined heart rate + don't go over 85% of actual or age prediceted Hrmax + Must go over at least 65% HR max?? - estimate VO2max from + sub max HR and workload/ VO2 to + Maximal HR and workload/ VO2max
What are some submaximal aerobic tests?
- treadmill, walking, cycle ergometer. - ymca cycle ergometer -Queen college step test - Rockport walking test - field test, bruce, balke - Fit
Functional Movement Screen
-A tool used for understanding movement quality in healthy populations -Not intended for those displaying pain in basic movement patterns -for ppl who want to increase physical activity -technically anyone can perform this -uses a grading system
resistance and blood flow
-resistance proportion to length and viscosity - inversely realted to radius of vessel to the 4th power - resistance= length x viscosity/ Radius ^4 - Reducing radus be 1/2 will increase resistance by 16: 1/2^4 -blood can be diverted to one organ or another or the muscle by vasoconstriction and vasodilation. - Greatest vascular resistance is in arterioles. change pressure/ resistance > pressure= flow x resistance > Resistance= (length x viscosity)/ radius ^4 - therefore the primary factor regulating blood flow through the organs is the radius of blood vessel.
Measure RBP
1. Resting: - Place cuff tightly around upper arm 1 in above ante-cubital space (elbow crease) center of rubber bag over brachial artery correct size cuff - Place stethoscope earpiences in ears, angled forward bell lightly over brachial artery - Raise pressure quickly to 20-30 mmHg above disappearance - Decreases pressure slowly at 2mm Hg/sec - listen: SBP: 1st appearance of clear tapping sounds DBP: disappearance of tapping sounds. 2. exercise: - Arm relaxed and supported at heart height - Decrease pressure: 5-7 mmHg/sec. quickly after SBP until just above DBP - Eliminate extraneous noises: keep cords from bouncing, Distinguish TM footsteps from BP tapping - the DBP Dilemma: May hear , record when it muffles.
important for health benefits
2 hour and 30 mins of moderate intensity or 75 minutes of vigorous activity every week- walking- running Muscle strengthing activities on 2 or more days a week that work all major muscle group great benefits: 5 hour of moderate intensity or 2.5 hours of vigorous aerobic acitivity. muscle strengthening acitivities on 2 or more day work all major muscle group.
Facts we know ...
35 years of age; resting heart rate = 70 bpm; weight = 135 lbs uses a heart watch Estimated; HR max= 185 beats/ min and VO2 max= 38 ml/ kg/ min ( 80% fitness percentile) Measured; HR max= 170 b/ min and VO2 max= 43 ml/ kg/min (95% fitness percentile)
Calculating THR based on % HRmax
40% VO2max R= 55% HR max 85% vo2 max R = 90% Hrmax
Mary- Hrmax= 180 bpm, HR rest = 80 bpm, m=140 lbs, Vo2 max= 40 calculare HR 50% and 70% of VO2 max R using % HR max.
50% of vo2 max R= 60-65% of Hr max and 85% of Vo2 max= 90% HRmax - HR @ 50% Vo2 max= 0.65 x 180= 117 bpm or 0.6 x 180= 108 bpm - HR @ 70% Vo2 max= (i would accept anything from 0.75- 0.8 x 180) = 0.75 x 180= 135 bpm or 0.8 x 180= 144 bpm.
Absolute Indications to Stop a clinical max test
Achieved volitional fatigue subject wants to stop Drop in SBP (10mm Hg) from basline with increase in work when accompaine by other evidence of ischemia. SBP> 260 &/or DBP> 115 mmHg Moderate to severe Agina Dizziness Vtach, multifocal PVCs, heart block technical difficulties monitoring ECG or BP Significant ST elevation.
Cardiorespitory change with training.
Be able to plot VO@ and HR vs work rate - pre and post training. - Also, be able to plot Q & SV vs workrate pre and post training.
Why is a submaximal test not as accurate as a maximal test? What are the sources of error?
Because the maximal Heart rate assumption is based on your age, it also terminates at a predetermined heart rate.
Based on an individuals aerobic fitness level how can we determine the appropriate activities for that person?
Calculate the % Vo2 max that fit the individual then calculate how much intensity the activity should be to fit Vo2 and HR.
Rotary Stability
Complex movement requiring proper neuromuscular coordination and energy transfer from one segment of the body to another through the torso. - assesses multi-plane trunk stability during a combined upper and lower extremity motion. - starting position in quadruped with their shoulders and hips at 90 degrees relative to the torso. The knees are positioned at 90 degrees and the ankles should remain dorsiflexed. - the individual then flexes the shoulder and extends the same side hip and knee. - the leg and hand are only raise enough to clear the floor by approximately 6 inches. - the same shoulder is then extended and the knee flexed enough for the elbow and knew to touch. - If a III is not attained then individual perform a diagonal pattern using the opposite shoulder and hip in the same movement.
If the radius of a vessel doubled and nothing else happens, what will happen to BP?
Decrease by 4 power
Purpose of cardio respiratory fitness testing
Diagnostic Functional - Maximal oxygen uptake Exercise prescription- exercise heart rate- determine acitivities that appropriate- Exercise caloric expensidure Improvement
Relative indications to stop clinical max test
Drop in SBP (10mmHg) from baseline with increase in work without any other evidence of ischemia. increasing chest pain fatigue, shorness of breath, wheeing, leg cramps, claudication Hypertensive response (> 250 and/or > 115) Arrhythmias, Bundle branch block, St changes.
As the technician, what is your primary responsibility during the exercise test? What are things that you will do to ensure this?
Ensure safety for the client Monitor heart rate Ask client on how they feel Equipment should be working well
Exercise Prescription
F x I x T = MET-min or kcal Health adults should accumulate a minimum of 450- 750 MET- min/week or 7.5- 12.5 MET - hrs/ week through a combination of moderate and vigorous acitivity example: exercising at 5 mets for 30 min- 5 mets x 30 min= 150 MET- min. >> if total volume is equal, higher intensity probably gives more benefit
Caloric Expenditure
F x I x T= MET- minutes F x I x T = calories Caloric expenditure: - 150- 400 kcal/ day - minimum threshold; 1kcal/ wk - ultimate 2000 or more kcal/ wk
(flow) resistance
Flow affected by - blood volume - heart rate - stroke voume Resistance affected by - blood viscosity - Peripheral resistance
During weight training what happens to flow during systole? Why? What happens to resistance during systole? Why? What happens to systolic blood pressure?
Flow in the same but resistant increase- flow doesn't really change Reduced elasticity in arteries and therefore increase systolic blood pressure
determinant of pressure
Flow x Resistance - SBP increase bz stroke vol/ cardiac output increase more than resistance decrease. -DBP will remain about the same or decrease bz flow during diastole increase the same as or less than resistance decrease.
Estimate VO2 for max test
From speed and grade of treadmill- use a test protocol and equation that has been valiedated- make your own protocol and estimate from published equations for speed and grade. Must be in steady state for this to work.
( in-line lunge) Look 4
Front view: -core: 2- core remains still, balance maintained 1- Client leans forward or to one side 0-- Client reports pain in the low back - rear leg: 2- Rear leg stays in line and falls behind front heel 1- Rear leg externally rotates or does not stay in line with front heel 0- Client reports pain in the rear leg or hip - Front heel - remains in contact with the floor Side view: -Core: 2- core remains still, balance maintained 1- Client leans forward or to one side 0- client reports pain in the low back - Lumbar spine: 2- Lumbar spine remains still, curve maintained 1- lumbar curve increase or decreases 0- Client reports pain in the lumbar spine.
other expressions of Oxygen uptake
Gross - reflect cost of both rest and exercise VO2. = Resting VO2+ exercise VO2 = 3.5 ml/kg/min + exercise VO2 Net - reflects the rate of oxygen uptake in excess of the resting oxygen uptake - Describes the caloric cost of the exercise. Mary: m= 50 kg. VO2max= 3L. Ml/ min- 3L x 1000ml/ L= 3000 ml Ml/kg/ min: 3000 ml/ 50 kg= 60 ml/kg/min Met: 60/ (3.5 ml/ kg/ min) = 17.1 METS
Calculating Exercise VO2 based on VO2 max R
Guideline: 40-85% % MET max R= % (METmax- MET rest) + MET rest Example: VO2max= 33.5 ml/kg/min= 9.6 METs - 40% VO2 max R= 0.4 (9.6-1) +1 = 0.4 (8.6) + 1 = 3.44 + 1 = 4.44 METs= 15.5 - 85% Vo2 max R = .85 (9.6-1) +1 = .85 (8.6) + 1 = 7.3 + 1 = 8.3 METs = 29 ml/kg/min.
Calculating Exercise VO2 Based on VO2 max R
Guideline: 40-85% % VO2 max R= % (VO2 max- VO2 rest) + VO2 rest example: VO2max= 33.5 ml/kg/min - 40% VO2max R= 0.4 (33.5- 3.5) + 3.5 = 0.4 (30) + 3.5= 15.5 ml/kg/min 85% VO2 max R= 0.85 (33.5- 3.5) + 3.5 = 0.85 x(30) + 3.5 = 25.5 + 3.5= 29.0 ml/kg/min
Calculating Exercise HR based on % HRmax
Guideline: 40-85% VO2 max R 55-90% Hr max example; HRmax = 200 - THR= HRmax THR= 200x 0.55= 110bpm THR= 200 x 0.9 = 180 bpm
Mary- Hrmax= 180 bpm, HR rest = 80 bpm, m=140 lbs, Vo2 max= 40 calculare HR 50% and 70% of VO2 max R using % HRR(heart rate reserve) equation, Karvonen equation.
HR @ 50%= Vo2 max R= % VO2 maxR (HRmax- HR rest) + HR rest = 0.5 (180 -80) + 80 bpm = 0.5 (100 bpm) + 80 bpm = 50 + 80= 130 bpm HR @ 70%= Vo2 max R= % VO2 maxR (HRmax- HR rest) + HR rest = 0.7 (180 -80) + 80 bpm = 0.7 (100 bpm) + 80 bpm = 50 + 80= 130 bpm
What is Rate Pressure Product or double product? What does this represent?
HR x SBP represent myocardial oxygen uptake
What is a "steady-state" heart rate?
HR, oxygen consumption and work rate reach an equilibrium. After some time - Steady state is important for receive a valid and reliable. data
Intensity
HRmax 190. HR at 70% max R? - 40% VO2 max R= 55% HRmax - 85% VO2 max R= 90% Hr max %VO2 max/ % HRmax= 40/55= 70/x= 85/90 70 is 67% of the way between 40 and 85; therefore x is 67% of the way between 55 and 90. 70-40= 30 ; 85-40= 45; 30/45= 0.67 90-55= 35 x 0.67= 23 + 55 = 78
How will BP compare during arm vs leg ergometry?
Higher in arms because smaller vessel.- heart need to work more for the muscle to receive adequate supply.
VO2 max: the physiological measure of cardiorespitory fitness?
How VO2 is expresses - Absolute: no body weight factor- total O2 consume + L/min + Ml/ min - Relative: weight factor in- more weight less VO2 with the same VO2 or work output + Ml/kg/ min + Ml/kgFFM/min + Mets- 1 Met= 3.5 ml/kg/ min
using the same protocol, you did a VO2max test on Joe when he was out of shape and again when he was in shaped. His weight and body composition didn't change. How will his myocardial VO2 compare at each speed and grade? Why?
How much work determine VO2 In shape or out shape = same amount of work. Total cardiac out put the same but heart rate will decrease bz increase in stroke volume = their heart wont be working as hard Myocadiac maximal oxygen will remain the same..
(Rotary Stability) scoring clearing and clinical
III performs one correct unilateral repetitions while keeping spine parallel to surface-- knee and elbow touch. II performs one correct diagonal repetition while keeping spine parallel to surface-- knee and elbow touch. I - inability to perform diagonal repetitions. Clearing test: - if pain is produced, a score of zero is given to the entire rotary stability test. - This clearing exam is nessary bz back pain can sometimes go undetected by movement screening. - Spinal flexion can be cleared by first assuming a quadruped position and then rocking back and touching the buttocks to the heels and the chest to the thighs. the hands should remain in front of the body reaching out as far as possible. Clinical implications: - require asysmmetric stability in both sagittal and transverse planes furing asymmetric upper and lower extremetity movement - Many functional activities require the trunk stabilizers to transfer force asymmetrically from the lower extremeties to the upper extremities and vice versa. - Running and exploding out of a down stance in foot ball and track are common examples of this type of energy transfer. if the trunk does not h ave adequate stability during these activities, kinetic energy will be dispersed, leading to poor performance and increases potential for injury. - poor performance - poor asymmetric stability of the trunk stabilizers.
Active straight leg raise (scoring and poor)
III: ankle/ dowel reside between mid thigh and ASIS II: Akle/ dowel resides between mid- thigh and mid- patella/ joint line I: Ankle/Dowel resides below- mid- thigh and mid- patella/joint line Poor performance: - first, poor functional hamstring flexibility - Second, inadequate mobility of the opposite hip, stemming from iliopsoas inflexibility associated with an anteriorly tilted pelves. if this limitation is gross, true active hamstring flexibility will not be realized.
(shoulder mobility) Scoring and clinical
III: fist are within one hand length ( assume one hand length is 8 inches) II: fists are within 1.5 hand length I: fist are more than 1.5 hand length Clinical implications: - requires shoulder mobility in a combination of motions including abduction/ external rotation, flexion/ extension, and adduction/ internal rotation. - also requires scapular and thoracic spine mobility. Poor score due to: - external rotation is gained at the expense of internal rotation in overhead throwing athlete. - excessive development and shortening of the pectoralis minor or latissimus dorsi muscles can causes postural alterations of forward or rounded shoulders
(Trunk Stability Push-Up) Scoring
III: males perform one repetition with thumbs aligned with the top of the forehead - females perform one repetition with thumbs aligned with chin. II: Males perform one repetition with thumbs aligned with chin. - Females perform one repetition with thumb aligned with the clavicle I: male are unable to perform one repetition with hand alighned with chin. - Females are unable to perform one repetition with thumbs aligned with clavicle.
If flow doubles and nothing else happens, what will happen to BP?
Increase, pressure double.
Aerobic Exercise Intensity
Is based on % VO2 max R or % VO2 max Cannot directly measure VO2 during exercise, therefor, indirect methods are used. Intensity 40/50- 85% VO2 max R- 60%- 80% - This equals +40/50%- 85% HR max R-- most 60-80% HRmax R +55/65%- 90% HR max (notice the difference here)- most 77%-90% HR max + RPE= 12-16 + RPE= some what hard to hard
Calculating Exercise HR based on HRmax reserve
Karvonen formula Guidelines: 40%-85% HR max reserve ex: HRmax= 200; HRrest= 60 THR=% (HRmax- HRrest)+ HRrest THR= 0.4(200 -60) + 60= 130 bpm THR= 0.85 (200-60) +60 = 179 bpm
Why might you conduct a submaximal test instead of a max test? When should a submax test be stopped?
Less strenuous on subject - Health concern - Faster - Can do a submax with more people - When HR reach 85% of HR max. if client decide to stop the test
Mets to kcals and back again
METs < >Vo2 (ml/kg/min) <> VO2 (l/min) <> Kcal Mets x 3.5 ml/kg/min (/MET)= VO2 (ml/kg/min) VO2 (ml/kg/min) x kg = VO2 (ml/min) Vo2 ml/min x 1L/1000ml= L/min VO2 (l/min) x 5kcal/ l o2= kcal/ min
What is oxygen up take or oxygen consumption
Maximal Oxygen uptake: - maximal oxygen consumption- VO2 max - Peak VO2 - Rate or amount of oxygen used to produce energy during maximal aerobic exercise. - Reflects: + capacity of heart, lungs, and blood to transport oxygen to working muscles + utililzation of oxygen by muscles during exercise
tangent: Types of cycle ergometers
Mechanically Braked: - rate dependent - Power= speed x resistance - 600$ - 1000 to make rate independent Electronically Braked - rate independent - set power and resistance adjusts to speed - Expensive: 5000-15000 Importance of calibration: - rate independent - set power and resistance adjust to speed.
oxygen cost of stepping
Net VO2 (ml/kg/min) = (0.2 x step rate) + (1.33 x 1.8 x step height x step rate) Horizontal component= 0.2 ml/kg/min x step rate Vertical component= 1.33 x 1.8 x step height in meter x step rate Gross Vo2 (ml/kg/min) = (0.2 x step rate) + (1.33 x 1.8 x step height x step rate) + 3.5=
oxygen cost of running
Net VO2 (ml/kg/min)= (0.2x speed)+ ( 0.9 x speed x grade) net VO2= (0.2 x A m/min) + (0.9 A m/ min x y% grade) Gross VO2 (ml/kg/min)= ( 0.2 x speed) + (0.9 x speed x grade) + 3.5 ml.kg.min
Oxygen cost of arm ergometry
Net VO2 = ( 18 x A Watts/ kg) Gross VO2= (18 ml/kg/ min x A Watts/kg) + 3.5 Joe m= 100kg ? gross oxygen uptake arm ergometry at 200 Watts/min Gross Vo2= ( 18ml/kg/min x A Watts/ kg) + 3.5 ml/kg/ min = (18 x 200/100) + 3.5 36+ 3.5= 39.5 ml/kg/ min
VO2 of stepping net VO2 step up and down on a 0.2 meter bench at a step rate 24 steps/min
Net VO2= (0.2 ml/kg/min x A step rate) + ( 1.33 x 1.8 x B step height x step rate) Net VO2= (0.2 ml/kg/min x 24) + ( 1.33 x 1.8 x 0.2 x 24) = 4.8 + 11.5= 16.3
When walking at 4 mph Joe used to get angina. After a training program, he no longer gets angina walking at 4 mph. Why?
Now his heart rate and systolic pressure is lower. - his storke volume increase so it does not have to work as hard.--
oxyen cost of leg ergometry
Nwt Vo2= ( 1.8 x (kg-m/min))/ weight (kg)) + 3.5 Net VO2= (10.8 X Watt)/ weight +3.5 - cost of unload cycling = 3.5 ml/kg/min - Cost of working against resistance= 10.8 X Watt/ kg Gross VO2= (10.8 x Watt/kg) + 3.5 + 3.5
What is myocardial oxygen uptake?
Oxygen used by the heart so that the heart can beat
Interpreting Test Results
Percentile ranking Current exercise program Goals Weight Use for Exercise Prescription VO2 max below the 20th percentile for age and sex is often indicative of sedentary lifestyle and is associated with an increased risk of death from all causes.
mean arterial pressure
Pulse pressure= SBP- DBP Mean arterial pressure: average pressure during cardiac cycle Determined rate of blood blow through the systemic circuit. At rest= DBP + 0.33 * PP > not accurate during exercise rest: - 120/ 80 mmHg - MAP= 80 + 0.33 (120-80)--= 80 +13 = 93 Flow affected by: blood volume- heart rate - stroke volume. Resistance affected by: blood viscosity- peripheral resistance.
In-line Lunge
Purpose: places the lower extremities in a scissor style position challenging the body's trunk and extremities to resist rotation and maintain proper alignment. - assesses hip and ankle mobility and stability, - quadriceps flexibility - knee stability. Procedure: - attain the individual's tibia length, by either measuring it form the floor to the tibial tuberosity. - Place the end of their heel on the end of the board or a tape measure taped to the floor. - tibia measurement is the applied from the end of the toes of the foot on the board and a mark is made. - dowel is placed behind the back touching the head, thoracic spine, and sacrum. the hand opposite to the front foot should be the hand grasping the dowel at the cervical spine. the other hand grasps the dowel at the lumbar spine. - Steps out on the board or tape measure on the floor placing the heel of the opposite foot at the indicated mark. - Lowers the back knee enough to touch the surface behind the heel of the front foot and the returns to starting position. - Lunge is performed in a slow controlled fashion.
Active Straight leg raise
Purpose: test the ability to dis- associate the lower extremety from the trunk while maintaining stability in the torso. assess active hamstring and gastroc- soleus flexibility while maintaining a stable pelvis and active extension of the opposite leg. process: - supine with the arms in an anatomical position and head flat on the floor. - identifies mid-point between the anterior superior iliac spine (ASIS) and mid- point of the patella, a dowel is then placed at the position perpendicular to the ground. - lift the test leg with a dorsiflexed ankle and an extended knee (opposite knee should remain in contact with the ground, the toes should remain pointed upward, and the head remain flat on the floor) - once the end range position is achieved, and the malleolus is located past the dowel then the score is recorded. - If the malleolus does not pass the dowel then the dowel is align along the medial malleolus of the test leg, perpendicular to the floor and scored.
Trunk Stability Push-Up
Purpose: tests the ability to stabilize the spine in an anterior and posterior plan during a closed- chain upper body movement. assess trunk stability in the saggital plane while a symmetrical upper - extremetiy motion is performed. process: - the individual assumes a prone postition with the feet together. - the hands are then placed shoulder width a part at the appropriate postion. - the knee are then fully extended and ankles are dorsifexed. - the individual is asked to perform one push- up in this position. - the body should be lifted as a unit; no lag should occur in the lumbar spine when performing this push up. - If the individual cannot perform a push up in this position, the hands are lowered.
24. How can a submaximal test be used to estimate VO2max?
Similar to a maximal test except it has a predetermined heart rate. By using submaximal HR and work load/ VO2 similar to maximal HR and workload/ VO2 max
assumption for submax- lab
Steady state HR is obtained for each exercise workload and it is consistent each day - linear relationship exists between steady state HR and work rate. - become curvilinear at higher work loads. - Mechanical efficiency ( VO2 at a given work load) is the same for every one- will underestimate VO2 for mechanically inefficient and overestimate for mechanically efficient individual - HR max for a given age is uniform: SD= 12beat/min
What are measures of blood flow?
Systolic P/ Diastolic pressure. Pressue/ resistance= mmhg/ om Pressure/ resistance- affected by blood volume/ heart rate
Why are these not as accurate as measuring the VO2? What are the sources of error?
The equipment might not be calibrated We are assuming that at the same power output everybody has the same oxygen uptake We are assuming everybody has the same oxygen output. So for the people who are less efficient (less fit) would be using more oxygen Personal perception of failure- assuming same mechanical efficiency is the same.
You are getting ready to conduct a maximal treadmill test on a client. Develop a short, but thorough talk to give them that covers the purpose, explains what is going to happen, what they need to do, etc.
This is a test is to find out what is your cardio respitory ability. I will increase the intensity of this test until you reach you maximal exertion. I need you to give me all you got okay. I will push you. But, When you reach your limit let me know. I will stop the test.
Max test
VO2 (ml/kg/min)= (10.8 x watt/ kg) + 7 - for every 1 watt increase in PO VO2 increase by 0.15 ml/kg/min for a 70 kg person. - assumes at steady stage - there error in this estimation- Gold standard: max test measure VO2: 1-2 ml/kg/min second best: max test without measure of VO2: error: 3-4 ml/kg/ min (2-10%)- ISSUE: not everyone has the same VO2 at same power output Third best: Submax test: - error: 5-6 ml/kg/min (5-10%) + not everyone has same VO2 at same PO + not everyone of the same age has the same Hrmax + the PO vs HR relationship establish submax may not hold to max.
Mary walk at 4mph for 30 minutes on the tread mill. What is her oxygen uptake in ml/kg/min?
VO2 (ml/kg/min)= 3.5 + (0.1 ml/kg/min x Amin) + (1.8 + A m/min x grade) 3.5 + (0.1 x
what speed will this person need to walk at 0% grade to elicit 60% of VO2 max?
VO2 = 20 VO2= (o.1 x A m/min) ( 1.8 ml/kg/min x A m/ min x B % grade) + 3.5 ml/kg/min 12= (0.1 x Am/min x B m/min) + 3.5 8.5= (0.1 x m/min) 8.5= 0.1 x A A= 85/ 26.8= 3.0 mph.
Calculating VO2 from Watts (YMCA)
VO2max (ml/kg/min) = (10.8 ml/kg/min :watts x Watts)/Mass + 3.5 + 3.5 - (1.8 ml/kg/min x kg-m/min ) / Mass + 3.5 + 3.5
how do we measure oxgen uptake? what are the variable we measure?
Ventilation- Insprired,./ expired Expired oxygen and carbon dioxide Vo2= (V inhale x F % inhale O2) - (V exhale x F % exhale O2) = ( 50L x 0.2093) - ( 50 L x0.17) = 10.5 - 8.5 = 2L
how to measure oxygen uptake- what variable
Ventilation- inspired/ expired Expired oxygen and carbon dioxide VO2= (V inhale x F inhale O2)- (V exhale x F exhale O2) = (50L x 0.2093) - (50L x 0.17) = 10.5- 8.5 = 20 L
Walking at 4 mph what grade will this person need to walk at to elicit 70% Vo2max?
Vo2= 40 > 70%= 28 ml/kg/min Vo2= (0.1 ml/kg/min x A m/min) + (1.8 ml/kg/min x A m/min x B% grade) +3.5 28 = (0.1 x 107.2 m/min) + ( 1.8 x 107.2 m/min x B% grade) + 3.5 24.5= (10.7) + (193) 13.8= 193 Y= 0.072 or 7.2%
What makes for a good aerobic exercise test protocol?
Warm up Cool down Progressive work loads of appropriate duration and intensity. 2 mets or more for healthy and 0.5 met for diseases Meets the need to the client Achieve maximal exertion
good maximal GXT protocol/ test
Warm- up Cool- down Progressive work loads of appropriate - Duration - Intensity: 2 MET or More increase for healthy- As small as 0.5 MET for diseased. Meets the needs of the client Achieve maximal exertion.
(Deep Squat) what to look 4
What to look for: side view - Arms: 2- Remain overhead 1- Come forward or squat is performed with arms held in front 0- Client reports pain in the shoulders or upper back during movement. - Core: 2- Remains still and lumbar curve is maintained 1- Does not remain still and lumbar curve increases or decreases (flattens) 0- Pain is reported in the lumbar spine - Torso: 2- torso is parallel to tibia 1- Torso is not parallel to tibia 0- Client reports pains in torso - Heel: 2- Heel remains in contact with floor 1- Heel comes off floor or movement is performed with heels lifted 0- Pain is reported in calf or ankle. - deep squat: 2- squat is low enough so thighs are at least parallel to floor 1- Client fails to squat low enough 0- Pain is reproted while squatting. Front view: - knee: 2- knee stays in line with feet 1- knee falls in or out 0- client reports pain in knee - Toes 2- toe stays pointing forward 1- Toe flares out 0- client reports pain in foot - Arch (right) 2- arch of foot does not collapse 1- Arch of foot collapse 0- client reports pain in foot.
predicted vs. reality
a 45 min workout at a HR of 150 bpm > watch calculated 372 total calories ( 8.3 kcal/ min) Reality? 420 total calories 420 cal (9.3) - 45 min workout at a HR 150 bpm > watch calculated 8.3 kcal/min or 372 kcal. - reality? 10.9 kcal/min or 491 kcal. that's 119 more calories and 25% underestimation.
Assumptions for submaximal testing
a steady state- HR is obtained for each exercise workload and it is consistent each day. Linear relationship exists between Steady State heart rate and work rate- Becomes curvilienar at higher workloads. Mechanical efficiency (VO2 at a given workload) is the same for everyone- will underestimate Vo2 for mechanically in efficient and overestimate for mechanically efficine individuals Hr max for a given age is uniform. - S.D.= - 12 beat/ min
Mode
aerobic activities using large muscle is a continous, rhythmical fashion. Group 1 activities- Easiest to maintain constant intensity and not skill dependent. Group 2 activities: Rate of energy expenditure dependent on skill level- aerobic dance, swiming, in-line skating. Group 3 activities; - highly variable in intensity and skill - Racquetball, handball, basket ball
Blood Flow formula
blood flow= change in pressure / Resitance > pressure = flow x resistance. Resistance= (Length x viscosity) / Radius ^4 > primary factor regularing blood flow through the organs is the radius of the blood vessels. What to do if DBP goes to 0- When to stop an exercise test due to BP - 260/115 - Significant drop in SBP or no increase with increase in workrate.
(Trunk Stability Push-Up) Clearing and clinical
clearing: If pain is produced, a score of zero is given for the entire push up test. necessary because back pain can sometime go undetected during movement screening. Spinal extension can be cleared by performing a press-up in the push-up position. Clinical implications: Require symmetric trunk stability in the saggital plane during a symmetric upper extremity movement. - Many functional activities in require the trunk stabilizers to transfer force symmetrically from the upper extremities to the lower extremities and vice versa. - Movements such as rebounding in basketball, overhead blocking in volleyball or passing blocking in football are common examples of this type of energy transfer. if the trunk does not have adequate stability during these acitivities, Kinetic energy will be dispersed and lead to poor functional performance, as well as increase in potential for micro traumatic injury. - poor performance during this test can be attributed simply to poor stability of the trunk stabilizers. ( what test are similar to this)
7 Movements
deep squat Hurdle step In-line Lunge Shoulder Mobility Leg Raise Stability Pushup Rotary Stability
If someone has high BP, how would you try to lower it or what mechanism would you try to use.
diuretic, diet, chemical, lyng down
During weight training what happens to flow during diastole? Why? What happens to resistance during systole? Why? What happens to diastolic blood pressure?
flow is the same, resistance increase, high diastolic pressure bz increase in resistance bc muscle expand and blood vessel increase in resistance.
what is blood pressure
force exerted by blood agansit aterial wall- volume pump & resitance to flow Systolic: highest F BP aganst arterial walls Diastolic: lowest BP during diastole- recoil arterial system proved continous pressure
What will happen to BP with exercise as individuals get older?
increase - less elasticity in blood vessel
which acitivity appropriate for joe
joe> 20 ml/kg/min 50% VO2 max R= 0.5 x( 20- 3.5) +3.5= 11.75 =3.36Met 85%= 17.5= 5 met - step Aerobic - 8.5 met eliptical- 25 stride/ min 8 met - runing: 5mph- 8 met - 6 mph= 10 met; walking combination- 6 met slow freestyle 7 met Water aerobic - 4 met walking:
How to Determine VO2
lab: - maximal with measurement of oxygen uptake- gold standard; criterion measurement - maximal with estimation of oxygen uptake.. - Submaximal with estimation of oxygen uptake. Field: Timed run, bike, swim Non- exercise test
effect of excess fat mass on VO2
less body mass (fat mass) more oxygen for the whole so lower ml/kg/ min. Joe: Vo2= 3.2 L/min. m= 100 kg. %25 fat body . if he loses 20 kg of fat. VO2 max= ? original= 3200/100 = 32 ml/kg/min New= 3200/80= 40 ml/kg/ min Improvement: = (new- old)/ old = (40-32)/ 32= 25%
Post op
look for patterns - what good what not so good What are they doing in life that could cause this give suggested exercises.
submax bruce protocol
make sure client is in steady -state each stage Do at lease three of 3 min stages VO2 max= VO2 @ stage 3 + b ( HR max- HR stage 3) b= VO2 stage 3- VO2 stage 2 // HR stage 3 - HR stage 2
Choosing/ designing a max protocol
mode. - General: treadmill gives higher values than bikes or other tests - Specificity: for atheletes it's best to test in mode they perform Length of Test: - Ideally 8-15 min - Appropriate workload increases - fit to fitness level of client.
oxygen cost of walking
net VO2= Horizontal Cost+ Vertica; Cost - Horizontal cost= 0.1 ml/kg. min for each 1 meters/min of speed. - Vertical cost= 1.8 ml/kg/ min for the product of each m/min and 1% grade. Net VO2 = (0.1 x speed) + (1.8 x speed x grade) Net Vo2= (0.1 ml/kg/min x meters/min) + (1.8 ml/kg/min x A meters/min x B % grade) Gross VO2 (ml/ kg/ min) = (0.1 x speed) + (1.8 x speed x grade) + 3.5 ml/ kg / min - resting component has been added in.
Myocardial oxygen uptake
oxygen used by the heart so the heart can beat How hard the heart is working. Determine primary by the HR x SBP-- double product. Rate pressure product RPP= HR x SBP- ex: 150 bpm x 200 mmHg= 30,000 170 bpm x 176 mmHg= 30,00 decrease with trainining at the same absolute workrate. Aerobic training decrease HR at same work rate, there by decreasing RPP and how hard the heart is working.
Physiological criteria for a true max test
plateau in O uptake w/ increase in workrate, failure of HR to increase w/ increase in workrate, RER more than 1.15- VCO2/ VO2- more extra energy burn with the max O2 given, RPE more than 17, lactate concentration more than 8mm/L
Hurdle step
purpose: - challenge the body's proper stride mechanics during a stepping motion/ - Requires proper coordination and stability between the hips and torso during the stepping motion as well as single leg stance stability. - Assesses bilateral functional mobility and stability of the hips, knees, and ankles. Procedure: - Place the feet together and aligning the toes touching the base of hurdle. - Hurdle adjusted to the height of the tibial tuberosity. - dowel positioned across the shoulders below the neck. - step over the hurdle and touch their heel to the floor while maintaining the stance leg in a extended position. - moving leg is returned to the starting position.
Deep Squat
purpose: assess bilateral symmetrical, functional mobility of the hips, knee and ankles Procedure: - feet approximately shoulder width apart and the feet align in the saggital plane. - Hands on the dowel to assume a 90 degree angle of the elbows with the dowel overhead. - Dowel is pressed overhead with the shoulders flexed and abducted and elbows extended. - Individual is then instructed to descend slowly into squat position.
(Hurdle Step) what to look for
side view: - balance: 2- client remains still and balanced during 1- Client moves but is able to maintain balance 0- client loses balance - Core: 2- remains still and lumbar curve is maintained 1- core does not remain still and lumbar curve is increase or decreases. 0- Client reports pain in lumbar spine - pelvis 2- pelvis does not tilt and lumbar spine remains still 1- pelvis titlts anteriorly and lumbar curve increases. 0- client report pain in pelvis. Front View: - arch of foot: 2- Arch of stabilizing leg does not flatten 1- Arch of stabilizing leg flattens 0- Client reports pain in the stabilizing foot or leg - Moving leg: 2- hips, knees and ankles remain aligned 1- Moving leg abducts and/ or externally rotates as it moves. 0- Client reports pain in the moving leg.
submax test to estimate of max O2 uptake
similar to max except - terminate at a predetermined heart rate: not over 85% of actual or age predicted Hrmax. must go over at least 65% HR max. - Estimate VO2 max from: submaximal HR and Workload/ Vo2 to maximal HR and workload/ VO2 max.
RPE vs VO2 max
somewhat hard= 50% vo2 hard= 70% VO2 Very har= 90%
Queen college step test
step up and down on 16.25 in bench for 3 min - Woman 22 bpm- men 24 bpm Standing recovery - Count pulse for 15 sec beginnig 5 sec after end of test Use regression equation to estimate Vo2max.
conduct submax test
take rest HR & BP - set set height- upright posture, 5 degree knee bend - 2-3 min warm up - record HR at end of each - BP measured during last min of each stage - Record RPE at end of each stage - A SS HR should be reach B$ continue next stage. Stop: HR >= 85% HR max or > 70 % HRR and other reason - cool down for at least 4 min. - last stage HR needs to be > 120/ 130
Max test conduct
take resting HR & BP 2-3 min warm - up observe and communicare Record HR & RPE at end of each min BP measured: last min of 3 min stage tests, every other min in 1 min stage tests or ramp tests Discontinue: termination criteria met- client requests Cool down for at least 4 min: exercise a level below stage of first stage of test, continue HR & BP measures, Passive sitting or supine recovery if discomfort or emergency arise. RPE 6- 20- add 0 = heart rate
How to conduct a submax test
take resting HR & BP set seat height - upright posture, 5 degree knee bend 2-3 min waarm up record HR at end of each min BP measured during last min of each stage Record RPE at end of each stage A Steady State HR should be reach before continuing to next stage Stop - Hr> 85% estimated HR max or > 70% HRR- Other Cool down for at least 4 min - Low level exercise - Continue HR & BP measures. Other important submax points Last stage HR needs to be > 120/130? Stop When reach 85% of HR max What submax protocl? - single stage vs multiple stage - Bike vs treadmill vs stairmaster vs step
Rockport Walking Test
walk 1 mile as fast as possible record time x.xx min Take HR immediately at end of walk Use regression equation to estimate Vo2max Voxmax= 6.315 (gender)- 0.10769 (BW,kg) - 0.3877 (age,years) - 3.2649 (time,min)- 0.1563 (HR,bpm) +132.9
Astrand- Rhyming Bike Test
workload elicit HR: 130- 150--women: 75- 100W: men 100- 150W Cycle for 6 min: Hr each min; HR 5 min& 6 min within 5bpm Stop test if HR between 130-150 bpm continue if HR <130 bpm+ add 50W Calculate VO2 max from nomogram
exercise intensity and Q relationship
x- inentsiy y- Q increase linearly as Q increase untrained and trained Q are about the same at the intensity. Q max is higher tin the trained person; therefore more oxygen is delivered to the muscle and Vo2max is higher in the trained state.
