Exercise Testing

What is used during a GXT/stress test?

- 12 lead ECG - physician supervision * - normal meds

What are examples of functional mobility/strength testing?

- 5 rep sit to stand test - 30 second sit to stand test - 10-meter gait speed

What are functional capacity tests?

- 6 MWT - 2 MST

What hemodynamic responses are we interested in?

- HR response - BP response - rate pressure product

What are the outcomes of the 6 MWT?

- MET level - VO2 - mph - comparison to age related norms - hemodynamic response

Submaximal treadmill/cycle tests are performed until...

- RHR + 20-30 BPM or <120 BPM - RPE </=13 - appropriate hemodynamic response

What exercise capacity measures are we interested in?

- VO2 peak - MET level - % from norms

What are signs or symptoms of exercise intolerance?

- angina - wheezing - marked fatigue - pallor/cyanosis - LE claudication - dizziness/lightheadedness/syncope - nausea/vomiting

What are the outcomes of the 30 second sit to stand test?

- baseline - comparison to age related norms

What are the outcomes of the 5 rep sit to stand test?

- baseline - comparison to age related norms

What do GXT/stress tests meaure?

- cardiac ischemic threshold - exercise capacity/VO2max - cardiovascular response (HRmax, HRR, BP, SpO2, etc.)

Who is a clinical exercise test recommended for?

- class 1: MI - class 2: post-revascularization (CABG, stent)

What are some reasons that class 1/2 individuals do not receive a clinical exercise test?

- co-morbidities - insurance - MD request - delay of care

What are indications for exercise testing?

- diagnosis - prognosis - evaluation of the physiologic response to exercise/activity

What results do we want to look at from these tests?

- exercise capacity - patient symptoms - hemodynamic response - SpO2 - ECG response

What does a CPET measure?

- exercise capacity/VO2max - cardiac ischemic threshold - ventilatory response - gas exchange (SpO2, PO2) - cardiovascular response (HRmax, HRR, BP) - etc.

What are the advantages of the 2 MST?

- fast - require minimal space/equipment - tolerated by wide range of abilities

What is the 5 rep sit to stand test now used to assess?

- function - fall risk

What are examples of low level exercise tests?

- functional capacity test - submaximal treadmill/cycle test

What does the 30 second sit to stand test measure?

- functional lower extremity strength - functional mobility/transitional movement

What are two clinical exercise tests that can be used?

- graded exercise test (GXT)/exercise stress test - cardiopulmonary exercise test (CPET)

What are the outcomes of the incremental shuttle walk test?

- gross METs - VO2 - mph - hemodynamic response

What are the outcomes of the 2 MST?

- hemodynamic response - comparison to age related norms

What does the 5 rep sit to stand test measure?

- lower extremity strength - functional mobility/transitional movement

What does the type of test we perform depend on?

- patient (mobility/stability, medical history/comorbidities, cognition) - environment (space, equipment, staffing, time)

What limits a CPET?

- peak HR - symptoms

When should exercise testing be terminated?

- subjects request to stop - signs or symptoms of exercise intolerance - exaggerated hypertensive response (SBP >250mmHg, DBP >115mmHg) - decrease of SBP >10 mmHg - significant ventricular or atrial arrhythmias with or without associated signs/symptoms - second and third degree heart block, BBB that cannot be distinguished from VT - ST displacement (elevation, depression) - ataxia/incoordination - technical difficulties/poor ECG tracing - SpO2 <80% with signs of hypoxemia (symptom limited maximal test only)

What patient symptoms are we interested in?

- subjetive symptoms - RPE/RPD

What limits general exercise/stress tests?

- symptoms - peak HR

What is the process of assessing aerobic capacity/readiness for exercise/activity in phase 1/inpatient?

1. semi-recumbent 2. sitting 3. standing 4. ambulation

When was the 6 MWT developed? By who?

1963, Balke

What is 1 MET equal to?

3.5 ml/kg/min

What is a normal maximal exercise response for rate pressure product?

>25,000

rate pressure product =

HR x SBP

What was the 5 rep sit to stand test developed to assess?

LE strength

What does rate pressure product indicate?

O2 demand of the heart muscle

Who standardized the 6 MWT?

american thoracic society

What is the goal of functional capacity/performance tests?

determine aerobic capacity or functional capacity compared to norms

What are GXT/stress tests?

exercise protocol with progressive workloads (TM, bike, pharmaceutical)

What does a CPET obtain in addition to stress test parameters?

expired gas analysis data

Is the incremental shuttle walk test self-paced or externally paced?

externally paced

What was the 30 second sit to stand test developed as part of?

fullerton functional fitness battery

What does the incremental shuttle walk test measure?

funcitonal aerobic capacity

What does the 2 MST measure?

functional aerobic capacity

What does the 6 MWT measure?

functional aerobic capacity

If class 1/2 individuals do not receive a clinical exercise test, what should we do during post-hospitalization/phase 2?

functional capacity tests (submaximal) - 6 MWT - 2 MST - shuttle walk test - other

What is the bruce protocol?

gold-standard for detection of myocardial ischemia when risk stratification is necessary

A heart rate product of >10,000 at rest indicates...

increased risk for heart disease

What is the history of the 2 MWT?

introduced in 1999 as part of the senior fitness test

What is performed prior to discharge?

low level exercise test (maybe, some physicians don't require)

Are general exercise/stress tests submaximal or maximal?

maximal

Is a cardiopulmonary exercise test (CPET) submaximal or maximal?

maximal

What does MET stand for?

metabolic equivalent of task

The incremental shuttle walk test was developed and modified from the ____________.

multistage fitness test (bleep running test)

Why is the 30 second sit to stand test used on its own now?

overcome the floor effect of the 5 and 10 repetition sit to stand tests

What does 1 MET mean?

resting VO2

Is the 2 MST self-paced or not?

self-paced

Is the 6 MWT self-paced or externally paced?

self-paced

Is the 2 MST a submaximal or maximal test?

submaximal

Is the 6 MWT a submaximal or maximal test?

submaximal

What limits the incremental shuttle walk test?

symptom/patient

What is a MET?

volume of oxygen consumption by the working muscles per minute