Graded Exercise Submaximal Tests

A failure to decrease HR by at least ___ bpm during the first min or ____ bpm by the end of the second min following exercise is strongly correlated with an increased risk of mortality.

12; 22

How many workloads are in a YMCA Cycle Test?

4

What should you use to determine if a relative reason warrants stopping testing?

sound clinical judgement

Describe the steps of an Astrand-Rhyming Cycle Test.

- Adjust seat height (legs nearly straight when extended; 5 degree bend max) - Measure pre-exercise BP and HR (w/subject seated on bike) - Pedal at 50 rpm (metronome = 100x/min), start warm-up (no resistance for 2-3 min) - Determine workload with pedal rate = 50 rpm - Do 6 min test - Take HR at end of 2nd minute - Take HR at end of 5th and 6th minutes (to ensure steady-state, HRs should be +/- 6 bpm of each other) - Take average of 5th & 6th min HRs - Take BP at 4:30 and 5:30 - Test concludes, set resistance to zero, cool down for 4 min - Determine VO2 from nomogram - Apply age-correction factor - Convert to relative value

What are absolute reasons to terminate testing?

- Arrhythmias - Pale or cold and clammy skin - Severe shortness of breath - Dizzy, blurred vision or confusion - Patient requests to stop - V-tach or multiform PVC's - ST segment depression

What are relative indications to stop testing?

- ECG changes from baseline - Chest pain that is increasing - Wheezing - Leg cramps - High systolic/diastolic - Less serious arrhythmias - Less severe shortness of breath

Discuss steps for the Bruce treadmill protocol.

- Measure resting BP and HR standing on treadmill - Ask subject to straddle belt and start treadmill at 1.7 mph/0% grade - Ask subject to begin walking and release handrails as soon as comfortable - Start test protocol after 2-3 min warm up

Indications for clinical exercise testing, per ACSM, encompass these three categories:

- diagnosis - prognosis - evaluation of physiological response to exercise

What is the cool-down for the Bruce protocol?

1.7 mph and 5% grade for 4 min

The first workload of a YMCA Cycle Test is the same for all. It is:

150 kgm/min (0.5 kp)

The McCardle's Step Test utilizes a bench height of _______ and a step rate of ______ for men and _______ for women. The test lasts for _____ minutes.

41.25 cm 24 step/min 22 step/min 3

What is the duration of an Astrand-Rhyming Cycle Test?

6 minutes

What is the ideal test time for the Bruce protocol?

8-12 min

What is a test sometimes used in place of the Bruce protocol?

Balke Treadmill Protocol

Per ACSM, when performing sign/symptom limited testing, how long should the test be?

Between 6-12 min

When taking the HR at the end of the 2nd minute in the Astrand-Rhyming Cycle Test, where do you want the HR to be? If it is greater than desired, what do you do? Less than?

Desired between 125-170 bpm If greater than 170 bpm, decrease resistance by 1 kp If less than 125 bpm, increase resistance by: 1 kp (men) or 0.5 kp (women). Then continue to monitor HR every min until it exceeds 125 bpm

From when/where is the VO2 estimated for the Bruce protocol?

From last minute of a fully completed stage

When do you take HR after the McCardle's Step Test?

From the first 15 sec after the stepping has stopped

How is VO2 max found with HR and work rate known?

HR and work rate are graphed against each other as they should be linear. Extrapolate out to HRmax to find the corresponding/intersecting VO2max

How often do you take HR and BP with Bruce protocol?

HR at end of each min BP at end of each stage

HR determines the workload for a YMCA Cycle Test. How is it utilized?

HR divided into one of three categories: HR < 86; 86 < HR < 100; HR > 100 Take HR in the second half of the 2nd and 3rd min of each stage/workload. If HR difference is <5 bpm, steady state is achieved. Carry out test to one workload past steady state >110 bpm.

What are the VO2max formulas for the McCardle Step Test?

Men: 111.33 - 0.42 x HRrec = VO2 Women: 65.81-0.1847 x HRrec = VO2

What is the speed for men and for women for the Balke treadmill protocol?

Men: 3.3 mph Women: 3.0 mph

What are the grade increases for the Balke treadmill protocol?

Men: start at 0%. After 1 min, raise grade by 2%, and increase 1% each minute until test termination criteria is reached Women: start at 0%. After 3 min, raise grade to 2.5% and increase by 2.5% each min until test termination criteria is reached

What is the quantity of stages in an Astrand-Rhyming Cycle Test?

One. Single-stage test where VO2 max is determined using one submaximal data point (HR)

What is a key experimental value to the Balke treadmill protocol?

RPE. Discuss RPE w/pt and remind them that they will be asked throughout for RPE

What formulas are used to calculate VO2max for Bruce protocol?

SMvo2 = submax VO2 from table or ACSM HRsm = submax HR from test Men: VO2 = SMvo2 ((HRmax - 61) / (HRsm - 61)) Women: VO2 = SMvo2 ((HRmax - 72) /(HRsm - 72))

For diseased or elderly, how is the Bruce protocol modified?

Start at 1.7 mph (same) but either 0% or 5% grade Increments of 10-15 W/min or 1-3%/min grade

What is the HR desired objective behind the Bruce protocol?

Steady-state between 115 and 155 bpm Once reached, terminate test at the end of present stage

SBP > 250 or decreased below pre-testing value is a reason to terminate the test. True or false?

True

Termination criteria for a GXT depends on:

population being tested purpose of the test

What is the ability to positively identify patients who truly have IHD called?

sensitivity

What is the ability to correctly identify patients who do not have IHD called?

specificity

Given the Astrand-Rhyming Cycle Test, what is the workload for each of the following: unconditioned male conditioned male unconditioned female conditioned female

unconditioned male - 300 or 600 kgm/min conditioned male - 600 or 900 kgm/min unconditioned female - 300 to 450 kgm/min conditioned female - 450 or 600 kgm/min