Exercise Principles/Testing

Question 1

define physical activity

Answer 1

a broad term used to describe all forms of large muscle movements including sports, dance, games, work, lifestyle activities and exercise for fitness

Question 2

define exercise

Answer 2

any activity designed to develop or hone a skill or ability. Physical activity intended to improve, fitness and specific athletic skills

Question 3

benefits of aerobic exercise (aka reconditioning)

Answer 3

1. enhanced pulmonary performance
2. enhanced cardiac performance
3. enhanced blood flow
4. enhanced ability of tissue to extract and to utilize the delivered O2

Question 4

what is an indirect assessment of aerobic capacity?

Answer 4

VO2 max

Question 5

what is VO2 max?

Answer 5

• maximal oxygen consumption → refers to the max amount of O2 that an individual can utilize during intense or maximal exercise
• this measurement is generally considered the best indicator of cardiovascular fitness and aerobic endurance

Question 6

T/F: Vo2 max is the gold standard for determining cardiorespiratory fitness

Answer 6

TRUE

Question 7

list factors that influence VO2max

Answer 7

1. gender
2. family history
3. age
4. body composition
5. training status
6. altitude

Question 8

T/F: after the age of 50 peak VO2 max declines by 10% per decade?

Answer 8

TRUE

Question 9

1 MET is equivalent to what?

Answer 9

3.5 ml/kg/min

ADL range is between 10.5-17.5 ml/kg/min

Question 10

list alternative methods for assessing submaximal exercise capacity

Answer 10

1. 6-min walk test
2. fixed workload tests
3. submax treadmill test
   
   1. preset HR
   2. symptom limited
4. step test
5. cycling test

Question 11

Other methods for determining/assessing aerobic fitness

Answer 11

1. paper and pencil → Duke Activity Scale
2. Weekly Activity levels
   
   1. Grodin Leisure Time Questionnaire
   2. Comparison against recommended amounts of weekly activity
3. Wearables
   
   1. FitBit and step couting

Question 12

what can we do with an estimate of VO2 peak?

Answer 12

1. describe the max aerobic capacity/max fitness status of an individual
2. use it to write exercise prescription
3. use it to demo improvements in exercise capacity associated with reconditioning (PT)
4. develop treatment goals

Question 13

List physical benefits of CV exercise

Answer 13

1. can reduce body fat
2. increase aerobic capacity
3. increases lung volume
4. reduces the demands on the heart
5. lowers BP
6. reduces risk factors for numerous diseases

Question 14

Mental benefits of CV exercise

Answer 14

1. reduces anxiety
2. improves mild to moderate depression, self-esteem, and mood

Question 15

list determinants of strength/anaerobic fitness

Answer 15

1. number of motor units recruited
2. frequency of motor unit firing
3. quality of motor unit synchronization
4. muscle fiber type
5. cross sectional area and strength

Question 16

list assessments of anaerobic fitness

Answer 16

1. MMT
2. 1-rep max
3. 8-10 max test
4. hand-held dynamometer
5. isokinetic testing
6. power testing
   
   1. wingate test
   2. stair test

Question 17

List some benefits of improved anaerobic capacity

Answer 17

1. increased strength
2. greater balance/reduced fall risk
3. muscle strength but not mass independently associated with physical function in older adults

Question 18

describe muscle decline associated with aging

Answer 18

1. sarcopenia
   
   1. muscle decline associated with aging
   2. reduced muscle mass (usually Type II fibers)
   3. can be helped w/strength training
2. reduction in capillary blood supply → can be helped w/endurance training
3. fewer satellite cells
   
   1. increased myostatin production

Question 19

incidence of frailty with aging

Answer 19

10% in those over 65

50% in those over 85

Question 20

describe the frailty-phenotypes

Answer 20

1. recent weight loss → 10 lbs in previous yr, BMI <18.5
2. self reported exhaustion → felt unusually tired or weak in the previous month
3. weakness → <20% of age predicted grip strength

Question 21

strength considerations: frailty

Answer 21

1. slow walking speed
   
   1. >5 sec to walk 4m or 4.57 >15 ft
2. decreased physical activity
   
   1. >270 kcal per week of activity
3. prefrail = 1-2 criteria
4. frail = 3 or more criteria

Question 22

how can you assess for fraility?

Answer 22

Carolina Frailty-Index

includes ADL and physical function questions

predictive of all-cause mortality in older adults w/cancer

Question 23

how do you define power

Answer 23

amount of work produced per unit time

power = Force x Velocity

reflects a combo of strength and endurance

Question 24

what is the relationship between power and functional capacity?

Answer 24

Bassey and colleagues demonstrated that among frail nursing home residents, leg muscle power is more important than strength for performing daily activities such as stair climbing, rising from a chair, and walking

Question 25

List some tests for power

Answer 25

1. Peak cycling test 2. stair climbing test 3. 30 sec repeated STS 4. strong man competition 5. gait speed (BW x distance/time) 6. TUG, TUDs, 5x/30sec STS, inclined board

Question 26

describe the acute CV response to exercise

Answer 26

1. increased HR 2. increased CO 3. increased SV 4. increased SP (MAP) 5. or no change in DP 6. decreased TPR

Question 27

BP responses to exercise that signal reevaluation/stop exercise

Answer 27

1. if SP fails to increase or drops below resting levels → stop exercise 2. if DP increase more than 10 mmHg → reevaluate 3. remember that BP should start to fall immediately after exercise stops

Question 28

what is exercise testing?

Answer 28

a noninvasive procedure that evaluates an individual's capacity for dynamic exercise

Question 29

who should be tested?

Answer 29

1. Men \>45 and women \>55 2. family hx of CVD 3. cigarette smoking 4. sedentary lifestyle → not meeting exercise guidelines for previous 3 months 5. obese 6. HTN 7. dyslipidemia 8. prediabetic → fasting 100 mg/dL \< glucose \< 124 mm Hg

Question 30

list absolute contraindications to participating in exercise testing

Answer 30

1. recent sig change in resting ECG 2. unstable angina 3. uncontrolled cardiac dysrhythmias causing symptoms or hemodynamic compromise 4. uncontrolled symptomatic HF 5. acute PE or pulmonary infarction 6. severe symptomatic aortic stenosis 7. acute myocarditis or pericarditis 8. suspected or known dissecting aneurysm 9. acute systemic infection, accompanied by fever, body aches, or swollen lymph

Question 31

relative contraindications to participating in exercise

Answer 31

1. left main coronary stenosis 2. moderate stenotic valvular heart disease 3. HCM 4. high degree AV block 5. tachy/bradycardia 6. electrolyte abnormalities (K\<3.5) 7. severe untreated arterial HTN (at rest) 1. SBP \>200 2. DBP \>120 8. uncontrolled metabolic disease (diabetes) 9. advanced or complicated pregnancy 10. abnormal increase in body mass in previous 2 days in pts with stable HF

Question 32

absolute contraindications for STOPPING an exercise test

Answer 32

1. onset of angina or angina-like symptoms 2. suspicion of an MI 3. drop in SBP \>10 with an increase in work rate or if SBP falls below the value obtained in the same position prior to testing 4. SBP \>250 and/or DBP\>115 5. serious arrhythmias 6. sig pulmonary HTN 7. Signs of poor perfusion → pallor, cyanosis, cold and clammy skin 8. SOB, wheezing, leg cramps, or claudication 9. technical inability to monitor the ECG 10. pt request

Question 33

what is wheezing?

Answer 33

continuous adventitious lung sounds with a constant pitch and varying duration usually heard on exhalation/airway obstruction

Question 34

relative contraindications to STOPPING an exercise test

Answer 34

1. failure of HR to increase with increasing exercise intensity 2. change in heart rhythm 3. severe fatigue 4. failure of testing equipment 5. ventricular aneurysm

Question 35

Exercise safely considerations

Answer 35

1. assess cardiovascular risk 1. pre-participation screening 2. self guided (self-report) 1. physical readiness activity questionnaire 2. PAR-Q 3. professionally guided 1. physician clearance, exercise/health fitness professional

Question 36

briefly describe the PAR-Q

Answer 36

7 questions if a pt responds to any of them w/yes the recommendation is that the pt be referred back to a physicain

Question 37

exercise testing and current guidelines

Answer 37

no exercise testing required before walking, flexibility, or resistance training. Follow ACSM guidelines for exercise testing before moderate to vigorous aerobic exercise training

Question 38

describe a submaximal exercise test

Answer 38

1. pt achieves a predetermined submax exertional level and then test is stopped 2. may be symptom limited or have a predetermined end point (85% HRmax) 3. these tests tend to be ramped, progressive protocol 4. no expired gas analysis performed 5. VO2max or VO2peak is typically extrapolated from the results of the test

Question 39

what is included in physiological monitoring during a functional exercise test?

Answer 39

1. HR 2. BP 3. O2 sat 4. RPE

Question 40

what info can be derived from the Bruce Protocol if expired gases are not analyzed?

Answer 40

1. stage completed 2. exercise duration (min and sec) 3. HR/RPE/Dyspnea at fixed workloads (i.e. at the end of a given stage) 1. each stage = a fixed work load 4. estimation of VO2 peak

Question 41

T/F: HRR provides the best available approximation of VO2 max?

Answer 41

TRUE HRR = estimated HRmax - HR rest

Question 42

when to stop a Modified Bruce Protocol?

Answer 42

1. achieved pre-determined HR → 85% of HRmax 2. volitional fatigue or symptom limited 3. pt choice

Question 43

what measurements should be made during a 6 MWT?

Answer 43

1. Physiological 1. BP (pre and post exercise) 2. HR (pre and post exercise) 3. RPE (pre and post exercise) 2. Other 1. RPE (during and at end of exercise) 2. rating of breathlessness 3. arterial O2 sat

Question 44

what is the MCSD for the 6MWT?

Answer 44

between 54 and 80m or 177-262 ft

Question 45

list other submaximal exercise testing

Answer 45

1. single-stage submax treadmill walking test 2. Astrand and Ryhming Cycle Ergometer Test 3. 2 min walk test; 12 min walk test 4. modified shuttle walking test 5. bag and carry test 6. physical function ICU test

Question 46

predicting 1 RM

Answer 46

1. 1 RM = weight than can be moved 10x resulting in fatigue/0.75 2. there is a near linear relationship between the number of reps to fatigue and the % of max load 3. select a weight, do an exercise to fatigue, count the reps, use the number of reps to define 1 RM

Question 47

importance of determining power

Answer 47

peak muscle power was superior to muscle strength and aerobic capacity in determining functional status and independently predicted functional dependency even after accounting for additional neuropsychological and health status indicators