3_2: Clinical Exercise Testing Programing

What are the 2 main parts of the Health Screening and Risk factor analysis?

1. Exercise Preparticipation Health Screening

2. Clinical Exercise testing and programming

What are the key steps in exercise participation health screening?

1. Determine readiness for activity

2. Identify signs and symptoms of CV, metabolic, renal diseases

3. Desired exercise intensity

4. Medical history

5. Lifestyle history

6. Informed consent

Health Evaluation: Clinical Tests (6)

1. Physical examination

2. Blood chemistry profile

3. Blood pressure assessment

4. 12-lead ECG

5. Graded exercise test

6. Additional lab test

Graded exercise test are recognized for:

• detection of coronary artery disease with chest pain syndrome

• evaluation of CAD severity

• prediction of CV events and all-cause death

• evaluation of physical capacity and effort tolerance

• assessment of chronotopic competence, arrhythmias, and response to implanted device therapy

• assessment of the response to medical intervention

What are some basic recommendations for evaluation of physical functioning?

• 6 or 8 m gait > 0.6m/s

• 8 sit to stand reps in 30s

• 8 arm curls (4kg)

• ascend 10 steps under 30 sec

• chair sit and reach

True or False? Those basic recommendations for evaluating physical functioning are used to asses health related physical fitness?

False; they are not used to assess health related physical fitness

What are the minimum exercise recommendations when testing is unavailable? (aerobic)

• 2 to 4 METs

• Exercise HR = resting HR + 20 bpm

• rate of perceived exertion: 11 to 14

What are the minimum recommendations when testing is unavailable? (strength)

• 2 sets of 30s of sit to stand reps

• 2 sets of 8 arm curls (4kg)

• 10 step ups 2 times

• chair sit and reach hold for 30 sec

What are the 4 intensity levels of physical activity?

1. light

2. moderate

3. vigorous

4. high

How does breathing change during light intensity PA? What are the MET ranges?

• Barely detectable, normal, increased depth

• 1.5-3 METs

How does breathing change during moderate intensity PA? What are the MET ranges?

• Can pass the talk test, slightly heavier breathing

• 3-6 METs

How does breathing change during vigorous intensity PA? What are the MET ranges?

• Can’t pass talk test, deep breathing

• 6-9 METs

How does breathing change during high intensity PA? What are the MET ranges?

• heavy breathing, talking is almost impossible

• > 9 METs

Step 1 for exercise programming

assess current health status (medical history, symptoms, restrictions and treatments)

Step 2 for exercise programming

assess current physical activity level

Step 3 for exercise programming

identify symptoms that limit physical activity (objective value, descriptions, recovery time)

Step 4 for exercise programming

evaluate physical function and performance

What are the four levels of physical function and performance?

1. Mildly impaired to normal

2. Moderately impaired, low functioning

3. Severely impaired, very low functioning

4. Needs aid, debilitated

Step 5 for exercise programming

• select physical performance assessments (ADLs)

• CHECK HEALTH RELATED FITNESS

List a few tests used for physical functioning

• Walking test

• Gait speed test

• Chair to stand test

Describe the gait speed and placed them into the perspective requirements for various activities

Step 6 for exercise programming

consider formal exercise tolerance training (whether an individual should undergo training before starting an exercise program)

List some types of exercise tolerance tests

• Balke or modified naughton protocol (gradual increase)

• Low-level constant-increment protocol (small increase in intensity)

• Continuous low-level ramping protocol

• branching low-level protocol

Step 7 for exercise programming

considerations for program referral

• what are the limitations in physical function?

• how safe is the exercise?

• adherence factors; accessibility

Step 8 for exercise programming

• develop a strategy for monitoring progress

track participation and clinical responses