Cardiopulmonary Function Assessment During Exercise

Cardiopulmonary Function

Assessment of heart and lung performance during exercise.

Pathophysiology Clarification

Understanding disease mechanisms in cardiac and pulmonary conditions.

Normal Response to Exercise

Increased oxygen demand and metabolic waste clearance.

Lactate Production

By-product of anaerobic metabolism during high exertion.

Oxygen Consumption (VO2)

Measurement of oxygen used during physical activity.

VO2 at Rest

Baseline metabolic activity at 3.5 mL/kg/min.

VO2 during Walking

Ranges from 8-10 mL/kg/min for slow walking.

VO2 Max

Maximum oxygen consumption during intense exercise.

Sedentary VO2 Max

30 mL/kg/min for sedentary 70-year-olds.

Athletic VO2 Max

80 mL/kg/min for young elite athletes.

Aerobic Metabolism

Primary energy source at lower exercise intensities.

Anaerobic Threshold

Point where lactate accumulates in the bloodstream.

Lactate Buffering

Bicarbonate neutralizes lactate, increasing CO2 production.

Ventilation Disproportion

Increased ventilation not matching VCO2 at high exertion.

Respiratory Exchange Ratio (R)

Ratio of CO2 produced to O2 consumed.

Resting Respiratory Quotient

0.8 at rest, indicating mixed fuel usage.

Exhaustion Respiratory Quotient

1.1 at exhaustion, indicating carbohydrate reliance.

Lactate Threshold

Occurs at 50-60% of peak exercise capacity.

Minute Ventilation (VE)

Increased ventilation to meet oxygen demand during exercise. Volume of air breathed/minute.

Tidal Volume

Volume of air per breath; increases with exercise.

Vital Capacity

Maximum amount of air exhaled after maximum inhalation.

End-Expiratory Lung Volume

Volume of air remaining in lungs after expiration.

Breathing Frequency

Rate of breaths taken per minute.

Ventilatory Reserve

Capacity for increased ventilation; VE/MVV%.

Maximal Ventilatory Reserve

70-80% in healthy individuals during exercise.

V/Q Ratio

Ventilation-perfusion ratio; stable during exercise.

Cardiac Output (QC)

Volume of blood pumped by heart per minute.

Stroke Volume

Volume of blood ejected per heartbeat.

Oxygen Delivery (DO2)

Product of cardiac output and arterial oxygen content.

Normal DO2 Value

About 1000 mL/min at rest.

Arterial Oxygen Content (CaO2)

Amount of oxygen carried in blood; influenced by hemoglobin.

Oxygen Dissociation Curve

Relationship between oxygen and hemoglobin; shifts with pH and temperature.

Oxygen Extraction Ratio

Percentage of oxygen extracted by tissues; varies with activity.

Peripheral Circulation

Increased blood flow to active muscles during exercise.

Cardiopulmonary Exercise Testing (CPET)

Assessment tool for physiological responses under exercise stress.

Incremental Exercise Testing

Structured exercise protocols to evaluate physiological responses.

Symptom-Limited Work Rate

Maximal workload in watts indicates exercise capacity.

VO2

Oxygen consumption during exercise, measured in mL/min.

Work Rate

Change in VO2 per change in watts.

Typical Response

Approx. 10 mL/min/watt during biking.

Impaired Oxygen Delivery

Below 8.8 mL/min/watt indicates potential issues.

Cardiac Ischemia

Sudden drops in exercise metrics indicate this condition.

Maximal Exercise Symptoms

Patient stops due to intolerable symptoms.

Max Effort Rating

19-20: feels almost impossible, cannot speak.

Very Hard Rating

17-18: difficult to maintain, can barely speak.

Vigorous Rating

15-16: short of breath but can speak a sentence.

Moderate Rating

13-14: comfortable pace, heavy breathing, can converse.

Light Rating

9-12: maintain pace for hours, can converse.

Very Light Rating

6-11: just above sleeping, can read.

Exercise Ventilation (VE)

Influenced by pH and PCO2 fluctuations.

End-Expiratory Lung Volume (EELV)

Increase may indicate air trapping presence.

Total Lung Capacity (TLC)

Difference from inspiratory capacity indicates lung function.

Arterial Blood Gases

Sampled during exercise, monitor oxygen and CO2 levels.

PaCO2 Stability

Remains stable during low to moderate exercise.

Lactate Threshold

Surpassing leads to rapid ventilation increases.

Heart Rate Monitoring

Approaches maximum predicted by 220-age formula.

Chronotropic Insufficiency

Inability to increase heart rate adequately.

ECG Monitoring

Used to identify dysrhythmias during exercise.

Fick Equation Limitations

Cardiovascular limitations observed at low exercise levels.

Key Indicators

Heart rates >80-90% of max predicted.

Base Excess

Decrease exceeding 3 mmol/L indicates stress.

Ventilatory Limitation

Respiratory limits cause dyspnea during exercise.

VEmax/MVV Ratio

Thresholds of 0.70-0.80 indicate ventilatory issues.

PaCO2 Levels

Rising levels suggest respiratory acidosis.

Gas Exchange Limitations

Barriers marked by low PaO2 or SpO2.

Arterial Oxygen Pressure (PaO2)

Levels <55-60 mm Hg indicate severe hypoxemia.

Oxygen Saturation (SpO2)

Dipping below 88-90% signals oxygen deficiency.

Increased VD/VT

Ventilation-perfusion mismatch affecting gas exchange.

P(A-a)O2

Widened gradient indicates impaired oxygen transfer.

VE/VO2 Ratio

Elevated at lactate threshold during exercise.

P(a-ET)CO2

Increased levels indicate poor ventilation.

Six-Minute Walk Test (6MWT)

Self-paced test detecting hypoxemia not seen in CPET.

Heart Rate Response

HR decrease of 12-13 bpm suggests cardiac disease.

Shuttle Walk Test

Gradually increasing speeds replicate CPET conditions.

Metronome Use

Increases pace during Shuttle Walk Test.

Walk Course Requirements

30 meters, unobstructed, and flat for consistency.

Patient Preparation

Includes bronchodilator therapy and rest before test.

Stopping Criteria

Record distance, dyspnea, HR, BP, and SpO2.

Cardiopulmonary Exercise Testing (CPET)

Recommended when routine evaluations fail to diagnose.

VO2 Max Measurement

Predictive of survival in CF and CHF patients.

Exercise Testing Termination Criteria

Includes chest pain, confusion, and low SpO2.

COPD

Chronic Obstructive Pulmonary Disease, a progressive lung disease.

Exercise Training

Enhances exercise capacity and psychological well-being.

VO2 Max

Maximum oxygen uptake during intense exercise.

Quality of Life (QoL)

Overall well-being and functional capacity of patients.

Pulmonary Rehabilitation

Multidisciplinary program optimizing outcomes in lung disease.

Functional Capacity

Ability to perform physical activities effectively.

Persistent Inflammation

Ongoing inflammation impairing lung function in COPD.

Ventilatory Reserves

Lung capacity available for increased breathing effort.

Dyspnea

Difficulty or discomfort in breathing, often experienced by COPD patients.

Acute Exacerbations

Sudden worsening of COPD symptoms requiring medical attention.

Accessory Muscles

Muscles aiding respiration, often wasted in COPD.

Exertional Dyspnea

Breathlessness triggered by physical activity.

Intensive Rehabilitation Programs

High-frequency sessions focusing on exercise and support.

Maintenance Programs

Ongoing support post-intensive rehabilitation for COPD patients.

Perioperative Programs

Rehabilitation for patients undergoing lung-related surgeries.

Patient Selection Criteria

Inclusion based on chronic respiratory disease and exertional dyspnea.

Hypoxemic Patients

Patients with low oxygen levels, requiring supplemental O2.

Patient Assessment

Comprehensive evaluation to diagnose and tailor rehabilitation.

Comorbidities

Other health conditions affecting rehabilitation outcomes.