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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.
