Clinical Testing Insights: Threshold Identification

Flashcards based on lecture notes about clinical testing insights.

What were the main topics covered in the lecture outline?

Transition from aerobic to anaerobic metabolism, cardiorespiratory responses to aerobic exercise, anaerobic threshold, ventilatory threshold, and ventilatory equivalents for efficiency.

What measure of expired air indicates the transition from aerobic to anaerobic metabolism?

Expired air is an indicator.

What has increased to initiate a change in ventilation/breathing rate during exercise?

increased oxygen consumption and increased carbon dioxide production

What detects the change in ventilation/breathing rate?

Chemoreceptors.

What does the heart, with circulation, couple during aerobic exercise?

Couples muscle activity to pulmonary and cellular respiration.

What is QO2 related to?

Peripheral O2 extraction coupled with ventilation.

What are the homeostatic controls that detect changes in the body during exercise?

Chemoreceptors and baroreceptors.

What do chemoreceptors detect changes in?

Changes in O2, CO2

What do baroreceptors detect changes in?

Changes in blood pressure.

What is CPET?

Non-invasive, simultaneous/integrated assessment of CV and pulmonary function under stress of exercise.

What is the focus of CPET?

Gaseous exchange variables.

Which modes are used for the CPET protocol?

Treadmill or cycle.

What is a ramp protocol?

Constant and continuous increase in external work.

What do sport scientists often do when doing VO2 max testing which is basically CPET?

Directly measure blood lactate.

What does CEPs stand for?

Clinical Exercise Physiologists.

What do CEPs specialize in?

Exercise testing and assessment, alongside the design, delivery and evaluation of evidence-based exercise interventions.

What does CEP scope of practice encompass along the care pathway?

Primary prevention, through acute management, to rehabilitation and maintenance.

How can CPET be used in differential diagnosis?

CPET can provide answers to why someone is breathless/unwell in a way that other functional tests cannot.

How is CPET used in disability evaluation?

CPET can objectively evaluate how unwell someone is, using CPET as an alternative marker of function.

How can CPET be used in intervention assessment?

CPET can be used to assess efficacy of therapeutic interventions (training, drugs, surgery).

How can CPET be used in rehabilitation prescription?

CPET can be used to personalise exercise training/rehabilitation programmes at an appropriate intensity.

How can CPET be used to determine suitability for medical intervention?

CPET can be used to determine if someone is fit for surgery.

How can CPET be used to determine pre-operative risk?

CPET can objectively risk assess cardiopulmonary reserve during surgery.

What is the utility in patients with CVD?

Key CPET variables hold powerful diagnostic and prognostic utility in patients with CVD.

What may evolve into a primary treatment goal in CVD patients?

Improving CPET response (VO2 peak) may evolve into a primary treatment goal in CVD patients.

According to Milani et al 2004, what 5 things CPET data identify if a patient is limited due to?

Circulatory, Ventilatory, Coronary Disease, Low Fitness, Poor Effort

What variables are important to look at in the 9-panel plots?

Oxygen Uptake (VO2), Carbon Dioxide Production (VCO2), Ventilation (VE), Heart Rate, Fuel Usage (RER), Oxygen Saturation (SaO2)

What is the cut-off for a normal VO2 peak?

≥ 85% of predicted VO2 peak

What is the cut-off for an abnormal VO2 peak?

< 85% of predicted VO2 peak

Define anaerobic threshold.

The physiological dividing line between moderate and heavy intensity exercise.

Cut-off for Anaerobic Threshold Status?

Normal ≥ 40% of predicted VO2 peak

Cut-off for Abnormal Anaerobic Threshold Status?

Abnormal < 40% of predicted VO2 peak

Define Ventilatory Threshold (VT1 and VT2)

Deflection between minute ventilation (Ve) and intensity

How much may VE increase with exercise?

VE may increase ~25-fold with exercise.

What do Ventilatory Equivalents give a measure of?

Gives a measure of instantaneous ventilatory and gas exchange efficiency: How many L does the patient have to breath in to uptake 1L oxygen or to produce 1L carbon dioxide?

Cut-off for normal Ventilatory Efficiency Slope (Ve/VCO2)?

Normal ≤ 34

Cut-off for abnormal Ventilatory Efficiency Slope (Ve/VCO2)?

Abnormal >34 = POOR PROGNOSIS

Define potential mismatching of ventilation:Perfusion

Mismatch of ventilation in/out of the lungs WITH perfusion of O2 in the heart/tissues = physiological dead space

What potential clinical skill is covered in the practical?

Respiratory Function

What was covered in the lecture?

Aerobic to anaerobic metabolism, cardiorespiratory responses to aerobic exercise, anaerobic threshold, ventilatory threshold and ventilatory equivalents - efficiency.

Coupling of _ activity to pulmonary to cellular.

Muscle

What are two types of receptors involved in homeostatic control?

Chemoreceptors and Baroreceptors

What does CPET stand for?

Cardio-Pulmonary Exercise Testing

With a RAMP protocol, _ increase in VO2, such that the range of metabolic capacity is distributed evenly over an appropriate duration.

Linear

CEP scope of practice encompasses apparently healthy individuals to those with _ conditions.

Chronic and complex

CPET can provide answers to why someone is breathless or unwell and objectively evaluate how unwell someone is in _ evaluation.

Disability

Improving CPET response (VO2 _) may evolve into a primary treatment goal in CVD patients

peak

The _-Panel plots are important variables to look at when interpreting the CPET results.

9

In clinical populations, they may not reach VO2 max as symptom-limited, therefore typically refer to as VO2 __

peak

The point above which further increases in intensity/work rate are increasingly sustained through _ metabolism.

Anaerobic

Efficiency Slope (Ve/VCO2) is an important measure for a patient assessment..

Ventilatory

Mismatch of _ occurs when air in/out of the lungs does not match perfusion of O2 in the heart/tissues.

Ventilation

Homeostatic control in action describes _ responses.

Physiological

The , with Circulation, Couples gas exchanges of muscle respiration with the lungs.

Heart

Constant and continuous increase in external work is a protocol.

Ramp

_ intervention suitability: CPET can be used to determine if someone is fit for surgery.

Medical

_ Diagnosis: CPET can provide answers to why someone is breathless/unwell in a way that other functional tests cannot.

Differential

What does VO2 Peak stand for?

Peak Oxygen Uptake (VO2 peak)

What kind of perscription can CPET be used for for individualized exercise?

Rehabilitation prescription

The 9-Panel plots includes Oxygen Uptake (VO2), Carbon Dioxide Production (VCO2), Ventilation (VE), Heart Rate, Oxygen Saturation (SaO2) and ?

Fuel Usage (RER)

What adapts to energy needs with increased respiratory rate (fB) and tidal volume (VT)?

Minute ventilation (VE)

Ventilatory Equivalents link with what?

Ventilation

What is the number value in a normal Ventilatory Efficiency Slope (Ve/VCO2)?

34

Potential clinical skills that can be covered in the practical include PDO and or Year 3 health module for more on _ ?

Respiratory function