ACSM's Chapter 4, Clinical Exercise Physiology

Clinical Exercise Physiology

The use of physical activity and exercise to delay or prevent the onset of chronic diseases; provide a therapeutic or functional benefits to individuals with disease conditions

Primary Responsibilities

assisting other health care professionals in diagnostic and functional capacity testing; prescribing exercise based on needs, abilities and desires; instructing, supervising and monitoring exercise programs

Primary duties  

Conducting preexercise screening, performing exercise testing and evaluation, developing exercise prescriptions, instructing individuals in proper training techniques, supervising safe and effective exercise programs in healthcare, community, and employment settings

Therapeutic

of or relating to the treatment of diseases or disorders by remedial agents or methods

Functional

performing or being able to perform a regular function

Pathophysiology

functional changes that accompany a disease condition

Angina Pectoris

serve chest pain caused by insufficient supply of blood to the heart

Cardiac Rehabilitation

a medically supervised program to help heart patients recover quickly or improve their overall physical and mental functioning

What was the major first study that lead to the connection between medical exercise and improvement in health?

London bus drivers done by Morris

Pulmonary Rehabilitation

a medically supervised program to help patients with chronic respiratory diseases stabilized or reverse systemic manifestations

American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)

The mission is to reduce morbidity, mortality, and disability from cardiovascular and pulmonary diseases through education, prevention, research, and aggressive disease management

Surgeon General’s report

Promotion of physical activity and exercise for healthy and diseased individuals

Government Associations

Department of Health and Human Services, Centers for Disease Control and Prevention, National Institutes of Health, American Heart Association, American Diabetes Association

Established health promotion to reduce the risk of disease development in healthy individuals and improve the health of those with disease conditions

Assessment Used to Determine Health-Related Physical Fitness

1. body composition

2. cardiovascular-respiratory fitness

3. muscular strength

4. muscular endurance

5. flexibility

Exercise testing

Used to clear individuals for safe participation in physical activity and exercise and as a basis for developing an exercise prescription. Diagnostic or functional capacity testing

Diagnostic Testing

used to determine a specific disease condition or a possible illness

measures heart rate, electrical activity of the heart, and blood pressure

used when there are symptoms of heart or lung disease, a history of possible abnormal cardiac incidents, abnormal electrical activity of the heart, or a high probability of an underlying disease

Functional Capacity Testing

used to provide an objective measure of an individual's safe functional abilities, also to prescribe an appropriate activity and exercise program to improve fitness

Submaximal or maximal exercise test that progressively increases in intensity

Well Known Diseases Conditions...

1. cardiovascular disease

2. myocardial infraction

3. coronary artery disease

4. angina's pectoris

5. cardiac arrhythmia

6. valvular heart disease

7. chronic heart failure

8. peripheral vascular disease

9. hypertension

Graded Exercise Tests (GXT)

a diagnostic and functional capacity test that uses workloads that are incremental; used to estimate VO2max; provides information for exercise prescription; must follow protocol; test conducted to inequity of about 70%-85% of specific age predicted max HR

Physical examination

Assesses the risk of an abnormal event while participating in exercise testing

Health history

Component of pretesting screening phase, designed to identify medical contraindications, identify clinically significant disease conditions, symptoms and risk factors for disease, and individuals with special needs for safe exercise participation

Medical Contraindication

a condition which makes a particular treatment or procedure inadvisable

Informed consent

A process whereby an individual participating in the exercise test is made aware of and understands the purposes, risks, and benefits associated with the test or exercise program

Rating of Perceived Exertion (RPE)

a subjective assessment of how hard an individual feels he/she is working

Electrocardiograph (ECG)

an instrument that measures electric potentials on the body surface and generates a record of the electric currents associated with the heart muscle activity

Maximal Oxygen Consumption (VO2max)

the maximal amount of oxygen used by the body during maximal effort exercise

Resting heart rate

Measured after the individual has been sitting quietly for 5 minutes or longer

Influenced by smoking, caffeine ingestion, fever, high humidity, stress, food digestion, medications, physical activity or exercise

Oscilloscope

an electronic instrument that produces an instantaneous trace on the screen that corresponds to oscillations of voltage and current

Blood pressure

After period of quiet sitting; the force exerting pressure against the walls of the blood vessels in the circulatory system

Cardiac Cycle

a complete beat of the heart, including systole and diastole and the intervals between; highest pressure during systole (contraction) phase, lowest pressure during diastole (relaxation) phase

Hypertension

When resting blood pressure is chronically elevated

Borg RPE scale

Provides a moderately accurate measure of how the individual feels in relation to the level of physical exertion

Shows when the individual is nearing exhaustion

Echocardiography (echocardiogram)

the use of sound waves to create a moving picture of the heart

Respiratory Diseases

1. obstructive pulmonary disease

2. restrictive pulmonary disease

3. asthma

4. cystic fibrosis

Oxygen consumption and Functional Capacity

measures the degree to which a person can increase physical activity and exercise intensity and maintain this increased level

Uses VO2max (the maximal rate at which oxygen can be taken up, distributed, and used by the body) measurement

Submaximal GXT

Conducted to an intensity that elicits between 70% and 85%, estimates an individual’s maximal fitness level

Maximal GXT

Direct assessment of cardiovascular, respiratory, and muscular function. Is continued to the point of exhaustion or to the point at which abnormal physiologic responses occur

Dyspnea

a feeling of difficult or labored breathing

Normative Data

data generated that allows comparison of an individual to a group, determines level of fitness

Orthopedic and Neuromuscular Disease

1. arthritis

2. osteoporosis

3. muscular dystrophy

4. multiple sclerosis

5. cerebral palsy

Ischemia

a decrease in the blood supply to a bodily organ, its, or part caused by constriction or obstruction of the blood vessels

Clinical Exercise Physiologist (CE)

a healthcare professional who is trained to work with patients with chronic diseases where exercise has shown to have a therapeutic benefit, including but not limited to cardiovascular, pulmonary and metabolic disorders

What is the work setting of a clinical exercise physiologist?

a medical setting such as a hospital, outpatient clinic

Type of Work a CE does...

1. cardio rehab

2. pulmonary rehab

3. diabetes education

4. weight management

5. fitness and wellness center

6. clinical testing

7. clinical research

8 specialized program for patients

What type of degree do CE need?

bachelor's degree in exercise science, exercise physiology or kinesiology

What type of degree does a Registered Exercise Physiologist (RCEP) need?

master's degree in exercise science, exercise physiology or kinesiology

Pretesting Procedure

1. pretest screening for health risks

2. physical examination

3. health history

4. informed consent

What would you monitor during a test?

EKG, BP, HR, RPE, O2/CO2 exchange

What are some influencing factor during diagnostic testing?

smoking, caffeine ingestion, fever, high humidity, stress, food intake, medications, prior physical activity....

Atherosclerosis

condition characterized by a reduced opening in the blood vessels

Diaphoresis

a condition of excessive sweating

Arrhythmia

irregular electric activity of the heart

Cardiac Output

the volume of blood ejected from the ventricles of the heart in a minute

Vasodilation

the dilation of a blood vessel

Renel Insufficiency

an ability of the kidneys to remove waste products from the body

Parenchymal Lung Disease

a disease affecting the tissue of the lungs

Allergenic

a substance that cause an allergy

Fibrosis

the development of stiff cartilaginous tissue

Hypoglycemia

below normal levels of blood glucose

Ketoacidosis

an acidotic condition caused by the increased production of ketone bodies

Atherogenic Dyslipidemia

abnormal levels of blood lipids that promote the development of atherosclerosis

Prothrombotic State

a condition of the body that favors the development of blood coagulation

Osteopenia

a condition of bone in which decreased calcification, decreased density, or reduced mass occurs

Symmetric

affecting corresponding parts simultaneously and similarly

Autoimmune

the immune response of body against its own tissue and organs