Weitere ähnliche Inhalte Ähnlich wie Exercise testing (20) Mehr von Dr. Vitthalrao Vikhe Patil Foundation's College of Physiotherapy, Ahmednagar (20) Kürzlich hochgeladen (20) Exercise testing1. © 2009 McGraw-Hill Higher Education. All rights reserved.
Exercise Testing
Dr.Nidhi Ahya ( Asst Prof)
(Cardio-vascular & Respiratory Therapy)
DVVPF College of Physiotherapy,
Ahmednagar 414111
1/9/2014 1Dr.Nidhi Ahya
2. © 2009 McGraw-Hill Higher Education. All rights reserved.
Objectives
Definition
Need for exercise testing
VO2 maximum
Exercise Physiology
Types of exercise testing
Bruce Protocol
Shuttle walk test
6 minute walk test
Summary
1/9/2014 2Dr.Nidhi Ahya
3. © 2009 McGraw-Hill Higher Education. All rights reserved.
Exercise Testing
Exercise testing is a non invasive
procedure that provides diagnostic and
prognostic information and evaluates an
individual’s capacity for dynamic exercises
1/9/2014 3
Dr.Nidhi Ahya
4. © 2009 McGraw-Hill Higher Education. All rights reserved.
Why do we need to do exercise testing
??
Exercise is a common physiological stress that
can elicit cardiovascular and respiratory
abnormalities which are not present at rest and it
can be used to determine the adequacy of cardiac
and pulmonary function
Both the systems are adequately stressed out
during the exercise
4
5. © 2009 McGraw-Hill Higher Education. All rights reserved.
Body’s Response to Exercise
During exercise, multiple cardiovascular,
respiratory and metabolic changes occur. These
include-
Increase in Heart Rate
Increase in Systolic Blood Pressure
Diastolic Blood pressure either remains same or
declines slightly
Increase in respiratory rate
All these responses are an attempt to meet the
increased oxygen demand during exercise
1/9/2014 5Dr.Nidhi Ahya
6. © 2009 McGraw-Hill Higher Education. All rights reserved.
VO2 max
It is also called as maximum O2 consumption ,
max O2 uptake , peak O2 uptake or aerobic
capacity
Definition :
It is the maximum capacity of an individual’s
body to transport and use oxygen during
incremental exercise ,which reflects the physical
fitness of the individual
It is expressed as-
VO2 max = ……. Litre of O2 / min
= ……. ml of O2 / kg body wt /min1/9/2014 6
8. © 2009 McGraw-Hill Higher Education. All rights reserved.
To measure the VO2 max , individual is involved in
physical effort sufficient in duration and intensity to
fully tax the aerobic energy system
VO2 max is reached when O2 consumption
remains at steady state despite an increase in the
workload
1/9/2014 8Dr.Nidhi Ahya
9. © 2009 McGraw-Hill Higher Education. All rights reserved.
Types of exercise testing
Maximal exercise testing
Submaximal exercise testing
1/9/2014 9
10. © 2009 McGraw-Hill Higher Education. All rights reserved.
Maximal exercise testing
Maximal exercises means an individual works
upto maximum effort of his work capacity
They are further divided into-
Field tests
Laboratory test
These tests predict or directly measure VO2
max
Cooper 12 min test
Shuttle Walk test Field test
Stepping tests
Treadmill tests Laboratory test
10
11. © 2009 McGraw-Hill Higher Education. All rights reserved.
Treadmill Tests
Treadmill Tests involve making the patient walk on
a treadmill in accordance to set protocols that
stress the individual to their maximal exercise
capacity.
These tests are highly sensitive for clinical
diagnosis of CAD
The HR and rhythm, BP response, RR and rate of
percived exertion are closely monitored before,
during and after the tests to determine abnormality
1/9/2014 11Dr.Nidhi Ahya
12. © 2009 McGraw-Hill Higher Education. All rights reserved.
The most common treadmill test protocol
used are –
BRUCE PROTOCOL
BALKE PROTOCOL
1/9/2014 12Dr.Nidhi Ahya
13. © 2009 McGraw-Hill Higher Education. All rights reserved.
Bruce Protocol
The Bruce treadmill test protocol was designed in
by Robert .A. Bruce in 1963
It is a non-invasive test to assess patients
suspected with heart disease.
It is also a common method to indirectly estimate
VO2 Max in athletes.
In this protocol, the individual walks on the treadmill
uptill complete exhaustion as the treadmill speed
and inclination increases every 3 minutes
1/9/2014 13Dr.Nidhi Ahya
14. © 2009 McGraw-Hill Higher Education. All rights reserved.
Stage Speed Grade
%
Duration MET
s
Modified Full
1 1.7 0 3 1.7
2 1.7 5 3 2.9
3 1 1.7 10 3 4.7
4 2 2.5 12 3 7.1
5 3 3.4 14 3 10.2
6 4 4.2 16 3 13.5
7 5 5.0 18 3 17.3
8 6 5.5 20 3 24.6
9 7 6.0 22 3 28.41/9/2014 14Dr.Nidhi Ahya
15. © 2009 McGraw-Hill Higher Education. All rights reserved.
Assessment Variables:
Hemodynamics
– Heart Rate
– Systolic/ Diastolic Blood Pressure Responses
ECG Waveforms
RPE
Limiting Clinical Signs & Symptoms
1/9/2014 15Dr.Nidhi Ahya
16. © 2009 McGraw-Hill Higher Education. All rights reserved.
Variable Before Exercise
Test
During the Test After Exercise
Test
ECG Monitored
continuously;
recorded in
supine and
exercise posture
Last 15 sec of
each stage
Last 15 sec of
each 2 min time
period
Immediately post
exercise, last 15
sec of first min
of recovery, then
every 2 mins
HR During last 5 sec
of each min
During last 5 sec
of each min
BP Last 45 sec of
each stage
Last 45 sec of
each 2 min time
period
Immediately post
exercise, every 2
mins thereafter
SIGNS/
SYMPTOMS Recorded as observed
RPE Scale explained Last 5 sec of
each min
Peak exercise
value obtained1/9/2014 16Dr.Nidhi Ahya
17. © 2009 McGraw-Hill Higher Education. All rights reserved.
Rate of Perceived
Exertion(RPE) 15 –Grade Borg scale for RPE
6 No exertion at all
7 Extremely light
8
9 Very light
10
11
12
13 Somewhat hard
14
15 Hard (heavy)
16
17 Very hard
18
19 Extremely
20
1/9/2014 17Dr.Nidhi Ahya
18. © 2009 McGraw-Hill Higher Education. All rights reserved.
Subjective Ratings & Symptoms
Angina
1.Mild, barely noticeable
2.Moderate bothersome
3.Moderately severe, very uncomfortable
4.Most severe or intense pain ever experienced
Dyspnea
1.Light barely noticeable
2.Moderate bothersome
3.Moderately severe
4.Very uncomfortable1/9/2014 18Dr.Nidhi Ahya
19. © 2009 McGraw-Hill Higher Education. All rights reserved.
Claudication
1.Definite discomfort or pain but only at the initial or
modest levels
2.Moderate discomfort or pain from which the patients
attention can be diverted
3.Intense pain from which patients attention cannot be
diverted
1/9/2014 19Dr.Nidhi Ahya
20. © 2009 McGraw-Hill Higher Education. All rights reserved.
Indications for Termination
Drop in systolic blood pressure of > 10 mm Hg
from baseline, despite increase in workload
Moderately severe angina ( 3 on scale)
Increasing nervous system symptoms
Signs of poor perfusion
Subject desires to stop
Sustained ventricular tachycardia
ST elevation ( +10mm) in leads without
diagnostic Q-waves
1/9/2014 20Dr.Nidhi Ahya
21. © 2009 McGraw-Hill Higher Education. All rights reserved.
Interpretation
Exercise tests are interpreted as either-
Positive: (+) ETT indicates that there is a point
at which the myocardial oxygen supply is
inadequate to meet myocardial oxygen demand
Negative:(-) ETT indicates that at every tested
physiological workload, there is balanced oxygen
supply and demand
1/9/2014 21Dr.Nidhi Ahya
22. © 2009 McGraw-Hill Higher Education. All rights reserved.
Submaximal test
Submaximal exercises means an individual
works below maximum effort of his work
capacity
Self- paced walking test
Modified shuttle walking test
Bag and carry test
Timed up and go test
6 Minute walk test
1/9/2014 22Dr.Nidhi Ahya
23. © 2009 McGraw-Hill Higher Education. All rights reserved.
Modified Shuttle walk test
The shuttle walk test is an adaptation of 20 meter
shuttle running test
The 20-mt shuttle running test (20-MST) assesses
maximal aerobic power
The test required subjects to run between 2 lines
spaced 20 m apart at a pace set by signals on
a prerecorded cassette tape
Starting speed is 8.5 km and the frequency of the
signals was increased by 0.5 km each minute.
1/9/2014 23Dr.Nidhi Ahya
24. © 2009 McGraw-Hill Higher Education. All rights reserved.
This test was designed for athletes participating in
sports requiring constant stopping and starting
It was too streneous for many patients, which
resulted in the development of a 10 meter ,12 level
shuttle walking test in adults with COPD. This was
called as ‘Shuttle walk test’
Somehow in some patient groups the test was felt
to be too easy, so modified shuttle walk test was
devised in which three additional levels were
added. Thus it now has15 levels
24
25. © 2009 McGraw-Hill Higher Education. All rights reserved.
Indications:
Before and After Treatment Comparisons
Lung transplantation or lung resection
Pulmonary rehabilitation
Pulmonary hypertension
Heart failure
To Measure Functional Status
Chronic obstructive pulmonary disease
Cystic fibrosis
Peripheral vascular disease
In elderly patients1/9/2014 25Dr.Nidhi Ahya
26. © 2009 McGraw-Hill Higher Education. All rights reserved.
Contraindications:
Absolute
Acute myocardial infarction (3–5 days)
Unstable angina
Uncontrolled arrhythmias causing symptoms or
hemodynamic compromise
Syncope
Acute myocarditis
Pericarditis
Symptomatic severe aortic stenosis1/9/2014 26Dr.Nidhi Ahya
27. © 2009 McGraw-Hill Higher Education. All rights reserved.
Relative
Moderate stenotic valvular heart disease
Severe untreated arterial hypertension at rest
( 200 mm Hg systolic, 120 mm Hg diastolic)
High-degree atrioventricular block
Hypertrophic cardiomyopathy
Significant pulmonary hypertension
Advanced or complicated pregnancy
Orthopedic impairment
27
28. © 2009 McGraw-Hill Higher Education. All rights reserved.
Procedure
Treatment area that is at least 12 meters in length
and a tape player
The standard instructions are given on the
audiocassette tape.
Subjects are required to walk back and forth, turning
around two cones placed 9 meters apart making the
shuttle distance 10 meters long
The subject must keep pace with the prerecorded
auditory signal such that they complete a turn as
each sound beeps
Every minute the audio signal sounds at increasingly
shorter intervals
28
29. © 2009 McGraw-Hill Higher Education. All rights reserved.
One beep indicates the length of one shuttle and
three beeps indicates an increase in speed
There are 12 levels of speed beginning at 0.50 m/s
and ending at 2.37m/s.
The test is measured in meters and no
encouragement is provided
If the patient chooses to stop or fails to keep up to
auditory signals after one warning the test will end
The test will also terminate if patient reaches 85% of
their maximal heart rate
29
30. © 2009 McGraw-Hill Higher Education. All rights reserved.
Protocol
6 8 3.02 1.35
7 9 3.40 1.52
8 10 3.78 1.69
9 11 4.16 1.86
10 12 4.54 2.03
11 13 4.92 2.20
12 14 5.30 2.37
Levels Shuttles / level Speed (mph) Speed ( m/s )
1 3 1.12 0.50
2 4 1.50 0.67
3 5 1.88 0.84
4 6 2.26 1.01
5 7 2.64 1.18
1/9/2014 30Dr.Nidhi Ahya
31. © 2009 McGraw-Hill Higher Education. All rights reserved.
6 minute walk test
The 12-MWT was introduced by McGavin and
colleagues to assess the distance covered in 12
minutes in individuals with Chronic Bronchitis
This test was modified from the 12-MRT described
by Copper for individuals without health problems
Butland et al reported that similar results could be
obtained in 6 minutes
Guyatt et al applied the 6-MWT in individuals with
heart failure
1/9/2014 31Dr.Nidhi Ahya
32. © 2009 McGraw-Hill Higher Education. All rights reserved.
Indications
A) Pre - Post – treatment comparisions
Lung transplantation
Lung volume reduction surgery
Pulmonary rehabilitation
COPD
Pulmonary hypertension
Heart failure
1/9/2014 32Dr.Nidhi Ahya
33. © 2009 McGraw-Hill Higher Education. All rights reserved.
B) Functional status
COPD
Cystic fibrosis
Heart failure
Peripheral vascular diseases
Older patients
C) Predictor of morbidity and mortality
Heart failure
COPD
Primary pulmonary hypertension 33
34. © 2009 McGraw-Hill Higher Education. All rights reserved.
Contraindications
Absolute Contraindications
unstable angina and myocardial infarction during
the previous month
Relative Contraindications
Resting heart rate of more than 120 beats/min
Systolic blood pressure of more than 180 mm Hg
Diastolic blood pressure of more than 100 mmHg
1/9/2014 34Dr.Nidhi Ahya
35. © 2009 McGraw-Hill Higher Education. All rights reserved.
Required Equipments
Countdown timer (or stopwatch)
Two small cones to mark the turnaround points
A chair that can be easily moved along the
walking course
Worksheets on a clipboard
A source of oxygen
Sphygmomanometer
Telephone
Automated electronic defibrillator
1/9/2014 35Dr.Nidhi Ahya
36. © 2009 McGraw-Hill Higher Education. All rights reserved.
Patient Preparation
Comfortable clothing should be worn.
Appropriate shoes for walking should be worn.
Patients should use their usual walking aids during
the test (cane, walker, etc.).
The patient's usual medical regimen should be
continued.
A light meal is acceptable before early morning or
early afternoon tests.
Patients should not have exercised vigorously
within 2 hours of beginning the test.
1/9/2014 36Dr.Nidhi Ahya
37. © 2009 McGraw-Hill Higher Education. All rights reserved.
The patient should sit at rest in a chair, located near
the starting position, for at least 10 minutes before
the test starts
During this time, check for contraindications,
measure pulse and blood pressure, and make sure
that clothing and shoes are appropriate
Have the patient stand and rate their baseline
dyspnea and overall fatigue using the Borg scale
Set the lap counter to zero and the timer to 6
minutes. Assemble all necessary equipment
37
38. © 2009 McGraw-Hill Higher Education. All rights reserved.
Termination of test
Patients vitals are taken immediately after the
test and then at the end of 2 minutes,5 minutes or
till return to baseline
Count the number of laps on the worksheet and
calculate the distance covered by the patient
Refer to worksheet for details
1/9/2014 38Dr.Nidhi Ahya
39. © 2009 McGraw-Hill Higher Education. All rights reserved.
Summary
Definition
exercise testing
VO2 maximum
Exercise Physiology
Types of exercise testing
Bruce Protocol
Shuttle walk test
6 minute walk test
1/9/2014 Dr.Nidhi Ahya 39
40. © 2009 McGraw-Hill Higher Education. All rights reserved.
THANK YOU…..
1/9/2014 Dr.Nidhi Ahya 40