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What are the three main reasons for administering a test for CV endurance?
- establish a safe and challenging workout regimen
- measure the effectiveness of your intervention
- address disability and back to work questions
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What are the ACSMs absolute and relative contraindications for CV endurance testing?
- absolute contraindications: say the pt is not to perform the tests unless seen by a doctor and the questioned risks are stabilized
- relative contraindications: pt is able to be tested after a careful risk/benefit ratio has been determined
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Along with the list in our ACSM book, what are some other relative contraindications?
- neuromuscular
- musculoskeletal
- rheumatoid disorders
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What are the 4 main types of tests to measure cardiovascular endurance?
- maximal graded exercise tests: directly measures VO2 max
- submaximal graded exercise tests: estimate VO2 max
- submaximal tests: rate CV fitness
- nonexercise tests: estimate VO2 max
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What is the purpose of maximal graded exercise tests?
direct measurement of VO2 max
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What do submaximal graded exercise tests measure and what are some examples?
- estimate VO2 max
- treadmill and bike YMCA test
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What do submaximal tests measure and what are some examples?
- rate CV fitness
- 6 minute walk test and YMCA step test
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What is an absolute unit of measure of VO2?
- liters O2/min
- DOES NOT INCORPORATE BODY WEIGHT
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What is a relative unit of measure of VO2?
- mL O2/kg min
- USES BODY WEIGHT
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Which unit of VO2 measure can be compared between subjects?
mL O2/kg min
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What is a MET?
- oxygen consumption at rest
- 3.5 mL/kg/min
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What is the easiest way to talk about aerobic capacity?
METS
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What does VO2 max have to be lower than for social security administration criteria to be considered disabled?
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To be independent at age 85 or older what is the minimum aerobic power necessary?
- men: 18 mL/kg min
- women: 15 mL/kg min
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What are the 4 main criteria for selecting a submax test for a pt?
- purpose of the test (screen, diagnosis, pre/post exam)
- mobility and balance of pt (safety)
- level of fitness of pt
- increase in intensity for submax graded exercise tests should be appropriate for pt
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What are some pre-test instructions to give the pt for the day of their submax test?
- don't eat a large meal, consume alcohol/caffeine or smoke 3 hours prior
- hydration
- avoid significant exertion that day
- comfortable clothing
- adequate rest
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Prior to the test what are some things the PT needs to do?
- calibrate equipment
- have paperwork ready
- room temp between 68-72 degrees
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What is included within an informed consent?
- purpose/explanation of test
- risks and discomforts
- pt responsibilities
- expected benefits
- med. record usage
- freedom of consent
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What are some guidelines for actually administering the test?
- instruct pt on how to do the test
- do 2-3 minute warm up
- follow specific protocol of test
- 2-5 minute cool down
- monitor HR and BP 5 min after test
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What are signs to STOP a test?
- onset of angina
- SBP drops 20mmHg
- SBP and HR don't rise with increase in exercise intensity
- exessive rise in BP >250/115
- signs of poor profusion (light headed, confusion, ataxia, pallor, clammy skin)
- O2 saturation <90 mmHg
- change in heart rhythm
- physicla or verbal manifestation of severe fatigue
- RPE (rate of perceived exertion) 14-15/20
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What is rate of perceived exertion (RPE)?
- how difficult a pt feels a task is
- make sure they understand this is cardiovascullarly NOT musculoskeletal pain
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What are 3 safety considerations?
- enough space so if the pt falls, injuries are minimized
- PT's current on CPR
- ready for emergency situations
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What are 3 ways to ensure validity/reliability of a test?
- make sure the pt understands the test
- encourage the pt
- may need to give pt a practice test to ensure they fully understand
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What does the YMCA ergometer test and who is it designed for?
- estimate VO2 max
- healthy individuals
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What do you calculate max HR as for the YMCA bike test, and why do you calculate it?
- max HR= 85% (220-age) x.85
- don't want the HR to go higher than that
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Prior to testing what do you need to do as a PT for the YMCA bike test?
- (have already went through risk factors, signs/symptoms, consent, risk stratification on a different day)
- adjust seat height so knees are at 10' flexion
- get resting HR and BP on bike
- warm up at 50 rpm
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What position is the individual supposed to be on the bike for the YMCA bike test?
seat height adjusted so knees at 10' flexion
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How does stage 1 of the YMCA bike test work?
- EVERYONE starts at the same workload for stage 1
- .5kp, 25 wattes, speed=50rpm, 150kpm/min
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How is the workload of the subsequent stages of the YMCA bike test based?
off the HR at the end of stage 1
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What is the procedure for each stage of the YMCA bike test?
- Take the HR at the end of 2nd and 3rd min, if the HR is less than 5bpm apart then you have reached steady state and can continue to next stage, if GREATER than 5bpm pt has not reached steady state and have to continue another minute
- Meausre BP and PRE in 3rd minutes
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When does the YMCA bike test end?
- When 2 HR's between 110-150 have been recorded in 2 different stages
- OR if the pt cannot reach steady state within a stage after 4 minutes the test is too difficult
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What are some assumptions for tests that estimate VO2 max?
- linear relationship between HR and work rate
- steady state HR obtained in each stage
- max HR for a given age is uniform
- mechanical efficiency is the same for everyeone
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Why is the linear relationship between HR and work load not always true in tests that estimate VO2 max?
beta blockers and Ca++ channels blockers may blunt HR response
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