Term
| What are the general princicples of GET? (8) |
|
Definition
| 1. Informed consent. 2. Appropriate pt preparation. 3. Starting intensity well below predicted max. 4. Gradual, incremental increases in intensity. 5. Observe contraindications. 6. Do not perform test if any doubt of the benefit. 7. Regularly monitor stats. 8. Continue observation into recovery period. |
|
|
Term
| What are the important pt preparation points? (4) |
|
Definition
| 1. Do not eat, smoke or drink 2-3hrs pre-test. 2. Hx and physical to rule out contraindications. 3. Question re: Meds. 4. Pt education. |
|
|
Term
| Why don't you want pts to eat, drink or smoke pre-test? |
|
Definition
| Caffeine can increase HR, eating diverts blood from working muscles, smoking vasoconstricts, drinking impacts bld volume. |
|
|
Term
| Why is it important to question pts re: meds pre-GET? |
|
Definition
| Beta blockers depress HR so won't get accurate HR measure during test. Digoxin makes it so you can't test ST segment changes. If on beta blockers, you need to use RPE instead of HR. |
|
|
Term
| What are the major pt education points needed prior to GET? (6) |
|
Definition
| 1. Purpose of the test. 2. Testing procedure. 3. Risks & possible complications. 4. On/off treadmill, rails for balance only. 5. Hand signs for communication if wearing a mask. 6. Work as hard as you possibly can until you can't go any further, then test will end. |
|
|
Term
| How long should the appropriate GET last? What happens if it's too long or too short? |
|
Definition
| should take 8-12mins to ensure adequate length to get accurate measures. But if it's too long pt gets bored and stops trying. If too short you have to make gradation changes that are too big, and it's hard to tell @ exactly what increment changes took place, and the work becomes more anaerobic than aerobic. |
|
|
Term
| What protocol do you want to use for pts w/ significant CAD? Which protocol is bad for them? |
|
Definition
| Use a ramp protocol like BALKE. The Bruce protocol is bad for them. |
|
|
Term
| What are the four most important things to monitor during a GET? |
|
Definition
|
|
Term
| Describe the recovery period. |
|
Definition
| Immediately after completion of the test, have the pt lie supine for a min of 5 mins and monitor stats. |
|
|
Term
| Why is it important to observe recovery? And why do you lie them supine? |
|
Definition
| It is often in recovery that you see abnormal changes, so you need to know if it's important for the pt to do cool down. You have them lay supine because it's more taxing on the heart and will make Sx more obvious. |
|
|
Term
| When is a submax test over? |
|
Definition
| At a predetermined HR or workload. |
|
|
Term
| What are the down-sides to using a submax vs a max GET? |
|
Definition
| 1. It's based on inaccurate age-predicted max. 2. Vulnerable pts may be stressed too much. 3. Less impaired pts are limited by a low target HR. |
|
|
Term
| What are the benefits of the submax test? (4) |
|
Definition
| It can be used early post MI, can be used to make exercise/activity recommendations and ID risk level, predict functional capacity and assess effects of Tx. |
|
|
Term
| How are a bike VO2max and TM VO2max different? Why? What is the practical implication of this? |
|
Definition
| A bike VO2max is less than TM b/c more muscles are used on a treadmill. So you can't compare the two measures to each other. |
|
|
Term
| What are the advantages of using a bike for GET?(5) |
|
Definition
| 1 Work increments easy to control 2. Less interferences w/ ECG and BP monitoring (less noise and artifacts. 3. Cheap. 4. Space Economy. 5. Practice doesn't change performance much. |
|
|
Term
| What are the disadvantages of using a bike?(4) |
|
Definition
| 1. Muscle fatigue early my limit performance. 2. 25% lower VO2 max vs treadmill; not using as many muscles. 3. People are not familiar w/ cycling. 4. Motivation affects performance > TM. |
|
|
Term
| What is the advantage of the arm ergometer? |
|
Definition
| Good for populations who can't complete a leg testing protocol for vascular, orthopedic or neurologic reasons. |
|
|
Term
| At maximal effort are the physiologic parameters (VO2) higher w/ arm or leg work? |
|
Definition
| leg work. arm VO2 = 65-80% leg VO2. |
|
|
Term
| For the same VO2, several physiologic parameters are higher w/ arm ex than w/ leg ex. What are they? |
|
Definition
| HR, BP, RPP, VE, Blood lactate (b/c of more fast twitch fibers in arms). |
|
|
Term
| Why are some physiologic measures higher for arm than for leg ex? |
|
Definition
| 1. Lower mechanical efficiency of arms. 2. Static work of trunk muscles to stabilize the shoulder girdle. |
|
|
Term
| What measurements do you take in resting prior to GET? |
|
Definition
| In supine, standing and w/ hyperventilation you measure ECG and BP for each position. |
|
|
Term
| What measurements do you take during exercise? (5) |
|
Definition
| ECG at each stage. BP in last 30 sec, RPE in last 15 sec, Sx and pt appearance. |
|
|
Term
| What measurements are taken during recovery? (5) |
|
Definition
| Every 2 minutes:ECG, BP, RPE, Sx, Appearance. |
|
|
Term
| Why is hyperventilation a measure taken prior to testing? |
|
Definition
| Because if we see what happens w/ HV on its own it may change the way we see the results of the exercise testing. We can determine which changes are due solely to the HV vs which changes are a result of ex testing. |
|
|
Term
| What are the absolute indications to stop ex testing? (8) |
|
Definition
| 1. SBP decrease >10mmHg w/ increase of work w/ other signs of ischemia. 2. Mod/Severe angina. 3. Neuro signs and sx (ataxia, dizziness, syncope). 4. Signs of poor perfusion. 5. Technical difficulties monitoring ECG or BP. 6. Sustained VTach. 7. ST elevation ?1mm. 8. Subject demands to stop. |
|
|
Term
| What are the relative reasons to stop a GET? (8) |
|
Definition
| 1. SBP decr >10 w/o signs of ischemia. 2. ST depress, QRS changes. 3. Arrhythmias ie: multifocal PVCs, PVC triplets. 4. SVT, heartblock/bradycardia. 5. BBB 6. SBP>200 or DP>110. 7. Increasing chest pain. 8. Other Sx: fatigue, SOB, wheezing, leg cramps, claudication. |
|
|
