Unit 3 Week 3: CardioResp Fitness Testing & Exercise Prescription

inverse relationship, as you increase exercise, you reduce the negative impact of chronic disease

very safe

• sedentary people • with underlying CV disease • participating in vigorous intensity exercise

• pre-participation health screening • gradual, progressive transitions from being sedentary to being physically active

• those who are at higher risk for exercise-related adverse CV events • benefit from medical clearance before initiating a moderate-vigorous intensity exercise program (light intensity is very safe for most) • those who have conditions that require medically supervised exercise or delaying exercise until symptoms are controlled

• self-guided (e.g. PARQ) • professional guided (e.g. ACSM) - medical history

• evidence based tools designed to decrease barriers to participation, decrease risk of false positive screening • screens for major signs and symptoms (cardiovascular, metabolic, or renal conditions)

• participation in regular exercise • presence of known health condition • presence of signs/symptoms • desired level of exercise intensity **hypertension is not considered CV disease for the purpose of the ACSM

• known CV, metabolic, or renal disease AND asymptomatic • any signs or symptoms of CV, metabolic, or renal disease (regardless of disease status)

a referral from a physician

astrand-rhyming single stage cycle ergometer test, 1 mile walking test

• predict fitness • set goals • prescribe exercise

• directly measure fitness • evaluate physiological response to exercise • develop prognosis of risk adverse events

• Bruce treadmill protocol • if includes GAS exchange monitoring aka “cardiopulmonary exercise test (CPET)” • if includes ECG monitoring aka “cardiac or exercise stress test”

• acute MI within 2 days • ongoing unstable angina • uncontrolled cardiac arrhythmias with hemodynamic compromise • active endocarditis • symptomatic severe aortic stenosis • decompensated heart failure • acute pulmonary embolism, pulmonary infarction, or DVT • acute myocarditis or pericarditis • acute aortic dissection • physical disability that precludes safe and adequate testing

• resting HR >100bpm • resting hypertension with systolic >140 or diastolic > 90 • known obstructive left main coronary artery stenosis • moderate to severe aortic stenosis with uncertain relationship to symptoms • tachyarrhythmias with uncontrolled ventricular rates • acquired advanced or complete heart block • recent stroke or transient ischemia attack • mental impairment with limited ability to cooperate • uncorrected medical conditions, such as significant anemia, important electrolyte imbalance, and hyperthyroidism

• avoid stimulants 2 hours prior (caffeine, ephedrine, nicotine) • avoid alcohol 6 hours prior • avoid vigorous exercise 24hrs before • cancel test if feeling unwell • take usual medications as prescribed by physician

• maximum O2 uptake measured via spirometry during an incremental graded maximal exercise test

• failure of VO2 to inc with inc workload (reached VO2 max) • failure of HR to inc with inc WL (reached vo2 max) • RPE >7/10 or 17/20 • venous lactate concentration >8.0mmol-l • respiratory exchange ratio >/= 1.10

no, they’re rarely met in untrained or those with CV or pulmonary disease

symptoms: joint pain, muscle fatigue, volitional fatigue (RPE), etc.

specific signs: 85% age-predicted HRmax or ST segment elevation

symptom-limited maximal tests or VO2 peak (VO2 peak is most commonly used clinically)

CPET - but they are resource intensive and mostly used when medically indicated or for athletic/occupational performance