rehab - assessment of health

• What to measure during exercise testing?

  1 - HR

  2 - RPE (Borg scales/talk test/OMNI test)

  3 - Blood pressure

  4 - Subjective symptoms like sweating/breathlessness/pallor/redness
• How to measure HR(max):

  When age is less than 45; use 220-age

  When age is greater than 45; use inbar method; 205.8-(age x 0.695)

  p.s. tanaka method; 208 - (0.7 x age)
• How do you measure body composition?

  1 - Hydrodensiometry

  2 - Air displacement plethysmography (BOD POD)

  3 - DEXA

  4 - MRI

  5 - Skinfolds

  6 - Bioelectrical impedance analysis
• what are the anthropometric measures of measuring body composition?

  1 - weight

  2 - Height

  3 - BMI

  4 - Waist circumference

  5 - Waist-height ratio

  6 - Waist-hip ratio
• Calculations

  Waist : height = waist/ height

  Waist : hip = Waist/hip

  BMI = Weight(kg) / Height^2(m)
• Define muscle strength

  the ability of a muscle group to develop maximal contractile force against resistance
• Define muscle endurance

  the ability of a muscle group to exert submaximal force for extended periods
• How to assess isometric strength

  1 - Dynamometers (handheld + spring loaded ones)

  2 - Oxford scale
• Pros and cons of dynamometers

  pros:

  • objective
  • Normative data available

  Cons

  • Expensive
  • Don't measure strength through full range
• Pros and cons of Oxford scale

  Pros:

  • Universally used
  • Simple
  • Inexpensive/free
  • Quick

  Cons:

  • Crude
  • Disproportionate distance between grades
  • Grade 5 subjective
  • No idea of "absolute strength"
• How to assess dynamic strength

  1 - One-repetition maximum (1-RM)

  2 - Estimated 1-RM

  3 - Dynamometer
• Pros and cons of Maximum 1-RM

  Pros:

  • Objective
  • Measures strength through full range of movement

  Cons:

  • Measures muscle strength at weakest point
  • Cost/equipment requirements
  • Need for practise if not experienced with lifting weights
  • Safety
  • Time consuming
  • May underestimate
• Pros and cons of estimated 1-RM

  Pros;

  • Objective
  • Measures strength through full range of movement
  • Practical

  Cons:

  • Measures muscle strength at weakest point
  • Cost/equipment
  • May overestimate
• How to assess static muscle endurance

  Using dynamometers

  Pros: objective/measures strength through full ROM/ measures maximal strength at all points of muscle range

  Cons: Cost/ accessibility/expertise/size
• How to assess dynamic muscle endurance

  1 - Submaximal muscle endurance

  2 - Calisthenic/ functional exercises

  3 - Dynamometers
• what are the pros and cons of submaximal endurance tests?

  pros:

  • objective
  • Measures muscle endurance through full range of movement

  Cons:

  • Need familiarisation with technique
  • Equipment needed
• Pros and cons of calisthenic exercises?

  Pros:

  • People usually familiar with exercises
  • Little/ no equipment required

  Cons:

  • Need standardisation of protocol (no rest between exercises)
  • Poor technique may bias result
  • Don't isolate single muscle
• Define ROM

  the extent of osteokinematic motion available for movement activities, functional or otherwise, with or without assistance
• Define joint flexibility


  The ability of a joint to move through an unrestricted, pain free range of movement
• what factors impact joint ROM (intrinsic/extrinsic)


  Intrinsic: shape of bony surfaces/ congruency of bony surfaces/ pliability of joint capsule/ pliability of ligaments and tendons/ pliability of skin/ muscle strength/ muscle flexibility

  Extrinsic: age/ body segment size/ disease (OA OR RA)/ injury/ overuse/ immobilisation or joint disuse
• what are the methods to DIRECTLY assess ROM

  1 - Goniometer

  2 - Inclinometer
• What are the pros and cons of goniometer?

  Pros:

  • Universally used
  • Inexpensive
  • Joint specific

  Cons:

  • Accuracy heavily dependant on skill/experience
  • Rely on ability to identify axis or rotation and bony landmarks
• What are the pros and cons of inclinometer?

  Pros:

  • inexpensive
  • Joint specific
  • Good intra-rater reliability

  Cons:

  • Accuracy heavily dependant on experience/skill
  • Poor inter-rater reliability
• What are the INDIRECT methods to measure flexibility?

  1 - sit and reach test

  2 - V-sit and reach test

  3 - Modified sit and reach test

  4 - Back-saver sit and reach test

  5 - Chair and reach test

  6 - Back scratch test
• Pros and cons of sit and reach and back scratch tests

  Pros:

  • inexpensive
  • little equipment needed
  • normative data available

  Cons:

  • not joint specific
  • Can be biased due to limb length
  • Poor evidence validity of using sit and reach to assess back flexibility and correlation with back pain
• Define CRF?

  The ability of the circulatory and respiratory systems to supply O2 to skeletal muscles during sustained Phys.A
• How is CRF measured?

  Measured maximally or sub-maximally through open circuit spirometry.

  
  

  Direct: Maximal and graded

  Indirect: Submaximal and single-stage and graded
• Pros for direct measurement:

  Direct: gives exact VO2 max

  Graded:

  • More accurate estimates of exercise capacity
  • Avoids patients starting at a workload that's greater than their maximal capacity
  • Best way to allow a person to reach maximal exertion during exercise
  • Maximal: gives true representation of max exertion
• What sub-maximal test are there?

  Treadmill test: Modified Bruce treadmill exercise test protocol

  Cycle tests: YMCA cycle ergometer submaximal exercise test protocol

  Stepping tests: Chester step test

  Field tests: 2.6 & 12 min walk test. Cooper 12-min test