CV Tut 6

• Purpose of functional capacity testing:

  • predict maximal cardiorespiratory fitness (MET max)
  • optimal MET for men = 10
  • optimal MET for women = 9
  • times MET by 3.5 to work out VO2 max
  • risk stratification
  • exercise prescription
  • physical activity advice
  • programme outcomes i.e. changes in fitness following a cardiovascular prevention and rehabilitation programme
  • 1 MET increase in fitness decreases all cause mortality by 8 to 17%
• Intensity is set by

  • work rates - speed and resistance
  • METs
  • heart rate
  • RPE
• Age-Adjusted Karvonen:

  • STEP 1: Calculate age predicted maximum heart rate
  • Predicted HRmax (220-age) – 30 if ß-blocked
  • STEP 2: Calculate HRR
  • Predicted HRmax – HRrest = HRR
  • STEP 3: Calculate training heart rate (e.g. 40-70% of HRR)
  • 0.40 X (HRmax – HRrest)
  • 0.70 X (HRmax – HRrest)
  • STEP 4: Add resting heart rate
  • 0.40 X (HRmax – HRrest) + HRrest
  • 0.70 X (HRmax – HRrest) + HRres
• FOR HR MAX:

  • pts under 45 years can use 220 - age
  • pts over 45 years use INBAR: 205.8 (0.685 x age)
  • if pts are on betablockers, minus 30 from the sum

  
• Risk stratification:

  • predict risk of an exertion related events during exercise
  • level of supervision
  • set and appropriate exercise intensity
  • on table:
  • bottom 2 sections are low risk
  • middle 2 sections are moderate risk
  • top 2 sections are high risk

  
• Risk stratification categories:

  • PLUMBING is chest pain/angina caused by ischaemia
  • PUMP is related to ejection fraction
  • ELECTRICS is related to any arrythmias
  • MET MAX - low MET MAX
  • CLINICAL DEPRESSION
• Heart Failure Patients

  • In heart failure patients treated with betablockers there is a greater impact on heart rate
  • In these instances the Keteyian method has been shown to be superior
  • 119 + (0.5 x resting HR) – (0.5 X age)