Exercise Prescription Test 2

• High levels of cardiorespiratory fitness are associated with reductions in what? 

  All-cause, cancer, and cardiovascular disease mortality. Improving low cardiorespiratory fitness can reduce the risk of all-cause mortality
• Familiarize yourself with the Fick equation and its components. 

  VO2 max = Q max x (a-VO2 diff max)

  The product of maximal cardiac output (Q) and maximal arterial-venous oxygen difference. VO2 variations across populations result primarily from Q. 
• Absolute contradictions

  should refrain from exercise participation until condition has been stabilized or adequately treated 
• Relative contradictions

  may be tested only after it has been determined that the potential benefits of exercise testing outweigh the associated risks.  
• Absolute contraindications

  • Acute myocardial infraction within two days
  • Ongoing unstable angina
  • Uncontrolled cardiac arrhythmia with hemodynamic compromise
  • Active endocarditis
  • symptomatic severe aortic stenosis 
  • decompensated heart failure
  • Acute pulmonary embolism, pulmonary infraction, or deep venous thrombosis
  • acute myocarditis or pericarditis
  • acute aortic dissection
  • physical disability that precludes safe and adequate testing
• Relative Contraindications 

  • Known obstructive left main coronary artery stenosis
  • moderate to severe aortic stenosis with uncertain relationship to symptoms
  • tachyarrhythmias with uncontrolled ventricular rates
  • acquired advance or complete heart block
  • recent stroke or transient ischemia attack
  • mental impairment with limited ability to cooperate
  • recent hypertension with systolic > 200 mm Hg or diastolic >100 mm Hg
  • uncorrected medical conditions, such as significant anemia, important electrolyte imbalance, and hyperthyroidism
• What is the proper sequence of exercise testing? 

  1. Cardiorespiratory 
  2. muscular fitness
  3. flexibility 
• Be familiar with CRF test measurements. When should they be measured? What position should they be taken? 

  Measurements appropriate for CRF should be measured prior to, during, and after the exercise test

  
  

  Prior to testing:

  Heart rate and blood pressure should be measured in testing position

  
  

  During Testing:

  Heart rate, blood pressure, and ECG should be measured in defined intervals 

  Signs and symptoms of cardiovascular disease or pulmonary disease should be monitored throughout 
• Be familiar with the advantages of and disadvantages of field testing?

  Advantages:

  • Easy to administer to large numbers 
  • Little equipment is needed

  Disadvantages:

  • Some can be maximal or near maximal in intensity, especially for those with low aerobic fitness
  • most are unmonitored for test termination criteria
  • individual motivation and pacing will significantly affect results
• Advantages and disadvantages for lab-based testing

  Motor driven treadmills

  Advantages: 

  • familiar form of exercise and accommodates many populations

  Disadvantages:

  • expensive, not easily transportable

  mechanically braked cycle ergometers

  advantages:

  • less expensive, easier to transport, and assess BP / ECG

  disadvantages:

  • calibration and constant pedal rates are necessary

  Step testing

  advantages:  

  • inexpensive and optimal for mass testing   

  disadvantages 

  • high energy cost and requires high level of balance
• What are the purposes for performing exercise tests? 

  Diagnosis, prognosis, and evaluation
• What are the exercise test modalities

  treadmill walking or running:

  • elicits the greatest physiological response due to the use of large muscle mass

  stationary cycling:

  • typically, 10% - 20% lower VO2peak then treadmill due to localized fatigue
  • individuals with limited use of lower extremities or balance issues may benefit from alternative modalities

  Arm ergometry:

  • total body recumbent stepping
• What are the criteria to confirm a true VO2max test? 

  •  RER > 1.10
  • +/- 10 bpm of maximal heart rate
  • VO2 plateau (< 150 mL O2/min or < 1.5 mL/kg/min change in VO2 between stages)
  • RPE > 17 on Borg scale
  • Blood lactate > 8 mmol/L 
  • Blood lactate is not a mandatory assessment 
  • Need 4/5 for a true test. If unable to meet all criteria, need 3/5. 
• If VO2 criteria not met, what information do you now possess?

  If criteria not met, test is considered VO2peak. 
• Be familiar with the common field tests for assessing CRF 

  1.5 mile run / walk test

  • Cover the distance as fast as possible

  Cooper 12 minute test

  • Cover the greatest distance possible in the allotted time period 

  Rockport one-mile fitness walking test

  • Cover the distance as fast as possible
  • Measure HR during the final minute of testing

  6 minute walk test

  • Cover greatest distance possible in allotted time period 
  • Ideal for older adults and individuals with reduced CRF due to clinical conditions (CHF and pulmonary disease). 
•  What are the different types of established standards for CRF? Know their general purpose. 

  Criterion referenced standards 

  • Consider desirable to achieve based on external criteria and may use adjectives such as “excellent” or “poor” within interpretation tables
  • exists mostly for CRF and body composition standards

   

  Normative standards

  • based on previous performances by a similar group of individuals
  • use percentile values to identify levels of fitness

   

   
• Know the components of muscular fitness. 

  Muscular strength, endurance, and power 
• Muscle plasticity describes changes in muscle characteristics when varying demands are placed on them. What characteristics are changed? 

  • Muscle size
  • Muscle architecture 
  • Enzyme activity 
  • Isoform expression 
• Strength training is typically performed relative to what measure? 

  One repetition maximum (1 – RM), a measure of maximum strength for a given movement
• Why do we assess muscular strength? 

  • Determine strengths and weaknesses
  • Establish obtainable goals
  • Track strength goals
  • Effectiveness of a training program
  • Examine secular trends 
• Isometric handgrip strength provides insight into what kind of health risks? 

  Isometric handgrip strength is negatively associated with mortality, risk of falling, and several risk factors
• What are Isokinetic machines helpful for? How could practitioners utilize them? 

  Useful for assessing muscular strength, power, and endurance in a variety of performance and health-related areas
• What is the general purpose of functional strength assessments?

  Preserving mobility and independence through maintenance of strength, endurance, and balance
• Familiarize yourself with Churilla’s MSA and metabolic syndrome stats (fully adjusted model) 

  In a fully adjusted model, if you meet the RT guidelines, your likelihood for dyplipidemia, impaired fasting glucose, prehypertension, and having an augmented waist circumference are 28%, 29%, 19%, 43% lower respectfully. 
• In healthy adults, what kind of effects can we see for isometric strength training on systolic and diastolic BP? 

  Isometric Resistance Training can help lower blood pressure, specifically the systolic blood pressure. while IRT did lower diastolic blood pressure, the decrease wasn't large enough to be considered significant in terms of clinical impact
• Explain information gathered from body comp. testing:

  • Percent body fat 
  • Fat distribution 
  • Body segment girth 
  • Bone density 
• How is the information gathered from body comp. testing useful?

  • Reduced health risks associated with disease. 
  • Designing safe and effective training programs 
  • Optimizing athletic performance 
  • % body fat estimation to provide information regarding health and fitness
  • Estimation of fat free mass and bone mineral density 
• Body Composition Methods:

  Direct method

  • In vitro: cadaver dissection and chemical analysis
  • In vivo: MRI, CT scans, and neutron activation analysis

  Indirect method: measure one parameter to estimate another

  • Hydrostatic weighing measures body volume and then predicts percent body fat based on assumed fat mass and fat free mass densities 

  Doubly indirect method: uses one indirect measure to predict another indirect measure

  • Skinfold measurements were primarily derived from hydrostatic weighing principle 

   
• Body Composition Models:

  Sum of compartment equal to the individual’s body mass

  Two-compartment model: partitions body into fat mass and fat free mass

  • Widest application to body composition analysis
  • Limited by assumptions

  Multicompartment models: partitions body into more than two compartments, which provides more accurate results

  • Three-compartment model: fat mass, dry fat free mass, and total body water
  • Four-compartment model: fat mass, total body water, bone mineral density, and dry fat free mass
• Increased android obesity is associated with what? 

  Hypertension, type 2 diabetes, and coronary artery disease
• Familiarize yourself with circumference measures and the insight that each measure provides into health risks. 

  Represents subcutaneous adipose tissue and visceral adipose tissue

  Immediately below the lowest rib at the narrowest waist 

  • Body fat distribution is considered a bigger risk of cardiovascular disease than excess total body fat
  • Most effective to use waist circumference and BMI to asses cardiometabolic risk
• What are the disadvantages associated with skinfold measurements? 

  • Technician training and measurement technique 
  • Anatomical site location 
  • Selection of calipers 
  • High level of physical contact with subject 
• Understand how bioelectrical impedance devices measure BF.

  Small electrical current is sent through the body, and the impedance to that current is measured

  • Lean tissue is good electrical conductor, whereas fat is a poor electrical conductor and impedes the electrical current 
  • BIA estimates total body water and uses hydration levels to predict percent body fat
• What are the advantages and disadvantages of bioelectrical impedance?

  Advantages: 

  • Noninvasive and easy to administer

  Disadvantages: 

  • Some devices cannot distinguish between intracellular and extracellular fluid 
  • Highly influenced by hydration levels
  • Athletes must abstain from exercise to ensure accurate results
• Understand how air displacement plethysmography devices measure body volume. What are the advantages and disadvantages associated with this technique? 

  Measures body volume via changes in air pressure using Boyle’s law

  • Air displaced is equal to body volume and is calculated indirectly by subtracting the volume of air remaining in chamber when the subject is inside versus volume of air when chamber is empty
• Advantages and disadvantages of air displacement plethysmography

  Advantages

  • Quick, noninvasive, comfortable assessment that accommodates a wide range of populations

  Disadvantages

  • Expensive equipment 
  • Assumptions associated with equations 
  • Many potential sources of technical error
• What three factors complicate interpretation of %body fat? 

  1. Lack of established / accepted universal standards 
  2. all measurements are indirect, so error should be considered
  3. no universally accepted criterion measurement (however 10% - 22% for men and 20% - 32% for women have long been viewed as satisfactory for health) 
• What factors determine joint ROM? How is ROM assessed?

  Determined by:

  • Genetics
  • Orthopedic health
  • Muscular tension
  • Strength

  Assessed:

  • Laboratory tests quantify flexibility in terms of ROM expressed in degrees
  • Goniometers
  • Inclinometers
• What factors influence the accuracy of ROM measures? 

  • Anatomical landmark identification
  • Position and stabilization of the body 
  • Application and stabilization of measurement device
  • Consistency in technique and protocol
  • Appropriate recording of measurements 
  • Recognition of limiting factors during recording
• How can clinicians utilize functional movement assessments? 

  Determines movement proficiency, potential for injury, and design for appropriate training and rehabilitation programs