PET 4551 EXAM 2 more
Terms in this set (70)
Exercise testing modalities
Cycle(5 to 25% less than a treadmill)
Arm ergometry (20-30% less than treadmill)
Bruce-sudden increments 1.7 mph, 10% grade
Ellestad (older adults)
Submax test should last 8-12 min
Contraindications to exercise testing absolute (box 3-5)
-Change in resting ECG-Ischemia, MI
-uncontrolled symptomatic heart failure
-acute pulmonary embolus
-acute myocarditis or pericarditis
-acute systemic infection
Contraindications to exercise testing relative (box3-5)
-left main coronary stenosis
-moderate stenotic valvular heart disease
-severe arterial hypertension @rest SBP:>200, DBP>110
-Tachyarrhythmias or bradyarrhythmias
-neuromuscular, rheumatoid disorders
-high degree airlock
-uncontrolled metal disease
-chronic infectious disease
Indications for stopping a test (Box 4-5)
-drop in SBP of > 10 mmHg with increase in workload
-onset of angina or angina-like symptoms
-failure of HR to increase
-excessive rise in BP: SBP > 250mmHg or DBP >15
-shortness of breath, wheezing, leg cramps, claudication
-noticeable change in heart rhythm
-signs of poor perfusion: light headiness, confusion, pallor, nausea, cold and clammy skin, cyanosis.
-subjects desire to stop
-ST segment elevation (+1.0mm)
-increasing nervous system symptoms (dizziness)
clinical stress test
-diagnostic exercise testing
-exercise testing for disease severity and prognosis
-exercise testing after MI
-functional exercise testing
Purposes of Fitness testing
-educating participants about their fitness levels
-get data that will provide in the development of exercise prescriptions
-to obtain base line data so comparisons can be made at a later date
-stratifying risk-diagnostic tool
Maximal oxygen uptake
-equipment is expensive
-subjects need to be motivated
-older individuals and individuals at risk
-field tests (walking, running)
Submax tests advantages
-personnel require minimal amount of training
-allow for mass testing
-test itself is shorter in duration
-safer since it does not require max exertion
Submax test disadvantages
-max HR, BP, RPP are not measured
-VO2 max not directly measured
-limited diagnostic value errors, range 10-20%
-true max HR is not obtained for exercise rx.
Assumption made in testing
-a steady state HR is obtained for each exercise work rate
-a linear relationship exists btw HR & work rate
-the max HR for a given age is uniform
-mechanical efficiency is similar for everyone
-stopwatch 3 mins
-no rest periods allowed
-stop subject standing find pulse within 5 sec, then take a 15 sec HR multiply HR X4
-proper position on cycle
-50 rev/min (rpm)
-pre exercise BP&HR
-warm up no resistance
Normal sinus rhythm
Arrhythmia abnormal rhythm
H-Hypoxia- lack of O2(change in partial pressures of O2)
I-Ischemia (heart attacks; abnormal HRs, lack of blood flow to myocardium)
S-Sympathetic stimulation-stressed; heart palpitations
D-Drugs-arrhythmias; PCP, cocaine
E-electrolyte disturbances-very dehydrated
B-Bradycardia (sick sinus syndrome)
S-Stretch-myocardium stretched; hypertrophies
Four types of arrhythmias
1. Sinus origin-either too fast or too slow or irregular (Sa node)
2. Ectopic rhythms-electrical activity originates elsewhere (when a cell overrides the SA node)
3.Conduction blocks- electrical activity encounters blocks or delays
4. Pre-excitation syndromes-aberrant conduction pathways, electrical short circuit
Arrhythmias of sinus origin:
-Bradycardia < 60 bpm
-Tachycardia > 100 bpm
-sinus arrest-heart stops
-asystole-prolonged electrical inactivity
-escape beat-beat originating outside the SA node (60-200bpm) node
-atrial pacemaker 60-75 bpm
-junctional pacemakers 40-60 bpm
-most common, no atrial depolarization; so no P wave.
-ventricular pacemaker- 30-45 bpm (no p wave )
physiological mechanism for this rhythm enhanced automaticity reentry.
any pacemaker can be accelerated to overtake the SA node & establish their own rhythm.
represents a disorder of transmission as opposed to a disorder of impulse formation.
4 questions when examining ectopic rhythm
1. Are P waves present?
2. Are QRS complexes narrow or wide?
3. What is the relationship btw P waves and QRS complex
4. Is the rhythm regular or irregular?
Ectopic Supraventricular Arrhythmias
-atrial premature beats or contractions (PAC) junctional premature contractions.
PAC-occur early, P wave looks different than other P WAVES; only 1 time
What is the difference between a junctional premature beat and a junctional escape beat?
They look exactly alike, but the junctional premature beat occurs early, prematurely, interposing itself into the normal sinus rhythm. An escape beat occurs late, following a pause when the sinus node has failed to fire.
What are the 4 types of sustained supraventricular arrhythmias
1. Paroxysmal supraventricular tachycardia
2. Atrial flutter
3. Atrial fibrillation
4. Multifocal atrial tachycardia
Paroxysmal supraventricular tachycardia (PSVT)
-150-250 bpm (rapid HR)
-QRS complex is narrow
-Carotid message can terminate problem
-P waves appear @250-300 bpm
-flutter waves; sawtooth pattern
-can be 2:1, 3:1, 4:1(p wave to QRS)
-regular rhythm usually (if 3:1, stays 3:1 all the way).
-a lot of times you don't see T wave
-carotid message:makes duration of QRS longer, changing the P waves. >>slows HR down; GOOD
-atrial activity completely chaotic generates an irregular ventricular pattern.
-no real P waves, varying rhythm
-QRS very irregular, duration changing
Multifocal Atrial tachycardia
(different atrial cells are taking over with different beats)
-random firing of several different atrial areas
-if <100 bpm, called a wandering pacemaker.
-P waves, coming from diff. areas where atria are depolarizing at diff areas.
Ectopic Ventricular Arrhythmias
(disturbances below the AV node)
-Premature ventricular contraction(PVC)
-Accelerated idioventricular rhythm
-Torsade de pointes
Premature ventricular contraction (PVC)
-prolonged QRS complex
-usually wide, bigger than other QRS complexes, followed by a pause.
-Bigeminy-every other beat = PVC
-Trigeminy-every third beat = PVC
Rules of malignancy
1. Frequent PVC's
2. Runs of PVC's -esp. 3 or more
3. Multiform PVC's (occurring all over heart rate)
4. PVC's falling on the T wave of a previous beat
5. PVC occurring in the setting of an acute MI
(heart does produce CO)
-3 OR more PVC's
(pre-terminal) heart generates no CO
Accelerated idioventricular rhythm
-sometimes seen during acute infarction
-no P waves
Torsade de Pointes
-twisting of the points
-like ventricular tachycardia but QRS complex rotates around the axis.
-QRS seems to spin around isoelectric line
What are the exercise equations?
(mL/Kg/min)= (3.5mL/Kg/min)+(m/min x .1) + (grade frac) x m/min x 1.8)
(mL/kg/min)= (3.5mL/Kg/min)+ (m/min x .2) + (grade frac) x m/min x .9)
Leg ergometer (cycle) equation
(mL/Kg/min)= (7.0mL/Kg/min) +(Kgm/min x 1.8/body weight in kg)
1 mph=26.8 m/min
1 L of O2 consumed is = to 5 kcals
1 inch = 2.54 cm
2.2 lbs. = 1 kg
1 MET= 3.5 mL/kg/min
Monark leg ergometer flywheel is 6 m/rev
1 RM the max amt. of weight that can be lifted one time thru the full range of motion
a sub max Amt of weight that can be lifted over a period of time
the ability to exert a force rapidly, P= work/ time
static flex- a fixed position of a stretch.
dynamic flex-movement of a joint
same length, example: hand grip dynamometer
same tension, example; free weights
same velocity, example; rehab machines i.e. BIODEX
length of muscle shortens (recommend exhale)
-should last 3-4 seconds
Factors that determine the rate and strength gains
muscles increase strength when they contract at near maximal tensions, greatest strength gains seen with 4-8 reps of 3 or more sets.
muscles trained will be the muscles that show improvement. Closed kinetic-chain exercises, such as squat or cleans, better than open kinetic chain exercises such as knee extension or curl for the transfer of power to motor skills
slow twitch muscles atrophy at a higher rate.
genetics do play a role in the ability to gain strength but a good training program is also important.
increase in muscle fiber or cell cross sectional area.
increase in number of muscle fibers or cells.
Time course of strength training
-decrease in reflexive protective mechanism
-inc. in # of motor units recruited
-inc. in motor unit synchronization
-inc. in motor unit firing rate
Hypertrophy in Type I and Type II fibers
-inc. in size of myofibrils
-inc. in total amount of contractile protein
-inc. in lean body mass
ACSM guidelines for strength benefits for healthy adults
-10 to 12 exercises;
(4-6 lower body) (6-8 upper body)
(10-12 reps, 7 secs. for each rep)
-2-3 x /wk. 48 hr rest (full body)
-Handgrip dynamometer- isometric strength
-one repetition max (1RM)
(bench press, leg extensions, squat)
(measures isometric strength)
Muscular endurance testing
Benefits of flexibility
-dec tightness of muscles & ligaments
-poor joint movement can lead to abnormalities in joint lubrication and deterioration
Reduction of DOMS
(delayed onset muscle soreness) soreness you feel after eccentric exercise
Relief of aches and pains from tension & sitting for too long
-improved body position for sports
-stretch held for 10-30 seconds, muscle spindle activity increases for about 10 seconds that diminishes with more than one stretch
muscles stretched suddenly due to bouncing heightened activity of muscle spindles can cause injury.
Stretching-Proprioceptive Neuromuscular Facillitation (PNF)
contraction of the muscle prior to stretching, causes muscle to relax prior to stretching.
sit & reach box
Sit & Reach
-warm up active followed by appropriate stretches
-shoes off, feet against board, knees slightly bent not hyperextended
-hands over ears, move slowly down towards feet, exhaling while stretching
-instruct no bouncing
-repeat 3 x best score
-Numerous ways to measure body comp:
-bioelectrical impedance analysis
-near infrared spectroscopy
-based on Archimedes principle
-body submerged in water is acted upon by a buoyant force which is equal to the weight of water
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