Physical Fitness Testing


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  • Testing CR endurance after assessing muscular fitness (which elevates HR) can produce inaccurate results about an individual’s CR endurance status, particularly when tests using HR to predict aerobic fitness are used. Dehydration resulting from CR endurance tests might influence body composition values if measured by bioelectrical impedance analysis (BIA). Because certain medications, such as beta-blockers, which lower HR, will affect some fitness test results, use of these medications should be noted.
  • Physical Fitness Testing

    1. 2. <ul><li>Strong relationship with good health </li></ul><ul><li>Related to performing daily activities with vigor </li></ul><ul><li>Associated with low risk of premature development of the hypokinetic diseases </li></ul>
    2. 3. <ul><li>Educate participants of health-related fitness status </li></ul><ul><li>Provide data helpful in development of exercise prescriptions </li></ul><ul><li>Collecting baseline that allow evaluation of exercise program </li></ul><ul><li>Motivational tool--establish reasonable and attainable fitness goals </li></ul><ul><li>Stratifying cardiovascular risk </li></ul>
    3. 4. <ul><li>Minimal recommendation is completion of a questionnaire (e.g. PAR-Q) </li></ul><ul><li>Participant should follow testing guidelines (ch.2) </li></ul><ul><li>Forms: </li></ul><ul><ul><li>informed consent, score sheets, tables, graphs, and other testing documents </li></ul></ul><ul><li>Calibrate all equipment </li></ul><ul><li>Maintain room temperature of 68°F to 72°F (20°C to 22°C) and humidity of <60% </li></ul>
    4. 5. <ul><li>Prescreening/risk stratification </li></ul><ul><li>Resting HR, BP, height, weight, body mass index, ECG (if appropriate) </li></ul><ul><li>Body composition </li></ul><ul><li>Cardiorespiratory fitness </li></ul><ul><li>Muscular strength </li></ul><ul><li>Muscular endurance </li></ul><ul><li>Flexibility </li></ul>
    5. 6. <ul><li>Resting measurements: </li></ul><ul><ul><li>Heart rate </li></ul></ul><ul><ul><li>Blood pressure </li></ul></ul><ul><ul><li>Height </li></ul></ul><ul><ul><li>Weight </li></ul></ul><ul><ul><li>Body composition </li></ul></ul><ul><li>Fitness measurements: </li></ul><ul><ul><li>Cardiorespiratory (CR) endurance, </li></ul></ul><ul><ul><li>Muscular fitness </li></ul></ul><ul><ul><li>Flexibility </li></ul></ul>
    6. 7. <ul><li>Anthropometric methods </li></ul><ul><ul><li>Body mass index </li></ul></ul><ul><ul><li>Circumferences </li></ul></ul><ul><ul><li>Skinfold measurements </li></ul></ul><ul><li>Densitometry </li></ul><ul><ul><li>Hydrodensitometry (underwater) weighing </li></ul></ul><ul><ul><li>Plethysmography </li></ul></ul><ul><li>Other </li></ul><ul><ul><li>Dual energy x-ray absorptiometry </li></ul></ul><ul><ul><li>Total body electrical conductivity </li></ul></ul><ul><ul><li>Bioelectrical impedance analysis </li></ul></ul><ul><ul><li>Near-infrared intercadence </li></ul></ul>
    7. 8. <ul><li>Table 4-2 </li></ul>
    8. 9. <ul><li>Table 4-5 </li></ul>
    9. 10. <ul><li>Table 4-6 </li></ul>
    10. 11. <ul><li>Low levels of CR fitness associated increased risk of premature death from all causes and specifically from cardiovascular disease. </li></ul><ul><li>Assessment of CR fitness is an important part of a primary or secondary prevention program </li></ul><ul><li>Commonly modes for exercise testing : </li></ul><ul><ul><li>cycle ergometry tests, </li></ul></ul><ul><ul><li>treadmill tests, and </li></ul></ul><ul><ul><li>step tests </li></ul></ul>
    11. 12. <ul><li>Estimates of VO 2max from the HR response to submaximal exercise tests are based on these assumptions: </li></ul><ul><ul><li>Steady-state HR is obtained for each work rate </li></ul></ul><ul><ul><li>Test terminated at 70% of PMHR OR signs/symptoms </li></ul></ul><ul><ul><li>A linear relationship exists between HR and work rate </li></ul></ul><ul><ul><li>The maximal workload is indicative of the VO 2max </li></ul></ul>. .
    12. 14. <ul><ul><li>The ability to carry out the activities of daily living, which is related to self-esteem </li></ul></ul><ul><ul><li>The fat-free mass and resting metabolic rate, which are related to weight management </li></ul></ul>
    13. 15. <ul><li>Muscular strength </li></ul><ul><ul><li>The ability of the muscle to exert force </li></ul></ul><ul><ul><li>Traditionally, the one-repetition maximum </li></ul></ul><ul><ul><li>Multiple RM can be used to determine 1RM </li></ul></ul><ul><li>Muscular endurance </li></ul><ul><ul><li>the muscle’s ability to continue to perform for successive exertions or many repetitions </li></ul></ul><ul><ul><li>Curl-up (crunch) test </li></ul></ul><ul><ul><li>Maximum number of push-ups </li></ul></ul>
    14. 16. <ul><li>Flexibility is the ability to move a joint through its complete range of motion. </li></ul><ul><ul><li>Normal Range of Motion for common joints </li></ul></ul><ul><ul><li>Sit and Reach </li></ul></ul>
    15. 17. <ul><li>The exercise test may be used for diagnostic, prognostic, and therapeutic applications, especially in regard to exercise prescription. </li></ul>
    16. 18. <ul><li>Exercise test may be used for diagnostic, prognostic, and therapeutic applications, especially in regard to exercise prescription </li></ul><ul><li>Greatest utility with intermediate probability </li></ul>
    17. 19. <ul><li>magnitude of ischemia is proportional to the degree of ST-segment depression </li></ul><ul><li>high probability of disease </li></ul><ul><ul><li>to assess residual myocardial ischemia </li></ul></ul><ul><ul><li>to assess threatening ventricular arrhythmias </li></ul></ul><ul><ul><li>prognosis rather than for diagnostic purposes </li></ul></ul><ul><li>Low-level testing provides sufficient data to make recommendations about ability to safely perform activities of daily living </li></ul>
    18. 20. <ul><li>Exercise testing after myocardial infarction can be performed: </li></ul><ul><ul><li>before or soon after hospital discharge for prognostic assessment, </li></ul></ul><ul><ul><li>for activity prescription, </li></ul></ul><ul><ul><li>for evaluation of further medical therapy, and </li></ul></ul><ul><ul><li>for interventions, including coronary revascularization. </li></ul></ul>
    19. 21. <ul><li>Most common clinical exercise testing </li></ul><ul><ul><li>treadmill, cycle ergometer, arm ergometer </li></ul></ul><ul><li>Treadmill testing provides a more common form of physiologic stress </li></ul><ul><ul><li>handrails for balance and stability, but can reduce the accuracy ECG recording </li></ul></ul><ul><ul><li>emergency stop button </li></ul></ul><ul><li>Cycle ergometers </li></ul><ul><ul><li>electronically or mechanically braked </li></ul></ul><ul><ul><li>less movement =better-quality ECG </li></ul></ul><ul><ul><li>unfamiliar method of exercise </li></ul></ul><ul><ul><li>localized leg fatigue=early end </li></ul></ul><ul><ul><li>Lower values for maximal oxygen consumption </li></ul></ul><ul><li>Arm ergometry </li></ul><ul><ul><li>alternative method </li></ul></ul><ul><ul><li>smaller muscle mass =20% to 30% lower V02 </li></ul></ul>
    20. 22. <ul><li>Protocol employed should consider: </li></ul><ul><ul><li>purpose of the evaluation </li></ul></ul><ul><ul><li>specific outcomes desired </li></ul></ul><ul><ul><li>characteristics of the individual being tested (e.g., age, symptomatology) </li></ul></ul><ul><li>Most common exercise test protocols </li></ul><ul><ul><li>Bruce </li></ul></ul><ul><ul><li>Ellestadt </li></ul></ul><ul><ul><li>Naughton </li></ul></ul><ul><ul><li>Balke-Ware </li></ul></ul><ul><ul><li>Ramp </li></ul></ul>
    21. 23. <ul><li>Common variables assessed during clinical exercise testing include: </li></ul><ul><ul><li>heart rate and blood pressure </li></ul></ul><ul><ul><li>ECG changes </li></ul></ul><ul><ul><li>subjective ratings </li></ul></ul><ul><ul><li>signs and symptoms </li></ul></ul><ul><ul><li>expired gases and ventilatory response </li></ul></ul>
    22. 24. <ul><li>Heart rate and blood pressure responses should be measured before, during, and after the GXT. </li></ul><ul><li>A standardized procedure should be adopted for each laboratory so that baseline measures can be assessed more accurately when repeat testing is performed. </li></ul>
    23. 25. <ul><li>The measurement of perceptual responses during exercise testing can provide useful clinical information. </li></ul><ul><li>Ratings of perceived exertion (RPE) and/or specific symptomatic complaints include: </li></ul><ul><ul><li>degree of chest pain, burning, and discomfort </li></ul></ul><ul><ul><li>dyspnea </li></ul></ul><ul><ul><li>lightheadedness </li></ul></ul><ul><ul><li>leg discomfort/pain. </li></ul></ul>
    24. 26. <ul><li>Situations in which gas exchange and ventilation measurements are appropriate include the following: </li></ul><ul><ul><li>When a precise cardiopulmonary response to a specific therapeutic intervention is required </li></ul></ul><ul><ul><li>When the etiology of exercise limitation or dyspnea is uncertain </li></ul></ul><ul><ul><li>When evaluation of exercise capacity in patients with heart failure is used to assist in the estimation of prognosis and assess the need for cardiac transplantation </li></ul></ul>
    25. 27. <ul><li>If maximal sensitivity is to be achieved with an exercise test, patients should assume a supine position during the postexercise period. </li></ul><ul><li>In patients who are severely dyspneic, the supine posture may exacerbate the condition, and sitting may be a more appropriate posture. </li></ul><ul><li>When the test is being performed for nondiagnostic purposes, an active cool-down usually is preferable. </li></ul><ul><li>Monitoring should continue for at least 5 minutes after exercise or until ECG changes return to baseline and significant signs and symptoms resolve. </li></ul>
    26. 28. <ul><li>Exercise echocardiography </li></ul><ul><li>Exercise nuclear imaging </li></ul><ul><li>Pharmacologic stress testing </li></ul><ul><li>Computed tomography </li></ul>