Individuals undergoing stress testing should have a physical examination, be monitored by the ECG, and the closely observed

at rest, during exercise, and during recovery.

Changing the workload by increasing the speed and/or grade of the treadmill or the resistance on the bicycle ergometer An initial workload that is low in terms of the individuals anticipated aerobic threshold Maintaining each workload for 1 minute or longer Terminating the test at the onset of symptoms or a definable abnormality of the ECG When available, measuring the individuals maximum oxygen consumption

Helps establish a diagnosis of overt or latent heart disease. Evaluates cardiovascular functional capacity as a means of clearing individuals for strenuous work or exercise programs. Determines the physical work capacity in kilogram-meters per minute (kg-m/min) or the functional capacity in METs. Evaluates responses to exercise training and/or preventive programs. Assists in the selection and evaluation of appropriate modes of treatment for heart disease.

Increases individual motivation for entering and adhering to exercise programs. It used clinically to evaluate pt. with chest sensations or a history of chest pain to establish the probability that such pt. have a coronary disease. It can also evaluate the functional capacity of pt. with chronic disease.

Have had a physical examination. Be monitored by ECG and closely observed at rest, during exercise, and during recovery. Sign a consent form.

Progressive angina A significant drop in systolic pressure in response to an increasing workload. Lightheadedness, confusion, pallor, nausea, or peripheral circulatory insufficiency. Abnormal ECG response including ST segment depression greater than 4 mm. Excessive rise in blood pressure. Subject wishes to stop.

Monitor the pulse to assess abnormal increases in heart rate Blood pressure increases with exercise approximately 7 to 10 mm of mercury per MET of physical activity Systolic pressure should not exceed 220 to 240 mm Hg. Diastolic pressure should not exceed 120 mm Hg Rate and Depth of respiration increase with exercise

Respiration should not be labored The individual should have no perception of SOB The increase in blood flow while exercising, which regulates core temp. and meets the demands of working muscles, results in changes in the skin of the cheeks, nose, and earlobes. They become pink, moist and warm to touch.

Can provide a direct measurement of VO2 max by analyzing samples of expired air. Differences in protocols involve the number of stages, magnitude of the exercise, equipment to be used, duration of stages, endpoints, position of the body, muscle groups exercised, and types of effort. Protocols have been developed for multistage testing. The most popular treadmill protocol is the BRUCE PROTOCOL. Treadmill speed and grade are changed every 3 minutes. Speed increases from 1.7 mph up to 5.0 mph, and the initial grade of 10% increases up to 18% during five stages.

There is no clear-cut information provided on the most effective frequency of exercise for adaptation to occur. Frequency may be less important factor than intensity of duration training. Frequency varies, dependent on the health and age of the individual. Optimal frequency of training is generally 3 to 4 times a week.

Low intensity, greater frequency may be beneficial. A frequency of 2 times a week does not generally evoke cardiovascular changes, although older individuals and convalescing pt. may benefit from a program of that frequency.

 Overload

principle Specificity principle Reversibility principle

is stress on an organism that is greater than that regularly encountered during daily life.

Exercise

load

Must be above the training stimulus threshold for adaptation to occur. Once adaptation to a given load has taken place, the training intensity must be increase for the individual to achieve further improvement. Level of health, level of activity, age, gender. The higher the initial level of fitness, the greater the intensity of exercise needed to elicit a change.

A conditioning response occurs at 60% to 90% maximum heart rate (50% to 85% VO 2 max )

Depending on the individual and the initial level of fitness. Methods to determine Maximum heart rate and Exercise rate.
Determine Maximum heart rate (HR)
From multistage test HR achieved in predetermined submaximum test 220 minus age

Determine Exercise heart rate

Percentage of maximum heart rate Karvonens formula
Exercise heart rate= HR rest + 60-70% (HR max - HR rest )

Adaptation in metabolic and physiological systems depending on the demand imposed. Workload and work- rest periods are selected so training result in:

Muscle strength without a significant increase in

total oxygen consumption. Aerobic or Endurance training without training the anaerobic systems. Anaerobic training without training the anaerobic systems. Aerobic training specific to the type of activity. When training for swimming events, the individual may not demonstrate an improvement in VO2max

Dependent on Total work performed Intensity Frequency Fitness level Greater Intensity Duration Lower Intensity Duration Shorter Longer

20 30 minute of session is generally optimal to 60% to 70% maximum of heart rate. o 45 minute continuous exercise period may provide the appropriate overload. o 10 15 minute exercise period o 3 5 minute daily period
o

Large muscles Rhythmic Aerobic such as Cycling and running the overload msut use the muscles required by the activity and stress the cardiorespi. System (Specific principle)

The beneficial effects of exercise training are transient and reversible. Detraining exercise occurs rapidly when a person stop exercising. After 2 weeks of detraining, significant reductions in work capacity can be measured, and improvements can be lost within several months. A similar phenomenon occurs with individuals who are confined to bed with illness or disability; the individual becomes severely deconditioned. With loss of the ability to carry out normal daily activities as a result of

The frequency or duration of physical activity required to maintain a certain level of aerobic fitness is less than that required to improve it.

Warm up period Aerobic exercise period Cool down period

Muscle temperature Need for oxygen to meet the energy demands for the muscle Vasodilation Adaptation of respiratory centers Venous return

Purpose
Prevent or Decreases Musculoskeletal system to injury. Risk for ECG changes (arrythmias) Guidelines Should nbe Gradual and Sufficient to Increase muscle and core temperature without causing fatigue or reducing energy stores. Characteristic of period include:
10 minute period of total body movement exercise such as calisthenics and walking slowly. Attaining heart rate that is within 20 beats/min of the target heart rate.

Is the conditioning part of the exercise program. Emphasized Continuous Interval Circuit Circuit interval

Submaximal and sustained Achievement of the steady state Duration; 20 60 minutes Most effective in increasing endurance for healthy individuals Work rate us Increased progressively as training improvements are achieved. Increase exercise duration

Is perceived to be less demanding than continuous training. Improve strength and power more than endurance. Exercise period is followed by rest interval

Rest relief (Passive recovery) Work relief (Active recovery)

Work recovery ratio

1:1 to 1:5

1 : 1.5 work interval allows the succeeding exercise interval to begin before recovery is complete

Circuit Training
Series of exercise activities Several exercise modes Improves both strength and endurance

Combining Circuit and Interval Training effective Stresses both aerobic and anerobic systems Delays the need for glycolysis and lactic acid production

Is similar to the warm up period in that it should last 5 10 minutes and consist of the total body movements and static stretching. Prevents

Pooling of blood

Fainting
Enhance recovery period With the oxidation of

metabolic waste and replacement of the energy stores. Myocardial ischemia, arrhythmias or other cardiovascular complications.

 Cardiovascular

Changes Respirator Changes Metabolic Changes

Changes at Rest
Reduction in the resting pulse rate occurs in some

individual Decrease in blood pressure Increase in blood volume and hemoglobin

Changes During Exercise

Reduction in the resting pulse rate occurs in some

individual Increased stroke volume Increased cardiac output Increased extraction of oxygen by the working muscle Decreased blood flow per kilogram of the working muscle.

Changes at Rest
Large lung volumes
Larger diffusion capacities

Changes during Exercise

Larger diffusion capacities
Maximum diffusion capacity is unchanged Maximal Ventilation is Increased

Ventilatory efficiency increased

Changes at Rest
Muscle Atrophy and Increased Capillary density

occurs. Number and size of mitochondria are increased Increase capacity to generate ATP aerobically. Increase Muscle myoglobin Concentration Increase the rate of oxygen transport and diffusion to the mitochondria.

Changes during Exercise

Decreased rate of depletion in muscle glycogen at

submaximum work level. Increased fat mobilizing and Fat metabolizing enzymes.

Changes during Exercise

Lower blood lactate level at submaximal work Mechanism is unclear Less reliance on phosphocreatine (PC) and ATP in

skeletal muscle Increased Capability to oxidize carbohydrate Increased Oxidative potential of the mitochondria Increased Glycogen storage in the muscle.

Decrease in body fat Decrease on blood cholesterol and triglyceride levels. Increased Heat acclimatization. Increase in the breaking strength of the bones and ligaments and the tensile strength in tendons.

END