Clinical exercise physiology vanaf week 10
• Week 11: Exercise testing
Aim to measure during exercise testing → it’s all because of performance!
Patients are also familiar with success and failures.
Performance depends on:
-skills
-equipment (apparatuur)
-environment
-motivation
- fitness → fit to transfer energy into movement.
1. ATP – Pcr
2. Glycolisis
3. Aerobic
Common complaints: dyspnea, chest pain, fatigue.
Optimal training design.
Also depends on the activity.
, Fick’s law is necessary.
SV increases after period
of hard training.
Several tests:
- Cardio pulmonary exercise Testing (CPET)
o Measures different organ systems
▪ 3 min warming up
▪ 10 min incremental workload 5 – 30 W/min
▪ 3 min recovery (no load)
Measurements: VO2, VCO2, minute ventilation (Ve), tidal volume, breathing frequency, ECG, blood
pressure, bloodlactate levels, BORG-score (dyspnea and leg fatigue), pulse oximetry (SpO2) and
arterial blood gases.
Question: what is the limiting factor?
Some contradictions for participation in this
test because of the high risk on cardiovascular
events.
, - Astrand-Rhyming Cycle Ergometer Test (Astrand)
o Sub maximal exercise test
o Estemation of VO2 max
o Measures:
▪ Heart frequency
▪ Workload
The better the aerobic capicity, the steeper the line.
o Protocol:
▪ Reach workload (HF: 180 – age)
▪ Note workload
▪ Cycle for 6 minutes
▪ Note HF in last minute
- Six minute walk test
o Self paced walking test
o Outcome is distance (also depends on encouragement, encouragement is standard)
o Protocol:
▪ 10 min. seated rest
▪ 6 min walk on a flat hard surface on a 30 m course
▪ Pre and end evaluation of HF, pulse oximetry and perceived dyspnea
o Consequence self paced: learning effect. Perform more often → better energy
distribution. 1 or 2 learn sessions are advised before the ‘real’ test.
The lower the work rate, the longer the person
can sustain that activity.
Critical power → the work rate on which a patient
can keep continue exercising.
After training the work rate is higher and
the critical power has increased.
The delta time is different at different
work rates. (improvement)
, - Enduced shuttle walk test (ESWT)
o Sub-maximal exercise test
▪ Fixed pace (vast tempo)
▪ Outcome is time
o Protocol:
▪ Subject walks a 10 m course
▪ Pace (80% of peak pace) determined by audio signal
• Peak pace is predetermined by an incremental shuttle walk test
(ISWT)
▪ No encouragement
▪ Terminate on failing to make cone (before the next beep)
▪ Express results as time (min/secs)
o It is more easy to pick up effects of interventions
o The closer to the critical power, the longer the test takes. Post can even be
‘unstopable’ (therefore around 70% of highest intensity)
o Used for evaluation of pharmacological, surgical and therapeutic interventions.
• Week 11: Exercise testing
Aim to measure during exercise testing → it’s all because of performance!
Patients are also familiar with success and failures.
Performance depends on:
-skills
-equipment (apparatuur)
-environment
-motivation
- fitness → fit to transfer energy into movement.
1. ATP – Pcr
2. Glycolisis
3. Aerobic
Common complaints: dyspnea, chest pain, fatigue.
Optimal training design.
Also depends on the activity.
, Fick’s law is necessary.
SV increases after period
of hard training.
Several tests:
- Cardio pulmonary exercise Testing (CPET)
o Measures different organ systems
▪ 3 min warming up
▪ 10 min incremental workload 5 – 30 W/min
▪ 3 min recovery (no load)
Measurements: VO2, VCO2, minute ventilation (Ve), tidal volume, breathing frequency, ECG, blood
pressure, bloodlactate levels, BORG-score (dyspnea and leg fatigue), pulse oximetry (SpO2) and
arterial blood gases.
Question: what is the limiting factor?
Some contradictions for participation in this
test because of the high risk on cardiovascular
events.
, - Astrand-Rhyming Cycle Ergometer Test (Astrand)
o Sub maximal exercise test
o Estemation of VO2 max
o Measures:
▪ Heart frequency
▪ Workload
The better the aerobic capicity, the steeper the line.
o Protocol:
▪ Reach workload (HF: 180 – age)
▪ Note workload
▪ Cycle for 6 minutes
▪ Note HF in last minute
- Six minute walk test
o Self paced walking test
o Outcome is distance (also depends on encouragement, encouragement is standard)
o Protocol:
▪ 10 min. seated rest
▪ 6 min walk on a flat hard surface on a 30 m course
▪ Pre and end evaluation of HF, pulse oximetry and perceived dyspnea
o Consequence self paced: learning effect. Perform more often → better energy
distribution. 1 or 2 learn sessions are advised before the ‘real’ test.
The lower the work rate, the longer the person
can sustain that activity.
Critical power → the work rate on which a patient
can keep continue exercising.
After training the work rate is higher and
the critical power has increased.
The delta time is different at different
work rates. (improvement)
, - Enduced shuttle walk test (ESWT)
o Sub-maximal exercise test
▪ Fixed pace (vast tempo)
▪ Outcome is time
o Protocol:
▪ Subject walks a 10 m course
▪ Pace (80% of peak pace) determined by audio signal
• Peak pace is predetermined by an incremental shuttle walk test
(ISWT)
▪ No encouragement
▪ Terminate on failing to make cone (before the next beep)
▪ Express results as time (min/secs)
o It is more easy to pick up effects of interventions
o The closer to the critical power, the longer the test takes. Post can even be
‘unstopable’ (therefore around 70% of highest intensity)
o Used for evaluation of pharmacological, surgical and therapeutic interventions.
