PHYSIOTHERAPY Cardiovascular Assessments in Exercise Testing

Pick one partner. Each person must measure blood pressure on either the bike or the treadmill. This lab should be completed by Oct. 5th. This lab cannot be used in conjunction with any other lab activities this semester. The purpose is to help you become proficient the skill of blood pressure measurement during exercise. During exercise, the blood pressure in the arteries increases as the heart contracts more rapidly and forcefully. Systolic blood pressure (SBP) is affected most by the increased output of the heart and increases in direct proportion to exercise intensity and cardiac output. In contrast, resistance to blood flow decreases during exercise because of dilatation of small arteries and arterioles in the active muscles. This causes a more rapid movement of blood out of the arteries and a more rapid fall in arterial pressure during diastole. As a result, the diastolic pressure (DBP) stays almost constant or increase only slightly even during intense rhythmic exercise. Many variables can influence blood pressure. In general, these influences can be grouped in physiologic/internal and environmental/external factors. Some the factors that affect blood pressure are as follows: cardiac output, peripheral resistance, vessel condition or elasticity of the vessel, total blood volume, blood viscosity. These physiological factors can cause a change in blood pressure. Some environmental factors that also affect blood pressure are: body position, exercise, temperature, altitude, emotions, food, and drugs. Hypertension excessively high blood pressure. Many suffer from this condition of unknown origin. While the cause may be diet-related in that sodium causes fluid retention creating a hyper tense condition, 95% of hypertensive patients have blood pressures that are elevated for no readily definable reason (1). However, Dangerous if uncontrolled as it may lead to myocardial infarction, stroke, or if untreated for many years congestive heart failure. Hypotension unusually low blood pressure. It is usually an indicator of insult or injury to the body. Conditions such as shock, myocardial infarction and drugs can create hypotension. Standing very quickly after lying down or sitting ca also created a drop in BP. Korotkoff sounds the sounds heard in the stethoscope marking the different phases of BP. Phase I First appearance of a thumping sound. Phase II A murmur or swish heard. Phase III Crisper sound increasing in intensity. Phase IV Sound becomes muffled. Phase V Sound disappears. For adults the first sounds mark SBP and the point where sound becomes muffled (Phase IV) marks DBP. Listen carefully for the other sounds, but be sure to note Phase I, IV, and V. Phase IV and V may be inseparable at rest but are often widely separated during exercise or in young children. For this reason, the AHA recommends that pressures corresponding to Phases I, IV, and V be recorded. The standard method for reporting blood pressure is to report the SBP (I) over the DBP (IV or V, whichever comes first). Heart rate for this lab should be assessed using the Time for 30 beat method (see attached). You will need a stop watch and a stethoscope to complete this methodology. Heart rate should be taken just after you finish the blood pressure measurement.

Cardiovascular Assessment Data Sheet

The purpose of this section of lab #1 is to gain appreciation and learn to become proficient in the assessment of heart rate and blood pressure during exercise. While obtaining an accurate heart rate (HR) and blood pressure (BP) at rest may seem almost second nature to most. However, HR and BP assessment while exercising on a treadmill, for example, may be next to impossible for most novice, exercise physiologist. More importantly, accurate and reliable assessment of these variables is imperative for precise assessment of cardiovascular function as well as in the measurement of submaximal and maximal fitness level (VO2 pk).

To assess cardiovascular function during todays lab, use a Polar Montior method to obtain HR and a standard BP cuff and sphygmomanometer to obtain BP. Make sure you record units of measure for every variable. Work with a partner and obtain the following information. You can work in groups of 3, however, you should each try to assess HR once and BP at the least once during the lab time. Method for proper BP assessment: 1. Make sure the cuff size is appropriate for the size arm of the person you are assessing. Most cuffs have marks designating when you should use a larger or smaller cuff size. The bladder should wrap about of the way around the arm. Most cuffs have an arterial reference indicator near the center of the cuff that is placed securely over the brachial artery. The lower edge of the cuff should be about 1 inch above the antecubital space. 2. The antecubital space at the elbow is where the brachial artery nears the surface. With a straight arm, apply moderate pressure and locate the pulse of the subject on his dominant arm (although there should be nominal differences in pressure from the left or right side in health individuals). You may also find it helpful to mark this spot for future reference. 3. Place the stethoscope in your ears with the pad place don the pulse location on the subjects arm. Pump the cuff up to about 180 to 200 mmHg and slowly release the valve. Watch the mercury fall and listen for the Korotkoff. Note the points on the mercury column when the sounds occur. Bike Ergometer: Resting: Obtain supine and seated (on Monarch) HR and BP. Exercise: Have your partner pedal at the following workloads for at least 4 minutes each after a brief warm-up lasting about 2 min ( at 0.5 kg). Record HR every minute and BP every 4 minutes. After 2 min and 45 sec., obtain BP and record this at the 4 minute mark. Then, obtain RPE (every 4 minutes) and HR. Both should take you no longer than 1 min and 15 sec. to obtain. Use the 3 loads for the bike test. You will be using this information later in the semester to determine your fitness level, so make sure you are very precise in your measurements. Females Workload 1: RPM = 60; kg = 1.0 (kgm/min = 360) Workload 2: RPM = 60; kg = 1.5 (kgm/min = ) Workload 3: RPM = 60; kg = 2.0 (kgm/min = ) Males Workload 1: RPM = 60; kg = 1.0 (kgm/min = Workload 2: RPM = 60; kg = 2.0 (kgm/min = Workload 3: RPM = 60; kg = 2.5 (kgm/min =

360) ) )

Treadmill: Resting: Obtain supine and standing HR and BP. Exercise: Give instructions for how to walk on the treadmill and have them exercise at the following workloads for at least 3 minutes each after a brief warm-up lasting about 2 min. Record HR every minute and BP every 3 minutes. After 2 min and 45 sec., obtain BP and record this at the 4 minute mark. Then, obtain RPE (every 3 minutes) and HR. Warm-up: Speed - 2.0 mph Grade 5% First Load: Speed - 3.4 mph Grade 5% Second Load: Speed 4.0 mph Grade 9%

YOUR Name Age: Date: Age-pred. peak HR Resting HR (supine) HR (sitting)

Exercise Testing Sheet BIKE TEST Name of partner/s: Ht (in): Wt (kg): Medications: 85% age-pred max HR: BP (supine) BP (sitting)
BP RPP (-10) (mmHg) RPE Signs/Symptoms

Time (kgm/min) METs HR (btsmin-1) 1 2 3 4 5 6 7 8 9 10 11 12

YOUR Name Age: Date: Age-pred. peak HR Resting HR (supine) HR (standing)

(sp/%gd)

Exercise Testing Sheet TREADMILL TEST Name of partner/s: Ht (in): Wt (kg): Medications: 85% age-pred max HR: BP (supine) BP (standing)
BP RPP (-10) (mmHg) RPE Signs/Symptoms

Time 1 2 3 4 5 6

METs HR (btsmin-1)