1Four categories of contraindications
Absolute contraindication: do not begin the test
Absolute termination: stop the test
Relative contraindication (before): testing may be possible if benefits outweight the risks
Relative termination(during): consider stopping based on the situation and clinical judgement
2Symptom limited maximal xercise test
A test in which exercise intensity progressively increase towrads the individuals maximum, with symptoms and safety finding determinign when it ends
3Absolute contraindications: do not start
MI within 48hrs
Ongoing angina - chest pain that is new/worseningnpredictable
Uncontrolled cardiac arrythmia with hemodynamic compromise
- abnormla heart rythm interfering with blood flow and circulation
Active endocarditis: inflammation of inner lining of heart
Symptomatic sever aortic stenosis: narrowing of aortic valve w/ syptoms
Decompensated heart failure: heart failure that is worsened and uncontrollled
Acute pulmonary embolus/infarction or DVT: clot in lungs or lung tissue injury bocking bs
Acute myo/pericarditis: herat muscle/sac inflam
Actue aortic dissectino: tear in inner wall of aorta
Physcal disability precluding safe and adequate testing
4Relative contraindications (before starting)
Known obstructive left main coronary artery stenosis: narrowing of artery thatsupplies heart
Mod-sev aortic stnosis w uncertain relationship to symptoms: aortic valve narrowing
Tachyarrythmias w uncontrolled ventricular rates
Acquired advanced/complete heart block: impulses blocked betweenatria/ventricles
Recent stroke or TIA: disruption of blood flow to brain
Mental impariment: difficulty fllowing instructions
Resting hypertension: systolic>200 ot diastolic>110
Uncorrected medical conditinons: anemia, hyperthyroidism, electrolyte imbalance
5Absolute indications for terminating a test
ST elevation >1mm
SBP drop>10 with evidence of ischemia
mod-sev angina
CNS symptoms: ataxia, dizzy, near syncope
Poor perfusion: cyanosi/pallor
Sustained ventricular tachycardia or serious arrythmia
Techincal difficulties
subject requests to stop
6Relative indications for terminating a test
Marked ST displacement >2mm
SBP drop>10 without other ischemic evidence
increasing chest pain
other potentially concerning arrythmias
fatigue, SOB, wheezing, leg cramps, claudication
exagggerated hypertensive repsonse: SBP>250 DBP>115
New bundle branch block
SPO2:
7Body weight to lbs
divide lbs by 2.2
8Rel vo2 to METS
divide rel vo2 ml/kg/min by 3.5
9rel vo2 to abs vo2
multiply rel vo2 by body weight in kg and then divide by 1000
or multiply abs vo2 L/min by 1000 and divide by body weight in kg
10Vo2 in L/min to kcals/min
multiply abs vo2 by 4.9
11mph to meters/min
multiply mph by 26.8
12% grade to fractional grade
divide % grade by 100
13Workrate on monark bike
kgm/min = resistance (kg) * 6 meters * RPMS
14Workrate on arm ergometer
kgm/min = resistance in kg * 2.4m * RPMS
15Convert kgm/min to watts
divide kgm/min by 6.12
16inches to meters
multiply inches 0.0254