SHOULD I CHECK MY PATIENT’S FITNESS LEVEL? · Submax #3 Calculator #4: easy/fast Gas Exchange...
Transcript of SHOULD I CHECK MY PATIENT’S FITNESS LEVEL? · Submax #3 Calculator #4: easy/fast Gas Exchange...
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SHOULD I CHECK MY PATIENT’S FITNESS LEVEL?
Robert M Pepper, DO, FAAFPAssociate Professor of Clinical Sciences
West Virginia School of Osteopathic [email protected]
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CRF
Ability respiratory and circulatory systems to deliver oxygen to working muscles during sustained exercise
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Maxim
al intensity
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VO2 MAX AND CV DISEASE
MENAGE 20-39 40-49 50-59 60+
20% >50 >47 >42 >37
20% <36 <34 <31 <26
AGE 20-39 40-49 50-59 60
20% >41 >38 >34 >31
20% <29 <24 <24 <23
WOMEN
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VO2 max normative values: Male
Schwartz W, Reibold RC. Aviat Space Environ Med 1990
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VO2 max normative values: Female
Schwartz W, Reibold RC. Aviat Space Environ Med 1990
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Fitness≠
Exercise
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NON-MODIFIABLE
•Age•Gender•Genotype
• Physical Activity• Smoking• Obesity• Cardiopulmonary disease
MODIFIABLE
CRF
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CARDIORESPIRATORY FITNESS MEASURES
VO2 Max:maximum amount of O2 that can be utilized during intense sustained exercise
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CARDIORESPIRATORY FITNESS MEASURES
METSMetabolic Equivalent Tasks
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METABOLIC EQUIVALENT TASKS
1 MET = energy produced average person seated at rest
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METS AVERAGE WALKING SPEED
Walking 3.1 mph
3.4 METS
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METS x 3.5= VO2 Max
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<9 9-14 >14
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AVOIDING SCA
Low vs High CRF 48% SCA
1 MET 14%
CardiorespiratoryFitnessandRiskofSuddenCardiacDeathinMenandWomenintheUnitedStatesMayoClinicProceedings,2016-07-01,Volume91,Issue7,Pages849-857
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ALMOST SMOKING
Low aerobic capacity in middle-aged men associated with increased mortality rates during 45 years of follow-up.
European Journal Preventive Cardiology, July 2016
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1913 TRIAL: 792♂ X 45 YEARS
Smoking > VO2max > HTN > Lipids
European Journal Preventive Cardiology, July 2016
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Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults.JAMA Intern Med. 2016;176(6):816-825.
esophageal adenocarcinoma (HR, 0.58; 95% CI, 0.37-0.89), liver (HR, 0.73; 95% CI, 0.55-0.98), lung (HR, 0.74; 95% CI, 0.71-0.77), kidney (HR, 0.77; 95% CI, 0.70-0.85), gastric cardia (HR,
Esophageal
LiverLung
KidneyGastricEndometrial
LeukemiaMyelomaBladder
HeadandNeck
RectalColonBreast
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HIGHEST IMPACT: ALL CAUSE MORTALITY
•Smoking•Cardiorespiratory fitness
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Smoke/Exercise
Lipids
Hypertension
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lipids
hypertension
cardiorespiratoryfitness
smoking
Measure me!
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Wen et al Lancet 378, 1244-1253 (2011)
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AHA SCIENTIFIC STATEMENT
ALL HEALTHY ADULTS SHOULD HAVE CRF MEASURED
CIRCULATION NOV 30,2016
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AHA SCIENTIFIC STATEMENT
•MORE RISK FACTORS: START EARLIER
•FOR CRF ASSESSMENT, NOT DIAGNOSIS CAD
CIRCULATION NOV 30,2016
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CHRONIC DISEASE
•KNOWN CORONARY DISEASE•CONGESTIVE HEART FAILURE•COPD•PERIPHERAL ARTERY DISEASE
MAXIMAL HEART RATE WITH CPX MEASURES
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VO2 Max TestingAll Healthy
Adults
Max Exercise
#2
Submax#3
Calculator#4: easy/fast
Gas Exchange
Gold standard
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CRF TESTING STEP 1: DECONDITIONED OR UNSURE
Duke Activity Status Index
“DASI”
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DASI
Maximum: 9.89 METS (VO2≅34)
Low to low-moderate fitness
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STEP 2: CRFVO2 CALCULATOR
DASI >9 or younger, higher level of functioning
Cardiac Exercise Research Group “CERG”
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CRF: STEP 2CERG VO2 CALCULATOR
•Need resting and maximum heart rate
•Vital statistics•Exercise volume and frequency
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•Age•Height (cm)•Weight (kg)•No B-blockers
•Max heart rate•Exercise frequency
•Resting HR•Waist (cm)
VO2 MAX
HTTPS://WWW.NTNU.EDU/CERG
MAX HEART RATE then
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VO2 AND METS CALCULATORS: AMERICAN HEART ASSOCIATION
Not a substitute for maximal exercise testing
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limits prosC
alcu
lato
rs
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Max heart rate
• Resting heart rate
• Waist circumference
More stats• Exercise
frequency• Exercise
intensity
VO2 Max
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CRF ASSESSMENT: ACTIVE
Submaximal•6 minute walk test•Rockport One Mile walk Test Maximal•Ramp protocols: Treadmill or Bike
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VO2 Max TestingAthletes only?
Max Exercise
#2
Submax#3
Calculator#4: easy/fast
Gas Exchange
Gold standard
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ATS 6MWT
•No definitive parameters•Better for treatment assessment
•<500 meters ?poor prognosis
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1 MILE WALK TEST (ROCKPORT)
PROS• Minimal resources• Done independently
• Cohort limitations (30-69 yoa)
• Need accurate measurements
• Time
LIMITATIONS
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VO2 MAX TESTING
CALCULATOR
CERG• Underestimates fit
• Requires subjective data
• Not substitute for exercise test
6MWT
• For advanced deconditioning
1 mile walk test
• Cohort dependent
• Multiple measurements
• Time=GXT
SUBMAXIMAL
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VO2 Max TestingAthletes only?
Max Exercise
#2
Submax#3
Calculator#4: easy/fast
Gas Exchange
Gold standard
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MAXIMAL EXERCISE TESTING
•Not for diagnosis of CAD!
•Exercise capacity evaluation
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MAXIMAL EXERCISE TESTING=LAB, NOT OFFICE
•Known Coronary disease•Congestive Heart Failure•Peripheral Arterial Disease•Chronic Obstructive Pulmonary Disease
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CRF: ACTIVEMAXIMAL EXERCISE TESTING
STEP 1
•Administer pre test questionnaire
•Par-Q+ validated
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MAXIMAL EXERCISE TESTING
•Easy•Inexpensive•Most are walking
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VALIDATED TREADMILL PROTOCOLS
•Bruce protocol•Balke•Modified Balke
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MOST
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REFERENCE ARTICLES
Estimating VO2 peak from a nonexercise prediction model: the HUNT Study, Norway.
Nes, BM et alMed Sci Sports Exerc: 2011 Nov;43(11):2024-30.
Reference Articles
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