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Exercise and Coronary Heart Disease during a GXT

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What would be objective indications of coronary heart disease during a graded exercise test, and how the results of such a test can be utilized in the cardiac rehabilitation exercise prescription?

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1. What would be objective indications of coronary heart disease during a graded exercise test?

1. The grade exercise test is used by doctors to determine if there is adequate blood flow to your heart during increasing levels of activity, evaluates the effectiveness of your cardiac treatment plan, and determine the likelihood of having coronary artery disease and the need for future testing (see attachment).

2. Objective measures of the person's blood pressure and ECG recording will be taken before, during and after exercise. The person will begin to exercise by walking on a treadmill or pedaling a stationary cycle. The degree of difficulty will gradually increase. She or he will be asked to exercise very hard until they are exhausted.

3. During the graded exercise test the lab personnel will ask how the person is feeling at regular intervals. The person is asked to tell them if she or he feels chest, arm or jaw pain or discomfort; shortness of breath; dizziness; lightheadedness; or any other unusual symptoms. If these subjective symptoms are present, this indicates possible coronary heart disease and the lab personnel will watch for any symptoms or changes on the ECG monitor that suggest the test should be stopped (i.e., objective indication of coronary heat disease).

4. It is within the "normal" range of functioning for a person's heart rate, blood pressure, breathing rate and perspiration to increase during the test. However, these are objective indicators of possible coronary heart disease when these four factors fall outside the normal range of functioning.

5. When the recordings of the blood pressure and the ECG, indicate a departure from this norm, this is an indication of coronary heart disease and ...

Solution Summary

This solution explains some objective indications of coronary heart disease during a graded exercise test, and how the results of such a test can be utilized in the cardiac rehabilitation exercise prescription. Supplemented with two highly relevant articles.

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Case Study: Health Screening and Analysis and Interpretation of GXT Data

I have attached a file with a case study and questions to be answered I have answered several of them I need to know if the ones I answered are correct ( my answers are in red on the attachment) and there are 4 I didn't answer #'s 12, 13, 14 & 15 that I need answered. I also need to know if the VO2 and Mets calculations are correct in the GXT testing results.

Case Study: Health Screening and Analysis and Interpretation of GXT Data
Purpose: The purpose of this lab is to introduce the student to case study review of simple analysis of health histories and the interpretation of GXT testing results. Because many of the procedures introduced in this lab are utilized in the interactive on-line course, it is recommended the student complete this lab first before attempting the on line course.

Situation: John is a 38-year-old archeologist whose job requires some walking and hiking when he is collecting data in the field. However, much of his time is spent analyzing artifacts in the laboratory and writing research reports in his office. He is thinking about joining the employee fitness program at work, and therefore contacted you to evaluate his health risk and aerobic fitness level. His last medical examination was 3 months ago. You gave him a GXT using a Bodyguard cycle ergometer (wheel size = 3 m/rev) and collected the following data:

Brief Health History
Client: 38-year-old male Resting BP: 131/92 mmHg
Resting HR: 71 bpm Total cholesterol: 210 mg • dl-1
Height: 5 ft 10 in. (177.8 cm) HDL-cholesterol: 30 mg • dl-1
Body weight: 180.8 lb (82 kg) Smoking history: 1 pack per day
Waist Circumference: 42 inches
Activity interests: cycling Physical activity: job-related walking/hiking

GXT Testing Results
Stage Min Work rate (kgm/min) HR BP RPE VO2 Mets
1 1 180 110
2 180 115
3 180 119 168/92 7 Need to know Vo2 Need to know mets
2 4 360 130
5 360 136
6 360 138 180/90 13 Need to know Vo2 Need to know mets
3 7 540 151
8 540 158
9 540 163 215/88 16 Need to know Vo2 Need to know mets

Questions
1. On the basis of demographic data, evaluate this client's CHD risk profile. Given his CHD risk classification, did a physician need to be present during the GXT?
2. On the basis of the client's health history, identify the client's coronary heart disease risk factors.
3. Based on the client's health history is the client at risk for metabolic syndrome?
4. Based on the client's resting BP, determine his BP classification.
5. Determine the subject's age predicted maximum heart rate (MHR).
6. Determine the subject's heart rate reserve (HRR).
7. Review the recorded BP responses during testing. Determine if the SBP and DBP responses with increased exertion were normal.
8. Review the recorded HR responses during testing. Determine if the HR responses to increased exertion were normal.
9. Determine if steady state in HR was reached in each test stage.
10. Determine how hard the client perceived he was working based based on his reported RPE.
11. Determine if the subject reached termination criteria for a submax GXT using both HRR and %MHR criteria.
12. Calculate the energy cost of each workload (three stages) using the ACSM leg ergometry formula. Convert ml • kg-1 • min-1 to METs for each stage.
13. Determine the client's predicted VO2max using the multistage equation method?
14. Determine the client's predicted VO2max using the single stage formula?
15. What is this client's CR fitness classification?
16. Use the Karvonen (%HRR) method to identify the target HR zone. Use 50% to determine his minimum exercising HR and 85% to determine his maximum exercising HR).
17. What lifestyle changes do you recommend for this client?
18. Determine the client's BMI and classification of Disease Risk Based on BMI and Waist Circumference
19. Compute the client's TC/HDL Ratio and determine if it is normal.

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