ACSM Clinical Exercise Physiologist Exam 2022/2023

Factors for a valid VO2 Max? - ANSWER RER > 1.1 Lactate >8mmol/L RPE>18 Plateu in VO2 HR @ age predicted max Drug has half life of 4 hours. IF given 1000mg, what concentration is left after 12 hours. - ANSWER 125m ...

Factors for a valid VO2 Max? - ANSWER RER > 1.1 Lactate >8mmol/L RPE>18 Plateu in VO2 HR @ age predicted max Drug has half life of 4 hours. IF given 1000mg, what concentration is left after 12 hours. - ANSWER 125mg Can HR max be changed with training? - ANSWER NO How many factors must we see for Valid Vo2 max test? - ANSWER 3 RER vs RQ - ANSWER RER: co2 expired/ o2 consumed at mouth RQ: Co2 produced by cell metabolism/ o2 used by tissues What variable caueses VO2 max to increase with training? - ANSWER Stroke volume because heart gets bigger (NOT MAX HR) Lactates main job is to _______________ and does not cause - ANSWER buffer Ph, muscle fatigue Client DOES NOT regularly exercise, when do they need clearance? - ANSWER - Have a chronic disease - Have a chronic disease and S/S Client DOES regularly exercise, when do they need clearance? - ANSWER Only if they have S/S Acute EXSC affect on leukocytes? - ANSWER INC concentration Gold std for diagnosing cardiac issues - ANSWER Cardiac catheterization ST segment elevation vs depression - ANSWER Elevation: Myocardial infarction Depression: ischemia 2 cases when you should not do a regular exsc stress test: - ANSWER - Client uses Beta Agonist - Client uses dipyridamole (a vasodilator) What BP level contraindicated during exsc test - ANSWER 250/115 Patient w/ CAD will exhibit what symptom relating to HR and BP after EXSC? - ANSWER VERY slow to return to resting levels Primary cause of type 2! diabetes? - ANSWER Inflammation S/S of diabetes mellitus: - ANSWER Polydipsia (thirst) Polyuria (urination) Polyphagia (hunger) Which diabetic medications is contraindicated for exercise? - ANSWER Insulin (if exercising at peak insulin effect) When programming EXSC for clinical population, what variables should be progressed first? - ANSWER Frequency, then duration, then intensity *When adjusting intensity, duration should be dropped back to baseline Primary cause of obesity - ANSWER Hypercaloric Diet Obesity BMI classifications - ANSWER >30 = OBESE 30-34=mild 34-39=moderate >40=morbid waist circumference - ANSWER > 40 Males >35 Females INCREASED RISK What type of adiposity is most inflammatory? - ANSWER Central (visceral) adiposity Most effective method for losing weight? - ANSWER Surgical intervention NIH's weight loss goal for obese individuals (what is clinically significant) - ANSWER 5-10% What is exercises effect on weight loss? - ANSWER LITTLE TO NONE! BMI qualifications for pharmacotherapy/surgery - ANSWER Pharma: BMI >27 w/comorbidities BMI >30 Surgery: BMI>35-39 w/comorbidities BMI>40 Average weight loss with bariatric surgery? - ANSWER 25% BP classifications - ANSWER Normal: 120/80 Elevated: 120-129/80 St 1 Hypertension: 130-139/80-89 St 2 Hypertension: >140/>90 Which physiological variable has greatest impact on BP? - ANSWER Blood vessel radius Atherosclerosis vs. Arteriosclerosis - ANSWER Athero: Thickening (Via damage to media of BV being patched by LDL cholesterol) Arterio: Stiffening (vascular remodeling due to high BP, inflammation and hyperglycemia) What does a higher DBP mean? - ANSWER Pt has a better elastic recoil What is the best predictor of future cardiovascular events? - ANSWER Arterial stiffness score (PP/Pulse wave velocity) BP changes during EXSC - ANSWER Aerobic: SBP inc, DBP dec Resistance: SBP inc, DBP inc ACE inhibitors - ANSWER stop conversion of angiotensin 1 to angiotensin 2 --- VASODILATE ARB's - ANSWER Block angiotensin 2 from binding to its receptor on artery -- VASODILATE which hypertension medication effects exercise? - ANSWER B-Blockers EXSC affect on blood lipid profile - ANSWER Decrease TG, Increase HDL Statin effect on lipids - ANSWER Decrease LDL, TG Increase HDL what drug decreases TG - ANSWER Fibrates You need 2/3 of these criteria to diagnose heart attack - ANSWER Chest pain >30 mins EKG shows ST Segment elevation / T wave inversion Presence of biomarkers in blood Fibrinolytics - ANSWER Streptokinase, Tenecteplase (TNKase) Clot buster used in emergencies Aspirin - ANSWER Inhibits thromboxane A2 (inhibiting clot formation) Recovery time after heart attack before EXSC - ANSWER 1-2 days What intensity should you exercise ACS/Heart attack patients - ANSWER 10 BPM below their ischemic threshold (elicits chest pain) Types of congestive heart failure: - ANSWER Right side: due to increased pulmonary pressure Left side: due to peripheral resistance - Systolic: <30% EF <30 SV Right side: <60 EF <30 SV Ejection fraction equation - ANSWER EF=(EDV−ESV)/EDV Edema is more prevalent in _________ sided heart failure - ANSWER Right sided (because there is a back up in venous return) gold std for diagnosis congestive heart failure - ANSWER Echocardiogram Which common medication is a negative chronotropic and how does it effect exercise - ANSWER B blocker When pt on B-blocker, must lower expectation of HR for a given intensity (lower hr for given intensity) What is PAD? - ANSWER Blockage of leg arteries by plaque Which population are at highest risk of PAD? - ANSWER Diabetics Diagnosis of PAD? - ANSWER Ankle Brachial index Ankle/brachial USUALLY = 1 Ankle/brachial of <.9 diagnostic of PAD What should you stress while EXSC someone with PAD? - ANSWER Push through leg pain!! Risk Stratification NOT a regular EXSCer - ANSWER Disease or S/S: CLEARANCE NO Disease or S/S: NO CLEARANCE Risk stratification REGULAR EXSCer - ANSWER NO disease or S/S: NO CLEARANCE Disease Asymptomatic: NO CLEARANCE Disease or S/S: CLEARANCE Cardiovascular disease Risk Factors - ANSWER NEGATIVE: Age: Men >45 Women >55 Family History: Myocardial infarct, coronary revascularization, sudden death before 55 father or 65 mother Cigarette Smoking: Current, quit within 6mo, secondhand smoke Sedentary lifestyle: doesnt exercise 30 minutes moderate intensity 3 days per week for 3 mo Obesity: BMI >30 / Waist Circ 40 male 35 female Hypertension: SBP >130 and or DBP >90 / antihypertensive meds Dyslipidemia: LDL >130 / HDL<40 / Lipid lowering meds Diabetes: Fasting BG >126 / OGTT >200 POSITIVE: HDL>60 Lipid Classifications - ANSWER LDL: >130 high HDL: <40 low TC: >200 high TG: >200 high General Indications for Stopping an Exercise Test - ANSWER - Angina - Drop in SBP >10 with increase in workload - Systolic >250/110 - SOB, wheezing, leg cramps, claudication - Poor perfusion: Light headed, confused, naseua, cyanosis - HR fails to increase with increased intensity - Change in heart rhythm - Subject requests to stop - Failure of equipment - Visually severely fatigued Absolute contraindications to exercise testing - ANSWER - Acute myocardial infarction within 2 days - Unstable Angina - Uncontrolled arrhythmia