Aerobic and MSK Assessments PDF

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Summary

This lecture talks about the CSEP-PATH sequence steps, aerobic fitness test protocols, aerobic fitness tests and protocols, musculoskeletal protocols and tests....

Description

Aerobic and MSK Assessments CSEP-PATH Sequence  5 Key Steps! -Ask, assess, advise, agree, assist Step 2 at a Glance Purpose

Detailed Objective

Detailed examination Select assessment of the client’s physical options and activity, fitness and administer lifestyle protocols

Useful Tools

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   Determine health benefit ratings

Discern the client’s Health Benefit Ratings with the help of objective, evidencebased standardized tests

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Physical activity & sedentary behaviourquestionnaire (PASB-Q) FANTASTIC lifestyle checklist Stages of change questionnaire (SOC-Q) Body composition: height, weight, BMI, waist circumference Aerobic : mCAFT, treadmill walk, 1mile walk, or cycle test Musculoskeletal: Grip Strength, Push- up, Sit & Reach, Vertical Jump, Back Extension, One Leg Stance Quick reference: Health benefit ratings

FANTASTIC F = Family A = Activity N = Nutrition T = Tobacco toxics A = Alcohol S = Sleep, seatbelts, stress and safe sex T = Type of behaviour I= Insight C = Career Aerobic Fitness Test Protocols • Designed by family physicians as a holistic approach to patient care • Used as a self assessment tool to evaluate strengths and weaknesses in lifestyle behaviours

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Can help stimulate discussion with client on lifestyle behaviours -assessment tool, how much sleep, diet, do you wear seatbelt

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-personal tool: new client may not feel comfortable answering in person

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-Ask person to do it themselves, and share score to have general understanding

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Self-administered

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Ensure clients read instructions at the top of the page

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Follow the scoring procedure listed on the form

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Completion of the FANTASTIC remains voluntary and results are confidential

Aerobic Fitness-mCAFT, Treadmill walking test, Cycle ergometer test, 1-mile walk -never do all assessments, choose 1-PA history, health status, fitness levels -depends on the client -mCAFT: stairs- arthritis or musculoskeletal problems, not have the ability to do intense stairs (85% of HR max) this wouldn’t be the best option -Treadmill: if people do not have a higher level of fitness, may not be able to get them up to intensity -Cycle test: legs burn out first, partly tap out due to leg burn rather than cardiopeople who are really fit to get a good idea or someone who is frail or has a low level of fitness (easy to make sure they won’t hurt themselves)

-easy to take HR and BP on the bike compared to treadmill -1 mile walk test: older or lower level of fitness: set up track and see how long it takes them to walk that track -Gold Standard: VO2 max test: protocols have been compared to this -in each test, use results and based on formula provided to find out what their VO2 max is from about 85% HR max Aerobic Fitness Test Protocols Protoc ol

Descript ion

Validat ed Popula tion

Time Require ment (minutes )

mCAF T

Multistage step testprogressi vely increase intensity

15-69 years

15-20

Tread mill Walkin g Test

Singlestage treadmill walking (5% grade)

Sedent ary adults, 20-59 years

15-20

OneMile Walk

Brisk walking over 1mile flat measure d distance

Sedent ary and/or older adults, 20-69 yrs

25-30

Cycle Ergom eter Test

Multistage cycle testprogressi vely increase intensity

15-69 years, have difficulty with balance or coordinati on and/or prefer cycling

20-30

-health benefit ratings don’t apply to the older population on mCAFT but can still do it

-age predicted HR max: 220-age -85% of that HR max must be calculated: don’t want them to go past this HR during the test- it will end if they reach it -data collection sheets: add HR to each stage and RPE -can be hard to know this at lower levels of intensity mCAFT - Starting Stage -determine what stage they start at: 2 steps to go up to start, but as you increase intensity you can go to 1 step -1st stage: warm up- slow start mCAFT – Scoring • Once the test is complete, calculate the client’s estimated VO2max using the formula below (O2 cost is taken from the table on the next slide). • Estimated VO2max (ml⋅kg-1⋅min-1) = [17.2+(1.29 x 02cost) – (0.09 x wt. in kg) – (0.18 x age in years)] ÜRecord the score and associated Health Benefit Rating on the Client Information Sheet. -looking at HR responses, what would 185 be in 10 second count -3 mins stepping, take HR get 10 second beat: know 85% of HR max to be able to work out 10s count quickly -hit 85% HR max: measure Hr and BPhave data to collect predicted VO2 max -this formula is relative to body weight -compare to population norms and see if they have good fitness levels or not mCAFT – O2 Cost Associated with Stepping Stage

-ex. female: 5 stages of protocol- O2 cost is 26.3 -just need to know what HR you cut them off at mCAFT – Example Calculation • Example: 36 year old female; Wt = 73.2 kg; Final stepping stage = 5; O2 cost (refer to previous slide) = 26.3 ml/kg/min • Estimated VO2max (ml⋅kg-1⋅min-1) = [17.2 + (1.29 x 02cost) – (0.09 x wt. in kg) – (0.18 x age in years)] = [17.2 + (1.29 × 26.3) − (0.09 × 73.2) − (0.18 × 36)] = 17.2 + 33.9 − 6.6− 6.5 = 38 ml⋅kg-1⋅min-1 Health Benefit Rating = Good Estimated VO2max - Health Benefit Rating -how does VO2 compare to population -female: VO2 = 38.0- good -lots of room for improvement: in health metric range excellent would be ideal: explain the meanings of each ratinggood is in the middle of the health range, want to improve fitness to get to excellent or very good level at the least Treadmill Test – Scoring • Calculate the estimated VO2max (ml⋅kg-1⋅min-1) using the formula below. • Estimated VO2max (ml⋅kg-1⋅min1 ) = 15.1 + (21.8 x speed mph) – (0.327 x SSHR bpm) – (0.263 x speed mph x age) + (0.00504 x SSHR bpm x age) + (5.98 for males) ÜRecord the score and associated Health Benefit Rating on the Client Information Sheet.

-2 additional calculations -50% of HR max and 70% HR max: in warm up get between these two ranges Warm up: pick speed that gets them into this range: quite difficult when you don’t know the person- 3-4 mins to play around with speed to try and get into that range -incline: 0 for warm up, 3.5mph they get HR 75%, overestimated what they need -pull the speed down: aiming for steady speed HR (2 mins of continuous HR) -monitor to see theyre HR is steady -With fitter people, get closer to 70% bc when the test starts you will just have to increase the incline not the speed -HR and Bp during active and passive recovery at the end Treadmill Test – Example Calculation • Female:32yrs; final speed of 3.8 mph at 5% grade; final steady state HR of 136 bpm • Estimated VO2max (ml⋅kg-1⋅min1 ) =15.1 + (21.8 x speed mph) – (0.327 x SSHR bpm) – (0.263 x speed mph x age) + (0.00504 x SSHR bpm x age) + (5.98 for males) • = 15.1 + (21.8 x 3.8) − (0.327 x 136) − (0.263 x 3.8 × 32) + (0.00504 x 136 × 32) + (5.98 x 0) = 43.4 ml⋅kg-1⋅min-1 Health benefit rating = very good Health benefits ratings based on health outcomes -performance outcomes would be much higher Cycle Test

-not appropriate for everyone due to strain on legs -calculate 85% of HR max -everyone starts at same intensity50RPMs (slower) to keep consistent and keep intensity the same -3 mins: based on HR response: -Low: fitter end- take more aggressive response -high: take a slower approach as there was a greater change

• Formula 2 Slope (b) = (SM2-SM1) / (HR2 – HR1) - HR1 = Average of last 2 heart rates from the 2nd last workload - HR2 = Average of last 2 heart rates from the last workload • Formula 3 Estimated VO2max (ml⋅kg-1⋅min-1) = SM2 + [b x (HRmax - HR2)]

Cycle Test– HR and Loading Sequence -controlling 3 mins at a time, slower progressive : aerobic range and legs are burning out- wont reach the same power output -Vo2 max test is an all out test to power output is higher

Cycle Test – Example • Example: • Weight:68 kg, Age:32 yrs • Data from YMCA Cycle Test

Cycle Test – Scoring • Formula 1: used to calculate the oxygen cost (VO2) for the last 2 completed workloads (SM1 and SM2) • Formula 2: need SM1 and SM2 to calculate the slope of the line based on the HR response to the last 2 workloads • Formula 3: used to calculate the client’s estimated VO2max based on slope from formula 2, HRmax, and HR at last workload Ü Record the score and Associated Health Benefit Rating on the Client Information Sheet Cycle Test – Scoring • Formula 1 VO2 = [(Workload in Watts / Weight in kg) x 10.8] + 7.0 - SM1 = Sub-maximal VO2 at 2nd last workload - SM2 = Sub-maximal VO2 at last workload

Workload

HR (bpm) 92 108 136 155

25 W 75 W 100 W 125 W Cycle Test – Example • Example: • Weight:68 kg, Age:32 yrs •

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Formula 1 Workload

HR (bpm)

SM (Submax VO2)

25 W

92

75 W

108

100 W

136

22.9

125 W

155

26.9

• »VO2 = [(Workload in Watts / Weight in kg) x 10.8] + 7.0 »SM2 = [(125 W / 68 kg) x 10.8] +7 = 26.9 »SM1 = [(100 W / 68 kg) x 10.8] +7 = 22.9

Cycle Test – Example

Workload HR (bpm) SM (Submax VO2) 25 W 92 75 W

108

100 W

136

22.9

125 W

155

26.9

• Formula 2 » Slope (b) = (SM2-SM1) / (HR2 – HR1) » b = (26.9-22.9) / (155-136) = 4/19 = 0.21 Cycle Test – Example Workload

HR (bpm)

SM (Submax VO2)

100 W

136

22.9

125 W

155

26.9

• • Formula 3 » Estimated VO2max (ml⋅kg-1⋅min-1) = SM2 + [b x (HRmax - HR2)] = 26.9 + [0.21 x ((220-32 yrs) – 155)] = 26.9 + [0.21 x (188 – 155)] = 26.9 + [0.21 x 33] = 26.9 + 6.93 = 33.8 ml⋅kg-1⋅min-1 • Health Benefit Rating = fair

1-Mile Walk Test – Overview • Created for males & females from 20-69 yrs. • Suitable for older & sedentary populations • One mile (1.6 km) track (not a treadmill) is required • Test is terminated when client completes one-mile walk or other test termination criteria reached 1-Mile Walk Test – Scoring • Estimate the client’s VO2max using the following formula • Estimated VO2max (ml⋅kg-1⋅min-1) =

132.853 – (0.0769 x weight in pounds) – (0.3877 x age in years) + (6.315 for males only) – (3.2649 x time) – (0.1565 x HR) ÜRecord the score and associated Health Benefit Rating on the Client Information Sheet 1-mile Walk Test – Example • Example: 33 yr old male; 72.7 kg; completed walk test in 11min & 20 seconds with a post-test HR of 160 bpm • Estimated VO2max (ml⋅kg-1⋅min-1) = 132.853 – (0.0769 x weight in pounds) – (0.3877 x age in years) + (6.315 for males only) – (3.2649 x time as a decimal) – (0.1565 x HR) = 132.853 − (0.0769 × 160) − (0.3877 × 33) + (6.315 × 1) − (3.2649 × 11.333) − (0.1565 × 160) = 52 mL/kg/min Ü Health benefit rating = excellent MSK Protocols – Overview -goals are not always related to aerobic fitness: want to work on strength or balance, covid making it harder: all depends on clients goals Grip strength

Strength (hand grip, forearms)- reading of how many kg of strength in that arm (grip gynometer) -sense if there is muscle imbalance that might need to be addressed

Push Ups-Endurance (chest, shoulders, arms) Strength in some clients -Not suitable for clients with osteoporosis, lower back pain or shoulder problems, wrist problems Sit and reachFlexibility (hips, lower back)- joint specific -Shoulders might be flexible but not hips for example -Not suitable for clients with osteoporosis or lower back pain Vertical jumpPower (legs)- subtle diffs for athletes more -Not suitable for clients with osteoporosis, lower back pain or knee problems

Back extensionEndurance (back) -Must pass prescreening test before attempting protocol One leg stanceBalance, strength, & endurance (legs)- would want to get stability up before going straight to more advanced movements Grip Strength – Scoring • Combine the maximum scores from each of the left and right hands. ÜRecord the result and associated Health Benefit Rating (next slide) on the Client Information Sheet. • Example: Right: 50kg, Left: 48kg; Total: 98kg » Female aged 25 years: Excellent » Male aged 25 years: Good - Both hands twice, but alternate to avoid fatigue Push-ups – Scoring Record the client’s total number of push-ups and associated Health Benefit Rating (next slide) in the Client Information Sheet ÜExample: Female aged 22 years of age completed 20 push ups. Total number of pushups to failure- max -females must do modified to stick to health benefit ratings -men tend to work on strength more, and women to aerobic- imbalance in health and strength: going to hit threshold that you cannot do ADLs at a younger age Sit and Reach – Scoring ÜRecord both readings to the nearest 0.5 cm on the Client Information Sheet and use the highest score to determine the Health Benefit Rating (next slide). • Example: Male aged 38 years obtains an 18cm and 19cm. • If the client is unable to reach the mark on the flexometer, measure the distance from the fingertips to the ‘0’ mark. » This can be used later in goal setting (e.g., to reach the mark upon re-assessment). -lower body range of motion -stretch hamstrings before completing the test -scale starting at 16 cm Vertical Jump – Scoring

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Subtract the standing reach height from the peak jump height to get the maximum difference. • Calculate Peak Leg Power in watts (W) = » [60.7 x jump height (cm)] + [45.3 x body mass (kg)] – 2055 • Example: A male aged 42 jumped a total of 20cm and weighs 68kg. » (1214) + (3080.4) -2055 = 2239.4 ÜRecord the Peak Leg Power and the associated Health Benefit Rating (next slide) on the Client Information Sheet. -stand against wall and reach as high as they can -difference bw jump height and reach height Back Extension – Scoring ÜRecord the number of seconds the horizontal position is maintained and the associated Health Benefit Rating (next slide) on the Client Information Sheet. • Example: 58 year old female was able to hold the position for 63 seconds. • -max or cut off is 3 mins •

-make sure that they arent dipping below parallel or hyperextending

One-Leg Stance – Scoring & Recording ÜTake the best time for each of the eyes-open and eyes-closed tests to compare to means by age group and gender (next slide) • Example: 64 year old male was able to maintain the position for 38 seconds with eyes opened. • -have a chair or something to grab on to if they loose their balance One Leg Stance- Mean Scores • The following values represent mean times based on the best of two trials.Interpretation will simply categorize clients as above or below the mean values (i.e., given the lack of evidence upon which to base a more detailed Health Benefit Rating). • just a threshold not detailed health benefit rating Be Prepared for Emergencies • Avoid emergencies! » always do physical activity readiness screening and ensure equipment is properly maintained

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Have an emergency action plan and know your role – PRACTICE IT! Have contact information for client’s physician and next of kin on client information sheet -protocols associated with certain risks

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-be ready for emergencies- internal or external (911)

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-need protocols if someone falls and hurts themselves

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-if someone has an injury or disease that predisposes them, then don’t even risk it

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-emergency medical history, emergency contacts

If an Adverse Event Occurs… •

If a client experiences dizziness or loss of consciousness » Put client in a supine position and elevate the legs. » Keep client in this position until his/her BP returns to the pre-exercise level. • If a more serious incident occurs (e.g., cardiac arrest) » Request emergency services » Provide emergency treatment such as CPR/Automated External Defibrillator • If any adverse event occurs, complete an incident report form -may need individualized EAP -if you don’t address this, you can be held accountable...