156. Computerized Cardiopulmonary Exercise

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156. Computerized Cardiopulmonary Exercise

CATEGORY: Fitness, Workout & Exercise 500 Courses

COURSE NUMBER: 01

FEES: 555/- INR only

CERTIFICATE VALIDITY: Lifetime

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Syllabus

Preface ix
Notice and Disclaimer xi
Part I Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Chapter 1 Clinical Applicability of the Pediatric Exercise Test . . . . . . 3

Thomas W. Rowland
Development of Pediatric Exercise Testing 4
Unique Features of Exercise Testing in Children 7
Normative Values 8
Adjusting Values for Body Size 8
Tyranny of “Maximal” Testing 9
Safety of Clinical Exercise Testing 10
Conclusion 11

Chapter 2 Conducting the Pediatric Exercise Test . . . . . . . . . . . . . . 13

Amy Lynne Taylor
Pediatric Exercise Laboratory Environment and Equipment 13
Optimizing Safety 14
Preparing the Child for an Exercise Test 16
Test Communication 17
Conclusion 19

Part II Exercise Testing Methodology . . . . . . . . . . . . . 21
Chapter 3 Exercise Testing Protocols . . . . . . . . . . . . . . . . . . . . . . . . 23

Richard J. Sabath III, David A. White, and Kelli M. Teson
Exercise Testing Modality 24
Protocol Design 25
Treadmill Protocols 26
Cycle Ergometer Protocols 28
Multistage Versus Ramp Protocols 32
Six-Minute Walk Test 35
Maximal Test Criteria 36
Scope of Pediatric Exercise Testing 37
Conclusion 38

Chapter 4 Normal Cardiovascular Responses

to Progressive Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Thomas W. Rowland
Reductionist’s Disclaimer 41
Historical Context 42
Empirical Evidence 43
Synthesis 46
Physiological Basis of Cardiovascular Fitness 47
Conclusion 49

Chapter 5 Exercise Electrocardiography . . . . . . . . . . . . . . . . . . . . . 51

Thomas W. Rowland
Effects of Exercise on the Cardiac Conduction System 52
ECG Setup and Monitoring 54
Measuring Heart Rate 55
Identifying Heart Block 57
Detecting Arrhythmias 58
Detecting Ischemia 60
Evaluation of Prolonged QT Interval 62
Risk Stratification With Ventricular Pre-Excitation 63
Conclusion 63

Chapter 6 Blood Pressure Response to Dynamic Exercise . . . . . . . . 65

Bruce Alpert and Ranjit Philip
Basic Physiology of Exercise Blood Pressure 65
Technical Aspects of Blood Pressure Measurement 66
Normal Blood Pressure Response to Dynamic Exercise in Healthy Children 67
When to Terminate Exercise Testing Based on Blood Pressure Response 72
Prognostic Value of Exercise BP Testing 72
Special Conditions 73
Interpretation of Results 77
Conclusion 77

Chapter 7 Maximal Oxygen Uptake . . . . . . . . . . . . . . . . . . . . . . . . . 79

Ali M. McManus and Neil Armstrong
Physiological Responses to Aerobic Exercise 80
Measuring Maximal Oxygen Uptake in Children 83
Developmental Patterns in Maximal Oxygen Uptake 87
Normal Values 91
Conclusion 93

Contents v

Chapter 8 Other Measures of Aerobic Fitness . . . . . . . . . . . . . . . . . 95

Robert P. Garofano
Peak Workload 95
Ventilatory Anaerobic Threshold 97
Submaximal Testing Protocols 101
Oxygen Uptake Efficiency Slope 102
Conclusion 104

Chapter 9 Cardiac Output Measurement Techniques . . . . . . . . . . 107

Darren E.R. Warburton and Shannon S.D. Bredin
Invasive Versus Noninvasive Techniques 107
Direct Fick Method 108
Dye-Dilution Method 110
Thermodilution Method 111
Lithium Dilution Method 111
Foreign Gas Rebreathing Techniques 112
Doppler Echocardiography 115
Impedance Cardiography 116
Arterial Pulse Contour Method 117
Conclusion 118

Chapter 10 Assessing Myocardial Function . . . . . . . . . . . . . . . . . . . 119

Thomas W. Rowland
Systolic Time Intervals 120
Radionuclide Exercise Testing 120
Pattern of Stroke Volume Response 120
Oxygen Pulse 121
Doppler Echocardiographic Techniques During Exercise 122
Stress Echocardiography 124
Conclusion 125

Chapter 11 Pulmonary Function . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

Patricia A. Nixon
Protocols 127
Pulmonary Function at Rest and During Exercise 127
Asthma 136
Cystic Fibrosis 137
Conclusion 138

Part III Exertion-Based Applications . . . . . . . . . . . . . . 139
Chapter 12 Congenital and Acquired Heart Disease . . . . . . . . . . . . 141

Michael G. McBride and Stephen M. Paridon
Factors Affecting Exercise Performance 141
Exercise Testing 142
Simple Two-Ventricle Defects 143
Obstructive Lesions 146
Complex Two-Ventricle Defects 148
Single-Ventricle Physiology 151
Primary Arrhythmias and Channelopathies 153
Acquired Heart Disease and Cardiomyopathies 153
Conclusion 156

Chapter 13 Exercise-Induced Dyspnea . . . . . . . . . . . . . . . . . . . . . . 157

Steven R. Boas
Differential Diagnosis 157
Evaluation 162
Exercise Testing 164
Conclusion 166

Chapter 14 Chest Pain With Exercise . . . . . . . . . . . . . . . . . . . . . . . . 167

Julie Brothers
Differential Diagnosis 167
Evaluation 170
Exercise Testing 172
Conclusion 173

Chapter 15 Presyncope and Syncope With Exercise . . . . . . . . . . . . . 175

Julie Brothers
Differential Diagnosis 175
Evaluation 179
Exercise Testing 180
Conclusion 182

Chapter 16 Exercise Fatigue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183

Thomas W. Rowland
Differential Diagnosis 183
Evaluation 186
Exercise Testing 188
Conclusion 188

Contents vii

Part IV Testing Special Populations . . . . . . . . . . . . . . 189
Chapter 17 Pectus Excavatum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191

Thomas W. Rowland
Physiological Implications 191
Surgical Results 193
Cardiopulmonary Testing 193
Conclusion 194

Chapter 18 Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195

Laura Banks and Brian W. McCrindle
Quantifying Childhood Obesity 195
Physiological Adaptations 198
Effects of Obesity on Physiologic Measures 198
Cardiopulmonary Exercise Testing Modifications 202
Conclusion 203

Chapter 19 Intellectual Disability . . . . . . . . . . . . . . . . . . . . . . . . . . 205

Bo Fernhall and Tracy Baynard
Physiological Implications 206
Exercise Testing 208
Conclusion 213

Chapter 20 Neuromuscular Disease . . . . . . . . . . . . . . . . . . . . . . . . 215

Olaf Verschuren, Janke de Groot, and Tim Takken
Cerebral Palsy 215
Duchenne and Becker Muscular Dystrophy 216
Conclusion 219

References 221
Index 263
About the Editors 274
About the Contributors 275

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