Equipment used in exercise physiology and its uses

7/23/2019 Equipment used in exercise physiology and its uses

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Index

1. Blood Pressure (3-9 pages)2. Resting Metabolic Rate (11-15 pages)

3. Lactate, lucose and !rigl"ceride (1#-23 pages)$. %eart rate and &' (25-3 Pages)5. piro*etr" (32-39 pages)+. naerobic s"ste* ($1-$5 pages)#. erobic "ste* ($#-52 pages)

1



2



Blood Pressure

3



Blood Pressure

Protocol: Recommendations from American Heart Association

o Ask the patient about the medication he/she using. Medications ma alter the

results.o Ask the patient not to consume alcohol or tobacco before the test.

o Ask the patient not to e!ercise at least 3 hour before the measurement.

o Ask the patient not to talk during the measurement

o Make patient sit in the chair in a comfortable position "ith his/her back

supported b the back support of the chair. Patient#s leg should not be

crossed.o Make sure that patient is not "earing tight clothing. $his ma obstruct the

smooth %o" of the blood and it ma ield false result.o Room temperature should be kept at appropriate le&el. 'deal Room

temperature is 2()2* degree +elsius.o

$he arm should be supported at the le&el of the right atrium of the heart.o $he bladder should co&er ,(- of the arm circumference.

o Appropriate cu sie should be used based on arm sie of the patient.

o Palpate for the brachial arter on medial side of the arm 0ust abo&e capitulum

of the humerus.o 'f patient is "earing long slee&e clothes roll up the slee&es. Make sure that

the rolled up slee&e is not obstructing the blood %o".o eep the lo"er border of the cu at least 2)3 cm abo&e the elbo" 0oint. so

that it lea&es enough space for stethoscope placement.o Make sure that the reading on the manometer gauge reads ( before ou

in%ate the cu. e%ate the cu completel before the measurement.o

+heck the &al&e properl before using it. +lose the &al&e completel beforein%ating the cu

o +heck the stethoscope4 $ap the bell area to check if it "orks properl or not.

o 'n%ate the cu 3( mmHg abo&e the point at "hich the radial pulse

disappears.o 2 readings should be recorded and the a&erage of t"o reading should be

taken for record.

Blood Pressure Measurement:

Make Patient to sit in the chair "ith the patient#s back should rest on the beck

rest of the chair. Allo" patient to rela! at least 5)1( minute after sitting. Prepare

the apparatus. 6rap the cu around patients arm at least 3)7 cm abo&e the

cubital fossa "hich "ill enable the obser&er to place the stethoscope.orotko#s sounds are best heard "ith the bell of the stethoscope. $he le&el of

the arm should be at the same le&el as the right atrium of the heart. Place the

stethoscope slightl medial side of the arm "here the brachial arter runs.

7



8igure Manometer 9auge

8igure Bulb

:o" close the &al&e and start to in%ate the cu. +u should be in%ated 2()3(

mmHg abo&e the sstolic pressure. Release the &al&e slo"l at the rate of 3)5

mmHg/s. Hear for the korotko#s sound. $he ;rst korotko#s sound gi&es us the

<stolic blood pressure. 'n the last phase =Phase >? of orotko#s sound "e get

the diastolic blood pressure. =8rese et al.2(11?

Korotkof’s Sounds: orotko#s sounds are rhthmic sound heard in the

stethoscope during the measurement. $he are heard in 5 phases.@ Phase I: 'n phase 1 clear tapping sounds appears and it corresponds to the

appearance of a palpable pulse@ Phase II: 'n phase 2 orotko#s sounds become softer and longer@ Phase III: 'n Phase 3 orotko#s sounds become crisper and louder@ Phase IV: 'n Phase 7 orotko#s sounds become mued and softer@ Phase V: Phase 5 is marked b disappearance of orotko#s sounds completel.

$he ;fth phase is thus recorded as the last audible sound.

Equipment :

Apparatus used to measure blood pressure in human

beings is called sphgmomanometer. Along "ith

sphgmomanometer stethoscope is also necessar to

measure blood pressure.

Manometer: $he manometer =8ig.1? is a dial shaped

instrument "ith the marking of numbers on it. 't

measures the pressure of air in mmHg. 't also has a "atch

like hand "hich reads the pressure applied to the cu. $he

manometer can be seen in 8ig. 1.

Bulb: $he bulb =8ig.2? is used to pumps air into the cu. A &al&e is placed at the end

of the bulb to pre&ent air from escaping.

Bladder: $he bladder is the in%atable bag. 6hen it is ;lled

it compresses the arm to occlude the brachial arter.

Bladder is pouched "ithin the cu. <ie of the bladder

&aries according to the sie of the cu.

5



8igure +u

8igure >al&e

8igure <tethoscope

uf: $he cu =8ig.3? pouches the bladder in it. 't

is "rapped around the arm. ierent sie of cus

is used depending upon the sie of the arm. ou

can see the sie marked on the cu. Proper sieof the cu ensures that it "ill ;t the indi&idual

properl and ield correct result.

Val!e: $he &al&e =8ig.7? controls de%ation of the

cu. >al&e is a critical tool for accurate

measurement of blood pressure. 't comes "ith a

nob. 't can be opened and closed to release or

obstruct the air%o" out of the cu.

Stethoscope: <tethoscope =8ig.5? is used to hear the

orotko#s sounds. 't comes "ith ear piece and chest piece

=Bell? connected "ith tubes.

C



Measurement "utcomes:

Blood pressure is de;ned as the lateral pressure e!erted b blood on the "alls of

arter. 't is measured in mmHg. 6hen blood %o"s through the arteries it e!erts

pressure on the arterial "all. =<embulingam 2(12?

Blood pressure is e!pressed in <stolic and iastolic blood Pressure.

S#stolic blood Pressure: 't is the ma!imum pressure e!erted on arterial "all

during the sstole of the heart. 't is measured during ;rst phase of the orotko#

sound. :ormal sstolic pressure is 12( mmHg.

$iastolic blood pressure: 't is the minimum pressure e!erted on arterial "all

during the diastole of heart. 't is measure during phase 5 of the orotko#s sound.

:ormal diastolic pressure is ,( mmHg.

Expected outcomes:

Blood pressure at restD 12(/,( mmHg

6hen blood pressure is measured at rest normal measurement readings should be

12(/,( mmHg.

Blood Pressure after and during E!erciseD E!ercise puts more demand for o!gen

and blood suppl to the "orking muscles. 'n order to ful;l the demand heart pumps

faster. 'n a result to that <stolic Blood pressure rises steadil during e!ercise. 'tma go abo&e 1C( mmHg up to 2(( mmHg in health indi&iduals. Ho"e&er there is

no or little increase in the diastolic blood pressure. 't ma remain at ,( mmHg.

*



Interpretation o% the blood pressure measurement:

$he chart belo" describes the dierent range for the blood pressure and "hat thosereading means. =American Heart Association?

Blood Pressure

+ategor

<stolic

mm Hg =upper F?

iastolic

mm Hg =lo"er F?

:ormal less than 12( and less than ,(

Prehpertension 12( G 13 or ,( G ,

High Blood Pressure

=Hpertension? <tage 1

17( G 15 or ( G

High Blood Pressure

=Hpertension? <tage 21C( or higher or 1(( or higher

Hpertensi&e +risis

=Emergenc care needed?

Higher than 1,( or Higher than 11(

Exercise and Blood Pressure:

Blood Pressure is measured during e!ercise to determine hemodnamic response to

e!ercise for the assessment of the cardio&ascular health of an indi&idual. :ormall

blood pressure rises graduall as the intensit of the e!ercise picks up. Blood

pressure returns to rest an hour after the e!ercise. <stolic blood pressure increasesas the e!ercise intensit increases. But there is no or little change is noted in

diastolic blood pressure.

$he rise in the sstolic blood pressure can &ar bet"een indi&idual. 't ma go up to

2(( mm Hg in a health indi&idual.

,

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Hypertensive-Crisis_UCM_301782_Article.jsp

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Hypertensive-Crisis_UCM_301782_Article.jsp



Regular e!ercise can help to lo"er our blood pressure. Endurance e!ercises make

the heart stronger. As heart gets stronger it can pump more blood "ith less eort.

Moderate aerobic e!ercise that increases both our heart and breathing rates such

as s"imming biccling 0ogging "alking etc. can impro&e the cardio&ascularendurance. Aerobic e!ercise conditions heart "hich enables heart to pump more

blood in single beat. +ontractile propert of the mocardium of the heart becomes

stronger in response to aerobic e!ercise. Peripheral resistance is decreases due to

pumping action of the "orking muscle "hich leads to decrease in resting blood

pressure in hpertensi&e indi&iduals.

Sources

1. Ethel M 8rese et al. =2(11? IBlood pressure measurement guidelines for Phsical

$herapistJ +ardiopulmonar phsical therap 0ournal. p. 5)122. $homas 9. Pickering et al. =2((5? IRecommendation for blood pressure

measurement in humansJ AHA scienti;c statement. p. C*)*1C3. . <embulingam P. <embulingam =2(12? Essentials of Medical Physiology . Cth

Edition =Kapee Brothers?7. American Heart Association#s 9uidelines for Blood Pressure Measurement..



1(



Resting Metabolic Rate

11



&estin' Metabolic &ate:

Introduction:

Resting metabolic rate is de;ned as the minimum amount of energ reLuire b

human bod to sustain normal metabolic functions at rest. ur bod reLuires

energ to carr out normal metabolic functions gro"th of the tissues and its

repair. ur bod generates energ b metaboliing ma0or dietar nutrients like

carbohdrates fats and proteins.

'ndirect calorimetr is used to measure resting metabolic rate. 't anales

inhaled and e!haled air to measure resting metabolic rate. Metabolic processes

in the bod are run at the e!pense of energ. 't comprised of anabolic processes

and catabolic processes. Anabolic processes build up tissues4 catabolic processesbreak do"n tissues and fuel sources for energ. $he rate at "hich these

processes occur is measured in calories per unit of time. RMR &aries greatl "ith

age se! and dierent "eather condition.

Respirator Luotient helps in determining "hat tpe of fuel is burned. i.e.

+arbohdrates fats or proteins. Resting metabolic rate slo"s do"n as the age

increases and "eight decreases. 9enes and en&ironmental temperature pla a

&ital role in metabolic rate. 9ain in muscle mass "ill increase our metabolic

rate. BMR is higher in men "hen compared to "omen. 'f "e are ill or sick our

resting metabolic rate increases to ;ght against the infection. ietar

de;ciencies like iodine de;cienc lead to decreased metabolic rate. Eecti&e

"eight loss needs increased metabolic rate to burn e!tra calories "hich can be

achie&ed b e!ercising.

Protocol:

=$ufts Nni&ersit 9uidelines for the measurement of RMR2((?

O 'nstruct the patient not to eat or drink anthing other than "ater for at least ,)12hours before the test.

O Ask the patient not to e!ercise at least for 7, hours before the test.O Allo" the patient to rest for 2( minutes in a chair before the test.O 'f the patient is on medications refer him/her to the phsician and ask for the

modi;cation or ad&ise on the drugs he/she is taking.O Make sure that patient sta a"ake during the test.

12



8igure Placement of the mask8igure Mask

O Make patient sit in the chair in rela!ed position "ith back of the patient is

supported b the back support of the chair.O Ha&e the participant lie comfortabl on his/her back on the bed.O 'nstruct the participant to rela! but not to sleep during the measurement and inform

him/her that "e "ill be looking in from time to time to make sure he/she is a"ake.O 'nform the participant that he/she is free to remo&e the mask if he/she feels

uncomfortable.O Place the mask o&er the participant#s face making sure that the plastic skirt is ling

%at to pre&ent air from leaking in under the mask. As sho"n in the ;gure 1 belo".O +heck that the %o"meter in front of the mask is not obstructed. $his %o"meter

permits room air to enter the bubble and allo"s the participant to breathe?.O Run the test for 2( minutes.O 'f participant remo&es the mask at an time during the 2( minutes make a note in

our data collection forms.O $his should not aect the reliabilit of the test as long as the machine collects at

least 1( minutes of a Istead stateJ reading.O 8ollo"ing each measurement clean the mask "ith hdrogen pero!ide and change

the sheets on the bed and pillo".O $he modi;ed 6eir eLuation is used to con&ert the &olume of o!gen consumed and

the &olume of +2 produced per minute into a &alue for resting energ e!penditure

e!pressed in calories. 't diers from the standard 6eir eLuation in that the gas

concentration measured b the RMR machine used b this stud is in liters/minute

not ml/min =6eir KB K Phsiol. 17D 1( 1)?.

Equipment:

(ans &udolph Mouthpiece )Mask*D

13



8igure 8lo"meter

8igure 8lo"meter sensor

8igure uark analer

Mask =8ig.1? is placed on the face co&ering mouth and nose

=8ig.2?. Appropriate sie should be used to ensure no air

should escape or enter into it e!cept from the %o"meter.

$he 8lo"meter is attached on the front.

+lo,meterD 8lo"meter =8ig.3? is attached to the mask. 't

has turbine mounted in it. 't allo"s the passage to air

inhaled and E!haled.

+lo,meter SensorD

8lo"meter sensor =8ig.7? is attached to the %o"meter. 't

sends data to the analer. $he sensor can be seen in the

;gure 7 abo&e.

-uark .nal#/erD

uark Analer =8ig.5? anales the air inhaled and e!haled

and transmits data to the

computer. $he sensor

attached "ith %o"meter

sends e!haled air

samples to the uark

analer. 't anales the room air as "ell. 't

interprets the content of the e!haled air and

transmits the data to the uark P8$ Ergo

program.

-uark P+0 Er'oD uark P8$ ergo is a program installed in the computer "hich

records the data transmitted from the analer. Pro;le of the patient is created in

the program. Patient#s data is recorded and then the test is run.

Values bein' measured durin' &M& measurement1

O >olume of 2 consumption per breath per minute per bod "eightO Breaths per minuteO +alorie e!penditureO +arbohdrate fat and protein uptake for energ production

17



O Respirator uotient

$hese &alues "ill enable us to interpret the pattern of energ e!penditure of the

patient. 8or e!ample &olume of 2 consumption per breath per minute per bod

"eight "ill tell us "hich dietar nutrient patient is burning to produce energ in thebod. +aloric e!penditure "ill tell us about the minimum calories reLuired to sustain

the bod functions.

Exercise and &estin' metabolic rate: Regular e!ercising can increase the

resting metabolic rate. Research sho"s that aerobic e!ercise increases the resting

metabolic rate. 't helps us in "eight loss. Moreo&er certain aerobic e!ercises help us

burn speci;c dietar nutrients like fat.

Sources

1. 6eir KB =17? Kournal of Phsiolog. 1( p. 1)2. $ufts Nni&ersit guidelines for the measurement of resting metabolic rate 2((.3. Nni&ersitat de Berlin=2(11? IRMR and its implicationJ 2(11

15



1C



Qactate 9lucose and $riglcerides

1*



8igure 1 Qactate <cout e&ic

Protocol:

O Patient should not ha&e an bleeding disorderO Patient should not engage into an phsical acti&it before the test

O Blood should be dra"n from the health ;nger4 de&oid of an infection.O Qactate measurement de&ice should be calibrated before testing.O <ensor code should match the code set on the de&ice.O +lenching the ;st or ha&ing the elastic band in place for a long time "hile ha&ing

blood dra"n can result in a false increase in serum lactate le&el.

E!plain the procedure of the test thoroughl to the patient. eep all necessar

items read =Alcohol s"ab Qancet Qactate scout test strip Band)Aid?. 'nsert the

sensor in the de&ice. $his "ill turn on the de&ice. $horoughl clean the tip of the

;nger "ith alcohol from "here the blood is going to be dra"n. Prick the ;nger

"ith lancet. Milk enough amount of blood. Bring the tip of the ;nger near thesensor inserted into the de&ice so that it can absorb the blood. 6hen the

chamber of the sensor is ;lled "ith blood completel the de&ice "ill beep. After

the gap of ten seconds another beep sound "ill come out of the de&ice. After

that beep screen "ill sho" the test result. Qactate is measured in mmol/Q. After

the test used sensor should be disposed properl. 'f an blood droplets are

spilled on the de&ice the de&ice should be thoroughl

cleaned. Nsed lancets should be disposed properl.

Equipment:

Qactate scout =8ig.1? measures the serum lactate

le&el.'t comes "ith lactate scout test strips or &ial. 6hen

used for the ;rst time t"o digit &ial number should be entered on the de&ice.

$he code is printed on the &ial container. >ial number and the number on thede&ice should match e&er time "hen used. $he test strips are inserted on the

de&ice before the test. $he de&ice "ill start automaticall "hen the sensor or the

strip is inserted.

1,



8igure $est strip

$he test strip =8ig.2? must be inserted into the de&ice before dra"ing blood from

the ;nger. $he de&ice should be stored "ith care. E!cess heat or cold can

damage the de&ice so the de&ice should ne&er be

stored abo&e 5( degrees centigrade or belo" (

degree centigrade temperature. $he sensor should

al"as be stored in its original container at thetemperature ranging , degree centigrade to )1,

degree centigrade. Qancets "ith &arious gauges are

a&ailable and should be used according to ho" "ell the

patient bleeds.

2actate and Exercise

:ormal <erum Qactate le&elD (.5)2.2 mmol/Q

E!ercise increases the serum lactate le&el. uring e!ercise anaerobic metabolism

increase in the muscle. Anaerobic metabolism increases the production of lactate. 'n

the initial phase of the e!ercise serum lactate le&el "ill rise graduall. At a certain

point serum lactate le&el "ill rise sharpl and it "ill become steadier at that le&el.

<o measurement taken immediatel after e!ercise "ill sho" the ele&ated le&el of

lactate in the blood. Qe&el of serum lactate "ill come do"n at rest due to theacti&it of the enme lactate dehdrogenase. Qactate dehdrogenase metabolies

lactate.

Qactate is mainl produced in muscle cells and red blood cells. 't forms "hen the

bod breaks do"n carbohdrates to use for energ during times of lo" o!gen

le&els. 6hen the concentration of lactate increases inside the cell due to increased

anaerobic production of A$P lactate "ill start to leak out of the cell into the blood.

Ele&ated serum lactate le&el at rest indicates Heart failure Qi&er disease Qung

disease sepsis or &er lo" le&el of o!gen in the blood. Higher serum lactate le&el

indicates lactic acidosis =Abo&e 7.5 mmol/Q?.

1



8igure +ardiocheck e&ice

Sources:

Banes K Marek H. . =2(15? Medical Biochemistry . 7th Edition =Else&ier?

Measurement o% Serum tri'l#ceride and serum 'lucose

Protocol:

O Patient should not ha&e an bleeding disorderO Patient should not engage into an phsical acti&it before the testO Blood should be dra"n from the health ;nger4 de&oid of an infection.O $ip of the ;nger should be thoroughl cleaned "ith alcohol s"ab before taking the

sampleO <erum triglceride and glucose measurement de&ice should be calibrated before

testing.O <ensor code should match the code set on the de&ice.O Patient should be in ,)12 h fasting state before the testO Ask the patient about the medications he/she takes

Equipment:

<erum triglceride and glucose le&el are measured b

using cardio check de&ice. +ardio check de&ice =8ig.1?

comes "ith the sensors and memor chip. <ensors are

dierent for triglceride and glucose measurement.

ierent memor chips are used for the measurement

of serum triglceride and glucose le&el. Memor chipscome "ith the sensors suitable to it. nl those

sensors should be used "ith corresponding memor

chips. <ensors are placed on the gi&en space on the

de&ice. Memor chips are inserted on the de&ice and

the de&ice is calibrated for the measurements. $he

de&ice can be connected to the printer.

2(



8igure e&ice "ith memor chip ans test strip mounte

8igure +ollecting blood "ith pipe

8igure Plunging blood on test s

Memor chips stores the readings it can be retrie&ed and printed later.

ierent gauge of lancets are reLuired. e&ice should be calibrated before

testing. Proper memor chip and sensor strip should be inserted for speci;c test.

Proper care should be taken in to store the de&ice. e&ice should be protected

from direct e!posure to sunlight dust or humidit. 't should be stored at theoptimum temperatures ranging from 1,)35 degree +elsius.

Memor# chips:

A memor chip recognies

"hich test to run and it stores

the measurement. 't tells the

e!piration date of the sensor. 't

contains the lot number of the

test strip. 't controls the test

seLuence and timing of the

test. 't establishes the measurement range of the test being done.

0est strips or sensor: $est strips come "ith the calibrated memor chips. $est

strip is inserted into the de&ice and the blood is plunged on the "indo" on the strip

Procedure:

+alibrate the de&ice "ith the chip and the sensors

for the gi&en test. Make sure proper sensors and

memor chip are inserted on the de&ice for gi&en

test. +onnect the de&ice "ith printer.Make patient sit on the chair in rela!ed manner. $urn

on the de&ice.

Place test strip on its place. +lean the area of the ;nger "ith alcohol from "here

the blood is going to be dra"n. Prick the ;nger "ithlancet and milk the blood out of ;nger. 8ill the pipet

"ith blood until it reaches the mark on the pipet.

=8ig.3?

21



8igure e&ice isplaing Resu

:o" plunge the blood =8ig.7? on the blood "indo" on strip. 6hen enough

amount of blood is plunged the de&ice "ill beep. 6ithin t"o minutes the results

"ill appear on the displa. =8ig.5? Memor chip "ill store the result. ispose the

used material used for test to ensure the sanit of the de&ice.

&esult:

Serum 0ri'l#cerides:

O <erum +holesterol D :ormal range D belo" 2(( mg/dQO <erum QQ D :ormal range D less than 1(( mg/dQO <erum $riglcerides D :ormal: Qess than 15( mg/dQ

Borderline High: 15( ) 1 mg/dQ High: 2(( ) 7 mg/dQ>er High: 5(( mg/dQ or

abo&eO <erum HQ D :ormal D More than 7( mg/dQO $+/HQ ratio D :ormal 3.5)1

Serum 3lucose 2e!el:

:ormalD 8asting plasma glucose le&el of *(G13( mg/dQ

After meals less than 1,( mg/dQ

<erum triglcerides and serum glucose le&el ma &ar and are highl related to the

diet of the indi&idual. 8or e!ample patients suering from diabetes ma sho"case

higher le&el of serum glucose le&el. A patient suering from li&er disease ma

sho"case abnormal le&el of serum triglcerides le&els.

Implication o% Exercise on serum tri'l#cerides and serum 'lucose le!el:

22



E!ercise helps in lo"ering serum triglceride and serum glucose le&el. E!ercise is

bene;cial for patients suering from diabetes and obesit. E!ercise helps in

pre&ention of cardio&ascular disease "hich results from higher serum triglceride

le&els. =isner S +olb 2(12?

'ntake of blood glucose b muscles is increased during e!ercise. Aerobic e!ercises

are kno"n to burn fats. >igorous e!ercise ma produce acute hpoglcemia4

hpoglcemia is a state marked b lo"er serum glucose le&el. 't ma lead to

blackouts. =isner S +olb 2(12?

Anaerobic e!ercise primaril uses glcogen =storage form of glucose? as a source of

energ in the muscle. <o "hile performing anaerobic e!ercise =higher intensit

e!ercise of short burst? glcogen stored in the muscle is broken do"n for energ

production. E!ercise also facilitates transport of the glucose from blood to the cell

b acti&ating 9QN$7 transportase enme acti&it. 'ndi&iduals "ith de;cient

production of insulin "ill bene;t b performing e!ercise.

Aerobic e!ercise uses o!gen and fat to produce energ in the muscle. Products of

fat metabolism =beta o!idation? are used in the mitochondria to produce A$P. bese

person can bene;t b performing aerobic e!ercise to burn do"n fat. Aerobic

e!ercise helps in the pre&ention of atherosclerosis.

Sources:

1. +aroln isner Qnn Allen +olb =2(12? Therapeutic Exercise Cth Edition =8.A.

a&is?

2. . <embulingam P. <embulingam =2(12? Essentials of Medical Physiology . Cth

Edition =Kapee Brothers?

23

http://www.google.com/search?tbo=p&tbm=bks&q=inauthor:%22Carolyn+Kisner%22

http://www.google.com/search?tbo=p&tbm=bks&q=inauthor:%22Lynn+Allen+Colby%22

http://www.google.com/search?tbo=p&tbm=bks&q=inauthor:%22Carolyn+Kisner%22

http://www.google.com/search?tbo=p&tbm=bks&q=inauthor:%22Lynn+Allen+Colby%22



27



25



Heart Rate and E+9

2C



(eart &ate

Protocol

<ha&e chest if it is hair. Hair hampers conduction of electrical signals. 6et the

chest strap =;g.1? "ith some "ater for best conduction of signal. 6ear the chest

strap =;g.1? on the chest such that it should be in direct contact "ith skin. <ie of

the strap can be ad0usted. $he transmitter =;g.1? can be seen mounted on the chest

strap should rest at the le&el of the !iphoid process of the sternum on the chest.

6ear the 6atch =;g.2? like recei&er on the "rist. $urn on the "atch b pressing start

button mounted on the sides of the dial. $he "atch "ill sho" the heart rate.

Equipment:

Heart rate monitor comes "ith t"o tools. A chest strap =;g.1? and a ,atch =;g.2?.

A transmitter is mounted on the chest strap as it is seen in ;gure 1. $he transmitter

transmits signals to the "atch. 6atch interprets the signal and it sho"s the &alue on

the dial of the "atch.

Measurement:

Heart RateD 't is de;ned as number of times the heart contracts in a minute.

:ormal >alueD 5()1(( beats per minute

$achcardiaD $achcardia results "hen heart starts beating T 1(( beats

per minute at rest

BradcardiaD Bradcardia results "hen

heart starts beating U 5( beats per

minute at rest

2*

Figure 1 Chest Strap

Figure 2 Watch



8igure Electrodes mounted on chest

8igure uark 12! de&ice

Electrocardio'ram

Protocol

Prepare the patient for the placement of the E+9

leads. Remo&e hair from chest "here the

electrodes are going to be placed. Presence of hair

hampers signal conduction from skin to electrodes.

+lean the area of chest "ith alcohol "here

electrodes are going to be placed and allo" it to

dr completel before placing electrodes.

Electrode should be placed o&er non)bone area.

Placement of Electrodes for 12 lead E+9D

&.: Kust belo" mid line of the Right cla&icle. 't can

be seen in ;gure 1 =Black color?.

2.: Kust belo" midline of the left cla&icle. 't can be

seen in ;gure 1 ="hite color?

V4: 't is placed at fourth intercostal space and 0ust

right to the sternum =8ig.1 Red lead 0ust belo"

black lead?

V5: 't is placed at fourth intercostal space 0ust left

to the sternum =8ig.1 ello" lead?

V6: 't is placed mid"a bet"een >2 and >7 =8ig.1 green lead 0ust belo" ello"

lead?

V7: 't is placed at 5th intercostal space on midcla&icular line of

the left cla&icle =8ig.1 Blue lead?

V8: 't is placed on anterior a!illar line at same le&el as >7.

=8ig.1 range lead?

V9: 't is placed at mid a!illar line at the same le&el of >7 and

>5

&2: 't is placed 0ust abo&e the anterior superior iliac spine of

the right Hip bone. =8ig.1 9reen lead 0ust right to umbilicus?

22: 't is placed 0ust abo&e the anterior superior iliac spine of

the right Hip bone. =8ig.1 Red lead 0ust left to umbilicus?

2,



8igure 5 uark resting E+9 program displaing E+9 graph8igure $ango recei&er

All leads are connected to uark 12! de&ice =;g.2?. $urn on uark 12! de&ice b

pressing start button. pen uark resting E+9 program on computer. 'nsert

Patients details like4 name age se!

"eight.

After completion of ;lling patient#s

information E+9 graph "ill start

displaing on the computer screen

=8ig.5?

Equipment:

-uark 45x de!ice is connected to

the leads placed on the chest. =8ig. 3?

't recei&es signals from the electrodes

placed on the chest. uark 12! is a "ireless de&ice. 't transmits signals recei&ed

from electrodes to the $ango recei&er =8ig 7?.

0an'o recei!er is connected "ith the computer.

-uark &estin' E3 pro'ram

installed on computer displas E+9

graph. =8ig. 5?

2

Figure 3 Quark 12x device connected to Electrodes



Measurement:

E+9 detects the seLuence of electrical e&ents that occur during the contraction and

rela!ation ccle of the heart. + +ontraction of the heart is initiated b the sinoatrial

node "hich transmits the electrical stimulus to the atrio&entricular node. 8rom here

the impulse is conducted through the bundle of His and along the bundle branches

to the Purkin0e ;bres. 't causes the heart to contract.

An E+9 comple! consists of ;&e "a&e forms labeled "ith the letters P R < $ as

seen in the ;gure belo" "hich represents the electrical e&ents that occur in one

cardiac ccle. =<embulingam S <embulingam2(12?

P ,a!e: it represents the atrial depolariation.

-&S complex: $he R< comple! represents the &entricular depolariation.

P& inter!al: PR inter&al represents the time bet"een the onset of atrial

depolariation and the onset of &entricular depolariation.

3(



re N<B cable ="hite? connects to computer

8igure 'W$A unit po"er cord =black? and N<B cord ="hite? conn

Protocol:

Place the reLuired eLuipment on the table. i.e. +omputer 'W$A transmitter

unit N<B cable to connect 'W$A unit to computer Po"er suppl cord for 'W$A

unit spirometer %o"

head Plethsmograph

and plastic tubes to

connect %o" head "ith 'W$A unit.

37



8igure 7 8lo" meter head

8igure 8ront panel of the

:o" connect 'W$A unit "ith po"er suppl cord =Black?. Plug the N<B cable

="hite? in the N<B cable socket =;g.1?. ther end of the N<B cable connects

to computer =;g.2?. 'W$A unit transmits data to the computer. Po"er suppl

socket and N<B cable socket are located on the rare panel =A5? of the 'W$A

unit. Plug in Plethsmograph cable pin =8ig.3 Black pin? to the front panel

=A5? of the 'W$A unit. :o" connect plastic tubes to the front panel =A1? of the

'W$A unit. Make sure ou connect plastic tubes properl. $ube "ith red lid and

rugged surface connects to ;rst socket and tube "ith "hite lid and smooth

surface connects to second socket =;g.3?. :o" connect the other end of the

tubes to spirometer %o" head. 8lo" head has

the socket to connect tubes to it. Here also

make sure to connect the tubes properl. i.e.

tube "ith rugged surface connects to the

"hite nob and tube "ith smooth surface

connects to the "hite nob. =;g.7?

:o" as e&erthing is connected turn the

po"er on of the 'W$A unit. +on;rm that

the green po"er light is : on the front

panel of the 'W$A unit.

:o" open the Qabscribe soft"are b

clicking on the Qabscribe short cut located

on the desktop of the computer. Npon

opening of the soft"are it "ill displa a message saing Ihard"are foundJ if

e&erthing is connected.

35



8igure C Plethsmograph

8igure * Hand held <pirometer

encircle the outer surface of the mouthpiece. Ask the patient to start

breathing. 6ait for 1( seconds before "e start

recording. +lick on the record button =Red ;g.5? on

the displa. :o" Qabscribe program "ill start

recording the data transmitted b the 'W$A unit. 6e

"ill see a graphical line on the screen for each

module. i.e. Pulse air %o" from spirometer lung

&olume and heart rate. 'f the graphical line falls out

of the con;ned area "e can ad0ust the margin of the

graph. 6e can e!port recorded data to sa&e as an

e!cel ;le.

A hand held spirometer =8ig.*? can also be used to

determine 8E>1 8>+ b forcefull e!piring into the

mouthpiece attached to the hand held spirometer.

Ask the patient to take a deep breath and e!hale into

the mouthpiece of the hand held spirometer "ith as

much force as the patient can. After fe" seconds <pirometer "ill sho" the

measurement of 8E>1 8>+ and 8E>1/8>+ ratio.

Measurement:

<pirometer measures ho" much =&olume? air inspired and e!pired.

<pirometer is a pi&otal instrument in pulmonar function testing.

<pirometer is used for the assessment of lung function b measuring the

total &olume of air the patient can e!pel from the lungs after a ma!imal

inhalation. <pirometr is performed to measure air%o" obstruction to help

make a de;niti&e diagnosis of +hronic bstructi&e Pulmonar isease

=+P? con;rm presence of air"a obstruction assess se&erit of air%o"

obstruction in +P detect air%o" obstruction in smokers "ho ma ha&e

fe" or no smptoms monitor disease progression in +P perform pre)

operati&e assessment and in e!ercise stress testing.

3*


http://slidepdf.com/reader/full/equipment-used-in-exercise-physiology-and-its-uses 38/559raph

<pirometer measures follo"ing 'ndicesD

+EV4 ) %orced expiratory &olume in one second $he &olume of air e!pired

in the ;rst second of the blo"

+V ) %orced &ital capacity $he total &olume of air that can be forcibl

e!haled in one breath

+EV4;+V ratio $he fraction of air e!haled in the ;rst second relati&e to the

total &olume e!haled

V ) Vital capacity A &olume of a full breath e!haled in the patient#s o"n

time and not forced. >+ is often slightl greater than the 8>+ particularl in

+P.

'ndi&idual &ariation according to age height ethnicit and gender

) Height ) $all people ha&e larger lungs

) Age ) Respirator function declines "ith age

) <e! ) Qung &olumes smaller in females

) Race ) <tudies sho" Blacks and Asians ha&e smaller lung

&olumes =)12-?

) Posture ) Qittle dierence bet"een sitting and standing4 reduced

in supine position

<pirometr out comes in bstructi&e

and restricti&e Qung diseases.

3,



9raph

3raph 4 sho"s ho" obstructi&e diseases like Asthma Bronchitis

Bronchiectasis +stic 8ibrosis Post $uberculosis Qung +ancer and

bliterati&e Bronchilitis aects lung &olume. 'n obstructi&e lung diseases

air%o" is obstructed b &arious structures of respirator tract and lung.

Resulting into slo" in%ation of lung i.e. &er lo" 8E>1.

3raph 5 abo&e sho"s eect of restricti&e lung disease i.e. 8ibrosing lung

diseases Pneumoconioses Pulmonar edema Parenchmal lung tumors

Qobectom or pneumonectom $horacic cage deformit besitPregnanc :euromuscular disorders 8ibrothora! on Qung &olume. 'n

restricti&e lung diseases lung is able to accomodate less air into it due to

e!ternal=$horacic cage deformit? and internal restriction=Qobectom?

resulting in lo"er 8E>1 and 8>+.

$able belo" compares the &alues of 8E>1 8>+ and the ratio of 8E>1/8>+ in

&arious conditions

>alue 8E>1 =Qitres? 8>+ =Qitres? 8E>1/8>+:ormal 7 5 (.,

bstructi&e Qung

isease

1., 3.2 (.5C

Restricti&e Qung

isease

1. 2.( (.5

3



&e%erence

1. . <embulingam P. <embulingam =2(12? Essentials of Medical

Physiology . Cth Edition =Kapee Brothers?2. Belfer M. Vce management of +P in primar careD A 2(( clinical

update. Postgraduate Medicine 2((4121=7?D,2)(3. +ha&eP.+. and <hokar:.. iagnosis and management of chronic

obstructi&e pulmonar disease =+P? in a primar care clinic. '(P)

2((4C=C?D 77C)751

71



8igure Monark Bike

8igure 8ront Panel ispla

Protocol:

Educate Patient

E!plain the procedure to the patient.

e.g. He/she "ill be pedaling for 3( seconds. He/she "ill be informed about thetime at the end of e&er 5 seconds. 6hile he/she is ccling ask him/her to

pedal as fast as he/she can.

Preparation of Monark Bike =;g.1?

Ad0ust the sit of the bike4 <it should

be at or belo" the le&el of the

patient#s "aist.

Ad0ust the handle of the bike to

Patient#s comfort.

<uspend the "eight in to produce

resistance in the %"heel. $he

amount of "eight being suspended is

calculated b the formula gi&en

belo".

Resistance X (.(*5 W Patient#s Bod

"eight g

Panel =8ig.2? mounted on the front side of the bike sho"s RPM HR $ime

<peed distance and cal per "att.

Before "e start "ith the e!ercise on Monark bike take the

measurement of the patient#s serum lactate le&el. $his "ill

record the le&el of serum lactate in patient#s blood at rest.

Nse lactate scout instrument to measure serum lactate le&el.

:o" put patient on Monark bike and allo" him/her to "arm

up for 2)3 minute b pedaling the bike. :o" as the patient is

"armed up suspend the calculated "eight resistance.

Ask the patient to pedal as hard as he/she can. Record thepo"er output at the end of e&er 5 second. Also record the

peak po"er output in the ;rst ;&e seconds.

At the end of the procedure again measure the serum lactate le&el.

6e can record the readings manuall as "ell as b &ideo recording the front panel

displa.

77



Allo" some time for the patient to cool do"n after the e!ercise.

Measurement

8rom the recording "e "ill ha&e C &alues of po"er measured at the end of e&er 5

second for 3( seconds.

$hese recordings can be used to calculate Peak Po"er output Relati&e Peak Po"er

output anaerobic fatigue and Anaerobic +apacit.

Peak po"er outputD 't is measured b obser&ing the highest po"er output recorded

in in the ;rst 5 second inter&al of the e!ercise. 'mmediate energ sstem in the

bod is emploed in energ generation. Peak po"er output re%ects the capacit of

A$P)Phosphocreatine sstem to produce energ for muscle contraction. $his sstemis depleted Luickl. <o it is used to produce short burst of intense po"er output.

Nnit for the Peak Po"er output is 6att.

Relati&e Peak Po"er outputD 6hen "e di&ide Peak Po"er output "ith bod mass =in

g? "e get Relati&e Peak Po"er output. Relati&e Peak Po"er output denotes the

po"er that can be generated in relation "ith bod mass.

Anaerobic 8atigueD Anaerobic fatigue re%ects the percentage decline in po"er

compared "ith the peak po"er output o&er the 3( seconds time. Anaerobic fatigue

re%ects the capacit of the immediate energ sstem to generate A$P. Anaerobic

fatigue is calculated b subtracting lo"est peak po"er from highest peak po"er anddi&iding the result "ith highest peak po"er multipling the result "ith 1(( gi&es

the &alue of anaerobic fatigue.

==Highest PP G Qo"est PP? / Highest PP? W 1(( X Anaerobic 8atigue

Anaerobic capacitD 't re%ects the amount of "ork accomplished during 3( second

e!ercise. 't is determined b adding all si! recorded &alue and di&iding the sum b

C. $he unit for anaerobic capacit is ilogram)Koule

<erum lactate le&el is tested before during and after e!ercise "ith lactate scout

eLuipment. $esting serum lactate le&el before during and after the e!ercise "ill

gi&e us an insight into the aerobic sstem. Qactate is an end product of the

glcolsis in anaerobic condition. Anaerobic sstem uses glucose as a source of

75



energ. End product of the glucose metabolism in the cell is lactate. More and more

glucose is metabolied to produce A$P during anaerobic e!ercise4 as a result lactate

starts to build up in the cell. 6hen the le&el of lactate increases too much lactate

starts to leak out in from the blood. <erum lactate le&el "ill increase due to leaking

out of lactate from the cell.

Expected out comes Pre< Post and durin' exercise

$he 6ingate Anaerobic $est has been established as an eecti&e tool in measuring

both muscular po"er and anaerobic capacit in a 3)second time period. $his test

can assess the athlete#s peak po"er and the functionalit of the athlete#s anaerobic

sstem.

Highest po"er output "ill be obser&ed in the ;rst 5 second of the e!ercise. 'n the

beginning of the e!ercise immediate energ sstem "ill be fresh and at its peak

capacit to generate A$P. As "e progress "ith the e!ercise the po"er output "ill

decline graduall due to the gradual e!haustion of the anaerobic sstem. Po"er

output "ill be at its lo"est at the end of the 3( second.

At rest normal serum lactate le&el "ill be at (.5)2.2 mmol/Q. As "e start e!ercising

"e "ill notice gradual increase in the serum lactate le&el. $his is because4 lactate is

the end product of the glcolsis in anaerobic condition. As "e keep e!ercising

serum lactate le&el "ill stop increasing. $his is "here serum lactate is at its

threshold.

Efects o% anaerobic trainin'

6hen our bod generates energ through the immediate anaerobic sstem it

reLuires no o!gen to produce energ. 't generates energ in short bursts "ith high

intensit. 't uses A$P and Phosphocreatine to generate energ. $his kind of energ

is reLuired in sprinters i.e. 6eight lifters 1((m and 2((m sprinters short distance

s"immers etc.

$raining of anaerobic sstem of these tpes of athletes "ill enhance their

performance. E!ercise like short inter&al training is especiall bene;cial for

sprinters. Phsiological eects of anaerobic train are increase in the number of fast

t"itch muscle ;bers recruitment of more fast motor ner&e ;bers into a muscle

greater force production in a single bout of muscle contraction.

+alcium is an important ion in muscle contraction. 6hen action potential reaches

the muscle cell sarcoplasmic reticulum in the cell releases calcium to initiate

muscle contraction. +alcium is also a signal transduction molecule in protein

snthesis. +alcium acti&ates protein kinase + enme in the cell "hich leads to

acti&ation of the dierent path"as "hich "ill initiates protein and mitochondrial

7C



7,



Aerobic <stem

7



Measurements

6e measured resting HR lactate and blood pressure of the patient. 6e

measured RPM "atts HR >2 RPE and lactate during e!ercise at the end of

e&er 2 minutes. 6e also measure lactate in the reco&er phase after the

e!ercise. $able belo" sho"s the obser&ations.

$ime RPM 6atts HR >2=Q/min

?

RPE Qactate

=mmol/Q?()2 ,1 1C( C 2,.22 1 1.*2)7 * 237 1(2 3(., 2 2.57)C ,1 2( 112 35.11 3 5.2C), * 31C 121 73. 3 1.7

,)1( ,( 327 137 52.3C 7 2.51()12 1 3C( 15* 5,.(( C 7.,12)17 1 3*C 1*1 C(.*3 ,/ C.*17)1C 3,( 1,1

=ma!?

C(.5=ma

!?

5

As the resistance increased po"er output HR >2 increased. <erum lactate

le&el increased graduall for ;rst 2 readings and then it suddenl shot up.

6atts denotes the intensit of the e!ercise. As the resistance increased

intensit of the e!ercise increased. 'ncreased intensit of the e!ercise

demands more energ production so that HR and >2 increase.

Rate of percei&ed e!ertion "as used to kno" ho" patient is feeling at the end

of the e&er 2 minutes.

Qactate "as measured to check the response of e!ercise on the aerobic and

anaerobic sstem.

'ntensit of the e!ercise "as measured b obser&ing "atts at the end of

e&er 2 minutes.

Ma!imum heart rate achie&ed during test "as 1,1 bpm. And the ma!imum

o!gen consumption obser&ed during test "as C(.5 Q/min.

51



E!pected utcomes Pre)Post and during e!ercise

Aerobic capacit is the ma!imal amount of "ork that an indi&idual can do. 't

is measured b o!gen consumption in ml/min. Before the e!ercise4 at rest

HR and >2 "ill be at normal le&el.

6hen "e e!ercise our muscles are "orking harder than normal. As a result

the reLuire more energ than normal. A$P used b our muscles is generated

"ith the help of o!gen in the mitochondria aerobicall and anaerobicall in

ctosol. An increase in e!ercise intensit "ill result in an increase in muscularA$P demands. $o match the demand rate of A$P production in the cell is

increased. Anaerobic sstem cannot suppl A$P in a sustainable manner.

Aerobic sstem can produce A$P in a more number than anaerobic sstem.

$herefore increased e!ercise intensit ultimatel corresponds to an

increased >2. ur respiration gets progressi&el faster and deeper as the

e!ercise intensit increases. ur bod is tring to pro&ide more o!gen to the

"orking muscles so that the can generate enough A$P to keep us mo&ing. 'n

addition to that nutrient material should be constantl supplied to the

"orking muscle to produce energ. $he rapid increase in energ reLuirements

during e!ercise reLuires eLuall rapid circulator ad0ustments to meet the

increased need for o!gen and nutrients and also to remo&e the end)products

of metabolism such as carbon dio!ide lactate and to dissipate heat. 8aster

pumping of heart "ill ensure that the "orking muscle gets constant suppl of

nutrients o!gen and its utiliation b the mitochondria to produce A$P. $hus

o!gen consumption =>2? and HR increases as the intensit of the e!ercise

increase.

Anaerobic metabolism produces lactate as its end product. As a result "hen

the intensit of the e!ercise increases production of lactate increases in the

cell. 6hen lactate concentration gets too high in the cell it starts leaking out

in the blood. 6ith increased intensit and time of the e!ercise lactate "ill

start building up in the blood. At one point "hen the anaerobic sstem "ill be

"orking at its peak there "ill be sudden sharp increase in the blood lactate

le&el. $his "ill follo"ed b stead higher blood lactate le&el throughout the

e!ercise. uring reco&er period lactate le&el in blood "ill come do"n

graduall as it is metabolied b the enme lactate dehdrogenase.

Eect of e!ercise on the Aerobic sstem

52



ardio!ascular &esponse

'ncrease in mocardial contractilit "ith a resultant increase in stroke

&olume.

'ncrease in the blood %o" through the "orking muscle

9eneralied &asoconstriction occurs that allo"s blood to be shuntedfrom the non)"orking muscles kidnes li&er spleen and other area to

the "orking muscle.

'ncreased heart rate due to increase in freLuenc of sinoatrial node

depolariation

$he &eins of the "orking and non)"orking muscles remain constricted.

ecrease in the blood cholesterol and triglceride le&els

Qo"er blood lactate le&el at subma!imal "ork

&espirator# &esponse

Respirator e!changes occur rapidl. 9as e!change increases across the al&eolar)capillar membrane.

'ncrease in the muscle metabolism during e!ercise results in more 2

e!traction from arterial blood.

Minute &entilation increases as respirator freLuenc and tidal &olume

increases.

Qarger lung &olume de&elops because of impro&ed pulmonar function

"ith no change in tidal &olume

Qarger diusion capacities de&elop because of larger lung &olumes and

greater al&eolar)capillar surface area

=euro<Muscular &esponse 'ncrease in the ner&e conduction &elocit.

More motor neuron recruitment to the muscle

:umber and sie of the mitochondria are increased

'ncrease in the capacit to generate A$P aerobicall

Muscle moglobin concentration increases4 increasing the rate of

o!gen transport and o!gen diusion to mitochondria

Muscle hpertroph

'ncrease in the muscle contraction force

'ncreased slo" t"itch muscle ;bers in the muscle

+ardiac muscle conditioning leads decrease in the heart rate at rest

+onditioning of Respirator muscle leads to increase in Qung

capacities.

'ncrease in the breaking strength of bones and ligaments and tensile

strength of tendons

53



Aerobic e!ercise impro&es e!ercise endurance of the indi&idual. Muscle fatigue is

delaed due to impro&ed endurance. A reduction in resting pulse rate occurs in

indi&iduals because of decrease in smpathetic dri&e "ith decreasing le&el of

norepinephrine and epinephrine. A decrease in blood pressure occurs due to

decrease in peripheral &ascular resistance. Aerobic e!ercise helps in impro&ing

blood pressure in hpertensi&e indi&idual. Aerobic e!ercise also helps in decreasingbod fat.

57



Sources

1. isner +. +olb Q A 2((* Therapeutic Exercise. 5th Edition =8.A. a&is

+ompan?2. . <embulingam P. <embulingam =2(12? Essentials of Medical Physiology. Cth

Edition =Kapee Brothers?3. #sulli&an < B <chmit $ K 2((* Physical Re habilitation. 5th Edition =8.A.

a&is +ompan?

Equipment used in exercise physiology and its uses

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Transcript of Equipment used in exercise physiology and its uses