Help File FCEase Manual

• Blood Pressure
• Heart Rate
• Pain Measurement
• Perceived Exertion Levels
• Cardiovascular Step Test
• Hand Dynamometer Testing

This data, collected prior to testing, is extremely valuable when compared to the data collected during testing to enable the evaluator to interpret the results of the evaluation.

  Reason for performing test:

The physiological basis for monitoring heart rate during the evaluation is to monitor consistency of performance, level of effort, and evaluating the client's response to determined physical demands. Heart rate response comparison is based on the clients’ previously evaluated ability to perform during the three (3) minute step test or other appropriately followed cardiovascular testing protocols.

Procedure (detail):

The heart rate is monitored continuously during testing by use of a remote heart rate monitor placed on non dominant wrist with transmitter placed around the chest and below the nipple line on men, below breasts on females.

Use of equipment during testing:

Record heart rate response reading achieved at the start and end of each test segment. When performing BABI testing, 30 or 60 second readings are required. Comparison should be made to the predicted maximal heart rate using a standard Karvonen (220 - age) = maximal heart rate x% of max desired. Set monitor alarm at 75% ± 5 beats per minute as a safety guide for the segment of testing.

  Data collection and correlation (what is being measured, observed, and how):

• Used to correlate predicted max VO2 to lifting VO2 achieved
• Used to determine general fitness level for the individual.
• Used to correlate consistency of effort to perceived exertion.

  Expected results or normally viewed patterns:

Heart rate normally increases with effort required to perform activity.

Heart rate and respiration will increase during the first 1-2 minutes of activity until steady state is achieved.

Increases or decreases in heart rate mirror the physical strain experienced subjectively under a standard rate of exercise (Astrand).

Hint:

Monitoring of heart rate can allow easier interpretation of results to produce a more objective F.C.E. report. Linking observed pain behaviors and heart rate to the activities being performed can provide data on the consistency of performance.

Objectively, this information indicates consistency in performance with minimal pain related dysfunction.

Contraindications:

If a resting heart rate is above 100 bpm, attempt to have the client relax and bring the heart rate down. This can be done with client taking slow deep breaths or having the client focus on relaxing thoughts.

Smoking, medications, caffeine, recent viral infections, or fever can artificially increase resting heart rate. In the case of Beta Blocker use, the heart rate may be reduced and should be taken into consideration. But the use of these medications is not a contraindication to performing the evaluation. Remember these clients will have to return to the job on some long term medications including Beta Blockers so performance abilities should be known.

• Noted changes in heart rate with activities.
• Correlation to blood pressure, respiration, pain reports, pain responses and behaviors.

Blood Pressure Testing

Individuals under 45 years of age - taken as a baseline control only at beginning of testing.

In individuals over 45 years of age and/or with history of hypertension or currently on hypertensive medication it is recommended that the blood pressure be taken periodically during testing, after every 3 activities.

Hints:

Digital blood pressure monitors are recommended for this evaluation.
Make sure to ask the client if they are currently under hypertensive medication or beta
blocking drugs, as they will significantly affect the accuracy of this portion of the
testing.
If extra B.P. monitoring is required, it is handy to measure B.P. after: Cardiovascular evaluation (Step Test) - during initial phase of the recovery period. After significant increases in subjective pain complaints. Between lifting and carrying. After simulated activities where exertion levels are high, or after every 3 activities.

Contraindications:

Any candidate with a resting systolic pressure.200 mmHg or resting diastolic pressure . 115 mmHg should be cleared by referring doctor prior to testing.

Pressures between 145/95 and 200/115 should be considered on the basis of professional judgement of the evaluator based on individual cases, referral information, available medical information, and client's report.

Classification of Blood Pressure for Adults Age 18 and Older

Table 3 - 4 ACSM's Guidelines For Exercise Testing and Prescription, pg. 33, 5th ed., 1995

  Typical Substitution patterns:

Valsalva Manoeuvre may be a noted occurrence causing sharp increases in blood pressure. The evaluator should monitor clients respiration pattern to make sure the client is not holding his/her breath during activities.

  Equipment required

• Sphygmomanometer (manual or digital)
  
• Stethoscope (required only if B.P. manually performed)

Pain Testing

For the purposes of this manual, a simple linear 0-10 pain scale is used and recorded. More involved processes can be used, however, time and simplicity of use by the client must be considered when examining the whole process. The real usefulness is to provide a means of reporting a rise, fall, or static pain reading in relation to certain activities.

Explain pain graph and establish pre-test pain level.

Beware that time is of the essence and that pain levels are not as important to you as they may be to the client.

Hint:

Ask for position of pain and number value of pain only.

It may help to ask if the pain has increased, decreased, or is about the same as the previous level.

It may also help to establish that tightness, heaviness, ache, and crampy feelings, are all regarded as pain when assessing pain values.

Perceived Exertion

The Modified Rating of Perceived Exertion Scale can be useful when correlating with Pain and heart rate levels (B.A.B.I.) to build up a profile of behaviors during the various components of the test.

This scale is useful as a means of objectively measuring the perceived difficulty of performing the activity as opposed to measuring pain levels.

It is an unusual concept for the client to grasp, but after several activities they will usually nominate the value spontaneously. Using the verbal correlation may also be useful in getting concept across to a client

Hint:

• Ensure a number value is given.
  
• Inserting the word "difficult" as opposed to "hard" can facilitate a number value during certain activities.

Original and Revised Scales for Ratings of Perceived Exertion (RPE)

G. Borg, 1982, Psychophysical judgement and the process of perception, H.G. Geissler and P. Petzold, Berlin: VEB Deutscher Verlag der Wissenschaften, 25-34.