## ACSM CES (clinical exercise specialist)

1 MET is equal to?
3.5 ml.Kg-.min-

Cardiac output(Q) at rest is appoximatley
5L/min

Cardiac output(Q) is the product of?
Stroke volume(SV)xHeart Rate(Hr)

Predicted Heart Rate maximum formula is
220-age

Stroke volume is found by what equation?
EDV(End Diastolic Volume)-ESV(End Systolic Volume)
diastolic is relaxation phase. systolic is contraction

Heart Rate Reserve=
(MHR-RHR)%+RHR
max. HR – resting HR x percent target + resting Hr

VO2 reserve=
(vo2max-vo2rest)% + vo2rest
vo2rest= 3.5 ml.kg-.min-

1mph= to want in m/min
26.8

1 watt=
6 kg.m.min-

1 lbs of Fat= how many Kcals
3500 Kcals

1L of consumed o2 infers how many kcal ?
5 Kcals

1 in to cm and m
2.54 cm or .0254 m

1l is how many ml?
1000ml

MAP(mean arterial pressure)=
(SBP-DBP)/3 + DBP
where SBP=sysytolic BP and DBP is diastolic

EF(ejection Fraction)=
(SV/EDV)x 100 = ef in % of 100
SV= stroke volume
EDV= end diastolic volume

Double Product(Rate Pressure Product)=
SBPxHR
SBP= systolic BP

formula for Vo2 on leg ergometer is?
(10.8x W)/m + 7.0 or (1.8xW)/m + 7.0
where W is work rate in Watt or Kg.m.min-1 respectively
m is Mass in Kg
7.0 is a constant taking into account vertical and horizontal components of resting metabolism.

formula for Vo2 on arm ergometer is?
(18x W)/m + 3.5 or (3.0xW)/m + 3.5
where W is work rate in Watt or Kg.m.min-1 respectively
m is Mass in Kg
3.5 is resting vo2

formula for Vo2 walking on a treadmill is?
(0.1xS)+(1.8xSxG)+ 3.5
S is speed in m/min

formula for Vo2 running on a treadmill is?
(0.2xS)+(0.9xSxG)+ 3.5
S is speed in m/min

formula for Vo2 on a step ergometer is?
(0.2xF)+(1.33×1.8xFxH)+3.5
where F is frequency in steps per min
H is height in meters

Formula for finding Work rate on bike or arm ergo?
RxRPMXD
where R is the resistance on the flywheel.
RPM is Rotations per Minute
and D is the distance the flywheel travels in on revolution.

o2 carrying capacity of hemoglobin is?
~1.34 ml of O2 / gram of Hb.

~ grams of Hemoglobin per 100 ml of blood?
20 g of Hb/ 100 ml blood

formula for the Fick equation?
Vo2= Q x a-vo2 diff
where Q is cardiac output
and a-vo2 diff is the difference in arterial and venous oxygen concentration.

absolute indications to terminate exercise testing are?
-drop in systolic BP > or = to 10mm Hg w/ increase work rate when -s/s present w/ the drop
-angina > or = 3/ 4 on the scale
-increasing nervous system symptoms
-signs of poor perfusion
-difficulties monitoring ECG or BP
-patient requests to terminate test
-sustained VT
-ST elevation greater than 1mm in leads w/o diagnostic Q wave (other than v1 or aVR)

relative indications to terminate exercise testing are?
-drop in systolic BP > or = to 10mm Hg w/ increase work rate not accompanied by s/s’s
-ST or QRS changes such as >2mm st depression downsloping or horizontal.
-arrhythmia other than VT(multifocal pvc’s, triplet pvc’s, SVT, high grade Heart blocks or bradycardia.
-fatigue, SOB, wheezing, claudication
-BBB or IVCD that can not be differentiated from VT ( such as new onset LBBB)
-increasing CP
-hypertensive response SBP >250 or DBP>115

absolute contraindications to exercise testing are?
-recent change in resting EKG suggestive of significant ischemia, recent MI or other acute cardiac event.
-unstable angina
-uncontrolled cardiac dysrhythmias causing symptoms.
-symptomatic severe aortic stenosis
-symptomatic Heart Failure
-acute myo- or peri- carditis
-dissecting aneurysm

relative contraindications to exercise testing are?
-left main coronary stenosis
-moderate stenotic valvular heart disease
-electrolyte abnormalities
-severe arterial Htn SBP>200 DBP>110 @ rest
-hypertrophic cardiomyopathy
-neuromotor, musculoskeletal, rheumatiod disorders worsened by exercise.
– High degree AV blocks
– Ventricular aneurysm
-uncontrolled metabolic disease
-Chronic infectious disease
-mental or physical impairments

CVD Risk stratification as Low Risk
<2 RF and asymptomatic

CVD Risk stratification as moderate Risk
>=2 RF and asymptomatic

CVD Risk stratification as High Risk
Symptomatic or known known cardiovascular, pulmonary, renal or metabolic disease.

cardiovascular RF are?
-Age >= 45 in men; 55 in women
-Family Hx; MI, CABG, SCD before 55 yoa in men and 65 in women owith 1st degree relative.
-Smoking within 6 months or exposure to environmental (2nd hand ex. working in a Bar)
– sedentary lifestyle. <30 min of moderate intensity physical activity(40-<60%vo2R) on at least 3d/week for at least 3 months -obesity BMI >= 30kg.m^2 or waist girth >102cm in men, >88 cm in women.
– hypertension sbp >= 140 dbp >= 90 confirmed on at least 2 occasions or on BP Rx.
-Dyslipidemia ldl >= 130, hdl <40, total chol >= 200 or on cholesterol Rx.
-Prediabetes aka impaired fasting glucose. >= 100 ans <=125 HVL>= 60 is a negative RF and one positive RF can be subtracted from the total.

also of importance is if a RF is not known or available it should be counted except prediabetes. for prediabetes it should be counted if their over the age of 45 or if under 45 with a bmi of >=25.

Timmy is a 43 Y.o male who smokes, his HDL is 65 , BMI 31 and He exercises moderately for 1 hr a day 3 time a week. everything else is WNL. what is his Risk Stratification for CVD?
Low.
Why, he has 2 positive RF; smoking and Weight but one negative RF HDL >60
2-1=1
1 RF puts him in the low RS

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