Evaluation of Aging:

Aerobic Capacity
(Endurance)
PRESENTOR: DR. SONAM JAIN
DATE: 20 T H MARCH 2018

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Objectives
By the end of this session we will be able to:
Define aerobic capacity and oxygen consumption
Know about impaired aerobic capacity
Answer why older adults are prone to impaired aerobic capacity
Know the factors influencing impaired aerobic capacity
Examine the aerobic capacity
Know how to perform tests to measure aerobic capacity

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Important terms
Aerobic capacity: body’s ability to take up, deliver and use oxygen.
Oxygen consumption (VO2):
◦ How much oxygen the body uses at rest or during activity
◦ Directly proportional to the intensity of exercise and will plateau when the maximum ability for
oxygen delivery is reached (VO2max)

Fick equation

VO2 = Cardiac output x Ateriovenous oxygen difference

stroke volume heart rate arterial and venous oxygen content

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Impaired Aerobic Capacity
Common patient impairment that can limit participation in :

◦ Functional activities

◦ Occupational activities

◦ Recreational activities

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Why older adults?
Older adults are vulnerable to impaired aerobic capacity due to the anatomical
and physiological changes that occur due to ageing.

SEDENTATRY LIFESTYLE
Increases the risk of diseases that leads to impaired aerobic capacity.
Aerobic capacity is directly proportional to the habitual activity pattern of the
individual.

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Persistent vicious cycle
Functional
limitations and
disability

Inability to
maintain healthy
lifestyle: Activity
restriction
Chronic diseases Deconditionin
associated with
inactivity g

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Factors influencing aerobic capacity
Deconditioning (decreased physical activity)

Age-related physiological changes

Specific pathology

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Physical therapy examination:
HISTORY
Help to clarify the contributory factors

Identify risk factors for cardiovascular disease

Form appropriate interventions based on risk and patient setting

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Screening
Age
Family history
Smoking
Sedentary lifestyle
Obesity
Hypertension
Dyslipidemia
Prediabetes/ diabetes
HDL level

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Tests and measures
Signs and symptoms in response to increased oxygen demand

◦ Baseline measurement of vitals : HR, BP, RR and SPO2

◦ Measuring these vital signs during aerobic exercises
◦ Patient’s symptoms: fatigue, shortness of breath and weakness during
exercise
◦ Objective measurements: dyspnea, claudication, angina and rate of perceived
exertion

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Walk tests
Commonly used clinical measure: 6 minute walk test

Cooper originally described a 12-min run test in 1968

Modified to 12 minute walk test

Then to 6- and 2-minute walk tests

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Advantages of using walk tests
Inexpensive
Require minimal equipment, facility space, expertise and time
Useful for patients that require use of an assistive device
They pose little risk to patients because the exercise intensity is controlled
Rest intervals can be taken

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How to perform?
Distance is the primary outcome measured in walk tests
Baseline measures: BP, HR, Oxygen saturation and Dyspnea score
Patients are instructed to walk as far as possible in the designated amount of
time
The patient’s self selected walking speed should not be altered
Consistent verbal encouragement should be given after every minute
Measure the vitals again: immediately, after a minute and after 3 minutes

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Graded exercise testing: Uses
oDiagnose cardiovascular and/or pulmonary diseases
oDetermine disease severity/risk stratification
oEvaluate functional ability
oEstablish baseline for exercise prescription
oEvaluate intervention effectiveness

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Graded exercise testing
Measurements: HR, ECG, SPO2, RPE and signs and symptoms
It consists of use of protocols with progressive preset stages of increasing work
intensities with no rest intervals
Modes:
◦ Treadmill walking/running
◦ Leg cycle ergometry
◦ Arm cycle ergometry
◦ Stair stepping

They can be:

◦ Submaximal
◦ Symptom limited or
◦ Maximal
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When can it be used?
When a patient wants to return to a specific occupational or
recreational activity, it is important to determine if the associated
aerobic demands are safe.
When conducting a walk test is not possible
◦ Lack of space
◦ In patients with lower extremity paralysis, testing with an upper body
ergometer is most feasible

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2 minute step test
The subject is expected to raise each knee to a point midway between the
patella and iliac crest.
Score is number of times right knee reaches the required height, in 2 minutes.
Risk zone: less than 65 steps for men and women.

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Question
A 65 year old female complaining of bilateral knee pain with left more than right
NRS: 7/10
◦ Known case of low back pain since 5 years
◦ Pain radiates to right lower limb
◦ Known case of IHD; angioplasty done 10 years back
◦ On further asking, gets breathless after walking a 100 meters

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Astrand Cycle ergometer test
Reliable and valid
Submaximal test
Person is asked to pedal against a constant load for 7 minutes
Measure heart rate at every minute
Determine the steady-state heart rate
Calculate the VO2 and VO2 max based on the gender, weight, height, pulse
rate and workload

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