Back Module: S-RS-S3

Clinical Exercise Testing

Module information

Module details

Title
Clinical Exercise Testing
Type
Specialist
Module code
S-RS-S3
Credits
10
Phase
3
Requirement
Compulsory

Aim of this module

At the end of this module trainees will be able to deliver quality assured clinical exercise assessments using the range of modalities.

Work-based content

Training activities

# Learning outcome Training activity Type Action
# 1 Learning outcome 1, 3 Training activities

Evaluate a local protocol for exercise testing against national and international guidelines and make recommendations

 Type DTA Action View
# 2 Learning outcome 1, 2, 3, 8 Training activities

Develop or review an existing risk assessment for an exercise testing procedure and present to the team

 Type DTA Action View
# 3 Learning outcome 2, 3, 5 Training activities

Assess patients for safety before, during and after exercise using a range of physiological parameters ensuring test termination where appropriate

 Type ETA Action View
# 4 Learning outcome 2, 3, 7, 8 Training activities

Review patient referrals for  patients referred for unexplained breathlessness and identify the most appropriate exercise protocol to answer the clinical question

 Type ETA Action View
# 5 Learning outcome 1, 2, 4, 5, 6, 7, 8 Training activities

Undertake exercise induced asthma assessment with patients and provide a report of the findings

 Type DTA Action View
# 6 Learning outcome 1, 2, 3, 4, 6, 8 Training activities

Undertake incremental shuttle walk assessments with patients and provide a report of the findings

 Type DTA Action View
# 7 Learning outcome 3, 4, 5 Training activities

Undertake field exercise tests and provide a report of the findings

 Type ETA Action View
# 8 Learning outcome 1, 5 Training activities

Identify and correct artefactual anomalies that can occur during the following tests:

  • Cardiopulmonary test
  • Field exercise test
 Type DTA Action View
# 9 Learning outcome 1, 2, 7, 8 Training activities

Assist in cardiopulmonary exercise testing by preparing the patient to undertake the test, ensuring effective communication and maintaining dignity at all times

 Type ETA Action View
# 10 Learning outcome 1, 2, 4, 5, 6, 7, 8 Training activities

Undertake cardiopulmonary exercise testing, generating a report appropriate for physiological interpretation, including relevant technical comments

 Type DTA Action View

Assessments

Complete 2 Case-Based Discussions

Complete 2 DOPS or OCEs

Direct Observation of Practical Skills Titles

  • Prepare CPET equipment in preparation for an exercise test.
  • Perform a field exercise test.
  • Perform a 12 lead ECG measurement during exercise.
  • Perform a manual blood pressure measurement during exercise.

Observed Clinical Event Titles

  • Communicate the results of an exercise test to a multidisciplinary team and make suggestions for future management.
  • Gather a history from a patient and use the information obtained to decide on the most appropriate exercise modality to answer the clinical question.
  • Explain an exercise procedure, using lay terms, to a patient to allow them to provide informed consent.

Learning outcomes

# Learning outcome
1

Prepare equipment and the environment in order to undertake clinical exercise assessments.
2

Prepare patients to undertake field and formal clinical exercise assessments.
3

Select the appropriate clinical exercise assessment based on referral criteria.
4

Undertake clinical exercise assessments.
5

Identify, critically analyse and report key clinical exercise assessment parameters.
6

Prepare reports answering clinical questions using the results of exercise tests, in conjunction with other physiological parameters and patient history.
7

Employ effective communication skills and compassion with a range of patients enabling patients to understand their treatment pathway.
8

Demonstrate a patient centered approach to practice, considering communication with patients and relatives and the patient experience.

Clinical experiences

Clinical experiences help you to develop insight into your practice and a greater understanding of your specialty's impact on patient care. Clinical experiences should be included in your training plan and you may be asked to help organise your experiences. Reflections and observations from your experiences may help you to advance your practice and can be used to develop evidence to demonstrate your awareness and appreciation of your specialty.

Activities

  1. Attend a multidisciplinary team meeting where exercise test outcomes are discussed.
  2. Attend a surgical clinic that uses exercise test results to inform decision making regarding surgical intervention e.g. vascular surgery or colorectal surgery.
  3. Attend a pulmonary rehabilitation session.
  4. Spend time with a Home Oxygen Service Assessment and Review (HOS-AR) team.

Academic content (MSc in Clinical Science)

Important information

The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.

Learning outcomes

On successful completion of this module the trainee will know and be able to:

  1. Describe the structure, function, mechanics and control of the cardiorespiratory system at rest and during exercise.
  2. Critically evaluate how lifestyle changes impact on exercise and know the importance of field exercise testing and cardiopulmonary exercise testing.
  3. Critically appraise the interpretation the various respiratory tests in the confirmation of disease and be aware of national and international clinical guidelines.

Indicative content

Structure, function, mechanics and control of the cardiorespiratory system at rest and during exercise:

  • Blood gas physiology
  • Acid-base balance
  • Ventilation
  • Gas transport and exchange

Field exercise testing:

  • Indications for performing field exercise tests
    • Objective assessment of exercise capacity
    • Assessment of symptoms
    • Unexplained dyspnoea on exertion
    • Assessment of disability
    • Desaturation on exercise
    • Serial monitoring
    • Assessment for ambulatory oxygen
  • Field exercise protocols
    • Equipment
    • How to decide the most appropriate protocol to use
    • Advantages and disadvantages of each protocol
    • Six-minute walk, incremental shuttle walk, endurance shuttle walk and sit to stand
    • Manual calculation of results and predicted values
  • Measurements
    • Heart rate and oxygen saturation
    • Assessment of symptoms: Borg scale, visual analogue scale and rating of perceived exertion
  • Interpretation and reporting of results
    • Common patterns of results in disease: cardiac vs respiratory disease
  • Normal vs abnormal results
    • Symptoms
    • Obstructive vs restrictive lung disease

Cardiorespiratory responses to exercise:

  • Normal response to exercise, to include:
    • Muscles – structure, metabolism and substrates
    • Cardiac response to exercise – control of response, cardiac frequency, stroke volume and cardiac output
    • Ventilatory response to exercise – control of response, breathing frequency, tidal volume and ventilation perfusion ratio during exercise
    • Circulatory response to exercise – redistribution of blood flow to muscles
  • Limiting factors to peak exercise in normal subjects
  • Exercise response in disease, to include:
    • Cardiac and respiratory (including obstructive and restrictive disease) – patterns of response, major limiting factors and assessments of symptoms
    • Other disorders – obesity, unfitness, malingering and deconditioning
    • Contraindications to exercise testing and safety during exercise tests
    • Recognition of indications to terminate the exercise test prematurely, e.g. symptoms
  • Common protocols used in cardiopulmonary exercise testing
  • Uses and limitations of cardiopulmonary exercise testing and its value in clinical practice

Full cardiopulmonary exercise testing:

  • Indications for performing full cardiopulmonary exercise tests
    • Assessment of symptoms
    • Differentiation of cardiac versus respiratory impairment
    • Unexplained dyspnoea
    • Assessment for surgery
    • Fitness assessment
  • Exercise protocols
    • Maximal vs submaximal
    • Advantages and disadvantages
    • Cycle ergometer vs treadmill
    • How to decide on the most appropriate protocol
  • Principals of equipment
    • Gas analysis
    • Volume measurement
    • Blood gases
    • Quality control and calibration
    • Graphical representation of results
  • Measurements
    • Ventilation and frequency
    • Oxygen uptake and carbon dioxide output
    • Heart rate and oxygen pulse
    • Respiratory exchange ratio
    • Oxygen saturation
    • Assessment of symptoms
  • Exercise facilities
    • Health and safety requirements
    • BLS/ALS, resuscitation equipment and oxygen
  • Concepts of interpretation of results
    • Graphs and flow charts
    • Common patterns of results in disease: cardiac vs respiratory
    • Symptoms
    • Breathing reserve
    • Cardiac reserve
    • Obstructive vs restrictive lung disease
    • Cardiac disease
    • Use of anaerobic threshold in interpretation

Interpretation:

  • Application of various respiratory tests in the confirmation of disease
  • Awareness of clinical guidelines, e.g. NICE, ERS/ATS, COPD and asthma
  • Clinical report writing techniques
  • The role of the respiratory physiologist in the multidisciplinary team

How lifestyle changes impact on exercise:

  • Smoking cessation strategies
  • Exercise prescription
  • Weight management
  • Pulmonary rehabilitation

Module assigned to

Specialties

Specialty code Specialty title Action
Specialty code SPS1-3-22 Specialty title Respiratory & Sleep Science [2022] Action View
Specialty code SPS1-3-23 Specialty title Respiratory & Sleep Science [2023] Action View
Specialty code SPS1-3-24 Specialty title Respiratory & Sleep Science [2024] Action View
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