ATS Pulmonary Function Laboratory Manual

ATS Pulmonary Function Laboratory Management & Procedure Manual | 3rd Edition

Pre-Test Preparation

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Step Action 8.

Determine exercise intensity • Several methods of determining the exercise intensity for the test are reviewed above ( see Exercise Intensity). • The most common approach is to multiply predicted Max HR times 0.85 to obtain target heart rate.

Test Procedure for Exercise Challenge Test

Step Action 1.

Position patient on treadmill or cycle ergometer

2. Treadmill Instructions: • Instruct the patient to keep hands at side. � If railings are used, the back of the hands can be used for balance or light touch. � Arm support decreases the effective work rate (6). Arm support also increases the muscle artifact in the ECG tracing (35). • A brief trial walk may be appropriate both to familiarize the patient with the equipment and to check the ECG signal for motion artifact. • For the patient’s safety, a spotter at the rear of the treadmill may be appropriate. 3, Cycle Ergometer Instructions: • Adjust handlebar and saddle height. • When pedal is at bottom dead center, leg extension should be about 20° at the knees. • Instruct patient on pedal speed ( see ergometer manual for linearity tolerance). • A brief trial with little or no power output may be appropriate both to familiarize the patient with the equipment and to check the ECG signal for motion artifact. 4. Instruct patient on use of Borg scale (47, 74) or other rating scales (e.g., chest pain, chest tightness, light- headedness, etc). 5. Place nose clip on the patient just prior to starting exercise and leave in place during the exercise test (5, 6, 36, 48, 73). • Nose clip is recommended to maximize the drying of the airways. • Use of a nose clip also ensures the same breathing strategy (mouth-breathing) throughout exercise. 6. Place pulse oximeter probe: • Select probe (e.g. finger, ear probe, or reflectance). • Prep the site, if applicable, according to oximeter manual instructions. 7. Obtain resting ECG. Results may differ morphologically (e.g. T-wave inversion) from standard ECG performed in the supine position with limb-lead configuration (37, 46). 8. Obtain resting blood pressure measurement and assess results for contraindications. 9. Obtain resting RPE and/or other subjective information (e.g., shortness of breath, chest tightness, wheezing, chest pain). A 0–4 scale can be used, where 0 is nothing at all, and 4 is severe (74).

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