What is the exercise medicine?
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Exercise medicine deals with responses and adaptations of cardio respiratory, metabolic and other physiological and pathophysiological functions on stress; mainly physical [1]. Exercise medicine became a part of comprehensive examination of many internal diseases. The prescription and the recommendation of therapeutic, psychotherapeutic or recreational physical activity should be a part of the conclusion after the exercise examination in most cases of internal diseases. The reason for the application of the exercise medicine for the prescription of physical activity lies mainly in different conditions for the examination. Patients are usually in health centers at rest. According to basal values (clinical, laboratory, ECG etc.) it is judged the seriousness of a disease and consequently the therapy, the physiotherapy or the diet are prescribed. Patients perform common moving activity after being released from a health centre - he works and wants to do (or should do) some recreational or other physical activities for improving the quality of life. However, the response of individual functions (neurohumoral control, cardio respiratory, metabolic and other functions) is changing under this physical stress, even some pathological reactions (in ECG, blood pressure etc.) may by provoked. Therefore the prescription according to basal values may lead to the improper recommendation of the physical activity. The consequences of the inappropriate prescription of the physical activity in the most of less serious diseases are not substantial and a cured patient lives without any consequences. In case of more serious diseases where the therapy and the activity regime were inappropriately recommended due to the basal examination without the stress verification, there may occur serious complications that lead to the relapse, an impairment of health status, the re-hospitalization and rather rarely to the death. The usual instrument of exercise medicine is an exercise test.

EXERCISE TEST

Exercise tests allow a measurement and an observation of the response and the adaptation of different organ functions (first of all cardio respiratory and metabolic) in the relation to certain exercise [1]. Exercise tests are important in clinic medicine because they allow observing the development of abnormal changes existing already at rest and they may also provoke some pathological reactions, which are not evident at rest. The response of parameters is either measured during exercise tests or during recovery, or both ways are combined. The figure shows the various possibilities of the exercise testing. It exists not only the dynamic test on the bicycle ergometer, which is the most spread method and everyone firstly imagines this type of exercise test, but also exist a lot of other types (see the figure 1.1). However, this dissertation deals with the biosignals produced during dynamic spiroergometric exercise test and therefore the term - exercise test - means only the spiroergometric examination further in the text.



Figure: Review of exercise tests

SPIROERGOMETRIC EXAMINATION

The spiroergometric examination is a common screaming method in various field of medicine and it serves as a gold basis in the exercise testing. It enables the simultaneous evaluation of the cardiovascular systemsí ability to perform its major function, i.e., gas exchange. It assists not only in the assessment of the physical fitness and efficiency of healthy, ailing and sick persons, but also in checking the effect of treatment, rehabilitation or training. The spiroergometric examination also serves as an additional decision criterion. For example, if it is important to determine whether new medical, surgical, and rehabilitation procedures are effective interventions. Also, when an individual patient may have mixed defects, e.g. cardiac and respiratory, and it is necessary to determine the relative contribution of each to the patientís symptoms before embarking on major therapeutic procedures directed at either one. Because spiroergometric testing allows an assessment of the circulatory and ventilatory reserves under stress it may also provide useful information prior to surgery. An ergometric examination is often also carried out for healthy individuals because of prevention. In this case the exercise test serves for different objectives: for the young the aim is to compare the fitness level with age norm, for sportsmen to assess the level of training etc. Furthermore; the spiroergometry is a method to find the reasons for lowered stress adaptation; especially for people without subjective problems with the normal clinic diagnosis, however with the degraded performance. Most of the spiroergometric examination requirements meet cycle ergometer figure 1.2. It allows no only the conventional work of lower limbs but also the work of upper limbs and it allows with suitable equipment also the application of invasive techniques (catheterization) in the supine position.

Reference:

[1] Wasserman, K.W., J.E. Hansen, D.Y. Sue, B.J. Whipp: Principles of Exercise Testing and Interpretation. Philadelphia: Lea&Febigner, 1987
 
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