Slide 1: Treadmill & Bicycle Ergometer Slide 2: A treadmill is a piece of indoor sporting equipment
The principle is a belt system (an electric motor or flywheel connected to a circular run of material) where the top of the belt moves to the rear so as to allow a runner to run an equal, and necessarily opposite speed.
the speed of the run can easily be set or measured
A cardiac treadmill, used by physicians to determine their patients' heart health
It is not always an accurate cardiac problem indicator
Even if the person is not having any symptoms of cardiac problem TMT can tell the heart health status and hence more prevalent in health insurance
To prepare for a heart treadmill exercise tests the patient have to avoid food or beverage for four hours prior to the testing Slide 3: A stress test, sometimes called a treadmill test or exercise test, helps a doctor find out how well your heart handles work
A test (sometimes called the exercise treadmill test or exercise test) in which a continuous electrocardiogram (ECG or EKG) recording of the heart is made as the patient performs increasing levels of exercise on the treadmill which is tilted to produce the effect of going up a small hill
The patient can stop the test at any time, if necessary.
Afterwards the patient has heart and blood pressure checked
The treadmill test screens for the presence of narrowed coronary arteries that can limit the supply of oxygenated blood to the heart muscle during exercise
The test also detects abnormal heart rhythms How does a Regular Stress Test Work? : Patients with coronary artery blockages may have minimal symptoms and an unremarkable or unchanged EKG while at rest
During exercise, healthy coronary arteries dilate (develop a more open channel) than an artery that has a blockage
This unequal dilation causes more blood to be delivered to heart muscle supplied by the normal artery.
In contrast, narrowed arteries end up supplying reduced flow to it's area of distribution
This reduced flow causes the involved muscle to "starve" during exercise
The "starvation" may produce symptoms (like chest discomfort or inappropriate shortness of breath), and the EKG may produce characteristic abnormalities
Most commonly, a motorized treadmill is used for exercise, while a stationary bicycle is used in some exercise laboratories. How does a Regular Stress Test Work? When is a Regular Stress Test ordered? : Patients with symptoms or signs that are suggestive of coronary artery diseases (CAD).
Patients with significant risk factors for CAD.
To evaluate exercise tolerance when patients have unexplained fatigue and shortness of breath.
To evaluate blood pressure response to exercise in patients with borderline hypertension.
To look for exercise-induced serious irregular heart beats. When is a Regular Stress Test ordered? How is a Regular Treadmill Stress Test Performed? : the heart rate and blood pressure are recorded at rest.
Sticky electrodes are attached to the chest, shoulders and hips and connected to the EKG portion of the Stress test machine.
A 12-lead EKG is recorded on paper
Leads 2, 3, and aVF = bottom or inferior portion of the heart.
Leads V1 and V2 = septum or partition of the heart.
Leads V3, V4, V5 and V6 = anterior or front portion of the heart.
Leads 1 and aVL = superior or top and outer left portion of the heart.
Lead aVR looks at the cavity of the heart and has almost no clinical value in identifying coronary disease.
Three of the EKG leads are also constantly displayed on the treadmill monitor How is a Regular Treadmill Stress Test Performed? How is a Regular Treadmill Stress Test Performed? : The treadmill is then started at a relatively slow "warm-up" speed
The treadmill speed and it's slope or inclination are increased every three minutes according to a pre programmed protocol
The protocol dictates the precise speed and slope.
Each three minute interval is known as a Stage
The patient's blood pressure is usually recorded during the second minute of each Stage
the EKG is constantly displayed on the monitor & is also recorded on paper at one minute intervals
The treadmill is stopped when the patient achieves a target heart rate
target heart rate is 85% of the maximal heart rate predicted for the patient's age.
The test may be stopped prior to achievement of the target heart rate if the patient develops significant chest discomfort, shortness of breath, dizziness, unsteady gait, etc., or if the EKG shows alarming changes or serious irregular heart beats.
It may also be stopped if the blood pressure (BP) rises or falls beyond acceptable limits.
the systolic BP (upper number) may normally rise to 200 at peak exercise
the diastolic BP (lower number) remains unchanged or falls to a slight degree How is a Regular Treadmill Stress Test Performed? Treadmill Parts : a walking belt that keeps moving
major part of a treadmill is its motor and the drive mechanism
There can also be two motors present in a treadmill – one for driving the treadmill belt and one for the incline
The motor that is used in a treadmill are usually DC motors.
other important part is the drive mechanism for the walking belt. There are chain drive mechanisms and also belt drive mechanisms
another motor for adjusting the inclination and also a gear system to raise and lower the walking belt for the required inclination.
The outer frame of the treadmill is the part that the patient can hold on when walking or jogging slowly
The side frame can also help the patient to regain balance if they feel like losing balance on the treadmill
The sophisticated electronics will help to know the speed at which patients are walking, the calories they burnt, heart rate, time and distance covered and lots more
The most important factor is horse power
Horse power is the amount of power which is delivered by the motor during working
A treadmill for running should have a minimum of 3.0 horse power rating Treadmill Parts How to Calculate Target Heart Rate : Karvonen Method of calculating THR is one of the most effective method
Find resting heart rate. Then obtain average resting heart rate (RHR)
Find your maximum heart rate and heart rate reserve.
a) Subtract patient’s age from 220. This is his/her maximum heart rate (HRmax).
b) Subtract RHR from your Hrmax. This is heart rate reserve (HRmaxRESERVE).
3. Calculate the lower limit of THR.
4. Calculate the upper limit of THR
5. Divide the values obtained in steps 3 and 4 by the number 6 to obtain your THR in beats per ten seconds
The target heart rate is an estimate only! How to Calculate Target Heart Rate The Bruce Treadmill Test : The original Bruce protocol was developed by DR. Robert. A. Bruce in 1963.
The Bruce Treadmill test simply refers to the protocol used. Other protocols include Naughton, Astrand and Balke.
At 3-minute intervals both the speed and incline of the treadmill are increased( Described in the table) The Bruce Treadmill Test The Bruce Treadmill Test : This is a maximal test - which means that the individual must continue until they are fatigued The Bruce Treadmill Test Modified Bruce protocol : Standard Bruce protocol for treadmill exercise test has 7 three minute stages
First stage starts at a speed of 1.7 miles per hour (mph) and a gradient of 10%.
Each subsequent stage has an increment of 0.7 to 0.8 mph in speed and 2% in gradient
Modified Bruce protocol starts with a speed of 1.7 mph and a gradient of 0%.
Second and third stages have the same speed, but the gradient increase by 5%.
Third stage of modified Bruce protocol is thus equivalent to stage 1 of standard Bruce protocol
Further stages are just like that of subsequent stages of standard Bruce protocol.
Earlier the first two stages of modified Bruce protocol were called stage 0 and stage 1/2 because the gradient was zero in the first stage and half of that of stage one in second stage Modified Bruce protocol Modified Bruce protocol : Modified Bruce protocol for treadmill testing is usually applied when poor condition of the subject is suspected clinically or while conducting a pre discharge treadmill test after treatment for acute myocardial infarction.
Pre discharge treadmill test is often a sign limited one unlike the symptom limited test done in other situations
Maximum heart rate aimed at is around 120 per minute, unlike the 220-age maximum predicted heart rate for the standard treadmill test. Modified Bruce protocol Bicycle ergometer : A bicycle ergometer is a static bicycle which has had the drive wheel removed
An apparatus used to measure energy expenditure at different activity levels
The workload is adjusted by altering the weight attached to a flywheel
A well-designed bicycle ergometer will have a heavy flywheel to provide a smooth ride, a comfortable seat, and straps on the pedals.
The handlebars and seat should be easy to adjust to individual requirements
A cycle ergometer supports the upper body, keeping it relatively immobile so that the cyclist's blood pressure can be measured and blood samples taken Bicycle ergometer Bicycle Ergometer : A stationary one-wheeled cycle used as an ergometer to measure a person's work output under controlled conditions
Most exercise bikes provide a mechanism for applying resistance to the pedals which increases the intensity of the exercise.
varying mechanical resistance (by tightening or loosening a flywheel), electrical resistance (by changing the strength of the magnetic field through which an electrical conductor moves), air resistance (produced by fan blades displacing air as the wheel turns), or hydraulic fluid resistance
Because much of the body weight is supported by the cycle, resistance is relatively independent of body weight (compare treadmill). Bicycle Ergometer Treadmill Vs Exercise Bike : Ease of operation
Bells and Whistles
Clinical condition Treadmill Vs Exercise Bike