HESS 544 Practice Lab

Purpose

The purpose of this laboratory experience is to develop your skill in measuring:

· Resting and exercise heart rates (HR) by palpation, auscultation, heart rate monitors, and,

· Resting and exercise blood pressures (BP) by auscultation.

Equipment

1. HR monitors

2. Aneroid sphygmomanometers

3. Stethoscopes

4. Aerobic Exercise Room Equipment

Student Assignments

1. Work in a group of four: one student as client, one student as tester, one student as data recorder, and one to critique others on protocol

2. Rotate assignments so that each student gets to be the client, tester, recorder, and critic.

Heart Rate Measurement Procedures

1. Review methods:

· Palpation

· Auscultation

· Heart rate monitors

2. Review procedures.

· Resting: Subject is seated and pulse rate is counted for 30 sec or 1 min. Evaluate resting HR (normal, bradycardia [<60 bpm], or tachycardia [100 bpm]?).

· Exercise: Pulse rate is measured using 10- or 15-sec count; HR is measured during last minute of each workload (usually every 2 to 3 min) during graded exercise test. For this practice, record every minute.

· Recovery: Pulse rate is monitored using 10- or 15-sec count; HR is measured every 1 to 2 min during the 3- to 5-min (low intensity and active) recovery period until stabilized.

3. Normal exercise HR responses:

· HR increases with increasing work intensities.

· HR stabilizes (steady state) during each workload.

· HR should stabilize during recovery but may not return to baseline levels within 5 min.

4. Abnormal exercise HR responses:

· HR fails to rise with increase in workload.

· There is noticeable change in heart rhythm.

· There is onset of angina or angina-like symptoms.

HR Activities

1. Attach HR monitor to the subject who will exercise.

2. Have the subject at seated rest for five minutes.

3. Following standardized procedures, take resting HR count using palpation and auscultation. Compare to HR monitor or ECG values when possible.

4. Have subject assume an exercise position on a stationary exercise device (treadmill, bike, elliptical glider, etc).

5. Have the subject begin exercising at low intensity (HR 120 bpm). Record the intensity (workload). Record Heart Rate at every minute by palpation and monitor

6. Have the subject work at a higher intensity (HR 130 150 bpm). Record the Heart Rate at every minute by palpation and monitor

7. Take exercise HR at end of each minute and compare to values obtained simultaneously from HR monitor. If you are palpating HR accurately, these values should be within 4 to 6 bpm.

BP Measurement Procedures

1. Review procedures:

· Resting: Subject is seated for at least 5 min with elbow flexed. Wrap cuff firmly around upper arm at heart level and align cuff with brachial artery. Place bell below antecubital space over the brachial artery. Rapidly inflate cuff to 200 mmHg or +20 mmHg above estimated systolic value. Slowly release pressure in cuff at rate of 2 to 3 mmHg/sec, noting first Korotkoff sound. Continue releasing pressure, noting when sound is muffled (fourth Korotkoff sound) and when it disappears (fifth Korotkoff sound). Take at least two readings. Evaluate (see table 2.3). Normal resting BP is <120/80 mmHg. Relative contraindication if resting BP is >200/110 mmHg. (Note: For clinical testing, resting BP is evaluated in both supine and exercise postures.)

· Exercise: BP is measured during the last minute of each work bout (usually every 2 to 3 min depending on graded exercise test protocol). For this practice, record every minute.

· Recovery: BP is measured immediately after termination of the graded exercise test (for clinical testing only) and then every 1 to 2 min during active recovery for 3 to 5 min until stabilized.

2. Normal exercise BP responses:

· Systolic BP should increase with increasing exercise intensities.

· Diastolic BP should decrease or stay the same during GXT.

· Rise in systolic BP will be steeper and diastolic BP will increase during arm ergometry GXT.

· Systolic BP is more elevated during exercise in upright versus supine posture and for weight-bearing (e.g., treadmill or step exercise) versus non-weight-bearing (e.g., cycling) exercise.

· BP should stabilize during recovery but may not return to baseline values within 5 min.

3. Abnormal exercise BP responses:

· Failure of systolic BP to increase or a significant drop in systolic BP (>20 mmHg) with increase in exercise intensity

· Excessive rise in systolic BP (>250 mmHg) or diastolic BP (>115 mmHg)

BP Activities

1. Practice taking resting BP following standardized procedures. Record values.

2. Practice taking exercise BPs with client exercising on the exercise equipment at low to moderate intensities. Remember to stabilize client's arm during measurement. Use dual scope to see if your readings coincide with other tester's values. (use same exercise protocol as for HR above

Discussion Questions

1. What are the potential sources of error in measuring heart rate by palpation? What can you do to minimize these sources of error?

2. What is your own resting HR classification?

3. Were your palpated HR values close to those obtained using the HR monitor?

4. Describe your HR response during exercise and recovery. Were your HR responses normal?

5. What are the potential sources of error in measuring blood pressure at rest and during exercise? What can you do to minimize these sources of error?

6. What is your resting BP classification?

7. Describe your BP response during exercise and recovery. Were your BP responses normal?

Data Collection Form for Measurement of Heart Rate and Blood Pressure

Resting HR (5 min seated rest)

Palpation ______bpm

HR monitor ______bpm

Auscultation ______bpm

Resting BP [SBP/DBP] – (5 minute seated rest)

Trial 1 _____/______

Trial 2 _____/______

Exercise HR / BP Exercise Modality = ______

Intensity HR monitorPalpation HR SBP/DBP

1. ______/______

2. ______/______

3. ______/______

4. ______/______

5. ______/______

6. ______/______

Recovery HR BP

1 minute ______

2 minute ______

3 minute ______

4 minute ______

5 minute ______

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