Cardiorespiratory Cardiorespiratory FitnessFitness

I Made Muliarta

Baian Ilmu Faal Fakultas Kedokteran

Universitas Udayana

Regular physical activity is fun and healthy

According to healthy people, there is a According to healthy people, there is a need to increase physical activity to need to increase physical activity to improve CRF improve CRF

This implies that changes in CRF can be This implies that changes in CRF can be measured measured

•However some people should check with their doctor before they start becoming much more physically active

•If you are planning to become much more physically active than now use the diagram

Testing ProceduresTesting Procedures

A sequence of steps in a “decision tree” A sequence of steps in a “decision tree” leading to participation in a fitness leading to participation in a fitness programprogram

The first step in the evaluation of CRF is to The first step in the evaluation of CRF is to identify those who might need a identify those who might need a physician’s clearance prior to taking an physician’s clearance prior to taking an exercise test or participating in an exercise exercise test or participating in an exercise program program

Screening Decision Tree Screening Decision Tree

PAR-QPAR-Q

Resting and Exercise MeasuresResting and Exercise Measures

Following the screening, measurements of Following the screening, measurements of HR and BP are taken at rest prior to the HR and BP are taken at rest prior to the exercise testexercise test

Additional: blood cholesterol and ECG Additional: blood cholesterol and ECG Exercise tests may require a submaximal Exercise tests may require a submaximal

or maximal effortor maximal effortThey may be conducted in a lab or field They may be conducted in a lab or field

Submaximal GXT (Graded Exercise Test), Submaximal GXT (Graded Exercise Test), HR is measured at each stage that HR is measured at each stage that progresses from light work to a progresses from light work to a predetermined end point such as 70-85% predetermined end point such as 70-85% of predicted MHR,or where specific signs of predicted MHR,or where specific signs (ECG or BP changes) or symptoms like (ECG or BP changes) or symptoms like chest pain or dyspnea occurchest pain or dyspnea occur

Field test for estimating CRFField test for estimating CRF Maximal run testMaximal run test

Some field test involve a measurement of how far a person Some field test involve a measurement of how far a person can run in a set of time (twelve to fifteen minutes) or how fast can run in a set of time (twelve to fifteen minutes) or how fast a person can run a set distance (one to two miles)a person can run a set distance (one to two miles)

Advantages: moderately high correlation with VOAdvantages: moderately high correlation with VO22max, max,

natural activity, large number of people who can be tested, natural activity, large number of people who can be tested, low costlow cost

Disadventages: difficulty of monitoring physiological Disadventages: difficulty of monitoring physiological responses, motivation plays in the outcome, maximal effort responses, motivation plays in the outcome, maximal effort

Cooper’s 12 minute or 1.5 mile runCooper’s 12 minute or 1.5 mile run

CooperCooper

The aim: to determine the average velocity that can be maintained over the time or distance

VO2max= 0.2 ml.kg-1.min-1/m.min-1 x speed m.min-1 +

3.5 (ml.kg-1.min-1)

(Powers and Howley, 2004)

VOVO22 max = d max = d1212 -505 -505

4545

dd1212 is distance (in is distance (in metres) covered in 12 ) covered in 12

minutes minutes

Table Men’s and women’s Aerobic Table Men’s and women’s Aerobic Fitness Classification Fitness Classification

                                                                                                            

                  

Harvard Step Up Test (HST)Harvard Step Up Test (HST) The idea is to step up and down on a bench continuously The idea is to step up and down on a bench continuously

for maximal 5 minutes at the rate of 30 steps/minute (1 for maximal 5 minutes at the rate of 30 steps/minute (1 step every 2 seconds) or until the person can no longer step every 2 seconds) or until the person can no longer maintain the rate of 30 steps/minute. maintain the rate of 30 steps/minute.

At the end of the 5 minutes, record the heart rate at three At the end of the 5 minutes, record the heart rate at three different times. different times.

The change in heart rate at Time 1, Time 2 and Time 3 The change in heart rate at Time 1, Time 2 and Time 3 shows the person's shows the person's recovery timerecovery time after the exercise. after the exercise.

That is how quickly the person's heart rate returns to its That is how quickly the person's heart rate returns to its normal resting rate after exercise. The step test is based normal resting rate after exercise. The step test is based on the premise that someone with a higher fitness level on the premise that someone with a higher fitness level will have a smaller increase in heart rate and a faster will have a smaller increase in heart rate and a faster recovery time recovery time

The Harvard Step Test is conducted as follows Step up on to a standard gym bench (45cm Step up on to a standard gym bench (45cm

high) once every two seconds for five high) once every two seconds for five minutes (~150 steps). Start with one foot minutes (~150 steps). Start with one foot (right or left ) and use that same foot as the (right or left ) and use that same foot as the starting "step up" foot throughout the starting "step up" foot throughout the exercise.exercise.

Have someone help you keep to the required Have someone help you keep to the required pace. pace.

One minute after finishing the test take your One minute after finishing the test take your pulse rate for 30 seconds. Have the person pulse rate for 30 seconds. Have the person refrain from talking any unnecessary refrain from talking any unnecessary movement when heart rates are being movement when heart rates are being counted since any activity can skew the heart counted since any activity can skew the heart rate and influence the results - rate and influence the results - Pulse 1

Two minutes after finishing the test take your Two minutes after finishing the test take your pulse rate for 30 seconds - pulse rate for 30 seconds - Pulse 2

Three minutes after finishing the test take Three minutes after finishing the test take your pulse rate for 30 seconds - your pulse rate for 30 seconds - Pulse 3

Step up-down Rest Count Count Count

0 5’or less 6’ 6’30” 7’ 7’30” 8’ 8’30”

Result

Fitness Index = 30000 ÷ (pulse1 + pulse2 + pulse3) Fitness Index = 30000 ÷ (pulse1 + pulse2 + pulse3)

NB: Pulse=beat per minute

Fitness Index (short form) = (100 x test duration in (short form) = (100 x test duration in seconds) divided by (5.5 x pulse 1). seconds) divided by (5.5 x pulse 1). 

Fitness Index (long form) = (100 x test duration in (long form) = (100 x test duration in seconds) divided by (2 x sum of heart beats in the seconds) divided by (2 x sum of heart beats in the recovery periods). recovery periods).

Criteria

Gender Excellent Above Average

Average Below average

Poor

MaleMale >90>90 80-9080-90 65-7965-79 55-6455-64 <55<55

FemaleFemale >86>86 76-8676-86 61-7561-75 50-6050-60 <50<50

McArdle W.D. et al; Essential of Exercise Physiology; 2nd Edition

Workload Categories

Category O2 consumption

(L/Min)

Lung Ventilation

(L/Min)

Rectal Temp. (oC)

Heart Rate (Beat/min)

-Mild-Mild

-Moderate-Moderate

-Heavy-Heavy

-Very Heavy-Very Heavy

-Extremely -Extremely HeavyHeavy

0,5-1,00,5-1,0

1,0-1,51,0-1,5

1,5-2,01,5-2,0

2,0-2,52,0-2,5

2,5-4,02,5-4,0

11-2011-20

20-3120-31

31-4331-43

43-5643-56

60-10060-100

37,537,5

37,5-38,037,5-38,0

38,0-38,538,0-38,5

38,5-39,038,5-39,0

>39>39

75-10075-100

100-125100-125

125-150125-150

150-175150-175

>175>175

CHRISTENSEN (1991:1699).Encyclopaeia of Occupational Health and Safety.ILO.Geneva

TUGAS MAHASISWATUGAS MAHASISWA

Buatlah video dan pembahasannya, setiap Buatlah video dan pembahasannya, setiap kelompok satu tentang Cooper Test dan kelompok satu tentang Cooper Test dan satu lagi tentang HSTsatu lagi tentang HST

PRAKTIKUM SIRKULASIPRAKTIKUM SIRKULASI

Tujuan: Praktikum ini bertujuan untukTujuan: Praktikum ini bertujuan untuk

mempelajari: mempelajari: Tekanan darah arteri brachialis pada berbagai Tekanan darah arteri brachialis pada berbagai

macam sikap macam sikap Tekanan darah arteri brachialis pada berbagai Tekanan darah arteri brachialis pada berbagai

macam aktivitas macam aktivitas Menghitung denyut nadi radialis Menghitung denyut nadi radialis

Bahan dan Alat:Bahan dan Alat:Tensimeter (Sfigmomanometer air raksa)Tensimeter (Sfigmomanometer air raksa)StetoskopStetoskop

TATA KERJA TATA KERJA TEKANAN DARAH ARTERI BRACHIALIS PADA BERBAGAI TEKANAN DARAH ARTERI BRACHIALIS PADA BERBAGAI

MACAM SIKAPMACAM SIKAP1.1. Berbaring Telentang Berbaring Telentang

• Suruh orang coba tidur telentang selama 10 menit dan pasanglah manset Suruh orang coba tidur telentang selama 10 menit dan pasanglah manset tensimeter di lengan atasnyatensimeter di lengan atasnya

• Tetapkanlah fase-fase Korotkov 3 kali berturut-turut dan ambillah nilai rata-Tetapkanlah fase-fase Korotkov 3 kali berturut-turut dan ambillah nilai rata-ratanyaratanya

• Berapa tekanan darahnya? (Korotkov I sistol, Korotkov II diastol)Berapa tekanan darahnya? (Korotkov I sistol, Korotkov II diastol)

2.2. DudukDuduk• Suruh orang coba yang sama duduk dengan tenang selama 2-3 menitSuruh orang coba yang sama duduk dengan tenang selama 2-3 menit• Catat tekanan darahnya 3 kali berturut-turut dan tentukan nilai rata-ratanyaCatat tekanan darahnya 3 kali berturut-turut dan tentukan nilai rata-ratanya• Berapa tekanan darahnya? Mengapa????Berapa tekanan darahnya? Mengapa????

3.3. BerdiriBerdiri• Suruh orang coba yang sama berdiri 2-3 menitSuruh orang coba yang sama berdiri 2-3 menit• Tetapkanlah tekanan darahnya 3 kali berturut-turut, Berapa nilai rata-Tetapkanlah tekanan darahnya 3 kali berturut-turut, Berapa nilai rata-

ratanya?ratanya?• Berapa tekanan darahnya? Mengapa????Berapa tekanan darahnya? Mengapa????

TEKANAN DARAH ARTERI BRACHIALIS PADA TEKANAN DARAH ARTERI BRACHIALIS PADA BERBAGAI MACAM AKTIVITAS BERBAGAI MACAM AKTIVITAS

1.1. Kerja OtakKerja Otak• Suruh orang coba duduk dengan tenang 2-3 menit (Orang yang Suruh orang coba duduk dengan tenang 2-3 menit (Orang yang

sama dengan sebelumnya) lalu suruh memecahkan soal hitungan sama dengan sebelumnya) lalu suruh memecahkan soal hitungan yang rumityang rumit

• Tetapkanlah fase-fase Korotkov 3 kali berturut-turut dan ambillah Tetapkanlah fase-fase Korotkov 3 kali berturut-turut dan ambillah nilai rata-ratanyanilai rata-ratanya

• Berapa tekanan darahnya? Bandingkan dengan waktu duduk diam Berapa tekanan darahnya? Bandingkan dengan waktu duduk diam sajasaja

2.2. Kerja OtotKerja Otot• Suruh orang coba yang sama melakukan kerja otot (jongkok-Suruh orang coba yang sama melakukan kerja otot (jongkok-

bangun) selama sedikitnya 1 menitbangun) selama sedikitnya 1 menit• Catat tekanan darahnya berturut-turut setiap 30 detik hingga Catat tekanan darahnya berturut-turut setiap 30 detik hingga

tekanan darahnya kembali normal (semua dikerjakan posisi duduk)tekanan darahnya kembali normal (semua dikerjakan posisi duduk)• Bandingkan hasilnya dengan percobaan waktu duduk diam sajaBandingkan hasilnya dengan percobaan waktu duduk diam saja

Menghitung Denyut Nadi Radialis Menghitung Denyut Nadi Radialis Orang coab dalam posisi duduk tenang Orang coab dalam posisi duduk tenang Rabalah arteri radialis dengan tiga ujung jari II-IV, Rabalah arteri radialis dengan tiga ujung jari II-IV,

rasakan denyut nadi radialisrasakan denyut nadi radialis Hitunglah banyaknya denyut dalam 15 detik, 30 detik, Hitunglah banyaknya denyut dalam 15 detik, 30 detik,

dan satu menitdan satu menit Hitunglah denyut nadi per menit dengan metode 10 Hitunglah denyut nadi per menit dengan metode 10

denyutdenyut Raba dan rasakan denyut nadi orang cobaRaba dan rasakan denyut nadi orang coba

Siapkan stopwatch atau jam tangan yang ada detiknya Siapkan stopwatch atau jam tangan yang ada detiknya Sambil meraba denyut nadi, catatlah lamanya waktu yang Sambil meraba denyut nadi, catatlah lamanya waktu yang

diperlukan untuk 10 denyutdiperlukan untuk 10 denyut

Hitung denyut nadi satu menit dengan Hitung denyut nadi satu menit dengan rumus: rumus: Denyut nadi 1 menit= 60 detik/waktu untuk 10 Denyut nadi 1 menit= 60 detik/waktu untuk 10

denyut x 10denyut x 10

Denyut Jantung atau Denyut Nadi sebagai Indikator Beban

KerjaDN merupakan metode tidak langsungDN merupakan metode tidak langsungKategori (Christensen, 1991): Kategori (Christensen, 1991):

Beban kerja ringan : 75-100 kali/mntBeban kerja ringan : 75-100 kali/mntBeban kerja sedang : 100-125 kali/mntBeban kerja sedang : 100-125 kali/mntBeban kerja berat : 125-150 kali/mntBeban kerja berat : 125-150 kali/mntBeban kerja sangat berat : 150-175 kali/mntBeban kerja sangat berat : 150-175 kali/mntBeban kerja sangat berat sekali : >175 kali/mntBeban kerja sangat berat sekali : >175 kali/mnt

SEVERITY OF WORKSEVERITY OF WORK(Astrand and Rodahl (1977)(Astrand and Rodahl (1977)

WORKWORK VO2VO2 HEART HEART ENERGYENERGYSEVERITY SEVERITY (L/M)(L/M) (Pulse/M)(Pulse/M) (KCAL/M)(KCAL/M)

LIGHT WLIGHT W < 0.5< 0.5 < 90< 90 <2.5 <2.5

MODERATE MODERATE 0.5-1.0 0.5-1.0 90-11090-110 2.5-5.0 2.5-5.0

HEAVYHEAVY 1.0-1.51.0-1.5 110-130110-130 5.0-7.5 5.0-7.5

VERY HEAVYVERY HEAVY 1.5-2.0 1.5-2.0 130-150130-150 7.5-10.0 7.5-10.0

EXTREMELYEXTREMELY >2.0 >2.0 150-170150-170 > 10.0 > 10.0

Pengukuran DNK dengan 10 pulse Pengukuran DNK dengan 10 pulse methodmethod

Denyut Nadi

Denyut nadi istirahatDenyut nadi istirahatDenyut nadi kerjaDenyut nadi kerjaNadi kerja adalah selisih DNI dan DNKNadi kerja adalah selisih DNI dan DNK

Beban KardiovaskulerBeban Kardiovaskuler

HR MAKSIMUM: LAKI , 220- USIA ; PR, 200- USIA

%CVL <30% : mungkin tidak akan menimbulkan kelelahan

%CVL 30-<60% : perlunya perbaikan %CVL 60-<80% : boleh bekerja dalam waktu yang

singkat %CVL 80-<100% : tindakan segera %CVL >100% tidak diperbolehkan melakukan

aktivitas.

Pengukuran denyut nadi dan denyut Pengukuran denyut nadi dan denyut jantung secara obyektif dan subyektifjantung secara obyektif dan subyektif

Obyektif: Obyektif: sthetoscopesthetoscope, palpasi, EKG , palpasi, EKG Subyektif: Borg’s ScaleSubyektif: Borg’s ScaleDenyut nadi = 10 x nilai Denyut nadi = 10 x nilai

Nilai/Skor Deskripsi Subyektif

6 Tidak terjadi pengerahan tenaga

7 Pengerahan tenaga yang sangat-sangat ringan

8

9 Pengerahan tenaga sangat ringan

10

11 Pengerahan tenaga ringan

12

13 Pengerahan tenaga agak berat

14

15 Pengerahan tenaga yang berat

16

17 Pengerahan tenaga sangat berat

18

19 Pengerahan tenaga yang sangat-sangat berat