1 Flashcards
Types of exercise?
Aerobic / endurance
Strength / resistance
Flexibility (joint)
Balance (static, dynamic)
Aerobic exercise - benefits?
Lower
- all cause mortality
- CV disease
- cancer
Better
- sleep, qol
Resistance exercise - benefits?
Reduced
- injury, fatigue, body fat, pain
Improved
- BMR, sleep, strength, qol, mental
-BMD
- chold, bgl
- NAFLD
The ROM possible at a joint?
Flexibility
What improves flexibility?
stretching, yoga, tai chi, pilates
Benefits of flexibility exercises?
- increase muscle length
- increase rom
Flexibility exercises don’t help with:
recovery/soreness
injury prevention
performance
Maintaining body’s equilibrium while stationary or moving?
Balance
Benefits of balance exercise?
Decrease
- injury from falls 37%
- injuries req medical care 30%
- severe injury falls 43%
- fractures 61%
Physical inactivity is the ? th leading risk factor for global mortality
4th
Aerobics Center Longitudinal Study
Low cardioresp fitness was the number ? cause of preventable deaths
One (16-17%)
8.3% deaths attributed to physical inactivity, for whgich age group?
> = 40
Years of life lost
- inactive, normal weight (4.7)
- active, obese (4.5)
What is sedentary behaviour?
- behaviour with <= 1.5 METs (metabolic equivalents of task)
while seated, reclined, lying - independently increases disease risk and mortality
(even if ppl are physically activity guidelines, but sitting lots too)
What % of ppl achieve recommended amount of physical activity each week?
1/3 (33%)
TV viewing increased all cause mortality with what hazard ratio, even in those getting 7 hrs exercise per week?
1.5
Equal to ppl who never execised and never watch tv
What is physically active?
> = 150 mins of MVPA (moderate to vigorous)
(Or > 0 mins of MVPA)
What is physically inactive?
0 mins of MVPA
Can patients meet physical activity guidelines, but still have significantly sedentary behaviour?
Yes
How to reduce sedentary time?
sitting for < 50 mins at a time with a 5 min movement break
Most benefit gained with how many MET hours per week of physical activity?
10-20
(plateaus around 80)
Standing for how many hours is associated with a 10% reduction in mortality?
2 hours per day
Nurse Health Study
Risk reduction 0.82
How many hours of MVPA?
1.0 - 1.9 hours per WEEK
Is it better to spread out exercise over more than two days?
Yes
(HR 0.7 –> 0.65)
How many MET hours and mins is = 150 min of MVPA?
8.30 MET hours
500 MET mins
> 65 yo
PA guidelines
150 min mod int OR
75 min vigorous int
Strengthen at least 2 times per week
Balance + stretching
Pregnancy + Post Partum
PA guidelines
150 min mod int aerobic / wk
- pref spread over week
IHD prevention
Exercise
risk reduction 20-30% of primary CAD
T2DM prevention
PA guidelines
150 mins / wk mod int
- reduces risk
lowers HbA1c only if PA +dietary asvice
Cancer prevention
Physical activity
Reduced risk of
- colon ca (17-3-%)
- breast ca (20-30%)
3-4 hrs MVPA
Also prevents recurrence
SPPB (predicts mobility)
Short Physical Performace Battery
Gait speed test
Balance test
Chair rise test
Best stability improvement in Parkinson’s ?
Stretching
Tai Chi
Resistance ex
Tai Chi
PA guidelines for Obesity
Weight Loss
2-3 kg with > 150 min
5 - 7.5kg with > 225-420 min
(need dietary input)
Weight Maintenance
> 250 min / wk
60-90 min/day
Strength twice / wk (not as helpful as aerobic)
- PA is a strong indicator
Aerobic exercise guidelines
3-5 yo
6-17 yo
18-64 yo
> 65 yo
Preg / post partum
Chronic conditions
Throughout the day
>60 min per day
150 min mod / 75 min vig
150 min mod
150 min mod, spread
150-300
Health benefits of flexibility exercise?
When is it best to do?
Unknown
When muscles are warm
Who should do balance training?
> 65 yo
= 3 times per week
What is PAVS?
Physical activity vital sign
Days/wk of aerobic PA
x
Mins of aerobic PA
=
Mins of aerobic PA / week
Exercise intensity tools?
- Talk test
- Resp rate (breaths/min)
- RPE - Rate of perceived exertion
- HRR - Heart rate reserve
- % max HR
- METs
Talk test?
Very light - can talk/sing
Moderate - can talk, but not sing
Vigorous - cannot talk complete sentence
Rate of perceived exertion
BORG scale
est max HR / 10
Heart rate reserve (HRR)
Max HR - Resting HR
Recommended intensity
- 40-85% of HRR
% Max HR
Light
Mod
Vig
Light : < 63% max hr
Moderate : 64-76% max hr
Vigorous : > 77% max hr
METs
Light
Mod
Vig
Light : < 3
Moderate : 3 - 5.9
Vigorous : >=6
What are physical activity assessment tools?
Functional capacity
Cardioresp fitness
Muscular fitness
Flexibility
Body Composition
Assessment tools for
Functional capacity
6 min walk test
8 foot up and go test
- muscular power
- sit to stand from chair, walk 8 feet afap, walk around cone, return, sit down
Assessment tools for
Cardioresp fitness
VO2 max
- max vol of O2 consumed during
(aerobic power)
Step testing
- 12 inch step, metronome
- steps for 3min to timing and rests for 1 min –> check HR and compare
Rockport fitness walking test
- 1 mile or 1.6km as fast as possible
- then measure HR
- estimate VO2 max with equation
12 min (Cooper) walk/run test
- cover max distance
- estimate VO2 with equation
Assessment tools for
Muscular fitness
Power
- Vertical jump
- Medicine ball throws
Strength
- 1 rep max
- hand grip strength
Endurance
- bodyweight exercise for time
Assessment tools for
Flexibility
Sit and reach (hamstrings, low back)
Apley back scratch test (ant should)
Goniometry
Assessment tools for
Body Composition
BMI
Skinfold thickness (body fat)
BIA (elecrical)
DEXA
Underwater weighing (hydro)
What is the 6 min walk test?
Measures functional capacity
- walk as far as possible in 6 min
Can stop, rest and resume
- reflective of ADLs
Helpful for patient’s before/after intervention
Norms for body fat % for optimal health?
10-22% (men)
20-32% (women)
Most accurate methods for body composition testing?
DEXA
Hydro (underwater)
Risk of death during physical activity
Rare!
Risk only if
- known disease symptoms
- sudden intense activity
Risk of AMI x 50 higher if vigorous activity in someone usually sedentary
Who should get a medical clearance before exercise?
(2015 Rec for Ex Prepart Health Screening from ACSM)
- Clinically significant disease needing supervised exercise
- Uncontrolled medical conditions that req treatment
PAR-Q+
Physical Activity Readiness Questionnaire for Everyone
- guides pre-participation (self)
–> to reduce barriers to exercise and false positive screenings
When should ppl have a medical clearance?
If they are inactive and have signs or symptoms of CV, metabolic, or renal disease
Indications for exercise stress testing (intermediate risk pts)
- symptoms of IHD
- presents to ED with chest pain
- syncope, valvular disease, arrhythmia
alt - myocardial perf scan
Skill related fitness?
agility, coordination, balance, power, reaction time, speed
What is 1.0 MET?
metabolic rate (amt of O2 consumed) during quiet rest/sitting
– 3.5ml of O2 per kg / min
METs
Sleeping
3mph walking
Climbing 2 stairs
Running 17.5 km/h
0.9
3
5
18
However this is regardless of fitness level
METs
Moderate Int
Vigorous Int
3 - 5.9 METs
>= 6 METs
FITT-VP Exercise Prescription
Frequency
- day per week
Intensity
- light, mod, vig
Time
- mins per session
Type
- aerobic, strength, b, f
Volume
- total
Progression
- advancement, increase
3 stages of exercise progression
Initial
- mod int, 15-30 mims, 3-4 times per week, 1-6 weeks
Improvement
- int variable, 20% each week
Maintenance
Only 23.5% ppl meet both aerobic and strengthening exercise.
T or F?
True
Prediabetes
- diabetes prevention with lifestyle
RCT (Diabetes Prevention Program Research Group)
58% vs 31% diabetes incidence
6.9 v 13.9 NNT to prevent diabetes
Resistance exercise can reduce HbA1c by > 0.5% in ppl with diabetes. T/F?
True
Effect of exercise on mortality outcomes
Meta-analysis of RCTs
No diff b/w exercise and drugs for secondary prevention heart disease and prediabetes
Exercise superior if hx of stroke
Exercise inferior for heart failure
Exercise vs PCI
in stable CAD
Superior event free survival
Improved exercise capacity
Lower costs
Higher HDL
BP and exercise
Modest but consistent reduction
But less than meds
Benefits of exercise after stroke?
Mobility and balance
Gait speed
Neuroplasticity
Obesity and exercise
150min mod int
Build to 250-300 min
- for long term weight loss
Non WB, less pressure on joints
Combine with nutrition
Diabetes and exercise
> 150 min / wk
Dietary changes
Weight loss 5-7%
Reduce sedentary time
Exercise daily
Aerobic and resistance combined
Diabetes on insulin
BGLs for exercise
< 100mg/dL - eat a snack before exercise
100-250 - ok to exercise
> 250 - test for ketones
Reduces short acting insulin by 50% around exercise time
