Increased state of vulnerability and decreased ability to cope with routine/stressors due to decine in reserve and function across multiple systems reduced adaptive capacity

Poverty of strength or force Age associated impaired ability to contract muscle, produce force/speed not due to nervous system Functional limitation - Physical diability

Loss of muscle fibers aging adults tend to selectivly lose type 2 fibers Inc when inactive Decrease in muscle tissue begins around 50, more dramatic at 60

2 Inactivity/Physiology Flashcards by Ryan Ylanan

What are the CDC Guidlines for Physical Activity?

Moderate intensity 150-300 minutes a week under 6 mets (moderate activity)
High Intensity 75-150 minutes a week > 6 mets
At least 10 minutes duration for each session

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What is the difference between Physical activity and Exercise?

PA is any bodily movement by skeletal muscle that requires energy
- Playing, exercise, working, active transport
Exercise is planned, structured, and purposeful movement for maintenance or imporice of physical fitness
- goal of making physiological adaptaions

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What is Frailty?

Increased state of vulnerability and decreased ability to cope with routine/stressors due to decine in reserve and function across multiple systems
- reduced adaptive capacity

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What is the critera for frailty?

3/5
Low grip strength
low endurance/easy fatigue
Slow walking speed
Low physical Activity
Unintentional Weight loss

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Describe the compenents in the Cycle of frailty

Dec strength
Dec Energy/Exhaustion/VO2max
Dec walking speed
Dec Activity
Weight loss

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What is Dynapedia?

Poverty of strength or force
- Age associated
- impaired ability to contract muscle, produce force/speed
  - not due to nervous system
Functional limitation - Physical diability

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What is the 6th vital sign?

Gait speed
- .8m/s significantly impaired
- 1.2 m/s normal rate for gait speed

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What is sarcopenia?

Loss of muscle fibers
aging adults tend to selectivly lose type 2 fibers
Inc when inactive
Decrease in muscle tissue begins around 50, more dramatic at 60

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What are cardiovascular adaptations to Deconditioning?

Reduced:
- total blood volume
- SV
- Max cardiac output
- Peak O2 uptake
- Ventricular compliance
- Baroreflex sensitibity
- POTS (orthostatic intolerance)

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When can you notice cardiovascular adaptations to deconditioning?

Some changes detected in 20hrs of bedrest
Hypersenstivty
Typeically related to atrophy of the heart when not loading

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What are exercises for the Frail?

Continuous Aerobic exercise
- good mortality reduction
resistance exercise
- Greater imporives in function and reduction in falls
- Better for ADL’s
Combined AT/RT

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What are some risks for training with the Frail?

Potential U shaped curve with activity and mortality
Some may not respond well
- increased intensity = possible adverse affects

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What is the normal and obese BMI levels?

18.5 - 25 = normal
25-30 Ovreweight
30-35 Obese I Moderate
35-40 Obese II severe
40 + Obese III Very severe

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What are some diseases related to obesity?

Coronary Heart disease
Type 2 Diabetes
Cancers
- endometrial, breast, colon
Hypertension
Dyslipidemia
Stroke
increased risk of falls
Liver diease
Gall bladder
Sleep Apnea/respiratory problems
OA
LBO
Gynecological problems

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What are functional limitations of obesity?

Difficult with
- vigorus/moderate activities
- Lifting/Carrying groceries
- Walking 1 or more flight of stairs
- Bending/Kneeling
- Walking 1 or more blocks
- Bathing/dressing

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What is the difference between White and Brown fat?

White: Lipid storage and undergoes pathological expansio during obesity
Brown: Thermogenic, large amounts of mitochondria, dissipate lage amoutn of chemical energy as heat
defends core body temp
Contributes to energy expenditure
Large amounts in infants, dimiishes with age
Body weight regulation
Regions: Axilla, adrenal regions, ect

What are the 3 types of adipose tissue?

Viscceral/intra-abdrominal
- surrounds organs
- pro inflammatory cytokines, Tumor necrosis factor (TNF-a) and IL 6)
- Increased sympathetic activity
- Strongly lined to CVD, DM@ and various other conditions
Subcutaneous
- concerning if around organs
Perivascular

What are the Physiological implications of obesity?

Chronic low grade inflamation
abromal production of proinflammatory cytokines
- TNF a (-ve)
Reuction in Nitric oxide and Endothelin (ET-1)

What is perivascular Adipose Tissue (PVAT)?

Specific to anatomic location, amount and disease state
Adiponectin - imporves NO and bioavailibility (modulator of vascular tone)

OBESE patients have LOWER adiponectin and loss of tone regulation

What is cornoary PVAT?

INC results in smooth muscle responsiveness between obese and lean coronary arteries
Atherosclerotic plaques have been shown to occur predominantyly in epicardial Coronary arties that are encased in PVAT

What is the obesity paradox?

obese patients more favorable prognosis compared to lean patients with cardiac problems
purposeful weight loss in obese patients led to a slight statisically insignificant reduction in mortality
3 year mortality was smaller than leaner subjects

FOCUS ON FITNESS AND NOT LOOSING WEIGHT

What are some clinical impliations of BMI and cardiorespiratory fitness?

BMI less accurate refelction
Cardiorespiraty fitness more closely linked to mortality risk populations
Emphasize CRF than weightloss

What are surgical interventions for Obesity?

Gastric Bypass
Lap Band
- less complications compared to gastric bypass
Bariatric surgery

What are some considerations for obese patient exercise?

long term diet isnt affective, exercise increase energy expenditure
- more calorie burn, more fat burn
Goals
- Weight loss/Energy balance
  - 5-10% of inital BW over 3-6 months
- Improve Cardiorespiraty fitness
- Improve functional mobility

What is resistance exercise for Obese patients

May facilitate Spontanouse Activity Outside compared to AT * greater compliance

What is the ideal format for obese exercise?

combined AT/RT

What is interval training for the obese patient?

* \<80VO2max * Variable duration bouts * may include active or passive recovery periods * May enhance adherence to an exercise program * enhance weight loss * Produces similar changes, greater than continuous in cardiorespiratory fitness

What are some confounders to obese exercise?

* Need reduction in net energy expendture (despite good compliance) * increase Energy intake/Reduction in SAEE * Be broad, what is causing weight gain, refer to dietician, give activty trackers * Social component * Behavior/social barrioers * low economic. low education * be a educator and motivator

What is Diabetes?

* Metabolic disease where body has inability to produce any or enough insulin sensitive resulting in elevated levels of glucose * A1C aboce 6.5% * Normal 4-6%

What abnormalities do you see with diabetes?

* Endothelial and vascular smooth muscle cell function to thrombosis * Contributes to atherosclerosis and complications * Decreases Endothelium derived NO * Increased vasoconstricuve prostanoids and endothelin -1 * Increased activate platelets, increased coagulation factors , inhibited pathways for fibrinolysis

What are risk factors for Type II diabetes?

* 3/5 * Large waist circumference/abdominal obesity * Elevated triglycerides * Low HDL * Hypertension * Elevated blood glucose level (fasting) Increased C reactive protien - increased risk of atherosclerosis and HTN

What is Type I diabetes?

* Onset 6-13 years old but also occur in adults * Beta cells in Islets of Langerhan fail to produce insulin Etiology: autoimmine diease that attack beta cells, beta cells display improper antigens to T cells Hallmark: Beta cells fail to produce sufficent insulin

What is Type II diabetes?

* Onset \>40 years * obesity epidemic = kids Hallmark: Insulin resistnace Chronic uncontrolled cases progress to beta cell burnout (stops producing isulin)

What are complications of Diabetes?

* Heart disease * Stroke * Retinopathy/glaucoma * Kidney disease * Peripheral nerve damage * Autonomic dysfunction * Integumntary issues

How does exercise affect the diabetic patient?

* Increases glucose uptake during and after * Increased insulin independant gluose uptake 1-3 hours * Increased sensitivty lasts hours to days

What is exercise for Type I patient?

* Check blood glucose before every exercise session * Check every 30 min * Criteria: \>100 \<250

What is exercise for Type 2?

* Check glucose before and after exercise for first few weeks * \>100 \<250