6: Exercise and Physical Activity

Question 1

Which of the following statements is NOT true about the benefits of physical activity?

A. Improved health-related fitness.

B. Decreased risk of disabling medical conditions.

C. Improved control and maintenance of body weight.

D. Decreased health care costs with decreased activity.

E. Lower chronic disease rates than inactive people.

Answer 1

D.
Overall benefits of physical activity include:
a. Higher health-related fitness.
b. Higher control and maintenance of a health body weight.
c. Lower risk of disabling medical conditions.
d. Lower chronic disease rates than inactive people.
e. Most interventions to increase physical activity are cost effective, as health care spending increases as activity levels decrease.

Question 2

The main components describing the types of physical exercise include all of the following EXCEPT:

A. Cardiovascular, aerobic and endurance exercise.

B. Flexibility and stretching.

C. Meditation.

D. Balance with static and dynamic exercises.

E. Strengthening and resistance training.

Answer 2

C. Meditation is not a form of physical exercise.

The different types of exercise include:

a. Aerobic and endurance (cardiovascular).
b. Strengthening (resistance training).
c. Flexibility (stretching).
d. Static and dynamic exercises (balance).

Question 3

The US Physical Activity Guidelines for Americans include all of the following EXCEPT:

A) Regular exercise reduces the risk of developing a chronic disease.

B) Most health benefits are achieved with 300 minutes a week of moderate intensity physical activity.

C) For children six to 17 years old, 60 minutes or more of vigorous physical activity is recommended daily.

D) Strength training for adults 18 to 64 years old is recommended at least twice a week.

E) For healthy adults, 20 to 30 minutes daily of balance and proprioceptive skill training is recommended.

Answer 3

B.
Most health benefits are achieved at 150 minutes a week of moderate-intensity of physical activity, or 75 minutes of vigorous physical activity or an equivalent combination. Beyond 150 minutes there are still benefits, but they are much less in amplitude.

Question 4

In a meta-analysis comparing the effectiveness of exercise and drug interventions on mortality, which of the following statements is TRUE?

A) Exercise is better than the use of medications in post-stroke treatment.

B) Exercise was better than medications for the secondary prevention of coronary artery disease and pre- diabetes.

C) Exercise is superior to medications in the treatment of heart failure.

D) Exercise increases the side effects of medications.

E) Exercise and medications should not be used in combination.

Answer 4

A.

Exercise is better than medications for post-stroke patients.

Question 5

“The Aerobics Center Longitudinal Study,” from 1987 to 2003, showed that the no. 1 preventable cause of deaths from all-cause mortality in 40,842 men and women was due to:

A) Cholesterol

B) Smoking

C) Diabetes

D) Obesity

E) Poor cardiorespiratory fitness

Answer 5

E. Poor cardiorespiratory fitness

Physical inactivity is the fourth leading risk factor for global mortality. Low cardiorespiratory fitness was the no. 1 cause of preventable deaths from all-cause mortality in 40,842 men and women who were enrolled in the Aerobics Center Longitudinal Study.

[Sui et al. Percentage of Deaths Attributable to Poor Cardiovascular Health Lifestyle Factors: Findings from the Aerobics Center Longitudinal Study. Epidemiology Research International. 2013.]

Question 6

Which of the following statements is true about sitting and sedentary behavior?

A) The prevalence of inactivity is at least twice that of smoking, hypertension and hyperlipidemia.

B) 6.9% of all-cause mortality is attributable to sitting.

C) Breaking up sitting with light- and moderate-intensity walking every 20 minutes reduced blood glucose and insulin levels in obese patients.

D) Physical inactivity is the cause of 1 in 10 premature deaths.

E) All of the above are true statements.

Answer 6

E. All of the above are true statements.

Question 7

Which prescription best describes the FITT cardiovascular exercise prescription?

A) Begin walking at a moderate intensity for 45 minutes at least five days per week.

B) Begin running for 60 minutes every three days.

C) Walk around the block twice daily.

D) Lift heavy weights for 25 minutes.

E) Swim 15 laps for 20 minutes.

Answer 7

A. Begin walking at a moderate intensity for 45 minutes at least five days per week.

The FITT exercise prescription for cardiovascular exercise includes Frequency, Intensity, Type of exercise, Time (duration). For example, begin a slow jog/race walk (type) at a moderate intensity (intensity) for 45 minutes (time) for at least five days per week (duration).

Question 8

When considering prescribing the correct level of intensity, the TALK test is a commonly used intensity measure and includes all of the following factors EXCEPT:

A) With very light exercise one should be able to talk and/or sing.

B) Moderate exercise is 64 to 76% of maximal heart rate.

C) With vigorous exercise, one should be able to carry on a conversation without difficulty.

D) With moderate exercise one should be able to talk but not sing.

E) Very light exercise is 63% or less of maximal heart rate.

Answer 8

C.
With vigorous exercise, one should be able to carry on a conversation without difficulty. The Talk Test is a common measure of exercise intensity.

a. Very light to light exercise (63% or less of maximum HR) and are able to talk and/or sing.
b. Moderate exercise (64% to 77% of maximum HR) and are able to talk but not sing.
c. Vigorous to maximal exercise (77 to 100% of maximal HR) and have difficulty speaking.

Question 9

What is ACSM recommended starting intensity [% 1-RM] for each patient le

1. New to resistance training
2. Intermediate exercisers
3. Experienced

Answer 9

A. 40-50% 1-RM
B. 60-80% 1-RM
C. 80% 1-RM

Reps usually 8-12 per set. Older adults & endurance training 10-15 reps

Question 10

_____ is defined as “any bodily movement produced by the contraction of skeletal muscle that increases energy expenditure above a basal level.”

A) Physical activity

B) Fitness

C) Exercises

D) Isokinetic exercise

Answer 10

A. Physical activity.
Fitness is defined as “the ability to carry out daily tasks with vigor and alertness without undue fatigue, with ample energy to enjoy leisure-time pursuits and the ability to respond to emergencies.”
Exercise is a subset of physical activity that is formally defined as “physical activity that is planned, structured, repetitive, and purposeful in the sense that the improvement or maintenance of one or more components.”
Isokinetic exercise is a type of strength training that uses special machines or dynamometers to maintain a constant (iso) speed (kinetic) of movement.
PLANS R PURPOSEFUL

[CDC. Glossary of Terms. Physical Activity. June 10, 2015.]

Question 11

Which of the following are considered components of physical fitness?

A) Cardiorespiratory exercise

B) Muscular strength and endurance

C) Body composition

D) A and B

E) All of the above

Answer 11

E. All of the above
These are all considered components of health-related physical fitness. Flexibility (which is not listed) is also considered a component.

[ACSM. Benefits and Risks Associated with Physical Activity. In: Whaley MH, ed. ACSM’s Guidelines for Exercise Testing and Prescription. 7th Ed. Baltimore: Lippincott Williams & Wilkins; 2006:3.]

Question 12

What are the recommended aerobic activity guidelines for children?

A) 30 minutes or more per day of moderate- to vigorous-intensity physical activity

B) 60 minutes or more per day of moderate- to vigorous-intensity physical activity

C) 150 minutes of moderate-intensity exercise per week, or 75 minutes of vigorous-intensity exercise per week.

D) 300 minutes of moderate-intensity exercise per week, or 150 minutes of vigorous-intensity exercise per week.

Answer 12

B. 60 minutes or more per day of moderate- to vigorous-intensity physical activity.

The current Centers for Disease Control and Prevention (CDC) guidelines recommend 60 minutes or more a day of moderate- to vigorous-intensity physical activity for children.
Choice C is the recommended physical activity guidelines for adults, while choice D provides additional health benefits to adults above and beyond choice C.
Thirty minutes per day is generally a good goal for most adults, but that’s not a specifically recommended amount of time by the CDC.

[CDC. 2008 Physical Activity Guidelines. Children. 2008. [2/25/18]; Available from https://health.gov/paguidelines/guidelines/children.aspx]

Question 13

Current aerobic exercise activity guidelines recommend that bouts of physical activity be at least minutes in duration for adults.

A) 5

B) 10

C) 15

D) 30

E) 60

Answer 13

B. 10.
While there is evidence that high-intensity interval training is effective in reaping health benefits and fitness improvements, guidelines still recommend that exercise bouts last at least 10 minutes.
Thirty minutes is generally a good goal for most adults, while 60 minutes is a good daily goal for children.

[CDC. 2008 Physical Activity Guidelines. Active Adults. 2008. [2/25/18]; Available from https://health.gov/ paguidelines/guidelines/chapter4.aspx]

Question 14

Which of the following is/are considered part of a FITT prescription for cardiovascular exercise?

A) Tone

B) Fitness

C) Type

D) Interval

E) C and D

Answer 14

C. Type.
A FITT prescription includes the Frequency, Intensity, Time and Type of activity.

[ACSM. Guidelines for exercise testing and prescription. 8. Philadelphia: Lippincott Williams & Wilkins; 2010.]

Question 15

According to the study by Naci and Ioannidis, exercise is equal to, or superior to, medication with regards to mortality for the treatment of:

1. Post-stroke
2. Secondary prevention of coronary artery disease (CAD) and pre-diabetes
3. Heart failure

A) 2

B) 1 and 2

C) 1 and 3

D) 2 and 3

E) All of the above

Answer 15

B. 1 and 2.
This meta-epidemiological study included 305 randomized controlled trials (RCTs) and found that exercise decreased mortality more than medications in post-stroke studies. Exercise also had an equivalent effect on mortality to medications for the secondary prevention of coronary artery disease (CAD) and pre-diabetes, but it was inferior to medications with regard to heart failure patients.

[Naci et al. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. BMJ. 2013]

Question 16

When counseling patients on physical activity, one approach is to use the 5A’s. What is the correct order that these steps should be delivered in?

A) Ask, assess, assist, agree, arrange

B) Ask, assess, assist, advise, arrange

C) Assess, advise, assist, arrange, agree

D) Assess, advise, agree, assist, arrange

E) Ask, advise, assist, agree, arrange

Answer 16

D. The correct order is: assess, advise, agree, assist, arrange.

The 5A’s begin with assessing patient beliefs, behaviors, and knowledge,
then advising by providing information about the health benefits of change,
and then agreeing on a collaborative goal.
Next, the provider assists the patient in identifying barriers, strategies and problem-solving techniques
before finally arranging to follow up on plans.

and for tobacco or intervention counseling are Ask, Advise, Assess, Assist, and Arrange.

Question 17

With regard to pre-participation screening, what are the major disease entities one needs to consider when deciding whether additional medical clearance is needed?

1. Cardiovascular disease
2. Pulmonary disease
3. Renal disease
4. Metabolic disease

A) 1, 3 and 4

B) 1 and 2

C) 1

D) 1, 2 and 3

E) All of the above

Answer 17

A. 1, 3 and 4.
Referral to a health provider should be made on the basis of current physical activity levels and presence of signs or symptoms and/or known cardiovascular, metabolic or renal disease. While one might modify an exercise prescription for someone with pulmonary disease, pulmonary disease alone does not require medical clearance, as it has not been shown to increase the risk of cardiovascular complications.

[Riebe D, et al. Updating ACSM’s Recommendations for Exercise Preparticipation Health Screening. 2015;47:2473-2479.]

Question 18

When using the Talk Test as an exercise intensity measure, a patient performing vigorous-intensity exercise is able to _____.

A) Sing but not talk

B) Talk but not sing

C) Sing or talk

D) Barely talk

E) None of the above

Answer 18

D. Barely talk
The Talk Test is an intensity measure that’s easy for patients to perform on their own.
Very light or light activity should allow patients to talk and/or sing without difficulty (HR 63% or less of maximal).
Moderate exercise (64 to 76% of maximal) should allow individuals to talk but not sing (Answer C).
Vigorous to maximal exercise (77 to 100% of maximal) should make it difficult for an individual to talk or hold a conversation.

[Persinger R, et al. Consistency of the talk test for exercise prescription. Med Sci Sports Exerc, 2004. 36(9): p. 1632-6.]

Question 19

Who should be referred to a health provider for medical clearance prior to starting a moderate- intensity exercise program?

A) A 45-year-old male who has no known cardiovascular, metabolic or renal disease, and who does not currently participate in regular exercise and is asymptomatic.

B) A 55-year-old male who has known cardiovascular disease, currently participates in regular exercise and is asymptomatic.

C) A 30-year-old female who has known diabetes, does not currently participate in regular exercise and is asymptomatic.

D) More than one of the above.

E) None of the above.

Answer 19

C. A 30-year-old female who has known diabetes, does not currently participate in regular exercise and is asymptomatic.

An asymptomatic male with no known cardiovascular, metabolic or renal disease does not require medical clearance before beginning a moderate-intensity or vigorous-intensity exercise program.

An adult with known cardiovascular, metabolic or renal disease who is already participating in regular moderate-intensity exercise and is asymptomatic does not need a referral for moderate-intensity exercise. However, a referral is recommended if they want to pursue vigorous-intensity exercise.

It’s recommended that an adult with known cardiovascular, metabolic (e.g., diabetes), or renal disease who does not currently exercise should be referred for medical clearance, even if they are asymptomatic.

Any symptomatic individual should be referred for medical clearance.

[Riebe D, et al. Updating ACSM’s Recommendations for Exercise Preparticipation Health Screening. 2015;47:2473-2479.]

Question 20

For 5% weight loss, many people need to do more than _____ per week of moderate-intensity activity.

A) One hour and 15 minutes

B) Two and a half hours

C) Five hours

D) Seven hours

Answer 20

C. Five hours.
People who want to lose a substantial amount of weight (more than 5% of body weight) and people who are trying to keep a significant amount of weight off once it has been lost need a high amount of physical activity unless they also reduce their caloric intake. Many people need to do more than 300 minutes of moderate-intensity activity a week to meet weight–control goals.
Seventy-five minutes is likely insufficient to meet health recommendations or weight loss goals.
Two and a half hours would be appropriate for general health benefits.
Seven hours may offer additional health benefits and further assist with weight loss efforts.

[CDC. 2008 Physical Activity Guidelines. Active Adults. 2008. [2/25/18]; Available from https://health.gov/ paguidelines/guidelines/chapter2.aspx.]

Question 21

A goal weight loss for achieving health benefits is _____, however weight loss of _____ may be necessary for continued disease improvement in individuals with a BMI > 35 and comorbidities.

A) 1 to 5% of initial weight; 5 to 10%

B) 5 to 10% of initial weight; 15 to 20%

C) 10 to 15% of initial weight; 20 to 25%

D) 15 to 20% of initial weight; 25 to 30%

Answer 21

B. 5 to 10% of initial weight; 15 to 20%.

Research has shown that goal weight loss for health benefits is five to 10%, however weight loss of 15 to 20% may be necessary for continued disease improvement in individuals who have a BMI > 35 and comorbidities.

Question 22

Your patient has reached initial goals and is now in weight loss maintenance phase. It’s important to remember that certain hormones can play a role in relapse, including:

A) Ghrelin and parathyroid hormone

B) Thyroid and parathyroid

C) Parathyroid and gherlin

D) Leptin and amylin

Answer 22

D. Leptin and amylin.
One year after initial weight loss, a change occurs in the circulating hormones of appetite that encourage weight gain, including increased gherlin, GIP, PP, and decreased leptin, peptide YY, CCK and amylin.

Question 23

You are discussing options in assisting with weight loss with your patient who is interested in medications or surgery. You know that:

A) Weight loss medications do not help with adherence to a lower calorie diet and physical activity.

B) Medications should be used for a duration of one month.

C) Approximately 50% of people who undergo bariatric surgery will experience weight regain within five years.

D) Patients who are physically active post-surgery may experience more surgical complications.

Answer 23

C.
Weight loss medications help with adherence to a lower-calorie diet and physical activity.
Medications should be used for the FDA approved duration of time with target weight loss in mind.
Approximately 50% of people who undergo bariatric surgery will experience weight regain within five years.
Patients who are physically active pre- and post-surgery may experience fewer surgical complications.

Question 24

Intensive behavioral therapy for obesity is a US Preventative Services Task Force (USPSTF) _____ recommendation and includes _____, _____, and _____.

A) Grade A; screening using BMI; nutritional assessment; intensive behavioral counseling and behavioral therapy.

B) Grade B; screening using BMI; nutritional assessment; intensive behavioral counseling and behavioral therapy.

C) Grade C; screening using BMI; nutritional assessment; intensive physical activity.

D) Grade D; screening using BMI; nutritional assessment; intensive physical activity.

Answer 24

B.
Intensive behavioral therapy for obesity is a US Preventative Services Task Force (USPSTF) grade B recommendation and includes screening using BMI, nutritional assessment, intensive behavioral counseling and behavioral therapy.

Question 25

The effects of lifestyle change with weight loss include:

A) Healing of liver cells in NASH

B) Improvement in hepatic steatosis, lobular inflammation and NAFLD score.

C) Favorable outcomes on abdominal obesity and insulin resistance.

D) All of the above.

Answer 25

D.

The effects of lifestyle change include all the above.

Question 26

What are the physical activity guidelines for children?

A. Exercise 150 minutes/week of moderate or 75 minutes of vigorous aerobic physical activity, or as close to guidelines as possible

B. Exercise one hour/day, with ≥ three days/week of vigorous activity

C. Muscle-strengthening or bone-strengthening exercises for one hour/day, ≥ three days/week

D. Exercise one hour/day, with ≥ three days/week of vigorous activity with muscle-strengthening or bone-strengthening exercises for one hour/day, ≥ three days/week

Answer 26

D
Children should exercise one hour/day, with ≥ three days/week of vigorous activity with muscle-strengthening or bone-strengthening exercises for one hour/day, ≥ three days/week.

Adults >65 should exercise 150 minutes/week of moderate to vigorous aerobic activity, or as close to guidelines as possible.

Question 27

Which is not a component of exercise screening?

A. Current exercise level

B. Desired exercise level

C. Presence of medical conditions (metabolic disorders, cardiovascular disease, kidney disease)

D. Presence of respiratory diseases

Answer 27

D
Respiratory diseases are not a significant cause of death associated with exercise and do not need to be evaluate in routine exercise screening.
The three components of exercise screening are:
Current physical activity level
Desired physical activity level
Presence of cardiovascular, renal, or metabolic disease

Question 28

Who needs to be screened by a medical provider before increasing intensity? Check all that apply.

A. A sedentary patient with diabetes who is uncontrolled

B. Patient with chest pain with light walking

C. Patient with asthma and wheezing during exercise

D. A patient with high cholesterol

E. Moderately active patient with chronic kidney disease who was cleared six months ago

Answer 28

A. A sedentary patient with diabetes who is uncontrolled
True

B. Patient with chest pain with light walking
True

C. Patient with asthma and wheezing during exercise
False

D. A patient with high cholesterol
False

E. Moderately active patient with chronic kidney disease who was cleared six months ago
False

Question 29

Which patient is at a 90% risk of having alcohol abuse disorder?

A. 22 year old college student who binge drinks three weekends a month with an AUD Score of 5

B. 48 year old woman who has three drinks every evening and had a DUI two years ago, AUD score of 8

C. 55 year old woman, who has five+ drinks every Saturday and Sunday and an AUD score of 15

D. 55 year old man, who has three beers most nights, AUD score of 10

E. 36 year old male physician, who has a bottle of wine every evening and six beers once a weekend, AUD 18

Answer 29

E.
36 year old male physician, who has a bottle of wine every evening and six beers once a weekend, AUD 18
AUDIT Scores help guide therapy
5-10: at risk drinker (20% will have alcohol use disorder)
11-15: more at risk (40% have alcohol use disorder)
16+: high probability of moderate + alcohol use disorder (90%)
Higher scores = greater sensitivity
An audit score of 18 is consistent with a 90% chance the patient will have alcohol use disorder.

Question 30

Which vital sign has been validated by research?

A. Emotional wellness

B. Stress

C. Tobacco

D. Physical activity

E. Nutrition

Answer 30

D
Physical activity is a validated vital sign; all others have not been validated by research but rather are markers suggested by expert opinion

Question 31

Which statement about physical activity is true?

A. Singleness and being overweight are risk factors for being sedentary

B. Physical inactivity has become a greater public health concern than smoking

C. Weight lifting is easy to assimilate into workout and usually does not require a referral

D. Fitness testing for muscular strength is easily accomplished in the clinic setting

Answer 31

A
Singleness and being overweight are risk factors for physical inactivity (Answer A).

Currently smoking is still listed as the number one cause of preventable deaths, but physical inactivity is becoming increasingly more important as a public health concern (Answer B).

Weight training incorporation often takes a referral to an exercise specialist (Answer C).

Muscular endurance is easy to test in clinic but muscular strength requires assistance with a machine like a bench or squat press (Answer D).

Question 32

What is the MET for each of the following activities?

A. Sleeping
B. Sitting and resting
C. Walking at 3mph
D. Climbing 2 flights of stairs
E. Running at 10.9mph/5.5 min per mile pace

Answer 32

A. 0.9 METs
B. 1.0 METs
C. 3 METs [3 = 3!]
D. 5 METs
E. 18 METs

Biking 12mph = 6 METs
Jumping rope = 9 METs

Question 33

How are METs adjusted as patients become more fit?

Answer 33

METs are an absolute measure, so the patient would need to increase the number of METs/hour/week over time to continue increasing their fitness

Question 34

List the exerkines for each organ’s contributions to the physiologic benefits of exercise?

A. CV
B. Adipose tissue
C. Liver
D. Skeletal muscle
E. Pancreas
F. CNS
G. Immune system
H. Gut microbiome
I. Bone

Answer 34

A. NO, VEGF: Enhanced endothelial function
B. Adiponectin, catecholamines
C. catecholamines, IL-6, myonectin
D. Adiponectin, myostatin, IL-6, -7,-15, GLUT-4
E. follistatin, IL-6
F. BDNF, BDNF-trophic factor
G. anti-inflammatory cytokines
H. increased SCFA
I. TGF beta 1, sclerostin

Question 35

At what exercise volume does risk of premature death level off?

Answer 35

at 400 minutes of moderate or vigorous exercise a week [this is about 15-22.4 METs]

though benefits still accrue, just diminishing returns (gain another 0.5 year at 500 minutes)

Question 36

HIIT

What are the 4 benefits to HIIT as an exercise tactic?

Answer 36

1. Improved diastolic dysfunction
2. increased cardiac efficiency
3. improved insultin-mediated glucose control
4. more energy expended in shorter timeframe

No other verified benefits. Any dislike is due to being above lactate and ventilatory thresholds

Question 37

What is the average result for 6-minute walk test (6MWT)?

Answer 37

Average 6MWD = 400-700 meters
(how far do they go in 6 minutes)

6MWD Used to estimate COPD severity

Question 38

What are the nine organ systems that benefit from exercise?

Answer 38

Sources of exercises

p203, 4th Ed.