7. CVD & exercise in older adults + JC Flashcards

1
Q
  • CVD in older adults imposes a huge burden in terms of (4)
  • CVD includes (5) –> prevalence increases/decreases across age groups –> how many at 40-50 vs 60-79 vs >80
  • CVD is the __how many th_____ leading cause of disability among older adults (compared to what?)
A
  • morbidity, disability, functional decline and healthcare costs
  • coronary artery disease, atherosclerosis, hypertension, heart failure and stroke –> increases! 40% ish VS 73% vs 79-86%
  • second! (after arthritis)
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2
Q

what are 8 common risk factors for CVD? + explain what exactly
- what is one negative risk factor?

  • are they cumulative?
A
  • AGE: men>45, women>55
  • FAMILY HISTORY heart attack, bypass surgery, sudden death before 55 for men or before 65 for women
  • CIGARETTE SMOKING: current smoking OR quit in less than past 6 months or exposed to environmental smoke
  • SEDENTARY LIFESTYLE: not participating in moderate PA at lest 3 days/wk for 3 months
  • OBESITY: BMI > 30 OR waist >102 (men) or 88 cm (women)
  • HYPERTENSION: >140/>90 or taking medication
  • DYSLIPIDEMIA: LDL > 130mg/dL OR HDL < 40mg/dL OR taking meds OR TC > 200 mg/dL
  • PRE-DIABETES: IFG > 100mg/dL OR OGTT > 140 and <199 mg/dL

negative risk factor (ie beneficial):
HDL > 60 mg/dL

  • cumulative! but depends on which risk factor
  • ie high BP AND high TC will have a big higher risk than just high TC
  • VS if you add diabetes diagnosis: increases risk a lot!
    VS if you add diabetes AND cigarette smoking, then very high risk
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3
Q

how to screen for high vs mod vs low risk for CVD?

A
  1. known CV (cardiac, peripheral, cerebrovascular), pulmonary (COPD, cystic fibrosis), metabolic disease (DM, renal disease)?
    - if yes = high risk
    - if no –> go to question 2
  2. major signs and symptoms suggestive of CV, pulmonary, metabolic disease? (ie pain discomfort in chest, SOB, dizziness, edema, palpitations, heart murmur…)
    - if yes –> high risk
    - if no –> question 3
  3. number of CV risk factors (age, family history, smoking, sedentary, obesity, HT, dyslipidemia, prediabetes)
    - >2 –> mod risk
    - < 2 –> low risk
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4
Q

what are the 5 main cardioprotective effects of regular PA?

A
  1. anti-atherosclerotic
    - increase HDL, insulin sensitivity
    - decrease LDL, BP, adiposity, inflammation
  2. anti-arrhythmic:
    - decrease resting HR, SNS activity
    - increase vagal tone, HRV
  3. anti-ischemic: (prevents build-up of plaque)
    - decrease myocardial O2 demand, endothelial dysfunction
    - increase coronary flow, EPCs and CCACs, NO
  4. anti-thrombotic:
    - decrease platelet adhesiveness, fibrinogen, blood viscosity
    - increase fibrinolysis
  5. psychological:
    - decrease depression, stress
    - increas social support
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5
Q

does PA and cardiorespiratory fitness impart the same decrease in relative risk of CVD?

A

no! as minutes of PA participation increases, cardiorespiratory fitness leads to a much bigger decrease in CV relative risk (almost double just doing PA alone!)

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6
Q

4 steps of history examination before an older adult wants to start/continue exercise

A
  1. SCREENING questionnaire (ie PARQ or get active questionnaire)
    - identify medical contraindications and whether medical clearance from physical is required
  2. HISTORY of prior myocardial infarction, coronary heart disease, peripheral vascular disease, cerebrovascular disease –> could place patient in higher risk category
  3. MEDICATIONS: complete list (ie beta-blockers, calcium channel blockers –> have indications for testing and HR prescription)
  4. evaluation of patient’s TYPICAL PA patterns and exercise-induced symptoms (ie chest pain, dyspnea, palpitations, light-headedness)
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7
Q

What should physical examination focus on before an older adult wants to start/continue exercise? (5)

A
  • Heart rate and blood pressure measurement (at rest and during exercise)
  • Cardiac and lung auscultation (sound) –> check for evidence of heart failure or significant valvular disease
  • Face, neck, arm, chest, abdomen, and leg SWELLING OR EDEMA, pain and/or stiffness
  • Peripheral pulses –> check for evidence of peripheral vascular disease
  • Breathing rates at rest and with mild exertion –> dyspnea?
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8
Q

what physical examination should be done in high-risk older individuals before starting exercise program or when recovering from a cardiac event?

  • performed when?
  • reviewed for (2) and to identify WHAT that contraindicate exercise testing
  • additional diagnostic testing to determine (2) can be performed when?
A
  • a 12-lead ECG!
  • before during and/or after exercise test
  • heart rhythm and heart rate –> identify arrhythmias
  • cardiac structure and function –> before, during and/or after exercise testing (more in a research context, ie with ultrasound)
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9
Q

who can exercise safely? explain big schéma

A

participates in regular exercise?
a) NO
1) no disease AND no signs and symptoms suggestive of CV, metabolic and renal disease –> no medical clearance necessary –> light to mod intensity recommended + gradually progress to vigorous
2) known CV, metabolic or renal disease AND asymptomatic –> [medical clearance recommended –> following med. clearance: light and mod PA rec + gradually progress as tolerated]
3) any signs or symptoms suggestive of CV, metabolic or renal (regardless of disease status) –> [same as 2)]

b) YES:
1) same as a.1 –> continue mod to vig intensity exercise!
2) known CV, metabolic or renal disease AND asymptomatic –> medical clearance for mod intensity NOT necessary VS recommended for vig –> continue mod PA + gradually progress after med. clearance
3) any signs or symptoms suggestive of CV, metabolic or renal (regardless of disease status) –> discontinue exercise and seek med. clearance –> may return to exercise following med clearance

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10
Q

what are the prognostic values of exercise testing used for? (3 ish)

  • what happens to relative risk of death depending on exercising at <5MET VS 5-8 METs VS >8METs
A
  • establish baseline fitness
  • guide prescription intensity
  • can see evaluation + relative risk of death…
  • lowest risk at >8 METs –> risk increase compared to >8MET for 5-8, and even more for <5MET
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11
Q

what does CPET stand for? another name for it? –> what does it output? (4)

  • who should get CPET vs who shouldn’t?
A

cardiopulmonary exercise testing (CPET) or just formal exercise testing
- Monitor peak VO2, heart rate, blood pressure, and ECG responses during test

  • Older adults with normal heart rate and blood pressure and no CV, metabolic or renal disease can generally begin moderate-intensity exercise, WITHOUT a formal exercise test
  • For older individuals at higher risk or those planning to begin a high-intensity training program, a formal exercise test is generally RECOMMENDED
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12
Q

CPET:
- are older adults able to complete maximal exercise effort?
- _________ exercise is best tolerated among older adults with protocols that increase in _________ increments (ie __-___ MET)
- name 3 different protocols

  • what is another exercise modality? advantages? (3) vs con?
A
  • no
  • treadmill –> modest increments –> 1-2MET
  • Modified Balke (increase incline % gradually), Haughton (more intense) or Bruce (more intense: increase speed and incline))
  • cycle ergometer testing!
  • ease of BP and ECG measurements + safer for frail individuals and those with balance deficits
  • BUT often observe decrease peak VO2 values (10% decrease) (bc less muscle group recruitment
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13
Q

what are the 4 criteria for determining VO2max?

A
  1. no increase in VO2 with increase in work rate (ie plateau)
  2. respiratory exchange ratio >1.15
  3. maximal HR +/- 10 bpm of predicted HR
  4. RPE >17/20
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14
Q

what is an alternative to CPET for older adults without the need to monitor (3)
- explain the test
- correlates well with what?
- strengths (3)

A
  • 6-minute walk test may be a useful and more convenient alternative for older adults without need for HR, BP and ECG monitoring
  • walking a 20-30m course as many times as possible in 6min (sometimes measure BP before and after)
  • correlates well with measured peak VO2
  • less intimidating + minimal cost + ease of administration
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15
Q

exercise training in CVD prevention
- exercise training can delay WHAT and prevent WHAT in older adults
- also plays a key role in (4)

A
  • delay age-related morbidity and prevent CVD events in older adults
  • secondary prevention
  • modifying symptoms
  • increasing function
  • improving quality of life
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16
Q

what are exercise recommendations for cardiorespiratory fitness for older adults:

CONTINUOUS AEROBIC EXERCISE
RESISTANCE TRAINING

  • frequency
  • intensity
  • time
A

CONTINUOUS AEROBIC EXERCISE
- frequency: at least 3-5 days/wk
- intensity: moderate (50-70% HRR or RPE 5-6) or vigorous (>70% HRR or RPE 7-8)
- time: 20-30min/d in bouts of >10min OR 30-60min/d in bouts of >10min

RESISTANCE TRAINING
- frequency: each major muscle group: 2 or more times per week + never on consecutive days
- intensity: RPE 5-6 (moderate) or 7-8 (vigorous)
- time: no specific duration, 2-4 sets of 8-12 reps per set with rest interval 2-3min

17
Q
  • define cardiac rehabilitation
  • involves who?
  • involves most or all of the following components: (4)
A
  • medically supervised exercise program: more appropriate for individuals with a diagnosed CVD
  • multidisciplinary team of health care providers! (exercise, nutrition, psychological)
  • medical assessment
  • PA and exercise
  • lifestyle education about nutrition
  • psychosocial support

(behavioral counseling, risk factor management…)

18
Q
  • is it safe for older adults to do mod and vigorous exercise?
  • what are exercise modifications for older patients with CVD? (5)
A
  • yes!
  • Avoid very vigorous-intensity exercise –> higher risk of injury (especially if lots of risk factors/symptoms/disease)
  • Watch for warning signs for stopping exercise
  • Include a longer warm-up and cool-down, stretching, and mild breathing exercises
  • Routine monitoring of heart rate, blood pressure, and perceived exertion
  • Intensity and duration of physical activity should be light-to-moderate at outset, with progression tailored to individual tolerance and preferences
19
Q

can older adults do HIIT?

  • for older adults, is training at moderate intensity sufficient to improve cardiorespiratory fitness and health?
  • what is HIIT?
  • most famous protocol? vs 2 different types ish
A

a basic assumption is that they can’t or will not engage in vigorous intensity exercise!!
- but for some, mod-intensity is NOT sufficient to improve cardiorespiratory fitness and health!
- exercise training involving alternating periods of short, intense exercise with less intense recovery
- Wisloff’s: 4 x 4min at RPE 15-18 with 3min active recovery at RPE 11-13 (fairly light to somewhat hard), with 3min WU and 2minCD
OR
- repeated short (<45sec) to long (2-4min) bouts of high intensity exercise (>75% VO2peak, >80% HR max)
- short (<=10sec, repeated) or long (>30-45sec, intervals) all out sprints

20
Q
  • what does evidence say about safety and feasibility of HIIT compared to MICT?
  • what do patients have to do before starting HIIT?
  • likely to necessitate what?
  • needs to consider what?
A
  • as safe as feasible as MICT
  • must be screened and receive a CPET
  • interval training likely to necessitate more qualified staff for better supervision
  • need to consider patient preference regarding type of training
21
Q

REVIEW Hwang et al. + Reed et al. papers!

A