7. CVD & exercise in older adults + JC Flashcards
- 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?)
- 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)
what are 8 common risk factors for CVD? + explain what exactly
- what is one negative risk factor?
- are they cumulative?
- 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
how to screen for high vs mod vs low risk for CVD?
- known CV (cardiac, peripheral, cerebrovascular), pulmonary (COPD, cystic fibrosis), metabolic disease (DM, renal disease)?
- if yes = high risk
- if no –> go to question 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 - number of CV risk factors (age, family history, smoking, sedentary, obesity, HT, dyslipidemia, prediabetes)
- >2 –> mod risk
- < 2 –> low risk
what are the 5 main cardioprotective effects of regular PA?
- anti-atherosclerotic
- increase HDL, insulin sensitivity
- decrease LDL, BP, adiposity, inflammation - anti-arrhythmic:
- decrease resting HR, SNS activity
- increase vagal tone, HRV - anti-ischemic: (prevents build-up of plaque)
- decrease myocardial O2 demand, endothelial dysfunction
- increase coronary flow, EPCs and CCACs, NO - anti-thrombotic:
- decrease platelet adhesiveness, fibrinogen, blood viscosity
- increase fibrinolysis - psychological:
- decrease depression, stress
- increas social support
does PA and cardiorespiratory fitness impart the same decrease in relative risk of CVD?
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!)
4 steps of history examination before an older adult wants to start/continue exercise
- SCREENING questionnaire (ie PARQ or get active questionnaire)
- identify medical contraindications and whether medical clearance from physical is required - HISTORY of prior myocardial infarction, coronary heart disease, peripheral vascular disease, cerebrovascular disease –> could place patient in higher risk category
- MEDICATIONS: complete list (ie beta-blockers, calcium channel blockers –> have indications for testing and HR prescription)
- evaluation of patient’s TYPICAL PA patterns and exercise-induced symptoms (ie chest pain, dyspnea, palpitations, light-headedness)
What should physical examination focus on before an older adult wants to start/continue exercise? (5)
- 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?
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 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)
who can exercise safely? explain big schéma
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
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
- 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
what does CPET stand for? another name for it? –> what does it output? (4)
- who should get CPET vs who shouldn’t?
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
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?
- 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
what are the 4 criteria for determining VO2max?
- no increase in VO2 with increase in work rate (ie plateau)
- respiratory exchange ratio >1.15
- maximal HR +/- 10 bpm of predicted HR
- RPE >17/20
what is an alternative to CPET for older adults without the need to monitor (3)
- explain the test
- correlates well with what?
- strengths (3)
- 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
exercise training in CVD prevention
- exercise training can delay WHAT and prevent WHAT in older adults
- also plays a key role in (4)
- delay age-related morbidity and prevent CVD events in older adults
- secondary prevention
- modifying symptoms
- increasing function
- improving quality of life
what are exercise recommendations for cardiorespiratory fitness for older adults:
CONTINUOUS AEROBIC EXERCISE
RESISTANCE TRAINING
- frequency
- intensity
- time
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
- define cardiac rehabilitation
- involves who?
- involves most or all of the following components: (4)
- 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…)
- is it safe for older adults to do mod and vigorous exercise?
- what are exercise modifications for older patients with CVD? (5)
- 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
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 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
- 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?
- 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
REVIEW Hwang et al. + Reed et al. papers!
