9/17ab Physical Activity, Deconditioning, & Aerobic Training (Intervention) Flashcards
1.Describe the 2018 Physical Activity Guidelines for Americans 2.Describe the impact of physical activity on general health 3.Summarize the physiological changes and functional consequences associated with bedrest 4.Explain the impact of reserve capacity on exercise prescriptions for patients with deconditioning 5.Compare physical activity prescriptions to aerobic exercise prescriptions
Combined Multivariate Study - Adjusted rate ratio effects of sitting for women. Break down the importance of sitting and PA.
- 6 studies included
- about 600k adults in study
- higher amounts of daily total sitting time are associated with greater risk of death in any way
- moderate to vigorous PA reduces association
- the LESS PA per week, and the more time spent sitting, the risk of mortality is increased by two fold
- Even if you are the most active, if you sit for more than 3 hours a day, your risk of death is higher than someone who exercises less but sits less
Why is the government concerned with the PAG?
- the cost of disease and mortality are extremely high
- annually, health care costs reach about $117 billion in the US
Why is the PAG called Physical Activity and not Exercise?
- Physical Activity is just more inviting and seems less tedious than exercise to many people
- Exercise is typically a planned movement and it can become a chore for some
Physical activity encompasses
- The amount of movement per day
- Encompasses all kinds of activity
***What are all PAGs based on?
-RCTs based on exercise trials because it is really challenging to be able to measure daily activities
Do PTs prescribe physical activity or exercises? What are the differences?
- As PTs, we prescribe exercises with a long term goal of physical activity levels
- PTs use heart rate (HR) and perceived exertion first
- PAG never uses HR because it could be a barrier for patients and it is not really something that is constant b/c it varies based on the patient’s circumstances
Where do PA and exercise fit in with ICF? Why?
- PA: Participation, because it involves what a person is able to do in society and builds quality of life
- Exercise: Activity, because it is based on more concrete and measurable tasks that help patients with day to day improvement
What does PAG encompass and what are the recommendations for physical activity
Multicomponent training is the best for physical health
- Aerobic endurance cardio (AEC): as often as possible (every day)
- Muscle Strengthening (MS): twice a week
- Bone Strengthening: AEC and MS yield bone strengthening
- Balance Activities: MS is an aspect of balance
***How do we know what the MVPA prevents?
- Cross sectional observational studies (framingham studies) look at people over time and take their measurements
- Association NOT Causation
What percentage of people in the US getting the right dosage of physical activity per day?
-50% of Americans get the activity they need to reduce and prevent chronic disease
How is the PAG consistent with the Physical Stress Theory (PST)?
- There is strong evidence that promotes progression and overload
- It crosses people’s lifespans and includes patients with all different traits
- Addresses lifelong behavior change
Moderate intensity PA vs Vigorous Intensity
- Moderate: 3-5.9 METs 2 minutes moderate yields 1 minute intense
- Intense: 6-9 METs
Immobility period of deconditioning
- The amount of time where you can see detectable muscle loss
- Changes in muscle that affect immobility
Physiologic changes from bedrest
- The longer the bedrest, the greater the VO2MAX loss
- The longer the bedrest, the less WORK a patient can do
- The longer the bedrest, the higher the HEART RATE
- The longer the bedrest, the more difficult it is to get back into MOTION
- The longer the bedrest, the more NOREPI at max exercise
- The longer the bedrest, the less STROKE VOLUME
What is VO2max?
- maximal capacity to use oxygen
- efficiency of a system
- how much work you can do
- the true capacity for performance of mitochondria and muscle cells
What are the cardiac effects of bedrest?***REVIEW CHART
**REVIEW CHART
Significance of the threshold of independence
- Typically, patients only receive therapy when a patient’s function drops below the threshold of independence
- If the patient DOES get PT, then the rate of recovery is MUCH FASTER than if they didn’t
- Even patients who don’t fall below the independence threshold recover slower than them without PT
Problems of Bedrest **Add the rest
- CV, orthostatic hypotension (fall risk), increase resting pulse
- Pulm, atelactasis and oxygen desaturation, increase chance of pneumonia
- depression
- constipation
- bed sores
- calciuria
Reserve Capacity Definition
Activities of Daily Living (ADL) + Independence in a Community = Reserve Capacity
As your max capacity decreases, your reserve capacity simultaneously decreases and ADL and Independence in community become moderate to vigorous intensity exercise
PAG Exercise prescription components
- Intensity
- Frequency
- Duration
- Mode
PAG for prescribing intensity
- Absolute: using the same amount of METs and for two different patients who have different capabilities
- -Moderate (3-5.9 METs), Vigorous (>=6 METs)
- Relative: dependent on the patient, form of perceived effort, HR, VO2 max percentage
- -Moderate (5-6 on 0-10 scale), Vigorous (7-8 on 0-10 scale)
Exercise prescription for intensity
Most typical relative method is HR -Karvonen Method -Age Predicted Max Never use Absolute values -Perceived Exertion 6-20 scale -Oxygen uptake reserve (% of VO2max)
calculating the Karvonen method
[(HRmax-HRresting)*x%] + HRrest
highest correlation with work - the method that is used most accurately
Age Predicted Max
[(220-age)*x%]
exercise prescription for frequency
days per week
PA prescription for frequency
- 5x a week moderate
- > =3x a week vigorous
- combo of the above 2
exercise prescription for duration of aerobic exercise
minimum duration of an hour a day of moderate-intensity activities or 30-40 minutes of vigorous intensity activities
PAG prescription for duration of aerobic exercise
- 150-330 minutes a week of moderate
- 75-150 minutes a week of vigorous
- combo of the above 2
exercise prescription for the mode/specificity of physical activity
there needs to be continuous exercise and interval training throughout someone’s lifestyle
PAG prescription for the mode/specificity of physical activity
Continued accumulation of physical activity
