9/17ab Physical Activity, Deconditioning, & Aerobic Training (Intervention)

Question 1

Combined Multivariate Study - Adjusted rate ratio effects of sitting for women. Break down the importance of sitting and PA.

Answer 1

• 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

Question 2

Why is the government concerned with the PAG?

Answer 2

• the cost of disease and mortality are extremely high

- annually, health care costs reach about $117 billion in the US

Question 3

Why is the PAG called Physical Activity and not Exercise?

Answer 3

• 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

Question 4

Physical activity encompasses

Answer 4

• The amount of movement per day

- Encompasses all kinds of activity

Question 5

***What are all PAGs based on?

Answer 5

-RCTs based on exercise trials because it is really challenging to be able to measure daily activities

Question 6

Do PTs prescribe physical activity or exercises? What are the differences?

Answer 6

• 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

Question 7

Where do PA and exercise fit in with ICF? Why?

Answer 7

• 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

Question 8

What does PAG encompass and what are the recommendations for physical activity

Answer 8

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

Question 9

***How do we know what the MVPA prevents?

Answer 9

• Cross sectional observational studies (framingham studies) look at people over time and take their measurements
• Association NOT Causation

Question 10

What percentage of people in the US getting the right dosage of physical activity per day?

Answer 10

-50% of Americans get the activity they need to reduce and prevent chronic disease

Question 11

How is the PAG consistent with the Physical Stress Theory (PST)?

Answer 11

• 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

Question 12

Moderate intensity PA vs Vigorous Intensity

Answer 12

• Moderate: 3-5.9 METs 2 minutes moderate yields 1 minute intense
• Intense: 6-9 METs

Question 13

Immobility period of deconditioning

Answer 13

• The amount of time where you can see detectable muscle loss
• Changes in muscle that affect immobility

Question 14

Physiologic changes from bedrest

Answer 14

• 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

Question 15

What is VO2max?

Answer 15

• 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

Question 16

What are the cardiac effects of bedrest?***REVIEW CHART

Answer 16

**REVIEW CHART

Question 17

Significance of the threshold of independence

Answer 17

• 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

Question 18

Problems of Bedrest **Add the rest

Answer 18

• CV, orthostatic hypotension (fall risk), increase resting pulse
• Pulm, atelactasis and oxygen desaturation, increase chance of pneumonia
• depression
• constipation
• bed sores
• calciuria

Question 19

Reserve Capacity Definition

Answer 19

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

Question 20

PAG Exercise prescription components

Answer 20

• Intensity
• Frequency
• Duration
• Mode

Question 21

PAG for prescribing intensity

Answer 21

• 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)

Question 22

Exercise prescription for intensity

Answer 22

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)

Question 23

calculating the Karvonen method

Answer 23

[(HRmax-HRresting)*x%] + HRrest

highest correlation with work - the method that is used most accurately

Question 24

Age Predicted Max

Answer 24

[(220-age)*x%]

Question 25

exercise prescription for frequency

Answer 25

days per week

Question 26

PA prescription for frequency

Answer 26

• 5x a week moderate
• > =3x a week vigorous
• combo of the above 2

Question 27

exercise prescription for duration of aerobic exercise

Answer 27

minimum duration of an hour a day of moderate-intensity activities or 30-40 minutes of vigorous intensity activities

Question 28

PAG prescription for duration of aerobic exercise

Answer 28

• 150-330 minutes a week of moderate
• 75-150 minutes a week of vigorous
• combo of the above 2

Question 29

exercise prescription for the mode/specificity of physical activity

Answer 29

there needs to be continuous exercise and interval training throughout someone’s lifestyle

Question 30

PAG prescription for the mode/specificity of physical activity

Answer 30

Continued accumulation of physical activity