ACE Senior Fitness Course

Question 1

** CARDIOVASCULAR DISEASES **
1- List some of the CVDs

2- Explain some from your list :)

Answer 1

*** 1 ***
. Coronary Artery Disease (CAD/CHD)
. Peripheral Artery Disease (PAD)
. Hypertension
. Stroke

** 2 **
. CAD: Major form of Cardiovascular diseases, results when coronary arteries are occluded/blocked by Atheroscloretic deposits of fibrous/fatty tissue (making arteries harder, thicker, and lose elasticity).
. Hypertension: High Blood Pressure, measured in mmHg. It is determined by CO and/or TPR. Tools used to measure it include Sphygmomanometer and a Stethoscope.
. Stroke: A sudden and often severe attack due to the blockage of an artery to the brain.

Question 2

Difference between Arthritis, OsteoArthritis, Rheumatoid Arthritis and OsteoArthrosis?

Answer 2

. Arthritis: Inflammation of the joints.

. Osteoarthritis: A degenerative disease involves wearing away of joint cartilage. It occurs chiefly in older persons.

. OsteoArthrosis: Similar to Osteoarthritis, but without the joint inflammation. It is a non-inflammatory joint disease in which the joint cartilage breaks down. It occurs as a result of injury, aging, and long-term wear and tear of joints’ cartilages.

. Rheumatoid Arthritis: Autoimmune disease that causes inflammation of connective tissues and joints.

Question 3

What is TTM? What are its different stages?

Answer 3

. Transtheoretical Model of Behavioral Change
. Stages of Change are:
1- Pre-contemplation
2- Contemplation
3- Preparation
4- Action
5- Maintenance

Question 4

What is the Health Belief Model?

Answer 4

. It is a model that suggests that major factors influencing behavioral change include perceptions of vulnerability to illness or -ve health outcomes, combined with the perception of the seriousness of those outcomes.

Question 5

Define each of the following:
1- Chronological Age
2- Functional Age (Biological Age, Psychological Age, and Social Age)

Answer 5

1- Chronological Age is the length of time, in years/months since birth, a person has lived.
2- Functional Age is a measure of aging using various indications beyond the Chronological Age (Biological, Social and Psychological Ages).
2.1- Biological Age measures age focusing on Senescent changes in biological/physiological processes rather than Chronological processes, and their subsequent effects on behavior.
2.2 Psychological Age measures aging based on an individual’s abilities of cognitive/mental functioning (self-esteem, self-efficacy, learning, memory, and perception).
2.3- Social Age considers aging in-terms of what is and is not socially acceptable behavior for a person of a particular age group.

Question 6

Let’s have some “fun” :) What are:

1- T-Cell
2- Elastin
3- Collagen
4- Dystrophy
5- Chromosomes
6- DNA and what it stands for

Answer 6

1- T-Cell is a type of white blood cell that is an essential part of the immune system.
2- Elastin, a protein, similar to Collagen, found in connective tissue that has elastic properties.
3- Collagen is the main constituent of connective tissue (ligaments, tendons, and muscles).
4- Dystrophy is any disorder arising from faulty or defective nutrition, especially muscular dystrophies.
5- Chromosomes are rod-shaped or threadlike DNA-containing structures of cellular organisms that contain genetic information.
6- DNA: Deoxyribonucleic Acid, It is a large, double-stranded, and helical molecule that is the carrier of genetic information.

Question 7

Discuss the Structural and Functional consequences of Aging. Then, discuss briefly the Physical Activity Continuum.

Answer 7

. Structural Changes show increased levels of Atrophy, Dystrophy, Edema, Demyelinization, Neoplastic growth, etc.
. Functional Consequences exhibit reduced Strength, Stability, Endurance, Balance, Coordination, Speed, Accuracy, Range, and Elasticity.

. 65% of the elderly population (65 years and older) is independent and fully functional, but due to reduced physical activity levels, they can be led into frailty. 5% are within the Fit/Elite category. 30% fall with those who need assistance with BADL/IADL.

Question 8

Didi Related
1- Degenerative Structural Changes
2- Nutrition, Vitamins, and Minerals
3- Food Choices
4- Ezapril Co (HP Medication)
5- Navilob / Erastapex

Answer 8

• ** 1 ***
• Degenerative changes in the vertebral discs alter the shape of the Thoracic Cavity with a resultant reduction in the pulmonary volume. Decreased strength and mass of the Thoracic muscles further compromise pulmonary efficiency.
• ** 2 ***
• Osteoporosis requires the consumption of Calcium (1,200 mg/day) and Vitamin D (600IU/day).
• Vitamin B12 and/or folic acid may help improve postural stability and/or muscle function and strength.
• Eat more Alkaline Foods (Fruits and Vegetables) and less Acidic Foods (Meat and cereal grains).
• Fiber intake is (21g/day).
• Protein intake is ~ (1.15g/kg/day).
• Average of (1600Kcals/day) is needed.
• Sodium is maxed at (2,300mg/day)
• ** 3 ***
• Replace foods high in saturated and trans fat such as butter, whole milk, and baked goods with foods higher in unsaturated fat found in plants and fish, such as vegetable oils, avocado, olives, nuts/seeds, and tuna.
• Less than 10% calories from Saturated Fat and less than 10% calories from added sugars.
• Drink fat-free (skim) or low-fat (1%) milk instead of reduced-fat (2%) or whole milk.

** 4 **
- Hydrochlorothiazide, the second component of EZAPRIL-CO is a thiazide diuretic that helps reduce the amount of salt and water in the body by acting on the kidneys to increase the flow of urine, this also helps to lower blood pressure.
USE –> It inhibits Na+ and CL- in the kidney; increases excretion of sodium and water, and controls HBP and fluid retention.
SIDE EFFECTS –> Drowsiness, dehydration, electrolyte imbalance, gout (kind of arthritis caused by a buildup of uric acid crystals in the joints), nausea, pain, hearing loss, elevated cholesterol, and lipoproteins.
EFFECT ON EXERCISE RESPONSE –> Hypotension

Note: Gout; If the body produces too much uric acid and/or fails to excrete it in the urine, crystals of monosodium urate form in the joints and tendons. These crystals cause intense inflammation leading to pain, swelling, and redness.

• ** 5 ***
• Navilob / Erastapex

Question 9

What are the FAT differences between:
1- Lipids
2- Adipose
3- Cholesterol
4- Triglycerides

Explain how all the above correlate together.

Answer 9

1- Lipids are fats used in the body and the bloodstream.
2- Adipose is fat cells stored in the body’s fatty tissues.
3- Cholesterol is a fatlike substance found in the blood, body tissues, and in certain foods. They can accumulate in the arteries leading to Atherosclerosis.
4- Triglycerides are 3 fatty acids joined to a glycerol (carbon and hydrogen) backbone, how fat is stored in the body.

Notes:

• Triglycerides and Steroids are different types of Lipids found in the body. Lipids are a broad group of biomolecules whereas Fats are a type of Lipids.
• • Thus, fat is a type of lipid. Fat cells (Adipose) are being stored in the body’s fatty tissues in the form of Triglycerides.

Question 10

Explain Lipoprotein and the difference between LDL, HDL, and Dyslipidemia.

Answer 10

• Lipoprotein is an assembly of a Lipid and Protein that serves as a transport vehicle for fatty acids and cholesterol in the blood and lymph.
• LDL (Low-Density Lipoprotein; bad cholesterol) is a Lipoprotein that transports cholesterol and triglycerides from the liver and small intestines to cells and tissues. Elevated levels of LDL may cause Atherosclerosis.
• HDL (High-Density Lipoprotein; good cholesterol) is a Lipoprotein that carries excess cholesterol from the arteries to the liver.
• Dyslipidemia is a condition characterized by abnormal blood lipid profiles; it may include elevated cholesterol, triglyceride, or LDL and/or low HDL levels.

Question 11

What is:
1- The difference between Maximal Oxygen Uptake (VO2 Max) and Vital Capacity?
2- Functional capacity?

Answer 11

• ** 1 ***
• Maximal Oxygen Uptake (VO2 Max); maximal capacity for the body to take in, transport, and use O2 during exercise; a common indicator of physical activity and an excellent measure of cardiorespiratory efficiency.
• Vital Capacity; the volume of air that can be maximally inhaled and exhaled in one breath.
• ** 2 ***
• The maximal physical performance represented by the maximal oxygen uptake.

Question 12

What do you know about Lactose?

Answer 12

. Lactose is a type of sugar found in milk products and can be difficult for some people to digest.
. Food Manufacturers produce lactose-free products by adding Lactase to regular cow’s milk.
. Lactase is an enzyme produced by people who tolerate dairy products, it is required to digest Lactose.

Question 13

Discuss the following and its preventative measures:
1- Osteoporosis
2- Sarcopenia and Sarcopenic Obesity

Answer 13

1- Osteoporosis is a disorder, mainly affecting postmenopausal women, in which bone density decreases (weakening of the bones), and susceptibility to fracture increases.
–> Calcium, Vitamins D and K: Vitamin D deficiency is associated with higher bone turnover, reduced calcium absorption, and decreased bone mass. Vitamin K can help decrease fracture risk.

2- Sarcopenia is “muscle wasting” or decreased muscle mass; often refers specifically to an age-related decline in muscle mass or lean-body tissue.

Question 14

** KNOW YOUR LABEL - Vitamins and Minerals **

What do you know about Vitamin B12 (know about, benefits, sources, etc.)?

Answer 14

• ** Vitamin B12 ***
• It is a micronutrient that helps keep the body’s nerve and blood cells healthy (metabolize amino acids and helps cells multiply), helps make Deoxyribonucleic Acid (DNA) that makes up the genetic information of all cells, and helps prevent Megaloblastic anemia which makes people feel tired and weak.
• Deficiency causes tiredness, weakness, constipation, loss of appetite, weight loss, and megaloblastic anemia. Nerve problems, such as numbness and tingling in the hands and feet. Problems with balance, depression, dementia, poor memory, confusion, and soreness of the mouth and/or tongue.
• HCL in the stomach separates B12 from the protein it is attached to in the food, then it combines with a protein made by the stomach (intrinsic factor) and is absorbed by the body.
• Mainly found in animal food but not plants (unless fortified). The best sources are Beef Liver and Clams.

Question 15

** KNOW YOUR LABEL - Vitamins and Minerals **

What do you know about Magnesium (know about, benefits, sources, etc.)?

Answer 15

• Magnesium is a mineral used in building bones and releasing energy from the muscles. It plays an important role in managing sleep, metabolism, and muscle health.
• Mainly found in Green Leafy Vegetables, Nuts/Seeds, Fruits (Avocado, Figs, Banana, etc.).

Question 16

** KNOW YOUR LABEL - Vitamins and Minerals **

What do you know about Zinc (know about, benefits, sources, etc.)?

Answer 16

• Zinc is a mineral that helps with normal growth, healing wounds (blood clots), decreases childhood diarrhea and respiratory infections, essential for taste and smell, and boosting the T-Cell (bolstering the immune system and fighting damaged/cancerous cells).
• It is said it can speed recovery between workouts.
• Excellent sources of Zinc are Meat and Shellfish.

Question 17

** KNOW YOUR LABEL - Vitamins and Minerals **

What do you know about Iron (know about, benefits, sources, etc.)?

Answer 17

• Iron is a mineral that is best known for ferrying O2 throughout the body. It is critical for motor and cognitive development.
• Iron is a leading cause of anemia (low hemoglobin concentration).
• Excellent sources of Iron are Beans and Lentils, Baked Potatoes, Cashews, Dark Green Leafy Vegetables, etc.

Question 18

** KNOW YOUR LABEL - Fibers **

What is the difference between Soluble and Insoluble Fiber? Expand on what they are, health benefits, and best food sources.

Answer 18

• Dietary fiber, the indigestible part of plant material, is made up of two main types: Soluble and Insoluble fibers. It is a complex carb and doesn’t raise blood sugar levels.
• They both assist in feeling full longer after meals and in lowering disease risk (obesity, cardiovascular diseases, metabolic syndrome, diabetes, and others).

** Soluble fiber **
- It easily dissolves in water and is broken down into a gel-like substance in the part of the gut known as the colon. It is then digested by bacteria in the large intestine, releasing gases and a few calories.
- Some of its benefits include:
1- Lowering fat absorption and helping weight management (blocks fats that would otherwise be digested and absorbed),
2- Lowering Cholesterol levels,
3- Stabilizing Glucose Levels (slows down the digestion rate of other nutrients),
4- Reducing the Risk of Cardiovascular diseases (lowering cholesterol levels, stabilizing blood sugars, and decreasing fat absorption), and
5- Feeding Healthy-Gut Bacteria.

** Insoluble fiber **
- It does not dissolve in water and is left intact as food moves through the gastrointestinal (digestive) tract. Because it is not digested at all, it is not a source of calories.
- Some of its benefits include:
1- Preventing Constipation (bowel movement), and
2- Lowering the Risk of Diverticular Disease (preventing Constipation and intestinal Blockages).

• According to the FDA, foods are considered high in fiber contain at least 20% of the RDV of dietary fiber/serving. Foods having 5% or less are considered poor sources of dietary fiber.
• Beans, Peas, and Lentils * ALWAYS *

Question 19

Explain the following Risk Stratification related:
1- Risk Stratification
2- What is it used to determine?
3- How to perform the main steps?

Answer 19

1- Risk STratification (ACSM) established recommendations concerning the need for a medical exam and exercise testing prior to participation in an exercise program.

2- It is used to determine the following:

2. 1- Presence/Absence of known Cardiovascular, Pulmonary and/or Metabolic disease
3. 2- Presence/Absence of Cardiovascular risk factors
4. 3- Presence/Absence of symptoms/signs suggestive of Cardiovascular, Pulmonary and/or Metabolic disease

3- The steps are followed in chronological order:

3. 1- Identify CAD risk factors
4. 2- Perform Risk Stratification based on CAD risk factors
5. 3- Determine the need for a medical exam/clearance and medical supervision.

Question 20

Following up on "Risk Stratification", explain the following signs/symptoms suggestive of CV, Pulmonary and/or Metabolic disease:
1- Ischemia
2- Dyspnea
3- Orthopnea
4- Edema
5- Tachycardia
6- Palpitations
7- Intermittent Claudication
8- Syncope
9- Heart Murmur

Answer 20

1- Ischemia is the decrease in blood supply to a bodily organ, tissue, or part caused by obstruction or constriction in the blood vessels. It may result in pain (tightness) or discomfort in the chest, neck, jaw, and arms.

2- Dyspnea is distress/difficulty breathing at rest or with mild exertion (shortness of breath).

3- Orthopnea is a form of Dyspnea in which an individual can comfortably breathe only when standing or sitting erect (associated with Asthma, Emphysema, and angina).

4- Edema is swelling caused by excessive accumulation of fluid in the body tissues.

5- Tachycardia is when heartbeats exceed 100bpm.

6- Palpitations are rapid and irregular heartbeats.

7- Intermittent Claudication is pain sensations (aches, cramps, numbness, etc.) in the lower extremities caused by the inadequate blood supply; usually relieved by a short period of rest.

8- Syncope (fainting) is a transient state of unconsciousness, during which an individual collapses to the floor as a result of reduced O2 flow to the brain.

9- Heart Murmurs are sounds (whooshing/swishing) during the heartbeat cycle, made by turbulent blood flow in/near the heart.

Question 21

** Blood Pressure **
1- Determined by CO and TPR. Explain both.
2- Equipment used for measurement.
3- What happens if:
a: Deflation Rates > 2mm per second
b: >10 mmHg between readings from arm to arm
c: You start to exercise
d: 20 mmHg increase in SBP and/or 10 mmHg increase in DBP above normal

Answer 21

• ** 1 ***
• CO (Cardia Output) is the volume of blood pumped by the heart per minute (liters of blood/min).
• TPR (Total Peripheral Resistance) is the resistance to the passage of blood through the small blood vessels, especially the arterioles.
• BP can be elevated by either or both.
• ** 2 ***
• Sphygmomanometer and a Stethoscope are the tools for BP measurement. The sphygmomanometer consists of a rubber bladder enclosed in a nylon cuff, inflatable bulb, and a manometer.
• ** 3 ***
  a: Significant SBP underestimation and DBP overestimation.
  b: Circulatory problem, the client should be referred to a physician
  c: On the onset of exercise, SBP tends to increase due to the rise in CO. With continuous exercise intensity, SBP increases linearly. DBP tends to remain constant or decrease (by 10-20 mmHg) due to the dilation of the peripheral arterioles of the exercising muscles.
  d: Doubles the risk of CVD.

Question 22

** OPEN FOR DISCUSSION **
1- Explain the sequence is carrying the Physical-Fitness Assessments.
2- Expand on Cardiorespiratory Fitness testing

Answer 22

• ** 1 ***
• Start by conducting the Health-Related Resting Measures (Anthropometric measures “Body Composition, WC”, HR, BP, and Static Posture).
• If the older adult can’t perform at least 20mins of continuous cardiorespiratory exercise, proceed with the 6MWT (lower-functioning older adult).
• If the older adult can do the 20mins, proceed with cardiorespiratory assessment for the higher-functioning older adults, and determine VT1 (Talk Test).
• If deemed necessary, proceed with Functional Assessments for lower functioning older adults.
• Use the Balance, Core, and Mobility Assessments for higher-functioning older adults.
• ** 2 ***
• Cardiorespiratory Fitness is an indication of how well the body can move in a dynamic fashion, using large muscle groups, with medium to high intensity for extended periods of time. Assessments are also valuable in assessing the individual’s overall health.

Question 23

Explain Wolff’s Law.

Answer 23

• Wolff’s Law indicates that changes in bone structure coincide with changes in bone function.
• When the skeleton is subjected to stressful forces (like those that occur @ exercise), it responds by laying down more bone tissue, thereby increasing its density.
• Conversely, when individuals experience prolonged periods of bed rest (injury, illness, etc.), their bones lose minerals and become less dense.

Question 24

Explain the difference between VT1 and VT2 and elaborate on their benefits.

Answer 24

• VT1 (First Ventilatory Threshold) is the intensity of aerobic exercise at which ventilation starts to increase in a non-linear fashion in response to an accumulation of metabolic by-products in the blood. Breathing (ventilation) starts to increase and an individual can continue to talk while breathing with minimal discomfort; quickened expiration rate tends to blow off more CO2 in an effort to buffer blood lactate.
• VT2 (Second VT) is a metabolic marker that represents the point at which high-intensity exercise has to conclude due to the accumulation of lactate.
• By determining VT levels, programs can be tuned to suit clients with different objectives (those looking for wellness and good health can train at or slightly below VT1, those interested in sports conditioning and/or competition would benefit from training at higher intensities).

Question 25

Explain the Human Lung Capacity.

Answer 25

• Vital Capacity (VC) = Tidal Volume (TV) + Inspiratory Reserve Volume (IRV) + Expiratory Reserve Volume (ERV).
• VC is the maximum volume of air that can be inhaled or exhaled during a respiratory cycle.
• TV is the amount of air that can be inhaled (inspired) /exhaled (expired) in 1 normal breath.
• ERV is the additional volume of air that can be exhaled after a normal exhalation (reserve amount to be exhaled beyond what is normal).
• IRV is the additional volume of air that can be inhaled after a normal inhalation.
• The Reserve Volume (RV) is the amount of air that is left after ERV is exhaled; the lungs are never completely empty.

Question 26

Describe the path of Disease / Inactivity leading to Disability.

Answer 26

. Disease/ Pathology Lifestyle / Inactivity
. Any of the above leads to “Decline” Physical Impairment.
. This will follow with “Restriction” Functional Limitations.
. All this will end in “Inability” Disability.

Question 27

List useful exercises to use when:
1- Abnormal perception of true vertical
2- Poor Dynamic COG Control
3-

Answer 27

1- Standing against the wall with eyes closed (Somatosensory cues).
2- Seated/Standing balance activities emphasizing backward (stand to sit), forward (sit to stand), or multidirectional (transfers) weight shifts.
3-

Question 28

General nutrition guidelines for Older Adults:
1- Healthy U.S.-Style Eating Pattern
2- DASH
3- Mediterranean Diet

Answer 28

1- Emphasizing overall eating patterns more so than individual nutrients, recognizing that the overall nutritional value of a person’s diet is more than “the sum of its parts”.

• Main components include:
  1. 1) Variety of vegetables from 5 different groups
  1. 2) Variety of food rich in protein
  1. 3) Grains (primarily whole grains)
  1. 4) Fat-free or low-fat dairy
  1. 5) Fruit
  1. 6) Limited amounts of Saturated / Trans Fats (<10% Kcals), added sugars (<10% Kcals), and sodium (<2,300 mg/day).

2- Dietary Approach to Stop Hypertension (DASH) - it was initially developed to manage hypertension.
- This plan emphasizes vegetables, fruits, and low-fat milk and milk products. Mainly higher in whole grains, poultry, seafood, and nuts. Lower in sodium, red and processed meats, sweets, and sugar-containing beverages.

3- Mediterranean Diet emphasizes vegetables, fruit, nuts, olive oil, and whole grains with limited amounts of meat and milk products.