Activity Tolerance and Fatigue

Question 1

__________ _______ is defined as the process of energy expenditure for the purpose of accomplishing an effect.

Answer 1

physical activity

Question 2

________ or endurance, exercise involves the body’s ability to improve its use of oxygen for energy during prolonged strenuous exercise. It involves rhythmic changes in muscle length (contraction and elongation) during activities such as walking, running, bicycling, or swimming.

Answer 2

aerobic

Question 3

muscles that use oxygen more efficiently such that the body can do more work with less cardiac and respiratory effort, it does not promote significant increase in

Answer 3

muscle mass

Question 4

Evidence reveals multiple advantages for people who participate in sustained aerobic exercises, including _________ ______ _________

Answer 4

oxidative stress reduction

Question 5

___________ or resistance, exercise, sustained muscle contraction is generated against a stable load with no change in length of the involved muscle group or joint movement.

Answer 5

isometric

Question 6

weight lifting and repeated movement against low to moderate resistance, that improve overall muscle strength and tone and build muscle mass is

Answer 6

isometric

Question 7

true or false

both aerobic exercise and resistance training have similar effects on bone density, glucose tolerance, and insulin sensitivity.

Answer 7

true

Question 8

For weight control, _______ exercise is considered a calorie burner.

Answer 8

aerobic

Question 9

Resistance training assists the body in expending calories through an increase in what two things?

Answer 9

lean body mass and basal metabolism

Question 10

Considerable evidence suggests that ______ exercises increase tendon flexibility, improve joint range of motion, and enhance muscular performance.

Answer 10

stretching

Question 11

Exercise produces an increase in heart rate and stroke volume (amount of blood pumped with each heart beat), which in turn increases

Answer 11

cardiac output

Question 12

With anticipation of exercise, cardiovascular centers in the brain stem are stimulated to initiate an increase in ________ activity concomitant with an inhibition of _____________ mechanisms.

Answer 12

increase sympathetic

decrease parasympathetic

Question 13

Stimulation of the sympathetic nervous system produces an increase in _______ ______ and _______ _________

Answer 13

heart rate and cardiac contractility

Question 14

At the start of exercise, the heart rate increases immediately and continues to increase until a plateau is reached. This plateau, or steady-state heart rate, is maintained until exercise is terminated. Catecholamine release of _________ and _________ assists in maintaining the heart rate.

Answer 14

epi and NE

Question 15

Also contributing to the increased heart rate during exercise are mechanisms intrinsic to the heart. An increase in venous return stimulates right atrial stretch receptors that initiate an increase in heart rate, and an increase in ventricular filling stretches the myocardial fibers, resulting in a more forceful contraction and a more complete emptying of the ventricles with each beat through the

Answer 15

frank-starling mechanism

Question 16

Increased sympathetic activity constricts the resistance vessels, leading to an increase in _____ ________, and it dilates the capacitance vessels in the visceral circulation, leading to an increase in venous return to the heart and maintenance of the cardiac output.

Answer 16

blood pressure

Question 17

It is important to note that the vasoconstriction during exercise that is produced by sympathetic innervation and circulating catecholamines (i.e., epinephrine) does not occur in what three places?

Answer 17

active skeletal muscles
coronary circulation
brain

Question 18

With the onset of aerobic exercise, the ________ blood pressure increases largely due to an increase in cardiac output, whereas the ______ pressure remains relatively unchanged because of vasodilation and increased blood flow to the working muscles.

Answer 18

systolic increases

diastolic stays the same

Question 19

The increased systolic pressure that occurs in exercise along with a nearly constant diastolic blood pressure generates an increased

Answer 19

MAP

Question 20

The role of the respiratory system during exercise is to increase the rate of

Answer 20

oxygen and CO2 exchange

Question 21

With the increase in cardiac output, a greater volume of blood under slightly increased pressure is delivered to the pulmonary vessels in the lungs. This results in the opening of more pulmonary capillary beds, producing better ________ _________ and more efficient exchange of oxygen and carbon dioxide.

Answer 21

alveolar perfusion

Question 22

In addition to pulmonary perfusion being enhanced during exercise, pulmonary ventilation is increased, resulting in a more optimal ventilation–perfusion ratio. This response is controlled by ___________ —located in the brain stem, aorta, and carotid arteries—that monitor blood gases and pH.

Answer 22

chemoreceptors

Question 23

During exercise, decreases in blood oxygen and pH and increases in carbon dioxide stimulate these receptors, producing an increase in both the ____ and _____ of respiration.

Answer 23

rate and depth

Question 24

_______ _________ is defined as the ability of muscle groups to produce force against resistance.

Answer 24

muscle strength

Question 25

_________ involves the range of movement of joints

Answer 25

flexibility

Question 26

___________ _________ refers to the ability of the body or muscle groups to perform increased activity for an extended time.

Answer 26

muscle endurance

Question 27

Skeletal muscle consists of two distinct types of muscle fibers based on differences in their size, speed, contractile properties, endurance, and metabolic characteristics: ______ slow-twitch (type I) and ______ fast-twitch (type II) muscle fibers.

Answer 27

red - slow - type 1

white - fast - type 2

Question 28

Both ________ and ________ influence the distribution of fast-twitch and slow-twitch fibers.

Answer 28

heredity and activity

Heredity appears to contribute to differences in muscle fiber composition, such that some people have considerably more fast-twitch than slow-twitch fibers, and others have more slow-twitch than fast-twitch fibers. This could determine, to some extent, the area of athletics for which a person is best suited.

Question 29

The _____-twitch fibers, which are smaller, tend to produce less overall force but are more energy efficient. They are better suited biochemically to perform lower-intensity work for prolonged periods.

Answer 29

slow

Question 30

Examples of exercising that uses ___-twitch fibers are long distance running, swimming, and cycling where endurance is desired.

Answer 30

slow

fatigue resistant and ideally suited for prolonged aerobic exercise or activity.

Question 31

____-twitch fibers predominate in the large muscle groups such as the leg muscles.

Answer 31

slow

Question 32

_____-twitch fibers are larger and better suited for high-intensity work, but they fatigue more easily. These fibers have high myosin adenosine triphosphatase (ATPase) activity, few mitochondria, low myoglobin concentration, and high glycolytic capacity, resulting in dependence on anaerobic metabolism to supply adenosine triphosphate (ATP) for energy.

Answer 32

fast

Question 33

___-twitch fibers predominate during activities in which short bursts of intense energy are required, such as sprinting or weight lifting.

Answer 33

fast

Question 34

People with _______ ______typically experience symptoms of breathlessness, exertional fatigue, and exercise intolerance resulting in atrophy of skeletal muscles. When these people engage in exercise, there is a shift toward using fast-twitch muscle fibers. This causes an early dependence on anaerobic metabolism and excessive intramuscular acidification that leads to increased fatigability.

Answer 34

heart failure

Question 35

Increased blood flow to working muscles is achieved by relaxation of the arterioles and the precapillary sphincters. Chemical changes such as ________ oxygen and pH and ________ levels of potassium, adenosine, carbon dioxide, and phosphate contribute to the vasodilation during prolonged exercise and recovery from exercise

Answer 35

decreased o2 and ph

increased K, adenosine, CO2, and phosphate

Question 36

Another mechanism that increases blood flow to the working muscles is the diversion of blood from organs such as the ______ and ______ structures that are less active than the working muscles.

Answer 36

kidneys and GI

The amount of blood flow diverted from the visceral organs is proportional to the level of exercise, and as exercise is increased, more blood is diverted to working muscles.

Question 37

“Trained muscles” have an increased number of _________ surrounding each muscle fiber that facilitates the delivery of oxygen to the working muscle cells during exercise. They are able to use oxygen more efficiently, probably because of enhanced enzymatic activity that increases oxidative capacity. The mitochondria appear to adapt by increasing the transport of oxygen and other substrates to the inner regions of the muscle fiber.

Answer 37

capillaries

Question 38

The enzyme _____ ______catalyzes the transfer of the high-energy phosphate groups from ATP to creatine, forming creatine phosphate and adenosine diphosphate (ADP). When muscle contraction begins and ADP levels start to rise, CK catalyzes the transfer of a high-energy phosphate group back to ADP, thus forming new ATP molecules that can be used by the muscle for energy.

Answer 38

creatine kinase

Question 39

During exercise, particularly aerobic exercise, the body uses its energy sources in a characteristic pattern. The first sources of energy are (3)

Answer 39

stored ATP, creatine phosphate, and muscle glycogen.

Question 40

For intense, prolonged periods of activity lasting more than 40 minutes, aerobic metabolism and the use of (3) becomes essential

Answer 40

glucose, fatty acids, and amino acids

Question 41

To supply the energy needed for increased activity, a person must consume a balanced diet and have adequate hydration. Although proteins are not used for energy sources during increased activity, they have an essential role in

Answer 41

building and rebuilding tissues and organs

Question 42

Almost all the energy released from metabolic processes involved in muscle contraction is converted to

Answer 42

heat

Question 43

Under normal resting conditions, the body is able to maintain its temperature within a set range. It does this by two mechanisms. The first mechanism used by the body to regulate temperature is to change blood flow to

Answer 43

skin

When the blood vessels of the skin dilate, warm blood is shunted from the core tissues and organs to the skin surface, where heat is lost more easily to the surrounding environment.

Question 44

the second mechanism used by the body to regulate temperature during exercise is through

Answer 44

sweating.

the evaporation of sweat from the skin surface contributes to the loss of body heat.

Question 45

As temperature regulation improves with training, the trained person begins to sweat sooner, often within 1 to 2 minutes of the start of exercise. Sweat production begins even before the core temperature rises, and a cooling effect is initiated soon after the start of exercise; the sweat produced is more ____ than that produced by a nontrained person.

Answer 45

dilute

Sweat normally contains large amounts of sodium chloride; production of a dilute sweat allows evaporative cooling to take place while sodium chloride is conserved.

Question 46

During exercise, _______ ________ are shifted from the interstitial to the vascular compartment so that there is an increase in the amount of proteins in the blood. These proteins exert an osmotic force that draws fluid from the interstitial space into the vascular compartment. This contributes to an increase in vascular volume, which in turn is delivered to the working muscles and which also provides more efficient heat dissipation.

Answer 46

plasma proteins

Question 47

During intense physical activity, blood flow is shunted away from the gastrointestinal tract toward the active skeletal muscles. As a result, gastrointestinal motility, secretory activity, and absorptive capacity are _________. This can result in heartburn or reflux, vomiting, bloating, stomach pain, and gastrointestinal bleeding. It may also cause cramping, urge to defecate, and diarrhea.

Answer 47

decreased

Question 48

Light and moderate exercise can benefit people with inflammatory bowel disease and liver disease. Evidence suggests that physical activity improves ______ ______ and lowers the risk of _______ ______ and reduces the risks for diverticulosis, gastrointestinal hemorrhage, and inflammatory bowel disease.

Answer 48

improves gastric emptying

reduces risk of colon cancer

Question 49

Increased ______ levels stimulate increased fibrinolytic (i.e., breakdown of the fibrin strands in a blood clot) activity. Thus, regular strenuous exercise can result in increased fibrinolytic activity and a slowing of coagulation activity.

Answer 49

epi

Question 50

A period of moderate-intensity exercise has been found to boost the immune system for several hours by producing an increase in circulating ______

Answer 50

WBCs including neutrophils and lymphocytes.

Question 51

exercise increases activity of ________ ________ cells

Answer 51

natural killer

Question 52

Chronic, intense, and exhausting exercise produces different effects on the immune system. Elevation in body temperature, cytokine release, and increased levels of various stress-related hormones (e.g., epinephrine, growth hormone, cortisol) may result in

Answer 52

temporary depression of body’s innate immune defenses

Question 53

Strenuous exercise alters mucosal immunity of

Answer 53

upper resp tract

This may explain why elite athletes are susceptible to illness, especially upper respiratory tract infections

Question 54

Strenuous exercise also lowers the availability of the nonessential amino acid ______, which serves as an energy source for lymphocytes and macrophages and general immunocompetence.

Answer 54

glutamine

Question 55

One method of assessing activity tolerance involves the administration of a screening tool in which participants describe their normal activities, their perceived level of activity tolerance, or their level of fatigue. An example of such a tool is the

Answer 55

human activity profile

Question 56

This tool consists of nine statements that describe symptoms of fatigue (e.g., exercise brings on my fatigue; fatigue causes frequent problems for me; fatigue interferes with my work, family, social life). People are instructed to choose a number from 1to 7that best indicates their agreement with each statement. The tool is brief, easy to administer, and easily interpreted.

Answer 56

fatigue severity scale

Question 57

________ is a procedure for determining physical performance capacity.

Answer 57

ergometry

The ergometer is a specific tool that imposes a constant level of work. A specified workload, expressed in terms of watts or joules per second, is imposed while the person performs the task. Two examples of ergometers include the bicycle ergometer and the treadmill ergometer.

Question 58

Maximal heart rate is estimated by age. Tables of maximal heart rate by age are available, but as a general rule, the predicted maximal heart rate can be estimated by

Answer 58

220-age

Question 59

___________ _________ can be viewed as not having sufficient physical or psychological energy reserve to endure or complete required or desired daily activities.

Answer 59

activity intolerance

Question 60

_________ is the sensation that comes with having exhausted those energy reserves.

Answer 60

fatigue

Question 61

true or false

Tiredness is relieved by a good night’s sleep, whereas fatigue persists despite sufficient or adequate sleep

Answer 61

true

Question 62

_______ ________ is muscle fatigue with a rapid onset and duration limited to the duration of the exercise. The time it takes to develop acute fatigue at any level of exercise depends on conditioning.

Answer 62

acute fatigue

Question 63

_______ _______ __________ is characterized by disabling fatigue and many nonspecific symptoms, including cognitive impairments, sleep disturbances, and musculoskeletal pain. The etiology is unknown, but it is associated with several chronic diseases such as fibromyalgia, depression, and irritable bowel syndrome.

Answer 63

chronic fatigue syndrome

Question 64

_______ ________ has a rapid onset and is often defined as muscle fatigue associated with increased activity, or exercise, that is carried out to the point of exhaustion. It also is frequently associated with a viral or bacterial infection and may present with other systemic symptoms such as fever or malaise.

Answer 64

acute fatigue

Question 65

____ _____ and ______ _______ are particularly sensitive indicators of activity tolerance or intolerance.

Answer 65

heart rate and blood pressure

Question 66

There are several possible causes of ________ __________ such as hypothyroidism, anemia, heart disease, Lyme disease, fibromyalgia, lung disease, electrolyte dysfunction, tuberculosis, hepatitis, and cancer. It is one of the more common problems experienced by people with chronic health problems

Answer 66

chronic fatigue

Question 67

_______ ________ occurs across a broad spectrum of disease states. It is a common complaint of persons with cancer, cardiac disease, end-stage renal disease, chronic lung disease, hepatitis C, arthritis, human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), and neurologic disorders such as multiple sclerosis, postpolio syndrome, and Parkinson disease.

Answer 67

chronic fatigue

Question 68

Chronic fatigue is almost a universal phenomenon in people with

Answer 68

cancer

Question 69

Cancer cells and the immune system appear to produce or express a number of cytokines with the potential for manufacturing many of the factors that contribute to fatigue particularly _________

Answer 69

interleukin-1 beta and tumor necrosis factor alpha (TNF-α)

Question 70

______ is a condition of disabling fatigue of at least 6 months’ duration that is typically accompanied by an array of self-reported, nonspecific symptoms such as cognitive impairments, sleep disturbances, and musculoskeletal pain.

Answer 70

CFS

Question 71

to diagnose CFS. there must be evidence of the concurrent occurrence of four of the following eight symptoms: sore throat, tender cervical or axillary lymph nodes, muscle pain, multijoint pain without swelling or redness, headaches, unrefreshing sleep, and postexertional malaise lasting more than ___ ______. The fatigue and concurrent symptoms must be of ____ _______ duration or longer.

Answer 71

24 hours

6 months

Question 72

Theories of the pathogenesis of ____ include genetic expression, infections, stress and prior psychological disorders, a dysfunction in the hypothalamic–pituitary–adrenal axis, nutritional deficiencies, or increased oxidative and nitrosative stress

Answer 72

CFS

Question 73

One of the most important findings in people with CFS is the complaint of fatigue. Often, the symptom of fatigue is preceded by a _____ or ______ _______. Frequently, the person describes the illness as recurring, with periods of exacerbations and remissions. With each subsequent episode of the illness, the fatigue increases.

Answer 73

cold or flu like illness

Question 74

true or false.

A holistic approach to the treatment of CFS is essential. With proper treatment and support, most people with CFS still do not demonstrate improvement.

Answer 74

false - do improve

Question 75

One of the most striking responses to assumption of the supine position during bed rest is the redistribution and change in

Answer 75

blood volume

Question 76

A major cardiovascular manifestation of bed rest is an increased

Answer 76

workload on the heart

In the supine position, the normal cardiac output is 7 to 8 L/minute, compared with a cardiac output of 5 to 6 L/minute for a person in the standing position.

Question 77

Bed rest also affects fluid balance. The increase in central blood volume results in an inhibition of ____ and _______, with a resultant water and sodium diuresis

Answer 77

ADH and aldosterone

Question 78

After ___ to ___ days of bed rest, resumption of the upright position results in orthostatic or postural intolerance. Standing after prolonged bed rest results in a decrease in central blood volume. Decreases in stroke volume and cardiac output occur along with increases in heart rate and systemic vascular resistance. The signs and symptoms of postural intolerance include tachycardia, nausea, diaphoresis, and sometimes syncope or fainting.

Answer 78

3-4 days

Question 79

Venous stasis in the legs results from a lack of the skeletal muscle pump function that promotes venous return to the heart. The skeletal muscle pump function decreases after assumption of the supine position, and there is mechanical compression of veins from the position of the lower extremities against the bed. This increased pressure can cause damage to the vessel intima, predisposing to

Answer 79

platelet aggregation and clot formation

Question 80

The development of DVT is a major complication of bed rest. It is believed that three factors (often referred to as the Virchow triad) combine to predispose a person to DVT. These factors are:

Answer 80

1) . Stasis of venous flow due to inactivity of the skeletal muscle pumps
2) . A hypercoagulability state resulting from a decrease in vascular volume and an increase in blood viscosity and concentration of blood coagulation factors
3) . Vessel injury to the endothelium resulting from external pressure against the veins

Question 81

The development of DVT also predisposes to the development of

Answer 81

pulmonary embolism

Question 82

Assumption of the supine position produces changes in lung volumes and the mechanics of breathing. Respiratory complications such as a (4) are all possible outcomes if a person is lying supine and on bed rest for more than 24 hours.

Answer 82

telectasis, accumulation of secretions, hypoxemia, and pneumonia

Question 83

In the supine position, breathing largely depends on the abdominal muscles rather than on movement of the chest cage. The ________ moves upward rather than downward, decreasing the size of the thoracic compartment, and chest and lung expansion are limited because of the resistance of the bed. As a result, the tidal volume and functional residual capacity are decreased, and the efficiency and effectiveness of ventilation are hindered

Answer 83

diaphragm

Question 84

people on bed rest need to work harder to breathe, and consequently they take fewer deep breaths. If the person must be on bed rest, it would be better to put the person in a _____ position if he or she could tolerate it.

Answer 84

prone

Question 85

poor fluid intake and dehydration may cause secretions to become thick and tenacious. Stasis of secretions provides an ideal medium for bacterial growth and increases the risk for development of pneumonia. Reduced activity and the recumbent position inhibit coughing, foster the retention of secretions, and adversely affect secretion distribution in the airways. _______ and ________ are necessary to prevent accumulation of secretions and airway collapse.

Answer 85

coughing and deep breathing

Question 86

Prolonged bed rest affects the renal system by altering the composition of body fluids and predisposing to the development of

Answer 86

kidney stones

Question 87

Prolonged bed rest causes muscle atrophy, protein breakdown, and decalcification of bone with the development of what two electrolyte imbalances?

Answer 87

hypercalcemia and hyperphosphatemia

increases risk for calcium stones

Question 88

inadequate emptying of the bladder while the person is in the supine position can lead to what two things?

Answer 88

incontinence and UTI

Question 89

_______ ________ can lead to loss of approximately one eighth of the muscle’s strength with each week of disuse.

Answer 89

disuse atrophy

Question 90

true or false

The larger and the better trained the muscle, the slower the loss of muscle strength and the slower the deconditioning occurs.

Answer 90

false

faster loss of strength and quicker deconditioning

Question 91

Muscle atrophy and disuse not only contribute to wasting and weakening of muscle tissue, they play a role in the development of joint

Answer 91

contracture

A contracture is the abnormal shortening of muscle tissue and connective tissue, rendering the muscle highly resistant to stretch. Contractures occur when muscles do not have the necessary strength to maintain their integrity (i.e., their proper function and full range of motion).

Question 92

consequence of prolonged immobility and bed rest for the musculoskeletal system is the loss of bone __________

Answer 92

mineralization

Question 93

According to the _______ law, the density of bone is directly proportional to the stress placed on it.

Answer 93

wolff

Question 94

__________ function in building the osseous matrix of the bone

Answer 94

osteoblasts

Question 95

_________ function in the breakdown of the bone matrix

Answer 95

osteoclasts

Question 96

During immobility and bed rest, the building of new bone stops, but the osteoclasts continue to perform their function. When bone experiences a lack of stress, as occurs with bed rest or immobility, there is a greater amount of bone resorption than bone formation, resulting in loss of bone mineralization or _______ _________

Answer 96

disuse osteoporosis

Question 97

true or false

permanent loss of bone mass and osteoporosis can result from long-term immobilization.

Answer 97

true

Question 98

The best measure to prevent the occurrence of osteoporosis is to begin ______ _________ exercises as soon as possible

Answer 98

weight bearing

Question 99

The basal metabolic rate _____ in response to decreased energy requirements of the body. Anabolic processes are slowed, and catabolic processes become accelerated, which leads to nutritional imbalance with a negative nitrogen balance. People in a negative nitrogen balance experience nausea and anorexia, which contribute to the catabolic state.

Answer 99

drops

Question 100

A major hormonal change that occurs with prolonged periods of immobility is an increase in the serum _____ due to the hypercalcemia that occurs secondary to bed rest.

Answer 100

PTH

Question 101

The person on bed rest also experiences an impaired responsiveness to the actions of

Answer 101

insulin —> hyperglycemic and hyperinsulinemic state

Question 102

The immune system also is subject to physiologic changes associated with bed rest including an increase in IL-1, IL-6, and TNF-α production. An increase in these mediators has been associated with

Answer 102

hyperinflammatory response and tissue injury

Question 103

Loss of appetite, slowed rate of absorption, and distaste for food combine to contribute to nutritional ____________ in prolonged bed rest

Answer 103

hypoproteinemia

Question 104

during bed rest, the large surface area of the skin bears weight and is in constant contact with the surface of the bed. Constant pressure is transmitted to the skin, subcutaneous tissue, and muscle, especially to those tissues over bony prominences. This constant contact causes increased pressure and impairs normal capillary blood flow, which interferes with the exchange of nutrients and waste products. the patient is at increases risk for development of

Answer 104

tissue ischemia –> necrosis

pressure ulcers

Question 105

During the first 3 days of bed rest, one of the first changes to occur is a massive _____

Answer 105

diuresis

Question 106

By days 4 to 7, there are changes in the hemolytic system. Fibrinogen and fibrinolytic activity increase, and clotting time is prolonged. The cardiovascular system responds with a decrease in _____ and _____

Answer 106

CO and SV

Question 107

Additional effects on the hemolytic system are observed on days 8 to 14. Red blood cell number is _____, and the phagocytic ability of leukocytes is _______.

Answer 107

RBCs decreased

phagocytic ability decreased

Question 108

There is a decrease in lean body mass, and after 15 days of bed rest, _________ and hypercalciuria occur.

Answer 108

osteoporosis