AEROBIC EXERCISE P.217 Flashcards
What are the 2 things aerobic training can improve?
training that improves the efficiency of aerobic energy-producing systems and can improve cardioresp endurance
Cardiorespiratory endurance
ability of body to sustain prolonged exercise
Cardiovascular deconditioning
a decrease in the cardiovascular system’s ability to deliver sufficient oxygen and nutrients
Best indicator of effort
Heart rate or RPE
Cardio decondition = _______ fatigue
early
Are most individuals who are deconditioned with disabltiies physically inactive or active?
INACTIVE
majority of those disabled are also inactive
What are the benefits of aerobic conditioning for individuals with disabilities?
- improve cardiovascular health
- decreased risks of cardiovascular deconditioning due to being sedentary
- appropriate body composition
- maintaining functional capacity*
- maintaing independace*
- improved performance in para-sports (adapted sports)
- improved selfimage
- reduced risk of depression
- improved vocational productivity (more satisfying participation in community, social, recreational family activities
Reminder: to cross a light you need ____ m/s
0.6
Normal walking is _____m/s
1-1.2
220-age vs. karvonenian method
which should you use if you want exercise to be harder?
whch should you use if you want xercise to be easier?
220-age - easier
karvonenian - harder
(Research paper: treadmill on stroke)
Normally subacute recovery with therapy targets basic mobility and ________.
activity of daily living
But, patients are usually discharged without full recovery and told to just generally exercise. Therefore, plateau in locomotor recovery happens within ___ weeks post-stroke.
11 weeks
HRR (Karvonean method)
(220-age) - resting heart rate X training intensity + resting heart rate = target heart rate
(Research paper: treadmill on stroke): exercise training
Treadmill group TAEX: 3 40 min sessions/week at HRR 60-70%
Training started at low intensity of 50-60 for 10-20 min then increased by 5 min every 2 weeks and increased HRR by 5% every 2 weeks too
CONTROL GROUP: stretched and did treadmill 5 minutes at 30-40 HRR
(Research paper: treadmill on stroke): main findings
1) treadmill aerobic training improves both functional mobility (6min walk) and cardiovascular fitness (peak VO2). It is more effective than CONVENTIONAL rehabilitation
25 out of 29 of the stroke patients in this study had
hypertension
(Research paper: treadmill on stroke): After 3 months… what happened?
no plateau for 6 min walk or VO2 peak
?
Regression analysis showed no associations between increases in…
time and age had no effect!!!!
increase in VO2 peak, 6 min walk, age at entry, latency since stroke, initial VO2 peak, gait deficient severity
Those who walked LONGER had what improvements?
increased 6 min walk, no change in VO2 peak
Those who were FASTER had what improvements?
increase in VO2 peak, no change in 6 min
(Research paper: treadmill on stroke):
clinical implications
1) plateau in locomotor recovery within 11 weeks post stroke, no longer true
2) VO2 post stroke = 50% of age-matched sedentary healthy individuals. Increases in peak fitness = increase in ADLs performance
3) increase in walking speed = better at crossing street and potential to be more independant
4) age and time since injury and gait deficit severity did not predict improvement in VO2 or walking speed
The Circle of deconditioning with physical disability
Physical impairment or disability (paralysis due to TBI or SCI) =
FUNCITONAL LIMITATION (decreased jogging) –>
DECREASED EXERCISE TOLERANCE OR INABILITY TO EXERCISE (decreased sports) –>
PHYSICAL INACTIVITY (decreased ADLs) –>
DECONDITIONING –> MEDICAL COMPLICATIONS AND SECONDARY DISABILITIES (increased weight and increased hypokinetic diseases)
Functional ability framework from test 1
physical impairment -> functional limitation -> reduced ability/disability
Four differences in VO2 max between able bodied people and those with disability
people with disabilities have lower VO2 max depending on:
1) limited exercising muscle (2/3 of muscle mass form legs)
2) impairment in ANS regulation of cardiac and circulating functions (pooling of blood)
3) motor dysfunction (spasticity, athetosis)
4) pain or fatigue (indirect effects)
Function of the Autonomic Nervous System (which leads to both para and symp)
- Regulates the activity of internal organs and vasculature
- Circulation
- resp
- digestion
- metabolism (heart beat)
- body temp
What is the origin of the ANS signal?
brain stem
Which part of the nervous system activates
the heart?
Sympathetic nervous
system
• level T1 to T5

T1 to T5 controls what?
Controls : • heart rate
• cardiac output (?)
• strength of cardiac contraction
ANS dysfunction commonly seen in:
Quadraplegia, high paraplegia (?), multiple sclerosis, TBI (b_r_a_in__st_e_m_)
Below T5, ANS is ____
ok, heart is intact
What does ANS controls do to the arterioles and capillaries?
Widening of the small arterioles and capillaries

How does ANS maintain BP?
Maintain BP by decreasing flow to inactive muscles and organs
If vasodilation of active muscles is uncompensated by vasocons-
triction in inactive organs =
Decreased BP can create exercise hypotension (low BP)


HR in ANS dysfunction
max HR may be reduced
around 12 bpm (highest)
at lesions at or above T1-T5
ANS dysfunction in regards to BP and force of heart
Diminished BP response to exercise
Force of heart muscle may be reduced
Can also decrease venous tone (lack of vasoconstriction)
ANS dysfunction is commonly associated with who?
quadriplegia and occasionally paraplegia (high) and MS and TBI
Which 2 factors might cause decreased breathing capacity after SCI?
SCI at or above the 5th cervical level (diaphragm problems, need breathing assistance)
SCI at the thoracic level (T2-T8) poliomyelitis, MS. Causes decrease in rib cage expansion and therefore decreased intercostal muscle function
What other problems arise with SCI at T5 and above?
Affects Adrenal gland function, which release epi and norepi. These catecholamines can act upon heart and arterial circulation to facilitate cardiovascular adjustment to exercise (increase HR, blood flow distribution and BP maintnance)
SCI AT T5 OR ABOVE = ABSENSE OF CATECHOLAMINES! SO THERE IS A DECREASED VENOUS RETURN, DECREASED CO FROM DECREASED SV.
FES is what? what does it promote?
FES is functional electrical stimulation, which promotes SV and increases CO. Thats why on the graph the line for those with FES was higher while standing, whereas those without FES decreased their stroke volume more. p. 288
is the venous system only a passive system?
no active too
Veins store the majority of blood at rest. _____ of total blood volume.
70%
Where theres lack of vasoconstriction (lack of sympathetic NS) …
pooling of blood in legs occurs
decreased cerebral blood flow can lead to
syncope
What are 2 ways to help prevent ANS dysfunction?
increase venous return and prevent hyperthermia
How to increase venous return
 Exercise in a horizontal posture (in water or on the ground)

 Use of abdominal binders and support stockings
How to prevent hyperthermia
maintain full hydration
minimize alcohol and caffeine
How does ANS dysfunction impair sweating during exercise (and cause hyperthermia)
ANS dysfunction can impair sweating during exercise:
decreases Heat evaporation = increased body temperature
\+  decreased venous circulation = decreased dissipation of heat from exercising muscle  WHICH EQUALS:  Risk of hyperthermia
Why should you minimize caffeine or alcohol to prevent hyperthermia?
they are diuretic drugs which increase production of urine
Hyperthermia symtpoms
- Elevated body temperature
- Visual disturbances
- Headache
- Feeling of weakness, dizziness , nausea
- Pulse may be rapid, irregular or weak
how does not having ANS dysfunction affect Q=HR X SV?
PARAPLEGIA
activation of sympathetic NS
hypokinesis (decrease in bood circ) –> blood pooling of legs (due to decreased exercising muscle mass) –> decreased stroke volume –> decreased cardiac output
Q = HR X SV
ONLY Q AND SV AFFECTED
how does having ANS dysfunction affect Q=HR X SV?
QUADRIPLEGIA
hypokinesis (decrease in bood circ) –> blood pooling of legs (due to decreased exercising muscle mass AND ANS DYSFUNCTION) –> decreased stroke volume –> decreased cardiac output AND HR plus adrenergic dysfunction
Q = HR X SV
ALL AFFECTED
Despite smaller muscle mass, max HR and systolic BP during arm exercise =
Only slightly lower than leg exercise
WHY? High level of ___________ stimulation equilibrates some of the effects
sympathetic
Normal arm muscle mass is _____ leg muscle mass
2/3
Arm vs leg exercises: arm training produces _____ SV and anaerobic threshold and ______ VO2, HR, systolic BP and lactic acid levels
lower
higher
Arm exercises do not ________ SV and Q as
effectively as leg exercises: not the mode of choice for central cardiovascular conditioning

increase
The less muscle mass, cardio and ANS integrity =
the lower the initial exercise tolerance
Arm or leg exercise with small or weak muscle: The limiting factor to exercise will be _____________ and not _______________ (fatigue due to muscle atrophy and not cardio capacity)
the muscle itself, cardio capacity
THIS IS DIFFERENT VERSUS AB PEOPLE
Long Term Exercise Training in Paraplegics
and Quadraplegics: SUBJECTS
• Subjects with traumatic SCI at C4 or below (ASIA A-D)
Long Term Exercise Training in Paraplegics
and Quadraplegics: PROGRAM
Supervised progressive exercise training 2 x /week for 9 months
Long Term Exercise Training in Paraplegics
and Quadraplegics: 2 important questions related tot his study
1- It is hypothesized that 9 months program would lead to improvements in muscle strength, exercise capacity, and quality of life
2- Is this 9 month program feasible from an adherence point of view?
Long Term Exercise Training in Paraplegics
and Quadraplegics: rational vs previous studies
- other studies = short in duration <24 weeks
- focused on quadriplegics or para
- no measure of long term Q of L in other studies
- 2 exercise session/week
Long Term Exercise Training in Paraplegics
and Quadraplegics: what was measured?
arm ergo
measured watts at different % of power intensities
40,60 and 80%
Long Term Exercise Training in Paraplegics
and Quadraplegics: What was used with subjects without a normal HR RESPONSE?
Borg ratings (RPE) of 1,2,4 were used to determine the intensity of the three workloads
Long Term Exercise Training in Paraplegics
and Quadraplegics: two types of exercise invoved in this study
arm ergo (aerobic) reisstance training (circuit)
Long Term Exercise Training in Paraplegics
and Quadraplegics: procedure
AEROBIC:
90-120 min per session
began with warm up
gentle upper body stretching
arm egro 15-30 min @ 70% max HR
if RPE decreased, workload or duration increased
RESISTANCE:
wall pulley, weights, weight machine
two sets of exercise progressed to three (50 to 70-80% 1RM)
Long Term Exercise Training in Paraplegics
and Quadraplegics: Arm ergo reuslst were higher for quadriplegics or para?
para becayse full use of arms
Long Term Exercise Training in Paraplegics
and Quadraplegics: Why is HR not constant for arm ergo graphs?
1) some used RPE to adjust exercise intensity
2) some probably oculdn’t reach target zone at pretest
Long Term Exercise Training in Paraplegics
and Quadraplegics: What happened 9 months after arm ergo training?
Increase of power output in exercise groupby 15 and 20 W in both quadriplegics and para
Long Term Exercise Training in Paraplegics
and Quadraplegics: What happened 9 months after resistance training?
Increase muscle strength in all but 1 muscle gorup in exercise group (LEFT ANTERIOR DELTOID DIDNT HAVE SIGNIFICANT DIFFERENCES WHEN COMPARED TO CONTROL, THE REST DID)
Long Term Exercise Training in Paraplegics
and Quadraplegics: What did the study say are the three things to potentially improving Q of L?
Changes in pain mediate QofL
Improve sense of control and mastery that people feel regarding their physical functioning
Social interaction = helps QofL
