Cardio and MS changes (Staloch) Flashcards
What decreases with the MS system that occur as we age?
- Size of type 1 muscle fibers (less decrease than type II)
- Size of type II muscle fibers
- Fasting rate of mixed and myosin protein synthesis
- Muscle protein metabolism
- Peak anaerobic muscle power
- Elasticity of tissues - Results in decrease in ROM (more in shoulders)
- Vertebral disc heights
- Glycogen storage capacity, glycogen synthesis
- Bone mineral density - Increased osteoclastic activity
- Mm strength, power and endurance
- Mm mass (sarcopenia)
What increases in the MS system with aging?
- Mm fat
2. Mm connective tissue
What are documentation requirements for sarcopenia?
Criterion 1-low muscle mass PLUS
Criterion 2-low muscle strength OR
Criterion 3 –low physical performance
What decreases in the CV system with aging?
- Maximal aerobic capacity
- Maximal Heart Rate
- Maximal cardiac output, stroke volume, peak HR, max 02 consumption
- Endothelial reactivity – harder time dilating or constricting
- Maximal skeletal muscle blood flow
- Capillary density
- Vascular insulin sensitivity
- Heart Size
- End diastolic filling
- Compliance of large arteries
- Secretion and release of catecholamines – impact on HR
- Pacemaker cells in SA node—can lead to a slightly lower heart rate
- Sensitivity of baroreceptors leading to postural hypotension in response to stress
- Speed of red blood cell production in response to stress of illness
- HDL cholesterol
- Lioprotein lipase activity – enzyme that helps break down triglycerides
What increases in the CV system with aging?
- Prevalence of A-Fib, aortic stenosis and valvular disease as a result of - Left ventricular mass and wall thickness increases—the amount of blood the chamber can hold may actually decrease leading to heart filling more slowly; Thickening of valvular structures; Epicardial fat
- Heart rate and blood pressure response to submaximal exercise
- Peripheral vascular resistance (HTN)
- Total cholesterol, LDL cholesterol
What are the functional implications of CV changes?
- Lower HRmax
- Lower stroke volume and cardiac output
- Increased BP
- Increased cardiovascular disease
- Reduced blood flow and therefore reduced oxygen to the skeletal muscles
- Decreased VO2 max
- Reduced skeletal muscle oxidative capacity
- Reduced exercise capacity/ blunted exercise response
What decreases in the pulmonary system with aging?
- Vital capacity
- Tidal volume
- Vascular insulin sensitivity
- Maximal flow rates
- Respiratory muscle strength
- Lung Expansion
- Elastic Recoil
- Alveolar surface area up to 20%-leads to decrease in max O2 uptake
- Alveolar vascularity
- Number of Cilia - Leads to respiratory infection
- Alveoli tend to collapse sooner on expiration
- no change in TLC
What increases in the pulmonary system with aging?
- Stiffness of chest wall
- Number of mucus producing cells
- Residual volume (RV)
- Functional Residual Capacity
- Respiratory Rate
What are functional implications of pulmonary changes in older adults?
- Reduced vital capacity and maximal ventilatory capacity
- Reduced forced expiratory volume in 1 second (FEV1)
- Up to 20% increase in work of respiratory muscles
- Ventilation/perfusion mismatch
- More vulnerable to respiratory infections
- Body becomes less efficient in monitoring and controlling breathing
- Lower threshold for shortness of breath
What are MS responses to exercise adaptations from aerobic training?
- Increase in type IIA fibers
- Increase in cross-sectional area of type IA and type IIA fibers
- Increase in capillary density
- Increase mitochondrial enzymes
- Increased muscle capillaries
- Increased oxidative enzyme activity - increased ATP
- Increased muscle protein synthesis
- Decrease in type IIB fibers
- Decreased Lactate dehydrogenase activity – decreased m soreness
What are MS responses to exercise adaptations from strength training?
- Increased oxidative capacity
- Increased mitochondrial volume density
- Increased muscle mass/size
- Increased power of both type I and type II muscle fibers
- Increased endurance
- Increased functional strength
- Increased insulin action
- May help increase ROM
- Increased myofibrillar protein turnover
What are normal cardiopulmonary responses to exercise?
- A progressive decline in SBP - Possibly sharp decrease in SBP may occur due to venous pooling and should normalize in a supine position
- DBP should remain the same post exercise - A decrease could be an indicator of heart failure; An increase of > 10 mmHg during or after exercise may be associated with CAD
What are valid aerobic capacity tests to use in older adults?
- 2min WT - for those that cannot walk long durations (acute care, CHF, frail) - distance during the time
- 400m WT - elicits greater effort that 6MWT - time taken to complete
- 6min WT - most widely researched in mult pt pops - measure distance
- 2min step test - for those concerned with walking, space not available - # steps
- 3 min step test - higher fxning - recover HR
- seated step test - for low level frail adults and those who cannot stand/ walk
- 1 min STS - # STSs without hands
- treadmill 6MWT - not interchangeable with 6MWT
What are valid muscle performance tests to use in older adults?
- MMT
- Hand held dynamometer
- STS - 5x or 30s - norms only for no use of hands
- Grip strength - predictive of mortality, future disability, and postop complications
- arm curl test - 5# or 8# dumbbell - as many as they can for 30s
the application of exercise science to physical therapist exercise prescription; Developed to address how tissues, organs and organ systems adapt to varying levels of physical stress; Includes other factor that may modify level of stress as well as the response of the tissues to stress Changes in relative level of physical stress causes a predictable response in all biological tissue - Stress below maintenance level=decreased tissue tolerance to stress (atrophy), Maintenance levels=do not change tissue (no change), Stress that exceeds maintenance levels=increased tissue tolerance to stress (hypertrophy)
Physical stress theory
Principle of physical stress theory:
- Tissue must be exposed to a load not normally exposed to in order to improve function
- Applied to aerobic capacity, strength training, balance training and flexibility
- Must be individualized
- Applies to: intensity, duration, frequency and speeds
- Intensity must be sufficient to overload the cardiovascular, pulmonary, musculoskeletal and neuromuscular systems without overstraining them
Overload
Principle of physical stress theory:
- Training will only improve those parts of the body being trained
- To become better at a particular skill, must perform that exercise or skill
- Effects are specific to the exercise or activity performed and muscles involved
- Long distance power walking will increase cardiovascular/pulmonary endurance
- Stretching the hamstrings will increase their flexibility
Specificity
Principle of physical stress theory:
- Prescribe an optimal does of exercise as soon as possible
Reach optimal level no later than by 3rd or 4th session
- As patient/client improves, must steadily progress intensity levels to continue to provide overload stimuli
- Each case is unique and patients will progress at individual rates (from rapid to no progress at all)
- Take care to progress patients/clients neither too quickly nor to slowly
Progression
Principle of physical stress theory:
- Cannot rush training
- Body needs times to allow physiological mechanisms required for the activity to adapt
- Overload training should not be done daily—muscles require time to heal
- If training intensity is increased too quickly, may lead to increased risk of fatigue or injury
Recuperation/ recovery
Principle of physical stress theory:
- Muscles will hypertrophy with use and atrophy with disuse
- Must balance between stress and rest
- Must be periods of low intensity between periods of high intensity for recovery
- Consider cross training – beneficial if worried about overloading or stressing
use/ disuse
- “Use it or lose it”
What are the components of exercise prescription?
- frequency
- intensity
- duration
- mode
- warm up/ cool down
What are guidelines to warm up?
5-10 minutes
Types:
- Passive: increase temperature by external means
- General: increase temperature using nonspecific body movements
- Specific: increase temperature using similar biomechanics used in subsequent, more strenuous activity—rehearses activity or event
Benefits:
- Rehearse movement
- Elevate body temperature
- Increase dissociation of oxygen from hemoglobin and myoglobin
- Increase muscle blood flow
- Reduce muscle viscosity
- Increase sensitivity of nerve receptors
- Increase speed of nerve impulses
- Increase flexibility
- Reduce likelihood of injuries
What are guidelines to cool down?
- 5-10 minutes
- A gradual tapering off of intensity
- Prevents blood from pooling in the lower extremities
- Decreases the likelihood of drop in BP, lightheadedness, fainting or abnormal heart rhythms
- Promotes removal of waste products from muscles
When should vitals be taken during aerobic capacity testing?
before, immediately after, and 10 mins after completion
- HR, BP, RR, RPE must be taken
- pulse ox may be taken
When should vitals be taken during aerobic training?
before, during (for intensity), and after (for recovery)
- during = HR, RPE, CIT
- after = HR, BP, RR, RPE
the body’s ability to work or participate in activity over time using the body’s oxygen uptake, delivery and energy release mechanisms; Is expressed in terms of VO2 max
aerobic conditioning/ endurance training
- max O2 uptake related to age, gender, genetic, health, exercise tolerance
- 3-5x per wk, more frequent (5-7 days) with older adults if exercise is at very low intensity of short duration
how do you determine target HR using the Karvonen method?
THR (bpm)=[%exercise intensity x HRR] +HRrest,
- where Heart Rate Reserve (HRR) =HRmax-HRrest
Intensity test:
- Shown to be well correlated with the ventilator and ischemic threshold
- A highly consistent method of exercise prescription
- Use as an alternative to THR or
- %CTT=[(count while achieved while exercising/CTTrest) x 100], the number they reach is their reserve
counting talk test
What is the RPE associated with physiological adaptations to exercise on the Borg Scale?
12-16
“somewhat hard” to “hard”
What population would you use RPE over HR for intensity?
People who are taking beta blockers
- Artificially depressed HR
HR will not rise as much during exercise
What are the correlations for exercise intensity on a 6-20 scale?
- RPE 9-11=20-40% of max aerobic capacity
- RPE 11-13=40-50%
- RPE 12-14=50-60%
- RPE 15-18=60-80%
Estimate exercise intensity (0-10 scale):
- RPE 5-6=moderate intensity (13-14 on 6-20 scale)
- RPE 7-8=vigorous intensity (16-17 on 6-20 scale)
Other than CTT, HR, and RPE, what are other scales used for measuring intensity?
- Borg dyspnea scale (0-10)
- Angina Scale (1+ to 4+)
- Claudication scale (grades 1-4)
What is the recommendation for how long someone should perform moderate activity?
30-40 inutes
- begins with what is tolerable. 5 mins is better than 0
What should the initial stage of aerobic conditioning/ endurance training look like (healthy adults 1st of 3 stages)?
- Longer warm up of 10-15 minutes
- Moderate intensity (40-60%) using interval format
- Longer cool down of 10-15 minutes including stretching
- 3-4 days per week
- 15-30 minutes
- Stage 1 last 1-6 weeks
What should the improvement stage of aerobic conditioning/ endurance training look like (healthy adults 2nd of 3 stages)?
- Warm up of 5-10 minutes
- Increasing Intensity (60-85%)
- Cool down of 5-10 minutes including stretching
- 3-5 days per week
- 25-40 minutes
- Last 4-8 months
What should the maintenance stage of aerobic conditioning/ endurance training look like (healthy adults 3rd of 3 stages)?
- Warm up of 5-10 minutes
- Intensity (70-85%)
- Cool down 5-10 minutes including stretching
- 3-5 days per week
- 20-60 minutes
- Lasts indefinitely—find variety and make it enjoyable
What are normal exercise responses?
- RPE=13/20
- Rise in SBP of 20-30 mmHg
- BP returns to within 10 mmHg and HR returns to within 10 bpm of pre-exercise value within 5 minutes of stopping exercise while sitting – indicates healthy heart
What are abnormal exercise responses?
- Failure to return to baseline as described above
- DBP drops 10-20 mmHg below baseline
- SBP >210-240
- DBP >110
- HR drops > 10 bpm below baseline
- HR rises > 50 bpm with low level activity
What diagnoses should exercise at lesser intensities?
- MI (wait 3-6 weeks s/p MI)
- Progressive degenerative neurological disorders (i.e. MS)
- Rheumatoid arthritis
- Acute musculoskeletal conditions
- Extremely frail or extremely deconditioned
- Patients for who resistance exercise would negatively affect post-surgical healing tissue
- should exercise at 30-60%
how many reps is equivalent to 30-60% 1-RM?
12- 25 reps
- Select amount of resistance you think they will experience momentary muscle fatigue around 15 reps
