Ch. 21 - Chronic Diseases Flashcards
CVD, PAD, hypertension, CHF, Stroke, MI
1
Q
What is the definition of a chronic disease?
A
A condition that lasts one year or more and requires ongoing medical attention or limits activities of daily living or both
2
Q
What is the prevalence of chronic diseases in adults in the United States?
A
6 in 10 adults have a chronic disease, and 4 in 10 have two or more
3
Q
What are cardiovascular diseases (CVDs)?
A
Disorders of the heart and blood vessels
4
Q
What is the leading cause of death globally?
A
CVDs
5
Q
What percentage of CVD deaths are due to heart attack and stroke?
A
85%
6
Q
What are the risk factors for CVDs?
A
- High blood pressure
- High low-density lipoprotein cholesterol
- Diabetes
- Smoking and/or secondhand smoke
- Obesity
- Unhealthy diet
- Physical inactivity
7
Q
What is arteriosclerosis?
A
When arteries become stiff and thus restrict blood flow
8
Q
What is atherosclerosis?
A
A type of arteriosclerosis involving the accumulation of plaque, or fatty deposits, in the arteries, which results in narrowing of the vessels and reduction of blood flow
9
Q
According to the American Heart Association and American College of Cardiology, what blood pressure readings define hypertension?
A
- ≥130 mmHg for systolic blood pressure
- ≥80 mmHg for diastolic blood pressure
10
Q
What are some lifestyle interventions for hypertension?
A
- Dietary habits
- Weight loss for individuals who are overweight
- Increased physical activity
11
Q
What is cardiac rehabilitation?
A
A medically supervised secondary prevention program with a multidisciplinary approach; supervised exercise is an important aspect
12
Q
What are the phases of cardiac rehabilitation?
A
- Phase I: hospitalization phase
- Phase II: outpatient, including monitored physical activity
- Phases III and IV: maintenance phases, minimal professional supervision
13
Q
In what situations are cardiac rehabilitation programs beneficial?
A
- Current stable angina
- History of myocardial infarction
- Coronary artery bypass graft surgery
- Percutaneous transluminal coronary angioplasty or coronary stenting
- Heart valve repair or replacement
- Heart or heart and lung replacement
- Heart failure
14
Q
Who describes the contraindications for cardiac rehabilitation?
A
The American College of Sports Medicine (ACSM)
15
Q
What must exercise prescription in cardiac rehabilitation reflect?
A
- Clinical status
- Risk factors
- Current capacity
- Threshold for ischemia, angina, or other adverse event
- Other limitations
16
Q
What are the general aerobic activity recommendations for cardiac rehabilitation?
A
3 to 5 days per week
17
Q
What are the general resistance training recommendations for cardiac rehabilitation?
A
2 or 3 nonconsecutive days per week
18
Q
What are the general flexibility recommendations for cardiac rehabilitation?
A
At least 2 or 3 days per week
19
Q
Are warm-ups and cool-downs important in cardiac rehabilitation?
A
Yes
20
Q
What is the SOAP method used for?
A
As a common organizational tool for health-care professionals
21
Q
What do the letters in SOAP stand for?
A
- S: subjective data
- O: objective data
- A: assessment
- P: plan of action
22
Q
What is coronary atherosclerosis or disease (CAD) associated with?
A
- Endothelial dysfunction
- Vascular inflammation and the accumulation of lipids
- Macrophages
- Blood-clotting elements
- Calcium
- Fibrous connective tissue in the coronary arteries
23
Q
What does atherosclerotic build up result in?
A
Impairment or obstruction of blood flow
24
Q
What is the difference between myocardial ischemia and myocardial infarction?
A
- Transient impairment in blood flow -> myocardial ischemia
- Complete obstruction of blood flow -> myocardial infarction
Transient means lasting for shor time
25
What are blood markers of inflammation highly associated with?
| (myocardial infarction)
The development of possible future MIs
26
What is the triad for MI diagnosis?
* Severe, prolonged chest pain or pressure which may radiate
* Increased serum levels of cardiac enzymes (CK, CPK, troponin)
* ECG changes: ST segment depression, T-wave inversion
27
How is aerobic capacity typically affected after a myocardial infarction?
* Subnormal aerobic capacity (**50-70%** of age, sex- predicted)
* **Reduced O2 transport** (↓ CO)
* Ventricular arrhythmias more common in those with previous MI
* Medication type and dose should be noted (medications usually affect heart rate and blood pressure and thus, myocardial oxygen demands)
28
What are the MI Effects of Exercise Training
* ↑ VO2max (~20%), ↑ ventilatory response
* ↓ angina
* ↓ body fat, BP, TC, TG, LDL
* Improved psychosocial well-being
* Protection against second MI
* Reduction in inflammatory markers
29
What do meta-analyses show regarding the impact of cardiac rehabilitation on mortality after MI?
A **20-25% reduction** in total and cardiovascular-related mortality
30
What is the effect of cardiac rehabilitation on the rate of nonfatal recurrent events after MI?
No difference
31
What does modern cardiology seem to warrant regarding cardiac rehabilitation for MI survivors?
The use of cardiac rehabilitation
32
What intensity of exercise testing is typically utilized for individuals recovering from an uncomplicated MI?
Low-level exercise testing (≤5 METs)
33
How should exercise intensity be increased during an exercise test for someone recovering from an MI?
Start at intensity level significantly below peak, increase gradually in 2-3 min stages
34
What type of monitoring is recommended during exercise testing for individuals recovering from MI?
**Hemodynamic monitoring:** Use direct analysis if at all possible
35
What is the typical total test time for exercise testing in individuals recovering from MI?
10±2 minutes
36
What are the FITT principles for aerobic exercise after MI?
* **F:** ≥ 3 days/week
* **I:** **40-80%** VO2 max or HRR; use RPE **11-16/20**; client tolerance
* **T:** **20-40** minutes **continuous** or **accumulated**; **5-10** minute **warm-up & cool-down**
* **T:** Large muscle activities, arm/leg ergometry
37
What are the FITT principles for resistance training after MI?
* **F:** 2-3 days/week
* **I:** **30-40%** 1RM (**upper body**), **50-60%** 1RM (**lower body**); Avoid Valsalva; gradually increase over time
* **T:** 2-4 sets x 12-15 repetitions
* **T:** Circuit training; 8-10 different exercises
38
What are individuals post-MI more likely to have during exercise?
Limiting symptoms (angina, ischemia, BP, serious ventricular arrhythmias)
39
What is a consideration regarding exercise intensity post-MI?
High-intensity may precipitate complications
40
What is suggested regarding supervision for exercise post-MI?
Supervision is suggested
41
What other conditions might be present in individuals post-MI?
Comorbidities may be present (PAD, Diabetes, Obesity)
42
How is Chronic Heart Failure (CHF) characterized?
By the inability of the heart to deliver O2 to tissues
43
What are the causes of CHF?
| (Chronic heart failure)
Depressed systolic function, abnormal diastolic function or both
44
What are some physiological consequences of CHF?
* **↓ CO**
* **↑ left ventricular filling**, compensatory ventricular volume overload
* **↑ pulmonary and central venous pressure**
45
What are the hallmark signs and symptoms of CHF?
Fatigue, dyspnea, reduced exercise tolerance
46
How is cardiac output affected by CHF during exercise?
CO reduced
47
How are catecholamines and hormone receptors affected by CHF?
Catecholamines elevated, hormone receptors less sensitive → reduced contractile activity
48
How is blood flow affected by CHF during exercise?
Reduced and redistributed blood flow; greater reliance on glycolysis
49
What contributes to muscle fatigue in CHF during exercise?
Muscle fatigue, lactate accumulation
50
What is the primary benefit of exercise training for CHF patients?
Peripheral adaptations improve exercise capacity (i.e. in skeletal muscle)
51
What does research indicate about the effect of exercise training on the heart muscle in CHF patients?
Research indicates that exercise training **neither harms nor has benefit** to the **heart** muscle
52
What type of exercise testing protocol is recommended for CHF patients?
Use low-level moderate increases in work rate (use Naughton or ramp protocol -> 10-15 Watts/min increase)
53
What symptoms indicative of unstable CHF are contraindications for exercise testing?
* Shortness of breath (dyspnea) when you exert yourself or when you lie down
* Fatigue and weakness
* Swelling (edema) in your legs, ankles and feet
* Rapid or irregular heartbeat
* Persistent cough or wheezing with white or pink blood-tinged phlegm
* Chest pain, if your heart failure is caused by a heart attack
54
What type of gas analysis is advisable for CHF exercise testing?
Direct gas analysis
55
What field test can supplement GXT in CHF?
6-minute walk tests
56
What are the recommended FITT principles for aerobic exercise in CHF?
* **F:** 3-7 days/week
* **I:** 11-16/20 on Borg RPE; 40-70% VO2 peak or HRR; tolerance is lower
* **T:** 20-40 min/session
* **T:** Large muscle activities
57
What are the recommended FITT principles for strength training in CHF?
* **F:** 2-3 days/week
* **I:** 50-70% 1RM
* **T:** High reps, low resistance
* **T:** Circuit training
58
What is a key consideration regarding exercise intensity in CHF patients?
Tolerance to exercise intensity lower
59
What is a common experience after exercise for CHF patients?
Prolonged fatigue
60
What might weight gain and/or increased dyspnea indicate in a CHF patient?
Decompensated heart failure
61
Where is hypertension a major public health concern?
In most developed countries
62
For what conditions is hypertension a major risk factor?
Cardiovascular disease (coronary artery disease, stroke, renal disease)
63
What is the usual etiology of primary hypertension?
Unknown and is called primary, essential, or idiopathic hypertension
64
What are the SBP and DBP for normal people?
* **SBP:** <120mmHg
* **DBP:** And <80mmHg
65
What are the SBP and DBP for prehypertension?
* **SBP:** 120-139
* **DBP:** or 80-89
66
What are the SBP and DBP for Stage I hypertension?
* **SBP:** 140-159
* **DBP:** or 90-99
67
What are the SBP and DBP for Stage II hypertension?
* **SBP:** ≥160
* **DBP:** or ≥100
68
Are lifestyle modifications reccomended for all hypertension classifications?
Yes
| Normal, prehypertension, stage I, stage II
## Footnote
For normal its just encouraged
69
What are some known etiologies of secondary hypertension?
Sleep apnea, due to drug intake, chronic kidney disease etc.
70
How does hypertension affect systolic blood pressure response to exercise?
Hypertensive's usually have a higher SBP response
71
What is the effect of acute moderate-intensity exercise on systolic blood pressure in hypertensive individuals?
A **10-20 mmHg reduction in SBP** for 1-3 hours following a 30-45 minute bout
72
How long may a training-induced reduction in blood pressure persist and what is it thought to be due to?
Up to 9 hr and appears to due to a **transient decrease in stroke volume vs. peripheral vasodilation**
73
What do longitudinal endurance training studies indicate regarding blood pressure reduction in hypertension?
A **5-7 mmHg reduction in SBP and DBP** in those with **stage 1 and stage 2** hypertension
74
How can exercise training be used for hypertension?
As definitive or adjunctive therapy
75
How does physical activity and cardiorespiratory fitness relate to mortality rates in hypertension?
Physically active individuals and those with high cardiorespiratory fitness have **lower mortality rates** than sedentary or less fit individuals
76
Does resistance training reduce blood pressure?
Yes but not to the same extent as endurance training
77
What exercise testing methods can be used for clients with only hypertension?
Standard exercise testing methods and protocols
78
When is ECG monitoring recommended during exercise testing for hypertensive individuals?
If other co-morbidities present (especially cardiovascular disease)
79
What resting blood pressure readings are considered a relative contraindication to exercise testing/training in hypertension?
Resting **SBP over 200 mmHg** or **DBP over 110 mmHg**
80
What blood pressure readings during exercise are an indication for exercise test termination in hypertension?
Attainment of **SBP over 250 mmHg** or **DBP over 115 mmHg**
81
What are the recommended FITT principles for aerobic exercise in a hypertension exercise program?
* **F:** 4-7 days/week
* **I:** **40-80%** of peak HR, **40-60%** of VO2 or HRR, RPE **11-13/20**
* **T:** 30-60 min/session
* **T:** Large muscle activities
82
What are the recommended FITT principles for resistance training in a hypertension exercise program?
* **F:** 2-3 days per week
* **I:** 60-80% 1RM
* **T:** 1 set of 8-12 reps, 8-10 exercises
* **T:** Circuit training
83
With which medications should one be aware of postexertional hypotension?
* Alpha1 blockers
* Alpha2 blockers
* Calcium channel blockers
* Vasodilators
84
When is exercise allowable in individuals with a pressor response controlled by medications?
When the pressor response is well controlled
85
What exercise intensity appears to lower resting blood pressure as much if not more than higher intensity exercise in hypertension?
40-70% VO2max
86
How is Peripheral Arterial Disease (PAD) defined?
Stenoses and occlusion of arteries to lower extremities – reduced blood flow
87
What are the four grades of PAD?
* **0** – asymptomatic
* **1** – intermittent claudication
* **2** – ischemic resting pain
* **3** – minor or major tissue loss from the foot
88
What is the most common effect of PAD on exercise response?
Claudication in leg muscles causing pain
## Footnote
Claudication means pain in extremidies when in use
89
How is the severity of PAD assessed?
By measuring ankle/brachial systolic pressure index (ABI)
90
How are ankle pressure and ABI affected after exercise in PAD?
They are decreased due to a shunt of blood flow to proximal musculature
91
How does exercise training affect blood flow in individuals with PAD?
* ↑ in leg blood flow
* Redistribution of blood flow
* Reduced blood viscosity
92
How does exercise training affect metabolism in individuals with PAD?
↑ oxidative enzymes, greater reliance on **aerobic** vs. anaerobic metabolism
93
How does exercise training affect functional capacity in individuals with PAD?
* ↑ walking efficiency & O2 uptake
* ↑ free-living energy expenditure
94
What is the preferred mode of exercise for testing in PAD?
Treadmill walking
95
How is ABI calculated during exercise testing for PAD?
Have client supine for 15 minutes and then calculate ABI by measuring ankle and brachial SBP (use Doppler)
96
Describe the treadmill protocol for exercise testing in PAD.
**Gradual** **increments** **in** percent **grade**, constant speed (**2 mph**) and increase of **2% grade every 2 minutes**
97
What pain scale is used to assess claudication pain during PAD exercise testing?
A scale from 0-4
* **0** = no pain
* **1** = onset of pain
* **2** = moderate pain
* **3** = intense pain
* **4** = maximal pain
98
How is recovery assessed after exercise testing in PAD?
Client recovers in a **supine** **position** for **15 min** -> measure time elapsed from the start of recovery to the relief of claudication pain
99
What are the recommended FITT principles for aerobic exercise in PAD?
* **F:** 3-5 days/week
* **I:** 40-60% VO2peak, HRR
* **T:** Begin at 15 minutes/session and progress by 5 min every 4 weeks to achieve 30-60 min/session
* **T:** Walking or stair stepping preferred; intervals with ~5 min of activity and full recovery; ¾ claudication pain scale
100
When should exercise training commence for individuals with PAD?
Only after MD clearance; graded exercise test should be done
101
What is common regarding other health conditions in individuals with PAD?
Concomitant cormorbidities common – may limit exercise tolerance
102
What other aspects of management are essential for individuals with PAD?
Lifestyle and lipid management essential
103
How might cold weather affect PAD symptoms?
Cold weather may worsen symptoms
