Ch 6 Exercise Options For Special Conditions Flashcards
Introduction to cardiovascular disease and exercise
•Cardiovascular disease—broad category of diseases involving the heart and circulatory system
•CVD—the major cause of mortality in many countries including US
•Approximately ___% of older adults have been diagnosed with a form of CVD
•Exercise helps in preventing and decreasing the risk of developing CVD and reduces CVD mortality
Physiology of CVD and Aging
•Effects of age on CV system
–Change in structure of blood vessels causes reduced _____ (including aorta and carotid arteries)
–Increased ________ nervous system activity
–Endothelial lining of blood vessels becomes less ‘______’
–These factors place additional stress on cardiac function
Vascular Stiffening Causes
•Increased amounts of _____ tissue
•Thickening and disorganization of structural cells that make up _____ walls
•Arterial wall thickening independent of ___build up
Hypertension
•Essential hypertension, or high blood pressure, has no known cause, but is associated with arterial stiffness, high peripheral ____.
•Problems associated with HT-
–Stiffer arteries, ____ damage, enlargement of the heart muscle
•____the most common CVD in the U.S
.73, compliance, sympathetic, functional,
Connective, vascular , plaque, resistance,
Capillary, HT
Coronary heart disease
•A condition where plaque is formed in the walls of the coronary artery, decreasing the size of the artery and thus limiting blood flow
•Consequences of Coronary heart disease
–_____, myocardial _____
Peripheral arterial disease •Peripheral arterial disease (PAD) occurs when plaque is formed in the peripheral arteries of the arms or legs (the legs are more frequently affected) •Characteristics of PAD •Intermittent \_\_\_\_\_\_ •Painful tightness •Squeezing in the legs
How exercise can improve CVD risk factors
•Exercise can improve the following for reducing CVD risk
•Management of body weight
•Improvements in glucose control
•Improvements in blood pressure
•Improvements in ____levels
Exercise guidelines
•High-risk patients—supervised cardiac rehabilitation programs
•Warm-up and Cool-down
•Aerobic and resistance exercise training for CVD patients
•Exercise programming
Contraindications to exercise
•Unstable ____
•Resting BP >1___/1___ or exercise BP >____/110
•Orthostatic intolerance or a BP drop of >____mm Hg during or immediately after exercise
•Unpredictable ventricular or atrial
•Uncompensated Heart____
•______diabetes
•Orthopedic issues that prevent_____ movement patterns
•Fever or severe _____
•Severe muscle soreness or pain that restricts_____
.angina , infarction, Claudia toon, lipid,
Angina, 180, 110, 240, 20, arrhythmias,
Failure, uncontrolled, proper , illness, ADL’s
Expected benefits of exercise in cardiovascular disease
•Exercise—Reduction in CVD risk factors and mortality rate from CVD
•Improvements in quality of life and reduced effort required in ADLs
•Exercise is medicine for patients with CVD
Introduction to Type ___diabetes mellitus
•Metabolic disorder resulting in high blood glucose even in the presence of adequate or high levels of insulin
•Long term complications for high blood glucose or poor glucose control
•Regular exercise and patients with diabetes
Diagrams and links
Issues associated with Type 2 diabetes •Blood glucose control •Diabetic neuropathic \_\_\_\_\_ulcers •\_\_\_\_\_\_arterial disease •\_\_\_\_\_pathy •\_\_\_\_\_\_\_ neuropathy •Microalbuminuria and nephropathy
Evaluation for exercise
•Evaluation can be complicated by the presence of diabetes-related complications
•Previous physical activity level should be considered
•_____ tests are recommended in older people with diabetes
Exercise program guidelines •\_\_\_\_\_\_\_\_ •Frequency •Intensity •Time •Type
Exercise contraindications
•Fatigue, light-headed, or dizziness
•Pain or blisters or the feet
•Blood glucose level ____ mg.dL−1 (167 mmol.L−1)
•Blurred vision
•The presence of _____bodies or protein in the urine
.2, foot, peripheral
Retino, autonomic, graded exercise , individualization
70, 300, ketones
Exercise and Diabetes Type 2
•Glucose taken into muscles by transport system, triggered by exposure to insulin, OR if the ______
•When glucose in blood stream ____ and a transporter needed to help move glucose into a cell to be utilized
•Transporter is called ____
•When muscle contracts more GLUT-4 transporters are brought to surface of cell allowing more____ transport efficiency
•This mechanism causes more glucose ____ during exercise
Exercise Impact on Diabetes Type 2
•_____ blood glucose levels due to GLUT-4 transporter mechanism from contracting muscles
•Glut-4 mechanism helps move glucose as _____ in muscle cell
•This allows more glucose to move into the cell and thereby reducing overall blood glucose levels
•This effect after exercise can remain in effect for approximately ___hours after
•Biggest impact on GLUT-4 transporters from resistance exercise
Expected benefits/outcomes
•Improvements in insulin _____
•Reducing excess body fat, thus helping to decrease and control weight
•Improvements in muscle strength
•Increase bone density and strength
•Reducing stress, promoting relaxation, and releasing tension, anxiety
Expected benefits/outcomes (cont.)
•Lowering blood pressure
•Helping to protect against heart and blood vessel disease
•Improvements in peripheral circulation
•Increase energy level and enhancing work capacity
•Improvements on quality of life
Exercise Prescription Recommendation for Diabetes Patients
•Due to GLUT-4 transporter effects on blood glucose recommendations for diabetes type 2 patients
–Exercise with increased frequency, at least 4+ days per week (every other day at least)
–Unless other health factors prevent this, prescribe resistance training at least every other day
Exercise can delay or even reverse the signs/symptoms of ____when close adherence to a regular progressive exercise program and healthy diet are strictly followed
.muscles contract , insulin , GLUT-4
Glucose, uptake, lowered, glycogen storage
48, sensitivity , type 2 diabetes,
Introduction to frailty
•Geriatricians agreement on frailty: a functional disability
•Frailty—_______ of various body system
•Frailty—_______
Frailty
•The various types of frailty
–Functional, ______, Mental/Psychological, ____
Five measured areas of frailty
•Unintentional Weight Loss, _____, Low Energy Expenditure, Slowness, _______
Issues and concerns
•Presence of other medical conditions that may impact the ability to exercise
•It is likely that the person will experience fatigue and weakness
•The risk of falls and fractures is high in this population as ____ is often compromised
Issues and concerns (cont.)
•The person may be easily confused or agitated
•Frail person will often be on multiple medications. Medications may alter heart rate or blood pressure response during exercise
•Mobility and motor coordination are usually limited, and this impacts the ability to perform exercise
Issues and concerns (cont.)
•Many conditions may coexist—
–Major challenges to consider when developing exercise programming for old and frail individuals
Exercise evaluation
•Medical history should be obtained
•Selection of tests for exercise evaluation should consider medical history
•Areas deemed important for____ should be assessed
.deterioration, biologic syndrome,
Medi-Cal, physical, exhaustion, weakness,
Balance, ADL
Exercise evaluation (cont.) •Body weight •Present and history of body weight •Muscle \_\_\_\_&\_\_\_\_ •Handgrip •Timed walk test; \_\_\_\_m walk test. •Activity of daily living •Timed get-up-and-go test •Slowing •Timed walk •Physical activity •Balance •One-legged stance •Flexibility •Sit and reach •Standard clinical exercise testing may be warranted (EEG and blood pressure) •Treadmill or cycle ergometer
Exercise prescription/programming
•Based on individual ability and preference—supervised
•The three main goals of exercise prescription for frail older adults
–Increase ____f, cardio ____ and overall _____ level
•Specific exercise for improving activities of daily living and _____
•Nutrition intervention to prevent weight loss
.strength and endurance , 400,
Stamina, endurance, daily activity , balance,
Table a
Expected outcomes
•Improved muscle strength
•Improved endurance
•Increases in physical activity energy expenditure
•Improved ability to perform activities of daily living
•Balance may improve
Copyright © 2014 American College of Sports Medicine
Intellectual disability and age-related cognitive impairment
•Intellectual disability: developmental disorder defined as significantly below average intelligence
•Lifelong condition
•_____ impairment: Mild impairments to severe dementia and Alzheimer disease
Copyright © 2014 American College of Sports Medicine
Issues and concerns
•Common feature—sedentary lifestyle with little physical activity
•Low fitness level
•Obesity in ID patients—patients with Down Syndrome
•Down syndrome—extremely low levels of _____ fitness and muscle _____
the use of multiple medications
.age related cognitive , cardiovascular, strength
Exercise evaluation
•Medical evaluation before starting an exercise programming
•Often have inadequate annual care
•The exercise evaluation recommended for frailty will often apply in these populations
Exercise prescription/programming
•The focus should be on improving cardiovascular fitness and muscle strength
•Increasing physical activity and activities of daily living
•Guidelines for frailty often apply to this population
Exercise prescription/programming (cont.)
•RPE is _____ in this population
•Heart rate prescription should never be based on _____heart rate
•Close supervised is recommended
•Familiarization with the exercise routine is important
Expected outcomes
•Improvements in work capacity
•Improvements in aerobic capacity and muscle strength
•Age-related cognitive impairment —small improvements in cognitive performance
Medications that increase type 2 diabetes: Corticosteroids Thiazides diuretics Some drugs for mental Illnesses Some drugs used to treat HIV
Takes____days to make lifestyle changes.
___days to build a new habit
____days to break a habit /routine.
Genetics have to do ____with Hijra response to exercise.
Rest is due to environment etc
.problematic, age predicted, 90, 21, 7
40%
