Chapter 1 Flashcards
Very light - light Metabolic equivalents (METs)
< 3.0 METs
Moderate Metabolic equivalents (METs)
3.0 - 5.9 METs
Vigorous equivalents (METs)
> ou égal 6.0 METs
Threshold daily dose of physical activity
30min or more of at least moderate PA on at least 3 days per week
Moderate PA %
40 to 60% of heart rate reserve HRR or maximal oxygen uptake reserve
Moderate intensity PA - RPE scale 6-20
12-13
Ischemia
Lack of oxygenated blood flow to the tissue, such as the heart
Other word chest pain
Angina
Chest pain or angina is not always located in the chest area; where else?!
Women may experience lower back pain or feelings of indigestion
Pain or discomfort in the chest, neck, jaw , arms, teeth, fingers
What is dyspnea?
Medical term for shortness of breath
Dyspnea at rest or mild exertion suggests what?
Suggest the presence of cardiopulmonary disorders, in particular left ventricular dysfunction or COPD (chronic obstructive pulmonary disease)
Syncope or fainting and dizziness during exercise may indicate what?!
It may indicate poor blood flow to the brain due to inadequate cardiac output from a number of cardiac disorders
Can also occur in healthy individuals as a result of a reduction in venous return to the heart
Orthopnea refers to what?!
Refers to trouble breathing while lying down
Ankle edema or swelling that is not due to injury is suggestive to what?
Suggestive of heart failure, blood clot, insufficiency of the veins, or a lymph system blockage
Palpitations and tachycardia both refers to what?
Refers to rapid beating or fluttering of the heart
Intermittent claudication refers to … and indicates what?
Refers to severe calf pain when walking
It indicates a lack of oxygenated blood flow to the working muscles
Heart murmurs are…
Unusual sounds caused by blood flowing through the heart
Some can be innocent but some may indicate valvular or other cardiovascular disease
CMR refers to..
Cardiovascular, Metabolic and/or Renal disease
Vigorous exercise is often defined as:
Greater than or equal to 60% of the client’s functional capacity
>= 6 METs >= 14 on 6-20 RPE scale
Another term for heart attack
Myocardial infarction
Coronary revascularization can refers to 2 serious disorders
Bypass surgery
Angioplasty
What is Coronary Bypass Surgery
It redirects blood around a section of a blocked or partially blocked artery in your heart. The procedure involves taking a healthy blood vessel from your leg, arm or chest and connecting it below and above the blocked arteries in your heart. With a new pathway, blood flow to the heart muscle improves.
It doesn’t cure the heart disease that caused the blockages, such as atherosclerosis or coronary artery disease. However, it can ease symptoms, such as chest pain and shortness of breath. For some people, this procedure can improve heart function and reduce the risk of dying of heart disease.
What is Angioplasty?
Angioplasty is a procedure to improve blood flow in coronary arteries that have become narrow or blocked. Your coronary arteries supply oxygen-rich blood to the heart. If you have coronary artery disease, a sticky material called plaque builds up in the coronary arteries. Plaque is made of cholesterol, calcium, and other substances in your blood. Over time, it can narrow your arteries or fully block them. When this happens, some parts of your heart don’t get enough blood.
Angioplasty widens the blocked part of the artery so more blood can get through. It is also called percutaneous coronary intervention (PCI).
Define sedentary lifestyle!
Not participating in a regular exercise program nor meeting the minimal recommendations of 30min or more of moderate PA on 3 days/week for at least 3 months
Obesity is defined as…
A BMI greater than or equal 30kg.m or a waist circumference of greater than 102cm for men and great than 88cm for women
Hypertension refers to…
Having a resting blood pressure equal to or above 130 mm Hg systolic
OR
Equal to or above 80 mm Hg diastolic OR if the client is taking any of the numerous antihypertensive medications
How many times resting blood pressure must have been assessed?
Resting blood pressure must have been assessed on at least two separate occasions
Dyslipidemia refers to what?
Having a LDL-C (low-density lipoprotein cholesterol) equal or above 130 mg.dL
And an HDL-C of less than 40 mg.dL
Or if the client is taking a lipid lowering medication
Diabetes can be defined as…
As having a fasting plasma glucose >= 126 mg.dL (7.0 mmol.L)
Or 2h plasma glucose values in oral glucose tolerance test >= 200 mg.dL
Or HbA1C >= 6.5%
What does a FBG (fasting blood glucose) of 126 mg.dL or greater would indicate?
It would indicate that the individual has diabetes which would automatically place him or her in the high-risk level
What level of High-serum HDL would represent a negative risk factor that would offset one positive risk factor?
High-serum HDL-C equal or greater than 60 mg.dL
In the systemic circulation (aorta to vena cava) what type of blood is being carried?
Arteries and arterioles carry oxygenated blood
In the pulmonary circulation (pulmonary artery to pulmonary vein) what type of blood is being carried?
Arteries and arterioles carry deoxygenated blood
As the vasculature is more distal from the heart, arteries become what and what?!
Arteries branch into smaller arterioles, which in turn branch and merge with the capillaries
What is the smallest and most numerous of the blood vessels and is the location of gas and nutrient exchange?
The capillaries
Deoxygenated blood and metabolic byproducts move from what to what?
Move out of capillaries into venules, which consolidated into veins as they move closer to the heart
What is responsible for delivering the deoxygenated blood back to the heart? (Which side of the heart?)
Veins are responsible for delivering the deoxygenated blood back to the right side of the heart
Following order of the deoxygenated blood in the circulatory system!
Right atrium, right ventricle, pulmonary artery, lungs, pulmonary veins, left atrium, left ventricle, aorta, organs and tissues and finally the vena cava before returning back to the right atrium
What are the three primary metabolic systems to create ATP?
Creatine phosphate (CP)
Anaerobic glycolysis
Oxidative system
What is the most immediate source of ATP?
The Creatine Phosphate (CP)
For what type of efforts the Creatine Phosphate system is only used?
The CP system can provide ATP to fuel work only during short-intense bouts of exercise, owing to the limited storage capacity of CP within each cell
Primary source of ATP during very short, intense movements?
Creatine phosphate system, for efforts lasting less than approximately 10 seconds
Next most immediate ATP energy source system after the CP system?
Anaerobic glycolysis
What anaerobic glycolysis breaks down into what?
Breaks down carbohydrates (glucose or glycogen) into pyruvate
In the absence of adequate oxygen supply, pyruvate is converted to…?
Converted to lactic acid, which gradually builds up in muscle cells and the blood
When oxygen is available in the mitochondria of the cell, pyruvate continues to be broken down to… and enters the … energy system
acetyl-coenzyme A (acetyl-CoA)
aerobic energy system
What is the primary source of ATP during medium-duration, intense exercise such as the 200m and 400m or any exercise that cannot be continued for more than approximatively 90 seconds?
Anaerobic glycolysis
What energy system is being used for longer duration exercise or low-intensity exercise?
The aerobic or oxidative energy system
Which energy system is able to sustain energy production for longer durations?
Aerobic or oxidative energy system
The aerobic/oxidative includes two metabolic pathways, which ones?!
The Krebs cycle (aerobic glycolysis)
The electron transport chain
What does the oxidative system requires to produce ATP? And where?
Requires the presence of oxygen, which takes place in the mitochondria of the cell
Where is the majority of ATP generated?
In the mitochondria (the powerhouse of the cell)
What nutrients does the Krebs cycle require?
It requires the presence of carbohydrates, proteins and fats
The oxidative/aerobic system is the primary source of ATP used during low to moderate intensity lasting longer than… all the way up to long distance endurance events
Longer than 1 to 2 minutes all the way up to long distance endurance events
Oxygen is required to create ATP via which energy system?
Via the oxidative energy system
What does EPOC stand for?
Excess postexercise oxygen consumption
After cessation of exercise, VO2 remains elevated because of…?
The increased work associated with the resynthesis of ATP and CP within muscle cells
Lactate removal
Elevated body temperatures
HR…
What equation can be used to determine VO2 max?
The Fick equation
Develop the Fick equation for VO2 max:
VO2max = HRmax . SVmax . a-VO2 diff max
a-VO2 difference refers to what?
Maximal arteriovenous oxygen difference
Why is it important that women not perform any exercises in the supine position after the first trimester?
Blood flow to the heart is reduced during exercise performed in the supine position due to the weight of the fetus lying compressing the inferior vena cava.
In order to ensure that orthostatic hypotension and obstruction of venous return do not occur, exercises performed in the supine position are discouraged
Prediabetes fasting glucose level:
100 - 125 mg.dL
The a-VO2 difference reflects the difference in oxygen content between the … and the …blood taken up by the working muscles
The arterial and the venous blood
Resting oxygen content is approximately … mL.dL in arterial blood and … mL.dL in venous blood
20 mL.dL in arterial blood
15 mL.dL in venous blood
During exercise, … oxygen content decreases as a result of the increased consumption of oxygen by the working muscles
Venous oxygen content
With increasing exercise intensity, a-VO2 difference … as well
Increases as well
What is SV (stroke volume)? (p56)
Stroke volume is the volume of blood the heart ejects with each beat
Cardiac output is the product of … and … and is also a measure of blood pumped per minute
The product of HR and SV
Pulmonary ventilation is the volume of air … and … per minute
Inhaled and exhaled
Blood pressure is proportional to the product of … and …
The product of cardiac output and total peripheral resistance (TPR)
What is total peripheral resistance (TPR)?
The overall resistance to blood flow by the blood vessels
Systolic blood pressure (SBP) is the pressure in the arteries during … contraction, or systole and is heavily influenced by changes in …
Ventricular contraction
Changes in cardiac output
Thus, just as cardiac output increases linearly with increasing workload, so does …
Systolic blood pressure (SBP)
… is the pressure in the arteries when the heart is relaxed, and is heavily influenced by …
Diastolic blood pressure (DBP)
Total peripheral resistance (TPR)
During graded exercise, TPR may drop slightly because of the large muscle …
Vasodilation
HR, pulmonary ventilation, a-VO2 difference, SV, cardiac output, SBP and mean arterial BP … during graded intensity exercise, whereas … remains stable or decreases slightly during aerobic type exercise
Increase
DBP remains stable
The Exercise Physiologist should assess … and … before, during and after exercise
HR and BP
HR should be assessed at least … times at each stage to ensure that it is appropriate to move to the next workload
Two times
At rest, the heart consumes approximatively …% of the oxygen delivered to the cardiac muscle
70%
SBP is the point at which the first of two or more … sounds is heard
Korotkoff
DBP is the point … the disappearance of Korotkoff sounds
Before the disappearance
BP should be measured in … arms during the first examination
In both arms
Cardiorespiratory fitness is an umbrella term that serves as an indicator of the functional capacity of ……. to work in synchrony to support dynamic, large muscle mass exercise
The heart, lungs, blood vessels, and muscles
The gold standard used to mesure Cardiorespiratory fitness (CRF) is the assessment of …
VO2 max
…… is the raw volume of oxygen consumed by the body, whereas …… is the volume of oxygen consumed relative to body weight and can serve as a useful measure of fitness between individuals
Absolute oxygen consumption
Relative oxygen consumption
One … is equal to the relative oxygen consumption at rest, which is approximately … mL.kg.min
One MET
3.5 mL.kg.min
… kcal equals 1lb of fat
3,500 Kcal
Other term for VO2 max?
Open circuit spirometry
What does the acronym FITT-VP mean?
Frequency
Intensity
Time (duration)
Type (mode)
Volume (amount of exercise)
Progression (advancement)
Frequency (how often should you perform aerobic exercise) - moderate & vigorous intensity
Moderate intensity: at least 5x/week
Vigorous intensity: at least 3x/week
Intensity of aerobic exercise for moderate and vigorous intensity
Moderate: 40-59% VO2R
Vigorous: 60-84% VO2R
Time for aerobic exercise during the week (moderate and vigorous)
At least 150 min.week of moderate intensity (at least 300min for weight/fitness goals)
75 min.week of vigorous intensity (at least 150min for weight/fitness goals)
Exercise Volume is the product of what?!
The product of FIT (frequency, intensity and time)
Weekly volume target in METs
> =500-1,000 MET min.week
equivalent to an energy expenditure of 1,000 Kcal.week
HIIT is traditionally performed at an intensity that is greater than the … threshold and is often performed at an intensity close to that which elicits >= …% peak heart rate
Anaerobic threshold
80 to 100%
Sprint interval training (SIT) is characterized by an all-out, supramaximal effort equal to or greater than the pace that elicits >= …% VO2peak
100% VO2peak
Heart Rate Reserve (HRR) or … method requires the EP-C to determine the resting HR and maximum HR of the client
Karvonen
The Heart Rate Reserve (HRR) method is the difference between … HR and … HR
Between Maximum HR and resting HR
Target HR (bpm) formula = ?!
Target HR= [(max HR - resting HR) x %intensity desired] + resting HR
Target method HR = ?!
Target HR = maximum HR x %intensity desired
The RPE range of …-… is recommended to improve CRF
11-16
Signs for stopping an exercise test:
Onset of angina-like symptoms
Drop in SBP of >= 10mmHg with an increase
Excessive rise in BP: SBP>250mmHg and/or DBP>115mmHg
Shortness of breath, wheezing, leg cramps or claudication
Signs of poor perfusion: light-headedness, confusion, ataxia, pallor, cyanosis, nausea or cold and clammy skin
Failure of HR to increase with increased exercise intensity
Noticeable change in heart rhythm by palpation or auscultation
Participant requests to stop
Physical or verbal manifestations of severe fatigue
Failure of the testing equipment
Hot environments reduce the body’s ability to dissipate … and thus promote an … in core body temperature
Dissipate heat
An increase
In an effort to maintain a neutral body temperature when exposed to a hot environment, … and … increase to promote heat loss
Sweat rate
Skin blood flow
Exercise in a cold environment facilitates … loss produced during exercise
Heat loss
However, long duration exercise events in a cold environment increase the risk of …
Hypothermia
If core temperature is challenged, the body attempts to increase heat production and limit heat loss via … and … on blood vessels in the skin
Shivering
Vasoconstriction of blood vessels
Individuals with greater subcutaneous fat mass have an davantage at limiting … loss in cold environments
Limiting heat loss
Overall, the effect on VO2max in a cold environment is … compared with that in a hot environment
Negligible
It is a common misconception that the thin air at altitude has less oxygen than the air at sea level; the percentage of oxygen in the air … the same at all elevations in the stratosphere
Remains
It is the change in … pressure that causes the pressure of oxygen (PO2) to decrease at altitude and reduce our ability to provide oxygen to working muscles
Barometric
In response to lower pressure of oxygen at altitude … ventilation increases
Pulmonary
… is the process of physiological adaptation that occurs in response to changes in the natural environment
Acclimatization

Both acclimatization and acclamation can … exercise performance in extreme environments
Improve
In order for a complete heat adaptation to occur … to … hours of moderate to high intensity exercise in the hot environment for 10 consecutive days is suggested
2 to 4 hrs
The first few days of exercise in the hot or humid environments should be … in intensity with frequent rest periods provided
Light
Cold acclimatization causes the shivering threshold to be reset to a … mean skin temperature
Lower
The lower pressure of oxygen at altitude stimulates the production of additional … blood cells (erythropoiesis) to increased oxygen carrying capacity of the blood
Red blood cells
The body has more than … skeletal muscles
600
The smallest contractile unit within a muscle is called a … Which is made up of different …
sarcomere
proteins
A … consist of many sarcomeres
Myofibril
Groups of … make up a single muscle fiber or muscle cell
myofibrils
Different types of connective tissue called … surrounds the muscles
Fascia
The muscles that are the primary movers of a joint or called the …, And the muscles that assist in that movement are called …
Agonists
Synergists
… are muscles that oppose a movement
Antagonists
Type I fibers are also called … … fibers
slow twitch
Type one fibers or slow twitch fibers have a high oxidative capacity and a lower contractile force capability and are better for … activities
Endurance
Type II fibers are also called … fibers
fast twitch
Type II fibers or fast twitch fibers have a high … capacity and a higher contractile force capability and are better for … activities
Glycolytic
Strength/power activities
The ratio of type one and type two fibers in the body varies for each person and depends mainly on … factors
hereditary
Regular resistance training may cause a … change in fiber type composition
Small
Resistance training will … convert type one fibers to type two fibers
Will not
Muscle fibers are innervated by a motor neuron and this neuromuscular gathering is called a …
motor unit
Smaller motor units like type one fibers are recruited … and larger motor units like type two fibers are recruited later depending on the demands of the exercise
First
When a weight is lifted, the involved muscles normally shorten and this is called a … muscle contraction
Concentric
When a weight is lowered, the involved muscles lengthen and this is called an … muscle action
Eccentric
If a muscle is activated but no movement at the joint takes place the muscle action is called … or static
isometric
The highest force produced occurs during an … muscle action
eccentric
Maximal force produced during an isometric muscle action is … than that seen during a concentric contraction
Greater
As the velocity of movement increases, the amount of force that is generated … during a concentric muscle contraction and increases during an eccentric muscle action
decreases
High force development during maximal … muscle actions has been linked to muscle soreness
Eccentric
The …, which is the heaviest weight that can be lifted only once using proper technique is the standard muscular strength assessment
The 1-RM
One rep max performance is significantly … on weight machines than free weights
Greater
Assessing muscular endurance with the … test
push-up
Seven fundamental principles that determine the effectiveness of all resistance training programs are the principles of …….
progression regularity overload creativity enjoyment specificity supervision
A reasonable guideline for a beginner is to increase the training weight about … per week and decrease the repetitions by 2 to 4 when given load can be performed for the desired number of repetition with proper exercise technique
5% to 10%
The principle of specificity is often referred referred to as the SAID principle which stands for …..
specific adaptations to imposed demands
The … plane cuts the body in the right and left side
sagittal
The frontal (coronal) plane cuts or separates the body in a … and … sides
Front and back sides
The … plane separates the body on an upper and lower parts
transverse (horizontal)
… training is the most common methods of resistance training for enhancing muscular fitness
Dynamic constant external resistance
DCER
… training involves dynamic muscular actions that are performed at a constant angular limb velocity
Isokinetic
Isokinetic training requires specialized equipment and most isokinetic devices are designed to train only … movements
single-joint
Unlike other types of resistance training, the … of movement rather than the resistance is controlled during isokinetic training
speed
… kinetic chain exercises are those in which the distal joint segment is stationary like a squat
Closed
… kinetic chain exercises are those in which to terminal joint is free to move like leg extension
Open
… kinetic chain exercises more closely mimic every day activities and include more functional movement patterns
Closed
Loads of six or less reps have the greatest effect on developing muscle …
Strength
Loads of 20 or more reps have the greatest effect on developing local muscular …
Endurance
Repetitions ranging between 8 to 12 (60% to 80% 1RM) are commonly used to enhance muscular fitness in … to … people
Novice to intermediate
Using lighter weights (<50% 1RM - 15-20reps) will have less effect on muscular strength but more effect on muscular …
Endurance
Consistent training at high intensities increases the risk of …
Overtraining
If the primary goal of the program is to maximize gains in muscular …, heavier weights and longer rest intervals are required
Muscular strength
Flexibility is defined as … of a joint or group of joints, as per the skeletal muscles and not any external forces
ROM
… flexibility is the full ROM of a given joint because of external forces
Static
… flexibility is the full ROM of a given joint achieved by the voluntary use of skeletal muscle in combination with external forces
Dynamic
Freely moveable joints or …
Synovial
Because … stretching is slow and controlled, it does not provide an increase in muscle temperature and blood flow redistribution
Static
PNF stands for…
Proprioceptive Neuromuscular Facilitation
PNF is a collection of stretching techniques combining … stretch with isometric and concentric muscle actions
Passive stretch
PNF is designed to use the autogenic and reciprocal inhibition responses of the …..
Golgi tendon organs (GTO’s)
There are … types of PNF stretching techniques
3 types
3 types of PNF stretching techniques:
Hold-relax (mostly used)
Hold-relax w/ antagonist contraction (mostly used)
Agonist contraction
Each PNF techniques consists of 3 phases:
1- a passive prestretch
2- passive stretch
3- contractions
… flexibility uses slow and controlled, sport-specific movements that are designed to increase core temperature and enhance activity-related flexibility and balance
Dynamic
There are … types of sensory organs that provide muscular dynamic and limb movement information to the central nervous system
Which ones are they?! …
Two types
Muscle spindles
Golgi tendon organs
… … are a collection of 3 to 10 intrafusal, specialized muscle fibers that are innervated by gamma motor neurons and provide information about the rate of change in muscle length
Muscle spindles
When muscle spindles are stimulated there is a dual response in which a rapid tension development is initiated in the stretched muscle and inhibited in the … muscle
Antagonist
The response in the stretched muscle is known as a stretch or … reflex and the response in the antagonist muscle is known as reciprocal inhibition
When talking about muscle spindles!
Myotatic
The … reflex is less likely to occur in slow and controlled movements
myotatic
… are located in the musculotendinous junction and respond to changes in muscle tension
GTO’s
The … for encapsulated in a series with 10 to 15 muscle fibers
GTO’s
When the GTO’s are …, there is a dual response in which tension development is inhibited in the contracting muscle (autogenic inhibition) and initiated in the antagonist muscles to protect the muscle tissue from damage
stimulated
A … is similar to a protractor and is used to measure a joints range of motion expressed in degrees
goniometer
Both lumbar flexion and lumbar extension are taking place in the … plane
sagittal
Define glenohumeral flexion
Lifting the arm in front of you
Define glenohumeral extension
Lifting the arm behind you
Both glenohumeral flexion and glenohumeral extension are happening in the … plane
sagittal
Both glenohumeral internal rotation and glenohumeral external rotation are happening in the … plane
transverse
Both hip flexion and hip extension are measured in the … plane
sagittal
Both hip abduction and hip adduction are being measured in the … plane
frontal
If the average range of motion is greater than 50°, the three measures should fall within … of the mean
When it comes to goniometer
+ or -10°
If the average range of motion is lesser than 50°, it is recommended that the measures fall within … of the mean
When it comes to goniometer
+ or -5°
Whereas … is the most accurate method to assess joint specific range of motion when used properly; the … test is perhaps the most commonly used assessment for flexibility in the lower back and hip joint
goniometry
sit and reach test
Flexibility gains are lost within … of ceasing flexibility exercises
4 to 8 weeks
To improve range of motion, … training sessions per week for at least 3 to 4 weeks may be required although daily stretching exercises may be more effective
2 to 3 training sessions
Flexibility training should be conducted when a muscle is … and therefore should be completed after an aerobic warm-up of at least five minutes and some general flexibility exercises
Warm
Since some researchers have demonstrated that acute pre-exercise flexibility training may have negative effects on ensuing performance, … …flexibility training may be more beneficial
post exercise
When … stretching is being used, a 20% to 75% maximum voluntary contraction should be held for 3 to 6 seconds contraction followed by a 10 to 30 seconds assisted stretch is recommended
PNF
Individuals who are using … antibiotics are at an increased risk for tendon rupture and joint and muscle damage and therefore should approach flexibility exercises with extreme caution
Fluoroquinolone
Holding a static stretch for … seconds is recommended for most adults
10 to 30 seconds
In older individuals holding a stretch for … seconds may confer greater benefit
30 to 60 seconds
… is understood to be the sense of knowing where one’s body is in space and is composed of static (joint position sense) and dynamic (kinesthetic movement sense)
Proprioception
… enables us with closed eyes to estimate the size of our feet, to describe the width of our pelvis and scratch our noses
Proprioception
Proprioceptive acuity is gathered from specialize nerve endings, termed … that are located within the skin, muscles, fascia and joints
mechanoreceptors
… is an important mediator of joint stability and mobility and ultimately the calibration of movement
Proprioception
… control is developed through enhancing proprioceptive acuity and grooving proper movement patterns through practice
Motor control
Information collected from … and … further supports proprioception and when taken together the result is precise body awareness and well adapted motor actions
visual and vestibular centers
… has been defined as the state of remaining unchanged, even in the presence of forces that would normally change the state or condition
Stability
Generally speaking, … muscles are superficially located and responsible for controlling locomotion, alignment, and balancing forces imposed on the spine
mobilizing
… muscles are more centrally located and largely function to create stiffness across joints
Stabilizing
… muscles are shorter in length and respond to changes in posture and extrinsic loads
Stabilizing
Conversely, … or global muscles comprise long lever arms, allowing greater force production, torque and gross multi-planar movements
mobilizers
Mobilizer muscles are:
Fast twitch
fatigues easily
superficial
relatively small proprioceptive role
high force production
prone to hold access tension/shorten
concentric
gross movement
Stabilizer muscles are:
Slow twitch
resistant to fatigue
deep
major contributor to proprioception
low force production
prone to inhibition/weakness
isometric/eccentric
joint stabilization
The hypertonicity of the hip flexors then contributes to the progressive weakening of the gluteus maximus via … …
reciprocal inhibition
The gluteus maximus is an important hip extensors; thus, when forceful hip extension is necessary, the … (synergist of the gluteus maximus) will compensate for the weakened gluteus maximus
hamstrings
When the pelvis rotates …, it reduces the neutral curvature of the lumbar spine (flattens the low back)
posteriorly
Alterations in movement … can stem from multiple factors including obesity and overweight, sedentary behavior, poor postures, unvaried movement, join structure, propensity for certain muscles to become inhibited, and age
quality
More specifically, … position optimizes ideal muscle-length tension and force-coupling relationships, minimizes compressive and shear forces imposed on the joint, and optimizes the timing and speed of contraction of stabilizing muscles
Neutral position
Use of a … line is useful in identifying deviations from a neutral position.
Clients should be barefoot, wear form-fitting clothing that enables the assessor to identify bony landmarks, and be encouraged to assume their everyday, relaxed posture during the assessment
P.168
Plumb line
Specific stretching that targets postural corrective deviations - p169
Useful Informations
The client should be encouraged to maintain three points of contact with the dowel:
the back of the head
the upper thoracic spine
and the pelvis
Progressive six stages for neutral posture
Lying on the ground
Seated
standing
standing and adding in hip hinging
farmer carries with bilateral loading
farmer carries with unilateral loading
First, the … muscles are not only the prime muscles of respiration but they are also a vital muscle of core stabilization
diaphragm
The … assessment is a simple assessment of proper diaphragmatic control during breathing
Hi-Lo assessment
Healthy breathing patterns, or diaphragmatic breathing, involve the expansion of the rib cage and abdomen and involves proper recruitment and Endurance of the … muscles
diaphragm
Clients demonstrating improper breathing habits should be encouraged to regularly practice breathing that is focused on expansion of the rib cage and upper abdomen prior to any chest movement and to increase the length of each breast, in particular the client should be encouraged to fully …
Exhale
Define the Hi-Lo breathing assessment
Client places one hand on his sternum and one hand on his upper abdomen
The client is then instructed to perform 10 breathing cycles
The client reports which hand moved first at the beginning of the inhalation face during the majority of their assessment. In addition, the practitioner should observe the hand movements of the client
Head positioned in front of the body or tilting up or down
Lots of cervical neutral
Rounding of the thoracic spine
Loss of thoracic extension
Loss of neutral lordosis in the lumbar spine or flattening of the lumbar spine
Posterior pelvic tilt
Excessive arching of low back
Anterior pelvic tilt
Knees collapsing inward
Knee valgus
Suggested corrective exercises for common alignment faults
P176
See the table there! Good informations for bettering posture
… involves the compression of soft tissue using tools such as foam rollers, roller massagers, or tennis balls and is performed by the individual rather than by a therapist
Self myofascial release
Self myofascial release increases local … which may aid in the reduction of inflammation
bloodflow
… are a set of non-invasive, quantitative techniques for determining body size by measuring, recording, and analyzing specific dimensions of the body, such as height, weight, and body circumference
Anthropometrics
… is a measure of weight in relation to a person’s height
Body mass index
Body mass index is calculated by … body weight in kilograms by height in meters squared
dividing
Classification of individuals as underweight using the body mass index
< 18.5 kg.m-2
Normal weight Classification using the body mass index
Between 18.5 to 24.9 kg.m-2
Overweight classification using the body mass index
From 25.0 to 29.9 kg.m-2
Obese classification using the body mass index
Superior or equal to 30 kg.m-2
… obesity (also referred to as abdominal or android obesity) is associated with a higher risk of hypertension, metabolic syndrome, type two diabetes mellitus, dyslipidemia, CVD, and premature deaths compared with … obesity, which is characterized by a greater proportion of fat distributed on hips and thighs
Central
Gynoid
Body fat distribution can be determined using the waist-to-hip ratio
You must … the circumference of the waist by the circumference of the hips
divide
Waist circumference alone can be used as an indicator of health risk because it reflects the level of … obesity
abdominal
Health risks are high when the waist circumference is …
superior or equal to 35 inches (88 cm) for a woman
superior or equal to 40 inches (102 cm) for men
Standardized sides when measuring circumferences
Abdomen
arm
buttocks/hips
calf
forearm
hips/thigh
mid-thigh
Waist
… … is the relative proportion of fat and fat-free tissue in the body
Body composition
When it comes to body fat percentage, a range of … for men and … for woman is considered satisfactory for health
10% to 22% for men
20% to 32% for women
… measurements are used to determine the amount of subcutaneous fat, that is, the fat located directly below the skin
Skinfold
The accuracy of predicting the percentage body fat from skin folds is …
+/- 3.5%
When measuring skin folds, take all measurements on the .., side of the clients body with the client standing upright
right
Bioelectrical impedance is related to the percentage of … contained in various body tissues
water
… estimates total body water and relies on regression equation to estimate percentage body fat
Bioelectrical impedance (BIA)
The accuracy of predicting the percentage body fat from bioelectrical impedance ranges between … …
+- 2.7% and 6.3%
These guidelines will assist in obtaining an accurate prediction of percentage body fat using bioelectrical impedance:
No eating or drinking within four hours of the test
No exercise within 12 hours of the test
Completely avoid the bladder within 30 minutes of the test
No alcohol consumption within 48 hours of the test
No diuretic medication within seven days of the test (clients should not discontinue use of prescribe diuretic medication unless approved by the personal physician)
Avoid taking measurements prior to menstruation to avoid possible effects of water retention in woman
Use the same bioelectrical impedance analyzer when measuring change in a clients body composition overtime
Complete measurements in a thermoneutral environment
The technique of … … calculate body density from body volume, based on Archimedes principle, which states that the weight underwater is directly proportional to the volume of water displaced by the body volume
Hydrostatic (underwater) weighing
Densities of muscle and bone are … than the density of water, whereas fat is less dense than water
higher
A person with high levels of muscle and bone will be … in water compared with a person with high levels of fat
heavier
Hydrostatic weighing has a standard error of the estimate of …
+- 2.7% body fat
… … … also measures body volume and is an alternative to hydrostatic weighing for determining body composition
Air displacement plethysmography
Air displacement plethysmography has many advantages over … …, and that it is quick and non-invasive, does not require submersion in water, and accommodates children, adults, and older adults as well as individuals who are obese or disabled
hydrostatic weighing
… uses very low current x-rays at two energy levels to measure bone mineral content, body fat, and lean soft tissue mass
DEXA
The … method requires an individual to lie supine on a table while being scanned from head to toe
DEXA
With appropriate standards and methodology, the reproducibility of DEXA is … for percentage body fat
1.7%
New guidelines indicate that a … reduction in body weight produces health benefits
3% to 5%
Safe and effective weight loss should occur at a rate of … pound per week
1 to 2 lbs
… … … is the total number of calories expended each day and reflects the amount of energy required to carry out or metabolic processes within the body
Total energy expenditure
There are three components to determining total energy expenditure (TEE):
Resting energy expenditure or basal metabolic rate; represents about 60 to 70% of TEE
Thermic effect of food represent 10% of TEE
Physical activity expenditure represent 20 to 30% of TEE
When calculating for weight loss, the recommended rate in adults is 1 to 2 pound per week, which is equal to a daily caloric deficit of … calories
500 to 1000 calories
Following the FITT principal what is the frequency for weight loss
Superior or equal to five days a week to maximize calorie expenditure
Following the FITT principal what is the time advised for weight loss?
A minimum of 30 minutes per day (150 minute per week) progressing to 60 minutes per day or 300 minutes per week or more of moderate intensity aerobic activity
DOMS stands for?
Delayed onset muscle soreness
Muscle hypertrophy occurs only after … weeks of higher intensity resistance training, and therefore it is highly unlikely to see any muscle gain in the first two months of exercise
6 to 8 weeks
Appropriate weight loss methods include exercise, dietary changes, behavioral strategies, and … …
bariatric surgery
Although a safe upper limit has been established for adults and caffeine …, there is no recommendation for adolescents
(250 to 300 mg per day)
For instants, the IOM recommends at least … g of carbohydrates each day for all age groups
130g
The pregnant woman needs an additional … cal each day to ensure that enough essential nutrients are available for both mother and baby
300 calories
In addition to the increased daily need for proteins, there’s also an increased dietary needs for … and … that is provided in prenatal vitamin
Folic acid and Iron
… (a B vitamin) is important in the prevention of serious birth defects such as neural tube defect and congenital heart disease
Folic acid
Extra … is needed to help support the increased blood supply needed to carry extra oxygen throughout the pregnancy
Iron
It is also recommended that pregnant women do not take herbal or botanical … because they were not FDA regulated in terms of dosage, purity, and testing
supplements
In addition, the demand for other nutrients such as …, … and … increase during pregnancy
calcium, proteins and carbohydrates
Vitamin D recommendations for children and adolescents ages 1 to 18 years is … IU, and recommendations for adults older than 71 years is … IU
600 IU
800 IU
Also in the older adults, vitamin D is particularly important in its role of promoting the absorption of … and in maintaining serum calcium levels, which in turn protects bone strength
calcium
Current daily calcium recommendations are … mg per day for 4 to 8 years olds, with an increase of calcium for 9 to 18 years olds to 1300 mg per day
1000 mg
Adults aged 19 to 50 years need … mg of calcium per day
1000 mg
Calcium absorption … with age, thus increasing the need of this nutrient in the older adult population
declines
Post menopausal woman (51 years and older) tend to experience greater bone loss and decreased absorption of calcium, which increases the need in this population to … mg per day
1200 mg
In older adults, vitamin … supplementation can be important
B12
… … account for more American deaths than any other disease, with nearly 650,000 total deaths annually
Cardiovascular diseases (CVDs)
… … disease is one of the most prevalent types of cardiovascular disease and also accounts for the most cardiovascular deaths
Coronary artery disease (CAD)
… … … is characterized by any one of several factors, including a buildup of atherosclerotic plaques, vascular remodeling resulting in luminal stenosis, and inflammation, brought on by numerous factors, including dyslipidemia and hypertension
Coronary heart disease (CAD)
Central to coronary heart disease is the formation of atherosclerotic plaque in the elastic and smooth lining inside of …
Arteries
Plaque formations in the … arteries will obstruct blood flow to cardiac muscle tissue downstream of the obstruction resulting in reduced cardiac function and/or tissue death (necrosis)
coronary
Atherosclerosis is a process where a … … develop causing the artery wall to thicken while reducing nominal diameter
fatty streaks
A partial impairment of coronary artery blood flow and therefore oxygen delivery to cardiac tissue is referred to as … …
myocardial ischemia
The complete obstruction of blood flow to the cardiac myocardial tissue is referred to as a … … or a heart attack and results in tissue death or necrosis
myocardial infarction (MI)
… is considered the “silent killer” because this condition’s signs and symptoms often go unnoticed
Hypertension (HTN)
Hypertension is characterized as a persistent elevation in either … and …
systolic blood pressure (superior to 130 mm HG)
or
diastolic blood pressure (superior to 80 mm Hg)
Blood pressure is regulated by two factors:
cardiac output (a function of heart rate and stroke volume)
total peripheral vascular resistance
Increased … resistance is the most common characteristic of primary and secondary hypertension and is caused by chronic vasoconstriction, or narrowing of the peripheral arterioles, or by vascular plaque buildup
peripheral
When … is present, arterioles lose elasticity because of the increase the presence of fibers collagen tissue
hypertension (HTN)
Specifically, … … … is characterized by occlusion or narrowing of peripheral arteries or vessels of the upper and lower limbs as a result of the buildup of atherosclerotic plaques
peripheral artery disease (PAD)
The most common symptom of peripheral artery disease (PAD) is … … that is characterized by repeatable aching, cramping sensation, or fatigue affecting the muscles of the calf in one or both legs
intermittent claudication
The severity of peripheral artery disease (PAD) is based on the extent of … and is qualified by the use of ankle/break your systolic pressure index (ABI)
claudication
Type one and type two diabetes are defined by a decrease in the production, release and or effectiveness, and action of …
insulin
Either form of diabetes mellitus results in increased blood glucose levels, a condition referred to as …
hyperglycemia
Type … diabetes is quite uncommon found in only 5 to 10% of all patients with diabetes and is characterized by an absolute deficiency in blood insulin release because of the destruction of pancreatic insulin secreting beta cells
Type 1
The patient with type two diabetes has elevated glucose levels which is typically result of increasing insulin …
resistance
Excessive … fat is the leading cause of type two diabetes
abdominal
Type … diabetes responds well to exercise therapy and drugs that either increase insulin sensitivity or decrease blood glucose levels
two
…, defined as elevated blood cholesterol and triglyceride levels, is caused by a combination of genetic and or environmental factors
Hyperlipidemia
Lipids are packaged with proteins and travel through the blood as ..,
Lipoproteins
… are classified by their density: chylomicrons, very low density lipoprotein (VLDL), low density lipoprotein (LDL), and high density lipoprotein (HDL)
Lipoproteins
… is responsible for aiding in the removal of lipids from the circulation, through reverse cholesterol transport
HDL
If HDL levels are less than … mg/dL, very little reverse cholesterol transport occurs, leading to further vascular lipid accumulation and accelerated atherosclerosis rates
40 mg.dL-1
Excessive amounts of total blood cholesterol (superior … mg/dL) and LDL or bad cholesterol (superior … mg/dL), is associated with increased risk of atherosclerosis and coronary artery disease
200 mg.dL-1
130 mg.dL-1
Obesity is defined as an excessive accumulation of body fat and is associated with a body mass index superior or equal to …
30 kg.m-2
… … involves a clustering of metabolic risk factors including hyperglycemia (or current blood glucose medication use), elevated blood pressure (or current hypertension medication use), dyslipidemia (or current lipid lowering medication use), and central adiposity based on waist circumference
Metabolic syndrome
Most pulmonary diseases are grouped into two categories:
chronic obstructive pulmonary disease is (COPD)
chronic restrictive pulmonary disease (CRPD)
… is an umbrella term for a collection of pulmonary diseases, including chronic bronchitis, emphysema, and asthma
COPD
… is characterized by progressive airflow limitation associated with an abnormal inflammatory lung response that limits the lung’s ability to move air during inhalation and exhalation
COPD
… … is characterized by a cough lasting for at least three months, resulting in chronic pulmonary inflammation which leads to damage of the bronchial lining and impeded lung function in airflow obstruction
Chronic bronchitis
… is the permanent enlargement of air spaces along with necrosis of alveolar walls, causing an accumulation of air in the lung tissue
Emphysema
… consist of both inflammation and increased smooth muscle constriction in the lungs in response to various stimuli
Asthma
During an… episode, inflammatory mediators are released causing bronchial smooth muscle spasm, edema formation, and the production of mucus resulting in vascular congestion
asthmatic
…, also known as interstitial lung disease, is made up of a small group of diseases that cause inflammation resulting in lung tissue necrosis and decreased lung volume
CRPD
Both clients with … and … have limited gas exchange within the lungs, frequent shortness of breath, and difficulty breathing
COPD and CRPD
Exercise has been shown to decrease coronary inflammatory markers, decrease stress and damage on the coronary arteries, an increase new blood vessel growth (…) and vascular regeneration which are all likely to promote faster recovery from myocardial infarction
angiogenesis
Regular exercise can also decrease blood platelet adhesiveness, fibrinogen levels, and blood viscosity, all of which reduce the risk of clotting and the likelihood for second … infarction
myocardial
Endurance exercise does lower … SBP and DBP values by 5 to 7 mm HG, and for individuals at risk for developing hypertension, endurance exercise is thought to slow blood pressure rise and delay hypertension development
resting
The most beneficial aspect for patients with type two diabetes that start an exercise program is the improved … … that is reported with exercise training which may result in lower medication requirement and greater control blood glucose levels
insulin sensitivity
… also provides a positive benefits on other blood lipid values by lowering blood concentrations of LDL and increasing concentrations of HDL
Exercise
What does FITT-VP stands for?
Frequency
intensity
time
type
volume
progression
PAD stands for:
Peripheral artery disease
DM stands for:
Diabetes mellitus
Being physically active and exercising … days a week is recommended for the patient with type two diabetes
5 to 7 days a week
Patients with type two diabetes that exercise in the early evening should be completed with caution because exercising at this time could cause … conditions later in the night, possibly during sleep cause dire consequences dire consequences
hypoglycemic
An individual who suffers an myocardial infarction has likely had a significant level of myocardial … as one key predisposing factor
ischemia
Myocardial ischemia, or simply ischemia, indicates a shortage of … blood flow to the heart myocardium
oxygenated
… is an imbalance of oxygen supply and demand
Ischemia
If oxygen supply fails to match an increased demand, even briefly, then … is present
ischemia
Often times, ischemia is associated with chest pain, or …
angina
CHF stands for:
Congestive heart failure
If the heart is deficient such as in the case of congestive heart failure (CHF) or because the arteries are partially blocked as in atherosclerosis, oxygen delivery to target muscle is impaired and exercise capacity is limited and the client has reach the “… …”
ischemic threshold
Any client experiencing … should exercise in the presence of someone with more specific training then the exercise physiologist (EP-C)
ischemia
An … … occurs when there is prolonged ischemia and can result in heart tissue death or necrosis
myocardial infarction (MI)
The ischemia duration necessary to produce an infarct varies; therefore, the EP-C must design exercise prescriptions that safely avoid the … … or the heart rate at which angina symptoms develop
ischemic threshold
Also, because … result in the loss of heart tissue, any necrosis will negatively impact the movement of an action potential throughout the heart as well as the contractile state of the heart as a pump, lowering ejection fraction and limiting exercise capacity and tolerance
necrosis
Normally, a single exercise session causes a linear increase in … while a steady constant DBP is maintained
SBP
The client with hypertension can exercise once hypertension is …
controlled
In the presence of uncontrolled hypertension (superior to 180/110 mm HG), exercise is only engaged … initiating drug therapy
after
For resting SBP greater than 180 mm Hg or resting DBP greater than 110 mm Hg, even if blood pressure medications are being taken, exercise is … and is not engaged until blood pressure is under control
contraindicated
During exercise, if SBP becomes greater than 220 mm Hg or DBP greater than 105 mm Hg, exercise is …, and blood pressure is allowed to return toward resting values
stopped
… can attenuate heart rate response by as much as 30 bpm
Betta blockers
Clients taking Betta blockers are advised to have … cool-down periods, where blood pressure is monitored after exercise to ensure that blood pressure does not fall to unsafe levels
longer
What is another name for the blood pressure cuff?
Sphygmomanometer
In more severe cases of PAD, some clients may need to begin exercising for only a total of … minutes per day will gradually increases of five minutes per day every 2 to 4 weeks depending on individual progression
15
A long warm-up may be needed for persons with PAD as a … environment mean aggravate symptoms of intermittent claudication
cold
Patients with … need constant blood glucose monitoring and the ability to measure before, during, and after exercise
diabetes
If preexercise or during exercise blood glucose measurements are less than … mg.dL, a carbohydrate snack 15 g is administered, and a blood glucose reading of greater than 100 mg.dL is obtained before starting or continuing exercise
70 mg.dL-1
When pre-exercise blood glucose values are greater than … mg.dL-1 with the presence of blood ketones or are greater than 300 mg with either presence or absence of ketones, blood glucose should be lowered prior to initiating exercise
250
When an active retinal hemorrhage is present or recent laser corrective surgery for retinopathy is completed, exercise is …
avoided
Because clients with … experience greater time for proper healing process, they should practice good foot care by inspection of feet before an after exercise and they wearing proper shoes and cotton socks to avoid foods sores and blisters
diabetes
Exercise with a partner or under the supervision of an exercise physiologist to reduce the risk of problems associated with … events
hypoglycemic
Exercise is not recommended during peak … action because hypoglycemia may result
insulin
… presents few, if any, exercise limitations, and individuals with elevated blood lipid levels are encouraged to engage in regular physical activity and exercise
Dyslipidemia
To optimize blood lipid concentrations, clients with dyslipidemia are encouraged to exercise for … durations
longer
In general, most lipid lowering drugs have no … on exercise responses
impact
Individuals who are obese are recommended to engage in moderate physical activity at least five, if not all, days of the week and progress to accumulating more than … kcal a week of energy expenditure
2000 Kcal
The primary goal when developing an exercise prescription for clients with … is to reduce barriers for activities of daily living and to help increase quality of life
COPD
The exercise physiologist must educated the client with COPD to push past the feeling of …
dyspnea
…, most commonly used for individuals with CVD, does not cause any concerns when prescribing exercise
Aspirin
Over-the-counter (OTC) cold and flu medications often contain some form of ephedrine that has been shown to … systemic blood pressure
increase
CCBs and ACE inhibitors increase … diameter
arterial
… … make setting initial exercise intensity difficult, may limit functional capacity, inhibit using HR as an exercise intensity target and require more rigorous patient self monitoring
Betta blockers
… … may also block symptoms of hypoglycemia and increase the risk of undetected hypoglycemia during and after exercise
Betta blockers
Two common nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen are used cautiously in patients with diabetes because both may increase the risk of …
hypoglycemia
… … are well known for decreasing mortality and risk of a second myocardial infarction but also have a profound effect on exercise response
Betta blockers
Although … … lower HR and myocardial contractility, these medications also increase exercise capacity by decreasing coronary ischemia
Betta blockers
Beta blockers may also block symptoms of … and increase the risk of an detected hypoglycemia during and after exercise
hypoglycemia
CCBs are used for treating … and …
hypertension and angina
Ace inhibitors are used for treating …
hypertension
… and … both increase arterial diameter, thereby lessening blood pressure and decreasing the work by the heart
CCBs and ACE inhibitors
CCB’s effect is …, whereas ACE inhibitors have a peripheral effect
central
CCB’s and ACE inhibitors pose less concern regarding exercise responses than … …
Betta blockers
… … do work in the lungs and can produce an irritating dry cough
ACE inhibitors
… and other cholesterol-lowering drugs tend to have very little effect on HR and contractility and thus no direct impact on exercise response and exercise capacity or the exercise prescription
Statins
