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Exercise for Special Populations > Chapter 1 exam > Flashcards

Chapter 1 exam Flashcards

1
Q

definition of physical activity

A

any bodily movement produced by skeletal muscles that results in caloric expenditure `

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2
Q

caloric expenditure is important in prevention and management of what 3 health issues

A
  1. obesity
  2. coronary heart disease
  3. diabetes mellitus
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3
Q

2 main benefits of physical activity

A
  1. health benefits

2. fitness benefits

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4
Q

4 fitness benefits of physical activity

A
  1. cardio-respiratory fitness
  2. muscular strength and endurance
  3. Musculoskeletal flexibility
  4. body weight
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5
Q

how can higher levels of cardiorespiratory fitness be acheived

A

increasing the frequency, duration, and intensity of an activity

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6
Q

how to improve muscular strength and endurance

A

regular use of muscles helps improve and maintain strength and endurance. This greatly increases the ability to perform the tasks of daily living without physical stress and fatigue

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7
Q

improving musculoskeletal flexibility

A

engaging in regular stretching exercises and physical activities that require one to stoop, bend and crouch and reach may help to maintain a level of flexibility to improve quality of daily living

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8
Q

improving body weight

A

physical activity burns calories increases the proportion of lean to fat body mass, and raises metabolic rate

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9
Q

what are the 2 biggest challenges facing public health in the US

A
  1. getting people to adopt a physical activity

2. getting people to maintain physical activity programs

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10
Q

what percentage of American adults are not sufficiently active

A

60%

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11
Q

what percent of adults get no leisure time physical activity

A

28%

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12
Q

when is there a dramatic decrease in physical activity

A

during adolescents in the last years of high school

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13
Q

what percent of 12y/o children report vigorous activity

A

70%

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14
Q

by age 21 what percentage of men and women continue vigorous activity

A

40% of men and 30% of women

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15
Q

what percentage of variation in physical activity is explained by genetic inheritance

A

20%

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16
Q

what is the dropout rate from exercise programs

A

50% across the first 6-12 months of participation

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17
Q

how many potential reasons have been found for people not being physically active

A

about 50

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18
Q

4 reasons why people are physically inactive

A
  1. beliefs about physical activity
  2. false expectations of a quick, easy impact on weight and shape
  3. poor self control skills
  4. social and physical environments which impede activity or reinforce other sedentary behaviors
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19
Q

6 barriers to physical activity

A
  1. demographic barriers
  2. socioeconomic status
  3. age
  4. obesity
  5. environmental barriers (physical and social)
  6. behavioral: past habits
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20
Q

what types of support are most important to adolescents and college students

A

Adolescents: peer pressure
College: family

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21
Q

top 8 reasons why people are not physically active

A
  1. embarrassed
  2. think of exercise as a punishment
  3. lack of time
  4. dangerous neighborhood
  5. can’t afford gym membership
  6. do not like to sweat
  7. results take too long
  8. exercise can be a lonely business i.e. lack of support
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22
Q

2 common determinants of participation in exercise

A
  1. self efficacy

2. social support

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23
Q

examples of how the physical environment can cause barriers

A
  1. lack of bicycle or walking trails
  2. inclement weather
  3. unsafe neighborhood
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24
Q

Risk Assessment: info required before beginning a program of moderate to vigorous activity

A
  1. awareness of pre-existing medical problems
  2. consultation before starting a program with a physician or other health care professional
  3. appropriate mode of activity and tips on different types of activities
  4. principles of training intensity and general guidelines as to rating of perceived exertion and training heart rate
  5. progression of activity and principles of starting slow and gradually increasing activity time and intensity
  6. principles of monitoring symptoms of excessive fatigue
  7. ways to make exercise fun and enjoyable
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25
Q

what theories/models have been most important to promote the initiation of and adherence to physical activity

A

cognitive behavioral techniques

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26
Q

what is life-style based physical activity promotion

A

focuses on home or community based participation in many forms of activity that include daily routine

researchers recommend promoting lifestyle changes whereby physical activity can be enjoyed throughout the day as part of ones lifestyle

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27
Q

what is the PACE+ model

A
  1. patient centered assessment and counseling for exercise and nutrition
  2. developed for use by primary care provider in the clinical setting targeting apparently clinically healthy adults
  3. stages of change model
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28
Q

what is the ecological perspective

A

the most effective form of interventions occurs at a variety of levels, meaning if you hear it from enough people you start to consider/believe it

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29
Q

what are the 2 factors withing behavioral interventions

A
  1. interpersonal factors: personality type, motivation, genetic pre-disposition
  2. environmental factors: social networks, physical environment
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30
Q

Type A personality traits

A
  1. competitive
  2. high acheivers
  3. sense of time urgency
  4. felt insecure at one point so they decide to change their lives by making achievements
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31
Q

Type B personality traits

A
  1. relaxed
  2. laid back
  3. not easily stressed
  4. procrastinators
    5.
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32
Q

Type C personality traits

A
  1. love details
  2. like figuring out how things work
  3. not assertive
  4. lack of assertiveness results in high amounts of stress and sometimes depression
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33
Q

Type d personality traits

A
  1. negative outlook on life
  2. pessimistic
  3. socially withdrawn
  4. fear of rejection
  5. 3 times more likely to get a heart disease than the other personality types
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34
Q

define exercise

A

planned, structured, and repetitive movements which result in the improvement and/or maintenance of one or more facets of physical fitness

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35
Q

3 major components of Total Energy Expenditure

A
  1. basal metabolic rate (70%)
  2. thermic effect of food (10%)
  3. physical activity (20%)
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36
Q

define energy balance

A

the difference between the number of kilocalories that you eat (energy intake) and the number of kilocalories that you burn (energy expenditure

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37
Q

what is positive energy balance

A

if energy intake is greater than energy expenditure

person will gain weight

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38
Q

what is negative energy balance

A

energy intake is less than the amount of energy that is expended

lose weight

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39
Q

what are lifestyle physical activities

A

physical activities that are part of a persons everyday routine, unstructured

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40
Q

define epidemiology

A

study of how a disease of health outcome is distributed in populations and what factors influence or determine this distribution

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41
Q

what are the 2 assumptions in epidemiology

A
  1. Human disease is not random
  2. Human disease has causal and preventative factors that can be identified through scientific investigation of different populations or subgroups of individuals within a population
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42
Q

what is the primary goal of epidemiology

A
  1. identify the determinants of health and disease to decrease mortality and morbidity
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43
Q

what does physical activity epidemiology focus on

A

focuses on physical activity within popultions and investigates how physical activity levels impact health and disease to decrease mortality and morbidity

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44
Q

what are the 2 measures of morbidity

A
  1. Incidence Rate: number of new cases of a disease that occurs in a given time divided by the number of people in the population that is at risk for developing the disease
  2. Prevalence: number of affected people present in the population divided by the total population
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45
Q

What is the measure of Mortality

A

mortality rate: number of deaths in a specified time divided by the number of people in the population

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46
Q

Define biologic plausibility

A
  1. a theory based on existing medical literature that support the relationship or casual link between physical activity and a particular disease or health outcome
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47
Q

what is a confounder

A

something that negatively impacts your study and can potentially cause you to throw the data away

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48
Q

what is a p value

A

calculated value of what you hypothesize

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49
Q

what are the 2 main designs for Epidemiology study designs and which one is more effective

A
  1. Observational Study Design: development of disease or health outcome is observed and compared between different levels of physical activity,
    - physical activity is self regulated
  2. Experimental Study Design: random assignment of physical activity levels to individuals without the disease or health outcome
    - these people are followed for a period of time to compare their development of the disease
    * * most effective
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50
Q

what are 3 observational study designs

A
  1. cross sectional: look at a community, sensu bureau
  2. case control: follow one or two individuals to monitor change
  3. prospective: make a prediction on the individuals you are following
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51
Q

what are the 3 considerations when determining the accuracy of an assessment tool

A
  1. validity
  2. reliability
  3. sensitivity
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52
Q

2 reasons that accurate assessments are needed

A
  1. understand the specific amounts of physical activity that are needed for health benefits
  2. determine if a particular behavioral intervention was successful in changing activity behavior
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53
Q

4 pros of of the subjective measures

A
  1. nonreactiveness
  2. practicality
  3. applicability
  4. accuracy
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54
Q

3 cons of subjective measures

A
  1. does not reflect total energy expenditure
  2. reliability and validity problems
  3. Misinterpretation of physical activity across different populations
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55
Q

What is direct observation

A
  1. measures physical activity and identifies the type and specifics of the activity
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56
Q

pros and cons of direct observation

A

Pro

  1. provides both quantitative and qualitative info on a persons activity
  2. timely and labor intensive
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57
Q

what is indirect calorimetry

A

measures O2 consumption and CO2 production of short and long periods of time.

  1. Short duration: face mask
  2. long duration: metabolic chamber
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58
Q

what is doubly labeled water test

A

uses biochemical markers to estimate energy expenditure

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59
Q

heart rate monitors

A
  1. heart rate is a direct indicator of ones physiological response to physical activity
  2. heart rate is used as an indirect estimate of energy expenditure

pro: valid in both field and lab settings. low participate burden
con: can be expensive and uncomfortable

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60
Q

Activity monitors: what they are and pros and cons

A
  1. assess the acceleration of the body in one or more planes of movement

Pro: valid in both free living and lab settings, monitors intensity, frequency, and duration, non invasive

con: expensive and do not provide info concerning type of activity. inaccurate in upper body testing and cycling

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61
Q

pedometer

A

record steps taken and offer the ability to estimate the distance walked if stride length is known

pro: inexpensive, practical
con: not waterproof, not used to calculate cycling

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62
Q

Physical fitness can be broken down into 5 components what are they

A
  1. cardiovascular fitness
  2. muscular strength
  3. muscular endurance
  4. body composition
  5. flexibility
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63
Q

how can cardiovascular fitness be measured

A
  1. directly usuing maximal exercise testing (VO2 max)

2. indirectly using submaximal exercise and field test protocols

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64
Q

4 factors that may influence physical activity

A
  1. genetics
  2. gender
  3. age
  4. relative weight
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65
Q

2 causes that americans are too sedentary

A
  1. increased use of technology

2. increased use of automobiles

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66
Q

in 2000 what percent of adults reported no leisure time physical activity

A

26%

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67
Q

how many deaths per year in the US does physical inactivity contribute

A

300,000 and these are preventable

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68
Q

Percentages according to the rates of physical inactivity in:

  1. hispanic women
  2. non hispanic women
  3. asian and pacific islander
  4. white women
A
  1. hispanic: 57.2%
  2. non hispanic black 55.2%
  3. asain: 42.6
  4. 36.1
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69
Q

physical activity can help with what 3 things

A
  1. contribute to weight loss
  2. helpful for the prevention of overweigh and obesity
  3. helps maintain weigh tloss
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70
Q

examples of occupational work, household chores, and leisure time activities

A
  1. carpentry, construction, waiting tables, farming
  2. Washing floors or windows, gardening, or yard work
  3. Walking, skating, biking, swimming, playing Frisbee, dancing, softball, tennis, football, aerobics
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71
Q

physical activity decreases the risk for what 3 things

A
  1. colon cancer
  2. diabetes
  3. high blood pressure: increase blood flow from result of exercise causes blood vessels to gradually increase
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72
Q

how long should someone trying to reduce the risk of chronic diseases in adulthood exercise for

A

30 min of moderate intensity most days of the week

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73
Q

how long should someone exercise for if they are trying to manage weight and prevent unhealthy weight gain

A

60 min of moderate to vigorous intensity most days of the week

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74
Q

how long should someone exercise if they are trying to sustain weight loss in adulthood

A

60-90 min of daily moderate to vigorous intensity

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75
Q

how to calculate ideal body weight for:
men?
Women?

A

Men: use 106 lbs for first 5 ft, then add 6 lbs for each inch

women: 100 lbs for 5 ft then add 5 lbs for every inch

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76
Q

before beginning an exercise program you should check with your doctor if you:

A
  1. a man older than 40 or woman older than 50
  2. had a heart attack
  3. family history of heart problems before age 55
  4. have heart, lung, or kidney disease
  5. high blood pressure
  6. smoke
  7. are overweight or obese
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77
Q

what type of exercise decreases the incidence of type 2 diabetes

A

aerobic and resistance training

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78
Q

what percent reduction is there with the risk of colon cancer and breast cancer if you are active

A

30-40%

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79
Q

increased self reported physical activity resulted in what

A
  1. decreased reoccurence of cancer

2. decreased risk of death from cancer

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80
Q

What 3 things does testosterone affect

A
  1. increase bone formation, larger bones
  2. increase protein synthesis, larger muscle
  3. increased EPO secretion, increase red blood cell production
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81
Q

what 4 things does estrogen affect

A
  1. increased fat deposition (lipoprotein lipase
  2. faster, more brief bone growth
  3. shorter stature, lower total body mass
  4. increased fat mass, % body fat
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82
Q

where is the distinct female fate deposition pattern located

A

Rapid storage on hips and thighs due to increased lipoprotein lipase activity

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83
Q

what issue causes regional fat loss more difficult

A

decreased lipolytic activity

84
Q

During pregnancy and lactation, what happens to lipoprotein lipase and lipolysis

A

lipoprotein lipase decreases while lipolysis increases

85
Q

when looking at both men and women, how does muscle strength differ in the Upper body and Lower Body

A
  1. Upper Body: women are 40-60% weaker
  2. Lower body: women 25-30% weaker

this is due to total muscle mass difference

86
Q

what causes the upper body strength disparity between men and women

A
  1. women have more muscle mass in the lower body
  2. women utilize lower body strength

women are more fatigue resistant

87
Q

Cardiovascular function differs greatly between men and women, for same ABSOLUTE submaximal workload how does it differ

A

Same cardiac output

  1. women have lower stroke volume and higher heart rate
  2. women have smaller hearts and lower blood volume
88
Q

Cardiovascular function differs greatly between men and women, for the same RELATIVE submaximal workload, how does it differ

A

Women have slightly increased heartrate, decreased stroke volume, decreased cardiac output
2. leads to decreased oxygen consumption

89
Q

how do women compensate for decreased amounts of hemoglobin

A

increased a-v O2 difference

-lower hemoglobin, lower oxidative potential

90
Q

what are the sex differences in respiratory function

A
  1. Due to difference in lung volume, body size
  2. Similar breathing frequency at same relative workload
  3. Women increased frequency at same absolute workload
91
Q

do men or women have a greater VO2 max

A

men

92
Q

what groups does the untrained sex category compare and is it fair

A
  1. Relatively sedentary nonathlete women
  2. Relatively active nonathlete men

not fair

93
Q

what groups are compared in the trained sex comparison

A

Similar level of condition between sexes

May reveal more true sex-specific differences

94
Q

what other body variables can you scale the VO2 max to

A
  1. Height, weight, FFM, limb volume

Sex difference minimized or gone with scaling

95
Q

what occurred when men simulated womens fat mass

A
  1. reduced sex differences in treadmill time, submaximal VO@ max
96
Q

what does women’s lower hemoglobin limit

A

VO2 max

97
Q

what does women’s lower cardiac output limit

A

VO2 max

  • SV max limited by heart size and plasma volume
  • plasma volume loading in women helps
  • submaximal absolute VO2, no sex difference
98
Q

what are the sex differences in lactate threshold

A

peak lactate concentrations lower in women

-lactate threshold occurs at same percent VO2 max

99
Q

during physiological adaptions to exercise training, how does body composition change

A
  1. decrease total body mass, fat mass, and %body fat

2. increase in FFM

100
Q

what type of exercise maintains bone mineral density

A

weight bearing exercise

101
Q

what are the strength gain differences between men and women

A
  1. less hypertrophy in women, though some studies show similar gains with training
  2. neural mechanisms more important for women
102
Q

during aerobic maximal intensity what occurs

A
  1. increased Cardiac output due to increased max stroke volume
  2. increased muscle blood flow, capillary density
  3. increased maximal ventilation
103
Q

what occurs during aerobic submaximal intensity

A

cardiac output unchanged

2. increased stroke volume, decreased heart rate

104
Q

what two changes are not sex specific

A
  1. cardiorespiratory

2. VO2 max

105
Q

what changes in VO2 max occur during physiological adaptations to exercise training

A
  1. roughly increase by 15-20%
  2. increase cardiac output max, increase muscle blood flow
  3. depends on training intensity, duration and frequency
106
Q

what happens to the lactate threshold and blood lactate during exercise training

A

lactate threshold increases while blood lactate for given work rate decreases

107
Q

what are 3 biological mechanisms that may play a role in the age related declines in physical activity

A
  1. general physiological declines with age
  2. declines in motor abilities
  3. neurobiological changes that may be involved in the motivation to be physically active
108
Q

when does muscular strength peak

A

people 20-29 years of age

109
Q

when do gender differences in physical activity occur

A

during childhood, on average males are more active

110
Q

what are 2 hypotheses that try to explain the observed gender differences in physical activity

A
  1. greater socialization toward sport participation

2. social factors such as peer pressure, and access to opportunities for physical actiivty

111
Q

what causes males to be generally stronger than females

A

absolute amount of muscle mass

112
Q

even though males tend to be stronger than females, what 2 things to women surpass men in

A
  1. trunk flexion

2. flexibility

113
Q

what are the 3 broad names for drugs

A
  1. chemical
  2. generic
  3. brand
114
Q

drugs do not confer new functions on organs and tissues, but what do they do?

A

they attenuate, accentuate, or replace a response

115
Q

what are the 2 main routes of administration of drugs

A
  1. enteral: administered through gastrointestinal tract orally or rectally
  2. parenteral: delivered through skin injection
    - subcutaneous, intravenous, intramuscular, epidural, intra-articular
116
Q

between the two types of drug administration, enteral and parenteral, which is usually the better option

A

Parenteral because some of the compounds in the medication could be broken down within the digestive tract

117
Q

define pharmaceutical

A

how a drug progresses from the state in which it was administered, is disintegrated, and then dissolved

118
Q

define pharmacokinetic

A

the effect of the body on the drug, how it is absorbed, distributed, metabolized, and excreted

119
Q

what is bioavailability influenced by

A

by route of administration for instances, the IV does not pass through the liver after administration whereas oral agents do after absorption

120
Q

define pharmacodynamic

A

the effect of the drug molecules in the body

121
Q

what are the 2 effects of pharmacodynamic

A
  1. Primary effect: planned or therapeutic effect

2. Secondary effect: unwated or side effect

122
Q

define the dose-response relationship

A

relationship between amount of drug and the body’s response

123
Q

what is the maximal response to a drug

A

the dose beyond which no further increase yields any further drug response

124
Q

what are anti-arrhythmic agents used for

A

used to suppress abnormal rhythms of the heart

125
Q

what are adrenergic blocking agents for (beta blocker)

A

helps to not overwork or stress the heart

126
Q

what are bronchodilators used for

A

dilates the bronchi and bronchioles to allow increased airflow to the lungs

127
Q

what are calcium channel blockers used

A

eases the workload on the heart

128
Q

what are cardiac glycosides used for

A

increase heart contractility

129
Q

What are nitrates used for

A

vasodilation to decrease anginal pain

130
Q

psychotropics are used for what

A

alleviate mental disorders

131
Q

what are thyroid agents used for

A

raise overall metabolism

132
Q

define mechanisms of action

A

two main means by which a drug alters a bodily function at the target cell

133
Q

what are the 2 main mechanisms of action

A
  1. mediated through protein receptor found on cell membrane
    - agonist: drug that leads to physiologic response
    antagonist: interferes with or counters the desired action of an agonist
  2. influence or inhibit the normal effet of an enzyme
134
Q

what does the Therapeutic Index refer to

A

the safety of the drug and is represented as the

  1. ration between the dose that is lethal
  2. the dose that is therapeutically effective
135
Q

what are 3 main factors that modify an agents physiological response

A
  1. age
  2. body mass
  3. gender
136
Q

what are some other factors that modify an agents physiological response

A 
genetics
coexisting disease
patients mood
ambient environment
time of day
137
Q

what are factors related to risk for noncompliance

A
  1. absence of symptoms
  2. health beliefs and health literacy
  3. social support
  4. chronic versus acute disorder
  5. cognitive impairment
  6. drug related side effects
  7. multiple medications with multiple doses
138
Q

what are some examples of improper medication use

A
  1. not filling script or not taking filled script
  2. over or underuse, taking at wrong time
  3. taking the wrong medication
  4. not finishing medication
  5. administration errors
  6. using another persons medication
  7. using old, possibly expired medication
139
Q

5 strategies to improve medication compliance

A
  1. level of language
  2. pictures/demonstration
  3. teach back method
  4. self monitoring
  5. RIM Method
140
Q

What is the RIM technique

A
  1. Recognize
    - using objective and subjective evidence
  2. Identify
    - determine the causes of noncompliance with supportive and probing questions, empathetic responses
  3. Manage
    - develop partnerships with patients
141
Q

what are benefits of improved compliance

A
  1. Patients: better outcomes and quality
  2. practitioners: healthier, more loyal patients
  3. managed care: lower total health care expenditures
  4. pharmaceutical industry: increased sales
142
Q

what is Medical Reconciliation

A

Formal process that compares patient’s current medications to those of the medical record or medical orders; meant to identify and rectify discordances

143
Q

what 4 things do discordances include

A
  1. omissions
  2. wrong dose or frequency
  3. wrong drug
  4. duplicate drugs in same class
144
Q

what are the general interview topcis

A
  1. demographic info
  2. history of present illness (HPI)
  3. Current medications
  4. allergies
  5. past medical history
  6. family history
  7. social history
145
Q

examples of demographic information that is needed

A
  1. age: independent predictor of survival in almost every cardiopulmonary condition
  2. Sex: differences in onset of disease
  3. ethnicity: ethnic differences are in fact socioeconomic
    - ex: obesity, left ventricular hypertrophy, chronic renal insufficiency, hypertension, diabetes
146
Q

During the interview process of HPI, what examples may require further investigation by the CEP

A
  1. Claudication (obstruction of arteries resulting in leg pain)
  2. Dyspnea (labored breathing)
  3. Angina (heart pain)
  4. Edema or weight gain
147
Q

for HPI, what do you need to drill down on with the patient

A
  1. date of onset
  2. chronicity
  3. types of symptoms
  4. exacerbating or alleviating factors
  5. current disease state
148
Q

What is the mnemonic to characterize symptoms of HPI

A
  1. Onset
  2. Provocation and Palliation
  3. Quality
  4. Region and Radiation
  5. Severity
  6. Timing
  7. Associated Signs and Symptoms
149
Q

For Angina, what do you check for during the patient interview

A
  1. is it worsening or unstable
  2. new onset or change in:
    a) frequency
    b) intensity (1-4 scale)
    c) duration
    d) precipitating factors (environmental conditions, distress, exertion)
150
Q

what are typical chest pain symptoms

A
  1. heaviness, pressure, squeezing, generalized left to mid-chest
  2. radiation to neck, jaw, back, left arm
  3. worsened with exertion or relieved with rest or nitroglycerin
151
Q

what are atypical chest pain symptoms

A
  1. sharp, stabbing pricking pain
  2. no radiation
  3. no exacerbating or alleviating factors
152
Q

what are non-cardiac chest pain symptoms

A
  1. discomfort clearly attributable to another cause
  2. radiation N/A
  3. exacerbating and alleviating factors N/A
153
Q

what are signs of heart failure

A
  1. swelling in ankles, feet and abdomen
  2. Dyspnea at rest or increased dyspnea on exertion (DOE)
  3. Orthopnea (shortness of breath when laying down)
  4. Paroxysmal nocturnal dyspnea (shortness of breath during the night)
  5. increased fatigue
  6. weight gain (3 lbs in 3 days, 5 lbs in 1 week)
154
Q

during the patient interview and HPI for heart failure what changes do you look for

A

change in

  1. frequency
  2. intensity
  3. duration
  4. precipitating factors
155
Q

during patient interview for medications and allergies, what are you looking for

A

medical reconciliation: compare the meds that the patient state they are taking against their medical record, find discrepancies

156
Q

during a patient interview on past medical history, what are you looking for

A

pertinent past medical problems while focusing on those that may have an influence on the ability to exercise test or train

  1. musculoskeletal: low back pain, gout, joint issues
  2. neurologic: cerebrovascular disease, stroke, dementia
  3. respiratory: asthma, obstructive lung disease
157
Q

during the patient interview of family and social history, what do you look for and limit it to

A
  1. limit it to first degree relatives: parents, siblings, and kids
  2. identify relevant heritable disorders such as cancers, diabetes, CHD after age 55 in men and 65 in women
  3. marital status
  4. transportation
  5. occupation
  6. nutrition patterns
  7. sleep habits
  8. leisure activities
  9. prior and current exercise habits
  10. estimate functional capacity (METS)
158
Q

substance abuse can influence exercise therapy, what substances should you inquire about?

A
  1. tobacco
  2. alcohol
  3. illicit drugs
159
Q

during a physical examination for general info what are you looking for

A
  1. does patient appear comfortable
  2. anxious
  3. healthy or frail
  4. well nourished or undernourished
160
Q

during pulmonary examination, the practitioner auscultates the anterior and posterior chest to listen for breath sounds, how are these characterized

A
  1. normal
  2. decreased or absent
  3. coarse
  4. wheezing
  5. crackling (rales)
161
Q

during the cardiovascular physical examination, what do you look for

A
  1. blood pressure being hypertensive (>200/>110) or hypotensive (<90/60)
  2. unexplained tachycardia (>100/min)
  3. unexplained bradycardia (<40/min)
  4. point of maximal impulse (PMI) this is the farthest away from the heart you can be and still feel a beat
  5. bruits: turbulent flow in artery
  6. syncope or near syncope (dizziness)
  7. medical record for characterization of arterial pulse needed, palpate for
    3=bounding
    2=normal
    1=diminished
    0=absent
162
Q

during cardiovascular examination you look for a change in the contour of the leg for edema, what is the ranking for edema

A

1+ means mild, distortion resolves quickly

2+moderate; pit a bit deeper, lasts for 10 to 15 s
3+ = severe; pit is >6 mm deep, lasts for 1 min
4+ = >8 mm deep, lasts >2 min

163
Q

during physical examination of musculoskeletal issues, what do you look for

A
  1. Gait: normal, antalgic (limping), hemiplegic, shuffling, wide
  2. joints: redness, warmth, swelling, tenderness
  3. strength: 0-5 scale
  4. pain in bone area
164
Q

examples of neurologic issues

A
  1. severe headaches
  2. tremor (parkinsons)
  3. tingling, numbess
  4. behavioral
  5. syncope
  6. transient ischemic attack
  7. recent fall
165
Q

examples of metabolic issues during the physical examination

A
  1. BMI
  2. diabetes
    - silent ischemia
    - hypoglycemia
    - foot wound
166
Q

During the physical examination and you look for infections, what qualities to you look for in the infection

A
  1. local or incisional
  2. wound healing
    - graft harvest site
  3. thoracic surgical incision
167
Q

define SOAP

A
  1. Subjective: interview,
  2. Objective: examination
  3. Assessment
  4. Plan
168
Q

What are the Chronic cardiovascular adaptations to Physical Activity

A
  1. Favorable changes in cardiac morphology
  2. Decrease in resting HR
  3. Increase in stroke volume
  4. Increase in cardiac output
  5. Increase in the A-VO2 difference
  6. Increase in total blood volume
  7. Increase in vascular capacitance / compliance
  8. Increase in Pre-Load / decrease in After-Load
  9. Decreases in both systolic and diastolic BP
  10. Increase in VO2max
169
Q

what is the normal heart weight

A

250-300 grmas

170
Q

how much does an athletes heart weigh

A

300-450 grams

171
Q

how much does a pathological hear weigh

A

over 500-1000 grams

172
Q

what causes eccentric hypertrophy (widening of the ventricles)

A

endurance training

173
Q

what causes concentric hypertrophy (less space in the ventricles)

A

strength training

174
Q

What is the respiratory adaptation to chronic physical activity

A
  1. decrease in rate of ventilation
  2. increase in depth of ventilation
  3. increase in surfactant (lipoprotein) within bronchial airways
175
Q

what is the inspiratory reserve volume of the lungs

A

3100 mL

176
Q

what is the tidal volume of the lungs

A

500 mL

177
Q

what is the expiratory reserve volume in the lungs

A

1200 mL

178
Q

what is the residual volume in the lungs

A

1200 mL

179
Q

what is the vital capacity of the lungs

A

4800 mL

180
Q

what is the total lung capacity

A

6000 mL

181
Q

what are the hormonal adaptations to chronic physical activity

A
  1. resting concentrations are generally less

2. high intensity exercise may accentuate some

182
Q

what are the steps following the binding of a hormone onto a cell

A
  1. receptor produces a G protein
  2. Adenylate Cyclase
  3. ATP
  4. cyclic AMP (does the hormones job)
  5. protein kinase
183
Q

function of the portal vessels from the hypothalamus to the pituitary gland

A

carry the trophic hormones directly to the anterior pituitary

184
Q

What are the acute effects of endurance training on the anterior pituitary

A
  1. Endorphins: Increases with long duration exercise
  2. Prolactin: increases with intensity
  3. Somatotropin: increases with moderate intensity
185
Q

What are the acute effects of endurance training on the posterior pituitary

A

Vasopressin/ADH: increases with intensity

186
Q

what are the acute effects of endurance training on the adrenal cortex

A
  1. Aldosterone: increases with intensity

2. Cortisol: Increases 60-90% of VO2max; Increase: Intensity / duration

187
Q

what are the acute effects of endurance training on the adrenal medulla

A
  1. Norepinephrine: Increases 50-60% of Vo2max: Increase: Intensity
  2. Epinephrine: Parallel to norepinephrine, but less
188
Q

what are the acute effects of endurance training on the thyroid

A
  1. Triiodothyronine (T3): Increases with intensity

2. Thyroxine (T4): Increase with intensity

189
Q

what are the acute effects of endurance training on the pancreas

A
  1. Glucagon: 1-2 hours after onset of exercise

2. Insulin: Decrease 50% of VO2max

190
Q

what are the acute effects of endurance on the parathyroid

A

parathormone increases with long duration exercise

191
Q

what are the acute effects of endurance on the ovaries

A
  1. estrogen: increases with exercise

2. progesterone: increases with exercise

192
Q

acute effects of endurance training on the testes

A

testosterone increases with exercise

193
Q

acute effects of endurance training on the kindeys

A

renin increases with intensity

194
Q

function of the parathormone

A

stimulates osteoclasts to release Ca into blood stream

195
Q

what is synthesized in the testes which produces estrogen

A

aromatase

196
Q

what are the estrogen levels in men and women

A

Women: 5-7ng/dl
Men: 2-5ng/dl

197
Q

what are the testosterone levels in men and women

A

Women: 30-95ng/dl
Men: 300-1200 ng/dl

198
Q

Chronic effects of endurance training on Hypothalamus-Pituitary Hormones

A
  1. ACTH: Increases
  2. Endorphin: Decreases
  3. FS / LH: Decreases
  4. Estrogen: Decreases
  5. Testosterone: Decreases; Resist. Trained males – Increases
  6. Somatotropin: No change – rest; Decreased - exercise
199
Q

what are the chronic effects of endurance training on the thyroid hormones

A

Triiodothyronine (T3): Decreases; Increased turnover

Thyroxine (T4): Decreases; Increased turnover

200
Q

what are the chronic effects of endurance training on the adrenal hormones

A

Cortisol: Increases slightly
Norepinephrine: Decreases – rest / exercise
Epinephrine: Decreases – rest / exercise

201
Q

what are the chronic effects of endurance training on the pancreatic hormones

A

Glucagon decreases

insulin decreases

202
Q

why type of exercise can aid the immune system by not elevating stress hormones

A

moderate exercise (3-4 METS)

203
Q

what are the effects of chronic physical activity on platelet aggregability

A
  1. associated with early/advanced atherosclerosis
  2. heavy exercise transiently increases blood coagulation
  3. moderate exercise activates fibrinolysis
204
Q

effects of chronic physical activity on adipose tissue

A
  1. increase in mobilization of fat stores
  2. upper body fat is easier to mobilize
  3. gluteal adipose cell liplysis to catecholamines is acutely increased following endurance exercise in men
  4. The response of adipose tissue LPL to insulin is increased in obese patients after weight loss
205
Q

what does lipoprotein lipase do

A

promotes fat storage in the body

206
Q

effects of chronic PA on lipid/lipoprotein metabolism

A

increased fat oxidation (carnitine transferase)

increased storage with endurance training (LPL)

207
Q

when is there a decrease in protein synthesis

A

during exercise

Exercise for Special Populations (2 decks)

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