Chapter 19-23

Question 1

What is LBP characterized as?

Answer 1

Pain, muscle tension, or stiffness localized below the rib margin and
above the inferior gluteal folds

 Can occur w/ or w/o leg pain

Question 2

What is CNSLBP?

Answer 2

Chronic non-specific low back pain (CNSLBP)
 No specific pathology; lasts >12 weeks

Question 3

What is CNSLBP associated with?

Answer 3

Often associated with sedentary behavior and low levels of PA due
to intolerance

Question 4

What are common comorbitities of CNSLBP?

Answer 4

Common comorbidities include OWOB, metabolic syndrome,
hypertension, and T2D

Question 5

How to assess individuals with CNSLBP?

Answer 5

 Treadmill, cycle, and step tests, as well as field tests such as 6MWT
are appropriate for assessment of CRF
 Multi-rep max is probably better than 1-RM for assessing muscular
fitness

Question 6

Prescription of exercise for CNSLBP?

Answer 6

 Use guidelines for healthy adults, but consider modifications based
on comfort and activity tolerance
 Bed rest is not recommended; start slow, but get active as soon as you
can!
 Use “two for two” rule for progression of PRT
 Heavy emphasis on posture and technique; modify exercises if pain
worsens
 Consider movement direction preference/bias
 Consider isometric exercises for core to improve stabilization
 If symptoms worsen or new ones develop, stop and refer
 Avoid prolonged sedentary behavior

Question 7

What is fibromyalgia?

Answer 7

Chronic pain syndrome that affects the joints, muscles, tendons, and soft
tissue of the body

Question 8

What is fibromyalgia thought to be caused by?

Answer 8

Thought to be caused by neurological imbalances in the central nervous
system associated with a heighted pain perception

Question 9

Primary triad of fibromyalgia?

Answer 9

• Bilateral, widespread musculoskeletal pain above and below the waist
  with pain in axial skeleton lasting longer than 3 months
  (Described as “diffuse ache” with specific “tender points” along the body)
• Fatigue
• Sleep disturbances

Question 10

Who is fibromyalgia prevalent in?

Answer 10

Higher prevalence among women; often combined with mood disorders

Question 11

Testing of people with fibromyalgia?

Answer 11

Suggestions for CRF testing include Åstrand cycle ergometer test,
walking test (5, 6, and 10 min), and shuttle walk test

 Monitor pain and fatigue levels throughout

Question 12

What is fibromyalgia marked by?

Answer 12

Typically marked by poor exercise adherence due to pain

Question 13

FITT for fibromyalgia?

Answer 13

 F: 1-2 days progressing to 2-3 days per week
 I: 30-39% of HRR progressing to 40-59%; 40-80% of 1-RM
 T: >10 minutes progressing to 30-60; 1 set progressing to 2 of 15-20
reps for endurance
 T: Low-impact; water-based activities are often well-tolerated

Question 14

What is rheumatoid arthritis?

Answer 14

 Chronic inflammatory disease primarily affecting synovial joints caused
by autoimmune response
 Marked by “flare-ups” and remissions; more common in women than men

Question 15

What can rheumatoid arthritis lead to?

Answer 15

Can lead to rheumatoid cachexia: loss of skeletal muscle with increase in
adiposity, which can result in lower PA levels and functional limitations

Question 16

What tests are effective for rheumatoid arthritis?

Answer 16

Functional testing is effective
 TUG test, functional balance tests, grip strength, 30-sec STS, 30 second bicep
curl
 6MWT can be used in place of standard CRF assessments

Question 17

What to consider for patients with rheumatoid arthritis?

Answer 17

 Potential limitations for exercise include grip weakness, joint instability,
and mobility restrictions
 Important to constantly monitor RPE and pain during exercise

Question 18

What exercises is most effective for rheumatoid arthritis?

Answer 18

 Combined aerobic and RT is most effective
 Water-based aerobic exercise demonstrates great outcomes due to
low joint stress

Question 19

Resistance training for rheumatoid arthritis?

Answer 19

RT: 1-3 sets, 8-12 reps, 50-80% of 1-RM, 2-3 days per week

Question 20

What can stretching do for rheumatoid arthritis?

Answer 20

Daily stretching may provide benefits of reduced pain and
increased function

Question 21

What will regular exercise do for patients with rheumatoid arthritis?

Answer 21

Regular exercise will lessen BMD loss and improve joint health and
body composition

Question 22

What is cancer?

Answer 22

Uncontrolled cell growth, usually the result of genetic or singlenucleotide mutations that occur because of environmental, lifestyle
and host factors

Question 23

Common types of cancer?

Answer 23

Most common types are lung, prostate, breast, colon, and rectum

Question 24

How is cancer classified?

Answer 24

Classified by stage (0-5) depending on types of tumor cells and spread

Question 25

What can exercise do for cancer patients?

Answer 25

Exercise reduces risk of recurrence, mitigates fatigue, and improves
QoL

Question 26

What do be mindful of when dealing with cancer patients?

Answer 26

Need to be mindful of treatment side effects
 Acutely: Pain, fatigue, nausea and vomiting, change in appetite, and
localized swelling or lymphedema
 Long-term: Changes in cognition, BW and comp, CV health, immune
function, and nerve function

Question 27

When is testing needed for cancer patients?

Answer 27

Testing only needed if fatiguing after low-to-moderate PA
 May use testing guidelines for healthy populations

Question 28

What to do if a clients is on medications that alter heart rate ressponse?

Answer 28

May be on medications that alter HR response; if so, use RPE
 12-13 for moderate intensity; 14-17 for vigorous

Question 29

Resistance training prescription for cancer patients?

Answer 29

RT on 2-3 days per week; start <30% 1-RM with slow progression
 Avoid high-impact activities due to fx risk

Question 30

What exercises can improve ADL for cancer patients?

Answer 30

Consider balance, flexibility, and coordination exercises to improve
ADLs

Question 31

When should exercise be avoided with cancer patients?

Answer 31

Avoid exercise if severe symptoms or side effects are present

Question 32

What to consider if patient is immune suppressed for exercise?

Answer 32

If patient is immunosuppressed, avoid swimming and consider
private facility or space for exercise

Question 33

What is osteoporosis?

Answer 33

Poor bone strength that leads to increased fx risk

Question 34

Who is osteoporosis most common in?

Answer 34

Most common in elderly women

Question 35

Behaviors to improve bone strength and reduce falls?

Answer 35

Behaviors to improve bone strength and reduce falls include
 Adequate calcium and vitamin D intake
 Regular exercise (slows ↓ BMD, ↑ SMM, ↑ strength and dynamic balance)
 Smoking cessation
 Avoidance of excessive alcohol intake
 Visual correction to decrease risk of falling

Question 36

What to consider for vertebral osteoporosis?

Answer 36

Consider cycle-based for vertebral osteoporosis
 May have balance and breathing issues if spine is compromised

Question 37

What should test should not be done for clients with osteoporosis?

Answer 37

No maximal strength testing

Question 38

What is most effective for bone health/

Answer 38

High-intensity WB exercise is most effective for bone health
 Balance safety and health considerations
 Unaccustomed loading and rest-inserted loading are key

Question 39

What can clients with osteoporosis start with to progress to weight bearing exercise?

Answer 39

May start with water- and cycle-based activities to improve
muscular fitness; progress to WB

Question 40

Osteoporosis?
 Maintain ____ spine and ____ end-range flexion and rotation
 ____ explosive or high-impact loading and lifting/lowering heavy
weight from floor or overhead
 May perform ____ training daily for up to 20 minutes

Answer 40

 Maintain neutral spine and avoid end-range flexion and rotation
 Avoid explosive or high-impact loading and lifting/lowering heavy
weight from floor or overhead
 May perform balance training daily for up to 20 minutes

Question 41

Forms of ____ ____ that are often comorbid and
accompany other chronic diseases

Answer 41

Forms of psychological distress that are often comorbid and
accompany other chronic diseases

Question 42

____ and ____ can have altered autonomic control of CV response (↓ HRV)
 May limit CRF testing due to abnormal or inadequate ____ response

Answer 42

anxiety and depression

HR

Question 43

 Exercise may interact with ____ ____
 Inform patients that exercise response may be similar to ____ ____
 Exercise prescription is same as for ____ ____
 Exercise can be equally effective as ____ and ____
 Non-adherence is common in individuals with ____

Answer 43

 Exercise may interact with psychoactive medication
 Inform patients that exercise response may be similar to anxiety
symptoms
 Exercise prescription is same as for healthy population
 Exercise can be equally effective as pharmacotherapy and psychotherapy
 Non-adherence is common in individuals with depression