Chapter 19-23 Flashcards
What is LBP characterized as?
Pain, muscle tension, or stiffness localized below the rib margin and
above the inferior gluteal folds
Can occur w/ or w/o leg pain
What is CNSLBP?
Chronic non-specific low back pain (CNSLBP)
No specific pathology; lasts >12 weeks
What is CNSLBP associated with?
Often associated with sedentary behavior and low levels of PA due
to intolerance
What are common comorbitities of CNSLBP?
Common comorbidities include OWOB, metabolic syndrome,
hypertension, and T2D
How to assess individuals with CNSLBP?
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
Prescription of exercise for CNSLBP?
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
What is fibromyalgia?
Chronic pain syndrome that affects the joints, muscles, tendons, and soft
tissue of the body
What is fibromyalgia thought to be caused by?
Thought to be caused by neurological imbalances in the central nervous
system associated with a heighted pain perception
Primary triad of fibromyalgia?
- 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
Who is fibromyalgia prevalent in?
Higher prevalence among women; often combined with mood disorders
Testing of people with fibromyalgia?
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
What is fibromyalgia marked by?
Typically marked by poor exercise adherence due to pain
FITT for fibromyalgia?
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
What is rheumatoid arthritis?
Chronic inflammatory disease primarily affecting synovial joints caused
by autoimmune response
Marked by “flare-ups” and remissions; more common in women than men
What can rheumatoid arthritis lead to?
Can lead to rheumatoid cachexia: loss of skeletal muscle with increase in
adiposity, which can result in lower PA levels and functional limitations
What tests are effective for rheumatoid arthritis?
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
What to consider for patients with rheumatoid arthritis?
Potential limitations for exercise include grip weakness, joint instability,
and mobility restrictions
Important to constantly monitor RPE and pain during exercise
What exercises is most effective for rheumatoid arthritis?
Combined aerobic and RT is most effective
Water-based aerobic exercise demonstrates great outcomes due to
low joint stress
Resistance training for rheumatoid arthritis?
RT: 1-3 sets, 8-12 reps, 50-80% of 1-RM, 2-3 days per week
What can stretching do for rheumatoid arthritis?
Daily stretching may provide benefits of reduced pain and
increased function
What will regular exercise do for patients with rheumatoid arthritis?
Regular exercise will lessen BMD loss and improve joint health and
body composition
What is cancer?
Uncontrolled cell growth, usually the result of genetic or singlenucleotide mutations that occur because of environmental, lifestyle
and host factors
Common types of cancer?
Most common types are lung, prostate, breast, colon, and rectum
How is cancer classified?
Classified by stage (0-5) depending on types of tumor cells and spread
What can exercise do for cancer patients?
Exercise reduces risk of recurrence, mitigates fatigue, and improves
QoL
What do be mindful of when dealing with cancer patients?
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
When is testing needed for cancer patients?
Testing only needed if fatiguing after low-to-moderate PA
May use testing guidelines for healthy populations
What to do if a clients is on medications that alter heart rate ressponse?
May be on medications that alter HR response; if so, use RPE
12-13 for moderate intensity; 14-17 for vigorous
Resistance training prescription for cancer patients?
RT on 2-3 days per week; start <30% 1-RM with slow progression
Avoid high-impact activities due to fx risk
What exercises can improve ADL for cancer patients?
Consider balance, flexibility, and coordination exercises to improve
ADLs
When should exercise be avoided with cancer patients?
Avoid exercise if severe symptoms or side effects are present
What to consider if patient is immune suppressed for exercise?
If patient is immunosuppressed, avoid swimming and consider
private facility or space for exercise
What is osteoporosis?
Poor bone strength that leads to increased fx risk
Who is osteoporosis most common in?
Most common in elderly women
Behaviors to improve bone strength and reduce falls?
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
What to consider for vertebral osteoporosis?
Consider cycle-based for vertebral osteoporosis
May have balance and breathing issues if spine is compromised
What should test should not be done for clients with osteoporosis?
No maximal strength testing
What is most effective for bone health/
High-intensity WB exercise is most effective for bone health
Balance safety and health considerations
Unaccustomed loading and rest-inserted loading are key
What can clients with osteoporosis start with to progress to weight bearing exercise?
May start with water- and cycle-based activities to improve
muscular fitness; progress to WB
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
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
Forms of ____ ____ that are often comorbid and
accompany other chronic diseases
Forms of psychological distress that are often comorbid and
accompany other chronic diseases
____ and ____ can have altered autonomic control of CV response (↓ HRV)
May limit CRF testing due to abnormal or inadequate ____ response
anxiety and depression
HR
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 ____
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
