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KNS 350 > Chapter 4- 8 (exam review) > Flashcards

Chapter 4- 8 (exam review) Flashcards

1
Q

behavioral risk factors

A

diet, smoking, alcohol use, physical inactivity, unsafe sex, drug use

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2
Q

metabolic risk factors

A

high systolic bp, high fasting blood glucose, high BMI, high low-density cholesterol, low bone mineral density

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3
Q

preventable death

A

a death that could be avoided through changes in behavior

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4
Q

non-preventable death

A

a death that occurs due to factors beyond one’s control (genetics & accidents)

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5
Q

life expectancy

A

statistical measure indicating the average number of years a person can expect to live based on current mortality rates

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6
Q

premature death

A

a death that occurs earlier than the expected age of mortality, often due to preventable health conditions

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7
Q

men vs women (all-cause mortality)

A

females (81) have a higher life expectancy than males (76)

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8
Q

usa differences (all-cause mortality)

A

USA is ranked in the 50s globally for life expectancy
males at 53rd
females at 51st

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9
Q

nurse’s health study (all-cause)

A

classification: PA assessment based on Hrs/wk (volume)
Findings: mortality risk reduction tapered after approximately two hours/ week of PA
Indicated diminishing returns beyond this point but still beneficial overall.
- clear negatively accelerating decrease in relative risk of dying associated with increased hours spent in PA

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10
Q

harvard alumni health (1986)

A

classifications: PA assessment quantified volume; daily stairs, blocks walked, type of sports etc
- total energy expenditure estimated in kilocalories per week
Findings:
1. Comparison of mortality rates across volume of physical activity
- all cause death rates showed a steady decline across increasing categories of weekly energy expenditure
- more volume of PA = better
2. life expectancy gains
- were observed in active men compared with inactive men
- greater in younger populations

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11
Q

harvard alumni (1995)

A

PA assessment: focused on vigorous intensity
- vig > 6mets
- non < 6 mets
Findings: significant inverse dose- response relationship between vigorous activities and all-cause mortality
- non-vigorous activities showed no relationship with all-cause mortality
- possibly due to imprecise reporting of non-vigorous activities

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12
Q

harvard alumni (2000)

A

PA assessment: focused on moderate intensity
light < 4met
mod 4-5.9 met
vig > 6met
Findings:
light intensity: no association with all-cause mortality
Moderate: trends were observed towards decreased ACM
Vigorous: a clear inverse association was also observed with ACM

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13
Q

ACLS (8-year follow up)

A

PA components: cardiorespiratory fitness and changes (f/m) follow ups
Findings:
- greatest risk reductions were seen between the bottom fitness quintile and the next 20% of fitness
> least fit men had MR 3x higher
> least fit women had MR 4.65x higher

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14
Q

ACLS ( 5-year follow up)

A

findings: regardless of BMI, unfit group had a significantly greater risk of ACM compared to fit
3 groups based on fitness changes: 1 exam > 2 exam
findings:
lowest MR: observed in men who were fit at both
Highest MR: observed in men who were unfit at both
1. Fit at both vs. unfit at both
- RR = 0.33,
2. Unfit to fit
- RR = 0.52
Dose Response: for every minute increase in treadmill time ( approx 1 MET increase) between examinations, MR was reduced by nearly 8%

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15
Q

leisure physical activity across the lifespan

A

1.) maintaining high PA
> all-cause mortality risk reduced by 36%
2.) increasing PA in later adulthood (ages 40-61)
> all-cause mortality risk reduced by 35%
Conclusion: maintaining or increasing PA levels in later adulthood significantly lowers all-cause mortality risk

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16
Q

Coronary Heart Disease

A

also known as “ischemia” heart disease, ischemia= lack of blood flow
- a condition characterized by the narrowing or blockage of the coronary arteries due to the buildup of plaque
can result in: angina, shortness of breath, fatigue with exercise, myocardial infarction ( heart attack)

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17
Q

atherosclerosis

A

process that leads to CHD
- buildup of plaque within the walls of arteries
- plaque= fatty deposits, low-density lipoproteins, inflammation, hemostasis
happens in coronary arteries

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18
Q

what regions in the US have the highest prevalence rates?

A

southeast

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19
Q

where does CHD rank compared to other top causes of death in the US?
Globally?

A

number 1

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20
Q

modifiable risk factors for CHD

A

hypertension, sedentary lifestyle, diabetes, obesity, dyslipidemia (elevated lipids)

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21
Q

non-modifiable risk factors for CHD

A

genetics, males, old age, and smoking

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22
Q

relationship with pa (CHD)

A

having a sedentary lifestyle leads to hypertension, dyslipidemia, which increases chance for coronary heart disease being physically active allows for normal bp, stable cholesterol and a reduced risk for CHD

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23
Q

london bus study (CHD)

A

1.) risk of coronary heart disease: bus conductors < bus drivers, total incidence
- first appearance of coronary heart disease may occur at a younger age in drivers
- generally bus conductors had a lower risk of developing coronary heart disease than bus drivers
2.) role of other risk factors
Hypertension: bus conductors < bus drivers, overall, bus conductors had lower bp
- among those w/ similar bp, risk of CHD was lower in bus conductors
Obesity: overall, bus conductors had less incidence of obesity
- among those w/ similar BMI, rate of death due to CHD was higher in bus drivers

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24
Q

london bus, occupational activity (CHD)

A

1.) active jobs reduce the rate and severity of coronary heart disease (CHD)
2.) CHD may occur at earlier ages for individuals with sedentary jobs
3.) occupational PA may have an independent role in reducing risk when considering other factors such as blood pressure and obesity

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25
harvard alumni (CHD)
1. Age-adjusted incidence rate of CHD inversely related to energy expended on physical. activities. 2. Men expending fewer than 2000 kcal per week had a 64% higher risk than more active classmates. 3. CHD risk (i.e., first heart attack) decreased by about 10% more when energy expenditure occurred in vigorous sports compared to walking or climbing stairs.
26
population attributable risk (PAR)
> Estimate of disease rate reduction if all individuals eliminated a specific risk factor if all individuals in the studied population disengaged / engaged in [insert behavior], the mortality rate from Coronary Heart Disease (CHD) would be reduced by [insert %] EX: if all individuals in the studied population had high cardiorespiratory fitness, the mortality rate from Coronary Heart Disease (CHD) would be reduced by 39%
27
mechanisms that explain rship between chd and physical activity
1.) Anti-inflammatory effects: PA —–> weight loss 2.) Effects on Blood Clotting Factors - fibrinogen is associated with increased risk of heart attack ^ PA = decrease in fibrinogen 3.) myocardial oxygen supply & demand - when “normal” blood flows efficiently - impeded process: coronary heart disease oxygen supply in the heart < demand > plaque (atherosclerosis); inflammation; blood characteristics —-> all contribute to clotting
28
blood pressure
The force exerted by circulating blood on the walls of the body’s arteries / major blood vessel
29
systolic
pressure in arteries/vessels when the heart contracts
30
diastolic
pressure in the arteries/vessels when the heart relaxes
31
primary hypertension
no underlying conditions or diagnoses for cause gradual onset (10-20 yrs) increased BMI, stress, alcohol intake, physical inactivity
32
secondary hypertension
results from underlying health conditions or certain medications thyroid disease, renal or kidney disease treat the underlying condition
33
bp categories
normal: SBP < 120 & DBP < 80 elevated: SBP = 120-129 & DBP < 80 Hypertension (1): SBP = 130-139 & DBP = 80-89 Hypertension (2): SBP >= 140 & DBP >= 90 Hypertensive Urgency: SBP > 180 &/or DBP > 120
34
randomized control trials (bp)
Meta-analysis looking at the results of 72 randomized controlled trials of aerobic exercise training * SBP decreased by 5% in people with hypertension and about 2% in people who were prehypertensive or normotensive. * Reductions of 3.3 mmHg (2%) SBP and 3.5 mmHg (4%) DBP were also observed after exercise training
35
temporal sequence (bp)
YES, risk factor was measured before outcome - prospective cohort studies
36
strength of association (bp)
YES, the associations were considered significant and RR/OR’s are different than 1.0
37
consistency of results (bp)
YES, both observational studies and randomized controlled trials reported similar outcomes, reinforcing the reliability of the association between physical activity and lowered blood pressure
38
dose response (bp)
NO< a clear relationship remains inconclusive even though there is an inverse relationship - studies focused on moderate levels of physical activity + inconsistent research on FITT principles
39
biological plausibility (bp)
YES, - improved arterial & vascular function - reduced systemic inflammation - reduced sympathetic nervous system activity ( Poiseuille’s Law)
40
Which criteria can we say there is sufficient evidence for?
temporal sequence, strength of association, consistency of results, biological plausibility
41
harvard alumni health (bp)
- 2/3 of men engaged < 2000 kcal/week of leisure time physical activity - After adjusting for age, a 30% greater risk of developing hypertension appeared likely for inactive individuals -Those not participating in vigorous activity had 35% greater risk of hypertension. Moderately vigorous sport participation also reduced the risk of hypertension
42
acls (bp)
- Low physical fitness had a 50% greater risk of developing hypertension. - Reduced fitness (going from high to low) resulted in an additional 28% increase in the risk of developing hypertension. - Those with/ low fitness and elevated BP had 10 times the risk of developing hypertension compared to those with high fitness and normal BP
43
strength of evidence (all-cause mortality)
-role of chance p > 0.05 association is non-significant (risk factor and outcome are likely due to chance) p< 0.05 association is significant ( risk factor and outcome highly unlikely to be due to chance
44
acls findings ( CHD)
The greatest difference in mortality rates was between low- and moderate-fitness categories. Further reductions were seen between moderate- and high- fitness categories. 1. Highly Fit (Top 40%) vs. Moderately Fit (Middle 40%): o CVD mortality rate was half for highly fit men 2. Least Fit (Bottom 20%) vs. Moderately Fit (Middle 40%): o CVD mortality rate for least fit men was 3 X’s greater Similar trends were noted where less fit women had higher rates of CVD mortality than more fit women.
45
physical fitness ACLS (CHD)
The increased risk of CHD mortality associated with low fitness was found to be similar in magnitude to or stronger than other known CHD risk factors == Dyslipidemia (Elevated Lipids) Smoking Hypertension (High Blood Pressure) Diabetes This identifies an important risk factor that is modifiable through physical activity, which can have a significant impact on CHD mortality
46
dose response CHD
Physical Activity > Curvilinear Dose-Response Cardiorespiratory Fitness > Curvilinear Dose-Response as well
47
general association of PA & mortality
Age: Physical activity during middle age reduces CHD risk by 30% to 40% for both men and women Leisure Time PA: Most active men have a 22% lower risk of CHD Most active women have a 33% lower risk of CHD
48
temporal sequence (CHD)
> Prospective cohort design - Activity or fitness is measured before the outcome occurs, thus demonstrating the appropriate temporal sequence. Prospective cohort studies have demonstrated consistent associations of higher activity or fitness levels with lower CHD risk
49
strength of association (CHD)
> Relative risk of CHD mortality due to inactivity ranged from 1.5 to 2.4 Active subjects had approximately a 20% to 40% reduction in CHD risk compared to least active subjects (PA Guidelines Advisory Committee) - 40-50% in some studies where PA is measured w/ accelerometers
50
consistency of results (CHD)
> Findings are pretty consistent for men and women. * Despite using different methodologies and samples from different parts of the world, studies have yielded similar results overall.
51
biological plausibility (CHD)
> As with any biological mechanism – it’s never fully understood…but we do know enough about certain mechanisms that allow us to establish a causal link 1. Myocardial Oxygen Supply and Demand 2. Hemostatic (aka blood) and Inflammatory Biomarkers
52
stroke
the loss or impairment of bodily function resulting from injury or death of brain cells as a result of insufficient blood supply to the brain
53
ischemic
blockage stops the flow of blood to an area of the brain
54
intracerebral hemorrhage
weakened or diseased blood vessels rupture
55
etiology of stroke
-similar process that leads to CHD By atherosclerosis: - buildup of plaque in carotid artery - forms blood clot, which may break off & lodge in the cerebral artery - blocks blood flow to the brain and results in ischemic stroke
56
northern manhattan stroke
1. Leisure time physical activity, across intensity and duration, reduces the odds of having a stroke for the first time 2. This is consistent across age, sex, and race 3. LTPA appeared to be an independent factor associated with having a stroke for the first time * Adjusted for confounding
57
temporal sequence (stroke)
YES, Physical Activity Measured First 2. Follow-up tracked stroke incidence / mortality > Follow-up ranged from 2-32 years Case-Control studies provided rationale for additional rigorous studies
58
strength of association Stroke
YES, prospective cohort studies show significant associations When risk reduction is averaged across studies (i.e., meta-analyses) – we observe an adjusted 25-30% risk reduction in stroke, which is significant
59
consistency of results stroke
YES, Results have shown risk reductions across males, females, and PA measurement. However, most studies had samples that are primarily of white European descent .. Very few studies have explored the relationship between PA and stroke in African American men and women This is a limitation and something to consider - however, given the consistency across studies, PA measurement, and males/females, we can say there is good evidence for consistency
60
biological plausibility stroke
YES, 1. Reduced atherosclerosis – particularly in the carotid artery 2. Improved lipid profile a increased high-density lipoproteins 3. Improved cerebrovascular endothelium § Better at vasodilating (increased radius) 4. Neuroprotective effects after a stroke occur
61
Harvard Alumni Health Study (stroke)
- < 500 kcal each week: > Stroke incidence rate: 6.5 per 10,000 person-years of observation. - - Expending 500 to 1999 kcal each week: > Stroke incidence rate: 5.2 per 10,000 person-years of observation. - >2000 kcal each week: > Stroke incidence rate: 2.4 per 10,000 person-years of observation
61
Dose response stroke
YES, We do see a dose-response primarily for ischemic stroke. Depending on the study, the “shape” may vary. We can always refer back to the PA Guidelines CURVILINEAR
62
nurses' health study stroke
PAR: Approximately 20% of ischemic strokes, and 17% of all strokes might have been prevented if all women had participated in at least thirty minutes of MVPA
63
rship between PA & stroke
1. A greater volume of LTPA reduces the risk of all strokes. 2. An inverse dose-response possibly exists between LTPA volume and ischemic stroke. 3. A greater volume of walking also produces a decreased risk of stroke in a similar dose- response fashion. 4. These associations are consistent across time spent being physically active as well as energy expenditure.
64
stroke in the USA
stroke belt: southeast 5th leading cause of death
65
males vs females (stroke)
as age increases- stroke incidence rates become less in males
66
globally stroke/chd
2nd leading cause of death
67
blood pressure regulation
Poiseuille’s Law * Basic determinants of blood flow / blood pressure > blood pressure depends on the volume of blood, its rate of flow, and especially the diameter of blood vessels (r 4) > radius and diamter of BV has greatest influence on TPR
68
HDL
HIgh-density lipoproteins - plays a major role in reverse cholesterol transport, which is the return of excess cholesterol to the liver for metabolism
69
LDL
low-density lipoproteins, the "bad cholesterol" > the main transporter of cholesterol in the blood, its ability to transport cholesterol in the blood makes a primary contributor to the development of atherosclerosis
70
dyslipidemia
refers to poor lipid profiles that double the risk for coronary heart disease and stroke Contributing Risk: 1. Different types of cholesterol respond differently to physical activity 2. A small change in one type of cholesterol can have a highly significant impact
71
prevalence of dyslipidemia & risk of CHD
>High LDL is fairly equal among all gender, racial, and ethnic groups > One exception is Hispanic American Males Prevalence = ~ 35-40% > Low HDL appears more prevalent in males compared females >This is true up until menopause when lipid profiles tend to change for female > Nearly 29 million (~11%) U.S. adults aged 20 years or older have high CHD and stroke risk because they have total cholesterol levels of 240 mg/dl or higher
72
framingham heart study
> Increases in total cholesterol (starting at 200 or more) and decreases in HDL (starting at 40-55) will significantly increase the risk of CHD. > Generally, small changes in HDL can lead to significant changes in risk for outcomes like CHD. > Both high LDL and low HDL are risk factors for cardiovascular disease > However – if a person has high HDL, any heart disease risk with elevated LDL is minimized > The increase in risk appears to be more reliant a decrease in HDL vs an increase in LDL
73
aerobic physical activity and HDL
Mechanisms which aerobic physical activity improves lipid levels and reduce risk of cardiovascular diseases primarily result from the following: Increased HDL up to 5% > reverse cholesterol transport * This means increased HDL may improve this process = less cholesterol in blood vessel
74
temporal sequence (dys)
NO, > Most of the evidence is derived from cross sectional study designs > We do not have the proper sequence of events in order to establish temporal sequence and causality > Because we have a lack of prospective studies, we can only suspect that a causal relationship might exist
75
strength of association (dys)
YES, > It does appear the effect is moderately strong, even after adjusting for confounding – PA Guidelines Committee Report provides consensus on this > RCTs also show robust responses after aerobic exercise training > Aerobic exercise interventions lasting ~12 weeks results in a 5% increase in HDL, 5% decrease in LDL, and a 4% decrease in triglycerides
76
consistency of results (dys)
YES, > Both cross-sectional studies and RCTs generally report a positive response from physical activity > We also see these responses are relatively consistent across sex/gender and ethnicity
77
dose response (dys)
YES, > There is a clear dose-response with physical activity energy expenditure > This may require individuals reach a certain threshold first (i.e., 900-1200 kcal/week), but once this is reached, the studies we have show a clear dose response > This dose-response can be described as ”linear” based on data we see with HDL and triglycerides
78
biological plausibility (dys)
YES, > The mechanisms surrounding physical activity and dyslipidemia primarily revolve around the effects of HDL > Increased HDL = increased reverse cholesterol transport = less cholesterol within blood vessels > This naturally results in reduced LDL and triglycerides, further reducing plaque formation and the formation of atherosclerosis
79
effects of physical activity on lipid profiles
> Increased HDL Increases up to 5% > Decreased LDL Decreases up to 5% > Decreased Triglycerides Decreases up to 4% HDL = reverse cholesterol transport * This means increased HDL may improve this process = less cholesterol in blood vessels * LDL = transport of triglycerides * This means less LDL and triglycerides = fewer fatty molecules in our blood stream * Triglycerides are used as “fuel” during aerobic exercise
80
strength of evidence (dys)
The committee has concluded that there is strong evidence that aerobic physical activity can improve blood lipid profiles * Those with poor lipid profiles at baseline will likely have a stronger response to exercise (more room for change) * 1 point increase in HDL = 3-4% decrease in CHD mortality * 1% decrease in LDL = additional 2-3% decrease in CHD mortality

KNS 350 (9 decks)

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