Dyslipiedemia, Hypertension, Old age

Question 1

What are the desirable and high cut off levels for LDL-C, HDL-C, Triglycerides and Non-HDL-C

Answer 1

LDL-C <100 desirable, >160 (mg.dL)
HDL-C: <40 men and <50 women - Low
Triglycerides: <150 (Normal) >200 - High
Non HDL-C <130 (desirable),

Question 2

What are the causes of Dylipidemia?

Answer 2

1) Poor dietary and lifestyle choices
2) Pure familial hypercholesterolemia (Genetically low LDL-C)
3) Familial combined hyperlipidaemia (Genetically low LDL-C and High triglycerides)
4) Hypothyroidism
5) Nephrotic syndrome
6) Steroids
7) Metabolic syndrome

Question 3

What did the Gaber ACSM position stand show?

Answer 3

1) Aerobic training reduces LDL-C 3-6 mg but does not consistently effect HDL-C or TG levels
2) Resistance training reduces LDL-C and TG concentration by 6-9 mg.dL but results less consistent compared to aerobic exercise
3) Dietary improvement and weight loss have benefit

Question 4

What four groups benefit from statin therapy?

Answer 4

A) Individuals with established CVD
B) Individuals with LDL-C above190 mg.dL
C) Individuals with diabetes over age forty
D) Individuals with an estimated 10 yr CV risk of >7.5%

Question 5

What did Koff show?

Answer 5

• 105 million patients records demonstrate dyslipidaemia levels have reduced due to improvement in cholesterol awareness, changes in dietary eating patterns, reduced trans fat consumption, and increased use of medications.

Question 6

What is the risk of dyslipidemia?

Answer 6

It is a major risk factor for atherosclerotic CVD

Question 7

What are the 4 exercise testing considerations for patients with dylipidemia?

Answer 7

1) Exercise test is not required for asymptomatic individuals prior to beginning an exercise training program at light to moderate intensity
2) Standard exercise testing methods and protocols are appropriate
3) Use caution when individuals have dyslipidaemia as undetected CVD may be present
4) Metabolic syndrome, obesity and hypertension still require adaptations to the protocol

Question 8

What are the FIIT principles for patients with dylipidemia?

Answer 8

F: 5 days or more to maximise caloric expenditure
I: 45-75 VO2R or HRR
T: 30-60 minutes. To promote or maintain weight loss, 50-60 minutes or more of daily exercise recommended
T: Prolonged rhythmic activities using large muscle groups
250-300 minutes/week

Question 9

What are the FIIT principles for resistance training in dyslipidemia?

Answer 9

F: 2-3 days/week
I: Moderate (50-69% 1RM) to Vigorous (70-85% 1RM) to improve strength
T: 2-4 sets, 8-12 repetitions for strength, <2 sets, 12-20 repeitions for muscular endurance
T: Resistance machines, free weights, and/or body weight

Question 10

What are the 3 considerations for exercise training in patients with Dyslipidemia?

Answer 10

1) Perform intermittent aerobic exercise of at least 10 minutes to achieve guidelines if continuous protocol not possible
2) Statin therapy may cause muscle weakness and soreness termed myalgia - although rare these medicines can cause severe muscle injury - healthcare provider should be contacted if soreness is persistent or unusual;
3) Consider comorbidities and prescribed prescription to these (hypertension, obesity, age over 65).

Question 11

What is the definition of hypertension?

Answer 11

Resting systolic blood pressure >130 and/or Diastolic >80 on two separate days across 2 measures (American college of cardiology)

Question 12

What does the joint national committee on prevention state?

Answer 12

Blood pressure between 120-139 or DBP 80-89 as having pre-hypertension and increased risk of HTN in the future

Question 13

What is primary and secondary hypertension?

Answer 13

Primary: 95% of all cases without known causes but likely to stem from genetic, diet (high-fat/high-salt diet), and physical inactivity
Secondary hypertension: 5% of cases with known cause - chronic kidney disease, renal artery stenosis, sleep apnea

Question 14

What did Gurven find in the longitudinal study “Does blood pressure inevitably rise in forager horticulturalists”? in hypertension journal

Answer 14

Hypertension is not a fundamental feature of human aging but the outcomes of lifestyle factors such diets high in fat and salt, excess bodyweight and physical inactivity - longitudinal study of 2300 tsimane forager farmers

Question 15

What lifestyle factors are recommended for hypertension?

Answer 15

• Smoking cessation, moderate alcohol consumption, weight management, habitual PA, reduced salt intake, overall healthy diet pattern

Question 16

What is the use of exercise testing in patients with hypertension?

Answer 16

• Individuals with hypertension may have exaggerated blood pressure response to exercise even when resting blood pressure is controlled.

Question 17

What are the four exercise testing considerations for patients with hypertension?

Answer 17

1) Individuals with hypertension who BP is not controlled (>140/>90) should consult with physician prior to starting an exercise programme
2) Individuals with stage 2 hypertension (>160/100) or with target organ disease (LVH, Retinopathy) - should not engage in exercise testing prior to medical evaluation and BP management - medically supervised symptom limited test recommended
3) If test is specifically for prescription design anti-hypertensive meds should be taken as normal
4) Beta blocker therapy patients have attenuated HR response and reduced max exercise capacity
5) Diuretic therapy increases false positive test result and can have increased risk of hypokalemia, electrolyte imbalance, cardiac dysrhythmias

Question 18

What did the ACSM position stand show for patients with hypertension?

Answer 18

• Chronic aerobic exercise of adequate intensity, duration, and volume that promotes increased exercise capacity reduced SBP and DBP 5-7 mmHg, and reduces SBP at submax workloads
• Regression of cardiac wall thickness and left ventricular mass

Question 19

What was found in the systematic review in the circulation journal (2019) by Nelson

Answer 19

• Dynamic resistance exercise results in BP reduction of a equal or greater magnitude than aerobic exercise
• Recommends to now have multi-modal approach with personal preference at the centre

Question 20

What are the FIIT principles for aerobic exercise in patients with hypertension?

Answer 20

F: 5-7/days/week
I: 40-59% HRR or 12-13 or 6-20 scale
T: >30 minutes of continuous or accumulated exercise
T: Prolonged rhythmic activity focusing on major muscle groups

Question 21

What are the FITT principles for resistance exercise in patients with hypertension

Answer 21

F: 2-3 days/week or more
I: 60-70% 1RM progressing to 80%, 40-50% 1RM progressing for novice or older exercisers
T: 2-4 sets, of 8-12 repetitions or each of the major muscle groups per session to total 20 minutes or more with rest days interspersed
T: Resistance, machines, free weight, resistance bands, and/or functional body weight exercises

Question 22

What are the 7 exercise training considerations listed in the ACSM booklet for hypertension?

Answer 22

1) Progression should be gradual particularly intensity
2) Consideration to level of BP control, recent changes in antihypertensive medication, medication related adverse effects, and the presence of target end organ disease
3) Exaggerated BP response to relatively low exercise intensities (<85% age predicted max) - exercise should factor this
4) SBP should be maintained below 220 and diastolic below 105 when exercising.
5) Moderate intensity exercise generally recommended to optimise benefit to risk ratio
6) Overweight and obesity guidelines should be used in individuals who are overweight or obese to maximise caloric expenditure
7) Valsalva maneuver should be avoided as results in high BP response, dizziness, and fainting

Question 23

What are 6 special considerations outlined in the ACSM booklet for individuals with hypertension?

Answer 23

1) Exercise testing and vigorous intensity training for individuals at moderate-high risk of cardiac complications should be medically supervised
2) Thermoregulation and Hypoglycaemia increase with beta blocker and diuretic therapy - educate about risks and signs/symptoms
3) Beta blocker downgrade peak HR in which case RPE should be used
4) Anti-hypertensive medications (alpha blocker, c channel blockers, vasodilators) can cause sudden BP drop post exercise - as such individuals should cool down slowly
5) Post-exercise hypotension should be monitored and patients educated on effects - walk slowly
6) Individuals with ischemia should have prescription changed according to this

Question 24

What is the criteria for metabolic syndrome from the International Diabetes Federation

Answer 24

3 or more of the following:
1) Waist circumference (M: 37 inch, F: 31.5 inch)
2) T2DM: >100 mg/dL FPGor medically treated T2DM
3) Dylipidemia: HDL-C: <40 mg.dL (Men), <50 mg.dL (Women). Or anyone on drug treatment
- Triglycerides >150 mg.dL or medically treated
4) Blood pressure: >130/85 mmHg in combination or individual or medically treated

Question 25

What is the international diabetes federation guidelines for primary prevention of Metabolic Syndrome?

Answer 25

1) Moderate restriction in energy intake for 5-10% weight loss in 1 year
2) Increased PA for 30 minutes most days of the week
3) Change in diet for specified CVD risk factors: Decreased simply carbohydrates, increased lean protein, reduced saturated fat.
4) Pharmacotherapy

Question 26

What are the 4 exercise testing considerations for patients with metabolic syndrome?

Answer 26

1) Special consideration to testing BP before, during and after exercise test
2) Testing should be specific to those overweight and obese
3) Met Syn does not require exercise test prior to low-moderate intensity exercise
4) Low initial workload (2-3 METs) and small increments in testing per stage (0.5-1.0 METs)

Question 27

Aside from the fact patients with Met Syn can undertake exercise training as per general guidelines. What are the 4 special considerations?

Answer 27

1) Attention should be given to each risk factor/condition present with most conservative approach taken
2) Initially moderate intensity (40-59% HRR) totaling a minimum of 150 minutes/week or 30 minutes most days the week for optimal improvement - progress to vigorous when appropriate
3) Gradually increase to 50-60 minutes/day or 250-300 minutes/week for bodyweight, 60-90 minutes/day may be necessary for some
4) Resistance training when combined with aerobic training provides greater benefit

Question 28

What are the cut off BMI values for obesity

Answer 28

25 kg/m2: overweight
30 kg/m2: obese
40 kg/m2 severe obesity

Question 29

What level of sustained weight loss is likely to provide benefits and what are these benefits?

Answer 29

3-5%: Improved triglycerides, Blood glucose, and HbA1C levels and risk of developing T2DM

Question 30

How does exercise and diet in combination effect weight loss and what are the moderators of this?

Answer 30

• Exercise and diet produce a 3kg (20%) greater weight loss than diet alone
• Effect lost when EI is severely reduced
• PA and diet restriction provide best weight loss when they are used in combination

Question 31

What does the ACSM position stand state on weight loss?

Answer 31

A) <150 minutes/week promotes minimal weight loss
B) >150 minutes/week of PA results in modest weight loss (2-3 kg)
C) 225-420 minutes/week results in 5 to 7.5 kg weight loss
D) 200-300 minutes/week to prevent weight maintenance

Question 32

What are the 5 exercise testing considerations outlined for patients who are overweight or obese in the ACSM textbook

Answer 32

1) Exercise test not necessary prior to beginning a low-moderate intensity exercise program
2) Presence of musculoskeletal and/or orthopaedic conditions undertake leg or arm ergometry
3) Low fitness (Initial workload 2-3 METs with increments of 0.5-1.0 MET per stage)
4) Exercise equipment should be calibrated to meet weight specification
5) Appropriate cuff size should be used to measure blood pressure

Question 33

What are the FIIT principles for aerobic exercise in individuals who are overweight or obese?

Answer 33

F: 5 or more days/week
I: 40-60% HRR with >60% for further health benefits
T: 30 minutes/day with increase to 60 min/day of more
T: Prolonged, rhythmic, activities using large muscle groups (walking, cycling, swimming)

Question 34

What are the FIIT principles for resistance exercise in individuals who are overweight or obese:

Answer 34

F: 2-3 days
I: 60-70% 1RM with gradual increases for strength and muscle mass
T: 2-4 sets of 8-12 repetitions for major muscle groups
T: Resistance, machine, and/or free weights

Question 35

What are the 5 exercise training considerations in individuals who are overweight or obese?

Answer 35

1) Duration of moderate to vigorous PA should gradually progress to 30 minutes/day
2) To promote long term weight maintenance individuals should progress to 250 minutes/week - best done 5-7 days/week
3) Multiple short bouts of 10 minutes or more is acceptable
4) Resistance training does not appear to prevent loss of fat-free mass or observed reduction in EE
5) Resistance training may enhance muscular strength. and physical function in individuals who are overweight or obese - more improvements for CVD and T2DM risk factors

Question 36

What are the 6 special considerations for individuals who are overweight or obese?

Answer 36

1) Utilise goal setting to target short-medium term weight loss goals (3-10% body weight over initial 3-6 months)
2) Target reducing EI (500-1000kcal/day) to achieve weight loss with reduction in fat intake
3) 1500 kcal/day energy restricted diet can be used in some individuals over short time periods
4) Enhance communication with registered nutritionists. healthcare professionals and exercise professionals after initial weight loss
5) Target changing eating and exercise behaviours to sustain weight. Assist with achieving aerobic exercise guidelines.

Question 37

What does the ACSM define as being a older adult

Answer 37

> 65 year or 50-64 yrs with clinically significant conditions or physical limitations that affect movement, physical fitness or physical activity

Question 38

What are 6 of benefits of physical activity in aging?

Answer 38

a) Slow age-related change in exercise capacity
b) Optimise age-related change in body composition
c) Promote psychological and cognitive well-being
D) Manage chronic disease
E) Reduce risk of physical disability
F) Increase longevity

Question 39

What are the the 7 listed special considerations for exercise testing in older adults?

Answer 39

1) Lower specificity due to LVH producing high number of false positive outcomes (LVH/Conduction system disturbance)
2) Light initial workload (<3 METs) and small increments (0.5-1.0 METs) (Modified Naughton treadmill protocol option
3) Cycle ergometer for poor balance, poor neuromotor coordination, impaired, vision, impaired gait
4) Handrail support for poor balance but reduces accuracy
5) Treadmill protocol needs be adapted by increasing grade rather than speed
6) Use tanaka heart rate formula equation as typical (220-age) underpredicts
7) Influence of prescribed medications on ECG/Haemodynamic response may wander from typical

Question 40

Outline the commonly used physical performance tests in older adults

Answer 40

1) Senior Fitness Test: 30-s chair stand, 30-s arm curls, 8ft up and go, 6-min walk, 2-min step test, sit and reach, and back scratch with normative scales. 30 min total
2) Short Physical Peformance Battery: Test of lower extremity functioning that combines scores from usual gait speed and timed tests of balance and chair stands; scores range from 0-12.
3) Usual gait speed: Time taken to walk 3019 metres
4) 6-min walk test: Furthest distance walked in 6 minutes

Question 41

Why are physical performance tests commonly used in older adults?

Answer 41

Require little space, equipment, cost, delivered with little training

Question 42

What are the cut off values for each of the 4 testing modalities in older adults?

Answer 42

1) Senior Fitness Test <25% age predicted norms
2) Short physical performance battery: <10 points
3) Usual gait speed: <1 m/s
4) 6 minute walk test: <25 age based norms

Question 43

What are the FIIT recommendations for aerobic exercise in older adults?

Answer 43

F: >5 days/week moderate intensity, >3days a week vigorous intensity or a combination of the two
I: 0-10 scale. 5-6 for moderate intensity and 7-8 for vigorous intensity
T: 30 min/day moderate, 20-30 min/day vigorous or combination of the two
T: Any activity that does impose excessive orthopaedic stress

Question 44

What are the FIIT principles for resistance exercise in older adults?

Answer 44

F: >2 days/week
I: Progressive from light intensity (40-50% 1RM, to MVPA (60-80% 1RM), or 5-6 or 7-8 RPE scale
T: 8-10 exercises involving major muscle groups, >1 set of 10-15 repetitions for beginners. progress to 1-3 sets for 8-12 repetitions for each exercise
Power training: 6-10 repetitions with high velocity
T: Progressive or power weight training if weight-bearing calisthenics, stair climbing, or other strengthening activities that use major muscles

Question 45

What are the resistance exercise training considerations for older adults?

Answer 45

1) Muscular strength decreases rapidly with age and need preserving
2) Strength training using sectorized machine or free weights needs supervising
3) Individuals with sarcopenia need to increase muscle strength before aerobic training

Question 46

What are the aerobic exercise training considerations in older adults?

Answer 46

1) Start low and progress slow with prescription tailored to individual’s preferences
2) Exceed recommended amounts to preserve/improve fitness
3) Chronic conditions precluding activity at recommended minimum amount should still allow incorporation of light exercise
4) Cognitive tasks can be combined with physical tasks but these individuals require individual assistance
5) Cooldown should involve gradual reduction with flexibility

Question 47

What are two other considerations specific to the exercise professional whilst working with older adults?

Answer 47

1) Incorporate behavioural strategies such as social support, self-efficacy, and perceived safety all enhance participation
2) The exercise professional should provide regular feedback, positive reinforcement, and other behavioural strategies to promote adherence