Exam 1 Flashcards
anaerobic metabolism
no oxygen utilizes only carbs (glucose) occurs IN the cytoplasm of cell by-product is lactic acid yileds net 2 ATP per molecule of glucose
anaerobic metabolism
no oxygen utilizes only carbs (glucose) occurs IN the cytoplasm of cell by-product is lactic acid yileds net 2 ATP per molecule of glucose
aerobic metabolism
requires oxygen utilizes carbs, fats, and proteins occurs in mitochondria byproducts: water and CO2 yields net 36 ATP per molecule glucose done through glycolysis, krebs, and ETC
where are aerobic cells located?
heart, CNS, PNS, skeletal muscle
where are anaerobic cells located?
connective tissue cell (bone, cartilage, RBC’s), skeletal muscle
VO2 max
maximum capacity of an individual’s body to transport and use oxygen during incremental exercise, which reflects the physical fitness for eh individual. Measured by mL O2/kg min
What is the gold standard for aerobic capacity testing?
oxygen consumption (VO2)
Ways to measure VO2
- CO x a-vO2 difference
2. Vol. O2 entering lungs-volume O2 leaving lungs
anaerobic threshold
not capable of performing work solely aerobically (start to perform work anaeriobically, so build up of lactic acid)
what % of VO2 max is anaerobic threshold usually?
55%- with training, above, with detraining, below
what is the “clinical” anaerobic threshold?
when exercising and have difficulty talking to another. Point when metabolic acidosis trying to compensate w/ respiratory alkalosis
1 MET= X mLO2/Kg*min
3.5 mLO2/Kg*min
Definition 1 MET
requirement of O2 of tissue of the body at rest.
Moderate intensity physical activity (MET)
3-6 METS
Vigorous-intensity physical activity
> 6 METS
Factors affecting peak VO2
age gender genetics body composition endurance training various diseases that affect oxygen transport
Mortality impact w/ 1 MET increase in women
mortality decreased by 17%
VO2 considered dialed?
What is the threshold value of maximally voluntary performance need for independence in older adults?
20 mL/Kg*min
Karvonen formula
(Max HR-Rest HR)*% intensity+ Resting HR=
general HR max equation
220-age x % intensity
Tanaka HR
(208-.7age) intensity
Heart rate reserve
describes the difference between a person’s resting HR and maximum HR. HRR= HR max-HR rest
as person becomes more fit, what happens to HRR?
HRR increases (HR rest will drop)
CV contraindications for exercise
recent MI (within3-6 weeks) PE or pulmonary infarction
Recent DVT protocol for exercise
If patient is on anti-coagulation therapy, whit hold high-intensity training on that limb
appropriate on other limbs if: using heparin (2-3x normal PTT 24-48 hrs)
IVC filter placed
3-5 hrs after first LMWH (lovenox, etc)
Coumadin if PTT is 2-3x normal and INR is 2-3
resting HR contraindications for exercise
100
READ THROUGH
POSSIBLE CONTRAINDICATIONS CV- slide 6
s/s of uncontrolled CHF
S3 heart sound at rest jugular venous distension pitting edema dypnea w/ mild exertion lack of endurance fluid retention (weight gain) crackles
pitting edema scale
1+ barely perceptible depression
2+ easily identified depression- skin rebounds in 15 sec
3+ skin rebounds in 15-30 sec
4+ skin rebounds >30 sec
uncontrolled hypertension
resting SBP >200 mmHg or 110 or
possible contraindications for exercise w/ cancer
bone metastasis sites: concern for pathological fx
tumors in strength training area
medication effects
possible MSK contraindications
recent fx unstable fx osteomyelitis avascular necrosis wounds w/ exposed tendon/muscle precaution w/ compression fx marfan syndrome- connective tissue disorder
craniotomy precautions
10 lbs, no valsalve
abdominal precauseions
no sit-ups/crunches, no valsalve, no lifting >10 lbs
sternal precautions
10 lbs
side effects steroids
hypertension, immunosuppression, osteoporosis, muscle weakness, thin skin
side effects beta-blockers
hypotension (FALLS)
bradycardia
drowsiness
CASES
go through cases following precautions/contraindication review
Exercise max BP
max w/ monitoring: 250/115
clinical 200/100-220/110
resting RR
12-18
BMI and % body fat
40= extreme obesity class III
normal % body fat
men=15-18%
women=22-25%
VO2 max slide 29
REVIEW
Normal Forced vital capacity
3-5 L
Forced expiratory volume values
2.5-4 L
Forced expiratory volume
2.5-4 L
aerobic metabolism
requires oxygen utilizes carbs, fats, and proteins occurs in mitochondria byproducts: water and CO2 yields net 36 ATP per molecule glucose done through glycolysis, krebs, and ETC
where are aerobic cells located?
heart, CNS, PNS, skeletal muscle
where are anaerobic cells located?
connective tissue cell (bone, cartilage, RBC’s), skeletal muscle
VO2 max
maximum capacity of an individual’s body to transport and use oxygen during incremental exercise, which reflects the physical fitness for eh individual. Measured by mL O2/kg min
What is the gold standard for aerobic capacity testing?
oxygen consumption (VO2)
Ways to measure VO2
- CO x a-vO2 difference
2. Vol. O2 entering lungs-volume O2 leaving lungs
anaerobic threshold
not capable of performing work solely aerobically (start to perform work anaeriobically, so build up of lactic acid)
what % of VO2 max is anaerobic threshold usually?
55%- with training, above, with detraining, below
what is the “clinical” anaerobic threshold?
when exercising and have difficulty talking to another. Point when metabolic acidosis trying to compensate w/ respiratory alkalosis
1 MET= X mLO2/Kg*min
3.5 mLO2/Kg*min
Definition 1 MET
requirement of O2 of tissue of the body at rest.
Moderate intensity physical activity (MET)
3-6 METS
Vigorous-intensity physical activity
> 6 METS
INR values
.9-1.1 normal
2-3 normal if on anticoagulation therapy
>5 evaluate mobility assess safety for discharge
>6 discuss w/ MD
Mortality impact w/ 1 MET increase in women
mortality decreased by 17%
VO2 considered dialed?
What is the threshold value of maximally voluntary performance need for independence in older adults?
20 mL/Kg*min
Karvonen formula
(Max HR-Rest HR)*% intensity+ Resting HR=
respiratory- reasons to stop exercise
mod-sev dyspnea (can’t say 5 words)
abnormal breathing pattern
drop in O2 sates>5% baseline or
Tanaka HR
(208-.7age) intensity
Heart rate reserve
describes the difference between a person’s resting HR and maximum HR. HRR= HR max-HR rest
as person becomes more fit, what happens to HRR?
HRR increases (HR rest will drop)
advantages/disadvantages max testing
advantages: accuracy
dis: health risk, time, expense, personnel
Recent DVT protocol for exercise
If patient is on anti-coagulation therapy, whit hold high-intensity training on that limb
appropriate on other limbs if: using heparin (2-3x normal PTT 24-48 hrs)
IVC filter placed
3-5 hrs after first LMWH (lovenox, etc)
Coumadin if PTT is 2-3x normal and INR is 2-3
resting HR contraindications for exercise
100
READ THROUGH
POSSIBLE CONTRAINDICATIONS CV- slide 6
s/s of uncontrolled CHF
S3 heart sound at rest jugular venous distension pitting edema dypnea w/ mild exertion lack of endurance fluid retention (weight gain) crackles
pitting edema scale
1+ barely perceptible depression
2+ easily identified depression- skin rebounds in 15 sec
3+ skin rebounds in 15-30 sec
4+ skin rebounds >30 sec
uncontrolled hypertension
resting SBP >200 mmHg or 110 or
possible contraindications for exercise w/ cancer
bone metastasis sites: concern for pathological fx
tumors in strength training area
medication effects
possible MSK contraindications
recent fx unstable fx osteomyelitis avascular necrosis wounds w/ exposed tendon/muscle precaution w/ compression fx marfan syndrome- connective tissue disorder
craniotomy precautions
10 lbs, no valsalve
abdominal precauseions
no sit-ups/crunches, no valsalve, no lifting >10 lbs
sternal precautions
10 lbs
side effects steroids
hypertension, immunosuppression, osteoporosis, muscle weakness, thin skin
side effects beta-blockers
hypotension (FALLS)
bradycardia
drowsiness
CASES
go through cases following precautions/contraindication review
Exercise max BP
max w/ monitoring: 250/115
clinical 200/100-220/110
resting RR
12-18
BMI and % body fat
40= extreme obesity class III
normal % body fat
men=15-18%
women=22-25%
VO2 max slide 29
REVIEW
Normal Forced vital capacity
3-5 L
tidal volume
.5L at rest
Forced expiratory volume
2.5-4 L
normal FEV/FVC values
> 80%
normal pH
7.4
normal pCO2
35-45 mmHg
normal pO2
80-100 mmHg
O2 saturation
95-100%
what would a PFT look like in a person w/ COPD?
decreased FEV1
longer time need to expel air from lungs
fasting blood glucose levels
60-100 normal
100-125 pre-diabetic
126+ diabetic
ideal blood glucose levels to be able to exercise
100-250
oral glucose tolerance test values
200 diabetes
normal platelet count
150.000-400,000
platelet count contraindication for exercise
normal WBC count
3900-11000 exercise as tolerated
normal hemoglobin values
males 13-18
females 12-16
normal hematocrit values
males 41-51%
females 36-47%
values for ABI in diagnosing PAD
normal=.91+
mild obstruction=.70-.90
moderate obstruction .4-.69
severe obstruction
CASE STUDIES
REVIEW CASE STUDIES
Expected change in DBP w/ exercise?
none or
Within how much time should BP and HR return to within 10 of resting value?
5 minutes
contraindications of BP w/ exercise
sudden drop in SBP >10 failure of SBP to rise SBP>250, DBP>115 w/ monitoring SBP>200, DBP>110 w/out EKG decrease in HR below baseline
respiratory- reasons to stop exercise
mod-sev dyspnea (can’t say 5 words)
abnormal breathing pattern
drop in O2 sates>5% baseline or
submax test assumptions
- stead-state HR is obtained for each exercise work rate
- a maximal HR for a given age is uniform (220-age)
- mechanical efficiency is the same for everyone
- there is a linear relationship between HR and workload
- HR will vary depending on fitness level between subjects at any given workload
advantages of submax testing
- safer
- controlled pace
- not population specific
- quick assessment
- cost effective
- do not need highly trained personnel
7 can do mass testing - no physician supervision required- if symptoms/disease free
disadvantages of submax testing
- VO2 max is not directly measured
2. Not a measure of true maximal HR (220-age can vary by 15 BPM)
advantages/disadvantages max testing
advantages: accuracy
dis: health risk, time, expense, personnel
populations for which the cycle ergometer is indicated for
balance disorders
obese
musculoskeletal problems (non WB)
protocol for cycle ergometer
1 watt= 6.12 kpm/min
start at 150 kpm/min and increase by 150 every 2-3 min
start at 50 wtts and increase by 25 watts every 2-3 min
different for arm ergometry?
decrease incremental workloads to 10-25 watts for every 2-3 minute stage
astrand cycle rhyming test
75 watts for 2 min, 50 RPM
progress workload to 100, 125, 150 watts dependent on characteristics
establish working submax HR 130-170 bpm
then maintain workload additional 5 min
astrand male/female diff
females start at only 50 watts, move up by 15
items included in SPPB
static balance, gait speed, sit to stand
SPPB scoring
0-3= severe limitations 4-6= moderate limitations 7-9= mild limitations 10-12= minimal limitations
dose response definition
intensity adequate for overload to musculoskeletal systems to induce adaptations
neuromuscular adaptations account for ____% strength gains per week
10-15% strength gains per week. Hypertrophy contributions pick up later in training program
60% 1 RM
12 reps 11 RPE
70% 1 RM
10 reps 13 RPE
80% 1RM
8 reps 15 RPE
failure
inability to complete final rep through full, available ROM w/out compensation
HR, SV and CO w/ exercise
all increase. SV increases significantly initially and then levels out
HR corresponds with…?
increasing VO2
what should a PT do w/ a patient complaining of angina?
stop exercising, ask if typical, do they have NG
unstable angina vs. chronic stable
unstable angina much more concerning
angina scale
1+ light, barely noticeable
2+ moderate
3+ severe, uncomfortable
4+ most severe pain ever experienced
uncontrolled vs controlled a-fib
uncontrolled= >100 bpm controlled= 100 bpm or less
what is double product?
HR x SBP
dyspnea levels
able to count to 15 in 7.5-8 seconds level 0= single breath 1= 2 breaths 2= 3 breaths 3= 4 breaths 4= unable to count
ventilation=
TV x RR
what happens to tidal volume with increasing ventilation
tidal volume increases with increasing ventilation
chronic bronchitis
over production of mucus causes an occlusion of airways
causes of emphysema
herditary alpha-1 antitrypsin deficiency
smoking 80-90%
how do PT’s assess whether the lungs are doing their job?
O2 saturation
cyanosis
pulmonary function tests
when someone w/ COPD is desaturating what might you consider
encourage patient to breathe out more
what would a PFT look like in a person w/ COPD?
decreased FEV1
longer time need to expel air from lungs
what happens to FEV1/FVC?
increases (sometimes stays the same)
what is the percent saturation of O2 w/ hemoglobin?
97% (90-100)
what happens to oxygen sats w/ hemoglobin dropping to 7.5g/100ml blood because of a GI bleed?
oxygen sats remain
at what point is supplemental oxygen provided?
what does blood flow provide for and remove from an exercising muscle?
brings: oxygen and nutrients
removes: CO2, lactic acid, and leads to heat dissipation
what happens to a-vO2 difference w/ activity?
a-v O2 increases w/ exercise
claudication scale
1- definite discomort, modest levels
2-moderate discomfort or pain from which the patient’s attention can be diverted
3. intense pain from which the patient’s attention cannot be diverted
4. excruciating and unbearable pain
ABI measurement
pt supine for 5 min
SBP both limbs- higher value= denominator
SBP measured in dorsalis pedis and posterior tin by placing cuff above ankle
values for ABI in diagnosing PAD
normal=.91+
mild obstruction=.70-.90
moderate obstruction .4-.69
severe obstruction
what value should be used for patient goals for improvement in walking speed?
gain of .1 m/s- predictor for well-being
MDC for gait speed?
.1-.2 m/s
MCID for gait speed?
.1 m/s
red/yellow/green flags for gait speed?
.6 ms/ or less= red flag
.6-1.0 ms/s= yellow flag
>1.0 m/s functional community ambulator
amount of protein needed by older adult w/out kidney disease
1-1.5 grams/kg
strength training for older adults
3 days/week
60-80% 1RM for 2-3 sets of 8-12 reps
what contributes to the preception that climbing a flight of stairs is more difficult with increasing age?
weakness and decreased performance from CV system
minimum aerobic capacity for men/women to live independently?
men= 18
women=15
how much does VO2 max decrease each decade for men and women?
men= decrease 4-5.5 each decade for men
women= 2-3.5 each decade
BUT still have capacity to increase VO2 max w/ proper training intensity
aerobic exercise for older adults
3-5 days/week
intensity: 60-75% HR max
11-14 RPE
20-60 minutes
