Exam 1 Flashcards
1
Q
anaerobic metabolism
A
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
2
Q
anaerobic metabolism
A
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
3
Q
aerobic metabolism
A
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
4
Q
where are aerobic cells located?
A
heart, CNS, PNS, skeletal muscle
5
Q
where are anaerobic cells located?
A
connective tissue cell (bone, cartilage, RBC’s), skeletal muscle
6
Q
VO2 max
A
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
7
Q
What is the gold standard for aerobic capacity testing?
A
oxygen consumption (VO2)
8
Q
Ways to measure VO2
A
- CO x a-vO2 difference
2. Vol. O2 entering lungs-volume O2 leaving lungs
9
Q
anaerobic threshold
A
not capable of performing work solely aerobically (start to perform work anaeriobically, so build up of lactic acid)
10
Q
what % of VO2 max is anaerobic threshold usually?
A
55%- with training, above, with detraining, below
11
Q
what is the “clinical” anaerobic threshold?
A
when exercising and have difficulty talking to another. Point when metabolic acidosis trying to compensate w/ respiratory alkalosis
12
Q
1 MET= X mLO2/Kg*min
A
3.5 mLO2/Kg*min
13
Q
Definition 1 MET
A
requirement of O2 of tissue of the body at rest.
14
Q
Moderate intensity physical activity (MET)
A
3-6 METS
15
Q
Vigorous-intensity physical activity
A
> 6 METS
16
Q
Factors affecting peak VO2
A
age gender genetics body composition endurance training various diseases that affect oxygen transport
17
Q
Mortality impact w/ 1 MET increase in women
A
mortality decreased by 17%
18
Q
VO2 considered dialed?
A
19
Q
What is the threshold value of maximally voluntary performance need for independence in older adults?
A
20 mL/Kg*min
20
Q
Karvonen formula
A
(Max HR-Rest HR)*% intensity+ Resting HR=
21
Q
general HR max equation
A
220-age x % intensity
22
Q
Tanaka HR
A
(208-.7age) intensity
23
Q
Heart rate reserve
A
describes the difference between a person’s resting HR and maximum HR. HRR= HR max-HR rest
24
Q
as person becomes more fit, what happens to HRR?
A
HRR increases (HR rest will drop)
25
CV contraindications for exercise
```
recent MI (within3-6 weeks)
PE or pulmonary infarction
```
26
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
27
resting HR contraindications for exercise
100
28
READ THROUGH
POSSIBLE CONTRAINDICATIONS CV- slide 6
29
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
```
30
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
31
uncontrolled hypertension
resting SBP >200 mmHg or 110 or
32
possible contraindications for exercise w/ cancer
bone metastasis sites: concern for pathological fx
tumors in strength training area
medication effects
33
possible MSK contraindications
```
recent fx
unstable fx
osteomyelitis
avascular necrosis
wounds w/ exposed tendon/muscle
precaution w/ compression fx
marfan syndrome- connective tissue disorder
```
34
craniotomy precautions
10 lbs, no valsalve
35
abdominal precauseions
no sit-ups/crunches, no valsalve, no lifting >10 lbs
36
sternal precautions
10 lbs
37
side effects steroids
hypertension, immunosuppression, osteoporosis, muscle weakness, thin skin
38
side effects beta-blockers
hypotension (FALLS)
bradycardia
drowsiness
39
CASES
go through cases following precautions/contraindication review
40
Exercise max BP
max w/ monitoring: 250/115
| clinical 200/100-220/110
41
resting RR
12-18
42
BMI and % body fat
40= extreme obesity class III
43
normal % body fat
men=15-18%
| women=22-25%
44
VO2 max slide 29
REVIEW
45
Normal Forced vital capacity
3-5 L
46
Forced expiratory volume values
2.5-4 L
47
Forced expiratory volume
2.5-4 L
48
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
```
49
where are aerobic cells located?
heart, CNS, PNS, skeletal muscle
50
where are anaerobic cells located?
connective tissue cell (bone, cartilage, RBC's), skeletal muscle
51
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
52
What is the gold standard for aerobic capacity testing?
oxygen consumption (VO2)
53
Ways to measure VO2
1. CO x a-vO2 difference
| 2. Vol. O2 entering lungs-volume O2 leaving lungs
54
anaerobic threshold
not capable of performing work solely aerobically (start to perform work anaeriobically, so build up of lactic acid)
55
what % of VO2 max is anaerobic threshold usually?
55%- with training, above, with detraining, below
56
what is the "clinical" anaerobic threshold?
when exercising and have difficulty talking to another. Point when metabolic acidosis trying to compensate w/ respiratory alkalosis
57
1 MET= X mLO2/Kg*min
3.5 mLO2/Kg*min
58
Definition 1 MET
requirement of O2 of tissue of the body at rest.
59
Moderate intensity physical activity (MET)
3-6 METS
60
Vigorous-intensity physical activity
>6 METS
61
INR values
.9-1.1 normal
2-3 normal if on anticoagulation therapy
>5 evaluate mobility assess safety for discharge
>6 discuss w/ MD
62
Mortality impact w/ 1 MET increase in women
mortality decreased by 17%
63
VO2 considered dialed?
64
What is the threshold value of maximally voluntary performance need for independence in older adults?
20 mL/Kg*min
65
Karvonen formula
(Max HR-Rest HR)*% intensity+ Resting HR=
66
respiratory- reasons to stop exercise
mod-sev dyspnea (can't say 5 words)
abnormal breathing pattern
drop in O2 sates>5% baseline or
67
Tanaka HR
(208-.7*age)* intensity
68
Heart rate reserve
describes the difference between a person's resting HR and maximum HR. HRR= HR max-HR rest
69
as person becomes more fit, what happens to HRR?
HRR increases (HR rest will drop)
70
advantages/disadvantages max testing
advantages: accuracy
dis: health risk, time, expense, personnel
71
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
72
resting HR contraindications for exercise
100
73
READ THROUGH
POSSIBLE CONTRAINDICATIONS CV- slide 6
74
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
```
75
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
76
uncontrolled hypertension
resting SBP >200 mmHg or 110 or
77
possible contraindications for exercise w/ cancer
bone metastasis sites: concern for pathological fx
tumors in strength training area
medication effects
78
possible MSK contraindications
```
recent fx
unstable fx
osteomyelitis
avascular necrosis
wounds w/ exposed tendon/muscle
precaution w/ compression fx
marfan syndrome- connective tissue disorder
```
79
craniotomy precautions
10 lbs, no valsalve
80
abdominal precauseions
no sit-ups/crunches, no valsalve, no lifting >10 lbs
81
sternal precautions
10 lbs
82
side effects steroids
hypertension, immunosuppression, osteoporosis, muscle weakness, thin skin
83
side effects beta-blockers
hypotension (FALLS)
bradycardia
drowsiness
84
CASES
go through cases following precautions/contraindication review
85
Exercise max BP
max w/ monitoring: 250/115
| clinical 200/100-220/110
86
resting RR
12-18
87
BMI and % body fat
40= extreme obesity class III
88
normal % body fat
men=15-18%
| women=22-25%
89
VO2 max slide 29
REVIEW
90
Normal Forced vital capacity
3-5 L
91
tidal volume
.5L at rest
92
Forced expiratory volume
2.5-4 L
93
normal FEV/FVC values
>80%
94
normal pH
7.4
95
normal pCO2
35-45 mmHg
96
normal pO2
80-100 mmHg
97
O2 saturation
95-100%
98
what would a PFT look like in a person w/ COPD?
decreased FEV1
| longer time need to expel air from lungs
99
fasting blood glucose levels
60-100 normal
100-125 pre-diabetic
126+ diabetic
100
ideal blood glucose levels to be able to exercise
100-250
101
oral glucose tolerance test values
200 diabetes
102
normal platelet count
150.000-400,000
103
platelet count contraindication for exercise
104
normal WBC count
3900-11000 exercise as tolerated
105
normal hemoglobin values
males 13-18
| females 12-16
106
normal hematocrit values
males 41-51%
| females 36-47%
107
values for ABI in diagnosing PAD
normal=.91+
mild obstruction=.70-.90
moderate obstruction .4-.69
severe obstruction
108
CASE STUDIES
REVIEW CASE STUDIES
109
Expected change in DBP w/ exercise?
none or
110
Within how much time should BP and HR return to within 10 of resting value?
5 minutes
111
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
```
112
respiratory- reasons to stop exercise
mod-sev dyspnea (can't say 5 words)
abnormal breathing pattern
drop in O2 sates>5% baseline or
113
submax test assumptions
1. stead-state HR is obtained for each exercise work rate
2. a maximal HR for a given age is uniform (220-age)
3. mechanical efficiency is the same for everyone
4. there is a linear relationship between HR and workload
5. HR will vary depending on fitness level between subjects at any given workload
114
advantages of submax testing
1. safer
2. controlled pace
3. not population specific
4. quick assessment
5. cost effective
6. do not need highly trained personnel
7 can do mass testing
8. no physician supervision required- if symptoms/disease free
115
disadvantages of submax testing
1. VO2 max is not directly measured
| 2. Not a measure of true maximal HR (220-age can vary by 15 BPM)
116
advantages/disadvantages max testing
advantages: accuracy
dis: health risk, time, expense, personnel
117
populations for which the cycle ergometer is indicated for
balance disorders
obese
musculoskeletal problems (non WB)
118
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
119
different for arm ergometry?
decrease incremental workloads to 10-25 watts for every 2-3 minute stage
120
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
121
astrand male/female diff
females start at only 50 watts, move up by 15
122
items included in SPPB
static balance, gait speed, sit to stand
123
SPPB scoring
```
0-3= severe limitations
4-6= moderate limitations
7-9= mild limitations
10-12= minimal limitations
```
124
dose response definition
intensity adequate for overload to musculoskeletal systems to induce adaptations
125
neuromuscular adaptations account for ____% strength gains per week
10-15% strength gains per week. Hypertrophy contributions pick up later in training program
126
60% 1 RM
12 reps 11 RPE
127
70% 1 RM
10 reps 13 RPE
128
80% 1RM
8 reps 15 RPE
129
failure
inability to complete final rep through full, available ROM w/out compensation
130
HR, SV and CO w/ exercise
all increase. SV increases significantly initially and then levels out
131
HR corresponds with...?
increasing VO2
132
what should a PT do w/ a patient complaining of angina?
stop exercising, ask if typical, do they have NG
133
unstable angina vs. chronic stable
unstable angina much more concerning
134
angina scale
1+ light, barely noticeable
2+ moderate
3+ severe, uncomfortable
4+ most severe pain ever experienced
135
uncontrolled vs controlled a-fib
```
uncontrolled= >100 bpm
controlled= 100 bpm or less
```
136
what is double product?
HR x SBP
137
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
```
138
ventilation=
TV x RR
139
what happens to tidal volume with increasing ventilation
tidal volume increases with increasing ventilation
140
chronic bronchitis
over production of mucus causes an occlusion of airways
141
causes of emphysema
herditary alpha-1 antitrypsin deficiency
| smoking 80-90%
142
how do PT's assess whether the lungs are doing their job?
O2 saturation
cyanosis
pulmonary function tests
143
when someone w/ COPD is desaturating what might you consider
encourage patient to breathe out more
144
what would a PFT look like in a person w/ COPD?
decreased FEV1
| longer time need to expel air from lungs
145
what happens to FEV1/FVC?
increases (sometimes stays the same)
146
what is the percent saturation of O2 w/ hemoglobin?
97% (90-100)
147
what happens to oxygen sats w/ hemoglobin dropping to 7.5g/100ml blood because of a GI bleed?
oxygen sats remain
148
at what point is supplemental oxygen provided?
149
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
150
what happens to a-vO2 difference w/ activity?
a-v O2 increases w/ exercise
151
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
152
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
153
values for ABI in diagnosing PAD
normal=.91+
mild obstruction=.70-.90
moderate obstruction .4-.69
severe obstruction
154
what value should be used for patient goals for improvement in walking speed?
gain of .1 m/s- predictor for well-being
155
MDC for gait speed?
.1-.2 m/s
156
MCID for gait speed?
.1 m/s
157
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
158
amount of protein needed by older adult w/out kidney disease
1-1.5 grams/kg
159
strength training for older adults
3 days/week
| 60-80% 1RM for 2-3 sets of 8-12 reps
160
what contributes to the preception that climbing a flight of stairs is more difficult with increasing age?
weakness and decreased performance from CV system
161
minimum aerobic capacity for men/women to live independently?
men= 18
| women=15
162
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
163
aerobic exercise for older adults
3-5 days/week
intensity: 60-75% HR max
11-14 RPE
20-60 minutes
