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ADV EXP > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

two common Disease designations

A
  • diesease of poverty

- diseases of affluence

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2
Q

diesease of poverty

A

disease that are mre prevalent among the poor ( infectious/contagious/communicable)
- AID, Tuberculosis, Diarrheal disease

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3
Q

diseases of affluence

A

disease that are thought to be result of ↑ wealth in a sociaety
-type 2 diabete, depression, stroke, obesity

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4
Q

disease related to sedentary lifestyels and poor nutrition

A
  • obesity
  • diabete
  • hypertension( silent killer)
  • metabolic syndrome
    • These are ↑ risk for heart disease, stroke, cancers kidney disease
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5
Q

Diabete

A

There are 4 different kinds

  • type 1– no insulin ( get a pump)
  • type 2– doesn’t work right (relative defincey) (preventable)
  • gestational
  • they dont know hwy it is acting this way
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6
Q

metabolic syndrome

A

Need 3 of these symptoms to have this disorder

    • abdominal obesity
  • -hypertension
  • -insulin resistance
  • -↑triglycerides
  • -↓HDL-C
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7
Q

the government have realized the importance of promoting healthy lifestyles

A
  • suregeion general report (1995)

- ACSM

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8
Q

Surgeon Generals Report (1995)

A

every adult should accumulate 30 min or more of moderate intensity physical activity on most days of the week

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9
Q

ACSM

A

recommendation for physical activity for Adults and Older Adults(2007) this is a update from the surgeon generals report.

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10
Q

Reasons ↓ physical Activity in society

A
  • societal values–priotities, taking short cuts
  • role models
  • economy– not enough money for good food
  • access
  • loss of PE in schools
  • discrimination claims by some
  • public acceptace of obesity/ sedentary
  • reliance on moderan medicine
  • misinformed public
  • not enough psychology related research
  • technology
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11
Q

2014 - number of deaths

A 
1- heart disease (23%)
2maliganant neoplasma (23%)
3 chronic lower respiratory disease (6%)
4 accidents 
5 strokes
6 alzheimers
7 diabetes
8 influenze and pneumonia
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12
Q

1900- number of deaths

A 
1 pneumonia  (12%)
2 tuberculosis (11 %)
3 diarrhea, enteritis ulcerations 
4 disease of the heart
5 stroke
6 nephritis 
7 all accindents 
8 caner and other malignant tumors
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13
Q

What is actually being measured?

Blood Pressure

A

low & high pressure on the artery

  • ↑ the ventral is contracting (stolic)
  • ↓ the ventral is relaxing ( diastolic)
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14
Q

what are the 4 vital measurements

A

1 core temp
2 heart rate
3 blood pressure
4 respiratory rate

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15
Q

What is making the noise that you are listening for ?

Blood Pressure

A

turbulence

normal flow- laminar flow– will not hear

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16
Q

Variability with BP is due too

A
  • circadian rhythme (body 24 hour clock)
  • stress
  • nutritional factors ( monster, preworkout)
  • drugs
  • disease
  • posture
  • exercise (high 480/350mmHG)
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17
Q

can blood pressure be too low?

A

no such thing unless they start to have symptoms → dizziness, fainting

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18
Q

methods of BP measurement

A

1 Auscultatory
2 oscillometric
3 invasive

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19
Q

Auscultatiory

methods of BP measurement

A
  • noninvasive
  • stethoscope and sphygmomanomete
  • typically performed with brachial artery
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20
Q

**Korokoff sounds
Auscultatiory
methods of BP measurement

A

1- snapping sound heard at the SBP
2- are the mumurs fro most of the area btwn the systolic and diastolic
3/4- pressures within 10mmgh above the dbp
(thumping and muting)
5 sound is silence as the cuff pressure drops below DBP

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21
Q

**cuff sized
Auscultatiory
methods of BP measurement

A
  • infant, peds, adult, large adult
    • cuff is too…
  • too big- underestimation of BP
  • too small- overestimation of BP
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22
Q

**location of Cuff
Auscultatiory
methods of BP measurement

A

should be level with the heart

  • should use the RIGHT side
  • can read BP anywhere on the body really
  • always use the higher number
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23
Q

Why use the right side for BP

A

for consistnacy

  • also when you are doing bp on someone you dont know you should do both their right and their left side
  • PAD pateints should have both arms and ankles
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24
Q

during bp should feet be flat on the floor or crossed

A

flat on the floor

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25
Q

over the sleeve for BP

A

can but hard to hear dont do it over the sweater and have them take it off.

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26
Q

How long between BP measurements?

A

60 sec

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27
Q

what if you find a high BP after the first measurement

A

take it again and DONT tell them anything

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28
Q

what are the areas of the stethoscope

A

diaphragm- the larger side that hears high frequency

bell- the smaller side and can here low frequency

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29
Q

MUST know adult classifiation for BP

A

see p 46 in book
also look at
p-45 & p-128-130

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30
Q

Oscillometric

methods of BP measurement

A
  • nonvinvasive
  • little training
  • automated bp machine
  • do not use during exercise
  • read the directions
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31
Q

Oscillometric- rules

methods of BP measurement

A
  • use ranged from chlinical to in home to ambulatory
  • machine “senses” oscillations of pressure within artery
  • reliability and validity have been questioned
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32
Q

Invasive

methods of BP measurement

A
  • pressure sensor is inserted into the artey
  • allows for real time and very accurate monitoring of BP
  • typially only found in research and medical settings
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33
Q

Pulse Pressure

Measurements

A

difference between max and min pressures

PP= SBP-DBP
units in mmHg

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34
Q

Mean Arterial Pressure (map)

Measurements

A

average pressure throughout the cardiac cycle
MAP= DBP +1/3 (PP)
MAP= SVR x CO
(mmHg units )

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35
Q

Systemic Vascular Resistance

Measurements

A

SVR=MAP / CO

units= mmHg*min/L

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36
Q

Cardiac Output

Measurements

A

CO= HR x SV
( units= L*min-1)– or L/min?
double check units

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37
Q 
Double Product (DP)
Measurements
A

an index of the workload on the heart
DP=HRxSBP
( no units)

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38
Q

read article

A

like now and highlight stuff thanks

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39
Q

Vo2

A

gross oxygen consumption

mlkg-1min-1

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40
Q

speed (s)

A

meters per minute (m*min-1)

1 mile per hour= 26.8 m*min-1

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41
Q

Body mass (BM)

A

kilograms (kg)

1 kg= 2.2 pounds

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42
Q

Grage (G)

A

percent grade expressed as a fraction

(5% grade= .05) use as fractions

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43
Q

Stepping frequency (F)

A

number of steps per minute;

note: (up-up-down-down)= 1 step

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44
Q

Height (H)

A

step height in meters

1 inch = 2.54 centimeters

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45
Q

work rate (WR)

A

kilogram meters per minute (kgm min-1)
1 watt= 6.12 kgmmin-1
(1200 watts is the highest)

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46
Q

caloric expenditure

A

(kcal) is estimated from absolute oxygen consumption (L*min-1)
1 lof oxgen per minute = 5kcal per minute

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47
Q

distance

A

1 mile= 1.61 kilometers

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48
Q

Time expressed as fractions

A

3min 43 sec = 3.72 min

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49
Q

1 MET

A

= resting energy expenditure=

3.5 mlkg-1min-1

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50
Q

other things to do when going through math problems

A
  • look at te answer and ask yourself if it makes sense
  • double check work
  • have you been provided with too much info or not enough
  • round to the thousandth place
  • dont forget to ad the 3.5 or 7 on the equations
  • use correct units of measure
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51
Q

What to do when using the equations and you are not int he ranges

A

you should see what the person is doing!!! to tell what equation to use.
-remember that if you use outside the range use with cation

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52
Q

basal metabolic rate (BMR)

resting energy expendituter

A
  • minimum level or energy required to sustain vital funcitons in the waking state
    • what we need to stay alive
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53
Q

how is BMR measured

resting energy expenditure

A
  • indirect calorimetry by open circuit spirometry
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54
Q

procedure for testing BMR

resting energy expenditure

A
  • right after 8 hours of sleep
  • lies supine in a comfortabe, thermoneutral, dark, distraction free room
  • 30-40 min
  • inspired and expired air is collected and analyzed
    • should not fall asleep
  • 48 hours abstinence form strenuous exercise and 12-14 hours abstinence form food or other calorie containing substances
  • *really only need the last 10 min of the test but you should be using more then that.
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55
Q

Resting Metabolic Rate (RMR)

resting energy expenditure

A

similar to basal metabolic rate but differs in how it is measured and pretest requirements and therefore yield less accurate info

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56
Q

how to do the RMR test

resting energy expenditure

A
  • 3-4 hours after a light meal without any prior physical activity
  • by definition RMR will be higher than BMR
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57
Q

Total daily energy expenditure (TDEE)

A

calories in and calories out

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58
Q

3 main parts of TDEE

Total daily energy expenditure (TDEE)

A

1 resting metabolic rate
2 thermogenesisi
3 energy expended during physical activity and recovery
***** These are all calories out

59
Q

Resting metabolic Rate

  • 3 main parts of TDEE
  • Total daily energy expenditure (TDEE)
A

60-70% TDEE also called resting daily energy expenditure

- sleeping, basal and arousal metabolism

60
Q

Thermogenesis

  • 3 main parts of TDEE
  • Total daily energy expenditure (TDEE)
A

~10% TDEE

-obligatory and facultative thermogenesis

61
Q

Thermogenesis– Obligatory

  • 3 main parts of TDEE
  • Total daily energy expenditure (TDEE)
A
  • ingesting, digesting, and processing food

- growth, pregnancy, lactation

62
Q

Thermogenesis– facultative

  • 3 main parts of TDEE
  • Total daily energy expenditure (TDEE)
A

superimposed on obligator thermogenesis; cns controlled

  • shivering and nonshivering thermogenessi
  • esercise induced in muscle, diet induced
63
Q

energy expended during physical activity and recovery

  • 3 main parts of TDEE
  • Total daily energy expenditure (TDEE)
A

occupation/ job, home, and sport/recreation

64
Q

Resting Daily energy expenditure (RDEE)

A 
estimated using 
1 indirect calorimetry
2 body surface
3 fat free mass
4 other estimation equations
65
Q

Indirect calorimetry

Resting Daily energy expenditure (RDEE)

A

direct metabokic measurement (metabolic cart)

–analyzing data in microsoft excel makes this very easy

66
Q

body surface

Resting Daily energy expenditure (RDEE)

A

equation to estimate RDEE(pg. 196)

    • need to konw
  • –standard basal metabolic rate (pg.196)
  • – body surface area (BSA) (pg. 195)
67
Q

Fat Free Mass

Resting Daily energy expenditure (RDEE)

A

equation on p. 197 need toknow percent body fat to get fat free mass
?? look that up!!

68
Q

other estimation equation

Resting Daily energy expenditure (RDEE)

A

table 5.3 on p. 145 of lab manual

69
Q

Read articles

A

the other ones he posted!!

70
Q 
#1
purposes of participation health screening and risk straification
A

identification of individual with medical contraindication for exclusion from exercise testing/ programs until those conditions have been abated or are under control

71
Q 
#2 
purposes of participation health screening and risk stratification
A

recognition of person with clinically significant disease or conditions who should participate in a medically supervised exercise program

72
Q 
#3
purposes of participation health screening and risk stratification
A

detection of individuals at increased risk for disease because of age, symptoms, and or risk factor who shoudl undergo a medical evaluation and exercise testing before initiating and exercise program or increasing the frequency intensity or duration of their current program

73
Q 
#4
purposes of participation health screening and risk stratification
A

recognition of special needs of individuals that may affect exercise testing and programming

74
Q

prior to exercise testing you need to give them…

A

instruction for patient on how to prepare for test ( instruction given in advance) (pp. 56-57)
- diet clothing, medication, execsie activity during the preceding

75
Q

component of prescription procedure

A

1 informed consent
2 medical history
3 resting physiological/ physical data
4 other

76
Q

Informed Consent

component of prescription procedure

A
  • purpose

- essential components

77
Q

Purpose

  • Informed Consent
  • component of prescription procedure
A

(pp. 55)
- protection of participant from harm (physical, psychological and any other types of harm)
- protection of participant right to priacy confidentiality

78
Q

Essential components

  • Informed Consent
  • component of prescription procedure
A
  • purpose of the test_ never tell them what you might thinks
  • description of what participant will do or will have done to them
  • potential benefits to participants
  • potential ham to participant (risk)
  • statement indication that particicpant may withdraw at any time without penalty
  • ask if paticipant understand what he or she has read
  • signature and dates ( in pen)
79
Q

Medical history

-component of prescription procedure

A 
1 purpose
2 risk stratification
3 other risk factors 
4 other medical inormation
5 accepted tools 
6 interview
80
Q

1 purpose

  • Medical history
  • component of prescription procedure
A
  • identify any health/ medical issues that
  • could be made worse by exercise testing and or training
  • could confound the results of testing and or training
81
Q

2 risk stratification

  • Medical history
  • component of prescription procedure
A

(p. 26; case studie on pp. 29-30)
- atherosclerotic cardiovascular disease risk factors
- signs and symptoms suggestvie of cardiovascular, pulmonary, metabolic disease (pp. 21-22)
- know disease (cardiovascular, pulmonary, metabolic) (pp. 34-35)

82
Q

READ page

A

2.2 page 27

83
Q

3 other risk factors or limiting

  • Medical history
  • component of prescription procedure
A
  • balance or gait issues
  • cognitive impairments
  • other disease, injury, disability, or functional limitations
84
Q

4 other medical information

  • Medical history
  • component of prescription procedure
A

medication, laboratory/blood test have references readily accessible.

85
Q

5 accepted tools

  • Medical history
  • component of prescription procedure
A

(p. 24-25)
- par-q min. requirement when working with apparently healthy
- aha/acsm health fitness facility preparticipation screening questionnaire
- many other (including tools that are custom made by institution organization departments)

86
Q

6 interview

  • Medical history
  • component of prescription procedure
A
  • specific question related to a particular population and related to a particular exercise setting
  • examples of general question to ask
  • -is there anything else that you think i shoudl know
  • -are there any other medical or health concerns that have not been addressed
    • are you on any medications?
87
Q

Resting physiological/ physical data

-component of prescription procedure

A 
1 questions
2 heart rate
3 blood pressure
4 heart rhythm 
5 important notes
88
Q

Questions

  • Resting physiological/ physical data
  • component of prescription procedure
A

what are the three classic vital measures in medicine?
HR
BP
ECG

89
Q

what are 4 common ways to obtain HR
Heart Rate
-Resting physiological/ physical data
-component of prescription procedure

A

1 palpation (60 sec or 10,15,30 seconds)
2 heart rate monitor
3 listening for it
4 EKG

90
Q

Heart rhythm (ECG)

  • Resting physiological/ physical data
  • component of prescription procedure
A

may not have necessary equipment in some setting

    • go to do in different postions
  • – if you have it use it
91
Q

important notes

  • Resting physiological/ physical data
  • component of prescription procedure
A
  • HR, BP and ecg should be measured in the supine standing and exercise posture
  • medication can have significant effect on HR, BP and ECG
92
Q

Should know for exam

  • Resting physiological/ physical data
  • component of prescription procedure
A

contraindication to exercise testing

pg. 53

93
Q

other stuff to know

  • Resting physiological/ physical data
  • component of prescription procedure
A
  • data anthropocentric data (height, weight, body composition and demographic data(sex, age, race)
  • a more detailed physical examination may be required (common for clinical exercise physiologist to be a part of this process)
  • when do yo not perform exercise testing or fitness assessment -if you dont think they should
94
Q

other issues

-component of prescription procedure

A

1 medial clearance for exercise testing
2 referal to an appropriate medical or health care professional
3 vulnerable populations (minors, disabilities, prisoners
4 good recording keeping- very important
5 establishment of a rapport with patient (you never get a second change to make a first impression)
6 discussion of patient goals– long and short
7 what is your role (motivator, friend, listener,guide
8 rule and regulation- the laws insurance, policies and procedures
9 credential: academic degree, certification, experience, testimonials

95
Q

Mode of exercies

A
  • aerobic exercise was running ( on treadmill)
  • strenght training was free weights
  • stretching was proprioceptiv neuromuscular facilitation (PNF)
96
Q

ergometer/ergometry

A 
ergon= work
metron= measure
ergometer=device for measuring work
ergometry= the measurement of work
the use of ergo as a prefix is more common in europe
97
Q

aerobic exercise

A

how would you define aerobic e.

  • what criteria would you used to determine whether or not an exercise or activity was aerobic
  • peak vs. max
  • the term exercise test is assumed to refer to aerobic exercise testing
98
Q

modes of aerobic Exercise

A
  • walking, joggin, running
  • lower body ccycling
  • upper body ergometry or arm crank ergometry
  • swimming
  • cross country skiing
  • rowing
  • bench stepping
  • elliptical machine roller blading
99
Q

Exercise testing purpose is to determine….

A
  • the maximal capacity of the cardiovascular system

- the body physiological response to physical stress

100
Q

max capacity of the cardiovascular system

-Exercise testing purpose is to determine….

A
  • athletic performance
  • disease and mortality risk
  • disease progression
  • functional capabilities
101
Q

The body physiological response to physical stress

-Exercise testing purpose is to determine….

A
  • HR
  • heart thytm
  • BP
  • heart fx
  • pulmonary fx– lung volumes and ventilation , blood gases
  • blood lactate
  • cardiac output
  • most often performed with a treadmill or upright bike
  • variations in vo2 with diff. forms/mode of e. generally reflect variation in the quantity of muscle mass
102
Q

The body physiological response to physical stress

  • PART 2
  • Exercise testing purpose is to determine….
A

-variations in vo2 with diff. forms/mode of e. generally reflect variation in the quantity of muscle mass
–training state and familiarity with the mode of e
–isolation fo smaller groupd ususally leads to lower peak values
=small muscle mass = ↓ absolute o requirements
= smaller muscle mass- ↓ absolute force output
-see table 9.1 on onenote

103
Q

Testing Modes

A 
1 treadmill
2 cycle ergometry
3 upper body ergometry 
4 step testing
5 pharmacological stress test
6 nuclear stress testing
7 rowing
8 swimmming and skiing
9virtually any mode of aerobic e can be sued for testing
104
Q

Treadmill

testing modes

A

1 standard testing mode
2 workload is modulated by speed or grade
3 usually has greatest potential to elicit max CV fx
4 individuals with balance issues may not be suitable candidate for treamill testing
5 walking/jogging can cause interference or artifact on eletrocardiogram
6 falling is significant risk
7 other notes for treadmill testing

105
Q

1 standard testing mode
Treadmill
testing modes

A

walking is familiar to most people

106
Q

2 workload is modulated by speed/ grade
Treadmill
testing modes

A
  • faster speeds are good for some and bad for other (untrained)
  • steeper grades help ↑ workload w/o a concomitant ↑ in s which has benefits but also has pitfalls
  • a testing treadmill with a capacity of 12mph and 25% will capture just about everybody.
107
Q

6 falling is a significatn risk
Treadmill
testing modes

A
  • in some cases a harness is used

- spotting and attentiveness are critical

108
Q

7 other notes for treadmill testing
Treadmill
testing modes

A
  • individual on treadmill shoudl have entire focus on the activity
  • the emergency shut off button good and bad
  • width and length of tread can be limitnig factor
109
Q

Cycle ergometry

Testing Modes

A

1 often used for individual with weight bearing balance issues
2probides a true measure of mechanical power
3 workload increment of 25-50 watts per stage are common
4 functional apacity indices lower tan treadmill
5 issues
6 other notes for lower body ergo meter

110
Q

2 provides a true measure of mechanical power
Cycle ergometry
Testing Modes

A

power

  • the rate at which work is performed
  • power not work not strenght
  • power = (force x distance) / time
  • or power= work / time
111
Q

3workload increments of 25-50 watts
Cycle ergometry
Testing Modes

A
  • smaller or great worklad increments my be warrant
  • different units of measure for force and power
  • -force: kiloponds, kiloram, newtons
  • -power: watts kilogram per min
  • pedal revolution or cadence
  • -crucial with mechanically braked ergometer
  • -not crucial with electronically raked ergometer
  • will pedal revolution rate effect test outcome in term of perforamnces- pro it will
112
Q

5 issues
Cycle ergometry
Testing Modes

A
  • seat- height and type
  • pedal-straps, no strap or clip in
  • handlebars
  • calibration fo flywheel tension
113
Q

6 other notes for lower body ergometry
Cycle ergometry
Testing Modes

A
  • local muscular fatigue can be limitng factor

- standing on pedals should be prohitbite

114
Q

upper body ergometry is used for

A

individual that can ont perform lower body exercise joint pain/ arthriti, injury disease or paralysis,
-athlete with a significan t aerobic upper body

115
Q

what is the work load of a upper body ergometry?

A

low worklad increment usually about 10 to 15 watts

116
Q

what is the functional capacity of upper body ergometry

A

↓ compared to lower body and ↓↓ compared to treadmill

  • max power values usuall much lower than lower body
  • provide a true measure of power
117
Q

what are some types of upper body ergometry

A
  • potable table tops

- non portabe full machine units

118
Q

what are some issue with upper body ergometry

A

1 seat- position, back support

2 crank- directin, lenght of crank, handgrip positions

119
Q

other notes about the upper body ergometry

A

-bp respons is ↑ with upper body compared tolower body
-cauiton with cardiac patient and other clinical populations
WHY
-large ↑ in periphearl vascular resistance in restin lower extremity
-signif. static component with arm cranking
-relative load on arm is hight than that of leg

120
Q

step testing workload

A

this si determined by step height and stepping rate.

-heght is measured and stepping rate is regulated

121
Q

step testing issues

A

balance, lowerbody strength, cadence, stepping rhythm

122
Q

phamacological stress testing

A
  • non exercise stress test.
    cardioaccelerator stimulate an increas in heart rate
    -used to assess heart function when exercise is contraindicated or not possible
123
Q

nuclear stress testing

A

READ this

124
Q

criteria for aerobic exercise

A

-significatn amount of muscle mass recruited
-cyclic/ rhythmic movement
-prolonged in duration ( more than a few min)
example of unique aerobic testing for specific populations– bridging for stroke pateints

125
Q

graded exercise testing (GXT)

A
  • 1846
  • edward smith
  • to evalute the rspones of different physiologic parameters (HR, respiratory, inspired air) duriing exertion
126
Q

overall risk during exercise testing

A
  • cardiac event
  • complication requiring hopital admission (acute mi and sudden cardiac death
  • risk of death
127
Q

why is exercise testing valuable

A

because of relationship between vo2 peak and all cause mortality and cv mortality

128
Q

what is mortality

A

death rate

129
Q

what is morbidity

A

rate of bad event ( stroke but you dont die)

130
Q

personnel/ supervision

A

-prior to 1980- GXT by cardiologist
-since 1980 GXT have been supervised by variety of heathcare professional
physician, PAs EXP, nurse, PT

131
Q

who watched over high risk medical conditions

A

direct physician supervision

morbibity: 3.6; mortality: .44

132
Q

regular gxt test morbiity and mortality

A

morbidity : 2.4

mortality: .77

133
Q

READ

A

page 28
figure 2.4 and
page 137

134
Q

when to stop and exercise test

A

p. 87 and p. 131

135
Q

sensitivity vs specificity

A

pages 15
-154
true/false -
true/fasle +

136
Q

contraindication of E testing

A

-relative contraidication: GXT can be performed is the benefits outweigh the risk
-absolute contraindication: GXT should not be performed
-

137
Q

protocols

A

duration 6-12 min

  • bruce treadmilll
  • duke treadmill score
  • naughton and balke ware treadmill
  • bike and upper body erg.
138
Q

how long a cardiac patient can e. on the bruce is indicative of risk

A

> 9 (low risk <1% per year mortality over 4 years)

<3 (high risk: annual mortality of >5% and up to 20%)

139
Q

Bruce

A

( most used)
-1.7 mph with 10%
modified (1.7mph with 0%)
-3 min stages

140
Q

-duke treadmill score

A

READ THIS ON NOTES

141
Q

naughton and balke ware treadmill

A

less aggressive; shorter stages (1-2 min) and smaller workloads

142
Q

ramping versus stepwise protocols

A
  • step- 1-3 min stages with noticeable workload ↑

* ramping- small time 15to30 sec and workload increments – is longer duration and is easier

143
Q

Testing higher aerobic fitness levels

A

must use and aggressive protocal that …

  • gets the person to max levels in short time (6-12min)
  • does ot waste a lot of time and energy in initial stages
  • is specific to the person training mode
  • -Astrand treadmill test work well in many situation table 9.2

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