Exam 1 Flashcards
1
Q
two common Disease designations
A
- diesease of poverty
- diseases of affluence
2
Q
diesease of poverty
A
disease that are mre prevalent among the poor ( infectious/contagious/communicable)
- AID, Tuberculosis, Diarrheal disease
3
Q
diseases of affluence
A
disease that are thought to be result of ↑ wealth in a sociaety
-type 2 diabete, depression, stroke, obesity
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
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
6
Q
metabolic syndrome
A
Need 3 of these symptoms to have this disorder
- abdominal obesity
- -hypertension
- -insulin resistance
- -↑triglycerides
- -↓HDL-C
7
Q
the government have realized the importance of promoting healthy lifestyles
A
- suregeion general report (1995)
- ACSM
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
9
Q
ACSM
A
recommendation for physical activity for Adults and Older Adults(2007) this is a update from the surgeon generals report.
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
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
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
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)
14
Q
what are the 4 vital measurements
A
1 core temp
2 heart rate
3 blood pressure
4 respiratory rate
15
Q
What is making the noise that you are listening for ?
Blood Pressure
A
turbulence
normal flow- laminar flow– will not hear
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)
17
Q
can blood pressure be too low?
A
no such thing unless they start to have symptoms → dizziness, fainting
18
Q
methods of BP measurement
A
1 Auscultatory
2 oscillometric
3 invasive
19
Q
Auscultatiory
methods of BP measurement
A
- noninvasive
- stethoscope and sphygmomanomete
- typically performed with brachial artery
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
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
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
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
24
Q
during bp should feet be flat on the floor or crossed
A
flat on the floor
25
over the sleeve for BP
can but hard to hear dont do it over the sweater and have them take it off.
26
How long between BP measurements?
60 sec
27
what if you find a high BP after the first measurement
take it again and DONT tell them anything
28
what are the areas of the stethoscope
diaphragm- the larger side that hears high frequency
| bell- the smaller side and can here low frequency
29
MUST know adult classifiation for BP
see p 46 in book
also look at
p-45 & p-128-130
30
Oscillometric
| methods of BP measurement
- nonvinvasive
- little training
- automated bp machine
- do not use during exercise
- read the directions
31
Oscillometric- rules
| methods of BP measurement
- use ranged from chlinical to in home to ambulatory
- machine "senses" oscillations of pressure within artery
- reliability and validity have been questioned
32
Invasive
| methods of BP measurement
- 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
33
Pulse Pressure
| Measurements
difference between max and min pressures
| PP= SBP-DBP
units in mmHg
34
Mean Arterial Pressure (map)
| Measurements
average pressure throughout the cardiac cycle
MAP= DBP +1/3 (PP)
MAP= SVR x CO
(mmHg units )
35
Systemic Vascular Resistance
| Measurements
SVR=MAP / CO
| units= mmHg*min/L
36
Cardiac Output
| Measurements
CO= HR x SV
( units= L*min-1)-- or L/min?
double check units
37
```
Double Product (DP)
Measurements
```
an index of the workload on the heart
DP=HRxSBP
( no units)
38
read article
like now and highlight stuff thanks
39
Vo2
gross oxygen consumption
| ml*kg-1*min-1
40
speed (s)
meters per minute (m*min-1)
| 1 mile per hour= 26.8 m*min-1
41
Body mass (BM)
kilograms (kg)
| 1 kg= 2.2 pounds
42
Grage (G)
percent grade expressed as a fraction
| (5% grade= .05) use as fractions
43
Stepping frequency (F)
number of steps per minute;
| note: (up-up-down-down)= 1 step
44
Height (H)
step height in meters
| 1 inch = 2.54 centimeters
45
work rate (WR)
kilogram meters per minute (kg*m *min-1)
1 watt= 6.12 kg*m*min-1
(1200 watts is the highest)
46
caloric expenditure
(kcal) is estimated from absolute oxygen consumption (L*min-1)
1 lof oxgen per minute = 5kcal per minute
47
distance
1 mile= 1.61 kilometers
48
Time expressed as fractions
3min 43 sec = 3.72 min
49
1 MET
= resting energy expenditure=
| 3.5 ml*kg-1*min-1
50
other things to do when going through math problems
- 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
51
What to do when using the equations and you are not int he ranges
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
52
basal metabolic rate (BMR)
| resting energy expendituter
- minimum level or energy required to sustain vital funcitons in the waking state
* * what we need to stay alive
53
how is BMR measured
| resting energy expenditure
- indirect calorimetry by open circuit spirometry
54
procedure for testing BMR
| resting energy expenditure
- 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.
55
Resting Metabolic Rate (RMR)
| resting energy expenditure
similar to basal metabolic rate but differs in how it is measured and pretest requirements and therefore yield less accurate info
56
how to do the RMR test
| resting energy expenditure
- 3-4 hours after a light meal without any prior physical activity
- by definition RMR will be higher than BMR
57
Total daily energy expenditure (TDEE)
calories in and calories out
58
3 main parts of TDEE
| Total daily energy expenditure (TDEE)
1 resting metabolic rate
2 thermogenesisi
3 energy expended during physical activity and recovery
***** These are all calories out
59
Resting metabolic Rate
- 3 main parts of TDEE
- Total daily energy expenditure (TDEE)
60-70% TDEE also called resting daily energy expenditure
| - sleeping, basal and arousal metabolism
60
Thermogenesis
- 3 main parts of TDEE
- Total daily energy expenditure (TDEE)
~10% TDEE
| -obligatory and facultative thermogenesis
61
Thermogenesis-- Obligatory
- 3 main parts of TDEE
- Total daily energy expenditure (TDEE)
- ingesting, digesting, and processing food
| - growth, pregnancy, lactation
62
Thermogenesis-- facultative
- 3 main parts of TDEE
- Total daily energy expenditure (TDEE)
superimposed on obligator thermogenesis; cns controlled
- shivering and nonshivering thermogenessi
- esercise induced in muscle, diet induced
63
energy expended during physical activity and recovery
- 3 main parts of TDEE
- Total daily energy expenditure (TDEE)
occupation/ job, home, and sport/recreation
64
Resting Daily energy expenditure (RDEE)
```
estimated using
1 indirect calorimetry
2 body surface
3 fat free mass
4 other estimation equations
```
65
Indirect calorimetry
| Resting Daily energy expenditure (RDEE)
direct metabokic measurement (metabolic cart)
| --analyzing data in microsoft excel makes this very easy
66
body surface
| Resting Daily energy expenditure (RDEE)
equation to estimate RDEE(pg. 196)
- - need to konw
- --standard basal metabolic rate (pg.196)
- -- body surface area (BSA) (pg. 195)
67
Fat Free Mass
| Resting Daily energy expenditure (RDEE)
equation on p. 197 need toknow percent body fat to get fat free mass
?? look that up!!
68
other estimation equation
| Resting Daily energy expenditure (RDEE)
table 5.3 on p. 145 of lab manual
69
Read articles
the other ones he posted!!
70
```
#1
purposes of participation health screening and risk straification
```
identification of individual with medical contraindication for exclusion from exercise testing/ programs until those conditions have been abated or are under control
71
```
#2
purposes of participation health screening and risk stratification
```
recognition of person with clinically significant disease or conditions who should participate in a medically supervised exercise program
72
```
#3
purposes of participation health screening and risk stratification
```
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
```
#4
purposes of participation health screening and risk stratification
```
recognition of special needs of individuals that may affect exercise testing and programming
74
prior to exercise testing you need to give them...
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
component of prescription procedure
1 informed consent
2 medical history
3 resting physiological/ physical data
4 other
76
Informed Consent
| component of prescription procedure
- purpose
| - essential components
77
Purpose
- Informed Consent
- component of prescription procedure
(pp. 55)
- protection of participant from harm (physical, psychological and any other types of harm)
- protection of participant right to priacy confidentiality
78
Essential components
- Informed Consent
- component of prescription procedure
- 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
Medical history
| -component of prescription procedure
```
1 purpose
2 risk stratification
3 other risk factors
4 other medical inormation
5 accepted tools
6 interview
```
80
1 purpose
- Medical history
- component of prescription procedure
- 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
2 risk stratification
- Medical history
- component of prescription procedure
(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
READ page
2.2 page 27
83
3 other risk factors or limiting
- Medical history
- component of prescription procedure
- balance or gait issues
- cognitive impairments
- other disease, injury, disability, or functional limitations
84
4 other medical information
- Medical history
- component of prescription procedure
medication, laboratory/blood test have references readily accessible.
85
5 accepted tools
- Medical history
- component of prescription procedure
(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
6 interview
- Medical history
- component of prescription procedure
- 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
Resting physiological/ physical data
| -component of prescription procedure
```
1 questions
2 heart rate
3 blood pressure
4 heart rhythm
5 important notes
```
88
Questions
- Resting physiological/ physical data
- component of prescription procedure
what are the three classic vital measures in medicine?
HR
BP
ECG
89
what are 4 common ways to obtain HR
Heart Rate
-Resting physiological/ physical data
-component of prescription procedure
1 palpation (60 sec or 10,15,30 seconds)
2 heart rate monitor
3 listening for it
4 EKG
90
Heart rhythm (ECG)
- Resting physiological/ physical data
- component of prescription procedure
may not have necessary equipment in some setting
- - go to do in different postions
- -- if you have it use it
91
important notes
- Resting physiological/ physical data
- component of prescription procedure
- 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
Should know for exam
- Resting physiological/ physical data
- component of prescription procedure
contraindication to exercise testing
| pg. 53
93
other stuff to know
- Resting physiological/ physical data
- component of prescription procedure
- 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
other issues
| -component of prescription procedure
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
Mode of exercies
- aerobic exercise was running ( on treadmill)
- strenght training was free weights
- stretching was proprioceptiv neuromuscular facilitation (PNF)
96
ergometer/ergometry
```
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
aerobic exercise
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
modes of aerobic Exercise
- 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
Exercise testing purpose is to determine....
- the maximal capacity of the cardiovascular system
| - the body physiological response to physical stress
100
max capacity of the cardiovascular system
| -Exercise testing purpose is to determine....
- athletic performance
- disease and mortality risk
- disease progression
- functional capabilities
101
The body physiological response to physical stress
| -Exercise testing purpose is to determine....
- 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
The body physiological response to physical stress
- PART 2
- Exercise testing purpose is to determine....
-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
Testing Modes
```
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
Treadmill
| testing modes
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
1 standard testing mode
Treadmill
testing modes
walking is familiar to most people
106
2 workload is modulated by speed/ grade
Treadmill
testing modes
- 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
6 falling is a significatn risk
Treadmill
testing modes
- in some cases a harness is used
| - spotting and attentiveness are critical
108
7 other notes for treadmill testing
Treadmill
testing modes
- 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
Cycle ergometry
| Testing Modes
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
2 provides a true measure of mechanical power
Cycle ergometry
Testing Modes
power
- the rate at which work is performed
- power not work not strenght
- power = (force x distance) / time
- or power= work / time
111
3workload increments of 25-50 watts
Cycle ergometry
Testing Modes
- 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
5 issues
Cycle ergometry
Testing Modes
- seat- height and type
- pedal-straps, no strap or clip in
- handlebars
- calibration fo flywheel tension
113
6 other notes for lower body ergometry
Cycle ergometry
Testing Modes
- local muscular fatigue can be limitng factor
| - standing on pedals should be prohitbite
114
upper body ergometry is used for
individual that can ont perform lower body exercise joint pain/ arthriti, injury disease or paralysis,
-athlete with a significan t aerobic upper body
115
what is the work load of a upper body ergometry?
low worklad increment usually about 10 to 15 watts
116
what is the functional capacity of upper body ergometry
↓ compared to lower body and ↓↓ compared to treadmill
- max power values usuall much lower than lower body
- provide a true measure of power
117
what are some types of upper body ergometry
- potable table tops
| - non portabe full machine units
118
what are some issue with upper body ergometry
1 seat- position, back support
| 2 crank- directin, lenght of crank, handgrip positions
119
other notes about the upper body ergometry
-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
step testing workload
this si determined by step height and stepping rate.
| -heght is measured and stepping rate is regulated
121
step testing issues
balance, lowerbody strength, cadence, stepping rhythm
122
phamacological stress testing
- non exercise stress test.
cardioaccelerator stimulate an increas in heart rate
-used to assess heart function when exercise is contraindicated or not possible
123
nuclear stress testing
READ this
124
criteria for aerobic exercise
-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
graded exercise testing (GXT)
- 1846
- edward smith
- to evalute the rspones of different physiologic parameters (HR, respiratory, inspired air) duriing exertion
126
overall risk during exercise testing
- cardiac event
- complication requiring hopital admission (acute mi and sudden cardiac death
- risk of death
127
why is exercise testing valuable
because of relationship between vo2 peak and all cause mortality and cv mortality
128
what is mortality
death rate
129
what is morbidity
rate of bad event ( stroke but you dont die)
130
personnel/ supervision
-prior to 1980- GXT by cardiologist
-since 1980 GXT have been supervised by variety of heathcare professional
physician, PAs EXP, nurse, PT
131
who watched over high risk medical conditions
direct physician supervision
| morbibity: 3.6; mortality: .44
132
regular gxt test morbiity and mortality
morbidity : 2.4
| mortality: .77
133
READ
page 28
figure 2.4 and
page 137
134
when to stop and exercise test
p. 87 and p. 131
135
sensitivity vs specificity
pages 15
-154
true/false -
true/fasle +
136
contraindication of E testing
-relative contraidication: GXT can be performed is the benefits outweigh the risk
-absolute contraindication: GXT should not be performed
-
137
protocols
duration 6-12 min
- bruce treadmilll
- duke treadmill score
- naughton and balke ware treadmill
- bike and upper body erg.
138
how long a cardiac patient can e. on the bruce is indicative of risk
> 9 (low risk <1% per year mortality over 4 years)
| <3 (high risk: annual mortality of >5% and up to 20%)
139
Bruce
( most used)
-1.7 mph with 10%
modified (1.7mph with 0%)
-3 min stages
140
-duke treadmill score
READ THIS ON NOTES
141
naughton and balke ware treadmill
less aggressive; shorter stages (1-2 min) and smaller workloads
142
ramping versus stepwise protocols
* step- 1-3 min stages with noticeable workload ↑
| * ramping- small time 15to30 sec and workload increments -- is longer duration and is easier
143
Testing higher aerobic fitness levels
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
