Exam 1: Physical Activity and Health & Hypertension Flashcards
Evidence-Based Practice
Clinical decision making that integrates the best available research with clinical expertise and patient characteristics/preferences
Physical Activity Guidelines
150-300 mins of aerobic activity/week OR 75-150 mins of aerobic activity/week
Minimum of 2 days/week of resistance training
Minimum of 3 days/week flexibility training
Health Related Physical Fitness
Parts of physical fitness that help a person stay healthy; includes cardiovascular fitness, flexibility, muscular endurance, and strength
Skill Related Physical Fitness
Parts of fitness that help a person perform well in sports and activities requiring certain skills; includes agility/balance, coordination, power, reaction time, and speed
Biologic Plausibility
Finding a correlation between 2 variables and believing there is a causation between them
Cofounder
Variable effecting an outcome measure
Herman Hellerstein
First to believe cardiac patients should be going back to work ASAP
Transformed cardiac rehab into what we know today
Right Atrium
Receives blood from 3 veins: Superior/Inferior Vena Cava and the Coronary Sinus
Blood passes from the RA into the RV through the tricuspid valve
Right Ventricle
Blood passes from the RV through the pulmonary valve into the pulmonary trunk which divides into the right/left pulmonary trunk
Left Atrium
Receives blood from the lungs through 4 pulmonary veins
Blood passes from the LA into the LV through the bicuspid valve
Cardiac Cycle
The alternating period of contraction and relaxation of the heart
Iso-volumetric Contraction Period
Brief period where ventricles contract but DO NOT eject blood
Ejection Period
Portion of systole where blood is ejected from the heart
Iso-volumetric Relaxation Period
Brief period where ventricles are relaxing BUT NOT filling with blood
Ventricular Filling Period
Portion of diastole where ventricles fill with blood
Frank Starling Law of the Heart
An increased stretch of the myocardium enhances the contractile force causing more blood to eject
Afterload
The pressure that the ventricle has to generate in order to eject blood out of the chamber
Ejection Fraction
Diastole - Systole
How much blood is coming in - how much blood is going out
Chronic Heart Failure (CHF)
Impairment in the ability of the ventricle to eject blood or to fill with blood
Systolic Dysfunction
Impaired emptying of the left ventricle, with a resulting fall in cardiac output
Diastolic Dysfunction
The left ventricle is non-compliant resulting in impaired filling
Myocardial Infarction (MI)
Death of cardiac myocytes resulting from prolonged ischemia caused by complete vessel occlusion
Coronary Artery Bypass Graft (CABG)
Surgery that improves blood flow to the heart
Stable Angina
Transient pain/discomfort in the chest caused by myocardial ischemia brought on by increased physical exertion
Unstable Angina
Chest pain that lasts for a longer duration, at increased frequency, or at a lower level of exertion than usual
Heart Attack
A condition in which blood flow to the heart muscle is blocked, causing heart cells to die
CABG - Exercise Considerations
No upper body RT before 5 weeks following
May need lower intensity initially due to musculoskeletal discomfort or health issues at incision
Nitroglycerin
Relaxes coronary arteries and other vessels
Valve repair
Procedure to treat stenosis or regurgitation
Mitral Stenosis
A narrowing of the mitral valve opening
Mitral Regurgitation
A leaking mitral valve which allows blood to flow in two directions
Coronary Stent: Percutaneous Coronary Intervention
Small metal mesh tube used to treat narrow/weak arteries
Pacemaker
Small device implanted in the chest to control arrhythmias
Implantable Cardioverter Defibrillator (ICD)
Same as pacemaker + uses electrical impulses to shock the heart to control life threatening arrhythmias
Implantable Devices - Exercise Considerations
ICD patients have low function capacity due to severe myocardial dysfunction
More formal and prolonged EKG monitoring
Prescribe intensities below ICD/pacemaker thresholds
Transplant
Removal of damaged heart and replaced with a donor heart
Transplant - Exercise Considerations
HR (95-115) and BP are often elevated at rest due to loss of parasympathetic innervation of the donor heart
Peak HR only slightly lower than predicted
May have delayed HR response at onset and post exercise
Can typically use light to moderate aerobic Rx
Atrial Fibrilation
Atria beats irregularly and fast
Meds: anticoagulants
Systolic Blood Pressure
Amount of pressure during contraction
Diastolic Blood Pressure
Amount of pressure during relaxation
Essential Hypertension
Unknown cause for high blood pressure
Anything that increases sympathetic response
Secondary Hypertension
High BP caused by the effects of another disease/condition
Hypertension in Older Persons
More than 2/3 of people over 65 have HTN
Lowest rates of BP control due to chronic conditions, med adherence, and/or rate of aging decline
Hypertension in Children and Adolescents
Secondary hypertension most common
Use lifestyle interventions before pharmacological
Effective doses are often smaller
Blood Pressure Classifications
Normal: ≤120/80
Elevated: 120-129/≥80
Stage 1 Hypertension: 130-139/80-89
Stage 2 Hypertension: ≥140/≥90
Hypertensive Crisis
Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage
Benefits of Lowering BP
Stroke incidence: 35-40%
Myocardial Infarction: 20-25%
Heart Failure: 50%
Severe Hypertension Associated with:
Headache
Dizziness
Palpitations
Easy fatiguability
Blurring of vision
Athersclerosis
Thickening/calcification of lipids in the arteries
Leading cause of CHD/stroke
Chronic immune-inflammatory disease
CVD Risk Factors
Hypertension
Cigarette smoking
Obesity (BMI ≥30)
Physical inactivity
Dyslipidemia
Diabetes mellitus
Age (men under 55/women under 65)
Family history or premature CVD
Lifestyle Modifications for CVD Prevention and Management
Stop smoking
Limit alcohol intake
Lose weight if overweight
Increase aerobic physical activity
Reduce sodium intake
Maintain adequate potassium intake
Cigarettes and CVD Risk Factors
Promoting platelet activation and aggregation
Decrease NO release (endothelial dysfunction)
Oxidizes LDL
Chronic, low-grade inflammation
Alcohol and CVD Risk Factors
Stimulates sympathetic nervous system
Increases renin which increases inflammatory response
Down-regulates calcium
Impairs electrolyte transport
Renin Angiotensin Aldosterone System (RAAS)
A hormone cascade pathway that helps regulate blood pressure and blood volume
Angiotensin I
THE potent vasodilator
Angiotensin II
Causes increases in blood pressure, influences renal tubuli to retain sodium and water, and stimulates aldosterone release from adrenal gland.
Sodium and Potassium Intake
Goal for adults is to consume less than 2,300 mg of sodium per day
Individuals are encouraged to increase their consumption of foods rich in potassium (lowers BP by vasodilating)
Sodium Sources in the Diet
Food Processing: 77%
Inherent in foods: 12%
Added at the table: 6%
Added during cooking: 5%
DASH Diet
Low in saturated and trans fat
Rich in potassium, calcium, magnesium, fiber, and protein
Emphasizes vegetables, fruits, and fat-free/low-fat dairy products
Limits sodium, sweets, and sugary beverages, and red meats
Acute Aerobic Exercise and BP
10-20% mmHg reduction during initial 1-3 hours
Effects decrease as time goes on from previous bout
Chronic Aerobic Exercise and BP
Exercise lowers BP at fixed exercise workloads
Benefits increase in a dose dependent manner
Decrease in plasma norepinephrine levels
Increase in circulating vasodilators
Reduces renal release to A2 to reduce vasoconstriction
Resistance Training and HTN
Elicits a “pressor” response: greater elevation of SBP and DBP due to local vasoconstriction with contraction
Generally reduces resting BP in HTN adults
HTN Exercise Prescription - Cardiovascular Training
Frequency: aerobic exercise on most days of the week
Intensity: moderate-intensity (40-60% VO2R/HRR)
Time: 30-60 mins of continuous/intermittent (10 min bouts) aerobic activity
Type: Large muscle groups
HTN Exercise Prescription - Resistance Training
Frequency: 2-3 d/wk
Sets: 1 - volitional fatigue
Reps: 8-12 (60-80% 1RM) per set for healthy adults/10-15 per set at a lower level of resistance for older adults
Stations/Devices: 8-10 exercises that condition the major muscle groups
Volitional Fatigue
Fatigue that has caused form to be impaired
Hypertension Contraindications
Systolic BP greater than 200 mmHg or diastolic BP greater than 110 mmHg at rest
Untreated/uncontrolled HTN may hinder exercise tolerance and/or performance
Diuretics
Indications: edema, HTN, HF, kidney dysfunction
Actions: assists kidneys in excretion of excess fluids (Na+, water)
Names: “-ide” (amiloride)
Beta Blockers
Indications: HTN, angina, arrhythmias, a-Fib, HF, anxiety
Actions: Reduces HR and force of contraction by increasing blood flow through the vessels; blunts sympathetic nervous system (max HR)
Names: “-lol” (Antenlol)
Angiotensin II Receptor Blockers (ARBs)
Indications: HTN, diabetes, HF
Actions: decreases effectiveness of angiotensin II (blocks response) resulting in blood vessel vasodilation (relaxation)
Names: “-tan” (Losartan)
Angiotensin Converting Enzyme (ACE) Inhibitor
Indications: HTN, CAD, diabetes
Actions: decreases hormone ACE-II preventing vasoconstriction, inhibit angiotensin I from turning into angiotensin II
Names: “-pril” (Ramipril)
Ca+ Channel Blockers
Indications: HTN, angina, diabetes, ischemic heart disease
Actions: causes blood vessels to dilate by blocking Ca+ from entering the muscle cells of the heart; decreases stroke volume and resistance to flow
Names: “pine” (Amlodipine)
