exam 4 Flashcards
adolescence is defined as age:
international conference on physical activity guidelines for adolescence)
11-21
ASCM children and adolescents range
6-19
after _____ physiological changes are equal for adolescence and adults
puberty
Physical activity in preadolescents
normally short-term and intermittent
various intensity
More time spent in high intensity than any other age group
recreational in type
VO2 expressed as l/min is ____ in children than adults
lower
VO2 expressed as kg/l/min is ____ in children and adults
is similar
after puberty (12 years) what happens to VO2 in males and females
males continue to increase in VO2 max while females after this age plateau
oxygen cost of movement ____ in preadolescents because economy is _____
greater, lower
why is movement economy lower in children
greater reliance of stride frequency than stride length with running
differences in body mechanics
no difference with cycling
Improvement in ________ contributes to improved endurance performance during adolescence
movement economy
due to lower economy, the VO2 at any absolute submaximal workload is _____ % _____
10-30% greater
Heat Production/kg body mass is ____ in children when children and adults are working at the same absolute workload
higher
Anaerobic capacity is ____ in young children compared to older children and adults
lower
decreased ability to perform intense anaerobic activity (like wingate test)
what is the related difference in rate of utilization of ATP or CP concentrations
in children versus adults
there is no difference
why is anaerobic capacity in youth decreased
decreased rate of utilization of muscle glycogen= lower PFK activity
lower rate of lactate production
what is lower in children during maximal exercise and submaximal exercise
lactate levels – which might be why children report a lower RPE to a given workload
child reach steady-state ____ than adults
faster
children have greater capacity to recover due to
less dependence on anaerobic mechanisms and less development of metabolic acidosis
Cardiopulmonary Responses to exercise in children at maximum exercise
CO is lower
HR is higher and SV is lower
a-vO2 difference is similar
VE is increased due to increased frequency (less efficient ventilatory response)
Cardiopulmonary responses to exercise in children at submax exercise
CO is somewhat lower at a given VO2
At any % of VO2max, children have a higher HR
a-vO2 difference is somewhat higher
Less efficient ventilatory response
what contributes to less efficient ventilatory response (VE to VO2 ratio is higher)
children depend more on increasing frequency than tidal volume to increase VE
Does NOT affect alveolar respiration but does result in a greater oxygen cost of respiration
______ in the heat is not compromised in preadolescent children
performance
at any absolute exercise intensity, the metabolic heat load is ____ in children
greater
at a relative workload, metabolic heat load is _____ in children
equal
children have ____ convective heat loss than adults due to high ______ to body mass ratio
greater, surface area
what is the surrogate marker for skin convective hear loss
increased skin blood flow rate
skin blood flow rate is ____ in the prepubertal group compared to post pubertal group
highest
Children have a _____ sweat rate per skin area
lower
there is a larger sweat rate difference from child to adult in what sex?
males
what do we know about sweat and children
they have more active sweat glands but less sweat is produced
core temperature when sweating begins is higher
the sweat is more hypotonic - lower osmolality
exercise testing is not indicated for children or adolescents unless ____
there is a health concern
what numerical RPE scale do you use for children and adolescents
0-10 scale
children may need several practice trials before being capable of reproducing a given exercise intensity using RPE
disadvantages of cycle ergometry for children
requires greater attention span bc it is self-directed
more likely to be limited by local fatigue
treadmill testing in children
typically, adjust grade while leaving speed constant
Frequency Recommendations for Preadolescents and Adolescents
Daily
Intensity Recommendations for Preadolescents and Adolescents
most should be moderate-to-vigorous; include vigorous at least 3x/week
Time Recommendations for Preadolescents and Adolescents
≥ 60 min of accumulated activity/day (the 60+ includes muscle strengthening activity)
Type Recommendations for Preadolescents and Adolescents
enjoyable and developmentally appropriate physical activity
monitored and supervision
what does muscle strengthening consist of for children
could be typical resistance training, playground equipment, climbing trees and tug of war contests
bone strengthening activities
moderate-to-high impact loading or muscle force production
running, jump rope, tennis
strength training recommendations for children
avoid maximum and and explosive lifts
SUPERVISON
no less than 8 RM
use moderate intensity (60-80%) 1-RM or 8-15 RM to moderate fatigue with good form
at what age is there a substantial decline in physical activity
middle school and then high school really drops off
who should provide physical activity for children?
parents/guardians and family members that are active role models
effects of strength training in younger children
voluntary muscular strength
endurance
there are minimal injury rates as long as it is appropriately administered
a process or group of processes occurring in living organisms that with the passage of time, lead to a loss of adaptability, functional impairment and eventually death
aging
Basic ADL
personal hygiene dressing transfers ambulation bladder/bowel management
IADL
important for community living taking medications care for living space manage finances use technology shopping for basic needs preparing meals
physically elite older adult
sports competition
senior olympics
high risk/power sports like hang gliding and weight lifting
physically fit older adult
moderate physical work
all endurance sports and games
most hobbies
physically independent
very light physical work
hobbies like walking and gardening
low physical demand activities like golf, driving, crafts and traveling
can pass all IADL
physically frail
light housekeeping
food prep
grocery shopping
can pass some IADL and all ADLs
physically dependent
cannot pass some or all BADL
needs home or institutional care
what physiological effects increase with aging
TPR, MAP and cardiac overload work of breathing risk of fracture due to osteoporosis risk of diabetes and heart disease disease risk
what is important to maintain to avoid falls
neuromuscular control
muscular strength and most important muscular POWER
Loss of neuromuscular/coordination is from
decrease in number size of neurons, conduction velocity, maximum frequency
increase muscle excitability threshold
decreased proprioceptive and vestibular function
consequence of decreased neuromuscular control/coordination
slower reaction times central processing affected less precise movement control balance abnormalities (falls) decreased strength/cognitive function/increased medicine use
Sarcopenia definition
loss of muscle mass with aging, contributes to decreases in muscular strength
strength loss can lead to ____ mobility and ______ risk of falling
limited mobility and increased risk of falling
why does mm mass decrease with age
fall in number of muscle fibers
denervation leads to degeneration of muscle fibers
decreased contractile protein with less activity
up to what age does number of muscle fibers not really change
age 50
by what age, do you have about 50% mm fibers than when you were younger and peak active
80 y.o
what decreases first, mm mass or strength
strength; you lose neural adaptation
decreased cross bridges kinetics slows contractile velocity and thus isokinetic force
atrophy occurs when activity levels are ___ because…
low because there is a reduction in contractile protein
effects of resistance training in older individuals
increase strength (neural and increase mm mass)
training effect can occur even in ages >75
substantial gains can even be seen in frail individuals
maintain or increase muscular strength/endurance and flexibility
maintain or regain mobility
decrease fall risk
neuromuscular benefits for resistance training in older adults
increased mobility increased motor unit integrity increased balance fiber type shift from IIx to IIa increased strength increased power
Resistance Training Recommendations for healthy older adults - Frequency
2-3 sessions/week
48 hour separation
Resistance Training Recommendations for healthy older adults - Intensity
between moderate and vigorous
5-8/10
start with 40-50% of 1RM
progress to 60-80% 1RM (moderate to vigorous)
Resistance Training Recommendations for healthy older adults - Type
8-10 exercises ≥ 1 set of 10-15 reps
stair-climbing, using all major muscle grpups
power weight training for older individuals
light to moderate intensity (30-60% of 1RM) for 6-10 reps with high velocity- as fast as you can
neuromotor exercises for older individuals
integration of balance, strength, endurance and/or flexibility work
reduce risk of fall-related injury in older adults
when older adults exercise there should be a high degree of ______ and _______
supervision and training
what accelerates the age-related fall in VO2 max
reducing habitual physical activity
large muscle performance in relatively well-maintained until what age (on average)
60-70
functional capacity loss is accelerated by
co-morbidities
reductions in physical function after 60 are from
declining intrinsic physiologic task capacity
age-related reductions in large muscle endurance performance is due to reductions in ____
VO2max
with age, deconditioning and disease what happens to CO reserve capacity
reserve capacity decreases
cardiovascular changes with age at MAXIMAL EXERCISE
decreased oxygen consumption decreased CO decreased SV decreased HR decreased a-vO2 difference
cardiovascular changes with aging during Submaximal ABSOLUTE
somewhat lower CO and SV Same VO2 (assuming economy hasn't changed) Same HR wider (increased) a-vo2 difference increased BP Increased TPR
max stroke volume increases with training in older ____-
men, not women
muscle adaptations to training with aging
increased oxygen extraction
increased VO2 max
increased capillary density and oxidative capacity
what explains the increase in VO2 max in older trained women
increased oxygen extraction at the muscle tissue
older individuals can decrease their resting ____ and ____ with training
HR and BP
why is there increased residual volume in older individuals
there is decrease in FORCED VITAL CAPACITY
what happens to alveoli with aging
loss of alveoli and increased size of alveoli
aging and breathing
aging increases the work of breathing due to increased airflow resistance and chest wall stiffness
work of breathing may increase to 15% of Vo2max when it is normally 8-11%
with loss of alveoli but increased alveolar size, the result is
decrease FVC and increased residual volume
air trapping
emphysemic changes
max ventilatory capacity ___ with aging
decreases
the VE/VO2 ______ in older individuals
increases
aerobic exercises guidelines for older adults
similar to standard guidelines
moderate intensity =5-6/10
vigorous intensity=7-8/10
prescribing exercise for healthy older adults : Intensity
5-6 moderate (40-60% HRR) and 7-8 (60-89% HRR) for vigorous
prescribing exercise for healthy older adults: Frequency
min 5d/week at moderate; or 3 days for vigorous
prescribing exercise for healthy older adults: time
moderate: 150-300 min/week
Vigorous: 75-100 min/week or combination
prescribing exercise for healthy older adults : type
may need to substitute for non-WB exercises
prescribing exercise for healthy older adults: progression
slow progression; emphasizing increased duration rather than intensity
ability to maintain high levels of training _____ with aging
decreases - motivation, time, injury and intrinsic drive
average loss of ___% VO2 max per decade after after of 25
10%
acceleration after age 60
rate of decline in absolute VO2max is _____ in endurance trained individuals compared to non-endurance trained
greater
overweight definition
a body mass greater than some standard, which usually is an average weight for a given stature
overfat definition
defined as body fat greater than a standard for sex and age
storage fat
accumulation of lipid in adipocytes
nutritional reserve
found in subcutaneous and visceral (intraperitoneal) depots
essential fat % in males
3%
essential fat % in females
12%
INCLUDES SEX-SPECIFIC FAT
essential fat =
bone marrow stores and stores in the viscera and nerves (necessary for normal physiologic function
LBM
includes essential fat, muscle, water, bone and minerals
FFM
all lipid contributions are excluded
desirable BMI for men and women
20-24.9 kg/m2
overweight BMI
25-29.9
Grade 2 obesity BMI
30-40
Grade 3 obesity BMI (morbid obesity)
> 40
BMI above _____ increases mortality (high risk)
35
average %fat men
12-15%
average % fat women
25-28%
which body composition methods use body density from body volume and mass
Hydrostatic weighing and skin folds and technically air-displacement because it measures body volume
Bioelectrical Impedance Analysis (BIA) calculates
total body water
body density =
body mass/body volume
what equations use body density to calculate body fat %
siri
brozek
Dexa scan uses which component of body composition
Modified 2-component model
component model of body comp
FFM (63%)
bone mineral density (7%)
Fat mass (30%)
2-component model of body comp
FFM (70%) Fat mass (30%)
3-component model of body comp
LBM (70%) essential fat (4%) Storage fat (26%)
if you don’t account for air in the lungs and GI tract you will _______ body fat %
overpredict
what is the theoretical minimal limit of accuracy
body fat % +/- 2.0% fat units of the true value
advantages of Hydrostatic Weighing
reproducible
highly accurate
valid for many populations
disadvantages of Hydrostatic Weighing
the best accuracy occurs in highly technical and experienced labs
equipment is bulky and can’t be moved
methodological concerns in predicting residual lung volume
accuracy of the weighing procedure is tricky
subject needs to cooperate
predictive accuracy of skinfold thickness
+/- 3.5% assuming that proper training and technique are used
skinfold thickness predicts total body fatness from ____
subcutaneous fat
what is the constant tension on the skinfold caliper
10 g/mm2
sites for skinfolds
normally 4-5 sites measured
triceps, subscap, suprailiac, abdominal, thigh and chest
what variables mostly contribute of error of measurement in skinfold testing
the investigators technique and experience
what are the generalized equations for skinfold testing
jackson and pollock
for obese populations ______ measurements are better for prediction of body fat
circumference
advantages of skinfold testing
inexpensive and quick
good for following changes in body comp
fairly reproducible and accurate with experience
disadvantages of skinfolds
population specificity in prediction equations can lead to error
error highly dependent on investigator technique
caliper used should be the same model as used in the prediction equation
electrical current is slow through _____
fat
why is there better conduction or flow through FFM
greater electrolyte concentraion
accuracy of BIA is better for
long-term changes and patients who are not super obese
accuracy of BIA is _____ to skinfold technique and varies from _____ to ____
equivalent, +/- 1.8 to 6%
standard recommendations for BIA
dry skin no eating/drinks w/n 4 hours no exercise w/n 12 hours no alcohol w/n 48 hours void before the assessment can't be on diuretics
what do the standard recommendations for BIA do
maintain normal hydration, plasma osmolality and body fluid distribution through compartments
near-infrared interactance measures
the amount of light absorption vs reflection
not accurate often > +/- 4% body fat units
advantages of Bod-Pod vs. underwater weighing
fast (5 min)
various pt population
there is a smaller unit for infants up to 17lbs
mobile
good compliance - don’t need to maximally exhale
less training required for the operator
sources of error in body comp assessment
error of measurement
error in underlying assumptions
experimental conditions
density of FFM is not necessarily constant among populations
obesity definition
excess accumulation of fat
a heterogenous disorder in which the final common pathway is chronic energy imbalance
energy intake exceeds energy expenditure
which group of people are less obese
non-hispanic asian adults and youth
obesity increases the incidence of
coronary heart disease gallbladder stones (cholelithiasis) hypertension, stroke cancer - breast, colon, kidney and endometrial osteoarthritis type II diabetes/glucose intolerance infertility
if you are obese and you ______ there is a 2x increase risk of death
smoke
what BMI causes reduction in survival by 2-4 years
30-35
survival is reduced by 8-10 years with a BMI of
40-45
what accounts for the excess mortality with LOW BMI
smoking
what is a good BMI when risk of death is the lowest
22-25
even if weight stays in a healthy range, increasing body weight of >10 lbs since your 20’s will
increase risk of developing obesity related disease like Type II diabetes, cholelithiasis
HTN and CHD
increased health risk if your fat is stored
in the viscera, over the abdomen
high health risk for young men when waist to hip ratio is >
0.95
high health risk for young women when waist to hip ratio is >
0.86
men high risk waist circumference
100-120 cm (39.5-47”)
very high risk men waist circumference
> 120 (>47”)
high risk waist circumference for women
90-109 cm (35.5-43”)
very high risk waist circumference for women
> 110 (43.5”)
high visceral fat is associated with
high cholesterol (LDL with low HDL)
high plasma insulin and insulin resistance
atherosclerosis, HTN, left ventricular hypertrophy
risk for endometrial and colorectal cancer
no matter the category of BMI, elevated __________ is associated with higher risk of mortality
waist girth
how man kcal = 1 lb of fat
3500 kcal
factors that affect energy expenditure
resting metabolic rate
dietary thermogenesis
physical activity (increasing BMR)
factors that affect energy intake
total daily calories
composition of the diet
behavior and environmental factors like timing of eating
genetics contribute ____% to body fat
25%
cultural (environmental factors) contribute ____% to body fat
30%
what does environmental factors of energy intake mean
density, availability and palatability
like higher fat, highly energy-dense diets increase the prevalence of obesity
scientifically what has a high correlation with obesity in children
TV watching
food intake has _____ over the years and physical inactivity has ______
decreased, increased
an extra _____ kcal can be spent if obese individuals matched the NEAT of lean folks
350
PA can aid in weight control by
improving the matching of food intake to expenditure
and raising energy expenditure
sustained weight loss of ______% is likely to improve health related factors like triglycerides, blood glucose, HbA1c and risk of T2DM
3-5%
how much PA to promote weight loss
300-500 kcal/day (1000-2000) kcal per week
150min/week of moderate but best results with 300 min/week or >2000 kcal/wk
start with moderate activity and progress to vigorous
intermittent activity is okay - may promote greater daily volume
to prevent weight gain PA should be
progressed to 250-300 min/week or 50-60min for 5d/wk at moderate to vigorous intensity
60-90 min per day might be neccessary
intermittent is okay
what is needed to keep weight off after you lose
Exercise and Diet
benefits of resistance training
improve mm endurance and strength
increase HDL, lower LDL and decrease triglycerides
improve insulin sensitivity and glucose intolerance
reduce blood pressure
resistance training and weight loss
resistance training increases FFM so it doesn’t show weight loss as much but it is still important
combined with aerobic training is where you will increase fat loss
only obese individuals will see a decrease in relative risk for _____ if they lower their BMI
CVD mortality and all cause mortality
what disorders make up the female athlete triad
disordered eating
amenorrhea
osteoporosis
updated position of female athlete triad
relationships among energy availability and menstrual function and BMD that may have clinical manifestations including eating disorders, functional hypothalamic amenorrhea and osteoporosis
undernourished male athletes can have
hypogonadotropic hypogonadism and impaired bone health
Risk factors for female athlete triad
high elite athlete
family history of disordered eating
perceived lack of control
pressure from coaches, parents, school, society
social isolation sports (individual sports)
sports that emphasize low body weight or subjective judging of appearance
gymnastics, figure skating, ballet, long-distance running
risks of disordered eating
decreased BMD (premature osteoporosis) menstrual abnormalities electrolyte disturbances decreased immune function diminished ability to heal wounds GI dysfunction
amenorrhea
the absence of at least 3-6 consecutive menstrual cycles in women who have already begun menstruating
Functional ammenorrhea
exercise or acute weight loss
psychogenic amenorrhea
associated with psychological trauma or stress
could be accompanied by caloric deficiency
anorexia nervosa amenorrhea
starvation
body wasting
severe hypothalamic and other endocrine abnormalities
hypothalamic amenorrhea
cessation of menstruation due to dysfunction of the hypothalamic signals to the pituitary gland, resulting in anovulation
athletes might not have amenorrhea but can have
menstrual dysfunction
oligomenorrhea
luteal phase defects (LPD)
what is Luteal Phase Defects (LPD)
patient ovulates but ovarian function is insufficient to support implantation
caused by energy deficit or hypometabolic state
exercise induced amenorrhea
suppression of reproductive function is a neuroendocrine adaptation to caloric deficit
amenorrhea and energy deficit cause….
decrease pulsatility of GnRH, LH and plasma levels of estradiol which lead to ovulatory irregularity
threshold for energy availability that is compatible with healthy LH pulsatility =
20-30 kcal/kg FFM/day
osteoporosis in Female Athlete Triad
premature bone loss or inadequate bone formation low bone mass micro-architectural deterioration increased skeletal fragility increased risk of fracture
amenorrheic athletes BMD loss
2-6% / year up to 25%
post-menopausal women BMD loss
3% per year for 10 years and then it returns to 0.3% per year
normal cycling adult women BMD loss
0.3%-0.5% / year
low estrogen leads to
accelerated bone reabsorption
energy deficit during exercise amenorrhea leads to decreased bone ______-
formation
slowed bone formation with amenorrhea can result from
low thyroid hormone
low IGF-1
Low leptin
=state of energy conservation
late-maturing/amenorrheic women will reach menopause _____ and have ___ BMD than their peers
later, lower
Treatment Order for the female athlete triad
recovery energy status, recover menstrual cycle and then recovery bone mineral density
recovery of energy status duration
days or weeks
recovery of menstrual cycle duration
months
recovery of bone mineral density
years
increasing energy status =
stimulate anabolic hormones (IGF-1) and bone formation
reverse energy conservative adaptations
recovery of menstrual cycle leads to
increased reproductive hormones
increased estrogen that exerts anti-resorptive effect on bone
recovery of BMD =
increased estrogen continues to inhibit bone resorption
increased energy status will stimulate IGF-1 (anabolic hormones) and bone formation
maternal adaptations to pregnancy (rest)
increased CO, SV and HR
initial decrease in MAP
decrease in TPR
increase in Uteroplacental blood flow
uteroplacental BF ______ during exercise because…
decreases, SNA increases to viscera and reduces or limits absolute BF
but it is WELL TOLERATED in healthy pregnancies
protective fetus mechanisms during exercise
redistribution from uterine wall to placenta
increased in uterine oxygen extraction (a-v O2 difference rises)
fetus maintains or slightly increases umbilical flow
decreased fetal activity
fetal growth is highly dependent on _________
maternal glucose
when in pregnancy is there a higher risk of hypoglycemia during/after strenuous exercise
in late pregnancy due to decreased liver glycogen stores, increased maternal skeletal muscle glucose utilization, increased demand by fetus
in late pregnancy, how can women avoid hypoglycemia of the fetus during exercise
ingesting carbs during or after exercise
during the first trimester women should not use a
HOT TUB
adaptations that enhance thermoregulation during maternal exercise
downward shift in sweating threshold so there is evaporative heat loss at lower core temps
increased skin BF in pregnancy to enhance heat transfer
increase in VE augments heat loss from respiratory tract
what does moderate exercise do for previously sedentary pregnant mothers
improves physical fitness
enhances metabolic and cardiopulmonary capacities
what exercise is recommended for pregnant women
light to moderate aerobic exercise 20-40 min bouts
will not increase risk of premature labor
cause fetal growth retardation
or alter fetal development
trained women who continue with strenuous exercise during pregnancy
volume is reduced as pregnancy progresses
maternal/gain of weight was less
babies were lighter with decreased adiposity
less labor pain and shorter labor
babies have normal growth and development
exercise _____ glucose tolerance
improves so there is less risk for gestational diabetes
during pregnancy when should you not abruptly increase intensity
before week 14 or after week 28
don’t use standard ______ training ranges to prescribe exercise intensity for pregnant women
HR
after 4 months, avoid exercise in the _____ position
supine
how to limit risk of future urinary incontinence after birth
initiation of pelvic floor exercises immediately postpartum
exercise _______ effect lactation
does not
Exercise Prescription in Pregnancy: Frequency
≥3-5 days/week
Exercise Prescription in Pregnancy: Time
around 30 min/session to total >150 min/week of moderate or 75 min/week of vigorous
Exercise Prescription in Pregnancy: Intensity
moderate 3-5.0 Mets RPE 12-13 Talk test or could be vigorous
Exercise Prescription in Pregnancy: intensity and type for women who exercise vigorously prior to pregnancy
REP 14-17
≥ 6 METS
dynamic and rhythmic using large muscle groups
intensity of resistance training during pregnancy
2-3/week
8-10, 12-15 RM weight that elicits moderate fatigue
during pregnancy and resistance training avoid..
isometric and valsalva maneuver
supine position after week 16 or 4 months (at second trimester)
Discontinue exercise during pregancy if
vaginal bleed, regular painful contractions
leak of amniotic fluid
dyspnea before exertion, dizziness, HA
chest pain, mm weakness that affects balance or
calf pain/swelling
contraindications to exercise during pregancy
pregnancy induced HTN or preeclampsia
pre-term rupture of membranes
preterm labor during the prior or current pregnancy or both
incompetent cervix
persistent bleeding during last 2 trimesters
intrauterine growth retardation
higher order pregnancy (triplets)
uncontrolled T1DM, HTN or thyroid disease
serious CV, respiratory or systemic disorder like Addison’s or RA
what type of pulmonary disease limit exercise intolerance
obstructive (high airway resistance/obstruction)
restrictive (fibrosis-loss of alveoli, non-compliant lung)
chest wall defects (mm weakness/chest wall deformity)
COPD
progressive development of airflow limitation, not fully reversible, caused by chronic inflammation of the airways and lung parenchyma
cause of COPD
long-term exposure to noxious gases and particles
three major mechanisms of COPD
loss of elasticity and alveolar attachments to airways (emphysema)
narrowing of small airways lumen (inflammation and scarring)
excessive secretion of mucus that blocks the airways
COPD is characterized by
high airway resistance (low FEV1%) and high FRC that encroaches on inspiratory capacity , harder work of breathing and muscles are mechanically inefficient
skeletal muscle deconditioning or myopathy
LOW VO2Max , lactic acidosis at low work rates, energy for breathing steals blood away from exercising muscles
emphysema
loss of elasticity (elastic recoil)
increased compliance of the lung) leads to hyperinflation of the lungs –> barrel chest (increased chest wall diameter
limiting symptom at rest and during exercise in COPD
dyspnea = perceived difficulty or distress in breathing
SOB
breathing during exercise with COPD
increased work of breathing due to obstruction and inefficient breathing mechanics
poor V/Q matching so there is higher VE at any absolute work rate to eliminate CO2 and maintain PaO2
why are some COPD patients limited by leg fatigue during exercise and not dyspnea
the cost of breathing steals blood away from exercising muscles
Decreasing Dyspnea
bronchodilation
oxygen therapy (decreased VE, dyspnea, hyperinflation and improves metabolic status)
exercise therapy
most of the disability in COPD is related to _____________
concurrent deconditioning and disease- related muscle dysfunction
muscle dysfunction in COPD
low mm mass and strength
low muscle aerobic enzymes and capillary density
decreased OBLA
slow rise in VO2 at exercise onset - rely on anaerobic metabolism (reach steady state later)
those with COPD, exercise can improve
exercise tolerance muscle function
mechanisms underlying muscle dysfunction in COPD
deconditioning
malnutrition
skeletal muscle myopathy
low circulating androgens
can exercise reverse progression of disease pathology of COPD
no but can increase the exercise capacity
benefits of regular exercise for those with COPD
improve functional capacity of daily tasks
reduce VE during submax exercise
shift OBLA to higher intensity by increasing skeletal muscle aerobic capacity (oxidative capacity)
improved coordination and economy, respiratory mm endurance, improved work toleranc and reducing dyspnea
what should be used for COPD patients with severe exercise induced hypoxemia
oxygen supplementation
what is always included in exercise testing for those with pulmonary disease
measurement of arterial oxygenation
pulse ox for SaO2 or arterial blood gases PaO2 or PaCO2
exercise testing with pulmonary disease should take pulmonary function measurements ____
and should include _____
before during and after exercise
static/dynamic lung function and respiratory mm tests
intensity for exercise prescription in COPD
can’t use age predicted HRmax or HRR
use dyspnea or symptoms to adjust
what RPE scale should be used for COPD patients during exercise
0-10
resistance training recommendations in COPD
2-3 nonconsecutive days/week
60-70% of 1RM for beginners and ≥80% of 1RM for experienced lifters: 2-4 sets, 8-12 reps
Endurance= <50% 1RM, 1-2 sets of 15-20 reps
oxygen supplementation is indicated during exercise if what values occur (PaO2, SaO2 and titrate O2)
PaO2 <55mmHg
SaO2 <88%
titrate O2 > 90%
Exercise induced bronchospasm
15% or greater post exercise reduction of FEV1 or peak expiratory flow rate
when can EIB occur
in those with chronic asthma or in persons with no evidence of asthma at rest
symptoms of EIB
wheezing chest tightness SOB cough mucus production need to stop exercising
conditions that evoke EIB
cold, dry air
pollens, dust and air pollution
more intense and long duration exercise
causes of EIB
mast cell release
release of bronchoconstrictor substance
airway fluid loss during conditioning of dry air
inflammation triggers neurally-mediated constriction or acts directly on smooth muscle
what inhaler is used for EIB
Beta-2 antagonist at least 15 min prior to exercise
