Exam 6 (Exercise Physiology, Vital Signs, GI and Endocrine Phys.) Flashcards
Importance of Vital Sign Assessment
1) Establish a baseline
2) Monitor responses to rest and progressive work/activity
3) Identify status of vital organ function
4) Determine need for further testing
5) Establish parameters for exercise/activity
4 Vital Signs
1) Temperature
2) HR
3) BP
4) Respiratory Rate
Normal HR values
· Adult: 60-100bpm
· Infant (1-12mo): 100-120
· Children (1-8yr): 80-100
· Tachycardia > 100
· Bradycardia < 60
Pulse/HR Assessment
1) Rate
2) Rhythm (regular vs irregular)
3) Amplitude or quality
- thready, normal, bounding
4) Assess symmetry by assessing bilaterally
Predicted Maximal HR
220- age = HR max
HR Response to Exercise
Increase of 10 (+/- 2) BPM per MET (untrained individuals)
HR Reserve and Target HR
· HR Reserve: Max HR - Resting HR
· Target HR: ((HR Reserve) x (%)) + Resting HR
HR Recovery
· (HR Peak - HR after 1min of recovery)
· Normal: HR decreases by 12 or more beats after 1min OR 22 beats after 2mins
What is HR?
Amount of myocardium contractions per minute
What is Blood Pressure (Systolic vs Diastolic) ?
· BP: indirect measure of pressure on the arterial walls as the heart contracts and relaxes
- BP= CO x PVR
· Systolic BP: force against arterial walls during ventricular systole contraction)
· Diastolic BP: force against arterial walls during ventricular diastole (relaxation)
Importance of measuring BP? (BP = CO x PVR)
· Measurements reflect:
- CO
- Vascular resistance
- Blood volume and viscosity
- Ability of vascular walls to expand and contract
- Critical perfusion (MAP)
Normal BP Range
· Systolic: <120 mm HG
· Diastolic: <80 mm HG
What determines a cell’s sensitivity to a hormone?
· Number of receptors (which can change over time)
Primary vs Secondary Endocrine Disease
· Primary: originates in the specific gland
- ex: Primary Hyperthyroidism is a result of defect in the thyroid itself
· Secondary: change in one organ as a result of disease in another organ
- ex: TSH- secreting pituitary adenoma
Clinical Presentations SPECIFIC to Type 1 Diabetes
· Polyphagia (excessive hunger)
· Weight loss
· Ketonuria
Hyperglycemia Clinical Symptoms
· Frequent urination
· Excessive thirst
· Lethargic
· Blood glucose > 240 mg/dl
Hypoglycemia Clinical Symptoms
· Nervousness
· Tachycardia
· < 70 mg/dl
Leading cause of blindness in adults?
Diabetic Retinopathy
What does gestational diabetes increase the risk of developing?
Type 2 Diabetes
Energy substrates and clinical relevance to exercise testing a patient with COPD?
Energy substrates produce CO2 so its important to help patients alter eating habits to manage metabolism and thus decrease the amount of CO2 being produced
MET
· Energy expended solely to stay alive
· Can convert VO2 level to MET and then to activity
· Used to identify a patient’s capacity and make reommendations
· 1 Resting MET = 3.5 mlO2/kg/min
* Ability to perform basic ADL’s is 3.5-4 METS
· MET = VO2 / 3.5
How does CV function limit maximal VO2?
1) oxygen delivery alteration (ex: hypoxia)
2) Increase VO2max with training due to increased CO but not increased a-vO2 difference (need to improve avo2)
3) Over-perfusion of smaller muscles
What’s the best indicator of aerobic performance?
· Lactic acid
· In trained individuals, the onset of lactic acid occurs much later into exercise (occurs at 80% of VO2max)
What happens to cardiac output during exercise?
Increases mostly due to HR (bc stroke volume only really increase significantly then in the beginning before it plateus then HR is what allows for progression to stages)
What happens to cardiac output around 160-180 bpm?
CO begins to decrease because you’re at peak EDV and the heart can’t fill/contract any faster
CV Response to UE exertion?
· Valsalva maneuver is more likely to occur (increasing intra-thoracic pressure for stability)
· UE = smaller muscle mass so more of the body is not exercising thus experiencing a greater amount of vasoconstriction
· Increased HR and systolic BP
Valsalva Effects
· Increase BP
· Decrease venous return
· Reflexive tachycardia
· Decreased cerebral blood flow
Why does BP increase with age?
Due to decreased vascular compliance/elasticity
What physiological factors increase with age?
1) Systolic and Diastolic BP
2) Residual volume
Mechanotransduction
Process by which the body converts mechanical loading into cellular responses resulting in a structural change
Mechanotherapy
Mechanical loading through exercise can stimulate tissue healing, repair, and regeneration
Skeletal Muscle Anatomy
· Fascicle is a group of fibers
· Endomysium surrounds the individual fibers
· Perimysium is between the fascicle groups
· Epimysium surrounds the fascicle
Tendon and joint function
· Tendons concentrate force to a specific place on a bone
· Absorbs and transmits force with the goal of generating movement
Neuromuscular Junction Function
· Where nerves innervate muscle, the connection/communication between the brain and periphery
NMJ Control Principles
1) All or none principle (stimulus> threshold, depolarizaiton occurs)
2) Size Principle- small motor units recruited before big ones
3) Selective Recruitment Principle- larger muscle groups/fast twitch can be recruited first for certain speed/power tasks
Sliding Filament Theory/ Muscle Contraction process
1) Action potential generated
2) Ca2+ binds to troponin
3) Tropomyosin is removed from blocking the cross bridges
4) Myosin and actin grab each other and create muscle contraction
5) Eccentric lengthening then pulls myosin and actin apart from each other
Muscle Fiber Types
· Type I - small, slow twitch, aerobic, high endurance
· Type IIa - large, fast twitch, anaerobic, medium/high strength/power
· Type IIx - larger, fast twitch, anaerobic, high strength/power
What muscle type and activities would you focus on training for a patient having difficulty with prolonged standing?
· Type I fibers to improve endurance
· Low intensity and long duration CV activity resulting in repetitive muscle firing and better recruitment
Energy System Function
To maximize production of ATP to sustain activity
What energy system would a patient use to complete 1 STS?
Phosphagen System
Energy Systems
· Anaerobic
1) Phospagen
2) Fast glycolytic
· Aerobic
1) Slow glycolytic
2) Oxidative
Glycolysis (Fast vs Slow)
· Breakdown of carbs into pyruvate
· Inverse relationship between duration and intensity
1) Fast glycolysis (anaerobic):
- short to medium term
- moderate to high intensity activities
- 1 glucose molecule produces 2 ATP
2) Slow glycolysis (aerobic) :
- medium to long term
- low to moderate intensity activities
- 1 glucose molecule produces 39 ATP
Oxidative System
· Long term, low intensity
· Can breakdown fat cells which produce the largest volume of energy over long duration
Work:Rest Ratio for high intensity vs low intensity
· High Intensity Ratio > Low Intensity Ratio
· Ex: High Intensity Ratio = 1:12-20, Low Intensity Ratio = 1:1-3
MSK Response to Resistance Training
· Increased muscle size, quality, and length
· Fiber Type Transitions
· Tendon, bone, cartilage remodeling
Endocrine Response to Resistance Training
Improved muscle size and strength
Exercise Movement Types
1) Core/Compound/ Primary
- multi-joint
- foundational movements
- ex: squat, lunge, hinge, step up, pull
2) Assistance/Secondary
- single joint
- support the foundational movements
- ex: LAQ, bicep curl
3) Structural
- axial load
- ex: back squat where axial load is applied on the spine vis the barbell
4) Power
- rate of force development
- ex: hang clean, kettlebell swing, plyometrics
OKC vs CKC
· OKC- distal limb free and trunk/proximal limb is fixed, origin fixed while insertion moves
ex: Bench press, pec major origin stays still while the insertion moves closer to the origin on the way down and away from the origin on the way up
· CKC- distal limb fixed and trunk/proximal limb is free to move, insertion is fixed while origin moves
-ex: push up
Is using a TB for PF/DF exercise considered weight-bearing across the tibia?
No, there is compressive loading but it is not due to weight bearing
If a patient is showing improvements in performance in a short period of time, what is that most likely a result of?
· Improved NM efficiency or NM performance (better timing, pattern, recruitment)
· NOT a result hypertrophy or strength bc those take much longer to occur
What changes occur quicker in response to resistance training, NM or MSK?
NM
Graded Exercise Test (GXT)
Cardiopulmonary exercise testing (CPET or CPX) with progressively increasing workloads that follow specific protocols
Field Tests
Submaximal tests that involve modalities that are more accessible in a clinical setting (ex: 1.5 mile run/walk test, 6 MWT, step tests)
Maximal vs Submaximal Test
· Maximal: requires maximal effort to the point of volitional fatigue
· Submaximal: NO volitional fatigue required, purpose is to determine HR responses to submax work rates
What is the relationship between O2 uptake and work load?
O2 increases with work load at the same rate
Risk Stratification (predicted risk for for clinical populations with known CVD during exercise)
· Categories (low, moderate, high) are based on presence and type of arrhythmias, EF, and baseline symptoms
* Type of symptoms and type of disease are very important
For individuals with CAD, what can rate-pressure product (RPP) indicate?
· It can indicate myocardial ischemia
· RPP can be used to guide future treatments by not allowing patients to go beyond that threshold and thus avoid an ischemic events
What happens when there is a decrease in RPP (ex: 20000) ? (Normal values at peak exercise are 25,000 - 40000)
A decreased threshold means symptom onset occurs sooner do to increased O2 demand
Why is an active cool down important for BP?
A sudden stop in exercise may cause a drop in BP do to venous pooling thus an active cool down may help prevent this
Bruce Protocol vs. Naughton Protocol (Incremental Exercise Tests)
· Bruce Protocol: incremental increase in BOTH speed and grade at each stage (3min stages)
* Better at assessing intensity
· Naughton Protocol: increase in only grade at each stage (2min stages)
When would you need a physician present during exercise testing?
Only for clinical populations (NOT healthy populations)
Benefits of HR max, VO2 max, and RPE/angina/claudication scales for exercise prescription
· HR max and VO2 max can determine target training zones
· RPE/angina/claudication can identify tolerable intensity
GI Disorders Signs and Symptoms
· Dysphagia (difficulty swallowing)
· Heartburn
· Nausea and vomiting
· Diarrhea
· Constipation
· GI Bleeding
· Abdominal pain
Leading cause of liver cancer?
Viral hepatitis
RUQ vs LUQ pain
· RUQ: gallstones
· LUQ: chronic pancreatitis
WHat is the primary fuel during high intensity exercise
Carbs
What is the primary fuel used by CNS, RBCs, and WBCs?
Glucose (converted from glycerol)
White vs Brown Adipose Tissue
1) White: few mitochondria, uniocular fat droplet, energy STORAGE
2) Brown: abundant mitochondria, multiocular fat droplets, energy EXPENDITURE
What happens during weight gain vs loss?
Hypertrophy or decrease in size of adipocytes
Subcutaneous Fat
Can increase in size and #
Hormones Released with Adipose Tissue
1) Leptin: controls appetite
- released by adipokines
- increased with obesity
2) Adiponectin: stimulates glucose utilization and fatty acid oxidation
- released by adipokines
- inversely related to obesity
3) Ghrelin: signals hunger and energy insufficiency
- released by endocrine cells
- overactive in obesity
BMI Formula
Weight (kg)/Height (m^2)
Obesity BMIS
· Overweight: 25-29.9 kg/m^2
· Obesity Class I: 30-34.9
· Obesity Class II: 35-39.9
· Obesity Class III: 40+
