Exercise In Special Groups Flashcards
What are the three main areas of benefit of exercise in CHD?
Prevention of cardiac events during physical exertion (double edged sword)
The prevention of atherosclerotic lesions becoming large or unstable
The prevention of accumulation of cardiac risk factors
What level of intensity is required to cause adaptation and reduced risk of CHD?
Greater than 50% of peak aerobic capacity, which us probably more than just including activity into their daily lifestyle. In the severely unfit this may be enough
What are the most important risk factors in predcting risk of CHD?
Inactivity, cholesterol (> obesity, diabetes, HTN etc(
How many kcals should an individual spend a week to reduce risk of cardiovascular disease ?
More than 1000 kcals a week ( equivalent to walking 1.5 miles a day), those who expend between 1500 and 2000 halted a regressed their atherosclerosis.
What are the four categories of cardioprotectice effects of exercise ?
Anti atherosclerotic- improved lipids, lower BP, reduced adiposity, Increased insulin sensitivity, Decreased inflammation
Anti thrombotic- Decreased platelet adhesiveness, increased fibrinolysis, Decreased fibrinogen, Decreased blood viscosity.
Anti ischaemic- Decreased myocardial O2 demand, Increased coronary flow, Decreased endothelial dysfunction, Increased nitric oxide
Anti arrythmic- Increased vagal tone, Decreased adrenergic activity, Increased HR variability.
How does exercise training help people with COPD?
There is a reduction in Ventilatory requirement for a given intensity of exercise and a reduction in the intensity of dyspnoea associated with a given level of ventilation. A reduction in the Ventilatory requirement of a given task also leads to a reduction in dynamic hyperinflation. These things are likely the result of improvements in Respiratory muscle function which leads to a reduction in inspiratory motor drive required to deliver a given level of ventilation.
How should exercise be prescribed to individuals with OA or Ra?
Initially allow the individual to have the option to control their own pace, a combination of non weight bearing and weight bearing activities, 2-5 times a week. Aim for 5 minutes per session to start then gradually increase. Progress towards 60-80% of HR maximum.
How should stretching and flexibility be trained in individuals with arthritis?
Aim to decrease pain and stiffness, improve gait. Maintain or increase joint range of motion.
Mode: active range of movement exercise and muscular stretches and/ or tai chi, yoga, regular walking.
Frequency- per movement 1-3 reps, one to two times a day, 3-5 times a week. Hold for 5-8 seconds.
Intensity- within pain free range of movement progress towards graded exposure to pain, stiffness and mobility limitations.
What benefits does exercise have for people with arthritis?
Improved functionality, reduced pain and improved coping strategies
What physiological changes occur in pregnancy?
Increased concentrations of oestrogen and progesterone promote B cell hyperplasia and thus greater insulin sensitivity and secretion. This causes increase in maternal adiposity until late gestation where fetal energy requirements increase.
Abdominal protrusion, upward displacement of the diaphragm. Flattening of the lower back and forward displacement of centre of gravity as well as ligament laxity can lead to back pain.
Increased aldosterone secretion leads to sodium and water retention causing a 40-50% increase in blood volume, red cell mass increases by 17-25%.
Systolic and diastolic BP falls during the first semester but rises towards term.
Cardiac output rises by about 40% during the first trimester due to I creased HR and stroke volume.
Venous return is reduced in the 3rd trimester due to mechanical compression of the vena cava
How does pregnancy affect exercise
Hr, SV, cardiac output, tidal volume and minute ventilation are greater, PCO2 and pH are lower. BP responses are unchanged. Weight dependent activities elicit an increased oxygen cost.
Absolute VO2 max is unchanged throughout pregnancy but expression of VO2 max relative to body mass indicates a declining maximal aerobic capacity throughout pregnancy.
Peak exercise Respiratory exchange ratio, blood lactate concentration and excess port exercise oxygen consumption are all reduced in pregnancy
What are the exercise guidelines during pregnancy?
Avoid abdominal trauma, exercising in the heat or in the supine position, exercising above 6000 feet and breath holding activities, vigorous activity should be avoided.
150 minutes of moderate activity / week.
How does ageing affect body fat?
It increases. The accumulation of 15kg of body fat in a 70kg man reduces oxygen transport by 18%!
What does ageing do to the cardiovascular system?
There is a reduction in mitochondrial volume and oxidative enzyme activity of cardiac muscle cells
There is a reduced ability of the heart to supply the working muscles with sufficient oxygen due to reduced cardiac output and maximal stroke volume , a decrease in sympathetic sensitivity and some loss of contractility
The heart becomes slightly hypertrophic and hyporesponsive to sympathetic stimuli
The aorta and other major arteries become elongated and stiffer, evidence of endothelial dysfunction and atherosclerosis
What does ageing do to the lungs ?
Total lung capacity does not change but FRC and residual volume both increase so IC and VC both decline with age.
There is a loss of elasticity in alveoli, decline is static recoil pressure and a tendency for the Airways to close at smaller lung volumes. This causes a decline in FEV1, FVC
