Exercise in the Management of Medical Conditions

Question 1

What are the current NICE guidelines for HTN?

• what are the diagnostic criteria
• how would you manage this?

Answer 1

Clinic BP 140/90+

• offer ABPM, HBPM
• assess CV risk and assess target organ damage

If over 135/85 => lifestyle interventions
if over 150/95 => antiHTN meds + lifestyle interventions

Question 2

Compare the relative efficacy of lifestyle interventions and medications to lower BP

• exercise
• diet
• relaxation strategies
• alcohol, salt reduction
• medications

Answer 2

Lifestyle factors decrease SBP, DBP fractionally but the CVD risk falls significantly

Physical activity is better than any single drug in multiple disease prevention

Question 3

What are the current NICE guidelines for non specific low back pain
What interventions are useful
What are ineffective

Answer 3

Staying physically active, exercising
Tailored exercise programme
-group or individual
-aerobic endurance, muscle strengthening, postural control, stretching

Ineffective interventions

• lifting programs
• back education
• stress management
• lumbar supports, shoe inserts

Question 4

What medical conditions benefit from exercise

Answer 4

Cancer
CVD, PAD, stroke
HTN
COPD
MH
Pre/post surgery
T2DM
Obesity
Dementia
OA/RA

Question 5

What are the barriers to physical activity

• environmental
• behavioural attributes and skills
• physical activity
• psychological
• social, cultural
• demographic, biographical

Answer 5

Environmental

• lack of facilities, infrastructure, safety
• weather

Behaviour, skills

• personality
• personal experience

Physical activity
-intensity and enjoyment

Psychological
-attitudes, knowledge, intentions

Social, cultural

• group cohesion
• family, doctor’s influence

Demographic, biological
-age, gender, education

Question 6

How would you take a 2 pronged approach to promoting exercise

Answer 6

Doctors, health professionals => individual

Public Health, community interventions => population

Question 7

Why is physical activity so important in mortality risk?

Answer 7

The greater time taken sitting => increased mortality

Increased CV fitness => decreased mortality

Question 8

What is physical fitness

Answer 8

Carry out daily tasks without fatigue with enough energy to enjoy leisure time activities and respond to emergencies

• aerobic power
• skeletal muscle endurance, strength, power
• flexibility, balance, speed, reaction time
• body composition

Question 9

What is physical activity

How does this differ from exercise

Answer 9

Bodily movement produced by contraction of skeletal muscle that increases energy expenditure above a basal level

Subcategory that is planned, structures, repetitive and purposeful => improvement or maintenance of components of physical fitness

Question 10

How does strength and power change with age

-how does this link to the amount of independence

Answer 10

Initially increases as we become adults

Decreased strength and force => decreased velocity

• decline is not linear
• once we fall under the threshold for independence => loss of independence
• can fall under this due to illness/falls

Question 11

What is sarcopenia
What are the age related changes in muscle size and quality
-what changes are associated with this

Answer 11

Loss of muscle fibres, atrophy
Increased fat infiltration => BUT THERE IS A GREATER DECREASE IN FORCE

Changes in anabolic hormones
-low GH, T

Metabolic dysregulation
-increased ROS

Inflammation => increased protein degradation

Anabolic resistance to feeding and exercise => decreased protein synthesis and regeneration (falling satellite cells)

Question 12

What is the set point theory of ageing

Answer 12

Absolute set point declines with age so level of physical activity needed to reach this falls
-there is a breakpoint at around 70 where your physical limits increase significantly

At your set point

• inherent ageing occurs
• health is better maintained
• morbidity compressed

Below your set point => insufficient physical activity interacts with ageing
-increased morbidity

Above set point
-no further gains to health or ageing trajectory but enhanced athletic performance possible

Question 13

How might the FEV1/FVC ratio change in an older adult at their set point

Answer 13

May be interpreted as obstructive as FVC is higher than others their age with reduced physical activity

Question 14

What are the benefits of strength training and physical activity in older adults

What are the goals for this

Answer 14

Reduced muscle atrophy and wasting
Reduced inflammageing

To support older adults achieve their own motor goals
Reduce rate of hospitalisation
Can only address inactivity related issues

Cannot reverse ageing, can only improve deconditioning from physical inactivity