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Pulmonary Dx > Exercise Physiology > Flashcards

Exercise Physiology Flashcards

1
Q

What is Convective O2 Transport? Determined by?

A
  • Movement of O2 in air or blood

- Hgb, O2 sat, CO

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2
Q

What is Diffusive O2 Transport? Based on? (4)

A
  • Passive movement of O2 down concentration gradient across tissue barriers (alveolar-capillary membrane, between tissue capillaries/cells to mitochondria)
  • Metabolic rate, vascular difference, tissue O2, diffusion distance
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3
Q

What is oxygen demand?

A

amount of O2 required by cells for aerobic metabolism

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4
Q

What is oxygen delivery (DO2)? Is the product of?

A
  • Volume of oxygen delivered to systemic vascular bed per minute
  • Is the product of cardiac output (CO) and arterial oxygen content
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5
Q

What is Oxygen Consumption (VO2)? (2)

A
  • Amount of oxygen that diffuses from capillaries to mitochondria
  • Amount of oxygen a person requires
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6
Q

What is Oxygen Extraction Ratio (OER)? Tissue oxygenation is adequate when?

A
  • O2 delivered/consumed

- Tissue oxygenation is adequate when tissues receive sufficient oxygen to meet their metabolic needs

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7
Q

DO2 = ? Cardiac output (Q)? It help you determine?

A

DO2 = arterial oxygen x cardiac output

Cardiac output (Q)
Q = SV x HR

O2 delivery

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8
Q

Stroke volume is affected by? (4)

A

Pre-load
Myocardial distensibility
Myocardial contractility
Afterload

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9
Q

How can we measure VO2?

A

Difference btwn arterial and venous lines

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10
Q

What is open circuit spirometry?

A

Subject does exercise stress test and is forced to breath in and out through mouth

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11
Q

How do you calculate VO2?

A

1) find volume O2 entering = (VI) x O2 % (convert into decimal)
2) find volume O2 entering = (VE) x O2 % (convert into decimal)
3) VO2 = (VO2 entering) – (VO2 leaving)
4) Convert to mL
5) divide by body weight

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12
Q

What is the Basal Metabolic Rate? Looks at? (5)

A
  • Rate of metabolism for an individual in a completely rested state
  • Work of breathing
  • Heart, renal, and brain function
  • Thermal regulation
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13
Q

What is a MET? 1 MET = ? Formula for energy cost of an activity?

A
  • Amount of oxygen consumed while sitting at rest
  • 1 MET = 3.5 mL 02/kg/min
  • Energy cost of an activity: MET level = VO2/3.5
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14
Q

VO2 Max aka? What is a true max? What is a peak? What happens when a lot of muscle group are working at once? VO2 max is always?

A
  • Often use maximal and peak VO2 interchangeably
  • True max of what body could do if exercising all muscles at once: how much O2 is necessary to make ATP
  • Peak: When body has “had enough”
  • The more muscle groups working at once, the more closely VO2PEAK approximates VO2MAX
  • greater than peak
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15
Q

How does exercise affect both DO2 and VO2?

A

at rest, DO2 is 3/4x greater than O2 demand. with exercise in health person, youre going to have increased metabolic demands, VO2 could increase 20fold depending on the exercise. Blood flow increases to peripheral muscles, blood vessel dilation, increases demand and extraction. increase in DO2 and VO2. Increase in CO

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16
Q

If DO2 declines – what happens to VO2? (2)

A

VO2 will stay the same

It may be different in a critically ill patient, VO2 could fall. Associated with development of anaerobic exercise, which leads to increase in lactic acid

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17
Q

What is O2 debt/deficit? Recovery Oxygen Consumption or Post Exercise Oxygen Consumption (PEOC)?

A
  • Difference b/t O2 body required and what it was able to take in during activity (ex: sudden sprint) = O2 Debt or Deficit
  • Once stop activity & begin to recoverneed more O2 to recover than body has available = PEOC
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18
Q

After a strenuous exercise there are four tasks that need to be completed?

A

Replenishment of ATP
Removal of lactic acid
Replenishment of myoglobin with oxygen
Replenishment of glycogen

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19
Q

Factors that Perturb Oxygen Transport? (3)

A

Gravitational, emotional, exercise stress

20
Q

Exercise does what to left ventricle output? By? (5) LV output must match?

A
  • Left Ventricle (LV) output is increased by increase in HR, increase in SV, increase in contractile pressure – which increases systolic pressure and force of ejection
  • LV output must match LV input
21
Q

How does LV input increase? (4)

A
  • Diastolic filling time is decreased with the increase in HR
  • Rapid and marked decrease in intra-ventricular pressure during diastole – this creates a relative LV ‘suction’ effect.
  • Increase force of systole leads to increased myocardial elastic recoil
  • Acceleration of myocyte relaxation due to increased rate of calcium reuptake by the sarcoplasmic reticulum
22
Q

Changes in exercise response in persons with heart failure? With ischemia? (4)

A
  • LV cannot augment diastolic filling in response to exercise

With ischemia:

  • Lose LV distensibility
  • LV wall stiffness
  • Increased diastolic pressure
  • Increases pulmonary congestion
23
Q

Oxygen diffusion at the tissue level depends on? (6)

A
  • Depends on quantity and rate of blood flow
  • Difference in tissue and capillary O2 pressure
  • Capillary surface area
  • Capillary permeability
  • Diffusion distance
24
Q

What causes oxygen to diffuse more rapidly into exercising cells? (4)

A

Capillary dilation with exercise:

Increases surface area

Reduces resistance to flow

Decreases diffusion distance

25
Q

Energy Transfer Systems - Immediate Energy - is when? Uses? (2) Timing?

A
  • When move from resting state and begin to exercise
  • Use cellular ATP & creatine phosphate in muscle fibers
  • Used in first 10 sec or so of exercise
26
Q

Energy Transfer Systems - Short-term Energy - is when? Uses?

A
  • High intensity, near maximal efforts when immediate energy runs out
  • Anaerobic production of ATP via glycolosis
27
Q

Energy Transfer Systems - Long-term Energy - is when? Uses? Need?

A
  • Moderate intensity activities, sustained physical activity
  • Aerobic production of ATP
  • Need O2 supply to match demand
28
Q

Aerobic metabolism uses? Produces? Occurs where? Requires? Uses? (3) By-product? Yields? Used primarily during?

A
  • Uses oxidative phosphorylation (Krebs Cycle)
  • Produces a lot of ATP, but SLOWER
  • Occurs in mitochondria
  • Requires oxygen
  • Uses carbs, fats, proteins
  • By-products are CO2 and H2O
    Yields 36 (skeletal muscle) or 38 (cardiac muscle) ATP per glucose
  • low, mod exercises
29
Q

Anaerobic Metabolism requires? Uses what macromolecule? Occurs in? By-product is? Uses what cycle? Yields? Used primarily during?

A
  • Does NOT require oxygen
  • Uses ONLY carbohydrates (glucose)
  • Occurs in cytoplasm
  • By-product is lactic acid
    Glycolosis -> doesn’t yield a lot of ATP, but occurs QUICKLY
    Yields only 2 (skeletal muscle) or 6 (cardiac muscle) ATP per glucose
  • Used primarily during high intensity exercise
30
Q

Anaerobic threshold typically at? What is it? (2) Produces? Anaerobic is? Why do you get SOB with this?

A
  • Typically at around 55% of peak VO2 an individual cannot produce all ATP demanded aerobically and will need SOME anaerobic work
  • Intensity beyond which body increases reliance on anaerobic metabolism to meet body’s energy demands
  • Produces lactic acid
  • SOB bc chronic anaerobic metabolism leads to not enough O2 delivery; lactic acid builds up -> trying to blow off CO2 bc you’re trying to increase pH
31
Q

What is Lactate threshold (LT)? Anaerobic threshold (AT)? (3) Ventilatory threshold (VT)? (3)

A

Lactate threshold (LT)– lactic acid being produced faster than it is metabolized

Anaerobic threshold (AT)– results from increase in blood lactate

  • OBLA = onset of blood lactate accumulation
  • O2 suppy is no longer in proportion to delay

Ventilatory threshold (VT)– results from lactic acid broken down into lactate and H+ → increase in CO2 → increase in ventilation

  • Sudden, heavy ventilation
  • H are neutralized and biproduct is CO2
32
Q

What is the formula for Metabolic Respiratory Quotient (RQ)? Used in? AKA? At rest you burn more? Max RQ?

A
  • RQ = CO2 produced / O2 consumed
  • Used in calculations of BMR (when estimated by CO2 production)
  • AKA: Respiratory Exchange Ratio (RER)
  • At Rest you burn more carbs than fat
  • ~1.15 after strenuous exercise
33
Q

Pulmonary pts prefer what kind of diet?

A

High fat, low carb bc less CO2 is produced

34
Q

Max TV reached?

A

50-60% VC then RR has to adjust

35
Q

Physiologic Changes with Exercise: HR - normal? (2) Abnormal? Adaptation to training? (2)

A

Normal: increases in linear fashion with the work rate and oxygen uptake during exercise
- Increase in HR has expense of decreased diastole rather than systole

Abnormal: lack of linear increase in HR with increased work or VO2

  • Adaptation to training: lower resting HR
  • HR with max exercise is the same or slightly lower
36
Q

Physiologic Changes with Exercise: SV - normal? (4) Abnormal? Adaptation to training?

A
  • Increases curvilinearly with work
  • Max around 50% aerobic capacity
  • Causes increased ejection fraction (EF)
  • diastolic stays the same or decreases, more reflective of peripheral resistance
  • Abnormal: depressed SV or impaired increase in SV with work due to impaired ventricular compliance
  • Adaptation to training: SV and EF will increase
37
Q

Physiologic Changes with Exercise: Cardiac Output - normal? Abnormal? Adaptation to training?

A

Normal: increases linearly with increased work due to increase in HR and SV

Abnormal: failure to increase linearly with work rate

Adaptation to training: max level will increase

38
Q

Physiologic Changes with Exercise: BP - normal? Abnormal? (2) Adaptation to training?

A

Normal: SBP increases linearly with CO during exercise; DBP should either remain constant or decrease slightly

Abnormal: sudden sharp rise in SBP or lack of increase with exercise; DBP increase (>10mmHg) or drop sharply (>20mmHg)

Adaptation to Training: in healthy people SBP should remain the same
- Only pt with HTN should get decrease in resting SBP with training

39
Q

Rate Pressure Product (RPP) formula? Important to monitor with whom? Strong correlation btwn? Reflects?

A
  • RPP = HR x SBP (r=.9 with MVO2)
  • Very important to monitor during exercise with patient with heart disease
  • Strong correlation b/t RPP and myocardial O2 consumption
  • Reflects cardiac function = one way to monitor exercise in heart disease
40
Q

Physiologic Changes with Exercise: RPP - normal? Abnormal? (2) Good marker of? Adaptation to training?

A

Normal: would increase with work rate

Abnormal: does not increase with work rate
If no increase, NOT tolerating ex session well and at risk for ischemia

Good marker of myocardial ischemia

Adaptation to training: Resting RPP may decrease over time – same at max effort

41
Q

Physiologic Changes with Exercise: A-V O2 difference reflects? Abnormal? Adaptation to training?

A
  • Reflects ability of skeletal muscle to extract oxygen

Abnormal: impaired ability to extract oxygen

Adaptation to training: improved ability to extract oxygen, so can increase exercise tolerance independent of central hemodynamic changes

42
Q

Physiologic Changes with Exercise: VO2 max - normal? Abnormal? With training?

A

Normal: can increase resting oxygen consumption 10 fold

Abnormal: inability to increase oxygen transport with increased energy demands

With training: can increase resting oxygen consumption 23 fold (endurance athlete)

43
Q

Lactate threshold is commonly associated with? What happens to blood lactate? With training? (2)

A
  • The onset of significant anaerobic contribution to exercise metabolism
  • Blood lactate is buffered during exercise to maintain a tolerable acid-base balance
  • With training: increased capacity to buffer and tolerate lactate
  • Training increases the anaerobic threshold
44
Q

Peripheral Changes in Response to Training? (3)

A

Increased capillary density

Increased oxidative enzymes

Increased mitochondria

45
Q

Effects of Bed Rest and Immobilization on Exercise Tolerance? (6)

A
  • Absence of gravitational and exercise stress
  • Resting tachycardia
  • Reduced cardiac output (Q)
  • Reduced VO2 max
  • Reduced blood volume
  • Reduced oxygen extraction at the tissue level
46
Q

Pulmonary Complications of Bed Rest? (5)

A
  • Reduced lung volumes and capacities
  • Decreased thoracic volume
  • Restricted chest wall motion
  • Increased thoracic blood volume
  • Increased blood viscosity and decreased venous flow result in increased risk of embolic event

Pulmonary Dx (5 decks)

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