Exercise Prescriptions & Hydrotherapy

Question 1

What percentage of adults are insufficiently active globally, contributing to health issues like heart disease and type 2 diabetes as of 2024?

A) 10%
B) 25%
C) 50%
D) 75%

Answer 1

Correct Answer: B) 25%
Rationale: The text specifies that over 25% of adults are insufficiently active globally, leading to health problems.

Rationale for Wrong Answers:

A) 10%: This underestimates the prevalence of physical inactivity.
C) 50%: This overestimates the actual percentage stated.
D) 75%: This is an exaggerated figure not supported by the text.

Question 2

Why is exercise counselling important in clinical practice?

A) To replace medication in treating all conditions.
B) To improve patient adherence to medications.
C) To guide patients toward healthier lifestyles and improve outcomes.
D) To ensure patients meet weight loss goals.

Answer 2

Correct Answer: C) To guide patients toward healthier lifestyles and improve outcomes.
Rationale: Exercise counselling helps clinicians support behaviour change, improving patients’ quality of life and health outcomes.

Rationale for Wrong Answers:

A) To replace medications with physical activity: Exercise complements, not replaces, medication in most cases.
B) To achieve weight loss in all patients: While exercise aids weight loss, its benefits extend beyond this.
D) To prioritize physical health over mental health: Exercise benefits both mental and physical health.

Question 3

What is one outcome of this exercise counselling lesson?

A) Memorizing fitness guidelines
B) Critiquing and applying research to a patient case
C) Teaching patients advanced training methods
D) Prescribing only aerobic exercises

Answer 3

Correct Answer: B) Critiquing and applying research to a patient case
Rationale: One of the learning objectives explicitly includes critiquing and applying research. Other options (e.g., memorizing guidelines, teaching advanced methods) are not mentioned in the context of this lesson.

Question 4

What is the primary approach to exercise counselling?

A) Focus solely on physical activity guidelines.
B) Take a patient-centered, tailored approach.
C) Recommend the same plan for all patients.
D) Avoid discussing physical activity in routine care.

Answer 4

Correct Answer: B) Take a patient-centered, tailored approach.
Rationale: The text emphasizes tailoring exercise counselling to individual patient needs as part of a patient-centered approach. Options A, C, and D neglect this individualization or discourage routine integration.

Question 5

Which step in the 5A’s framework involves assessing a patient’s physical activity level?

Answer 5

Correct Answer: B) Assess
Rationale: “Assess” focuses on understanding a patient’s current activity level to inform the exercise plan.

Rationale for Wrong Answers:

A) Ask: While it initiates the conversation, it doesn’t involve evaluating current activity.
C) Advise: This step involves giving recommendations, not assessment.
D) Arrange: This involves follow-up planning, which comes after assessment.

Question 6

What tool can be used to efficiently assess physical activity levels?

A) Heart Rate Monitor
B) Physical Activity Vital Sign (PAVS)
C) Pedometer
D) Borg Scale

Answer 6

Correct Answer: B) Physical Activity Vital Sign (PAVS)
Rationale: PAVS is explicitly mentioned as a brief, efficient tool for assessing activity levels.

Rationale for Wrong Answers:

A) Heart rate monitor: While helpful for tracking exercise, it doesn’t assess overall activity levels.
C) Readiness ruler: This assesses readiness to change, not activity levels.
D) Resistance bands: These are tools for exercise, not assessment.

Question 7

Which behaviour change model focuses on perceived severity, benefits, barriers, and self-efficacy?

A) Transtheoretical Model
B) Health Belief Model
C) Social Cognitive Theory
D) Stages of Change Model

Answer 7

Correct Answer: B) Health Belief Model
Rationale: The Health Belief Model is described in the text as addressing perceived severity, benefits, and self-efficacy.

Rationale for Wrong Answers:

A) Transtheoretical Model: Focuses on stages of change, not perceived factors.
C) Social Cognitive Theory: Centers on observational learning and self-efficacy, not perceived barriers.
D) Theory of Planned Behaviour: Emphasizes attitudes, norms, and intentions, not perceived severity or benefits.

Question 8

What does the “T” in the FITT-VP model stand for?

A) Timing
B) Training
C) Type
D) Time

Answer 8

Correct Answer: D) Time
Rationale: “T” refers to the duration of exercise sessions in the FITT framework.

Rationale for Wrong Answers:

A) Timing: This is not a term used in the FITT framework.
B) Training: While relevant, it doesn’t fit the “T” in FITT.
C) Technique: Important in exercise, but not part of the FITT framework.

Question 9

Which of the following is NOT part of a written exercise prescription?

A) Type of exercise
B) Nutritional supplements
C) Dose of activity
D) Frequency of exercise

Answer 9

Correct Answer: B) Nutritional supplements
Rationale: Exercise prescriptions focus on physical activity, not diet or supplements.

Rationale for Wrong Answers:

A) Type of exercise: A key component of an exercise prescription.
C) Dose of exercise: Refers to intensity and duration, both critical to a prescription.
D) Frequency of activity: Specifies how often the patient should exercise, integral to the plan.

Question 10

What is the recommended duration increase for exercise in the first 4–6 weeks?

A) 1–2 minutes every week
B) 5–10 minutes every 1–2 weeks
C) 15 minutes every 3 weeks
D) 20 minutes every month

Answer 10

Correct Answer: B) 5–10 minutes every 1–2 weeks
Rationale: The text advises gradual progression with small increases in duration over the initial weeks to prevent injury.

Rationale for Wrong Answers:

A) 20 minutes every week: This is too rapid and risks overexertion.
C) 15 minutes every 3–4 weeks: This is slower than recommended.
D) No increase in duration: Progression is necessary to meet activity goals.

Question 11

What is the benefit of using the 5A’s framework in exercise counselling?

A) It eliminates the need for motivational interviewing.
B) It provides a structured approach to encourage and support physical activity.
C) It focuses solely on aerobic exercises.
D) It replaces written prescriptions.

Answer 11

Correct Answer: B) It provides a structured approach to encourage and support physical activity.
Rationale: The 5A’s framework offers a systematic way to address physical activity in patient care. The other options either overstate its role (e.g., replacing prescriptions) or misrepresent its purpose.

Question 12

During the acute phase of an injury (0–72 hours post-injury), what is the most appropriate therapy to apply?

A) Heat
B) Ice
C) Contrast Therapy
D) Massage

Answer 12

Correct Answer: B) Ice
Rationale: Ice reduces inflammation, swelling, and pain during the acute phase.
Rationale for Wrong Answers:

A) Heat: Heat can increase swelling and should be avoided in the acute phase.
C) Contrast Therapy: This is better suited for later stages when circulation enhancement is needed.
D) Massage: Massage is typically contraindicated in the acute phase to avoid aggravating the injury.

Question 13

In which phase of healing is contrast therapy most appropriate?

A) Acute Phase (0–72 hours)
B) Subacute Phase (4–14 days)
C) Chronic Phase (>14 days)
D) Not recommended in any phase

Answer 13

Correct Answer: B) Subacute Phase (4–14 days)
Rationale: Contrast therapy alternates between vasoconstriction and vasodilation, helping to reduce swelling and improve circulation during the subacute phase.
Rationale for Wrong Answers:

A) Acute Phase: Contrast therapy can exacerbate swelling by introducing heat too early.
C) Chronic Phase: Contrast therapy is less effective when inflammation is no longer present.
D) Not recommended in any phase: Contrast therapy is a valid technique for the subacute phase.

Question 14

Heat application is most beneficial during which phase of healing?

A) Acute Phase
B) Subacute Phase
C) Chronic Phase
D) Contraindicated in all phases

Answer 14

Correct Answer: C) Chronic Phase
Rationale: Heat is useful in the chronic phase to increase blood flow, relax tight muscles, and improve tissue extensibility.
Rationale for Wrong Answers:

A) Acute Phase: Heat can worsen inflammation and swelling.
B) Subacute Phase: While heat may be introduced cautiously, it’s not the primary modality.
D) Contraindicated in all phases: Heat has therapeutic value in later stages of healing.

Question 15

. What is the primary purpose of applying heat during the subacute and chronic phases of healing?

A) To constrict blood vessels
B) To increase blood flow and promote tissue relaxation
C) To decrease swelling
D) To prevent further injury

Answer 15

Correct Answer: B) To increase blood flow and promote tissue relaxation
Rationale: Heat improves circulation and helps relax muscles, aiding tissue repair and flexibility.
Rationale for Wrong Answers:

A) To constrict blood vessels: Ice, not heat, causes vasoconstriction.
C) To decrease swelling: Heat is not effective for reducing swelling; it may worsen it in early stages.
D) To prevent further injury: Heat doesn’t directly prevent injury but aids in recovery.

Question 16

Which therapy is most appropriate to reduce muscle spasm in the chronic phase?

A) Ice
B) Heat
C) Contrast Therapy
D) None of the above

Answer 16

Correct Answer: B) Heat
Rationale: Heat helps relax muscles and alleviate spasms by improving circulation and tissue elasticity.
Rationale for Wrong Answers:

A) Ice: Ice is better suited for acute injuries or inflammation but doesn’t relax muscle spasms effectively.
C) Contrast Therapy: While it may have some benefits, heat is more directly effective for spasms.
D) None of the above: Heat is a validated approach for muscle spasms in the chronic phase.

Question 17

What is the primary benefit of contrast therapy in the subacute phase?

A) Reducing muscle tightness
B) Enhancing circulation and minimizing swelling
C) Preventing scar tissue formation
D) Relaxing injured tissues

Answer 17

Correct Answer: B) Enhancing circulation and minimizing swelling
Rationale: Alternating hot and cold applications helps reduce lingering inflammation and promotes blood flow.
Rationale for Wrong Answers:

A) Reducing muscle tightness: This is more effectively achieved with heat.
C) Preventing scar tissue formation: While improved circulation may support healing, contrast therapy is not directly tied to scar tissue prevention.
D) Relaxing injured tissues: Heat alone is better suited for tissue relaxation.

Question 18

Does the 150- 300+ minutes/week (which is 30 -60 mins per day) of moderate intensity aerobic or 75-150 minutes/week of High intensity aerobic exercise (i.e. running, swimming laps) include strength training or is that just aerobic training?

Answer 18

The 150 minutes of aerobic exercise recommendation is specific to moderate-intensity aerobic activity per week (e.g., brisk walking, cycling).

Strength training (e.g., resistance exercises) is not included in these 150 minutes but is recommended in addition to aerobic exercise for at least 2 sessions per week to improve muscle strength, mass, and overall metabolic health.

Question 19

Why would someone with blood sugar > 16.5 mmol/L + ketones be told to avoid exercise?

Question 20

What are the benefits of training beyond the recommended 150–300 minutes of moderate-intensity aerobic exercise per week or 75–150 minutes of vigorous-intensity exercise per week can offer additional health benefits, depending on the individual’s fitness level and goals.

Answer 20

1. Enhanced Cardiovascular Health
   Further reduction in blood pressure and resting heart rate.
   Improved blood vessel elasticity and circulation.
   Lower risk of developing heart diseases and stroke.
2. Improved Weight Management
   Increased calorie expenditure supports weight loss or maintenance.
   Helps reduce visceral fat, which is particularly important for individuals with obesity or diabetes.
3. Enhanced Glycemic Control
   Longer durations of exercise improve insulin sensitivity, allowing better blood sugar regulation.
   Reduces postprandial glucose levels (blood sugar after eating) more effectively.
4. Greater Endurance and Fitness
   Improved aerobic capacity (VO2 max), allowing for better performance in daily activities and exercise.
   Builds greater stamina and muscle efficiency.
5. Psychological and Cognitive Benefits
   Reduces stress, anxiety, and depression more effectively with extended exercise.
   May improve cognitive function and lower the risk of dementia.
6. Additional Metabolic Benefits
   Further reductions in triglycerides and LDL cholesterol.
   Increases HDL (good cholesterol) beyond the improvements seen with lower durations.
7. Stronger Musculoskeletal System
   Improved bone density and joint health with prolonged weight-bearing activities.
   Reduced risk of osteoporosis and musculoskeletal injuries.
8. Prevention of Chronic Conditions
   Greater exercise duration lowers the risk of various chronic conditions like certain cancers, Type 2 diabetes, and metabolic syndrome more significantly.
   Caveats of Exercising Longer
   Risk of Overtraining: Excessive exercise without proper recovery can lead to injuries, fatigue, or burnout.
   Diminishing Returns: Beyond a certain threshold, additional health benefits may plateau.
   Individualized Approach: Duration and intensity should align with fitness levels, health conditions, and goals.
   For individuals with diabetes or obesity, exercise plans exceeding the basic recommendations should be implemented cautiously, with medical supervision if necessary, especially if there are complications such as retinopathy or neuropathy.

Question 21

How does ambient temperature affect insulin absorption?

Answer 21

Hot temperatures: Increase blood flow, which can speed up insulin absorption and lead to a higher risk of hypoglycemia.
Cold temperatures: Reduce blood flow, which can slow down insulin absorption, potentially leading to hyperglycemia.
It’s crucial for individuals using insulin to monitor their blood sugar closely and adjust their dose or timing during extreme temperatures.

Question 22

What are examples of autonomic neuropathy, peripheral neuropathy, and how does systolic BP ≥170 affect the eye in those with retinopathy?

Answer 22

Autonomic Neuropathy:

Impaired regulation of blood pressure and heart rate (e.g., orthostatic hypotension).
Gastrointestinal issues like gastroparesis.
Bladder dysfunction.
Loss of awareness of hypoglycemia.

Peripheral Neuropathy:
Numbness, tingling, or pain in extremities (hands and feet).
Increased risk of foot ulcers due to reduced sensation.
Retinopathy and Systolic BP ≥170 mmHg:

High blood pressure can worsen diabetic retinopathy, a condition caused by damage to the small blood vessels in the retina.
Elevated systolic BP increases the risk of retinal hemorrhages, vision loss, and progression to proliferative retinopathy.

Question 23

How does caffeine reduce hypoglycemia?

Answer 23

• Caffeine stimulates the release of adrenaline (epinephrine), which promotes the breakdown of glycogen into glucose in the liver (glycogenolysis).
• This can increase blood sugar levels slightly, acting as a buffer against hypoglycemia.
• However, the effect varies and should not replace other hypoglycemia prevention measures, such as consuming carbohydrates.

Question 24

What is sarcopenia?

Answer 24

Definition: Sarcopenia is the progressive loss of skeletal muscle mass and strength associated with aging.
Implications:
Common in older adults and individuals with chronic diseases like diabetes and obesity.
Can lead to reduced physical function, frailty, and increased risk of falls.
Prevention/Treatment:
Regular resistance training and adequate protein intake can slow or reverse sarcopenia.

Question 25

Can Ketones Enter Muscle Without Insulin?

Answer 25

Yes, ketones can enter muscle cells and provide energy, even in the absence of insulin. Here’s how it works:

Ketone Metabolism: Unlike glucose, ketones (like beta-hydroxybutyrate) do not require insulin to enter cells. Muscle cells can use ketones as an alternative energy source when glucose is unavailable.
Limitation: While this helps provide some energy, it’s not as efficient as glucose metabolism. Additionally, excessive ketone production leads to ketoacidosis, which can overwhelm the body’s buffering systems, causing serious health risks.

Question 26

What is insulin role in exercise and at what blood sugar reading should one not exercise?

Answer 26

Glucose Uptake by Muscles: Insulin is essential for moving glucose from the blood into muscle cells. During exercise, muscles need more energy, and glucose is a primary source.
Without Insulin: In people with Type 1 diabetes or severe insulin deficiency, glucose cannot efficiently enter muscle cells, regardless of how much glucose is in the blood. This leaves the muscles starved for energy.
2. How the Body Compensates Without Insulin
Fat Breakdown: When the muscles cannot use glucose due to lack of insulin, the body starts breaking down fat for energy.
Ketone Production: Fat breakdown produces ketones as a byproduct. Normally, ketones are a backup energy source, but in the absence of insulin, their production becomes excessive, leading to ketoacidosis.
Demand-Driven Escalation: Exercise increases the muscles’ energy demand, which drives even more fat breakdown and ketone production, worsening DKA.
3. Why This Precipitates (Brings About) DKA
Energy Mismatch: The body tries to meet the muscles’ energy needs but fails to utilize glucose properly without insulin. Fat metabolism ramps up, and ketone production spikes.
Hyperglycemia Worsens: Stress hormones released during exercise (like cortisol, adrenaline, and glucagon) signal the liver to release even more glucose into the bloodstream. However, without insulin, this glucose also cannot be used, further raising blood sugar levels.
Dehydration: High blood sugar causes increased urination, leading to dehydration. Dehydration concentrates ketones in the blood, exacerbating DKA.
Key Takeaway
For people with Type 1 diabetes or severe insulin deficiency:

Exercise without adequate insulin doesn’t just fail to lower blood sugar; it can actively worsen the situation by increasing fat breakdown, ketone production, and dehydration.
This is why individuals with blood sugar > 16.5 mmol/L and ketones present are advised to avoid exercise until their insulin and hydration are properly managed.

Question 27

Why is 16.5 mmol/L (297 mg/dL) commonly used as the cutoff for advising individuals with diabetes to avoid exercise?

A) Because exercise always increases blood sugar levels.
B) Because high blood sugar levels above this threshold indicate the risk of dehydration and worsening diabetic ketoacidosis (DKA).
C) Because insulin sensitivity decreases drastically at this level, making exercise ineffective.
D) Because glucose levels below this threshold are always safe for exercise.

Answer 27

Correct Answer:
B) Because high blood sugar levels above this threshold indicate the risk of dehydration and worsening diabetic ketoacidosis (DKA).

Rationale:
At blood sugar levels above 16.5 mmol/L, there is a significant risk of ketone production due to inadequate insulin, especially in individuals with Type 1 diabetes.
Exercise increases the body’s demand for energy. Without sufficient insulin, the body breaks down fats for fuel, producing ketones that can lead to DKA.
High blood sugar also causes fluid loss through frequent urination, which increases the risk of dehydration. Exercise exacerbates this through sweat loss.
This threshold is not because insulin sensitivity decreases or because exercise is ineffective but rather to prevent severe complications like DKA and dehydration.
Choices A, C, and D are incorrect because they either oversimplify or misrepresent the physiological mechanisms involved.

More info:
The 16.5 mmol/L (297 mg/dL) cutoff for avoiding exercise in individuals with diabetes is a general guideline based on clinical observations and safety considerations. Here’s why this threshold is used:

1. Risk of Diabetic Ketoacidosis (DKA)
   At or above 16.5 mmol/L, the likelihood of significant ketone production increases, particularly in individuals with Type 1 diabetes or those with insufficient insulin.
   Exercising at this level can worsen ketone accumulation, as exercise demands energy, and without adequate insulin, the body relies on fat breakdown for fuel. This fat metabolism releases ketones, which can lead to or exacerbate DKA.
2. Dehydration Risk
   High blood sugar levels cause the kidneys to excrete glucose through urine, leading to fluid loss and dehydration.
   Exercise also causes fluid loss through sweat, increasing the risk of dehydration and further exacerbating hyperglycemia and ketone buildup.
3. Safety Guidelines
   Blood sugar levels above 16.5 mmol/L often indicate that insulin levels are inadequate. Without enough insulin:
   Glucose cannot enter cells for energy.
   Exercise further increases stress hormones like cortisol and adrenaline, which raise blood sugar even more.
   Exercise in this state may do more harm than good.
4. Individualized Cutoffs
   The 16.5 mmol/L threshold is a guideline, but healthcare providers may adjust it based on:
   The individual’s diabetes type (Type 1 vs. Type 2).
   Presence of ketones in blood or urine.
   Overall health and exercise tolerance.
   Why Not a Lower Cutoff?
   Blood sugar levels slightly below 16.5 mmol/L (e.g., 13–15 mmol/L) might still allow for safe exercise, provided ketones are absent and hydration is maintained.
   However, levels above 16.5 mmol/L are considered risky enough to warrant avoiding exercise until blood sugar is stabilized.