Exercising for successful Aging

Question 1

what factors contribute to successfula aging?

Answer 1

Factors that contribute to successful aging:

1. minimize risk of Disease and disability
2. Maintain physical and cognitive function
3. continue engagement with life
4. Maintain positive spirituality

Question 2

Describe the current “Graying of America” and how there have been changes to percentage of elderly that make up the population. Also discuss which individuals survive longer.

Answer 2

The Graying of America:

• Elderly person (> or equal to age 85) make up the FASTEST GROWING segment of American society
• 13% of the U.S. populate exceed age 65 and by the year 2030, 20% will exceed age 85.
• Persons with more HEALTHFUL Lifestyles Survive longer. and the risk of disability and necessity to seek home health care is postponed and compressed into fewer years at the end of life

Question 3

Describe the health consequences of physical inactivity

Answer 3

Physical inactivity relates casually to nearly 30% of all deaths from heart disease, colon cancer, and diabetes.

Question 4

Explain what entails of the “New Gerontology”, including what health span is and what gerontologists consider successful aging to include.

Answer 4

The New Gerontology:
goes BEYOND age-related diseases and prevention to include concept of “Healthspan”
Healthspan- Total number of years a person remains in excellent health
-Gerontologists consider successful aging to include:
-Physical health
-Spirituality,
-Emotional and Educational Health
-Social Satisfaction

Question 5

What is primary goal of aging?

Answer 5

VITALITY is the primary aging goal.
(NOT longevity)
-it is important to not just live longer, but live a LONG, HEALTHY life.

Question 6

Describe what Health Life Expectancy is, including the disability adjusted life expectancy any how it relates to it.

Answer 6

Health Life Expectancy- EXPECTED number of years living with full health
-it involves Disability-Adjusted LIfe expectancy (Years of ill health, weighted according to severity and subtracted from expected overall life expectancy

Question 7

What lifestyle behaviors add years to life?

Answer 7

Lifestyle behaviors that add years to life:

• No smoking
• Drink Moderately
• Keep physically active

Question 8

What is the Healthy Life Expectancy for people in the U.S. ?

Answer 8

70 years old

Question 9

Define all physical activity terminology such as Physical activity, exercise, physical fitness, Health, health-related physical fitness and Longevity.

Answer 9

Physical activity terminology:

• Physical activity: body movement produced by muscle action that increases energy expenditure
• Exercise- Planned, structured, repetitive and purposeful physical activity
• Physical fitness: Attributes related to how well one performs physical activity
• Health: Physical, mental and social well-being, NOT simply absence of disease
• health-related physical fitness: Components of physical fitness associated with some aspect of good health and or disease prevention
• Longevity- Length of life.

Question 10

What are the major components of Health-related physical fitness?

Answer 10

Major components of Health-related physical fitness:

1. Cardiovascular (aerobic) fitness
   - keep heart rate up (help keep tissue healthy and get nutrients)
2. Flexibility of the lower back and hamstrings
3. Abdominal muscular strength and endurance
4. body composition (lean to fat ratio)
   - keeping fat-free mass up, and maintain healthy fat levels

Question 11

Describe the different methods that assess physical activity. Also discuss why it is difficult to have for getting estimates of physical activity from large groups

Answer 11

Different methods assess physical activity:

• direct and indirect calorimetry, self-reports, job classifications, physiologic markers, behavioral observations, mechanical or electronic monitors, and activity surveys.
• Obtaining VALID ESTIMATES of physical activity of large groups proves Difficult because of RELIANCE On SELF-REPORTS.

Question 12

Describe the breakdown of U.S. Adult population and how many of them participate in physical activity, versus live sedentary lifestyle.

Answer 12

U.S. Adult Population:

• 15% engage in vigorous physical activity three times weekly for at least 30 mins.
• 60% do NOT engage in physical activity regularly
• 25% lead SEDENTARY lifestyles
• walking, gardening, and yard work are the MOST POPULAR leisure time activities
• 22% engage in light-moderate physical activity regularly.

Question 13

Describe the activities of American who report physical activity

Answer 13

48% women do walking

• Majority of men do resistance training (20%)
• Cycling (same amount for men and women who participate)
• running- men do it more (12%) than women
• Stair climbing- 10% in males and 12% in females. More commonly seen in women
• Aerobics- females mostly participate in this (impact type)

-it is important to maintain bone density in females, as they are more likely to lose bone density than men.
Hence physical activity help avoid osteoporosis

Question 14

Describe the level of exercise sen in U.S. children and teenagers. Also discuss the factor that leads to decline in physical activities

Answer 14

About one-half between ages 12 to 21 do NOT Exercise vigorously regularly

• fourteen percent report NO recent physical activity
• 25% engage in Light-to-moderate physical activity nearly everyday
• Participation in ALL types of physical activity DECLINES strikingly with Increasing AGE and school grade

Question 15

Discuss the components of the physical activity pyramid and its purpose.

Answer 15

Physical Activity Pyramid: prudent goals to increase daily physical activity.
Levels of Pyramid:
Top Level: REDUCE TV viewing, internet surfing, excessive reading, and computer use
Second level: At Least Twice Weekly; leisure-lifestyle activities (low-aerobic exercise) like golf, light gardening and housework , Flexibility and strength- easy calisthenics, yoga, light-moderate resistance training.
Third level: At Least Three Times Weekly; Aerobic exercise: like walking, jogging, swimming, bicycling, and aerobics; Recreational exercise like tennis, hiking, racquetball and basketball

Question 16

describe what the Health People 2020 is and discuss its objectives.

Answer 16

Healthy People 2020,

• launched in December 2010; represents the 4th generation of initiatives to guide national health promotion and disease prevention to improve health of all people in the U.S.
• has comprehensive Set of objectives and targets to measure progress for two objectives:
  1. A foundation for disease prevention and wellness activities across various state and local sectors and within the federal government
  2. A model for measurement of the state and local levels.

Question 17

Explain the ways in which Health People 2020 plans to commit to society and people to live long health lives.

Answer 17

Healthy People 2020 ,

• commits to the vision of a society in which ALL people live long, healthy lives
  1. Emphasizing ideas of *Health Equity that address social determinants of health and promote health across all stages of life
  2. Replacing traditional print publications with *Interactive Websites as main dissemination vehicle
  3. Maintaining website that allows user to tailor information to needs and explore “Evidence-based resources for implementation

Question 18

what are the four primary goals of Healthy People 2020?

Answer 18

Healthy People 2020 is designed to achieve 4 primary goals:

1. Attain HIGH-QUALITY, Longer lives, free of preventable disease, disability, injury, and premature death
2. Achieve HEALTH EQUITY, eliminate disparities, and improve health of all groups
3. Create Social and physical environments that PROMOTE good health for all
4. Promote QUALITY of LIFe, Healthy Development and healthy behaviors across all life stages.

Question 19

Describe the different factors that increases an exercise catastrophe

Answer 19

Likelihood of Exercise Catastrophe INCREASES With:

• Genetic predisposition
• History of fainting or chest pain with physical activity
• Unaccustomed vigorous exercise (can damage tendon or muscle)
• Exercise done with accompanying psychologic stress (more likely to get injured)
• extremes of environmental temperature
• Straining exercise with static muscle- action
• Exercise during Viral Infection or when feeling ill
• Mixing prescription drugs or dietary supplements

Question 20

Describe the relationship between frequency of exertion (exercising) and Triggering of acute cardiac events.

Answer 20

studies have shown that 0 days of exercise during a week will have the HIGHEST RISK of Myocardial Infarction (MI). However, Increase exercise or those who exercise 5 times a week will hav lowest risk of MI.

Question 21

Explain the importance of prehabilitation during physical activity and its major goals.

Answer 21

Prehabilitation (preventive program) Reduces sports and Recreational injuries

prehabilitation:
- Ensures readiness for participation; Reduces exercise-induced disability
- Emphasizes JOINT STRETCHING, Muscle Activation, Core Stability, and Strength, balance and muscle coordination
- Ensures Maximum Motor unit recruitment and Joint Stability

Question 22

Describe SeDS (Sedentary environmental Death Syndrome) and its impact on American society, and accepts.

Answer 22

Sedentary Environmental Death Syndrome (SeDS) - growing list of health disorders that caused by lack of physical activity (major public health burden)
-will cause 2.5 million Premature American deaths in next decade
-Will cost $2-3 trillion in health care expenses in the U.S. in next decade
-U.S. children are now getting SeDS- related diseases; are increasingly overweight, showing Fatty streaks in arteries, and developing type 2 diabetes.
SeDS relates to numerous medical conditions/diseases

Question 23

Describe the changes in muscular strength that occur with aging. Which body parts weakens more slowly than legs? differentiate between when concentric and eccentric strength decline.

Answer 23

Muscular Strength During Aging

• Men and women attain HIGHEST STRENGTH levels between ages 20 and 40 (when muscle cross-sectional area is Largest)
• Concentric strength Declines slowly at first, and the more rapidly after middle age
• Power capacity DECLINES faster than Maximal strength
• Eccentric strength DECLINES at a Later age and progresses more slowly than concentric strength
• ARM Strength Detoriates more SLOWLY than Leg strength

Question 24

discuss the age trend among elite weightlifters and powerlifters

Answer 24

Weightlifting performance DECLINEs on a curvilinear train with age, while Powerlifting performances Declines LINEARLY with age

• Performance rate and magnitude of Decline with age are GREATER in Weightlifters than powerlifters
• Magnitude of decline in peak muscular power is GREATER in lifting techniques that require more complex and explosive movements
• Gender differences in age-related performance Decline (Greater in women ) only in events that require complex and explosive power movements.

Question 25

Explain what leads to muscle mass decrease and the results of this. What is result of remodeling? What is the main cause of reduced strength between ages 25 and 80?

Answer 25

Muscle mass Decrease:

• Motor unit remodeling represents Normal CONTINUOUS process that involves motor endplate repair and reconstruction
• Remodeling leads to DENERVATION muscle atrophy which magnified by reduced physical activity, progressively Reduces muscle cross section, mass and function
• Primary cause of reduced strength between ages 25 and 80 relates to a 40-50% REDUCTION in muscle mass from muscle fiber Atrophy and Loss of motor units, even among healthy, physically active adults

Question 26

What is the relationship between total number of muscle fibers and muscle cross-sectional area?

Answer 26

Total number of muscle fibers and cros-sectional area are DIRECTLY Related.
as you have more muscle fibers, cross-sectional area Increases.

Question 27

Discuss th effects of resistance training for older adults.

Answer 27

Resistance training for older adults

• Moderate resistance training provides a SAFE way to Stimulate protein synthesis and Retention while slowing the normal and inevitable loss of muscle mass and strength with aging.
• Older men who resistance train have GREATER absolute gains in muscle size and strength (due to men having greater cross-sectional area) than women, but percentage improvement is similar
• A regular program of aerobic, strength, flexibility, and balance training for those 70 to 89 prevents both loss of muscle strength and increase in muscle fat infiltration
• muscle responds to vigorous training with Rapid improvement into the night decade of life

Question 28

How does muscle strength change with older adults who train?

Answer 28

Muscle strength increases(both extension and flexion ) progressively throughout training in Older Adults
after training, older men have an increase In muscle fibers.

Question 29

Explain what occurs with Neural function during aging. What can help with improving neural function while aging?

Answer 29

Neural function:
neural function declines as we age
-Aging leads to a 40% DECLINE in a spinal cord axon number and a 10% Decline in nerve conduction velocity
-Changes likely contribute to age-related DECREMENT In Nueromuscular Performance
-a physically active lifestyle and specific exercise training POSITIVELY affects neuromuscular functions at any age to slow age-related decline in cognitive performance.

Question 30

Differentiate between the simple and complex movement time in young and old active as well as Young and Old Nonactive.

Answer 30

• Young active have QUiCKEST simple movement

- Old active is better than young nonactive an old non-active is the worst

Question 31

describe the endocrine changes that occurs with aging

Answer 31

Endocrine changes

• 40% of those 65 to 75 years and 50% of those > 80 have IMPAIRED Glucose Tolerance leading to type 2 diabetes
• Pituitary gland DECREASES Thyrotropin release- leads to REDUCED metabolic function- decreased metabolic rate, glucose metabolism and protein synthesis.

Question 32

What are the three hormonal system changes that occur due to aging?

Answer 32

Hormonal system changes due to aging:

• Hypothalamic-pituriatary-gonadal axis leading to MENOPAUSE and ANDROPAUSE( men tesotrone levels drop)
• Adrenal cortex leading to REDUCED Output of DHEA
• Growth hormone/ Insulin-like growth factor axis leading to SOMATOPAUSE.

Question 33

Describe the potential mechanisms that underlie association between physical activity and reduced risk of cognitive decline

Answer 33

• Physical activity can lead to reduced vascular risk which leads to reduced cognitive decline/dementia
• Physical activity along with reduced obesity also lead to reduced vascular risk
• Reduced obesity or reduced vascular risk can lead to reduced inflammatory markers which leads to reduced cognitive decline and dementia.
• reduced inflammatory marks can lead to reduced cognitive decline/dementia which lead to enhanced neuronal function
• physical activity can cause enhanced neuronal function and hence reduced cognitive decline/dementia

Question 34

Discuss the age-related decline in three hormone systems.

Answer 34

in the ANTERIOR pituitary: Growth Hormone DECREASES and causes IGF-1 in Liver and tissues to Decrease (somatopause)

• In the posterior pituitary- Corticotropic hormone and ACTH, have NO change, cortisol has NO change but DHEA DECREASES (Androgenopause)
  3. The gonadotropic hormones (LSH/FSH) DECREASE causing estradiol in the ovaries to decrease (Menopause) and in testes, decreases Testosterone (Andropause)

Question 35

Describe the changes in pulmonary function that occur with aging. What is the benefit of aerobic training for elderly individuals.

Answer 35

Pulmonary function
-Mechanical constraints cause Deterioration in Static and Dynamic lung function
-SLOWING of pulmonary ventilation and gas exchange kinetics during translation from rest to submaximal exercise
In elderly men, aerobic training INCREASES gas exchange kinetics to levels approaching values for fit young adults.
-Older endurance-trained athletes demonstrate GREATER pulmonary function capacity than sedentary counterparts.

Question 36

Discuss the changes in cardiovascular function that are seen with aging. What happens to cardiac output in both trained and untrained individuals and why?

Answer 36

Cardiovascular function:

• VO2 max DECLINES 1% yearly and occurs TWICE as fast in sedentary Compared to Physically active
• Regular aerobic exercise CANNOT Fully Prevent age-related decline in aerobic power with aging
• Exercise maximal heart rate DECLINES with age
• Maximum Cardiac Output DECREASES IN trained and Untrained due to LOWER maximal heart rate and Stroke volume
• Compliance of Large arteries DECLINES from changes in arterial wall properties.
• DECREASED Capillary: muscle fiber ratio and Arterial Cross-section causes LOWER Blood flow to muscle

Question 37

Describe the relationship of VO2 max to Appendicular Muscle Mass

Answer 37

VO2 max DECREASES with age

• Young men have the highest VO2 max levels
• Older women tend have lowest VO2 max levels
• those with highest VO2 max levels will have HIGHEST appendicular muscle mass.

Question 38

What are the peripheral and cardiovascular functions? discuss their effects with aging.

Answer 38

Central and Peripheral Cardiovascular functions
Central:
1. Heart Rate
-Maximum heart rate DECLINES with age
-reflects REDUCED medullary outflow of sympathetic activity (men and women)
-Maximum heart rate DECLINE In athletes between age 50 and 70 is SMALLER than predicted (indicates Training effect)
2. Cardiac output
-maximum cardiac output DECREASES with age in trained and untrained due to LOWER maximum heart rate and stroke volume
-stroke volume DECLINE reflects combined effects of REDUCED Left Ventricular Systolic and Diastolic Myocardial performance
Peripheral factors:
-REDUCED Peripheral BLOOD FLOW capacity accompanies age-related decrease in muscle mass.

Question 39

Descirbe the physiologic loss that occurs with aging. Also discuss how training effects this and how bone mass Changes as we age.

Answer 39

Physiologic Loss with Aging:

• Sedentary and unhealthy behaviors produce LOSSES in Functional capacity as great as aging affects
• Training of older person may SLOW or even Reverse decline in functional capacity
• Low- and high-intensity exercise allow elderly to RETAIN cardiovascular function at higher level than sedentary counterparts.
• After age 18, men and women progressively GAIN body mass and Fat until 5th or 6th decade
• Bone mass DECREASES 30 to 50% in those above age 60. ; weight-bearing and resistance exercise can INCREASE BONE MASS

Question 40

Describe the relationship between age and 100M sprint performance in males and females ages 35 to 88.

Answer 40

The older the age, the longer it will take to run 100-M sprint
-Men run the 100 M sprint faster than women due to greater muscle mass and muscle strength.
The time it takes to run 100-M sprint will increase as we age.

Question 41

Discuss the anthropometric (measurements of body) and body composition changes with aging. What happens to waist girth, Waist:Hip ratio, Sum of skin folds, Percentage body fat, and Fat-free body mass with aging.

Answer 41

As we age most measurements of the body increases.

• Waist Girth Increases as we age
• Waist:Hip ratio Increases as we age
• Sum of skin folds increases as we age
• Percentage of body fat increases as we age
• Fat-free Body Mass DECREASES as we age (when one is younger, Fat-free body mass is higher)

Question 42

Explain the benefits of exercise for people and for elderly. also discuss the adaptations required for training.

Answer 42

Trainability and Age

• Exercise improves Physiologic responses at any age
• Several factors affect magnitude of response, including initial fitness, genetics and type of training
• Exercise in healthy elderly men ENHANCES heart’s systolic and diastolic properties and INCREASES VO2 max to same relative extent as younger adults.
• INCREASES in VO2 max for older women depend largely on Peripheral adaptations in trained muscle
• Sex hormones probably INFLUENCE gender-related adaptations to endurance training.

Question 43

Differentiate between the classic vs current view of training Adaptations with aging.

Answer 43

Classic View of training- belief that we just Decline in training as we age
Modified view- We can maintain health and fitness until we reach a certain age (curve line)

Question 44

Describe the relationship between physical activity, health and longevity. Also discuss what conclusions can be made form long-term studies on effects of physical activity

Answer 44

maintaining physical activity and fitness throughout life provides SIGNIFICANT HEALTH and LONGEVITY Benefits

• Low physical fitness is a more POWERFUL Risk Factor than High blood pressure, high cholesterol , obesity and family history.
• Long-term studies (ex: Harvard Alumni Study) on effects of physical activity include:
• COUNTERS Life-shortening effects of Cigarette smoking and Excess weight
• REDUCES death from hypertension by one Half
• REDUCES genetic tendencies towards early death
• DECREASES mortality rate by 50% for active men who’s parents lived > or equal to 65 years.

Question 45

discuss the epidemologic evidence that exists discussing the effect of heart disease from lack of physical activity

Answer 45

Epidemiologic Evidence:

• Forty-three studies of relationship between inactivity and coronary heart disease showed LACK of regular physical activity contributes to Heart Disease in a CAUSE-and-EFFECT manner
• Sedentary person DOUBLES Risk of developing heart disease as most active individual
• Strength of association between lack of exercise and heart disease risk equals that for high blood pressure, cigarette smoking, and high cholesterol
• Light-to-moderate physical activities produce health benefits for previously sedentary middle-aged and older persons

Question 46

Discuss the benefits of regular moderate physical activity. How does physical activity benefit post-menopausal or active women?

Answer 46

Regular Moderate physical activity

• Moderate activity such as walking REDUCES levels of Diabetic, hypertensive and cholesterol medications required by patients
• for postemenopausal women, walking briskly for 2.5 hr per week REDUCES heart disease risk by 30% regardless of age, race or body weight
• Most active women REDUCED risk by 63%.

Question 47

Discuss the influence one physiological factors on aspects of life. How does it affect mortality or risk of disease?

Answer 47

Physiologic measures like Low-level of Cardiorespiratory fitness provide a strong INDEPENDENT PREDICTOR of Increased risk for Cardiovascular Disease and all-cause mortality

• A Strong INVERSE ASSOCIATION exists between regular physical activity and level of aerobic fitness and All-cause mortality.
• Moderate-intensity regular activity substantially REDUCES risk of dying form heart disease, cancer and other causes.

Question 48

Discuss the trend for effects of regular physical activity of increased fitness and risk for Chronic Disease

Answer 48

Trends for effects of physical activity or increased fitness on risk of chronic disease

• EXCELLENT Evidence of reduced disease rates for All-cause mortality, Coronary Heart disease, Obesity, and Type 2 Diabetes with regular physical activity and increased fitness
• GOOD Evidence of reduced Hypertension rates, Colon cancer and OSTEOPOROSIS with regular physical activity and increased fitness
• SOME Evidence of Stroke, Breast cancer, Prostate cancer, Lung cancer with regular physical activity, and increased fitness.
• There is NO apparent difference in rate of peripheral vascular disease , rectum and stomach cancer and pancreatic caner, and Osteoarthritis across activity or fitness categories (NO change in these rates based on l regular physical activity or increased fitness)

Question 49

Is structured physical activity necessary for health benefits?

Answer 49

NO, Health- Derived Benefits from regular physical activity DO NOT require highly structured or Vigorous activity

Question 50

Describe what occurs in coroner heart disease and the consequences of this. What happens if arterial walls are damaged? What is the first sign of atherosclerosis

Answer 50

Coronary Heart Disease

• Involves DEGENERATIVE CHANGES in intimate or Inner lining of larger arteries that supply myocardium
• Damage to arterial walls begins as a multifactorial immunologically mediated, inflammatory response to injury.
• From hypertension , cigarette smoking, infection, homocysteine, elevated cholesterol, or free radicals .
• Damage INITIATES complex Series of Changes that produce lesions that bulge into vessel lumen
• initally take form of fatty streaks: FIRST Sign of ATHEROSCLEROSIS
• vessels congests and bursts with fibrous scar tissue

Question 51

Describe the role of C-reactive protein and its function. Where is it produced?

Answer 51

C-reactive protein- INDICATOR of Arterial Inflammation

• Half of people with Heart disease have normal or slightly elevated cholesterol; must consider other factors like C-reactive protein (CRP) in process
• CRP produced in LIVER and ADIPOCYTES to help Fight Inflammation
• CRP levels rise during acute and chronic reactions
• Levels rise when arteries Accumulate PLAQUE
• HIGH CRP also relates to hypertension (CRP increases with people who have hypertension)
• Normal CRP=1.5 mg/dL; High CRP= 3.0-4.0 mg/dL

Question 52

Discuss the plaque that is seen in arteries and consequences that occur if seen.

Answer 52

Vulnerable Plaque: Difficult to Detect, yet Lethal

• Soft type of metabolically active Unstable plaque
• Does NOT produce arterial Narrowing but tends to FISSURE and BURST resulting in CLOT Formation (THROMBUS) and subsequent Myocardial Infarction

Question 53

Describe when vascular degeneration occurs in humans and how to identify those with degeneration

Answer 53

Vascular Degeneration Begins Early in Life

• Fatty streaks and Plaque DEVELOP rapidly during Adolescence through third decade of life
• Can identify those with DEGENERATION by examining related risk variables:
• Increased BMI, Elevated blood pressure, and high cholesterol, triacylglycerols, and LDL-C

Question 54

Describe what occurs in Atherosclerosis and its effect on the arteries

Answer 54

Atherosclerosis- is a progressive occlusion (blockage) of the artery that results form build up Calcified fatty substances.
These substances form plaque (containing fat, cholesterol, other substances) that obstruct blood flow.

Question 55

Explain why Cardiovascular Disease (CVD) is considered a pandemic

Answer 55

Cardiovascular Disease (CVD) -Epidemic

• CVD ranks as LEADING HEALTH PROBLEM and primary cause of death among Americans less than or equal to 85 years old.
• In 2012, 82,600,000 individuals suffered from CVD in U.S
• GREATEST PREVALENCE occurs for Hypertension and Coronary heart disease
• Over 1,255,000 heart attacks yearly
• About 500,000 recurrent yearly heart events

Question 56

List the modifiable and unmodifiable coronary heart disease risk factors.

Answer 56

Modifiable and Unmodifiable Coronary Heart disease risk factors
- Modifiable Factors - Diet, elevated blood lipids, Hypertension, personality and behavior patterns, cigarette smoking, high serum uric acid, sedentary lifestyle, pulmonary function abnormalities, excessive body fat, Diabetes mellitus, ECG abnormalities, tension and stress, Poor education, Elevated Homocysteine, Sleep apnea
Unmodifiable Factors:
-Age
-Gender,
-Ethnic background
-Male-pattern baldness, particularly lack of hair on the crown of head; possibly from raised androgen levels
Family history

Question 57

Explain in many reasons as to why Coronary Heart Disease is Not only a male disease

Answer 57

Coronary heart disease (CHD) : Not only Male Disease:

• LEADING CAUSE OF DEATH for Women in U.S.; accounted for 1 in 4 female deaths in 2009
• SAME number of females as males die form CHD
• Leading cause of Death for African American and white women in the U.S.
• For Hispanic women, CHD and CANCER cause EQUAL deaths each year
• SECOND LEADING CAUSE OF DEATH among Native Americans, Alaska, and Pacific Islander women
• CHD prevalence about: 5.8% white, 7.6% of black, 5.6% Latino women

Question 58

Discuss the blood lipid abnormalities that occur and what cholesterol distribution indicates.

Answer 58

Blood lipid abnormalities:
Hyperlipidemia- Abnormal Blood Lipid level and a crucial component in genesis of Atherosclerosis
-Approximately 30% of adults require intervention for High cholesterol
-Cholesterol distribution among various lipoproteins provides a more POWERFUL PREDICTOR of heart disease risk the Total blood cholesterol
-Elevated HDL-C levels relate CAUSALLY with a Lower Heart disease risk
-Total Cholesterol: HDL-C ratio greater than or equal to 4.5 HIGH heart disease risk; ratio of less than or equal to 3.5 desirable risk

Question 59

What are the AHA recommendations for Cholesterol and Triacylglycerol (All Values mg/DL)

Answer 59

Total cholesterol
-200-239: Borderline High
- > or equal to 240- HIGH 
HDL: cholesterol 
-less than 4O: Major risk for CHD
LDL: cholesterol 
-130-159- Borderline High 
-160-189- HIGH 
- > 190 - VERY HIGH
Triacylglycerol: 
-150-199 : Borderline High 
-200-499 - HIGH 
- > 500- Very High

Question 60

What are the factors that Favorably affect cholesterol and lipoprotein levels?

Answer 60

Behaviors that FAVORABLY affect cholesterol and lipoprotein levels :

• Weight loss
• Regular aerobic exercise
• Increased dietary intake of water-soluble fibers
• Increased intake of polyunsaturated-to-saturated fatty acid ratio and monounsaturated fatty acids
• Increased Dietary intake of Omega-3 fatty acids and elimination of trans fatty acids
• Moderate alcohol consumption

Question 61

what are the variables that adversely affect cholesterol and lipoprotein levels?

Answer 61

Variables that Adversely (unfavorably) affect cholesterol and Lipoprotein levels;

• Cigarette smoking
• Diet high in saturated fatty acids and preformed cholesterol and Trans fatty acids
• Emotionally stressful situations
• Oral Contraceptives

Question 62

Discuss the short term and long term exercise effects on cholesterol

Answer 62

Specific Exercise Effects on Cholesterol:

• Short-term effects
• A single exercise session produces only Transient changes in lipid and apolipoprotein concentrations
• Long-Term effects
• Exercising regularly produces SMALL reductions in LDL
• Exercise DURATION exerts the GREATEST positive effect on HDL while exercise Intensity favorably modifies Blood pressure and waist girth.
• Standard resistance training exerts Little or NO EFFECT on triacylglycerol, cholesterol or lipoproteins

Question 63

Describe the immunological factors that pertain to arterial disease and role of physical activity

Answer 63

An immune response likely TRIGGERS PLAQUE DEVELOPMENT within arterial walls
-Regular physical activity may STIMULATE the immune system to INHIBIT agents that facilitate arterial disease

Question 64

Discuss what homocysteine is and how it relates to coronary heart disease

Answer 64

Homocysteine:

• Highly reactive, Sulfur-containing amino acid, forms as byproduct of Methionine metabolism
• High levels related to arterial or venous thrombosis by age 30
• LOCKSTEP ASSOCIATION (linear relationship) between homocysteine and heart attack and mortality in men and women.

Question 65

Explain the mechanism or Homocysteine’s Negative impact on Cardiovascular health. What is good defense for this mechanism?

Answer 65

Homocysteine mechanism:
1. Protein-rich foods contain an amino acid, methionine, that converts to homocysteine
2. Excess homocysteine levels damage the lining of arteries
3. cholesterol builds up inside the scarred arteries, which leads to fatal blockages (cut of blood flow)
Proposed DEFENSE:
-Vitamins in fresh foods and dietary supplements CATABOLIZE homocysteine
-vitamin B12- meat, fish and dairy products
Vitamin B6, - green leaf, vegetables, poultry, nuts, whole grain cereal, fish
-Folic acid- green leafy vegetables, fruits, organs juice, wheat germ, dried beans and peas

Question 66

distinguish between the effects of 1 CHD risk factor vs 3 risk factors.

Answer 66

One risk Factor: 45 year old man’s chance of heart risk DOUBLES risk vs man without risk factors
With Three risk factors, chance for angina, heart attack or sudden death INCREASES 10-fold.
Regular physical activity exerts POSITIVE Influence on obesity, hypertension, type 2 diabetes, stress, and elevated blood lipid profile

Question 67

What is the single most important, modifiable and preventable CVD risk factor

Answer 67

SMOKING is the single most important, modifiable and preventable cardiovascular disease risk factor: one of the STRONGEST predictors of premature CHD

Question 68

Discuss the positive effect of physical activity

Answer 68

Regular physical activity exerts POSITIVE Influence on obesity, hypertension, type 2 diabetes, stress, and elevated blood lipid profile

Question 69

discuss the relationship between abnormal risk factors and heart disease risk

Answer 69

The greater the number of CHD risk factors, the LARGER the CHD incidence per 100,000 persons

Question 70

Discuss the risk factors in children and how the purpose of supervised program

Answer 70

Risk factors in children:

• Risk factors assessed in childhood associated with THICKNESS of Carotid Artery later in life
• Fatter children usually have HIGHER levels of cholesterol and Triacylglycerol
• Childhood adiposity INCREASES heart disease morbidity and mortality in adulthood.
• A supervised program of moderate food restriction and physical activity with behavior modification REDUCES Heart disease risk in Obese adolescents.

Question 71

Distinguish between the coronary heart disease risk before and after treatment in obese adolescents

Answer 71

For pre-treatment- there were MORE risk factors

with post-treatment, there is a reduction in risk factors.

Question 72

Explain how you calculate CHD risk, using European Score, Framingham Risk Score, American Heart Association

Answer 72

Calculating CHD Risk
-Risk inventories assess susceptibility to CHD
-Framing Risk Score- considers age, gender, smoking status, total cholesterol, HDL cholesterol, systolic blood pressure and diabetes
-European SCORE- estimates a 10-year risk of FATAL cardiovascular disease in European nation in primary prvention; includes age, gender, total cholesterol, systolic blood pressure, and smoking status
-The AHA assesses the risk profile by determining numerical value that best describes a person’s status
-

Question 73

Discuss a summary of effect of physical activity on maintain health and various levels of molecules in the body.

Answer 73

Summary

1. Physical activity evaluates nature, extent, and demographics of exercise participation
2. Only 10 to 15% adults in U.S. obtain enough regular physical activity for health benefits
3. Healthy people 2020 attempts to achieve new health goals for U. S. citizens
4. Prehabilitation, particular among older adults, that emphasizes core strengthening and training can REDUCE injury from exercise.
5. Physical inactivity promotes Unhealthy gene expression
6. Increasing regular physical activity should become TOP public health prioritiy
7. Physiologic and performance capability usually declines after age 30
8. Biologic: Aging relates to changes in 3 hormonal system; Hypothalmaic-pituitary-goandal axis.
9. Four important factors to evaluate physiologic and performance differences, between children and adults: Exercise economy, FFM (fat-free mass) and anaerobic power, and anabolic hormones insulin
10. Primary cause of age-associated reduction in muscle strength is 40 to 50% reduction in muscle mass from a loss of motor units and muscle fiber atrophy
11. considerable plasticity exists in physiologic, structural and performance characteristics among older individuals
12. Physically active lifestyle affects neurotransmitter
    - 13. VO2 max declines 1% a fat, for men and women
13. Physically active Older men and women have higher VO2 max than sedentary peers
14. Sedentary living cause functional capacity losses at least as a great
15. Regular physical activity improves physiologic function at any age
16. Active older athletes average at least 20% less fat and 20% more Fat free mass than nonathletic lifestyle.
    - 18. Vigorous physical activity and early in life contributes little to increased longevity or health in later life.
17. Physically active lifestyle throughout life confers significant health benefits.

Question 74

What other points are mentioned in summary?

Answer 74

Continuation of summary

20. Regular, moderate physical activity counters the life shortening effects of heart disease risks that include cigarette smoking and excess body weight
21. Sedentary person runs almost twice the risk of developing heart disease as the most active individuals.
22. The risk of CHD form sedentary living equals that for hypertension,Cigarette smoking, and high serum cholesterol
23. The life-protecting benefits of physical activity relate more to preventing early mortality than extending overall life span
24. Regular, moderate physical activity substantially reduces risk of dying from heart disease, cancer and other medically related maladies
25. Greatest health benefits emerge when a person alters a sedentary lifestyle and becomes just moderately physically active
26. Regular, moderate physical activity counters the life-shortening effects of heart disease risks such as cigarette smoking, and excess body weight
27. CHD is most Prevalent cause of death in western world
28. Major CHD risk factors include: age, gender, blood, lipid abnormalities, hypertension, smoking, obesity, inactivity, diet, family history, ECG abnormalities during rest and exercise
29. Chronic low-grade arterial inflammation is major trigger for heart attack
30. Desirable: cholesterol value is less than or equal to 200 mg/DL

Question 75

Further discuss points in summary

Answer 75

31. Distribution of HDL-C and LDL-C provides a more powerful predictor of heart disease than Total cholesterol
32. LDL-C participates in atherosclerosis by stimulating monocyte-macrophage infiltration
33. HDL-C facilitates reverse cholesterol transport
34. Increased physical activity favorably alters HDL-C
35. Homocysteine exerts a powerful independent CHD risk
36. Dietary fiber prevents hyperinsulinemia
37. Cigarette smoking doubles risk of heart disease compared to nonsmokers
38. Sedentary lifestyle doubles the risk of Fatal heart attack
39. Interaction of heart disease risk factors magnifies there individual effects
40. Nutrition, physical Activity, and weight control favorably alter heart disease risk and usually improve one’s health profile

Question 76

Discuss the importance of a clinical exercise physiologist. What closely links to the clinical exercise physiology?

Answer 76

Clinical Exercise Physiologist (CEP)- has become an integral component in TEAM APPROACH to patient care
In the clinical setting, the CEP focuses on RESTORING patient mobility and functional capacity.
-SPORTS MEDICINE closely links to clinical exercise physiology

Question 77

Describe the clinical areas and diseases where regular physical activity applies

Answer 77

1. Cardiovascular Diseases/Disorders- ischemia. chronic heart failure, cardiomyopathies,
2. Pulmonary Diseases/Disorders- COPD, cystic fibrosis, Asthma and exercise-induced asthma
3. Neuromuscular Disease/Disorder- Stroke, multiple sclerosis, Parkinson’s disease an Alzheimer’s disease
4. Metabolic diseases/Disorder- Obesity, diabetes, renal disease
5. Immunologic and hematologic disease/disorder- immune deficiency; Allergies, sickle cell disease, HIV/AIDS
6. Orthopedic Diseases and Disorders- Osteoporosis; osteoarthritis and rheumatoid arthritis; Back pain
7. Aging: sarcopenia
8. Cognitive and Emotional Disorder: Anxiety and stress disorders; mental retardation, depression

Question 78

What are the protective effects that Regular physical activity has on cancer occurrence ?

Answer 78

Regular Physical Activity; protective Effects on Cancer Occurrence

• LOWERS circulating levels of blood glucose and insulin
• INCREASES anti-inflammatory cytokines
• INCREASES Corticosteroid hormones
• AUGMENTS insulin-receptor expression in cancer fighting T cells
• PROMOTES Interferon production
• STIMULATES glycogen synthesis
• ENHANCES leukocyte function
• IMPROVES ascorbic acid metabolism
• EXERTS beneficial effects on provirus or oncogene activation

Question 79

Describe how physical activity prescription benefits people who have cancer.

Answer 79

cancer patients receive a SYMPTOM-LIMITED GXT to form their exercise prescription. GXT (graded exercise testing)

• Procedure is the same as for healthy individuals except GREATER Attention to sensations of fatigue
• Prescription recommendations include symptom-limited progressive and individualized physical activity
• AMBULATION (movement of body) of any kind as soon as possible
• Intervals of LOW-to MODERATE aerobic physical activity performed several times daily
• ROM (range of motion) and other exercise to improve muscular strength, augment FFM (fat free mass) and improve mobility

Question 80

Discuss the benefits of physical activity on breast cancer patients

Answer 80

Most studies of physical activity for cancer patients demonstrate physiologic and psychologic benefits
-effects of 10 weeks of moderate aerobic exercise on depression, trait and state anxiety in women recovering from breast cancer surgery.
Before exercise- depression, and anxiety (trait and state anxiety) were high
after exercise- depression levels, state and trait anxiety levels DECREASED
State anxiety- induced by a situation (ex: time of diagnosis of cancer can cause depression or high anxiety to occur )
Trait anxiety- occurs on a daily bias; happens to someone who already had anxiety initially and has added more anxiety after cancer diagnosis

Question 81

What factors should be considered when designing aerobic exercise programs for cardiac patients?

Answer 81

Designing aerobic exercise programs for cardiac patients should consider :

• Specific Pathophysiology of the disease
• Mechanisms that may LIMIT exercise performance
• INDIVIDUAL DIFFERENCES in functional capacity.

Question 82

What terms can be used to indicate myocardial disease?

Answer 82

Terms to indicate myocardial disease: Degenerative Heart disease (DHD); ATHEROSCLEROTIC Cardiovascular disease, arteriosclerotic cardiovascular disease, coronary artery disease (CAD) or coronary heart disease (CHD)

Question 83

Discuss the Heart diseases that cause functional impairment

Answer 83

Diseases affecting the Heart Muscle:
-CHD, Angina, Myocardial Infarction, Pericarditis, Congestive heart failure, Aneurysms
Diseases affecting the Heart Valves-
-Rheumatic fever, Endocarditis, Mitral valve prolapse, congenital deformations
Diseases Affecting the Cardiac Nervous System
-Arrhythmias
-Tachycardia
-Bradycardia

Question 84

Discuss the prevalence of hypertension for Blacks versus Whites for males and females of different ages.

Answer 84

HIGHER percentage of hypertension for African Americans compared to whites
-also hypertension is increased in males compared to females.
High percentage of hypertension in black males and females
-as you age, higher rate of hypertension for black females

Question 85

Discuss how regular physical activity affects hypertension. What are the contributing factors of how physical activity lowers Blood pressure?

Answer 85

Regular physical Activity and Hypertension

• Systolic and Diastolic blood pressure DECREASES from 6 to 10 mm Hg with aerobic physical activity in previously sedentary individuals.
• Regular physical activity controls tendency for blood pressure increase over time in those at risk
• Precise way physical activity LOWERS blood pressure is unclear, but contributing factors include:
• REDUCED sympathetic nervous system activity and possible normalization of arteriole morphology decreases peripheral resistance to blood flow
• ALTERED renal function facilitates kidneys’ elimination of sodium, which reduces fluid volume

Question 86

Describe the Changes in resting blood pressure with aerobic training for older adults who had 1 month detraining vs this who trained at lactate threshold for 3 to 6 times a week

Answer 86

Changes in resting blood pressure;
-During 1 month of detraining blood pressure of individuals were HIGH
after 3 to 6 weeks of training , there was a DECREASE in ALL levels of Blood pressure.
-Decrease in systolic blood pressure, Mean blood pressure and diastolic blood pressure

Question 87

Discuss the Noninvasive Physiologic Tests that are used for those with Heart Disease

Answer 87

Noninvasive Physiologic Tests
-ECHOCARDIOGRAPHY: pulses of reflected ultrasound assess functional and structural characteristics of myocardium
-used to diagnose heart murmurs, evaluate valvular lesions, quantify congenital defects and myopathies
Ultrafast CT scan: 10 mins, noninvasive test that uses rapid electron beam computed tomographic scan to assess calcium deposition within plaque in coronary artery linings
-Determines how aggressively to treat blood lipid abnormalities and other CHD risk factors.

Question 88

Discuss the functions and roles of Graded Exercise Stress Testing (GXT)

Answer 88

Graded Exercise Stress Testing (GXT) :

• EVALUATES cardiac function under conditions that exceed resting requirements in defined, progressive exercise increments to increase myocardial workload.
• OBJECTIFIES functional capacity of patients with known disease and evaluates progress following surgery or other therapeutic interventions
• Cardiologist and exercise physiologist supervise GXT, interpret data, and prescribe exercise intervention

Question 89

Describe what congestive heart failure is and its causes.

Answer 89

Congestive Heart Failure (CHF)- Heart failures to pump adequately to meet needs
primary causes include:
-NARROWED arteries form CHD
-past MI with necrosis
-Chronic HYPERTENSION
-Heart valve disease form past RHEUMATIC FEVER
-Intrinsic myocardial DISEASE
-CARDIONMYOPATHY
-CONGENITAL defects
-Infected heart valves (endocarditis, myocarditis)

Question 90

Discuss the deaths from people with congestive heart failure

Answer 90

For CHF (congestive heart failure) patients who contract before age 60, about 20% die within 1 year of diagnosis; nearly half die within 5 years

• after the year 2000s, the number of deaths have increased
• At age 55-64 those with congestive heart failure increased for men
• after age 65, CHF rates are Equal for men and women

Question 91

What occurs in graded exercise stress testing? What is the role of GXT in heart disease? what can GXT not show?

Answer 91

Graded exercise stress testing:

• Graded multistage bicycle and treadmill tests
• include several levels of 3 to 5 min submaximal effort to a volitional end point
• Graded test permits intensity increase in small increments to pinpoint ischemia and rhythm disorders
• In heart disease GXT provides reliable, quantitative index of person’s functional impairment (cardiac)
• GXT cannot show extent of CHD or specific location.

Question 92

Discuss the four purposes for use of exercise testing

Answer 92

Four purposes for the use of exercise testing:

1. ECG observations (look for arrhythmias)
2. EVALUATE patients with Exertional discomfort (indicator of angina)
3. DETERMINE pharmacological and therapeutic treatment strategies
4. EVALUATE physiologic adjustments to increasing metabolic demands to objectify physical activity recommendations

Question 93

Discuss the major reasons for Stress Testing

Answer 93

Six functions in CHD evaluation:

1. DIAGNOSE overt heart disease and screens for “silent” CHD in seemingly healthy adults
2. ASSESS exercise- related chest symptoms
3. SCREEN candidates for entry into preventive and cardiac rehabilitative programs
4. UNCOVER abnormal blood pressure responses
5. MONITOR value of therapeutic interventions to improve hear disease status and cardiovascular function
6. QUANTIFY functional aerobic capacity

Question 94

Who requires stress testing? Start from High risk and then low risk

Answer 94

Those who require Stress testing (ACSM Recommendations) :
High risk : individuals with one sign/symptoms of cardiovascular or pulmonary disease or know cardiovascular or pulmonary, or metabolic disease (COPD< asthma, cystic fibrosis, thyroid disorder, renal or liver)
-medical examination and GXT, along with MD supervision recommend moderate exercise or vigorous exercise
-Moderate risk
Men with HDL-C <45 mg dL: moderate exercise not necessary
Women with HDL-C < 55 mg dL :
recommended vigorous exercise
Low risk: Men < 45 years: moderate exercise not necessary
Women < 55 years; asymptomatic ;with less than 1 risk factor; moderate exercise not necessary

Question 95

What are the stress test protocols for Treadmill tests?

Answer 95

Stress Test protocols: Treadmill Tests

• CHOICE of specific exercise test should consider overall health, age, and the person’s fitness status
• Total DURATION should average about 8 minutes
• Longer than 15 mins adds LITTLE additional information

Question 96

Compare and contrast the Bruce and Blake Tests

Answer 96

BOTH Bruce and Blake Treadmill tests begin at moderately-high levels of exercise for cardiac patients and older individuals so may need Modification

• Bruce test provides more ABRUPT INCREASES in exercise intensity between stages, which may improve sensitivity to detect ischemic ECG responses
• Bruce protocol incorporates LOWER initial exercise levels
• Balke has 2 to 3 min initial stage at 2 mph, O% grade

Question 97

Discuss the Stress test protocols for Bicycle Ergometer. What are the two types of Ergometers?

Answer 97

Stress Test protocols: Bicycle Ergometer Tests
-Portable, safe, inexpensive and power output is easy to compute and INDEPENDENT of BODY WEIGHT
-two types of ergometers
-ELECTRICALLY BRAKED
-preselected power input that remains fixed within range of RPMs
-WEIGHT-LOADED, friction-type
-Weight-loaded power output relates directly to FRICTIONAL RESISTANCE and PEDALING RATE.
Guidelines for treadmill testing APPLY to bicycle tests:
2 to 4 min stages with initial resistance between 0 and 15 to 30 watts
-increases in 15 to 30 watt increments per stage, at 50 to 60 RPM

Question 98

Describe the role of arm-crank Ergometer Tests

Answer 98

Arm-Crank Ergometer Tests
-Application for GXT in special situations and DISABLED individuals
-Arm exercise LOWERS VO2 max by 30%, and maximum heart rate average 10 to 15 bpm lower than treadmill or bicycle exercise; BLOOD PRESSURE DIFFICULT to measure
-Submaximal arm cranking produces HIGHER blood pressure, heart rate and oxygen consumption values at same power output with legs
The arm-crank ergometer have protocols SIMILAR to leg cycling tests
-Initial resistance remains lower in arm exercise with SMALLER increments in adjusted power inputs

Question 99

Discuss what the stress testing safety is based on, and its components. What favors GXT testing?

Answer 99

Stress Testing Safety

• Depends on knowing who NOT to test, knowing when to TERMINATE test and preparing for emergency
• RISK-Benefit ratio favors GXT testing as part of medical evaluation process
• Risk of death: < or equal to 0.01%
• Risk of an acute MI: less than or equal to 0.04%
• Risk of complications that require hospitalization, including acute MI or serious arrhythmias: less than or equal to 0.2%

Question 100

Describe the improvements in CHD patients that can be seen with exercise

Answer 100

Improvements in CHD patients:
-Properly PRESCRIBED and monitored exercise safely IMPROVES patient’s functional capacity
Clinical symptoms IMPROVE or DISAPPEAR from structural and functional changes in myocardium
-Cardiac patients respond to exercise training with physiologic adjustments that Reduce cardiac work at any given external exercise load
-REDUCED exercise heart rate and blood pressure
-REDUCED rate pressure product delays onset of angina or Greater intensity and duration of activity.

Question 101

What are the benefits of resistance exercise? What occurs when you combine resistance and aerobic training ?

Answer 101

Resistance exercise benefits:

• Resistance exercises with normal cardiac rehabilitation, RESTORES strength, PRESERVES FFM (fat-free mass) , IMPROVES psychologic status and quality of life, INCREASES glucose tolerance and insulin sensitivity
• Combining resistance and aerobic training YIELDS more pronounced Physiologic ADAPTATIONS in CHD patients than AEROBIC training alone

Question 102

What are contraindications that occur with exercise ?

Answer 102

-CONTRAINDICATIONS: Unstable angina; uncontrolled arrhythmias, left ventricular outflow obstruction, recent history of CHF (congestive Heart failure ); severe valvular disease, hypertension, poor left ventricular function and exercise capacity (less than or equal to 5 METs with anginal symptoms or ischemic S-T- Segment depression)

Question 103

Discuss the components of resistance training prescription

Answer 103

Resistance training prescription

• Cardiac patients: Light resistance with elastic bands, light cuff and hand weights, light free weights, and wall pulleys
• NO resistance training until 2 to 3 week post-MI
• Introduce barbells and or weight machines after 4 to 6 weeks convalescence
• Peform 1 set 10 to 15 reps with RPE of 11 to 14 using 8 to 10 different exercises, 2 to 3 days a week.

Question 104

What is the purpose of Cardiac Rehabilitation? What does a Successful cardiac rehabilitation include?

Answer 104

Cardiac Rehabilitation

• Focuses on IMPROVING longevity and quality of life, plus risk factor modification
• A SUCCESSFUL cardiac rehabilitation program includes:
  1. APPROPRIATE patient selection
  2. CONCURRENT medical, surgical and pharmalogic therapies
  3. COMPREHENSIVE patient education
  4. APPROPRIATE exercise prescription
  5. CAREFUL patient monitoring during rehabilitation

Question 105

What are the major objectives of Inpatient Cardiac programs?

Answer 105

Inpatient Cardiac Programs

• Focuses on Four objectives:
  1. Medical SURVEILLANCE
  2. IDENTIFICATION of patients with significant impairments before discharge
  3. RAPID patient return to daily activities
  4. PREPARATION of patient and family to optimize recovery upon discharge
• physical activity during the first 48 hr post MI/ and or Cardiac surgery restricted to self-care movements; then sit and stand without assistance, perform self-care activities, and walk independently up to 6 times a day.

Question 106

What are the 4 goals for Outpatient Rehabilitation Programs? How are these programs supervised?

Answer 106

Outpatient Rehabilitation programs

• Four goals:
  1. MONITOR to detect changes in clinical status
  2. RETURN to premorbid/vocational/recreational activities
  3. ASSIST in at-home, unsupervised exercise program
  4. PROVIDE family support and education
• Most sites encourage MULTIPLE physical activity (resistance exercise, Walking, cycling, and swimming)
• SUPERVISION includes those trained in CPR, Advanced life support, and home defibrillators.

Question 107

What are the two main types of pulmonary disease and how do you differentiate between them?

Answer 107

Pulmonary Diseases:
classify as either OBSTRUCTIVE (normal airflow impeded) or RESTRICTIVE (Lung volume dimensions reduced)
1. Chronic Obstructive pulmonary disorder (COPD)
-comprises respiratory tract diseases that obstruct airflow (ex: emphysema, asthma, and chronic bronchitis)
2. Restrictive Lung Dysfunction
-Abnormal Reduction in pulmonary ventilation which diminished lung expansion, decreased TV (tidal volume) , and Loss of functioning alveolar-capillary units (not optimizing gas exchange)

Question 108

What is chronic bronchitis and why is called the Blue Boater ?
What unique characteristic feature is present in this disease?

Answer 108

Chronic bronchitis- long-term inflammation (swelling) of the bronchi (occurs when airways in lungs are inflamed)

• when airways are irritated and inflamed, mucus forms which makes it harder to breathe and the body does not take in enough oxygen. This causes cynaosis, which leads to one’s skin and lips to turn blue (hence blue boater)
• Characteristic Emphysemic “BARREL CHEST” (where there is increased anterior-posterior chest diameter). This arises due to lung being filled with too much air and air being trapped in lungs, causing lungs to inflate like a ballon and expands the ribs.

Question 109

Describe the different alveoli changes in lung diseases such as pneumonia and emphysema

Answer 109

Pneumonia- fluid and blood cells in alveoli, and alveolar walls are thickened by edema
Emphysema- Alveolar membrane’s breakdown and NO gas exchange occurs.

Question 110

What are the clinical signs and symptoms of cystic fibrosis?

Answer 110

Clinical signs and symptoms of cystic fibrosis:
Early stage- clinical signs and symptoms of cystic fibrosis:
-persistent cough and wheezing
-Recurrent pneumonia
-Excessive appetite but poor weight gain
-Salty skin or sweat
-Bulky, foul-smelling stools (undigested lipids)
Late-Stage clinical signs and symptoms of cystic fibrosis with pulmonary involvement
-tachypnea (rapid breathing)
-sustained chronic cough with mucus production on vomiting
-Barrel chest
-cyanosis and digital clubbing
-exertional dyspnea with decreased exercise capacity
-pneumothorax
-Right Heart failure secondary to pulmonary hypertension

Question 111

Describe the typical response to Asthma Attack

Answer 111

Typical response to Asthma Attack:
Early response in asthma:
-Air passage becomes smaller from bronchial spams and edema (cannot get air in, and passage for air flow is reduced_
Late response in asthma
-Greater inflammation, increases bronchial constriction, mucus secretion and edema
(no passage for air to go in, causing difficulty breathing)

Question 112

What are the major goals for Pulmonary rehabilitation?

Answer 112

Major goals for pulmonary rehabilitation:

1. IMPROVE health status
2. IMPROVE respiratory symptoms
3. RECOGNIZE signs that require medical intervention
4. DECREASE frequency, severity of respiratory problems
5. MAXIMIZE arterial O2, saturation and CO2 elimination
6. ENHANCE daily functional capacity
7. MODIFY body composition to help functional capacity
8. OPTIMIZE nutritional status

Question 113

What is the exercise prescription for pulmonary rehabilitation? What does the interpretation of GXT include?

Answer 113

Pulmonary Rehabilitation Exercise prescription

• Pretraining GXT and spirometric analyses FORM BASIS for exercise prescription
• INTERPRETATION of GXT includes
  1. Whether test TERMINATED because of cardiovascular or ventilatory end points
  2. DIFFERENCE between pre-and post exercise pulmonary function (look at improvements )
  3. NEED for supplemental oxygen during exercise

Question 114

What is dyspnea? What is the purpose of dyspnea scale and how it is used for physical training?

Answer 114

Dyspnea- difficult or labored breathing that aren’t due to underlying disease
-Dyspnea scale - a way to describe the shortness of breath one feels while exercising
to monitor dyspnea , it requires assessment by perceived Dyspnea scale

Question 115

What are the benefits of warm up and medication when it comes to physical training?

Answer 115

Benefits of warm-up and modification
-Fifteen to 30 min light-to moderate, continuous warm-up intervals initiate refractory period where subsequent intense exercise DOES NOT trigger severe bronchoconstrictive response
-EFFECTIVE pre-exercise medications: bronchodilators and inhaled heparin therapy, anti-inflammatory corticosteroids or cromolyn sodium
Training INCREASES pulmonary airflow reserve and REDUCES ventilatory work by potentiating exercise bronchodilation to let asthmatics maintain HIGHER airflow and SUSTAIN intense exercise despite impaired pulmonary function

Question 116

What are the main Neuromuscular diseases, disabilities and disorders?

Answer 116

Stroke, Multiple sclerosis, and Parkinson Disease

Question 117

Describe what occurs during a stroke and what are the effects of it. Also discuss the exercise prescription that is created.

Answer 117

Stroke:
-POTENTIALLY fatal reduction in brain’s blood flow resulting from ischemia or hemorrhage
Effects include motor and sensory impairment and language, perception, and affective and cognitive dysfunction
Exercise prescription:
- EMPHASIZES rehabilitation of movement (passive and active- assisted flexibility and muscle strength) during first 6 months of recovery.

Question 118

What occurs in multiple sclerosis and what does the exercise prescription entail?

Answer 118

Multiple Sclerosis:

• CHRONIC disease characterized by destruction of myelin sheath surrounding nerve fibers
• Exercise prescription
• INVOLVES aerobic, strength, balance coordination, and flexibility exercises
• Ideal exercise CONSISTS of walking in climate-controlled area providing stable temperature, level surface, opportunity to rest frequently
• Training 3 times weekly; minimum 30 min per session in 10 min periods

Question 119

Describe Parkinson’s Disease and the clinical symptoms that occur. Also discuss the exercise prescription created.

Answer 119

Parkinson’s disease
-Motor system DISORDER from loss of Dopamine-producing brain cells
-CLINICAL symptoms include tremor, bradykinesia (slowness of movement) rigidity, impaired postural reflexes
-produces extreme gait/postural instability
Exercise prescription
-INDIVIDUALIZED, directed toward interventions that affect associated motor control problems; emphasizes slow, controlled movements for specific tasks while lying, sitting, standing, walking.

Question 120

what is chronic renal disease and what are the symptoms associated with it? Also discuss the exercise prescription created.

Answer 120

Chronic renal disease- Kidneys no longer carry out filtering functions
-symptoms referred to as UREMIA (retention in body of waste products normally excreted in urine)
-Chronic UREMIA progresses to end-stage renal disease (kidney failure) , requiring life-long dialysis or transplant
Exercise prescription:
-LOW-LEVEL Endurance training lowers muscle protein degradation in renal insufficiency (lower amino acid breakdown) ; lowers resting blood pressure in hemodialysis and improves aerobic capacity

Question 121

Discuss the prevalence of cognitive/Emotional Diseases and disorders

Answer 121

Cognitive/Emotional Diseases and Disorders:

• Twenty-six percent of U.S. adults suffer from a diagnosable mental disorder in a given year
• Four of the 10 leading causes of disability in U.S
• MENTAL DISORDERS
• Depression, bipolar disorder, schizophrenia, obsessive-compulsive disorder

Question 122

What are the five major classifications of of Cognitive/emotional diseases and disorders.

Answer 122

5 main classifications:

1. MAJOR DEPRESSIVE DISORDER: referred to as depression
2. DYSTHYMIA- mildly depressed on most days
3. SEASONAL AFFECTIVE DISORDER- recurrence of depression during certain seasons (winter)
4. POSTPARTUM DEPRESSION- occurs in the first few months after delivery
5. BIPOLAR DISORDER: previously termed manic-depressive illness; characterized by extremes in mood and behavior

Question 123

What does Depression arise from?

Answer 123

Depression has NO SINGLE CAUSE, but often results from a combination of factors:
FAMILY situation
PESSIMISTIC personality
HEALTH status
-OTHER Psychologic disorders
(the more chronically ill someone is, the more likely they will have depression)

Question 124

What are the common signs/symptoms of Depression ?

Answer 124

Common signs/symptoms of Depression:

1. Loss of enjoyment from things that were once pleasurable
2. Loss of energy
3. Feelings of hopelessness or worthlessness
4. Difficulty concentrating
5. Difficulty making decisions
6. Insomnia or excessive sleep
7. Stomachache and digestive problems
8. Decreased sex drive
9. Aches and pains (ex: recurrent headaches)
10. Change in appetite causing weight loss or gain
11. Thoughts of death or suicide
12. Attempting suicide

Question 125

Describe the exercise prescriptions that will be considered for clinically depressed individuals

Answer 125

Exercise prescription in Clinically Depressed individuals;

• ANTICIPATE barriers
• KEEP expectations realistic
• DESIGN a feasible plan
• ACCENTUATE pleasurable aspects
• INCLUDE group activities
• ENCOURAGE compliance
• INTEGRATE exercise with other treatments