KIN 405 Midterm 1 Flashcards
What % of Canadians aren’t active enough to achieve the health benefits they need from physical activity?
~50-63%
What is obesity?
The accumulation of an excessive amount of fatty or adipose tissue…the presence of this excess fat impairs the functioning of many important organs and body systems and can lead to multiple health problems, even death
Even though BMI doesn’t take LBM into account, why is it widely used to assess body composition?
Easy to do and most of the published literature uses it
Even though BMI isn’t the best measure of body comp, is it well correlated with TBF%?
Yes
What is the prevalence of overweight and obese in Canadian adults?
58.8% in 2004
Why hasn’t there been that much of a change in overweight/obesity in the last ten years?
We aren’t getting fatter or obese people are dying sooner
What are the contributing factors to obesity?
Activity levels (impact on systems controlling food storage and energy use), diet (over consumption of foods rich in fat and calories), genetic predisposition more likely to store energy as fat, more vulnerable to negative effects of poor diet and limited exercise, metabolism (age, disease), endocrine dysfunction (relatively uncommon), environment (cultural eating habits, availability of healthy food and gyms), social, economics, and psychological and behavorial
How do genetics influence obesity?
Can determine resting metabolic rate, response to exercise, and nutrition
What is energy balance?
Enregy in = energy out = weight maintenence
What is an energy imbalance leading to obesity?
Energy in > energy out = storage of excess energy as body fat (TAG)
Central obesity?
Fat deposition principally over the abdomen and upper body (android; visceral adiposity. Worse because it surrounds organs and impairs their function
Peripheral obesity?
Fat distribution is more peripheral, often around the hips and gluteal region (gynoid)
4 compartments of abdominal obesity
Visceral, retroperitoneal, subcutaneous, and intramuscular
WC for assessing abdominal obesity?
> 102 cm for men and >88 cm for women…varies with ethnicity
Total abdominal fat as a risk factor?
Total abdominal fat appears to be an independent risk factor even when BMI is not markedly increased…decrease in visceral adiposity with exercise can reduce these risks
Why visceral adiposity so harmful?
VAT is more metabolically active and is linked to accelerated mobilization of fatty acids to the portal system due to increased rate of lipolysis in visceral fat cells
What are undesirable effects of elevated portal free fatty acids?
Glucose intolerance, dyslipidemia, hyperinsulinemia (likely the result of abnormal hormonal regulation of lipolysis)
Sarcopenia
Loss of muscle, low musclarity
What is sarcopenic obesity?
Increased fat depots results in impairments of various organs including muscle. Increased risk of simultaneous loss of muscle and gain of fat tissue = SARCOPENIC OBESITY
Normal fasting glucose
< 6.0 mM
Prediabetic fasting glucose
6.0-7.0 mM
Type 2 Diabetes fasting glucose
> or equal to 7.0 mM
OGTT normal blood glucose
< 7.8 mM after 2 hrs
OGTT perdiabetic blood glucose
7.8-11.0 mM after 2 hrs
OGTT Type II diabetes blood glucse
> or equal to 11.1 mM after 2 hrs
Gestational diabetes?
Temporary condition that occurs during pregnancy, affects ~3.5% of all pregnancies, increaased risk of developing diabetes for both the mother and child
What can diabetes cause if left untreated?
Heart disease, kidney, eye disease, problems with an erection, nerve damage. Damage is related to glycation of proteins in the basement membrane and damage to endothelial cells
Diabetes risk factors?
Ethnic background (Aboroginal, Hispanic, Asian, South Asian or African descent), overweight/obese, family history (parent, brother or sister), health ocmplication associated with diabetes, giving birth to a baby >4 kg, had gestational diabetes, impaired glucose intolerance or impaired fasting glucose, high blood pressure, high cholesterol or other fats in the blood
How can improve muscle metabolism?
Enhances glucose uptake and lipolysis/fatty acid uptake
Risk factors for CVD?
High blood pressure, smoking, high cholesterol, diabetes or high blood sugar, low physical activity, stress, obesity, diet, and excess alcohol consumption
% of Canadian adults with hypertension?
22% (40% are above >55)
What are the mmHg for hypertension?
> 140 mmHg and 90 mmHg on two separate occasions
Prehypertension?
120-139 mmHg and 80-89 mmHg
Hypertension for diabetes or kidney disease?
130/80 mmHg
BP readings to not allow someone to exercise?
> 144 mmHg and/or >94 mmHg after 2 readings separated by 5 minutes of quiet resting
Factors that influence BP
Sedentary lifestyle, unhealthy diet (too little of fresh fruit, veggies, and low fat dairy products), too much salt and saturated fats, being overweight, excess alcohol, and stress
Standardized technique for measuring BP
1) no caffeine in the preceding hour 2) no smoking or nictomine 15-30 minutes prior 3) no use of substances containing adrenergic stimulants such as phenylephrine or pseudoephedrine 4) bladder and bowel comfortable, quiet environment 6) no tight clothing 7) no acure anxiety, stress or pain 8) patient should stay silent prior and during the procedure
Posture for BP
calmy deated for 5 minutes, back well supported, arm supported at heart level, feet touching the floor, no talking
Sources of error in BP meausrement
inaccurate device, improper cuff length or width, cuff not centred, too loose or over clothing, arm unsupported or elbow below heart level, poor auditory acuity of physician, improper stethoscope position or pressure, expecation bias, slow reaction time of technician, error in reading, noise, client holding bars of treadmill or bike
Pharmacological things that lower BP
diurectis (decrease excess salt and fluid in body, beta blockers (decrease HR band CO by clokcing beta adrenergic receptors), sympathetic nerve inhibitors (prevent arteriole constriction), vasodilators (induce relaxation in arterial smooth muscle), ACE inhibitors (decreease arteriole constriction by disrupting angiotensin production), calcium channel blockers (reduce herat contractility)
Non-pharmacological things that lower BP
sodium resitricted diet, weight loss, restricted alcohol intake, exercise
Dyslipidemia?
Higher than normal levels of total cholesterol, higher than normal LDL cholesterol, lower than normal HDL cholesterol, or higher than normal TG levels…Metabolic disorder that is secondary to many diseases including atherosclerosis and cardiovascular disease
LDL-C?
Low density lipoprotein cholesterol—bad cholesterol, high levels in the blood can stimulate plaque (fatty deposits) formation in blood vessel walls –> atherosclerosis
HDL-C?
“Good” cholesterol, helps carry LDL away from blood vessel walls and removing it from the body
TGs
Trigylcerides, most common fat in our bodies, food intake: increase risk of blood clots. Increased TGs in food determine the amount of cholesterol more so than high cholesterol foods in the body
Key secondary causes of dylipidemia
Diet (saturated fat and cholesterol in food), weight (being overweight tends to increase your cholesterol, particularly abdominal obesity), physical inactivity (regular exercise can help lower LDL-C and raise HDL-C). Others: kidney disease (nephrotic syndrome), hypothyroidism, anorexia nervosa, family history
Canadian 2003 guidelines for people that are recommended for regular lipid profile testing
Males >40 years, Females >50 years and/or postmenopausal, diagnosed with heart disease, diabetes, or high BP, abdominally obese, smokers, individuals with strong family history of heart disease
Total cholesterol cutoff
<5.2 mM (200 mg/dL)
LDL-C cutoff
< 3.5 mM (about 130 mg/dL)
HDL-C cutoff
> 1.0 mM for men and >1.2 mM for women
TG cutoff
<1.7 mM
TC/HDL-C cutoff
<5.0 mM
Metabolic syndrome?
A cluster of symptoms combined may be defined as clinical condition –> now also referred to as cariometabolic syndrome. Combination of CVD risk factors associated with hypertenion, insulin resistance, dylipidemia and abdominal obesity
Prevalence of MS in Canada?
17.5% male adults; 11.2% female adults
Generic cutpoints for MS diagnosis?
Central obesity plus any 2 of the following 4 factors: raised BP (>130/85 mmHg or treatment of previously diagnosed hypertension), raised fasting plasma glucose (>100 mg/dL/5,6 mM or previously diagnosed Type II Diabetes), raised TGs (>150 mg/dL/1.6mM or specific treatment for this lipid abnormality), HDL-C (<50 mg/dL/1.29 mM females)
Key risk factors for cancer
Genetics, physical inactivity, diet, weight, environmental factors
Body composition changes (increased fat and loss of muscle) and their implications
Decreased treatment response, increased treatment toxicity, morbidity in surviorship and decreased survival, increased disease recurrence
How much exercise do people need?
To achieve health benefits, adults aged 18-64 years should accumulate at least 150 minutes of moderate to vigourous intensity aerobic physical activity per week in bouts of 10 minutes or more
Volume of physical activity needed to improve TGs 0% to 40%
250 kcal/wk
Volume of physical activity needed to improve HDL-C 0-40%
1800 kcal/wk
Volume of physical activity needed to improve BP by 40%
~600 kcal/wk
Volume of physical activity needed to improve body composition by 40%
1200 kcal/wk
CSEP-PATH 5 As?
Ask, assess, advise, agree, assist/arrange
What are the objectives for ASK in the PATH model?
Get to know your client by screening for readiness, establish a rapport, father information about goals, find their physical activity background, and knowledge/level of interest
What does the ask section consist of?
Preliminary meeting and first meethig, explanation of events, review prlimiary instructions for clients, informed consent, and PAR-Q+ and related questionnaires
Components of a consent form?
Explanation of the test, risks and discomforts, responsibilities of the participant, benefits to be expected, how information will be used and stored, and freedom of participation of withdrawal
The do’s of a consent form?
Explain clearly in layman’s terms, encourage questions and provide time to think about it and discuss with others; include all signatures: yours, client’s, witness’s; appreciate the importance of this step
The don’ts of a consent form
Don’t downplay risks and don’t assume they understand it or even read it
What info do you gather in an assessment?
Medical history (past and present, family health, focus on conditions that may need medical attention, information to help determine the risk of classification), lifestyle and preferences information, and goals of client (not YOUR goals)
Why gather information?
1) Understand any medical considerations which will help confirm whether physician approval is required 2) Disease risk classificaion 3) understand what the client wants to accomplish and how you will make it feasible
Examples of cardiovascular diseases
hypertension, hypercholesterolemia, heart murmur, myocardial infarction, fainting or dizziness, claudication, chest pain, palpatations, ischemia, tachycardia, ankle edema, stroke
Examples of pulmonary diseaes
asthma, bronchitis, emphysema, nocturnal dyspnea, coughing up blood, exercise induced asthma, breathlessness during/after mild exertion
Examples of metabolic diseases
diabetes, obesity, glucose intolerance, McArdle’s syndrome, hypoglycemia, thyroid disease, cirrohosis
Examples of musculoskeletal problems
osteoporosis, osteoarthritis, low back pain, prosthesis, muscular atrophy, swollen joints, orthopedic pain, artificial joints
Absolute contraindications to exercise testing
1) Recent significant change in testing ECG suggesting significant ischemia, recent MI (within 2 days), or other acute cardiac events 2) Unstable angina 3) Uncontrolled cardiac arrhythmias causing symptoms or hemodynamic compromise 4) Unctrolled symptomatic heart failure 5) Acute infections 6) severe symptomatic aortic stenosis 7) suspected or known aneurysm 8) acute myocarditis or pericarditis 9) acute pulmonary embolus or pulmonary infarction
Relative contraindications to exercise testing
1) Left main coronary stenosis 2) Moderate stenotic valvular disease 3) Known electrolyte abnormalities (hypokalemia, hypomagnesemia) 4) Severe arterial hypertension; resting DBP >110 an’or resting systolic >200 5) Tachyarrhythmias or bradyarrythymias 6) Hypertrophic cardiomypothathy or other forms of outflow tract obstruction 7) High degree AV block 8) Ventricular aneursym 9) Uncontrolled metabolic disease 10) Chronic infectious disease (AIDS, hepatitis) 11) Neuromuscular, musculoskeletal, or rheumatoid disorders that are exacerbated by exercise
CHD risk factors (not specifics)
family history, cigarette smoking, hypertension, dyslipidemia, impaired fasting glucose, obesity, physical inactivity
CHD risk factor family history
MI or sudden death in male relative (father or first degree relative) <65 yr
CHD risk factor cigarette smoking
current or smoking cessation <6 months
CHD risk factor hypertension
SBP >140 mmHg and/or DBP >90 mmHg on 2 separate occasions
CHD risk factor dyslipidemia
TC >200 mg/dL, HDL-C 130 mg/dL, or on lipid lowering medication
CHD risk factor impaired fasting glucose
fasting glucose >110 mg/dL on 2 separate occasions