Master Deck Flashcards
Explain how muscle spindles work, with 2 examples (anteriorly rotated pelvis, adducted & internally rotated knees)
7/168
Muscle spindles are composed of fibers that lie parallel to the muscle fiber. Muscle spindles are sensitive to change in muscle length & rate of length change. Their function is to prevent muscles from stretching too far or too fast. But when a muscle on one side of a joint is lengthened (because of a shortened muscle on the opposite side), the spindles of the lengthened muscle are stretched. This information is transmitted to the brain & spinal cord, exciting the muscle spindle and causing the muscle fibers of the lengthened muscle to contract. This often results in micro muscle spasms or a feeling of tightness.
The hamstring complex is a prime example of this response when the pelvis is rotated anteriorly, meaning the anterior superior iliac spines (front of pelvis) move downward (inferiorly) and the ischium (bottom posterior part of pelvis where hamstrings originate) moves upward (superiorly). If the attachment of the hamstring complex is moved superiorly, it increases the distance between the two attachment sites and lengthens the hamstring complex. Here, the hamstrings do not need to be statically stretched because it is already in a stretched position. When a lengthened muscle is stretched, it increases the excitement of the muscle spindles and further creates a contraction (spasm) response. Here, the shortened hip flexors are helping to create the anterior pelvic rotation that is causing the lengthening of the hamstrings. Instead, the hip flexors need to be stretched.
Another example is one whose knees adduct & internally rotate (knock knees) during a squat. The underactive muscle is the gluteus medius (hip abductor & external rotator), and the overactive muscles include the adductors (inner thighs), & tensor fascia latae (hip flexor & hip internal rotator). Thus, one does not need to stretch the gluteus medius, but instead stretch the adductor complex & tfl, which are overactive, pulling the femur into excessive adduction & internal rotation.
Identify & demonstrate all 5 Back-Strength Resistance exercises.
13/332-333/588-589
Identify & demonstrate all 5 Leg-Stabilization Resistance exercises
13/344-345/593-594
Identify & demonstrate all 7 Plyometric-Strength exercises
11/280-282/582-583
.
Describe Balance-Strength exercises and their function
10/257
Involve dynamic eccentric & concentric movement of the balance leg, through a full range of motion. Movements require dynamic control in mid-range of motion, with isometric stabilization at the end-range of motion. The specificity, speed, & neural demand are progressed.
Designed to improve the neuromuscular efficiency of the entire HMS.
Identify & demonstrate all 7 Plyometric-Stabilization exercises.
11/582/276-279
Identify & demonstrate all 5 Plyometric-Power exercises.
11/583/283-285
Identify & demonstrate all 6 SAQ Speed Ladder Drills
12/297
Identify the reps, sets, tempo, intensity, rest interval, frequency, duration, exercise selection for Phase 4: Maximal Strength Training (flexibility, core, balance, plyometric, SAQ, resistance)
14/376
Identify & demonstrate all 5 Leg-Power Resistance exercises
13/348/595
What is the ultimate reason or motivation for clients who seek PT services?
20/561
the desire to improve their quality of life eg not to improve appearance or performance.
Identify the reps, sets, tempo, intensity, rest interval, frequency, duration, exercise selection for Phase 2: Strength Endurance Training. (flexibility, core, balance, plyometric, SAQ, resistance)
14/372
Identify & demonstrate all 5 Leg-Strength Resistance exercises.
13/346-347/594
Identify & demonstrate all 6 Balance-Power exercises
10/580-581/262-264
Identify & demonstrate all 4 Biceps-Stabilization Resistance exercises
13/339-340/592
Describe Core-Power exercises & their function
9/239
Prepare one to dynamically stabilize & generate force at more functionally applicable speeds.
Designed to improve the rate of force production of the core musculature.
Identify & demonstrate all 5 Total Body-Stabilization Resistance exercises
13/321-322/584
Describe Plyometric-Strength exercises & their function
11/279
Involve more dynamic eccentric & concentric movement through a full range of motion. The specificity, speed, & neural demand may be progressed. They are performed in a repetitive fashion (spending a short time on the ground before repeating).
Designed to improve dynamic joint stabilization, eccentric strength, rate of force production, & neuromuscular efficiency of the entire HMS.
Conversation points to form a relationship
19/528
Building a relationship with clients initially is time spent getting to know who they are and what their needs & goals are; get to know their readiness for exercise, listening, showing support, collaborating with them to design their program, ask about previous experiences with exercise, ask what worked best & worst; daily activities; health concerns; benefits of exercise.
Identify the percentages of each component that makes up skeletal muscle
17/474
72% water
22% protein
6% fat, glycogen, & minerals
These conditions are necessary for the body to synthesize endogenous protein
17/476
Availability of all essential & nonessential amino acids in proper amounts.
An adequate supply of exogenous protein (supplying amine groups , which synthesize the nonessential amino acids).
Adequate energy-yielding carb & fat (sparing the protein).
What are actin and myosin?
2/40
Muscle fibers have structures called myofibrils. Myofibrils contain myofilaments that are the actual contractile components of muscle tissue. These myofilaments are actin (thin stringlike filaments) and myosin (thick filaments).
The actin and myosin filaments form a number of repeating sections within a myofibril. Each one of these sections is a sarcomere.
Identify and demonstrate all 8 Core-Stabilization exercises
9/235-236/577
Define these Anatomic Locations: superior Inferior Proximal Distal anterior Posterior Medial Lateral Contralateral ipsilateral
5/83
Positioned above a point of reference
positioned below a point of reference
Positioned nearest the center of body or point of reference
Positioned farthest from the center of body or point of reference
On the front of the body
On the back of the body
Positioned near the middle of body
Positioned toward outside of body
Positioned on opposite side of body
Positioned on the same side of body
Define vO2 max
3/685
The highest rate of oxygen transport and utilization achieved at maximal physical exertion.
Explain aging considerations and identify physiologic considerations for seniors
16/420-423
Various physiologic changes are normal with aging and some are pathologic, meaning related to disease. Blood pressure tends to be higher at rest and during exercise, which can be the result of natural causes, as a result of disease, or a combination. Arteriosclerosis is a normal physiologic process of aging that results in arteries that are less elastic and pliable, which in turn leads to greater resistance to blood flow and thus higher blood pressure. Conversely, atherosclerosis, which is caused largely by poor lifestyle choices (smoking, obesity, sedentary lifestyle), restricts blood flow as the result of plaque buildup within the walls of arteries and thus leads to increased resistance and blood pressure.
Another disease-related cause of hypertension is peripheral vascular disease (a group of diseases in which blood vessels become restricted or blocked, usually as a result of atherosclerosis), which refers to plaques that form in any peripheral artery, typically those of the lower leg. People with BP’s between 120 over 80 mm HG and 139 / 89 mm hg are considered pre-hypertensive and should be carefully monitored. Anyone regardless of age who has a BP of 140 over 90 mm HG or higher should be referred to a physician.
Normal physiologic and functional reductions from aging include: Maximal attainable heart rate, cardiac output, muscle mass, balance, coordination (neuromuscular efficiency), connective tissue elasticity, and bone mineral density.
Many of the reasons for decreased functional capacity in older adults can be slowed or reversed through engaging in routine physical activity or exercise.
Physiologic considerations: A) Maximal oxygen uptake, maximal exercise HR, and pulmonary function all decrease with increasing age: so gradual progression, shorter duration, lower intensity. B) Percentage of body fat will increase and both bone mass and lean body mass will decrease with increasing age: So resistance training is recommended with lower initial weights and slower progression. C) Balance, gait, and neuromuscular coordination may be impaired: Safeguard against falls and foot problems. Cardio options: cycling, treadmill with handrail, aquatic. Resistance options: seated machines, progressing to standing. D) Higher rate of both diagnosed and undetected heart disease in elderly: pulse assessment is critical as well as monitoring for chronic diseases. E) Pulse irregularity is more frequent: Careful analysis of medications and exercise effects.
Describe the SAQ exercises for SAQ-Strength and 4 examples
12/296
Drills allowing greater horizontal inertia but limited unpredictability such as 5-10-5, T-drill, Box drill, stand up to figure eight, etc.
Explain how veins, arteries, arterioles, capillaries, and venules work
3/CR
The blood vessels that move blood into the heart are veins, while the vessels that move blood out of the heart are arteries. As blood moves out of the heart through the arteries, the vessels branch off and become smaller. These smaller branches are arterioles. The arterioles then further branch off into capillaries within tissues. Capillaries are where nutrients, water, and oxygen are taken up by the cells for metabolism. As those nutrients are used, waste products and CO2 are exchanged back into the blood at the capillaries. Blood then flows back to the heart through the larger venules and then veins.
Explain what the goal of a PT is (rather than having the goal of communicating information) IE active listening
19/533
Build a relationship with their client by respecting their perspective and being interested in them.
Explain and identify an area to be cautious about in regards to high protein diets
17/475
A high protein diet (over 35% of calories) forces the kidneys to work harder to eliminate the increased urea produced. Thus caution should be taken for those with a history of kidney problems such as renal insufficiency or kidney stones.
Explain the importance of plyometric training
11/272
Plyometrics enhance the excitability, sensitivity, & reactivity of the neuromuscular system and increase the rate of force production (power), motor unit recruitment, firing frequency (rate coding), and motor unit synchronization.
All movement patterns that occur during functional activities involve a series of repetitive stretch-shortening cycles (eccentric and concentric contractions). Stretch-shortening cycles require the neuromuscular system to react quickly and efficiently after an eccentric muscle action to produce a concentric contraction and impart the necessary force (or acceleration) in the appropriate direction. The purpose of this activity is to produce the necessary Force to change the direction of an object’s Center of mass efficiently. Therefore, functional movements such as “cutting or change of Direction” require training exercises that emphasize plyometric training to prepare each client for the functional demands of a specific activity.
Plyometrics provides the ability to train specific movement patterns in a biomechanically correct manner at a more functionally appropriate speed. This provides better functional strengthening of the muscles, tendons, & ligaments to meet the demands of everyday activities and Sport. The ultimate goal of plyometric training is to decrease the reaction time of the muscle action Spectrum (eccentric deceleration, isometric stabilization, concentric acceleration). This is also what results in increased speed of movement in the individual.
The speed of muscular exertion is limited by neuromuscular coordination. This means that the body will only move within a range of speed that the nervous system has been programmed to allow. Plyometric training improves neuromuscular efficiency and improves the range of speed set by the central nervous system. Optimal reactive performance of any activity depends on the speed at which muscular forces can be generated.
Define ventilatory threshold
8/684/212
The point during graded exercise in which ventilation increases disproportionately to oxygen uptake, signifying a switch from predominantly aerobic energy production to anaerobic energy production.
Explain water and performance; how to ensure adequate fluid replacement; and guidelines for fluid replacement
17/490-491
The importance of proper hydration cannot be stressed enough. The body cannot adapt to dehydration, which impairs every physiologic function. Table 17.11 show the effects of dehydration.
Table 17.11 Effects of Dehydration: Decreased: blood volume, performance, blood pressure, sweat rate, cardiac output, blood flow to the skin. Increased: core temperature, water retention, sodium retention, heart rate, perceived exertion, use of muscle glycogen.
A fluid loss of even 2% of body weight will adversely affect circulatory functions and decrease performance levels. But if a fairly regular daily pattern of exercise and water and food consumption is followed, average body weight will give a very good index of the body’s state of hydration.
Thirst alone is a poor indicator of how much water is needed. Athletes consistently consume inadequate fluid volume, replacing 50% of sweat losses. A good way to keep track of how much one needs to drink is to first determine their average daily weight. Use this number as the standard for their euhydrated (or normal state). Do not begin a practice or competition until the body is at, or slightly above, it’s standard weight. Drink enough water, juices, or sports drinks during exercise to maintain the starting weight.
Guidelines for fluid replacement in the athlete: A) consume 14 to 22 oz of fluid 2 hours before exercise. B) drink 6 to 12 oz of fluid for every 15 to 20 minutes of exercise. C) fluids should be cold because of more rapid gastric emptying. D) If exercise exceeds 60 Minutes, of a sports drink containing up to 8% carb can replace both fluid and dwindling muscle glycogen stores. E) when exercising for less than 60 minutes, water is the best choice for fluid replacement. F) the goal is to replace sweat and urine losses. G) ingest 16 to 24 oz of fluid for every pound of body weight lost after exercise bouts, especially if rapid rehydration is necessary, as in twice a day training.
Explain diabetes, define it, explain how exercise affects it, and identify its physiologic considerations
16/429-432
Diabetes is a metabolic disorder in which the body does not produce enough insulin (type 1) or it cannot respond normally to the insulin that is made (type 2). It’s the 7th leading cause of death in United States and is associated with a greater risk for heart disease, hypertension, & blindness.
Diabetes: Chronic metabolic disorder, caused by insulin deficiency, which impairs carbohydrate usage and enhances usage of fat and protein.
Type 1 (insulin dependent diabetes) and type 2 (non-insulin dependent diabetes). Some with type 2 cannot manage their blood glucose levels and do require additional insulin. Type 2 is strongly associated with obesity.
Type 1 diabetes is usually diagnosed in children and young adults. Specialized cells in the pancreas called beta cells stop producing insulin, causing blood sugar levels to rise, resulting in hyperglycemia (high levels of blood sugar). To control this high level of blood sugar, one with type 1 must inject insulin to compensate for what the pancreas cannot produce. Exercise increases the rate at which cells utilize glucose, which may mean that insulin levels may need to be adjusted with exercise. If one with type 1 does not control their blood glucose levels (via insulin injections and dietary carbs) before, during, and after exercise, blood sugar levels can drop rapidly and cause a condition called hypoglycemia (low blood sugar) leading to weakness, dizziness, and fainting. Although insulin, proper diet, and exercise are the primary components prescribed for type 1, these people must still be monitored throughout exercise to ensure safety.
Type 2 diabetes is associated with obesity, especially abdominal obesity. There’s a rising incidence of type 2 in children associated with both an increase in abdominal obesity and decrease in physical activity. Those with type 2 usually produce enough insulin; however their cells are resistant to the insulin (the insulin present cannot transfer adequate amounts of blood sugar into the cell). This condition can lead to hyperglycemia (high blood sugar). Chronic hyperglycemia is associated with several diseases associated with damage to the kidneys, heart, nerves, eyes, and circulatory system. Although those with type 2 do not experience the same fluctuations in blood sugar as those with type 1, it is still important to be aware of the symptoms, especially for those with type 2 who use insulin medications.
The most important goals of exercise for those with either type of diabetes are glucose control, and for those with type 2 diabetes, weight loss. Exercise is effective with both goals because it has a similar action to insulin by enhancing the uptake of circulating glucose by exercising skeletal muscle. Exercise improves many glucose measures, including tissue sensitivity, improved glucose tolerance, and even a decrease in insulin requirements. Thus, exercise has a substantial positive effect on the prevention of type 2 diabetes.
In contrast to walking being a preferred form of exercise for obese clients, care must be taken when recommending walking to clients with diabetes to prevent blisters and foot micro trauma that could result in foot infection. Care should also be taken for giving advice regarding carb intake and insulin use, not only before exercise but afterward, to reduce the risk of a hypoglycemic or hyperglycemic event.
Low impact activities can reduce the risk of injury, whereas resistance training is advised for health. Phases 1 and 2 of opt model are appropriate, but maybe not Plyometrics.
Physiologic considerations: A) associated with comorbidities eg cardiovascular disease, obesity, hypertension: for type 2, target weekly caloric goal of 1000-2000 calories. B) exercise exerts an effect similar to that of insulin: increased risk of exercise induced hypoglycemia. C) hypoglycemia may occur several hours after exercise, as well as during exercise: for those recently diagnosed, glucose should be measured before, during, and after exercise. D) Those taking beta blocking medications may be unable to recognize signs and symptoms of hypoglycemia. Some reduction in insulin and increase in carbohydrate intake may be necessary and proportionate to exercise intensity and duration. E) exercise in excessive heat may mask signs of hypoglycemia: Postexercise carb consumption advisable. F) increased risk for retinopathy: Be cognizant of signs and symptoms of hypoglycemia. G) peripheral neuropathy may increase risk for gait abnormalities and infection from foot blisters: use weight bearing exercise cautiously and wear good Footwear.
Identify and demonstrate all 7 Balance-Stabilization exercises
10/579/254-257
Identify and demonstrate all 6 Core-Power exercises
9/240-241/578
.
Identify and demonstrate all 4 Chest-Strength Resistance exercises
13/327-328/586
Identify and demonstrate all 3 Triceps-Strength Resistance exercises
13/343/593
Identify and demonstrate all 5 Total Body-Power Resistance exercises
13/324-325/585
Define SMART goals
19/543
Specific: Clearly defined; detailed description
Measurable: quantifiable; a way to assess progress
Attainable: the right mix of goals that are challenging but not extreme
Realistic: An objective toward which one is both willing and able to work
Timely: A specific date of completion that is not too distant in the future
Define Osteoporosis, describe it, how exercise affects it, and physiologic considerations
16/440-443
Osteopenia: a decrease in the calcification or density of bone as well as reduced bone mass.
Osteoporosis: Condition in which there is a decrease in bone mass and density as well as an increase in the space between bones, resulting in porosity and fragility.
Osteopenia is a condition in which bone mineral density (BMD) is lower than normal and is a precursor to osteoporosis, whereas osteoporosis is a disease of bones in which bmd is reduced, bone microstructure is disrupted, and the actual proteins in bone are altered. Primary (type 1) osteoporosis is associated with normal aging and is attributable to lower production of estrogen and progesterone, both of which are involved with regulating the rate at which bone is lost. Secondary (type 2) is caused by medical conditions or medications that can disrupt normal bone reformation, including alcohol abuse, smoking, diseases, medications. Both types are treatable with exercise. Most clients will be women.
Type 1 osteoporosis is prevalent in post-menopausal women because of a deficiency in estrogen. The disease is characterized by an increase in bone resorption (removal of old bone) with a decrease in bone remodeling (formation of new bone), which leads to a decrease in bone mineral density.
Osteoporosis commonly affects the neck of the femur and the lumbar vertebrae. These structures are part of the core and are located where most of all forces come together. Thus, a decrease in bmd places the core in a weakened state, and thus, more susceptible to injury, such as a fracture. New bone formation (remodeling) occurs as the result of stress placed on the musculoskeletal system. To maintain bone remodeling, one must remain active enough to ensure adequate stress is being placed on their body. Other risk factors are smoking, excess alcohol, low calcium intake.
Training that focuses on the prevention of falls, rather than strength alone, is more advantageous for the elderly. Therefore, programs that combine resistance, flexibility, core, and balance may be best. Exercises should be seated or standing. Weight bearing activities may be more beneficial to increasing bmd. Plyometrics not recommended. Phases 1 and 2 of opt. Progressing exercises to the standing position will increase stress and increase demand for balance. Both components are necessary to overcome the effects of osteoporosis.
Physiologic considerations: A) maximal oxygen uptake and ventilatory threshold is frequently lower, as the result of chronic deconditioning: 40 to 70% of Maximum work capacity. B) Gait and balance may be negatively affected: low intensity, weight supported programs emphasizing balance training. C) chronic vertebral fractures may result in great lower back pain: resistance training to build bone mass. Heavier loads improve bone density. Circuit format recommended. D) Age, disease, stature, deconditioning may place one at risk for falls: water modalities or weight supported exercise eg cycling. Reinforce Lifestyle Changes.
Identify and demonstrate all 9 SMR stretches
7/177/570-571
Define cumulative injury cycle and explain it
7/667/170-172
A cycle whereby an injury will induce inflammation, muscle spasm, adhesions, altered neuromuscular control, and muscle imbalances.
Poor posture and repetitive movements create dysfunction within the connective tissues. This dysfunction is treated by the body as an injury, and as a result, the body will initiate a repair process termed the cumulative injury cycle. Any trauma to tissue of the body creates inflammation. Inflammation, in turn, activates pain receptors and initiates a protective mechanism, increasing muscle tension or causing muscle spasm. Heightened activity of muscle spindles in particular areas of the muscle create a micro spasm, and as a result of the spasm, adhesions (or knots) begin to form in the soft tissue. These adhesions form a weak, inelastic matrix (inability to stretch) that decreases normal elasticity of the soft tissue, resulting in altered length tension relationships (leading to altered reciprocal inhibition), altered force couple relationships (leading to synergistic dominance), and arthrokinetic dysfunction (leading to altered joint motion). Left untreated, these adhesions can form permanent structural changes in the soft tissue that is evident by Davis’s law.
Davis’s law states that soft tissue models along the lines of stress. Soft tissue is remodeled (or rebuilt) with an inelastic collagen matrix that forms in a random fashion, meaning it usually does not run in the same direction as the muscle fibers. If the muscle fibers are lengthened, these inelastic connective tissue fibers act as roadblocks, preventing the muscle fibers from moving properly, which creates alterations in normal tissue extensibility and causes relative flexibility.
If a muscle is in a constant shortened state (eg hip flexor muscles when sitting for long periods), it will show poor neuromuscular efficiency (as a result of altered length tension and force couple relationships). In turn, this will affect joint motion (ankle, knee, hip, and lumbar spine) and alter movement patterns (leading to synergistic dominance). An inelastic collagen matrix will form along the same lines of stress created by the altered muscle movements. Because the muscle is consistently short and moves in a pattern different from its intended function, the newly formed inelastic connective tissue forms along this altered pattern, reducing the ability of the muscle to extend and move in its proper manner. This is why it’s critical that an integrated flexibility training program be used to restore the normal extensibility of the entire soft tissue complex. It is essential for pts to address muscular imbalances through an integrated fitness assessment and flexibility training program. If PT’s neglect it, this will add more stresses to joints and muscles because they have improper mechanics and faulty recruitment patterns.
Explain the physiologic differences between children and adults that impact their response and adaptation to exercise
16/CR/418-420
A) Peak oxygen uptake: Because children do not usually exhibit a plateau in oxygen uptake at maximal exercise, the term “peak oxygen uptake” is a more appropriate term than VO2 Max or maximal oxygen uptake. Adjusted for body weight, peak oxygen consumption is similar for young and mature males, and slightly higher for young females compared with mature females. A similar relationship also exists for force production, or strength. Because of their high peak oxygen uptake levels, children can perform endurance activities fairly well. B) Sub-maximal oxygen demand (or economy of movement): youths are less efficient and tend to exercise at a higher percentage of their peak oxygen uptake during sub-maximal exercise compared with adults. This means that youths have a greater chance of fatigue and heat production in sustained higher intensity activities. C) Glycolytic enzymes are lower than adults: this means that youths have decreased ability to perform longer duration (10 to 90 seconds) high intensity activities or tasks. D) Decreased sweating rate: children have immature thermoregulatory systems, including both a delayed response and limited ability to sweat in response to hot, humid environments. This results in a decreased tolerance to environmental extremes, especially heat and humidity.
Unlike with sustained low intensity endurance activities, children are at a disadvantage in short duration (10 to 90 seconds) high intensity anaerobic activities because they produce less glycolytic enzymes that are required to support sustained anaerobic power. They should have planned rest intervals. In other words, lower glycolytic enzyme concentrations limit their ability to use glycogen for ATP production and decreases performance for longer duration, high intensity activities that rely on anaerobic glycolysis.
Describe Chronic Lung Disease, exercise effects, and physiologic considerations
16/453-455
Restrictive lung disease: condition of a fibrous lung tissue, which results in a decreased ability to expand the lungs.
Chronic obstructive lung disease: condition of altered airflow through the lungs, caused by airway obstruction as a result of mucus production.
Smoking is one of the leading preventable causes of death and a primary risk factor for the development of chronic lung diseases. Chronic lung disease is broken into two categories, obstructive and restrictive. In restrictive lung disease or disorders, lung tissue may be fibrotic and thus dysfunctional as in the case of pulmonary fibrosis or asbestosis. In restrictive lung disease the ability to expand the lungs may be decreased as a result of a number of causes such as fractured ribs or obesity. In chronic obstructive lung disease, the lung tissue may be normal, but air flow is restricted. Major obstructive lung diseases include asthma, bronchitis, and emphysema. These diseases are characterized by chronic inflammation (caused primarily by smoking, although in the case of asthma may be caused by environmental irritants) and airway obstruction via mucus production. Cystic fibrosis is another disease that is characterized by excessive mucus production, but is a genetic disorder.
The impairments during exercise are similar with both types. Problems include decreased ventilation and decreased gas exchange ability, resulting in decreased aerobic capacity and endurance and in oxygen desaturation. Clients will experience fatigue at low levels of exercise and often have shortness of breath (or dyspnea). Those with emphysema are usually underweight and may have muscle wasting with hypertrophied neck muscles (which are excessively used to assist in labored breathing). Those with bronchitis may be the opposite: overweight and barrel chested.
In general, exercise is similar to the general population. Exercise can improve functional capacity and decrease symptoms of dyspnea. The peripheral heart action system is advised. For some, inspiratory muscle training can improve the work of breathing.
Physiologic considerations: A) lung disease is frequently associated with other comorbidities, including cardiovascular disease: screen for comorbidities. B) a decrease in the ability to exchange gas in the lungs may result in oxygen desaturation and marked dyspnea at low workloads: Ascertain the level of oxygen saturation using a pulse oximeter. Values below 85% are a contraindication for exercise. C) chronic deconditioning results in low aerobic fitness and decreased muscular performance: guide aerobic exercise by client’s shortness of breath. D) upper extremity exercise may result in earlier onset of dyspnea and fatigue than expected, when compared with lower extremity exercise: Modify upper extremity exercise based on fatigue. Resistance training. Circuit training in a PHA format. E) may have significant muscle wasting and be of low body weight: recommend more calories per day.
Identify guidelines for the uncompromising customer service philosophy
20/560-561
A) never give the impression that any question is inconvenient
B) represent a positive image
C) obsess on opportunities to create moments that strengthen relationships
D) take ownership of complaints
E) routinely ask “Did I exceed this client’s expectations?”
F) always look for ways to improve
Define the principle of specificity (SAID), describe it, explain the 3 types of specificity with examples
13/307-310
States that the body will adapt to the specific demands that are placed on it. Example: if one repeatedly lifts heavy weights, they will produce higher levels of maximal strength. Conversely, if they lift lighter weights for many reps, they will have higher levels of muscular endurance.
According to the principle of specificity, training programs should reflect the desired outcomes. It’s important to remember that the body is made up of many types of tissues and these tissues may respond differently to the same stimulus. Remember that Type 1 muscle fibers function differently than type 2 muscle fibers. Type 1 or slow twitch fibers are smaller in diameter, slower to produce maximal tension, and more resistant to fatigue. Type 1 fibers are important for muscles that need to produce long-term contractions necessary for stabilization, endurance, and postural control. Type 2 or fast twitch fibers are larger in size, quick to produce maximal tension, and fatigue more quickly. These fibers are important for muscles producing movements requiring force and power such as performing a Sprint. To train with higher intensities, proper postural stabilization is required. Therefore, tissues need to be trained differently to prepare them for higher levels of training. This is the specific purpose behind periodization and the opt model.
The degree of adaptation that occurs during training is directly related to the mechanical, neuromuscular, and metabolic specificity of the training program. To effectively achieve program goals, PT’s need to consistently evaluate the need to manipulate the exercise routine to meet actual goals. The body can only adapt if it has a reason to adapt.
A) mechanical specificity: Refers to the weight and movements placed on the body. To develop muscular endurance of the legs requires light weights and high repetitions when performing leg exercises. To develop maximal strength in the chest, heavy weights must be used during chest exercises.
B) neuromuscular specificity: Refers to the speed of contraction and exercise selection. To develop higher levels of stability while pushing, chest exercises need to be performed with controlled, unstable exercises, at slower speeds. To develop higher levels of strength, exercises should be performed in more stable environments with heavier loads to place an emphasis on the prime movers. To develop more power, low weight, high velocity contractions must be performed in a plyometric manner.
C) metabolic specificity: Refers to the energy demand placed on the body. To develop endurance, training requires prolonged bouts of exercise with minimal rest periods between sets. Endurance training primarily uses aerobic Pathways to supply energy for the body. To develop maximal strength or power, training requires longer rest periods, so the intensity of each bout of exercise remains high. Energy will be supplied primarily via the anaerobic Pathways.
Applying the concept of specificity to a client whose goal is body fat reduction: Mechanically, the body burns more calories when movements are done while standing (versus seated or lying positions) and use moderate weights. From a neuromuscular standpoint, the body burns more calories when more muscles are being used for longer periods in controlled, unstable environments. Metabolically, the body burns more calories when rest periods are short to minimize full recuperation.
Define exercise selection.
Define single joint, multijoint, and total body exercises with examples.
Identify which ones are used in each opt level.
Identify the progression Continuum components.
14/362
The process of choosing appropriate exercises for one’s program.
Single joint: These exercises focus on isolating one major muscle group or joint EG bicep curls, calf raises
Multijoint: Use two to three joints EG squats, lunges, chest press
Total body: Multiple joint movements EG Step Up balance to overhead press, squat to two arm press, barbell clean
Stabilization: Total body; multijoint or single joint; controlled unstable
Strength: Total body; multijoint or single joint
Power: Total body; multijoint; explosive
The progression continuum: Stabilization continuum: Floor to sport beam to half foam roll to foam pad to balance disc to wobble board to bosu ball
Lower body: Two leg stable to staggered stance stable to single leg stable to two leg unstable to staggered stance unstable to single leg unstable
Upper body: Two arm to alternating arms to single arm to single arm with trunk rotation
Identify the Adaptive benefits of Resistance training
13/304
Physiologic: 1) improved cardiovascular efficiency 2) beneficial endocrine (hormone) and serum lipid (cholesterol) adaptations 3) increased bone density 4) increased metabolic efficiency (metabolism)
Physical: 5) increased tissue (muscle, tendons, ligaments) tensile strength 6) increased cross-sectional area of muscle fibers 7) decreased body fat
Performance: 8) increased neuromuscular control (coordination) 9) increased endurance 10) increased strength 11) increased power
Explain Coronary Heart Disease, how exercise affects it, and physiologic considerations
16/436-440
Coronary heart disease (CHD) is the leading cause of death and disability for both men and women. CHD is caused by atherosclerosis (plaque formation), which leads to narrowing of the coronary arteries and ultimately angina pectoris (chest pain), Myocardial infarction (heart attack), or both. The primary cause is poor lifestyle choices, primarily cigarette smoking, poor diet, and inactivity. Getting more exercise and eating better is a primary treatment.
Clients must monitor their own pulse rate or use a monitor to stay below their safe upper limit of exercise. The HR response to exercise can vary considerably, and will often be lower in age predicted formulas. Signs and symptoms vary greatly among this population, so monitoring of HR, rating of perceived exertion, and signs of worsening CHD like angina are important. Heart disease can be slowed or reversed when programs include exercise. All exercises (or most) should be done in a seated or standing position because they’re the easiest to do. Plyometrics is not recommended. Phases 1 and 2 of opt model are appropriate.
Physiologic considerations: A) The nature of heart disease may result in a specific level of exercise, above which it is dangerous to perform: The upper safe limit of exercise must be obtained, preferably by HR. HR should never be estimated from formulas for this population. B) may not have angina (chest pain) or other warning signs: clients must monitor pulse rate or use monitor to stay below their limit. C) Between the disease and medications, the HR response to exercise will almost always vary a lot from age predicted formulas, and will almost always be lower: Although symptoms should always supersede anything else as a sign to decrease or stop exercise, some may not have this warning system, so monitoring HR is important. D) may have other comorbidities such as diabetes, hypertension, peripheral vascular disease, obesity: Screening for comorbidities is important and modifications may be made. E) Peak oxygen uptake (as well as ventilatory threshold) is often reduced because of the compromised cardiac pump and peripheral muscle deconditioning: start with low intensity; weekly goal of 1,500 to 2000 calories.
Identify Core Training variables and exercise selection
9/231
Variables:
Plane of motion: Sagittal, frontal, transverse
Range of motion: Full, partial, end range
Type of resistance: Cable, tubing, medicine ball, powerball, dumbbells, kettlebells
Body position: Supine, prone, side lying, kneeling, half kneeling, standing, staggered stance, single leg, standing on unstable surface
Speed of motion: Stabilization, Strength, Power
Duration
Frequency
Amount of feedback: PT’s cues, kinesthetic awareness
Exercise selection:
Progressive: Easy to hard, simple to complex, known to unknown, stable to unstable
Systematic: Stabilization, Strength, Power
Activity or goal-specific
Integrated
Proprioceptively challenging: stability ball, BOSU, core board, half foam roll, Airex pad, Bodyblade
Explain why SAQ Training is effective for more than just improving sports performance in the athletes
12/292
SAQ programs can also significantly improve the health of sedentary people and those with medical or health limitations. The increased neuromuscular, biomechanical, and physiological demand for such training can Aid in weight loss, coordination, movement proficiency, and injury prevention. Also, many populations find SAQ training fun, increasing exercise adherence and Effectiveness.
Unlike the common steady-state, moderate intensity modalities such as treadmill walking, often prescribed for non-athletic populations, SAQ drills require greater integration of a variety of the body’s biologic systems. One must accelerate, decelerate, and change direction, all in response to a variety of both predictable and unpredictable stimuli at a relatively High rate of speed. Thus, SAQ training provides a unique challenge to the biologic systems of non-athletes, facilitating constant responses and adaptation. Such rapid adaptation to SAQ training is critical in the development, maintenance, and improvement of neuromuscular, physiologic, and biomechanical proficiency from childhood through the senior years.
Describe Resistance-Stabilization exercises and their functions
13/CR
Used lighter weights and a slow tempo and are performed in the most proprioceptively enriched environment possible to challenge one’s limit of stability. Proprioceptive modalities should be used to progress these exercises before increasing the load.
Designed to improve neuromuscular efficiency and Joint stability.
Identify, explain, and define TEE/TDEE and its 3 components and their percentages of TEE
17/465
Estimated total energy expenditure (TEE), or total daily energy expenditure (TDEE) is defined as the amount of energy (calories) spent, on average, in a typical day. TEE is the sum total of three components:
1) resting metabolic rate (RMR): The amount of energy expended while at rest; the minimal amount of energy required to sustain vital bodily functions such as blood circulation, respiration, and temperature regulation. RMR usually accounts for 70% of TEE.
2) thermic effect of food (TEF): The amount of energy expended above RMR as a result of the processing of food (digestion) for storage and use. TEF usually accounts for 6 to 10% of TEE.
3) energy expended during physical activity: The amount of energy expended above RMR and TEF associated with physical activity. Physical activity accounts for 20% of TEE.
For how long can exercise elevate RMR after exercise?
17/466
10 to 90 minutes after exercise, depending on duration and intensity
Define carbohydrates. Explain the different types of carbs
17/477
Neutral compounds of carbon, hydrogen, and oxygen, such as sugars, starches, and celluloses.
Carbs are compounds containing carbon, hydrogen, and oxygen, and are classified as sugars (simple), starches (complex), and fiber. The definition of sugar, on food labels, is any monosaccharide or disaccharide.
A monosaccharide is a single sugar unit, many of which are connected to make starches (the storage form of carbs in plants) and glycogen (the storage form of carbs in humans). Monosaccharides include glucose (referred to as blood sugar), fructose (or fruit sugar), and galactose. Disaccharides (two sugar units) include sucrose (or common sugar), lactose (or milk sugar), and maltose.
Polysaccharides are long chains of monosaccharide units linked together and found in foods that contain starch and fiber. These foods are often called complex carbs and include starch found in plants, seed, and roots. Complex carbs are primarily starch and fiber, and the starch is digested to glucose. Dietary fiber is a part of the plant that cannot be digested by human gut enzymes, and passes through the small intestine and colon, where it is expelled as fecal material or fermented and used as food by the gut bacteria.
Carbs are a cheap source of energy for all body functions and muscular exertion. This fact leads to a rapid depletion of available and stored carbs and creates a continual craving for this macronutrient. Carbs also help regulate the digestion and utilization of protein and fat.
Describe pregnancy; it’s exercise affects and considerations and physiologic considerations
16/450-452
Most recreational exercises are appropriate for all pregnant women. A reduction in activity in the third trimester is recommended.
The growth of the fetus can alter their posture, making flexibility and core training important, particularly Core-Stabilization exercises, to improve the strength of the pelvic floor muscles. It is not advised to do prone or supine positions in second or third trimesters, as well as uncontrolled twisting motions of the Torso. Hip abduction and hip adduction Resistance exercises are also not advised.
Changes occur in the cardiovascular system, decreasing work capacity and leading to needed changes in the cardiorespiratory program and the increased importance of hydration during aerobic activity. They are vulnerable to nausea, dizziness, fainting. They should stop exercise if they have any of these symptoms, or abdominal pain (contractions), shortness of breath, bleeding, or leakage of amniotic fluid. Plyometrics is not advised. Phases 1 and 2 of opt model may be used in first trimester; in second and third trimesters, use only phase one.
Physiologic considerations: A) contraindications include bleeding, pregnancy induced hypertension, preterm labor: Screen carefully. B) decreased oxygen available for aerobic exercise: low to moderate intensity aerobic exercise, emphasizing non-weight bearing exercise eg cycling. C) Posture can affect blood flow to uterus during vigorous exercise: Avoid supine exercise. D) even in the absence of exercise, pregnancy may increase metabolic Demand by 300 KCAL per day to maintain energy balance: advise adequate caloric intake to offset exercise effects. E) high risk considerations include older than 35, history of miscarriage, diabetes, thyroid disorder, anemia, obesity, sedentary lifestyle: advise cool clothing. Lower intensity. Resistance circuit training.
Explain the 2 phases of isotonic muscle contraction
5/90-91
Isotonic: force is produced, muscle tension is developed, and movement occurs through a range of motion
1) eccentric phase: An eccentric muscle action occurs when a muscle develops tension while lengthening. The muscle lengthens because the contractile force is less than the resistive Force. The tension within the muscle is less than the external forces trying to lengthen it. As the muscle lengthens, the actin and myosin cross bridges are pulled apart and reattached, allowing the muscle to lengthen. In reality, the lengthening usually refers to its return to a resting length and not actually increasing in its length as if it were being stretched. An eccentric motion is synonymous with deceleration and can be observed in movements such as Landing from a jump, or lowering a weight. Eccentric muscle action is known as a “negative” because work is actually being done on the muscle (because forces move the muscle) rather than the muscle doing the work (or the muscle moving the forces). Eccentric motion moves in the same direction as the resistance is moving. Muscles work as much eccentrically as they do concentrically or isometrically. Eccentrically, the muscles must decelerate or reduce the forces acting on the body (or Force reduction). Weight must be decelerated and then stabilized to be properly accelerated.
2) concentric phase: a concentric muscle action occurs when the contractile force is greater than the resistive Force, resulting in shortening of the muscle and joint movement. As the muscle shortens, the actin and myosin cross Bridges move together (sliding filament theory), allowing it to shorten. Concentric action is synonymous with acceleration and is seen in jumping upward and the lifting phase in resistance training.
Explain how Static Stretching works
7/179
Static stretching is the process of passively taking a muscle to the point of tension and holding the stretch for at least 30 seconds. This is the traditional form of stretching that is most often seen in Fitness. It combines low force with longer duration.
By holding the muscle in a stretched position for a prolonged period, the Golgi Tendon Organ is stimulated and produces an inhibitory effect on the muscle spindle (autogenic inhibition). This allows the muscle to relax and provides for better elongation of the muscle. Also, contracting the antagonistic musculature while holding the stretch can reciprocally inhibit the muscle being stretched, allowing it to relax and enhancing the stretch. Example: when doing the kneeling hip flexor stretch, one can contract the hip extensors (gluteus maximus) to reciprocally inhibit the hip flexors (psoas, rectus femoris), allowing for greater lengthening of these muscles. Another example is to contract the quadriceps when doing a hamstring stretch.
Static stretching should be used to decrease the muscle spindle activity of a tight muscle before and after activity.
Explain why a cool down is so important
8/207
The body undergoes many and dramatic physiologic changes depending on the intensity and duration of exercise. Some cardiovascular responses to exercise are linear increases in heart rate and systolic blood pressure and an increase in stroke volume (up to 40 to 60% of maximum), after which it plateaus, and an increase in cardiac output from an average resting value of 5 L/min to as high as 20 to 40 L/min occurs during intense activity. Also, at rest only 15 to 20% of circulating blood reaches skeletal muscle, but during intense exercise it increases up to 80 to 85% of cardiac output. During exercise, blood is shunted away from major organs such as the kidneys, liver, stomach, and intestines, and is redirected to the skin to promote heat loss. Blood plasma volume also decreases with exercise, and as exercise continues, increased blood pressure forces water from the vascular compartment to the interstitial space. During prolonged exercise, plasma volume can decrease by 10 to 20%. Thus, with these and many other physiologic changes with exercise, the cool down is important. The cool down gradually restores physiologic responses to exercise close to Baseline.
Identify physiologic and other considerations for obese clients
16/424-428
Heavier people exhibit worse balance, slower Gait velocity, and shorter steps. Exercise should focus on energy expenditure, balance, and proprioceptive training to expend calories and improve balance and gait mechanics. By doing exercises in a proprioceptively enriched environment (controlled, unstable), the body is forced to recruit more muscles to stabilize itself. Thus, more calories are expended.
Resistance training is important for weight loss because it increases lean body mass, which results in a higher metabolic rate and better body composition. Core and Balance training is also important because they lack balance and walking speed.
Use caution when placing an obese client in a prone or Supine position because they are prone to hypotensive and hypertensive responses to exercise. Standing or seated positions are recommended. Phases 1 and 2 are appropriate for this population.
Ensure that they are breathing properly. Avoid squeezing exercise bars tightly, as this can increase BP (or straining during exercise).
Dumbbells, cables, and tubing work better than machines because of size considerations. Weight supported exercise such as cycling or swimming decreases Orthopedic stress.
Physiologic considerations: A) may have other comorbidities including hypertension, cardiovascular disease, diabetes: screen well. B) maximal oxygen uptake and ventilatory (anaerobic) threshold is usually reduced: Consider weight supported modalities eg cycle ergometer, swimming. C) coexisting diets may hamper exercise ability and result in significant loss of lean body mass: initial exercise should emphasize low intensity, with a progression in duration and frequency before increasing intensity. Intensity should be 60 to 80% of work capacity. Progress to 2000 calories expended per week (from 1250 calories). D) measures of body composition may not be accurate: use BMI, scale weight, or circumference measurements.
Explain the importance of training the Core Stabilization Systems
9/227
Active people will develop their movement system; few develop their local stabilizers. The body’s core stabilization system must be operating with efficiency to effectively use the strength, power, and endurance that has been developed in the prime movers. The kinetic chain senses imbalance and forces won’t be transferred or used properly. A weak core causes inefficient movement and injury such as low back pain. An efficient core is necessary for muscle balance throughout the HMS. Optimal lengths (length-tension relationships), recruitment patterns (Force-couple relationships), and joint motions (arthrokinematics) in the muscles of the LPHC establish neuromuscular efficiency throughout the entire HMS, which allows for efficient acceleration, deceleration, and stabilization during movement, as well as prevention of injury.
Explain carbohydrate recommendations after exercise
17/482
Repeated days of strenuous exercise take a toll on one’s glycogen stores. A high carb intake helps to replenish glycogen stores; however, the timing of carb ingestion can also be important to maximizing recovery. Consuming 0.7 grams per pound of carbohydrate within 30 minutes of completing exercise is recommended to maximize glycogen replenishment. Delaying carb intake by 2 hours can decrease total muscle glycogen synthesis by 66%. The post-workout environment may hasten glycogen repletion as a result of increased blood flow to the muscles and an increased sensitivity of the cells to the effects of insulin. Additional meals of 0.7 grams per pound of carbohydrate every 2 hours are recommended to completely restore muscle glycogen.
Explain protein’s role during a negative energy balance
17/473
For those pursuing body fat reduction, body fat goals require a caloric deficit. During a negative energy balance, amino acids are used to assist in energy production, a term referred to as gluconeogenesis. Anaerobic or aerobic exercise depletes glycogen, increasing gluconeogenesis. The increase in gluconeogenesis is supported by the release of branched chain and other amino acids from structural proteins to maintain glucose homeostasis during exercise. A hypocaloric diet establishes less than optimal glycogen stores, and when this is combined with increased glycogen demand during exercise, protein’s energy utilization is increased. The amount of lean body mass lost in one in a negative energy balance can be reduced by increasing the amount of protein in the diet, leading to a more rapid return to nitrogen balance. Studies show that an increase in protein utilization during a hypocaloric diet will produce effects that can be exacerbated by exercise.
Define and explain essential vs. nonessential amino acids and semiessential amino acids
17/468
Essential amino acids cannot be manufactured in the body or are manufactured in insufficient amounts; therefore, they must be obtained from food or another exogenous Source.
Non-essential amino acids are manufactured in the body from dietary nitrogen and fragments of carbs and fat.
Because of their rate of synthesis within the body, arginine and histidine are semi-essential amino acids because they cannot be manufactured by the body at a rate that will support growth.
Identify and demonstrate all 4 Shoulder-Power Resistance exercises
13/338-339/591
Explain the classes of Levers and examples
5/97
First class levers: The fulcrum is in the middle, like a seesaw. Example: Nodding the head; top of spinal column is the fulcrum (joint axis).
Second class levers: Resistance in middle with fulcrum and effort on either side, like a load in a wheelbarrow. Example: Full body push-up or calf raise. For Calf raise: ball of foot is fulcrum, body weight is resistance, and effort is applied by calf muscles.
Third class levers: Effort is between resistance and Fulcrum. The effort always travels a shorter distance and must be greater than the resistance. Most limbs are third class levers. Example: Forearm; fulcrum is elbow, effort is applied by biceps muscle, load is in hand eg dumbbell.
Explain carbohydrate loading
17/481
In endurance exercise of greater than a 90 minute duration eg Marathon running, muscle glycogen stores become depleted. This depletion limits the performance of endurance exercise. Carbohydrate loading, also called glycogen supercompensation, is a technique used to increase muscle glycogen before an endurance event. This practice can nearly double muscle glycogen stores, increasing endurance potential.
Historically, the week-long program includes 4 days of glycogen depletion (through a low-carb diet that is 10% of calories and exhaustive exercise), followed by three days of rest and a high carb diet (about 90% of calories). This method has many drawbacks, including periods of hypoglycemia, irritability, increased susceptibility to injury, and difficulty in compliance.
A revised method accomplishes the same goal with greater ease of compliance and fewer side effects: Glycogen loading schedule:
Days before event: 6 days out. Exercise intensity and duration: 70 to 75% of VO2 max for 90 minutes. Carb intake: 1.8 grams per pound of body weight.
Days before event: 4 to 5 days out. Exercise intensity and duration: 70 to 75% of VO2 max for 40 minutes. Carb intake: 1.8 grams per pound.
Days before event: 2 to 3 days out. Exercise intensity and duration: 70 to 75% of VO2 max for 20 minutes. Carb intake: 4.5 grams per pound.
Days before event: 1 day out. Exercise intensity and duration: rest. Carb intake: 4.5 grams per pound.
Although maximizing muscle glycogen before an event may improve power, performance, output, and speed by postponing muscle glycogen depletion, glycogen loading before exercise does not always improve performance. Some athletes experience extreme gastrointestinal distress including diarrhea when attempting glycogen loading. Thus, meals should contain familiar foods that are relatively low in fat and fiber to minimize gastrointestinal distress. Because leg muscles become heavier with the addition of glycogen and water, many athletes complain they feel heavy and sluggish, and they can experience a slight weight gain.
Identify the RDA, distribution range, and sedentary, strength, endurance recommendations for protein
17/474
The recommended dietary allowance (RDA) for protein is 0.4 grams per pound per day.
The acceptable macronutrient distribution range for protein intake is 10 to 35% of total caloric intake. This range allows for differences in goals and activity and bioindividuality in terms of satiety and performance.
Recommended protein intakes: Activity level: Sedentary adult: 0.4 grams per pound per day. Strength athletes: 0.5 to 0.8 grams per pound per day. Endurance athletes: 0.5 to 0.6 grams per pound per day.
Describe and explain fatty acids
17/485-486
Fatty acids may be saturated or unsaturated. Unsaturated fatty acids can be further classified according to their degree of unsaturation. If the fatty acid has one double bond in its carbon chain, it’s called a monounsaturated fatty acid. If there is more than one point of unsaturation, it is classified as a polyunsaturated fatty acid.
Polyunsaturated fatty acids provide important essential fatty acids (or fats that cannot be manufactured by the body but are essential for proper health and functioning). Saturated fatty acids are implicated as a risk factor for heart disease because they raise bad cholesterol levels (low density lipoproteins; LDL), whereas unsaturated fats are associated with increases in good cholesterol (high density lipoproteins; HDL) and decreased risk of heart disease. Monounsaturated fatty acids (found in olive and canola oils) and polyunsaturated fatty acids such as Omega-3 fatty acids (found in cold water fish like salmon) are considered to have favorable effects on blood lipid profiles and may play a role in the treatment and prevention of heart disease, hypertension, arthritis, cancer. Another prevalent fatty acid is trans fatty acids, the result of hydrogenation (or the process of adding hydrogen to unsaturated fatty acids to make them harder at room temperature and increase food shelf life). Trans fatty acids have been shown to increase LDL cholesterol and decrease HDL cholesterol, much like saturated fats.
Food sources and types of fats:
Monounsaturated fats: Olive oil, canola oil, peanut oil, avocados, peanuts, almonds, pistachios.
Polyunsaturated fats: Vegetable oils (safflower, soy, corn, sunflower oils); omega-3 Fatty acids (herring, mackerel, salmon, sardines, flaxseeds); most nuts and seeds.
Saturated fats: Meat, poultry, lard, butter, cheese, cream, eggs, whole milk; tropical oils (coconut, palm, palm kernel oil); many baked goods.
Trans fats: Stick margarine, shortening, fried foods (fried Chicken, doughnuts); fast food; many baked goods and pastries.
Identify the 5 kinetic chain checkpoints and what to look for from anterior, lateral, posterior views
6/137
In general, check for neutral alignment, symmetry, balanced muscle tone, and specific postural deformities.
Anterior view:
Foot and ankles: Straight and parallel, not flattened or externally rotated.
Knees: in line with toes, not adducted or abducted.
LPHC: Pelvis level with both anterior superior iliac spines in same transverse plane.
Shoulders: Level, not elevated or rounded.
Head: neutral position, not tilted nor rotated.
Lateral view:
Foot and ankles: Neutral position, leg vertical at right angle to sole of foot.
Knees: neutral position, not flexed nor hyperextended.
LPHC: Pelvis neutral position, not anteriorly (lumbar extension) or posteriorly (lumbar flexion) rotated.
Shoulders: Normal kyphotic curve, not excessively rounded.
Head: Neutral position, not in excessive extension (jutting forward).
Posterior view:
Foot and Ankle: Heels are straight and parallel, not overly pronated.
Knees: neutral position, not adducted or abducted.
LPHC: Pelvis is level with both posterior superior iliac spines in same transverse plane.
Shoulders: Level, not elevated or protracted (medial borders essentially parallel and three to four inches apart).
Head: Neutral position, neither tilted nor rotated.
Identify the three phases of flexibility training, their purposes and functions, and stretching techniques and describe how the techniques work
7/173
Corrective flexibility: Designed to increase joint ROM, improve muscle imbalances, and correct altered joint motion. Techniques: Self-myofascial release (foam roll): Uses the principle of autogenic inhibition to cause muscle relaxation. Static stretching: uses either autogenic inhibition or reciprocal inhibition to increase muscle length depending on how stretch is performed. Phase 1.
Active flexibility: Designed to improve the extensibility of soft tissue and increase neuromuscular efficiency. Techniques: SMR. Active isolated stretching: Allows for Agonist and synergist muscles to move a limb through a full range of motion while the functional antagonists are being stretched. Phases 2, 3, and 4.
Functional flexibility: designed to improve the extensibility of soft tissue and increase neuromuscular efficiency. Techniques: SMR. Dynamic stretching: requires integrated, multiplanar soft tissue extensibility, with optimal neuromuscular control, through the full range of motion, or essentially movement without compensations.
Explain protein in foods: complete versus incomplete proteins, examples
17/471
Dietary protein is the delivery vehicle for amino acids. Meats, fruits, vegetables, grains, dairy, and supplements Supply us with the building blocks of protein. If a Food Supplies all of the essential amino acids in appropriate ratios, it is a complete protein. If a food is low or lacking in one or more essential amino acids, it is an incomplete protein. The essential amino acid that is missing or present in the smallest amount is the limiting factor of that protein. Because the process of protein synthesis works on an all or none principle, all amino acids must be present at the site of protein manufacture, or synthesis will be reduced to the point at which the cell runs out of the limiting amino acid.
The ability of a protein to satisfy these essential amino acid requirements can be Quantified by protein efficiency ratio, net protein utilization, and biologic value (BV). BV is a measure of protein quality, or how well it satisfies the body’s essential amino acid needs. A source with a higher score provides an amino acid profile that is more closely related to the human body’s needs. However, consuming protein above requirements will not force the body to unleash a previously untapped muscle building capacity. Instead, if one exclusively consumes high BV proteins, their amino acid requirements would be met with less protein. Conversely, if one chooses mostly lower BV sources, the total protein requirements will increase.
The major sources of complete proteins are animal sources, dairy, and meats.
Sources of incomplete protein include grains, legumes, nuts, seeds, and other vegetables. Barley, cornmeal, oats, buckwheat, pasta, rye, wheat, beans, lentils, dried peas, peanuts, chickpeas, soy products, sesame seeds, sunflower seeds, walnuts, cashews, pumpkin seeds, and other nuts are the main sources of incomplete proteins. Incomplete proteins can be combined to make available all of the essential amino acids and form a complete protein.
Protein quality improves when a small amount of complete protein like a dairy food is combined with plant-based foods and when incomplete proteins from plant-based foods such as rice and beans are mixed together.
Explain carbohydrate recommendations during exercise
17/481-482
For exercise lasting more than one hour, carb feedings during exercise can help Supply glucose to working muscles whose glycogen stores are dwindling. This technique also maintains blood glucose levels, increasing time to exhaustion by 20 to 60 minutes. It is recommended that endurance athletes consume between 30 and 60 g of carbs every hour to accomplish this. Popular sports drinks are perfect for this goal and have the added benefit of replacing fluid losses, also benefiting performance. The replacement of carbs and water has individual benefits that together are additive.
One study showed that performance during 1 hour of intense cycling was improved by 12% with the consumption of 53 oz of water containing 79 G of carbs. Sports drinks including potassium and sodium help replace electrolytes, whereas carbs provide energy. Sports drinks containing 6 to 8% carbs are recommended for exercise lasting longer than 1 hour.
Explain the importance and benefits of water
17/490
Water is vital to life itself; it constitutes 60% of the human body by weight. Whereas deficiencies of nutrients such as macronutrients, vitamins, and minerals may take weeks or years to develop, one can only survive for a few days without water.
Consuming an adequate amount of water will benefit the body in these ways:
A) endocrine gland function improves.
B) fluid retention is alleviated.
C) liver functions improve, increasing the percentage of fat used for energy.
D) natural thirst returns.
E) Metabolic functions improve.
F) nutrients are distributed throughout the body.
G) body temperature regulation improves.
H) blood volume is maintained.
Explain fat supplementation during exercise
17/487-488
In general, fat is digested and absorbed quite slowly. Long chain triglycerides, or LCT, which make up the majority of dietary fatty acids (16 - 18 carbons), must go through the process of digestion and absorption described earlier before they can be utilized. Medium chain triglycerides or MCT, however, are more rapidly absorbed. Also, they do not require incorporation into chylomicrons for transport, but can enter the systemic circulation directly through the portal vein, providing a readily available, concentrated source of energy.
It’s been suggested that MCT could benefit endurance performance by supplying an exogenous energy source in addition to carbohydrate during exercise and increase plasma free fatty acids (FFA), sparing muscle glycogen. However, several studies of trained endurance athletes have found that MCT ingestion does not alter fat metabolism, spare muscle glycogen, or improve performance. Ingestion of MCT with ultraendurance cyclists actually compromised performance. The impaired performance may have been due to the gastrointestinal upset from MCT.
Explain what to do when compensations are observed and what to do to determine compensations
6/CR
First, static posture should be assessed, looking for evidence of postural distortion patterns. These patterns identify muscles that are either too short or too long. Imbalances found here will mean the identified muscles are not the optimal lengths to keep joints in the right resting position.
Then, moving posture should be observed to determine muscles that are overactive or underactive. Overactive muscles receive too much signaling from the CNS, while underactive ones do not receive enough. One may stand with good posture, but overactive muscles can pull a joint in the wrong direction during movement if they are firing more than others, and underactive ones will not correctly balance the forces from the overactive muscles. When the joint moves incorrectly, it’s called a compensation. The overhead squat, pushing, and pulling assessments are the primary movement assessments.
Once one’s compensations are observed, all of the short and long and over and underactive muscles can be identified. This directly correlates to the Flexibility and Resistance training one will need to do during workouts. Muscles identified as short or overactive should be stretched, while those that are long or underactive will need to be strengthened. Doing so will return the muscles to their correct length tension relationships, balance the forces around the joint, and optimize posture and stability for more intense exercise. Phase 1 of the opt model helps with this.
Define and describe General Adaptation Syndrome and describe its three stages
13/304
A term used to describe how the body responds and adapts to stress.
The optimal state for the HMS to be in is one of physiologic balance or homeostasis. The General Adaptation Syndrome is a term used to describe how the body responds and adapts to stress. In this case, the stress being placed on the body is the weight being lifted during resistance training. Exercise, including resistance training, is a good form of stress called eustress that over time allows the HMS to adapt and thus be able to maintain homeostatic States under a variety of conditions. For adaptation to occur, the body must be confronted with a stressor or some form of stress that creates the need for a response.
There are three stages of response to stress:
Alarm reaction stage: The alarm reaction is the initial reaction to a stressor. The alarm reaction activates many physiological and psychological protective processes within the body. During the initial sessions of resistance training, the body is forced to try and adapt to increased amounts of force on Bones, joints, muscles, connective tissues, and the nervous system. Numerous physiologic responses occur, including an increase in oxygen and blood supply as well as neural Recruitment to the working muscles. Initially, one’s body May be very inefficient at responding to the demands placed on it. But gradually over time and by applying the principle of progressive overload, the body increases its ability to meet the demands being placed on it.
Consider the usual response to either unaccustomed exercise or a sudden increase in a training program. The new work is performed, and during the next 2 to 3 days, the muscles May exhibit classic delayed onset muscle soreness or DOMS. During this period of DOMS, any attempt at replicating or advancing the soreness-inducing exercise will be limited by the factors contributing to the soreness. This could be considered an alarm reaction. Most experts agree minimizing DOMS involves starting a progressive training program at a low intensity and introducing overload gradually.
DOMS: Pain or discomfort often felt 24 to 72 hours after intense exercise or unaccustomed physical activity.
Resistance development stage: During the resistance development stage, the body increases its functional capacity to adapt to the stressor. After repeated training sessions, the HMS will increase its capability to efficiently recruit muscle fibers and distribute oxygen and blood to the proper areas in the body. Once adaptation has occurred, the body will require increased stress or overload to produce a new response and a higher level of Fitness.
PT’s often use the adaptation response improperly by only manipulating the amount of weight one uses when this is but one of many ways to increase stress on the body. Chapter 14 discusses the importance of manipulating the many acute variables (sets, reps, intensity, rest periods, etc) for optimal adaptation while avoiding breakdown or exhaustion.
In the example of unaccustomed exercise, once the DOMS subsides, further work will be met with less and less soreness so that performance May gradually advance. This would be resistance development. Performance will continue to improve until some new performance Plateau is reached and will be maintained if training is maintained.
Exhaustion stage: Prolonged stress or intolerable amounts of stress can lead to exhaustion or distress. When a stressor is too much for any one of the physiologic systems to handle, it causes a breakdown or injury such as stress fractures, muscle strains, joint pain, or emotional fatigue. In turn, many of these injuries can lead to the initiation of the cumulative injury cycle.
Avoiding the pitfalls of the exhaustion stage is one of the main reasons for using the opt model (a systematic, progressive training program) that is based on science and proven application. Resistance training, and other forms of training, must be cycled through different stages that increase stress placed on the HMS, but also allow for sufficient rest and recuperation periods. The term used for this approach, in which a training program is divided into smaller, progressive stages, is periodization.
In the above example, if the resistance is continually increased with the intention of stressing specific muscles or muscle groups to produce an increase in size or strength, it can lead to injury of the muscle, joint, or connective tissue, especially if the resistance is added too quickly or inadequate rest and Recovery periods Are not planned for. Training- related injuries occur more often to connective tissue, such as ligaments and tendons, than muscles because connective tissues lack blood supply. Different tissues in the body (muscle fibers versus connective tissue) each have their own adaptive potential to stresses. Thus, training programs should provide a variety of intensities and stresses to optimize the adaptation of each tissue to ensure the best results. Adaptation can be more specifically applied to certain aspects of the HMS depending on the training techniques used, which is the basis of the principle of specificity. Overtraining syndrome is training beyond the body’s ability to recover, which leads to mood problems, decreased performance, fatigue, etc.
Identify and describe all 10 Resistance Training systems
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Single set system: One set per exercise. Just as beneficial as multiple set training for beginners. It allows for adaptive responses of the connective tissue and nervous system before engaging in more rigorous systems. By not lifting more than one can handle, synergistic dominance and injury can be avoided.
Multiple set system: Multiple numbers of sets for each exercise. Can be appropriate for both novice and advanced clients, but is superior to single set training for advanced clients.
Pyramid system: increasing or decreasing weight with each set. In the light to heavy system, one typically does 10 to 12 reps with a light load and increases the resistance for each following set, until one can perform one to two reps, usually in four to six sets. This system can easily be used for workouts involving 2 to 4 sets or higher repetition schemes (12 to 20 reps). The heavy to light system begins with a heavy load for one to two reps, then decreases the load and increases the Reps for 4 to 6 sets.
Superset system: Performing two exercises in rapid succession with minimal rest. The first variation is performing two exercises for the same muscle group back to back. This improves muscular endurance and hypertrophy because the volume of work performed is high. This style of super sets can use two, three (a tri-set), or more exercises (a giant set) for the Target muscle group. The greater the number of exercises, the greater the fatigue and demands on muscular endurance. The second variation is performing two exercises back to back that involve antagonist muscle groups (EG chest and back or quadriceps and hamstrings). This allows a significant load to be placed on the target muscle during each set. This is possible because while The Agonist is working, the antagonist is recovering, and vice versa. Supersetting typically involves sets of 8 to 12 reps with no rest between sets or exercises, but any number of reps can be used. It’s popular among bodybuilders and may be beneficial for muscular hypertrophy and endurance.
Drop sets: Performing a set to failure, then removing a small percentage of the load and continuing with the set. It’s a technique that allows one to continue a set past the point at which it would usually terminate. One performs a set to failure, then removes a small percentage of the load (5 to 20%), and continues the set, completing a small number of reps (usually two to four). This procedure can be repeated several times (usually 2 to 3 drops per set). A set to failure followed by three successive load decrements done with no rest is called a triple drop. It’s an advanced form of training and popular among bodybuilders.
Circuit training system: Performing a series of exercises, one after the other, with minimal rest. A great system for those with limited time and for those who want to alter body composition.
Peripheral heart Action System: A variation of circuit training that alternates upper body and lower body exercises for each set through the circuit. It distributes blood flow between the upper and lower extremities, potentially improving circulation. It’s very beneficial for altering body composition.
Split routine system: Training different body parts on separate days. By breaking up the body into parts that can be trained on different days, more work can be performed for the allotted time per workout. When training each body part more than once a week, volume and intensity should be accounted for (for proper recovery time). Popular among bodybuilders and strength athletes. Brings about optimal muscular hypertrophy.
Vertical loading: Alternating body parts trained from set to set, starting from the upper extremity and moving to the lower extremity. (1. total body 2. chest 3. back 4. shoulders 5. biceps 6. triceps 7. legs) Can be done in a circuit style, by minimizing the rest periods between exercises. Can be very beneficial for allowing maximal recovery to each body part while minimizing rest time. If it takes 1 minute to do each exercise, by the time one returns to a particular exercise, 7 to 10 minutes could have passed, which should be sufficient time to allow for full adenosine triphosphate (ATP)/phosphocreatine (PC) recovery.
Horizontal loading: Performing all sets of an exercise or body part before moving on to the next exercise or body part. Appropriate for maximal strength and power training when longer rest periods are required between sets. But the amount of time spent resting can often be more time than the workout itself. It can be a metabolic progression if rest periods are limited to 30 to 90 seconds between sets. This can lead to faster development of metabolic and hypertrophy-related adaptations in the muscle.
Define arthritis, describe it, how exercise affects it, and physiologic considerations
16/444-446
Arthritis: Chronic inflammation of the joints.
Osteoarthritis: Arthritis in which cartilage becomes soft, frayed, or thins out, as the result of trauma or other conditions.
Rheumatoid arthritis: Arthritis primarily affecting connective tissues, in which there is a thickening of articular soft tissue, and extension of synovial tissue over articular cartilages that have become eroded.
Arthritis is an inflammatory condition that mainly affects the joints. It is the leading cause of disability for US adults and is associated with significant activity limitation, work disability, reduced quality of life, high Healthcare costs.
Two types: Osteoarthritis is caused by degeneration of cartilage within joints. This lack of cartilage creates a wearing on the surfaces of articulating bones, causing inflammation and pain at the joint, eg hands, knees, hips, spine. Rheumatoid arthritis is a degenerative joint disease in which the immune system mistakenly attacks its own tissue (tissue in joint or organs). This can cause an inflammatory response in multiple joints, leading to pain and stiffness. The condition is systemic and may affect a variety of joints and organs. Joints commonly affected are hands, feet, wrists, knees.
It is important for PT’s to be aware of the symptoms of an acute rheumatoid arthritis exacerbation. A low volume circuit program is preferred over higher intensity or High Reps (which aggravate joints). Those with osteoarthritis have decreased strength and proprioception. Those with arthritis have decreased balance. Symptoms of arthritis (eg joint pain, stiffness) are heightened from inactivity as a result of muscle atrophy and lack of tissue flexibility. Core and Balance Training are important to increase joint stability and balance. Plyometrics not recommended. Phase 1 of opt model is appropriate using modified reps (10 to 12) to avoid heavy, repetitive joint loading that increases stress to affected joints.
Physiologic considerations:
A) maximal oxygen uptake and ventilatory threshold are frequently lower as a result of decreased exercise due to pain and Joint inflammation: Circuit format using treadmill, elliptical.
B) medications May significantly influence bone and muscle health: incorporate functional activities.
C) tolerance to exercise may be influenced by acute arthritic flare-ups: Be aware of symptoms and joint pain lasting longer than 1 hour should result in Altered program.
D) Rheumatoid arthritis results in early morning stiffness: avoid early morning exercise.
E) Evaluate for comorbidities, particularly osteoporosis: Resistance training recommended.
Describe Plyometric Training and its three phases
11/270-272/CR
Also known as jump or reactive training; is a form of exercise using explosive movements EG bounding, hopping, jumping, to develop muscular power. One reacts to the ground surface in a way that develops larger than normal ground forces that can then be used to project the body with a greater velocity or speed of movement. The term reactive training refers to the reaction stimulus clients encounter during plyometric training, which is the ground surface in this case.
Good performance in functional activities emphasizes the ability of muscles to exert maximal Force output in a minimal amount of time (rate of force production). Success in everyday activities and sports depends on the speed at which muscular force is generated. Speed of movement and reactive neuromuscular control are a function of muscular development and neural control; the first is a function of training and the other of learning. The key then is muscular overload and Rapid movements during training.
Plyometric/reactive training involves exercises that generate quick, powerful movements involving explosive concentric muscle contraction preceded by an eccentric muscle action. These explosive muscular contractions can be seen in rebounding in basketball. The overall height that one achieves is determined by their Vertical Velocity or how fast they leave the ground. This is the essence of Plyometrics and uses a characteristic of muscle called the stretch-shortening cycle of the integrated performance paradigm. The integrated performance Paradigm states that to move with Precision, forces must be loaded (eccentrically), stabilized (isometrically), and then unloaded or accelerated (concentrically).
The Eccentric phase: Also called deceleration, loading, yielding, counter movement, or cocking face. This phase increases muscle spindle activity by pre-stretching the muscle before activation. Potential energy is stored in the elastic components of the muscle during this loading phase, much like stretching a rubber band.
The amortization phase: Involves Dynamic stabilization and is the time between the end of The Eccentric muscle action (the loading or deceleration phase) and the initiation of the concentric contraction (the unloading or force production phase). The amortization phase, sometimes called the transition phase, is also referred to as the electromechanical delay between the eccentric and concentric contraction during which the muscle must switch from overcoming Force to imparting force in the intended Direction. A prolonged amortization phase results in less than optimal neuromuscular efficiency from a loss of elastic potential energy. A rapid switch from an eccentric loading phase to a concentric contraction leads to a more powerful response.
The concentric phase: or the unloading phase; occurs immediately after the amortization phase and involves a concentric contraction, resulting in enhanced muscular performance after The Eccentric phase of muscle contraction. This is synonymous with releasing a rubber band after it was stretched.
Example: Basketball players, as they prepare to jump up for a loose ball: They prepare by lowering their body slightly by flexing at the ankles, knees, hips. They will reverse this downward motion and rapidly project themselves from the ground, extending their ankles, knees, hips, and arms upward.
Another way to describe plyometric training: the driving principle behind plyometric training is the integrated performance Paradigm, which states that for movements to be efficient, forces must be properly dampened, stabilized, and accelerated. This is also known as the stretch-shortening cycle. Plyometrics first stretch the muscle with an eccentric muscle action. This stretches the muscle like a rubber band, building up potential energy. Next, the body must quickly stabilize and transition from The Eccentric action to a concentric contraction. This in between period is called the amortization phase and is where the body isometrically stabilizes all the forces built up during the loading phase. Then, the jumping or unloading phase occurs with an explosive concentric contraction that propels the body off the ground. The ability to move through this stretch-shortening cycle at faster rates represents higher levels of neuromuscular efficiency.
Explain the three systems of the core musculature
9/225
Local stabilization system: The local core stabilizers are muscles that attach directly to the vertebrae. They consist primarily of type 1 slow twitch muscle fibers with a high density of muscle spindles. Core stabilizing muscles are primarily responsible for intervertebral and intersegmental stability and work to limit excessive compressive, shear, and rotational forces between spinal segments. Another way to view them is that they provide support from vertebra to vertebra. These muscles also Aid in proprioception and postural control because of their muscle spindles. The primary muscles of the local stabilization system include the transverse abdominis, internal obliques, multifidus, pelvic floor muscles, and diaphragm. These muscles provide segmental spinal stability by increasing intra-abdominal pressure (pressure within the abdominal cavity) and generating tension in the thoracolumbar fascia (connective tissue of low back), thus increasing spinal stiffness for improved intersegmental neuromuscular control.
Global stabilization system: Attach from pelvis to the spine. These muscles act to transfer loads between the upper extremity and lower extremity, provide stability between the pelvis and spine, and provide stabilization and eccentric control of the core during movement. The primary Global stabilizers are the quadratus lumborum, psoas major, external obliques, portions of the internal oblique, rectus abdominis, gluteus medius, and adductor complex.
Movement system: Attach the spine and/or pelvis to the extremities. These muscles are primarily responsible for concentric Force production and eccentric deceleration during activity. The primary movement muscles are the latissimus dorsi, hip flexors, hamstring complex, and quadriceps.
Collectively, all of the muscles within each system provide Dynamic stabilization and neuromuscular control of the entire core (LPHC). They produce Force (concentric contractions), reduce Force (eccentric actions), and provide Dynamic stabilization in all planes of movement. To better understand how these muscles work to stabilize the LPHC, it helps to view the systems From the Inside Out (local stabilizers to Global stabilizers to movement system). Training the movement system muscles before training the global and local stabilizers would not make sense from a structural and biomechanical standpoint. It’s analogous to building a house without a foundation. One must be stable first to move efficiently.
Few people develop their local stabilizers required for intervertebral stability.
Explain how self-myofascial release works
7/177
A stretching technique that focuses on the neural system and fascial system in the body (or the fibrous tissue that surrounds and separates muscle tissue). By applying gentle Force to an adhesion or “knot”, the elastic muscle fibers are altered from a bundled position (which causes the adhesion) into a straighter alignment with the direction of the muscle or fascia. The gentle pressure (applied with implements such as a foam roll) will stimulate the Golgi tendon organ and create autogenic inhibition, decreasing muscle spindle excitation and releasing the hypertonicity (tension) of the underlying musculature. In other words, gentle pressure (similar to a massage) breaks up knots within the muscle and helps to release unwanted muscular tension.
When using SMR, one must find a tender spot (which indicates the presence of muscle hypertonicity) and sustain pressure on that spot for at least 30 seconds. This will increase the GTO activity and decrease muscle spindle activity, thus triggering the autogenic inhibition response. It may take longer, depending on one’s ability to consciously relax. This process will help restore the body back to its optimal level of function by resetting the proprioceptive mechanisms of the soft tissue. SMR is suggested before stretching because breaking up fascial adhesions (knots) may improve the tissue’s ability to lengthen through stretching techniques. It can also be used during cool down.
Define Intermittent Claudication and Peripheral Arterial Disease, describe them, exercise effects, and physiologic considerations
16/456-457
Intermittent Claudication: The manifestation of the symptoms caused by Peripheral Arterial Disease.
Peripheral Arterial Disease: A condition characterized by narrowing of the major arteries that are responsible for supplying blood to the lower extremities.
Essentially, intermittent claudication is characterized by limping, lameness, or pain in the lower leg during mild exercise resulting from a decrease in blood supply (oxygen) to the lower extremities. Peripheral arterial disease is the narrowing of the major arteries that are responsible for supplying blood to the lower extremities.
The primary limiting factor for exercise for one with PAD is leg pain. If one has a diagnosis of PAD, symptoms are likely to be due to intermittent claudication, although they could still be associated with deconditioning. In many respects it does not matter to differentiate between disease and deconditioning, because PT’s should still create programs that improve physical function in the face of limiting factors. Phase 1 of opt model.
Physiologic considerations:
A) PAD clients frequently have coexisting coronary artery disease or diabetes: Do not exceed HR upper limit. Walking preferred.
B) Smoking significantly worsens PAD and exercise tolerance: strongly recommend cessation and ban smoking 1 hour before exercise.
C) PAD frequently results in decreased aerobic capacity and endurance: Focus on aerobic activities; emphasize walking.
D) Resistance Training May improve overall physical function, but may not address limits of PAD: Resistance exercise should not replace aerobic exercise. Circuit training advised.
Explain the digestion, absorption, and utilization of carbohydrates
17/477-478
The principal carbs present in food occur in the form of simple sugars, starches, and cellulose. Simple sugars, such as those in Honey and fruits, are very easily digested. Double sugars, such as table sugar, requires some digestive action but are not nearly as complex as starches, such as those found in whole grain. Starches require prolonged enzymatic action to be broken down into simple sugars (IE glucose) for utilization. Cellulose, commonly found in the skins of fruits and vegetables, is largely indigestible by humans and contributes little energy value to the diet. It does, however, provide the bulk necessary for intestinal motility and aids in elimination.
The rate at which ingested carbohydrate raises blood sugar and it’s accompanying effect on insulin release is referred to as the glycemic index (GI). The GI for a food is determined when the food is consumed by itself on an empty stomach. Mixed meals of protein, other carbs, and fat can alter the glycemic effect of single Foods. One can see in table 17.8 that foods lower on the glycemic index are good sources of complex carbs, as well as being high in fiber and overall nutritional value.
Glycemic Index: high equals greater than 70; moderate equals 56 to 69; low equals less than 55.
Glycemic Index for assorted Foods:
Low: Peanuts equals 14; plain yogurt equals 14; Apple equals 38.
Moderate: Apple juice equals 40; snickers equals 41; carrots equals 47; whole wheat bread equals 67.
High: white bread equals 70; popcorn equals 72; instant rice equals 87.
Through the processes of digestion and absorption, all disaccharides and polysaccharides are ultimately converted into simple sugars such as glucose or fructose. However, fructose must be converted to glucose in the liver before it can be used for energy. Some of the glucose (blood sugar) is used as fuel by tissues of the brain, nervous system, and muscles. Because humans are periodic eaters, a small portion of the glucose is converted to glycogen after a meal and stored within the liver and muscles. Any excess is converted to fat and stored throughout the body as a reserve source of energy. When total caloric intake exceeds output, any excess carb, fat, or protein may be stored as body fat until energy expenditure once again exceeds energy input.
Define cancer, describe it, how exercise affects it, and physiologic considerations
16/447-449
Cancer: Any of various types of malignant neoplasms, most of which invade surrounding tissues, may metastasize to several sites, and are likely to recur after attempted removal and to cause death of the patient unless adequately treated.
Cancer is the second leading cause of death in the US. Because cancer is a collection of diseases, its symptoms vary widely. Medications used by clients with cancer can have large adverse effects, including skeletal muscle myopathy (muscle weakness and wasting).
Exercise is important for those recovering from cancer. It can reduce cellular risks of cancer and improve quality of life. Low to moderate intensities for moderate durations have a positive effect on the immune system when compared with higher intensities for longer durations. Core and Balance Training are essential to regain stabilization for ADL’s. Plyometrics not recommended initially. Phases 1 and 2 of opt model initially.
Physiologic considerations:
A) fatigue and weakness is common: Low to moderate intensity (aerobic).
B) excessive fatigue may result in diminished overall activity: Use intermittent bouts of exercise.
C) diminished immune function: Resistance Training.
D) Decreased lean muscle mass: Address decreased range of motion and balance.
Define rest interval and explain how it affects recovery of ATP and PC
14/359
The time taken to recuperate between sets.
Dynamic resistance training, and isometric training, can significantly reduce ATP and PC supplies. The ability to replenish the supplies is crucial for Optimal Performance and the desired adaptation. By adjusting rest interval, energy supplies can be regained according to the goal of the program.
Rest intervals of:
20 to 30 seconds will allow 50% recovery of ATP and PC.
40 seconds will allow 75% recovery of ATP and PC.
60 seconds will allow 85 to 90% recovery of ATP and PC.
3 minutes will allow 100% recovery of ATP and PC.
The rest interval between sets determines to what extent the energy resources are replenished before the next set. The shorter the rest interval, the less ATP and PC will be replenished and consequently less energy will be available for the next set. With new clients, this can result in fatigue, which can lead to decreased neuromuscular control, force production, and stabilization by decreasing motor unit recruitment. Thus, inadequate rest can decrease performance, lead to altered movement patterns, and injury. Conversely, if rest periods are too long, the effects could be decreased neuromuscular activity and decreased body temperature. This could entail injury.
Summarize how one progresses through all three stages in Cardiorespiratory Training
8/215
In stage one, one should start slowly and gradually work up to 30 to 60 minutes of continuous exercise in zone 1. Those who can maintain Zone 1 heart rate for at least 30 minutes two to three times per week will be ready for stage 2.
Stage 2 is focused on increasing the workload (speed, incline) in a way that will alter HR in and out of Zone 1 and Zone 2. Warm up in zone 1 for 5 to 10 minutes. Move into a one minute interval in zone 2. Once the HR reaches Zone 2 of maximal HR, maintain it for the rest of that minute. After the interval, return to Zone 1 for 3 minutes. Repeat this if one can recover back into the Zone 1 range. The most important part of the interval is to recover back to zone 1 between the intervals. If one cannot reach Zone 2 in 1 minute, then use the HR they did reach as their 85%. Take 9% off this number to get the lower end of the new Zone. It is important to alternate days of the week with Stage 1 training. Intervals should begin brief with a work to rest ratio of 1:3. Then it can be progressed to 1:2 and 1:1. Also, the duration of each interval can be gradually increased.
Stage 3 is focused on further increasing the workload in a way that alters HR in and out of each Zone. Warm up in zone 1 for 5 to 10 minutes. Then increase workload every 60 Seconds until reaching Zone 3. This requires a slow climb through Zone 2 for at least 2 minutes. After pushing for another minute in Zone 3, decrease workload. This one minute break is important to gauge Improvement. Drop workload down to the level they were just working in before starting the zone 3 interval. The HR will drop. As improvements are made, HR will drop more quickly. This indicates a stronger heart. If one Cannot drop to the appropriate HR during the one minute break, stay in zone 1 or 2 for the rest of the workout. If the HR does drop to a normal rate, then overload the body again and go to Zone 3 for 1 minute. Then go back to Zone 1 for 5 to 10 minutes and repeat. It is vital to rotate all three stages every day.
Explain Insulin Resistance and Obesity
17/488
Proponents of low carb diets erroneously claim that carbs are to blame for the increasing prevalence of metabolic syndrome (or Syndrome X) and therefore lead to weight gain. Metabolic syndrome is a cluster of symptoms characterized by obesity, insulin resistance, hypertension, and dyslipidemia, leading to an increased risk of cardiovascular disease. Syndrome X is usually associated with obesity (especially abdominal), a high fat diet, and a sedentary lifestyle.
A common denominator associated with these factors is high levels of circulating free fatty acids (FFA). In the presence of high FFA concentrations, the body will favor their use as energy, decreasing glucose oxidation and glycogen synthesis and inhibiting glucose transport. The result is chronically elevated levels of blood sugar levels, a condition called hyperglycemia. During states of hyperglycemia, insulin will also be elevated, leading to the conversion of the excess blood sugar to other products such as glycoproteins and fatty acids.
The truth is that a healthy person would need to eat an extremely high percentage of simple carbs (such as sucrose) and fat, maintain a constant energy excess, or be overweight to have chronically elevated blood sugar. Although some evidence points to genetic components that contribute to insulin resistance (IR), the condition itself will not allow for weight gain without an energy intake in excess of expenditure. In fact, obesity itself is a risk factor for development of IR, not the other way around.
So, what is the cause of IR? If one constantly overeats, excess calories are stored as fat, which causes fat cells to increase in size. The growing fat cell itself becomes insulin resistant, and the resulting prevalence of FFA will cause the body to favor the use of fat for energy at the expense of glucose. This becomes a vicious cycle, with the overweight condition leading to IR, which in turn leads to impaired glucose use. Blood sugar levels rise, insulin levels rise, and cholesterol, triglycerides, and blood pressure rise as well. To make matters worse, the impaired ability of glucose to enter muscle cells keeps glycogen stores lower, which can increase appetite, motivating one to eat more, increasing fat stores, exacerbating IR, and so on.
High fat diets are strongly associated with obesity, and thus insulin resistance and diabetes. Eating fat does not make one fat unless it is consumed in excess of energy requirements. However, it is easier to consume excess energy (or be hyperphagic) on a high-fat diet, owing to fat’s High caloric density. When large quantities of high caloric dense foods are consumed in combination with excess calories and a sedentary lifestyle, it is easy to Envision an abundance of fatty acids floating around in the bloodstream.
It is much more likely that a high-fat diet leads to excess calorie consumption, obesity, IR, and eventually non insulin dependent diabetes mellitus then it is that carbs cause IR, and, as a result, obesity. The only solution is a diet with the right amount of energy, high in fibrous vegetables or starchy carbs, and exercise. In a study of type 2 diabetics, those with IR, and those of normal weight found that 3 weeks of a high carb, low-fat diet and an exercise program significantly lowered insulin levels.
Explain the digestion, absorption, and utilization of protein
17/469-470
Proteins must be broken down into the constituent amino acids before the body can use them to build or repair tissue or as an energy substrate. The fate of the amino acids after digestion and absorption by the intestines depends on the body’s homeostatic needs, which can range from tissue replacement or tissue addition to a need for energy.
As ingested proteins enter the stomach, they encounter Hydrochloric acid (HCl), which uncoils or denatures the protein so that digestive enzymes can begin dismantling the peptide bonds. Also, the enzyme pepsin begins to cleave the protein strand into smaller polypeptides (strands of several amino acids) and single amino acids. As these protein fragments leave the stomach and enter the small intestine, pancreatic and intestinal proteases (or protein enzymes) continue to dismantle the protein fragments.
The resulting dipeptides, tripeptides, and single amino acids are then absorbed through the intestinal wall into the enterocyles and released into the blood supply to the liver. Once in the bloodstream, the free form amino acids have several possible Fates: They can be used for protein synthesis (building and repairing tissues or structures), immediate energy, or potential energy (fat storage).
The body has a constant need for energy, and the brain and nervous system, especially, have a constant need for glucose. If carbohydrate or total energy intake is too low, the body can use amino acids (from dietary or body proteins) to provide energy. The amino acids are first deaminated (or stripped of the amine group), allowing the remaining carbon skeleton to be used for the production of glucose or ketones to be used for energy. The removed amine group produces ammonia, a toxic compound, which is converted to urea in the liver and excreted as urine by the kidneys.
If protein intake exceeds the need for synthesis and energy needs are met, then amino acids from dietary protein are deaminated, and their carbon fragments may be stored as fat. Among Americans, protein and caloric intakes are typically well above requirements, allowing protein to contribute significantly to one’s fat stores.
Explain the role of fiber in health
17/478-479
A great contribution made by dietary complex carbohydrate is fiber. Higher fiber intake is associated with lower incidence of heart disease and cancer. Fiber is an indigestible carb. There are two types of fiber, soluble and insoluble. Soluble fiber is dissolved by water and forms a gel-like substance the digestive tract. Soluble fiber has many benefits, including moderating blood glucose levels and lowering cholesterol. Good sources of soluble fiber: Oats and oatmeal, legumes (peas, beans, lentils), barley, and many uncooked fruits and vegetables, especially oranges, apples, carrots.
Insoluble fiber does not absorb or dissolve in water. It passes through the digestive tract close to its original form. Insoluble fiber has many benefits to intestinal Health, including a reduction in the risk and occurrence of colorectal cancer, hemorrhoids, and constipation. Most of insoluble fibers come from the bran layers of cereal grains.
The recommended intake of fiber is 38 G per day and 25 G per day for men and women, respectively.
Additional benefits of fiber:
A) provides Bulk in diet, thus increasing the satiety value of foods.
B) some fibers also delay the emptying of the stomach, further increasing satiety.
C) prevents constipation and establishes regular bowel movements.
D) may reduce the risks of heart and artery disease by lowering blood cholesterol.
E) Regulates body’s absorption of glucose (diabetics included), because fiber can control the rate of digestion and assimilation of carbs.
F) High fiber meals exert regulatory effects on blood glucose levels for up to 5 hours after eating.
Define force-couple
Explain force-couple relationships
5/95
Muscle groups moving together to produce movement around a joint.
Muscles produce a force that’s transmitted to bones through their connective tissues (tendons). Because muscles are recruited as groups, many muscles will transmit Force onto their respective bones, creating movement at the joints. This synergistic action of muscles to produce movement around a joint is a force-couple. Muscles in a force-couple provide Divergent pulls on the bone or bones they connect with. This is a result of the fact that each muscle has different attachment sites, pulls at a different angle, and creates a different force on that joint. The motion that results from these forces is dependent on the structure of the joint and the collective pull of each muscle involved (see table: Common force-Couples).
In reality, however, every movement must involve all muscle actions and all functions (Agonist, etc) to ensure proper joint motion and to eliminate unwanted motion. Thus, all muscles working in unison to produce the desired movement are working in a force-couple. To ensure that the HMS moves properly, it must have proper Force-couple relationships, which can only happen if the muscles are at the right length-tension relationships and the joints have proper arthrokinematics (joint motion). Collectively, proper length-tension relationships, force-couple relationships, and arthrokinematics allow for proper sensorimotor integration and ultimately proper, efficient movement.
Explain the stages of change model and five questions to assess one’s current stage
19/525-527
PT’s need to tailor their actions and recommendations to a client’s Readiness to change.
Stage 1: Pre-contemplation: PT’s do not usually see people in this stage. People here have no intention of changing. They do not exercise and do not intend to start in the next 6 months. The best strategy with pre-contemplators is education.
Stage 2: Contemplation: People here do not exercise, but are thinking about starting in the next 6 months. The best strategy here is still education eG pros and cons of exercise, dispel myths.
Stage 3: Preparation: People here do exercise occasionally but are planning to begin exercising regularly in the next month. The best strategies: Clarify realistic goals and expectations, discuss programs, consider preferences, ask about previous successful experiences, build social network.
Stage 4: Action: People here are active. They have started to exercise, but have not yet maintained it for 6 months. The best strategies: Education, discuss barriers, redesign programs.
Stage 5: Maintenance: people here have maintained change for 6 months. The best strategies: Reinforce pros of exercise, discuss progress, change plans, tailor to preferences.
Questions to assess one’s stage: What experiences with physical activity have you had in the past? What worked best to help you stick to an exercise program? What work the least? What contributed to you quitting a program? During the last 6 months, what kept you from exercising? How did you keep up your exercise program when disruptions got in the way?
Explain carbohydrate intake for altering body composition
17/482
Carbs should generally make up the highest percentage of macronutrient calories when attempting fat loss or muscle gain. Carbs provide variety, nutrients, and volume to the diet. The satiating value of complex carbs is especially important in a caloric deficit for fat loss. A diet centered around low glycemic index carbs may be useful in the prevention of obesity, coronary artery disease, colon cancer, and breast cancer.
Weight loss or gain is primarily related to Total caloric intake, not the macronutrient profile. The weight lost on a low-carb diet can be attributed to two factors: Low caloric intake and loss of fat free Mass (FFM). Added to the caloric reduction are dwindling glycogen stores. For every gram of glucose taken out of glycogen, it brings with it 2.7 grams of water. This loss of muscle glycogen (including water) can be significant in the first week of a low-carb diet, and adds to the pounds lost. This is how low carb fad diets can promise dramatic weight loss in short periods. Long-term success in weight loss is associated with realistic eating style, not one that severely limits a macronutrient.
Explain carbohydrate’s role in performance
17/479-480
Carbohydrate availability is vital for maximal sports performance. When performing high intensity, short duration activity (anaerobic), muscular demand for energy is provided for and dependent on muscle glycogen. During endurance exercise (aerobic) performed at a moderate intensity (60% of maximal oxygen consumption or VO2 max), muscle glycogen provides about 50% of energy needs. During high intensity aerobic exercise (greater than 79% of VO2 max), it yields nearly all of the energy needs.
Duration of exercise also affects the amount of glycogen used for energy. As duration of activity increases, available glucose and glycogen diminish, increasing the Reliance on fat as a fuel source. Also, one could presume that if there is an appreciable increase in duration, there must also be a decrease in intensity, decreasing the use of glycogen. However, that does not mean that the best way to lose body fat is to perform low intensity activities for a long duration. If the workout contributes to a caloric deficit, the body will draw on it’s fat stores at some point to make up for the deficit.
Ultimately, the limiting factor for exercise performance is carb availability: “Fat Burns in a carbohydrate Flame.” That is to say, maximal fat utilization cannot occur without sufficient carbohydrate to continue Krebs cycle activity. When an endurance athlete “hits the wall”, it is the result of fatigue caused by severely lowered liver and muscle glycogen. This occurs even though there is sufficient oxygen being delivered to the muscles and in abundance of potential energy from fat stores.
Explain carbohydrate intake recommendations
17/480
A diet containing between 2.7 to 4.5 grams per pound per day of carbohydrate is recommended. The acceptable macronutrient distribution range for carb intake is 45 to 65% of total caloric intake.
Complex carbs such as whole grains and fresh fruits and vegetables should constitute the majority of calories because of their nutrient dense (providing B vitamins, iron, fiber) nature.
High carb diets increase the use of glycogen as fuel, whereas a high-fat diet increases the use of fat as fuel. However, a high fat diet results in lower glycogen synthesis. This is of particular concern if one is consuming A reduced Energy diet. For the endurance athlete, a carb rich diet will build glycogen stores and Aid in performance and Recovery. Although some studies show an increase in performance associated with high fat diets, these improvements are seen in exercise performed at a relatively low intensity (less than 70% of VO2 max). As the intensity increases, performance of high intensity exercise will be impaired.
Explain how Golgi Tendon Organs work
7/169
Golgi tendon organs are located within the musculotendinous Junction (or the point where the muscle and the tendon meet) and are sensitive to changes in muscular tension and rate of tension change. When excited, the GTO causes the muscle to relax, which prevents the muscle from excessive stress, which could result in injury. Prolonged GTO stimulation provides an inhibitory action to muscle spindles (located within the same muscle). This neuromuscular phenomenon is termed autogenic inhibition and occurs when the neural impulses sensing tension are greater than the impulses causing muscle contraction. The phenomenon is termed autogenic because the Contracting muscle is being inhibited by its own receptors.
Identify and explain the adaptations from Resistance Training
13/310-313
As clients develop strength and endurance, they can train for longer periods before reaching the exhaustion stage (General Adaptation Syndrome), which leads to Greater change and adaptation realized over time.
1) Stabilization: The HMS’s ability to provide optimal dynamic joint support to maintain correct posture during all movements. In other words, stabilization is getting the right muscles to fire, with the right amount of force, in the proper plane of motion, and at the right time. This requires high levels of muscular endurance for optimal recruitment of prime movers to increase concentric Force production and reduce eccentric Force. Repeatedly training with controlled, unstable exercises increases the body’s ability to stabilize and balance itself. Improper stabilization can negatively affect a muscle’s Force production. Stability is an important training adaptation because it increases the ability of the kinetic chain to stabilize the LPHC and Joints during movement to allow the arms and legs to work more efficiently.
2) Muscular endurance: the ability to produce and maintain Force production for prolonged periods of time. Improving muscular endurance is an essential part of all programs. Developing muscular endurance helps to increase core and Joint stabilization, which is the foundation on which hypertrophy, strength, and power are built. Training for muscular endurance of the core focuses on the recruitment of muscles responsible for postural stability, namely, type 1 muscle fibers. Resistance training using high repetitions are the most effective way to improve muscular endurance.
3) Muscular hypertrophy: the enlargement of skeletal muscle fibers in response to overcoming Force from high volumes of tension. Muscle hypertrophy is characterized by an increase in the cross-sectional area of individual muscle fibers resulting from an increase in myofibril proteins (myofilaments). Although the visible signs of hypertrophy may not be apparent for 4 to 8 weeks in an untrained client, the process begins in the early stages of training, regardless of the intensity used. Low to intermediate repetition ranges with Progressive overload lead to muscular hypertrophy.
4) Strength: the ability of the neuromuscular system to produce internal tension (in the muscles and connective tissues that pull on the bones) to overcome an external load or Force. Whether the external Force demands the neuromuscular system to produce stability, endurance, maximal strength, or power, internal tension within the muscles is what leads to force production. The degree of internal tension produced is the result of strength adaptations. The specific form of strength or internal tension produced from training is based on the type and intensity of training used (principle of specificity).
Resistance training programs have traditionally focused on developing maximal strength in individual muscles, emphasizing one plane of motion (typically the sagittal plane). Because all muscles function eccentrically, isometrically, and concentrically in all three planes of motion at different speeds, programs should be designed using a progressive approach that emphasizes the appropriate exercise selection, all muscle actions, and repetition tempos.
Because muscles operate under the control of the CNS, strength needs to be thought of not as a function of muscle, but as a result of activating the neuromuscular system. Using heavier loads increases the neural demand and recruitment of more muscle fibers until a recruitment Plateau is reached, after which further increases in strength are a result of fiber hypertrophy.
Strength cannot be thought of in isolation. Strength is built on the foundation of stabilization requiring muscles, tendons, and ligaments to be prepared for the load that will be required to increase strength beyond the initial stages of training. Whereas stabilization training involves type 1 slow twitch muscle fibers, strength training involves type 2 fibers. The majority of strength increases will occur during the first 12 weeks of resistance training from increased neural Recruitment and muscle hypertrophy.
5) Power: The ability of the neuromuscular system to produce the greatest force in the shortest time. This is represented by the equation of force multiplied by velocity. Power adaptations build on stabilization and strength adaptations and then apply them at more realistic speeds and forces seen in everyday life and sports. The focus of Resistance-Power training is getting the neuromuscular system to generate Force as quickly as possible (rate of force production).
An increase in either force or velocity will produce an increase in power. Training for power can be achieved by increasing the weight (Force), as seen in the strength adaptations, or increasing the speed with which weight is moved (velocity). Power training allows for increased rate of force production by increasing the number of motor units activated, the synchronization between them, and the speed at which they are activated. The General Adaptation Syndrome and principle of specificity both dictate that to maximize training for this adaptation, both heavy and Light loads must be moved as fast as possible in a controlled fashion. Thus, using both methods in a superset fashion can create the necessary adaptations to enhance the body’s ability to recruit a large number of motor units and increase the rate (speed) of activation.
Define hypertension, describe it, how exercise affects it, and physiologic considerations
16/432
Hypertension: consistently elevated arterial blood pressure, which, if sustained at a high enough level, is likely to induce cardiovascular or end-organ damage.
Blood pressure is defined as the pressure exerted by the blood against the walls of the blood vessels, especially the arteries. It varies with the strength of the heartbeat, the elasticity of the arterial walls, the volume and viscosity of the blood, and age, health, condition. Hypertension, or high blood pressure, is a disorder in which arterial blood pressure remains High (resting systolic greater than or equal to 140 or diastolic greater than or equal to 90 mm hg. People with resting BP between 120 over 80 and 135 over 85 mm HG are prehypertensive and should lower their BP through Lifestyle Changes. Causes include smoking, diet high in fat (particularly saturated fat), and excess weight. Health risks include increased risk for stroke, cardiovascular disease, chronic heart failure, kidney failure.
Although medications are effective, lifestyle changes including regular exercise, diet, and smoking cessation are also effective in reducing BP. Exercise can lower elevated BP by an average of 10 mm hg for systolic and diastolic BP. Low to moderately intense cardiorespiratory exercise is just as effective as high intensity activity. PTs should evaluate HR responses to exercise. It’s important to monitor body position at all times. As with obese and diabetic clients, body position can dramatically affect BP before, during, and after exercise. Supine or prone positions, especially when the head is lower in elevation than the heart can often increase BP and as such these positions may be contraindicated. Both hypotensive and hypertensive responses to exercise are possible in those with hypertension. Most exercises should be done in a seated or standing position. Slow progression in phases 1 and 2 are appropriate. Programs should be done in a circuit style or peripheral heart Action System to distribute blood flow between the upper and lower extremities. PTs should ensure that clients breathe normally and avoid the Valsalva maneuver (: maneuver in which one tries to Exhale forcibly with a closed glottis (windpipe) so that no air exits through mouth or nose as, for example, in lifting heavy weight. It impedes the return of venous blood to the heart) or overgripping (squeezing tightly) when using equipment as this can dramatically increase BP.
Physiologic considerations:
A) blood pressure response to exercise may be variable and exaggerated, depending on mode and intensity: Continuous, lower intensity aerobic exercise is initially recommended.
B) despite medication, clients may arrive with pre-exercise hypertension: Resistance exercise should be circuit Style or peripheral heart action. Avoid holding breath (Valsalva maneuver).
C) hypertension is associated with other comorbidities including obesity, cardiovascular disease, diabetes: Screening is important. Weekly caloric goal of 1500 to 2000 calories.
D) Some medications, such as beta blockers, will attenuate the heart rate at rest and its response to exercise: Do not use predicted maximal HR or estimates for exercise. Use talk test for those taking medications.
Identify and demonstrate all 4 Chest-Power Resistance exercises
13/328-329/587
Describe Resistance-Strength exercises and their functions
13/CR
Performed on a more stable base of support so that heavier loads can be handled. Can Target muscular endurance, hypertrophy, or maximal strength depending on how the acute variables are organized.
Focus mainly on increasing Prime mover strength.
Identify the Reps, sets, tempo, intensity, rest interval, frequency, duration, exercise selection for Phase 1: Stabilization Endurance Training (flexibility, core, etc)
14/370
What percentage of US population does not engage in 30 minutes of low to moderate physical activity daily?
19/523
over 75%
Identify and demonstrate all 4 Chest-Stabilization Resistance exercises
13/326-327/586
Identify and demonstrate all 8 Core-Strength exercises
9/577-578/237-239
Explain the benefits of self-monitoring (keeping a daily written record)
19/544-545
A) opportunity to look at progress over time
B) seeing progress builds self-confidence and adherence
C) accountability and motivation
D) honesty
E) logging a workout serves as a reward
F) identifies challenges
What aids in satiety (the feeling of fullness)?
17/474
Protein suppresses food intake for several hours and to a greater extent than fats and carbohydrates. Thus, protein aids in fat loss.
Identify the 8 essential, 10 nonessential, and 2 semiessential amino acids
17/468
Essential: Isoleucine leucine lysine methionine phenylalanine threonine tryptophan valine.
Nonessential: Alanine asparagine, aspartic acid, cysteine, glutamic acid, glutamine glycine proline serine tyrosine.
Semi-essential: Arginine histidine.
How much water should be consumed?
17/490
Sedentary men and women should consume on average 3 liters (13 cups) and 2.2 liters (9 cups) of water per day, respectively. Those in a fat loss program should drink an additional 8 oz of water for every 25 lb they carry above their ideal weight. Water intake should also be increased if one is exercising briskly or residing in a hot climate.
Identify the psychological benefits of exercise
19/547-548
Positive mood: Feeling of satisfaction, energized, positive outlook, relaxation, stress reduction, alertness, concentration.
Reduced stress: Less headaches, stomach aches, frustration, pressure, uncertainty, anger, irritability.
Improves sleep: Falling asleep quickly, longer deep sleep, more refreshed in morning.
Reduced anxiety and depression: Less worry, self Doubt, fear, uncertainty.
Explain what to eat and what to avoid for fat loss and hunger control
17/492
Overconsumption of sugar, refined processed carbohydrates, and high glycemic foods can lead to uncontrolled spikes in blood sugar, low energy, and increased appetite. Therefore, to avoid hunger, choose unprocessed, whole Food carb sources such as a vegetables, starchy vegetables, whole fruit, and grains to provide fiber, vitamins, and minerals for healthy weight loss.
Define calorie and Calorie / kilocalorie (kcal)
17/465
The amount of heat energy required to raise the temperature of 1 G of water 1° C.
A unit of expression of energy equal to 1,000 calories. The amount of heat energy required to raise the temperature of 1 kg or liter of water 1° C.
Identify three nutrition topics that should be left for RDs
Identify the general topic that PT’s should address
17/464
Individual nutrition assessment, meal plans, recommendations for nutritional therapy.
Educate clients on healthy food choices.
Identify and demonstrate all 4 Total Body-Strength Resistance exercises
13/323-324/584
Describe Balance-Power exercises and their functions
10/261
Move the body from a dynamic state to a controlled stationary position.
Designed to develop proper eccentric strength, dynamic neuromuscular efficiency, and reactive joint stabilization.
Identify and demonstrate all 7 Balance-Strength exercises
10/258-261/579-580
Identify and demonstrate all 5 SAQ Cone Drills
12/298-299
Identify General benefits of exercise
19/523
Reduced anxiety, depression, risk of cardiovascular disease.
Better weight control.
Increased self-esteem.
Differentiate between resting metabolic rate (RMR) and basal metabolic rate (BMR)
17/466
BMR is used when measurements are taken after the subject has spent the night in a metabolic Ward and has fasted for 12 hours.
RMR is measured after the subject spends the night at home and is driven to the laboratory.
They differ by less than 10%, usually.
Identify what positively affects RMR
17/466
Slight increases in fat free mass can have a gradual increase in RMR; thus exercise has a positive effect on RMR indirectly if FFM is increased.
Thus, to avoid declines in resting metabolism, one should avoid starvation diets that could waste skeletal muscle and instead build and maintain muscle for active living. Maintaining muscle mass is especially important during aging because some of the decline in RMR is caused by less muscle.
Characteristics, functions, examples of short bones?
2/26-28
Similar in length and width and appear somewhat cubicle in shape.
Their spongy bone tissue maximizes shock absorption.
Example: carpals of hand, tarsals of feet.
Identify how to make rejection much less likely
20/569
When you have established rapport, built a relationship, had empathy for why their goals are important to them, conducted a thorough assessment, and made the right opt program recommendations.
Explain how exercise affects protein requirements
17/472
Exercise increases the oxidation of amino acids as well as the rate of protein turnover in lean body mass during recovery. Because different types of exercise (anaerobic, aerobic) have specific effects, one engaging in both types of exercise may have a need for protein greater than one involved in only one.
Identify and demonstrate all 11 Dynamic Stretches
7/190-192/576
.
Identify and demonstrate all 5 Shoulder-Strength Resistance exercises
13/337-338/590-591
Identify and demonstrate all 17 Static Stretches
7/571-572/181-184
Identify and demonstrate all 4 Triceps-Stabilization Resistance exercises
13/342/593
Identify and demonstrate all 4 Biceps-Strength Resistance exercises
13/340-341/592
Identify the Reps, sets, tempo, intensity, rest interval, frequency, duration, exercise selection for phase 3: Hypertrophy Training (Flexibility, Core, etc)
14/374
Explain what social facilitation is
19/532
Studies show that people increase their effort and performance when others are watching them, a principle called social facilitation. People want to create an impression that they are just as fit as those around them. People report lower ratings of perceived exertion when they exercise next to someone.
Identify and describe the SAQ-Stabilization exercises and two examples
12/296
Drills with limited horizontal inertia and unpredictability, such as Cone Shuffles and Agility Ladder Drills.
Explain how the heart (ventricles and Atria) pumps blood
3/56-57
The right ventricle has thin walls and pumps under low pressure because it only has to pump blood a short distance to the lungs. The left ventricle has thicker walls and pumps under high pressure because it pumps blood out to the rest of the body.
The right ventricle receives the deoxygenated blood from the right atrium and then pumps it to the lungs to be saturated with oxygen. The left ventricle receives the oxygenated blood from the left atrium and then pumps it to the whole body.
Describe Resistance-Power exercises and their function
13/CR
Performed as supersets. Many of the lower-body Power exercises are the same as Plyometric-Strength ones.
Focused on the velocity at which force can be produced.
Explain what you need to eat to build muscle
17/474
Theoretically, one needs to ingest an extra 14 g of protein per day, although most experts believe the most important factor in gaining lean mass (along with resistance training) is having adequate calories. Therefore, to ensure the body has sufficient energy for lean mass accretion, consume an additional 200 to 400 calories daily (1.5 to 2.5 calories per pound per day) above maintenance requirements in addition to consuming a little extra protein (2 oz of lean meat).
Identify and demonstrate all 5 Shoulder-Stabilization Resistance exercises
13/335-336/589-590
Describe Plyometric-Power exercises and their function
11/283
Involve the entire muscle action spectrum and contraction-velocity Spectrum used during integrated, functional movements. They are performed as fast and as explosively as possible.
Designed to further improve the rate of force production, eccentric strength, reactive strength, reactive joint stabilization, dynamic neuromuscular efficiency, and optimal Force production.
How does pulse work?
6/117
A pulse is created by Blood moving or pulsating through arteries each time the heart contracts. Each time the heart contracts or beats, one wave of blood flow or pulsation of blood can be felt by placing one or two fingers on an artery. The artery contracts and relaxes periodically to rhythmically Force the blood along its way circulating throughout the body. This coincides with the contraction and relaxation of the heart as it pumps the blood through the arteries and veins. Thus the pulse rate is also called the heart rate.
Define scapular retraction, protraction, depression, elevation
5/88
Adduction of scapula; shoulder blades move toward the midline
Abduction of scapula; shoulder blades move away from midline
Downward (inferior) motion of the scapula
Upward (Superior) motion of the scapula
What is maximal oxygen consumption (vO2 max)?
3/66
The highest rate of oxygen transport and utilization achieved at maximal physical exertion or the maximum amount of oxygen one can consume and use during maximal intensity.
It’s a great measure of cardiorespiratory Fitness.
Identify pros and cons of elastic resistance (rubber tubing and bands)
15/396
Pros: Inexpensive, portable, multiple planes of motion, sport specific movements, improve proprioceptive demands, muscular endurance, joint stabilization.
Cons: Hypertrophy or maximal strength, tension in rubber changes as its stretched.
Why is the waste to hip ratio important?
What are good ratios for men and women?
6/128
There is a correlation between chronic diseases and fat stored in the midsection.
Anything at or below 0.95 for men and at or below 0.80 for women will not put people at risk for diseases.
How much time should people exercise per week for General Health?
8/213
150 minutes of moderate intensity aerobic activity ie brisk walking every week or 75 minutes of vigorous intensity aerobic activity iE jogging, running every week or an equivalent mix.
Define glycogen (including its function)
When would glucose from glycogen be used by the body for energy?
4/71
The complex carbohydrate molecule used to store carbs in the liver and muscle cells. When carbohydrate energy is needed, glycogen is converted into glucose for use by the muscle cells.
During intense or prolonged exercise.
Define reciprocal inhibition and give one example (biceps curl)
7/167
The simultaneous contraction of one muscle and the relaxation of its antagonist to allow movement to occur.
To perform elbow flexion during a biceps curl, the biceps brachii contracts while the triceps brachii (the antagonist muscle) relaxes to allow the movement.
Define motor Behavior. What does it include?
5/99
Motor response to internal and external environmental stimuli (ie sensory information).
Motor behavior is the collective study of motor control, motor learning, motor development.
Define postural distortion patterns and relative flexibility
7/164
Predictable patterns of muscle imbalances.
The tendency of the body to seek the path of least resistance during movement patterns.
Define plantarflexion and dorsiflexion
5/668/678
Ankle motion such that the toes are pointed toward the ground.
When applied to the ankle, the ability to bend at the ankle, moving the front of the foot upward.
What is heart rate or HR?
And cardiac output or Q?
3/58
The rate at which the heart pumps or beats is HR. Average resting: 70 to 80 BPM.
Q is the overall performance of the heart; the volume of blood pumped by the heart per minute (ml blood per minute); cardiac output is a function of heart rate times stroke volume.
What explains most of the disparities in athletic performance between men and women?
16/450
Differences in body structure, muscle mass, lean to fat body mass ratio, and to a lesser extent, blood chemistry.
What is excitation-contraction coupling?
2/42
The process of neural stimulation creating a muscle contraction. It involves a series of steps that start with the initiation of a neural message (neural activation) and end up with a muscle contraction (sliding filament theory).
Define gluconeogenesis
When does gluconeogenesis occur and what is its function?
4/71
The formation of glucose from non-carbohydrate sources, such as amino acids.
Gluconeogenesis occurs during a negative energy balance and amino acids from protein become a significant fuel source.
What are the primary goals of a cool-down?
8/206
Reduce heart and breathing rates, cool body temperature, return muscles to Optimal length-tension relationships, prevent venous pooling of blood in lower extremities (which may cause dizziness or fainting), and restore physiologic systems close to Baseline.
Define lateral flexion, eversion, and inversion
5/87
Bending of the spine (cervical, thoracic, or lumbar) from side to side or side-bending.
Eversion is movement of the calcaneus (heel bone) and tarsals (ankle bones) in frontal plane, away from midline of body.
Inversion is movement of the calcaneus (heel bone) and tarsals (ankle bones) in frontal plane, toward midline of body.
Explain how proteins are structured
17/468
Proteins are made up of amino acids linked together by peptide bonds. The body uses 20 amino acids to build its many different proteins. Just as specific words are formed by certain sequences of letters, arranging the amino acids in different sequences yields the body’s Myriad of proteins (from a muscle protein like actin to proteins that make up the lens of the eye).
What is the main purpose of a successful business?
What are successful businesses interested in?
20/550
To create and keep a loyal customer base or following.
Successful businesses are interested in who their customers are, where they live, where they come from, what their likes and dislikes are, etc.
Identify the steps to manually monitor heart rate
3/58
1) place index and middle fingers around Palm side of wrist, about one inch from top of wrist, on thumb side.
2) locate the artery by feeling for a pulse with index and middle fingers. Apply light pressure to feel it.
3) during rest, count the number of beats in 60 seconds.
4) during exercise, count the number of beats in 6 seconds and add a 0 to that number. This estimates the beats in 60 seconds.
Monitoring HR during exercise is a good estimate of how hard the heart is working.
What are blood vessels?
Name three types of blood vessels
3/60
Blood vessels are a network of hollow tubes that circulates blood throughout the body.
Arteries, capillaries, veins.
Define set
14/357
A group of consecutive reps.
Define adenosine triphosphate (ATP) and its function
4/CR/72
Energy storage and transfer unit within the cells of the body.
ATP is the body’s internal energy currency that is used in all biochemical reactions that sustain life.
Explain what undulating periodization is and what it achieves
14/365
Allows one to train at varying intensities during the course of a week, which allows for multiple adaptations once a level of Fitness has been achieved.
Define arteries
3/60
Vessels that transport blood away from the heart.
What is skeletal muscle made up of?
2/39
Individual muscle fibers; “muscle” refers to multiple bundles of muscle fibers held together by connective tissue.
Define overtraining and what causes it
8/215
Excessive frequency, volume, or intensity of training, resulting in fatigue (which is also caused by a lack of rest and Recovery).
Why is it important to remember tendons’ poor vascularity?
2/40
To consider the number of days rest taken and structure of programming for high intensity exercise to prevent overuse injuries.
Explain mitochondria and what they do
2/44
They transform energy from food into ATP, or cellular energy.
The principal energy source of the cell. They convert nutrients into energy.
What are the three metabolic pathways in which cells generate ATP?
4/73
ATP-PC system, glycolytic system (glycolysis), and oxidative system (oxidative phosphorylation).
Define general and specific warm up
8/202
Low intensity exercise consisting of movements that do not necessarily relate to the more intense exercise that is to follow.
Low intensity exercise consisting of movements that mimic those that will follow in intense exercise.
All exercise training should use the FITTE principle:
8/208
Frequency
Intensity
Type
Time
Enjoyment
Define radioulnar (forearm) pronation and supination
5/87/n/a
Rotation of forearm and palm downward; associated with Force reduction.
Rotation of forearm and palm upward; associated with Force production.
What is a simple one sentence summary of the cardiorespiratory system’s function?
3/65
Oxygen and carbon dioxide trade places in the tissues, blood, and lungs. As one is coming in, the other is going out.
OR
It provides the body with oxygen and nutrients and removes waste products like CO2.
What are two strong indicators of cardiorespiratory Fitness?
6/117/cr
HR and BP.
Resting HR is a fairly good indicator of overall cardiorespiratory Fitness.
Exercise HR is a strong indicator of how one’s cardiorespiratory system responds and adapts to exercise.
What happens when there is more glucose in the blood than cells can readily use?
4/cr
It gets converted to triglycerides and stored on the body as fatty tissue.
What are the substrate forms of protein?
4/cr
Amino acids.
Define protein
What is protein’s main function?
Is it used for energy much?
4/71
Amino acids linked by peptide bonds, which consist of carbon, hydrogen, nitrogen, oxygen, and usually sulfur, and that have several essential biologic compounds.
Mainly for building and repairing soft tissues.
Protein rarely supplies much energy during exercise, except in Starvation, ie gluconeogenesis.
What’s a few reasons for assessing body composition?
6/121
To assess effectiveness of nutrition and exercise choices.
To use as a motivational tool.
To monitor changes in body composition.
To identify health risks.
Why is it valuable to know the types of bones and joints?
2/cr
Better understanding of how the kinetic chain Works to create movement.
Which Energy System fuels most of our regular daily activity?
4/cr
Oxidative system.
Why is it important to know about one’s history of musculoskeletal injury?
6/113
Previous history of musculoskeletal injury is a strong predictor of future musculoskeletal injury during physical activity.
The three components of the kinetic chain/human movement system?
2/17
Nervous
Skeletal
Muscular systems.
What substrate does ATP-PC use?
And glycolysis?
And oxidative?
4/cr
Phosphocreatine.
Carbohydrates (glucose, glycogen).
Glucose, fats.
Average resting HR for males? Females?
6/118
70 BPM.
75 BPM.
Define training duration
14/362
The timeframe of a workout or the length of time spent in one phase of training.
Instead of skinfold measurements, what should be used for very overweight or obese clients?
6/123
Circumference measurements
Scale weight
How clothes fit.
The more that functional Anatomy is understood, the more _____ an exercise prescription can become.
5/93
Specific.
Define internal and external rotation
5/87
Rotation of a joint toward middle of body.
Rotation of a joint away from middle of body.
There is an inverse relationship between which three acute variables?
14/357
Sets
Reps
Intensity.
Why or how is training intensity a function of more than just external resistance?
14/358
Training in unstable environments, rest periods, and tempo can all affect training intensity.
Define program design
14/354
A purposeful system or plan put together to help one achieve a specific goal.
Identify the type of fat to consume and to avoid
17/489
A high polyunsaturated to saturated fat ratio is desirable.
What kind of hormones influence RMR/metabolism?
17/466
Thyroid hormones influence Many metabolic functions, including fat and carb metabolism and growth.
Explain what a good first impression entails
19/524
PT’s have 20 seconds to make a good first impression. It includes:
Making eye contact
Introducing yourself by name and getting their name
Smiling
Shaking hands
Remembering their name and using it
Using good body language.
Define protein
What is protein’s primary function?
17/468
Amino acids linked by peptide bonds.
To build and repair body tissues and structures. It’s also involved in the synthesis of hormones, enzymes, and other regulatory peptides. Also, it can be used for energy if calories or carbohydrates are insufficient.
Explain how fat-free mass (FFM) and muscle tissue helps to lose fat /weight loss
17/494
If FFM and muscle can be increased during weight loss, it is easier to maintain RMR and fat loss.
Why are most sales lost?
20/568
Because they’re not asked for.
Identify and demonstrate all 5 Back-Stabilization Resistance exercises
13/330-331/587-588
Identify and demonstrate all 4 Back-Power Resistance exercises
13/334/589
Identify examples of positive self-talk
19/545
Replacing negative thoughts with positive ones.
A list of positive, motivating keywords to use as an awareness tool: Fast, energetic, go, focus, get it.
The body needs fats for:
17/489
Energy
Structure and membrane function
Precursors to hormones
Cellular signals
Regulation of uptake and excretion of nutrients in the cells.
What inhibits muscle-protein breakdown?
17/473
Carbohydrate (0.5 grams per pound), not protein, consumed within an hour after heavy resistance training inhibits muscle-protein breakdown, resulting in a positive protein balance.
Describe Core-Stabilization exercises and its purpose or function
9/234
Exercises involve little motion through the spine and pelvis.
Designed to improve neuromuscular efficiency and intervertebral stability, focusing on drawing-in and then bracing during the exercises.
What does elastin in ligaments do?
2/38
Elastin gives a ligament some flexibility or elastic recoil to withstand the bending and twisting it may have to endure.
Since each person has unique goals and fitness needs, programs must be _____ to each client.
14/cr
Individualized
Define training frequency
14/361
The number of training sessions performed during a specified period (Usually one week).
If an exercise is not enjoyable:
8/213
Clients will not adhere and won’t reach goals.
How can stride rate (speed) be improved?
12/290
Core strength, plyometric training, and technique.
Define expiration (exhalation)
3/62
The process of actively or passively relaxing the inspiratory muscles to move air out of the body.
The PAR-Q is aimed at screening for what?
6/110
Cardiovascular disease.
Define rate of force production
11/271
Ability of muscles to exert maximal Force output in a minimal amount of time.
How should one breathe?
What can breathing reveal?
3/67
Breathe diaphragmatically (through the stomach).
Assessing one’s breathing pattern can also help determine muscle imbalances.
Muscle imbalances may be caused by or result in what four things?
7/167
Altered reciprocal inhibition
Synergistic dominance
Arthrokinetic dysfunction
Overall decreased neuromuscular control.
Explain why the OPT model is needed and what it stands for
1/8
The Optimum Performance Training model was designed for a society with structural imbalances and susceptibility to injury. It’s a process to get any client to any goal. It minimizes injury, maximizes results.
The use of oxygen by the body is known as what?
3/65
Oxygen uptake (oxygen consumption).
Identify pros and cons of bosu balls
15/409
Pros: Stability, balance demands; upper and lower body.
Cons: Not for hypertrophy or max strength.
What is the muscular system?
What are the three muscle types?
2/39
Series of muscles that moves the skeleton.
Skeletal muscle
Cardiac muscle
Smooth muscle.
Name the five phases in opt model
1/10-12
Phase 1: Stabilization Endurance Training
Phase 2: Strength Endurance Training
Phase 3: Hypertrophy Training
Phase 4: Maximum Strength Training
Phase 5: Power Training
Balance training exercises are progressed how? And Why?
10/cr
Proprioceptively, since the purpose is to challenge one’s balance threshold.
The primary function of a PT?
14/364
Designing safe and effective training programs.
Characteristics and examples of irregular bones?
2/26-29
Unique shape and function that do not fit the others.
Example: Vertebrae, pelvic bones.
The seven parts of integrated training
1/8
Flexibility
Cardiorespiratory
Core
Balance
Plyometric
Speed agility quickness
Resistance
What are the three criteria for an exercise to be “aerobic”?
8/213
A) rhythmic in nature
B) use large muscle groups
C) continuous in nature.
One’s cardiorespiratory Fitness level is one of the strongest predictors of what?
8/202
Morbidity and mortality; increase in risk of premature death from all causes, but particularly from cardiovascular disease.
Define abduction and adduction
5/87
Movement in frontal plane away from the midline of body
Movement in frontal plane back toward the midline of body.
