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exercise prescription > obesity and cardio basics > Flashcards

obesity and cardio basics Flashcards

1
Q

ways of measuring body weight reference and pros and cons

A

wells and fewtrell 2006

  1. skinfold assumes adipose compresses same manner, double compressed same as single, only subcut, equation not population specific
  2. BMI false negative and positive, bio age, distribution,
  3. wc: not so accurate doesnt measure internal fat and only round waist
  4. impedance= affected by lots of factors eg age, hydrations, meds etc poor accuracy individual
  5. dexa= radiations, hydration affect, assumes for torso where lots of bones has to make lots of assumptions of fat mass as pixels can only diff fat and muscle
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2
Q

prevalence of obesity

A

SHS 2017
for 2016 29% men and 29% women were obese and 29% of 2-15 at risk or incl. obese
68% men and 61% women were overweight/ obese

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3
Q

obesity health related consequences

A

cvd, mortality, dm, asthma, oa, kidney, pancreatitis, decrease repro, depression, dementia, cancer

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4
Q

cmo physical activity and health related consequencues

A
  1. all cause mortality 30
  2. metabolic 30-40
  3. energy expenditure Pa no effect on 5% need diet
  4. functional 30%
  5. cancer 30% colon 20 % breast
  6. cvd 20-35
  7. depression 20- 30
  8. musculoskeletal 22-83 oa
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5
Q

risk of diabetes with bmi

A

2.5x risk of diabetes with bmi 30-32.5 6xat 40 bmi

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6
Q

weight loss recommendation guidelines references

A

nhs sign 2010 managing obesity
swift 2014
o’donovan et al 2010
o’ halloran and bhogal 2014

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7
Q

NHS SIGN 2010 GUIDELINES FOR MANAGING OBESITY

A
  1. -REDUCING CO-MORBIDITIES:
    - BMI 25-35 need 5-10kg weight loss
    - bmi >35 need 5-10% weight loss
  2. overweight/ obese individuals should be supported to undertake more pa part of a multi-component management weight programme including BCT such as goals, support, maintenance, info on benefits
  3. overweight and obese individuals should be prescribed a volume of pa equal to approx 1,800-2,500 kcal per week or 225-330 min week mod intensity pa 5x60 sessions
  4. moderate intensity means increase rate of breathing, increase heart rate 55-70%
  5. This should be built up to if SB start at 20x 4 week
  6. recommended walking as lower load bearing 1km= 60kcal for 70kg
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8
Q

Swift 2014 guidelines

A

-maintain health 150 minutes
-promote WL 225-420
prevent WG after WL is 200-300 minutes
-aerobic +caloric restrict= -9kg to -`13 kg weight loss only clinical sig option

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9
Q

O’halloran and Bohgal

A

recommend starting with walking 3x30 minutes a week 10 minute bouts then add 5-10 minutes every week so by end of month walking 3x60 minutes
plus flexibility
plus strength with low weight high reps 10-15

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10
Q

weight loss evidence references

A

McQuigg 2008
martinez-gomez et al 2010
shaw et al 2006
Franz et al 2007

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11
Q

mcquigg 2008

A

found that 10% weight loss isg reduced odds ratio for dm, dyslip, hp , cvd and chd

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12
Q

martinez gomez et al 2010

A

that >18 minutes/day in vigorous physical activity and
>55 minutes/day in MVPA signifıcantly discriminated between normal-weight and overweight obesity
categories.

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13
Q

shaw et al 2006

A

Found that combined exericse diet and behaviour largest effect on weight loss

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14
Q

franz et al 2007

A

Found that very low energy diet not sustainable as 6 month -18 kg but between 6 and 24 month increase to only -6kg loss
exercise alone was also not very effective as lack of evidence long term and only -2kg weight loss at 6 months
drugs most effective but costly

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15
Q

nhs 2010 sign guideline for managing childhood obesity

A

BMI >98th percentile

  • need to increase PA general rec is stick to the 60 mins a day and reduce SB and screen time less than 2 hrs a day
  • behavioural use goal setting, rewards and family support as more effective
  • diet decrease total energy intake but no evidence that any particular diet is effective
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16
Q

Kelley and kelley 2013

A

found that exercise sig reduce percentage fat in overweight and obese children and adolescents but no sig effect on bmi, kg or central obesity.
Intervention:
1-7x week, 90-200 minutes per week, aerobic strength or both, supervised and unsupervised

17
Q

FFIT brief description

A 
Hunt et al 2014
-86% of coaches covered key tasks
-80% attendance at 6+sessions
-12 weekly sessions
-hwk daily pedometer
- maintenance 12 months 
-35-65 bmi >28 all SES
RESULTS
wl AT 12 WEEKS >5.18 KG 
self reported pa increased 1219 MET mins/wk compared to 375
-47 achieved 5% wl in 12 week only 7 in cg
- lower bp 
and sig less drinking and bad eating
cost £165 per man
18
Q

what are the core components of CR

A

PA and exercise
diet
smoking cessation

19
Q

flow of CR

A

patient referred
assessed
centre based, home based or ongoing support for pa out with programme
RE-assess

20
Q

screening for CR

A 
ECG
ECG exercise tolerance test
Echocardiogram
diagnostic angiogram
thallium scan
cardiac mri/ ct scan
21
Q

CI to exercise FOR CARDIAC REHAB

A

-embolism
-thromophlebiltis
-thyroditis
-acute pericarditis
-acute systemic illness
uncontrolled DM or HBP
-uncontrolled arhythmia
-high or low HR
-sig aortic narrowing

22
Q

baseline measure early assessment for cardiac rehab

A
  • nurse and physio
  • patient’s understanding of diagnosis and treatment
  • relevance meds and compliance
  • baseline measures full CV risk factor profile
  • all relevant co-existing morbidities identified
  • assessing signs and symptoms eg bmi, bg, hr, rhythm, angina, dyspnoea…
  • functional capacity test using incremental shuttle or six minute walk test
23
Q

Program for cardiac rehab

A
  • behaviour change techniques
  • 1-2x week, 1 hr classes
  • home based using DVD or telehealth
  • home based in familiar surroundings, timing, transport, daily activity if dislike group , more out ptients
  • structured exercise training FFIT, 203, 11-14 rpe or 40-70% hrr, 20-60 min, large muscle groups
24
Q

how to work out hrr

A

karvonen formula

max hr-resting hr (-30 if on beta blockers) = hrr

25
Q

why is a warm up for cardiac rehab important

A

-enables mycardium to meet metabolic demands
-increase blood flow
-vasodilation
-decrease cardiopulmonary distress with adrenaline increase
-increase ischaemic threshold
-decrease muscle and joint injuries
-increase perofrmance of activity
40% hrr, rpe <11

26
Q

cardiac rehab conditioning phase

A

moderate intensity 20-35 minutes
-vary intensity and duration
-large muscles
-mse low weights and high reps uses strength as active recovery to aerobic in the circuits
-occupational targeted
ie functional requirenment
-alllows for individual tailored exercise
-more sociable
1:1
-lower functioning seated exercise and avoid stand too quickly with feet keep moving to maintain venous return
also reduce duration of conditioning

27
Q

cardiac rehab resistance training

A

-8-10 muscle groups, 1+ set, 10-15 reps
-base levels on fatigue at 10-15 reps
Improves: bp, bg, weight, function, aerobic, bone strength
CI; No excessive gripping
Avoid valsalva (↑↑in BP

28
Q

cool down

A

-risk of bp decrease in first 30 min after conditioning
-decrease venous return
-graded cool down
stretch
-minimum 10 minutes

29
Q

what are the 6 components of cardiac rehab and reference

A
  1. disease education and health education
    2, lifestyle and risk factor management
  2. psychological health
  3. med risk management
  4. long term management
  5. audit and evaluation
    BACPR British association cardiac pulmonary rehab
30
Q

definition of cardiac rehab

A

the co-ordinated sum of activities required to influence favourably the underlying cause of cvd as well as to provide the best possible physical, mental and social conditions

so patients may by their own efforts preserve or resume optional functioning

31
Q

the hart manuals workbook

A

6 week program
heart condition facts
facts and advice to aid recovery with behavioural target

32
Q

Cardio heart manual 3 references

A
  1. Clark et al 2015
  2. Dalal et al 2010
  3. Clark et al 2011
33
Q

Clark et al 2015

A

-83 studies
- Multifactorial individualized telehealth and community- or home-based cardiac
rehabilitation are effective alternative models of cardiac rehabilitation, as they have produced similar reductions in
cardiovascular disease risk factors compared with hospital-based

34
Q

Dalal et al 2010

A

12 studies (1938 participants) were included. Most studies recruited patients with a low risk of further events after myocardial infarction or revascularisation. No difference was seen between home based and centre based cardiac rehabilitation in terms of mortality , cardiac events, exercise capacity, modifiable risk factors , total cholesterol , low density lipoprotein cholesterol or relative risk for proportion of smokers at follow-up , or health related quality of life, with the exception of high density lipoprotein cholesterol. In the home based participants, there was evidence of superior adherence. No consistent difference was seen in the healthcare costs of the two forms of cardiac rehabilitation.

supports home and hospital equal and supports heart manual

35
Q

Clark et al 2011

A

Ninety studies were included (2010 patients, 120 caregivers, 312 professionals). Personal and contextual barriers
and facilitators were intricately linked and consistently influenced patients’ decisions to attend. The main personal factors
affecting attendance after referral included patients’ knowledge of services, patient identity, perceptions of heart disease, and
financial or occupational constraints. These were consistently derived from social as opposed to clinical sources. Contextual
factors also influenced patient attendance, including family by providing transport and transport to rehab classes and, less commonly, health professionals via making telephone calls offering the services
Decisions to attend programs are influenced more by social factors than by health professional advice or
clinical information

36
Q

Prevalence of cardiac disease

A

BHF,2018
CVD causes over 26% of all deaths in the uk every year
42,000 people under the age of 75 will die a year from CVD

exercise prescription (8 decks)

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