Other Conditions

Question 1

Explain the differences in Type I and Type II diabetes.

Answer 1

• Type I is caused by the fact that the insulin producing cells in the pancreas are destroyed, resulting in a lack of insulin production. This is hereditary and the onset occurs before the age of 20.
  
  • Type II, which is the most common type (90%), occurs because the glucose produced can’t get into the cells of the body because it has become insulin resistant. This is also hereditary but also occurs because of a unhealthy lifestyle. Onset is usually after the age of 30.

Question 2

Describe “neuropathy” and why is it so prevalent in diabetes.

Answer 2

-Basically what happens is the nerve tissue breaks down, and there is a loss of blood supply and sensation. This is incredibly important to keep in mind with the diabetic client, as they may have loss of sensation in their feet. If they simply get a blister, or a cut on their toes, they might not be aware of it and it can lead to serious complications, like amputation.

Question 3

List the MET criteria for diabetes training. (3)

Answer 3

• They must have medical clearance from their physician
• ability to self-monitor blood glucose -acceptable blood pressure values
• blood glucose values between 90-240 mg/dl.

Question 4

List the MET precautions for diabetes. (6)

Answer 4

• They need a long warm up
• use the RPE scale to rate exertion
• check feet periodically for blisters
• check blood glucose before exercise-avoid values below 100mg/dl
• don’t exercises during peak insulin
• don’t exercise the injection sites.

Question 5

List the MET guidelines for diabetes. (5)

Answer 5

• Begin each session with a blood glucose check (100-240)
• have a snack or juice available
• engage large muscle groups
• keep it long duration and low intensity
• type I 5-7days per week for 20-30min, type II-4-5 days per week for 40-60 minutes, 50-60% Vo2 Max

Question 6

What are some of the major complications caused by diabetes?

Answer 6

• stroke
• kidney dysfunction
• cardiovascular disease
• neuropathy
• amputation

Question 7

Why is exercise effective for the treatment of diabetes?

Answer 7

Because exercise has an insulin like effect on the body

Question 8

Describe essential and secondary hypertension

Answer 8

• Essential has an unknown cause, meaning it’s not a medical condition that you treat, but the symptoms themselves. A common essential cause is high stress levels.
• Secondary hypertension, the hypertension is caused by another medical condition, like pregnancy. In that case, treating the medical condition will improve the hypertension.

Question 9

List the four common types of hypertension medications.

Answer 9

• diuretics
• beta blockers
• calcium channel blockers
• ACE inhibitors

Question 10

List the MET criteria for hypertension training (4)

Answer 10

• Medical clearance from physician
• blood pressure of 160/100 or less (unless you have something in writing from doctor)
• no unstable angina or arrhythmias
• they are medically managed

Question 11

List the MET precautions for hypertension (5)

Answer 11

• Long warm up
• use RPE scale
• check blood pressure before each session (160/100 or less for cardio, 180/105 for circuit training)
• establish safe blood pressure levels via communication with physician
• terminate session is BP exceeds 220/110
• terminate session if there is a greater than 20 point drop in systolic blood pressure

Question 12

List the MET guidelines for hypertension (2)

Answer 12

• Begin each session with blood pressure check (less than 160/100)
• low intensity/long duration (40-65% intensity, 4-5x/week, 30-60 min), for circuit training keep it 30-50 1RM (BP 180/105), 10-15 reps, 30-45 sec sets with 60s rest, 10-12 exercises max, and use RPE scale

Question 13

List acceptable blood pressure guidelines for cardiovascular and resistance training.

Answer 13

Cardio-160-100

Resistance-180/105

Question 14

What happens in congestive heart failure?

Answer 14

Long time hypertension causes the heart to work overtime, and essentially wears it out. This causes the left ventricle wall to become weak and is unable to effectively pump blood throughout the body. The blood will then pool in the ankles causing pitting edema.

Question 15

Describe the pathology associated with the cerebrovascular accident and what are the two types of stroke.

Answer 15

It is damage to neural tissue caused by loss of blood supply.
-Hemmorrhagic-where blood leaks into the brain tissue and the tissue then dies as a result. This is commonly associated with hypertension.

-Ischemic-where a blood clot stops the blood supply to an area of brain tissue and the tissue dies as a result. This is commonly associated with diabetes.

Question 16

Indicate the common location of the CVA

Answer 16

Middle cerebral artery

Question 17

Describe the differences in the terms “contralateral” and “ipsilateral”.

Answer 17

Contralateral is opposite side, ipsilateral is same side.

Question 18

Define the term “hemiparesis”.

Answer 18

weakness of an entire side of the body

Question 19

Define the term “hemiplegia”.

Answer 19

paralysis of an entire side of the body

Question 20

List the MET criteria for the CVA client. (4)

Answer 20

• Medical clearance
• Alert & oriented x3 (who, where, time)
• Independent with sitting and standing balance
• Hypertension and diabetes are medically managed

Question 21

Describe the pathology associated with multiple sclerosis

Answer 21

MS is a slow progressive disorder common in young adults, which causes the myelin sheath to degenerate in the white matter of the brain and spinal cord.

Question 22

List the symptoms commonly seen with multiple sclerosis

Answer 22

Loss of neurological control (bowel/bladder, motor control, vision deficits, GI dysfunction, weakness, gait dysfunction, balance dysfunction), difficulty in temperature regulation, and pain.

Question 23

List the MET criteria for the MS client. (2)

Answer 23

• Medical clearance

- Independent with ambulation

Question 24

List the MET precautions for the MS client (5)

Answer 24

• Assess gait & balance and use gait belt
• Avoid training in extreme humidity, heat, and cold
• Allow for frequent rests
• Strictly control sets/reps/rest
• Give two days off btw sessions

Question 25

Describe the pathology and symptoms associated with Parkinson’s disease.

Answer 25

It is a reduction in dopamine produced by the basal ganglia in the brain. Tremors, shuffling gait, speech impairment, bradykinesia (slow movement), and balance dysfunction .

Question 26

List the MET criteria for the Parkinson’s client. (4)

Answer 26

• Medical clearance
• Stand and ambulate with minimal assistance
• Alert & oriented x 3
• Family support

Question 27

List the MET precautions for the Parkinson’s client.

Answer 27

• Provide standby assistance with ambulation and standing
• Check mental status each session
• Break all tasks into small segments
• Do not try to push through spasticity or rigidity

Question 28

Explain the importance of dopamine and the substantia nigra in Parkinson’s.

Answer 28

Dopamine prevents unwanted movement.

Question 29

Explain the importance of using a gait belt with the CVA, MS and/or Parkinson’s client

Answer 29

As they suffer from neurological problems, a gait belt can keep them safe from falling during a session.

Question 30

Describe the layers found in articular cartilage

Answer 30

Superficial
Middle
Deep
Calcified zone

Question 31

Describe the differences in osteoarthritis (OA) and rheumatoid arthritis (RA)

Answer 31

• Osteoarthritis is a degenerative process that occurs with a breakdown of articular cartilage. This can occur simple by wear and tear of a joint and aging, as well as injury to a specific area. Common in larger joints and is not always symmetrical.
• Rheumatoid arthritis is an auto-immune disease where the body is attacking itself. This occurs in all connective tissue and is usually symmetrical, affecting both sides of the body. It is also more common in smaller joints of the body, and affects all areas of the body including organs.

Question 32

List the exercise precautions for the osteoarthritis client. (5)

Answer 32

• Avoid high impact/compression
• Avoid painful points of ROM
• Avoid stretching to ROM extremes
• Do not exercise painful or swollen joints
• Measure painful response two hours after exercise and next day

Question 33

Identify the common body regions affected by RA

Answer 33

Wrists, hands, elbows, shoulders, knees, and ankles

Question 34

List the connective tissue structures affected by rheumatoid arthritis

Answer 34

1. ligaments
   
   2. synovial membrane/joint capsule
   3. fat tissue
   4. tendons
   5. Bone
   6. blood vessels
   7. cartilage
   8. disc

Question 35

Describe the pathology associated with osteoporosis.

Answer 35

• Greater loss of bone than production
• Usually post-menopausal women
• Trabecular bone is primarily effected
• Fractures are a major complication (femur, wrist, thoracic spine)
• Also seen in males over 70 (more compact bone)

Question 36

List the MET criteria for osteoporosis. (4)

Answer 36

• Medical clearance
• Independent ambulation
• No bed/pressure sores (if dementia)
• Alert & oriented x 3 (if dementia)

Question 37

List the MET precautions for osteoporosis. (3)

Answer 37

• Avoid high impact and excessive truck flexion and rotation
• avoid painful activities
• no exercise in the period immediately following vertebral fracture

Question 38

Describe the pathology associated with fibromyalgia.

Answer 38

-It is a change in the muscle fibers, mostly type II. These changes result in atrophy, contraction time, and reduces mitochondria levels. This causes a loss of dynamic joint stability and constant pain

Question 39

List the MET criteria for fibromyalgia. (4)

Answer 39

• medical clearance
• Full active ROM of all joints
• independent with all personal ADLs
• Psychological counseling if needed

Question 40

List the MET precautions for fibromyalgia.

Answer 40

-avoid high or mod intensity exercise-do not exceed 30-40% maximal capacity