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Lifestyle Medicine > Physical Activity > Flashcards

Physical Activity Flashcards

1
Q

What are the benefits of aerobic exercise?

A

1.Increases bone mineral density
2. Decreases percent body fat
3. increases muscle strength (minimally)
4. decrease in insulin response to glucose challenge
5.increases insulin sensitivity
6. small increase in HDL
7. minimal decrease in LDL
8.moderate decrease in triglycerides
9. decreases resting heart rate
10. increases SV and CO
11.Increases VO2 max

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2
Q

Benefits of resistance training

A
  1. moderate increase in mineral bone density
    2.moderate increase in lean body mass
  2. large increase in muscle strength
  3. decreases insulin response to glucose challenge
  4. increase in insulin sensitivity
  5. minimal decrease in LDL and triglycerides
  6. low increase in HDL
  7. moderate increase in endurance time
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3
Q

definition of getting adequate physical activity

A

getting 150 minutes of moderate to vigorous physical activity a week

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3
Q

How do balance exercises effects falls in the eldery?

A

37% decrease in injury from falls
30% decrease in injuries resulting in medical care
43% decrease in severe injury falls
61% decrease in falls results in fracutres

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4
Q

What is the definition of sedentary behavior?

A

any behavior characterized by low energy expenditure < or equal to 1.5 METs while in a seated, reclined or lying position

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5
Q

What did the Nurse’s study find in-regards to physical activity and all cause mortality?

A

The nurses study found that there is a significant decrease in all cause mortality in those who got 1-1.9 hours of MVP/ week. Did not see a huge benefit >7 hours per week

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5
Q

definition of insufficiently physically active

A

getting between 0-149 minutes of physical activity/week

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6
Q

Definition of exerkines

A

signaling molecules that are released in response to acute and/or chronic exercise that exert their effects on endocrine, paracrine and autocrine pathways.

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7
Q

Effects of exerkines on the cardiovascular system

A

enhance vascularization and angiogenesis.

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8
Q

Effects of exerkines on adipose tissue

A

increase fatty acid uptake
enhance lipolysis, thermogenesis and glucose metabolism

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9
Q

effects of exerkines on the liver

A

improve liver glucose metabolism and fatty acid uptake

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10
Q

Effects of exerkines on skeletal muscle

A
  1. enhance muscle formation, repair and maintenance.
  2. improve glucose uptake, lipid oxidation, mitochondrial biogenesis and muscle capillarization
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11
Q

Effects of exerkines on the brain

A

Acute exercise increases brain-derived neurotrophic factor (BDNF), which is involved in plastic changes related to learning and memory. BDNF trophic factor is associated with cognitive improvement and the alleviation of depression and anxiety.

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12
Q

Exerkines on the immune system

A

decrease inflammatory markers

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13
Q

Recommendations for physical activity in those who are >65yo

A
  1. try to follow physical activity guidelines for adults as much as possible.
  2. focus on balance, stretching and flexibility 3 days week
  3. Overweight older adults should focus on exercise and losing weight–> combined is better than focusing on one alone
  4. muscle quality is more important than muscle mass
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14
Q

Goal of physical activity in pregnant women

A

aim for 150 MPV/week if healthy uncomplicated pregnancy

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15
Q

Benefits of exercise in pregnancy

A
  1. prevent excessive weight gain
  2. prevent gestational diabetes
  3. decrease risk of gestational hypertensive disorders
  4. prevent depression
  5. decrease risk of surgical delivery
  6. decrease risk of low birth weight and preterm birth
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16
Q

How does physical activity effect ischemic heart disease?

A
  1. moderate intensity physical activity reduces the risk of primary CAD in men and women by about 20-30%
  2. RR of ischemic heart disease is decreased dramatically as patients moved from sedentary to burning 550kcal/wk during leisure time activity
  3. Patients with coronary heart disease, heart failure, stroke, and peripheral vascular disease who become physically active have fewer complications and lower mortality rates than predicted.
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17
Q

How does physical activity help with prevention of type 2 diabetes?

A
  1. 150 min/wk is sufficient to reduce the risk of type 2 DM
  2. physical activity advice is associated with lower a1c ONLY if combined with dietary advice
  3. Structured aerobic exercise, resistance training, and a combination of the two were associated with decreased HbA1c and with greater regression of HbA1c if exercise training exceeded 150 minutes per week.
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18
Q

What are the American College of Sports Medicine recommendations for physical activity for weight maintenance?

A

> 250minutes of moderate intensity/wk or
60-90 minutes/ day of moderate intensity
include strength training 2x/wk

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19
Q

Explain the dose response relationship between physical activity levels and magnitude of weight loss

A

the dose of exercise prescribed for weight-loss changes the effectiveness
<150 minutes/ wk promotes minimal weight loss
>150 minutes/ wk promotes modest weight lost 2-3kg
>225-420 minutes/week 5-7kg weight loss
diet is needed for weight-loss and physical activity is needed to maintain weight loss

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20
Q

What are the aerobic physical activity guidelines for kids 3-5yo?

A

These ages should be physically active throughout day to promote growth and development.

Adults should assist children in physical activity by encouraging a variety of “active play” activities.

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21
Q

What are the aerobic physical activity guidelines for kids 6-17yo?

A
  1. These ages should get 60 minutes or more per day of physical activity of moderate to vigorous intensity.
  2. Include vigorous intensity activity on at least 3 days a week.
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22
Q

What are aerobic physical activity guidelines for adults 18-64 yo?

A

150 minutes (2.5 hours) of moderate intensity exercise per week or 75 minutes (1.25 hours) of vigorous intensity exercise per week, or a combination of both, is recommended.

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23
Q

Definition of dynamic stretching

A

gradual transition from one body position to another with a progressive increase in reach and range of motion as a movement is repeated
Dynamic stretching is most appropriate pre-exercise.

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24
Q

Definition of static stretching

A
  1. most appropriate post exercise
  2. slowly stretching a muscle or tendon unit and holding it
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25
Q

What is ballistic stretching?

A

repeated bouncing movements
Contraindicated in non- athletes populations due to high injury rate.

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26
Q

what is the best indicator of perceived exertion

A

breaths per minute

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27
Q

What is the definition of heart rate reserve?

A

HRR= maximal heart rate- resting heart rate
target heart rate for exercise is 40-85% of HRR

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28
Q

Definition of light, moderate and vigorous intensity based on maximal heart rate percentage.

A

light intensity is <63% of max HR
moderate intensity is 64-76% of max HR
vigorous intensity is >77% of max HR

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29
Q

Definition of low, moderate and vigorous intensity in METS

A

<3 METs is low intensity
>4-6 METs is moderate intensity
>6 METs is vigorous intensity

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30
Q

If a patient currently participates in regular exercise when do they need pre participation screening?

A
  1. asymptomatic- no screening needed
  2. asymptomatic with known cardiac, metabolic or renal disease–> do no need clearance for a slow progressive program, if they become symptomatic they need clearance
  3. symptomatic patients regardless of disease state
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31
Q

Step testing for assessing cardiorespiratory fitness

A
  1. validated
  2. best for individuals who are not fit
  3. 12 inch step, metronome, stopwatch
  4. pt steps up and down for 3 minutes to the beat of the metronome. then rests for 1 minute. Then the heart rate is calculated and compared to age related norms
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32
Q

Rockport walk test for assessing cardiorespiratory fitness

A
  1. pts complete a 1 mile walking course as fast as possible, then record the pulse. VO2 max is then calculated.
    actual VO max is within 0.33 L/min (±4.4 mL × kg × in) of the 2 Rockport walk test’s predicted VO max.
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33
Q

cooper 12 minute walk test-for assessing cardiorespiratory fitness

A

pts cover their max distance in 12 minutes.
Use the following equation to determine VO max: (35.97 × ± miles) – 11.29

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34
Q

What is the Fitness registry and the importance of exercise national database (FRIEND)

A

national database of reference ranges for maximal oxygen consumption per decade for men and women (20–79 years old) during treadmill testing. Having these references on hand can be helpful in counseling patients about their fitness level.

35
Q

How do we measure muscular strength?

A

can be difficult to measure in clinic unless there are weights available.
strength typically correlates to few (<3) reps of a movement before reaching muscular fatigue
one rep max is a good indicator of muscular strength

36
Q

How do we measure muscular endurance?

A

testing endurance helps assess the ability of someone to perform ADLs.

Measured as the maximum number of correctly performed repetitions of squats, push-ups, or sit-ups without rest. This number can be compared to established norms based on age and sex.

37
Q

measuring flexibility

A
  1. sit and reach test measures flexibility in hamstrings and lower back.
  2. highly consistent but moderately accurate
  3. poor accuracy for low back flexibility
  4. not accurate for ppl with lbp
  5. the higher the score the better the hamstring/lbp flexibility.
  6. box is placed 38 cm/15in
    preform the test 3 times and then average the results
38
Q

3 ways to measure Body composition

A
  1. skin fold thickness
  2. densitometry (gold standard)
  3. Bioelectrical impedance analysis (BIA)
39
Q

What is normal body fat percentages associated with optimal health for men and women?

A

men 10-22%
women 20-32%

40
Q

How do measure muscular power?

A

athletes- vertical jump, max height
overhead medicine throw (low eight medicine ball <10lbs overhead for max distance.

older adults- 8 ft up and go test

41
Q

Based on recommendations from ACSM which 2 groups of ppl should receive medical screening prior to starting an exercise program?

A
  1. those with clinically significant diseases
  2. those with uncontrolled medical conditions that require treatment or control prior to starting exercise
42
Q

pre-participation screening for patients who do not currently exercise

A

asymptomatic with no known cardiac, renal or metabolic disease do not need screening.

patients with known cardiac, renal or metabolic disease should have screening

symptomatic need screening regardless of disease state

43
Q

American college of cardiology recommendations for exercise testing

A

recommends testing ppl who are at risk of cardiovascular disease before they start a moderate to vigorous exercise program even though they know their is not good evidence

44
Q

Definition of physical activity

A

any movement of the body done through skeletal muscle contraction that causes energy expenditure to be beyond its baseline

45
Q

Definition of physical inactivity

A

the absence of physical activity. the amount or proportion of time not spent in physical activity

46
Q

exercise

A

purposeful physical activity that is organized, planned and reoccurring that is done with the intent of improving or maintaining one or more components of health

47
Q

sedentary behavior

A

a distinct class of behaviors characterized by little physical movement or energy expenditure in a sitting or reclining position.

48
Q

fitness

A

the ability to perform the activities of daily living, respond to emergencies, and enjoy leisure time activities with sufficient energy and vitality without excessive fatigue.
Can be subdivided into health related fitness and skill related fitness.

49
Q

Definition of skilled related fitness

A

the components of physical activity related to movements necessary to demonstrate a variety of motor skills and movement patterns. (agility, coordination, balance, power, reaction time and speed)

50
Q

Health-related fitness

A

a component of physical fitness that emphasizes the ability to perform ADLs with vigor, with a focus on assessment of body composition, cardiorespiratory endurance, muscular strength, muscular endurance, and flexibility. associated with lower prevalence of chronic disease and health conditions

51
Q

Definition of deconditioning

A

a state of health that occurs from consistent physical inactivity and lack of exercise in daily life that results in functional loss
common cause preventable cause of morbidity and mortality

52
Q

non-exercise activity thermogenesis (NEAT)

A

the energy expended by all daily activities, excluding purposeful exercise, sleeping or eating.

53
Q

progressive overload

A

gradually increasing weight, frequency, or number of repetitions in routine to challenge the MSK system to adapt to challenging stimuli.

54
Q

Define MET

A

Metabolic Equivalent of a Task
-the ratio of metabolic rate during a task compared to the standard resting metabolic rate.
-Standard resting metabolic rate is the metabolic rate during quiet rest/sitting approximately 3.5ml of 02/kg of body weight/ minute

55
Q

Moderate intensity in METs

A

3-5.9 METs

56
Q

Vigorous intensity in METs

A

> 6 METs

57
Q

FITT exercise prescription format

A

Frequency- how often during the week
Intensity- how hard the individual is working
Time- duration of each training
Type- type of training mode

58
Q

FITT-VP

A

Frequency
Intensity
Time
Type
Volume- total amount of training load per week or month
Progression- advancement and increase in exercise stimulus over time

59
Q

What are the 3 stages of exercise progression for ACSM

A

Initial stage (1-6wk)
Improvement stage (4- 8 months)
Maintenance stage (Indefinitely)

60
Q

Initial stage of exercise progression

A
  1. the first 1-6 weeks
  2. designed to minimize muscle soreness, discomfort, and injury and to prepare individuals for exercise at the next stage
    I- moderate intensity (40-60% of HRR)
    D- starts at 15 minutes and progresses to 30minutes
    F- 3-4 times per week.
61
Q

Improvement stage

A
  1. 4-8 months
  2. dependent upon the individual and changes with fitness level.
  3. Intensity is usually increased after target duration and frequency have been achieved
    can be measured in multiple ways
  4. Maximum heart rate during exercise should be increased by no more than 5% every 6th session
  5. Duration- Steadily increase at no more than 20% more each week until 20-30 minutes of continuous moderate to vigorous intensity is achieved.
62
Q

maintenance stage (indefinitely)

A

this is reached once the patient has reached their predetermined fitness goals.

63
Q

Muscle- strengthening activity components.

A

Frequency- # of exercise session per day per week
Intensity- the amount of resistance imposed on the contracting muscle
Repetitions- # of times a weight is lifted or a single cycle of moving against force
Sets- # of cycles of repetitions
Rest interval: time taken btwn sets
Exercise order- sequence that the exercises are performed in
Repetition tempo- speed/velocity at which each repetition is performed

64
Q

FITT guidelines for resistance training from ACSM

A

F: 2-3 nonconsecutive days each week
I: new: 40-50% of their one rep max
Intermediate: 60-80% 1-RM
Experienced 80% RM
lighter loads with shorter rest periods can improve endurance
T: no recommended duration
T: multiple exercises targeting multiple joints and major muscles, mix different equipment, target agonist and antagonist muscle groups
R: 8-12 reps, older adults 10-15 reps at lighter weight. want to improve endurance then shld focus on 10-15 reps
S: 2-4 SETS
R: 2-3 minutes btwn sets, 48 hours btwn sessions
P: gradual progression of resistance, repetition and frequency

65
Q

Strength training and resistance exercise guidelines for children 3-5 yo

A

no specific recommendations

66
Q

Strength training and resistance exercise guidelines for children 6-17yo

A

shld participate in muscle strengthening and bone strengthening activities that place force or impact on bones for at least 1 hour 3 days a week
ex: tag of war, jump rope, squat jumps, and climbing

67
Q

Strength training and resistance exercise guidelines for adults 18-64 yo

A
  1. 2-3x/wk on nonconsecutive days
    can do daily but then should not work the same muscle group 2 days in a row
    healthy adults 8-12 reps
  2. older adults one set of 10-15 reps
  3. resistance training: multi-joint or compound exercises over single joint exercises
  4. focus on core muscles
  5. exercises that promote resistance through agonist and antagonist muscle groups
68
Q

What were the results of the diabetes prevention program research group in-regards to exercise and pre-diabetes/diabetes?

A
  1. Had >3200 participants
  2. lifestyle medicine goal was 7% weight loss.
  3. used tracking food intake, body weight along with 150 minutes of physical activity per wk
  4. compared to placebo metformin decreased incidence of diabetes by 31%, lifestyle intervention reduced incidence by 58%
  5. NNP (number needed to prevent) one case of diabetes in 3 years for metformin was 13.9 for lifestyle it was 6.9 persons
69
Q

The Look AHEAD (action for health in diabetes) trial and their findings

A
  1. Largest RCT evaluating lifestyle intervention in older adults with type 2 diabetes compared with diabetes support and education
  2. target weight loss of at least 7% via modest dietary energy deficit and at least 175min/wk of unsupervised physical activity.
  3. the intensive lifestyle group maintained significantly more weight loss, as well significant improvement in cardiorespiratory fitness, blood glucose control, BP and lipid levels with fewer medications
70
Q

what are the effects of exercise on mortality outcomes based on the meta-epidemiological study of 16 meta-analysis?

A
  1. Compared exercise and drug interventions with each other or with control
  2. exercise offered similar mortality reduction benefits in the secondary prevention of CAD, rehabilitation of stroke, prevention of DM, but was less effective in treating heart failure.
71
Q

Exercise vs anticoagulants and antiplatelet therapy in patients with hx of stroke, their reduction in mortality

A

favors exercise.

72
Q

There was a 12 month RCT of 101 male patients what did it show when Exercise was compared with percutaneous coronary intervention (PCI) in stable CAD

A

1.exercise showed superior event-free survival
2. improved exercise capacity
3. lower cost
4. higher HDL levels

73
Q

How does aerobic, resistance and combined exercise programs mitigate CV risk factors in 8 weeks

A
  1. significant changes in:
    peripheral and central blood pressure
    upper and lower body strength
  2. increases in lean mass
  3. improved VO2 max
  4. reduced body weight
  5. reduced weight circumference
74
Q

What have we found with exercise and cancer?

A
  1. 2017 systematic review found that exercise interventions are beneficial before, during and after treatment for a wide range of cancers. MVP was the most efficacious.
  2. 18 wk supervised exercise intervention performed during treatment for breast and colon cancer found to significantly improve physical activity and fatigue compared to usual controls.
  3. higher levels of physical activity are associated with reduced risk of more than 26 types of cancer.
  4. 16 wk of combined aerobic and strength training improved quality of life, fatigue, depression symptoms, VO2 max, muscular strength, osteocalcin, and bone specific 2 alkaline phosphatase levels in overweight and obese cancer survivors.
75
Q

What are the benefits of aerobic exercise and aerobic combined with resistance exercise on post-stroke patients?

A

Helps to improve mobility and balance

76
Q

List the various healthcare providers that can assist patient care with behavioral change with physical activity

A
  1. PT
  2. OT
  3. clinical exercise physiologists.
  4. Coaches
  5. Certified personal trainers
  6. Cardiopulmonary rehabhilitation
77
Q

Exercise recommendations for patients with obesity

A
  1. focus on increasing energy expenditure with a goal of weight loss
  2. initial goal should be 150 min MVP/wk and work towards 250-300 min/wk to promote long-term weight-loss
  3. consider using aerobic activities that are not weight bearing. (swimming, biking, rowing)
  4. exercise should be combined with reduced energy intake (exercise)
78
Q

Exercise recommendations for patients with heart disease (HTN, CAD, CHF)

A

1.Important to maintain CV fitness to help prevent/ lessen the effects of heart failure
2. There is correlation btwn CV fitness and mortality with poor CV fitness corresponding to worsening CV outcomes
3. Patients on BB can have decrease exercise capacity
4. Patients on diuretics are at higher risk of dehydration, hypokalemia, and orthostatic hypotension after exercise.

79
Q

General exercise recommendations for patients with diabetes

A
  1. participation in aerobic exercise and sustained cardiorespiratory fitness has been one of the strongest independent predictors of mortality in patients with T2DM.
  2. Physical activity is recommended for patients to lose weight and maintain appropriate weight
  3. also want to encouraged patients to reduction total sedentary time and encouraged multiple bouts of activity which aid glycemic control
  4. require careful, frequent monitoring of blood glucose when starting physical activity
80
Q

American Diabetes Association exercise recommendations for patients with T1DM.

A
  1. All patients should be encouraged to exercise
  2. blood glucose responses to physical activity are highly variable
  3. carbohydrate intake and/or insulin reductions are typically required to maintain glycemic balance during and after physical activity
  4. frequent blood glucose checks are required
  5. can use either basal-bolus or insulin pump during exercise
  6. continuous glucose monitoring during physical activity can detect hypoglycemia during exercise.
81
Q

Blood glucose monitoring/levels during exercise

A
  1. 100-250mg/dL–> okay to exercise
  2. > 250 mg/dL–> if ketones present should postpone exercise
  3. > 350 mg/dL –> check for ketones, if present should postpone exercise
  4. <100 mg/dL eat a snack consisting easily absorbed carbs
82
Q

Exercise recommendations for patients with cancer

A
  1. aerobic and resistance exercise are most beneficial to improve health related quality of life in patients with cancer.
  2. exercise has been found to improve cancer related anxiety, depression, fatigue, physical functioning and health-related quality of life.
  3. exercise should be tailored to the patient’s individual cancer diagnosis
  4. need to consider bone health, cardiotoxicity, chemotherapy- induced peripheral neuropath, depression symptoms, fall risk, fatigue, lymphedema, nausea, sleep and treatment tolerance
83
Q

Exercise recommendations for patients with disability

A
  1. patients need to consult with their healthcare provider or see a physical activity specialist
  2. Consider starting under the supervision of PT, OT or clinical exercise physiologist
  3. emphasis should be on locomotion.
84
Q

Exercise recommendations or patients who had a stroke

A
  1. exercise after a stroke can maximize recovery, reduce disability
  2. exercise prescriptions after a stroke will need to be tailored to their individual deficits
  3. patient often receive 3-6 months of PT/OT after a stroke and focus on balance, mobility and recovering ADLs.
  4. Avoid valsalva maneuver with resistance training to avoid elevating BP
85
Q

Who should you continue cardiopulmonary rehabilitation in?

A

patients with heart attack in the last 12 months, CABG, current stable angina, heart valve repair or replacement, coronary angioplasty with or without stent, heart or lung transplant, stable CHF with reduced ejection fraction.

86
Q

If physical activity is used along as weight loss intervention what results can you expect?

A

improved diastolic pressure, triglycerides, and fasting glucose as well as lowered cardiovascular disease but usually little weight reduction

87
Q

If a patient does not currently participate in regular exercise when do they need pre participation screening?

A

If they are asymptomatic and do not have cardio, metabolic or renal disease they do not need screening for light to moderate exercise. If they have cardio, metabolic or renal disease or are symptomatic they need screening

Lifestyle Medicine (7 decks)

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