physical activity and physical fitness assessment

Question 1

define physical activity

Answer 1

Physical activity is defined as any bodily movement produced by skeletal muscles that results in energy expenditure.

Being physically fit is “the ability to carry out daily tasks with vigor and alertness, without undue fatigue and with ample energy to enjoy leisure-time pursuits and to meet unforeseen emergencies”

Exercise is a subcategory of physical activity. Exercise is physical activity that is planned, structured, repetitive, and purposive in the sense that improvement or maintenance of one or more components of physical fitness is an objective
Casperson

Question 2

sedentary behaviour

Answer 2

Sedentary behaviour is any waking behaviour characterized by an energy expenditure ≤1.5 metabolic equivalents (METs), while in a sitting, reclining or lying posture

Question 3

define MET

Answer 3

One MET isdefinedas 1 kcal/kg/hour and is roughly equivalent to the energy cost of sitting quietly. A MET also isdefinedas oxygen uptake in ml/kg/min with one MET equal to the oxygen cost of sitting quietly, equivalent to 3.5 ml/kg/min

Question 4

children and physical activity

Answer 4

Physical Activity
It is recommended that:
► Children and adolescents should do at least an average of 60min/day of moderate-to-vigorous intensity, mostly aerobic, physical activity, across the week;
► Vigorous-intensity aerobic activities, as well as those that strengthen muscle and bone should be incorporated at least 3 days a week.

Sedentary Behaviour
It is recommended that:
► Children and adolescents should limit the amount of time spent being sedentary, particularly the amount of recreational screen time.

Question 5

physical activity adults

Answer 5

It is recommended that:
► All adults should undertake regular physical activity;
► Adults should do at least 150–300 min of moderate-intensity aerobic physical activity, or at least 75–150min of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate-intensity and vigorous-intensity activity throughout the week for substantial health benefits;
► Adults should also do muscle-strengthening activities at moderate or greater intensity that involve all major muscle groups on 2 or more days a week, as these provide additional health benefits.
► Adults may increase moderate-intensity aerobic physical activity to >300min, or do >150min of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate-intensity and vigorous-intensity activity throughout the week for additional health benefits (when not contraindicated for those with chronic conditions).

It is recommended that:
► Adults should limit the amount of time spent being sedentary. Replacing sedentary time with physical activity of any intensity (including light intensity) provides health benefits;
► To help reduce the detrimental effects of high levels of sedentary behaviour on health, adults should aim to do more than the recommendded levels of moderate-tovigorous physical activity

Question 6

physical activity older adults

Answer 6

► As part of their weekly physical activity, older adults should do varied multicomponent physical activity that emphasises functional balance and strength training at moderate or greater intensity on 3 or more days a week, to enhance functional capacity and to prevent falls

► Adults should limit the amount of time spent being sedentary. Replacing sedentary time with physical activity of any intensity (including light intensity) provides health benefits;
► To help reduce the detrimental effects of high levels of sedentary behaviour on health, adults should aim to do more than the recommended levels of moderate-to vigorous physical activity.

Question 7

benefits of physical activity

Answer 7

Improved physical fitness (cardiorespiratory and muscular fitness), Improved cardiometabolic health (blood pressure, dyslipidaemia, glucose and insulin resistance),
Improved bone health,
Improved cognitive outcomes (academic performance, executive function) Improved mental health (reduced symptoms of depression) and
Reduced adiposity
Reduced allcause mortality,
Reduced cardiovascular disease mortality,
Reduced incident hypertension,
Reduced incident type 2 diabetes,
Reduced incident site-specific cancers
Improved sleep
Prevent falls and falls-related injuries in older adults
Prevents declines functional ability in older adults and those with chronic disease/disability

Question 8

sedentary behaviour

Answer 8

Reduced fitness
Reduced cardiometabolic health
Increased adiposity,
Reduced behavioural conduct/pro-social behaviour
Reduced sleep duration
Increased all-cause mortality,
Increased cardiovascular disease mortality
Increased cancer mortality
Increased incidence of cardiovascular disease,
Increased incidence of type 2 diabetes
Increased incidence of cancer

Question 9

assessment of physical activity

Answer 9

Self–report/subjective 
Modifiable Activity Questionnaire (MAQ) 
 Previous Week Modifiable
Activity Questionnaire (PWMAQ)
Recent Physical Activity Questionnaire (RPAQ)
International Physical Activity Questionnaires (IPAQ) 
Previous Day Physical
Activity Recall (PDPAR) 
7-day Physical Activity Recall (PAR)

objective 
direct observation 
pedometer 
HR monitor 
acclerometer

Question 10

self report bs objective measurements

Answer 10

Self–report/subjective
Cheap
Quick
Target large groups
People tend to over-estimate their physical activity
Depending on level of cognition/literacy may find it difficult to fully answer questionnaire

Objective:
More accurate
Expensive
Analysis can be time consuming
Compliance with wearing device: comfort/forgetfulness

Question 11

assessment of physical fitness

health related components

Answer 11

Components of physical fitness
Muscular strength and endurance*
Body composition*
Flexibility*
Cardiorespiratory fitness*
Balance
Coordination 
Reaction time
Power

Question 12

muscular strength

Answer 12

The subject should warm up by completing a number of submaximal repetitions of the specific exercise that will be used to determine the 1-RM.
Determine the 1-RM (or any multiple of 1-RM) within four trials with restperiods of 3–5 min between trials.
Select an initial weight that is within the subject’s perceived capacity(50%–70% of capacity).
Resistance is progressively increased by 5.0%–10.0% for upper body or 10.0%–20.0% until the lower body until the subject cannot complete the selected repetition(s); all repetitions should be performed at the same speed of movement and ROM to instill consistency between trials.
The final weight lifted successfully is recorded as the absolute 1-RM or multiple RM

Question 13

grip strength

Answer 13

Reduced grip strength, and therefore muscle strength, is linked to increased risk of death.

Question 14

body composition

Answer 14

DEXA scan (Gold standard)
Skinfold (callipers) (field method)
Bioelectrical impedance analysis (individual methods)
Hydrodensitometry (underwater) (individual methods

Question 15

CV fitness

Answer 15

V˙O2max is the accepted measurement of cardiorespiratory fitness

V˙O2max is expressed as ml.kg-1.min-1

VO2 = Q x (a-v O2 difference) [cardiac output X the amount ofO2 taken up from the blood by the tissues]

Can use maximal and submaximal graded exercise tests to determine V˙O2max

Specific protocols for graded exercise tests.

Question 16

Vo2 max testing

Answer 16

VO2 max is determined in a graded exercise test, where workload is incrementally increased

The designation of VO2max implies an individual’s true physiologic limit has been reached, and a plateau in VO2 may be observed between the final two work rates of a progressive exercise test.

This plateau is not consistently observed during maximal exercise testing and rarely observed in individuals with CVD or pulmonary disease. Peak VO2 (VO2peak) is used when leveling off, of O2 does not occur, or maximum performance appears limited by local muscular factors rather than central circulatory dynamics

Question 17

open circuit spirometry

Answer 17

Open circuit spirometry is used to measure VO2max during a graded incremental or ramp exercise test to exhaustion.
In this procedure, the subject breathes through a low-resistance valve with his or her nose occluded (or through mask) while pulmonary ventilation and expired O2 and CO2 are measured. In addition, the use of open circuit spirometry during maximal exercise testing may allow for the accurate assessment of an anaerobic/ventilatory threshold and direct measurement of VO2max/ VO2peak

Question 18

ventilatory and anaerobic threshold

Answer 18

Ventilatory threshold is the point where pulmonary ventilation increases disproportionately relative to increases in oxygen consumption during a graded exercise test.

The ventilator threshold indicates that bodies increased reliance on anaerobic metabolism.

Question 19

cardiopulmonary exercise test

Answer 19

CPET involves the measurement of respiratory gas exchange: oxygen uptake , carbon dioxide output, and minute ventilation, in addition to monitoring electrocardiography, blood pressure, pulse oximetry, typically during a symptom-limited maximal progressive exercise tolerance test
Indications for CPET
Evaluation of exercise tolerance
Evaluation of undiagnosed exercise intolerance
Evaluation of disease (CVD and respiratory)
Evaluate pre-operative
Evaluate for impairment and disability
Exercise prescription
Evaulation of treatment

Question 20

pre -op CPET

Answer 20

CPET provides a good objective measure of a patient’s preoperative fitness, which in turn is a strong predictor of postoperative outcome.

CPET has been well documented in certain surgical interventions (liver, AAA, pancreatic, and intra-abdominal), but it is less well defined in other areas (colorectal, renal transplant, upper GI, and bariatric).

Anaerobic threshold (AT) is a stronger predictor of outcome in hepatic, pancreatic, and intra-abdominal surgery (Moran et al. 2016)

An AT cut-off value 10–10.1 ml− 1 kg− 1 min is likely to be predictive of poor outcomes after pancreatic surgery, and AT cut off value of 9.9–11.5 ml− 1 kg− 1 min is likely to be predictive of post hepatic surgery complications (Dutton et al. 2021)

Question 21

pre test prep

Answer 21

Perform the informed consent process and allow time for the individual undergoing assessment to have all questions adequately addressed.
Perform exercise preparticipation health screening.
Complete a pre-exercise evaluation including a medical history and a CVD)risk factor assessment
A minimal recommendation is that individuals complete a self-guided questionnaire such as the PAR-Q+
Participants should be give the following instructions:
Refrain from ingesting food, alcohol, or caffeine or using tobacco products within 3 h of testing.
Avoid significant exertion or exercise on the day of the assessment.
Wear appropriate clothing
Drink ample fluids in the previous 24 hours

If the exercise test is for diagnostic purposes, it may be helpful for patients to discontinue prescribed cardiovascular medications but only with physician approval. Currently, prescribed antianginal agents alter the hemodynamic response to exercise and significantly reduce the sensitivity of ECG changes for ischemia. Patients taking intermediate- or high-dose β-blocking agents may be asked to taper their medication over a 2- to 4-d period to minimize hyperadrenergic withdrawal responses
If the exercise test is for functional or exercise prescription purposes, patients should continue their medication regimen on their usual schedule so that the exercise responses will be consistent with responses expected during exercise training
Bring list of medications and dosage with them

Question 22

CPET in test procedures

Answer 22

Heart rate
Blood pressue
12 Lead ECG
Subjective ratings (RPE)
Ventilatory expired gas analysis responses
Arterial Blood gases (radial artery catheter)

Question 23

test protocol

Answer 23

Bruce treadmill test is one of the most commonly used in CPET
Bruce or Ellestad is better suited for screening younger and/or physically active individuals (larger progressive workload)
Naughton or Balke-Ware is preferable for older or deconditioned individuals and patients with chronic diseases. (smaller progressive workload)

Question 24

RER

Lactate

Answer 24

RER: respiratory exchange ratio: Ratio between the amount of CO2 produced in metabolism andO2 used. When > 1.00 should happen at anaerobic threshold.
Lactate: measure of the accumulation of lactate in the blood. The lactate threshold happens at the anaerobic threshold. (point at which lactate accumulation exceeds clearance)

Question 25

termination of test

Answer 25

Onset of angina or angina-like symptoms
Drop in SBP of ≥10 mm Hg with an increase in work rate or if SBP decreases below the value obtained in the same position prior to testing
Excessive rise in BP: systolic pressure >250 mm Hg and/or diastolic pressure >115 mm Hg
Shortness of breath, wheezing, leg cramps, or claudication
Signs of poor perfusion: light-headedness, confusion, ataxia, pallor, cyanosis, nausea, or cold and clammy skin
Failure of HR to increase with increased exercise intensity
Noticeable change in heart rhythm by palpation or auscultation
Subject requests to stop
Physical or verbal manifestations of severe fatigue
Failure of the testing equipment
Or if maximal effort is achieved

Question 26

patient effort is maximal if

Answer 26

The patient achieves predicted peak oxygen uptake and/or a plateau is observed
Predicted maximal heart rate is achieved.
Patient exhaustion

Question 27

post test

Answer 27

An appropriate cool-down/recovery period should be initiated consisting of either a. Continued exercise at a work rate equivalent to that of the first stage of the exercise test protocol or lower or b. A passive cool-down if the subject experiences signs of discomfort or an emergency situation occurs
All physiologic observations (e.g., HR, BP, signs, and symptoms) should be continued for at least 5 min of recovery unless abnormal responses occur, which would warrant a longer post test surveillance period. Continue low-level exercise until HR and BP stabilize but not necessarily until they reach pre-exercise levels.

Question 28

interpretation

Answer 28

Blood Pressure
The normal systolic blood pressure (SBP) response to exercise is to increase with increasing workloads
Hypertensive response: An SBP >250 mm Hg is a relative indication to stop a test. An SBP ≥210 mm Hg in men and ≥190 mm Hg in women during exercise is considered an exaggerated response. A peak SBP >250 mm Hg or an increase in SBP >140 mm Hg during exercise above the pre-test resting value is predictive of future resting hypertension.
Hypotensive response: A decrease of SBP below the pre-test resting value by >10 mm Hg after a preliminary increase, particularly in the presence of other indices of ischemia, is abnormal and often associated with myocardial ischemia, left ventricular dysfunction, and an increased risk of subsequent cardiac events
Postexercise response: SBP typically returns to pre-exercise levels or lower by 6 min of recovery
A peak DBP >90 mm Hg or an increase in DBP >10 mm Hg during exercise above the pretest resting value is considered an abnormal response and may occur with exertional ischemia. A DBP >115 mm Hg is an exaggerated response and a relative indication to stop a test

HRThe normal HR response to incremental exercise is to increase with increasing workloads.
A failure of the HR to decrease by at least 12 beats during the first minute or 22 beats by the end of the second minute of active post exercise recovery is strongly associated with an increased risk of mortality in patients diagnosed with or at increased risk for IHD

Question 29

maximal vs sub maximal test

Answer 29

The decision to use a maximal or submaximal exercise test depends largely on the reasons for the test, risk level of the client, and availability of appropriate equipment and personnel

Maximal tests require participants to exercise to the point of volitional fatigue, which may be inappropriate for some individuals and may require the need for emergency equipment

Question 30

submaximal test

Answer 30

Exercise professionals often rely on submaximal exercise tests to assess CRF because maximal exercise testing is not always feasible in the health/fitness setting.
The basic aim of submaximal exercise testing is to determine the HR response to one or more submaximal work rates and use the results to predict VO2max . Although the primary purpose of the test has traditionally been to predict VO2max from the HR workload relationship, it is important to obtain additional indices of the client’s response to exercise.
The exercise professional should use the various submaximal measures of HR, BP, RPE or Borg scale and other subjective indices as valuable information regarding one’s functional response to exercise.
The most accurate estimate of VO2max is achieved from the HR response to submaximal exercise tests if all of the following assumptions are achieved: A steady state HR is obtained for each exercise work rate. A linear relationship exists between HR and work rate. The difference between actual and predicted maximal HR is minimal. The subject is not on any medications that may alter the HR response to exercise . The subject is not using high quantities of caffeine, ill, or in a high-temperature environment, all of which may alter the HR response

Question 31

summary

Answer 31

Physical activity, physical fitness, exercise and sedentary are different entities by definition
There a number of different methods of assessing physical activity; time, patient, training, population, purpose and access to resources will dictate the method used.
Muscle strength, muscle endurance, flexibility, body composition and cardiorespiratory fitness are measures of health related physical a fitness (CRF).
Direct VO2 max testing is the gold standard for measuring CRF.
A variety of maximal and submaximal exercise tests can be used as measures of CRF: time, patient population, purpose and access to resources will dictate the method used.
There are specific pre test procedures to be followed (including participant instruction) prior to test and participants should be evaluated correctly for any contraindications.
Patients should be monitored appropriately during and after the test.
VO2 max results gives us an indication of patients CRF and functional capacity.