Quiz 1 Flashcards
Physical Activity is important for…
prevention and treatment of many chronic diseases, health conditions, and associate risk factors with these
What is PA?
Any bodily movement produced by contraction of skeletal muscles that results in increased caloric requirement above resting energy expenditure
What is exercise?
A type of PA- planned, structured, and REPETITIVE bodily movement to improve and/or maintain greater than or equal to 1 component of physical fitness
Physical Fitness
a set a of attributes/ characteristics individuals have or achieve - related to ability to perform PA and activities of daily living (ADLs) - split into health and skill
Physical Fitness Components - Health Related
- Cardiorespiratory endurance (ability of cardio and respiratory to supply O2 during sustained PA
- Body composition (relative amounts of muscle, fat, bone, and other vital body parts)
- Muscular strength (ability of muscle to exert force- move skeleton)
- Muscular endurance (ability of muscle to repeatedly exert force against resistance)
- Flexibility (range of motion available at any joint
Physical Fitness Components- Skill Related
- Agility (ability to change to position of body in space with speed and accuracy)
- Coordination (ability to use senses - sight/ hearing- together with body parts in performing tasks - multitasking)
- Balance (maintenance of equilibrium while standing or moving smoothly and accurately)
- Power (ability of rate at which one can perform work)
- Reaction time (time elapsed between when stimulation and beginning of rxn to it)
-Speed (ability to perform a movement within a short period of time)
Ways to identify/ prescribe exercise intensity?
- VO2R- percentage of O2 uptake reserve
- HRR- heart rate reserve
- VO2- ml O2/min volume of O2 consumed
- HR- heart rate
- MET- metabolic equivalent (behaviors/actions)
METs
1MET= 3.5ml O2/min
light = 1.6-2.9 METS
Moderate = 3.0-5.9 METS
Vigorous = greater than or equal to 6.0 METS
Compendium of Physical Activities
Shows METS for all sports, activities of daily living (ADLs), and occupatins
Across the lifespan
1st half: characterized by rapid growth and development
2nd half: gradual loss & deterioration
Rate of change varies between individuals depending on genetics & lifestyle choices
With age…
decline in maximal aerobic capacity; when older and younger work at a similar MET level… older will be working at a greater relative % of VO2 max than the younger
ACSM, CDC, US Surgeon General, NIH published PA & health recommendations to…
Clarify amount & intensity of PA needed to improve health, lower susceptibility to disease, and decrease premature death (increase PA = decrease health risks up to a point)
1995 guidelines
adults should do 30 minutes or more of moderate (3.0-5.9 METS) PA on most days of the week
1996 guidelines
there was an emphasis on health benefits with regular PA
2007 guidelines
adults (18-65) should do moderate intensity aerobic PA for at least 30 min 5 days/week OR vigorous intensity aerobic PA for at least 20 min 3 days/week (combination of two can happen to meet recommendation)
Bouts last at least 10 min
Perform activities to maintain/ increase muscular strength & endurance at least 2 days/week
2008 government adaptation of guidelines
- benefits to health obtained if perfroming moderate amount of PA on most if not all days of week
- greater amounts of PA= more benefit (program of long duration and/or increased intensity = better results than those with less amounts)
2018 update (in addition)
- For inactive, PA of any intensity provides health benefits
- Health benefits- can be seen with a single bout of moderate to vigorous PA (MVPA)
- any bout of MVPA- regardless of duration can be included to meet recommendation
- <10 min is also ok- previous statement that it must be more than 10 min deleted
Guidelines NOW
- move more than sit, some activity better than none- any amount of MVPA
- For substantial benefits: greater than or equal to 150 min/week to 300 min/week of moderate PA OR greater than or equal to 75 min/ week to 150 min/week of vigorous AEROBIC
- additional health benefits with greater than 300 min/week of moderate PA
- muscular strength activities of greater than or equal to moderate intensity and involving all major muscle groups at least 2 days/week
Note for PA
Sufficient PA reduces risk of chronic disease and mortality but does not necessarily reverse weight gain - need to diet too
PA studies show
increase PA= decrease cardiovascular disease (CVD) incidence and mortality rate due to CVD
greater levels of PA or cardiorespiratory fitness (CRF) provide additional health benefits
Sedentary behavior and health
- people who are inactive
- 1 of 4 contributors to mortality
- role of sedentary behavior in disease risk and progression has increased and is a prominent public health concern
- sedentary behavior= less than or equal to 1.5 MET (sitting, lying down, reclining, watching TV)
How to combat cultural/global lack of PA?
With MOVEMENT! Sedentary behavior is associated with cardiometabolic risk
Sedentary behavior studies
Used waist-worn activity monitors
- people reported 4.7 hr/day of sedentary behavior
- activity monitors recorded 7.7-8 hr/day
Risks of Sedentary Behavior
Short-term:
- glucose & insulin control
- lipid metabolism
- vascular function
Long- term:
- risk of diabetes
- risk of heart disease
- risk of cancer
- risk of mortality
- risk of CVD
Benefits of PA and Exercise
Inverse relationship between PA/ exercise and: premature mortality, CVD, CAD, hypertension, stroke, osteoporosis, type 2 diabetes mellitus, metabolic syndrome, obesity, 13 cancers, depression, function health, risks of falls, cognitive function
More Benefits
- aerobic capacity (CRF) has inverse relationship with negative health outcomes
- increased PA levels associated with increased CRF and associated health benefits
With increased PA there is improvement in cardiovascular and respiratory function:
- increase maximal O2 uptake with both central and peripheral adaptations
- decrease ventilation at a given absolute submaximal intensity
- decrease myocardial O2 cost
- increase capillary density in skeletal muscle
- increase exercise threshold for accumulation of blood lactate (aerobic and anaerobic threshold)
- increase threshold of onset of disease sings or symptoms
With increased PA there is reduction in cardiovascular disease risk factors
- decrease systolic/diastolic pressure
- increase serum high-density lipoprotein cholesterol and decrease serum triglycerides
- decrease total body fat and intraabdominal fat
- decrease insulin needs-improved glucose tolerance
- decrease blood platelet adhesiveness and aggregation
- decrease inflammation
To decrease morbidity & mortality
- Initial prevention ( high activity/ fitness to lower CVD, CAD, stroke, diabetes, etc incidents)
-secondary prevention - preventing a second cardiac event (cardiac rehabilitation)
Other benefits
- decrease anxiety and depressin
- improved cognitive function
- enhanced physical function and independent living in older people
- enhanced feelings of well being
- enhanced quality of life
- improved sleep quality/ efficiency
- enhanced performance of work/ recreational/ sport activities
Higher levels of muscular strength are associated with:
- better cardiometabolic risk profiles
-lower risk of mortality (all cause) - fewer CVD events
- lower risk to develop physical function limitations
- lower risk of non-fatal diseases
- improvements in body composition, blood glucose levels, insulin sensitivity, and BP
to improve muscular fitness: Resistance training (RT) is as effective as aerobic training in management of:
- type 2 diabetes
- improve blood lipid profile of those overweight/obese
- increases walking distance and velocity for patients with peripheral artery disease
- increases bone mass and bone strength and muscle strength and mass
RT…
- reduces pain and disability (osteoporosis)
- effective treatment of chronic back pain
- increase vigor
- reduce fatigue
Risks
- musculoskeletal injury (MSI)- from exercise intensity, nature of activity, preexisting condition, musculoskeletal anomalies
- cardiovascular complication- SCD (sudden cardiovascular death) or acute myocardial infarction (AMI/ heart attack) due to vigorous intensity exercise
Musculoskeletal injury (MSI)
- walking/moderate PA = low risk
- jog/run/competitive sports = higher risk
common places = lower extremities
increase PA = increase risk of MSI
Reduce risk = stretch, warmup, cool down, gradual intensity/ volume progression
Cardiorespiratory fitness (CRF)
strong predictor of CVD mortality and morbidity
Dose-relationship between CRF and CVD morbidity, metabolic syndrome, and mediating biomarkers of CVD
Low PA and high sedentary time =
higher risk of all-cause mortality, CVD, hypertension, obesity, type 2 diabetes mellitus, metabolic syndrome, and increased waist size
Cardiac arrest vs heart attack
cardiac arrest = electrical problem
heart attack = circulation problem
Primary mechanism of cardiac arrests and SCDs for runners
- atherosclerosis (narrowing/clogging of arteries)
increase O2 demand = increased blood flow
can cause SCD if O2 demand increases and heart is not fit to handle it
Secondary mechanism of cardiac arrests and SCDs for runners
tissuing of plaque… geometric/ hemodynamic changes (changes if there’s a block) of epicardial arteries and thrombotic response to vigorous exercise
eschemia = lack of BF and O2
Cardiac events (AMI, ventricular fibrillation, hospitalization, death) with exercise testing
risk is low with easier intensity, higher risk in CVD patients- should exercise in medically supervise settings
How to reduce risk with vigorous intensity exercise:
- have a healthcare professional present that understands risks/ symptoms
- physically active individuals should know symptoms
- high school/ college students usually get a pre-screening by healthcare professionals
- Athletes with known cardiac condition or family history evaluated before competition
- healthcare facilities
- physically active individuals should modify PA to be individualized to their needs
Role of clinical exercise physiologist
look at people individually and figure out how to get them moving; understand relationship between PA and/or exercise and disease prevention and rehabilitation
First step of clinical exercise testing:
Informed consent!
Obtain proper written informed consent for ethical and legal consideration. Prior to collection of personal and confidential info, any form of fitness testing, and exercise participation
- should verbally explain everything to participant
- must say that participant can withdraw at any time
- must protect health info
Informed consent in research environment
must be reviewed by institutional review board or international review board
- must include purpose, plan, risk-discomfort, confidentiality, results, data handling-storage, emergency plan in place, etc
Common components of informed consent
- purpose/ explanation of test
- attendant risks and discomforts
- responsibilities of participant
- benefits to be expected
- inquiries
- use of medical records
- freedom of consent
Purpose of pre-screening
- see who needs medical clearance before PA or before increasing intensity
- see with clinically significant diseases who may benefit from participating in medically supervised exercise program
- see who has medical conditions that prevent participation unless conditions are improved or better controlled
ACSM pre-screening algorithm makes recommendations for medical clearance based on:
- individual’s current level of exercise participation
- presence of signs or symptoms and/or known CV, metabolic, or renal disease
- anticipated/ desired exercise intensity
To decrease risk of cardiac event
progressive transitional phase of 2-3 months for gradual increase of duration of exercise or intensity of exercise
- common recommendation = start w/ light to moderate intensity 2-3 METS then gradually increase to 3-5 METS over time if no symptoms`
Used for pre-screening
- ACSM’s preparticipation screening algorithm
- health history questionnaire (HHQ)
- PAR-Q+ (used in absence of professional assistance w/ ACSM algorithm) - more detailed than ACSM and HHQ
ACSM algorithm indentifies the risk modulators of
- current PA levels
- identify signs and symptoms of underlying CV, metabolic, and renal disease
- identigy individuals with diagnosed CV and metabolic disease
- Use signs and symptoms, disease history, current exercise participation, and desired exercise intensity to guide recommendation for preparticipation medical clearance
Signs/ symptoms of cardiovascular, metabolic, renal disease
-pain/ discomfort in chest, neck, jaw, arms from myocardial ischemia
- shortness of breath at rest/ mild exertion
- dizziness/ syncope
-orthopnea (COPD possibly) or paroxysmal nocturnal dyspnea
- ankle edema
- palpations/tachycardia
- intermittent claudication (insufficient blood supply)
-heart murmur
-unusual fatigue, shortness of breath with usual activities
HHQ (health history questionnaire)
Overview of participants overall well-being:
- demographic info
- recent illness, hospitalization, surgeries, etc
- medication
- medical diagnoses and history of procedures
- history of symptoms
- physical findings and lab results
- family history
- physical activity/ exercise evaluation
- other lifestyle habits
Risk assessment
working with individuals with known CVD or other conditions in exercise-based rehabilitation or medical fitness settings should use more in-depth risk stratification to find:
- ejection fraction
-dysrhythmias
-prior MI, CABG, angioplasty, stent,
-symptoms
- functional capacity (# of METS)
CVD risk factors and defining criteria: AGE
men at least 45 years old and women at least 55 years old at risk for CVD
CVD risk factors: FAMILY HISTORY
MI, coronary revascularization or sudden death ( 55yr or younger father or 1st degree male relative; less than 65. year old mother or 1st degree female relative)
CVD risk factors: cigarette smoking
current or quit in last 6 months or environmental exposure to smoke
CVD risk factors : PA
not meeting minimum requirements
CVD risk factors: BMI/ Waist circumference
BMI greater than or equal to 30 kg.m-2 or waist girth greater than 102 cm (40 in) for men and greater than 88cm (38 in) for wome
CVD risk factors: BP
systolic BP greater than or equal to 130 mmHg and/ or diastolic BP greater than or equal to 80 mmHg or on antihypertensive medication
CVD risk factors: Lipids
specific levels of LDL (bad, so want low levels) or HDL (good so want high levels)
CVD risk factors: Blood Glucose
fasting plasma glucose greater than or equal to 100 or 2 h plasma glucose values in oral glucose tolerance test (OGTT) greater than or equal to 140; or glycated hemoglobin (HbA1C) greater than or equal to 5.7%
Number of risk factors relationship to CVD
Increase in number of risk factors present is exponentially related to an increase in estimated 10-year risk of CHD in both men and wome
Criteria for hypertension
- Normal = 120/ 80 (or less)
- Elevated = 120-129/ less than 80
- Stage 1 hypertension = 130-139/ 80-89
- Stage 2 hypertension = greater than or equal to 140/ greater than or equal to 90
Criteria for dyslipidemia
elevation of plasma cholesterol, triglycerides, or both, or LDL cholesterol level that contributes to artherosclerosis
