Quiz 2 Flashcards
Prevention of CVD: positive risk factors and negative risk factors
- Positive: age, family, history, cigarette smoking, physical inactivity, obesity, hypertension, dyslipidemia, and diabetes mellitus
- Negative: high HDL cholesterol
Positive risk factors mean the increase likelihood of getting cardiovasc
Modifiable risk factors vs nonmodifiable
- modifiable: dyslipidemia, hypertension, type 2 diabetes, obesity, physical inactivity, and cigarette smoking
- nonmodifiable: age, sex, family history
Life Simple 7 Factors that assess and support healthy lifestyle changes to have ideal cardiovascular health:
- Manage BP
- Control cholesterol
- Reduce blood sugar
- Get active
- Eat better
- Lose weight
- Stop smoking
Improving safety for Patients during testing
- Monitor participants for changes
- minimum of a 2-3 month transitional phase
- proper warm-ups and cool-downs
- educate paricipants on warning signs and symptoms
- delay vigorous intensity PAs until they have gained sufficient physical fitness
Exercise testing
regular PA and exercise programs that increase physical fitness and have a strong relation to health
- fundamental goal= primary and secondary prevention and rehabilitation programs to promote health
exercise programs should focus on health-related components of physical fitness
Health-related fitness components
- cardiorespiratory endurance
- body composition
- muscular strength
- muscular endurance
- flexibility
Purpose of exercise testing
Info from exercise testing and medical and health history are helpful for=
- baseline data and info about present health/fitness status/ health-related standards for age, sex norms
- individualized exercise programs depending on health and fitness components
- follow-up data for short and long-term progress from exercise prescription
- motivation (establishes realistic health/fitness goals)
Pre-test
- informed consent
- pre-screening evaluation (medical clearance for exercise?)
- risk stratification-risk assessment
Test preparation
- documents, forms, questionnaires ready
- equipment on and calibrated
- room temp stable (68-72F/ 20-22C) and less thatn 60% humidity with airflow
- consider sequence of testing (what are you gonna do firtst)
- First = resting measurements
- let HR and BP return to baseline in between tests
- Note time of day, body positions for measurements, nutrition, meds taken before testing (same parameters in subsequent sessions)
Typical comprehensive health/fitness assessment
- informed consent, pre-participation screeingin, and risk evaluation
- resting measurements
- circumference/ body comp. analysis
- cardiorespiratory fitness assessment
- muscular fitness
- flexibility assessment
- additional assessment (balance)
aftewards: data collection, results, interpretation, assess individuality, assess short/long term goals, plan exercise prescription, and follow-up assessments
Heart Rate Measurement
Palpation (2 fingers or stethoscope) on arteries:
- carotid
- brachial
- radial
- chest (5th intercostal)
- femoral
- popliteal fossa
- dorsalis pedis
- abdominal
count for 30 or 60 seconds or 6 seconds
heart rate monitor- dampened for best signal
ECG
Blood Pressure Measurement
- seated quietly for 5 min (feet flat, arm at heart level)
- Can have both supine and standing measurements
- wrap cuff firmly around upper arm at heart level, align cuff with brachial artery
- Appropriate cuff size
- place stethoschope ches piece below antecubital space over brachial artery
- inflate to above 120
- slowly release pressure at 2-3mmHg/sec
- SBP is point where first sound is heard (Korotkoff sound), DBP is point where sound disappears
- at least 2 measurements should be taken 1 min apart - average taken
- BP measured in both arms on first examination (higher bP used)
- Tell patient and write down ther numbers and associated goals
What is oxygen uptake?
Volume of O2 consumed per minute (ml of O2/min)
Rate of oxygen utilization (how much O2 being consumed in relation to metabolism, how is body responding to increased energy expenditure)
Measured with direct calorimetry or indirect calorimetry
Direct Calorimetry
Measurement unit of energy = calorie
How much energy does food give us?
How much energy did we use?
Measuring air in room we can see the amount fo heat generated by the body in a large space
1 calore= amount of energy required to raise temp of 1ml of water by 1 degree C
Indirect Calorimetry
Measures of gas exchanges, type and rate of changes in substrate utilization and energy metabolism
Close-circuit spirometry - uses a spirometer around person’s mouth, 100% oxygen chamber/ closed-circuit (continual supply of environment)
Open circuit spiromentry- inspire room air (or contion: hypoxia/ hyperoxia), spirometer, computer assessment
Indirect Calorimetry: open-circuit spirometry types
- Portable systems: small, fit in pack, samples collected (gas analysis), applicable for field measurements
- Stationary systems (metabolic cart): mixing chamber, breath by breath analysis, increased accuracy compared to portable
- Douglas Bag (gold-standard for validation of gas exchange): use of impermeable bag to collect/store gases expired during exercise, multi-purpose, creative, use for control of current systems- validation multiple metabolic cart, standard check of accuracy and reliability of measurements, innovative important historical method to bridge towards current systems
Fick Equation
VO2= Q x A-VO2 diff
- Q= cardiac output (amount of blood pumped from left ventricle per minute) - stroke volume x heart rate
- A-VO2 diff = difference in oxygen content of arterial versus venous blood ( amount of O2 delivered to cells arterial and amount of oxygen extracted by cells venous)
Measurements of O2 Uptake
- VO2 (ml/min, ml/kg/min, L/min; volume oxygen consumed)
- VCO2 (ml/min, ml/kg/min, L/min; volume carbon dioxide consumed)
- RER or RQ (VCO2/ VO2, respiratory exchange ratio OR respiratory quotient)
- VE (L/min, volume expired)
- RR or BF (breaths/min, respiratory rate OR breathing frequency)
- PetO2, PetCO2 (mmHg, end tidal partial pressure of O2 and CO2 in air exhaled)
- VC (L, btps, vital capacity)
- FetO2, FetCO2 (%, fractional end tidal conc. of O2 and CO2 in exhaled air)
- FiO2, FiCO2 (%, fractional conc. of O2 and CO2 in air inhaled)
- Ratios for ventilatory efficiency, pulmonary function
How are these data calculated?
Volume of gas depends: temperature, pressure, content of water vapor
- Open-circuit: sometimes measure only expired air, can figure out how much O2 was inspired air by measuring amount and composition of expired air
Protocol to measure O2 uptake
graded exercise test- incremental/ ramp/ progressed difficulty or workload (to task failure or volitional exhaustion)
Vo2max test needs supramaximal effort for at least 3-5 minutes
- short tests (5-8min)
- long tests (combine purposes with anaerobic/lactate/ventilatory threshold, 3-5min stages, upwards of 30+ min)
Ways to detect VO2max or rather VO2peak criteria to achieve max: determinants of anaerobic capacities
- wingate (30s ‘all-out’ test)
- 3 min ‘all-out’ test
Ways to detect VO2max or rather VO2peak criteria to achieve max: determinants of aerobic capacities
- VO2max (time to exhaustion, TTE)
- lactate/ ventilatory/ anaerobic threshold
- 5km + time-trials (TT)
- fixed time test for distance
How to know when max is acheived?
- VO2 plateau- small or no increase in VO2 with increased work rate
- blood lactate conc. greater than or equal to 8-10ml
- RER greater than or equal to 1.10
- HR at above HR max
- Rating of perceived exertion
How is O2 uptake affected in diff. modes of exercise?
- whole body exercise: uphill (increased uphill, maximal work in arms is 70% of that legs)
- Amount of muscle mass (aleration in O2 delivery via active muscles)
