Section 6: Physical Activity 14% Flashcards
when were The first and second edition of the Physical Activity Guidelines published?
2008, 2018 (update started in 2016)
What are the health benefits of physical activity outlined in the secong ediction of PAG for Americans?
Meeting the recommendations in the Physical Activity Guidelines for Americans consistently over time can lead to long-term health benefits. (New benefits appear in bold with .)
improve cognition,
YOUTH: bone health, fitness, and heart health. It can also reduce the risk of depression.
For ADULTS: prevent 8 types of cancer (bladder,* breast, colon, endometrium,* esophagus,* kidney,* stomach,* and lung);
reduces the risk of dementia (including Alzheimer’s disease),
all-cause mortality,
heart disease, stroke, high blood pressure, type 2 diabetes,
depression;
improves bone health, physical function, and quality of life.
For OLDER ADULTS, physical activity also lowers the risk of falls and injuries from falls.
For PREGNANT WOMEN, physical activity reduces the risk of postpartum depression.*
For ALL GROUPS, physical activity reduces the risk of excessive weight gain* and helps people maintain a healthy weight.
NEW EVIDENCE shows that physical activity can help manage CHRONIC conditions that Americans already have: decrease OA PAIN, reduce disease progression for hypertension and type 2 diabetes, reduce symptoms of anxiety and depression, and improve cognition for those with dementia, multiple sclerosis, ADHD, and Parkinson’s disease.
What age groups does the 2nd edition of PAG for Americans cover?
The second edition of the Physical Activity Guidelines for Americans provides evidence-based recommendations for ADULTS and YOUTH ages 3 through 17 to safely get the physical activity they need to stay healthy.
What are the recommendations of the 2nd edition of PAG for Americans for youth aged 3-5 yo?
The new key guidelines for children ages 3 through 5 state that preschool-aged children should be active throughout the day to enhance growth and development. Adults caring for children this age should encourage active play (light, moderate, or vigorous intensity) and aim for at least 3 hours per day.
How does the second edition of PAG for Americans differ from the first edition?
- new key guidelines for children ages 3 through 5
- updated guidelines for youth ages 6 through 17, adults, older adults, women during pregnancy and the postpartum period, adults with chronic health conditions, and adults with disabilities.
- We now know that any amount of physical activity has some health benefits. Americans can benefit from small amounts of moderate-to-vigorous physical activity throughout the day. The first edition of the Physical Activity Guidelines for Americans stated that only 10-minute bouts of physical activity counted toward meeting the guidelines. The second edition removes this requirement to encourage Americans to move more frequently throughout the day as they work toward meeting the guidelines.
New evidence shows that physical activity has immediate health benefits. For example, physical activity can reduce anxiety and blood pressure and improve quality of sleep and insulin sensitivity.
What are the recommendations of the 2nd edition of PAG for Americans for youth aged 6-17 yo?
youth ages 6 through 17 is the same: at least 60 minutes of moderate-to-vigorous activity
Most activity can be aerobic, like walking, running, or anything that makes their hearts beat faster.
They also need activities that make their muscles and bones strong, like climbing on playground equipment, playing basketball, and jumping rope.
What are the recommendations of the 2nd edition of PAG for Americans for adults (18 and over)?
most health benefits from physical activity: at least 150 to 300 minutes of moderate-intensity aerobic activity, like brisk walking or fast dancing, each week.
Adults also need muscle-strengthening activity, like lifting weights or doing push-ups, at least 2 days/ week
The first key guideline for adults is to MOVE MORE, SIT LESS.
With regards to physical activity: Choose CORRECT statement(s):
A) Mortality risk increases with increasing amount of moderate to vigorous physical activity
B) Risk of accidents increases with decreased physical activity
C) There is a dose response between all-cause-mortality and moderate to vigorous PA. Most benefit is seen if physical activity is increased from less than 30min/week to 60-120min/week of moderate to vigorous exercise; modest additional benefits are obtained from further increase in dose and this is encouraged
D) extreme levels of vigorous physical activity show additional benefit to all-cause mortality
E) sedentary behavior significantly increases the risk of CHD, HTN and all-cause mortality
answer: B, C, E ( source BC Manual)
A) FALSE: mortality risk increases with decreasing amount of PA
B) true
C) true
D) FALSE: extreme levels of vigorous activity (eg extreme sports) can be harmful (accidents, etc)
E) true New evidence shows a STRONG RELATIONSHIP between INCREASED SEDENTARY BEH. and increased RISK OF HEART DISEASE, HIGH BP AND ALL CAUSE MORTALITY All physical activity, especially moderate-to-vigorous activity, can help offset these risks.
With regards to physical activity: Choose CORRECT statement(s):
A) the newest (2nd ed) of APAG (American Physical Activity Guidelines 2018) states that short bouts, i.e. even < 10 min bouts of PA throughout the day count toward meeting the guidelines
B) there is no recommendation for pre-school aged children in the latest edition of American Physical Activity Guidelines (2018)
C) the recommended dose of PA for youth aged 7-17 is at least 3 hours a day
D) recommended daily dose for adults is 30min of moderate-vigorous exercise a day or 150min a week
E) seniors (>65) need to do 30-60 min of mild to moderate activity/ day to achieve health benefits
answer: A (source APAG 2nd edition)
A) TRUE: Any amount of physical activity has some health benefits, incl small amounts of moderate-to-vigorous physical activity throughout the day.
The first edition of the Physical Activity Guidelines for Americans stated that only 10-minute bouts (or more) of physical activity counted toward meeting the guidelines. The second edition removed this requirement to encourage Americans to move more frequently throughout the day as they work toward meeting the guidelines.
B) FALSE: ages 3 through 5 (preschool-aged children) NEW recommendation: should be active throughout the day to enhance growth and development. Adults caring for children this age should encourage active play (light, moderate, or vigorous intensity) and aim for AT LEAST 3 HOURS/DAY of active play
C) FALSE: youth ages (6 through 17): at least 60 minutes of moderate-to-vigorous activity. Most activity can be aerobic, like walking, running, or anything that makes their hearts beat faster.
They also need activities that make their muscles and bones strong, like climbing on playground equipment, playing basketball, and jumping rope.
Vigorous activity at least 3/week
D) FALSE : American PA guidelines adults: 150 - 300min or more of moderate PA / week OR at least 75min of vigorous PA/ week, OR combination of both AND at least 2 days a week of strength training; MOVE MORE, SIT LESS
E) FALSE: same as adult guidelines OR as much as possible
With regards to Strength Training, the current American Physical Activities Guidelines 2018, recommend all EXCEPT:
A) children/youth 6-17 yo: muscle and bone strengthening activities at least 30min/day, at least 3/week
B) 18-64: 75min/week, not on consecutive days
C) >65 2/week, or as per adult guidelines as much as possible start light, increase, 10-15 rept.
answer B
A) true
B) FALSE: 2-3/week on non consecutive days (if consecutive days, then exercise different muscle gps. ; 8-12 rept each major muscle gp
C) true
With regards to FLEXIBILITY Training, all the statements below are true, EXCEPT:
A) there is no recommendation for dose and frequency of flexibility exercise in the current guidelines
B) is most effective when muscles are warm
C) recommendation is for 10 min 2-3 times a week, not on consecutive days
D) 60 sec. accumulated duration for each major muscle gp is recommended
E) intermittent bouncing increases effect, stretching shouldn’t be painful
answer: C, E
A: true
B: true
C) FALSE: 10 min 2-3/week, greatest benefit if done daily
D) true
E) FALSE: bouncing is not recommended; discomfort but no pain
With regards to BALANCE exercises, Choose CORRECT statement(s):
A) is a combination of motor and proprioceptive skills
B) 30min 2-3/week is recommended in the current guidelines for those over 65 yo, who are known to gain most benefit
C) exact dose and frequency are not specifically known for age groups younger than 64
C) most available research is on older adults and shows significant reduction in falls and associated burden
D) Examples of proprioceptive exercise are tai chi, yoga
E) all of the above
answer: E (all are correct)
With regards to exercise and physical activity, choose all of the correct recommendations of 2018 American Physical Activity Guidelines that apply:
A) pregnant women should not be performing vigorous physical activities, particularly from the second trimester onwards
B) pregnant and post-partum women should do at least 150min of moderate or 75 min of vigorous activity or a combination of the two a week is recommended
C) Avoid exercise that could cause abdominal trauma
answer: C
A) FALSE: if they habitually performed vigorous activity prior to pregnancy they can continue, after consulting their physician
B) FALSE: 150min / week of moderate is (vigorous only if habitual pre pregnancy)
C) true
Choose all CORRET statements with regards to people with chronic health conditions, as recommended in 2018 American Physical Activity Guidelines:
A) People with known chronic, lifestyle related conditions are recommended to do appx. twice as much more physical activity than healthy individuals for both endurance and strength training. If they are not able to do this they should do as much as possible
B) physical activity is safe for most people with chronic conditions, including cardio-vascular disease, it is more dangerous to be sedentary than suffering a cardiovascular accident during exercise, however they should consult their physician before they commence exercise
C) Physical activity for individuals with existing chronic disease should be adjusted to their level of fitness and ability and be done as safely as possible
D) all of the above are true
answer: D (all correct) A) true B) true C) true D) true
With regards to physical fitness testing, all statements below are correct, EXCEPT:
A) caliper testing is a common and highly reliable and validated way of testing body composition
B) cardioresp. fitness can be tested with a STEP TEST, which is easy to perform in a clinic and has been validated. It’s most accurate for those who are not already fit. Another commonly used test of endurance in non-fit subjects is 6-min walk test
C) muscular strength can be easily tested in the office
D) squats, push ups and sit ups are good examples of testing muscular endurance
E) the sit and reach test measures hamstring and lower back flexibility and can be easily done in the office. It is not accurate for those with low back pain.
answer: A, C
A) FASLE- not reliable but common, not validate, accepted ranges produced by Am Col of Sports MEd,
B) TRUE
C) FALSE (need access to bench or squat press => best done in a gym)
D) true
E) true: high consistency, moderately accurate for hamstrings, poorly accurate for lower back
Choose statement(s) that are INCORRECT, with regards to SEDENTARY BEHAVIOR:
A) twice as prevalent as smoking, HTN, High cholesterol, and has a 6.9% risk of all-cause-mortality across all spectra of population
B) sitting time is an independent risk factor for all all cause mortality and public health initiatives should focus on promoting less sitting time, as well as more physical activity
C) negative effects of sedentary behaviour can be reduced by increased levels of activity when not sitting
D) another study found that intermitting sitting with 2min bouts of walking every 20 min, had a positive effect on glucose and insulin levels
E) TV watching independently increases risk of all cause mortality (HR 1.5), even if “counteracted” by very high levels of physical activity at other times
answer: C
A: TRUE
B) TRUE; this is one of the findings of a large (200.000 subjects + , w/ 2.8y follow up). The association between sitting and all-cause mortality appeared consistent across the sexes, age groups, body mass index categories and physical activity levels (including those who were meeting PAGs), and across healthy participants compared with participants with pre-existing cardiovascular disease or diabetes mellitus.
C) FALSE: independently increases risk despite leisure time exercise
D) TRUE: this was a small (n=19: obese or overweight) RCT (uninterrupted sitting = controls, int 1 = light walking for 2 min q 20 min, int 2 = 2min mod. walking q 20 min): improved BSL and insulin levels, no dif betw two INT gp’s
E) TRUE, TV also assoc w/ eating unhealthy foods and prolonged sitting
Choose statement(s) that are INCORRECT, with regards to EXERCISE:
A) A large observational study by Naci & Ioannidis, comparing the efficacy of exercise with medication, published in 2013 in BMJ found that exercise had lower mortality rates than medications for for post-stroke patients
B) same study found that exercise was better than medication for secondary prevention of coronary artery disease and pre-diabetes
C) same study found that exercise is equivalent to medications for treatment of heart failure
D) all above are true
E) all above are false
Answer: E (all false)
A) FALSE: it was a meta-analysis (305 RCTs, >300000 subjects), the lower mortality rate with exercise comp with meds is correct
B) FALSE: exercise is equivalent to meds as sec prev. of both coronary art and prediabetes
C) FALSE: exercise was inferior to meds, however authors conclude that it has better side effect profile and “is probably best in combination with medications”
With regards to physical activity and health, choose all that are CORRECT:
A) Lack of exercise is the no 1 preventable cause of all-cause mortality, according to WHO
B) according to Aerobics Centre Longitudinal Study findings, 16% of all-cause-deaths in men and 17% in women could have been prevented if they had better cardiorespiratory fitness
C) in comparison, the same study found that normalising blood pressure could prevent 15% all-cause-deaths in men and 7% in women, and smiking avoidance could prevent 8% of deaths in men and 9% in women
A) FALSE: LOW CARDIORESPIRATORY FIRTNESS (CRF) was the no 1 cause of mortality among 40.000+ men and women in the Aerobics Centre Longitudinal Study
B) TRUE: poor cardiorespiratory fitness as measured by max. on treadmill test was, indeed, assoc. with 16% attributable fraction of all cause mortality in men and 17% in women
C) TRUE
With regards to PHYSICAL ACTIVITY: Choose INCORRECT statement(s):
A) it is estimated that lack of physical activity is the cause of 1 in 10 premature deaths worldwide
B) There is a dose-response relationship between dose (time spent doing mod to vig physical activity) and reduced risk of all-cause-mortality
C) people who exercise more, regardless of their body weight lose significantly less years of life compared to those who are inactive
D) physical activity reduces the risk of coronary heart disease by 6%, T2D by 7%, breast cancers and colon cancers by 10%
E) EXERCISE PRESCRIPTION uses the acronym FITS
answer: D, E A) TRUE B) TRUE: C) TRUE D) FALSE: these numbers are the percent of burden of disease attributed to physical inactivity, worldwide
E) TRUE
1. Woodckock et al, 2011 (systematic review and meta-analysis), 7.5 mil subjects (22 studies):
150min (2.5hrs or 30 minx5)/ week of MOD exerc reduces mortality by 19%;
420min (7 hours or 60min a day) reduces mortality by 24%
2. Lee et al. Lancet 2012: analysis of burden of disease and life expectancy
all-cause-mortality:
RR 0.8 w/ 1.5hr (90min)/ week of exerc
RR 0.7 w/ 3hr (180 min)/ week of exerc.
RR 0.6 w/ 6 hrs (360min) / week of exerc.
E) FALSE: Frequency, Intensity, Type (of exercise), Time (duration)
Physical activity as a vital sign (PAV): choose incorrect statement(s)
A) physical inactivity and obesity are linked to increased risk of CVD, T2D, some cancers and all-cause mortality in a dose-response fashion
B) PA reduces the risk of all0cause-mortality and years of life lost in ALL individuals, regardless of weight
C) to accurately address someone’s future health risks, weight and physical activity should be measured at least once a year
D) the equation to assess PAV is: (type of activity) + (intensity) + (Frequency) + (Duration) = PAV
E) there is good evidence that PAV can be used consistently in health care as a quick tool to assess PA
Answer: C, D
A) TRUE
B) TRUE
C) FALSE : then should be checked and addressed at each visit
D) FALSE (days per week) + (minutes per day) = minutes per week:
Questions: On average, how many days do you perform physical activity where your heart is beating faster and your breathing is harder?
On average, how many total minutes of physical activity or exercise do you perform on those days?
E) TRUE: Kaiser PErmanente: almost 2 mil patients ; 86% records adherence
Match the correct steps for each patient scenario (e.g. D-2)
A) Joseph is walking, for 40 min 4 times a week, he used to experience faster heart beat and harder breathing but this is no longer happening. He doesn’t do any other exercise.
B) Jamie is walking around the block for 10 min after evening meal. This makes her heart beat faster and she is struggling to speak. She doesn’t think she could manage any more due to knee pain.
C) Susan works as a typist. She parks her car as close to her work as she can as she is always rushing. She doesn’t do any recreational physical activity.
D)
1) Congratulate. Encourage to continue this if tolerated and slowly build up to meet the guidelines. Consider introducing light muscle strengthening exercises or water based cardio +/- stretching/ balance. Establish follow up.
2) Lead to acknowledge sedentary behaviour. Briefly discuss evidence and link to health problems if appropriate. Guide to acknowledge insufficiency of PA. Ask what it would take to get to the standard. e.g. How can we get you more active? Offer support. Establish follow up.
3) Congratulate. Suggest to increase intensity and introduce strength +/- balance/ stretching. Establish follow up.
answer:
A-3
B-1
C-2
With regards for screening for suitability to exercise. Choose all that apply:
A) American college of sports medicine guidelines recommend screening every individual with cardiovascular risk factors to be screened prior to commencing exercise
B) the goal of screening is to prevent injury during exercise and to stratify people into different intensity groups (low/ moderate/vigorous)
C) everyone should be able to, and encouraged to do low-level physical activity, regardless of their screening status, as it is known to be beneficial
D) people with moderately severe pulmonary disease require medical clearance before commencing exercise program
A) FALSE: screening prior commencement of exercise or increasing intensity of exercise:
- SIGN/ SYMPTOMS or known clinically significant cardiovascular, meatbolic or renal dis, who would benefit from medically supervised exercise prog’s
- UNCONTROLLED condition that requires treatment or control before exercise
B) FALSE: the goal of screening is to reduce risk of exercise-related CV events
C) TRUE: low level of activity (universally beneficial) vs sedentary behaviour (universally harmful) ; LOW LEVEL = sing and talk while exercising (e.g. walked into your office and is not breathless); Everyone should be able to do
D) FALSE - no increase in CVD complications on pulmonary dis.
With regards to pre-participation screening for exercise, choose all the correct statements.
A) people with known CVD risk factors must all be medically cleared before engaging in any form or exercise
B) Gold Standard Protocol for ETT must be followed for valid results
C) There are two types of testing of cardiorespiratory fitness: ETT (exercise tolerance test) and Nuclear myocardial perfusion imaging stress test; they can be used interchangeably, depending on the person’s/ physician’s personal preference
D) everyone with CVD risk factors needs to get an ETT
E) none of the above are correct
Answer: E (none are correct)
A) FALSE:
1. American College of Cardiology: before MODERATE OR VIGOROUS activity - this is based on conflicting evidence and expert opinions;
2. USPSTF recommends AGAINST ROUTINE testing or ETT in ASYMPTOMATIC individ. before initiating ex prog.
B) FALSE: not routinely done
C) FALSE: see answer D)
D) FALSE: pre-test probability is calculated: age, gender,
- > 70% = referred for catheterisation type of symptoms;
- <30% = low yield os ETT:
- if symptom limited ECG normal no further testing needed
- if exercise ECG abnormal, nuclear myocardial perfusion imaging is appropriate - 30-70% ETT HELPFUL
- <30% but symptoms difficult to categorise ETT may be HELPFUL
- unable to exercise: –> nuclear perfusion imaging
With regards to proven benefits of strength and resistance training, choose INCORRECT statement(s):
A) reduce injury
B) Reduced basal metabolic rate
C) Reduced fatigue
D) improved sleep
E) improved performance and muscle strength
F) improved quality of life, strength, endurance and bone mineral density in early post-menopausal years
G) reduced body fat, improved weight maintenance, improved body aesthetics
F) decreased pain and disability assoc w/ arhtritis
H) improved abdominal adiposity, accompanying improved hepatic TAGs in NAFLD and improved
answer:
B) increased BMR
H) improved intrahepatic TAGs even in the absence of improved abdo adiposity
With regards to strength or resistance training, choose CORRECT statement(s)
A) it’s common even for active patients to not do resistance training
B) the prescription follows the acronym FITT (frequency, Intensity, type (of activity), time (duration))
C) when initiating strength/ resistance training, the person should use weights as heavy as they can, to manage to perform 3 sets of 10 repetitions at 8/10 perceived intensity
D) for the best muscle bulk gain, the same muscle group should be exercised at least 2 days in a row
Answer: A
A) TRUE
B) FALSE:
Intensity (the weight or force used relative to persons ability to lift
Frequency (how often)
Repetitions (number of times a weight is lifted)
Sets (the number of cycles of repetitions)
e.g. use 2kg dum bell in each hand, do 2 sets of 15 repetitions of biceps curls, once a week
C) FALSE: 5-6/10 intensity, complete 8-12 repetitions before fatiguing (may need to add weight to reach difficulty level)
D) FALSE: workouts for same muscle groups should be separated by 48 hours at least
With regards to FLEXIBILITY EXERCISE, choose INCORRECT statement(s):
A) There is conclusive evidence that shows reduced risk of injury for muscle stretching prior to engaging in physical activity
B) stretching of hip flexors in the elderly has been shown to reduce falls
C) small but significant improvements in BSL and HBA1c were shown in a study of people w/ T2D who engaged in a flexibility exercise program
D) can improve range of motion and healing of muscles
E) warmer environments allow for better stretching
answer: A, B
A) FALSE: “mixed” evidence is stated in the manual
B) FALSE: increased gait (incr stride length)
C) TRUE
D) TRUE
E) TRUE
T/F: latest scientific evidence shows that physical activity has many HEALTH BENEFITS INDEPENDENT OF OTHER HEALTHY BEHAVIORS (e.g. good nutrition)
true (source PAGA)
Choose INCORRECT statement(s):
A) MET = metabolic equivalent of a Task, MET hour = metabolic equivalent of activity for one hour
B) = ratio of the metabolic rate during a task compared to a standard resting metabolic rate
C) standard resting metabolic rate = amount of calories used up during sleep
D) MET hrs / week = MET/hr x hrs/week
A) true
B) true
C) amount of O2 consumed during quiet rest or sitting = appx 3.5ml of O2/kg body wt/ min= 1.0 MET
D) True
choose INCORRECT statements:
a) sleep = 1 MET
b) 3mile/hr walking = 3MET
c) climbing 2 flights of stairs = 5METs
d) Running at 17.5km/h = 18METs
e) most benefit is gained w/ 20-30 MET hours/ week
a) FALSE sleep = 0.9 MET
b) TRUE
C) TRUE
D) TRUE
E) FALSE: most benefit 10-20MET hrs/week
What is NEAT= non exercise activity thermogenesis ?
daily expendityre of energy doing activities, excluding purposeful exercise, sleeping or eating (sitting, fidgeting, yard work, house work, typing. etc. )
