Therapeutic Exercise & Manipulation Flashcards
Work =
ATP + adp + Pi + energy
Average 70K human expends ______ kcal/min at rest.
Exercise can increase energy expenditure _____ times > resting values.
1.2 kcal/min at rest
15-25 times
3 metabolic energy systems
High intensity (short) High intensity (long) Moderate intensity
High:
Creatine Phosphate System (5-25 sec)
Lactic Acid System/Rapid Glycolysis (2 min)
Mod: aerobic oxidation system (>2 min)
Cardiovascular exercise physiology
Resting heart rate:
Max heart rate
______increase with work
60-80
220-age
Linear increase
Stroke volume =
Ranges:
At rest:
Max:
______ increase with work
Esv-edv
Rest: 60-100ml/beat
Max: 100-120ml/beat
Curvilinear. Plateau around 50%
Stroke volume is greatest in which position?
Why?
Supine/prone. Less in standing or with static exercises due to increase in intrathoracic pressure
Cardiac output (Q) =
____ at rest
____ max
Q = HR x SV
4-5L/min at rest
20L/min max
______% of cardiac output is distributed to skeletal muscle at rest
______% is delivered to working muscle during exercise
15-20%
85-90%
Venous return during exercise occurs by what three things?
- Contracting skeletal muscle
- Venoconstriction by smooth muscle
- Diaphragmatic contraction lowering intrathoracic pressure facilitating blood flow to lower extremities.
SBP increases _______ with work.
Max around _____mmHg
Linearly with work
190-220mmhg
BP is related to ___ and ____ making it a good way to monitor ionotropic response during exercise.
______ & _____ are abnormal responses of BP to exercise
CO and PVR
Decrease in SBP with increase in work
Increase in DBP with increase in work
= severe exercise intolerance (pulm htn) or cardiac disease.
HR, SBP, DBP greater in arm or leg exercise?
Greater during arm work due to decrease total muscle mass requiring greater percentage of mass to perform work and decreased mech efficiency
Pulmonary ventilation: _____ in adults at rest
Can increase ____ fold with exercise.
6L/min at rest
15-25 fold increase with exercise
Define anaerobic threshold
Peak work rate and oxygen consumption at which energy demand exceeds circulatory ability
What is the best index of physical work capacity or cardio respiratory fitness?
Max O2 consumption/VO2 max - highest rate of O2 transport at max physical exertion
Which of the following statements is false regarding the major energy sources?
The creatine phosphate system is responsible for providing energy for brief, high-intensity exercise lasting up to 5 seconds in duration.
Rapid glycolysis is responsible for fueling activities lasting up to 1-2 minutes in duration.
The aerobic oxidation system is capable of using carbohydrates, fat, and protein to produce energy.
During most activities, all energy systems may be active to some degree.
A
All energy-producing pathways are active during most exercises. However, different types of exercise place greater demands on different pathways. Shorter duration, high-intensity activities rely more on the anaerobic systems, whereas longer, lower intensity activities receive a greater contribution from the aerobic pathway. During high-intensity work, the first 5 seconds are energized by stored ATP. The next 25 seconds or so are supplied by the creatine phosphate system. Glycolysis predominates during activities lasting up to 1-2 minutes (long sprints or middle distance activities). Longer duration activities rely primarily on the aerobic oxidation system, including the Krebs cycle and electron transport chain, and are capable of using fats, carbohydrates, and even small amounts of protein to produce ATP.
Changes at Rest: Heart rate: \_\_\_\_ (secondary to?) Stroke volume \_\_\_\_\_ (secondary to?) Cardiac output: \_\_\_\_\_\_ Oxygen consumption \_\_\_\_\_\_\_
Changes at Rest
Heart rate decreases, probably secondary to decreased sympathetic tone, increased parasympathetic tone, and a decreased intrinsic firing rate of the sinoatrial node.
Stroke volume increases secondary to increased myocardial contractility.
Cardiac output is unchanged at rest.
Oxygen consumption does not change at rest.
Changes at Submaximal Work:
Heart rate: _____ (secondary to?)
Stroke volume _____ (secondary to?)
Cardiac output _____ ( secondary to?)
Submaximal oxygen consumption ______ (secondary to)
Arteriovenous oxygen (avO2) difference _______
Lactate levels ______ ( secondary to?)
Changes at Submaximal Work*
Heart rate decreases, at any given workload, because of the increased stroke volume and decreased sympathetic drive.
Stroke volume increases because of increased myocardial contractility.
Cardiac output does not change significantly because the oxygen requirements for a fixed workload are similar. The same cardiac output is generated, however, with a lower heart rate and higher stroke volume.
Submaximal oxygen consumption does not change significantly because the oxygen requirement is similar for a fixed workload.
Arteriovenous oxygen (avO2) difference increases during submaximal work.
Lactate levels are decreased because of metabolic efficiency and increased lactate clearance rates.
Changes at Maximal Work Maximal heart rate: Stroke volume: Maximal cardiac output: Maximal oxygen consumption (O2max): Ability of the local mitochondria to use oxygen is \_\_\_
Changes at Maximal Work
Maximal heart rate does not change with exercise training.
Stroke volume increases because of increased contractility and/or increased heart size.
Maximal cardiac output increases because of increased stroke volume.
Maximal oxygen consumption (O2max) increases primarily because of increased stroke volume.
Ability of the local mitochondria to use oxygen is improved.
Physiologic changes with regular exercise: Blood Pressure: Blood Volume Changes: Blood lipids: Body Composition: Biochemical changes:
Blood Pressure
In normotensive individuals, no significant effect.
In hypertensive individuals, there can be a modest reduction in resting blood pressure as a result of regular exercise.
Blood Volume Changes
Total blood volume increases because of an increased number of red blood cells and expansion of the plasma volume.
Energy System Changes
Chronic anaerobic training using the ATP–creatine phosphate system results in increased ____ and ___ because of enhancement of enzyme activity and increases in the amount of ATP and creatine phosphate in the muscle.
Anaerobic glycolysis is improved if ________
Regular aerobic training improves _______. It increases muscle glycogen and triglyceride stores, as well as the rate at which carbohydrates and fat are metabolized.
Energy System Changes
Chronic anaerobic training using the ATP–creatine phosphate system results in improved capacity and power of this system because of enhancement of enzyme activity and increases in the amount of ATP and creatine phosphate in the muscle.
Anaerobic glycolysis is improved if the training program uses this system, resulting in increased stores of muscle glycogen and improved ability of enzymes in the system.
Regular aerobic training improves O2max. It increases muscle glycogen and triglyceride stores, as well as the rate at which carbohydrates and fat are metabolized.
Which of the following statements is true regarding blood pressure response to exercise?
Both systolic blood pressure and diastolic blood pressure normally rise linearly with increasing work intensity.
Only diastolic blood pressure rises during exercise.
Systolic blood pressure increases with exercise intensity; diastolic blood pressure typically remains unchanged or only slightly increases.
At similar oxygen uptakes, blood pressure is higher during leg work than during arm work.
C
Systolic blood pressure increases linearly with increasing work intensity, by approximately 8-12 mm Hg per metabolic equivalent. Diastolic blood pressure remains unchanged or only slightly increases with exercise. At similar oxygen consumptions, blood pressure is higher during arm work than during leg work.
8 signs of overtraining
Sudden decline in quality of work or exercise performance Extreme fatigue Elevated resting heart rate Early onset of blood lactate accumulation Altered mood states Unexplained weight loss Insomnia Injuries related to overuse
five components of an exercise prescription
- Mode - Form or Type of Exercise
2 Intensity - Difficulty level
3 Duration - Time or length of session - Frequency - Number of exercise sessions per day and per week
- Progression Increase activity over time
Describe the Borg scale of perceived exertion
Level Perceived Exertion 6 — 7 Very, very light 8 9 Fairly light 10 11 12 13 Somewhat hard 14 15 Hard 16 17 Very hard 18 19 Very, very hard 20
9 indications a patient needs exercise stress testing
- Pain and discomfort (or other anginal equivalent) in the chest, neck, jaw, arms, or other areas that may be ischemic in nature
- Shortness of breath at rest or with mild exertion
- Dizziness or syncope
- Orthopnea or paroxysmal nocturnal dyspnea
- Ankle edema
- Palpitations or tachycardia
- Intermittent claudication
- Known heart murmur
9 Unusual fatigue or shortness of breath with usual activities
Type of muscle: Type 1 (slow oxidative) Major source of ATP: Mitochondria: Myoglobin content: Capillarity: Muscle color: Glycogen content: Glycolytic enzyme activity: Myosin ATPase activity: Speed of contraction: Rate of fatigue Muscle fiber diameter
Oxidative phosphorylation High High High Red Low Low Low Slow Slow small
Type of muscle fiber: Type 2A (Fast oxidative glycolytic) Major source of ATP: Mitochondria: Myoglobin content: Capillarity: Muscle color: Glycogen content: Glycolytic enzyme activity: Myosin ATPase activity: Speed of contraction: Rate of fatigue Muscle fiber diameter
Oxidative phosphorylation High HIgh HIgh Red Intermediate Intermediate High Fast INtermediate Intermediate
Type 2B (Fast Glycolytic) Major source of ATP: Mitochondria: Myoglobin content: Capillarity: Muscle color: Glycogen content: Glycolytic enzyme activity: Myosin ATPase activity: Speed of contraction: Rate of fatigue Muscle fiber diameter
Glycolysis Low Low Low White HIgh HIgh HIgh Fast Fast Large
Muscle fiber orientation: 1 pectoralis major 2. Sartorius 3. Orbicularis Oris 4. Deltoid 5. Biceps brachii 6. Rectus femoris 7. Extensor digitorum longus
- Convergent
- Parallel
- Circular
- Multipennate
- Fusiform
- Bipennate
- UNipennate
Types of muscle contration:
- Isometric
- Concentric
- Eccentric
- Muscle contracts but does not shorten
- Muscle shortens
- Muscle elongates
Determinants of Strength
Force is proportional
Pennate muscle are able to
Length-Tension Relationship
Max force of contraction occurs at
This is around
Efficiency occurs at around ___% velocity of max contraction (energy=work not heat)
Determinants of Strength
Force is proportional to cross-sectional area
Pennate muscle are able to generate more force
Length-Tension Relationship
Max force of contraction occurs at resting length
This is around midrange joint motion
Efficiency occurs at around 30% velocity of max contraction (energy=work not heat)
describe the torque-velocity relationship of muscle contractions:
from greatest to least
Torque-Velocity relationship
Force Generated by Contraction from greatest to least:
Fast eccentric (lengthening) > slow eccentric > isometric > slow concentric > fast concentric (shortening)
