Unit 1 Flashcards
agonist
muscle or muscle group that is the prime mover for a joint action
anatomical position
the universally accepted reference position to describe regions and spatial relationships of the human body and to make reference to body positions
antagonist
muscle or muscle group that opposes the action of the prime movers
appendicular skeleton
all of the bones that are found in the limbs of the body
atrioventricular valves (AV)
separate the atria from the ventricles. the right AV has 3 leaflets called tricuspid valve. the left AV has 2 leaflets called the bicuspid valve.
auscultation
the act of listening to sounds of the body
a practitioner can use a stethoscope to assess blood pressure, heart rate and heart and lung sounds
contractile proteins
specialized proteins found within muscle cells that interact with one another to cause muscle force production
joints
the articulations between bones, typically classified according to structure as being fibrous, cartilaginous, or synovial.
motor unit
a single somatic motor neuron and the group of muscle fibers innervated by it
muscle fiber architecture
the orientation of the muscle fibers to the longitudinal axis of the muscle.
planes of motion
orthogonal planes the divide the human body and can be used to describe various body movements
regulatory proteins
specialized proteins found within muscle cells that block the binding of the contractile proteins to one another and thus keep the muscle in a relaxed state
respiratory membrane
the membrane formed by the walls of the alveoli and capillaries as the come in contact with one another in the lungs.
synergist
muscle or muscle group that assists the agonist in performing a joint action
ventilation
the act of breathing in (inhalation) and out (exhalation) so that air can enter the alveoli to allow oxygen and carbon dioxide to exchange
major regulatory proteins
troponin
tropomyosin
where does diffusion of oxygen and carbon dioxide occur in the lungs
respiratory membrane
inhalation
breathing in
exhalation
breathing out
sagittal
right and left
frontal
anterior and posterior
transverse
superior and inferior
anterior
front of body
deep
below the surface and not relatively close to surface
distal
farthest point in distance from reference point
inferior
away from the head
lower
lateral
away from the midline
medial
toward the midline
posterior
the back of the body
proximal
closest point in distance to reference point
superficial
located close to or on body surface
superior
toward the head
higher
7 functions of cardiovascular system
1 transports oxygenated and deoxygenated blood
2 distributes nutrients to cells
3 removes metabolic wastes
4 regulates pH
5 transports hormones and enzymes
6 maintains fluid volume to prevent hydration
7 maintains body temp by absorbing and redistributing heat
primary function of cardiovascular system
transport of nutrients and removal of waste products
heart positon
obliquely within thoracic cavity
mediastinum
cavity where heart is postioned
4 chambers of the heart
right atria
left atria
right ventricle
left ventricle
pericardium
double walled loose fitting membranous sac that covers the heart
myocardium
thickest layer of tissue in the heart
cardiac muscle
cardiac skeleton
network of criss crossing dense connective tissue fiber within myocardium
3 function of cardiac skeleton
insertion points for fibers of of the cardiac musculature, support for the valves of the heart,
and some separation between atria and ventricles
why is the LV walls and internventricular septum thicker
to allow left side of heart to pump blood against the greater resistance offered by the large vascular tree
4 valves of the heart
atrioventricular valves AV
semilunar valves
RCA
right coronary artery
LCA
left coronary artery
function of heart valves
maintain unidirectional blood flow
AV
separate atria from ventricles
tricuspid valve
controls blood flow from RA to RV
mitral valve
controls blood flow from LA to LV
semilunar valve
has 3 cusps
pulmonary valve
between RV and pulmonary artery
aortic valve
between LV and aorta
what do the cusps of semilunar valve prevent
backflow of blood from the arteries to ventricles
where does the blood flow begin
return of systematic blood to RA
Blood flow 1-7
1 venous blood flows into RA
2 RA free wall contracts and additional blood moves to RV
3 RV free wall contracts, pulmonary valve opens and blood flows to pulmonary artery
4 blood reaches alveolar caplillaries, gas exchanged
5 blood flows back to LA
6 LA free wall contracts and blood flows to LV
7 LV free wall contracts and blood flows through the system
where does the functional blood supply for the heart come from
LCA and RCA
what does the LAD supply blood to
interverntricular septum and anterior myocardium
what does the CxA supply blood to
laterodorsal walls of the LA and LV
arteries
carry blood away from heart
large are near heart
veins
carry blood toward the heart
carotid pulse
anterior neck groove
radial pulse
lateral aspect of forearm near distal head of radius
where is blood pressure typically taken
brachial artery
controls breathing
respiratory center
peripheral chemoceptors
afferent and efferent nerves
distribution of ventilation
upper respiratory tract
conducting airways
repiratory broncioles
ventilatory pump
chest walls, respiratory muscles, pleura
distribution of blood flow
pulmonary arteries, caplillaries, veins
bronchial clearance
muccociliary escalator
lung clearance and defense
alveolar macrophages
lymphatic drainage
gas exchange
passive diffusion across the respiratory membrane
4 primary functions of musculoskeletal anatomy
support soft tissue,
protect internal organs,
provide nutrients and blood constituents,
serve as rigid levers for movement
axial skeleton
skull, vertebral column, sternum, ribs
appendicular skeleton
all other bones of upper and lower limbs
fibrous joint
bones are united by dense fibrous connective tissue
cartilaginous joint
bones are united by cartilage
synovial joint
fibrous articular capsule and an inner synovial membrane enclose a joint cavity filled up with synovial fluid
major joint motions and planes of motion
20
major movements of the upper extremities
22
major movements of the lower extremities
23
most common type of joint
synovial
AROM
voluntary degree of movement at a joint
PROM
degree of movement at a joint achieved by external means
three types of muscle
skeletal
cardiac
smooth
4 characteristics of all muscle tissue
irritability
contractility
extensibility
elasticity
irritability
ability to respond to stimuli
contractility
ability to develop tension
extensibility
ability to stretch or increase in length
elasticity
ability to return to its original length
twitch
single, brief muscle contraction caused by a single action potential traveling down a motor neuron
summation
addition of individual twitch contractions to increase the intensity of the overall muscle force
tetanus
maximal amount of force the motor unit can develop
type I slow twitch
low force production, fatigue resistant
aerobic metabolism
type IIa fast twitch
high force production, moderately fatigable both
ana and aerobic
type IIx fast twitch
high force production, quickly fatigable, anaerobic
muscle actions
isometric
concentric
eccentric
muscle roles
agonists
antagonists
synergists
isometric
muscle generates force without joint movement
concentric
muscle generates force and shortens
eccentric
muscle generates force and lengthens
biomechanics
the study of the motion and causes of motion of living things and the application of mechanical principles
impulse
the effect of force acting over time
kimematics
the branch of mechanics that describes motion
kinetics
the branch of mechanics that explains the causes of motion
force
linear effect that can be defined by push, pull or tendency to distort
3 types of motion
translation or linear
rotation or angular
general
translation or linear motion
force acting through the center of mass
rotation or angular motion
force with a line of action not acting through the object’s center of mass
general motion
combo of linear and angular motion
most common measurement of force
newtons
moment of force
torque
rotary effect of force
newton’s 1st law
law of intertia
newton’s 2nd law
law of acceleration
F=ma
newton’s 3rd law
law of action
3 fluid forces
buoyancy
lift
drag
buoyancy
supporting or flotation force of fluid
lift
acts at right angle to the relative flow
drag
acts in the same direction as the fluid flow and the opposite direction of the subject moving through the fluid
1st class lever
axis is situated between applied force and the resistance to the movement
seesaw,
2nd class lever
the applied force and resistance are on the same side of the axis with the resistance situated closer to the axis
wheelbarrow
3rd class lever
applied force and resistance are on the same side of the axis with the resistance being farther from the axis
shovel
acute mountain sickness
a sickness characterized by headaches, nausea, fatigue that is related to acute exposure to altitude
central fatigue
the progressive reduction in voluntary drive to motor neurons during exercise
cold stress
the loss in heat either from the core or locally that is brought on by environment, metabolism, and clothing
concentric
when muscle length decreases during muscle action
eccentric
when muscle length increases during muscle action
energy metabolism
the net effect of chemical reaction in the body resulting in ATP production
glycolysis
a series of chemical reactions for the conversion of glucose to pyruvate and the anaerobic production of ATP
heat stress
an increase in core temp collectively brought about by the environment, metabolism, and clothing
hemodynamics
the mechanics of blood flow
hypoxic ventilatory response
the increase in ventitlation seen with acute altitude exposure as a result of reduced barometric pressure and lowered arterial oxygen pressure
krebs cycle
a series of chemical reaction in the mitochondria in which citric acid is oxidized
maximal oxygen comsumption
the maximal volume of oxygen consumed per unit time VOmax is generally established in an incremental exercise test using a large amount of muscle mass in which in which a plateau of VO2 is attained or signs of maximal effort are attained
motor unit
a motor neuron an dthe muscle fibers it innervates
muscle fatigue
the loss of force or power output in response to voluntary effort leading to reduced performance
peak oxygen consumption
the greatest rate of oxygen consumption attained in a given test when indications of maximal effort were not or when the amount of muscle mass used was insufficient to reach a similar VO2, as attained during treadmill exercise
peripheral fatigue
the loss of force and power that is independent of neural drive
primary pollutant
a direct source of pollution
secondary pollutant
a pollutant formed when the interaction of a primary pollutant with an environment factor
size principle
the recruitment of motor units in order from smallest to largest according to recruitment thresholds and firing areas, resulting in a countdown of voluntary force
anaerobic phosphocreatine
phosphocreatine
no oxygen required
extremely limited ATP yeild
glycolysis
glycogen
no oxygen required
extremely limited ATP yeild
aerobic
krebs cycle and electron transport system
glycogen, fats, protein
yes oxygen required
large yield of ATP
shorter more intense
anaerobic
longer and less intesne
aerobic
glycolysis glucose substrate
2 ATP
glycolysis glycogen substrate
3 ATP
ATP
ATP (myosin ATPaseP to ADP+ Pi+ energy
CP
ADP+ CP(creatine kinase) to ATP + C
Glycolysis anaerobic
rapid, yeilds 2-3 ATP
glycolysis aerobic
slower, yeilds 38-39 ATP
oxidative phosphorylation
can use carbs, fats, and protein to produce large amounts of ATP
metabolic response to exercise
oxygen deficit
oxygen debt or EPOC
2 exceptions to steady state VO2
1 prolonged exercise in a hot and humid environment results in a steady drift upward of VO2 during the course of exercise
2 continuous exercise at a high relative workload results in a slow rise in VO2 across time similar to that observed during exercise in a hot environment
during prolonged low and moderate intensity exercise there is a gradual shift from
carbohydrate metabolism to use of fat as a substrate
EPOC
elevated postexercise oxygen consumption
what does heart rate do linearly with work and O2 uptake rates
increase
peak hr
220 - age +/- 10
stroke volume
EDV-ESV
cardiac output
HR*SV
EDV
end dystolic volume
ESV
end systolic volume
blood flow at rest
15-20% of CO delivered to skeletal muscles
blood flow during exercise
85-90% of CO delivered to skeletal muscle
how does blood pressure react to exercise
increases linerally
CO
cardiac output
ventilation
volume of air exchanged per minute
6 L * min^-1
avO2 at rest
5mL* dL^-1
avO2 peak exercise
15 mL*dL^-1
cardiovascular drift
progressive increase in HR with decrease in SV and MAP during steady state exercise
where do neuromuscular stimulus for contraction orginate
premotor and motor cortexes
DOMS
delayed onset muscle soreness
when does DOMS occur
24-48 hrs after intense resistance training and may last up to 10 days
what is DOMS
local muscular stiffness, tenderness, local edema, limited ROM caused by edema, pain
where is DOMS most pronounced
novice lifters
mechanism of DOMS
speculative, but Z disk damage is suspected
functional unit of neuromuscular system
motor unit
motor unit
motor neuron and muscle fibers it innervates
what does HR and BP do with dynamic training
increase
SV due to dynamic training
linear during concentric, increases during eccentric phase
CO due to dynamic training
may increase during both lift phases during higher intensity and larger muscle group movements
mechanisms of muscular fatigue during endurance exercise
glycogen depletion
Ca^2+ uptake by the SR vesicles
brain serotonin
glycogen depletion
higher intensity tends to burn greater percentage of glycogen than lower intensity
heat balance
heat generated=heat dissipated
sweat evaporative cooling
major cooling mechanism where vaporization of water from skin dissipates heat
how many liters of sweat to evaporate 350 W of excess heat
.5L
acclimation
physiological adjustment that occurs naturally in conjunction with repeated exposures to exercise in heat
what happens when you acclimate to heat
increased sweat rate, onset time and decreased sodium loss
reduced cardiovascular strain and lower core temp, occurs over 10-14j days
exertional heat cramps
painful muscle cramps, especially in abdominal or fatigued muscles
heat syncope
blurred vision
fainting
dehydration
fatigue, weakness, dru mouth, no early symptoms
exertional heat exhaustion
fatigue, weakness, blurred vision, dizziness, headache
exertional heat stroke
chills, restlessness, irritability
sole source of heat in cold conditions
metabolism
heat loss occurs primarily by
conduction and convection
hypothermia
chills, fatigue or drowsiness, pain in the extremities
frostbite
burning sensation at first coldness, numbness, tingling
frostnip, trench foot
possible itching or pain, severe pain, tingling, itching
hypoxic ventilary response
increased pulmonary ventilation
occurs above 1200m altitude
blood CO2 decreases
acute mountain sickness occurs
higher than 2500 m
high altitude pulmonary edema
progression in the severity of AMS
dyspnea fatigue, chest pain, tachycardia, coughing, cyanosis
primary pollutants
CO, sulfur oxides, nitrogen oxides, hydrocarbons, particulates
secondary pollutants
O3, aldehydes, sulfuric acid and peroxyacetyl nitrate
acceptable macronutrient distribution range
AMDR
represents range of intakes for a particular macronutrient associated with reduced risk of chronic diseases while providing adequate intake of essential nutrients
adequate intake
the recommended average daily intake level based on observed or experimentally determined approximations of nutrient intake by a group of apparently healthy people that are assumed to be adequate
antioxidants
dietary components present in small concentrations such as vitamin C and E, which prevent or reduce the extent of oxidative damage of cellular components such as DNA and cell membranes by scavenging free radicals
dietary reference intake
DRI
a set of reference values for specific nutrients that expands upon the former RDA, which includes the estimated average requirement, RDA, AI, and tolerable upper intake level
essential amino acids
amino acids required for maintaining proper growth and development that are not synthesized in the body and therefore must be consumed in the diet.
essential nutrient
refers to any nutrient, such as essential amino acids and fatty acids, necessary for normal body functions that is not synthesized in the body and must be consumed in the diet
estimated average requirement
average daily nutrient intake level estimated to meet the requirement for half of the healthy individuals of a particular sex or age
gluconeogenesis
endogenous production of new glucose from nonglucose carbonprecursors, such as amino acids, lactate, pyruvate, and glycerol, which occurs primarily in the liver and to a lesser extent the kidney
glycemic index
the rate at which ingestion of a food or food component, such as carbs, increases blood glucose in comparison to a reference food, white bread in particular
glycogenolysis
the breakdown of liver and muscle glycogen in response to elevated glucagon and epinephrine levels to produce either glucose in the liver that is able to be circulated throughout the body or glucose in skeletal muscle made available for energy production
glycolysis
the breakdown of glucose into two pyruvate molecules accompanied by the formation of adenosine triphosphate. the pyruvate can be converted to lactate or enter mitochondria for aerobic metabolilsm
macronutrients
organic energy- providing nutrients, which include carbs, fat, protein, and alcohol consumed in large quantities in the diet
micronutrient
organic and inorganic nutrients including vitamins and minerals, respectively which are consumed and/or required in much lower amounts in comparison to the macronutrients
nonessential amino acids
often referred to as dispensable amino acids, these amino acids are synthesized in the body and therefore not essential in the diet
recommended daily allowance
average daily dietary nutrient intake level sufficient to meet the nutrient requirement of nearly all healthy individuals of a particular gender and life stage
tolerable upper intake level
the highest average daily nutrient intake level not likely to pose an risk or adverse health affects to almost all individuals in the general population. the potential risk for adverse effects may increase as intake exceeds the UL
carb energy
4 per gram
protein energy
4 per gram
fat energy
9 per gram
alcohol energy
7 per gram
carbohydrates
simple
complex
fiber
where does dietary fiber come from
plant sources
are the health benefits of dietary fiber positive or negative
positive
RDI of dietary fiber for men and woman
men 25g/day
women 38g/day
water insoluble dietary fiber
derived from cell walls of plants
cellulose, hemicellulose, liginins
water insoluble dietary fiber
metabolized via bacterial fermintation in large intestine to gas and short-chain fatty acids, which can be absorbed,
digestion and absorption of carbs
broken down to monosaccharide in intestine and absorbed into blood and distributed to all tissues
carb metabolism
one glucose yeilds 38 ATP
glucagon
release upregulated by low blood glucose, stimulates gluconeogenesis and glycogenolysis in the liver to increase blood glucose
where is fat stored
adipose tissue
saturated fatty acid
all carbon bonded to hydrogen
unsaturated fatty acid
one (mono) or more (poly) carbon-carbon double bond
cis isomer
trans isomer
cis isomer
both hydrogen atoms on the same side of the double bond
trans isomer
hydrogen atoms on opposing sides of the double bond
essential fatty acids
required from diet for growth, healthy skin and producing elements for the immune system
cholesterol
waxy, fatlike substance and steroid formation
HDL
good cholesterol
LDL and VLDL
bad cholesterol
where is cholesterol produced
liver
how is cholesterol transproted
by blood as lipoproteins
Fat DRI
no RDA
AMDR for fat for total energy intake
20 to 35 %
AMDR for cab for total energy intake
50 to 65%
protein
unique because it contains Nitrogen
what is protein part of structural components
muscle, bone, tendons, and ligaments
4 functions of proteins
enzymes critical in energy producing reactions
hormones that regulate metabolism
transporters of other critical nutrients
energy source in energy deprived conditions
is animal or plant proteins more complete
animal
is alcohol recommend for exercise and athletics
no
6 functions of water balance
carry nutrients and waste products,
maintain the integrity of proteins and glycogen, participate in metabolic reactions,
provide a medium for nutrients,
maintain blood volume, blood pressure, and body temp,
act as a lubricant
AI for water
- 7 L/day for men
2. 7 L/day for women
anaerobic capacity
the ability of the anaerobic energy systems to produce energy during short-term maximal effort exercise
deconditioning
a partial or complete reversal of physiological adaptations to exercise resulting from a significant reduction of cessation of exercises
detraining
the process that occurs after the cessation of training in which adaptations to exercise are gradually reduced or lost
muscle atrophy
reduction in muscle size from disuse
sarcopenia
the loss of muscle mass that results from the aging process
functional capacity
throughout the lifespan, the ability to effectively perform extended (aerobic) and short term (anaerobic) work is notably related to fat free mass
functional capacity from early adulthood on
there is a general decline in physical work capacity, which is matched with a concurrent loss in FFM
what does relative VO2max
remains constant throughout childhood, but absolute is lower than adulthood due to less FFM
how much does VO2max decline in adulthood
1% anually
how is magnitude and timing of declined affected by
amount and intensity of physical activity
how does a sedentary state affect decline
doubles rate
what does exercise training do to decline
attenuates rate of decline
what is absolute and relative (to body mass) anaerobic power in children than in adults
anaerobic power is lower in children
when does anaerobic power plateaus
about age 35, then begins to decline
when does anerobic capacity in adults decline
to level of childhood by the age of 65
how can persons aged 60 to 70 increase peak power
high intensity training
what does maximal CO do in children
increase with growth
do boys or girls have a higher stroke volume
boys
what would resting SV and CO not decrease
in persons known to be free of arterial disease
heart rate
80-100 BPM is common in children
resting HR doesn’t change throughout adulthood
what happens to blood vessels with age
stiffen with age secondary to worn elastin and changes in collagenous properties in the arterial walls
what happens with thoracic wall compliance
decreases with age and ability to expand the chest cavity becomes limited
pulmonary system with age
decreased maximal expiratory flow and lung volume reserve
residual volume increases 30-35%, vital capacity decreases 40-50% by 70
during exertion increased ventilation is accomplished by increased breathing frequency
20% increase in the work of respiratory muscles
ventilation does not limit exercise capacity in adulthood
what is predetermined at birth
number and proportion of fiber types
what is type I fibers resistant to
atrophy until seventh decade
what do type II fibers do
atrophy sooner and type I proportions increases
sacropenia
loss of skeletal muscle mass common with aging
what does sacropenia cause
decreased fiber number and area, decreased motor unit size and recruitment, decreased innervation, decreased capillarization, decreased protein synthesis and growth factor alterations
effects of sacropenia
decreased force production capacity and loss of neural function
what helps attenuate losses with sacropenia
both resistance and aerobic exercise
bone during age
continuously changing, osteoclastic and osteoblastic activity due to genetics and loading
bone childhood
epiphysis not yet connected to bone
senescene
osteoblastic> osteoclastic = bone loss
joint ROM age
typically decreases with aging due to decreased tendon and ligament elasticity
how to help maintain and/or increase flexibility throughout adulthood
exercise training and ROM exercise
nervous system with aging
hearing and vision deficits, decreases coordination and increases fall risk
when does immune system activity peak
around puberty
what does immune system decrease
loss of suppressor T cell function
inability to fight pathogens
increased incidence of tumors and autoimmune disorders
renal function with aging
declines up to 50%
total body water declines 10-50% with aging
decreased skin blood flow, which may contribute to a reduced ability to thermoregulate
children sweat rate
lower and rely more on radiation and convection for heat dissipation
impact of deconditioning
exercise cessation led to loss of previous exercise induced increases in BMD in postmenoupausal women
decreased activity of middle age persons decreased travecular BMD
effects on bone due to deconditioning
prolonged inactivity increases resporption of calcium from bone
effects on bone dure to deconditioning
decreased 1-2% per month typical in response to weightlessness,
implications of bone loss
bone mass restoration is outspaced by muscle strength, practitioners must be careful not to induce fracture by overly aggressive exercise programs
skeletal muscle impact of deconditioning
atrophy
degree of atrophy
during the first few weeks in linearly related to duration and extent of unloading
when is atrophy most severe
in muscles involved in weight bearing and postural control
what types of muscle is most severely affected by atrophy
extensors
skeletal muscle metabolic consequences due to deconditioning
decreased mitochondrial content
unloading compromises absolute muscular endurance
strength and muscular endurance on skeletal muscle due to deconditioning
strength decreases,
magnitude of strength decreases, weight bearing muscles most affected
nueromuscular consequences on skeletal muscle due to deconditioning
ability to recruit high threshold motor units also decrease
greater relative decrease in strength than in size
submaximal loads that were once easily borne require more absolute muscle involvement
vulnerability of muscle damage in skeletal muscle due to deconditioning
unloading for 5 weeks increases vulnerability to eccentric exercise induced dysfunction and muscle injury
myocardial infraction
The death of myocardial tissue resulting from prolonged ischemia
angina pectoris
Chest pain or discomfort that is caused by myocardial is ischemia
cardiovascular disease
Class pf diseases that affect the heart or circulatory system
ischemia
a lack of blood flow relative to tissue needs
morbidity
The rate of incidents of a particular disease
mortality
the number of deaths in a given time or place
peripheral arterial disease
Condition in which blood flow through noncoronary arterial beds is impaired
sudden cardiac arrest
An unexpected death that is results from the abrupt loss of heart function and that occurs within one hour of the onset of symptoms
thrombus
A blood clot that may cause a vascular obstruction
What is cardiovascular disease
a major public health burden
estimated 17.1 million worldwide deaths per year
underlying cause of 33.6 percent of all US deaths in 2007
atherosclerosis
an active process involving molecular signals that produce altered cellular behavior as well as endothelial dysfunction and a subsequent inflammatory response and lipid deposition
when can initial endothelial lining injury occur
early in life CO or other toxins from smoking hypertension LDL-C Homocysteine
hypertension
SBP > 140 or DBP > 90 or taking anihypertensive meds
increased restriction of peripheral arteries, decreased blood flow and increased workload of heart
Coronary heart disease
advanced atheroslerotic progression in one or more coronary arteries
single largest killer of Americans one of 6 deaths
What is angina pectoris
Pain from myocardial ischemia, substernal pressure, heaviness, or burning sometimes accompanied by dyspnea
Heart failure
impaired ability have one or both ventricles to fill with or eject blood
symptoms of heart failure
Dyspnea, fatigue, exercise intolerance, and fluid retention
Causes of heart failure
cardiomyopathies, CHD, MI, HTN, smoking, obesity, high cholesterol, diabetes
Cardiac remodeling
valvular leakage
elevated catecholamines, aldosterone, and angiotensin II
Stages of heart failure
A- at high risk for HF without structural heart disease or symptoms a HF
B- structural heart disease but without signs are symptoms of HF
C- scherschel heart disease with prior or current symptoms of HF
D- refractoy HF requiring specialized intervention
stroke
The loss of brain function subsequent to the interuption of blood flow caused my hemorrhage or obstruction
symptoms of stroke
hemiplegia, altered coordination, vertigo, memory loss, problems with speech and vision and behavioral changes
Transient ischemic attack
have neurological symptoms that last more than 24 hours and are predictive of stroke
Prevention strategies for strokes
modifying CVD risk factors: dislipedema, hypertension, obesity, smoking, and physical activity
peripheral arterial disease
It hit it blood flow through non coronary arterial beds
What arteries are typically affected by PAD
femoral, popliteal, tbial, iliac, abdominal aorta, renal, mesenteric arteries
Classic symptoms of intermittent claudication
Leg pain that predictably follows physical exertion is relieved by rest
Fontaine’s classification of PAD
I- asymtomatic IIa- mild claudication IIb- moderate to severe claudication III- ischemic rest pain IV- ulceration or gangrene
Surgical treatments for cardiovascular disease
coronary or femoral/ popliteal bypass graft
CA risk factors
Nonmodifiable: age and family history
modifiable: Smoking, sedentary lifestyle, obesity, hypertension, dyslipidemia, and impaired fasting glucose
Smoking with CA
contain several 1000 chemicals in at least 40 carcinogens
contributes the initiation in progression of atherosclerosis, damage endothelial cells, leads to acute increases in blood pressure, and increases platelet aggregation
complete cessation is the goal
Dyslipidemia
NCEP recent recommendation
LDL- C < 100mg/ dL if triglycerides are > 200 mg/dL, and all non- HDL-c should be < 130 mg/dL
what is mandatory for those with CHD
statin medications
sedentary lifestyle
many positive effects of regular exercise on CAD
a minimum of 30 min of moderate intensity exercise for 5 days a week
two or more days per week of resistance training
What is a major independent risk factor for CVD
obesity
impaired fasting glucose
Chronic hyperglycemia
chronic hyperglycaemia
Associated with accelerated atherosclerosis/ lesion formation
promotes monocyte recruitment in adherence to the endothelial monolayer by stimulating expression of endothelial adhesion molecules
related to advanced atherosclerotic plaques and clinical outcome
antiplatelet medication
CAD
asprin and clopidogrel interfere with platelet activation and or aggregation
anticoagulants
CAD
warfarin and herarin interfere with the coagulation cascade
antianginals
CAD
nitroglycerin increases vasodilation and blood flow
antihypertensives
CAD
diuretics
furosemide, thiazides, amiloride
β-blockers
CAD
atenolol, propranolol, metoprolol
calcium channel blockers
CAD
diltiazam, verpamil
angiotensin- converting enzyme inhibitors
CAD
enalapril, ramipril, lisinopril
angiotensin receptor blockers
CAD
irbesartan, losartan, valsartan
antihypercholesterolemics
simvastatin, lovastatin, atorvastatin
cholestryramine
gemfibbrozil, fenofibrate
niacin
pathophysiology of healing myocardium
4-6 h post MI- acute ischemia
6 h - 7d post MI- inflammation and necrosis
>7 d post MI- collagen deposition rapidly increases
assumption of risk
waiver
an agreement by a client, provided before beginning participation to give up, relinquish, and waive the participant’s rights to legal remedy in the event of injury, even when such injury arises as a result of a provider’s ordinary negligence
informed consent
a process that entails conveying info to a client so that the client achieves an understanding about the options to choose to participate in a procedure, test, service, or program
negligence
a failure to conform one’s conduct to a generally accepted standard or duty
risk management
an initial and ongoing process to identify relevant risks associated with the delivery of a service and then, through the application of various techniques to eliminate, reduce, or transfer those risks through the implementation of operations strategies to the program activities designed to benefit the clients and programs
contract law
defines and governs the undertakings that may be specified among individuals
contract
promise or performance bargained for and given in exchange for another promise or performance, all which is supported by adequate consideration
what is informed consent intended to ensure
that the client entered in to the procedure with adequate knowledge of the relevant material risks, any alternative procedures that might satisfy certain objectives, and the benefits associated with that activity
how can consent be expressed
written or implied by law simply a function of how the two parties to the procedure conducted themselves
who can give informed consent
be of legal age, not be mentally incapacitated, know and fully understand the importance and relevance of the material risks and benefits, and given consent voluntarily and not under any mistake of fact or duress
tort law
simply a civil wrong
most tort claims on exercise professionals are
based on allegations of negligence or malpractice causing personal injury or death
negligence
failure to conform one’s conduct to a generally accepted standard or duty
validity of negligence
defendeant owed a duty
one or more failures occurred
injury or damage is attributable to an established act or failure to perform
whether exercise professional provided service in accordance with so called standard of care
malpractice
generally involve claims against professionals who have been provided with public authority to practice for alleged breaches of professional duties and responsibilities toward patients or other persons to whom they owed a particular standard of care or duty.
defense to negligence or malpractice
proper conduct of the informed consent
proof of negligence committed by participant
liability insurance to protect against financial loss
standards of practice
express how contemporary services should be delivered to give reasonable assurance that desired outcomes will be achieved in a safe manner
developed and periodically revised
unauthorized practice of medicine
stimulated a variety of initiatives to clarify roles and responsibilities, promote professionalism, and increase professional opportunities for exercise professionals
What is the most common method of prescreening whole process
Standardized forms
Limitations of pre participation screening for
Cannot cover all situations Some forms (PAR-Q) can only identify those who are at high risk Most do not make recommendations based on intensity of the proposed exercise program
4 Purposes of pre participation health screening
Identifying and exclude individuals with medical contradictions to exercise
Identify individuals who should undergo a medical evaluation and exercise testing before starting an exercise program because of increased stress for disease as a result of age, symptoms, or risk factor
Identify persons with clinically significant disease who should participate in medically supervised exercised programs
Identify individuals with other special needs
Medical screening examination
Can range in complexity from a simple clinical examination to extensive diagnostic testing depending on age, medical history, risk factors, and symptoms
Components of detailed medical history
Previous diagnosis, especially cardiac\vascular
Risk factors
Past and current skeletal and muscular injuries
Medications
Current symptoms
thorough physical exam
assessment of cardiovascular, respiratory, and skeletal muscle symptoms BP, HR, auscultation of heart and lungs height, weight joint mobility, ROM, strength balance test foot exam
why would further medical testing be ordered
hx, exam, and published recommendations indicate
medical conditions that complicate the exercise prescription
cardiovascular disease hypertension chronic obstructive pulmonary disease diabetes mellitus elderly individuals arthritis
cardiovascular disease exercise prescription
must be done with MD approval and input
start slowly and gradually increase intensity and duration
goal 30-60 min of daily moderate intensity aerobic exercise
osteoporosis
hypertension exercise prescription
high risk
silent killer
chronic obstructive pulmonary disease
long term illnesses of the respiratory system
chronic obstructive pulmonary disease exercise prescription
exercise is an imporant part of rehab
increase indurance, decrease dypnea
physician approval to start
diabetes mellitus exercise prescription
high risk
must have physician clearance
elderly individuals exercise prescription
physician clearance
extended build up period of intensity and duration
arthritis exercise prescription
decrease pain and stiffness
increase flexibility, muscle strength, cardiac fitness, and endurance
osteoporosis exercise prescription
weight bearing exercise and resistance training can help prevent and treat
need physician approval
special safety considerations for resistance training
moderate to risk patients with cardiac disease
low to moderate risk patients with cardiac risk disease
moderate to risk patients with cardiac disease
safety of resistance testing and training requires additional study
low to moderate risk patients with cardiac risk disease
first participate in a traditional aerobic exercise program for a min of 5 weeks
