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applied exercise science > week 1 > Flashcards

week 1 Flashcards

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1
Q

COVID and decreased physical activity

A
  • significant decreases observed in all types of physical activity across all age groups
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2
Q

physical activity in hospital and SNF

A
  • upright (standing/walking) in hospital: 5%
  • 12% of time in SNF
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3
Q

barriers for implementation of optimal practice patterns

A
  • reimbursement-based vs evidence-based practice
  • limited incentives for high-quality transitional care (few ACOs)
  • fear of adverse events, penalties, or litigation
  • current emphasis is on returning patients to PLOF (often low)
  • lack of awareness of more effective clinical care strategies
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4
Q

reimbursement-based practice

A
  • acute care
  • SNF - prior state (PPS)
  • SNF - current state (PDPM)
  • home health care - current state (PDGM)
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5
Q

limited incentives for high-quality transitional care

A
  • historically very limited coordination of care across settings (hospital -> SNF -> home health)
  • changes that have prioritized transitional care:
  • improving medicare post-acute care transformation (IMPACT) act
  • accountable care organizations
  • bundled care
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6
Q

fear of litigation

A
  • practice of “negative defensive medicine” prevalent in many settings, especially older adults
  • mobility is often avoided by nursing and CNAs because it is unnecessary fall risk
  • “do no harm principle” too extreme?
  • falls more quantifiable and more closely tied to financial penalties and are more likely to result in “fault” than deconditioning
  • so we avoid supervised and unsupervised mobility to decrease risk of falls – at risk of deconditioning
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7
Q

threshold of independence

current emphasis on returning patients to PLOF

A
  • independently standing from chair
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8
Q

lack of awareness of more effective clinical care strategies

A
  • safe dosage of exercise for medically complex patients
  • high-intensity is necessary but perceived as unsafe
  • older adults underdosed
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9
Q

updating practice patterns for older adults following hospitalization

A
  • shift from conservative, low-intensity interventions –> high-intensity interventions
  • based on American college of sports medicine (ACSM) guidelines and the american geriatrics society (AGS)
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10
Q

high-intensity prescription

A
  • achieving muscle overload
  • providing a stronger and different stimulus every time
  • objectively assessing progression daily
  • creating conditions for safe physiological adaptation
  • high resistance with low reps: T2 fibers, power, strength, hypertrophy
  • low resistance with high reps: T1, postural endurance
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11
Q

improving the lives of older adults - bottom line

A
  • high-intensity rehabilitation has the potential to improve physical function across all settings
  • greater function, greater independence, less risk – better lives
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12
Q

anaerobic metabolism

A
  • does not require oxygen
  • utilizes only carbohydrate (glucose)
  • occurs in the cytoplasm of the cell
  • by-product is lactic acid
  • yields net 2 ATPs per molecule of glucose
  • less efficient
  • types of cells: connective tissue cell (bone, cartilage, RBCs - no mitochondria), skeletal muscle (fast twitch fibers)
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13
Q

aerobic metabolism

A
  • requires oxygen
  • utilizes carbohydrates, fats, and proteins
  • occurs in the mitochondria
  • by-products: water and CO2
  • yields 36 ATPs per molecules of glucose
  • more efficient
  • types of cells: heart, CNS/PNS, skeletal muscle (slow twitch fibers)
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14
Q

comparing anaerobic and aerobic metabolism

A
  • anaerobic: 2 ATP/molecule of glucose
  • aerobic: 36 ATP/molecule of glucose
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15
Q

endurance - major factors

A
  • oxygen consumption
  • VO2 max: max capacity of a person’s body to transport and use O2 during incremental exercise - reflects physical fitness
  • maximal
  • peak
  • variation
  • 4-6% in persons with no known impairments
  • 6-10% in persons with CP impairments
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16
Q

endurance or aerobic capacity testing

A
  • evaluation of a person while performing work
  • gold standard - oxygen consumption (VO2)
  • ways to measure
  • VO2 = CO x a-v O2 difference
  • VO2 = volume of O2 entering lungs minus volume leaving lungs (used more often)
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17
Q

anaerobic threshold (AT)

A
  • point at which you are no longer capable of performing work solely aerobically (start to perform anaerobically so build up of lactic acid)
  • usually about 55% of max VO2
  • with training increases (>55%)
  • with detraining decreases (<55%)
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18
Q

relationship of VO2 to METs

A
  • 1 MET = requirement of O2 of tissue of body at rest
  • 1 MET = 3.5 mLO2/Kg x min
  • with activity VO2 increases and therefore METs increase
  • any activity that burns 3-6 METs is considered moderate-intensity physical activity
  • any activity that burns > 6 METs is considered vigorous-intensity physical activity
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19
Q

factors affecting peak VO2

A
  • age
  • sex (men > women)
  • genetics (muscle fibers type)
  • body composition (fat:muscle)
  • endurance training
  • various diseases that affect oxygen transport
  • VO2 improves with training
  • loss of muscle mass contributes to age-related VO2 changes
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20
Q

oxygen consumption and disability

A
  • social security administration uses the criteria that < 18 mL/kgxmin (5 METs) is considered disabled – or struggles functioning independently
  • 18-20 range important for independence
21
Q

before exercise capacity testing

A
  • prelim screen
  • history
  • lab values
  • resting measurements - BP and HR
  • physical exam
22
Q

risks of exercise testing

A
  • muscle soreness
  • diaphoresis
  • SOB
  • angina
  • MI
  • stroke
  • death
23
Q

risks and exercise testing

A
  • for persons with CAD, risk of complications like MI or death are 60-100 times greater during exercise testing than in usual activity
  • actual risk of death is very low (0.5/10,000) due to appropriate screening and adherence to methods of conducting tests
24
Q

sub-maximal test

A
  • low level graded exercise test (LLGXT)
  • field testing - time, distance
  • other - walk, bike, activity
25
Q

standardized procedures for exercise testing

A
  • explanation of procedure
  • avoid maximal activity for 24 hours prior
  • avoid for 2-3 hours prior: large meal, nicotine, caffeine (unless it’s part of their normal routine)
  • repeat submax test if possible
26
Q

general guidelines for submax testing

A
  • warm up: 2-3 minutes
  • measure HR, BP, RPE at regular intervals
  • end of each stage or every minute
  • if HR does not reach steady state during the stage, extend stage 1 minute
  • increase intensity in 0.5-2 MET increments
  • closely observe for signs/symptoms
  • cool-down: low intensity for > 4 minutes
  • continue measuring HR, BP, RPE
27
Q

submax test assumptions

A
  1. a steady-state HR is obtained for each exercise work rate (plateau HR in each stage)
  2. a mx HR for a given age is uniform (220-age)
  3. mechanical efficiency (VO2 at a given work rate) is the same for everyone
  4. there is a linear relationship between HR and workload
  5. HR will vary depending on fitness level between subjects at any given workload

submax testing underestimates VO2 max in untrained and overestimates tra

28
Q

advantages of submax testing

A
  1. safer - not true max
  2. controlled pace - motivation not a factor
  3. not population specific - no pacing advantage
  4. quick assessment - faster
  5. cost effective
  6. do not need highly trained personnel
  7. can do mass testing
  8. no physician supervision required - if symptom and disease free
29
Q

disadvantages of submax testing

A
  1. VO2 max not directly measured: error rate of 10-20%
  2. not a measure of true max HR
30
Q

max testing advantages and disadvantages

A
  • advantages: accuracy
  • disadvantages: health risk potential, time, expense (metabolic cart), personnel (MD supervision)
31
Q

symptom limited graded exercise tests

endurance/aerobic capacity testing

A
  • treadmill: Bruce, modified Bruce, balke, naughton
  • cycle ergometer: for balance disorders, obesity, MSK problems
  • arm ergometry
  • air-dyne
32
Q

short physical performance battery

A
  • predictive: VO2, aerobic capacity (Bruce) - measure ADLs and functoin
  • static balance
  • gait speed
  • 5x sit to stand
33
Q

possible cardiovascular contraindications

A
  • recent MI: 3-6 weeks
  • pulmonary embolism or pulmonary infarction < 6 weeks
  • if recent DVT detected and pt is on anti-coagulation therapy, then withhold high-intensity training on that limb
  • myocarditis endocarditis, pericarditis
  • recent cerebral shunting or aneurysm coil
  • RHR < 50 or > 100 BPM
  • unstable angina - occurs at rest and medication does not relieve
  • severe pulmonary hypertension
  • severe and symptomatic aortic or valvular stenosis
  • fistula on UE for dialysis - no HIRT on involved limb
  • uncontrolled hypertension (200-220 is upper limit SBP)
  • decompensated CHF
  • absent pulses in limbs
  • suspected or known dissecting aneurysm
34
Q

retinopathy and HIRT

A
  • avoid increase in BP to avoid progressing retinopathy
  • want to be careful, keep BP < 170
35
Q

cancer: possible contraindications

A
  • bone metastasis - concern for pathological fractures
  • tumors in targeted strength training area
  • medication effects
  • side effects of cancer meds: osteoporosis, change in HR, anemia, neuropathy - balance, fatigue, hypoglycemia
36
Q

MSK: possible contraindications

A
  • recent fractures < 6 weeks - can do other limbs
  • unstable fractures: no HIRT on involved
  • osteomyelitis: no HIRT on involved
  • avascular necrosis: no HIRT on involved
  • wounds with exposed tendon or muscle on involved joint
  • compression fractures - precautions: encourage neutral alignment of joint, more isolated and open chain movements
  • WB restrictions with graft or fractures sites: open chain, isometrics only
  • marfan syndrome: connective tissue disorder
37
Q

surgical precautions: possible contraindications

A
  • craniotomy < 6 weeks: no bending over, no lifting > 10 pounds, no valsalva
  • abdominal precautions < 6 weeks: no sit ups/crunches, no valsalva, no lifting > 10 lbs (can bike, STS)
  • sternal precautions < 8 weeks: no UE high intensity, no valsalva, no lifting > 10 lbs
38
Q

other medical conditions: possible contraindications

A
  • acute infection: HR already high, let body heal itself
  • chronic infectious disease: mononucleosis, hepatitis, AIDS
  • steroids: side effects of HTN, immunosuppression, osteoporosis, muscle weakness and myopathy, thin skin and poor wound healing
  • beta-blockers: side effects of hypotension, bradycardia, drowsiness
39
Q

FITT principles

A
  • frequency
  • intensity
  • time (duration)
  • type
40
Q

tissue adaptation: dose response

A
  • intensity adequate for overload to MSK or CP systems to induce adaptations
41
Q

what does high-intensity strengthening do

A
  • improve LE strength
  • improves physical function
  • improves strength, cognitive function, and ADLs
42
Q

neuromuscular adaptations account for

A
  • neuromuscular adaptations account for 10-15% strength gains per week
43
Q

intensity prescription

A
  • failure is defined as the inability to complete the final rep through full available ROM without significant compensation
44
Q

signs of failure

A
  • sudden increase in speed to overcome resistance
  • improper form/significant compensation
  • requires one level increase in level of assist
45
Q

resistance training exercise prescription

A
  • frequency: 2-3x/week
  • intensity: start 40-60% and progress to 70-80%
  • time: 6-8 weeks (for hypertrophy)
  • type: strength (free weights, body weight) and functional training (sit to stand, floor transfers)
46
Q

patient education on DOMS

A
  • peaks in 72 hours
  • monitor ability to complete daily activities
  • you may feel pain most when you: touch the muscle, try to massage the muscle, stretch the muscle, use the muscle
  • you should not feel pain when you rest
47
Q

high intensity principles can also be used for

A
  • transfers
  • ADLs
  • balance and gait activities
  • therapeutic exercise/strengthening
48
Q

aerobic training exercise prescription

A
  • frequency: 3-5x/week
  • intensity: start 40-60% and progress to 70-80%
  • time: 150 minutes/week
  • type: treadmill, ground walking, stationary bike
49
Q

parameters to monitor

A
  • O2 saturation
  • blood pressure
  • heart rate
  • dyspnea scale
  • claudication scale

applied exercise science (7 decks)

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