week 3 Flashcards
1
Q
function of lungs
A
- ventilation - transport O2 to alveoli and transport CO2 from tissues to atmosphere
2
Q
respiratory tree
A
3
Q
ventilation =
A
- ventilation = TV x RR
- (tidal volume x respiratory rate)
- TV and RR increase with activity
4
Q
changes in titdal volume with increase VE
A
- TV increase at expense of inspiratory reserve volume (IRV) and expiratory reserve volume (ERV)
5
Q
chronic obstructive pulmonary disease (COPD)
A
- major types - affect 21 million in US
- 3 million emphysema
- 11 million chronic bronchitis
- 4th leading cause of death
6
Q
chronic bronchitis
A
- over production of mucus causes an occlusion of airways - makes O2 exchange difficult
- blue bloaters - shutdown of systems not oxygenated, skin takes on blue tint
7
Q
emphysema
A
- pink puffers - O2 sats higher than chronic bronchitis
- destruction of elastic fibers in lungs
- after expiration, fibers and alveoli unable to bound back - barrel chest
- inhibition of alpha 1-antitrypsin leads to destruction of elastic fibers surrounding alveoli
- mostly due to long term smoking - damaged airways (80-90%)
- some hereditary parts
8
Q
signs/symptoms of COPD
A
- shortness of breath
- dyspnea on exertion
- orthopnea (only able to breathe in upright position)
- wheezing
- increased RR
- peripheral cyanosis
- digital clubbing
- pursed-lip breathing
- malaise
- chronic cough
- barrel chest
- weight loss
- use of accessory muscles of respiration
- prolonged expiratory period (with grunting)
- decreased FEV1/FVC ratio - due to blockage, decreased ability to forcefully expel air quickly as proportion to total lung capacity
- anxiety/depression
9
Q
how PTs assess lung function
A
- O2 saturation
- cyanosis
- pulmonary function tests (FVC, FEV1, FEV1/FVC)
pulmonary function tests differential for lung function
10
Q
how PTs assess lung function
A
- O2 saturation
- cyanosis
- pulmonary function tests (FVC, FEV1, FEV1/FVC)
pulmonary function tests differential for lung function
11
Q
exercise in COPD
A
- obstructive disease impedes lung emptying (requires more time)
- increased breathing leads to hyperinflation and small tidal volumes
- impairment of gas exchange
- decreased efficiency
12
Q
pulmonary function test criteria for determination of pulmonary degree of impairement in patients with COPD
A
13
Q
effects of exercise training for COPD
A
- CV reconditioning
- desensitazation to dyspnea
- improved ventilatory efficiency
- increased muscle strength
- improved flexibility
- improved body composition
- better balance
- enhanced body image
14
Q
restrictive lung diseases
A
- diminished lung volumes
- etiologies
- neuromuscular disorders (DMD, ALS, guillian barre, SC disorders) - not muscle to support lung function
- chest wall disorders: kyphoscoliosis, ankylosing spondylitis, obesity, compression fractures
- pleural disorders: fibrosis, effusion
15
Q
some pathologies/conditions affecting the pulmonary circulation
A
- body position
- stenosis or incompetence of heart valves
- congestive heart failure (CHF)
- pulmonary congestion/edema: edema backs up into lungs due to pressure and interferes with O2 transfer
- pulmonary embolus
16
Q
supplemental O2
A
- if oxygen saturation is < 88%, then oxygen supplementation is necessary to improve survival and cognition
- less clear on O2 need with exercise
- do know that patients need exercise to improve functional capacities, even if O2 drops some - greater support for allowing O2 to drop transiently for short periods to achieve exercise benefits
17
Q
patient is in bed and might need to use the bathroom soon, just not right now. how can you start HI strength training while patient is still in room
A
- bed mobility
- STS
18
Q
patient has poor safety awareness but is able to STS without UE support. how do you integrate safety and education while challenging to failure during STS exercise?
A
- slow down
- use UE support
19
Q
patient is “too tired” and keeps requesting breaks
A
- coordinate with OT
- limite to 1 minute break between sets
- combo - mix in squats while walking
- add in patient ed
20
Q
patient with knee OA has trouble with standing exercises. how can you integrate HI strength during session?
A
- more open chain activities
- assist in concentric phase (eccentric usually less painful)
- smaller ROM STS
- patient ed
- intervals/circuits
21
Q
patient “too old and tired for this”
A
- switch exercises between sets
- pt ed and pt goals - never too old to get stronger, data
- family involvement
22
Q
muscle strength vs power
A
- strength: amount of force a muscle or group of muscles can generate at a given velocity
- power: amount of work a muscle or groups of muscles can produce per unit of time
23
Q
force vs velocity relationships
A
as you increase speed, you reduce force
24
Q
contributions to muscle power
A
- maximal rate of force development (RFD)
- force production at slow and fast contraction velocities
- stretch shortening cycle performance (efficiency)
- coordination of movement pattern and skill
25
Q
power =
A
- power = force and velocity
- force: heavy resistance training with slow velocities - increases max force production
- velocity: power training, light to mod loads at high velocities - increases force output at higher velocities
26
Q
training parameters for power development
A
- traditional strength training
- general recommendations: multi-joint, 0-60% 1 RM LE, 30-60% 1 RM UE, 3-6 reps (not failure), 1-3 sets
- advanced training: heavy loading, 85-100% 1 RM, 1-6 reps, 3-6 sets
- advanced training: fast contraction velocity, 0-60% load 1 RM LE, 30-60% 1 RM UE, performed at fast contraction velocity, 1-6 reps, 3-6 sets
- rest 1-2 minutes, 2-3 ih HI
27
Q
low load (40% 1 RM) power training and high load (70% 1 RM) power training are [ ] for muscle power/functional performance
A
- equivocal
- BUT higher loads superior for maximal strength and endurance
- low loads for postural control/balance
- choice of low vs high load depends on: patient preference, task specificity, direction
28
Q
muscle power in adults
A
- loss of muscle cross-sectional area with age: sarcopenia and weakness
- greater and faster loss of type II muscle fibers
29
Q
why train muscle power
A
- muscle power declines faster than muscle strength in older adults
- deficit is early predictor of functional decline
- asymmetrical differences in muscle power strongly predict fallers vs non fallers
- functional connections
- power training = slightly larger gains in physical function and muscle power than traiditional resistance training in highly controlled trials
30
Q
power training examples
A
31
Q
training specificity
A
- specificity: train at the speed you want to improve
- loaded jump squats with 30% of 1RM have been shown to increase vertical jump performance more than traditional back squats and plyometrics
- lower limb muscle power at 40% 1RM has a greater relationship to gait speed than power at 70% of 1 RM
32
Q
joint specificity and power training
A
- knee extensors very responsive to speed-specific training
- knee flexors not as receptive
- ankle dorsiflexors have similar increases in power during both high-speed and low-speed training
- plantar flexors respond better to low speeds
33
Q
measuring power
A
- isokinetic dynamometry
- functional tests
- expressed in units equivalent to work/time
34
Q
equipment for power training
A
35
Q
safety for power training
A
- may require more easing into protocols
- similar precautions/contraindications to HI strengthening
- monitor vital signs and response
36
Q
high-intensity aerobic training
and karvonen
A
- 60s all out (75-85% MHR) with 30-60s rest (active recovery preferred) x 20 minutes
- karvonen if patient on beta blockers: MHR = 164 - (0.7 x age)
- want 6-8 modified borg for high intensity, 14-16
- shorter rest is better
37
Q
examples of HIIT aerobic trianing
A
38
Q
importance of rest period
A
- mitigate fatigue
- improve CV safety
- critical power: lactate threshold (75-85% MHR) not sustainable
- active recovery preferred
39
Q
HIIT benefits
A
- reduce subcutaneous fat/total body mass
- improve VO2 max
- improve insulin sensitivity
- improved endothelial function
- decrease LDLs/vLDLs, increase HDLs
- decrease BP
- decrease risk CV event
- decreasing barriers to exercise: shorter time commitment
40
Q
HIIT vs moderate intensity continuous exercise (MICT)
A
41
Q
physiology of HIIT
A
- high level of T2 muscle fiber recruitment
- enhanced mitochondrial enzyme expression
- decrease rate glycogen utilizaiton, increase resting glycogen content
- decrease lactate production
- increase glucose transporter
- increase lipid oxidation (reduction in lipid droplets in T2 muscle fibers)
42
Q
CV/HIIT exercise and the brain
A
- angiogenesis, neurogenesis, synaptic plasticity
- improved and efficient cerebral perfusion/metabolism
- maintenance/improvement cognitive, corticomotor activation, increased BDNF
43
Q
benefits with HIIT
A
- 12-week HIIT protocol vs usual care (pulm rehab program: improved VO2, improved quad strength, improved daily step count, decreased time in sedentary activities, improved HR-QoL
- CVA: improved ventilatory threshold, O2 utilizaiton, gait speed, stride length
44
Q
costs of HIIT
A
- HIIT not as helpful as strengthening, balance, and coordination for reducing fall risk
- transient increase in fall risk (between 10-29 minutes) following session
45
Q
safety and HIIT
A
- among individuals with CAD, MI, and HR, there have been 2 nonfatal cardiac arrests in more than 46,000 hours of HIIT
- may need to ease into protocol starting with moderate exercise
- hypotension
- may need ECG exercise testing prior to participation
- check vitals, signs of dehydration, ask about nutrition
- rest after
46
Q
precautions and contraindications for HIIT
A
47
Q
peripheral circulation roles
A
- transport blood to the body
- transport O2 to the tissues
- transport O2 from the tissues to the lungs, to atmonsphere
48
Q
arteries
A
- transport blood to tissue
- more elasti: made of elastic fibers and smooth muscles
- tunia externa/adventitia: attaches arterty to surrounding tissue, dense tissue near tunica media but looser closer to periphery of vessel
- tunica media: smooth muscle, support for vessel and controls diameter to regulate blood flow and BP
- tunica intima: simple squamous epithelium, surrounded by connective tissue, basement membrane with elastic fibers
49
Q
veins
A
- transport blood from tissue
- have same 3 layers as arteries but with less connective tissue and smooth muscle
- makes walls of veins thinner - related to lower BP in veins
- also lets veins hold more blood - almost 70% of blood in veins at one time
- medium and large veins have valves like semilunar valves of heart - prevent retrograde flow, especially in arms and legs
50
Q
blood flow to exercising muscles
A
- brings: oxygen, nutrients (glucose and FFA)
- removes: CO2, lactic acid, leads to heat dissipation
51
Q
oxygen hemoglobin dissociation curve
how tightly O2 is bound to Hgb
A
- shift right due to increased temperature or decreased pH - leads to decreased affinity of O2 bound to Hgb, leading to greater O2 release
52
Q
pathologies affecting transport of O2 in the vasculature
A
- peripheral vascular disease (PVD) AKA peripheral arterial disease (PAD) affects 12-20% of Americans age 65 and older
53
Q
claudication scale
A
- measure clinical impact of PAD/PVD
- grading discomfort of physical activity
54
Q
arterial-brachial index
A
- measures degree of atherosclerotic plaque formation resulting in occlusion/decreased blood flow in LEs due to PAD/PVD
- ABI is measured by placing patient in supine for 5 minutes
- systolic BP measured in both arms - higher value is used as denominator of ABI
- systolic BP then measured in dorsalis pedis and posterior tibial arteries by placing cuff above the anking - using a doppler ultrasound
55
Q
ABI measuring
A
- difference should be < 10 mmHg between arms
- significant difference represents stenosis
56
Q
DVT vs PAD pain
A
- DVT - painful at rest
- PAD - painful with activity
57
Q
how do PTs assess vasculature
A
- signs
- pulse
- skin color, nail and hair growth
- venous engorgement
- ulceration
- ABI segmental blood pressures (for arterial assessment)
- symptoms
- claudication
- lightheadedness
58
Q
walking speed indicators
A
- predictive of health and disease
- evaluative of abnormal gait speed
- simple and feasible for normative data and meaningful change
59
Q
normal walking speed changes
A
60
Q
red flag walking speed is
A
- < 0.6 m/s
61
Q
yellow flag walking speed is
A
- 0.6-1.0 m/s
62
Q
green flag walking speed is
A
- > 1.0 m/s
63
Q
walking speeds and functions
A
64
Q
to safely cross, critical speed =
A
- critical speed = total distance/available time
65
Q
considerations with gait speed and crossing road
A
66
Q
walking speed is predictive
A
of mortalities
67
Q
predictive life span increases as
A
predictive life span increases as gait speed increases
68
Q
feasibility of walking speed use
A
- safe
- no significant cost to assessment
- easy - no additional equipment, in 2 minutes
- easy to calculate and interpret based on published norms
69
Q
10M walk test
A
- “walk at a comfortable pace as if you are walking in the park”
- 6 meter path - central 4 meters timing area
- 4M and 10M WTs have excellent reliability but should not be used interchangeably
70
Q
self-selected vs fast WS
A
- self-selected WS
- numerous studies show preferred speed is associated with mortality and disability
- feasible
- predictor of disability outcomes
- established cutpoints with excellent reliability
- energy efficient, minimizes metabolic cost per unit distance walked
- fast WS
- protrays larger deficits that might be missed at SSWS
- suggests muscle strength and power losses more so than submax WSs
- index of functional capacity - reserve
- allows individuals to meet demands of activity and environment
have similar rates of decline
71
Q
most common MDC for walking speed
A
- 0.1 m/s
