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applied exercise science > week 3 > Flashcards

week 3 Flashcards

1
Q

function of lungs

A
  • ventilation - transport O2 to alveoli and transport CO2 from tissues to atmosphere
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2
Q

respiratory tree

A
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3
Q

ventilation =

A
  • ventilation = TV x RR
  • (tidal volume x respiratory rate)
  • TV and RR increase with activity
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4
Q

changes in titdal volume with increase VE

A
  • TV increase at expense of inspiratory reserve volume (IRV) and expiratory reserve volume (ERV)
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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
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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
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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
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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
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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

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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

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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
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12
Q

pulmonary function test criteria for determination of pulmonary degree of impairement in patients with COPD

A
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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23
Q

force vs velocity relationships

A

as you increase speed, you reduce force

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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
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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
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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
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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
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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
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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

applied exercise science (7 decks)

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