WK13 ( CH 17) - Exercise For Special Populations Flashcards
Differentiate between Type I and Type II diabetes and how exercise can help manage diabetes and the possible dangers of exercising with excess insulin.
Type I: inadequate insulin secretion
Type II: reduced insulin action
exercise can increase the rate at which muscle removes glucose from blood to provide energy for contraction, but only if person exercising has glucose levels close to normal. Those in control have enough insulin for glucose to be taken up into working muscles to counter the effect of glucose release from hepatic stores. Furthermore, too much insulin will cause an excess rate of glucose utilization by the muscle, glucose from liver is decreased and thus the person may become hypoglycemic.
Describe the terms diabetic coma and insulin shock.
diabetic coma: a life threatening state of hyperglycemia which causes the patient to become unconscious, little insulin present.
Insulin shock: happens when patient is hypoglycemic, too much insulin present leads to excess shuttling of glucose into muscle, and decreased plasma glucose.
Discuss the primary concern for prescribing exercise to those with Type I diabetes and what factors should be considered for patient safety ?
hypoglycemia which can lead to insulin shock
metabolic control: avoid PA if glucose is above 250 mg/dl and ketosis is present, use caution if glucose is less than 300 mg/dl and no ketosis present. If glucose is less than 100 mg/dl, consume carbohydrates
Food Intake: carbs should be available during and after exercise, prevent hypoglycemia.
What are the aerobic and resistance exercise recommendations for Type I diabetics ?
Aerobic: 3-7 days/week, 40%-85% HRR or 12 to 16 on RPE scale, 20 to 60 minutes per session for at least 150 minutes a week of moderate or 75 minutes vigorous exercise; non-weight bearing, low impact, swimming, biking, water exercise
Resistance: 2-3 days/week, 60-80% 1RM, or 11-15 on RPE scale, 1-3 sets of 8-12 reps, avoid valsava maneuver.
Why is it recommended that Type II diabetics engage in exercise more so than Type I diabetics.
In Type I diabetics, glucose management is a complex task due to medicinal supplementation of the hormone insulin, however in Type II diabetics insulin is present, therefore exercise can enable systemic glucose control. Additionally, obesity ( which is often correlated with Type II diabetes ) can be managed through exercise.
What is the best method of Type II diabetes prevention ?
Lifestyle changes, and increasing PA to 150 minutes per week along with a decrease in body weight by 5-10% reduces the risk of Type II diabetes by 58% which is better than the leading drug, metformin.
Describe the effective methods of treating and preventing complications for type I and II diabetics.
- Exercise, described as: Aerobic: 3-7 days/week, 40%-85% HRR or 12 to 16 on RPE scale, 20 to 60 minutes per session for at least 150 minutes a week of moderate or 75 minutes vigorous exercise; non-weight bearing, low impact, swimming, biking, water exercise
Resistance: 2-3 days/week, 60-80% 1RM, or 11 to 15 on RPE scale, 1-3 sets of 8-12 reps, avoid valsava maneuver.
- Diet: high carbohydrate diet ( with little processed sugars), low fat
Explain the physiology of asthma and the effective preventative measures and relief methods.
B cells typically make antibodies in response to antigens, in those who have genetic predispositions to allergies the B cells produce IgE instead of IgG anitbodies , those antibodies attach to the surface of the mast cells lining the airway and upon exposure to the antigen large amounts of histamine, prostaglandins, and leukotrienes and cause increased secretion of mucus, increased blood flow, swelling of epthelia lining the airways, contraction of smooth muscle surrounding the airway.
Avoidance of allergen is effective, if contact cannot be avoided, then immunotherapy may help reduce immune response. Cromolyn sodium can inhibit chemical mediator release from mast cells. Beta receptor agonists also decrease chemical mediator release and cause relaxation of smooth bronchiolar muscle.
Explain exercise induced asthma (EIA) and how it is classified.
- an exercise induced bronchioconstriction in addition to normal asthmatic symptoms; can be caused by exposure to cold air, since air needs to be humidified and warmed before entering the lungs, mast cells are triggered by an increase in osmolarity to release inflammatory chemical mediators, narrowing the pathway
- classified by a 10% drop in forced expiratory reserve volume.
How can EIA be managed ?
A combination of PA and diet and lifestyle changes such as; a reduction in salt consumption, increased uptake of omega 3 fatty acids, and caffeine. Along with aerobic exercise that begins with a normal warmup; if exercise is new to person then exposure should be gradual;
- aerobic plan may be up to 2-3 days/week, at 60% intensity of VO2 or at the ventilatory threshold, for at least 20 to 30 minutes a day
Describe COPD, the impact of smoking on COPD and how COPD can affect functional capacity.
-COPD is a pulmonary disease found primarly in smokers and can present in a few different ways; chronic bronchitis, bronchial asthma, and emphysema
chronic bronchitis: persistent production of sputum due to excess bronchial secretions
bronchial asthma: decreased ability to exhale, a characteristic wheezing sound
emphysema: all persons with this have COPD, but not all COPD patients have emphysema
- Smoking enlargens the structure of the alveoli which means a greater gas diffusion distance, while surface area is decreased because of a loss of alveolar tissue. See Figure 17.5
-Those who suffer from COPD will have limitations in so far as they’re required to do physical work.
Describe the testing for COPD patients.
A complete medical exam is recommended for those who suffer from COPD, along with an exercise test. COPD can be classified by the forced expiratory reserve volume. The tester should focus on the hyperinflation of the lung, resulting from trapped air in the lung due to trouble exhaling. A GXT can also help to evaluate VO2 max for exercise prescription which may slow the progression of COPD. One accepted GXT is the 6 minute walk test in which patients are asked to cover as much distance as they can in 6 minutes. If a patient cannot walk at least 350m in 6 minutes they are predicted to have worse outcomes.
Describe the GOLD classification of those with COPD.
GOLD I: Mild COPD, FEV>80% predicted
GOLD II: Moderate COPD, FEV 50-79% predicted
GOLD III: Severe COPD, FEV 30-49% predicted
GOLD IV: Very Severe COPD, <30% predicted
In GOLD I the patient hardly notices their shortcomings, from GOLD II-IV the health status varies greatly
What is the dyspnea scale ?
level of breathlessness or dyspnea;
- Light, barely noticeable
- Moderate, bothersome
- Moderately Severe, very uncomfortable
- Most severe or intense dyspnea ever experienced
What are the recommendations made to those who suffer from HTN ?
endurance PA is a good way to decrease mortality rates of all causes ( 40-59% HRR), reduction of sodium intake, reduction of caloric intake for those who are overweight
Preferred medications for those who already suffer from HTN are ACE inhibitors and Calcium Channel Blockers
