Chapter 11-Hhp

Front 1

Clinical Exercise Physiology

Back 1

using exercise science to prevent or delay the onset of chronic disease in healthy people and the provision of functional benefits to patients with underlying pathologies

Front 2

clinical exercise physiologists (CEP)

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a healthcare professional who uses the principles of exercise physiology in a clinical setting

Front 3

what do clinical exercise physiologists do?

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minimize the risk of chronic diseases associated with inactivity and treat those who already have disease

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responsibilities of CEP

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-pre exercise screening
-exercise testing and eval
-develop exercise prescriptions
-teach proper techniques
-supervising safe exercise

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Classifications of exercise testing

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diagnostic and functional

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Diagnostic exercise testing

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finding the extent of someone's sickness

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functional exercise testing

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evaluating the extent of someone's health; determining capacity for exercising, enhancing exercise perscription
- its based on measuring the volume of O consumed during testing

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Graded Exercise test (GXT)

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incremental test protocol that provides standardized workloads in a certain amount of time

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Maximal GXT

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performed to volitional fatigue; true maximum and symptom limited

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Sub-maximal GXT

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performed to pre-determined endpoint before volitional fatigue

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Pre-GXT issues

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medical screening, physical examination, health history questionnaire, informed consent

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resting measures of GXT

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heart rate, blood pressure, ECG, other

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ways to measure GXT

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heart rate, blood pressure, ECG, rating of percieved exertion, other

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exercise prescription

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a plan for physical activity designed to achieve specific outcomes while minimizing accompanying risks

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components of exercise prescription

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FITT
-Frequency(of training)
-Intensity(of effort)
-time(duration of session)
-Type(mode of activity)

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fundamental goals of exercise program

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-improve physical performance
-improve health or reduce disease
-ensure safety

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special populations

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cariovascular disease, pulmonary disorders, metabolic disorders, obesity, rheumatologic diseases, orthopedic and neuromuscular diseases

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Cardiovascular Disease

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the leading cause of death in the United States and other industrialized nations

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Cardiovascular disease stats

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1 million deaths per year; 1 in 4 americans will have some form of it, atherosclerosis accounts for 50%; gradual narrowing of 1 or more arteries supplying the heart

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Heart attack survival

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over 1 million people survive heart attacks each year; majority is younger than 65, rehab after is critical

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pulmonary disease

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accounts for 15% of all Dr. visits, affects 19.5 mil Americans

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3 major groups of pulmonary disease

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-obstructive(asthma, bronchitis)
-Restrictive(pulmonary fibrosis, chest wall deformity)
-Hypoxemia( deficiency of O in blood)
-Disordered breathing control(sleep apnea, obesity hyperventilation)

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What is included in Pulmonary Rehab?

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-exercise therapy
-education
-stop smoking
-nutrition
-breathing retraining

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Metabolic Disorders

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Diabetes- heterogenous collection of metabolic diseases that result in hyperglycemia; 16 million Americans have it and 1/2 are undiagnosed

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2 types of diabetes

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-type 1- insulin dependent(needle)
-type 2- non-insulin dependent

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type 1 diabetes (IDDM)

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(Insulin Dependent Diabetes Mellitus) autoimmune disorder that destroys the beta cells of the pancreas that leads to inability to produce insulin; usually seen in people under 30; requires injection

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type 2 diabetes (NIDDM)

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(Non-Insulin Dependent Diabetes Mellitus) Inability to efficiently transport glucose into body cells to produce energy; 90-95% of diabetics; risk increases with age

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acute complications of diabetes

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hypoglycemia, diabetic ketoacidosis

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long term complications of diabetes

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heart disease, peripheral vascular disease, retinopathy, nephropathy, neuropathic conditions

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DCCT

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Diabetes Control and Complications Trail- long term study that good control of blood glucose will reduce the risk of long term complications

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Treatment of Diabetes

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-Medication
-Nutrition
-Exercise

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Obesity

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Excess accumulation of body fat; 58 million Americans (33%) are overweight

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Obesity increases risks for what?

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-hypertension
-diabetes
-hyperinsulinemia
-osteoarthritis
-some forms of cancer

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Rheumatologic Diseases

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disorders of the musculoskeletal system that include: osteoarthritis, rheumatory arthritis, gout, lupus

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neuromuscular diseases

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-muscular dystrophy- a collection of biochemical and structural changes within the muscle cell
-all forms result in muscle wasting, disability, and deformity

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Multiple Sclerosis

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-afflict middle aged individuals(20-40); females are twice as likely to get it
-demylination of the nerves leading to scarring of the nerve fiber and inability to conduct nervous impulses

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heart transplantation

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-transplanted heart will not respond to exercise as will the native heart
-loss of neural imput
-higher resting heart rate
-rejection is the greatest risk