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150 Cards in this Set
- Front
- Back
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Normal fasting sugars
Diabetic fasting sugars |
70-99
over 126 |
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pre diabetes-
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IGT: Impaired Glucose Tolerance:
With food, blood glucose is elevated IFG: Impaired Fasting Glucose: Even without food, glucose is elevated Associated with dyslipidemia and HTN TREATMENT: “Diet and Exercise” |
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TYPE I Diabetes
Cause = Pancrease Function = Treatment = |
Pancreatic beta cells are destroyed
Unable to produce insulin Insulin injection |
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Type 2 Diabetes
Cause = Pancrease Function = treatment = |
Insulin resistance has exhausted the pancreas
diet, exercise, meds, possible insulin injection Unable to produce enough insulin. |
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Non Modifiable Risk factors Of type 2 Diabetes
(there are 6) |
Age > 45 y/o
First-degree relative with diabetes High-risk population (African American, Latino, Native American, Asian American, Pacific Islander) Women who delivered a baby weighing >9 lb or were diagnosed with Gestational Diabetes (GDM) Women with polycystic ovarian syndrome (PCOS) IGT or IFG on previous testing |
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Modifiable risk factors for
Type II diabetes (4) |
Physical inactivity
Obesity: BMI >25 Hypertension ( 140/90 mmHg or on therapy for hypertension) HDL cholesterol level <35 mg/dl (0.90 mmol/l) and/or a triglyceride level >250 mg/dl (2.82 mmol/l) CVD |
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Describe pancrease by the time type II DM is diagnosed...
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half the pancreatic beta cells still produce insulin
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adipokines =
In obesity, they can...(3) |
hormones and molecules released by adipocytes
Impair insulin signalling Stimulate inflammation Impair vascular relaxation |
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List components of Metabolic Syndome= (4)
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Waist Circumference
HTN Dyslipidemia High blood sugars |
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Primary Goal of Diabetes Prevention Program
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To prevent or delay the development of type 2 diabetes in persons with pre-diabetes
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Diabetes PT modifiable risk factors (5)
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physical inactivity
Obesity hypertension cholesterol level CVD |
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List normal (which is same for DM) servings per day of :
Fiber Fat Sodium |
Fiber: 20-35 grams a day
Fat: < 7% from saturated fat and trans fat Sodium: < 2400 mg/day (HTN guideline) |
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effects of PA on blood glucose (esp for DM)
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Immediate lowering of blood glucose by using it for energy.
Long term lowering of blood glucose by restoring the glucose storage inside muscle tissue. |
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Musculoskeletal complications of DM
Integumentary Complications |
Charcot’s foot
Hammertoes Foot deformities changes in foot biomechanics ulceration functional decline amputation ____________________ Dryness Turgor Scars Active wounds Non-healing wounds |
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Neuro Complications of DM
Cardiopulm Complications |
Autonomic:
Resting HR > 100 bpm Orthostasis No increase in HR during physical activity Undesirable exercise-induced elevation of BP _____________ CVD VS perceived exertion PVD/PAD Peripheral pulses Ankle Brachial Index Silent MIs Intermittant claudication shortness of breath with activity |
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DM Indications for Cardiac Testing
(8) (Prior to Initiating an Exercise Program (> 60% max HR) |
> 35 y/o
DM type 2 > 10 years DM type 1 > 15 years. CAD risk factors such as: BP > 140/90, Smoking, Dyslipidemia or Family hx of premature CAD Any microvascular complication Peripheral vascular disease Autonomic neuropathy |
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Specific Exercise Guidelines for Nephrapathy (microvascular compliations commen in DM)
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Get individual BP precautions
General “rule of thumb”: Keep SBP <180 mmHg Avoid strenuous weight lifting, valsalva, and strenuous aerobic activity |
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Obvious Exercise Guidelines For Retinopathy (as in things to avoid)
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Avoid jarring motions of or to the head
Avoid valsalva Avoid putting the head below the waist Avoid increases in SBP >30mmHg from resting SBP |
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Exercise precautions with peripheral nueropathy
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monofilament sensation testing
Non-weightbearing exercise if severe neuropathy Vigilant foot checks |
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Things to think about with exercise and someone with autonomic neuropathy
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Watch for dyspnea, diaphoresis or orthostasis
Warm up and cool down are crucial HR and BP response to activity may be eabnormal |
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Reminders for DM pt before they start to exercise
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Individuals with CAD need to wait at least an hour after eating before they begin any aerobic activity
Individuals injecting insulin should not inject into the muscles which will be immediately exercised Remind patients to look out for lower blood sugars during and after activity |
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Steps to take after hypoglycemia isnt fixed after 15 g of carbs
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If blood glucose is still < 70 mg/dL, eat 15 more grams of carbohydrate and notify the physician
If blood glucose is > 70 mg/dL, a light snack may be needed depending upon medicine and activity |
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Obvious Exercise Guidelines For Retinopathy (as in things to avoid)
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Avoid jarring motions of or to the head
Avoid valsalva Avoid putting the head below the waist Avoid increases in SBP >30mmHg from resting SBP |
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Exercise precautions with peripheral nueropathy
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monofilament sensation testing
Non-weightbearing exercise if severe neuropathy Vigilant foot checks |
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Things to think about with exercise and someone with autonomic neuropathy
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Watch for dyspnea, diaphoresis or orthostasis
Warm up and cool down are crucial HR and BP response to activity may be eabnormal |
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Reminders for DM pt before they start to exercise
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Individuals with CAD need to wait at least an hour after eating before they begin any aerobic activity
Individuals injecting insulin should not inject into the muscles which will be immediately exercised Remind patients to look out for lower blood sugars during and after activity |
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Steps to take after hypoglycemia isnt fixed after 15 g of carbs
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If blood glucose is still < 70 mg/dL, eat 15 more grams of carbohydrate and notify the physician
If blood glucose is > 70 mg/dL, a light snack may be needed depending upon medicine and activity |
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Ways to measure blood glucose
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AIC =
glucometer = |
test to measure Glucose attached to hemoglobin that takes 2-3 months. Directly related to DM complications.
immediate measure of blood glucose. |
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signs and symptoms of HypErglycemia
when prolonged can cause- |
dry skin
decreased healing blurred vision drowsiness extreme thirst frequent urination hunger diabetic ketoacidosis |
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Diabetic Ketoacidosis =
signs and symptoms = |
When the body resorts to breaking down fat for its primary energy.
Shortness of breath Nauseau/vomitting Dry mouth Fruity smelling breath |
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AIC =
glucometer = |
test to measure Glucose attached to hemoglobin that takes 2-3 months. Directly related to DM complications.
immediate measure of blood glucose. |
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signs and symptoms of HypErglycemia
when prolonged can cause- |
dry skin
decreased healing blurred vision drowsiness extreme thirst frequent urination hunger diabetic ketoacidosis |
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Diabetic Ketoacidosis =
signs and symptoms = |
When the body resorts to breaking down fat for its primary energy.
Shortness of breath Nauseau/vomitting Dry mouth Fruity smelling breath |
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Single fiber force generation is proportional to
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the number of attached cross-bridges. More recruited by nervous system
and angle of fibers. Bipennate is faster and stronger then the straight angle or diagonal. |
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Force generated by a muscle depends on:
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– The number of motor units activated
– The frequency of those motor units firing – The total cross-sectional area of the muscle fibers controlled by those motor units • Most important: the number of fibers in the motor unit • Size of individual fibers contributes ~ • FT motor units have more fibers then ST |
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All of the motor neurons that innervate fibers
within a given muscle constitute a |
motor pool
– Usually distributed over several contiguous spinal cord segments • All cell bodies are located in the ventral horn – Size and type of motor neurons are randomly distributed spatially • This includes neurons that innervate intrafusal fibers |
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Recruitment of mn is determined by the size of
the |
cell body
– Smallest mn have the smallest soma, least # dendrites – lowest input resistance (first to reach threshold) |
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How to increase activation of fast motor
units: |
– Stimulate the skin overlying the muscle
– Increase the rate of contraction Activate the muscle in a rapid eccentric rather than a slow concentric contraction |
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During maximum voluntary effort, human
subjects are not able to recruit 100% of the motor pool |
– Starts around 75%
– Number recruited increases somewhat with training (we cant do 100% because of central inhibition- the supratentorial thing) |
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Neural strategies differ for concentric vs
isometric contractions |
Repeated bouts of concentric result in increased
levels of activation |
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Subjects who exercise to exhaustion have
been found to retain significants amounts of |
glycogen in type II muscle fibers
• The only way to significantly deplete glycogen from all muscle fibers it to: – Exercise at 75-85% of max for a really long time – Exercise at higher intensity, with repeated bouts to exhaustion (within a limited period of time) |
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Sample CHO Loading Protocol
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During the first 3 days: you eat a normal diet (5 gm CHO/kg/d)
(about 2.5 grams of carbohydrate per pound) • On the sixth day before the event, you run at 70% of aerobic capacity for 90 minutes. • On the fifth and fourth days before the event, decrease your run to 40 minutes at the same intensity. • On the third and second day before the event, you reduce your run to 20 minutes. • On the day before the event, you rest. – During the last three days, you eat a high carbohydrate diet providing 10 grams of carbohydrate per kilogram per day • (about 5 grams of carbohydrate per pound). |
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There are several side effects of carbohydrate loading that may make it
inappropriate for some people |
For each gram of glycogen stored, additional water is stored. Some people
note a feeling of stiffness and heaviness associated with the increased glycogen storage. Once you start exercising, however, these sensations will work out. and CHO loading will only help for continuous exercise lasting more than 90 minutes. Greater than usual muscle glycogen stores won't enable you to exercise harder during shorter duration exercise. In fact, the stiffness and heaviness due to increased glycogen stores can hurt your performance during shorter competitions such as a 10 K. runs. – Keep in mind that carbohydrate loading enables you to maintain high intensity exercise longer, but will not affect your pace for the first hour of exercise. You won't be able to go out faster, but will be able to maintain your pace longer. |
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The CNS and Fatigue
Cortex: |
– Threshold for activation/inhibition declines after a
few seconds of MVE, recovers after 15 sec (even is muscle is ischemic) |
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Motor Unit Rotation
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Synergistic muscles rotate in a
complementary manner |
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Increased CNS levels of 5-HT are associated with
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- Decreased number of receptors with training
– Patients on SSRIs fatigue faster – Increase brain blood glucose levels, decrease release of 5-HT |
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Exercise response on 5-HT (seratonin)
on NEpi? |
• Spinal cord:
– Serotonin levels in ventral funiculus increase up to 4x with exercise – Training decreases the sensitivity of the SC to this increase _________________ Increases with training, significant within a few days – Perhaps the reduction in depression reported in people with regular exercise is related to modulation in NE levels – In rats, treadmill training resulted in decreased depletion of NE in response to foot-shock, as well as an increased latency of response • Changes in NE and NE receptor levels also explain some of the positive changes in CV markers |
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Neuronal Aspects of Fatigue
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Muscle mitochondrial content is largely
due to neuronal factors independent of activity – Is modulated up/down with changes in activity levels – Changes in fatigue resistance of ST muscles is influenced by activity much less then Type II fibers are. • For Soleus, this holds true even if the muscle is cross-innervated by a FT nerve • After SCI, Soleus maintains it’s fatigue resistance for about 6 weeks… |
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Mental rehearsal has effects on
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both supraspinal
and spinal cord efficiency There is an elevated level of excitability of motor pools during practice – even without muscle activation – Memories form |
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Cross education training effects?
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Cross-Educational training:
– Strength in the contralateral limb will improve with exercise (no hypertrophy) • Supraspinal and SC changes • Has been shown with concentric, isometric (5-25%), and eccentric (up to 75% of ipsilateral effect) training • Effects appear to be highly specific for mode of training • EStim has the greatest effect • ? Due to coordination and planning circuits? |
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whats the most dynamic of skeletal system?
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Bone is the most dynamic – can turn over within 3
years – Genetics influence up to 80% of bone peak mineral density – Can atrophy and hypertrophy Ligaments and tendons change much less – In response to immobilization, decrease in elasticity and strength • Disrupts parallel fiber arrangements and increases cross-linking, decreasing GAG and water content • Both ligaments and tendons depend on tensile load to maintain biochemical and biomechanical properties – Tendons usually rupture at the site of insertion, after 8 wks of immobilization Achilles tendon failure is usually from calcaneal fx |
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_________ is sufficient to maintain 80-
90% of the potential of ligaments – will increase with training |
normal dailey activity
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Describe bone mass
- initial values and - diminished returns |
Initial values:
• There is an inverse relationship between initial values and osteogenic potential 5. Diminishing returns: • Several brief bouts of loading are more of an osteogenic stimulus than one long bout of activity |
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Forces on bone due to _________ are much
greater than most WB activity |
muscle insertion
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osteogenesis is proportional to
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frequency of loading
– High frequency requires lower strain – Low frequency requires higher strain (impact) |
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Typical skeletal muscle takes ____ msec to
reach max force development |
3-400
meaning that reaction time is more important than force development in certain sports which is influenced by: Neural drive to the muscle – Muscle cross-sectional area – Muscle fiber type and MHC isoform |
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Short-Term Activity
• Fatigue can occur on many levels, Most common= |
– Potassium accumulation: in ISF with repeated
depolarizations impairs membrane excitability • Decreased IC [K+] combined with increased IC [Na+] • Membrane becomes less negative – decreased calcium ion release with APs • High-intensity, dynamic, intermittent training helps – Lactate accumulation: • pH from 7.1 to 6.5 have been measured – Training increases buffer capacity which also decreases the IC loss of K+ |
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Individual fiber fatigue has been correlated
with loss of |
creatine phosphate
– Oral CP over several days will increase muscle CP and has been shown to improve performance during heavy, intermittent exercise • Only shown to help for the first high-intensity bout • Repeated bouts of exercise benefit as much/more from increased muscle glycogen |
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define resistance exercise
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Any form of active exercise in which a dynamic or static muscle contraction is resisted by an outside force, applied either manually or mechanically (Kisner and Colby)
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Hypertrophy:
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increase in the size of muscle fibers
Less fiber atrophy secondary to increased motor unit activation |
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Power
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force of contraction and speed of movement
Greater force outputs leading to more power Increased speed |
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Endurance:
Strength: |
ability of a muscle to maintain force or power over time
Smaller muscle mass required for a given task maximum force generation capacity of an individual More motor units contract so force output is greater |
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Functional Tasks that assess power...
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Functional Tasks:
Chair Rise Test Gait Velocity Test Stair Climb Test |
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Ways to assess endurance
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Repetitions to failure
Predictive equations are used to calculate Duration to failure Predictive equation used to calculate Maximum repetition with 90% 1 RM 6 Minute Walk Test |
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hand held dynometry Digital strain gauge that assess the ...
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the static strength of a muscle
Units measured in kg/pounds/Newtons Select preference on the machine Normative data (isometric contraction) has been studied by Andrews Hold 3-5 seconds Retest after 15 second rest, repeat 3 times to obtain average Test contralateral side for reference |
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1 RPM =
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Maximum weight that can be lifted concentrically through the full range of motion
Include warm up and cool down Careful of eccentric exercises with untrained individuals secondary to delayed onset muscle soreness Re-evaluate progress every 2 weeks to adjust load Methods of testing: resistive machines, free weights, cuff weights, and resistive bands 60% of 1RPM initial recommendation to allow proper form and technique Experienced individuals, strength gains with 70% of 1RPM, but optimal load is 80% of 1RPM |
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Contraindications to a Resistance Program
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Aortic Aneurysms
Enlarging Non-operable Ventricular arrhythmias Malignant Associated with exercise Severe aortic stenosis End stage CHF Behavioral agitations that becomes exacerbated by resistance training |
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Exercise Selection
Single vs. Multi Joint Exercises |
Single vs. Multi Joint Exercises
Both effective for increasing strength, power, endurance, and hypertrophy Multi joint exercises more neurally complex Single joint exercises require less skill and technique Exercise Order 1st exercise will be performed the best Large muscle groups before small muscle groups Multi joint before single joint Choose no more then 6 muscles total Higher intensity before lower intensity |
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resistance band
Stress – Strain Relationship Excursion = |
the amount of resistance (stress) generated when the band is stretched is related to its amount of deformation (strain)
how far you move during an exercise Resting Length = Excursion/Deformation |
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____ = how far the Theraband must be stretched out to get the desired amount of weight.
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deformation
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(borg scale) When patients begin to rate exercise at ____ you need to advance the program
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12-14
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kcal =
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is the amount of heat
(energy) needed to increase the temperature of one kg of water by 1 °C, exactly 1000 small calories, or about 4.184 kJ |
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2 types of stress test intensity
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– Constant intensity:
• “Step” tests – Graded intensity- More common • Multiple modalities – Usually involve 3-5 levels of submaximal exercise until |
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• A 70 kg man steps onto a 0.5m bench at a
rate of 30 steps/min. In 10 minutes, the work = |
Force = 70 kp (kilopond),
– Distance = 0.5 m/step x 30 steps/min x 10 min = 150m – Work = 70kp x 150m = 10,500 kpm – Power = 10,500 kpm / 10 min = 171.6 W |
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Since there is a direct relationship
between oxygen consumed and heat produced, metabolic rate can be |
estimated
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Define Efficiency=
what influences it? |
Efficiency = work / energy expended above rest
• Influenced by: – Rate of exercise: • Efficiency decreases as rate increases – Speed of movement: • There is an “optimum” speed of movement for any given work rate • Higher speed of movements are required at greater power outputs to maintain efficiency – Fiber composition: • ST fibers are more efficient than FT |
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Who should be stress tested?
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1) People < 35 yo with no Hx CV disease and no
primary risk factors (eval within 2 years) can begin exercise without medical clearance, test for functional evaluation purposes 2) People < 30 yo with evidence of CHD or significant risk factors should have medical clearance before exercising – GXT with medical supervision 3) People > 30 yo, medical evaluation including ECG is advised. GXT with ECG supervised by internist or cardiologist. |
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Exercise Contraindications
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Acute myocardial infarction or unstable angina
• Acute cardiac inflammation -Pericarditis, -Endocarditis , -Myocarditis • Severe congestive heart failure • Uncontrolled sustained ventricular arrhythmias, symptomatic supraventricular arrhythmias or high-grade block • Hemodynamically significant aortic stenosis • Severe hypertension (systolic pressure >200 mm Hg or diastolic pressure >110 mm Hg) • Severe acute medical illness, drug toxicity or electrolyte abnormalities • Active thromboembolic processes -Pulmonary embolism , -Deep venous thrombosis • Poor candidate for exercise • Extreme obesity, with weight exceeding the recommendations or the equipment capacity (usually >159 kg [350 |
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relative exercise contraindications
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Current medications
-Digoxin -Type I antiarrhythmic agents (e.g., quinidine, procainamide [Pronestyl], disopyramide [Norpace]) -Tricyclic antidepressants -Vasodilators (nitrates, alpha-adrenergic blockers, alcohol, other antihypertensive agents) -Beta-adrenergic blockers • Metabolic abnormalities • Acid-base disorders • Thyroid abnormalities • Abnormal calcium, magnesium or potassium levels • Vasoregulatory disorders • Other cardiac conditions -Mitral valve prolapse syndrome -Wolff-Parkinson-White syndrome -Recurrent paroxysmal supraventricular |
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Clinical Findings That Suggest an Exercise Stress Test Positive for Ischemia
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• Exercise-induced hypotension
• Exercise-induced angina or anginal equivalents • Appearance of an S3, S4 or heart murmur during exercise |
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Hypotension=
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defined as a drop of more than 10 mm Hg in the systolic blood pressure
during exercise, may signify severe cardiac ischemia. Hypotensive response: • SBP doesn’t increase more than 20-30 mmHg or drops > 20 mmHg • Opinions vary as to the definition of a hypertensive response to exercise, but most authorities accept as a maximal limit a systolic pressure of 230 mm Hg. The diastolic blood pressure during exercise usually varies 10 mm Hg in either direction. |
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Normal ECG changes with exercise=
Abnormal = |
Shortening of QT interval
-Peaking of T waves and P wav -Shortening of P-R interval _____________ ST segment depression (or elevation) > 2 mm • PVCs |
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heart rate indicator s of CHD with exercise =
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Heart Rate Response:
• Early, rapid, large increase in HR • Bradycardia (SAN problems) • No change with increased intensity |
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Vo2Max estimation errors with the following
1. last stage of a max test 2. HR values during a submax test 3. One mile walk test |
1. 3
2. 4-5 3. 5 |
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A person needs to perform for AT LEAST ______
minutes at a stage for reach steady-state |
1.5 min
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Aortic Stenosis
• Compare Left ventricular pressure to Aortic pressure: |
– Mild - 20 mmHg difference
– Moderate - 40 mmHg difference – Severe > 80 mmHg difference |
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Signs/Symptoms of Uncontrolled CHF
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• At rest S3 heart sound
• Jugular Venous Distension • Swan-Ganz Catheter Value > 12 mmHg • Pedal edema – pitting edema • Dyspnea with mild exertion • Lack of endurance • Fluid retention (as evidenced by weight gain 6-10 lbs) • Crackles |
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blood glucose and exercise
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Blood glucose < 100 mg/dl
– Run the risk of hypoglycemia • Blood glucose > 250 - 300 mg/dl – may lead to further increase in BGL and run risk of hyperosmotic non-ketotic coma or ketotic coma • Pre-exercise blood glucose levels of 100 - 250/300 mg/dl – able to exercise |
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platelet count with exercise...
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Platelet count:
– < 60,000/mm3 - no resistive – < 20,000/mm3 - AROM, maybe walking – < 5,000/mm3 -“no activity” |
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Protime or PT measures=
Uses= |
extrinsic pathway clotting factors
V, VII,X, II (prothrombin) & I (fibrinogen) – Normal values < 13 seconds _______________ To screen for bleeding disorders • Effectiveness of anticoagulation therapy (Coumadin) when 1.5 to 2.5 times the reference value • Physical therapy tx. contraindicated above 2.5 times the reference value INR is the standardization technique to correct for variations in protime test materials between laboratories. |
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Hemaglobin levels for exercise
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Hemoglobin (gm/dl)
– Reference range - • Male 14-16 • Female 12-14 • Reduced exercise capacity occurs Q 10 • Markedly reduced exercise Q 8-10 • Don’t perform activity < 8 |
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Hematocrit Range for exercise =
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Hematocrit (%)
– Reference range • Male 42-52 • Female 35-47 • Reduced exercise capacity occurs Q 30 • Markedly reduced exercise Q 24-30 • Don’t perform activity < 24 |
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what level peripheral ischemia would you terminate exercise?
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8/10
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Exercise prescribed by calories burned
per week: |
– Improved fitness - 700 - 1,000 Kcal/week
– Optimal weight loss - 1,200 - 1,500 Kcal/week – Maximal Cardiovascular Prevention - 2,000 Kcal/week – Regression of Atherosclerosis - 2,200 Kcal/week |
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MOS of metformin (glucophge)
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• ¯dec hepatic glucose production
• ¯dec intestinal absorption of glucose •inc insulin sensitivity by inc peripheral glucose uptake and utilization |
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Why does exercise help dec risk of cancer?
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• ¯ dec free radicals
• inc immune system function • ¯dec body fat • inc GI motility (¯ transit time) |
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EKG paper speed
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25 mm/sec
(each small box = 1 mm, 0.04 sec, 5 small boxes = 0.2 sec ) |
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Wide QRS =
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Size (not wider then 3 small blocks)
– Too wide indicates conduction delays/problems in the ventricle |
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How many blocks is significant ST depression?
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2
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You can only use 300 rule with EKG if...
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Can only use if
Rhythmical!!!! |
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conduction block is ...
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Whenever the normal
conduction pathway is disrupted (scar tissue, mechanical, anoxic damage) – Sinus node block: looks like a pause in the normal cycle – AV block: between SAN and AVN (including node) • 1st, 2nd or 3rd degree – BBB: bundle branch block; right, left, both, partial (fascicular block) |
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Heart Blocks
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• First degree
– PR interval is longer than normal – EVERY time – Five little boxes (one big box, 0.2 sec) • Second degree – Extra P wave(s) – dropped QRS • Mobitz type I (Wenkebach): PR gets progressively longer until a QRS complex is skipped • Mobitz type II: a QRS complex is dropped without lengthening PR interval • Third degree – There is no relationship between atrial and ventricular HR (report both) |
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With 3rd degree heart block, If the ventricular rate is too slow, syncope ensues Stokes-Adams Syndrome this patient will
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need a pace maker
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Preexcitation Syndromes is when...
Name 2- These predispose pt to... |
When the electrical current is
transmitted to the ventricles more quickly than usual – Less than 1% of people have alternate pathways between atria and ventricles (other than AVN) _______________ – WPW: Wolff-Parkinson-White syndrome – LGL: Lown-Ganong-Levine syndrome • Inside the AVN itself ____________ Predisposes the patient to tachyarrhythmias secondary to re-entry – In WPW syndrome at least 50% of patients experience at least one supraventricular arrhythmia or induce V-Fib |
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WPW =
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• Pathway has been named: the Bundle of Kent
– Can be left or right sided – PR interval is < 0.12 sec, Wide QRS |
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LQTS =
Associate with = Caused by = |
The long QT syndrome (LQTS) is
a disorder in which there is an abnormally long delay between the electrical excitation and relaxation of the ventricles of the heart. – It is associated with syncope and sudden death due to ventricular arrhythmias. – Arrhythmias in individuals with LQTS are often associated with exercise or excitement. The cause of sudden cardiac death in individuals with LQTS is V fib. • Usually due to a mutation in a K+ channel – Most common form inherited in an autosomal dominant fashion |
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LQTS Treatment-
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• Prevention of arrhythmias
– Beta blockers – Potassium supplements – Amputation of the cervical sympathetic chain • Termination of arrhythmias (favored Rx) – ICD – Implantable Cardioverter Defibrillator – ICD are commonly used in patients with syncopes despite beta blocker therapy, and in patients who have experienced a cardiac arrest. • Psychosocial considerations |
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___= derived from measruing the load applied on the person.
____ = derived from measuring the deformation on of persons elongation, compression or distortion. |
stress
strain |
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under exercise and activity, the muslce-tendon unit behaves like a spring and the viscous element has ____ influence on its behavior
the ______ is the greatest contributer to flexibility! |
MIN
muscle tendon unit |
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a muscle stretch activates the spindle reflex with is composed of _____ fibers contracting.
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extrafusal
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_____ = less force is required over time to maintain a given increase in length during a sustained stretch.
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stress relaxation
(and fyi, most of the muscle stretch occurs during the first 4 sec of a hold) |
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_ a fixed force is applied and a continuous slow deformation occurs
___ when a muscle is stretched, more energy is absorbed during the stretch than is released when the stretch is terminated. So heat is transfered to the msucles. |
creep
- supports the strain rate dependence principal, where a slower stretch produces greater elongation than a faster stretch. hysteresis |
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even though the majority of the muscle lengthens dueing the first 4 seconds, muscle lengthening occurs during ______ sec of stretched an dduring the first __ stretch cycles
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12 sec
4 cycle yes this makes like no sensse, thanks megan riley |
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beighton scale =
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tests for ligament laxity
total score = 9 looks at all joints |
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Increasing flexibility of an antagonist muscle can increase.....
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contraction speed of agonist muscle.
so recoomened 3 x 30 secs for a stretch 5 days per week. |
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stress test common for younger, activte peeps
this test disadvantage = |
bruce
exercise stages are unqual and overestimates persons capacity |
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whats the best exercise stress test for older more deconditioned individuals
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bulke
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what cardiomyopathy ejection fraction is contraindicated for exercise?
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under 30%
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______ incorporates cues to action as important elements in eliciting or maintaining pattersnf of behavioe. Includes self eficacy and confidence
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health belief model
1. severity of illness 2. suceptibility to it 3. benefits of prevention 4. barriers to action |
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what model ID's situations carring high risk?
Which one integrates ecological with other theories over a 5 stage process? |
relapse prevention model
transtheoretical model 1. pre 2. contem 3. prep 4. action 5. maintain |
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what theory is primarilry determined by a persons intention to perform an action
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theory of resoned action or planned behavior
2 major factors: social envirionmt and persons attitude and perceieved control |
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what theory says self efficacy is most important? (belief in ability)
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social cog / learning theory
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list the order of the highest costing disesases
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CAD, Osteperosis, strke, HTN
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Desribe Resistance Strength Program for a NOVICE
List exercise order |
muscle: eccentric and con
Load: 60-70% 1 RM Usual Freq Multi (2-3 rest break) and single joint (1-2) slow and mod velocity order 1. large than small 2. multi, then single 3. high I then slow |
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Describe resistance endurance trainning program for a NOVICE
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muslce: con and eccen
Load: 30-60% 1 rm 10-15 reps, 4-7 sets multi and single vary sequencing slow vel 2-3 times per week |
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Describe resistance POWER training program for NOVICE
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muscle: con and ecc
load: 20-60% 1 RM vol: 6-10 reps, 1-3 sets multi joint fast 2-3 titmes per week |
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Describe resistance training program for hypertrophy (NOVICE)
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muscle: con and ecc
load: 70-85% 1 RM 8-12 reps, 1-3 sets multi and single 1-2 min rest slow and moderate velocity 2-3 times per week |
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Assess Power via..
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force plate, functional tests (chair rise, gait velocity, stair climb, weight stack machine, isokenetic dynometer and force plate)
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what does duration to failure and 90% 1 RM test?
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endurance
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can you exercise someone with an OLD DVT?
old vent arrythmia? |
yes
yes, its now only a precaution |
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Guideline to start ALL patients at = __ % of strength
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60
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A1C – good if less than __ %
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7
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___= derived from measruing the load applied on the person.
____ = derived from measuring the deformation on of persons elongation, compression or distortion. |
stress
strain |
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under exercise and activity, the muslce-tendon unit behaves like a spring and the viscous element has ____ influence on its behavior
the ______ is the greatest contributer to flexibility! |
MIN
muscle tendon unit |
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a muscle stretch activates the spindle reflex with is composed of _____ fibers contracting.
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extrafusal
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_____ = less force is required over time to maintain a given increase in length during a sustained stretch.
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stress relaxation
(and fyi, most of the muscle stretch occurs during the first 4 sec of a hold) |
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_ a fixed force is applied and a continuous slow deformation occurs
___ when a muscle is stretched, more energy is absorbed during the stretch than is released when the stretch is terminated. So heat is transfered to the msucles. |
creep
- supports the strain rate dependence principal, where a slower stretch produces greater elongation than a faster stretch. hysteresis |
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_____ = The maximum volume of air, measured in liters that can be forcibly and rapidly exhaled.
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FVC
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Normal spirometry results are based
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on the age, height, and gender of the person being tested and most are expressed as a percentage of a predicted value.
• Tidal volume - 5 to 7 milliliters per kilogram of body weight • Expiratory reserve volume - 25 percent of vital capacity • Inspiratory capacity - 75 percent of vital capacity • Forced expiratory volume - 75 percent of vital capacity after one second, 94 percent after two seconds, and 97 percent after three seconds |
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____ values (percentage of predicted) can be used to classify the obstruction that may occur with asthma and other obstructive lung diseases like emphysema or chronic bronchitis:
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FEV1
• FEV1 60 percent to 79 percent predicted = Mild obstruction • FEV1 40 percent to 59 percent predicted = Moderate obstruction • FEV1 less than 40 percent predicted = Severe obstruction |
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In obstructive lung conditions, the airways are narrowed, usually causing ______ in the time it takes to empty the lungs
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an increase
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Describe the following for obstructive diseases
Forced vital capacity (FVC) Forced expiratory volume Total lung capacity (TLC) (VT) Functional residual capacity Residual volume (RV) |
Normal or lower
Lower Normal or higher Higher Higher |
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describe the following based on resitrictive lung values
Forced vital capacity (FVC) Total lung capacity (TLC) (VT) Functional residual capacity (FRC) Residual volume (RV) |
Lower than predicted value
Normal or lower Lower Normal or lower Normal, lower, or higher |
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Heart rate x Systolic BP =
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double product- relates to anginal threshold. related to vo2max.
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Contraindications for WBC-
absolute gran- |
5,000
2500 |
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INR time-
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24 seconds and 3
where as prothrombin less than 13 sec and 2.5 APPT 25- 38 sec |
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Heart rate x Systolic BP =
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double product- relates to anginal threshold. related to vo2max.
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Contraindications for WBC-
absolute gran- |
5,000
2500 |
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INR time-
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24 seconds and 3
where as prothrombin less than 13 sec and 2.5 APPT 25- 38 sec |
