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109 Cards in this Set
- Front
- Back
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What is the purpose of a pre-participation health screening? |
-Identify if individual has contraindications -Identify if exercise will increase risk for disease -Identify if pt. has a clinically significant disease (for supervised ex. program) |
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What are the major signs and sx of CVD, pulmonary, or metabolic disease? |
(9) 1. Chest pain; discomfort (anginal equivalent), neck, jaw, arms 2. SOB at rest or mild exertion 3. Dizziness or syncope 4. orthopnea or paroxysmal nocturnal dyspnea 5. ankle edema (bilateral) 6. palpitations or tachycardia 7. intermittent claudication (cramping in leg) 8. known heart murmur 9. unusual fatigue or shortness of breath w usual activities (CanSaraDoOrthoAndPlayInKara'sUnivan) |
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Where do you feel ishemic chest pain vs. non-ischemic chest pain? |
Ischemic=sternal non-ischemic= hemithoracic |
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What are the absolute contraindications of exercise testing? |
(9) 1. recent change in ECG, significant ischemia or recent MI 2. unstable angina 3. uncontrolled cardiac dysrhythmias causing sx or hemodynamic compromise 4. symptomatic severe aortic stenosis 5. uncontrolled symptomatic heart failure 6. acute pulmonary embolus 7. acute myocarditis or pericarditis 8. suspected or known dissecting aneurysm 9. acute systemic infection, accompanied by fever, body aches, or swollen lymph glands |
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What does ST depression show/mean? |
someone had a MI |
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What does ST impression show/mean? |
someone is having a MI |
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Unstable vs. stable angina: |
Unstable: happen at anytime, often more painful, may not go away with rest or meds Stable: sx stop after meds or rest, triggered by activities that make the heart work harder |
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What are the sx or hemodynamic instability? |
chest pain dyspnea hypotension light headedness changes in the mental status cold, clammy skin |
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What is the classic triad of sx in pt. with aortic stenosis? |
-Chest pain -Heart Failure -Syncope |
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What are the mild sx of acute myocarditis or pericarditis? |
fever sweats chills dyspnea |
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What are the sx of acute pulmonary embolus or pulmonary infarction? |
chest pain tachypnea or dysnea cough cyanosis palpitations wheezing sweating |
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What is a dissecting aneurysm, and sx for it? |
serious condition in which the inner layer of the aorta -sudden severe chest or upper back pain -loss of conciousness -sob -sudden difficulty speaking, loss of vision, weakness paralysis of one side of body |
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What are the sx of acute systematic infection? |
fever body aches swollen lymph glands |
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What are 3 screening's typically done in preparticipation? |
1. self-reported 2. PAR-Q physical activity readiness questionnare 3. CVD risk factor assessment and classification |
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CVD risk factors: pic |
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What are the CVD risk factors? |
Age Family Hx Cigarette smoking sedentary lifestyle obesity hypertension dyslipidemia prediabetes |
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What are the age related CVD risk factors? |
-males over or equal to the age of 45 -females over or equal to the age of 55 |
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What are the family hx related CVD risk factors? |
MI, sudden death, coronary revascularization in a first degree relative before male age 55, female age 65 |
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What are the cigarette smoking related CVD risk factors? |
current smoker or quit within the past 6 mo exposure to tobacco smoke |
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What are the sedentary lifestyle related CVD risk factors? |
not participating in at least 30 min of moderate intensity PA (40-60% VO2 R) on at least 3 days a week for 3 months |
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What are the obesity related CVD risk factors? |
BMI greater than or equal to 30 kg x m^2 or waist girth males: >102 cm (40in); females: >88 cm (35in) |
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What are the hypertension CVD risk factors? |
SBP greater than or equal to 140 mmHg and or DSP greater than or equal to 90 mmHg |
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What are the dyslipidemia CVD risk factors? |
LDL greater than or equal to 130 mg x dL HDL lower than 40 mg x dL on lipid lowering meds total cholesterol: is greater than or equal to 200 mg x dL |
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What are the prediabetes CVD risk factors? |
IFG (impaired fasting glucose) greater than or equal too 100 mg x dL and less than or equal to 125 mg x dL |
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What are the HDL considerations on CVD? |
greater than or equal to 60 is good and should get-1 if there are any factors. *ask if akef consideres this? |
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What is considered high risk for starting an exercise program?? |
-known CV (cardiac, peripheral vascular, or cerebrovascular disease), pulmonary (COPD, asthma, interstitial lung disease, or cystic fibrosis), or metabolic disease (diabetes mellitus, or renal disease) -any of the 9 signs or sx of cv, pulmonary, or metabolic diseases -requires med exam, exercise test, and MD supervision before mod or vig exercise |
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What is considered moderate risk for starting and exercise program? |
greater than or equal to 2 CVD risk factors -requires a medical exam before vig exercise |
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What is considered low risk for starting and exercise program? |
less than 2 CVD risk factors |
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What is moderate exercise? |
40-60% VO2 R 3-6 MET's -noticiable increase in HR and breathing |
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What is vigorous exercise? |
greater than 60 % VO2R greater than 6 MET's -substantial increase in HR and breathing |
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Cardiorespiratory & Health Related PA assessment |
lecture 2 |
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What are the components of physical fitness? |
Cardiorespiratory capacity and endurance Muscular strength and endurance Flexibility Agility Balance Reaction time Body composition |
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How do we measure cardiorespiratory fitness? |
-Field tests: step test, 1.5 mile walk/run, 1 mile walk test -Submaximal test: YMCA, submaximal cycle test, astrand rhyming cycle test -Maximal tests: Graded exercise test, bruce protocol stress test |
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What are the primary reasons for conducting a pre activity screening? |
-Identify any medical contraindications -Identify those that should recieve a med eval before participating -Identify those who should be medically supervised during health assessments -identify any other health/medical concerns |
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How do we measure CRF? |
Cardiorespiratory fitness is measured by doing a maximal oxygen uptake VO2 max test |
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Why do we measure CRF? |
-to help us determine the intensity, duration, and mode of the exercises for the pt. -assists in identifying, diagnosing, and prognosing health/medical situations |
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How do we find predicted max heart rate? |
HR max=(220-age) |
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What are the common measurements taken during exercise testing? |
-HR -BP -RPE -ECG |
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What are the general indications for stopping an exercise test? |
-Onset of angina or angina-like symptoms -Drop in SB >10 mmHg with an increase in work rate or if SBP decreased below the value obtained in the same position prior to testing -excessive rise in BP: systolic >250, diastolic >115 -Shortness of breath, wheezing, leg cramps, or claudication -signs of poor perfusion: light headedness, confusion, ataxia, pallor, cyanosis, nausea, or cold and clammy skin -failure of HR to increase with increase intensity -change in heart rhythm by palpation or auscultation -subject requests to stop -physical or verbal manifestations of severe fatigue (RPE 17) -failure of testing equipment ---max HR, RER 1.01 |
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What are the common techniques to measure muscular strength ? |
1 RM (bench or leg press) MMT push up test partial curl up (crunch) test isokinetic testing |
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What does muscular strength and endurance help to improve or maintain? |
-Bone mass -glucose tolerance -musculotendinous integrity |
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What are the absolute contraindications for resistance training? |
•Unstable CHD •Decompensated HF •Uncontrolled arrhythmias •Severe pulmonary hypertension (mean pulmonary arterial pressure >55 mm Hg) •Severe and symptomatic aortic stenosis •Acute myocarditis, endocarditis, or pericarditis •Uncontrolled hypertension (>180/110 mm Hg) •Aortic dissection •Marfan syndrome •High intensity RT (80% to 100% of 1-RM) in patients with active proliferative retinopathy or moderate or worse nonproliferative diabetic retinopathy |
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What are the variables that flexibility depends on? |
-distensibility of the joint capsule -adequate warm-up -muscle viscosity |
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How to calculate BMI? |
body wt. kg/ ht. meters^2 (kg x m-2) underweight <18.5 normal 18.5-24.9 Overweight in adults BMI is above 25-29.9 Obese in adults BMI is above 30 |
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What is android obesity vs. gynoid obesity? |
Android: apple abdominal fat Gynoid: pear hip and thigh fat |
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Clinical Ex. testing |
lecture 3 |
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What is the purpose of exercise testing? |
Diagnositc (identify abnormal physiologic response) Prognositc (identify adverese events) Therapeutic (gauge impact of a given intervention) |
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What measurements are taken during exercise testing? |
HR BP ECG RPE Sx Expired gasses and ventilatory responses |
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What is the recommended monitoring of ECG for exercise testing? |
Before: monitor continuously, record supine, and pos. of exercise posture During: monitor, record during last 15 sec of every stage After: monitor, record immediate post exercise, during last 15 sec of first 5 min of recovery, then every 2 min thereafter |
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What is the recommended monitoring of HR for exercise testing? |
Before: monitor, record supine pos., and posture of exercise During: monitor, record during the last 5 s of each minute After: monitor, recorded during lst 5 s of each minute |
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What is the recommended monitoring of BP for exercise testing? |
Before: recorded in supine and pos of posture of exercise During: record during last 45 s of each stage After: record immediately postexercise and then every 2 min after |
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What is the recommended monitoring of signs and sx for exercise testing? |
Before: monitor, record as observed During: monitor, record as observed After: monitor, record as observed |
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What is the recommended monitoring of RPE for exercise testing? |
Before: explain scale During: record in last 15 sec of each exercise stage After: obtain peak exercise value then not measured in recovery |
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What is the recommended monitoring of gas exchange for exercise testing? |
Before: baseline reading to ensure proper operational status During: measured cont. After: generally not needed in recovery |
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What is normal rhythm ECG, and what does it look like? |
Rate: 60-100 bpm Normal p wave and PR interval with each QRS complex |
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Explain the waves and intervals of a normal ECG: |
Pwave: depol of atria PR interval: delay of av node to allow filling of ventricles QRS complex: depol of ventricles ST segment: beg of ventricle repol should be flat T wave: ventricular repol |
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What is the minimal diagnositc threshold for ischemia on an ECG? |
at least 1 mm of horizontal/downsloping ST-segemtn depression |
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What does ST-segement changes early in exercise in multiple leads predict? |
Either Severe single-vessel CAD Multivessel disease |
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What are dysrhythmias that increase in frequency or complexity with progressive exercise associated with? |
ischemia hemodynamic instability |
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What are sx of coronary artery disease? |
-substernal chest discomfort that may radiade to the back, jaw, or arms (typical angina) |
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*How do we interpret response of graded exercise testing? |
Hemodynamics: assessed by the heart rate and systolic and diastolic bp ECG waveforms: particularly ST-segment displacement and supraventricular and ventricular dysrhythmias Limiting clinical signs or symptoms |
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What does st segment depression suggest? |
Myocardial ischemia |
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What does st segment elevation suggest? |
previous MI coronory stenosis |
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Cardiorespiratory exercise prescription |
Lecture 4 |
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What is the principle of adaptation? |
if a specific physiologic capacity is taxed by a physical training stimulus within a certain range and on a regular basis, this physiologic capacity usually expands |
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What is training threshold? |
point beyond which the physiologic capacity must be challenged to effect a training stimulus, this process is termed overload and is required for adaptation |
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What is overtraining? |
the overload is excessive relative to the amount of time allotted for recovery, resulting in a chronic overtaxing of physiologic systems and a decrease in performance |
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What is cardiorespiratory capacity? |
max ability to perform large dynamic exercise through the use of oxygen (vo2max) |
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What is oxygen consumption reserve VO2R? |
the range of oxygen consumption from rest to maximum; the difference betweent he resting VO2 and max VO2 |
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What is heart rate reserve? |
HRR range of heart rate from rest to max |
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What is the FITT-VP principle? |
Frequency (how often) Intensity (how hard) Time (duration or how long) Type (mode or what kind) Total Volume (amount) Progression (advancement) |
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Define frequency: |
typically the number of exerccise sessions per week or, in some cases, per day |
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Define Intensity: |
the level of effort, which may be expressed relative to the patient's maximum ability, often measured by VO2 (work rate 'watts', HR, RPE) |
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Define time: |
the duration of each session, not including warm-up and cool-down, generally expressed in minutes |
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Define volume: |
product of frequency, intensity and duration |
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What is the recommendation for frequency or aerobic exercise? |
Moderate intensity: 5 days a week Vigorous intensity: 3 days a week or combination: 3-5 days a week |
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Describe MET's |
Metabolic Equivalent of Task -ratio of work metabolic rate to the resting metabolic rate <3 light intensity 3-6 moderate intensity >6 vigorous intensity |
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Aerobic Exercise Intensity Recommendation from VO2 R or HRR: |
Moderate: 40- <60 % Vigorous: 60- <90% light: 30-<40% |
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Define ACSM duration of cardioresp exercise: |
-5-7 days a week at mod intensity for duration 30-60 min -3-5 days a week at vig intensity for duration 20-60 min |
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What are the three stages of exercise progression? |
Initiation stage: must allow time for adaptation to occur, often lower intensity and duration, goal is to limit extreme fatigue and muscle soreness. Progression stage: Initiate progressive overload principle, f,i,d should not be increased together in any single week, and total weekly trainging volume should not be advanced by more than 10% Maintenance stage: goal is long-term maintenance, some try new activities to avoid boredom or monatomy |
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Adaptations to cardiorespiratory exercise training |
Lecture 5 |
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What is CRF, and how is it described? |
Cardiorespiratory fitness -maximal oxygen consumption VO2 max -max ability of body to transport & use oxygen |
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*What is the VO2 equation? |
VO2= Q x a - VO2 diff Q=HR x SV a-Vo2 diff====arteriovenous O2 difference; volume of o2 extracted per liter of blood |
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What is the Fick equation? |
Vo2= Q x a - VO2 diff |
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What are the values and ranges of VO2max in humans? |
Rest: 3.5 mL Upper end men: 85 mL Upper end women: 75 mL Range for healthy adults: 25-50 mL Average for congestive heart failure: 15 mL Ill pt: <10 mL |
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Table with normal physiologic adaptations to cardiorespiratory exercise testing: |
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How is SV increased with exercise training? |
-increased venous return (Frank starling law) -increased contractile status (neurohormonal influences) -cardiac hypertorphy (enlarged ventricular chamber and increased wall thickness) -10-15% increase in blood volume (hypervolemia) -strengthens of myocardial tissue and enables more forceful contraciton |
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How is HR affected with exercise training? |
-decreases rest and exercise HR -lower HR and greater SV for increased Q -lower HR rerquires less oxygen demand to heart and means delayed onset of angina and less shortness of breath |
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What happens to arteriovenous oxygen difference with regular aerobic exercise? |
-increase number of capillaries surrounding each muscle fiber -enhances the activity or mitochondrial enzymes used in aerobic metabolism (AOD: reflects ability of skeletal muscle to extract and use oxygen) |
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What happens to blood pressure with regular aerobic exercise? |
After a single bout of exercise, resting SBP will be reduced and will remain below preexercise values for about 24 hours |
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What can bed rest do to VO2max, SV, blood volume, heart rate |
Vo2max: 10-30% decrease SV: rapid decline BV: decreases HR: increase slightly |
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Musculoskeletal Exercise Prescription & Adaptations |
Lecture 6 |
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What is the difference between response and adaptation? |
Response: acute change in physiological function to the stress adaptation: the quantification of consistent individual response to stress |
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What are the early phase adaptations in the neuromuscular system? |
neural factors predominate for increases in strength and power in the initial 4-8 wk of training |
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What are the late phase adaptations in the neuromuscular adaptations? |
increase in muscle fiber size via muscle protein accretion are responsible for most adaptation after 4-8 wk of training |
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What are the neuromuscular junction adaptations of resistance training? |
produce more disperes, erregularly shaped synapses, high terminal branching, increased endplate perimeter lengtha dn area, and greater disprersion of acetylcholine receptors within the endplate region. |
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What are the muscle architecture adaptations of resistance training? |
increases the angle of pennation in the pennate muscle |
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What are the enzyme adaptations of resistance training? |
increased rates of ATP production |
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What are the muscle substrate stores adaptations of resistance training? |
anaerobic energy source substrates are enhanced with resistance training -these include creatine phosphate (CP) and ATP |
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What are the adaptations in skeletal muscle from resistance training? |
There is not an increase in capillary or myoglobin in muscle, only in aerobic. |
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What are the primary anabolic hormones? |
ANABOLIC -testosterone (T) 'increase' -growth hormone (GH) 'increase' -insulin-like growth factor (IGF) -insulin 'remains the same' CATABOLIC -cortisol 'increase acute or same, decrease, and increase with overtrining chronic' |
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What are the adaptations on bone for resistance training? |
- increase in mass and strength -increase BMD -cartilage, ligaments, tendons, and fascia also adapt to support greater loading |
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What are the cardiorespiratory adaptations for resistance training? |
HR BP VO2max (not affect) |
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What are the health and fitness adaptations from resistance exercise? |
-enhanced flexibility -reduced percent body fat -increase insulin sensitivity -decrease basal insulin levels and insulin response to glucose challenge -increase basal metabolic rate -attenuated muscle sarcopenia -reduced risk of osteoporosis, colon cancer, and low back pain, maintenacne of long-term independence and functional capacity |
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What should the frequency of resistance exercise be? |
Train the major muscle groups (chest, shoulders, upper and lower back, abdomen, hips, legs) 2-3 days a week with at least 48 h. separating the exercise training sessions for the same muscle group. |
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What should the intensity of resistance exercise be? |
-lifting to the point of muscular fatigue (not complete failure) in 8-12 reps is recommended (corresponding to approximately 60%-80% of the 1 RM) -rest between sets 3-5 minutes for large muscle mass multijoint exercises, and 1-2 min for smaller muscle mass single-joint movements 60-70% 1 RM = mod-vig intensity > 80% 1 RM = vigorous intensity 40-50% = light intensity |
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What should be the volume of resistance exercise? |
-each muscle group should be trained for a total of 2 to 4 sets with 8-12 reps per set (cam be derived form same exeercise or combo of exercises affecting same muscle group) -rest 2-3 min between sets - |
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What is the FITT VP principle for resistance exercise? |
Frequency(each major muscle group 2-3 d), Intensity (60-70% 1RM max), Time (not specified), Type (involving major m groups & multijoint), Reps(8-12) , Sets (2-4), Pattern(rest 2-3 min, and at least 48 hours, Progression( more weight, more reps, sets, or increase frequency) |
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What is the FITT-VP principle for flexibility? |
Frequency (more than 2-3x a week) Intensity (stretch to feel tightness) Time (hold for 10-30 sec, PNF 3-6 sec) Type (series for each of major muscle-tendon) Volume (60 s of total stretching time for each flexibility exercise) Pattern (Reps : 2-4x warm muscle first) Progression (unknown) |
