Shared Flashcard Set

Details

Physical Activity
Review
247
Medical
Professional
08/16/2011

Additional Medical Flashcards

 


 

Cards

Term
What are 3 ways ATP is produced?
Definition
a.Creatine phosphate system
b.Glycolysis (2 ATP)
c.Aerobic oxidation through Krebs cycle (36 ATP)
Term
What type of energy is needed for shorter activity?
Definition
shorter the activity, the greater the anaerobic
Term

What type of energy is needed for longer activity?

Definition
longer the activity, the greater the aerobic
Term
What is primarily used at the onset of exercise and during high intensity work?
Definition
Carbohydrate
Term
What is used during prolonged work (>30min)?
Definition
Fat
Term
How long does a steady state VO2 can usually be maintained during submaximal continuous exercise?
Definition
10 to 30 minutes
Term
What are the two exceptions of steady state VO2?
Definition
Prolonged exercise in a hot, humid environment resulting in a steady “drift upward” of VO2 during exercise.

Continuous exercise at a high relative work load results in a slow rise in VO2 during exercise, probably due to rising body temperature and increasing blood catecholamines

Term
Descibe the VO2 level and type of energy used in incremental excercise?
Definition
Oxygen uptake increases in a linear function to work rate until VO2 max is reached.
After reaching a steady state, most of the ATP production during the early stages of an incremental exercise test comes from aerobic metabolism. 


As the exercise intensity increases, blood lactate levels increase; the lactate “inflection” point represents a point of increasing reliance on anaerobic metabolism

Term
How is the O2 level during recovery from excercise?
Definition
Oxygen debt - VO2 values remain elevated above resting levels for several minutes during recovery from exercise

Term
Compare the metabolism of post-excercise and moderate/short exercise
Definition

 

High-intensity exercise: 
post-exercise metabolism >moderate exercise metabolism

Prolonged exercise:
post-exercise metabolism > short-term exercise metabolism.

 

Term
Why is post-excercise metabolism higher than that of moderate/short excericise?
Definition
High-intensity and prolonged exercise result in higher body temperatures and higher plasma catecholamine levels.
Term
What is MET?
Definition
amount of energy expended during 1 minute of rest
Term
What is 1 MET?
Definition

1 MET = 3.5 ml/kg/min VO2  = 1.5 kcal/min Energy Expenditure

Term
What is cardiac output?
Definition
number of liters of blood pumped per minute
Term
What is the importance of cardiac output?
Definition
a reflection of the overall functional activity of the heart and is a principal determinant of the rate of O2 delivery to peripheral tissues
Term
What is teh formula of cardiac output?
Definition
Q = HR x SV
Term
Describe Q during excercise.
Definition
Q increases rapidly at first with exercise and then more gradually until a steady state is reached or a maximum is attained
Term
What is the normal cardiac output?
Definition
5 L/min
Term
What is Q during excercise?
Definition
20 to 25 L/min in young, healthy men
15 to 20 L/min in young, healthy women
Term
What is HR for a sedentary individual 
Definition
72 BPM
Term
How is the HR of trained person compared to that of a sedentary person?
Definition
Lower
Term
What happens to HR with age?
Definition
Decreases
Term
What is the formula to calculate maximum HR?
Definition

Average maximal HR (BPM)  =  220  –  Age  (years)

Term
What happens to HR as O2 consumption increase?
Definition
Increase
Term
What is Stroke Volume?
Definition
amount of blood pumped by the heart with each contraction
Term
How is SV regulated?
Definition

Intrisic Factor: Frank-Sterling Relationship

Extrinsic factors: Sympathetic neural stimulation and catecholamines
Term
Describe SV during excercise
Definition

SV increases progressively until a work-load of 40 to 50% of VO2 max is attained

After this only small increases in SV occur with increasing oxygen demand


Thus during exercise, SV increases to approximately twice its resting value

Term
What is TPR?
Definition
sum of all forces that oppose blood flow in the systemic vascular bed
Term
What are the factors that affect TPR?
Definition
length of arterial vasculature, blood viscosity, hydrostatic pressure and vessel radius
Term
What is the most important factor for TPR?
Definition
Vessel Radius
Term
How is vessel radius controlled?
Definition

neural control (sympathetic nervous system)

local factors (pH, pCO2, and lactic acid concentration)

Term
What happens to TPR diring excercise?
Definition
TPR decreases during exercise through vasodilation of the arterial vascular bed in the active muscle tissue thereby, diverting blood flow to the working muscle tissue and away from viscera and inactive muscles
Term
What is the normal resting SBP?
Definition
120 mmHg
Term
Descibe SBP, Q, TPR during excercise
Definition

SBP increases in proportion to exercise intensity

Q Increases

TPR reduces

Term
What is isometric exercise?
Definition
produces muscle contraction but shortening or lengthening is prevented; tension is developed but no mechanical work is performed, with all energy liberated as heat
Term
What is isotonic exercise?
Definition
cause muscle contraction in which constant tension is maintained by the muscle while the length of the muscle is increased or decreased
Term
What is isokinetic exercise?
Definition
produces muscle contraction such that joint movement occurs at a constant angular velocity
Term
What is normal DBP?
Definition
80 mmHg
Term
How is DBP during high resistance excercise?
Definition
Increases
Term
What is the oxygen carrying capacity of blood?
Definition
 20 ml of oxygen per 100 ml of blood
Term
What is a-v O2 difference?
Definition
the difference between the oxygen content of arterial blood and mixed venous blood and represents the extraction of oxygen from the blood by the peripheral tissues
Term
What is the average value of a-v O2?
Definition
Average value at rest is 5 ml of oxygen are extracted from each 100 ml of blood
Term
Describe a-v O2 during excercise
Definition
a – v O2 increases linearly with workloads to a maximal value approximating 16 ml of oxygen per 100 ml of blood
Term
Is all O2 removed from blood during exercise?
Definition
No
Term
What is the formula for VO2?
Definition

VO2 max  =  max Q   x   max (a – v  O2 diff)

Term
What is minute ventilation?
Definition
volume of air passing through the pulmonary system in 1 minute
Term
What is the formula of minute ventillation?
Definition
Minute ventilation (L/min) = tidal volume (L)  x  respiratory rate
Term
Descibe minute ventillation during excercise
Definition

below 50% VO2 max, the relationship between ventilation and workload is linear

at higher intensities, the relationship is curvilinear

Term
During lower excercise, how is the rate if ventillation?
Definition
increased by increased tidal volume and respiratory rate
Term
During higher excercise, how is the ventillation rate?
Definition
Ventillation rate increases by increased respiration rate
Term
What is ventilatory anaerobic threshold (VANT)?
Definition
the point where the ventilatory response first departs from linearity to curvilinear
Term
What is teh significance of VANT?
Definition
corresponds closely to the time when lactic acid begins to accumulate
Term
What happens physically when VANT occurs?
Definition
as the exercise intensity increases,  breathing becomes somewhat labored and talking becomes difficult
Term
What is VANT a marker for?
Definition

At VANT: the upper end of the exercise intensity range usually applied in “aerobic” training programs

 

 

 

Above VANT: rapid accumulation of lactic acid in muscle and blood may preclude prolonged activity 

 

 

Term
What is dynamic exercise?
Definition
Dynamic exercise is characterized by moderate increases in HR and SBP and minimal change or a slight decrease in DBPand minimal change or a slight decrease in DBP
Term
What is static excercise?
Definition
Static exercise cause a pronounced rise in HR and SBP and an increase in DBP
Term
Which one performs at a greater physiologic cost, arm or leg exercise?
Definition
Arm
Term
What are the cardiovascular effects during exercise?
Definition
HR, SBP, DBP, oxygen intake and blood lactate values are increased, whereas SV is decreased
Term
What are the peripheral effects during aerobic training?
Definition
1)Increased concentrations ofaerobic enzymes
2)Increase in size and number of mitochondria
3)Increased concentration of myoglobin
4)Increased stores of triglycerides and muscle glycogen if accompanied with a high carbohydrate diet
5)High capillary to muscle fiber ratio
Term
What are the peripheral effects of muscle training?
Definition
1)Increase in muscle size through the synthesis of contractile proteins and thickening of connective tissue
2)Neurogenic training seems to occur with decreased inhibitions and more effective application of force
Term
What are the central effects of aerobic training?
Definition

 

1. alarger lung volumes but lung capacity is not highly correlated to performance.
2.More efficient respiration with endurance, larger tidal volumes,  slower respiratory rates and an elevated VANT
3.Improved SV, lower HR at sub maximal exercise levels,  increased maximal cardiac output
 
4.Increased LVEDV; the type of cardiac hypertrophy that allows for a greater SV and slower HR
5.Increase in blood volume and total hemoglobin
6.Improved blood distribution to the working muscles from the skin, viscera and unused muscles

7.Reduced levels of some hormones like epinephrine, increased sensitivity of other hormones like insulin 

Term
What are the central effects of muscle fitness training?
Definition
1.Nominal effects on the components of the oxygen transport system
2.Cardiac hypertrophy with increased LV wall thickness and a normal LVEDV
3.CNS exhibits reduced central inhibition and an enhanced ability to recruit muscle fibers
Term
What is improved during muscle fitness training?
Definition
Strength, muscular endurance and power 
Term
What is the purpose of anaerobic training?
Definition
Task specific anaerobic tests are necessary to reflect the effects of training
Term
How can exercise increase VO2?
Definition

Exercise training can increase the VO2 max by increasing both the max Q and max (a – v O2) difference

Alsong with improvements in respiration, central circulation and cardiac function, peripheral circulation or skeletal muscle metabolism 

 

 

Term
Describe Slow twitch fiber (type I)
Definition
Predominantly oxidative fibers with low glycolytic activity
Rich capillary supply
Small diameter
High myoglobin content
Numerous and large mitochondria
Low myosin-ATPase activity, slow contraction velocities and prolonged twitch duration
Heavy reliance on fat oxidation
Fatigue resistant and suited for prolonged tonic contraction
Term
What is an example of Type I muscle fiber?
Definition
Postural muscles
Term
Describe Fast-twitch (type IIa)
Definition
fast oxidative fibers
High oxidative capacity with moderate glycolytic activity
Rich capillary supply
Small diameter
Relatively high mitochondrial content
High myosin-ATPase activity
Suited for sustained phasic activities
Term
What is an example of Type II muscle fiber?
Definition
Muscles needed for running and cycling
Term
Describe Fast-twitch fibers (type II b)
Definition
fast glycolytic fibers
Low oxidative capacity but high glycolytic activity
Large diameter
Few mitochondria
High myosin-ATPase activity
Suited for brief powerful contractions sustained by anaerobic metabolism
Term
What is an example of Type II b muscle fiber?
Definition
Muscles used for jumping and throwing
Term
Describe Fast-twitch fibers (type II c)?
Definition
Intermediate contractile and metabolic characteristics
Appear during fiber type transition
Term
Does a motor unit have different types of muscle fibers?
Definition
No
Term
Describe muscle units with type I/II fibers
Definition
Units containing type I or type IIa fibers are small and are recruited during sustained phasic contractions that require minimal to moderate force
Term
Describe muscle units with muscle fiber type IIb
Definition
Units containing type II b fibers are usually large and simultaneous contraction of several large type II b fibers produces high levels of force required for powerful movements
Term
When are small and large motor units recruited?
Definition
During an intense contraction, small motor units are recruited first, and recruitment of progressively larger units occurs until the desired force production is attained
Term
With endured muscle training, which muscle fibers increase?
Definition
greatest increases in type I fibers after continuous training and in type II a fibers after interval training
Term
Besides the muscle fiber, what other things change with endurance training?
Definition
Increased skeletal muscle oxidative enzyme activities
Increases in mitochondrial size, number, and enzyme activities
Increased oxidative capacity to utilize pyruvate, fatty acids and ketone bodies
Increases in Krebs cycle enzyme activities, electron transport chain components, and the capacities to transport NADH, glucose and oxidized fatty acids
Minimal increases in ATP and CP content 
• Increase in Glycogen stores; can improve endurance performance and delay the onset of fatigue during prolonged submaximal exercise
The enhanced oxidative capacity of type I and type II a fibers allows more work to be done before anaerobic glycolysis and type II b fiber recruitment are required, minimizing or delaying the onset of lactic acid accumulation
The number of capillaries per muscle fiber increases
Myoglobin concentrations may also increase 
Both increases and decreases in type I cross sectional areas have been reported, but overall muscle hypertrophy is not a consequence of endurance training
 
Term
What is the primary adaptation of Skeletal Muscle to strength training?
Definition
increase in muscle bulk that results from hypertrophy of existing fibers, primarily type II a fibers
Term
How can strength increase more rapidly than muscle bulk?
Definition
 Because of increased motor unit recruitment and coordination
Term
How can muscle bulk increase more than strength?
Definition
 hypertrophy altering attachment angle to bone and reduces the mechanical advantage
Term
What increases  in response to muscle overload and strength training?
Definition
cross-sectional area and strength of connective tissue increase
Term
Which has no little/change with muscle training?
Definition
Little or no change in muscle enzyme activity occurs with strength training 
Term
What are the cardiovascular benefit of physical activity?
Definition
Increase in maximal exercise capacity
Submaximal exercise tasks require lower O2 consumption and a lower rate-pressure product

Reduced resting, exercise and intrinsic heart rate and increased stroke volume

Term
What are the benefits of physical activity in terms of myocardial contractility and LV Function?
Definition
Global physiologic ventricular hypertrophy with maintenance of normal wall stress and no reduction in myocardial contractility
Increased LVEDV
Term
What are the benefits of physical activity in terms of coronary artery?
Definition
Increased myocardial vascularity, myocardial capillary density and coronary flow reserve in animal models
Increased coronary artery size
Term

What are the benefits of physical activity in terms of peripheral muscle metabolism?

Definition
Increased anaerobic threshold due to improved metabolic capacity of skeletal muscle with larger size of mitochondria, an increase in oxidative enzymes and an increased oxygen extraction ability
Term

What are the benefits of physical activity in terms of lipid and lipoprotein?

Definition
1.Increased HDLs and apolipoprotein A-I and E
2.Decreased VLDLs and triglycerides
Term

 

What are the benefits of physical activity in terms of hypertension?

 

Definition
1.Slows chance of development  of hypertension
2.Reducing BP
Term

What are the benefits of physical activity in terms of weight reduction?

 
Definition
1.Weight loss if combined with reduced caloric intake
2.Maintenance of reduced weight is dependent on adherence to an exercise program
Term
What are the benefits of physical activity in terms of smoking?
Definition
1.Little help in the long term cessation of smoking
Term
What are the benefits of physical activity in terms of glucose intolerance?
Definition
1.Improvement in glucose intolerance with exercise
2.Reduction in insulin levels after exercise
Term

What are the benefits of physical activity in terms of psychology?

Definition
1.Promotes a sense of well being, reduces depression and is anxiolytic
Term

What are the benefits of physical activity in terms of vascular factors and bone?

Definition
1.Increases bone density
2.Promotes fibrinolytic activity
3.Reduces hypercoagulable states
4.Inhibits platelet aggregation

Reduces circulating catecholamines

Term
What effect does repeated bursts of high energy output established in terms of cornary?
Definition
a plateau of protection against coronary mortality
Term
What are the MET values associated with a plateau in death rates?
Definition
»Men – 10 METS
»Women – 9 METS
Term
What is the relation between death rate and excercise?
Definition
Low physical activity attributes to risk for all cause mortality in both men and women
 

Higher levels of physical fitness appear to delay all cause mortality primarily due to lower rates of cardiovascular disease and cancer

Term
What are the projected Benefits on Longevity with Exercise?
Definition
Net effect of exercise in terms of years added to life is not certain
Exercise training reduces premature mortality and does not extend the maximum life span
Term
What is the Risk of Sudden Death in relation to Exercise?
Definition
The risk of sudden cardiac death is more common during exercise than at rest;
Risk greater in sedentary subjects who initiate exercise
Risk greater in the elderly
Risk greater in the initial period of the exercise program
Risk of sudden death is reduced in physically fit people
Term
What is apparently healthy?
Definition
those who are apparently healthy and have no major coronary risk factors
Term
Who are individuals with higher risk?
Definition
those who have symptoms suggestive of possible coronary disease and / or one major risk factor
Term
Who are individuals with the disease
Definition
those with known cardiac, pulmonary, or metabolic disease
Term
What are the uses of clinical exercise testing for diagnostic/prognostic?
Definition
Evaluation of suspected heart disease
Evaluation of asymptomatic individuals with risk of CAD
After myocardial infarction (predischarge)
After coronary angioplasty
Dysrhythmia provocation
Term

What are the uses of clinical exercise testing for functional capacity?

Definition
Exercise prescription for healthy, sedentary individuals
After myocardial infarction
After coronary bypass surgery
After repair of valvular or congenital heart defect
Chronic pulmonary disease
Term
What are the components of physical fitness?
Definition
1.Cardiorespiratory endurance
2.Body composition
3.Flexibility
4.Muscular strength and endurance
Term
What are the principles of exercise prescription?
Definition
1.Type of activity
2.Intensity
3.Duration
4.Frequency
5.Rate of progression
Term
What is the basis of any type of physical activity?
Definition

Any activity that uses large muscle groups for a prolonged period and is aerobic in nature.

Term
What should be the intensity of physical activity in terms of functional capacity?
Definition
50-85% of the functional capacity
Term
What is the intensity of excercise presceibed by?
Definition
by heart rate, relative perceived exertion, or by METS
Term
How can you determine the target HR from the intensity of exercise?
Definition

plotting the relationship between the heart rate and the functional capacity (METS or VO2) and the instensity of exercise is 60-85% of the functional capacity

  

OR

 

 

Using a specified percentage of the maximal heart rate; This method underestimates the target heart rate for a given MET level by approximately 15%.

 

Term
What are the formulas for target HR?
Definition
        a.220 – Age = Estimated MHR

 MHR  x  percentage  =  THR


b. [ Percentage (MHR – RHR) ]  +  RHR =  THR


Term
What is the duration period of exercise?
Definition

15-60 min

 

Usually 30min

Term
What is the recommendation of exercise activity?
Definition
Every US adult should accumulate 30 minutes or more of moderate intensity physical activity, performed at an intensity of 3 to 6 METS on mostly all days of the week
Term
How much exercise should chidren and adolescent exercise
Definition
60 minutes or more of physical activity daily with muscle-strengthening and bone-strengthening activity
Term
What is the guideline of excercise activity for adults?
Definition
Adults should do at least 150 min a week of moderate-intensity or 75 min a week of vigorous-intensity aerobic physical activity
Term
What are the stages of rate of progression?
Definition
1.Initial conditioning stage
2.Improvement stage
3.Maintenance stage
Term
What is the initial stage?
Definition
1.Start slow and begin 1 MET lower than that estimated at 50-85% of the functional capacity
2.The duration should be at least 10 to 15 minutes
3. On average, the initial phase lasts 4 to 6 weeks, depending on people
Term
What is the improvement stage?
Definition
1.An increase in the intensity to a target heart rate level within 50 to 85% of functional capacity should occur during this stage.
2.The duration should be increased every 2 to 3 weeks and should last 20 to 30 minutes before increasing the intensity.
Term
What is maintenance stage?
Definition
This stage begins after the first 6 months of training and is designed to maintain fitness, provide enjoyable, varied activities and to minimize boredom
Term
What is the recommended calorie intake?
Definition
not to exceed 500-1000 kcal/day lower than dietary recommendations and no lower than 1200 kcal/day for normal adults
Term
What is energy expenditure?
Definition
300 kcal per exercise session. An endurance exercise program should be used with a minimum intensity of 65% of maximal heart rate
Term
What is minimal fat content for men? 
Definition
5% of weight
Term
What fat content is eesential for obtaining optimal fitness for men?
Definition
12-15%
Term
What fat content is regarded obesity for men?
Definition
Over 30%
Term

What is minimal fat content for women? 

Definition
14%
Term
What fat content is eesential for obtaining optimal fitness for women?
Definition
16-24%
Term
What fat content is regarded obesity for women?
Definition
Over 35%
Term
Why do pateints with CHD respond to dynamic exercise?
Definition
ischemia, irreversible myocardial necrosis or damage to the conduction system
Term
How are the parameters of cardiovascular in CHD pateints?
Definition
Majority have diminished Q, VO2 max and work tolerance, although some have normal parameters
Term
What is the reason behind reduced work load in CHD pateints?
Definition
diminished peak SV or HR while the a – v O2 diff is usually within normal limits
Term
How is the BP on CHD patients?
Definition
Blood pressure at submaximal and maximal exercise levels may be elevated, normal or decreased, with the latter being critical in patients with myocardial ischemia
Term
What is teh reason behind Impaired left ventricular response to exercise in CHD pateints?
Definition
 due either to ischemia or to permanent myocardial scarring
Term
Why would CHD patients with normal hemodynamic function atrest demonstrate an abnormal response duringexercise?
Definition
due to poor LV compliance or abnormal contraction patterns that may become apparent with increased LV work
Term
What is the major decrements in work capacity in patients with normal hemodynamics at rest? 
Definition
due to effort induced myocardial ischemia
Term
What are the cardiovascular adjustments in CHD patients with normal resting hemodynamics exercise at submaximal levels?
Definition
Have a normal Q and a– v O2 difference, but Q may be achieved by a higher HR and lower SV
Term
What happens in terms of the cardiovacular when LV impairment increases  in CHD pateint due to fixed or reversible abnormalities?
Definition
There is increased HR that will not fully compensate for the drop in SV, so Q for any VO2 is decreased and there is a widening of the a – v O2 difference provides the needed delivery of O2
Term
How is coronary reserve impaired?
Definition
atherosclerosis reduces the cross sectional area of the coronary lumen by at least 70%
Term

What is the association between the extent of arterial disease and work capacity or VO2 max?

 

Definition
Inverse
Term
What does the average work capacity deline depend on?
Definition
Average work capacity declines with  (1) severity of stenosis and (2) number of major vessels involved, but the magnitude of physical impairment cannot be used to predict accurately the extent of anatomic involvement
Term
How can a patient with double or triple vessel disease be free of angina or LV dysfunction at relatively high workloads
Definition
by having well-developed collateral vessels may 
Term
What is Class I of Functional Classification?
Definition
patients with no symptoms with a VO2 max greater than 6 METS
Term

What is Class II of Functional Classification?

Definition
patients with symptoms during ordinary physical activity with a peak VO2 of 4 to 6 METS
Term

What is Class III of Functional Classification?

Definition
patients with symptoms with less than ordinary physical activity with a peak VO2 of 2 to 4 METS
Term

 

What is Class IV of Functional Classification?

 

Definition
patients with symptoms at rest with a peak VO2 of less than 2 METS
Term
What ischemia result in CHD patient
Definition

  1. Diminished SV

  2. A more rapid increase in HR

  3. An earlier widening of the a – v O2 difference

  4. A subnormal rise in SBP, with the possibility of no increase or even a drop in DBP

Term
Why do CHD patients with increasing ischemia usually terminate exercise? 
Definition
because of the inability to transport sufficient oxygen to the myocardium as well as to the contracting muscles
Term
How is the onset of ischemia detected?
Definition

It occurs at a relatively constant threshold of myocardial work for an individual patient;

this threshold is best defined noninvasively by the HR x SBP (rate-pressure product, RPP)

Term
Does the threshold for ischemia remain relatively constant with alterations by static arm exercise, cigarette smoking, lower environmental temperature or food ingestion?
Definition
YES
Term
What is the effect of RPP threshold during upright dynamic exercise? 
Definition
LV volume differs during upright dynamic leg exercise, thus RPP threshold for ischemia may change
Term
What is the effect of RPP threshold during supine exercise?
Definition
LVEDV is increased due to an elevated central blood volume and the onset of ischemia occurs at a lower RPP
Term
What is the difference between static and dyanamic exercise in terms of load on myocardium?
Definition
Static or isometric exercise primarily produces a pressure load on the myocardium,
Large muscle dynamic exercise puts predominantly volume load on myocardium 
Term
How are the cardiovascular factors effected with static exercise?
Definition

static contraction of even small muscle mass in normal individuals produces a significant rise in HR, Q and BP with minimal or no change in SV or TPRsignificant rise in LVEDP,  a small increase in LV stroke work 

 

 

 

Term
In patients with poor dynamic exercise tolerance and who does static exercise, what is the cardiovascular effect? 
Definition

the left ventricle has scant physiologic capacity to increase its output during static exercise and a sustained muscular contraction that may produce myocardial ischemia, LV failure, or complex ventricular arrhythmias

systemic BP rises normally with static exercise due to an increase in peripheral arterial tone 

 

 

Term
What define a pateint with good dynamic exercise?
Definition
> 6 METS
Term

True of False

Patients with a relatively good dynamic exercise capacity (>6 METS) tolerate static exercise quite well
Definition
True
Term
What effect does endurance type training have on CHD patients?
Definition
Patients with exertional ischemia, the intensity needed to precipitate chest pain or ST segment depression becomes greater, and less anti-anginal medication may be required
Term
How are improvements due to excercise trained possible?
Definition
reduction in myocardial workandoxygen demand at rest and submaximal exercise than to any substantial increase in myocardial oxygen supply
Term
How does reductions in myocardial oxygen demand result after excercise training? 
Definition

from decreases in HR with some systemic drop in BP

The site of effect is the muscle in training

Term
How does metabolic change of skeletal muscles due to exercise have an effect on cardiovascular?
Definition
alterations in the metabolic capacity of skeletal muscle probably makes a major contribution to the quite rapid decrease in HR and increase in    a – vO2 diff that occurs during submaximal exercise soon after training begins
Term
What is the basic premise of exercise?
Definition
exercise should be of sufficient intensity to produce improvements in performance and health status but not so vigorous as to precipitate cardiovascular complications
Term

What HR should be used for stable cardiac patientsduring testing?

Definition
For stable cardiac patients who perform symptom-limited exercise tests that are free of abnormalities, a percentage of the peak heart rate is an appropriate value to use, as it is used with healthy adults
Term

What HR should be used for patients with abnormalities detected during testing?

Definition
HR at which the intensity at the onset of these abnormalities should then be used
Term
What are regular vigorous physical exercise, leisure-time physical activity, and physical fitness associted with?
Definition
lower blood pressure and a lower prevalence of hypertension
Term
What is the effect on Bp with excercise?
Definition
lower blood pressure in groups of hypertensive patients by 5 to 10 mm Hg systolic and diastolic and may enhance the antihypertensive effect of weight loss and sodium restriction
Term
What is the recommended exercise regiment of high BP patient?
Definition
dynamic or endurance training, such as walking, jogging, cycling, etc. that use large muscles in a continuous repetitive manner
60 – 90 % of maximum heart rate
20 – 60 minutes duration
3 – 5 days per week
Term
What is the best exercise routine for pateints with borderline or mild hypertension and no objective signs of organic change?
Definition
combination of aerobic and isometric exercises
Term
What is the best exercise patients with moderate or severe hypertension and objective signs of organic change?
Definition

aerobic exercise should be encouraged to maintain physical conditioning, provided there is good BP control.

Weight lifting, strenuous isometric exercises and exhausting aerobic exercises must be avoided

Term
What is the low intensity excercise prescription for obese people?
Definition
 60 to 75% of max HR
Term

What is the long duration excercise prescription for obese people?

Definition
50 to 60 min / day
Term

 

What is the high frequency excercise prescription for obese people?

 

Definition
6 to 7 days / week
Term
What are the thorough medical evaluation for diabetes mellitus?
Definition

  1. Cardiovascular exam

  2. Diabetic complications

  3. Blood glucose regulation

  4. Patient education and awareness

Term
What are the benefits of excercising for diabetes mellitus?
Definition
Lowers blood glucose
Increases insulin sensitivity
Reduces cardiovascular risk factors

  1. HDLs increase

  2. Triglycerides decrease

Improves hypertension
Decreases cardiac work
Adjunct to diet for weight reduction
Increases physical work capacity
Increases sense of well-being and quality of life 

 

 

Term
What are the risks associated with excercising for diabetics?
Definition
Hypoglycemia during and after exercise
Increased blood glucose and ketones in poorly controlled patients
Complications of ASCVD

  1. Myocardial infarction

  2. Arrhythmias, sudden death

Degenerative joint disease
Soft tissue injuries
Worsening of diabetic complications
Proliferative retinopathy

1.  Vitreous hemorrhage

2.  Retinal detachment

Diabetic nephropathy

1.  Increased proteinuria

Peripheral neuropathy
Autonomic neuropathy 
 
Term
What are special considerations for diabetics when they are exercising?
Definition

1.Be prepared to reduce the overall insulin or oral medication requirement

2.  Estimate the number of calories that will be expended per session. Increase or decrease the intake of food to match the extent that the exercise will deviate from the normal amount.

3.  Try to exercise at about the same time of day to facilitate planning

4. Plot the time of peak blood sugar lowering effect of each type of insulin. If planning to exercise at about the same time, plan to take a light snack 20 to 30 minutes prior to exercise.

5.  Do not exercise if ketones are present in the urine or if the blood sugar is above 300 mg/dl.

6.  If you feel hypoglycemic, irritable, or nervous prior to exercise, check the blood sugar.

7. If planning an unusually large amount of physical activity, be prepared to eat additional food or to reduce the insulin dose. If choosing to increase caloric intake, light snacking every 30 to 60 minutes will help to avoid hypoglycemic reactions.  

8. Alter the injection site for insulin if subsequent exercise would cause the insulin level in the blood to rise too quickly. Avoid:

  • arms and shoulder injections sites if weight training or swimming will be done
  • thigh injection sites if running, cycling, playing basketball, or doing aerobic dance.  
Term
Which area of the body seems to be minimally affected by exercise and may be a suitable alternative site for these exercise activities?
Definition
Speed of absorption of insulin from the abdomen and gluteal area 
Term
What is the purpose behind excercise testing for pulmonary patient
Definition
Objective measurement of exercise tolerance
An explanation and rating for exercise related symptoms
Identification of the factors limiting exercise
Limited ventilatory capacity
Poor pulmonary gas exchange
Hypoxia
Abnormal cardiac function
Muscle weakness
•Prescription of exercise levels
Term
How do you test Pulmonary Patients who are not severely disabled?
Definition
Incremental progressive test on a cycle ergometer or treadmill
Term
What is being measure in cycle ergometer or treadmill for pulm. patient?
Definition
Heart rate and blood pressure
Ventilation and breathing frequency
Magnitude scaling of dyspnea
Arterial oxygen saturation
End tidal carbon dioxide levels
EKG monitoring (CAD often coexists with COPD)
Term

How do you test Pulmonary Patients who are disabled?

Definition
6 to 12 minute walk test carried out in an indoor corridor
Term
What is being measured in a walk test for pulmonary patient?
Definition
Distance covered in 6 to 12 minutes
Stride length
Heart rate
Breathing frequency
Arterial oxygen saturation  
Term
How do you test Pulmonary Patients who are disabled and need O2?
Definition
A constant exercise level that produces limiting symptoms in 4 to 6 minutes during air breathing, e.g. cycle ergometer or a treadmill at 1 to 3 mph, 0% grade
Oxygen and air can be administered without patient’s knowledge
Term
What is being measured in the cycle ergometer or a treadmill for pulmonary patient who is disabled and need O2?
Definition
Arterial oxygen saturation
End tidal or arterial carbon dioxide
Term
Describe Grade I disabled pulmonary patient
Definition
Not limited by impaired pulmonary function
Usual method of prescription based on submaximal exercise levels and heart rate responses
Monitoring of training intensity uses the appropriate percentage of the heart rate response determined during the exercise test
Term
What is the exercise prescription for Grade I disable pulm pt.
Definition
Exercise sessions should be 30 to 60 minutes and be performed daily
Term
Describe Grade II disabled pulmonary patient
Definition
Moderate impairment exists and maximal exercise may be limited by a reduced ventilatory capacity
Term

What is the exercise prescription for Grade II disable pulm pt.

Definition
Training intensity should not exceed 60 to 80% of the ventilatory capacity and that was shown in the exercise test to lead to a breathing frequency of less than 30 breaths/minute
An equivalent heart rate is chosen and is used for monitoring purposes
Initial exercise duration may be severely limited and exercise frequency may require the patient to exercise more than once a day, every day, for short periods of time
Term
Describe the exercise prescription of Grade III pulm. pt
Definition
Most difficult to give a prescription
Guidelines for Grade II apply, the exercise may not produce a training effect
Consider utilizing the following:
Oxygen supplementation
Interval training methods
Training of muscle groups 
Breathing training
Term
Describe Grade IV disabled pulm. patient?
Definition
Patients may be in chronic respiratory and cardiac failure
Term
Describe the exercise prescription of for a Grade IV disabled pulm pt.
Definition
Activity prescribed is directed toward efficiency and energy conservation
The benefits and risks of exercise and oxygen administration must be carefully considered since the long term benefit from oxygen during training sessions has not been established
Patients may require treatment with continuous low flow oxygen 24 hrs / day
Term
What is the recommended exercise for elderly?
Definition
For the average 70 to 75 year old woman, simply walking at 3 mph is maximum aerobic capacity
Term
What are the benefits for elders excercising?
Definition
Improving active life expectancy, prolonging independent living and postponing and / or diminishing the morbidity due to chronic disease.
The economic implications of a health habit that decreases morbidity and prolongs independent living; reduction in the demand for health services. 
Improvements in the cardiovascular and respiratory systems, beneficial metabolic changes in cholesterol, triglycerides, glucose tolerance and osteoporosis, weight loss and psychological improvements
Term
What are the risks of excercising for adults?
Definition
Asymptomatic coronary artery disease and sudden death are major concerns
A risk of sudden death is associated with exercise and is greater in individuals who are unaccustomed to vigorous exercise than in those individuals who were conditioned

Term
What is an important step to do when elders begin excercising program?
Definition
Screening for CAD becomes an important part of the screening process when allowing a elderly patient to begin an exercise program
Term
What are the physiological changes in aging in the cardiovascular system?
Definition

 

1) VO2 max

  a. Highest value is observed in 1st decade of life

  b. Linear decline continues throughout life

  c. 1 % decline / year between 20 and 70 years

  d. Exercise affects the rate of decline

  e. 5% decline per decade in master athletes and a 9% decline per decade in healthy, untrained individuals

 

2) Cardiac output –   decline of app 1% / year

3)  Stroke volume –   decline of app 0.7% / year

4)  Maximal heart rate – decline

5)  Peripheral resistance – increases

6)  Blood pressure - increases

 

Term

What are the physiological changes in aging in the respiration system?

Definition

1.  Structural changes in lungs and thorax limit ventilatory excursions

2.  Tidal volume and respiratory rate – unchanged

3.  Forced expiratory volume and vital capacity – decreases

4.  Residual volume and anatomic dead space - increases

Term

 

What are the physiological changes in aging in in terms of body structure and composition?

 

Definition

1.     Increased contribution to body weight of adipose tissue

lMen gain weight up to age 55 and women gain weight for an additional 20 yrs before a decline in weight begins; increase in both the absolute and relative amounts of body fat

 

2.  Reduction in lean muscle mass

·    Decrease in total number of muscle fibers, especially type II, fast twitch fibers

3.  Loss of bone mass

 1. During the 30 to 40 yrs after age 40, the total loss in skeletal mass may be 30 to 50% of that at an earlier age

2. Rate of bone loss occurs faster in women than men

3. Although the architecture of bone does not change substantially, there is a dramatic decrease in its mineralization

Term
What are the effects of excercise on VO2 in elderly?
Definition
Increase in VO2 max depending on initial activity level, limitations due to medical problems, and the intensity, duration and frequency of training
Approximately half of the increase in VO2 max is due to changes in cardiovascular system and half is due to peripheral changes
The benefits of training occur at submaximal work loads that are used in the activities of daily living
Term

What are the effects of excercise on cardiovascular system at submaximal work in elderly?

Definition
Stroke volume – increases
Heart rate – decreases
Blood pressure – decreases
Term

What are the effects of excercise on peripheral effects in elderly?

Definition
There is an increase in the capacity for aerobic metabolism and extraction of substrate and oxygen at the tissue level
Term

What are the effects of excercise on body composition and structure in elderly?

Definition

 

 

1.  Lean body mass

 

·        Reversal in age-associated muscle fiber atrophy

 

·        Increase in the activity of aerobic muscle enzymes

 

·        Increase in muscle strength

 

2.  Bones and Joints

 

·        Improvement in bone mineralization

           •     Improvement in range of motion and flexibility

 
 
 
 

 

Term

What are the effects of excercise on metabolism in elderly?

Definition

1.  Glucose tolerance – improves

2.  Insulin sensitivity – improves

3.  Serum triglycerides – reduced

4.  HDL cholesterol – increases

5.  Apolipoprotein A-I - increases

Term

What are the effects of excercise on psychology in elderly?

Definition

1.  Anxiety – reduced

2.  Psychological tension – reduced

3.  Body image – improved

4.  Mood and attitudes - improved

Term
What should elders do before starting an excercise program?
Definition
Mandatory before an aerobic exercise program
Preferable before a low-intensity exercise program
Term
What evaluation should be conducted by physicians before elders begin excercise program?
Definition
Careful history and review of medications
Cardiovascular evaluation
Resting EKG
Exercise stress test
Lab studies
Term
What is the excercise prescription of elders?
Definition
Intensity –
1.Begin at a low level, particularly for individuals who are overweight, sedentary or arthritic
2.Increase intensity slowly to avoid musculoskeletal injury
Duration – 20 to 60 minutes
Frequency – 3 to 4 days / week
Flexibility exercises
Weight training – low intensity
 

Term
What is the excercise session for elders like?
Definition

 

Warm-up period
Low intensity walking to gradually increase the HR
Light calisthenics
ROM and stretching
Aerobic or conditioning part
1.Aerobic activities that do not involve the same joints on a daily basis
2.Activities that incorporate different muscle groups
Cool-down period
1.Same type of activities as in warm-up but to slow the HR and avoid blood pooling in the extremities

 

Term
What are the safety and precautions that elders should follow when excercising?
Definition
•Wear thick layered clothing in cold weather
In hot or humid weather, exercise during the coolest part of the day or in an air-conditioned environment
Fluids should be available throughout the exercise session to prevent dehydration
•Wear good quality foot wear.
Individuals should report chest pain immediately.

Orthopedic problems are usually minor in nature but can become major problems if ignored

Term
What is the nutrition criteria in terms of carbohydrates for athletes?
Definition

About 55 to 60% of the total caloric intake should be from carbohydrates to ensure repletion of glycogen stores as an energy source and to protect lean body mass

 

The caloric consumption must be equivalent to the total energy expenditure

Term

What is the nutrition criteria in terms of proteins for athletes?

Definition
Approximately 15% of the total caloric intake should be from high-quality protein.
•Athlete can meet protein needs with diet and does not need protein supplements.
Excess protein does not increase muscle mass or potential for strength development
Term

What is the nutrition criteria in terms of fat for athletes?

Definition
Fat intake should not exceed 30% of the caloric intake
Term
What is the nutrition for athletes during pre-competition?
Definition
Consumed 3 to 4 hours before competition with easily digested foods and fluids, including foods high in complex carbohydrates and low in fat and protein.
Ingestion of salty, high fiber, or gaseous foods should be minimized before competition.
Liberal intake of fluids should be taken for adequate hydration.
Term
How can athletes tolerate heat during excercise?
Definition
By repeated exposures to heat, referred to as heat acclimatization.
The primary physiologic adaptation of heat acclimatization include:
1.An expansion of plasma volume
2.An increase in sweat rate
3.A decrease in the NaCl content in sweat
4.Improved circulatory control
Term
How can athletes avoid heat injury?
Definition

1. Allow time for heat acclimatization (10 to 14 days).

2. Exercise during the cooler parts of the day.

3. Limit or defer exercise if WBGT is in the high risk zone.

4. Plan to drink before, during and after exercise in the heat (400-500 ml before and 300 ml every 20 min during the activity);Don’t judge your need for water by thirst alone;Water is the best fluid;Avoid alcoholic beverages, since alcohol impairs sweating

5. Modulate training intensity (by heart rate monitoring).

6. Monitor daily weight closely. Acute losses are due to water loss. If losses are greater than 3% of weight, they need to be replaced by drinking before the next training session.

7. Salt replacement is essential. Adequate electrolyte replacement is provided by liberal salting of food and a balanced diet. 

8. Wear as little clothing as possible. Clothing should be loose and porous, to allow air to circulate over the skin and permit evaporation of sweat. Never use rubberized sweat suits. White clothing and a visor or hat are suggested

Term
What are the heat related syndromes?
Definition
1.Heat cramps
2.Heat exhaustion
3.Heat stroke
Term
How can heat related syndromes haooen?
Definition

thermoregulatory mechanisms fail to cope with the competing loads:

           (1) external heat load

(2) heat produced metabolically so that core body temperature rises

Term

 

 

 

True or False 

People who habitually function in cold temperatures develop the ability to burn more calories per unit of exercise than the unhabituated person

Definition
True
Term
What are the classes of doping?
Definition
1.Stimulants
2.Narcotics
3.Anabolic steroids
4.Beta-blockers
5. Diuretics
Term
What are the doping methods?
Definition
1.Blood Doping
2.Pharmacological, chemical and physical manipulation of urine
Term
What Classes of Drugs are subject to certain restrictions?
Definition
1.Alcohol
2.Local anesthetics
3.corticosteroids
Term
What are some of doping stimulants?
Definition
amphetamines, cocaine, Caffeine, Beta 2 agonists, Sympathomimetic amines 
Term
What amount of caffeine is considered doping?
Definition

An amount greater than 12 mcg/ml in the urine is considered doping.

To reach this limit one would have to consume 6-8 cups of coffee in one sitting and be tested within 2-3 hrs

Term
What are examples of beta 2 agonist (in aerosol form)?
Definition

Metaproterenol, AlupentSalbutamol,  Albuterol, Ventolin, Proventil,  Terbutaline, Brethaire

Term
What are usually present in cold and hay fever preparations as decongestants?
Definition
sympathomimetic amines
Term
Is morphine banned?
Definition
YES
Term
Which narcotics are not banned?
Definition
Dextromethorphan, Diphenoxylate (Lomotil)
Term
What is the action of anabolic steroids?
Definition

They increase protein synthesis which will, with training, create an increase in lean muscle mass, resulting in an increase in strength and endurance

They have both anabolic and androgenic effects 

 

Term
What modification in anabolic steroids allows significant activity after oral administration and resistance to the “first pass effect” of the liver?
Definition

Alkylation in the C-17 alpha position

(Hepatotoxic) 

 

Term
What modification of anabolic steroids allows significant activity after IM administration?
Definition

Esterification in the C-17 beta position

They are not subject to first pass effect and rarely are implicated in hepatotoxicity 

 

Term
What is the mechanism of action of anabolic steroids?
Definition
Steroid molecule binds with a receptor in the cytosol, migrates to the cell nucleus, causing RNA transcription and ultimately, protein synthesis
Term
What does anabolic steroid have positive effect on?
Definition
Steroids have a positive effects on nitrogen balance, and the greatest effect occurs in catabolic states where nitrogen intake is normal
Term
Do athletes have positive or negative nitrogen balance?
Definition
Negative because of strenuous activity
Term
What is the reason behind progressive decrease in sensitivity of muscle tissue to androgens
Definition
Down regulation of receptors, which decreases receptor concentration and sensitivity
Term

How can steroids maximizes anabolic stimulation and minimizes side effects from high-dose steroid consumption?

Definition

simultaneous use of different anabolic steroid preparations with the expectation of saturating multiple androgen receptor populations

 

 

 utilize drug-specific side effects 

 

cycle different steroids over a 6 to 12 week period. 

 

Term
Is human growth hormone doping?
Definition
Yes
Term
How are beta blockers used as doping?
Definition
Beta blockers are used as anti-hypertensives and anti-anginal drugs because they block the sympathetic response of the body
Term
How are diuretics used as doping?
Definition
To reduce weight quickly in sports where weight categories are involved
To reduce the concentration of drugs in urine by producing a more rapid excretion of urine to attempt to minimize detection of drug misuse
Term
What is blood doping?
Definition
Blood doping is the administration of blood or related red blood products to an athlete other than for legitimate medical treatment
Term
For what purpose is corticosteroids not banned?
Definition
topical use (aural, ophthalmological, and dermatological), inhalational therapy (asthma, allergic rhinitis), and local or intra-articular injections
Term
How is corticosteroids banned?
Definition
Oral, intramuscular and intravenous use 
Term

A 65 year old male patient who develops angina at exercise levels less than ordinary activity (i.e. 2-4 mets), would be classified at what class according to the New York  Heart Classification?

Definition
Class III
Term

A 55 year old sedentary male wants to begin an exercise program. What is the common etiology for exercise induced sudden death for this type of patient?

Definition
Coronary disease
Term
A 38 year old woman weights 60 kg and has no physical findings of cardiopulmonary disease. Her resting heart rate is 60 bpm. During an exercise test, she attains a maximal heart rate of 180 bpm and a VO2max of 35 ml/kg/min. At an 80% of maximal heart rate level of intensity, which of the following is her target heart rate?
Definition
156 bpm
Term

 

A 38 year old woman weights 60 kg and has no physical findings of cardiopulmonary disease. Her resting heart rate is 60 bpm. During an exercise test, she attains a maximal heart rate of 180 bpm and a VO2max of 35 ml/kg/min. W/an 80% of maximal heart rate level of intensity, how many METS is her current excercise capacity?

 

 

 

Definition
10 METS
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