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
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|
Term
What is used during prolonged work (>30min)? |
|
Definition
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|
Term
How long does a steady state VO2 can usually be maintained during submaximal continuous exercise? |
|
Definition
|
|
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
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|
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.
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|
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
|
Definition
amount of energy expended during 1 minute of rest |
|
|
Term
|
Definition
1 MET = 3.5 ml/kg/min VO2 = 1.5 kcal/min Energy Expenditure |
|
|
Term
|
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
|
|
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
|
|
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
|
|
Term
How is the HR of trained person compared to that of a sedentary person? |
|
Definition
|
|
Term
What happens to HR with age? |
|
Definition
|
|
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
|
|
Term
|
Definition
amount of blood pumped by the heart with each contraction |
|
|
Term
|
Definition
Intrisic Factor: Frank-Sterling Relationship
Extrinsic factors: Sympathetic neural stimulation and catecholamines |
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|
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
|
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
|
|
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
|
|
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 |
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|
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
|
Definition
|
|
Term
How is DBP during high resistance excercise? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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 |
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|
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
|
|
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
|
|
Term
What fat content is eesential for obtaining optimal fitness for men? |
|
Definition
|
|
Term
What fat content is regarded obesity for men? |
|
Definition
|
|
Term
What is minimal fat content for women?
|
|
Definition
|
|
Term
What fat content is eesential for obtaining optimal fitness for women? |
|
Definition
|
|
Term
What fat content is regarded obesity for women? |
|
Definition
|
|
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
|
|
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
|
|
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 TPR, significant 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? |
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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
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Term
What define a pateint with good dynamic exercise? |
|
Definition
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Term
True of False
Patients with a relatively good dynamic exercise capacity (>6 METS) tolerate static exercise quite well |
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Definition
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Term
What effect does endurance type training have on CHD patients? |
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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 |
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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 |
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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 |
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Term
How does metabolic change of skeletal muscles due to exercise have an effect on cardiovascular? |
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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 |
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Term
What is the basic premise of exercise? |
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Definition
exercise should be of sufficient intensity to produce improvements in performance and health status but not so vigorous as to precipitate cardiovascular complications |
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Term
What HR should be used for stable cardiac patientsduring testing? |
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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 |
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Term
What HR should be used for patients with abnormalities detected during testing?
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Definition
HR at which the intensity at the onset of these abnormalities should then be used |
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Term
What are regular vigorous physical exercise, leisure-time physical activity, and physical fitness associted with? |
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Definition
lower blood pressure and a lower prevalence of hypertension |
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Term
What is the effect on Bp with excercise? |
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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 |
|
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Term
What is the recommended exercise regiment of high BP patient? |
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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 |
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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 |
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Term
What is the best exercise patients with moderate or severe hypertension and objective signs of organic change? |
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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 |
|
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Term
What is the low intensity excercise prescription for obese people? |
|
Definition
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Term
What is the long duration excercise prescription for obese people?
|
|
Definition
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Term
What is the high frequency excercise prescription for obese people?
|
|
Definition
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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 |
|
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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
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Term
What are the risks associated with excercising for diabetics? |
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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
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Term
What are special considerations for diabetics when they are exercising? |
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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.
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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 |
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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 |
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Term
How do you test Pulmonary Patients who are not severely disabled? |
|
Definition
Incremental progressive test on a cycle ergometer or treadmill |
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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) |
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Term
How do you test Pulmonary Patients who are disabled? |
|
Definition
6 to 12 minute walk test carried out in an indoor corridor |
|
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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 |
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Term
How do you test Pulmonary Patients who are disabled and need O2? |
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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 |
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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 |
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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 |
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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 |
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Term
Describe Grade II disabled pulmonary patient |
|
Definition
Moderate impairment exists and maximal exercise may be limited by a reduced ventilatory capacity |
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|
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 |
|
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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 |
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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 |
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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
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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
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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 |
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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
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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
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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 |
|
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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
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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
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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 |
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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
|
|
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 |
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|
Term
What are examples of beta 2 agonist (in aerosol form)? |
|
Definition
Metaproterenol, Alupent , Salbutamol, Albuterol, Ventolin, Proventil, Terbutaline, Brethaire |
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|
Term
What are usually present in cold and hay fever preparations as decongestants? |
|
Definition
|
|
Term
|
Definition
|
|
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
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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)
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|
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
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|
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 |
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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.
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|
Term
Is human growth hormone doping? |
|
Definition
|
|
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
|
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
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|
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
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|
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
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|
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?
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|
Definition
|
|