ExRx midterm

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ExRx midterm
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  1. ACSM Coronary Artery Disease Risk Factor Thresholds
    Risk Factors (8)
    • Family history
    • Cigarette Smoking
    • Hypertension
    • Dyslipidemia (an abnormal amount of lipids)
    • Impaired Fasting Glucose
    • Obesity
    • Sedentary Lifestyle
    • High Serum HDL
  2. Total Blood (or Serum) Cholesterol Levels
    • Less than 200 mg/dL
    • Desirable level that puts you at lower risk for coronary heart disease. A cholesterol level of 200 mg/dL or higher raises your risk.
    •   200 to 239 mg/dL
    • Borderline high
    • 240 mg/dL and above
    •   High blood cholesterol. A person with this level has more than twice the risk of coronary heart disease as someone whose cholesterol is below 200 mg/dL.
    • *Your total cholesterol score is calculated by the following: HDL + LDL + 20% of your triglyceride level.
  3. ACSM Coronary Artery Disease Risk Factor Thresholds
    Family history
    • MI, coronary revascularization, or sudden death in an immediaterelative (male <55 years or female <65 years)
    • Score: +1
  4. ACSM Coronary Artery Disease Risk Factor Thresholds
    Cigarette Smoking
    • Current smoker or those who quit within the past 6 months
    • Score: +1
  5. ACSM Coronary Artery Disease Risk Factor Thresholds
    Hypertension
    • SBP ≥140 mmHg or DBP ≥90 mmHg confirmed by measurements on at least two separate occasions, or on antihypertensive medication
    • Score: +1
  6. ACSM Coronary Artery Disease Risk Factor Thresholds
    Dyslipidemia
    • Total >200 mg/dL or
    • HDL <40 mg/dL or
    • LDL >130 mg/dL; if LDL >130 mg/dL,
    • use LDL rather than total >200 mg/dL,
    • or onlipid-lowering medication
    • Score: +1
  7. ACSM Coronary Artery Disease Risk Factor Thresholds
    Impaired Fasting Glucose
    • Fasting blood glucose ≥ 100 mg/dL confirmed on two separate occasions
    • Score +1
  8. ACSM Coronary Artery Disease Risk Factor Thresholds
    Obesity
    • BMI >30, or waist girth >102 cm (40 in) for men and > 88 cm(35 in) for women, or waist-to-hip ratio ≥ 0.95 for men and ≥0.86 for women
    • Score: +1
  9. ACSM Coronary Artery Disease Risk Factor Thresholds
    Sedentary Lifestyle
    • Persons not participating in a regular exercise program or accumulating 30 minutes or more of moderate physical activity on most days of the week
    • Score: +1
  10. ACSM Coronary Artery Disease Risk Factor Thresholds
    High Serum HDL
    • >60 mg/dL
    • Score: -1
  11. Initial ACSM Risk Stratification
    Low Risk (younger)
    • Men <45 years of age AND no more than one positive risk factor
    • Women <55 years of age AND no more than one positive risk factor
  12. Initial ACSM Risk Stratification
    Moderate Risk (older)
    • Men 45 or older
    • Women 55 or older
    • Those who meet the threshold for two or more positive risk factors
  13. Initial ACSM Risk Stratification
    High Risk
    • Cardiac, peripheral vascular, or cerebrovascular disease
    • Chronic OPD, asthma, interstitial lung disease, or cystic fibrosis
    • Diabetes mellitus type 1 or 2, thyroid disorders, renal, or liver disease
    • Those with one or more of the following signs or symptoms:
    • Angina, Ankle edema, Shortness of breath at rest or with mild exertion , Palpitations or tachycardia, Dizziness or syncope, Intermittent claudication, Orthopnea or paroxysmal nocturnal dyspnea, Known heart murmur, Unusual fatigue or shortness of breath with usual activities
  14. ACSM Recommendations for (A) Current Medical Examination and Exercise Testing Prior to Participation and (B)Physician Supervision of Exercise Tests
  15. ACSM Current Cardio Recommendation
    • -Adults should get at least 150 minutes of moderate-intensity exercise per week.
    • -Exercise recommendations can be met through 30-60 minutesof moderate-intensity exercise (five days per week) or 20-60minutes of vigorous-intensity exercise (three days per week).
    • -One continuous session and multiple shorter sessions (of atleast 10 minutes) are both acceptable to accumulate desiredamount of daily exercise.
    • -Gradual progression of exercise time, frequency and intensity isrecommended for best adherence and least injury risk.
    • -People unable to meet these minimums can still benefit from some activity.
  16. Interpretation of Levels
    • -Low-risk: can do maximal testing or enter a vigorous exercise program
    • -Moderate-risk: can do submaximal testing or enter a moderate exerciseprogram
    • -High-risk: can do no testing without physician presence; can enter no program without physician consent
  17. Risk Levels
    • Low-risk: young (<45yr for men, <55yrfor women), with no more than 1coronary disease risk factor - no symptoms
    • Moderate-risk: older (men >45, women>55); or 2 or more coronary risk factors
    • High-risk: 1 or more symptoms of cardiopulmonary disease; or with cardio-vascular,
  18. Medication effect on HR and BP
  19. Physical Screening
    • -Establishes initial baseline and shows trainerinterest/individual
    • BP – norm 120/80 systolic?/diastolic?
    • HR – norm 60-100 regular rhythm
    • Observation – SOB at rest, limp,posture
    • Flexibility
    • Strength – baseline and imbalances
  20. Body Mass Index Categories
    • <18.5       Underweight
    • 18.5-24.9  Normal
    • 0-29.9       Overweight
    • >30.0        ACSM criterion for obesity
    • 30.0-34.9  Obesity class I
    • 35.0-39.9   Obesity, class II25.
    • >40.0         Obesity, class III(morbid)
  21. Units
    • -Total Cholesterol should be around200 mg per 100 ml of serum
    • -LDL reading should be below 130 mg·dl-1
    • -HDL should NOT be below 35 mg·dl-1(If HDL is above 60 subtract 1 risk factor)
    • -Fasting Glucose should be below110 mg per 100 ml of serum
    • (A fasting glucose above 126 is the criterion fordiagnosing diabetes)
  22. Case Study Questions
    • -How many risk factors does he have,and what risk stratification category is he in?
    • -Can you perform a sub-max or maxfitness test on him at this time?
    • -Can he enter a moderate or vigorous exercise program before obtaining physician clearance?
  23. 5 Components of fitness that have great relevance to health and to functional capacity and can be regularly tested
    • 1. Body composition (%fat vs %lean body mass; butmay also be judged from waist circumference orBMI)
    • 2. Aerobic capacity (max aerobic power, VO2max)
    • 3. Muscular strength (max muscular force, 1-RM)
    • 4. Muscular endurance (ability to repeat a given level of contractile force for multiple repetitions)
    • 5. Flexibility (ROM at a given joint)
  24. Exercise Testing
    • -Practical means of assessing physical effort
    • -can define limits and functional capacity
    • -can be used to predict disease,prognosis, and severity
    • -evaluation of surgical & medical treatments
  25. Measuring performance responses
    • Continuous sports:- ergometers, heart rates, lactates
    • Time trials:
    • -sprint cycling(60 sec, Hla = 15-19mM)
    • - long distance run(2-3 hrs Hla = 2- 4 mM)
    • Team sports- time motion analyses
  26. Testing rationale
    • -identify strengths &weaknesses
    • -monitor progress
    • -provide incentives
    • -predict performance potential
  27. Criteria for test selection (5)
    • relevance
    • specificity
    • validity
    • reliability
    • interpretable procedures and results
  28. Test conditions
    • – Prior to the test, subjects should not engage in intense/ prolonged exercise for 24 hrs, smoke for 2-3 hrs, consume caffeine for 3 hrs, or consume a heavy meal for 3-5 hrs
    • – Subject should not drink excessive alcohol during the 24 hours before the test
    • – Subject should get a good night of sleep
    • – Subject should never carry out a test if they have a high temperature or feel ill
  29. Laboratory tests
    • Anthropometric test
    • - height
    • - mass
    • - lengths
    • - girths
    • - % body fat estimations or densitometry
    • Lung function test
    • - FVC - FEV1
    • Heart rate
    • Blood pressure
  30. Lab Measures of CV Endurance
    • VO2 max test
    • - ergometers
    • - protocols - Balke / Bruce
    • - expired gas
    • Submax tests
    • - PWC
    • - Step tests
    • - Astrand Rhyming
  31. Field tests for estimating CV fitness
    • Step Tests
    • Running tests
    • - Cooper’s 12 minute run
    • - 1.6 km run
    • Shuttle run test
  32. Anaerobic Characteristics
    • POWER
    • Maximal rate of ATP production via anaerobic pathways
    • Maximal efforts of short duration
    • - vertical jump
    • - stair climb
    • - max’l cycling
    • CAPACITY
    • -exercise time to exhaustion
    • -mean power or total work
    • -max accumulated O2 deficit
    • -post ex. blood lactate
    • -40 m sprint
    • -400 m sprint
  33. Anaerobic Performance
    • age ( 6% per decade after 20’s)
    • sex
    • muscle mass
    • muscle fibre type
    • substrate availability
    • accumulation of reaction products
    • heredity
    • trainability
  34. Wide variation in Sit & Reach test &its components: Sacral & spinal flexion
    • Both standing and sitting
    • only tests forward range of trunk flexion
    • not a measure of spinal flexibility
    • not a measure of hamstring flexibility
  35. Expect variation between and within groups
    • motivation
    • attitude responses to exercise
    • age
    • health status
    • social class
    • previous experience
  36. Value of initial screening & testing
    • education
    • motivation
    • safe and effective programs
    • insight for potential enjoyment
  37. Need for Exercise Prescription
  38. Training
    • adaptations to repeated stimuli
    • complete - no problem adjusting to demands
    • incomplete when
    • - too great
    • - applied too rapidly
    • - too often
    • - too long
    • partial adjustment can manifest as
    • - fatigue
    • - soreness
    • - pain
    • - injury
  39. Principles of Training (4)
    • Overload
    • Specificity
    • Reversibility
    • Maintenance
  40. Basic Components of Programs
    • frequency
    • duration
    • intensity
    • type
    • progression
  41. Exercise Intensity
    Intensity (%VO2)
    • (Exercise HR - Resting HR)
    • / (Max HR - Resting HR)
  42. Cardiac Output
    • -Preload
    • -ventricular wall tension at the end of diastole. (End diastolicpressure).
    • -Afterload
    • -Ventricular wall tension during contraction. (systolic ventricularpressure).
    • -Contractility
    • -Changes in the strength of contractions in the heart muscle.
  43. Compensatory Mechanisms
    • With heart failure the heart tries to make up for the loss of pumping capacity by doing three things initially
    • -Enlarging- to pump more blood efficiently
    • -Developing more muscle mass- the heart contracts more forcefully
    • -Beating faster- to increase the heart's output
    • These can be seen in the frank-starling mechanism,neurohormonal alterations, and myocardial hypertrophy and ventricular remodeling
  44. Maximal Oxygen Consumption
    • Maximal volume of oxygen one can consume
    • -VO2max
    • -Maximal oxygen uptake
    • -Maximal aerobic power
    • -Aerobic capacity
    • Provides a quantitative measure of capacity for aerobic ATP resynthesis
  45. VO2 max involves
    • ventilation of lungs
    • exchange of O2 and CO2
    • transport of O2 and CO2
    • exchange of gases at tissue level
    • use of oxygen in mitochondria
  46. Peripheral Limitations
    • Conditions in skeletal muscle that reduce the cell’s ability to take up and use O2during exercise
    • involve factors at the muscle level
    • *capillarization
    • *neuromuscular function
    • *sarcolemmal function
    • *fibre type
    • *O2 extraction
    • *O2 use
    • Evidence of significant LOCAL adaptations with training1950-1970
    • e.g.
    • Mitochondrial density
    • capillarization
    • FT oxidative fibres
    • -i.e. changes of greater magnitude than those known centrally and neuromuscularly
  47. Endothelial Function
    • -Endothelial cells are responsible for the production of chemical reactions that control vasodilation and vasoconstriction
    • -Acetylcholine, serotonin, thrombin, and shear stress can induce the release of NO from the endothelium into the smooth muscle resulting in vasodilatation
  48. Endothelial function
    • -Agnoist: ACh or shear stres sstimulates release of nitric oxidesynthase
    • -NOS forms NO from L-arginine
    • -NO diffuses into smooth muscleactivating guanylyl cyclase
    • -G-cyclase forms cyclicguanosine monophosphate fromguanosine triphosphate (GTP)
    • -Increased cGMP results in smooth muscle cell relaxation due to reduction of Ca2+
  49. Central Limitations
    • Cardiorespiratory or CNS function orconditions that limit skeletal muscles’ ability to take up and useO2 during exercise
    • CNS and systemic circulation
    • e.g. arousal ,cardiac function,
    • blood volume, O2 transport capacities
  50. Early support for Central Theory
    • 1920’s - observed reduced HR in athletes vs non athletes = increased SV
    • Thought that endurance athletes -
    • increased SV
    • increased Q
    • increased heart mass
    • Animal research showing cardiac hypertrophy
  51. Central Theory (cont.)
    • Adding arm exercise to leg exercise at VO2 max did not result in increased oxygen consumption(Secher et al. 1977; Toner et al. 1990)
    • Conclusion– Active muscle mass is too large– Decreased blood flow to the exercising muscles
  52. Rowell’s work
    • Increased muscle mass =compromised blood flow +systemic blood pressures
    • inability to maximally perfuse large working musculature of well trained athletes
    • therefore peripheral limitations may result from central limitations
  53. Essential fat– 3% male; 12 % female
    Storage fat– 12% male; 15% female
    Fat Free mass–
    BM - FFM; 85% male; 75%female
    Minimal weight– 3% male; 12-17% female
  54. Factors Affecting Aerobic Training “F I T T”
    • • Frequency of Training
    • • Intensity of Training
    • • Time (Duration) of Training
    • • Type of Training
  55. Training Intensity
    • Intensity is the most critical factor related to successful aerobic conditioning.
    • kCal per unit time
    • Percentage of maximum
    • HR zone
    • METS
  56. VO2max ~ VO2peak
    • • VO2max - reached when O2 consumption fails to increase by some value
    • • VO2peak - when the accepted criteria for the attainment of VO2max are not met, or test performance appears limited by localfactors rather than central hemodynamics
  57. HR Reserve
    • •In the HRR method, resting HR is defined as0% of HRR and maximum HR is 100% of HRR.
    • • This approach to calculating a target training HR gives a higher value compared to the HR computed as the percentage of HR max, if both were calculated using the same percentage(e.g. 70%)
  58. Intensities have been recommended by ACSM corresponding to between 40% to 85% of VO2R or HRR for healthy adults and between 40% and 50% VO2R or HRR for patients with heart disease
    • However, recommendations for patientswith CHF have not been well established.
  59. VO2 Reserve (VO2R) 2000
    • • A percentage of the difference between resting and maximal VO2.
    • • Use to be based on percentage of VO2 max(Assumed that clients could be placed at a given%age of HRR)
    • • ie. If one wished a client to exercise at 60%of VO2 max, the target HR would be calculated at 60% of HRR (60% of difference between HR max
  60. VO2 Reserve (VO2R)
    • • There is error between %HRR and % VO2max.
    • • At rest a person is at 0% of HRR but is not at 0% of VO2 max, (A VO2 of 0 would be dead!)
    • • Error at rest is quite large, depending on the fitness level
  61. VO2 Reserve (VO2R)
    • Average person has a VO2 at rest of 3.5 ml/min/kg (or1 MET) and a VO2 max that is 10 times higher, or 35(10 METs)This person would be at 1/10 of VO2 max, or 10%, when resting
    • • A poorly fit client, with a max capacity of only 17.5ml/min/kg, (5 MET) is at 1/5 (20%) of VO2 max at rest
    • • There is very little error between %HRR and % VO2max for highly fit people (as in chart with 20 MET person 70ml/min/kg at 1/20 or 5% of VO2 max at rest)
  62. VO2 Reserve (VO2R)
    CALC
    • • Use the following formula to calculate a target intensity using VO2R:
    • Target VO2 =
    • (intensity fraction)(VO2max- VO2rest)+ VO2rest
    • • Resting VO2 averages 3.5ml/min/kg so rewrite as
    • Target VO2 =
    • (intensity fraction)(VO2max- 3.5)+ 3.5
  63. Prescription by Workload (MET)
    • One MET is the average oxygen consumption at rest, 3.5 ml/min/kg
    • • Tables have been compiled that provide general ranges of the oxygen consumption, or MET levels for predictable modes of exercise (walking,running, cycling)
    • • The MET level is the oxygen consumption expressed as multiples of resting metabolism
    • • You can use the MET tables to assign intensity in exercise prescription
  64. Case Study using RPE & %HRR
    • Estimate Lisa’s maximal HR as 220 - 42 = 178 bpm. The RPE values that correspond to 50-70% VO2R are 13-15,or “somewhat hard” to “hard.” Corresponding to the following target HRs:
    • Lower target HR =
    • (0.50)(178 - 68) + 68=
    • (0.50)(110) + 68=
    • 55 + 68= 123 bpm
    • Upper target HR =
    • (0.70)(178 - 68) + 68=
    • (0.70)(110) + 68=
    • 77 + 68= 145 bpm
  65. The ACSM’s Metabolic Equations
    • Walking
    • VO2 =3.5 + 0.1(speed) + 1.8(speed)(fractional grade)
    • Running
    • VO2 = 3.5 + 0.2(speed) + 0.9(speed)(fractional grade)
    • Leg cycling
    • VO2 =7 + 1.8(work rate) /(body mass)
    • Arm cycling
    • VO2 = 3.5 + 3(work rate) /(body mass)
    • Stepping
    • VO2 = 3.5 + 0.2(stepping rate) + 2.4(step rate)(Step ht)
    • • {VO2 = ml/min/kg, speed = m/min, work rate = kg/m/min, body mass = kg, stepping rate = steps/min, step ht = m}
  66. Phases of Training
  67. Periodization definitions
    • macrocycle - several months- largest division
    • mesocycle - smaller divisions
    • - starts low intensity high volume
    • - ends with high intensity low volume
    • microcycle - daily or weekly variation
    • - volume, intensity & load
  68. Macrocycle
    • “The whole picture”
    • Highlight important dates
    • Cycle includes
    • – Preparatory Phase
    • – Competitive Phase
    • – Transition Phase
  69. Mesocycle
    • Preparatory phase is broken into sub-phases or Mesocycle (usually 4-6weeks)
    • – General Preparatory
    • – Specific Preparatory
  70. General Preparatory Phase
    • Overall conditioning
    • Increase load volume (amt)
    • Increase VO2 + anaer thresh
    • Gain muscular strength
    • Improve mechanics
  71. Transitional Phase
    • Recovery period from intense training
    • Active recovery (x-training)
    • Try to avoid complete break(sedentary)
  72. Microcycle
    • A weekly plan for training
    • Balance between work and rest is most noticeable
    • Plan according to principles of overload, rest and compensation
  73. Training Intensity
  74. Reversibility Principle
    • Detraining- SV1st; mitonext; up to 50% in one week;
    • most gains lost in 4-­12months
  75. bmi
    • kg/m2
    • lbs/in2x703

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