Symptoms of hypoglycemia
tachycardia, excessive sweating (diaphoresis), light-headedness, visual disturbances
Physical Activity
Any bodily movement produced by contracting skeletal muscles, with an increase in energy expenditure.
Exercise
Planned, purposeful, repetitive
Physical Fitness
Attributes or characteristics that individuals have achieved that related to their ability to perform physical activity
3 metabolic pathways the body uses to creates ATP
1. Creatine Phosphate
2. anaerobic glycolysis
3. 0xidative system
Claudication
pain in the leg is induced by exercise, usually because of an artery obstruction.
Creatine Phosphate system
Small amounts of CP are stored within each cell. Simple one-to-one trade off that allows for the rapid production of ATP. ONLY for use during short bouts of exercise. less that 10 seconds.
Anaerobic glycolysis
No oxygen required. NExt most immediate energy source. break down carbs (glucose or glycogen) into pyruvate. Used during medium-duration exercise. no more than about 90 seconds.
Aerobic glycolysis (oxidative system)
Oxygen dependent. As exercise intensity decreases allowing for longer duration activities, use of the oxidative system increases. (Krebs cycle and ETC). Produce ATP in the mitochondria of the cell--requires oxygen. Lasts longer than 1-2 minutes.
What is VO2?
The volume of oxygen the body consumes. VO2 max is the highest volume of oxygen the body can consume.
Define Stroke Volume
the amount of blood ejected by the heart in one beat
SV= EDV x ESV
end diastolic volume
end systolic volume
How does SV increase with workload?
Similar to HR, it increases as workload increases but only up to ~40% to 60% of VO2max. The percentages can be decreases in sedentary individuals and increased with training.
What happens to resting HR as stroke volume increases?
it decreases, as more blood being pumped per beat allows the heart to beat less often.
What is cardiac output?
the amount of blood pumped from the heart by each ventricle per minute. The product of stroke volume and heart rate.
Q(L/min)= HR (bpm) x SV (mL/beat)
What does Diastolic Blood pressure do during exercise?
Remains stable or decreases slightly.
What is rate pressure product?
serves as an estimate of myocardial oxygen demand. Product of HR and Systolic BP. RPP=HR X SBP
What is the Fick equation used to determine VO2 max?
VO2 = Q x (a - VO2 diff)
What is the gold standard to measure Cardiorespiratory fitness?
VO2 max during open circuit spirometry.
How does a submaximal exercise test work?
It estimates VO2 max from the HR response to submaximal single stage or graded exercise.
absolute oxygen consumption vs. relative oxygen consumption
absolute is the raw volume of O2 consumed by the body.
Relative is the volume of O2 consumed relative to body weight. Useful to compare fitness levels between individuals.
What is one of the largest components of PA-related energy expenditure?
Occupational Physical Ativity
5 Health related physical fitness components
Cardio respiratory endurance,
body composition,
muscular strength,
muscular endurance,
and flexibility
6 Skill (performance) related physical fitness components
Agility, coordination, balance, power, reaction time, and speed
cardiorespiratory endurance
ability of circulatory system and respiratory system to supply o2 during sustained physical activity
Body composition
relative amounts of muscle, fat, bone, and other vital parts of the body
Muscular strength
Ability of muscle to exert force
muscular endurance
ability of muscle to continue to perform without fatigue
flexibility
ROM at a joint. as per the skeletal muscles and not any external forces.
Agility
ability to change position of the body in space with speed and accuracy
coordination
ability to use the senses together with body parts to perform tasks smoothly and accurately
balance
maintenance of equilibrium while stationary OR moving
reaction time
time elapsed between stimulation and the beginning of the reaction to said stimulus
speed
ability to perform a movement within a short period of time
ACSM's weekly/daily physical activity recommendations
150 minutes Moderate PA per week (30 min or more most days of the week), 75 minutes of vigorous intensity
Can most sedentary individuals safely begin a low-to moderate intensity PA Program without the need for baseline testing or medical clearance?
Yes indeed
Most common musculoskeletal injuries occur in what area of the body?
lower body- particularly the knee or foot
Who is most at risk for sudden cardiac death?
Sedentary individuals performing infrequent exercise
Light PA is defined as
<3 MET's
Moderate PA is defined as
3 to <6 MET's
Vigorous PA is defined as
>/=6 MET's
What is 1 MET? Why do we use METs?
1 MET = the relative oxygen consumption at rest. or, 3.5 mL per kg per minute. It is an easy way for the general public to gauge their exercise intensity. Also used to calculate energy expenditure over time.
What is a kilocalorie? what is it also known as?
AKA: Calorie. estimate of energy cost that can be directly related to physical activity and exercise. Weight gain, loss and maintenance can be estimated remembering that 3,500kcal =1 lb of fat.
Two types of pre-participation self-guided screenings
1. PAR-Q (physical Activity Readiness Questionnaire)
2.Fitness Facility Pre-participation screening questionnaire
What is the PAR-Q? Limitation?
A minimal standard for entry into Moderate-intensity exercise programs. allows individuals to gauge their own medical readiness to participate . does not screen well for those at low to moderate risk.
What is a pre-participation screening questionnaire?
Also useful for clients to assess their health readiness. More comprehensive and recognizes signs and symptoms of CVD and other risk-factor thresholds.
What are the ACSM Coronary Artery Risk factors?
Age (Men 45 and older women 55 and older), Family History (MI, coronary revascularization or sudden death before 55 in father and 65 in mother or first degree relative), Smoker (current or quit within the last 6 months), Sedentary (no PA in at least 30 mi
What is the negative risk factor?
HDL value of greater than or equal to 60. (this is reverse cholesterol transport and reduces the risk of CVD)
Dyspnea
Shortness of breath
Orthopnea
trouble breathing while lying down
paroxysmal nocturnal dyspnea
difficulty breathing while asleep
What classifies as low, moderate, and high risk clients?
Low: <2 risk factors and asymptomatic
Moderate: 2 or more risk factors and Asymptomatic
High: Symptomatic OR known CVD, CPD, renal or metabolic disease
What is the exception to missing risk factor information?
Prediabetes is counted as a positive risk factor ONLY if the person is 45 or older OR The BMI is 25 or more (and have additional risk factor for prediabetes)
What is a contraindication
individual's characteristic that make PA more risky
Absolute contraindications to exercise
Absolute cannot participate in andy PA program and/or assessment and should consult with their doctor first.
Relative contraindications to exercise
the benefit of exercise outweighs the risk of testing.
Left main coronary stenosis, moderate stenotic valvular heart disease, Electrolyte abnormalities, severe atrial hypertension, tachy or bradydysrhythmia, hypertrophic myopathy, most disorders exacerbat
Exercise testing is recommended for individuals at ____ risk
High risk.
What is prehypertension?
120-139 SBP and/or 80-89 DBP
Normal BP?
<120 and <80
Stage 1 hypertension?
140-159 SBP and 90-99 DBP
Stage 2 hypertension?
160 + SBP 100+ DBP
Optimal LDL, total cholesterol, HDL, and triglyceride levels?
LDL: <100
HDL: <40
Triglyceride: <150
TOTAL: <200
3 assesments for muscular endurance
1. Bench press
2. Curl up
3. push up
twitch
When a motor unit is stimulated by a single nerve impulse
tetanus
motor unit stimulated constantly
summation
motor unit has more than 1 stimulus
What is the SAID principle? What is it dependent on?
The specificity principle. Specific exercise elicits specific adaptations, creating specific training effects. (Specific Adaptations to Imposed Demands). Dependent on the TYPE and MODE of exercise. Example: a client wants to improve their time in an endur
7 ways of determining exercise intensity
1. Heart rate reserve method.
2. Peak HR method
3. Peak VO2. method
4. Peak METs method
5. VO2 reserve method
6. Talk test method
7. RPE method
(HRR) Heart rate reserve method KARVONEN FORMULA
The difference between max HR and resting HR.
Target HR = [(max HR -resting HR) X %intensity desired] + Resting HR.
Peak HR method
220-age = max HR. (SD of 12-15 BPM)
Target HR = max HR X % intensity desired
Peak VO2 method
must have measured or estimated VO2max.
Target VO2 = VO2max X intensity desired
Peak METs method
Target METs = (%intensity desired)(VO2max in METS -1) +1
VO2 reserve method
What is VO2 reserve?
VO2 reserve is the difference between VO2 max and VO2 rest. (determined in a lab setting)
Target VO2 reserve = [(VO2max - VO2 rest) x %intensity desired] + VO2rest
Talk test method
differentiates between moderate and vigorous activity. If they can talk, but not sing it is moderate. If they are unable to say more than a few words without pausing for a breath it is vigourous.
Borg's RPE scale. What level is recommended to improve cardiorespiratory fitness?
ranges from 6 to 20. from no exertion at all to maximal exertion. 11 to 16 to improve CRF.
What is the CR-10 scale of exertion? (Borg's category ratio scale)
scale of 0 to 10. in which 0 is sitting and 10 is max effort possible. 5-6 is mod. 7-8 is vig.
Symptoms identified during an exercise test in which the test should be stopped.
Drop in SBP 10 or below.
Rise in BP above 250 and/or 115.
Failure of HR to increase
failure of test equipment
Do individuals with cardiac, respiratory, metabolic, or musculoskeletal disorders need to be supervised by trained personnel?
Yes, when beginning an exercise program
What is target heart rate? How do you determine it?
Must consider the habitual PA, exercise level, and goals to determine the % intensity desired.
Common musculoskeletal injuries signs and symptoms.
Point tenderness
Pain when body part is at rest
Joint pain
Pain that continues after warming up.
Swelling or discoloration
Increased pain with weight bearing activities
changes in normal bodily functions
Intrinsic risk factors to injury
History of previous injury
Inadequate fitness/conditioning
Body composition
Bony alignment abnormalities
Flexibility/strength imbalances
Joint laxity
Musculoskeletal disease
Extrinsic risk factors to injury
Excessive load on the body
Type or speed of movement
number of reps
footwear
surface
training errors
excessive distances
fast progression
high intensity
running on hills
poor technique
fatigue
environment conditions
Exercise in heat yields? (relate to HR as well)
Dehydration risk, increased blood flow to the skin (away from working muscles), HIGHER HR values.
Exercise in the cold yields?
Vasoconstriction of blood vessels in the skin, HR and cardiac output are similar to thermoneutral environment, wearing bulky clothing is a barrier, Respiratory rate is higher and VO2 max may be slightly lower. Some individuals may perceive exercise to be
Exercise in high altitude
thin air" same amount of oxygen in the air at ALL elevations. It is the change in barometric pressure that causes the PO2 to decrease. SV decreases and HR increases during first initial days. Safe to assume that there will need to be a significant reduct
acclimatization vs. acclimation
acclimatization - Physiological adaptation that occurs in response to a change in the "natural" environment.
acclimation - physiological adaptation that occurs in response to EXPERIMENTALLY induced changes in climate.
Heat acclimatization, cold acclimatization, altitude acclimatization benefits
Heat- lower core body temp, skin temp, high sweat rate, lower HR, lower perception of effort, improved conservation of sodium. (recommended 10 consecutive days in heat)
cold- maintain heat production by means beside shivering, maintenance of hand and feet
Smallest contractile unit of a muscle
Sarcomere
Type I fibers
Slow twitch fibers. Lower contractile force. better for endurance activities
Type II fibers
Fast twitch fibers. Higher contractile force. better for strength and power activities.
Which type of muscle fibers are recruited first?
Type I then Type II. as force production increases.
initial simple assessment of muscular strength and change in muscular strength between clients (calculation)
(kg) weight lifted / (kg) body weight
What is a 1RM? Multiple RM? What equipment should be used?
1RM is the heaviest weight that can be lifted in 1 rep. using proper form and technique. STANDARD muscular strength assessment. multiple RM can provide an index of change over time. Performance is significantly greater on weight machines than free weights
Muscular endurance assessments. How do you determine which test to use based on each client?
Curl-up and push up test. Based on the needs of the client. (poor ab strength is thought to contribute to low back pain.
What are the PROS principle of designing a resistance training program? What do they mean?
Progression-
Regularity
Overload
Specificity
Progression
demands placed on the body must be continually and progressively increased over time. Increase at 5% to 10% per week and decrease the reps by 2 to 4 when a given load can be performed for the desired number of reps.
Frequency
Resistance training must be performed on a regular basis several times per week to make gains. 2-3 per week.
Overload
to enhance muscular fitness, the body must exercise at a level beyond that at which it is normally stressed. Manipulated by changing the INTENSITY, DURATION, or FREQUENCY
Specificity
SAID principle. Specific adaptations to Imposed demands. Distinct adaptations that take place as a result of the training program. Must mimics demands of their sport or desired goals.
Types of resistance training (3). Explain each.
DCER(isotonic)- most common. weight lifted does not change through the lifting and lowering phase of an exercise. the heaviest weight that can be lifted is limited by the strength of a muscle at the weakest joint angle.
Isokinetics- muscle actions perform
What is the amortization phase?
in plyometrics it is the amount of time it takes to change direction from eccentric to concentric. Should be as short as possible. (<0.1s) to maximize training adaptations.
Resistance training program variables.
Choice of exercise- promote balance across joints and between opposing muscle groups.
Order of exercise- Total body (perform more challenging first and large muscle groups first)
Resistance Load Used- Most important variables. Performed to muscle fatigue
4 types of flexibility training
1. Static- most common. slow constant motion held to the point of mild discomfort.
2. Ballistic- rapid bouncing movements. Used by coaches for athletes to increase blood flow before competition. Contraindicated.
3. PNF (proprioceptive neuromuscular facili
Muscle spindles
collection of 3 to 10 muscle fibers that are innervated by a motor neuron. Provide info about rate of change in a muscle.
What are Golgi Tendon Organs?
located in the musculotendinous junction. respond to changes in muscle tension.
Explain myotatic reflex reciprocal inhibition.
Myotatic reflex "stretch reflex" occurs in the stretched muscle by attempting to resist the stretch. Muscle spindles monitor muscle length. Helps keep us upright.
What is reciprocal inhibition?
*The antagonist muscle responds with reciprocal inhibition. Causes antagonist to contract less as the agonist contracts.
Flexibility assesments
Goniometers
sit and reach tests- most commonly used for flexibility in lower back and hip joint.
functional movement screens
Flexibility program designs
Flexibility gains are lost within 4 to 6 weeks of quitting exercises. 2-3 x per week for at least 3-4 weeks may be required. Do these exercises when the body is warm. hold to mild discomfort. NO link between ROM training and prevention of lowback pain or
Central abdominal obesity is associated with..
metabolic syndrome.
what is metabolic syndrome?
a clustering of metabolic factors that increase the risk of cardiorespiratory disease.
What are anthropometric measures?
noninvasive and quantitative techniques for determining body size by measuring specific body dimensions.
Anthropometric methods for measuring body composition
BMI- measure of weight in relation to height.
Waist circumference
Skinfolds
WHR
How to calculate BMI. Limitations of BMI?
divide weight (kg) by height (meters squared).
1kg = 2.2 lbs
1in = 2.54cm
1m = 100cm
Does not differentiate between fat and fat free mass. Not a true measure of body fatness.
what is BMI classifications of:
Underweight
Normal
Overweight
Obesity class I
Obesity class II
Obesity class III
Underweight <18.5
Normal 18.5-24.9
Overweight 25-29.9
Obesity class I 30-34.5
Obesity class II 35-39.9
Obesity class II 40+
Central obesity versus gynoid
central (apple, or abdominal) vs. pear shaped (hips and thighs)
Waist to hip ratio
identify people with more central abdominal fat. Divide the circumference of the waist by the circumference of the hips (buttocks/hips) in inches.
Using waist circumference alone
describes abdominal fat measurement. health risks are higher when measurement is 35+ in for women and 40+ for men.
risk category for waist circumference in male and female adults. (very low, low, high, very high)
Women:
very low <70cm
Low 70-89cm
High 90-110cm
Very high >110
Men
very low <80cm
Low 80-9cm
High 100-120cm
Very high >120
standard circumference sites
Abdomen
Arm
*Buttox/hip
Calf
Forearm
Hips/thigh
Mid-thigh
*Waist
% body fat methods. What is the % for men and women that is considered satisfactory for health?
Skinfold measurements
Bioelectrical Impedance
Lab methods for measuring body composition
Hydrostatic weighing- calculates body density from body volume
Air displacement plethysmography- measures body volume.
DEXA- x- ray to measure bone mineral content, body fat, and lean soft tissue.
what does hydrostatic weighing assume
standard densities for muscle bone and fat
9 skinfold measurements. Principle behind skinfold measurements
+- 3.5% error
Tension set at ~12 g/mm-2
Abdominal
Triceps
Biceps
Chest/pectoral
Medial calf
Midaxillary
Subscapular
Suprailiac
Thigh
*the amount of subcutaneous fat is proportional to the total amount of body fat.
diagonal skinfolds
Chest, suprailiac, subscapular; all other skinfolds are vertical
Procedures for skinfolds
measure all on the right side of the body
pinch with thumb and index finger 1cm away from the center mark
wait 1-2 sec before reading the caliper
measure perpendicular to the skinfold.
7 site formula sites
chest, midaxillary, triceps, subscapular, abdomen, suprailiac, thigh
3 site formula sites (men)
Chest
abdomen
thigh or subscapular
3 site formula sites (women)
triceps
suprailiac
thigh or abdominal.
the National Heart, Lung, and Blood institute recommend _____% weight loss reduction improves overall health
5-10%
define negative energy balance
energy expenditure must exceed energy intake.
define positive energy balance
energy intake exceeds energy expenditure
define Total Energy Expenditure
the total number of calories expended each day and reflects th amount of energy required to carry out all metabolic processes within the body
3 components of determining energy expenditure
Resting energy expenditure (REE)- 60-70% TEE
Thermic effect of food: 10% TEE
Physical activity expenditure: 20-30% TEE
define Resting energy expenditure
what influences it the most?
resting metabolism! energy required to maintain normal regulatory balance and body functions at rest. Also called basal energy expenditure. The amount of calories a person uses if they want to do no activity throughout the day.
lean body mass influences i
define thermic effect of food
energy required to eat and digest food. The more physically active, the more active their metabolism TEE
recommended 1-2lbs/week weight loss in calories
1lb of weight loss is a calorie deficit of 3,500 calories. or 500 calories per day.
nor recommended for an individual to consume less than ____ calories per day
1,200 calories
ACSM postion stand indicates that engaging in _____ minutes per week of MVPA would result in better weight management
250 min/week.
demonstration of exercise is especially important in _____ populations
overweight or obese
Behavioral strategies for weight loss
Self monitoring
goal setting
stimulus control
problem solving
How many calories in 1 gram of:
carb
protein
fat
alcohol
1 g carbs- 4 calories
1 g protein- 4 calories
1g fat- 9 calories
1g alcohol- 7 calories
energy intake for carbs, protein and fat
45 - 65% of daily energy intake; 70% for athletes; 4 cal/gram
10-15% of daily intake; .8 g/kg of body wt.; athletes may need 1.2 - 1.4 for endurance and 1.6-1.7 for strength; 4 cal/gram
3 abnormal curves of the spine
hyperkyphosis, hyperlordosis, scoliosis
Pregnant women need an additional ____ calories per day
150 cal per day then 300cal in the 3rd trimester
avoid exercising in the ______ position after week _____
Supine position after week 16
pregnant women need as increase dietary need for....
folic acid (B vitamin to prevent serious birth defects) and iron.
Vitamin D intake have increased for?
what are the levels?
all populations but particularly children and older adults (65+).
children and adolescents 1-18 600 IU
Older adults 800IU
Coronary Artery disease
accounts for the most cardiovascular deaths. The most prevalent types of CVD.
Define athlerosclerosis
process where fatty streaks develop, causing the artery wall the thicken while reducing the luminal diameter. begins with a focal injury to the lining of the artery and eventually causes damage to the endothelium. The endothelium then becomes more permeab
Define myocardial ischemia
partial impairment of coronary artery artery blood flow reduces oxygen to cardiac tissue.
Define myocardial infarction
hEART ATTACK. results in heart tissue death.
stable ischemia vs. unstable ischemia
stable: result of increased O2 demand of the heart (as seen with exercise) increased chest pain (angina) and decreased exercise capacity because of reduced blood supply to the heart.
unstable: more severe often seen at rest with time of little exertion an
Hypertension is also known as _____
The silent killer because the signs and symptoms go unnoticed.
BP is regulated by 2 factors:
Cardiac Output and total peripheral vascular resistance (narrowing of vessels)
3 most common metabolic diseases/disorders
Diabetes
Hyperlipidemia
Obesity
Type 1 and type 2 diabetes are defined by
a decrease in the production, release and/or effectiveness and action of insulin. Both results in increased blood glucose levels. (hyperglycemia)
type 1: deficiency in blood insulin release.
type 2: elevated blood glucose levels due to developed insulin r
what does insulin do?
allows blood sugar to be absorbed into cells to be used for energy.
Hyperlipidemia
elevated blood cholesterol and triglyceride levels caused by genetic and environmental factors. Low HDL's and/or High LDL's
Define Obesity
excessive accumulation of body fat and is associated with a body mass index of 30+. combo of increased calorie intake and decreased daily physical activity are the primary contributors.
Define COPD
COPD (Chronic obstructive pulmonary disease) umbrella term for a collection of diseases including chronic bronchitis, emphysema, and asthma.
characterized by airflow limitation.
define emphysema
permanent enlargement of airspaces along with necrosis of alveolar walls
wasted ventilation
pink puffers
define CRPD
Chronic restrictive pulmonary disease. (interstitial lung disease) resulting is desreased lung volume and lung tissue necrosis.
endurance exercise lowers resting SBP and DBP by____
5 -7 mm Hg
Scope of practice for pulmonary disease patients for EP-C
prepared to work with a well-controlled asthma client but refer COPD and CRRD clients.
NSAID's
Nonsteroidal anti-inflammatory drugs.
Ibuprofen, naproxen. increase risk of hypoglycemia
Strain
definition, signs and symptoms. most common sites, treatment
injury to a muscle or tendon
acute pain, muscle pain and dysfunction usually becomes more apparent 1-2 days after the the injury because of DOMS. most common in the calf and thigh (quads and hamstrings) rates I to III. III is the worst RICE
Sprian
definition, signs and symptoms. most common sites, treatment
injury to a ligament.
most common is ankle due to inversion. RICE
contusion
soft-tissue hemorrhage and/or hematoma that occurs after the disruption of the muscle fibers.
PRICE
Protection Rest Ice Compression Elevation
Phases of tissue healing
inflammatory phase (2-3 days)
(edema)-fluid in surrounding tissues that act as a brace.
repair- 3-5 days after lasting up to 2 months. Exercise during this phase
remodeling-weakened repaired tissue.
Overuse injuries
Tendinopathy (tendinitis-acute inflammatory,tendinosis-degenerative changes in the absence of inflammation)
Plantar Fasciitis
Low back pain
Plantar fasciitis
repeated trauma of the plantar fascia. common in running athletes. Stretching is incorporated
Low back pain
*drawing in maneuver
endurance of core musculature is more critical than strength
focus on bracing
Arthritis. 2 types.
inflammation of a joint.
Rheumatoid
autoimmune chronic inflammatory disease affecting the synovial lining of joints and other connective tissue. Slow progressive disease.
osteoarthritis
more prevalent with age. bone remodeling at the joint and overgrowth occurs. Thought to be the result of mechanical injury due to excessive loading or repeated low-force stressors.
osteoporosis
silent disease". low bone density or bone mass. increases risk of fracture. largely preventable. Women are 3x more likely to develop it.
Type I - postmenopausal - most common and is associated with fractures in the vertebrae
Type II - senile osteoporosis
osteopenia
between normal and osteoporosis. describes those at risk for osteoporosis.
The female athlete triad.
disordered eating
amenorrhea (absence of menstruation, which can result from excessive exercise)
osteoporosis
age difference between children, adolescents, and older adults
children: younger than 13
adolescents: 13-18
older adults: 65+
Age Groups
NeoNatal - brith to 3 week
Infancy - 3 weeks to 1 year
Early Childhood: 1-6 years
Middle childhood: 7-10
late childhood/prepuberty
adolescent: 6 years following puberty
Early adulthood: 20-29 years
Middle adulthood: 30-44 years
Older Adulthood: old - 65-7
accelerated periods of growth in childhood. When do they stop growing?
12 for girls and 14 for boys.
girls stop growing in stature by 15, boys by 17.
HR, strove volume, and cardiac output in children
higher HR, lower stroke volume, higher cardiac output.
Sweat rate production in children. and exercise in the heat
Lower sweat rate production and lower tolerance to exercising in the heat.
in general... drink ____ for every ____lbs of fluid lost
1 pint for every 1 pound lost
define hyponatremia
low blood sodium (drink too much water)
In general, exercise recommendations for children
exercise is safe as well as resistance training. just make it age appropriate.
weight gained during pregnancy
typically 26lbs.
cardiac output, stroke volume, heart rate, resting O2 uptake for pregnant women.
all increase.
Why is the supine position avoided in pregnant women?
because the expanded uterus compresses on the inferior vena cava and reduces venous blood flow back to the heart. Supine positions may exacerbate this situation.
Exercise for pregnant women and recommendations
highly encouraged. Those physically active before pregnancy can exercise at a higher level than those more sedentary. ensure proper hydration.
exercise 30 minutes of moderate intensity exercise on most days of the week.
During adulthood individuals tend to gain ___ and ___ and tend to lose____
fat mass and body weight and tend to lose fat-free mass.
Cardiorespiratory function in older adults
vessels become stiffer, elasticity is lost in cardiac tissue resulting in high blood pressure.
Define a theory
systematic view of a behavior by specifying relationships between variables and predicting specific behaviors and situations
define a model
hypothetical depiction of a behavior or situation
5 stages of stage in the transtheoretical model
1. pre-contemplation
2. contemplation
3. preparation
4. action
5. maintenance
At what stage are people at most risk of relapse?
action
Stages of change (motivational readiness)
Stage 1: Precontemplation - no physical activity (no intent to start)
Stage 2: Contemplation - intention to start within the next 6 months
Stage 3: Preparation - participation in some physical activity or exercise
Stage 4: Action - physical activity that
Transtheoretical model (5 cognitive processes)
1. consciousness raising (increasing knowledge)
2. dramatic relief (warning of risks)
3. environmental re-evaluation (caring about consequences to oneself and to others)
4. self-revolution (comprehending benefits)
5. social liberation (increasing healthy
Transtheoretical Model - (5 Behavioral processes)
1. counter conditioning
2. helping relationships
3. reinforcement management
4. self-liberation
5. stimulus control
Social cognitive theory
first known as social learning theory. Emphasizes interaction between individuals and their environments.
Theory of reasoned action
Intention --> behavior
Subjective norms
Attitudes
self-efficacy
one's confidence in their ability to engage in PA. derived from social cognitive theory. The more confident one feels in their ability to succeed the more likely they are to engage in the behavior.
3 main factors that influence behavior and behavioral choices
1. the environment
2. individual personality characteristics
3. behavioral factos
self-efficacy can be influenced by 4 sources of information:
1. Performance accomplishments- successful completion of target behavior
2. vicarious experience- seeing a similar person complete the behavior
3. verbal persuasion- others express faith in the individuals capabilities
4. psychological affective states- i
Key to social cognitive theory
focus on what they CAN do. not what they CAN'T do.
What is the social ecological model
comprehensive approach integrating multiple variables or layers that influence behavior. Each layer has an impact on the next.
It helps identify opportunities to promote participation in PA by recognizing multiple variables that may influence a person's c
what 6 factors (layers) are involved in the social ecological model
Physical activity behavior
personal factors
social factors
institutional factors
community factors
public policy
What is the Health Belief model?
As individuals take greater investment in their health they are more likely to make relevant and meaningful behavior changes. Must feel that the risks outweight the benefits.
4 main components of the health belief model
1. perception of risk
2. perception of severity of threat
3. perception of benefits
4. perceptions of barriers to reduce health threat
What is the theory of planned behavior?
identifies intension as the primary influence determining behavior.
intension + perceived behavioral control
What is the self-determination theory?`kkb bhbuuj7 bf8
Individuals have 3 basic psychological needs that must be met in order to be motivated to engage behavior. Autonomy and competence are key with this theory. The person must feel that they have a sense of control. Must also feel challenged yet successful.
what are those 3 psychological needs?
1. competence- feeling capable of mastering a task
2. relatedness- need to be connected and involved with the social world
3. autonomy- maintaining a perceived internal locus of control and a sense that behaviors are chosen freely.
extrinsic vs. intrinsic motivation.
intrinsic is more likely to maintain PA. Extrinsic is doing it for weight control, weight loss, and stress reduction.
intrinsic rewards
anything that is fulfilling because of the internal pleasure. more sustainable over time.
extrinsic rewards
tangible things earned in response to completing a task. Help increase motivation in the initial stages of change.
self-monitoring
important in the initial days of adaptation to keep the person accountable and on track. Continue for entire adoption phase (up to 6 months)
SMART goals
Specific
Measurable
Attainable
Realistic
Time-bound- Short term goals are better than long term goals.
Barriers to physical activity
1. lack of time
2. environmental changes
3. fear of injury
5. lack of enjoyable activities
Motivational Interviewing
person-centered technique to strengthen motivation for change.
*individuals become more committed to what they say to themselves than what they hear from others.
goal of motivational interviewing
generate change talk
4 principles motivational interviewing conversation
1. obervations, not evaluations
2. express feelings, not thoughts
3. identify needs, not strategies
4. make requests, not demands.
Visual imagery
visualizing onesself performing the desired behavior. also used to improve muscle memory
Exercise Imagery Questionnaire
Energy imagery
Appearance imagery
Technique imagery
define negligence
one's failure to act. Overwhelming majority of cases against trainers are negligence.
Statutory law (legislative law)
enacted by federal and state governments. Imposes duties or restriction upon individuals.
Case Law (common law)
based on court descisions
Civil lawsuits
handle disputed between two parties, organizations, businesses and governmental agencies.
Most cases you will encounter will fall here.
Tort Law
wrongful act whether intentional or accidental.
breach of legal duty amounting to a civil wrong or injury for which a court of law will provide compensation/damages.
Transactional model of leadership
influence based on reward and punishment. capitalize productivity and efficiency.
Visionary model of leadership
leader using emotion to inspire and create buy-in by the followers.
organic leadership model
centers around the group as a team.
Leadership Trait Theory
the idea that someone is born to lead. can awaken dormant traits over time
Situational leadership theory
leadership style is adapted by the leader's diagnosis of the subordinant
Path-goal leadership theory
leader sets up a path to a specific goal for the team
transformational leadership
that which inspires and motivates others
transactional leadership
exchanging one this for another. Closely resembles a manager.
Lewin's leadership style
autocratic-leader makes decisions and does not consult with others
democratic- leader involves peers in decision making process
Laissez-faire- followers make their own decision, but leader is still ultimately responsible.
servant leadership
organizational performance is secondary to the relationship between the leader and follower
leader-member exchange theory
centers on the interactions between the leader and follower.
emotional intelligence
set of skills (street smarts) that include awareness of self and others. The ability to handle emotions and relationships.
contextual intelligence
abiloty to adapt or respond appropriately to any number of different contexts. The context is dertermined by environmental factors
Examples of current assets
Things expected to be turned into cash within the next year. inventory, cash, accounts receivable, prepaid expense
fixed assets
things that have been aquired for long term use by the business. property, equipment, office furniture
liabilities examples
financial obligations or credits owed by the business. accounts payable, income tax, accruals, rent
noncurrent liabilities. examples
debts and expanses that are not due in the next 12 months. future loan payments, deferred rent or revenue
variable expense vs. fixed expense
variable changes based on the usage. payroll, benefits, equipment repairs
fixed expense- relatively consistent year after year. rent, property tax, etc.
the 4 P's of marketing
Product
Place
Price
Promotion
(People)
People
data about the people you are providing the service to.
Product
What you are trying to offer. can be tangible and intangible. Belief in the VALUE of the product. What do people want from the product and what are they expecting?
Place
where the product can be purchased or delivered. Home, gym, internet, etc. what is appropriate based on each person. Identifies your market.
Price
cost of delivery (overall cost to give client what they want)
acceptable profit margin (price is too low, people are skeptical of the product's quality)
market value- balance between perceived value and the demand for the product.
Promotion
advertising
referrals
direct mail/email
internet
sponsorship
personal sales
public relations
Scope of practice
-conducting risk classification
-physical fitness assessments
-construct appropriate exercise prescriptions for healthy adults and individuals with controlled conditions released for independent physical activity
-motivating people with medically controll
define conflict of interest
a significant financial interest in a business or other direct or indirect personal gain provided by a business that may compromise an ACSM member's personal judgement.
4 steps to providing evidence based information
1. develop a question
2. search for evidence
-personal experience not always relevant for each client
-academic preparation not always up to date
-***research knowledge
3.evaluate the evidence*** holds the least amount of bias.
4.incorporate evidence into
Acronym WISE
Wisdom
Integrity
Stewardship
Enthusiasm
Depolarization
excited state of the cell caused by change in polarity
Repolarization
The return of the stimulated myocardial cells to their resting state
a P-wave represents
atrial depolarization
a QRS complex represents
ventricular muscle depolarization
a T-wave represents
ventricular muscle repolarization
The PR interval represents
Atrioventricular node, His bundle, Purkinje fibers
Sinus bradycardia
less than 60bpm
sinus tachycardia
hr of 100 to 180 bpm
Atrial Flutter
atrial contraction of 250-350 bpm
atrial fibrillation
atrial contraction of 400-600 bpm
Junctional Arrhythmias
arrhythmias of the AV node
typically occur if the SA node fails to fire - no P wave
ventricular arrhythmias
abnormal heart rhythm originating in the lower chambers of the heart
premature ventricular contraction (PVC)
premature ventricular depolarization that occurs in one of the ventricles and spread to the other ventricle with some delay
First degree AV block
delay in conduction of the impulse through the av junction to the ventricles - pr interval longer than .20 sec
causes - hyperkalemia (high level of potassium)
Mobitz I block
progressively longer pr interval until finally a p wave is not conducted
causes - certain drugs, ischemic heart disease
Mobitz II
2nd degree block. PR is regular except some QRS are dropped
Third degree AV block
complete heart block, because no conduction of impulses occurs, from atria to the ventricles
causes: MI, advanced age, drugs
Right Bundle Branch Block
delay in impuse conduction through right bundle branch, wide R wave
Left Bundle Branch Block
LBBB" a block in the electrical conduction through the left bundle; evidenced by a wide QRS in lead 1 and V6
left anterior fascicular block
qrs axis greater than -45 degrees
left posterior fascicular block
mean QRS axis of greater than +120 degrees
Hyperventilation
increased rate and depth of breathing
What is the appropriate mean QRS axis?
60 degrees
what condition causes ST-segment elevation?
acute pericarditis (between the heart and sac)
Symptoms of hyperglycemia
acetone odor on breath, confusion, slurred speech
conditions that can prolong the QT interval
hypocalcemia and hyperkalemia
causes a wide QRS complex
defective intraventricular conduction
abnormally tall and peaked T waves suggests
acute pericarditis
Stroke Volume and concentric phase
Stroke volume is NOT significantly elevated to more than resting during the concentric phase of resistance training.
P wave can be
positive or negative
stroke volume and eccentric phase
Stroke volume is significantly increased during eccentric phase
What is muscle fatigue?
The loss of force or power output in response to voluntary effort leading to reduced performance.
What is central fatigue? Peripheral fatigue?
The progressive reduction in voluntary drive to motor neurons during exercise.
The loss of force and power that is independent of neural drive.
Blood flow from periphery
superior and inferior venae cavae, right atrium, tricuspid valve, right ventricle, pulmonic semilunar valve, pulmonary arteries, and lungs
Blood flow from Lungs
Left pulmonary vein, left artrium, bicuspid valve, left ventricle, aortic semilunar valve, ascendina aorta, systemic circulation
tidal volume
amount of air leaving or entering with each breath, ranges from .5 to 4L
systolic vs diastolic
is contractile heart movement, blood is leaving the heart. Pressure against arteriol walls .
is relaxation or blood filling the heart
end diastolic volume
amount of blood in each ventricle at end of resting phase.
Frank Starling Law of the Heart
Describes the relationship between end-diastolic volume and stroke volume. It states that the heart will pump out whatever volume is delivered to it. If the end-diastolic volume doubles then stroke volume will double.
actin and myosin
contractile proteins; form crossbridges and slide past one another during contraction. Thin and thick filaments
Triponin and tripomyosin
regulate bridging of actin and myosin
what are class 1 A drugs?
Antiarrhythmic agents: Disopyramide, Moricizine, Procainamide, Quinidine
What are class 1B drugs?
Lidocaine, Mexiletine, Phenytoin, Tocainide
What are class 1C drugs?
Flecainide (Taborcor); Propafenone (Rythmol)
beta blockers
decrease/lower HR.
increase exercise capacity
cold/flu medication
Raise BP. (Ephedrine)
CCB's
Decrease BP
ACE inhibitors
Decrease BP
Diuretics
Increase HR
Decrease BP
origin vs. insertion.
origin is the part the doesn;t move. insertion is the part that moves.
fat soluble vitamins
A, D, E, K
water soluble vitamins
B and C
what happens when you take in too much protein
body can only absorb so much protein at a time. 40-50 grams. Stores the rest as fat.
Law of Inertia
a body will maintain a state of rest or constant velocity unless acted on by an external force that changes the state
Law of Acceleration
Newton's 2nd law: an object will move in the direction of the force applied to it
Law of Reaction (3rd law)
For every action there is an equal and opposite reaction
net force
The combination of all forces acting on an object
Friction
A force that opposes motion between two surfaces that are in contact
center of gravity
the point around which an object's weight is evenly distributed.
Axis
pivot point between the force and the resistance
Force Arm (FA)
distance between force and axis
Resistance Arm (RA)
distance between resistance and axis
first class lever
fulcrum in the middle
second class lever
the load is between the fulcrum and the effort
third class lever
The fulcrum is at one end of the bar and the effort is between the fulcrum and the resistance
walking speed
approximately 1.5m/s
Phases of Gait Cycle
stance phase and swing phase
stance phase
heal strike
foot flat
midstance
heel off
toe off
swing phase
initial swing (acceleration)
midswing
terminal swing (deceleration)
Archimedes' Principle
the principle that states that the buoyant force on an object in a fluid is an upward force equal to the weight of the volume of fluid that the object displaces
energy pathway composed of
ATP and phosphocreatine (PCr)
air pathway
nasal cavity - pharynx - glottis - trachea - bronchi - bronchioles - alveoli
respiratory rate
12-50 breaths perminute
ejection fraction
% of blood in the ventricle during diastole that is actually pumped out during systole
EF= SV/EDV
vascular system
arteries, arterioles, capillaries, venules, veins
vasodilate
Widening of arterial blood vessels.
vasoconstriction
narrowing of blood vessels
Afterload
the amount of resistance to ejection of blood from the ventricle
Preload
volume of blood in ventricles at end of diastole
when venous blood returns and enters the ventricles during diastole, it increases EDV and stretches the heart before contraction (the stretch is called preload)
mean arterial pressure
pressure forcing blood into tissues, averaged over cardiac cycle
MAP (mm hg) = (SBP-DBP) x 0.33+ DBP
blood shunting
Blood redistributed around the body to increase oxygen supply to your muscles
cardiovascular drift
a phenomenon where cardiac output remains stable, where as heart rate increases, and stroke volume decreases over a submaximal exercise of constant intensity.
Aging factors
lifestyle
genetics
disease
environmental
1`AZ
...
diaphysis
shaft of a long bone
this is where ossification begins
Epiphysis
End of a long bone
epiphyseal plates
Plates which allow for growth of long bone during childhood.
aging fat free mass
remains relatively constant
after age 50 nitrogen
negative state which contributes to loss of muscle mass
syncope
loss of muscle tone and consciousness caused by diminished cerebral blood flow
exercise induced asthma
a medical condition characterized by shortness of breath induced by sustained aerobic exercise
cough, wheeze, chest tightness, chest pain, breathlessness
short intense bouts of exercise are more likely to elicit it
increase the duration of warm up
bronchitis
inflammation of the bronchial tubes
chronic cough, sputum production and dyspnea
ashtma
a respiratory condition marked by spasms in the bronchi of the lungs, causing difficulty in breathing. It usually results from an allergic reaction or other forms of hypersensitivity.
restrictive lung disease
disease of the lung that causes a decrease in lung volumes
pulmonary embolism
Blocking of a pulmonary artery due to a blood clot
common in heart failure, atrial fibrilation
pulmonary edema
fluid in the lungs
Pulmonary hypertension
elevated pulmonary pressure resulting from an increase in pulmonary vascular resistance to blood flow through small arteries and arterioles.
coronary artery disease
disease of the arteries surrounding the heart
arteriosclerosis
hardening of the arteries
Atherosclerosis
condition in which fatty deposits called plaque build up on the inner walls of the arteries
endothelial cells lose selective permiability
lose antithrombic porpertities
decrease recreation of vasiodilating substances
myocardial ischemia
blockage of blood to the heart muscle
angina pectoris
chest pain that results when the heart does not get enough oxygen
acute myocardial infarction
the condition in which a portion of the myocardium dies as a result of oxygen starvation; often called a heart attack by laypersons
electrocardiography
process of recording the electrical activity of the heart
radionuclide imaging
Radionuclides are injected into the blood stream and then monitored as they pass through the heart. This can be used to show heart function and blood supply.
radionuclide ventriculography
a diagnostic procedure used to determine the shape and size of the heart's chambers
echocardiography
an ultrasonic diagnostic procedure used to evaluate the structures and motion of the heart
coronary angiography
radiographic study of the coronary arteries after introduction of an opaque dye by means of a catheter threaded through blood vessels into the heart
electron beam computed tomography
electron beams and CT identify calcium deposits in and around coronary arteries to diagnose early CAD
Calcium Channel Blockers
agents that inhibit the entry of calcium ions into heart muscle cells, causing a slowing of the heart rate, a lessening of the demand for oxygen and nutrients, and a relaxing of the smooth muscle cells of the blood vessels to cause dilation; used to preve
Nitrates
reduce ischemia by reducing myocardial oxygen demand
Digitalis
strengthens the contraction of the heart muscle, slows the heart rate, and helps eliminate fluid from body tissues
normal resting heart rate
60-100 bpm
Forced Vital Capacity (FVC)
The volume of air expired during a forced maximal expiration after a forced maximal inspiration.
FEV1
forced expiratory volume in 1 second
Maximal Voluntary Ventilation (MVV)
maximal possible volume of airflow per minute
standard error of estimate
indication of the error of the estimate compared with the actual measurement of the variable
Bioelectrical Impedance Analysis (BIA)
A method of assessing body composition by running a low-level electrical current through the body.
discontinuous test protocol
test is momentarily stopped, measurements are taken then test is resumed
Continuous test protocol
common form involving straight forward stages
Cooper 12 minute test
The subject must cover the greatest distance possible during the 12-minute test period. VO2max is estimated based on the distance covered.
1.5 mile test
in this field test:
the subject must cover 1.5 miles as rapidly as possible walking or running - VO2max is estimated based on time
-maximal test
-unmonitored
-performance / pace effect results
-inappropriate for sedentary, at risk or older
Rockport Walk Test
cardio fitness assessment
1 mile walk as fast as possible
record time, and clients HR 15 seconds immidiately
variable resistance exercise
strength training in which the resistance varies throughout the range of motion
anorexia nervosa
An eating disorder characterized by an obstinate and willful refusal to eat, a distorted body image, and an intense fear of being fat
Bulimia
an eating disorder characterized by episodes of overeating, usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise
Absolute V02
L/min-1
Relative V02
relative to body weight
ml/kg/min
Walking Equation for VO2
v02= (0.1xS)+(1.8xSxG)+3.5
treadmill vo2
v02= (0.2xs)+(0.9xSxG)+3.5
Leg Cycling
v02= (1.8xwork rate/body weight)+3.5+3.5
arm cycling
v02= (3xwork rate/body weight)+3.5+3.5
Net V02
net V02= gross oxygen uptake - resting oxygen uptake
LDL
3.37
HDL
1.04
total sum of cholesterol
5.18
Triglycerides
1.7
A1C
<6%
Impaired fasting glucose (IFG)
6.1-6.4%
fasting glucose
4-5.5 mmol/L norm
>7 mmol/L - Diabetes
1 Watt
6 kgm
1mph
26.8 m/min
Waist Circumference (WC)
Women = 88cm
Men = 102 cm
cm to m
divide by 100
inches to meters
x 0.0254
inches to centimeters
multiply by 2.54
liters to milliliters
x1000
miles per hour to meters per minute
26.8
rev per minute on an arm ergometer
x2.4
rev per minute on a monark leg ergometer
x6
3500 kcal
1 lb of fat
resting heart rate
60-80 beats per minute
resting stroke volume
70 ml/beat
plateaus at 50%
resting cardiac output Q
Men - 5L/min
women - 4L/min
Resting Pulmonary Ventilation
6L
ss submax 75
ss max 150
resting tidal volume
0.5L/breath
Respiratory rate (breathing rate)
12bpm
respiratory rate exchange ratio
1 CHO
0.7 fatty acid molecule
Colorado guideline for concussion management
Grade 1
Presentation: 1. confusion without amnesia
2. no loss of consciousness
management: evaluate athlete immediately and every 5 minutes. Athlete may return to play if amnesia or symptoms do not appear for 20 minutes
Grade 2
Presentation: 1 confusion w
The energy equivalent chart
METs ? x3.5 ? relative VO2 (mlxkg-1xmin-1) ? x body weight in kg ? absolute V02 (mlx min) ? / 100 ? Absolute V02 (Lxmin) ? x 5 ?Kcal/minute ? x total number of minutes ? total kcal ? /3500 ? lb of fat
Kilojule
a unit for measuring energy intake or expenditure
kg . m . min to Watts
6
How long is the QRS complex?
4
Parasympathetic
decreases hr
decreases myocardial contractility
decreases stroke volume
decreases cardiac output (Q)
release of acetylcholine
sympathetic control
increase hr
increases myocardial contractility
increases stroke volume
increase cardiac output
release of catecholamine ---> norepinephrine, epinephrine
Lung Volumes
Tidal Volume (Vt) - volume of air exchanged with each breath
Inspiratory reserve volume (IRV) at the end of a quiet inspiration, the amount of air that a person can maximally in hale
Expiratory reserve volume (ERV) - maximally exhaling
Residual Volume (RV
open chain exercise
exercise in which a distal segment of the body moves freely in space
closed chain exercise
Movement where the distal segment of the joint is fixed.
Onset of Blood Lactate Accumulation (OBLA)
occurs when the concentration of blood lactate reaches 4 mmol/L
1RM equation
...
Rate Pressure Product (RPP)
The mathematical product of heart rate x systolic blood pressure. Also called the double product
RPP = HR x SBP
Total Peripheral Resistance (TPR)
the resistance to the flow of blood through the entire systemic circulation
TPR = MAP x Q
oxygen-hemoglobin dissociation curve
shows shifts in whether oxygen is being picked up by lungs and delievered to tisues.
alveolar ventilation
The volume of air that reaches the alveoli. It is determined by subtracting the amount of dead space air from the tidal volume.
minute ventilation
The volume of air moved through the lungs in 1 minute minus the dead space; calculated by multiplying tidal volume (minus dead space) and respiratory rate; also referred to as minute volume.
EMG (electromyography)
a measurement technique that records the electrical activity of a muscle or group of muscles. It indicates the muscle activity
female triad
disordered eating, amenorrhea, osteoporosis