health
-physical, metal, and social well being
-not just absence of disease
exercise
-planned, structured, repetitive, and purposeful physical activity
physical activity
-body movement produced by muscle action that increases energy expenditure
-health benefits with SOME physical activity
-more physical activity greater health benefits
fitness
-attributes related to how well one performs physical activity
planned exercise
-set to develop ones physical fitness level
effects of exercise training on...
-triglycerides
-HDL (good cholesterol)
-dyslipidemia
-abdominal obesity
-diabetes
effects of exercise on triglycerides
-decrease
effects of exercise on HDL
-increase
effects of exercise on dyslipidemia
-volume specific >1200-1500 kcal/week
-pharmacoligic therapy is primary
-exercise and proper diet are secondary therapies
effects of exercise on abdominal obesity
-decreased fasting glucose
-decreased fasting insulin
-increased glucose tolerance
-decreased insulin resistance
-decreased body weight and fat mass
effects of exercise training on diabetes
-improved insulin sensitivity
-reduced body fat
-decreased risk of cardiovascular disease
-stress reduction
-prevention of type II diabetes
benefits of exercise training and age
-may slow muscle fiber loss
-can retard loss in cross sectional area
physical activity continuum
-health
-fitness
-performance
physical activity continuum (health)
-lower health risks
-moderate intensity
-40-59% HRM
-5-7 days/week
-at least 30 mins
physical activity continuum (fitness)
-enhance physical fitness
-CV fitness:
-60-84% HRM
-3-5 days/week
-20-60min
-Muscular fitness:
-1-2 sets of 8-12 reps
-2-3 days/week
-6-10 exercises
physical activity continuum (performance)
-athletic performance
-75-95% HRM
-7+ times a week
- >45min/session
modification of the classic view
-capacity to improve physical fitness is not ablated with age
-training programs will require modification
-need more rest between exercises
-adaptations take more time
SOAP
-subjective
-objective
-assessment
-plan
subjective information
-persons complaints and symptoms
-why they are coming to you
-past PA
-any limitations
-injuries
-current medical and musculoskeletal problems
-current medication
objective information
-information collected during physical examination and lab studies
-aerobic tests
-anaerobic tests
-endurance tests
-strength tests
-flexibility tests
-neuromuscular tests
-functional performance tests
assessment
-use the subjective and objective information to create list of problems
-assessment may explain persons problems or lead to further testing
plan
-plan will lead to diagnosis of problem, treatment, or both
-prioritize problems:
-1 establish exercise prescription (long term/short term goals)
-2 consider anything that may require modification of a typical program (injuries, medications)
-3 design exe
tips on SOAP notes
-be concise
-avoid sentances
-leave out irrelevant information
-organize problems by exercise family (aerobic, anaerobic)
-assign number to each problem and refer to problem by its number
-follow up unresolved problems
-prioritize problems
pre-participation health screening
-purposes
-PAR-Q
-ACSM risk factors
-major signs or symptoms
-risk stratification
-ACSM recommendations for current medical exam, and exercise testing prior to participation and physician exam, test supervision
testing procedures
- subjective info
-objective info
-informed consent
-patient instruction
-contraindications to exercise testing
pre participation screening purposes
-identification and exclusion of individuals with medical contraindications to exercise
-identification of people with increased risk for disease because of age, symptoms, and/or risk factors who should undergo medical evaluation and exercise testing befo
major signs and symptoms of cardiovascular and pulmonary disease
-pain, discomfort in chest, neck, jaw, arms, or other areas that may be due to ischemia
-shortness of breath at rest of with mild exertion
-dizziness or syncope
-orthopnea or paroxysmal nocturnal dyspnea
-ankle edema
-palpitations or tachycardia
-intermit
ACSM risk stratification
-low risk
-moderate risk
-high risk
ACSM risk stratification (low risk)
-1 or less risk factor
low risk medical exam and GXT before exercise?
-moderate not recommended
-vigorous not recommended
low risk MD supervision of exercise test?
-submax not recommended
-max not recommended
ACSM risk stratificatoin (moderate risk)
-2 or more risk factors
moderate risk medical exam and GXT before exercise?
-moderate exercise not recommended
-vigorous exercise recommended
moderate risk MD supervision of exercise test?
-submax not recommended
-max recommended
ACSM risk stratification (high risk)
-symptomatic or known cardiac, pulmonary, or metabolic disease
high risk medical exam and GXT before exercise?
-moderate recommended
-vigorous recommended
high risk MD supervision of exercise test?
-submax recommended
-max recommended
components of medical history
-medical diagnosis
-previous physical examination findings
-history of symptoms
-recent illness, hospitalization, new medical diagnosis, or surgical procedures
-medication use and drug procedures
-orthopedic problems
-medication use and drug allergies
-li
components of informed consent form
-purpose and explanation of the test
-attendant risks and discomforts
-responsibilities of the participant
-benefits to be expected
-inquiries
-use of medical records
-freedom of consent
-signature and date from patient
-signature and date from witness
for a valid informed consent individual must:
-be of lawful age
-not be mentally incapacitated
-know and fully comprehend the importance and relevance of the material risks
-give consent voluntarily and not under any mistake of fact or duress
absolute contraindications to exercise testing
-recent significant change in resting ECG suggesting significant ischemia, recent myocardial infarction, or other acute cardiac event
-unstable angina
-uncontrolled cardiac arrhythmias causing symptoms or hemodynamic compromise
-severe symptoms aortic ste
relative contraindication to exercise testing
-left main coronary stenosis
-moderate stenotic valvular heart disease
-electrolyte abnormalities
-severe arterial hypertension (systolic BP >200 and/or diastolic BP >110
-tachyarrhythmias or bradyarrhythmias
-hypertrophic cardiomyopathy and other forms o
primary risk factors
-family history
-gender
-race
-age
-cholesterol
-smoking
-hypertension
-physical inactivity
secondary risk factors
-obesity
-stress
-diabetes
-others (triglicerides)
non-modifiable risk factors
-family history
-age
-gender
-race
modifiable risk factors
-cholesterol
-smoking
-hypertension
-physical inactivity
-obesity
-stress
-diabetes
-others
genetic risk factors
-family history
-gender
-race
-others (Lp(a)
lifestyle risk factors
-cholesterol
-smoking
-hypertension
-physical inactivity
-obesity
-stress
-diabetes
-others
risk factor (age)
-men 45 or older
-women 55 or older
risk factor (family history)
-some heart disease in 1st degree relative only and only if its a male relative before 55 or female before 65
risk factor (smoking)
-current or quit within 6 months
-exposed to 2nd hand
risk factor (sedentary lifestyle)
-not active in at least 30 mins of moderate aerobic activity for at least 3 days a week for at least 3 months
risk factor (obesity)
-BMI of 30 or more
-waist girth: men > 102 cm women >88cm
risk factor (hypertension)
-systolic 140 or greater and/or diastolic 90 or greater
risk factor (dyslipidemia )
-LDL 130 or greater
-HDL less than 40
-total cholesterol 200 or greater
-counts as 1 risk factor even if 2 are bad
risk factor (prediabetes)
-impaired fasting glucose between 100-125 you are pre diabetic
-126 and up your diabetic if confirmed on 2 occasions
risk factor (high HDL)
-only negative
-HDL 60 or higher
-high HDL is good so ratio of total cholestrol is below 5
heart healthy interventions
-exercise
-diet
-medications
risk factors for heart disease
-lipoprotein
-homocysteine
-prothrombotic factors
-proinflammatory factors
-subclinical atherosclerosis
lipoprotein
-distinct lipoprotein that promotes atherogenesis and clot formation
homocysteine
-fasting plasma levels 16umol/L or greater increases risk for CVD and is related to low folate intake from fruits and vegitables
prothrombotic factors
-factors that promote clot formation (fibrinogen)
proinflammatory factors
-factors that reflect chronic inflammation such as IL-6
subclinical atherosclerosis
-atherosclerosis that is below clinical detection levels and does not produce symptoms in patients
claudication
-pain in calf from limited flow of blood due to blocked vessels
ischemia
-decreased blood supply to tissue
heart murmur
-valves fail to completely close leading to regurgitation of blood
myocardial infarction
-subendocardial
-transmural
types of MI
-transmural myocardial infarction
-subendocardial myocardial infarction
transmural myocardial infarction
-entire heart wall is affected (endocardium, epicardium, myocardium)
subendocardial myocardial infarction
-only a portion of thickness of the heart wall is damaged
sedentary vs trained heart rate
-resting sedentary is higher
-begin workout both increase sedentary way faster
-60% max sedentary higher but not by much
-max sedentary and trained is even but trained is performing at a higher level
sedentary vs trained stroke volume
-sedentary is less and stays less as intensity increases
sedentary vs trained cardiac output
-start fairly even
-as workout begins stays pretty even
-when they get to 60% both increase trained increases more
-at max trained is higher
sedentary vs trained VO2 absolute
-start fairly even
-as workout begins stays pretty even
-when they get to 60% both increase trained increases more
-at max trained is higher
sedentary vs trained V02 relative
-start fairly even
-as workout begins stays pretty even
-when they get to 60% both increase trained increases more
-at max trained is higher
sedentary vs trained METs
-start fairly even
-as workout begins stays pretty even
-when they get to 60% both increase trained increases more
-at max trained is higher
sedentary vs trained A-VO2 difference
-start out even
-as intensity increases both increase, trained gets slightly higher
sedentary vs trained systolic blood pressure
-sedentary starts higher and increases faster
-at max they are both the same
sedentary vs trained diastolic blood pressure
-both stay relatively unchanged until max where they both increase very slightly
sedentary v trained mean arterial pressure
-start about the same both increase at about the same rate
sedentary vs trained tidal volume
-start the same
-as intensity increases both increase trained increases more
sedentary vs trained breathing frequency
-start the same
-as intensity increases sedentary takes more breathes per minute
-at max trained takes more
sedentary vs trained ventilation
-same until max trained is higher