KINE 1020 MIDTERM EXAM

Susruta

first doctor prescribe daily exercise as medicine

Hippocrates

Used scientific/evidence based medicine to determine the interaction b/w regular physical activity and nutrition is the safest way to health

Aristotle

Realize complex relationship b/w exercise and health

Edward Stanley

Those who think they have no time for exercise will later have to find time for illness

Physical Fitness

❖ The ability to perform muscular work satisfactorily influenced by ➢ Cardiovascular-Respiratory Endurance ➢ Muscular Strength/Endurance ➢ Flexibility ➢ Body Composition

Health Related Fitness

❖ Allow you to do activities of daily living

Performance Related Fitness

❖ Enable optimal work or sport performance

What is Health

On a spectrum of health (disease/death to optimum wellness) ➢ Still have room for improvement and deterioration

Lalonde framework

helped form current health care system in canada

4 factors that are needed to for a healthy community

➢ Health care organization
➢ Human Biology
➢ Environment ➢ Lifestyle

Canadian Health Care System Defined

Government-sponsored public plan available to all citizens and covers almost all elements of healthcare.

United States Health Care System Defined

Some government-sponsored programs, majority private healthcare through their employer

Where most money is being spent on Health Care

❖ Hospitals
❖ Drugs
❖ Physicians

Canadian Physical Activity Guidelines

- Adults 150 mins a week
- muscle and bone strengthening activities at least 2 days a week

Canadian Access to Care Model

Canada promised care to all citizens, no one is uninsured(not helped) because of income or job medical insurance

Problem with Canadian Access to Care

❖ longer wait times ❖ less equipment
❖ patients are ranked by urgency

Medicare

Universal coverage for medically necessary health care services provided by basis of need, rather than pay
❖ Publicly Funded health care system
❖ Province run -> each provide coverage -> difference in wait time

Canada vs US Wait times

USA is better

Canada vs US Medicare

❖ US Medicare restricted to elderly ❖ Canada is all ages of citizens/residents and get access throughout the country

OHIP, Ontario Health Insurance Plan Requirements

❖ Canadian citizen or permanent resident ❖ Can't be out of Ontario for 153 days/year
❖Must make Ontario primary place of residence

Health care

diagnosis, treatment and prevention of disease, illness, injury and other physical and mental impairments in humans

The National Health Service medical model (UK and Canada)

❖ Tier 1
➢ Wide scope: first point of consultation, (family physician)
➢ Every 5,000-50,000
❖ Tier 2
➢ Focused scope- medical specialists, typically in a hospital (cardiologist)
➢ Every 50,000 to 500,000 people per specialist
❖ Tier 3
➢ Specialists: in hospital with advanced facilities for medical investigation (cancer management)
➢ Every 500,000 to 5,000,000 people

The PRECEDE-PROCEDE model

❖ Cost efficient
❖ Analyze health-related behaviours and environments then design interventions needed to influence them and their consequences
❖ Assess what's wrong with the community then make change
➢ E.g. Factory workers get sick, evaluators analyze whats unhealthy and redesign it to make it safer

Where was the PRECEDE-PROCEED model invented

❖ John Hopkins University

Precede Acronym

❖ Predisposing, Reinforcing and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation. Involves assessing the following factors:
➢ Social assessment: social problems that are wrong in a community that makes us unhealthy ➢ Epidemiological assessment: identify how widespread the problem is
➢ Ecological assessment: analyze the community and identify how they are reinforcing unhealthy behaviours
➢ Match appropriate interventions: Who is in charge to implement change
➢ Implementation of interventions

Proceed Acronym

❖ Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development. It involves the identification of desired outcomes and program implementation:
➢ Implementation: Design intervention, assess availability of resources, and implement program ➢ Process Evaluation: Determine if program reaching target population
➢ Impact Evaluation: Evaluate change in behaviour
➢ Outcome Evaluation: Report to show if your implementation worked

How is Health Influenced

❖ Voluntary behaviours ❖ Shaped by community environment (physical, social, political, economic, ecological)

Leading Cause of Death

As we age, it is an Evolution from Accidents, Suicide, and Homicide to Cancer, Heart Disease, and Stroke.

Complementary and Alternative Medicine (CAM) Defined

❖ Not evidence based ❖ Not part of standard medical care
❖ E.g acupuncture, supplements, chiropractic
❖ OHIP covers evidence based/western medicine not CAM

Why CAM?

When traditional medicine is not working ❖ Typically chronic pain ❖ E.g. painkillers don't work so you go to chiropractors

Types of CAM

❖ Natural products
❖ Mind and body medicine (yoga)
❖ Manipulative and body-based practices (chiropractics)

(CAM) - Issues and Safety Downsides

- Unregulated industry, packaging can have marketing claims but not work/contaminated ❖ The person prescribing treatment most likely tells you more than what you need because they benefit from it. (chiropractors)

Evidence-Based Medicine

❖ "Best evidence" in making decisions about the care of the majority of individual patients for optimum care
❖ Evidence comes from peer reviewed original published journals
❖ Used to determine the strength of evidence for a type of care
➢ Must factor clinical/cost effectiveness

How to find evidence based meds

❖ PubMed to determine the efficacy of treatments
❖ Not google because it is advertised and funded

issues/Not EBM on Where to obtain medical advice

❖ We typically take advice from our peers and take their word for it but doesn't mean it actually works/safe
➢ Man w muscle says take x amount of certain types of supplements
❖ Animal studies on PubMed does not necessarily mean it works on human
❖ Physician: sometimes does not practice EBM ➢ If last patient took a supplement and work, they recommend it to you

Best Place to get Medical Advice/Only type of EBM

❖ Large group of individuals compared vs a control
➢ You see improvement and no compromise of safety

Quality of Evidence Design - Higher on chart more likely to work - EBM

❖ Level 1:
➢ Evidence obtained from properly designed randomized controlled trial
➢ Sometimes can't use it cause unethical so settle for L11
❖ Level 11a:
➢ Evidence obtained from well designed controlled trials without randomization
❖ Level 11b:
➢ Evidence obtained well designed analytic studies(to test specific hypotheses) from more than one research group over a period of time. ❖ Level 111:
➢ Opinions of respected authorities based on expertise

Limitations of Evidence Based Medicine

❖ Randomized trials not always ethical
❖ Does not replace doctor-patient relationship
❖ May work on a large group of people but not you
❖Insurance/coverage/affordability might differ in medication

Mentally Healthy Individual

❖ Establishes and maintains close relationships
❖ Feels fulfillment in daily living
❖ Carries out responsibilities

Tool to assess physical and mental health

❖ (36) question health survey relate to physical and mental health

EBM

is the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimum clinical care to patients

Motivation

• Triggered by internal and external factors
• Comes from within (intrinsic- you must care) •
Comes from outside (extrinsic- you feel accountable)

locus of control

• Internal
• External
• Continuum

External Locus of control

-Feel things happen to you, out of your control - Tend to be happier

Internal Locus of control

■ You make things happen, control of destiny
■ More internal as age

The disadvantages of an Internal Locus of Control

- • Can be unhealthy and unstable.
- a need for competence, self-efficacy
- can become neurotic, anxious and depressed.
- internals need to have a realistic sense of their circle of influence in order to experience 'success'.

Externals Locus of Control pros

Externals can lead easy-going, relaxed, happy lives.

Stressor

❖ Neurogenic ➢ Comes from brain
❖ Metabolic
➢ starvation/diabetes
❖ Physical
➢ Injury
❖ Body response to all of these are the same

Negative Stress (Distress)

Death of a close friend Interview for a job Being a student at York

Positive Stress (Eustress)

Going out on a date Getting a promotion A squash or hockey game

The neuroendocrine stress response hormones

❖ HPA axis
➢ Hypothalamus perceive stress release CRH to pituitary
➢ Pituitary release hormone ACTH
➢ ACTH travel to adrenal gland
➢ Adrenal gland release stress hormone cortisol

Nervous System stress response hormones

❖ Normally want PNS to be activated to be chill, but when under stress it deactivates and SNS axis
➢ Feel symptoms of SNS
■ Sweaty palms
■ Increase heart rate

Why you need bad stress

❖ Cortisol is important to have in the morning and and decreases at night
❖ Helps wake up, lower BP

Physiological Responses to Stress is caused by the

- Autonomic nervous system (ANS) =Parasympathetic nervous system (PNS) &
Sympathetic nervous system (SNS)
- Hypothalamo-pituitary-adrenal (HPA) axis/system and associated hormones (ACTH, Cortisol, catecholamines)

Acute Stress Effects

- The brain is more alert - Breathing quickens
- Digestive system slows down
- Heart rate increases
- Adrenal glands produce stress hormones
- Muscles tense

Chronic Stress Effects

- Cold sores
- Sleep disrupted
- Can increase appetite and thus body fat

Cushing's syndrome

Chronic stress + bad diet - Makes the body look more androgynous - Very fatty in the middle

If the HPA axis was always fully active

Physical exhaustion
- Immune and growth suppression
- Central obesity
- High blood sugar
- Brain damage

Learn coping mechanisms for stress

Breathing exercises
- Progressive relaxation therapy
- Imagery (happy place) - Physical exercise

Physiological age

- Physical attributes (wrinkles, hair colour, etc)

Chronological Age

- Literal age (days alive)

Dental age

- development of teeth
- Used by archaeologists to identify the age of people
- Looks at the mineralization and demineralization

Skeletal age

- an estimate of physical maturity based on development of the bones of the body
- Long bones have growth plates
- When the growth plates meet/close the bones stop growing
- Flat bones(cartilage) keep growing (jaw, nose)

Babies

Ossification- bone development
- Babies do not have complete bones, lots of gaps of cartilage
- Their bones develop over time to keep them from breaking their bones as they learn to walk

Age-height and weight tables

See's how children are developing compared to others

Age size and sports

Some people are born with advantages due to developmental advantages (older so more develop)
- January babies are more likely to be successful in sports and academics
- December babies are more likely to be labelled as problem children
- The bigger students have more advantages
- Smaller students are more likely to be injured in sports

Puberty in girls

Onset of menses
- A girls first menstruation
- Usually occurs at around 12 years of age, but can occur anywhere between 8 and 16

Puberty - Sexual Development

Tanner Stage I-V
Pubic hair
- Genital size (males)
- Breast size (females)

Puberty Skin appearance - AGE

30 - forehead furrows
40 - Crows feet @ eyes
50 - web of lines @ eyes
60 - sun spots
70- facial skin seems too big for face, face is dry & wrinkled , yellow skin

puberty - hair

As you get older (males and females) your hair thins and becomes less abundant
- Male Pattern Baldness (MPHL)
- Asian, native american, and african men have a decreased frontal hair loss and less extensive hair loss compared to white men

Height loss

-Compression of vertebrae in the spine due to long term weight bearing (body mass and brain mass)

Physiological age

A person's age as estimated by his or her body's health and probable life expectancy
- A person's age is estimated in terms of function

Functional declines with age

-Brain weight decreases linked to cognitive abilities
- Basal metabolic rate
- Cardiac Output:
-Respiratory capacity(lung functioning)

Stages and process of behaviour change - Precontemplation

- If you've never thought about it the you likely won't do it
- Not intending to make changes

Precontemplation Characteristics

- No intention of change
- They're not fully aware of the implications of change
- May be demoralized
- Pros for not changing outweigh the cons

Precontemplation Intervention goals

- Increase awareness of importance
- Increase pros
- Help them think and talk about their habits

Stages and process of behaviour change - Contemplation

- Starting to consider the change
- Thinking about it

Contemplation Characteristics

- Intending to change in the next few months
- May be ambivalent
- More open to education and consciousness-raising
- Self-confidence low

Contemplation Intervention goals

Addressing ambivalence
- Highlighting self specific benefits
- Building self-efficacy - Abilities: you can do it

Stages and process of behaviour change - Preparation

- Making small changes and/or seriously planning to change soon

Perparation Intervention goals

- Make a plan - Set a target date - Focus on the pros
- Get helpful resources - Establish a commitment

Perparation Characteristics

- Intending to take action in the next month - Modifying behaviour - Tried in the past year

Stages and process of behaviour change - Action

- Actively engaging in a new behaviour

Action Characteristics

Has changed behaviour in the last 6 months
- Risk for relapse (old habits die hard)
- Need lots of support

Action Intervention goals

- Support to prevent relapse
- Teach to deal with potential relapses
- Promote social support (hold them accountable)
- Reward driven (not counterproductive reward)

Stages and process of behaviour change - Maintenance

- Sticking with the behaviour change
- Skilled at it
- Subconscious

Maintenance - Characteristics

- Confidence is high
- Lasts for 6 months or longer
- Learned strategies to deal with lapses
- No longer need as much support for their behaviour

Maintenance Intervention goals

- Support person to maintain
- Prepare them for relapses
- Refine and add variety to program
- Reward (but less immediate that stage 4)

Factors affecting participation in physical activity:

1. Health benefits
2. Enjoyment and pleasure
3. Body and self image
4. Practical considerations

Factors affecting participation in physical activity -- Beliefs

Shaped by personal experiences, observations of others, and what is learned from media and other sources
- Some people, despite hard proof, will not change their beliefs

Factors affecting participation in physical activity -- Attitudes

Values attached to a belief
- Good attitude helps with actions

Factors affecting participation in physical activity --- Intentions

- A plan to make changes, a plan of action to do so, and a commitment to do so
- Come up with realistic change program
- Reinforce behaviours so that they will be repeated (praise/rewards)

Factors affecting participation in physical activity -- Social involvement

- Leisure pursuits are governed by who they do it with rather than what they're doing
- People crave social support; the interest and encouragement of friends and family

Factors affecting participation in physical activity-Body and self image

- The poor image of self may spark a desire and motivation for change
- Want to like how they look and want other people to like how they loo

Factors affecting participation in physical activity -Practical considerations

If you don't have access to facilities equipment or don't have the time or money for the desired activity then it's not really possible

Principles of exercise prescription - WHY

- Enhance physical fitness
- Decrease disease
- Ensure safety during participation in exercise
- Fitness benefits
-Physical health benefits - Mental health benefits

Principles of exercise prescription - WHAT

Regiment of physical activity designed to reach SMART goals in a systematic and individualized manner
- What works for some people does not work for all
- What's healthy for some is not healthy for all

Principles of exercise prescription - HOW

FITT principle
- Frequency
- Intensity
- Time
- Type

FOCUSED GOALS

- Intrinsic goals- things that are under your own control, and are self-motivated
- Extrinsic goals- dependent on things outside your control or are done for other people

Poor focused goals

Inspecific, externally motivated, no specific plans (want women to find me more sexy)