DPT775: Ex Phys Final

in a study on ACLR, 3 main reasons that 27% of subjects did not RTS

1. fear of another injury *
2. reported poor knee function
3. team/training change

4 most common psychological measurement tools used in PT for injury research

-FABQ
-FPQ
-TSK
-PCS

primary psychological responses most commonly encountered by PTs (knuth et al)

-stress, anxiety, depression, anger
-issues w/ pain mgmt, tx adherence, motivation, confidence, attention/concentration
-exercise addiction

4 main factors that influence psychological impact of injury

-athlete/exercise participant vs non athletes
-duration of injury
-pre-injury personal & situational factors
-injury severity

2 levels of psychological distress associated with FAM

low and high

describe low psychological distress

will resume normal activities

someone w/ high psychological distress may avoid normal activities due to

anticipation of ↑ pain &/or injury

why is a score greater than 17 on TSK-11 important in pts returning to sport after ACL

-4x more likely to report ↓ levels of activity
-7x more likely to have hop limb symmetry <95%
-6x more likely to have quad strength symmetry <90%

significance of a 19 or greater score on the TSK-11 in pt about to RTS

13x more likely to suffer a 2nd ACL tear w/in 24 months after RTS

Elements of thorough needs analysis (goal meeting) include goals, age, gender, availability, access to equipment, as well as

-training age/hx
-mvmt analysis
-metabolic need analysis
-injury & medical hx
-strengths/weakness
-likes/dislikes

how do you classify a patient as a beginner

-training age: < 2 months
-frequency: 1-2x/week
-training stress: low

how do you classify a patient as intermediate?

-training age: 2-6 months
-frequency: <= 2-3x week
-training stress: medium

how do you classify a patient as advanced

training age: >= 1 year
frequency: >= 3-4 weeks
training stress: high

primary exercises are

-multi-joint exercises, large muscles, high loading capacity
-choose a few per workout
-should come before accessory

describe accessory exercises (assistance)

single-joint exercises, small muscles lower loading capacity

6 fundamental movement categories

1. push
2. pull
3. squat
4. hinge
5. carry
6. split stance

what are the "rules" for exercise order

1. primary before accessory
2. multi-joint before single-joint
3. bigger muscles before smaller muscles
4. power before strength
5. strength before endurance
6. skilled before unskilled

what will the distribution of older adults to children be in 2034

77% older adults; 76.5% children

list the recommended FITT ACSM guidelines for moderate intensity aerobic exercise in geriatrics

freq: >= 5 d/wk
intensity: 5-6 RPE, mod intensity
time: 30-60 min/day

list the recommended FITT ACSM guidelines for vigorous intensity aerobic exercise in geriatrics

freq: >= 3 d/wk
intensity: 7-8 RPE
time: 20-30 min/day

list the recommended FITT ACSM guidelines for resistance training in geriatrics (& progression)

Freq: 2-3 d/week
Intensity: 40-50% of 1RM for beginners then progress to mod-vig intensity 60-80% 1RM
Time: >= 1 set of 10-15 reps for beginners then progress to 1-3 sets of 8-12 reps for each exercise

what is the recommended intensity and time for power training in geriatrics

-light to mod intensity (30-60% of 1RM)
-6-10 reps with high velocity

what are physiological adaptations seen from resistance training in geriatrics

-counteract age-related changes to muscular function/physiology
-enhances strength, power, & neuromuscular function

what are functional benefits seen from resistance training in geriatrics?

improve mobility, physical function, ADL function, preserve independence, resistance to injury & falls, improve psychosocial well-being

what is a typical program design for resistance training in geriatrics for an individualized, periodized approach?

2-3 sets of 1-2 multi-jt exercises per major muscle group
-intensities of 70-85% of 1RM
2-3x/wk, including power exercises performed at higher velocities, intensities (40-60% of 1RM)

what percentages of youth DO reach the recommended PA

overall only 21.6% (26.0% boys; 16.9% girls)

what % of 6-11 y/o meet PA guidelines

42.5%

what % of 12-15 y/o meet PA guidelines

7.5%

what % of 16-19 y/o meet PA guidelines

5.1%

compare youths resting HR, CO, SV, VO2max, BP, tidal volume/min ventilation/RER to geriatrics

HR = higher
CO = lower
SV = lower
VO2max = higher
BP = lower
TV/min vent/RER = lower

when/how much does BV & RBC volume ↑ during pregnancy?

↑ up to 50% by end of 2nd trimester

what makes CO ↑ at rest in pregnancy & when does it peak?

during 1st & 2nd (peaks) trimesters due to ↑ SV, HR, & BV = ↑ CO

what factors promote the decreased sensitivity to insulin in pregnancy & why?

↑ cortisol levels & lactogen
natural ↑ in insulin resistance because BG levels must ↑ in order to supply more energy to baby

what msk changes occur during pregnancy

-CoG shift
-wider stance/larger strides
-lax ligaments due to ↑ relaxin released
-↑ lordosis

what maternal adaptation occurs in early pregnancy

-surge in HCG hormone which can cause nausea/vomiting
-time of greatest in crease in RBC production which causes SOB & fatigue due to O2 lag

what are the risk factors for developing GDM other than having GDM during previous pregnancy?

-have given birth to a baby who weight >9lbs
-are overweight
-are more than 25 y/o
-have family hx of T2D
-have PCOS

signs and symptoms of preeclampsia

-HA, SOB
-abdominal pain
-burning behind sternum nausea & vomiting
-confusion
-heightened state of anxiety &/or visual disturbances

risk factors for preeclampsia including previous hx of preeclampsia are

-obesity, POS
-lupus or other autoimmune d/o
-multiple gestation
-hx of chronic HBP, diabetes, kidney disease, or organ transplant
-1st pregnancy
-over 35 y/o or under 20 y/o
-family hx of preeclampsia
-in-vitro fertilization
-sickle cell disease

list the absolute contraindications to exercise during pregnancy

-hemodynamically significant HD, severe anemia
-restrictive lung disease
-incompetent cervix, ruptured membranes
-persistent 2nd 3rd trimester bleeding
-placenta previa after 25 wks
-multiple gestation at risk for premature labor
-preeclampsia

list the relative contraindications to exercise during pregnancy

-anemia
-unevaluated maternal cardiac arrhythmias
-chronic bronchitis or heavy smoker
-very low or high BMI
-hx of extreme sedentary lifestyle
-intrauterine growth restrictions
-orthopedic limitations
-poorly controlled seizure d/o, T1D, HTN, or hyperthyroidism

list the reasons you should stop exercising immediately for a preg pt

-amniotic fluid or vaginal fluid loss, vaginal bleeding
-calf pain/swelling
-chest pain
-dizziness/syncope, HA, SOB
-muscle weakness esp weakness affecting balance
-regular painful uterine contractions

what is an appropriate exercise prescription for a previously sedentary pregnant patient?

freq: start at 2-3 days & progress to 4-5
intensity: start at light intensity & progress to mod
time: start at 15-20 min session & progress to 30

what is an appropriate exercise prescription for a previously active preg pt

freq: at least 4-5 day/wk ↑ to 6-7
intensity: similar or mod intensity as before pregnancy
time: aim for at least 30 min session & progress to 60 min

what is the recommended HR range for pregnant women <20 y/o when exercising?

140-155

what are the recommended HR ranges for a sedentary, mod active, and fit 20-29 y/o individual

low fit = 129-144
active = 135-150
fit = 145-160

what are the recommended HR ranges for a sedentary, mod active, & fit 30-39 y/o individual

low fit = 128-144
active = 130-145
fit = 140-156

Consistency with same participant, different assessors

Inter-rater

Consistency with same assessor across participants

intra-rater

Consistency with same participant, same assessor

test-retest

Systematic variation of training variables (volume, intensity) to promote long-term performance gains and prevent overtraining.

periodization

several months to a yr of training program

macrocyle

Typically 2-6 weeks (or several months), a block

mesocycle

Typically 1 week training program (sometimes up to 4 weeks)

microcycle

Gradual increase in intensity, decrease in volume

linear periodization

what are the reinjury rates post-ACLR?

30% in young athletes w/in 2 years

Kubler-Ross 5 Stages of Grief

Denial

Anger

Bargaining

Depression

Acceptance

What are some psychological interventions for injury recovery?

Imagery/visualization.

Goal setting.

Relaxation techniques.

Self-talk strategies

Fick equation for VO2 =

= Q x (a - vO2 difference)

Fick equation for Q (aka CO)

= HR x SV

What refers to the natural variation in time between each heartbeat? (ANS balance)

HRV

What does a higher HRV indicate?

better parasympathetic activity & recovery status