Exercise Physiology Exam 1

Obesity Prevelance in the US?

42.4%

Population with the highest obesity prevalence

Non-Hispanic Black Women

Characteristics of Normal BMI and Metabolically Healthy (6)

- Reduced Fat

- Increased Muscle

- Increased Fitness

- Normal Insulin Sensitivity

- Normal Blood Sugar

- Low Cardiovascular Risk

Characteristics of Obese BMI and Metabolically Healthy (7)

- Excessive subcutaneous fat > visceral

- Increased Muscle

- Increased Fitness

- Hyperinsulinemia

- Normal Insulin Sensitivity

- Normal Blood Sugar

- Mild Cardiovascular Risk

Characteristics of Normal BMI and Metabolically Unhealthy (9)

- Chronic Illness

- Muscle Loss (sarcopenia)

- Excess visceral fat

- Reduced Fitness

- Insulin Resistance

- Diabetes

- Inflammation

- High cardiovacular Risk

High Cancer Risk

Characteristics of Obese BMI and Metabolically Unhealthy (9)

- Excess Visceral Fat > Subcutaneous Fat

- Muscle Loss (sarcopenia)

- Reduced Fitness

- Hyperinsulinemia

- Diabetes

- Dyslipidemia

- Inflammation

- High Cardiovascular Risk

- High Cancer Risk

Physical Activity

Any bodily movement that results in the contraction of skeletal muscle and results in increased caloric requirements above normal resting levels

Exercise

A subset of PA that is planned, repetitive bodily movement done to improve or maintain one or more componants of fitness

Physical Fitness

Set of attributes or characteristics that individuals have or can achieve that relate to their ability to perform PA and their activities of daily living

- Can work to improve this

Health-Related Physical Fitness

- Body Composition (BMI, Waist Circumference, DEXA)

- Cardiorespiratory Fitness Assessment (Exercise Stress Tests)

- Muscular Strength, Endurance, and Flexibility

Skill-Related Physical Fitness

- Agility

- Balance

- Power

- Speed

- Reaction Time

Assessed during daily tasks like PA, work, or ADLs

Physiology-Related Physical Fitness

- Metabolic Fitness

- Morphologic Fitness

- Bone Integrity

Metabolic Fitness

Status of metabolic systems and variables predictive of the risk for diabetes

Morphologic Fitness

The status of body compositional factors such as body circumference, body fat, and regiona body fat distribution

Bone Integrity

The status of bone mineral density

Total Fitness

Physical + Psychological Attributes of a Person

2018 PA Guidelines for Americans

- Even < 10-minute increments are beneficial

- 150 - 300 minutes/week of moderate intensity PA

OR

- 75 - 150 minutes/week of vigorous intensity PA

T/F: A single bout of PA can provide health benefits

True

T/F: For inactive people, moderate or vigorous intensity must be reached to gain health benefits

False; any intensity, even light intensity, can lead to health beneifts for inactive people

There is a(n) _______ dose response relationship between PA and the development of chronic disease and premature mortality

Inverse; Greater amounts of PA are related to decreased risk and development of chronic diseases and premature mortality

Strong Evidence Related to Increased PA (7)

- Reduced All-Cause Mortality

- Reduced Breast Cancer

- Reduced Colon Cancer

- Increased CR Health

- Increased Metabolic Health

- Increased Weight Loss

- Increased Muscle Health

Moderate Evidence Related to Increased PA (7)

- Weight Maintenance Following Weight Loss

- Reduced Abdominal Obesity

- Increased Bone Health

- Increased Functional Health

- Decreased Bladder Cancer

- Decreased Endometrial Cancer

- Improved Sleep

Limited Evidence Related to increased PA (4)

- Reduced Stroke

- Reduced Ovarian and Lung Cancers

- Reduced Anxiety

- Increased Prevention of Weight Gain

Insufficient Evidence Related to Increased PA (3)

- Decreased Prostate Cancer

- Improved Cognition

- Improved Quality of Life

Characteristics of Improved Cardiorespiratory Function (7)

- Increased Maximum O2 Uptake

- Lower Minute Ventilation (RR x TV)

- Decreased Need for O2 (submaximal)

- Lower HR and BP

- Increased Capillary Density in Skeletal Muscle

- Increased Exercise Lactate Threshold

- Increase Exercise Threshold before Onset of Disease (ex. angina)

Characteristics of Reduced CVD Risk Factors

- Reduced Resting Systolic/Diastolic BP

- Increased Serum HDLs

- Reduced Total Body Fat and intra-abdominal fat

- Reduced Insulin Need

- Decreased Blood Platelet Aggregation

- Reduced Inflammation

Primary Prevention

BEFORE DISEASE OCCURS

- Preemptive efforts to prevent or reduce the risks of an injury or illness from occurring

- Ex: Higher activity and/or fitness levels are associated with reduced mortality from CAD, CVD, Stroke, Diabetes Type II, and Metabolic Syndrome

Secondary Prevention

AFTER DISEASE OCCURS

- Prevention of a recurrence of a disease or decreasing the severity of a recurrence of a disease

- Ex: Interventions after a cardiac event to prevent another one

Tertiary Prevention

MANAGING DISEASE

- Actions taken to contain damage once a disease or disability has progressed beyond its early stages

- Learning to adapt and live with the disease and reduce further complications

METs

Metabolic Equivalents

- Used to estimate exercise intensity

Sententary MET Value

Light MET Value

Moderate MET Value

Vigorous MET Value

- < 1.5 METs (Lying in Reclined Position)

- 1.6 - 2.9 METs (Walking Slowly)

- 3.0 - 5.9 METs (Walking at a Brisk Pace: 3 MPH)

- > 6.0 METs (Jogging/Running > 4.5 MPH)

Moderate Intensity Activity (%HRR/%VO2R, RPE, MET)

%HHR: 40 - 60%

%VO2R: 40 - 60%

RPE: 12 - 13

MET: 3 - 5.9 METs

FITT Principle

F: Frequency (e.g., days)

I: Intensity (e.g., light, moderate, heavy)

T: Time (duration in minutes)

T: Type (e.g., arm or leg bike, treadmill)

How do we manipulate parameters to obtain a moderate dosage of PA?

FITT Principle allows us to tailor our PA to fit the recommendations by modifying each parameter to what we want

Age Positive CVD Risk Factor

- Men >45

- Women >55

Family History Positive CVD Risk Factor

MI, Coronary Artery Revascularization, or Sudden Death in:

- Father before 55

OR

- Mother before 65

Cigarette Smoking Positive CVD Risk Factor

- Current cigarette smoker

OR

- Has quit within the previous 6 months

OR

- Exposure to tobacco smoke

Physical Inactivity Positive CVD Risk Factor

Not meeting the minimum requirement of:

- 150 - 300 min/week of moderate

OR

- 75 - 150 min/week of vigorous

BMI Positive CVD Risk Factor

BMI >30 kg/m2 (Obese Categories)

Waist Circumference Positive CVD Risk Factor

Waist Circumference

- >102 cm for men

- >88 cm for women

Blood Pressure Positive CVD Risk Factor

- >130 mmHg systolic

OR

- >80 mmHg diastolic

OR

- Taking antihypertensive medication

Lipid Positive CVD Risk Factor

- LDL > 130 mg/dL

OR

- HDL <40 mg/dL for men, < 50 mg/dL for women

OR

- Lipid-lowering medication

OR

- Total serum cholesterol >200 mg/dL

OR

Non-HDL-C >160 mg/dL

Blood Glucose Positive CVD Risk Factor

- Fasting Plasma Glucose >100 mg/dL

OR

- Oral Glucose Test >140 mg/dL

OR

- HbA1C > 5.7%

What is a Negative Risk Factor for CVD?

HDL > 60 mg/dL

3 Components of Pre-Exercise Evaluation

1. Medical History

2. Physical Examination

3. Laboratory Tests

4 Components of Medical History

1. PAR-Q

2. Signs and Symptoms of CV, Pulmonary, and Metabolic Disease

3. Risk Factors

4. Blood Pressure

3 Components of Physical Examination

1. BMI and Waist Circumference

2. Anginal Patterns and Equivalents

3. Heart Tests

4 Components of Laboratory Tests

1. Blood

2. Lipoprotein

3. Enzyme

4. Metabolic Syndrome Criteria

______ is the minimum standard for entry into a moderate-intensity exercise program

PAR-Q

3 Purposes of PAR-Q

1. Identify the small number of adults for whom PA may be inappropriate

2. Identify those who should receive medical advice about the most suitable type of activity

3. Evaluate persons for selected risk factors associated with CAD

Signs and Symptoms of CV, Pulmonary, and Metabolic Disease (8)

- Pain above the waist with 3 Es

- Syncope

- Orthopnea

- Anke Edema

- Palpitations

- Paroxysmal Nocturnal Dyspnea

- Dyspnea/Shortness of Breath

- Intermittent Claudication

3 Es Associated with Pain Above the Waist

- Eating

- Exercise

- Emotion

Symptom

Syncope

Fainting

- Symptom

Orthopnea

Measured using the number of pillows needed to sleep to breathe more easily

- Sign

Ankle Edema

Swelling in the ankle due to a venous problem, heart failure, or DVT (if unilateral)

- Sign (measured using the edema scale)

Palpitations

Tachycardia associated with feeling like the heart is beating out of the chest

- Symptom (tachycardia is a sign, however -> HR >100 bpm)

Paroxysmal Nocturnal Dyspnea (PND)

SOB occurring in the recumbent position at night shortly after going to bed

- Goes away when sitting up

- Symptom

Dyspnea (SOB)

Difficult or labored breathing due to a heart or lung condition or deconditioning

- Symptom

Conditions Associated with SOB Shortness of breath (5)

- Asthma

- COPD

- Heart Disease

- Anemia

- Pulmonary Embolisms

Intermittent Claudication

Cramping or pain in the calves when walking, indicative of poor blood supply

- Symptom

Modifiable Risk Factors (6)

CAN change the risk

-Hypertension

- Smoking

- Diabetes

- Overweight/Obesity

- Physical Inactivity

- Atherogenic Diet/ Abnormal Cholesterol

Non-Modifiable Risk Factors (3)

CANNOT change the risk

- Age

- Male Gender

- Family History (Minority pops. have higher prevalence of risk factors for CAD)

Blood Pressure Categories (5)

- Normal: <120 and <80

- Elevated: 120-129 and <80

- Hypertension Stage 1: 130-139 OR 80-89

- Hypertension Stage 2: >140 OR >90

- Hypertensive Crisis: >190 OR >120

Angina

Squeezing/tightness/crushing feeling type pain usually presents in typical areas

- Brought on by 3 Es

- Relived by Rest and Nitro

Anginal Patterns

- Radiating down the left arm

- Localized chest

- Upper neck

- Jaw

- Back between shoulder blades

Anginal Equivalents

Symptoms misinterpreted as not being cardiac

- Dyspnea

- Fatigue

- Lightheadedness and Belching

- Fullness in the throat and jaw

Electrocardiogram (EKG)

Shows the electrical activity of the heart

- Completed during graded exercise stress test, rest, or during ambulation

Angiogram

Contrast dye is injected into the arteries

- Used to determien if there is a blockage from atherosclerosis/plaque

ECHOcardiogram

Pre/post-exercise stress test

- Measures ventricle size, wall motion, valve function, and estimated EF (normal is 65%)

-CBC

-RBC

-HCT

-Hgb

-MCHC

- Complete Blood Count

- Red Blood Cell Count

- Hematocrit: proportion of red blood cells in your blood (40-50% in males; 36-44% in females; 36-40% in children)

- Hemoglobin: carries oxygen in blood

- Mean Cell Hemoglobin Concentration: Average conc. of hemoglobin in a given volume of packed RBCs (MCHC = Hgb/HCT *100)

Anemia

Low hemoglobin and therefore decreased oxygen-carrying capacity of RBCs

- Due to sickle cell, kidney failure, surgery, colon cancer, deficiency of vitamin B12

LDL Levels

Low-Density Lipoprotein

- <100 mg/dL = Optimal

- bad

HDL Levels

High-Density Lipoprotein

- <40 = low (increased CAD risk)

- >60 = high (decreased CAD risk)

Total Cholesterol Levels

<200 = desirable

Triglycerides Levels

<150 mg/dL = Normal

Troponin I

The gold standard for determining if myocardial damage has occurred

- >0.5

Metabolic Syndrome Criteria

1. Abdominal Obesity

- Men > 102 cm

- Women > 88 cm

2. Atherogenic Dyslipidemia

- Triglycerides >150mg/dL

- HDL <40 (men) <50 (women)

3. Increased Blood Pressure

- >130/>85 mmHg

4. Insulin Resistance

- >110 mg/dL

Client has Metabolic Syndrome if they have ____ out of 4 criteria

3: Increased Risk for CAD, Stroke, Diabetes, Plaque build-up in arteries

Prothrombic State

Increased platelet activity

- Common in metabolic sydrome

• can be a concern of blood clotting

Proinflammatory State

Increased C-reactive protein (CRP) in blood

- Common in metabolic syndrome

What is the first stage of the Transtheoretical Model of Behavior?

Precontemplation: Unaware of changes needed for a healthier lifestyle

What is the second stage of the Transtheoretical Model of Behavior?

Contemplation: Aware of and thinking about making changes within the next 6 months

What is the third stage of the Transtheoretical Model of Behavior?

Preparation: Making moves to start changes

What is the fourth stage of the Transtheoretical Model of Behavior?

Action: Less than 6 months into changes

What is the fifth stage of the Transtheoretical Model of Behavior?

Maintenance: More than 6 months into changes

What is the sixth stage of the Transtheoretical Model of Behavior?

Relapse: Return to bad habits

Mechanical Work

Chemical energy is transferred into mechanical energy within muscle protein filaments for movement through muscle contraction.

Chemical Work

All cells perform work for maintenance and growth, so you have the synthesis of macromolecules like glucose, glycogen, and proteins

Transport Work

This concentrates various substances in the intracellular and extracellular matrix of the cell

- Passive diffusion

- Active transport

___ is the body's energy currency that powers biological work

ATP

T/F: The body maintains a continual energy supply through ATP

True; It is the chemical driving force for muscle contraction

ATP-PCr System

- Immediate Energy (<10-15 Seconds)

- Anaerobic

- Occurs in the cytoplasm

- Limited Fuel

- Ex: 100m Sprint, Power Lift, 25m Swim

Glycolytic System

- Short-Term Energy (15s - 2 min)

- Anaerobic

- Occurs in the cytoplasm

- Lactic Acid Build-Up

- Ex: 400m Sprint, 100m Swim

Oxidative System

- Long-Term Energy (>2 min)

- Aerobic

- Occurs in Mitochondria

- Primary for endurace events

- Ex: Marathon

Why is fat less accessible for metabolism?

It must be reduced to glycerol from free fatty acids (FFA)

• also take 9kcal of thermic effect on food to burn

What is a substantial energy reserve during prolonged low-intensity exercise?

Fat

How many kilocalories are in 1 gram of fat?

9 kcal

How much ATP does glycerol yield?

19 ATP

What macroniutrient is not a good energy source?

Protein

How can protein be used as an energy source?

Can be used as a secondary energy source if converted to glucose via gluconeogenesis.