637 Ch9 CVP Implications of Systemic Diseases

What are the largest factors contributing to the rise of obesity?

Environmental, increased caloric intake and reduced physical activity (also: genetics)

What are general factors that contribute to obesity?

• Environmental

• Increased caloric intake

• Decreased physical activity

• Genetics

• Monogenic mutations

• Polygenic abnormalities

• Hormonal

• Medical conditions

• Medications

• Low calcium/dairy intake

• Sleep deprivation

• Novel possibilities

What are prenatal and early postnatal environmental factors that contribute to obesity? What factor reduces risk?

• Maternal smoking during pregnancy

• Low birth weight relative to gestational age

• Higher maternal BMI at the onset of pregnancy

• Breastfeeding appears to REDUCE risk

What are health hazards of obesity?

Higher prevalence of: HTN, CAD, stroke, insulin resistance, glucose intolerance, T2DM, dyslipidemia, gallbladder disease, OA, other ortho problems, sleep apnea, gynecologic problems, obesity hypoventilation syndrome, pHTN, cancer

*What are the classifications of obesity based on BMI?

• I: 30-34.9 kg/m2

• II: 35-39.9 kg/m2

• III: 40 kg/m2 or more (extreme or morbid)

What are health complications associated with obesity?

HTN, dyslipidemia, insulin resistance, T2DM, CAD/CVD/CKD, LV dysfunction/HF, cardiomyopathy, PFT abnormalities/restrictive lung dysfunction, obstructive sleep apnea, obesity hypoventilation syndrome, orthopedic problems (osteoarthritis, plantar fasciitis), GI disease (GERD, gallstones, nonalcoholic fatty liver, steatohepatitis), increased risk of breast, prostate, colon, endometrial, and other cancers

What are CVP complications of obesity i.e. associated diagnoses/underlying factors?

• Associated diagnoses

  • HTN (3x greater) - weight gain, BP, and risk for CHF

  • HF: increased risk of LV dysfunction, increased SNS activity (inc RHR, inc BP, dec HRV, susceptible to illness, cardiac events, and higher risk for arrhythmias), SCD

  • Elevated minute ventilation, reduced FEV1, VC, ERV, FRC, and TLV, reduced pulmonary compliance, respiratory muscle insufficiency, increased risk for respiratory failure and infection, DKA

  • Obstructive sleep apnea

  • CAD, stroke

• Underlying factors: atherosclerosis, insulin resistance, increased C-Reactive protein, dyslipidemia

What is a significant, realistic weight loss % goal?

5-10% of baseline weight

*What are the treatments for mild/moderate vs. severe obesity and examples of each?

*What are the clinical implications for physical therapy?

• Stepped care approach - tx assoc. w/ severity of classification of obesity

• Goal - 5-10% weight reduction from baseline

• Combine approaches effective i.e. diet & exercise

  • Consistent, long term compliance w/ diet modification, 1-2lbs per week is safe

    • Emphasize high protein vs low fat, NOT low calorie diets

  • *40-60% of HHR, duration, emphasized over intensity (45-60min/day) of NWB, resistance, endurance, etc.

• Injury prevention priority, temperature regulated envt b/c impaired thermoregulation

What is the common criteria for metabolic syndrome? What relationships are important?

• 3/5

• Central obesity, elevated TGs. low HDl cholesterol, HTN, elevated FBG

  • Relationship btwn cardio, renal, metabolic disease

  • Importance of multidisciplinary support to reduce risk of developing DM

True or false: drug treatment reduces the risk of developing adverse CVP events.

False

What are the 5 criteria measures for metabolic syndrome?

• Increased waist circumference

• Elevated TGs or drug tx

• Reduced HDL-C or drug tx

• Elevated BP or drug tx

• Elevated FBG or drug tx

Can you describe what these comorbidities/RFs can result in: HF, T2DM, smoking, age, gender

• HTN → HF

• T2DM → stroke, renal failure

• Smoking → CAD, COPD

• Age → CAD, osteoporosis, ventricular dysfunction, decreased lung compliance

What are CVP complications of diabetes?

• Conduction dysfunction: Sinus node dysfunction, AV arrhythmias

• Small blood vessel damage: eyes, kidneys, nerves

• Prevalence of comorbidities: HTN, autonomic neuropathy, CAD, PAD, stroke, neuropathy, renal failure, non healing foot ulcers

• Slowed digestion of food in stomach, carpal tunnel syndrome, erectile dysfunction, autonomic dysfunction, other nerve problems

What comorbidity is 1.5-3x more prevalent in people with DM?

• HTN

• Accelerates microvascular & macrovascular complications of DM, causes irreversible myocardial damage

• Aggressive tx of borderline HTN → reduces risk

Describe how the CVP complications of diabetes affect/worsen the condition.