exercise and health exam 4

Boyle's law

P = 1/V

if you decrease the volume of a container, the pressure increases; air moves from an area of higher pressure to an area of lower pressure

Henry's law

at a given temperature, the amount of gas in solution is proportional to the partial pressure of that gas

when a gas under pressure encounters a liquid, it is forced into that liquid

- If the partial pressure of the gas rises à more gas is forced into a solution

- If the partial pressure of the gas lowers à gas molecules come out of solution

Dalton's law

each gas contributes to the total pressure in proportion to its relative abundance

Quiet breathing

normal breathing at rest, only uses the diaphragm & external intercostals, NOT active

Forced breathing

occurs during exercise or exertion, requires contraction of accessory muscles, ACTIVE

Tidal volume

the volume of gas inspired or expired in an unforced respiratory cycle

Inspiratory reserve volume

the maximum volume of gas that can be inspired during forced breathing in addition to tidal volume

Expiratory reserve volume

the maximum volume of gas that can be expired during forced breathing in addition to tidal volume

Residual volume

the volume of gas remaining in the lungs after a maximum expiration

Total lung capacity

the total amount of gas in the lungs after a maximum inspiration

Vital capacity

the maximum amount of gas that can be expired after a maximum inspiration

Inspiratory capacity

the maximum amount of gas that can be inspired after a normal tidal expiration

Functional residual capacity

the amount of gas remaining in the lungs after a normal tidal expiration

Ve (minute ventilation)

= f (breaths/min) * Tv (tidal volume)

volume of air moved into & out of the respiratory tract each minute

Va (alveolar ventilation)

volume of air reaching the alveoli each minute

Restrictive disorders

vital capacity is reduced, FEV1 is normal; pulmonary fibrosis, obesity, scoliosis, muscular dystrophy

Obstructive disorders

vital capacity is normal, FEV1 is reduced; can diagnose with FEV1 tests; COPD, asthma, cystic fibrosis

Ventilatory threshold (VT)

The point at which the volume of air inhaled per minute increases at an exponential rate compared to the increase in workload; Tied to the lactate threshold, where a drop in pH is driving an increase in CO2 from the bicarbonate system thus stimulated the respiratory center in the brain to increase ventilation to rid the body of the CO2; Training can delay the onset of VT; Exercising aerobically at higher intensities before metabolic acidosis begins to incur, leading to the VT; When the lactate threshold is hit, CO2 is continuing to be produced as blood is being buffered à increased respiration rates

Hypocapnia

a decrease in PCO2 (usually due to hyperventilation) decreases chemoreceptor activity & the respiratory rate falls

Hypercapnia

a rise of 10% PCO2 doubles the respiratory rate, even if PO2 levels are normal

Bohr effect

Slope of the saturation curve changes due to the pH

Carbaminohemoglobin

When CO2 is bound to Hb by attaching to exposed amino groups (NH2) of the Hb polypeptide chains

Chloride shift

HCO3- is transported out the RBC in exchange for Cl- (antiport)

Metabolic acidosis compensation

increased respiratory rate to eliminate CO2 in the lungs, increased secretion of H+ and reabsorption of HCO3- in the kidney

Asthma exercise testing

Cardiopulmonary capacity (CRF): inhaler should be used prior to the test to accurately assess CRF

Pulmonary function: FEV1 at baseline & at 5, 10, 15, 30 min following the test

Oxyhemoglobin saturation (pulse ox): test termination at ≤ 80% saturation

COPD exercise prescription

Higher intensities yield greater physiologic results- should be encouraged when possible

- Interval training may be an alternative

Blood oxygen should be measured at least the first exercise training session

Dyspnea on the scale should be between 3-6

- HRmax or HRR may not be accurate

Resistance training should be a mandatory part of the exercise prescription to address muscle dysfunctions seen in COPD

- Upper body to reduce dyspnea exhibited in daily living activities involving the upper body

- Lower body to reduce risk of falls and increase gait and muscle weakness

Lung transplant exercise prescription

Pretransplant should exercise closest to the highest workload they can tolerate

Exercise should be closely supervised

Infection control procedures should be followed

Postoperative rehab can begin as early as 24 hours after surgery to minimize detrimental effects of immunosuppressants & bed rest on skeletal muscle

Interstitial lung disease

A group of disorders characterized by fibrosis and inflammation; Symptoms include dry cough, exertional dyspnea, hypoxemia, & exercise intolerance

Cystic fibrosis

Genetic disease affecting the lungs & digestive system- body produces too much mucus à blocks lungs and/or pancreas; Symptoms include cough, mucus & possibly blood in mucus, dyspnea, exercise intolerance, functional & QoL impairment

Prolactin

Stimulates mammary gland development & milk production

Growth hormone

Stimulates cell growth & replication by accelerating the rate of protein synthesis

Thyroid stimulating hormone (TSH)

Triggers the release of thyroid hormones from the thyroid gland, iodide uptake, and the production of thyroglobulin & thyroid peroxidase

Adrenocorticotropic hormone (ACTH)

Stimulates the release of glucocorticoids (cortisol & corticosterone) & adrenal androgens from the adrenal cortex of the adrenal gland

Antidiuretic hormone (ADH)

Released in response to a rise in blood solute concentration, a fall in blood volume, or a fall in blood pressure; acts on the kidneys to retain water & decrease urination

Oxytocin

Stimulates smooth muscle contraction in the uterus & ejection of milk; also linked to sexual activity

Aldosterone

Stimulates the retention of Na+ and elimination of K+; most sensitive to increase in K+ concentration

Cortisol

Increased rate of gluconeogenesis in the liver, increased rates of lipolysis in adipose tissue, anti-inflammatory effect

Calcitonin

Inhibits osteoclast activity, stimulates Ca++ loss by the kidneys

Parathyroid hormone (PTH)

Stimulates osteoblasts to make RANKL; increases number & activity of osteoclasts, enhances Ca++ absorption in the kidney, activates 1-hydroxylase in the kidney that converts calcidiol -> calcitriol (active form); calcitriol increases gut absorption of Ca++ & PO43-

Insulin

increase in glucose uptake in liver, skeletal muscle, & adipose tissue via GLUT4 translocation; leads to dephosphorylation on key metabolic enzymes (increase in glycogen synthesis, increase in de novo fatty acid synthesis, increase in glycolysis, decrease in lipolysis in adipose tissue, increase in TAG synthesis, increases amino acid uptake

Glucagon

Activates adenylate cyclase via g-coupled protein; leads to cAMP which activates PKA (activates catabolic processes), increase in glycogenolysis, increase in lipolysis, decrease in glycolysis & increase in gluconeogenesis

Melatonin

Collaterals from the vision pathway enter the pineal gland & affect the rate of synthesis, rate is highest at night so important for maintaining the circadian rhythm

Erythropoietin

Responsive to low O2 content in blood, stimulates RBC production in bone marrow -> increase in blood volume & improves O2 delivery

Atrial natriuretic peptide (ANP) & brain natriuretic peptide (BNP)

Lead to a decrease in blood volume & blood pressure by Na+ & water loss by the kidneys, inhibiting renin release, suppressing ADH & aldosterone secretion, suppressing thirst, prevent angiotensin II & NE from elevating blood pressure

Diabetic ketoacidosis

Cells can't take in glucose -> FA's are primary energy source -> excess lipolysis/beta oxidation produces excess acetyl CoA which combine to form ketones which are especially important for the brain

normal fasting blood glucose

< 100 mg/dl

Pre-diabetes fasting blood glucose

100-125 mg/dl

Diabetes fasting blood glucose

≥ 126 mg/dl on 2 separate tests

Normal hemoglobin A1c

4-5.6%

Diabetes hemoglobin A1c

≥ 6.5% on 2 separate tests

Goodpaster paper

16 week exercising 4-6 weeks for 30 min, progressing to 40 min, then progressing to 40 min at a higher intensity; diet was a 500-1000 kcal restricted low-fat diet; Results showed exercise & diet increased rates of insulin-stimulated glucose disposal

Sigal paper

Exercised 3x/week for 22 weeks, aerobic on the treadmill/cycle ergometer progressing from 15/20 min -> 45 min/session, resistance was 7 exercises progressing to 2-3 sets/exercise; Results showed a decrease in hemoglobin A1c with this experiment

Aerobic exercise frequency for diabetics

3-7 days/week, no more than 2 consecutive days w/o activity

Resistance exercise frequency for diabetics

a minimum of 2 nonconsecutive days/week, but preferably 3 days/week

Flexibility & balance exercise frequency for diabetics

≥ 2-3 days/week for both

Innate immunity physical barriers

Hair, tears, skin, mucous, stomach acid, urine, glandular secretions

Eosinophils

target pathogens covered in Abs

NK cell function

attacks cells that have abnormal antigens displayed on the PM, including cancer cells

muscles used for inspiration

diaphragm, external intercostals, sternocleidomastoid, & scalene

primary muscles used for inspiration

diaphragm and external intercostals

accessory muscles used for inspiration

sternocleidomastoid and scalene

muscles used for expiration- quiet breathing

no muscles are contracted but diaphragm & external intercostals relax

muscles used for expiration- forced breathing

internal intercostals, external & internal obliques, transversus abdominis, & rectus abdominis

primary muscles used for expiration- forced breathing

internal intercostals

accessory muscles used for expiration- forced breathing

external & internal obliques, transversus abdominis, & rectus abdominis

lung volumes

the four nonoverlapping components of total lung capacity

lung capacities

measurements that are the sum of two or more lung volumes

training effect on functional residual capacity & residual volume

decreases it

training effect on vital capacity

increases it

normal FEV1 test

> 80%

restrictive disorders FEV1 test

FEV1 is normal compared to FVC, but FVC is significantly reduced

obstructive disorders FEV1 test

FEV1 is significantly reduced compared to FVC, FVC may be reduced as well

what happens if PCO2 levels rise in the tissues

relaxation of smooth muscles occurs (vasodilation) delivering more blood to that area

what happens if PO2 in specific lobules increase

capillary perfusion (vasodilation) in the lobule increases (alveolar capillaries constrict when PO2 levels are low

what happens if PCO2 levels rise in a specific lobule

smooth muscle relaxes (bronchodilation) in the bronchioles allowing for more ventilation

what happens if PCO2 levels decrease in a specific lobule

smooth muscle constricts (bronchoconstriction) decreasing ventilation in the bronchioles (airflow is directed to lobules w/ a high PCO2)

if pH decreases, what happens to the Hb saturation curve

at a given PO2, Hb releases additional O2

if temperature increases, what happens to the Hb saturation curve

Hb releases more oxygen

BPG mutase

unique to RBCs/placenta & is inhibited by oxyhemoglobin

what happens when % oxyhemoglobin drops

RBP can be produced & stabilizes deoxyhemoglobin

what can increase BPG

high BP, anemia, thyroid hormones, growth hormone, E, & androgens, or when plasma PO2 levels are low for an extended period of time

how is CO2 transported

70% as carbonic acid, 20% bound to Hb by attaching to exposed amino groups (NH2) of the Hb polypeptide chains, 10% is dissolved in plasma

equation of CO2 transportation/buffering

CO2 + H2O -> H2CO3 -> H+ + HCO3- (H+ diffuses out of the RBC); The first conversion is facilitated by carbonic anhydrase; The second conversion is due to the buildup of the H2CO3 which favors disassociation; Most of the H+ bind to Hb -> HbH+ which buffers the protons

follicle-stimulating hormone (FSH) in females

promotes follicle development, in combo w/ LH

follicle-stimulating hormone (FSH) in males

maturation of sperm

anterior pituitary hormones

prolactin, growth hormone, thyroid stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), gonadotropins including follicle-stimulating hormone (FSH) and luteinizing hormone (LH)

posterior pituitary hormones

antidiuretic hormone (ADH) & oxytocin

oxytocin function in females

stimulates SM contraction in the uterus & vagina -> may be important in promoting sperm travel to the fallopian tubes

oxytocin function in males

stimulates SM contraction in the walls of the ductus deferens & prostate gland -> may be important in ejaculation of sperm

adrenal androgens

small quantities in response to ACTH, can be converted to adrenal estrogen stimulates pubic hair in boys & girls before puberty; in women, promotes muscle mass, blood cell formation, & sex drive

adrenal cortex hormones

aldosterone, cortisol, & adrenal androgens

catecholamines

epinephrine (E) & norepinephrine (NE)

epinephrine (E) & norepinephrine (NE)

glycogenolysis in skeletal muscle & liver, lipolysis in adipose tissue, increase in HR & force of contraction in cardiac muscle à increased CO, vasodilation in muscles, increased mental alertness, increased respiratory rate; sympathetic ANS

thyroid gland hormones

thyroid hormones & calcitonin

thyroid hormones

enter the cell & bind to cytoplasmic receptors for storage, enter the cell & bind to mitochondria causing an increase in ATP production, enter the cell & bind to DNA leading to an increase in protein synthesis à mitochondria biogenesis, Na+/K+ pump synthesis, enzymes involved in glycolysis & ATP production (increases BMR)

pancreas hormones

insulin and glucagon

pineal gland hormone

melatonin

kidney hormones

calcitriol, renin, erythropoietin

calcitriol

Ca++ & PO43- absorption in the gut

renin

converts angiotensinogen to angiotensin I, responsive to sympathetic stimulation or a decrease in renal blood flow