Clinical 1

what is epidemiology

the study of the relation among factors that determine the frequency and distribution of disease in a population

what is incidence

the number of new cases of an outcome at a specialized point in time

what is prevelance

the number of existing cases of an outcome at a point in time

what is the difference between incidence and prevalence

incidence=NEW

prevalence =EXISTING

what is mortality

the number of deaths in a population

what is morbidity

the number of cases of disease in a population

what is pathophysiology

the symptoms and physiological processes associated with a disorder

what is etiology

the known or suspected cause of a disorder

what is classification

the organization of disorder phases, such as by severity, progression, age, or functional abilities

what is an exercise response

acute (short term) measurements, often on the first or second visit

what is exercise training

Long term changes in measurements that can occur over weeks, months, or years

what is exercise testing?

measuring the body’s reaction to increases in an exercise challenge

what measurements can be take during exercise testing

HR, BP, VO2, ECG

what is exercise programming?

A specific plan of exercise activities forming the basis of an exercise prescription

what are the three major types of exercise included in programming

aerobic, resistance/strength, flexibility

what are the three ways physical activity is measured in the slides?

objective measurement, self-reported questionnaires, and fitness

what are the examples of objective physical-activity measurements

HR monitors, accelerometers, pedometers, and diaries

what are two drawbacks of objective measurements

Remembering to wear devices/ keep logs and difficult to use in large population-based studies

what are three ways questionnaires can be administered?

face to face interviews, telephone administrations, and self administration

for whom is questionnaire reliability low

children

what are some major benefits of regular physical activity in children and adolescents?

increase bone health, CV/muscular fitness, cardiometabolic health, cognition and decrease in risk of depression

what are major benefits of regular physical activity in adults and older adults?

Decrease in all cause mortality, cardiovascular disease, hypertension, type 2 diabetes, dementia, anxiety, depression, and inflammation. Increase in cognition, quality of life, bone health, sleep, and physical function

what is regular physical activity associated with regarding cancer?

reduced risk of cancers of the bladder, breast, colon, endometrium, esophagus, kidney, lungs, and stomach

what did early epidemiologic research focus on

acute illness, such as scurvey and cholera

what did early to mid 1900s health literature focus on

the threat of infections disease

what shifted peoples attention toward chronic disease

the development of antibiotic and new treatments

what did early occupational studies investigate

workers with different levels and intensities of movement at work and how this related to health

what is important about the framingham study

began in 1948, originally recruited 5,209 men and women ages 30-62

what is important about the china study

took place 1973-1975 and included people from 65 countries in china

what did the 1987 summary of physical activity research conclude

physical inactivity was a risk factor for CVD

Who is considered and older adult?

anyone 65 years or older

what are the major manifestations of aging in older adults

decrease in physical functioning, frailty, deconditioning, and age-associated disease, which can lead to loss of ADL ability and independence

what happens to skeletal muscle with aging

decrease in muscle mass, strength, velocity, and Type II fibers (which is the ability to produce quick/ explosive movements and maintain agility)

what happens to bone, cartilage, and connective tissue

decrease in bone mineral density, thickness, elasticity, and tensile strength and in increase in fracture and joint/tendon injury risk

what happens to body composition

decrease in lean mass and increase in body fat, also increase in risk of obesity and sarcopenia

What happens to the cardiovascular system with aging

arteriosclerosis goes up and HRmax, a-vO2 difference, and peak aerobic capacity goes down. Also hypertension/Heart failure risk goes up and ability to perform strenuous activity goes down

what is arteriosclerosis

hardening of arteries

what happens to the respiratory system with aging

increase in shest-wall stiffness, residual volume, and dead space. breathing becomes more difficult and chronic lung disease risk increase

what happens to metabolism with aging?

resting metabolic rate and insulin sensitivity goes down and the risk of obesity and diabetes goes up

what happens to thermoregulation

thirst sensation and sweat production decreases and risk of dehydration and heatstroke increases

what happens to renal function

decrease in kidney size, renal blood flow and GFR. Drug excretion and potential electrolyte balance problems decrease

what happens to CNS

β-adrenergic sensitivity, brain volume, balance, coordination, hearing, vision, and cognitive function decrease and the risk of falls increase

when does bone mineral density peak

around 30s then generally decreases with age

what happens to VO2peak with age

it decreases progressively with age in both men and women

how is the older adult population expected to change

the 65+ population roughly doubles while the 80+ population roughly tiples

what percentage of adults 65+ exercise regularly

about 20-25%

what percentage of adults 85+ exercise regularly

about 5-10%

What happens to the major maximal exercise responses with aging

These decrease: VO₂ , a-vO₂ difference , cardiac output , HR , EF , contractility .
these increase: EDV , ESV , systemic vascular resistance .
Stroke volume stays about the same.

what maximal exercise response decreases the most?

contractility decreases 60%

which variable has the largest increase

ESV increases 100%

What happens to plasma catecholamines and cardiovascular β-adrenergic responses?

plasma catecholamines ↑, while β-adrenergic responses ↓.

what is the normal resting ejection fraction

about 55-60%

What are the major benefits of exercise training for older adults?

Slows physiologic aging, optimizes body composition, promotes psychological/cognitive well-being, manages chronic disease, reduces physical-disability risk, and may increase longevity.

Is the effect of exercise on longevity definite?

No. The slide notes that evidence is mixed.

What should the initial aerobic exercise workload be for an older adult?

<3 METs, with small workload increases of 0.5–1.0 METs.

What is a MET?

A metabolic equivalent unit; 1 MET = 3.5 mL/kg/min.

Low exercise-intensity ranges?

1–2.9 METs

Moderate exercise-intensity ranges?

3–5.9 METs

Vigorous exercise-intensity ranges?

6+ METS

What is the Naughton Protocol?

An aerobic exercise-testing protocol where speed stays the same while the treadmill grade increases.

What should be performed before exercise testing in older adults?

A resting 12-lead ECG to look for ST-segment changes and dysrhythmias.

What is important about exercise improvement in older adults compared with younger adults?

Their percent improvement can be comparable to younger adults.

What issues should exercise programs for older adults address?

Loss of independence, low functional capacity, muscle weakness, and deconditioning.

What three abilities should balance exercises improve?

Balance, agility, and proprioception.

How often should balance exercises be performed?

2–3 days/week.

What are examples of balance exercises?

Decreasing base of support, dynamic movements that perturb the center of gravity, different walking patterns, and reducing sensory input.

What are the key moderate aerobic exercise prescription guidelines

RPE 5–6, at least 5 days/week, 30–60 min/day.

What are the key vigorous aerobic exercise prescription guidelines

RPE 7–8, at least 3 days/week, 20–30 min/day.

What are the key resistance-training guidelines?

At least 2 days/week, using about 8–10 exercises with 8–12 reps

What are the key flexibility-training guidelines?

At least 2 days/week, using stretching through range of motion/static stretching, including it before and after exercise.