Advanced Exercise Testing & Prescription (unit 1)

What is the definition of physical activity (PA)?

any bodily movement produced by the contraction of skeletal muscles that result in an increase in caloric requirements over resting energy expenditure

What is exercise?

exertion consisting of planned, structured, & repetitive bodily movement done to improve and/or maintain 1 or more components of physical fitness, occurs with a specific intensity level

What is physical fitness?

the ability to carry daily tasks with vigor & alertness without undue fatigue, and with ample energy to enjoy leisure time pursuits & meet unforeseen emergencies

What is the amount & intensity of exercise needed to improve health, lower susceptibility to disease, & decreased premature mortality?

18-65 yrs old

150 mins/week aerobic moderate intensity

2 days a week of strength training

What is the amount & intensity of exercise needed for substantial health benefits?

300 mins/week aerobic moderate intensity OR 150 mins/week of aerobic vigorous intensity

What is a MET?

“metabolic equivalent”

the amount of kcals needed to expend to do an activity, a way to gauge intensity

What is the MET value of being at rest?

1.0 or less METs

What is the MET value of light/very light intensity activity?

<3.0 METs

What is the MET value of moderate intensity activity?

3.0-5.9 METs

What is the MET value of vigorous intensity activity?

>6.0 METs

What is a MET minute?

intensity x duration, MET amt x amt of mins

more detailed method of calculating weekly energy expenditure

What is the minimum recommended MET mins per week?

600 MET mins

What amount of MET mins is associated with reduced risk of disease?

600-4,000 MET mins

What amount of MET mins is associated with the most amt of health gains?

3,000-4,000 MET mins

At what value in MET mins is there a plateau in benefits?

10,000 MET mins

What are some of the benefits of regular physical activity/exercise?

decrease in premature mortality, CMR disease, stroke, osteoporosis, cancer, negative cognitive functions

improved V02 max

decreased HR & BP at a submax activity

increased capillary density

reduced insulin needs, improved glucose tolerance

improves psychological factors

What are higher levels of muscular strength associated with?

Improved CM risk factor profile, lower all cause mortality, fewer CVD events, lower risk of developing physical function limitations

What are some risks to exercise?

musculoskeletal injury (MSI), sudden cardiac death (SCD), & acute myocardial infarction (AMI)W

What are the purposes of medical/pre-participation screenings?

1. identify individual’s w/ medical signs/symptoms that require a medical exam before starting an exercise program

2. identify those with clinically significant disease/conditions who should participate in medically supervised exercise programs

   1. identify other special needs that may require accommodations during exercise testing & programming for the individual

What was previously promoted for pre-participation screenings?

risk factor analysis/classification: low, moderate, & high

care/needing medical clearance before continuing treatment

What is new preparticipation health screening based on?

1. the individual’s current level of structured PA

   1. the presence of major signs/symptoms suggestive of CV/CMR diseases

2. the desired exercise intensity

What are the 8 risk factors used?

1. smoking

2. age

3. family history

4. BP

5. inactivity

6. glucose

7. cholesterol

   1. obesity/BMI

Why was there a change in the process of pre-pariticipation screening?

simplify the process, reduce barriers to participate in care

What is some evidence to support these new recommendations?

there is not a uniformly recommended screening procedure

exercise testing is a poor predictor of cardiac events in asymptomatic individuals

Are individuals with pulmonary disease automatically required to receive medical clearance?

No

What are some major signs/symptoms of CMR disease?

pain (esp. in jaw, neck, chest, shoulders, back)

shortness of breath at rest or with mild exertion

syncope/dizziness

orthopnea/paroxysmal nocturnal dyspnea

ankle edema

palpitations/tachycardia

intermittent claudication

heart murmur

unusual fatigue or shortness of breath

What is ischemia?

constricting, heaviness, squeezing or burning

What are the provoking factors for pain/ischemia?

exercise

exertion

excitement

stress

cold

after meals

What are provoking factors for non-ischemic pain?

completion of exercise

certain body part movements

What are two cardiopulmonary disorders have the symptom of shortness of breath?

left ventricular dysfunction

chronic obstructive pulmonary disorder

What is left ventricular dysfunction?

blood and fluid buildup which affects cardiac output and C02 production

What is chronic obstructive pulmonary disorder?

decreased pulmonary function

compliance

air resistance

decrease in respiratory muscle strength

What are the causes of dizziness or syncope?

reduced oxygen perfusion of the brain

What is stenosis?

unusual stiffening of the heart including valves & chordae tendon

causes a decrease in cardiac output

What is cardiomyopathy?

abnormal swelling of the heart due to non exercise reasons

What is orthopnea/paroxysmal nocturnal dyspnea?

dyspnea (out of breath) in a supine or recumbent position, relieved by sitting or stand up

What is the cause of orthopnea?

the filling capacity of the heart has decreased & the lack of gravity leads more blood to the heart

overloads the heart and causes the feeling of being out of breath or congestion

Why does ankle edema occur?

the body struggles to push venous blood back to the heart

What are some causes of bilateral ankle edema?

heart failure

chronic venous insufficiency (valves not working properly)

What are some causes of unilateral ankle edema?

venous thrombosis (clot)

lymphatic blockage

What are some causes of tachycardia/palpations?

irregular cardiac rhythms (arrythmia)

anxiety

valvular regurgitation (backflow of blood with values)

anemia

fever

thyrotoxicosis (thyroid gland issues)

What is intermittent claudication?

extreme pain in the lower body brought on by exercise (typically calves)

What is the cause of intermittent claudication?

atherosclerosis/plaque buildup

When is the risk for CV events the highest?

during unaccustomed vigorous intensity activities

What are the two stages of health screening before initiating participation in an exercise program?

1. the need for medical clearance before participating in exercise (decision tree)

   1. if indicated medical clearance should be sought from the appropriate provider

What is the prescreening recommendations for resistance training?

there is insufficient evidence regarding CV complications during resistance training so there are NO formal recommendations

If someone does NOT participate in regular exercise, has no CMR disease, no signs/symptoms, and wants to participate in exercise do they need medical clearnce?

No- light to moderate recommended

vigorous intensity can be gradually worked up to

If someone does NOT participate in regular exercise, has a known CMR disease, has NO signs/symptoms, and wants to participate in exercise do they need medical clearance

medical clearance is recommended (light to moderate to start)

If someone does NOT participate in regular exercise and has any signs or symptoms, and desires to participate in exercise do you need medical clearance?

medical clearance is recommended

If someone DOES participate in regular exercise, does not have a known CMR disease, no signs/symptoms, and wants to participate in exercise do they need medical clearance?

no medical clearance necessary

If someone DOES participate in regular exercise, has a known CMR disease, no signs/symptoms, and wants to participate in exercise do they need medical clearance?

No clearance necessary for light to moderate intensity

medical clearance recommended before engaging in vigorous intensity

If someone DOES participate in regular exercise, has signs/symptoms, and wants to participate in exercise do they need medical clearance?

discontinue exercise and seek medical clearance

Besides identifying CMR diseases, what else does the ACSM prescreening steps determine?

client limitations- surgeries, complications, barriers

contraindications

risk factors