ES340: Exam 1 Review

What does the FITT-VP principle stand for?

Frequency, Intensity, Time, Type, Volume, Progression

what is frequency?

how often the exercise program will be done

what is intensity?

difficulty of the exercise

what is time?

number of minutes per exercise session

what is type?

the kind of exercise (mode)

what is volume?

total amount of exercise performedwh

what is progression?

systematic increase in any of the FITT-V components, which can be altered to elicit responses and adaptations to the exercise program

the FITT recommendation for individuals with cardiovascular disease participating in outpatient cardiac rehabilitation should include all except...

only RPE should be used to assess intensity

for most cardiovascular diseases, the focus of exercise prescription should be on...

a balance of all 3 types of exercise

for individuals with PAD, the most noticeable improvements from exercise rehabilitation tend to occur...

after at least 12 weeks

which of the following has the highest risk for CVD?

a 55-year-old woman with HDL level of 35 and blood pressure of 140/90

the difference between stable and unstable angina is...

unstable = tightness that spread into the arm, neck, back, and jaw
stable = progressively worsens with exertion or rest

in the FITT recommendation for individuals with lower extremity, symptomatic peripheral arterial disease, the frequency of exercise, at minimum, should be at least...

3 days a week

for a previously sedentary patient with stage 1 hypertension, which of these options is an appropriate initial exercise prescription?

cycling at low intensity, 30min, 6 days per week

parameters indication it is safe to initiate inpatient cardiac rehabilitation include all of the following except...

new onset ST-segment depression

during walking, your patient experiences claudication pain of 3 out of 4. what should you instruct the patient to do next?

complete a cool down and end exercise for the day

maximal pressure when the left ventricle contracts is...

systolic pressure

which of the statements below is true regarding inpatient cardiac rehabilitation programs?

activities and programs during the early recovery period will depend on the size of the myocardial infarction and the occurrence of any complications

major risk factors for PAD include all of the following except

female gender

______ hypertension has no obvious cause and is experienced by over 90% of all hypertensive individuals

essential

which of the following is assessed before, during, and after each CR session

HR, blood pressure (BP), body weight

which should be part of the FITT recommendation for individuals with a cardiac transplant

include treadmill or free walking if possible

PAD generally affects which area of the body?

the lower legsh

hypertension can lead to all of the conditions EXCEPT which?

type 1 diabetes

decreased cardiac output results in what response in blood pressure?

reduction in blood pressure

for patients with heart failure, heart rate should not exceed _____bpm

120 bpm

which of these cardiovascular conditions necessitates an initial training prescription of 40-50% VO2R progressively increasing time up to 60min>

heart failure

according to the U.S department of health and human services, individuals who perform at least ____ min of moderate-intensity aerobic exercise per week experience the greatest health benefits.

150min

which component below may be placed variably in the ordering sequence of the exercise training session?

stretchingw

which of these is an appropriate resistance training prescription to improve muscular power for an older adult with no co-morbidities?

5 d/wk; 40-50% 1RM; 1-3 sets of 10-15 repetitions spanning a variety of muscle groups

which type of exercise is indicated in the exercise prescription for older adults, but NOT younger adults?

yoga or other flexibility exercises

which of these is an appropriate aerobic exercise prescription for a 10 year old child?

daily; moderate/vigorous intensity (vigorous at least 3 d/wk); 60 total minutes of exercise; running, hopping, swimming, dancing, team sports

Lucirida is a 46 year old woman who was recently diagnosed with Type 2 diabetes. Lucinda works as an executive assistant and spends most of her day sitting. Her doctor older her that if she loses weight and makes some changes to her diet, she will be able to manage her blood glucose and prevent diabetic complications. Here are Lucinda's lab results:
BMI: 31 kg/m2
Resting BP: 124/78 mmHg
Waist circumference: 92 cm
Fasting triglycerides: 120 mg/dL.
Total Cholesterol: 230 mg/dL
HbA1c: 8.5%
During a recent exercise session, Lucinda started feeling shaky and dizzy. These signs are suggestive of which of the following conditions?

hypoglycemia

Lucinda is a 46 year old woman who was recently diagnosed with Type 2 diabetes. Lucinda works as an executive assistant and spends most of her day sitting. Her doctor told her that if she loses weight and makes some changes to her diet, she will be able to manage her blood glucose and prevent diabetic complications. Here are Lucinda's lab results:
BMI: 31 kg/m2
Waist circumference: 92 cm
Resting BP: 124/78 mmHg
Fasting triglycerides: 120 mg/dL
Total Cholesterol: 230 mg/dL
HbA1c: 8.5%
Lucinda's PCP gave her treatment goals for her HbA1c and blood glucose levels during the day. Which of the following blood glucose levels are optimal for the treatment of diabetes?

HbA1c of

which of these is NOT a special consideration for a patient who has type 1 diabetes?

having a source of CHO available

what is exercise testing for individuals with diabetes dependent upon?

age, previously activity status, and high risk of cardiovascular event

a blood glucose level of less than ____ mg x dL-1 is considered a relative contraindication for exercise

80

the numbness, tingling, pain, and swelling in the extremities sometimes experienced by diabetics is called...

neuropathy

which of the following is NOT an effective strategy to prevent hypoglycemia and hyperglycemia during exercise?

increasing protein intake

if a type 1 diabetic client gets dizzy and feels faint during exercise, you should immediately...

give the client orange juice, or something else with sugar in it

resistance training should be encouraged for individuals with diabetes mellitus unless they...

also have hypertension

excess ketones in the blood can

lower pH

what do i do about multiple co-morbidities?

start with the most conservative prescription (lowest intensity, lowest volume, one exercise mode that is most beneficial)

when do i need physician consultation/clearance?

ACSM algorithm dictates medical clearance is necessary with any CVD, metabolic disease, or renal disease

T/F: sedentary children require physician clearance before starting physical activity

false

when is exercise testing needed?

generally, when CVD is a primary concern or a comorbidity, and with previously sedentary individuals

a scale that can be used to estimate exercise intensity is...

Borg RPE

what type of contraindication for exercise indicates exercise should definitely NOT be performed?

absolute contraindication

which of these is an absolute contraindication to exercise for people with CVD?

unstable angina

difference between absolute and relative contraindications

absolute = definitely nots
relative = warrants significant caution

absolute contraindications for CVD

1. acute MI within the past 2 days
2. unstable angina
3. uncontrolled cardiac arrhythmias and heart failure (symptomatic)
4. symptomatic aortic stenosis
5. acute pulmonary embolus, pulmonary infarction, myocarditis, pericarditis, aortic dissection

relative contraindications for CVD

1. left main coronary stenosis
2. moderate stenotic valvular heart disease
3. electrolyte imbalance
4. severe arterial hypotension
5. tachyarrhythmias and bradyarrhythmias
6. hypertrophy cardiomyopathy
7. mental or physical impairment that interferes with the ability to exercise
8. high degree AV block

neuromotor activity is recommended 2-3 d/wk for which population?

older adults

which of these is NOT a modifiable risk factor for CVD?

1. family history of CVD
2. tobacco use
3. sedentary behavior
4. dyslipidemia

1. family history of CVD

for patients, progression of an ex rx will increase ____ before ____

1. time; intensity
2. intensity; time

1. time; intensity

which of these is NOT a part of in-patient cardiac rehabilitation (CR)?

a. moderate intensity walking, at least 30 min/day
b. discharge planning
c. current clinical status assessment
d. referral to outpatient CR

a. moderate intensity walking, at least 30 min/day

When is ECG monitoring necessary during outpatient CR?

a. stable with low risk, and no complications after 6 sessions
b. stable with low risk, and has complications
c. moderate/high risk, and no complications after 12 sessions
d. moderate/high risk, and has complications

b. stable with low risk, and has complications
d. moderate/high risk, and has complications

What is atherosclerosis?

a. The process of hardening of artery walls
b. The process of thinning and hardening of artery walls
c. The process of thickening and hardening the artery walls

c. The process of thickening and hardening the artery walls

Which of the following is a major cause of myocardial infarction?

a. Jaundice
b. Diabetes
c. Diet
d. Atherosclerosis of coronary arteries

d. Atherosclerosis of coronary arteries

Blockages of blood vessels outside the heart is...

a. Coronary artery disease
b. Peripheral artery disease
c. Acute coronary syndromes
d. heart failure

b. Peripheral artery disease

What is damage to the heart muscle as a result of ischemia?

a. Myocardial Infarction
b. Unstable Angina Pectoris
c. Stable Angina Pectoris
d. Transient Ischemic Attack

a. Myocardial Infarction

What is heart failure?

a. atherosclerosis narrows the coronary arteries
b. death of heart muscle due to ischemia
c. heart cannot adequately pump blood

c. heart cannot adequately pump blood

Which of these is NOT a symptom of a myocardial infarction?

a. Angina
b. sudden rapid weight gain
c. Radiating pain to the neck, back, jaw, or shoulder
d. Shortness of breath

b. sudden rapid weight gain

common symptoms of myocardia infarction (MI; heart attack)

1. (angina) acute chest pain, tightness, or pressure
2. pain into the arms, back, neck or jaw, SOB, cold sweating, nausea/vomiting, or lightheadedness.
3. Females: exhaustion, overall discomfort, shortness of breath, and depression before the event

T/F unknown
Unknown etiology of high blood pressure is termed essential hypertension.

true

Which of the following blood pressure readings is considered Stage I Hypertension?

a. 124/76
b. 132/84
c. 144/94
d. 120/78

b. 132/84

Hypertension can be caused by . . .

a. salt
b. high metabolism
c. high cholesterol
d. low salt intake

a. salt

T/F resistance training is contraindicated for clients with hypertension

False

when blood pressure is _______ during exercise, you should gradually decrease exercise intensity

a. 250 systolic and/or 200 diastolic
b. 220 systolic and/or 115 diastolic
c. 250 systolic and/or 115 diastolic
d. 220 systolic and 115 diastolic

c. 250 systolic and/or 115 diastolic

Some rules to the dash diet include limiting the total salt intake to _______

a. 1,800 or 2,000 milligrams per day
b. 1,500 or 2,300 milligrams per day
c. 1,500 or 2,200 milligrams per day
d. 1,600 or 3,000 milligrams per day

b. 1,500 or 2,300 milligrams per day

Ankle Brachial Index is used to diagnose which cardiovascular disease?

a. Coronary Artery Disease
b. Transient Ischemic Attack
c. Heart Failure
d. Peripheral Artery Disease

d. Peripheral Artery Disease

What is functional ischemia?

a. lack of blood flow during exercise and at rest
b. lack of blood flow during exercise, but normal at rest
c. angina pain associated with exercise

b. lack of blood flow during exercise, but normal at rest

In Type I diabetes

a. pancreas cannot make insulin
b. pancreas cannot accept insulin
c. liver does not make glucagon
d. liver cannot convert glycogen

a. pancreas cannot make insulin

When can Type II diabetes be diagnosed?

childhood, adolescence, and adulthood

which reading indicates diabetes in oral glucose tolerance test?

a. More than 200mg/dL
b. Between 140-199mg/dL
c. More than 140mg/dL
d. Between 99-130mg/dL

a. More than 200mg/dL

Which test measures the amount of glucose attached to hemoglobin?

a. Random plasma glucose test
b. Fasting plasma glucose test
c. Oral glucose tolerance test
d. A1c test

d. A1c test

HbA1c% levels: diabetic, pre diabetic, normal

(greater than or equal to 6.5), (5.7 - 6.4), (~5.7)

fasting blood glucose (mg/dL): diabetic, pre diabetic, normal

(greater than or equal to 126), (100 - 125), (less than or equal to 99)

oral glucose tolerance test (mg/dL): diabetic, pre diabetic, normal

(greater than or equal to 200), (140 - 199), (less than or equal to 139)

T/F ex rx and diet do not differ between type 1 and type 2 diabetes

true

T/F exogenous insulin is only used to treat type 1 diabetes

false

insulin

- Used any time there is none/inadequate production of insulin by the pancreas.
- All Type I diabetics use insulin, since they produce none.
- Some Type II diabetics use it after lifestyle and medical therapy options are exhausted.

How should mild hypoglycemia (BG 78 mg/dL) be managed after exercise?

a. Provide a protein and carbohydrate snack
b. Provide a simple sugar snack
c. Provide only clear fluids
d. Restrict food and fluids until insulin can be given

a. Provide a protein and carbohydrate snack

Diabetic Ketoacidosis is caused by:

a. Lack of insulin leading to the use of other fuels for energy
b. Overdose of insulin leading to the release of ketones
c. Ketones are poisonous chemicals which can build up
d. Most common in Type 1 DM

a. Lack of insulin leading to the use of other fuels for energy

Which of these is NOT a special exercise consideration for a patient with diabetes?

a. Wear well-fitting footwear.
b. Have a quick carbohydrate source available.
c. Do not inject insulin into exercising limbs.
d. Avoid heavy resistance training and weight-bearing exercise.

Avoid heavy resistance training and weight-bearing exercise.

Which of these is NOT a symptom of hypoglycemia?

a. Flushed (red) and hot skin
b. Blurred vision
c. Lack of coordination
d. Headache

a. Flushed (red) and hot skin

what are some changes in cardiac structure that occur in adulthood?

1. loss of cardiac muscle, elasticity in cardiac muscle, conduction cells
2. thickening of left ventricle
3. fibrotic changes in valves
4. maximum achievable heart rate with exercise declines
5. stroke volume and cardiac declines
6. slower relaxation of cardiac myocytes

what are some cardiovascular changes due to aging

exercise capacity and blood flow

definition: cardiac rehabilitation (CR)

commonly used to deliver exercise and other lifestyle interventions to individuals with cardiovascular disease

T/F beginning exercise should occur under supervision and guidance of an exercise professional with CPR certification

True

when can a cardiac patient begin an exercise program?

after screening and the client receives medical clearance from their physician

T/F after a cardiac incident, the rehab program should begin in a clinical setting under supervision

true

Guidelines for the inpatient CR program (should occur quite quickly after a cardia event)

1. current clinical assessment
2. physical ambulation and mobilization
3. identification and provision of information regarding modifiable risk factors and self care
4. discharge planning with a home PA and ADL
5. referral to outpatient CR

when can someone START an inpatient CR program?

1. No new or recurrent chest pain in previous 8 hours
2. Stable or falling creatine kinase and troponin values
3. No indication of decompensated heart failure (e.g., resting dyspnea and bibasilar rales)
4. Normal cardiac rhythm and stable electrocardiogram for previous 8 hours

when can someone STOP an inpatient CR program?

1. Diastolic blood pressure more than or equal to 100mm/Hg
2. Decrease in systolic blood pressure >10mm/Hg during exercise with increasing workload
3. Significant ventricular or atrial arrhythmias with our without associated signs/symptoms
4. Second- or third-degree heart block
5. Signs/symptoms of exercise intolerance including angina, marked dyspnea, and electrocardiogram (ECG) changes suggestive of ischemia

INPATIENT aerobic recommendations for CR program

F = 2-4 sessions/day for the first 3 days of the hospital stay

I = 1. seated or standing HRrest +20 beats/min for people with an MI and +30 beats/min for people recovering from heart surgery
2. upper limit

INPATIENT flexibility recommendations for CR programs

F = minimally once per day, but as often as tolerated

I = very mild stretch discomfort

T = all major joints with at least 30s per joint appropriate with sternal precautions

T = focus on ROM and dynamic movement. Bed-bound people may benefit from passive stressing provided by an allied health care professional

Components of OUTPATIENT CR

1. Cardiovascular risk factor assessment and counseling on aggressive lifestyle management
2. Education and support to make healthy lifestyle changes to reduce the risk of a secondary cardiac event
3. Development and implementation/supervision of a safe and effective personalized exercise plan
4. Monitoring with a goal of improving blood pressure, lipids/cholesterol, and diabetes mellitus
5. Psychological/stress assessment and counseling
6. Communication with each individual’s physician and other health care providers regarding progress and relevant medical management issues
7. Return to appropriate vocational and recreational activities

before, during, and after an exercise session for OUTPATIENT people, what should be measured?

1. HR, blood pressure (BP), body weight

Routine pre-exercise assessment for outpatient CR

1. symptoms and evidence of exercise intolerance
2. change in medications and adherence
3. ECG and HR surveillance