HNES 370 Exam 3 (new)

AD/ADRD Risk Factors

Cardiovascular fitness; education; social and cognitive engagement; TBI and stroke; sleep; alcohol use; chronic morbidity; strength capacity

AD/ADRD Physical Activity Effects

Physical activity shows promise for improving cognitive function and overall health

AD/ADRD Dose Response

Optimal dose is unclear but 45–60 minutes of physical activity shows cognitive benefits

AD/ADRD Acute Exercise

Short bouts of physical activity may temporarily increase cognitive function

AD/ADRD Functional Benefits

Improves strength; cardiovascular fitness; mobility; and ability to perform ADLs

AD/ADRD Exercise Guidelines (CDD4)

Use low-impact movements with assistance; supervision is important

AD/ADRD Environment Recommendations

Calm environment; avoid loud distractions; use music and visual cues

AD/ADRD Behavioral Strategies

Do not confront or argue; focus on engagement

AD/ADRD Timing of Activity

Morning hours are often best

Dementia Overview

Significant age-related condition with increasing prevalence and workforce need

Dementia and Physical Activity

Physical activity may improve symptoms and other health factors

How many kids meet youth guidelines

Between 20-28% of youth meet the 60 minutes of moderate-vigorous PA recs

Youth Physical Activity Statistics

74% of childcare facilities provide 2 outdoor play opportunities daily

Youth PA Duration

About 50% meet 60–90 minutes of physical activity guidelines

Youth Meeting Both Standards

43.1% meet both outdoor play and PA duration recommendations

Physical Education Trends

PE participation decreases from 94.3% in 6th grade to 56% in 12th grade

School PA Laws

Laws vary by state for required physical activity during school

Recess Requirements

Only 12 states require daily recess with specified duration

Youth Physical Activity Importance

Important for current and future health; improvements are needed

Osteoporosis Exercise Role

Exercise is used to manage osteoporosis

Osteoporosis Exercise Benefits

Slows bone loss; improves BMD; increases strength; reduces fall risk

Recommended Training for Osteoporosis

Combine resistance training and balance training

Primary Prevention Osteoporosis

Physical activity helps prevent bone loss by maintaining bone loading

Secondary Prevention Osteoporosis

Exercise slows bone loss in at-risk individuals

Tertiary Prevention Osteoporosis

Exercise improves strength; balance; posture; and reduces fracture risk

Osteoporosis Key Idea

Physical activity improves quality of life even if reversal is limited

Osteoporosis Exercise Types

Weight-bearing; resistance; and balance training

General PA Guidelines

150–300 min/week moderate or 75–150 min vigorous activity

Strength Training Recommendation

Train all major muscle groups at least 2 days per week

Bone Health Principle

Regular skeletal loading supports bone mass

Osteoporosis Treatment PA

150 min/week moderate activity plus strength training

Fall Prevention Recommendation

Balance training 3+ days/week for older adults

Exercise Adjustment

Based on fracture risk; bone density; and functional ability

Osteoporosis Safety

Avoid excessive spinal bending or twisting

Safe Exercise Focus

Proper posture; safe loading; strengthening; fall prevention

Bone Health Nutrients

Vitamin D; calcium; and protein are most important

Vitamin D Function

Regulates calcium and phosphorus and improves calcium absorption

Vitamin D Sources

Sunlight; salmon; fortified foods; mushrooms; supplements

Calcium Role

Essential for bone structure and remodeling

Calcium Sources

Dairy; nuts; seeds; beans; leafy greens; seafood

Protein Role in Bone

Provides structural framework (scaffolding) for bones

Protein Sources

Dairy; fish; poultry; legumes; grains; nuts; vegetables

Osteoporosis Medications (Antiresorptive)

Reduce bone breakdown

Osteoporosis Medications (Anabolic)

Increase bone formation

Parkinson’s Disease Symptoms

Bradykinesia; rigidity; tremor; gait freezing; poor posture

Parkinson’s Functional Impact

Reduced dexterity; increased BADL limitations

Types of Tremors

Resting; action; postural; kinetic; intention; task-specific; isometric; essential; dystonic; cerebellar

Parkinson’s Exercise Considerations

Progress slowly; monitor HR; BP; and temperature regulation

Parkinson’s Evaluation Measures

Balance; gait speed; reaction time; sit-to-stand; cadence; step length

Parkinson’s Exercise Programming

Early stages may follow general guidelines; later stages need modified programs

Parkinson’s Resistance Exercises

Shoulder shrugs; hip bridges; wall push-ups; leg exercises

Parkinson’s Flexibility Exercises

Head turns; arm stretches; wrist circles; hamstring stretch

Parkinson’s Gait Training

Focus on large steps; arm swing; visual and auditory cues

Parkinson’s Balance Training

Tandem walking; sideways walking; posture exercises

Parkinson’s Functional Training

Transfers such as bed mobility

Parkinson’s Orofacial Exercises

Lip presses; breathing; speech therapy

Parkinson’s Disease Overview

Age-related neurodegenerative disease

Parkinson’s Treatment

Exercise; PT/OT; diet; medications; and brain stimulation

Organizations

North Dakota Geriatric Workforce Enhancement Program
National Institute on Aging
• Strong interest in dementia research

Dementia

Classification of brain conditions that limit cognitive function for daily living
interference

Alzheimer’s disease (AD)

• Brain condition that causes memory loss, confusion, and problems in thinking
• Accumulation of β-amyloid outside neurons and tau tangles
• Most common form of dementia (60-80%)

Alzheimer’ disease related dementias (ADRD)

• Cerebrovascular
• Brain blood vessels are damaged; brain tissue is injured from lacking blood and related
blood flow factors
• Frontotemporal
• Frontal and temporal lobes shrink; other brain anatomy functions changes
• Mixed pathologies
• Multiple forms are present

Cognitive screening

• Telephone Interview of Cognitive Status
• MoCA
• SLUMS
• Mini-cog
• Blood biomarkers
• Underdiagnosis is high

Diagnosis

Comprehensive assessments (e.g., scans, physical, blood tests, history)

Youth populations could be viewed as important because

• Behavior development
• Human development
• Early morbidity and functional limitations
• Longevity

Risk from parents

• One obese parent = 50% increased odds for being obese
• Two obese parents = 80% increased odds for being obese

Role of parents

• Genetic
• Family history
• Environmental
• Health behaviors
• Food, physical activity, sleep

Observation is important

• Restriction to palatable foods: overconsumption when available
• Pressuring consumption of healthy foods: lower intake
• Healthy food as reward: lower healthy food consumption
• Authoritarian parenting styles for food: overeating, food rejection, picky eating

Physical Activity Guidelines for youth

at least 60 minutes of moderate- vigorous physical activity each day for youth

Youth Scored on 10 indicators (2022 report card):

• Overall PA
• Active transportation
• Organized sports
• Active play
• Sedentary behavior
• Sleep
• Physical fitness
• Family and peers
• School
• Community and built environment

Recommendations to improve

• Update nationally representative data to include objective monitoring
• Step based tracking?
• Develop relevant PA surveys
• Harmonize different PA estimates by source
• Better improve integration of muscle and bone strengthening activities

Youth transportation

• About 38% of youth aged 12-19 years use active transportation for at least 10 minutes continuously once or more a week
• Most youth do not walk or bike for travel
• Fewer children in rural areas walk to school compared to urban

Ways to get youth more active

• Low cost intramural programs and competitive programs
• Connect the schools and community
• Recreation facilities may foster sport
• Expand access

Inconsistent recess time mandates

Two states mandate over 30 minutes of daily recess; five states require 2030 minutes, while another five stipulate less than 20 minutes. Ten states require recess without specifying duration, and 28 (56%) have no requirements (CLASS 2021).

International recommendation for screen time in youth

less than 2 hours/day

When adolescents reported their own sleep:

• 62% of 16-19 year olds reported bed and wake up times that equaled at least 8 hours on an average weekday night (NHANES 2017-2020).
• 23% of high school students reported at least 8 hours on weeknights (YRBSS 2023).

Only 12 states require daily recess with a specified minimum duration

• Two states (AR, IL) mandate over 30 minutes of
daily recess
• Five states (RI, NJ, CT, MO, FL) require 20-30
minutes
• Another five (VA, AZ, TN, DC, TX) stipulate less
than 20 minutes
• Ten states (AK, VT, MN, IN, CA, WV, KS, SC, OK,
MS) require recess without specifying duration,
• 28 have no requirements (CLASS 2021).

Osteoporosis and Vertebral Fractures

Programs should especially include resistance and balance training for individuals with vertebral fractures

Exercise Individualization in Osteoporosis

Programs should be tailored based on age; fracture risk; bone density; and physical ability

Osteoporosis and Fall Risk

Exercise reduces fall risk which is a major cause of fractures in individuals with osteoporosis

Menopause and Bone Health

Hormonal changes during menopause contribute to decreased bone density and increased osteoporosis risk

Calcium Absorption Role of Vitamin D

Vitamin D enhances calcium absorption in the gastrointestinal tract through receptor activity

Parkinson’s Disease

Progressive neurodegenerative condition involving the extrapyramidal part of the nervous system, leading to impaired motor function
• Dopaminergic vs. cholinergic imbalance

Risk factors of Parkinson’s Disease

• While no know cause has been identified, risk factors are multiple and include genetics, lifestyle, and environmental (e.g., toxins)
• Aging (>60 years)
• Immediate relative with diagnosis roughly doubles odds
• Some pesticides/herbicides, heavy metals, industrial solvents
• TBI
• S*x
• Generally known for motor impairments and movement limitations

How does Parkinson’s Disease affect the brain

• Degeneration of nerve cells in the substantia nigra region, which impacts the basal ganglia (brain)
• Neurotransmitters become impaired and brain chemistry becomes imbalanced (dopamine)
• Lack of dopamine generates motor limitations
• Extend into symptoms that are similar to dementia

Parkinson’s Disease risk factors

• Aging (>60 years)
• Immediate relative with diagnosis roughly doubles odds
• Some pesticides/herbicides, heavy metals, industrial solvents
• TBI
• Sex

Parkinson’s Disease protective factors

• Moderate-vigorous exercise
• Tobacco use (nicotine)
• Caffeine consumption
• NSAID use
• Diet

Symptoms of Parkinson’s Disease

• Tremors
• Upper and lower extremities and mouth
• Rigidity
• Increased muscle tone/stiffness
• Postural changes
• Decreased facial expression
• Reduction in volume
• Swallowing problems
• Visual problems
• Gait changes
• Loss of smell

Parkinson’s Disease Diagnosis

• Bradykinesia: reduced ability to rapidly move fingers, hands, arms, legs etc. (slow movement)
• Standing posture becomes curved
• Dexterity is limited
• Gait freezes (including first steps)
• BADL limitations are generally higher
• Rigidity also often present

Parkinson’s Disease Tremmoring

• Rest: tremoring while at rest
• Action: voluntary tremor from muscle contraction
• Postural: holding a position against gravity (e.g., outstretched arms)
• Kinetic: linked to voluntary movement
• Intention tremor: intended movement toward a target (finger to mouth)
• Task-specific: performing goal-oriented tasks such as writing or speaking
• Isometric: tremoring when muscle are activated but not moving
• Essential: involuntary, rhythmic tremoring (includes voice)
• Dystonic: sustained unwanted movements
• Cerebellar: slow, but large tremor that worsens at then end of purposeful
movements