KIN 420 Final Exam

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according to the recent NHANES III data:

_________ % of Americans are overweight

_________ % of Americans are obese

65% and 35%

compared to 1960, the average adult weighs _________ lbs more

24 lbs

obesity/sedentary lifestyle is the ______ leading risk factor of preventable death in America

second

what are the BMI ranges for overweight and obesity?

underweight =

is BMI accurate?

yes, relatively speaking

what is one issue with BMI?

it does not account for lean body mass/muscle mass

what percentages does excess body weight contribute to the following diseases:

type ii diabetes

ischemic heart disease

hypertension

ischemic stroke

endometrial cancer

colon cancer

postmenopausal breast cancer

osteoarthritis

58%

21%

39%

23%

32%

12%

8%

13%

adipose tissue is defined as an _________ after the discovery of ________

endocrine organ

leptin

what does adipose tissue act directly on and what does it control?

beta cells, immune cells, and neurons

hunger and satiety

what does adipose tissue affect?

systemic inflammation

insulin sensitivity

stress responsiveness

reproductive hormone production

tissue morphogenesis

what are the 2 reasons obesity has become more prevalent?

industrialization

encouragement to eat unhealthy foods

which chronic diseases does excess fat increase the risk of?

type ii diabetes

HTN

Dyslipidemia

CVD

stroke

what are the health risks of obesity?

reduced life expectancy

increase risk of gallstones

increased osteoarthritis

increase risk of certain cancers

psychological burden

what are the relative risks for cardiovascular disease in obese vs healthy individuals:

MI

angina

HTN

ischemic stroke

men/women

3\.2/1.5

1\.8/1.8

2\.6/4.2

1\.3/1.3

what are the relative risks for cancer in obese vs healthy individuals:

adenocarcinoma of the esophagus

endometrial

kidney

post-menopausal

colon

3

2\.5

1\.8

1\.3

1\.3

what does the J curve mean

hazards are increased both at the lowest and highest points (not linear increased risk)

how much do americans spend on weight control?

$50+ billion a year

what are the challenges to treating obesity?

only 20% follow the 2 key recommendations: calorie deficit and increase PA

many do not stay in treatment

weight loss can increase serum ghrelin levels (appetite increasing hormone)

what are treatments for obese individuals?

VLCD

hypocaloric diets

lifestyle interventions

medications

surgery

what is VLCD?

very low calorie diet

individuals are given 500-800 kcal per day

what is a hypocaloric diet?

individuals are given 500-750 less kcal than their predicted

when is medication recommended for obese individuals

when their BMI is greater than 30 or if it’s greater than 27 and they have related comorbidities

what are the 3 most common medications used to treat obesity?

phentermine

sibutramine (Meridia)

Orlistat (Zenuical)

when is surgery recommended for overweight individuals?

BMI greater than 40

what is the most common surgery recommended for obese individuals?

route-en-Y gastric bypass

reductions in body weight and fat from increased exercise are proportional to the amount of ______________

aerobic exercise performed

it is important for an exercise professional to address the following:

previous attempts to lose weight

weight loss goals

PA goals

perceived barriers

preferred exercise modes

obese subject underestimate food intake by ___ and over estimate PA by ______

50% and 33%

modest levels of weight loss (5-10%) are associated with what improvements?

blood pressure

diabetes

prediabetes

lipids

mortality

focus on __________ and __________ weight loss

gradual and permanent

for obese patients, aim for gradual loss of _________

0\.5-2 lbs a week

for obese patients, reduce fat intake by ___________

special considerations for obese individuals and exercise prescription:

* use low impact modes
* increased risk of hyperthermia
* equipment modification
* strength training may be valuable
* HR/BP/RPE response will be higher at rest and with exercise
* increased risk for orthopedic injury
* reducing sedentary time
* consider
* environment
* safety
* efficient exercise

misconceptions regarding exercise and weight loss

* accelerates weight loss when combined with a reducing diet
* causes the RMR to stay elevated for a long time
* counter the diet induced decrease in RMR

what is metabolic syndrome?

condition in which several coronary heart diseases risk factors are cluttered together

how many US adults have metabolic syndrome?

22% (47 million)

what are the aerobic exercise Rx for obese clients?

frequency: 5-7 days a week

intensity: 2,000 kcal per week

time: 40-60 min

what are the resistance exercise Rx for obese clients?

frequency: 2-3 days a week

intensity: 8-15 reps

time: 2-3 sets

what are the flexibility exercise Rx for obese clients?

frequency: daily

intensity: mild discomfort

time: 10-30 seconds

what is diabetes mellitus?

the inability to produce sufficient insulin, use it properly, or both

what are the characteristics of type ii diabetes?

* occurs gradually
* overweight individuals
* can also develop in thin and elderly people
* genetics plays a role
* low PA, poor diet, and excess body weight

how does type i diabetes work?

beta cells that make insulin are destroyed

what is immune meditated type i diabetes?

autoimmune disease

what is idiopathic type i diabetes?

of no known cause

what does type ii diabetes start as?

insulin resistance

what happens over time with type ii diabetes?

pancreas cannot increase insulin secretion enough to compensate; eventually loses ability to produce it

what are the dual metabolic abnormalities in type ii diabetes?

insulin resistance

* decreased glucose uptake
* unrestrained lipolysis
* excessive hepatic glucose output

insulin deficiency

* decreased insulin secretion

what are major risk factors for T2D?

* first degree relative with diabetes
* prediabetes
* habitually inactive
* race (african american, latino, native american, asian american, pacific islander)
* hypertensive
* HDL level

what are the symptoms of type i diabetes?

excessive urination

excessive and prolonged thirst

unusual weight loss (from excess urination)

excessive eating

extreme fatigue

irritability

what are the symptoms of type ii diabetes?

any of the type i symptoms

frequent infections

blurred vision

cuts or bruises that are slow to heal

tingling or numbness in the hands or feet

what are the three methods of diagnosing diabetes?

fasting plasma glucose >126 mg/dL after no caloric intake for 8 hours

casual plasma glucose >200 mg/dL

oral glucose test >200 mg/dL

what are the levels of fasting blood glucose?

normal:

how does the oral glucose test (OGTT) determine diabetes?

normal oral glucose falls to baseline after 2 hours, diabetic patients stays high

what are the medical complications of diabetes?

heart disease

stroke

overall mortality

blindness

kidney disease

high blood pressure

nervous system disease

amputations

complications of pregnancy

psychosocial dysfunction

what is the daily treatment for type i diabetes?

frequent blood glucose monitoring

medication (insulin injections)

diet

exercise

what is the treatment for type ii diabetes?

diet control

exercise

home blood glucose testing

oral medication or insulin

what is the most important objective for obese individuals with type ii diabetes to achieve/maintain

a desirable body weight

what does achieving a desirable body weight do for obese individuals with type ii diabetes do?

reduces serum glucose

improves insulin sensitivity

influencing CVD risk factors

exercise has an _________

insulin like effect

what are the general exercise guidelines for type i diabetes

metabolic control before exercise

blood glucose monitoring before and after exercise

food intake (avoid hyopglycemia)

what are some additional concerns with diabetes and exercise?

dehydration from polyuria

overt neuropathy

peripheral neuropathy (balance and gait abnormalities) (increased risk of foot ulceration and fracture)

chronotropic incompetence (use RPE)

monitor for silent ischemia

blunted sbp response

blunted oxygen uptake

what are the outcomes of exercise training in diabetic individuals

decreased insulin requirements

improved glucose tolerance

increased insulin sensitivity

decreased HbA1C (glycated hemoglobin)

improved lipid profile

reduced BP

weight management

increased functional capacity

improved well being

what do the kidney’s do?

acid/base balance

water balance

electrolyte balance

toxin elimination

blood pressure regulation

erthropoietin production

d-vitamin activation

what are the signs of hypoglycemia?

sweating

trembling

weakness

dizziness

confusion

irritability

what are the signs of hyperglycemia

increased thirst

frequent urination

fatigue

blurred vision

slow healing wounds

what are the clinical manifestations of kidney dysfunction?

urea in the blood

arrythmias

osteoporosis

anemia

acidosis

edema

increased BP

the selectively permeable capillary membrane allows for…

H2O and small particles (glucose) to pass through

_____ like ___________ stay in the blood

large particles

proteins and blood cells

what 2 diseases have the greatest affect on the kidneys?

diabetes

HTN

synthesis and activation of hormones the kidney include:

active form of vitamin D

erthropoietin

what hormone system controls renal blood flow?

RAAAS

renin-angiotensin aldosterone antidiuretic-hormone system

what is the pathway of RAAAS?

liver produces angiotensinogen

a drop in blood pressure and fluid volume causes the kidney to produce renin

renin acts on angiotensinogen to form angiotensin i

ACE is released from the lungs

ACE acts on angiotensin i to form angiotensin ii (which constricts arterioles in the kidney)

angiotensin ii acts on the adrenal gland and stimulates the release of aldosterone

aldosterone acts on the kidneys to stimulate reabsorption of salt and water

what does aldosterone do?

increase rate of sodium ion absorption and chloride follows

increases rate of potassium and H+ secretion

what does fluid and sodium retention do?

increases BP

what is acute renal failure?

abrupt onset

potentially reversible

what is chronic renal failure?

progresses over at least 3 months

permanent damage to the nephrons

how does high BP affect the glomerulus?

high BP in the afferent arteriole causes the BP in the glomerulus to fall which causes the BP in the efferent arteriole to fall

what are the causes of chronic kidney disease?

diabetic nephropathy

hypertension

NSAID overuse

glomerular disorders

vascular disease

polycystic kidney disease (genetics)

chronic inflammation

obstruction

progressive destruction of nephrons leads to:

decreased glomerular filtration, tubular reabsorption, and renal hormone regulation

remaining functional nephrons compensate (leads to damage)

functional and structural changes occur

inflammatory response triggered

healthy glomeruli are overburdened and become stiff, sclerotic, and necrotic

the kidneys cannot do what when chronic kidney disease is present?

regulate fluids and electrolytes

balance fluid volume and RAAAS

control BP

eliminate waste

synthesize erythropoeitin

regulate serum phosphate and calcium levels

what are the four stages of renal failure?

1. reduced renal reserve: no symptoms; GFR = 50 mL/min
2. renal insufficiency: 1/2 function of both kidneys lost; GFR 25-20 mL/min
3. renal failure: GFR 5-25 mL/min
4. end stage renal disease: GFR < 5 mL/min

what are some other signs and symptoms of CKD?

anemias

azotemia

cretainine

hyocalcemia

hyperkalemia

hyperlipidemia

proteinuria

what are some visual and verbal signs of CKD?

dry mouth, fatigue, nausea

hypertension

hypervolemia

gray/yellow skin

cardiac irritability

muscle cramps

bone and muscle pain

restless leg syndrome

what are the possible physiological benefits of exercise training in patients with CKD?

reduced risk of CV-related mortality

decreased use of antihypertensive meds

favorable changes to body comp

increased serum albumin

improved exercise capacity

improved BP control

improved lipid profile

increased hematocrit

improved glucose regulation

what are the ACSM recommendations for patients with CKD?

frequency: aerobic 3-5 days/week, resistance 2-3 days/week

intensity: moderate (RPE 11-13) aerobic, 60-70% 1RM resistance

time: aerobic 20-60 min/day, resistance 1 set of 10-15 reps

type: walking or cycling; machine or free weights

what is sarcopenia?

age related loss of muscle mass

what are the direct consequences of sarcopenia?

lower strength

reduced physical functioning

increased risk of chronic disease

what is NOT sarcopenia?

cachexia

wasting

muscle disease

what are the possible causes of sarcopenia?

atrophy

chronic inflammation

decline in anabolic hormones

loss of innervation

altered fat metabolism

what is the health ABC hypothesis regarding sarcopenia?

acute and chronic conditions contribute to the loss of lean mass and gain in fat observed with aging

loss of lean mass and gain in fat lead to physical impairments in strength and fitness

these impairments, whether clinically apparent or subclinical contribute to functional limitations and disability

**thus, changes in body composition with age may act as a common pathway contributing to disability**

what is the difference between sarcopenia and dynapenia?

sarcopenia is a loss of muscle mass while dynapenia is a loss of muscle strength

what are some methods for assessing early limitation in function and disability?

self reported difficulty or inability

performance testing (strength test, 400 meter walk, SPPB)

what are the changes in skeletal muscle that come with age?

loss of muscle fibers

loss of motor neurons at the spinal cord

reduction in type ii fibers from 60% to 30%

increased infiltration of muscle fat and increase in intramyocellular fat

clustering of fibers by type

increased connective tissue

what does the Skeletal Muscle Index (SMI) define as sarcopenia?

2\.5 SD below the norm

people over what age have the highest sarcopenia rates?

80 years old

sarcopena is diagnosed in younger, healthier adults when they are _______ below the mean (International Working Group)

2 SD

what are the values for sarcopenia?

7\.32 kg/m2 for men

what is the criteria for sarcopenia according to the European Working Group?

low muscle strength

low muscle quantity or quality

low physical performance