4_1: Chronic conditions strongly associated with physical inactivity (IN CLASS #4)

Hypertension, Dyslipidemia, Obesity, Metabolic Syndrome

Hypertension

• high blood pressure due to force of blood against the walls of the arteries being high

• arteries constrict (vasoconstriction)

What’s the prevalence for hypertension (HTN)?

2021-2023: estimated 47.7% of US adults (50.8% men, 44.6% women)

How many deaths have happened due to hypertension?

> 670,000

Normal BP Levels

• SBP <120mmhg AND DBP <80mmhg

Elevated BP Levels

SBP 120-129mmhg AND DBP <80mmhg

Hypertension Stage 1 BP Levels

• SBP 130-139mmhg

• DBP 80-89mmhg

Hypertension Stage 2 Levels

SBP >140mmhg OR DBP > 90mmhg

Hypertensive Crisis

• SBP >180mmhg

• DBP > 120mmhg

What is the percentage of people with HTN using strictly lifestyle modifications as an intervention?

20.9%

What is the percentage of people with HTN using lifestyle modifications AND medication?

79.1%

What percentage of people’s blood pressure is UNCONTROLLED?

77.5%

What percentage of people’s blood pressure is CONTROLLED?

22.5%

Primary hypertension

essential and idiopathic (cause is unknown)

Secondary hypertension

develops from other medical problems

Causes of primary HTN (6)

no definitive causes

• genetic

• alcohol

• stress

• high fat and salt diet

• physical inactivity

• obesity

Causes of secondary HTN (5)

• genetic

• renal

• vascular

• endocrine

• over the counter medication

What’s the pathophysiology of HTN? *hint 5

• high sympathetic nervous system

• structural narrowing of arteries and arterioles

• reduction of capillaries

• arterial stiffness

• increased resistance to bloodflow (TPR)

If a person’s SBP is >140 mmhg and DBP is > 90 mmhg (uncontrolled BP), what should they do?

determine if exercise testing is needed prior to beginning an exercise program

If a person’s SBP is >160mmhg and DBP is >100 mmhg OR has target organ disease, what should they do?

• cannot engage in any exercise

• no exercise testing prior to medical evaluation and BP management

• medically supervised symptom-limited exercise test before exercise program testing

What are 2 target organ disease?

• left ventricular hypertrophy

• retinopathy

How do β-Blockers affect exercise and the body?

• decreased submax and max heart rate

• impair thermoregulation

• increase risk of hypoglycemia (esp. in diabetic patients taking insulin)

• reduce submaximal and maximal exercise capacity (mainly in those w\o myocardial ischemia)

name 3 types of antihypertensive drugs

1. alpha blockers

2. calcium channel blockers

3. vasodilators

How do antihypertensive medications affect exercise and the body?

• can cause sudden excessive reductions in post-exercise BP

• gradual exercise termination and extended cool-down are necessary to stabilize BP and HR

Digoxin

slows HR, at atria to ventricle

• inhibits sodium potassium adenosine triphosphate (Na+/K+ ATPase)

Beta Blockers

slows HR

• antagonists

• blocks the receptor sites for epinephrine and norepinephrine (stress hormones) on adrenergic beta receptors of SNS

Calcium channel blockers

slows HR, reduces the strength of cardiac muscle contraction

• prevents the opening of channels, not allowing Ca++ to get into cells

Alpha blockers

relax vascular smooth muscle cells, VASODILATE

What effects does exercise have on HTN?

• reduces resting BP by 5-10 mmHg

• potential mechanisms (improved kidney function, lower norepinephrine, increased vasodilators in circulation)

Dyslipidemia

abnormal amount of lipids (triglycerides, cholesterol, phospholipids) in the blood

Is dyslipidemia a disease or condition?

Condition

What’s the prevalence for Dyslipidemia?

almost 30% of people in the US

Name the 2 forms of dyslipidemia

• hyperlipidemia (high lipid levels in the blood)

• hypercholesterolemia (high cholesterol levels)

What are the main causes of dyslipidemia? 3

• high-fat diet

• excess alcohol intake

• physical inactivity

How does exercise affect triglyceride levels in ind. with dyslipidemia?

lowers triglycerides by improving skeletal muscle uptake of fats

How does exercise affect HDL cholesterol? What type of exercise?

• higher HDL-c levels

• Aerobic exercise

How does exercise affect LDL and total cholesterol levels?

• reduction in both BUT weight or fat loss is required

How does exercise affect postprandial lipemia?

reduced levels

Statin drugs: what do they do and what can it ultimately lead to?

• decreases insulin secretion

• decreases in glucose uptake

• increase in glucose production

• increase in blood glucose level

• CAN LEAD TO TYPE 2 DIABETES

True or False? If individuals are low fit, they have a low risk of getting T2D

False; they have a higher risk

How do statin drugs help treat dyslipidemia?

prevents MI and strokes

What are symptoms from statin drugs?* 2

• muscle weakness and soreness (myalgia)

• cause direct and severe muscle injury

What’s the % of Obesity in adults?

• 68% of US adults are overweight/obese

• 34% are obese

• 6% extremely obese

What’s the % of Obesity in children?

32%

What does BMI have to equal to or be greater than to be classified as obese?

BMI ≥ 30kg/m2

What are some causes of obesity? *4

• diet

• sedentary lifestyle

• genetics

• gut bacteria

What’s the pathophysiology of obesity? *3

• adipose tissue

• leptin

• central nervous

True or False? Obesity is an endocrine disease

False; it’s a condition that can LEAD to endocrine disease

Adiposopathy

AKA ‘sick fat”

• dysfunction and inflammation of adipose tissues

• causes metabolic and cardiovascular disease

True or False? Obesity and Hypertension trends among US adults overlap

true

Metabolic Syndrome

name for a group of risk factors that raise your risk for CVD, diabetes and stroke

What % of adults in the US have metabolic syndrome?

35%

Name two other characteristics of metabolic syndrome

• increases w/ age

• differences in sex, race, ethnicity

How many risk factors does one need to be diagnosed w/ metabolic syndrome?

3

Name all the risk factors regarding metabolic syndrome *5

• abdominal/central obesity

• high fasting blood glucose (hyperglycemia)

• dyslipidemia

• high bp

• microabluminuria

Name the causes of metabolic syndrome *9

• diet

• sedentary lifestyle

• insulin resistance

• aging

• genetics

• disrupted sleep

• stress

• mood disorders

• excessive alcohol use

What are the effects of exercise when one starts showing signs of metabolic syndrome? *5

• weight loss/fat loss

• decrease in serum triglycerides, LDL and VLDL cholesterol levels

• increase in serum HDL level

• reduction in blood pressure

• lower fasting glucose

  • improvement of Insulin resistance

What’s the frequency of exercising to reduce risk factors associated w/ CVD and DM?

minimum 3 days/week and most days of the week

What’s the intensity/progression for exercising to reduce risk factors associated w/ CVD and DM?

• initial exercise training: moderate intensity

• progress to more vigorous intensity

How long should one exercise to reduce risk factors associated w/ CVD and DM?

minimum 150/week or 30min/day

What’s the frequency of exercising to reduce body weight/fat?

5 days/week

What’s the intensity for exercising to reduce body weight/fat?

moderate intensity

How long should one exercise to reduce body weight/fat?

• minimum of 300min/week or 50-60min/day

What two concepts are required to reduce the severity of metabolic syndrome?

• diet control

• exercise

What type of diets can reduce the severity of metabolic syndrome? *3

• hypocaloric diet

• low fat and high fiber diet

• Mediterranean diet

What type of exercise can reduce the severity of metabolic syndrome?

• aerobic interval training

• high/vigorous intensity interval training (HIIT)

• high intensity endurance training mixed w/ resistance training

How can one prevent metabolic syndrome?

have a healthy diet and participate in PA

How can one treat metabolic syndrome?

• lose weight

• reduce risk factors from proper diet/exercise