NUTRITION 486 exam 1

Physical activity

Any bodily movement produced by the contraction of skeleton muscles that result in an increase in caloric requirements over resting requirements

Exercise

Type of physical activity that consists of plant structures and repetitive bodily movement done to improve, or maintain a one or more component of physical fitness

Physical fitness

Generally described as a set of attributes or characteristics, individuals have or achieve that relate to their ability to perform physical activity in activities of daily living, commonly separated into health and skill related

Health related component of physical fitness

Cardio respiratory endurance

Body composition

Muscular strength

Muscular endurance

Flexibility

Cardio respiratory endurance

The ability of the circulatory and respiratory system to supply oxygen during sustained physical activity

Body composition

The relative amounts of muscle, fat bone and other vital parts of the body

Muscular strength

The ability of a muscle to exert force

Muscular endurance

The ability of a muscle, to continue to perform without fatigue

Flexibility

The range of motion available at a joint

Skill related physical fitness components

Agility

Coordination

Balance

Power

Reaction time

Speed

Agility

The ability to change the position of a body in space with speed and accuracy

coordination

The ability to use the senses, such as sight, and hearing together with body parts in performing test, smoothly and accurately

Balance

The maintenance of equilibrium while stationary or moving

Power

The ability or rate at which one can perform work

Reaction time

The time elapsed between simulation and the beginning of the reaction to it

Speed

The ability to perform a movement within a short period of time

Informed consent

Clearly explained procedures

Comprehensive explanation of risks and benefits

Free to withdraw

Emergency procedures

ACSM algorithm

Previous screening guidelines, emphasized risk classification based on

* CVD risk factors
* Signs or symptoms of CVD metabolic disease and pulmonary disease
* Known diseases

goals of ACSM

* Identify individuals who should receive medical clearance
* Identify those with clinical significance diseases
* Identify those with medical conditions who should be restricted from exercise
* Accomplished by collecting
* Current physical level
* Signs symptoms
* Diagnosis of disease
* Desired exercise program intensity

\

Major signs and symptoms of cardiovascular metabolic or renal disease

Pain in chest neck, jaw, arms

\-Could be from myocardial ischemia

Shortness of breath

Dizziness or syncope

Orthopnea or paroxysmal nocturnal dyspnea

Ankle edema

Palpations or tachycardia

Intermittent claudication

Known heart murmur

Unusual fatigue, or shortness of breath with activity

PARQ+

Physical activity, readiness, questionnaire for everyone

\-Reduce is barriers to exercise in the number of false positive screenings

Also allows the exercise professional to better tailor the exercise prescriptions EXRX

Risk stratification for cardiac rehabilitation

More in-depth screening process for individuals in cardiac rehab/medical fitness facilities

AACVPR

Low risk stratification

During

\-Absence of ventricular dysrhythmias, angina, Dyspnea, dizziness

\-Presence of normal heart rate and blood pressure, functional capacity of over seven Mets

Non-exercise

\-Resting ejection fraction over 50%

\-Absence of uncomplicated myocardial infraction, uncomplicated revascularization, ventricle, dysrhythmias, congestive heart failure, signs, symptoms of post event, post procedure, myocardial ischemia, clinical depression, labs to fuck

Moderate risk stratification

During exercise

\-Presence of angina, shortness of breath, lightheadedness or dizziness, occurring at moderate levels of intensity

\-Mild to moderate level of silent ischemia

— ST segment depression, less than 2 mm from baseline

Non-exercise

\-Absence of resting ejection fraction 40 to 50%

High risk stratification

During exercise

\-Presence of ventricular dysrhythmias, angina, Dyspnea dizziness, lightheadedness at low levels of exertion, or during recovery, high levels of silent ischemia(ST segment depression, greater than 2 mm from the baseline) abnormal heart rate and blood pressure functional capacity less than five Mets

Not exercise

\-Presence of resting ejection fraction less than 40% complicated myocardial infarction complicated revascularization complex dysrhythmias signs symptoms of post event, post procedure of myocardial, ischemia, clinical depression and survivor of cardiac arrest

CVD risk factors-medical history

Eight and development of individuals, exercise prescription

Lifestyle modification

Disease, prevention and management

Steps for CVD risk factor assessment

1\. Determine if the patient meets any positive risk factors.

—— if they don’t know if they meet the criteria, it should be counted


2. Sum of the positive risk factors


1. If client meets negative risk factor, then subtract one from the total of positive risk factors

Positive risk factor

Bad for your health

Negative risk factor

Good for your health

PRF age

Men over 45 years

Women over 55 years

PRF family history

Myocardial infarction coronary revascularization or sudden death before 55 years in father or before 65 year in mother

PRF smoking

Current smoker or quit within the last six months or exposure to secondhand smoke

PRF physical activity

Not physically, active

PRF Obesity

Body mass index over 30Lg/m2

Waste girth over 102 cm for men

Waist girth over 88 cm for women

PRF hypertension

Systolic blood pressure over 130 mmHg or diastolic pressure over 80 mmHg

Confirmed on two or more separate occasions, or on anti-hyper intention medication

PRF dyslipidemia

Low density lipoprotein cholesterol over 130 mg/dL

High density lipoprotein cholesterol under 40

If total serum cholesterol is accessible use over 200

Lipid, lowering medication

PRF Diabetes

Fasting plasma glucose over 100

To our plasma, glucose values in oral glucose tolerance test over 140

Glycosylated hemoglobin over 5.7%.

NRF HDL-C

Over 60 mg/dL

Blood pressure

Systolic should increase with intensity

Diastolic should decrease with intensity

Normal is under 120 over under 80

Elevated (pre-hypertension)

120-129/

Stage one hypertension

130-139/80-89

Stage two hypertension

>140/>90

Basic data or resting measurements

HR

BP

Height

Weight

Error sin BP recording

Improper cuff size

Posture

caffeine

location

Background noise

ACSM Screening Algorithm

1. Physical activity level
2. Presence of CV metabolic, and or renal disease
3. Symptomatic or asymptomatic
4. Signs and symptoms of CVD, metabolic and renal disease


1. Is medical clearance necessary?

Primary function of the heart

1. Pump blood to the lungs to be oxygenated (pulmonary circulation)
2. Pump oxygenated blood to the system circulation(systemic circulation)
3. Deliver oxygen and nutrients to vital organs in muscle tissue


1. Assist in elimination of waste products

Structure of the heart

Four chambers and four sets of valves

\-Atria-receive blood from pulmonary and systemic circulation, deliver blood to ventricles

\-Ventricles-pump blood to pulmonary and systemic circulation

\-interatrial and interventricular septum’s

Atrioventricular valves

Tricuspid - right atria from ventricle

Bicuspid - (mitral) left atria from ventricle

Semilunar valves

Pulmonary - right ventricle to pulmonary artery

Aortic - left ventricle to aorta

Coronary blood supply

Right coronary artery

Left coronary artery

Circumflex artery

Heart tissue

Pericardium

Myocardium - muscle of the heart

Endocardium

Myocytes

Muscle cells of the heart

Heart structure

Striated and same contractile proteins

* actin
* Myosin
* Troponin
* Tropomyosin

Stimulated by the nervous system

Intercalated discs

Connective tissue structures

* allow one cell to pull on surrounding cells
* Within intercalated discs are gap junctions
* Gap junctions allow for ephaptic conduction

Myocardium

Autorhythmicity

* Electrical stimulus begins in the SA node
* Electrical impulse reaches AV node
* Back up to the SA if needed
* impulse continues through the bundle of his
* Impulse travels down to the bundle branches (right and left)
* Impulse continues to the purkinje fibers
* Wrap around the bottom of the heart and go in
* Allow for entire thing to contract at once

\

Autonomic nervous system

Involuntary

Controls

* Automaticity
* Excitability
* Conductivity
* Contractility of myocardial cells

automaticity

The ability of cardiac cells to generate spontaneous action potential

Excitability

The individual in sequential, depolarization and repolarization of cardiac cells, communication with adjacent cells and propagation of the impulse

conductivity

The network of notes cells and signals that control your heartbeat

Contractility of myocardial cells

The force in velocity of contracting heart muscles

Sympathetic nervous system

Speeds up heart rate

Increases contractility

Speed of conduction through the AV node

Epinephrine Synthetic, synthetic, synthetic synthetic

Parasympathetic nervous system

Slow down heart rate

Decreases contractility

Slows conduction through the AV node

Acetylcholine

Electrocardiogram

Graphical recording of electrical activity of the heart

10 electrodes to form 12 leads

Used to determine the heart rate and rhythm

A wave of depolarization traveling towards a positive electrode

Results in positive deflection in the ECG trace

A wave of depolarization traveling away from a positive electrode

Results of the negative deflection

A wave of depolarization, or repolarization, traveling perpendicular to an electrode axis

Biphasic deflection of equal positive and negative voltages(no net deflection)

A wave of repolarization traveling towards a positive electrode

Results of the negative deflection

A wave of repolarization traveling away from a positive electrode

Result in a positive deflection

The instantaneous amplitude of the measured potential’s will depend upon

The orientation of the positive electrode relative to the mean electrical vector

The voltage amplitude is directly related to

The mass of tissue undergoing the depolarization or repolarization

10 electrode = 12 lead ECG

Three bipolar limb leads

\-leads I II III

Three augmented(unipolar) leads

\-leads aVR aVL aVF

Six precordial unipolar leads

\-V1 V2 V3 V4 V5 V6

Lead 1

Horizontal left arm (+) and right arm (-)

Lead 2

Right arm (-) and left leg (+)

Lead 3

Left arm (-) and left leg (+)

V1

Net negative deflection

V6

Net positive deflection

Sinoatrial node

Silent

P wave

Atrial depolarization

0\.08 -0.12 sec

PR interval

Atrioventricular node

Bundle of his

Left and right bundle branches

0\.12-0.20

QRS complex

Ventricular muscle depolarization

0\.06-0.10

T wave

Ventricular muscle repolarization

Positive deflection

QT interval

0\.20-0.40

1500 method

Count number of small boxes between R waves

Divide 1500 by small boxes

Buffering

Reactions that serve to minimize the changes in H + concentrations

Fluids

Digestive acid - 1 pH

Blood 7.35 pH

Metabolism is highly sensitive to pH changes

Buffering regulated by

Chemical buffers (bicarbonate binding to H+)

Pulmonary ventilation (blow off Co2)

Renal function (excrete CO2)

Continuous maximal testing

No rest between workloads , often varies in duration and intensity

Stages between 2-3 minutes

Total test length 6-12 minutes

Includes ramp testing

Discontinuous maximal testing

Workload is increased during each stages but patient rests 5-10 minutes between

Each exercise last 5-6 minutes

Total test length 5 times as long as continuous

CVS primary function

To ensure exercising muscles are adequately supplied with oxygen via increase blood flow and ventilation

Remove CO2 and metabolic byproducts due to increased metabolic activity

Maintain homeostasis ca

Cardiac output

Amount of blood ejected by the heart each minute

At rest 5 L/min

Can increase to over 40

CO = HR x SV

CO

Increase in maximal CO is more significant cardiovascular adaptation in aerobic training

\-directly from improved SV

Training induceD

\-more effective redistribution of blood flow

\-trained muscles enhanced capacity to generate ATP aerobically

CO during exercise

Systemic blood flow increases directly with intensity of exercise

CO increases rapidly during transitions from rest to steady rate

Endurance athletes achieves a large maximal cardiac output

Stroke Volume

Endurance training causes hearts stroke volume to increase during rest and exercise regardless of age or sex

Factors

* increased internal left ventricular volume and mass
* Reduced cardiac and arterial stiffness
* Increased diastolic filling time
* Improved intrinsic cardiac contractile function

Metabolic adaptations

Muscle fiber type and size

* enhanced metabolic adaptations in each muscle fiber type
* All fibers maximize existing aerobic potential
* Endurance athletes have larger ST fibers, then FT fibers, and say muscle
* ST fibers with high capacity to generate ATP aerobically contain large quantities of myoglobin

Oxygen extraction

Aerobic training increases quantity of O2, extracted from circulating blood

\-Results from

* More effective, cardiac output, distribution to active muscles
* Enhance capacity of trained muscles to extract and process available oxygen (increase capillary density)

Metabolic adaptations 2

Preferential use a free fatty acids as energy

* Endurance trained individuals tend to use fats over carbs to produce ATP
* Causes a carbohydrate sparing affect an increase is muscular endurance
* At sub max exercise, ATP production mainly comes from fatty acids in trained individuals compared to untrained

Metabolic adaptations Myoglobin

Iron containing structure that transports oxygen from the sarcolemma to the mitochondria

Increases up to 90% with endurance exercise

Increases amount of oxygen available

\-Enhances aerobic ATP production

Metabolic adaptations

Mitochondria size number, and enzymes

Size and number increase up to 120%

The level of enzymes that are involved in activation, transportation and beta oxidation of long chain fatty acids can increase up to 24%

\-Improves ability to use fat as a fuel source

Blood flow and distribution

Lower cardiac output in Submaximal exercise training

* Rapid training, and Dusse changes in vasoactive properties of large arteries and local resistance vessels within skeletal and cardiac muscles
* Muscle cells change that enhance oxidative capacity

Maximal exercise
* Larger maximal , cardiac output
* Greater blood distribution to muscle from non-active areas
* Enlargement of cross-sectional areas of arteries and veins, 20% increase in capillarization

Heart Rate

Training decreases, intrinsic firing rate of SA node pacemaker tissu

* Increased parasympathetic activity in small, decrease in sympathetic
* Contributes to resting and submaximal exercise bradycardia in trained endurance athletes, or the previously sedentary who train aerobically

Submaximal heart rate for standard exercise, decreased by 1215 bpm with endurance training
* Reduction coincides with increased maximum stroke, volume in cardiac output