PTE 764: quest 3

 define physical activity.

any bodily movements produced by skeletal muscles that result in an energy expenditure

define exercise training.

planned structured and repetitive bodily movement done to improve or maintain one or more components of physical fitness

what is the principle of adaptation?

if a specific physiological capacity is taxed by a physical training stimulus within a certain range and on a regular basis the physiological capacity usually expands

what is the principle of threshold?

in order to elicit an adaptation, the physiological capacity must be challenged beyond a certain minimal intensity called the training threshold

what is the training threshold?

the intensity level where the body improves its ability to produce and clear lactate aka lactic threshold; value depends on the individual

T or F: there is a threshold of activity that is needed to increase the proportion of type II muscle fibers.

T

which muscle fiber types are involved in activities of daily living?

type I

what is the principle of overload?

adaptation is achieved by challenging the physiological capacity above threshold

how does overload work within resistance training?

time spent in overload will cause micro-trauma to the muscle fibers and will ultimately build them up to stronger fibers (hypertrophied)

how does overload work within aerobic training?

overtime, aerobic training causes enzyme induction because the muscles require a higher concentration of the enzymes to meet the training demands

what is the principle of progression?

after adaption, the training stimulus becomes sub-threshold and workload must increase to maintain overload 

T or F: during exercise, there must be stress placed on the system to maintain function and avoid possible de-conditioning.

T; mild stress tho

what is the principle of regression?

the transient changes in metabolic enhancement from training that occurs once training is stopped

what’s the difference between regression and retrogression?

regression: returning to a previous state

retrogression: specifically denotes a worsening

can a trained individual experience retrogression?

yes; retrogression can be acute or chronic and relates to periods of excessive overload without sufficient rest

what is the principle of specificity?

specific physiological capabilities expand only if they are stressed in the course of a exercise program

the ability of training for one activity to transfer to another is _____ _______.

cross training

what’s the different grading methods used between aerobic and resistive capabilities?

aerobic: VO2 max, RPE, or HR

resistive: 1-RM

list the elements of an exercise prescription.

• mode of exercise (type)

• frequency

• duration (time)

• intensity of exercise   

what factors must be combined in a systemic overload that will result in physiological adaptations (aka result in progression)?

frequency, duration, and intensity

what are the 5 components of choosing a proper mode of exercise?

1. readily accessible

2. tolerable exercise intensity

3. easily regulated

4. economically feasible

5. safety

exercise, regardless of mode, can be monitored via:

HR and BP (and therefore RPP)

what is the volume of exericse?

product of absolute intensity, duration, and frequency yielding the total energy expenditure associated with a physical activity over a specified time

• measured as kilocalories, METs/min, and METs/hr

when determining the frequency and duration of exercise, what is the typical time frame for both?

frequency is usually 3-5x/wk and duration is usually 5-60 mins of exercise

what are frequency and duration dependent upon?

the patient and his/her progression

ACSM recommends at least ___ mins/week of exercise.

150

ACSM recommends at least _____ mins/week of exercise for weight loss or deconditioning. 

250-300

to prevent pre-diabetes or type 2, ACSM recommends _____ MET/min/wk of exercising.

500-1000

list some ways a scientist can identify if a patient is at a high intensity.

• exercise below/at/above lactate threshold (4 mM lactate)

• exercise HR at 180 bpm or percentage of HRmax at 80%

• relative metabolic level of VO2max at/around 85%

• multiples of resting metabolic rate (6 METs)

• rating of perceived exertion at/above 14

• dyspnea scale

what is the dyspnea scale?

grade 1: breathless with strenuous exercise

grade 2: short of breath when hurrying on level or slightly inclined ground

grade 3: walks slower than people of the same age or stops for breath while walking at own pace on level ground

grade 4: stops for breath after walking 100 yards

grade 5: too breathless to leave the house or when dressing

ACSM recommends an intensity of exercise corresponding to ______ to upwards of 90% maxHR or ______ of VO2R.

55-65%'; 40-50%

what is the value for intensity that is good for reporting purposes?

METs

T or F: exercise intensity should not be prescribed above the intensity used in the exercise assessment. 

T

as exercise increases aerobically so does…

heart rate, perceived exertion, and energy expenditure

when determining the age adjusted max heart rate for a patient, we all know the 220-age formula, but it has a high error probability. what are examples of other equations that are better?

Londeree formula: 206.3 - (0.711 x age)

Miller formula: 217 - (0.85 x age)

Tanaka formula: 208 - (0.7 x age)

what is cardiovascular drift?

a phenomenon described as a decrease in stroke volume and an increase in heart rate during prolonged exercises; especially in warmer climates due to the decreased ventricular filling from dehydration

a patient with a history of cardiac disease is exercising with a trainer to get back into shape. during one of the initial sessions, he complains of chest pain. the trainer takes his vitals discovering low blood pressure but high heart rate. what is going on?

patient is suffering an ischemic response from exercising 

prescribing exercise intensity below the ischemic response ______ incidence of an abnormal response.

decreases

%HRmax equation

(HRmax) x (%intensity)

%HRR equation

((HRmax - HRrest) x %intensity) + HRrest

list some times when RPE is substituted for target HR values during exercise.

• ability to monitor HR is compromised

• no exercise test HR values exist

• patient is applying effort to physical activity other than cardio-respiratory endurance

• medication usage like beta-blockers

what are the three steps of forming an exercise prescription?

1. assessing health and fitness information 

2. interpretation of this information

3. use the above information with interpretation along with the goals of the patient to formulate 

ACSM recommendations for cardiorespiratory training:

mode: exercises using large muscle groups

frequency: 3-5x/wk

duration: 20-60 mins

intensity: 40-50% or up to 85% VO2R (VO2 reserve)

what are the reasons for exercise testing?

• establishes a starting point for therapy

• projects a therapeutic goal

• documentation of changes in exercise response

• functional capacity test for individuals

• evaluation of the physiological effects of acute and chronic diseases

T or F: exercise testing is rarely used for healthy individuals and instead is helpful in pointing out symptoms in unhealthy individuals.

T

standard methods of exercise test are designed to measure _____ in healthy athletes and non-athletes.

VO2max

why are treadmills a good choice for laboratory testing of VO2max?

because it’s actions best mimic the “natural” movements of walking

if a scientist is utilizing a treadmill for a laboratory test, what two components must be noted?

1. speed

2. elevation

what is a graded exercise test (GXT)?

a medical procedure used to assess the cardiovascular system's response to increasing physical exertion via regularly incrementing (increases in) work intensity

during a GXT, the choice of protocol, speed, grade, or Watt increments all depend on the _______ being tested.

population

what are three guidelines to remember when utilizing a GXT?

1. the test should last 12-16 mins but the patient may terminate the test whenever

2. must obtain informed consent prior to GXT

3. with children, get the info and get out

what are the big reasons to terminate an exercise test?

• patient’s request

• clinical observation of pallor, cyanosis, or extreme exertion (RPE 17-20)

• ECG arrhythmias and chronotropic incompetence

• venous lactate concentration greater than 8mM/L

• decrease SBP or increase DBP with increase in exercise intensity

• decrease in oxygen saturation below 90%

• RQ greater than 1.15 showing acidosis (blood pH less than 7.35)

a patient is performing a GXT at her cardio-pulmonary check up appointment. she complains of angina at the 10 min mark, so the physician takes her vitals. her blood pressure is 260/115 mmHg and her HR has failed to increase (chronotropic incompetence). what should the physician do?

immediately stop the exercise test

a patient is performing a GXT at his cardio-pulmonary check up appointment. the physician notices the patient’s systolic blood pressure has dropped by 20 and a change in his heart rhythm (frequent PVC). the patient doesn’t want to stop, because he’s determined to finish. what should the physician do?

immediately stop the exercise test anyway

signs of perfusion are also indicators to stop a GXT test. list the signs of perfusion.

lightheadedness, confusion, ataxia, pallor, cyanosis, nausea, or cold and clammy skin

what is PVC?

premature ventricular contraction (PVC); an early heartbeat that originates in the ventricles before the normal heartbeat

• 3 in a row is called ventricular tachycardia

Balke protocol

The participant walks on a treadmill at a constant speed while the incline is gradually increased each minute. The test continues until the participant is unable to continue due to exhaustion.Time to exhaustion is recorded and used to estimate VO2 max. Heart rate, blood pressure, and rating of perceived exertion (RPE) are often monitored throughout the test. 

the _____ protocol is the most common GXT.

Balke

Bruce protocol

It consists of seven stages, each lasting three minutes. During each stage, the speed and incline of the treadmill increase. The test starts with the patient walking at a speed of 1.7 mph and an incline of 10%. The speed and incline increase incrementally until the patient reaches their maximum effort or exhibits signs of cardiovascular distress. 

the _____ protocol is used in cardiac stress testing laboratories.

Bruce

what is a steady state (exercise) test?

a physiological test used to determine the highest exercise intensity an individual can sustain without a continuous and significant rise in blood lactate levels

what measurements can a steady state test be useful in achieving?

• assess O2 saturation

• measure arterial blood gasses

• determine if a patient needs supplemental O2

• evaluate effectiveness of therapy

• test a patient’s response to a pulmonary medication

what are the two stages of an exercise test that asseses for exercise-induced bronchospasms?

1. short to accommodate patient (1-2 mins)

2. load is then increased to a predicted level that elicits an increase in ventilation resulting in airway cooling or an increase in water loss in the conducting airways (7-8 mins)

what type of air quality usually sets of asthma attacks?

cool and dry

a decrease in flow rates of ______ are considered diagnostic criteria for exercise-induced asthma.

15% or greater

what is exercise field testing?

a practical, often inexpensive, assessments of physical fitness conducted in a real-world environment to measure fitness and performance

what are the three bases for field testing?

1. time

2. distance

3. incremental pace adjustments

how is time used to predict VO2max when performing a field test?

it can be predicted based on the distance covered in 6 or 12 mins.

what populations was the 6 min field test developed for? 

children and patients with low exercise capcity

_______ is a good indicator for schools to judge physical fitness when utilizing a field test.

distance (how long it takes to cover a distance- either 1 mile run or 600 yards)

can field tests be sensitive enough to detect a change in fitness status of patients?

not really; only good when compared to patient’s previous score of him or herself as these tests’ comparative findings are meant for large groups of participants

what are some safety considerations for exercise testing?

• careful planning in equipment and in selecting an appropriate protocol

• performing a pre and post-test clinical assessment and evaluation

• participant should refrain from eating large meals, smoking, or drinking caffeine for 2 hours before test

• check for absolute or relative contraindications

• training in advance CPR

what are some variables to monitor during exercise testing?

• changes in color, level of exertion, shortness of breath, cyanosis, and other signs of difficulty

• heart rate, blood pressure, and ECG monitoring

• arterial saturation oximetry (O2%)

how does a scientist measure fatigue (limits of aerobic fitness) during aerobic tests?

look at heart rate (about 200 bpm) and/or RER rating >1 (lactic acid production and accumulation)

what three systems govern the body’s response to exercise?

1. pulmonary

2. cardiovascular

3. muscle/metabolic

at what age are alveoli somewhat developed, blood gases are stable, compliance is stable barring pathology, and airway resistance has developed?

8 years old

respiratory system compliance and airway resistance are determinants for:

tidal volume and frequency of breathing

resting tidal volume relative to body mass and frequency of breathing decreases as we age, therefore the breathing economy ______ as we age. 

improves

T or F: due to a smaller body mass, the work of breathing and total minute ventilation during exercise is lower in children compared to adults.

F; higher

what are the overarching differences seen in the cardiovascular system between adults and children?

in children:

• heart volume/mass is bigger (compared to body)

• resting and exercise HRs are higher

• mean arterial pressure is lower

• exercise stroke volume is lower

although the resting cardiac output in children is higher compared to adults, the exercise cardiac output is lower. why? 

the higher heart rates cannot compensate for the lower stroke volumes

• the arterial to venous oxygen difference must become greater to compensate instead

what are the two ways a child’s cardiovascular system increases the arterial to venous oxygen difference?

1. increases removal of O2 from the blood at the tissue level

2. muscles of greater oxidative capacity

T or F: pre-adolescent children have higher oxidative enzyme activities than adults yet there is no difference in mitochondrial size and number.

T

what are the factors contributing to the changes seen in aerobic capacity and VO2max as children age?

• changes in myocardial contractibility and blood volume levels

• muscle and metabolism variables

• hormones (gender)

• genetics

what is aerobic reserve?

the difference between maximum aerobic capacity and resting aerobic level, or more commonly, the margin of safety and energy available for everyday and activities beyond basic survival

young children have higher energy requirements and lower movement economies, meaning they work ______ to their maximum capactiy.

closer (resulting in a decreased aerobic reserve)

anaerobic training programs elicit improvements in anaerobic power in pre-pubertal children but with no change in peak lactate levels. why?

these improvements are due to neural adaptations

how can a trainer avoid stress on the growing musculoskeletal system of a young client?

use lower weights for a high repetition count

what are some difficulties experienced when performing exercise testing on children? 

• small body size

• poor peaked performance

• short attention span

• poor motivation and reserves

• lower capacity leading to fatigue

according to the notes, how is aging defined?

alterations in cellular genetic coding that results in abnormalities in synthesis of cellular components, alterations in fiber-type distributions, and changes in motor innervations

what’s the difference between primary and secondary aging?

primary: deterioration of physiological systems

secondary: disease and decrease in functions

define chronological age.

the number of years that have passed since birth

• “I am 68 years old today!”

define biological age.

the gradual accumulation of cellular and molecular changes over time that lead to the decline in function and increased susceptibility to disease that occurs with advancing age

• “I am 68 years old but my back is like that of a 90 years old’s!”

what causes joint stiffness (inflexibility) and a decreased ability to absorb and disperse energy in older adults?

changes in the elastic properties of connective tissues

well trained older individuals with a high initial VO2max have a _______ rate of decline.

greater

• bigger they are, the hard they fall

how can an older individual slow the rate of decline as he or she ages?

perform moderate-high levels of training into later years as long as he or she remains disease free

what are the physiological effects of aging?

• decrease sensitivity of baroreceptors (leading to OH)

• increase plasma catecholamines

• decrease contractility of the heart

• decrease ability to vasodilate vessels in response to stress

T or F: as an individual ages, the heart takes longer to reach steady state and recover from exercise.

T

which two diseases are associated with a decline in the cardiovascular system as individuals age?

1. hypertension

2. coronary artery disease

HRmax decreases by __ every decade after the age of 30 :( (too soon)

5%