Exercise science: exercise for special populations

Is diabetes characterized by hyperglycemia?

Yes and it is due to a defect in insulin secretion (type 1) and defect in insulin action (type 2)

What are some warning signs of diabetes?

-frequent urination/thirst

-extreme hunger

-rapid weight loss, weakness

-irritability, nausea

What is ketosis?

-metabolic acidosis from accumulation of ketone bodies (excessive fat metabolism)

-may result from a lack of insulin

Is exercise a part of treatment for type 1 diabetes?

Yes along with insulin and diet

Does exercise improve blood glucose control in type 1 diabetes?

No; it improves CHD risk factors and may help increase tissue sensitivity

Is hypoglycemia a major concern for type 1 diabetes?

Yes it may result in insulin shock

Should we maintain a regular exercise schedule with type 1 diabetes?

Yes; FITT, altering diet and insulin

When is the GXT recommended prior to exercise for people with type 1 diabetes?

-age > 35 years

-age >25 years if the person has had type 1 for more than 15 years or type 2 for more than 10 years

-presences of CHD risk factors

-presence of microvascular disease

-peripheral artery disease

-autonomic neuropathy

When can people with type 1 diabetes be medically cleared for exercise?

-currently active (40-60% HRR, 3+ days a week for 30+ minutes)

Should we consider strategies to avoid hypoglycemia during exercise?

Yes

Is metabolic control before physical activity important for type 1 diabetes?

Yes: avoid exercise if fasting glucose is > 300 mg/dl, and consume carbs if glucose is < 100 mg/dl

Why is blood glucose monitoring important before and after exercise important for type 1 diabetes?

-can identify when changes in insulin or food intake are needed

-learn how blood glucose responds to different types of exercise

What is the aerobic training exercise RX for type 1 diabetes?

-3-7 days per week

-50-80% HRR or 12-16 on RPE

-20-60 minute sessions (150 moderate or 75 vigorous)

-non-weight bearing low impact

What is the resistance training exercise RX for type 1 diabetes?

-2-3 days per week

-60-80% 1-RM reps

-avoid valsalva maneuver

When can people with type 1 diabetes train vigorously?

-are free from diabetic/medical complications

-can obtain the same benefits as nondiabetics

Where should insulin injection site be for exercise?

Away from working muscle to prevent increased rate of uptake and hypoglycemia

Should a person with type 1 diabetes follow a progression schedule?

Yes for both aerobic and anaerobic exercise

Is exercise a primary treatment for people with type 2 diabetes?

Yes; helps treat obesity, control blood glucose (reduces insulin resistance), treats chd risk factors

Will a combo of diet and exercise eliminate the need for drug treatment for type 2 diabetes?

Yes

What is the exercise RX for people with type 2 diabetes?

-4-7 times/week; sustained increase in insulin sensitivity and promote weight loss

-moderate intensity

-150 min/week 21+ minutes each day

What is prediabetes?

Having impaired fasting glucose or impaired glucose tolerance which is likely to develop type 2 diabetes

What is an impaired fasting glucose (IFG)?

Fasting BG 100-125 mg/dl

What is impaired glucose tolerance (IGT)?

-oral glucose tolerance test (75 g glucose)

-2 hour blood glucose 140-199 mg/dl

What are the health benefits of combining aerobic and resistance exercise for type 2 diabetes?

-lowered fat % (visceral fat)

-improved VO2 max

-lower blood pressure

-improved glycemic control

-increased muscular strength

What is asthma?

A respiratory problem characterized by a shortness of breath accompanied by a wheezing sound

What happens during asthma?

-contraction of smooth muscle of airway

-swelling of mucosal cells

-hypersecretion of mucus

How is asthma diagnosed?

Pulmonary-function testing with a low maximal expiratory flow rate

What are some asthma triggers?

Dust, chemicals, antibodies and exercise

What is the bodies response to asthma?

-b-cells produce IgE which attach to mast cells lining of bronchial tubes

-mast cells release inflammatory mediators

Asthma in children?

-leading cause of chronic illness

-most common respiratory disorder

What are the preventions of asthma?

Avoidance of allergens and immunotherapy making a person less sensitive

Where is exercise-induced asthma most common?

In asthmatics and in some sports

Is exercised induced asthma caused by cooling and drying of respiratory tract?

Yes; increases osmolarity on surface of mast cells, triggers Ca+ influx and airway narrowing

How is exercise-induced asthma diagnosed?

-strenuous running at 85-90% max HR

10% decrease in FEV indicates EIA

How can you reduce the chance of an exercise induced asthma attack?

Warm up, short duration exercise, and use mask in cold weather

What is a treatment of exercise-induced asthma?

-Beta-agonist in case of attack during exercise

-other medications

What treatment improves performance?

Ingested salbutamol B2-agonist improves strength, anaerobic power and endurance at 10-20x inhaled dose

How can we manage exercise-induced asthma?

-Reducing dietary salt; low calcium osmolarity and pro-inflammatory factors

-increasing intake of antioxidants (vitamin C, vitamin Em lycopene, beta-carotene)

-increased omega 3 fatty acid intake

Can people with asthma safely participate in all sports?

Yes except for scuba diving as long as exercise-induced bronchospasm in controlled. Need inhaler

How does scuba diving effect people with asthma?

Diving can cause lung damage but may be safe for people who do not exhibit exercise-induced bronchospasm

What does chronic obstructive pulmonary disease (COPD) include?

Includes chronic bronchitis, emphysema, and bronchial asthma

How do we test for COPD?

-FEV1

-GXT to measure VO2 max, maximal exercise ventilation and changes in pressure

What are the symptoms of COPD?

Shortness of breath (dyspnea), poor exercise tolerance, and inability to perform ADLs

How long are pulmonary rehab programs for COPD?

8-12 weeks with both patient education and exercise

What are beneficial effects of pulmonary rehabilitation?

-reduced risk of falls

-reduced anxiety and depression

-reduced dyspnea

-improved walking capacity and cardio fitness

-increased muscular strength

What is stage 1 of COPD?

FEV1 > 80%

What is stage 2 COPD?

FEV1 50-<80% predicted

What is stage 3 COPD?

FEV1 30-<50% predicted

What is stage 4 COPD?

FEV1 <30% predicted

What are goals of treatment of COPD?

Reduced reliance on O2 and medications with improved ADL tolerance

What are some outcomes of COPD treatment?

Increased exercise tolerance without dyspnea and increased well-being

How does exercise training help COPD?

-does not reverse disease but improves exercise tolerance and lowers dyspnea

-requires supplemental oxygen

-resistance training

-HIIT is the best

What are medication for COPD?

Long acting bronchodilators, supplemental O2 (28% O2 and 72% He)

How does inspiratory pressure support help COPD?

It reduces the work of inspiratory muscles

How does inspiratory muscle training help COPD?

It improves muscle endurance

What types of training are treatment for COPD?

Interval and resistance training

Is exercise therapy for hypertension?

Yes aerobic exercise lowers resting arterial blood pressure where several mechanisms account for the exercise-induced reduction in arterial blood pressure

What are the mechanisms behind exercise-induced reduction in arterial blood pressure?

-increased production of nitric oxide for vasodilation

-reduced plaque formation and arterial stiffness

-formation of new blood pressure

What is stage 1 hypertension?

Systolic BP 140-159 or diastolic BP 90-99

What are the non-pharmacological approaches for mild or borderline hypertension?

Diet and exercise!

What diet changes help with hypertension?

-DASH diet

-reduction in sodium to reduce bp -5mmHg systolic or -3mmHg diastolic

-reduction in caloric intake for 1kg weight loss = 1.6 mmHg systolic, 1.3mmHg diastolic

How does exercise help hypertension?

It causes a 5-7 mmHg reduction in resting SBP

What are the exercise recommendations for people with hypertension?

-moderate intensity (40-59% HRR)

-at least 30 minutes

-700-2000 kcal/week

-resistance training (60-80% 1RM)

What are some additional recommendations for hypertension treatment?

-lose weight

-limit alcohol intake

-reduce sodium intake

-stop smoking

-eat a whole foods diet

What do exercise-based cardiac rehab reduce?

Reduces the risk of adverse health events by helping patients achieve a healthy body weight and reducing several risk factors associated with CHD, and improve their VO2 max

What are the mechanisms contributing to cardiac rehab induced protection against adverse health events in CHD patients?

-maintenance of healthy body fats

-improved VO2 max

-lower blood pressure

-improved blood lipid profile

-exercise-induced cardioprotection

What is a stroke?

The rapid onset of vascular-induced brain dysfunction lasting more than 24 hours

Are most strokes an infarction of brain tissue?

Yes and it results in cognitive impairment and unilateral muscle weakness

What kind of exercise has many positive physiological benefits for stroke patients?

Aerobic exercise

What are the physiological benefits of aerobic exercise to stroke patients?

-enhanced cardiorespiratory fitness

-improved walking and motor coordination

-better balance

-increased force production

-improved cognitive ability

-better postural control

-reduced risk of future strokes

What is angina pectoris?

Chest pain due to ischemia

What is myocardial infarction (MI)?

Heart damage due to coronary artery occlusion

What is coronary artery bypass graft surgery (CABGS)?

Bypass one or more blocked coronary arteries using saphenous vein or internal mammary artery

What is an angioplasty (PTCA)?

A balloon-tipped catheter used to open occluded arteries and possible stent insertion

What are some common medication for cardiac rehab patients?

Beta blockers, anti-arrhythmia medications and nitroglycerin

What do beta blockers do?

Reduce HR and BP and also reduce the work of the heart

What do anti-arrhythmia medications do?

They control dangerous heart rhythms

What are nitroglycerin medication for?

Relax smooth muscle in veins to reduce venous return and reduce angina symptoms

What are the different tests in the GXT for cardiac rehab patients?

EKG monitoring, blood pressure, RPE, signs and symptoms of chest pain, and radionuclide imaging (evaluate perfusions and ventricular ejection)

What is phase 1 for a cardiac rehab patient?

Inpatient exercise program

What is phase 2 for a cardiac rehab patient?

Outpatient exercise with close supervision

What is phase 3 of exercise for a cardiac rehab patient?

Less supervision and may be home based

How can we determine an exercise prescription for a cardiac rehab patient?

-based on GXT (MET level, heart rate, signs)

-whole body dynamic exercise

-FITT

What are the effects of cardiac rehabilitation?

Improved cardiovascular function, improved risk factor profile and secondary prevention programs to reduce future heart attack risk

How does cardiac rehab improve cardiovascular function?

Improve VO2 max, higher work rate without ischemia, and greater capacity for more exercise

How are individualized exercise plans for patients with cancer prescribed?

Based on cancer stage, treatment type and other medical considerations

What are some limitations to medical management and exercise for cancer patients?

Edema, surgical trauma or amputation

Do we want to match our Ex Rx goals to medical realities for cancer patients?

Yes

Do cancer patients need supervised and independent exercise?

Yes supervision may be required

What is the frequency prescription for exercise for cancer patients?

Every other day with a goal to eventually exercise most days

What is the intensity prescription for cancer patients?

HR: <60% HRR to begin

MET: <3METS or <12 RPE to begin

What is the time prescription for cancer patients?

-goal of 30+ min of continuous exercise

-progress to moderate intensity when more than >150 hours

What types of exercises should cancer patients perform?

Preferred aerobic modalities (walking) and strength and flexibility for 2 days a week

What does aging result in physiologically?

Decline in all organ systems: cardiorespiratory fitness, muscular strength, bone density, and cognition

Is aging associated with a loss of bone minerals?

Yes which results in weaker bone structure and higher fracture rates

Does aerobic training improve VO2 max in older people?

Yes the % improvement is similar to that in young people

Does weight bearing activities improve bone mineral density?

Yes: walking, running, climbing stairs

What are the mechanisms involved for exercise-induced improvements in older adults for increased VO2 max?

There is an increased stroke volume and an increased arterial-mixed venous oxygen difference

What are the mechanisms involved for exercise-induced improvements in older adults for increased muscular strength?

Protein synthesis leads to muscle hypertrophy and there are nervous system adaptations

Does Vo2 max decline 1% each year?

Yes but regular exercise may reduce rate of decline