PTRS 825 KUMC Exercise Physiology

Carbohydrates (CHO)

Energy source: glucose and glycogen

predominate at muscular effort (exercise)

ADV: Highest energy yield per liter of 02 uptake (5.1 kcal / LO2), aerobic and anaerobic metabolism, rapid metabolic pathway, stores are sensitive to training and diet, can serve as SOLE source of energy

DIS: stored in small amounts, anaerobic accumulates lactate, muscle fatigues upon depletion

TtE: CHO oxidation could support energy demand for 2-2.5 hours

Lipids

Energy source: free fatty acids and triglycerides

predominate at rest

Contributes 50-70% of energy during light/moderate activity

ADV: More energy-dense than CHO(9.5 vs. 4.2 kcal/g), Stored in large amounts throughout the body, Stable energy source for exercise

DIS: Metabolized slowly, and only through oxidation, Yields less energy per L of O2 consumed than CHO (4.62 vs. 5.1 kcal), Majority of lipids are stored outside of muscle tissue, CANNOT serve as SOLE energy source

TtE: lipid oxidation could support energy demand for 3-5 days

Protein

Energy source: amino acids

serve as building blocks for tissue, provide little energy

NOT a primary provider of energy

TtE: protein oxidation could support energy demand for 2-2.5 days

The Crossover Concept

Fat predominates at rest, as more activity occurs, it transitions to CHO dependence

Respiratory Exchange Ration (RER)

Ratio of CO2 production to O2 consumption

RER = 0.7: Predominantly lipid metabolism

RER = 0.85: Lipid → CHO

RER > 1.0: Predominantly CHO metabolism

Ketone bodies

Produced in LIVER as a by-product of lipid metabolism and gluconeogenesis. Used when there is a secondary energy source when glucose is not readily available. Production is increased during uncontrolled diabetes, prolonged exercise, starvation/fasting

Diabetic Ketoacidosis

More commonly associated with type I diabetes, but possible in type II, Production of ketones is increased due to low insulin levels preventing uptake of glucose.

Symptoms: excessive thirst/dry mouth, polyuria, flushed or dry skin, stomach pain, nausea, and/or diarrhea, excessive fatigue and/or sleepiness, blurred vision, fruity odor on breath (acetone)

You are performing a pre-exercise screening for an individual who would like to begin a structured exercise program. In order for this individual to be considered as participating in regular exercise, they must have a history of which of the following?

20 minutes of vigorous intensity activity, at least 2 days/week for the past 1 month

30 minutes of moderate intensity activity, at least 3 days/week for the past 3 months

60 minutes of light intensity activity, at least 3 days/week for the past 6 months

75 minutes of moderate intensity activity, at least 2 days/week for the past 12 months

30 minutes of moderate intensity activity, at least 3 days/week for the past 3 months

As a physical therapist in a facility that offers exercise testing and training services to the general community, you are often asked to supervise exercise for individuals from a wide range of different populations. Which of the following would be the MOST likely to experience an acute myocardial infarction or sudden cardiac event during exercise?

A sedentary adolescent engaging in moderate intensity exercise

A high school athlete engaging in vigorous intensity exercise

A sedentary adult engaging in vigorous intensity exercise

A physically active older adult engaging in moderate intensity exercise

A sedentary adult engaging in vigorous intensity exercise

You have been asked to develop a physical activity and exercise program for an individual that has recently initiated services at your clinic. Which of the following would be the MOST appropriate first step in your pre-participation evaluation?

Administering a fitness assessment

Obtaining informed consent

Conducting a health history review

Assessing cardiovascular risk

Obtaining informed consent

You are providing physical therapy services to an apparently healthy young adult who is recovering from an upper extremity injury. During your treatment, this patient indicates that they are planning to begin participating in a moderate intensity aerobic exercise program. What is the minimal level of pre-participation screening you would encourage this individual to complete prior to initiating this program?

Pre-participation screening is not necessary for healthy adults

A self-reported medical history and/or self-screening

A supervised submaximal exercise test

A medical evaluation, including a physical examination and stress test

A self-reported medical history and/or self-screening

You are preparing to develop a physical activity and exercise intervention for a sedentary individual. Which of the following factors would be the MOST strongly related to exercise-related musculoskeletal injury?

Frequency of activity

Intensity of activity

Duration of activity

Progression of activity

Intensity of activity

You are performing a pre-exercise evaluation on a 66 year old individual, and find that their resting blood pressure is 134/85. They are otherwise healthy and do not currently take any medications. Which of the following would be the MOST appropriate response to this finding?

No intervention is needed; this is a normal blood pressure for an older adult

You should encourage lifestyle modifications, including physical activity and diet

You should instruct them to begin taking anti-hypertensive medication and refer them to a physician

You should administer an aerobic exercise test to assess the blood pressure response to exercise

You should encourage lifestyle modifications, including physical activity and diet

You are preparing to assess the cardiorespiratory fitness of a 56 year old sedentary individual. Which of the following would be the MOST important consideration in your test selection?

Treadmill tests are often ideal for individuals with very low levels of fitness

Field tests are ideal for assessing sedentary and high-risk individuals

Cycle ergometry tests frequently overestimate aerobic capacity

Step tests require a low energy cost and are appropriate for all individuals

Treadmill tests are often ideal for individuals with very low levels of fitness

Strategies to reduce the risk of cardiac events during exercise include which of the following?

Pre-participation screening of high school and college athletes

Participant education regarding the nature of cardiac prodromal symptoms

Program modifications according to usual activity level, exercise capacity, and environment

All of the above

All of the above

You are providing physical activity and exercise recommendations for a sedentary 55 year old individual. You would educate this individual that their ideal target amount of physical activity should be a minimum of ______ minutes of moderate intensity activity or _____ minutes of vigorous intensity activity per week.

150; 75

120; 50

100; 40

60; 35

150; 75

The goal of pre-participation health screening is to identify individuals who:

Should receive medical clearance before beginning or advancing an exercise program

Have diseases or conditions that may benefit from a medically supervised exercise program

Have medical conditions that may require exclusion from exercise

All of the above

All of the above

You are preparing to assess the upper body 1-repetition maximum of a healthy 41 year old individual. Which of the following would be the MOST important consideration for administering this test?

You should attempt to determine the 1-RM in no more than 2 trials

You should progressively increase resistance by 5-10% after each successful trial

You should allow rest periods of 1-2 minutes between trials

You should select an starting weight that is at least 90% of the individual's perceived capacity

You should progressively increase resistance by 5-10% after each successful trial

You are planning to initiate an aerobic and resistance training program for a sedentary 41 year old individual. In which of the following anatomical areas is this individual MOST likely to experience an exercise-related musculoskeletal injury?

Lower extremity

Lower back

Cervical spine

Upper extremity

Lower extremity

You conduct an aerobic exercise test for a healthy 63 year old individual. During the test you observe a linear increase in heart rate with increasing workload and measure a maximum heart rate of 140 bpm and a maximal BP of 198/88 mmHg. After completing the test, you would continue to monitor this person's recovery until which of the following has occurred?

They are no longer out of breath

At least 15 minutes have passed

Heart rate and blood pressure have stabilized

The respiratory exchange ratio (RER) is < 0.85

Heart rate and blood pressure have stabilized

You are performing health-related fitness testing for a healthy 36 year old individual. Information gathered from this testing can be useful for which of the following?

Participant education

Establishing goals

Evaluating progress

All of the above

All of the above

You are performing health-related fitness testing for a 56 year old individual. Which of the following would be the MOST important consideration for how the tests should be administered?

You should sequence the tests so that flexibility is always tested before cardiorespiratory fitness

You should sequence the tests so that cardiorespiratory fitness is always tested before muscular fitness

You should sequence the tests so that the same muscle groups are stressed repeatedly

You should administer the tests in the same sequence for any subsequent testing sessions

You should administer the tests in the same sequence for any subsequent testing sessions

You are preparing to assess the muscular fitness of a 46 year old individual. Which of the following would be the MOST appropriate consideration in terms of administering and interpreting this testing?

Testing should be preceded by 5-10 minutes of light aerobic activity

Dynamic stretching should be avoided prior to testing

The results can be readily generalized across different muscles and muscle groups

The results can only be interpreted in comparison to published normative values

Testing should be preceded by 5-10 minutes of light aerobic activity

You are performing a cardiovascular risk screening on a 55 year old African American man who is currently sedentary, but is hoping to begin an exercise program that will include moderate intensity aerobic and resistance training. He states that he was motivated to begin this program because his father died of an MI at the age of 61, and his younger brother recently underwent a 3-vessel cardiac bypass at the age of 51. He is currently taking Lisinopril (20 mg qd), Simvastatin (15 mg qd), and Metformin (500 mg qd) for hypertension, dyslipidemia, and diabetes, respectively. Other than this, he reports no significant health problems. He does have a 25 pack-year history of smoking, but successfully quit 2 years ago.

Tests

BMI: 29 kg/m2

Blood Pressure: 146/90 mmHg

Lipid Profile: LDL=114 mg/dL; HDL=45 mg/dL

Fasting Blood Glucose: 143 mg/dL

Does he need clearance?

Yes

No

Unable to determine

Yes

You are performing a cardiovascular risk screening on a 55 year old African American man who is currently sedentary, but is hoping to begin an exercise program that will include moderate intensity aerobic and resistance training. He states that he was motivated to begin this program because his father died of an MI at the age of 61, and his younger brother recently underwent a 3-vessel cardiac bypass at the age of 51. Currently taking Lisinopril (20 mg qd), Simvastatin (15 mg qd), and Metformin (500 mg qd) for hypertension, dyslipidemia, and diabetes. He reports no significant health problems. He does have a 25 pack-year history of smoking, but successfully quit 2 years ago.

Tests

BMI:29 kg/m2

Blood Pressure:146/90 mmHg

Lipid Profile: LDL=114 mg/dL; HDL=45 mg/dL

Fasting Blood Glucose:143 mg/dL

Does he need clearance?

How many cardiovascular risk factors does he have?

Four

Five

Six

Seven

Unable to determine

Six

You are performing a cardiovascular risk screening on a 55 year old African American man who is currently sedentary, but is hoping to begin an exercise program He states that he was motivated to begin this program because his father died of an MI, and his younger brother recently underwent a 3-vessel cardiac bypass at the age of 51. He is currently taking Lisinopril, Simvastatin, and Metformin for hypertension, dyslipidemia, and diabetes, respectively. Other than this, he reports no significant health problems. He does have a 25 pack-year history of smoking, but successfully quit 2 years ago.

BMI:29 kg/m2

Blood Pressure:146/90 mmHg

Lipid Profile: LDL=114 mg/dL; HDL=45 mg/dL

Fasting Blood Glucose:143 mg/dL

MOST appropriate for this individual?

Maximal effort cycle ergometer test

Submaximal effort treadmill test

Cooper 12-minute run/walk field test

Exercise testing would be of little benefit for this individual

Submaximal effort treadmill test

You are developing a physical activity and exercise program for a sedentary, but otherwise healthy older adult. Which of the following would be the MOST important consideration for this program?

Exercise intensity should be defined relative to metabolic equivalents (METs)

Resistance training is of little benefit for individuals > 75 years old

An exercise test must be conducted prior to initiating moderate intensity activity

The expected percentage of improvement in fitness is comparable to that of a younger adult

The expected percentage of improvement in fitness is comparable to that of a younger adult

You are preparing to develop a physical activity and exercise program for a sedentary 9 year old child. Which of the following would be the MOST appropriate consideration for this program?

The program should not include activities that will exceed a moderate level of intensity

The program should include both structured and unstructured bouts of physical activity

The program should include no more than two bouts of resistance training per week

The program should include continuous, prolonged bouts of low intensity physical activity

The program should include both structured and unstructured bouts of physical activity

You are developing a moderate intensity exercise program for a sedentary, but otherwise healthy 54 year old man. Your assessment reveals a resting heart rate of 81 bpm and blood pressure of 143/91. Which of the following would likely be the MOST appropriate target heart rate range to begin aerobic training?

107 - 119 bpm

140 - 153 bpm

102 - 115 bpm

115 - 132 bpm

115 - 132 bpm

You are approached by a healthy, physically active individual who has recently learned that they are pregnant. This individual currently participates in approximately 200 minutes of exercise each week, including both aerobic and resistance activities. Which of the following would be the MOST appropriate recommendation for physical activity during pregnancy?

They should discontinue resistance training

They should distribute exercise sessions throughout the week

They should not exceed a moderate level of intensity

They should reduce their total volume of weekly exercise

They should distribute exercise sessions throughout the week

You are asked to evaluate an individual who suffered the acute onset of low back pain 2 days ago. Which of the following would be the MOST important to consider in the development and administration of a physical activity and exercise program for this individual?

Activities that result in centralization of symptoms should be promoted

Physical activity and exercise should be avoided for at least 4 weeks

Improved trunk flexibility should be a primary goal of the exercise prescription

Progressive resistance training should be discouraged until pain has resolved

Activities that result in centralization of symptoms should be promoted

You are conducting a symptom-limited graded exercise test for an individual with known cardiovascular disease, and are measuring heart rate, blood pressure, and gas exchange during exercise. Which of the following values could you calculate from this data to provide the MOST accurate estimation of myocardial oxygen uptake?

Respiratory exchange ratio

Maximal oxygen consumption

Rate-pressure product

Mean arterial pressure

Rate-pressure product

You are asked to develop an exercise program for a sedentary 34 year old individual. Although currently healthy, this individual has little experience with exercise. Which of the following would be the MOST appropriate initial recommendation for resistance training?

1 set of 8-12 repetitions at 75-85% of 1-RM, 6 days/week

3 sets of 4-6 repetitions at 90% of 1-RM, 2 days/week

4 sets of 12-15 repetitions at 50% of 1-RM, 4 days/week

2 sets of 8-12 repetitions at 60-70% of 1-RM, 3 days/week

2 sets of 8-12 repetitions at 60-70% of 1-RM, 3 days/week

You are administering a symptom-limited graded exercise test to an individual with known cardiovascular disease. Which of the following would MOST likely be the result of an abnormal chronotropic (i.e. heart rate) response to exercise?

A 15 bpm increase in heart rate in response to an increase in workload

A 19 bpm decrease in heart rate during the first minute of post-exercise recovery

An inability to reach ≥ 85% of age-predicted maximal heart rate despite maximal effort

A 8 mmHg decrease in diastolic blood pressure in response to an increase in workload

An inability to reach ≥ 85% of age-predicted maximal heart rate despite maximal effort

As a physical therapist at a facility that offers community-level fitness programming, you are often asked to provide education regarding the benefits and risks of exercise to older adults wishing to initiate exercise programs. Which of the following would be the MOST appropriate to include in the information you provide to these individuals?

Multicomponent exercise programs can reduce the risk of age-related functional decline

Preparticipation clinical exercise testing is recommended for all adults over the age of 60

The risk of a cardiovascular event during exercise is elevated in older adults

High intensity exercise has relatively little benefit and is discouraged for older adults

Multicomponent exercise programs can reduce the risk of age-related functional decline

As a member of your facility's cardiac rehabilitation team, you are often involved in exercise testing for patients preparing to initiate a cardiac rehabilitation program. Today, you are administering a symptom-limited graded exercise test to a patient who suffered a myocardial infarction 2 weeks ago. Which of the following would be the MOST appropriate reason to stop the test?

Oxygen saturation decreases from 96% to 92% with an increase in workload

Systolic blood pressure increases from 172 to 195 mmHg with an increase in workload

The ECG leads become displaced, resulting in ECG signal failure

Diastolic blood pressure increases from 86 to 94 mmHg over the course of 5 minutes

The ECG leads become displaced, resulting in ECG signal failure

You are developing an exercise program for a healthy 69 year old woman. Which of the following considerations about the inclusion of neuromotor activities would be MOST important to incorporate into your program?

Activities should be dynamic and progressively reduce base of support

Supervised group exercise programs such as tai chi do not effectively reduce fall risk

Neuromotor activities must be performed most days of the week in order to effectively reduce fall risk

Activities should stress postural muscles and progressively increase the level of sensory input

Activities should be dynamic and progressively reduce base of support

You are treating a 64 year old man who was recently admitted to the hospital due to a myocardial infarction. Which of the following would be the MOST appropriate indication to discontinue an exercise session for this individual?

A 15 bpm increase in heart rate with an increase in workload

A decrease in oxygen saturation from 98% to 94% with an increase in workload

A 6 mmHg decrease in diastolic blood pressure with an increase in workload

The onset of significant dyspnea with an increase in workload

The onset of significant dyspnea with an increase in workload

You are preparing to develop an exercise program for a 42 year old woman who is receiving chemotherapy and radiation treatments for breast cancer. She currently reports mild treatment-related symptoms of mild fatigue and occasional nausea, but is optimistic that light-to-moderate intensity exercise will help with this. Which of the following is MOST applicable to this individual's exercise prescription?

A medically supervised exercise test is required prior to participation

The intensity of resistance training should not exceed 75% of 1-RM

The frequency of aerobic activity should not exceed 3 days per week

The type of exercise should not include swimming or aquatic activities

The type of exercise should not include swimming or aquatic activities

You have developed an exercise program for an individual with moderately severe osteoarthritis of the right knee. Which of the following would be the MOST appropriate progression of aerobic training for this exercise program?

Increase duration by 5-10 minutes every 1-2 weeks over the first 6-8 weeks of the program

Increase frequency to 5-7 days per week within the first 8-10 weeks of the program

Increase intensity by 15-20% every 2-4 weeks over the first 10-12 weeks of the program

Progression should be avoided until the individual can perform 10 minutes of pain-free activity

Increase duration by 5-10 minutes every 1-2 weeks over the first 6-8 weeks of the program

You are developing an exercise program for a 53 year old individual with metabolic syndrome. One of the goals of this program is to help the person establish a stable, healthy weight. Which of the following would be the MOST appropriate target for weight reduction?

A 3-10% reduction over 1-2 months

A 3-10% reduction over 3-6 months

A 15-20% reduction over 2-4 months

A 15-20% reduction over 1-2 months

A 3-10% reduction over 3-6 months

You are supervising the exercise session of an individual with moderately severe Alzheimer's disease. Prior to beginning the session you determine that the individual's vital signs are normal. However, as the session progresses, you observe that they appear to be slightly more confused than usual, forgetting exercises and requiring periodic redirection to remain on-task. Which of the following would be the MOST appropriate response to this situation?

Discontinue exercise; instruct the patient's caregiver to take them to the emergency room for evaluation

Reduce the duration and intensity of activity as needed; inform the patient's caregiver of your observations

Discontinue exercise; place the patient in a supine position and activate an emergency medical response

Continue the session as planned; it is important to ensure that the patient completes at least 30 minutes of continuous exercise

Reduce the duration and intensity of activity as needed; inform the patient's caregiver of your observations

You are preparing for a treatment with an 8 year old child with autism spectrum disorder. Which of the following would be the MOST appropriate strategy to employ during this session?

Frequently change and vary activities to minimize boredom

Provide limited feedback and guiding to promote task retention

Break activities up onto simpler tasks to facilitate motor learning

Arrange large group treatment sessions to maximize socialization

Break activities up onto simpler tasks to facilitate motor learning

You are developing a treatment plan for a 46 year old individual with Hoehn and Yahr Stage 2 Parkinson's disease. This individual is currently physically active and has expressed interest in progressing to vigorous intensity aerobic exercise. After obtaining medical clearance, you administer a graded exercise test which elicits a peak heart rate of 167 bpm. Which of the following would be the MOST appropriate target heart rate range for this individual's training?

110-120 bpm

120-130 bpm

130-140 bpm

150-160 bpm

130-140 bpm

You are treating a 22 year old individual who experienced an incomplete spinal cord injury at the level of T8. Which of the following describes the MOST appropriate component of the exercise prescription you would provide for this individual?

Resistance training initiated at 50% of 1-RM for all large muscle groups

Daily passive stretching to a discomfort level of 5 on a 0-10 pain scale

30 minutes of continuous aerobic training initiated at 65-75% of HRR

A combination of aerobic and resistance training performed each day

Resistance training initiated at 50% of 1-RM for all large muscle groups

You are developing a physical activity and exercise program for a 55 year old individual who has a history of obesity, hypertension and dyslipidemia. This individual is currently sedentary, but reports no signs or symptoms of cardiovascular, metabolic, or renal disease. Which of the following would be the MOST important consideration for this individual's exercise program?

The prescription should follow guidelines for the condition with the most conservative approach

A clinical exercise test would be required prior to participation in light-to-moderate intensity activity

Vigorous intensity aerobic activity is contraindicated for individuals with multiple comorbidities

Low volumes of exercise are indicated to minimize the risk of a cardiovascular event

The prescription should follow guidelines for the condition with the most conservative approach