Chapter 15

Card Front: What is identified as a major risk factor for numerous chronic diseases in the US and other countries? Card Back: Physical inactivity is a major risk factor for numerous chronic diseases in the US and other countries1. It is also an independent risk factor for coronary heart disease (CHD)2....

Card Front: What are the top two leading causes of death in the United States? Card Back: The leading cause of death is heart disease (approximately 23% of deaths)1.... The second leading cause is cancer (approximately 22% of deaths)1....

Card Front: How frequently do heart attacks occur and cause death in the US, according to the sources? Card Back: Every 33 seconds someone will have a heart attack4.... Every 40 seconds someone dies from a heart attack4.... In 2022, approximately 702,000 individuals in the United States alone died from a heart attack4.

Card Front: What is the lifetime risk of getting some type of cancer? Card Back: The risk of getting some type of cancer in your lifetime is one in three4....

Card Front: Besides heart disease and cancer, name some other leading causes of death with lifestyle-related causes mentioned in the sources. Card Back: Five of the top six leading causes of death have lifestyle-related causes, including physical inactivity1.... These include unintentional injuries, respiratory disease, stroke, and diabetes4....

Card Front: What are two respiratory diseases commonly grouped under COPD that are leading causes of death? Explain the difference. Card Back: Emphysema is where the alveolar sacs (where gas exchange occurs) are destroyed and flattened8. Chronic Bronchitis is where the bronchial tubes are constantly inflamed and contain mucus, leading to constant coughing8. Respiratory disease is listed as a leading cause of death4....

Card Front: What is a stroke? What are the two main types? Card Back: A stroke occurs when blood flow to the brain is inhibited or blocked8. The two main types are hemorrhagic stroke and ischemic stroke8. The ischemic stroke, where blood flow to the brain is blocked, is seen most frequently8. Stroke is a leading cause of death4....

Card Front: What percentage or ratio of Americans are estimated to be living with diabetes? Which type is most prevalent? Card Back: Approximately one in ten Americans are living with diabetes8.... More than 30 million individuals have diabetes in the United States10..., with roughly 10 million being undiagnosed10. The most prevalent type is type 28....

Card Front: What are some warning signs and symptoms of diabetes? Card Back: Frequent urination and unusual thirst, extreme hunger, rapid weight loss, weakness, fatigue, irritability, nausea, and vomiting12.

Card Front: How do Type 1 and Type 2 diabetes differ in terms of insulin production/action, onset, and prevalence? Card Back:

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Type 1: Lack of insulin production (pancreas beta cells destroyed)9.... Dependent on exogenous insulin9.... Develops early in life10.... Associated with viral infection (often autoimmune)10.... Affects 5 to 10% of the diabetic population9....

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Type 2: Resistance to insulin action (pancreas produces insulin, but cells are resistant)10.... Historically developed later in life, but now seen more in adolescence and young adults10.... Associated with upper-body obesity10.... Affects 90 to 95% of the diabetic population9....

Card Front: How is Type 2 diabetes typically treated and improved? Card Back: Type 2 diabetes is treated and improved by regular physical activity and exercise, dietary restrictions, and weight loss5.... Medications may also be used13.... Changing lifestyle (diet and exercise) can sometimes eliminate the need for medication13.

Card Front: What are some key health outcomes linked to regular physical activity participation? Card Back: Lower rates of all-cause mortality, lower risk of all major forms of cardiovascular disease (CVD), improved weight management, improved cardiometabolic health, lower risk of many major forms of cancer, decreased fall risk, and improved brain and bone health15.

Card Front: Describe the dose-response relationship between physical activity and health outcomes, including all-cause mortality. Card Back: There is a dose-response relationship, meaning changes in the amount of exposure (activity) alter the occurrence and severity of disease16.... More activity is generally better for most health outcomes17. The biggest health gains are seen when transitioning from sedentary to some activity17. Any amount of activity is beneficial over none19.

Card Front: How much can increasing physical activity volume (more minutes/sessions) reduce chronic disease risks? Card Back: Increasing the volume of physical activity can drop the risks for many chronic diseases by 20% to 40%17.... Getting 150 minutes of light to moderate physical activity weekly can reduce all-cause mortality by a minimum of 20%16.

Card Front: What is a MET value, and what are the general MET ranges for sedentary, moderate, and vigorous activity? Card Back: A MET (Metabolic Equivalent of Task) is a measure of the energy cost of physical activity20.

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Sedentary: < 1.5 METs (waking activity performed sitting, reclining, or lying)20....

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Moderate: MET value below 620....

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Vigorous: MET value of 6 or higher20....

Card Front: What are the US Physical Activity Guidelines key recommendations for adults regarding moderate and vigorous intensity activity per week? Card Back: Adults should aim for:

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150 to 300 minutes per week of moderate intensity physical activity20....

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OR 75 to 150 minutes per week of vigorous intensity physical activity23.

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OR an equivalent combination of both23.

Card Front: What additional type of exercise is recommended and how often? Card Back: Moderate to high intensity strength activity should be performed at least two times/week or more19....

Card Front: What are the three major categories of risk factors for chronic diseases? Card Back: Genetic (Inherited/Biological), Environmental, and Behavioral17....

Card Front: Give examples of genetic risk factors for chronic diseases. Can they be changed? Card Back: Age, gender, race, and susceptibility to disease17.... These are unmodified risk factors that cannot be changed20....

Card Front: Give examples of environmental risk factors for chronic diseases (Physical, Socioeconomic, Family). Card Back:

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Physical: Air/water quality, unsafe highways, noise17....

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Socioeconomic: Income, housing, employment, status, education17....

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Family: Divorce, death of a loved one, children leaving17....

Card Front: Give examples of behavioral risk factors for chronic diseases. Card Back: Smoking, poor dietary habits, physical inactivity, drinking alcohol, overuse of medication, fast driving/no seat belt use17.... These are behaviors that increase risk.

Card Front: What is the number one actual cause of death, and what percentage does it account for? Card Back: Smoking is the number one actual cause of death, accounting for 18%20. Lack of physical activity is number two (15.2%), and alcohol is number three20.

Card Front: What is the "Web of Causation"? Card Back: An epidemiological model used to help establish the cause of chronic diseases, which is often difficult due to the complex involvement of multiple interacting risk factors (genetic, environmental, behavioral)16....

Card Front: What is Atherosclerosis? What is it associated with and what does it lead to? Card Back: Atherosclerosis is the thickening of the inner lining of arteries and plaque formation16.... It is associated with various risk factors (diet, obesity, inactivity, hypertension, high lipids, smoking, type 2 diabetes)16... and is a leading pathological contributor to heart attack and stroke death6.... Atherosclerosis begins at birth26.

Card Front: What did research find about the prevalence of heart disease (atherosclerosis) in young people? Card Back: Research found that one in six teenagers undergoing heart transplants had heart disease16. Autopsies of young soldiers after the Korean War also revealed atherosclerosis16.

Card Front: What are the "Plausibility Principles" used by epidemiologists to demonstrate disease causation? Card Back: Principles include: Temporal association (cause precedes effect), Plausibility (consistent with other observations), Consistency (replicated results), Strength of evidence (quantified likelihood), Dose-response (exposure changes alter disease), Reversibility (minimizing risk lowers disease), Study design (outcomes verified), and Judging the evidence (multiple lines confirm relationship)16....

Card Front: What are the specific modifiable risk factors for Coronary Heart Disease (CHD) listed in the sources (ACSM)? Card Back: Cigarette Smoking, Sedentary Lifestyle, Obesity, Hypertension, Dyslipidemia, Prediabetes24.... (Age and Family History are also risk factors but cannot be changed24...).

Card Front: Define the Age risk factor for CHD. Card Back: Men 45 years and older24.... Women 55 years and older24....

Card Front: Define the Family History risk factor for CHD. Card Back: A first-degree male relative (father or brother) having a heart attack, heart surgery, or death from CHD prior to age 5528. A first-degree female relative (mother or sister) having a heart attack, heart surgery, or death from CHD prior to age 6528.

Card Front: Define the Cigarette Smoking risk factor for CHD. Card Back: Being a current smoker, using tobacco products, or having quit smoking less than six months ago24....

Card Front: Define the Sedentary Lifestyle risk factor for CHD. Card Back: Not exercising at least 3 days a week, for at least 30 minutes each day, for fewer than 3 months24....

Card Front: Define the Obesity risk factor for CHD. Card Back: A BMI of 30 or greater24.... OR a waist circumference greater than 102 cm (men) or greater than 88 cm (women)24....

Card Front: Define the Hypertension (High Blood Pressure) risk factor for CHD. Card Back: A blood pressure reading greater than 130/80 mmHg on two separate occasions29... OR taking anti-hypertensive blood pressure medications29.... Normal resting blood pressure is less than 120/80 mmHg32.

Card Front: Define the Dyslipidemia risk factor for CHD, including key values for cholesterol and triglycerides. Card Back: An unhealthy cholesterol and triglyceride profile26....

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Total Cholesterol > 200 mg/dl26....

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HDL (good cholesterol) < 40 mg/dl (men) or < 50 mg/dl (women)29.... (Ideally > 60 mg/dl29...).

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LDL (bad cholesterol) ≥ 130 mg/dl29. (Ideally < 130 mg/dl29...).

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Triglycerides > 150 mg/dl29.... (Ideally < 150 mg/dl29).

Card Front: Define the Prediabetes risk factor for CHD, based on fasting blood glucose or OGTT. Card Back:

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Fasting Blood Glucose ≥ 126 mg/dl (after fasting ≥ 8 hours)29.

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OR a 2-hour Oral Glucose Tolerance Test (OGTT) ≥ 200 mg/dl29. (Note: Fasting glucose ≥ 100 mg/dl is a criterion for Metabolic Syndrome33).

Card Front: When is an individual considered at elevated risk for CHD based on the presence of multiple risk factors? Card Back: When an individual has two or more of the positive coronary heart disease risk factors29.

Card Front: What is the definition of Metabolic Syndrome and how many criteria must be met for diagnosis? Card Back: Metabolic syndrome is a cluster of risk factors that promote the development of coronary heart disease33.... An individual must have three or more of the specific risk factors to be diagnosed33....

Card Front: List the specific criteria for diagnosing Metabolic Syndrome and their values. Card Back:

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Abdominal obesity: Waist circumference > 102 cm (men) and > 88 cm (women)33....

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Hypertriglyceridemia: Triglycerides ≥ 150 mg/dl33....

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Low HDL cholesterol: < 40 mg/dl (men) and < 50 mg/dl (women)33....

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High blood pressure: ≥ 130/85 mmHg33....

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High fasting blood glucose: ≥ 100 mg/dl33....

Card Front: What is the health significance of being diagnosed with Metabolic Syndrome? Card Back: Patients with metabolic syndrome are at a higher risk for the development of coronary heart disease36... and have a higher co-morbidity risk (e.g., for diabetes)36....

Card Front: What is the prevalence of Metabolic Syndrome among US adults? Card Back: Approximately 36% of adult women and 30% of adult men in the US have metabolic syndrome36....

Card Front: What causes Metabolic Syndrome, according to the sources? Card Back: The sources suggest two major hypotheses: low-grade chronic inflammation and increased oxidative stress36.... Inflammation, particularly from enlarged adipose cells, leads to insulin resistance, obesity, type 2 diabetes, and cardiovascular complications34....

Card Front: How does obesity promote inflammation, and what are some inflammatory markers? Card Back: Obesity promotes inflammation because adipocytes (fat cells) secrete inflammatory cytokines39. Visceral fat (around organs) secretes more inflammatory cytokines34.... Key inflammatory cytokines mentioned are TNF-alpha, IL-6, and CRP36.... CRP is a marker of inflammation34....

Card Front: How does exercise training help reduce chronic inflammation? Card Back: Exercise training decreases pro-inflammatory cytokines (TNF-alpha, CRP)34... and increases anti-inflammatory cytokines (such as IL-6 produced by muscle)34.... It also improves adipose tissue, endothelial cells, and immune cells, leading to reduced systemic inflammation40.

Card Front: What is the difference between sedentary behavior and physical inactivity? Card Back: Sedentary behavior is time spent sitting, reclining, or lying with low energy expenditure (<1.5 METs)20.... Physical inactivity is not meeting the recommended guidelines for moderate-vigorous physical activity21. One can be both sedentary and physically active21....

Card Front: What are the health risks of being highly sedentary, even if you meet physical activity guidelines? Card Back: Highly sedentary people are at a higher risk for all-cause mortality3.... Being physically active does not completely counter the negative effects of being highly sedentary3.... Prolonged sitting decreases blood flow, affects metabolic health (triglycerides, HDL, insulin sensitivity), and increases blood pressure, contributing to atherosclerosis41. Sitting for more than 8 hours a day increases all-cause mortality risk42.

Card Front: What are some strategies to counteract the negative effects of prolonged sitting? Card Back: Prioritize movement and physical activity throughout the day41. Take regular breaks from sitting (stand, stretch, walk)41. Use standing desks or active workstations41. Engage in regular structured exercise (e.g., 150+ mins moderate aerobic weekly)41.

Card Front: How significant is physical inactivity as a risk factor for Coronary Heart Disease compared to other factors? Card Back: Inactivity is an independent risk factor for CHD2.... Physically inactive individuals are two times as likely to suffer from CHD as active individuals2. The relative risk of CHD due to inactivity is similar to other risk factors like smoking, high cholesterol, and high blood pressure2.... Being physically active is considered the greatest way to reduce CHD2.

Card Front: What percentage of the US population is classified as overweight or obese? Card Back: 39.8% of adults are obese43, and 66.3% are classified as obese or overweight43.

Card Front: What diseases is obesity linked to an increased risk for? Card Back: Obesity increases disease risk for CHD, Hypertension, Type 2 diabetes, and Cancer43.