BIO 460 exam 1

Physical Fitness

"The ability to carry out daily tasks with vigor and alertness, without undue fatigue and with ample energy to enjoy leisure pursuits..." Measurable health and skill-related attributes that include cardiorespiratory fitness, muscular strength/endurance, body comp, flexibility, balance, agility, reaction time, and power

• VO2max must meet #1, or 2 out of 3 of #2-4: 1. Plateau of VO2 with increased power output (failure to increase oxygen uptake with increase in intensity) 2. RER >1.10 (CO2/O2) CO2 out:O2 in 3. RPE > 17 4. HR within 10 beats of age-predicted Hrmax 220-20 = 200 BPM so ≥190BPM • "VO2peak" is the maximal oxygen uptake documented without meeting the criteria for a VO2max.

"VO2max" vs. "VO2peak": Criteria

Risk of Cardiac Events: Exercise Testing

- Risks: • acute myocardial infarction (MI) • ventricular fibrillation • hospitalization • death - Mixed population: • Risk of exercise testing is low. • ~6 cardiac events per 10,000 symptom-limited maximum tests. **risk of AMI following vigorous exercise 50x for habitually sedentary -habitually training dec risk for CV issues

Physical fitness

A set of attributes or characteristics that people have or achieve that relates to the ability to perform PA

Exercise

A type of physical activity consisting of planned, structured, and repetitive bodily movement done to improve or maintain physical fitness

BOD POD

Air Displacement Plethysmography Dual-chamber plethysmograph that measures body volume by changes in pressure in a closed chamber

• Height: cm or m • Weight: kg • Body Mass Index (BMI): kg/m^2 • Circumferences: cm

Anthropometric Methods *know the values/conversion

Physical activity (PA)

Any bodily movement produced by the contraction of skeletal muscles that results in a substantial increase over REE

Purpose of Physical Fitness Testing

Assess different components of fitness -Develop physical fitness profiles for individuals -Identification of strength and weaknesses Allows setting realistic and attainable goals -Helps make accurate and precise exercise prescription tailored to the individual Evaluation of progress and response to an exercise program *more precise info = more precise EX Rx *watch your own improvement/progress

4 kg

Assume this man weighs 70 kg. Approximately how much do you think he weighs submerged?

CARDIORESPIRATORY FITNESS- CRF

Best predictor of morbidity and mortality Low levels associated with inc risk of death from all causes - and esp. CVD Improved levels associated with dec in death from all causes High levels are associated with higher levels of habitual PA → additional health benefits

VO2 = (VI * FI O2) - (VE * FEO2) O2 in ≠ O2 out but N2 in = N2 out (VI * FI N2) = (VE * FEN2) Rearrange: VI = VE * FEN2 / FI N2 Now we have VI that we can plug in our equation VO2 = (VI * FI O2) - (VE * FEO2) VI = VE * FEN2 / FI N2 Final Rearrange: VO2 = VE * [(FEN2 * FI O2 / FI N2) - FEO2] Same process for CO2 : VCO2 = VE * [FECO2 - (FEN2 * FI CO2 / FI N2)] ***Keep all fractions (FE/FI ) to 4 decimal places Example: VO2 = VE * [(1- FEO2- FECO2) * 0.2093 / 0.7904) - FEO2

How Measure VO2 max with only exhaled air?

MAXIMAL EXERCISE TESTING SUBMAXIMAL EXERCISE TESTING FIELD TESTS (can be max or submax, usually measure own HR-most practical)

How Measure/Assess CRF?

PA is a complex concept which can be determined separately by different indicators: - Frequency - Duration - Intensity ...but is really a product of the interaction between all three

How can we assess/quantify PHYSICAL ACTIVITY?

VO2 = (VI)(FIO2) - (VE)(FEO2) Indirect calorimetry (how much O2 is consumed, calories) direst = measure heat production Open circuit spirometry Know: FI O2= 0.2093 FI CO2= 0.0003 FI N2 = 0.7904

How do we measure O2 consumption?

Physical Function

The capacity of an individual to carry out the physical ADL. Reflects motor fx + control, physical fitness and habitual PA. Independent predictor of fx independence, disability, morbidity and mortality

mortality

likelihood you will die from disease

Activity Monitors (2nd gen)

measure HR using light absorbed

VO2 max Protocol Selection

modality- typically treadmill/cycle ergometer => more ppl able to give max effort => makes VO2max test easier

morbidity

risk factors of disease like obesity

Submaximal Test Protocols

• ACSM Bicycle Ergometer Submaximal Exercise Test • Astrand-Rhyming Step Test: known height and weight • Multistage or Single-stage Walking/Jogging Test Typically terminated when HR reaches 85% of age-predicted HRmax

Expressing VO2 max

• Absolute - L/min • Relative - mL/kg/min or mL/kgFFM/min (fat free mass, not typically used) • What are typical values/norms? men = 50 women = 40 but not every table is equal

SKILL-RELATED

• Agility • Coordination • Balance • Power • Reaction Time • Speed ***can also be trainable

Subjective Methods to Assess PA Questionnaires

• Applicable in epidemiological studies • Gives gross classification of PA for a population (i.e. low, moderate, highly active) • Limited validity - No detailed information of PA - Dependent on subjects memory and interpretation; how active you used to be at a certain age

Assessment Areas

• Body Composition & Anthropometrics (measurement of humans) • Cardiorespiratory Fitness - Maximal vs. submaximal - Treadmill, cycle ergometer, step tests - Field tests • Muscular Fitness - Maximal strength, power, endurance • Anaerobic Power • Flexibility • Agility

HEALTH-RELATED

• CV Endurance • Body Composition • Muscular Strength • Muscular Endurance • Flexibility

6x

• Cardiac Rehabilitation - In one survey, there was: - 1 nonfatal complication per 34,673 hours - 1 fatal cardiovascular complication per 116,402 hours - More recent studies have reported even lower rates - Mortality rate: ___ in facilities without ability to successfully manage cardiac arrest.

10,000

• Exercise-related cardiac events in adults - Absolute risk of sudden cardiac death during vigorous PA has been estimated at one per year for every 15,000 to 18,000 individuals - Another study reported a risk estimate of 0.3 to 2.7 events per ____ person-hours for men and 0.6 to 6.0 events for women

RESISTANCE EXERCISE

• Frequency: 2-3 d/wk • Intensity: % 1-RM depending on goal • Time: no specific duration • Type: Resistance ex involving major muscle groups • Repetitions: 8-12 reps to improve strength and power 15-20 reps to improve muscular endurance • Sets: 2-4 sets Pattern: 2-3 min rest btw sets, min. 48 hrs btw sessions • Progression: gradual

Preparticipation Screening: ATHLETES

• Health history questionnaire - Prior and current injuries - Medications - Supplements • EKG • Musculoskeletal (most common adverse affect of exercise) Screening Tests - Posture, mobility, joint stability • Blood tests

Prevention of EX-related cardiac events

• Healthcare professionals should know the pathologic conditions associated with exerciserelated events so that physically active children and adults can be appropriately evaluated • Active individuals should know the nature of cardiac prodromal symptoms and seek prompt medical care if such symptoms develop. • High school and college athletes should undergo preparticipation screening by qualified professionals. • Athletes with known cardiac conditions should be evaluated for competition using published guidelines. • Healthcare facilities should ensure staffs have - Training in managing cardiac emergencies - A specified plan - Appropriate resuscitation equipment • Active individuals- modify exercise program in response to - exercise capacity - habitual activity level - environment

Maximal Oxygen Consumption: VO2max

• Highest rate at which O2 can be taken up and utilized by the body during severe exercise (aerobic) • A marker of CRF / aerobic capacity (inc ___ = CRF) • Most common method used to show training effect in research studies • Use in exercise prescription

Benefits of Regular Exercise

• Improved CV and Respiratory Function --• VO2 max, LT • Reduced CVD Risk Factors --• BP, Lipid profile, Body composition --• Insulin sensitivity, Coagulation, Inflammation • Decreased Morbidity and Mortality --• Primary prevention --• Secondary prevention

Importance of Metabolic Calculations

• It is imperative that exercise physiologists can interpret test results, calculate work and energy expenditure • Optimizing exercise protocols • Exercise prescription

Recommended Laboratory Tests

• Lipid profile (fasting) - Total cholesterol - LDL-C (VLDL very low) -HDL-C - Triglycerides • Plasma glucose (fasting) • CBC (complete blood count) + blood chemistry

Initial Risk Stratification (old guidelines)

• Low - Men < 45y, women < 55y, asymptomatic, no more than one risk factor • Moderate - Men > 45, women > 55, asymptomatic, 2+ risk factors • High -One or more signs/symptoms, or known CV, pulmonary, or metabolic disease

Medical and Health History (Box 3.1)

• Medical diagnosis • Previous physical examination findings • Laboratory findings • History of symptoms • Recent illness, hospitalization, new medical diagnoses, or surgical procedures • Orthopedic problems • Medications, supplements and drug allergies • Caffeine, alcohol, tobacco, or drug use • Exercise history • Work history • Family history

Informed Consent- Explanation of Testing

• Obtaining informed consent from participants before exercise testing is an important ethical and legal consideration • Content and extent may vary. Enough information must be in the informed consent process to ensure participant knows/understands the purpose/risks associated with the testing • Test may be: - Diagnostic - Ex RX - For experimental (scientific) purposes • All stages are subject to approval - IRB - Safety Committee

Activity Monitors (1st gen)

• Omnidirectional accelerometers • Minute-by-minute EE • Easy to collect data for an extended period • Indication of intensity of the movement *logs continuous activity; inc intensity = inc acceleration measured

Public Health Perspective for Current Recommendations

• Over 20 yr ago, ACSM in conjunction with the CDC, the U.S. Surgeon General, and the NIH issued landmark publications on PA and health • What are the amount and intensity of PA needed to: - improve health? - lower susceptibility to disease (morbidity)? - decrease premature mortality? • They documented the dose-response relationship between PA and health (i.e., some activity is better than none, and more activity, up to a point, is better than less)

Major Signs or Symptoms Suggestive of Cardiovascular, Metabolic and Renal Disease

• Pain; discomfort (or other anginal equivalent) in the chest, neck, jaw, arms, or other areas that may result from ischemia-low amt of blood flow, may lead to hypoxia • Shortness of breath at rest or with mild exertion • Dizziness or syncope-fainting • Orthopnea (trouble breathing laying down) or paroxysmal nocturnal dyspnea-painful breathing • Ankle edema-swelling • Palpitations or tachycardia- high HR • Intermittent claudication • Known heart murmur • Unusual fatigue or shortness of breath with usual activities

Pre-participation screening SUMMARY

• Physical Exam findings - Risk stratification? • Laboratory Tests - Blood - CBC, lipids, Chemistry panel - Blood pressure - Pulmonary Function • Current Physical Activity Hx - Previous exercise test findings - Current physical activity level - detailed - Signs and symptoms (SxS) - Frequency, Type

Risk Factors

• Positive Risk Factors (bad) - old Age (men >45y, women >55y) - direct Family History (MI, bypass, death before 55 in dad, 65 in mom) - Cigarette Smoking (current or quit within 6 mo/2nd hand smoke) - Physical inactivity - Obesity - Hypertension - Dyslipidemia - Diabetes • Negative Risk Factor (good) - High serum HDL (> 60 mg/dl)

3

• Risk estimates per 10,000 person-hours - 0.3 to 2.7 events per for men - 0.6 to 6.0 events for women ---call it 1:10,000 hours of exercise For example: • Boston Marathon - ~30,000 registered participants (per year!) - ~3:50 avg finish time (call it 4 hours) - 30,000 persons * 4 hours = 120,000 person-hours - 120,000/10,000 = 12 cardiac events estimated per year? • The Boston Marathon has been run for 115 years during which there were ___ sudden cardiac arrests

Risks associated with exercise

• Sudden cardiac death in young individuals - Congenital and hereditary abnormalities (hypertrophic cardiomyopathy (heart muscle grows too much), coronary artery abnormalities, aortic stenosis (stiffen/thicken)) - Absolute risk of exercise-related death among high school and college athletes is low - Of the 136 total identifiable causes of death, 100 were caused by cardiac disease.

VO2 max/Stress testing

• Test Preparation - Equipment calibration - Protocol selection • Subject Preparation - Health history (meds)/Exercise history - EKG prep/Resting EKG evaluation - Resting BP - Explaining the procedure

Submaximal Test Example: ACSM Bicycle Ergometer Submax Test

• The protocol is based on body weight and activity level: • Measure HR during the last 15 sec of each workload: at end to measure steady state • Stop the test when HR reaches 65-70% of HRR or 85% of age-predicted HRmax • Graph HR vs. submaximal work rates to estimate maximal work capacity

Purpose of Preparticipation Health Screening and Risk Stratification:

• To identify individuals: - at risk for serious exercise-related CV events or other medical contraindications requiring exclusion from exercise programs - with clinically significant disease(s) or conditions who should participate in a medically supervised exercise program - needing medical clearance prior to engaging in exercise

VO2 max test: Criteria for termination (without EKG)

• Typically: VOLITIONAL EXHAUSTION: cannot go any longer, will fall off treadmill • Onset of chest pain: hypoxia • Drop in SBP or excessive rise in BP • Leg cramps, claudication: pain in lungs • Signs of poor perfusion • Failure of HR to increase with increased work load: possibly reached VO2max or another physiological reason • Failure of testing equipment • Subject requests to stop

Basic Goal: determine if safe for an individual to start an exercise program What type of exercise testing is appropriate What medical supervision is necessary given type of EX testing What is the goal of the exercise program Four "risk modulators" are considered: Individual's current level of PA Presence of signs/symptoms of CV, metabolic, or renal disease Known cardiovascular, metabolic, or renal disease The desired exercise intensity What's the greatest risk? vigorous exercise

What is involved in the pre-screening process?

25.9 kg/m^2 false; they are in overweight category BMI: 25 and 30 (obese vs overweight)

What is the BMI of an individual who weighs 201 lbs and is 74 inches tall? True or false: Based on their BMI, this individual is considered obese.

METs 1 MET = energy of rest 2 MET = 2 X energy of rest 1 MET = 3.5 mL O2/kg/min = RMR of a healthy 40y, 70-kg man...

What terms can we use to define or prescribe exercise intensity? (absolute value)

Aims of Medical Screening for athletes

1. Prevent sudden death 2. Ensure optimal medical health asthma, diabetes, menstrual, depression 3. Ensure optimal musculoskeletal health 4. Optimize performance Nutrition, psychology, biomechanics 5. Prevent injury 6. Review medications and vaccinations 7. Collect baseline data Blood tests, neuropsychological testing in contact sports 8. Develop professional relationship with athlete 9. Educate

• Incomplete medical screening • Elevated resting BP (>160/95 mm Hg) • 2nd or 3rd degree heart block, fixed rate pacemaker, • MI, angina, or heart failure within last 3 mos • Uncontrolled or severe chronic disease state • Acute illness (flu) • Any sign or symptom that makes the GXT potentially hazardous

Contraindications to GXT

Field Tests

Cooper 12-minute Run Test: VO2 max (mL/kg/min) = (distance in meters - 504.9) / 44.73 • 1.5 mi run/walk test: VO2 max (mL/kg/min) = 3.5 + 483 / 1.5 mi time (min) • Rockport One-Mile Walking Test • Step Tests Key: in general, to move a certain distance, it takes a given amount of energy (relative to body weight) so if we know how long it takes to go a distance (or how far you can go in a given time) we can estimate the VO2 required to complete that task.

• CONTRAINDICATION criteria: reasons to not start test • TERMINATION criteria: during test • "SUCCESSFUL TEST" criteria: did they actually reach VO2max

GXT criteria

Physical Inactivity

Global pandemic identified as 1 of 4 leading contributors to premature mortality Globally, 31.1% of adults are physically inactive United States: • 51.6% of adults meet aerobic activity guidelines • 29.3% meet muscle strengthening guidelines • 20.6% meet both the aerobic and muscle strengthening guidelines

INTEGRATED HEART RATE

Using conductive materials woven into the vest, Vector is designed to make heart rate monitoring comfortable for athletes and efficient for practitioners

<3.0 Very light/Light 3.0-5.9 Moderate ≥6.0 Vigorous

METs intensity classifications (which values should you know?)

preexercise eval- already in clinic screening- overall eval

Preexercise Evaluation (vs. exercise preparticipation health screening?) What is the "clinical" process? 1. Clinical/research setting, obtain informed consent 2. Medical and health history 3. What goals for activity does the person have? 4. Risk stratify based on CAD risk factors 5. Decide whether it is recommended to exercise test the person AND what type of test is appropriate 6. Decide if your facility can test the person

Health Concerns - Contraindications: reason not to do something (like taking a certain medication) - Increased Risk - Medical supervision or other special needs

Reasons for screening?

• Moderate-intensity aerobic activity Minimum 30 min on 5 days each week OR • Vigorous-intensity aerobic activity Minimum 20 min on 3 days each week Combination Minimum goal should be 500-1000 MET ∙ min ∙ week^-1

Recommendation Guidelines for Cardiovascular (aerobic) Exercise

Exercise Preparticipation Health Screening

Recommendations are not a replacement for sound clinical judgment • Decisions about referral for medical clearance prior to an exercise program should be made on an individual basis • CEP (cardiovascular exercise professional) - when working with individuals with known disease, a more in-depth risk stratification criterion is recommended

Risk Factors

These are clinically relevant established CVD risk factor criteria and should be considered collectively when making decisions about the: - level of medical clearance - need for exercise testing prior to initiating participation - level of supervision for both exercise testing and exercise program participation onset of exercise = inc risk ongoing = dec risk

Submaximal CRF testing

Uses HR response to predict VO2 max -Accuracy/reliability? pretty good but uses assumption More accurate if following assumptions are met: 1. Steady state HR is obtained for each work rate 2. A linear relationship exists btw HR and work rate/intensity/power output 3. Difference btw actual and predicted HRmax is minimal 4. Mechanical efficiency (VO2 at a given work rate) is the same for everyone (this is not true) 5. Subject is not on meds that alter HR response 6. HR response is not affected by environment (temp), illness, or supplements

Anyone: Apparently healthy adults Individuals with known conditions Athletes

Who is involved in the pre-screening process?

more dense in water = sink; less adipose tissue (more muscle mass) *need to empty lungs bc air in lungs floats

Who weighs more in water?

physical fitness components

health vs skill related

dose-response

inverse or direct response? ex) inc exerc = dec mortality = inc general health