Chapter 12 exercise

exercise and arthritis

improved joint function and ROM increase muscle strength and aerobic fitness: enhance ADLs improves phycological state decreases loss of bone mass decreases risk of chronic disease exercise guidelines: daily develop joint rom and flexibility 2-3 times a week: muscle strengthening most days: aerobic exercise, recreational activities choose activities with low stress on joints: walks, cycle swim

Which population made progress in the total amount of physical activity, according to Healthy People 2020?

Obese individuals

According to the National Health and Nutrition Examination Survey (NHNES), which age group has the highest percentage of obesity?

12- to 19-year-olds

Activity recommendations for adults with diabetes include:

150 minutes of accumulated weekly physical activity for all adults living with diabetes, including those with type 1 diabetes, with no more than two consecutive days of no physical activity Resistance training 2-3 times per week Children and young people with diabetes should perform at least 60 minutes of physical activity per day

or endurance training, the ACSM recommends

3-5 sets of 8 to 12 repetitions

For strength and power development, ACSM recommends:

2-4 sets of 8-12 repetitions With 2 to 3 minutes of rest between sets Rest of ≥48 hours between sessions for any one muscle group

According to the CDC (2015), older adults require at least:

2.5 hours of moderate-intensity aerobic activity weekly Muscle strengthening on two days or more per week According to data from the BRFSS, over 30% of older adults do not engage in leisure-time physical activity

a sports beverage should generally contain:

20 to 30 mEq of sodium per liter 2 to 5 mEq of potassium per liter 5% to 10% of carbohydrates

The recommended amount of moderate intensity aerobic activity for all healthy Americans should include at least 30 minutes for how many days per week?

5

physical fitness

A set of attributes that people have or achieve that relates to the ability to perform physical activity without undue fatigue or risk of injury; includes: Cardiorespiratory fitness Muscular fitness Flexibility

aerobic exercise

Activity using large muscle groups to improve oxidative energy- producing system and improve cardiorespiratory status Fuel= adipose tissue

Flexibility

Adequate muscle length and joint mobility to allow free and painless movement (wide ROM) - STRETCH muscles/ increasing joint rom - hold position 10-20 seconds ; repeat 3-5 times

General recommendations by ACSM (2018) for individuals with heart failure are:

Aerobic activity 3-5 days per week - At 60% to 80% HR or an RPE of 11 to 14 - Beginning at 30 minutes and increasing to 60 minutes - Using walking or stationary cycling Resistance training 1-2 days per week - At 40% to 50% 1 rep max increasing to 70% over several months - Performing 2 sets of 10 to 15 repetitions with major muscle groups Static or PNF stretching 2-3 days per week minimum, with 10 to 30 second holds

what increases cardiorespiratory fitness and functional capacity

Aerobic exercise

What are recommendations for aerobic exercise, including frequency, intensity, and duration?

Benefits of aerobic exercise are cumulative. Recommended frequency is 3 to 5 times a week. Every other day :Is a good frame of reference Allows recovery between training sessions, potentially decreasing the chance of overuse injuries Recommended duration of aerobic conditioning exercise is generally 20 to 60 minutes. Walking is probably the most accessible and popular form of aerobic exercise.

Obesity Statistics

Between 1999 to 2000 and 2015 to 2016, there was a significant increase in obesity in adults from 30.5% to 39.6% OBESE: 41.1% among women 37.9% among men Prevalence of overweight adults decreased from 34.0% in 1999 to 2000 to 31.6% in 2015 to 2016. Prevalence of severe obesity increased from 4.7% to 7.7% during the same time frame.

Studies with school-aged and obese children found that physical activity training and exercise were associated with reductions in:

Blood pressure Triglycerides Overall cardiovascular risk profiles

physical activity

Bodily movement that results in energy expenditure and encompasses many modes and intensities. Movement that is not structured exercise such as recreational pursuits (e.g., golfing, gardening, and walking a dog). Common modalities: Transportation, vocational and leisure time activity

The yoga philosophy encourages an appreciation of:

Body sensations Slow stretching Maintenance of proper posture

Range of acceptable exercise duration allows greater flexibility and gives reassurance of benefit to the individual who varies exercise choices daily on the basis of:

Capability Interests Life demands

How do obesity rates vary by age and sex?

Children and adolescents (aged 2 to 19 years) are categorized as being obese if their body mass index (BMI) is equal to or greater than the 85th percentile in age- and gender-specific BMI growth charts. BMI is expressed as weight in kilograms divided by height in meters squared. 18.5% of children and adolescents are obese Percentage has steadily increased from 13.9% in 2007 Same pattern found in both sexes

When and why should exercise be reduced or ceased?

Choosing to stop or reduce the amount of exercise when not feeling well is the right choice. Missing an occasional workout will not affect the fitness level. However, after missing workouts for 2 weeks, a decline in fitness is inevitable. When starting exercise again, resumption of the activity should be slow, gradually working back to the usual level of activity. Inactivity for 3 to 5 months results in the loss of all conditioning benefits gained. Resumption of exercise involves starting over

In addition to the Healthy People initiative, there is a National Physical Activity Plan that:

Complements the initiative Offers evidence-based strategies and tactics to attain the objectives Takes into account the demonstrated relationship between physical activity and an improvement in the biological markers associated with health Identifies reasons for the trend toward a more sedentary lifestyle Has a vision that all Americans will be physically active in all aspects of their lives - Including work and play

three interacting cognitive processes

Confidence in the ability to be physically active is strongly related to participation and compliance self efficacy goals to outcome expectations

Tendency to be sedentary:

Continues to increase with age Affects all the body's systems, including: Cutaneous Cardiovascular Respiratory GastrointestinalUrinary

Purposes of weight training from a health perspective are to:

Develop healthy muscles that provide the strength to do daily activities without risk of injury Stimulate bone health ACSM (2018) recommends the incorporation of bilateral and unilateral and single-joint and multijoint exercises, including total body exercises.

What measures can be taken to maintain normal blood glucose levels?

Diet Weight control Exercise

Physical activity may be most beneficial in preventing the progression of type 2 diabetes:

During the earlier stages of the disease process Before insulin therapy is required

Which intervention has shown to be the most effective in decreasing childhood obesity?

Early detection

Major functions of insulin are to:

Promote glucose uptake into the cells Control metabolic homeostasis during exercise, working in synergy with the counter-regulatory hormones

Which component produces the best outcomes when it comes to obesity management? Select all that apply. One, some, or all responses may be correct.

Exercise Cognitive strategies Behavioral techniques Nutrition management Social support strategies

How can exercise vary, and why?

Exercise focus can and should vary on a daily basis depending on need, mood, and intent. Some days it feels right to focus on the more physical aspects of the activity, appreciating the challenge of working harder or longer.

A holistic approach to physical activity involves:

Exercise for cardiorespiratory health, for endurance Exercise for musculoskeletal health for: Strength Flexibility Bone density

Exercise and Osteoporosis

Exercise helps maintain/build bone density, especially weight-bearing exercise goal is to increase mechanical stress on bone exercise guide: 20-30 minutes frequency 3-5 times a week intake CA++ AND vit D essential increased fx --> older women high morbidity and mortality with fx

first-line intervention for diabetes

Exercise, in addition to diet During physical activity, contracting skeletal muscles work with insulin to enhance glucose uptake into the cells Exercise: Increases insulin sensitivity Improves the inherent effect of endogenous insulin Decreases obesity Plays a role in lowering TRG levels and blood pressure

What are recommended physical activity guidelines?

F (frequency)Aerobic exercise three to five times a weekResistance training two to three times a week I (intensity)Moderate to vigorous, by heart rate and perceived exertion Able to complete each resistance exercise, 8 to 12 repetitions, without strain T (time) 20-60 minutes, plus warm-up and cool-down periods 15-30 minutes to complete a series of 8-10 resistance exercises T (type) Aerobic (walking, jogging, biking, swimming, rowing, cross-country skiing, elliptical trainer, NordicTrack, StairMaster, aerobics, dancing, skating, or rollerblading)Multijoint resistance training including free weights and machines (e.g., chest press, pull downs, pushups, squats, etc.)

Body awareness and mindfulness during exercise:

Facilitate self-inquiry and self-acceptance Help to relieve psychological stress Prevent physical injury

Complications of diabetes include:

Heart disease and stroke Peripheral arterial disease Retinopathy Nephropathy Peripheral neuropathy Lower-extremity amputation

Cool-down period:

Follows the endurance phase Usually lasts 5 to 10 minutes Allows the body to readjust gradually from the demands of exercise back to the baseline May consist of stretching and slow, rhythmical movement that help to: Increase muscle elasticity Prevent blood pooling and hypotension Facilitate dissipation of body heat Facilitate the removal of lactic acid Benefits include prevention of: Injury Light-headedness Fatigue Muscle soreness

Despite the abundance of research on the positive effects of exercise, research has not yet established the optimal dosage, including:

Frequency Time Duration

These individuals should have a medical evaluation, including an exercise tolerance test, before starting the program to determine:

Functional capacity Severity of disease

What is the role of water and hydration in the human body?

Functions as a solvent Regulates cell volume Plays a critical role in thermoregulatory and overall function A hypohydrated state has been linked to: Decreases in: Exercise and sport performance Cognitive function Mood Consuming beverages containing electrolytes and carbohydrates may be beneficial If a rapid recovery is needed, drinking 1.5 L/kg of body weight water loss is beneficial.

Slow, controlled movements result in:

Greater benefits Lower risk of injury More appreciation of how the body feels as its muscles are challenged

How does genomics explain the risk of diabetes?

H63D variant was associated with a moderate increase in the odds/risk of type 2 diabetes.

people with diabetes:

Have a lower maximum heart rate Achieve a lower cardiac output at maximal exercise Have a higher blood pressure during exercise These result in LOWER maximal oxygen consumption.

Strength training can keep the heart healthy by:

Helping to control body weight Reducing cholesterol levels Regulating blood glucose levels

anaerobic exercise

High-intensity, short-duration activity that improves the efficiency of the phosphocreatine and glycolytic energy-producing systems; increases muscle strength, power, and speed of reactivity; Fuel = uses phosphagens, glucose-glycogen as major fuel sources.

growing body of evidence to support the use of yoga to:

Increase ROM Reduce pain Improve: Posture, Function, Mental health, Sleep patterns Reduce disability Improve quality of life in select populations

Diabetes mellitus encompasses a group of metabolic disorders that have in common:

Increase in blood glucose levels Associated metabolic dysfunction Type 1 involves elevated blood glucose levels that are a result of a deficiency of circulating insulin caused by destruction of the pancreatic β cells. Type 2 diabetes involves elevated blood glucose levels from insulin resistance (decreased insulin sensitivity)—largely in skeletal muscles—or impaired insulin secretion Insulin resistance impedes glucose mobilization into cells, thereby increasing plasma glucose levels. Although insulin resistance in skeletal muscles may be the primary defect, the development of disease appears to be related to elevated insulin levels, as a result of the body's response to the need to mobilize glucose into the cells. 10% pop have DM TYPE 2 34.5% prediabetic

How does exercise affect individuals with diabetes? Diabetic individuals can:

Increase their exercise capacity with training Experience benefits related to overall fitness and cardiorespiratory training similar to benefits gained by people without diabetes

Ketosis may also result from:

Increased mobilization and incomplete combustion of free fatty acids in muscle cells Accelerated ketone body formation in the liver

The purpose of healthy weight training is to develop which characteristic?

Increased strength

Resistance training

Increases muscle strength and endurance Increases muscle mass Increases metabolic efficiency Maintains or increases bone density Prevents limitations in performance of everyday tasks Decreases the effort required to perform these tasks Decreases the potential for injury during physical activity Resistance training is recommended for older adults because it has a positive effect on many of the degenerative problems associated with the aging process.

Research literature strongly demonstrates that the risk of coronary heart disease (CHD) decreases as physical activity increases:

Increasing levels of high-density lipoprotein (HDL) cholesterol Decreasing levels of low-density lipoprotein (LDL) cholesterol Decreasing total cholesterol levels Decreasing serum triglyceride (TRG) levels Decreasing high blood pressure Improving glucose tolerance and insulin sensitivity Decreasing obesity; altering the distribution of body fat Reducing the sensitivity of the myocardium to the effects of catecholamines, thereby decreasing the risk of ventricular arrhythmias Enhancing fibrinolysis and altering platelet function

Regular physical activity:

Is an important component of primary prevention Is an essential modality in the treatment of chronic disease Establishes the potential for benefit in all aspects of the biopsychosocial and spiritual model of health

Walking at least twice daily for a total of 20 minutes:

Is associated with less functional decline in older adults Benefits individuals with lower functional status

rheumatoid arthritis and exercise

LOW impact chronic systemic autoimmune disease aerobic and resistance exercise: muscle strength, joint mobility, reduced inflammation postpone exercise during exacerbations

Activities that help preserve lean body mass involve:

Lifting Carrying Performing repetitive movement against resistance, such as: Vacuuming, Raking, Shoveling, Kneading dough with baking bread

Individuals who should consult an appropriate health care provider before starting vigorous exercise (intensity more than 60% of maximum heart rate or Vo2max) include:

Men older than 40 years Women older than 50 years Individuals who have a chronic disease or risk factors for chronic disease

AGE groups that are obese

Middle-aged adults (40 to 59 years) have the HIGHEST rate at 42.8%. Older adults (60 years or older) are in the middle at 41.0%. Younger adults (20 to 39 years) demonstrate the lowest rate at 35.7%.

appears to have the greatest effect on HDL levels with a threshold of 1,200 to 2,200 kcal/week

Moderate-intensity aerobic exercise training

Weight that is lifted should result in near muscle fatigue at the end of each set and differs substantially depending on:

Muscle being trained Amount of resistance Fitness level of the athlete

Making progress in the percentage of subpopulations who engaged in moderate or vigorous physical activity were:

Non-Hispanic Black individuals, increased from 52.7% to 62.2% Older Americans (>65 years), improved from 44.3% to 49.1% Women, improved from 55.3% to 59% Individuals with obesity, improved from 55.4% to 61.5%

Intensity is defined by:

Objective measure of heart rate (HR) Subjective measure of perceived exertion Increase in HR during exercise has a strong linear relationship with exercise intensity and aerobic capacity. Resting heart rate is the HR measured at rest. Maximum heart rate is the rate measured at the highest workload tolerated during exercise and decreases with age.A generic formula for determining maximum heart rate is 220 minus age.

What is the relationship between the Healthy People initiatives and individual health?

Only 24% of the adult population met both the aerobic and muscle resistance training recommendations in the United States in 2018. 25.4% of adults 18 years or older reported no leisure-time physical activity

Adults, those aged 20 years or older, are classified as:

Overweight if their BMI is 25.0 to 29.9 kg/m2 Obese if their BMI is 30.0 kg/m2 or higher Extremely obese if their BMI is 40 kg/m2 or higher

What type of exercise has been shown in research to prevent or treat hypertension?

Percentage of the US population with hypertension was similar between the sexes, men more at 30.2% Variation in prevalence of hypertension is noted among racial and ethnic groups in the United States. BLACK MOST COMMON

Cross-training can mean either:

Performing different types of exercise on different days of the week Performing different types of exercise within one session Benefits of cross-training include: Decreased risk of musculoskeletal injury Increased potential for total body conditioning Improved long-term compliance because variety decreases boredom and eliminates the exercise barrier of limited choices

How does exercise impact the musculoskeletal system and the brain?

Physical training results in positive outcomes for brain: Structure Function Cognition There is evidence that greater cognitive performance of executive functions is associated with: Moderate intensity aerobic exercise Resistance training Combination training Physical activity has been consistently found to be associated with reduced risk of developing: Dementia Alzheimer disease Mild cognitive impairment Decline Health of the musculoskeletal system depends on movement and activity. Bone is a dynamic tissue. Bone strength depends on stresses applied by mechanical stress during active movement including:Muscular activityWeight bearing Exercise may increase or maintain bone mineral density (BMD). Recent meta-analytic data suggest that the effects of exercises on BMD may depend on: Mode of exercise Body part Combination of exercises Concurrent treatments such as pharmacological Health of the cartilage covering the joint surfaces is vital for maintaining proper joint function. To stay healthy, joints must move and, in the lower extremities, bear weight. The only way the cartilage can receive nourishment is through the manufacture and distribution of synovial fluid, which: Delivers nutrients Removes waste products Lubricates joint surfaces

with injected insulin:

Plasma insulin concentration does not decrease with exercise. Hepatic glucose is not produced as quickly as it is used. A decrease in blood glucose concentration results.

goal of healthy people 2030

Preschool-aged children (ages 3 to 5 years) should be physically active throughout the day to enhance growth and development. Children and adolescents (6 to 17 years) should perform at least 60 minutes of moderate to vigorous physical activity daily. OR 150 minutes per week Adults should perform at least 150 minutes of moderate-intensity activity per week or 75 minutes of vigorous activity per week.

Periodization involves planned training variations relating to the exercise

Volume Intensity Frequency

Moderate physical activity and resistance training have both been found to improve which activity of daily living (ADL)?

Quality of gait

Combining resistance and aerobic exercise led to:

Remarkable reductions in LDL levels Significant increases in HDL levels Significant decreases in total cholesterol levels

Successful elicitation of the RR involves two basic components:

Repetitive focus: Breath,Mantra,Cadence or rhythm of physical activity Nonjudgmental attitude About everyday thoughts and the quality of performance

Once 12 to 15 repetitions can be completed without fatigue:

Resistance can be increased by 5% or less Same weight can be used to do an additional set to fatigue

Commonly cited interventions for physical activity and exercise include:

Self-monitoring General health education Goal setting Supervised center-based exercise Problem-solving Feedback reinforcement Relapse prevention education

Limitations in the ability to exercise are related to:

Severity of the disease Signs and symptoms of intolerance

the problem are youth activity patterns outside the school experience:

Significant increase in the percentage of 9th to 12th graders who report playing video or computer games or using a computer for three hours or more per day Decrease in the percentage who played on at least one sports team

The various types of flexibility exercises include:

Static stretching - Arguably the most common type of stretching - Muscle or tendon is slowly stretched actively or passively, usually held for a duration of 10 to 30 seconds Proprioceptive neuromuscular facilitation (PNF) -involves an isometric contraction at 20% to 75% maximum voluntary isometric contraction (MVIC) of the targeted muscle for 3-6 seconds - Followed by a static stretch Ballistic stretches use the momentum of the moving body segment to produce a stretch A total of 60 seconds of flexibility exercise per joint is recommended by ACSM

Amount and rate of fluid replacement depends on:

Sweating rate Environment Exercise duration

It has been suggested that decreases in blood pressure and blood lipids in individuals with hypertension can be provided by traditional Chinese exercise, including:

Tai chi Baduanjin qigong Wuqinxi YiJinjing However, a recent systematic review and meta-analysis found no firm evidence to support the effectiveness and safety of this type of exercise due to the poor quality of the studies

How does sex (female, male) affect metabolic rate and body fat?

Tend to have a 5% to 10% lower resting metabolic rate Have a higher percentage of body fat than men of similar weights (McMurray et al., 2014) Have a lower percentage of lean body mass May not be as metabolically active during exercise Women may expend up to 40% fewer calories than men during the same exercise protocol at the same relative intensity Males have a higher average proportion of body fat in the trunk. Females have a larger proportion of body fat in the legs.

In the United States, type 2 diabetes is 30% more prevalent in blacks than in whites.

The presence of type 2 diabetes in each of these ethnic groups provides strong support for the existence of one or more modifiable risk factors in the cause of the disease.

Muscular fitness

The strength and endurance of muscles that allows for participation in daily activities with low risk of musculoskeletal injury.

What factors affect cholesterol and triglyceride (TRG) levels?

There is a strong negative correlation between CHD and plasma HDL levels. Increases in HDL levels lower the total cholesterol to HDL ratio, thereby reducing CHD risk. Exercise has a major influence on lipoprotein metabolism, primarily plasma levels of HDL and TRG. East Asian adults who performed moderate-intensity exercise in a volume of ≥150 minutes per week had significant improvements in: HDL LDL Total cholesterol TRG A meta-analysis of randomized controlled trials examining the effects of progressive resistance training on adults found significant reductions in: Cholesterol levels Ratio of total cholesterol to HDL Levels of non-HDL, LDL, and TRG

What is an exercise prescription, and how does it affect health and wellness?

There is evidence that individuals have increased adherence and improved motor performance when they access: Peer-led exercise groups Integrated programs that turn daily routines into opportunities for exercise Increasing energy expenditure is effective when individuals: Replace sedentary time with short periods of moderate to vigorous physical activity Use frequent levels of light-intensity physical activity

warm-up:

Usually lasts 5 to 10 minutes May include: Light stretching Calisthenics Performance of the chosen aerobic activity at a low intensity Decreases the risks of: Injury Heart irregularities Prepares both the musculoskeletal system and the cardiorespiratory system for the transition from rest to exercise by: Increasing blood flow Respiration Body temperature Muscle flexibility Dynamic stretching exercises within a warm-up may enhance performance including: Strength Jump Speed Explosive movements

people with CHD demonstrate a reduction in

Vo2max and the ability to do submaximal levels of work With exercise training, the increase in Vo2max in persons with CHD averages approximately 20% after 3 months.

Some of the most significant increases in exercise tolerance have been noted in individuals with angina.

With a decrease in submaximal HR or a decrease in systolic blood pressure resulting from conditioning, myocardial oxygen demand is decreased. Individuals are able to do a greater amount of work before reaching the anginal threshold. This boost is reflected in an observed increase in the heart rate-pressure product or double product (RPP: HR × SBP) at the anginal threshold

Populations with Low Rates of Physical Activity

Women are generally less active than men at all ages. People with lower incomes and less education are typically not as physically active as those with higher incomes and education. Black Americans and Hispanics are generally less physically active than Whites. Adults in northeastern and southern states tend to be less active than adults in north central and western states. People with disabilities are less physically active than people without disabilities. By age 75 years, one in three men and one in two women engage in no regular physical activity.

What are the current trends in physical activity in childhood, and how does this affect later health

Youth Risk Behavior Surveillance System (YRBSS) data from the CDC (2017) reveals trends in schools: Decline in percentage of adolescents (9 to 12th graders) who participated in daily school physical education Decrease in youths attending physical education on one or more days Percentage of elementary schools requiring daily physical education decreased Percentage of middle and junior high schools requiring physical education decreased

Guidelines for determination of appropriate individual training for CHD:

aerobic capacity of at least 4-5 metabolic equivalents Ejection fraction of greater than 30% Absence of severe, symptomatic aortic stenosis

Osteoarthritis and exercise

choose low impact exercise should include aerobic and resistance - avoid stressing joints

With exercise, insulin secretion

decreases slightly, and the concentrations of counter-regulatory hormones increase. This increase stimulates hepatic glucose production, which balances the increased use of glucose by the working muscles, maintaining normoglycemia.

low back pain and exercise

health of vertebrae and disk dependent on movement prevent dehabilitation from inactivity; improve endurance, strength and flexibility individualized program- no one regimen prove superior to others

Obesity rates are the highest among which ethnicity in children?

hispanic

Yoga

is an excellent example of a form of exercise to use during warm-up and cool-down periods. "union" During yoga: Mind is quiet Awareness is focused on feeling the body as it moves Movement into and out of yoga postures (called asanas) provides the necessary stimulation of weight-bearing activity. Yoga: Keeps bones strong Provides the movement to increase joint range of motion (ROM)Stretches and tones muscles

What is the relaxation response (RR), and why and how can it be used as part of overall health?

is an inborn set of physiological changes that offset those of the fight-or-flight (stress) or sympathetic nervous system response. When elicited, the RR results in a "letting go" of tension: Physical Emotional Mental Some techniques that are used commonly to elicit the RR include: Diaphragmatic breathing Meditation Imagery Mindfulness Yoga stretching Repetitive exercise

promising treatment option for individuals with type 1 diabetes

moderate to vigorous physical activity of at least 4 hours/week

People with type 2 diabetes should

monitor their blood glucose levels and determine their responses to exercise

exercise

planned, structured, repetitive movement intended to improve or maintain physical fitness

What are trends evident in physical activity data from Healthy People 2020?

progress made toward achieving the original objectives Regress that has occurred

what exercise was not commonly recommended for individuals with CHD

resistance training BELIEVED: Resulted in a disproportionate rise in blood pressure Increased the myocardial oxygen demand Increased the risk of angina and MI However, data from several studies indicate that moderate, supervised weight training is feasible, tolerable, and beneficial for individuals with hypertension and CHD.

The American College of Sports Medicine (ACSM, 2018) and the American Heart Association (AHA, 2020) recommend this kind of training in the prevention and treatment of hypertension

resistance training meta-analysis that found resistance training reduced both systolic and diastolic blood pressure in prehypertensive and hypertensive individuals