KIN 485: Exam 1

Bioelectrical Impedance (BIA)

An imperceptible electric current (~500 uAMPs at > 50kHz) is sent through the body. The electrical signal is detected by electrodes at a distal point. The speed of electrical conduction is directly related to the amount and type of body tissue. This method is based on the assumption that lean tissue facilitates electrical conduction, while fat tissue impedes electrical conduction. (Lean tissue has less impedance (resistance and reactivity) than fat tissue).

Atheroslcerotic CVD Risk Factors: obesity

Body Mass Index (BMI) greater or equal to 30 kg/m2 OR waist girth > 102 cm (40 in) for men or > 88 cm (35 in) for women

Body Mass Index (BMI)

Body weight should be measured using a calibrated balance beam or electronic scale with the client wearing minimal clothing and having empty pockets. Shoes should be removed prior to the use of a stadiometer for the measurement of height

CVD Risk Factor Case Study 1 Female, age 21 yr, smokes socially on weekends (~10-20 cigarettes). Drinks alcohol one or two nights a week, usually on weekends. Height = 63 in (160 cm), weight = 124 lb (56.4 kg), BMI = 22.0 kg/m2, RHR = 76 bpm, resting BP = 118/72 mm Hg. Total cholesterol = 178 mg/dL, LDL-C = 98 mg/dL, HDL-C = 62 mg/dL, FBG = 96. Currently taking oral contraceptives. Attend group exercise class two to three times a week. Both parents living and in good health.

CVD Risk Factors Age? No Family history? No Cigarette smoking? Yes Physical inactivity? No Obesity? No Hypertension? No Dyslipidemia? No Diabetes? No Negative Risk Factor (HDL-C ≥ 60) Yes Number of CVD risk factors Zero

Atheroslcerotic CVD Risk Factors: Cigarette smoking

Current cigarette smoker or those who quit within the previous 6 months or exposure to environmental tobacco smoke (i.e. secondhand)

The accuracy of the estimate is influenced by:

Degree to which the client meets the technique assumptions Skin fold technique Skin fold site Intra- and Inter-technician reliability Caliper type Db and/or % fat regression equation

Subscapular skin fold

Diagonal fold (at a 45-degree angle); 1-2 cm below the inferior angle of the scapula

Suprailiac skin fold

Diagonal fold; in line with the natural angle of the iliac crest taken in the anterior axillary line immediately superior to the iliac crest

Chest/Pectoral skin fold

Diagonal fold; one-half the distance between the anterior axillary line and the nipple (men), or one-third of the distance between the anterior axillary line and the nipple (women)

Does participate in regular exercise: Any Signs or Symptoms Suggestive of CV, Metabolic, or Renal Disease Regardless of Disease Status

Discontinue exercise and seek medical clearance Following Medical Clearance, Light to Moderate Intensity Exercise Recommended May Gradually Progress as Tolerated following ACSM Guidelines

other techniques of measurement of body composition

Dual energy X-ray absorptiometry Total body electrical conductivity TOBEC Bioelectrical impedance analysis BIA

calculation of fat free mass

FFM = total body mass- total fat mass

Commonly used spirometry measurements:

Forced vital capacity (FVC) Forced expiratory volume in one second (FEV1.0) FEV1.0/FVC ratio Peak expiratory flow (PEF)

High Density Lipoprotein Cholesterol

HDL-C > 60 mg/dL -known as a negative risk factor -subtract one positive risk factor from the sum of positive risk factors

Dyslipidemia

LDL > 130 OR HDL < 40 OR Currently on lipid lowering medication Total Cholesterol > 200

Magnetic Resonance Imaging (MRI)

MRI requires clients to lie still in a magnetic chamber. Electromagnetic radiation excites the hydrogen nuclei of water and lipid molecules in the presence of a magnetic field. The water and lipid molecules emit defined, detectable signals that are measured as multiple high-quality images (10mm thickness at 50mm intervals) from head to toe. MRI is safe (no ionizing radiation is used), requires little client preparation and takes ~30 minutes.

Does participate in regular exercise: Known CV, Metabolic, or Renal Disease AND Asymptomatic

Medical Clearance For Moderate Intensity Exercise Not Necessary Medical Clearance Recommended Before Engaging in Vigorous Intensity Exe Continue with moderate intensity exercise may progress as tolerated

Does not participate in regular exercise: No CV, Metabolic or Renal Disease AND No S/S

Medical Clearance not necessary Light to Moderate Intensity Exercise Recommended May Gradually Progress to Vigorous Intensity Exercise Following ACSM Guidelines

Does not participate in regular exercise: Known CV, Metabolic, or Renal Disease AND Asymptomatic

Medical Clearance recommended Following Medical Clearance, Light to Moderate Intensity Exercise Recommended May Gradually Progress as Tolerated following ACSM Guidelines

Atheroslcerotic CVD Risk Factors: Age

Men 45 and up Women 55 and up

Atheroslcerotic CVD Risk Factors: Family history

Myocardial infarction, coronary revascularization or sudden death before 55 years of age in father or other male first degree relative or before 65 years of age in mother or other female first degree relative

Near-Infrared Light Interactance (NIR)

NIR has been used by the USDA to measure protein, fat and water contents of agricultural products. This method was introduced in the 1980s for body composition assessment. The most common NIR device, the FUTREX - 5000, emits a near-infrared light at two frequencies (938nm and 948nm) into the biceps area of the client's dominant arm. At these frequencies, body fat absorbs the light, while lean tissue reflects the light. Body fat and FFM is estimated from the amount of light emitted and reflected. NIR systematically underestimates %FAT by as much as 2 - 10%, especially in obese clients.

Atheroslcerotic CVD Risk Factors: Physical inactivity

Not participating in at least 30 min of moderate intensity physical activity (40%-59% VO2R) on at least 3 d of the week for at least 3 months

height and weight tables

Provides weight data based on height. Ideal weight ranges are obtained from actuarial tables developed to identify individuals at increased risk for all-cause morbidity and mortality. Assumes that all excess weight is "fat weight", which increases the health risk of the individual.

Atheroslcerotic CVD Risk Factors: Hypertension

SBP greater or equal to 140 mmHg and/or DBP greater or equal to 90 mmHg confirmed on at least 2 separate occasions OR on antihypertensive medications

Total Body Electrical Conductivity (TOBEC)

The TOBEC machine consists of a cylinder, open at both ends, that generates a very weak magnetic field produced with electric energy. As the client passes through the cylinder, the strength of the magnetic field is altered in relation to the electrolytes found in the body water.

Our measurement of under water body weight, and ultimately, our estimate of body density can be influenced by:

The client's comfort in the water The client's hydration status GI and bladder contents Residual volume estimate Gastrointestinal air estimate Assumption of tissue densities (1.1 for lean tissue, 0.9 for adipose tissue, relative to water)

Hydrodensitometry (Underwater Weighing)

The underwater weighing procedure is based on "Archimedes' Principle of Displacement", which states, "An object submerged in water is buoyed up by the weight of the water it displaces". Bone and muscle tissue are denser than water, whereas fat tissue is less dense.

renal disease

Underfined by ACSM

Abdominal skin fold

Vertical fold; 2 cm to the right side of the umbilicus

Thigh skin fold

Vertical fold; on the anterior midline of the thigh, midway between the proximal border of the patella and the inguinal crease (hip)

Midaxillary skin fold

Vertical fold; on the midaxillary line at the level of the xiphoid process of the sternum. An alternate method is a horizontal fold taken at the level of the xiphoid/sternal border in the midaxillary line

Triceps skin fold

Vertical fold; on the posterior midline of the upper arm, halfway between the acromion and olecranon processes, with the arm held freely to the side of the body

physical fitness

a set of attributes or characteristics individuals have or achieve that relates to their ability to perform physical activity

exercise

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

The waist circumference can be used alone as an indicator of health risk because ___________ is the primary issue

abdominal obesity

energy expenditure

aerobic or anaerobic (both occur in PA but which one is used depends on the type of exercise being done)

skill-related

agility, balance, coordination, power, reaction time, and speed

Duel-Energy X-ray Absorptiometry (DEXA)

allows simultaneous measurement of bone mineral, fat and non-bone tissue. DEXA is based on the three component model of composition (bone, fat and lean soft tissue). DEXA requires little client preparation, minimal technical expertise and is completed in 10 - 20 minutes. DEXA is precise and correlates well with underwater weighing.

Physical Activity

any bodily movement produced by the contraction of skeletal muscles that results in a substantials increase in caloric requirements over resting energy expenditure

android

apple shaped male pattern fat storage in the trunk and upper body. Android fat distribution is associated with increased risk for hypertension, hyperlipidemia, insulin resistance, heart attack and stroke.

medical clearance recommended

approval from a health care professional to engage in exercise

Circumfrence Measurements

assumes that the girth or circumference is directly related to fat accumulation. Girth measurements may also be used to estimate regional body fat distribution and to monitor changes in specific girths over time

Skin Fold Measurement

assumes that body density can be estimated from fat distributed subcutaneously. It also assumes that we are obtaining an accurate assessment of subcutaneous fat from the chosen skin fold sites.

Cardiovascular Disease (CV)

cardiac, peripheral vascular or cerebrovascular disease

physical fitness

cardiorespiratory endurance body composition muscle strength, endurance and power flexibility agility balance reaction time coordination speed

health-related

cardiorespiratory, muscle endurance, muscle strength, flexibility and body composition

Direct assessment of body composition assessment method

chemical dissolving of body components into fat and non-fat components or physical dissection of fat from muscle, organ, connective and bone tissue

A __________ evaluation in the clinical setting generally includes a medical history and risk factor assessment, physical examination, and laboratory test

comprehensive pre-exercise

Individuals with increased visceral fat

confer a higher risk for development of the metsyn compared to distribution of fat within the subcutaneous compartment

for young individuals the most common causes of sudden cardiac death are_____

congenital and hereditary abnormalities

regional body fat

dat deposited im a body region that be a combination of storage and sex - specific essential fat stores

indirect assessment of body composition assessment method

estimates body composition from body density (the ratio of body mass to body volume)

purpose and explanation of written informed consent

exactly what you are going to do and how you are going to do it

T or F: before conducting any type of pre-exercise evaluation written informed consent must not be obtained

false it HAS to be obtained

storage fats

fat accumulated in adipose tissue: visceral adipose tissue- protects internal organs from trauma -subcutaneous adipose tissue- fat stores beneath the skin's surface

___________ amounts of physical activity can produce additional health benefits

greater

PA is just as protective if not more protective in decreasing risk of ______ in older adults

heart disease

essential fat

includes fat stored in bone marrow, heart, lungs, liver, spleen, kidneys. intestines, muscles and tissues of the central nervous system

Health risk _________ as WHR _______________, and the standards for risk vary with age and sex.

increases increases

highest risk is associated with activities that are weight bearing or involve repetitive motion:

jogging, walking, cycling, weight training

fat free mass (FFM)

mass of muscles, bones, and ligaments, tendons and internal organs

lean body mass

mass of muscles, bones, ligaments, tendons, and internal organs including the small percentage of essential fast associated with each

Does participate in regular exercise: No CV, Metabolic or Renal Disease AND No S/S

medical clearance not necessary Continue Moderate or Vigorous Intensity Exercise May Gradually Progress Following ACSM Guidelines

Does not participate in regular exercise: Any Signs or Symptoms Suggestive of CV, Metabolic, or Renal Disease Regardless of Disease Status

medical clearance recommended Following Medical Clearance, Light to Moderate Intensity Exercise Recommended May Gradually Progress as Tolerated following ACSM Guideline

lack of PA coincides with the current epidemic of ______

obesity

The FEV1.0/FVC is diminished with ________ However, it remains normal with _______

obstructive airway diseases restrictive disorders

PA can help with ___________and improve mobility, thus decreasing the risk of falls

osteoarthritic

gains in bone mineral density developed during childhood PA help prevent ______ in adult years

osteoporosis

gynoid

pear-shaped female pattern fat storage in the hips, buttocks and thighs. Gynoid fat distribution is resistant to fat mobilization.

exercise participation

performing planned, structured physical activity at least 30 min at moderate intensity on at 3 d/week for the last 3 months.

those who are _____________ are at a higher risk for re-injury

previously injured from exercise

sudden cardiac death related to moderate intensity exercise is _____

quite rare

in females, essential body fat also includes _______

sex-specific fat

Buttocks/Hips

standing erect and feet together, a horizontal measure is taken at the maximal circumference of buttocks. This measure is used for the hip measure in a waist/hip measure.

Abdomen

standing upright and relaxed, a horizontal measure taken at the height of the iliac crest, usually at the level of the umbilicus.

Waist

standing, arms at the sides, feet together, and abdomen relaxed, a horizontal measure is taken at the narrowest part of the torso (above the umbilicus and below the xiphoid process).

Muscle Contraction

static or isometric dynamic or isotonic (both occur in PA but dynamic is more common)

Android obesity

that is characterized by more fat on the trunk (abdominal fat) increases the risk of hypertension, metabolic syndrome, T2DM, dyslipidemia, CVD, and premature death compared with individuals who demonstrate gynoid or gynecoid obesity (fat distributed in the hip and thigh).

waist-to-hip ratio

the circumference of the waist (above the iliac crest) divided by the circumference of the hips (buttocks/hips measure) and has traditionally been used as a simple method for assessing body fat distribution and identifying individuals with higher and more detrimental amounts of abdominal fat.

freedom of consent

this is a voluntary process which mean they can withdraw at any time

fat mass (FM)

total body fat including essential body fat and storage fat

PA during childhood decreases metabolic risk factors for ________

type 2 diabetes

metabolic disease

type 2 or type 2 diabetes mellitus

the consent form should be ____ explained and include a statement indicating that the patient has been given an opportunity to ask questions about the procedure and has sufficient information to give informed consent

verbally

2008 PA guidelines for Americans

weekly accumulation of 150 mins of moderate intensity PA spread over multiple days

BMI equation

weight (kg) / height (m^2)

Purposes of Health-Related Physical Fitness Testing

-Collecting baseline data and educating participants about their present health/ fitness status relative to health-related standards and age- and sex-matched norms -Providing data that are helpful in development of individualized exercise prescriptions (Ex Rx) to address all health/fitness components -Collecting follow-up data that allow evaluation of progress following an Ex Rx and long-term monitoring as participants age -Motivating participants by establishing reasonable and attainable health/fitness goals

Pulmonary function testing with spirometry is recommended for all smokers >45 yr and in any individual presenting with:

-Dyspnea (shortness of breath) -Chronic cough -Wheezing -Excessive mucus production.

anthropometric methods

-Height, weight and body mass index (BMI) -Circumferences -Skinfold measurements

The accuracy of the BIA estimate of body density is influenced by:

-Hydration Status -Temperature (exercise & illness) -Body Water Distribution (body position, intestinal contents)

densitomerty

-Hydrodensitometry (underwater) weighing -Plethysmography

signs and symptoms at rest of during exercise

-Pain or discomfort in the chest, neck, jaw, arms or other areas that may result from ischemia (cardinal manifestation of cardiac disease) -Shortness of breath (Dyspnea) with normal activity -Dizziness or syncope (loss of consciousness) -Orthopnea (Dyspnea at rest in the recumbent position which is resolved promptly by sitting upright or standing -Paroxysmal nocturnal dyspnea (PND and Orthopnea are symptoms of left ventricular dysfunction -Ankle edema - bilateral edema predictive of heart failure -Palpitations or tachycardia -Intermittent claudication - pain that occurs in the lower extremities due to inadequate blood flow during activity -Known heart murmur - may indicate hypertrophic cardiomyopathy which is the leading cause of sudden cardiac death -Unusual fatigue or shortness of breath with usual activities

Factors that may contribute to measurement error within skinfold assessment include:

-Poor anatomical landmark identification -Poor measurement technique -An inexperienced evaluator -An extremely obese or extremely lean subject An improperly calibrated caliper

Diabetes

-fasting plasma glucose > 126 mg/dL OR -2 h plasma glucose from OGTT > 200 mg/dL OR -HbA1C >6.5%

2007 aerobic exercise recommendation

-moderate intensity: 30+ mins for 5 days/week OR -vigorous intensity: 20+ mins, 3 days/week

increases energy expenditure through PA is associated with a multitude of benefits:

-weight loss and weight control -reduced risk for type 2 diabetes, CVD, hypertension, colon cancer, and all cause mortality

A 22-yr-old recent college graduate is joining a gym. Since becoming an accountant 6 mths ago, she no longer walks across campus or plays intramural soccer and has concerns about her sedentary lifestyle. Although her body mass index (BMI) is slightly above normal, she reports no significant medical history and no symptoms of any diseases, even when walking up 3 flights of stairs to her apartment. She would like to begin playing golf.

1. Currently participates in regular exercise? NO 2.Known CV, metabolic, or renal disease? NO 3.Signs or symptoms suggestive of disease? NO 4.Desired intensity? MODERATE 5.Medical clearance needed? NO

A 60-yr-old woman is beginning a professionally led walking program. Two years ago, she had a drug-eluting stent placed in her left anterior descending coronary artery after a routine exercise stress test revealed significant ST-segment depression. She completed a brief cardiac rehabilitation program in the 2 months following the procedure but has been inactive since. She reports no signs or symptoms and takes a cholesterol-lowering statin and antiplatelet medications as directed by her cardiologist.

1. Currently participates in regular exercise? NO 2.Known CV, metabolic, or renal disease? YES 3.Signs or symptoms suggestive of disease? NO 4.Desired intensity? MODERATE 5.Medical clearance needed? YES

A 35-yr-old business consultant is in town for 2 wk and seeking a temporary membership at a fitness club. She and her friends have been training for a long-distance charity bike ride for the past 16 wk; she is unable to travel with her bike and does not want to lose her fitness. She reports no current symptoms of CV or metabolic disease and has no medical history except hyperlipidemia, for which she takes a HMG-CoA reductase inhibitor (statin) daily.

1. Currently participates in regular exercise? YES 2.Known CV, metabolic, or renal disease? NO 3.Signs or symptoms suggestive of disease? NO 4.Desired intensity? VIGOROUS 5.Medical clearance needed? NO

A 45-yr-old former collegiate swimmer turned lifelong triathlete requests assistance with run training. His only significant medical history is a series of overuse injuries to his shoulders and Achilles tendon. In recent weeks, he notes his workouts are unusually difficult and reports feeling constriction in his chest on exertion - something he attributes to deficiencies in core strength. Upon further questioning, he explains that the chest constriction is improved with rest and that he often feels dizzy during recovery.

1. Currently participates in regular exercise? YES 2.Known CV, metabolic, or renal disease? NO 3.Signs or symptoms suggestive of disease? YES 4.Desired intensity? VIGOROUS 5.Medical clearance needed? YES

Case Study: A 50-year nonsmoking male was recently invited by colleagues to participate in 10-km trail run. He reports currently walking 40 min on M, W, F - something he has don "for years". His goal is to run the entire race without stopping, and he is seeking training services. He reports having what he describes as a "mild heart attack" at 45 yr old, completed cardiac rehabilitation, and has had no problems since. He takes a statin, an angiotensin-converting enzyme (ACE) inhibitor, and aspirin daily. During the last visit with his cardiologist, which took place 2 yr ago, the cardiologist noted no changes in his medical condition

1. Currently participates in regular exercise? YES 2.Known CV, metabolic, or renal disease? YES 3.Signs or symptoms suggestive of disease? NO 4.Desired intensity? Vigorous 5.Medical clearance needed? YES

Skin Fold Measurement Technique

1. Locate the exact anatomical site on the right side of body, with client standing upright 2.Feel the site prior to measurement to prepare yourself and the client. 3.Grasp the fold with your index finger and thumb. Obtain the fold by pulling away from the body. 4.Place the calipers ¼ to ½ " away from the fingers holding the fold and half-way between the base and crest of the fold, 1cm from finger and thumb. 5.Read the calipers within 2 seconds of placement. (maintain pinch) 6.Obtain 2 measurements within 1 mm of each other. (Assure consistency!)

Why assess body composition?

1. body composition is related to metabolic health 2. body composition assessment is useful for establishing optimal weight, formulating dietary guidelines and developing exercise prescriptions for weight management and control 3. body composition assessment is useful for monitoring changes in composition with growth, maturation, age, and training

purposes of health screening

1. identification of signs and symptoms of underlying CV and metabolic and renal disease 2. identification of individuals with diagnosed CV and metabolic disease 3. using signs and symptoms, disease history, current exercise participation and desired exercise intensity to guide recommendations for pre-participation medical clearance

Levels of screening

1. self-guided 2. profesional screenings 3. medical evaluation including a physical examination and stress test by a qualified health care provider

Measurements for skin folds at each site should be at least ______ seconds apart. (Rotate through sites)

15

how many adults meet both the aerobic and muscle strengthening guidelines

20.6%

how many of adults meet muscle strengthening guidelines

29.3%

globally, ______ of adults are physically inactive

31.1%

how many adults meed aerobic activity guidelines

51.6%

for girth measurements how much should measurements be within

5mm of .5cm

Waist-to-Hip Ratio Health risk is very high for young men when WHR is _______and for young women when WHR is ________.

>.95 >.86

For individuals aged 60-69 yr, the WHR cutoff values are _____ for men and ______ for women for the same high-risk classification as young adults.

>1.03 >.90

girths measurements include

Abdomen Forearm Arm Hips/Thigh Buttocks/Hips Mid-Thigh Calf Waist Neck

CVD Risk Factor Case Study IV. Woman, age 36 yr, nonsmoker, height = 64 in (162.6 cm), weight = 108 lb (49.1 kg), BMI = 18.5 kg/m2, RHR = 61 bpm, resting BP = 142/86 mmHg, total cholesterol = 174 mg/dL, blood glucose normal with insulin injections. Type 1 diabetes diagnosed at age 7 yr. Teaches dance aerobic classes three times a week, walks approximately 45 minutes four times a week. Both parents in good health with no history of CVD.

Age? No Family history? No Cigarette smoking? No Physical inactivity? No Obesity? No Hypertension? Yes Dyslipidemia? No Diabetes? Yes Negative Risk Factor (HDL-C ≥ 60) No Number of CVD risk factors Two

CVD Risk Factor Case Study III. Man, age 44 yr, nonsmoker, Height = 70 in (177.8 cm) , weight = 216 lb (98.2 kg), BMI = 31.0 kg/m2, RHR = 62 bpm, resting BP = 128/84 mmHg, total serum cholesterol = 184 mg/dL, LDL-C = 106 mg/dL, HDL-C = 44 mg/dL, FBG 130 mg/dL, Reports that he does not have time to exercise. Father had type 2 diabetes and died at age 67 yr of a heart attack, mother living , no CVD. No medications.

Age? No Family history? No Cigarette smoking? No Physical inactivity? Yes Obesity? Yes Hypertension? No Dyslipidemia? No Diabetes? Yes Negative Risk Factor (HDL-C ≥ 60) No Number of CVD risk factors Three

CVD Risk Factor Case Study II. Man, age 45 yr, nonsmoker, Height = 72 in (182.9 cm) Weight = 168 lb (76.4 kg), BMI = 22.8 kg/m2, RHR = 64 bpm, resting BP = 124/78 mmHg, Total cholesterol = 187 mg/dL, LDL-C = 103 mg/dL, HDL-C = 39 mg/dL, FBG = 88 mg/dL. Recreationally competitive runner, runs 4-7 days/week, completes one to two marathons and numerous other road races every year. No medications other than over-the-counter ibuprofen as needed. Reports no symptoms. Father died at age 51 yr of a heart attack, mother died at age 81 yr of cancer

Age? Yes Family history? Yes Cigarette smoking? No Physical inactivity? No Obesity? No Hypertension? No Dyslipidemia? Yes Diabetes? No Negative Risk Factor (HDL-C ≥ 60) No Number of CVD risk factors Three

Air Plethysmography

Air displacement is based on the same principles as underwater weighing. The client sits for 20 seconds in a capsule of known volume while sensors measure how much air is displaced.