Exercise, Wellness, and Nutrition

Noncommunicable diseases or _________ such as heart disease, cancer, chronic respiratory disease, and diabetes, are the leading cause of death ________ and represent an emerging global health threat.

- Chronic condition - world wide

Common Substances being overused

- alcohol - opioids - stimulants - hallucinogens - cannabis

Distribution of cardiac output during rest and maximal exercise

- at rest cardiac output is 5L/min (20-25% GI) - during max exercise cardiac output is 25L/min (80-85% muscle)

_________ is not one size fits all

- diet

Anticipatory balance control

- feedforward balance - know changes are being made - promote external focus

______ occurs when an individual's skill level is well matched to the demands of the task they are doing

- flow

The amount of sleep people need is _______ and depends on a variety of factors

- individualized

- social ______ is the lake of availability quality relationship

- isolation

steady state static balance control

- maintain positions on a firm solid surface - then progress to moving surfaces - promote internal focus

Roll with resistance

- patients unwillingness to change - approach the resistance without judgement and recognize that the patient currently hold an opposing view to one you wish to promote

restless legs syndrom

- persistent and overwhelming urge to move legs while at rest or attempting to sleep

Transtheoretical Model of behavior change

- pre-contemplation - contemplation - preparation - action - maintenance

Macronutrients AMDR

- provide energy - Carbohydrates: 4kcal/gram - Proteins: 4kcal/gram - Fats: 9kcal/gram - Alcohol: is 7kcal/gram (not ideal source of energy)

fat:

- provide fuel for energy - absorption of fat-soluble vitamins and fats comprise an important component of cell membrane structure - synthesis of steroid hormones and provides insulation for the body - two essential fatty acid, linoleic acids (omega-6) and alpha-linolenic acid (omega-3) - NO RDA - acceptable macronutrient distribution range (20-30%E) equates to 44 to 78g of fat per day for an individual that consumes 2000 kcal/day

Volume

- quantity of exercise completed weekly is the product: frequency intensity time

Transfer of training effects

- some carryover of training effects from one variation of exercise or task to another has been reported - another name for it is overflow or cross-training effect - it has been suggested that a cross-training effect can occur from an exercised limb to a non exercises, contralateral limb in resistance training program

What is neuromuscular control (sensorimotor control)?

- the ability to produce controlled movement through coordinated muscle activity

motivational learning

- the aim is to employ a nonjudgemental and non- confrontational counseling style. - listen, understand patients perspective and emphasize that the patient should contemplate their own values to promote behavior change. - you are a guide - should be more persuasive then coercive, more supportive than argumentative.

muscular performance is...

- the capacity of a muscle to do work (Force x distance)

In the past few decades our lifestyles have shifted from physically engaged to _______

- very few physical challenges

Fat-Soluble vitamins

- vitamins A, D, E, and K. SO these are limited amounts

Gluconeogenesis

- when we have lactate we process it in the liver to create glycogen (Stored) or glucose (energy used right away) - The Cori cycle: during intense exercise, lactate is formed in the muscle fibers. The lactate formed in muscle can then be transported via blood to the liver and converted to glucose by glycogenesis. glucose-> pyruvate-> AcetylCoA-> Krebs/Citric Acid Cycle-> ETC and oxidative phosphorylation

Sedentary behavior is associated with ______ mortality and morbidity

-high

Exercise Intensity Levels

Light Intensity, Moderate Intensity, Vigorous Intensity

Maximal direct

oxygen uptake is measured HRmax is often measured

ground substance

a structureless organic gel-like material that: - reduces friction between the collagen and elastic fibers - maintains spacing between the fibers to prevent excessive cross-linking - transports nutrients to the fibers - man components: glycosaminoglycans, proteoglycans, and adhesive glycoproteins

definitions of diet

a. food and drink regularly provided or consumed: a diet of fruits and vegetable or a vegetarian diet b. habitual nourishment: links between diet and disease c. the kind and amount of food prescribed for a person or animal for a special reason: was put on a low-sodium diet d. a regimen of eating and drinking sparingly so as to reduce one's weight: going on a diet

Mobility

ability of the joint to move actively through a range of motion, required ability to initiate, control, or sustain active movements of the movement of the body to perform motor tasks

Acceptable Macronutrient Distribution Range (AMDR)

adults should get: - 45%-65% of their calories from carbohydrates - 20%-35% from fat - 10%-35% from protein

What are common components of neuromuscular training warm-ups?

aerobic (for blood flow), strength (injury prevention), agility (better prepared for activity), balance (injury prevention)

Resistance exercise

an activity in which dynamic or static muscle contraction is resisted by an outside force applied manually or mechanically

phases of stretch-shortening cycle (SSC)

eccentric, amortization, concentric

alignment and stabilization

effective stretching requires max the distance between origin an dinsertion

The SAD is also lower in......

fiber, fruits and and other whole, plant foods

Regular exercise=

history of planned, structures physical activity of at least moderate intensity for at least 30 min on 3 or more days per week during the past three months

________________ connections are decreasing at an alarming rate in the US

human to human

Noncommunicable diseases are largely related to....

lifestyle behaviors, and are largely preventable

if patient does not regularly exercise, and has no sign and symptoms of any diseases

medical clearance is not necessary, but light to moderate intensity recommended, with gradual progression to vigorous

if patient does not participate in regular exercise and is having signs or symptoms of disease

medical clearance is recommended, and following clearance, light to moderate intensity is recommended progression to vigorous gradually

if patient does not regularly exercise, and has a known disease and asymptomatic

medical clearance is recommended, and following clearance, light to moderate intensity is recommended progression to vigorous gradually

if patient does partake in regular exercise, and had a known disease but is asymptomatic

medical cleared for moderate intensity exercise is not necessary, but is recommended for vigorous exercise (within the past 12 months if no change in signs and symptoms)

if patient does partake in regular exercise, and has no history of disease and no signs or symptoms

no medical clearance is necessary, and they can continue moderate or vigorous intensity exercises

if patient participates in regular exercise and is having signs and symptoms of disease

patient must discontinue exercise and seek medical clearance, they may return to exercise following medical clearance and must gradually progress intensity.

What is a noncommunicable disease?

refers to a group of conditions that are not mainly caused by an acute infection, not passed from one to another

Flexibility

the ability of the musculotendinous unit to elongate with application of a stretching force does not require active movements

One MET=

the amount of oxygen consumed while sitting at rest

Self-efficacy=

the confidence that one can successfully engage in the behavior across different challenging situations.

interconversions of energy

the total energy in a closed system remains constant, so a decrease in one form of energy matches an equivalent increase in another form.

Goals of neuromuscular training:

to improve neuromuscular control and achieve functional stability. focus on quality and efficiency of the movements, and have an emphasis on trunk control and lower limb alignment

Dietary Reference Intakes (DRIs)

umbrella term for dietary standards

2018 National Survey on Drug Use and Health, estimated _______ Americans aged 12 or older where current alcohol users and _________ were binge drinkers

- 139.8 million - 67.1 million

Every _____________, a person dies prematurely from an NCD

- 2 seconds

Metabolic Equivalence

- 3.5mlO2/kgbodyweight/min (VO=3.5ml/kg/min) - example: working at 40 ml/kg/h=11.4 METs (divide 40 by 3.5) - example: running at 13km/h (8.1 m/h)=12.9 METs (looking at compendium)

NCDs kill ____ million people each year, equivalent to over 7 out of 10 deaths worldwide

- 41 million

over ______ of all adults suffer from the adverse effects of stress

- 43%

approx. ____ of U.S. adults do not engage in the recommended amount of activity.

- 60%

The National Sleep Foundation recommends_____ hours of sleep for adults between the ages of 18-65

- 7 to 9

around ____ of all primary care provider visits are related to stress and lifestyle

- 70%

2 different processes we have

- Anabolic: extracting energy from food and conserving it - Catabolic- Extracting and transferring chemical energy in ATP to use up in biological work.

What are the 5 A's?

- Ask: screen all patients for tobacco use - Advice: strongly urge user to quit - Assess: obtain readiness to quiet; screen for nicotine dependance - Assist: provide recommendations and educational material - Arrange: schedule follow-up to encourage continuation

Frequency

- At least 3x a week - supercompensition want the perfect intensity to get this phase

Hypertension

- CHD occurs due to atheroscelorisis and is marked by a gradual narrowing of the arteries serving the heart - hypertension is one of the most important risk factors for CHD - mean arterial blood pressure is determined by two factors: Cardiac output and total vascular resistance - increases the workload on the left ventricle, resulting in an adaptive increase in the muscle mass of the left heart - the increase in cardia mass helps to maintain the hearts pumping ability - with time, left ventricular hypertrophy changes the organization and function of cardia muscle fibers - the presence of hypertension is a major risk factor for developing arteriosclerosis and heart attacks - hypertension also increases the risk of kidney damage and the rupture of a cerebral blood vessel resulting in localized brain injury.

Heart disease and ______ accounted for 1.29 million deaths, whereas COVID-19 accounted for approximately 350,000 deaths

- Cancer

physiological adaptations to aerobic exercise

- Cardiac output increases - resting HR decreases - resting BP decreases - total blood volume increases (RBC increases, plasma volume increases) - number of capillaries increase - mitochondria size and number increases - alveoli activity increases

Oxidative Phosphorylation from Glucose/Glycogen

- Citric Acid Cycle: start with glycolysis, then if there is oxygen available, the pyruvate then travels to the mitochondria to be processes. - starting with glucose in muscle and brain cells yield 36 ATP - starting with glycogen in muscle and brain cells yield 37 ATP - starting with glucose in liver, kidney,, and cardiac cells yields 39 ATP - starting with glycogen in liver, kidney, and cardiac cells yields 39 ATP

Physical Therapy in Sports Study

- Had 1,352 physiotherapists from 56 countries - most agreed that their role as a PT included prescribing aerobic exercises (75%) and resistance training (89%) - 37% had the confidence to deliver aerobic exercises following guidelines - 58% had the confidence to deliver resistance training following guidelines

In 2020, the leading cause of death was _______(20.6%), which is almost double the death caused by _______ (10.4%).

- Heart disease - COVID-19

What are the top noncommunicable diseases?

- Ischemic Heart Disease - Chronic Obstruction Pulmonary Disease (COPD) - Type 2 Diabetes Mellitus - Hypertension - Stroke - Obesity - Certain Cancers

What is the most important prerequisite for behavior change?

- It affects the individual's level of effort and persistence in engaging in the behavior in the face of difficulty and barriers

Light Intensity Exercise Levels

- METs: 1.5-2.9 - RPE: 2-4 (0-10 scale), 9-11 (6-20 scale) - An intensity that causes slight increases in HR and breathing

Moderate Intensity Exercise Levels

- METs: 3-5.9 -RPE: 5-6 (0-10 scale), 12-13 (6-20 scale) - Noticeable increases in HR and breathing

Vigorous Intensity Exercise Levels

- METs: 6 and above - RPE: 7-8 (0-10 scale), 14 and above (6-20 scale) - Substantial increases in HR and breathing

Anaerobic Glycolysis System

- Moderate intensity, short duration - activities lasting 30sec to 2min - glucose or glycogen - Maximum power: intermediate 1.6mol of ATP/min - Maximum capacity: intermediate 1.2mol ATP (also produces lactate)

What are the key domains of social determinants of health (5 of them)

- Neighborhood and environment - economic stability - education - health care access - social and community context

What is lifestyle medicine focused on?

- Nutrition - Physical Activity - Sleep - Stress Management - Risky Substances - Social Connections

6 contracts of the Health Belief Model

- Perceived susceptibility - perceives severity - perceived benefits - perceived barriers - cues to action - self-efficacy - other contributing factors include; demographic variables, sociopsychological variables

What are the 5 R's?

- Relevance: discuss reasons to quit based on patients personal values - Risks: identify negative consequences of tobacco use - Rewards: benefits of successful cessation - Roadblocks: identify barriers and discuss solutions - Repetition: periodically revisit the topic and remind patient you their to assist

Example of 1 MET levels

- Take care of self - eat/dress/use toilet - walk indoors around house - walk 1-2 blocks on level ground at 2-3 mph - dusting/washing dishes (some classify this as 1-4 METs)

ATP-PC System/Phosphagen System

- The ATP molecule is broken down by ATPase into ADP, Pi, and energy for contraction. When the phosphocreatine is broken down to creatine the energy from the reaction is used to rebuild the ADP and Pi into ATP that can be used for additional muscle contraction. -most common form of energy, and is used first before other systems

What is the role of Physical Therapists in Health Promotion?

- The leading non-pharmacological health profession - Can be the front-line healthcare provider to help prevent and manage lifestyle related noncommunicable diseases

________ should address the interconnection of emotional well-being and healthy living

- Therapeutic lifestyle change (TLC)

Key terms for muscular performance

- Volume: the total amount of weight lifted in a training session - set: a group of reps performed before client stops to rest - repetition-volume: total number of reps performed during the workout session - volume load: the total number of sets multiplied by the number of reps per set, multiplied by the weight lifted per rep

first law of thermodynamics

- a basic tenet that states energy cannot be created or destroyed but transforms from one form to another without being depleted. - this law described the important conservation of energy principle that applies to both living and nonliving systems. - the law describes the important conservation of energy principle that applies to both living and nonliving systems.

Mobility training- contraindications

- a body structure limits joint motion - there was a recent fracture, and bony union is incomplete - there is evidence of an acute inflammatory or infectious process - necessary healing of restricted for adjacent tissues could be disrupted by elongation - there is sharp, acute pain with joint movement or muscle elongation - joint hypermobility is present - shortened soft tissues provide necessary joint stability in lieu of normal structure stability or neuromuscular control

metabolic syndrome

- a cluster of cardiovascular disease risk factors that contribute to much of the cardiovascular and metabolic disease in the US and other industrialized nations

mechanical response to stretch

- a stretched soft tissue is elastic if it returns to its pre stretch position

what is adaptation of aerobic exercises?

- ability of the cardiovascular system and muscles to adapt to the training stimulus over time

what is energy?

- ability or capacity to do work - the breakdown of the chemical bonds in macronutrients that provides the energy necessary to perform biological work

adaptive control

- ability to improve balance with experience

Steady-state control

- ability to maintain a stable upright posture while at rest, when supporting surface is moving, when the body is moving on a stable surface

sleep insufficiency: higher risk of

- accidents - injuries - falls - also has increased mortality

General Recommendations for Health

- actively look for opportunities to socially engage - accept other individuals as they are - have an uplifting attitude - get a roommate or a pet - volunteer - commit to reaching out to friends, family members and colleagues - expect the best from yourself and others - identify reasons why you feel lonely - start a journal to track thoughts and feelings - understand the mental and physical impacts of social connection

principles of neuromuscular training

- activity movements in synergies of the joints of the targeted extremity - bilateral transfer effect (keep training other parts of body) of motor learning when previous injuries/weaknesses/osteoarthritis exists - muscular coactivation on obtain low, evenly distributed articular surface pressure (the way they are meant to be loaded) - enhancement of postural function and provocation of postural reactions

_______ is compulsive use of habit- forming substance despite negative consequences, characterized by tolerance and by well-defined physiological symptoms upon withdrawal.

- addiction

without treatment or engagement in recovery activities, _______ is progressive and can results in disability and premature death

- addiction

Copenhagen Adductor Protocol

- adductor strain - help with groin pain

Oxidative phosphorylation from glucose/glycogen

- aerobic energy production - Long, Moderate intensity - Activities lasting 2min to 2hr - Glucose or Glycogen - Maximum power: small 1.0mol of ATP/min - Maximum Capacity: high 90mol ATP

Oxidative phosphorylation from Fatty Acids (lipolysis)

- aerobic energy production - Long, light intensity - Long endurance activities - Triglycerides - Maximun Power: Very small (1mmol/s/kg of muscle) - Maximum capacity: very high (hard to exhaust)

factors to consider with programming plyometrics

- age - goals - injury history - activity type - activity level - foundational strength - experience with resistance training - warm-up routine

Neuromuscular training

- aims to improve sensorimotor control and functional stability - examples: injury prevention warm-up programs in team sports, treatment of knee and hip osteoarthritis, treatment of persistent/recurrent LBP

Risks of pathology associated with alcohol

- alcoholic dementia - subdural hematoma from falls - convulsions from withdrawal - delirium tremens - cardiomyopathy - hypertension - hepatic cirrhosis - pancreatitis - dupuytren's contracture - myopathy - peripheral neuropathy (most impacted organs consist of liver, pancreas, and brain)

ATP-PC System

- anaerobic energy production - Short, high intensity - Activities lasting up to 30sec - Phosphocreatine - Maximum Power: High 3.7mol of ATP/min - Maximum Capacity: Small (0.7mol ATP)

Estimated Energy Requirement (EER)

- average daily dietary energy intake that meets the needs of a health person that is maintaining his or her weight - takes into account the person's physical activity level, height, weight, sex, and age.

Sleep hygiene strategies

- be consistent. sticking to the same sleep schedule every day, even on weekends - establish aa relaxing bedtime routine - avoid large meals, caffeine, and alcohol before bedtime - remove electronic devices from the bedroom at least 30 minutes before bed - physical activity throughout the day NOTE: if you don't fall asleep after 20 minutes, get out of bed. Do a quiet activity without a lot of light exposure. It is especially important to not get on electronics

eustress: moderate or normal psychological stress interpreted as being _____

- beneficial

impact of social connections

- benefits mental and physical health - reduces the impact of stress - enhances belief of self- control - fosters a sense of meaning and purpose - personal growth and development - source enjoyment

a mismatch between a person's skill level and the difficulty of the challenge can lead to ________ or _______

- boredom -anxiety

Physical activity encompasses all activities, performed during any time of day or night; including....

- both exercise and incidental activity integrated into daily routine

Assessment of Body Composition

- cadaver dissection - hydrostatic weiighing - bod pod - dual-energy x-ray absorptiometry - bioelectrical impedance - skinfold thickness

Major Minerals include

- calcium, phosphorus, magnesium, sulfer, sodium, potassium, and chloride

Light-intensity

- can talk and sing without any difficulty

moderate intensity

- can talk, but not sing

smoking is a risk factor for....

- cancer - coronary heart disease - other cardiovascular diseases - stroke - diabete - COPD - tuberculosis

vigorous intensity

- cannot talk or sing

Bioelectrical impedance

- cheap and fast with little burden - lack of accuracy, devices very differently - is practical - limited reliability - limited validity

Skinfolds

- cheap and relatively quick - technician has a big influence - is practical - limited reliability - limited validity

what are the forms of energy?

- chemical - mechanical - heat energy - nuclear energy - electrical energy - light energy

Most of the leading causes of death are ______ and _____

- chronic - preventable

In mitochondria to produce ATP

- citric acid cycle/respiratory chain (aerobic) - fatty acids - pyruvate from glucose - some deaminated - amino acids

Example. of 4 and above MET levels

- climb one flight of stairs or walk up a hill - walk on level ground at 4mph - run a short distance - scrubbing floors/moving heavy furniture - golf, bowl, dance, doubles tennis, throw baseball or football

Create connective tissue components

- collagen - elastin - reticulin - ground substance

addition is

- complex chronic disease - arising from individual and environmental factors - involves cycles of relapse and remission

principles of good addiction treatment

- comprehensive and continuous - evidence-based or evidence- informed - collaborative - cultural responsive - recovery oriented

hydrostatic weighing

- considered accurate "gold standard for living" - expensive, time consuming, uncomfortable - not practical - is reliable - is valid

Cadaver dissection

- considered the gold standard - not feasible with living subjects - not practical - not reliable because you cannot retest - it is valid

Poor diet is responsible for more _______ around the world than any other risk factors

- death

PA can _________ the risk of depression and anxiety and improve sleep

- decrease

immediate effects of sleep deprivation

- decreased focus - increase risk of accident - increase hunger - impairs emotional processing - more likely to get a cold - long term effects: increased risk of NCDS and increased risk of death

general recommendations of stress management

- deep breathing - mindfulness practices - physical activity - get adequate amount of quality sleep - eat a healthy diet - creative pursuits - gratitude practice - recognize negative stress responses ad identifying coping mechanisms leads to improved wellbeing

Adequate intakes (AI)

- describe levels of nutrients for which their is insufficient data to establish the EARs or RDA. (guessing) - AI's are intended to cover the nutrient requirements of 97-98% of people in a specific age group

Programming- general guidelines for an aerobic training program

- determine the baseline and program targets - determine type and frequency - establish target intensity - determine weekly volume - describe each workout

purpose of stress testing

- diagnostic tool for overt or latent heart disease - determining the physical work capacity - evaluating response to exercise training - cardiac stress test - select and evaluation of appropriate modes of treatment for heart disease

people that are relatively resilient still experience __________ and _________

- difficult times - stressful circumstances

chronic isnomnia

- difficulty felling asleep, staying asleep, or waking up too early al least more than 3 night for 3 months

Time

- duration: is dependent on totally work performed, exercise intensity and frequency, fitness level - higher intensity short time, decreased intensity longer time

Sleep health

- during sleep, the human brain undergoes a characteristic cycle of brain wave activity, including intervals of dreaming - sleep is a daily occurring activity that is essential for restoration and renewal of the body

Time to rebound phase

- elctro-mechanical delay phase - time delay of overcoming negative (eccentric) work to the force generation of the concentric phase - the shorter the amortization phase= more effective and powerful - delayed= energy wasted as heat

express empathy

- empathy is always important in all aspects of clinical practice - patient is more likely to elaborate when they see that the clinician is attempting to understand their perspective - an empathetic clinician uses reflective listening skills and communicates respect for acceptance of their patients

What are the three key elements to muscular performance?

- endurance - power - Strength

Type

- endurance activities requiring minimal skills or physical fitness to perform - vigorous intensity endurance activities requireing minimal skill - endurance activities required skill to perform - recreational sports

Phosphate bond energy

- energy in food does not transfer directly to cells for biological work. Rather, energy from macronutrient oxidation is harvested and funneled through ATP - The potential energy within this nucleotide molecule powers all the cell's energy-requiring processes. In essence, the energy donor-energy receiver role of ATP represents the calls' two major energy-transforming activities

Estimated Factors of Musculoskeletal Recovery

- environmental factors: 10% - medical care in health and recovery: 20% - behavioral patterns: 30% - Social and Economic circumstances: 40%

reticulin

- essentially type 3 collagen fibers - weaker then type 1 - they are particularly important during repair following injury

Specific Adaptation to Impose Demands Principle (SAID)

- extension of Wolffs law - to improve a specific muscle performance element, the resistance program should match the contracts of that element - mimic the anticipation function

balance during functional activities

- external focus - work on different activities to recreate activities patient would be doing

two major energy-transforming activities/phosphate bond energy

- extract potential energy from food and conserve it within the bonds of ATP - extract and transfer the chemical energy in ATP to power biological work

distress: ________

- extreme anxiety, sorrow, or pain

BodPod

- fast with little subject burden - expensive, careful, standardization - is practical - is reliable with standardization - is valid

Reactive balance control

- feedback balance - unexpected perturbations

Connective tissue composition

- fibers in the extracellular matrix - the main components of extracellular matrix: fibers and ground substance. The principle fibers are collagens and elastic fibers - collagen and elastic fibers in a loose connective tissue spread.

______ is the state of concentration and engagement that can be realized by a person when performing a task that challenges their skills

- flow theory

Pathway of food into energy

- food consumption gets digested and is absorbed into blood transportation to active cells (site of energy production) and can be immediately used or stored

Adults to sit less and do any amount of moderate-to-vigorous physical activity _____ some health

- gain

Glycogenolysis

- glycogen is a polysaccharide stored in animal tissue - it is synthesized within cells by linking glucose molecules using the action of the enzyme glycogen synthase - glycogen molecules are generally large and consist of hundreds to thousands of glucose molecules. - for example, during exercise, individual muscle cells break down glycogen not glucose (glycogenolysis) - also occurs in the liver, with the free glucose being released into the bloodstream and transported to tissue throughout the body

Definitions

- glycogen: stored form of glucose - glycogenolysis: production of glucose from glycogen - glycolysis: is the production of ATP using glycogen or glucose - Glucogeonesis: production of glucose from noncarbohydrate substances

In cytosol to produce ATP

- glycolysis (anaerobic) - phosphocreatine - glycose/glycogen - glycerol - some deaminated - amino acids

fat-

- goes into bloodstream as fatty acid and can be used right away and becomes ATP, OR it can be stored as adipocytes to be used later as ATP

carbohydrates-

- goes into bloodstream as glucose (6-carbon molecule chain) and glucose can by used right away at ATP or stored as excess glucose (glycogen: several glucose molecules stored in muscles cells and liver) to later be used as ATP

Dual energy x-ray absorptiometry (DEXA)

- good accuracy - expensive, radiation dose - is practical - is reliable with standardization - is valid

Muscular strength

- greatest measurable force that is exerted by a muscle or muscle group in single effort - A muscle strengthening program has been shown to moderately improve muscular endurance, whereas endurance training has little to no cross-training effect on muscle strength

nordic hamstring curl

- hamstring strain

action

- has changed behavior for less than 6 months - task as clinician: congratulate patient and affirm change

maintenance

- has changed behavior for more than 6 months - task for clinician: help develop strategies to prevent relapse

pre-contemplation

- has no intention of taking action within the next 6 months - task for clinician: educate and provide advice

a _______ lifestyle should promote mental and emotional well-being as well as physical health

- healthy

A ______ eating pattern is the collective byproduct of a person's choice regarding what they _____ and drink habitually

- healthy - eat

what are the key parameters to muscle strength?

- heavy external loads - low number of reps - short period of time

Diet can influence

- human development - musculoskeletal integrity - pain - physical function - tissue healing - chronic inflammation - immune function - mental well-being - longevity - risk of chronic disease - status of chronic disease

someone is diagnosed as having a metabolic syndrome when they have at least three of the following risk factors

- hypertension: an elevation is systolic BP or diastolic BP (above 130/80mmHg) - obesity: excess body fat, was it circumference greater than 102cm in men and 88in women - dyslipidemia: abnormal blood levels of triglycerides or other lipid sub-fractions. ( tri above 150; LDL above 130; HDL less then 40 in men and 50 in women)

postexercise hypotension

- immediate effects of aerobic activity - BP is lower - normal healthy response

sleep insufficiency can impair

- immune function - tissue healing - pain modulation - cognitive function - memory consolidation - quality of life

Protein-

- in bloodstream as amino acids (DO NOT want to use this as energy; want this for growth and repair of tissue) then becomes lean body mass or excretion of excess occurs OR in extreme cases if NEEDED can be used as ATP as a last resort

Physical Activity Advice in PT Practice

- incorporating advice on PA into normal consultations is deemed the most feasible form of lifestyle PA promotion in PT practice. - adult patients expect advice on PA and consider it important

power can be gained by...

- increasing the work a muscle must perform during a specific period of time - reducing the amount of time required to produce the work.

Social Cognitive Theory

- individuals act as contributors to their own motivation, behavior and development. - behavior and characteristics are modified by the environment. - primary mediator include self-efficacy and the ability to self-regulate which isn't easy. (need to have adequate support system and environment) - mastery is the best way to create a strong sense of efficacy.

What is the efficacy of injured prevention exercise programs?

- injury prevention decreases the risk of all ACL injuries by half in all athletes - created the risk of non-contact ACL injuries by 2/3 in female athletes - insufficient data to make conclusions on ACL injury prevention in male athletes - effective in the decrease injury incidence/rate of lower extremity, knee, ACL ligaments and ankle injuries, but not groin injuries

contemplation

- intending to take action within 6 months - task for clinician: weight advantages and disadvantages

preparation

- intends to take action within the next 30 days and has taken some behavioral steps in this direction - task for clinician: create SMART goals

Trace minerals include

- iron, zinc, copper, iodine, selenium, molybdenum, fluoride, manganese, and chromium

What these minerals do in the body

- iron: bone health - potassium: fluid balance - magnesium: fluid balance - calcium: blood clotting

what is viscoelastic deformation?

- is a time dependent property of soft tissue - initially resists deformation, but will slowly lengthen if the force is sustained - will gradually return to its pre stretched configuration

Adenosine Triphosphate (ATP)

- is the energy currency of the human body - ATP is broken down into ADP, Pi, and energy is released - ADP is converted into ATP with a phosphate

TRUE. OR FALSE: You'll lose more weight and body fat if you work out in a lower intensity "fat burning zone". Thus, you should workout at a lower intensity if you're trying to get rid of excess body fat

- it depends - but if we have to chose, then FALSE, because it is hard of for people to dedicate enough time to get into the "fat burning zone". - better for people to work with what's available for them

tobacco is the ____________ cause of death in the United States

- leading preventable - mortality is about 3x higher then those who have never smoked

The American College of Lifestyle Medications defines ______ as a medical specialty that uses evidence-based, whole-person therapeutic lifestyle interventions, as a primary modality to prevent, treat and, when used intensively, often reverse_____

- lifestyle medicine - chronic conditions

Due to COVID-19, we have had to adjust to a new routine that _______ social interaction and required "sheltering in place", which has further increased sedentary behavior

- limit

substance abuse disorder

- listed in the fifth edition of the diagnostic and statistical manual of mental disorder (DSM-5) - can cause mild, moderate or severe functional impairment - polysubstance use is common - addiction is the chronic stage with loss of control and compulsive use despite the desire to stop - note that substance abuse often co-occurs with other mental health disorders like depression and anxiety

principles of mobility training

- low load long duration stretching is safest and yields most significant long term - in elderly 60 seconds was best strength length - in young or middle adults 30 nd 60 seconds were best - anything passed 2 minutes creates stiffness - cyclic stretching is equally effective as static - minimum of two times per week for healthy hyomobile individuals - use it or lose it

what are the key parameters of muscular endurance

- low-intensity muscle contraction - high number of repetitions - prolonged time period

class of nutrients: macronutrients and micronutrients

- macronutrients: water, carbohydrates, fat, and protein - micronutrients: vitamins (from fruit and veggies), mineral, and trace elements

variables too the eccentric phases include

- magnitude of strength - rate of stretch - duration of stretch - manipulation of any of these three will have a significant effect on the energy stored during the phase

anticipatory control

- maintain stability by compensating for destabilization associated with voluntary movements such as postural transitions and navigation

Harvard medical school healthy eating plate recommmendations

- make 1/2 of you plate fruits and vegetables of many colors (NOT POTATOES) - 1/4 of your plate should be whole grains: whole wheat, barley, wheat berries, quinoa, oats, brown rice, and foods made with them. Good for the GI system because of the blood glucose and fiber - 1/4 of your plate should be protein: fish, poultry, beans and nuts are healthy, limit red meats. - Healthy plant oils in moderation: olive, canola, soy, corn, sunflower, peanut ( may not be best anymore?), and others. Remember that low-fat does not mean "healthy" - drink water, coffee, or tea: low sugar, limit milk and dairy to one to two servings per day, and limit juice to a small glass per day. - stay active - type of carbohydrate is more important then amount

general recommendations of substance abuse

- many individuals who suffer from substance overuse or other addiction believe that they can stop not heir own but it is recommended to receive some sort of assistance or support in the process

support self-efficacy

- many patients do not have a strong sense of self-efficacy/can be difficult to envision change -patients may have tried to change and failed before which may perceive further efforts to change as futile - your role as a clinician is to identify the patient's strengths and highlight these whenever possible to promote self-efficacy

Cardiovascular disease

- many problems associated with cardiovascular disease are related to atherosclerosis (often starts from childhood) - atherosclerosis is a progressive disease that results in narrowing of arteries due to the buildup of fatty plaque within the inner wall of an artery - three major classes of risk factors for atherosclerosis: 1. genetic 2. diet 3. physical inactivity

approach for obese/overweight individual

- most people dont need their PT to tell them about their overweight/obesity - that doesn't mean we dont discuss diet and nutrition - consider framing the conversation around well-being, performance, gut health etc. Find what is relevant for your patient - You can discuss overweight/obesity but avoid being just another clinician who tells the patient to lose weight - E.g. increased lean muscle mass can be beneficial even if weight remains the same

Develop Discrepancy

- motivation for behavior change occurs when patient perceive discrepancies between their current situation and their hopes for the future. - help patient focus on how current behavior isn't consistent with the desired behavior - a method of this is exploring the advantages and disadvantages of behavior change.

Supporting lifestyle change

- motivational interviewing - express empathy - support self-efficacy - develop discrepancy - roll with resistance

reconditioning effects associated with bed rest

- muscle mass, strength, CV function, total blood volume, plasma volume, heart volume, orthostatic tolerance, exercise tolerance, and bone mineral density all decrease

interrelated components of physical function

- muscle performance - cardiopulmonary/endurance - mobility/flexibility - neuromuscular control/ coordination - stability - balance/postural equilibrium

Muscular Power

- muscle power is related to the strength and speed of movement and is defined as the work produces by a muscle per unit of time work= force x distance/time - greater the intensity of the exercise and the shorter the time period taken to generate force, the greater is the muscle power time is most often varied

PTs are established _________ health professional and are in a unique position to be leaders in integrating evidence-informed health promotion practices into standard professional practice

- non-pharmacological

____________ approaches have been shown to be those of choice for preventing and reversing most noncommunicable diseases and maximizing a person's health over the life cylce

- nonpharmacological

_______ is the process of providing or obtaining the food necessary for health and growth

- nutrition

Adverse health outcomes related to inadequate sleep duration or quality

- obesity - diabetes - cardiovascular disease - depression - anxiety

substance use, abuse and dependence has become _______ dominant societal problems we face in the twenty-first century

- one of the most

musculoskeletal recovery is complicated and is rarely associated with _______ factor.

- only one

anaerobic glycolysis net gain

- our net product of ATP will be different if we start with glycogen vs. glucose - Glucose: 2 molecules of ATP and 2 molecules of pyruvate/lactate per molecule because we start with 2ATP and make 4ATP. Leaving net gain as 2 ATP - Glycogen: 3 molecules of ATP and 2 molecules of pyruvate/lactate per molecule because we start with 1ATP and make 4ATP. Leaving net gain at 3 ATP

Why do PT's care about their patients dietary habits?

- overall energy, mood, sleep, and diet influence recovery from sports

Intensity

- overload - response generally at 60-90% HRmax - 70% HRmax good for healthy young - 40-50% for sedentary

Oxidative Phosphorylation from Fatty Acids

- oxidative phosphorylation from fatty acids are converted to acetyl-CoA through beta oxidation - it then goes through the citric acid cycle, through ETC, and ATP is created

submaximal direct

- oxygen uptake is measured sub maximal heart rate is measured (usually 85%) - oxygen uptake line is extrapolated to estimate or know HRmax

contraindications of plyo

- pain - inflammation - acute/sub-acute sprain - acute/sub-acute strain - joins instability - soft tissue limitations in postoperative conditions - force deficiency

Examples of 10 and above MET levels

- participating is strenuous sports including: - singles tennis, football, basketball skiing

________ is defined as any voluntary bodily movement produced by skeletal muscles that requires energy expenditure

- physical activity

According to the current_________, adults should engage in 150 minutes of moderate-intensity physical activity and 2 days of muscle strengthening activity weekly

- physical activity guidelines/ recommendations

neurophysiological model

- potentiation= change in the force-velocity characteristics of the muscles contractile component cause by stretch - stretch reflex= the bodies involuntary response to an external stimulus that stretches the muscles - when muscle spindle are stimulated, the stretch reflex is stimulated sending input in type 1a fibers - after synapsing with alpha motor neurons, impulse travels to the agonist fibers causing a reflex

Safety during gait, locomotion, or balance

- practice within their actual stability limits - better balance better mortality rate

Carbohydrates:

- primary source of energy and fiber - recommended dietary allowance: 130 g/day - RDA for carbohydrates refers only to the minimum level of carbohydrate required to provide adequate glucose for the CNS and replacement of muscle glycogen stores used during activity. - RDA is well below the midpoint for the AMDR for carbohydrates which amounts to 275g of carbohydrates for a 2000-kcal diet

factors to consider with plyo

- quality over quantity - rate of muscle stretch is more relevant then length of muscle stretch - high intensity ( above 80% of max volitional contraction) - increased recovery time

mobility training- indications

- range of motion is limited - restricted motion - muscle weakness and shortening - as part of a total fitness or sport-specific conditioning program

reactive control

- recover balance in response to unexpected perturbations and forces that move the center of mass

plyometric training

- refers to activities that enable a muscle to reach maximal force in the shortest possible time - quick, powerful movement using a pre stretch, or countermovement, that involves the stretch-shortening cycle

What is bioenergetics?

- refers to the flow and exchange of energy within a living system

________ physical activity can help keep thinking, learning, and judgement skills sharp with time.

- regular

WHO guidelines on PA and Sedentary Behavior

- regular PA is recommended/Any PA is better then none - adults should do 150-300 moderate-intensity PA weekly or 75-150 vigorous- intensity PA weekly, or a mix of both. - adults should include muscle-strengthening on 2 or more days a week, and include multicomponent balance and strength 3 days a week. - adults should limit the amount of time spend sedentary and replace with more PA of any intensity

anaerobic glycolysis

- requires energy in early investment phase to generate energy in the generation phase. - muscles store a limited amount go glycogen. Glycogen consists of long strings of glucose sugar molecules, when split become pyruvate and energy to create ATP - pyruvate is transformed into lactate with a hydrogen ion -net product depends on whether energy is produced from a glucose or a glycogen molecule

________ is the process of adapting well in the face of adversity, trauma, threats, or significant sources of stress.

- resilience

relapse

- return to old behaviors and abandoning the change - task for clinician: learning opportunity and help patient recommence the process

Healthy eating patterns can prevent, treat and _______ many chronic conditions

- reverse

alcohol, smoking tobacco and taking medications not prescribed or at levels beyond what is considered safe are examples of _______

- risky substances

The Standard American Diet (SAD) is an eating pattern that is high in refined grains, added sugar, ________ and oils, and ______ packaged foods, which tend to be high in sodium.

- saturated fats - ultra-packaged

____________ are characterized by little physical movement in a sitting or reclining posture requiring low levels of energy expenditure for prolonged periods of time

- sedentary behavior

key constructs

- self-efficacy - environment - situation - behavioral - capability - expectations - expectancies - self-control - observational learning - reinforcement - emotional coping responses

-balance impairments

- sensory input impairments: proprioceptive deficits - sensorimotor integration impairments: damage to basal ganglia, cerebellum, or supplementary motor area from lacking incoming sensory information - biomechanics and motor output impairments: musculoskeletal impairments - deficits with aging: decline of somatosensory, viral, and vestibular sensory systems

_____ is a natural state of rest for the mind and body in which the eyes are closed and there is a decrease in bodily movement and responsiveness.

- sleep

Approx. 60 million adults have difficulty _____ and 20% of adults sleep less than 6 hours per night

- sleeping

_______ is developing and maintaining a relationship with another person, such that emotional experiences can be shared

- social connections

People who are overweight/obese often experience ________________ in the health care system.

- stigma and discrimination

______ is a state of mental or emotional strain or tension due to the perception of pressure as well as the body's response to it

- stress

Stress-strain curve

- stress is the force per unit area. mechanical stress is the internal reaction or resistance to an externally applied load - strain is the amount of deformation or lengthening that occurs when an external load is applied to a structure

Submaximal indirect

- submaximal HR is measured - Heart rate line is extrapolated to estimated or known HR - VO2 max is estimated by converting the workload at HRmax to oxygen uptake

it is said that social connections are as important to a person's _____ and vitality as food, shelter, and safety

- survival

Barriers to social connection

- technology - lack of self-confidence - lack of interpersonal skills - reluctance to interact with others - poor communication skills - fear of change - environment

plasticity

- tendency of soft tissue to assume a new and greater length because of alterations

muscular endurance

- the ability of a muscle to contract repeatedly against an external load, over an extended period of time - the muscles adapt to endurance training by increases in their oxidative and metabolic capacities, which improves oxygen delivery and use - for many patients with impaired muscle performance, endurance training has a more positive impact them strength training

What is functional stability (dynamic stability)?

- the ability of the joint to remain stable during physical activity

Atherosclerosis process

- the atherosclerosis process is caused by inflammation initiated within the inner lining of the artery - inflammation is in response to tissue injury that involves the recruitment of white blood cells (leukocytes) to the affected site - Normally, the endothelial cells that line the inner surface of the artery do not support the binding of leukocytes - however, when the endothelium is activated by such risk factors, the endothelium generates adhesion molecules on its surface that can bind readily to leukocytes in the blood - once bound to the adhesion molecules, the endothelial cells secrete chemokine that attract the monocytes to enter the intimate, where they mature into macrophages - the macrophages develop scavenger receptors on their surface that ingest large amounts of modified LDL cholesterol - the macrophages become loaded with fatty droplets and develop into foam cells. These foam cells and T cells make fatty streak, which is the earliest form of atherosclerotic plaque - as process continues, macrophages multiply due to growth factors they produce, and size of plaque increases - some smooth muscle cells in middle layer of artery move to the the top layer of the inter where they multiply, and with connective tissue form a fibrous matrix cap over the fatty core of the plaque - foam cells release inflammatory signals that lead to the digestion and weakening of the fibrous matrix cap. if cap ruptures, chemicals released interact with factors in the blood to form a clot

Estimated Average Requirement (EAR)

- the daily intake of a nutrient that will meet the needs of 50% of people within a defined age group - an EAR for a specific nutrient is only established when the Food and Nutrition Board agrees that sufficient evidence exists. - Currently, EARs exist for 17 different nutrients

balance postural stability

- the dynamic process by which the body's position is maintained in equilibrium - glance is greatest when the body center of gravity is maintained over its base of support

Tolerable upper intake levels (UL)

- the maximum daily intake amount of nutrients that will. not cause adverse health effects in almost all individuals within a specific age group. - highest daily nutrient intake level that will not pose adverse health effects

collagen

- the most abundant protein in the body - some type of collagen is found in the connective tissue - provide tissue with strength and stiffness

Recommended Dietary Allowance (RDA)

- the nutrient intake level that is sufficient to meet he nutrient requirement of nearly all healthy individuals (97-98%) in a life stage. - a key consideration in establishing a RDA is the nutrients ability to prevent disease and not just prevent deficiency. - more common

Acceptable Macronutrient Distribution Ranges (AMDR)

- the ranges of intakes of carbohydrates, fat and protein that provide adequate amounts of vitamins and minerals and reduce the risk of developing diet-related chronic diseases such as type 2 diabetes and heart disease. - these values are expressed as a percent of total energy intake (kilocalories)

harmful weight-based stereotypes are well documented-

- they are typically thought of as lazy, weak-willed, unsuccessful, unintelligent, lack self-discipline, have poor willpower, and are noncompliant with weight-loss treatment - be aware of your biases

Water- soluble vitamins

- thiamin, riboflavin, niacin, vitamin B-6, biotin, pantothenic acid, folate, and vitamin C.

progression

- time, frequency intensity

Overload principle

- to improve muscular performance, a resistance load that exceeds the metabolic capacity of the muscle must be applied. - muscle must be challenged to perform at a level greater than that to which is it accustomed - strength training: the amount of external resistance applied to the muscle is incrementally and progressively increased - endurance training: emphasis is place don increasing the time over which a muscle contraction is sustained or the number of repetitions performed increases

sensory organization

- to reduce or destabilize the visual inputs, have the patient close his or her eyes, wear prism glasses, or move eyes and head together during the balance activity - to decrease reliance on somatosensory cues, patients can narrow the BOS, stand on foam, or stand on an incline board

principles of plyo

- train movement patterns in isolation and break the desired functional movement into smaller components - isolation first, if it cannot perform dont progress - neuromuscular overload: progressive overload - spatial overload: increase distance or height (ROM) - Temproral overload: faster is better - intensity - volume - frequency - recovery - specificity

reversibility principleq

- use it or lose it - detraining, reflected by reduction in muscle performance. begins a week or two after cessation of resistance exercises and continues until training effects are lost in an average of 4 weeks - it is imperative that gains in strength and endurance are incorporated into daily activities as early as possible in a rehabilitation program

Concepts to understand

- we start with anaerobic energy production then go to aerobic - the shorter duration of exercise, more carbohydrates, the longer duration is more fats. - We use carbohydrates as long as they are available

noncommunicable diseases are among the leading causes of...

- years of life lost - years lived with disability

Mechanical model of plyometric exercise

-Elastic energy in the musculotendinous components is increased with a rapid stretch and then stored -If a concentric muscle action follows immediately, the stored energy is released, increasing the total force production - the series elastic component, when stretched, stores elastic energy that increases the force produces - the contractile component is the primary source of muscle force during concentric muscle action - the parallel elastic components exerts a passive force with unstimulated muscle strength

addiction is marked by a biological change in behavior caused by the biomechanics changes in the ______ after continued substance use; subsequently, continued substance use reinforces addiction.

-brain

sleep can be distinguished from coma or hibernation by its rapid_______

-eye movements

fundamental skills

-open ended questions: more in depth - affirmations: compliments or statements of appreciation and understanding -reflection: show you engaged in the session by restating their understanding of what has been said - summaries: longer reflection, overall brief of what was important

glycogenolysis simplified is...

-process of breaking down stored glycogen

elastin

-provide a structure with extensibility - elastic fibers can withstand elongation stress and return to normal length - tissues that have more elastin have more flexibility

obstructive sleep apnea

-repetative blockage or narrowing of the upper airway during sleep -> periods of reduces or absent breathing

Metabolic Pathways Power vs. Time/Capacity

1. ATP-PC system 2. Glycolysis 3. Oxidative phosphorylation from glycogen/glucose 4. Oxidative phosphorylation from fatty acids (lipolysis)

Exercise Pre-participation Health Screening

1. Determine current physical activity levels 2. Identify signs and symptoms of underlying cardiovascular, metabolic ore renal disease 3. identify individuals with diagnosed cardiovascular, metabolic or renal disease 4. Using signs and symptoms, disease history, current exercise participation and desired exercise intensity to guide recommendations for pre-participation medical clearance.

approx. ____ of U.S. adults are not active at all

25%

Patients who are unable to tolerate the equivalent of _____ METs of activity are poor candidates for surgery

4 METs

SHRed injuries basketball warmup

Aerobic - forward run - forward run and backwards sig-sag - skipping Strength: - plank - side plank - hamstrings - walking lunges - side lunges Balance: - single leg balance - single leg balance toss Agility: - single-leg jumps over a line - jumps in place - forward run processing speed

Why is screening so important?

Anyone can have problems, even those deemed healthy. Better to check everyone instead of missing someone because of assumptions

what are the general recommendations for injury prevention

Duration: 10-15 minutes Frequency: 2-3x/wk Volume: 30-60 min/wk

ACLM position statement:

For the treatment, reversal and prevention of lifestyle-related chronic disease, the ACLM recommends an eating plan based predominately on a variety of minimally processed vegetable, fruits, whole grains, legumes, nuts, and seeds

FITT-VP

Frequency Intensity Time Type Volume Progression

maximal indirect

HRmax is measured VO2 is estimated

MET min calculation example

Jette, 45 years, wants to start exercising more. They currently play doubles tennis once a week for an hour and swim breaststroke recreationally for an hour. They want to add some cycling (9.4 mph). For how many minutes should they cycle per week to achieve 1000 MET minutes? By doing so, would they meet the physical activity guideline? - Doubles Tennis: 60min x 4.5MET= 270METmin -Breakstroke: 60min x 5.3MET= 318METmin - Cycling: 1000METmin-270METmin-318METmin=412METmin - 412METmin/5.4= 76.3 min

Negative attitudes towards people who are obese are pervasive in ____________

North America society (and elsewhere)