Exam 1: Exercise Testing
How large was the sample used to develop the prediction equation?
- 100-400 subjects generally needed to ensure the data are representative of the population - more stable regression weights
What is the recommended minimum amount of daily physical activity for health?
- 150 minutes moderate-intensity activity - 75 mins of vigorous-intensity activity
starting out with exercise...
- 150 minutes of moderate can be good but may be insufficient for weight gain - may need to increase minutes - possibly around 60 minutes of daily physical activity in something
resistance exercise
- 2 or more days a week - 8-12 repetitions - 8-10 exercises - rest at least one day between workouts
flexibility exercise
- 2 or more days a week, preferably daily - 10 min duration minimum - 3-4 repetitions - hold each stretch 10-30
sports and recreational activities
- 2-3 days a week - intersperse days of training with a variety of sport and recreational activities - follow safety rules for each activity - wear protective equipment
Identify the purpose of each component of the comprehensive evaluation
- 2018 Par-Q+ - Signs and symptoms of disease and medical clearance - coronary risk factor analysis - medical history - lifestyle evaluation - informed consent - physical examination - blood chemistry profile - blood pressure assessment - 12-lead electrocardiogram - graded exercise test - additional laboratory tests
balance activities
- 3 or more days a week for prevention of falls - tai chi, yoga, pilates, and dance improve balance
Define metabolic syndrome and identify its relationship to CVD (IDENTIFY)
- 3 or more of CVD's risk factors are classified as having metabolic syndrome - it increases CVD by threefold - criteria vary by organization
aerobic exercise
- 30min, moderate-intensity, 5 days a week or - 20 minutes, vigorous-intensity activity, 3 days a week - activity can be continuous or in multiple segments of at least 10 min
What percentage of Americans have some form of CVD?
- 92 million Americans have some form of CVD
summary of testing validity
- An acceptable method is used to derive reference measures of the physical fitness component. - A large sample (N = 100-400) and 20 to 40 subjects per predictor variable - The sizes of the multiple correlation and validity coefficients exceed .80. - The group prediction errors (SEE and TE) are acceptable - Demographic characteristics (e.g., age, gender, race, fitness status) of the validation and cross-validation samples are described. - The prediction equation is cross-validated in the original study or on independent samples from other studies. - The constant error (bias), or difference between the measured and predicted means for the cross-validation sample, is not statistically significant. - The 95% limits of agreement are acceptable
obesity risk factors
- BMI greater than or equal to 30 kg/m2 - waist circumference greater than 102cm (40 inch) for men and 88cm (35 inch) for women
what effect do arm position and body posture have on BP readings?
- BP increases from lying (supine) to sitting to standing - usually, taken in sitting position - upper arm must be held or supported horizontally - raising arm above underestimates and having cuff below overestimates - try to support it at heart level
What NCDs are related to physical inactivity?
- CVDs - diabetes - obesity - musculoskeletal disorders - cognitive disorders
osteoporosis
- Disorder characterized by abnormal rarefaction of bone, occurring most frequently in postmenopausal women, sedentary or immobilized individuals, and patients on long-term steroid therapy. - fracture may be first clue and indicator of future fractures - prevalence varies by race - diagnostic criteria: low BMD of hip or lumbar spine, history of site-specific low trauma fracture
1 Timothy 4:8
- For physical training is of some value, but godliness has value for all things, holding promise for both the present life and the life to come.
basic elements of exercise prescription
- Frequency of exercise Sessions - Intensity of Exercise sessions - Time / Duration of exercise sessions - Type of exercise session/program - P: rate of Progression through program
dyslipidemia risk factors
- HDL-C less than 40 - LDL - C greater than 130 - TC greater than 200 - on lipid-lowering medication
metabolic syndrome
- MetS - a combination of cardiovascular disease risk factors associated with hypertension, dyslipidemia, insulin resistance, and abdominal obesity. - adult prevalence: highest in USA, underestimated globally - underlying factors: Age, physical inactivity, genetics? - increases risk of other conditions: stroke, CVD, and type 2 diabetes
family history risk factors
- Myocardial infarction, coronary revascularization, or sudden death - before 55 yr in father or other male first-degree relative - before 65 yr in mother or other female first-degree relative
identify the component parts of a typical normal ECG tracing. What does each component represent relative to the cardiac cycle?
- P-wave - PR interval - QRS complex - T wave - ST segment
2018 PAR-Q+
- Physical Activity Readiness Questionnaire for Everyone - this determines client's readiness for physical activity - has seven general health questions - answers yes to any of these, additional information is needed - also complete ePARmed-X+ - can engage low-intensity activities while waiting
hypertension risk factors
- SBP greater than 130 or DBP greater than 80 (taken on two separate occcasions) - individual is taking antihypertensive medication
elevated blood pressure
- SBP: between 120 and 129 - DBP is lower than 80
Medical History
- To review client's past and present personal and family health history - focusing on conditions requiring medical referral and clearance - these are for personal illnesses, surgeries, and hospitalization - assess them, especially if they've occurred in the past year - analyze family history - watch out for certain drugs and
Cirrhosis
- a chronic disease of the liver by degeneration of cells, inflammation, and fibrous thickening of tissue - result of alcoholism or hepatitis
body composition
- a component of physical fitness - absolute and relative amounts of muscle, bone, and fat tissues composing body mass
electrocardiogram (ECG)
- a composite record of the electrical events in the heart during the cardiac cycle - not having anything to do with clogging or cholesterol
persuasive technology
- a computer system, device, or application that is intentionally designed to change a person's attitude or behavior
pedometer
- a device used to count the number of steps taken throughout the day - fairly accurate - low-cost - walking programs work well! - worn at hip for slower, worn at waist for more active - 8,000-9,000 steps per day is equivalent of 30 mins of adult moderate-intensity - weight loss: 11,000- 13,000 - 12,000 for girls, 15,000 for boys
photoplethysmography (PPG)
- a technology found in pulse oximeters and smart watches - uses light to determine heart rate by detecting changes in blood volume and blood flow in capillary beds - exercise HR may actually be a few beats higher than what is displayed - need to be approved by the U.S. Food and Drug Administration
atrial fibrillation
- a very common thing - you'll be very tired and have a very hard time breathing - abnormal electrical pathways - instead of one signal telling the atrium to go, there's a bunch of different signals that are contracting random - they quiver, don't really contract
validity
- ability of a test to accurately measure, with minimal error, a specific component -
reliability
- ability of a test to yield consistent and stable scores across trials and over time
cardiorespiratory endurance
- ability of heart, lungs, and circulatory system to efficiently supply oxygen to working muscles - part of physical fitness - measure VO2 max - test this during rest and exercse - use GXTs for this purpose - most important benefits of training
muscular endurance
- ability of muscle to maintain submaximal force levels for extended periods - resistance training develops this
musculoskeletal fitness
- ability of skeletal and muscular systems to perform work - requires muscular strength, muscular endurance, muscular power, and bone strength
muscular power
- ability to exert force per unit of time - rate of performing work - plyometrics and explosive free weight lifts are best for this
flexibility
- ability to move joints fluidly through complete range of motion without injury - limited by factors such as bony structure of joint, size and strength of muscles, ligaments, and other connective tissues
functional balance
- ability to perform daily activities requiring balance - picking up an object from the floor
physical fitness
- ability to perform occupational, recreational, and daily activities without undue fatigue - four components are: 1. cardiorespiratory endurance 2. musculoskeletal fitness 3. body weight and body composition 4. flexibility 5. balance
What is percentage of the American population does not get the recommended amount of physical activity for health benefits?
- about 79.3% of the population does not meet the recommended amount. - 53.2% met either one or the other, but not both.
ideas to encourage movement
- active breaks from sitting to move around: walk laps, walk down the hall, climb a flight of stairs - recreational sport activities add variety
ST segment elevation
- acute pericarditis - left ventricular aneurysm - myocardial infarction - pulmonary embolism - needs to be on the same line as the p-wave
The point of the comprehensive health evaluation...
- administer the PAR-Q+ - obtain signed informed consent - evaluate client participation in regular exercise in the past 3 months - identify signs and symptoms of diseases - analyze the coronary risk factors - determine if medical clearance is needed
Identify the positive and negative factors for CHD
- age - family history - hypercholesterolemia - hypertension - tobacco use - diabetes mellitus or prediabetes - overweight and obesity - physical inactivity - low cardiorespiratory fitness level
emphysema
- air sacs of of the lungs are damaged and enlarged, causing breathlessness - also when air is abnormally present within the body tissues
false negative
- an error in which individuals are incorrectly identified as having no risk factors when in fact they do have risk factors
false positive
- an error in which individuals are incorrectly identified as having risk factors when in fact they do not have risk factors
theory of planned behavior
- an extension of the theory reasoned action that takes into consideration the individual's perception of behavioral control - perform a specific behavior if they evaluate it positively, believe others think it important, and perceive the behavior to be under their control - intention alone is insufficient for prediction
HbA1c
- an indicator of the average blood glucose over the previous 2 to 3 months; glycosylated hemoglobin
additional laboratory tests...
- angiograms - ECG - Chest X-ray - comprehensive blood chemistry - echocardiograms - pulmonary tests - to provide a more in-depth assessment of client's health status, particularly if there is a known disease - some of these are usually done by professionals
total error (TE)
- average deviation of individual scores of the cross-validation sample from the line of identity
constant error (CE)
- average difference between measured and predicted values for cross-validation group: bias
direct renin inhibitors
- block conversion of angiotensinogen into angiotensin - I
documented benefits of exercise
- blood lipids - blood glucose - insulin sensitivity - body composition - inflammation - cognitive function - not necessarily health condition or diseases - vitality - not necessarily health condition or disease - social function - not necessarily health condition or disease
cognitive performance
- can be improved with exercise interventions - inverse relationship between PA and cognitive function - MIPA and VIPA = higher cognitive function scores - lots of sedentary time = lower cognitive function scores - exercise for cardiovascular system protects the brain - not one best exercise modality
Graded Exercise Test (GXT)
- can identify ischemic heart disease - can be problematic if contraindications present - administered by trained professionals - low level of cardiorespiratory fitness is a strong predictor of CVD - results of GXT are foundation of aerobic training program - to assess functional aerobic capacity and to detect cardiac abnormalities due to exercise stress - it's what WE do - also put together a training program that is science-based
inverted T wave
- can indicate - coronary ischemia - left ventricular hypertrophy
Identify the reference (criterion) method for each of the four components of physical fitness
- cardiorespiratory fitness: direct measurement of VO2 max during maximal exercise - muscular strength: maximal force (kg) or torque (Nm) - body composition: Db, FFM, or %BF - bone strength: bone mineral content and bone density - flexibility: ROM at joint (degrees) - balance: NONE
Explain the etiology of CHD
- caused by lack of blood supply to the heart muscle or myocardial ischemia - resulting in atherosclerosis (buildup of low-density lipoprotein / LDL / cholesterol, scavanger cells, and more - plaques form along arteries that are medium or large-sized - bulge into the arterial lumen - restrict blood flow and cause angina pectoris - myocardial infarction happens
Relative Contraindications
- check with physician first - Known obstructive left main coronary artery stenosis - Moderate to severe aortic stenosis with uncertain relation to symptoms - Tachydysrhythmias with uncontrolled ventricular rates - Acquired advanced or complete heart attack - Hypertrophic obstructive cardiomyopathy with severe resting gradient - Recent stroke or transient ischemic attack - Mental impairment with limited ability to cooperate - Resting hypertension with systolic or diastolic blood pressure >200/110 mmHg, respectively - Uncorrected medical conditions, such as significant anemia, important electrolyte imbalance, and hyperthyroidism
tobacco
- cigar, cigarette usage - decreasing in many, not all, countries - preventable risk factor for many chronic diseases - second-hand smoke hazard - electronic cigarette risk not yet known - quitting has health benefits within weeks
precontemplation
- client does not exercise and does not intend to start exercising
maintenance
- client has been exercising regularly at the recommended amount for 6 months or longer
action
- client has been performing the recommended amount of exercise regularly for less than 6 months
preparation
- client is exercising but is not meeting the recommended amount of physical activity
contemplation
- client is not exercising but intends to start
ePARmed-X+
- completed by self or with exercise professional - results: clearance to participate or suggestions while waiting clearance - this and PAR-Q+ is available online!
balance
- complex construct involving multiple biomechanical, neurological, and environmental systems
objectivity coefficient
- correlation between pairs of test scores measured on the same individuals by two different technicians.
validity coefficient
- correlation between reference measure and predicted scores - cannot be greater than 1.0 - valid physical fitness field tests and prediction equations typically have validity coefficients in excess of r = 0.80
reliability coefficient
- correlation depicting relationship between trial I and trial 2 scores or day 1 and day 2 scores of a test
What reference measure was used to develop the prediction equation?
- criterion measure obtained directly measuring the component - using a laboratory method and then directly comparing it to the criterion measure
body mass index (BMI)
- crude index of obesity; body mass divided by weight squared - pros: BMI has utility as a simple index of obesity - cons: cannot account for relative fatness
cigarette smoking risk factors
- current smoking, exposure, or stopped within previous 6 months
wearable technology
- data collection or data monitoring devices that may be worn during the day as well as during bouts of activity - e.g., heart rate monitors, pedometers, accelerometers - these devices do not restrict movement, thereby providing insights into physiological responses to activity and daily patterns of activity.
preliminary health evaluation
- detect presence of or suggestion of disease - assess likelihood of unexpected cardiovascular event related to exercise or PA - use questionnaires and data from the lab
what does an electrocardiogram measure?
- detects ischemia - myocardial infarction - conduction disorders - electrolyte disturbances: potassium and sodium is necessary - pericarditis - inflammation is squeezing against the heart - valvular heart disease - an enlarged heart - heart working extra heart because it's too stretched out
heart rate monitor
- device used to assess heart rate and monitor exercise intensity - simple strap worn next to the skin just below the pectoral muscles - HR linearly related to oxygen uptake, estimate exercise energy expenditure - can be affected, however, because HR is affected by different things
accelerometer
- device used to record body acceleration from minute to minute, providing detailed information about frequency, duration, intensity, and patterns of movement - do not provide accurate estimates of energy expenditure and should not be worn at the hip during slow walking - need to be in action
residual score
- difference between the actual and predicted scores (Y - Y')
pulse pressure
- difference between the systolic and diastolic blood pressures - normal value: A: 60 (5mmHg); 85 (10); 95(15) B: 50; 75; 90 C: 40; 65; 85 D: less than that
cardiovascular disease (CVD)
- disease of the heart, blood vessels, or both; types of cardiovascular disease include atherosclerosis, hypertension, coronary heart disease, congestive heart failure, and stroke - is not just a man's disease or an older person's disease - physical activity helps a lot! Not moving increases risk
angiotensin-converting enzyme inhibitors
- disrupt the body's production of angiotensin, which constricts arterioles
blood pressure medications
- diuretics - beta-blockers - calcium channel blockers - direct renin inhibitors - potassium channel openers - sympathetic nerve inhibitors - vasodilators - angiotensin-converting enzyme inhibitors
absolute contraindications
- do NOT exercise with these! - Acute myocardial infarction (within 2 days) - Ongoing unstable angina - Uncontrolled cardiac arrhythmias causing symptoms or hemodynamic compromise - Active endocarditis - Symptomatic severe aortic stenosis - Decompensated heart failure - Acute pulmonary embolism, pulmonary infarction, or deep vein thrombosis - Acute myocarditis or pericarditis - Acute aortic dissection - Physical disability that precludes safe and adequate testing
heart rate testing procedures
- do not use thumb - know sequence of palpation site selection - if clock is running, first beat = 1 - if clock started with palpated beat, first beat = 0 - if resting, count for 30 sec and multiply by 2 to get beats per min - if exercising, count for 10 sec and multiply by 6
exercise as medicine
- dose-response relationship in terms of health benefits - delays onset of chronic non-communicable diseases - inactivity is a better predictor of mortality than are hypertension, diabetes, blood lipid levels, and smoking
electrocardiogram testing procedures
- easiest to place electrodes if client is supine - shave chest as needed - scrub electrode sites with gauze or fine-grain sandpaper - wipe scrubbed areas with alcohol swab - position electrodes properly and firmly - connect lead wire to corresponding electrode - test electrodes and leads
making your clients comfortable
- establish good rapport - relaxed confidence - testing environment: friendly, quiet, private, safe, and comfortable. 70-74 degrees in the room - comfortable chairs and a table for completing paperwork - examination table or bed for evaluations - make sure equipment is set up
what you can do if the client's physician requests this
- explain 12-lead ECG and graded exercise test (GXT) - obtain informed consent for these - prepare and administer 12-lead - physician interpret these - use disease risk classification to determine whether maximal or submaximal GXT should be done - assess client's resting blood pressure and heart rate - administer GXT - assess and classify the client's functional aerobic capacity
informed consent
- explain the procedures, purpose, risks, confidentiality (password protected environment), voluntary participation, and benefits of physical fitness tests - obtain client's consent for participation in the tests - your "contract" with the client; legal document - signatures required - minors need signatures of parent or guardian
diabetes risk factors
- fasting plasma glucose: greater than or equal to 126 mg - dl-1 (about eight hours) - 2 hr oral glucose tolerance test greater than 200 mg - dl-1 (measured on two separate occasions) - HbA1C greater than or equal to 6.5% (how your body has used glucose in the past three months)
physical inactivity
- fourth leading cause of global mortality - contributes to burdens of disease - most important public health issue of this century? = risk from smoking + obesity combined
bone strength
- function of mineral content and density of bone tissue - related to risk of bone fracture
McArdle's syndrome
- genetic disorder that mainly affects skeletal muscles - deficiency or absence of an enzyme called myophosphorylase - painful muscle cramps, weakness, and fatigue
reference method
- gold standard or criterion method - typically a direct measure of a component used to validate other tests
criterion method
- gold standard or reference method - typically a direct measure of a component used to validate other tests
procedures to follow for conducting a comprehensive health evaluation
- great the client - explain purpose of health evaluation and lifestyle evaluation - obtain client's informed consent - complete PAR-Q+ - do medical history - do lifestyle profile - look at cholesterol and lipoprotein levels - measure and classify RBP and HR - assess coronary risk factors and current exercise participation - evaluate blood chemistry profile
regular physical activity...
- guards against noncommunicable diseases - protection against 25+ chronic medical conditions - numerous other health benefits
atherosclerosis
- hardening of the arteries or thickening and loss of elasticity in the artery walls that obstruct blood flow; caused by deposits of fat, cholesterol, and other substances
key motivating factors
- health - aesthetics - hypertrophy - weight loss
AV block
- heart is trying to send a signal to the ventricles, but it's not happening - p-waves are sending signals but the ventricle is not contracting - three degrees: first, second, and third
hypertension
- high blood pressure; chronic elevation of blood pressure - leading preventable cause of premature death for those younger than 70 years old - if unchecked, primary risk factor for other conditions such as stroke, heart attack, heart failure, kidney failure, dementia, and blindness
Explain how regular physical activity may prevent or delay select forms of cancer and cognitive decline
- highest levels of LTPA (leisure-time physical activity) were associated with lower risk for 13 of the 26 cancers of interest - 7 of those, LPTA reduced risk by 20% - steroid hormones, insulin resistance, growth factors, immune system function, and adipokines as well as body composition
potassium channel openers
- hyperpolarize vascular smooth muscles and endothelial cells
explain the importance of BP cuff size selection
- if it's too big or small, you won't get the correct BP readings
What is the ratio of sample size to the number of predictor variables in the equation?
- in multiple regression, you have the multiple correlation coefficient - the larger it is, the stronger the relationship - can be inflated if there are too many predictors - minimum of 20 subjects per predictor available - you have three predictors, you need a minimum of 60 subjects
self-efficacy
- individuals' perception of their ability to perform a task and their confidence in making a specific behavioral change
vasodilators
- induce relaxation in smooth muscles of arterial walls
type 1 diabetes
- insulin-dependent diabetes, caused by lack of insulin production by the pancreas - its etiology and response to exercise are different than type 2
exergaming
- interactive digital games in which the player physically moves to score points - Wii boxing: moderate intensity; Sportwall and Xavix: vigorous-intensity - multiple skill levels are good - promoting functional independence, improving balance, preventing falls, reducing premature disability, and maintaining health
objectivity
- interester reliability - ability of test to yield similar scores for a given individual when the same test is administered by different technicians
Explain how chronic adherence to moderate-to-vigorous-intensity physical activity affects the aging process
- it lengthens the telomere length, which is linked to increased life - moreover, autophagy is increased, which keeps the cells healthy and reduces the aging of skeletal muscle - delay onset or development or reverse or limit effects of chronic diseases - short telomeres: numerous chronic diseases - TARGET 40 to 60 year olds for increasing LTPA
low glomerular filtration rate
- kidneys aren't filtering your blood as well as they should
cancer
- leading cause of death globally - primary risk factors: tobacco and alcohol use, unhealthy food choices, and physical inactivity - inverse relationship between many cancers and leisure time PA - physically active patients have better survival rates - exercise gets sugar and starts the cancer cells that LOVE the sugar - exercise: digestive system works better as well, especially for the colon cancer
bundle branch blocks
- left bundle branch block or right bundle branch block - the QRS will be upside down or all over the place. The t will either be huge or upside down. Flipped or double peeks
describe the anatomical locations for placement of the 10 electrodes used to obtain a 12-lead ECG recording
- limb leads: right arm, left arm, and left leg - ground electrode: right leg - six chest leads: v1: fourth intercostal space to the right of the sternal border v2: fourth intercostal space to the right of the sternal border v3: at the midpoint of a straight line between v2 and v4 v4: fifth intercostal space along the midclavicular line v5: horizontal to v4 on the anterior axillary line v6: horizontal to v4 and v5 on the midaxillary line
regression line
- line of best fit depicting relationship between reference measure and predictor variables
HDL-C cutoff values
- low: less than 40 - normal: 40-59 - high: greater than 60
body weight (BW)
- mass or size of body; body mass
muscular strength
- maximal force or tension level produced by a muscle or muscle group - resistance training is the best for this
maximum oxygen consumption (VO2 max)
- maximum rate of oxygen utilization by muscles during exercise - VO2 max
how good is the prediction equation for estimating reference values of individual clients (i.e., what is the individual predictive accuracy of the equation)?
- may not necessarily give accurate estimates for all individuals comprising that group - researchers Bland and Altman method - difference scores and average scores are calculated for each individual and plotted on a group - 95% should lie within 2 standard deviations from overall mean difference
specificity
- measure of a test's ability to correctly identify individuals with no risk factors for a specific disease
standard error of estimate (SEE)
- measure of error for prediction equation - quantifies the average deviation of individual data points around the line of best fit - magnitude of it depends on the size of the residual score - reflects the average degree of deviation of individual data points around the line of best fit - when they're close the line, the SEE is small
The Exercise Motivation Inventory
- measures specific motives for engaging in exercise
The Behavioral Regulation in Exercise Questionnaire
- measures your clients' level of motivation on a continuum, ranging from amotivation to intrinsic motivation
prediabetes
- medical condition identified by fasting blood glucose or glycated hemoglobin levels or HbA1c levels above normal values yet below the threshold for diagnosis of diabetes
what to look for
- missing waves - inverted T - depressed or elevated ST segment - irregular waves
social networks useful for promoting exercise program adherence
- mobile technologies and the internet - low barriers to social networking - social support interventions for physical activity
transtheoretical model
- model describing the process a client goes through when adopting a change in health behavior - clients progress through five stages at different rate - may move back and forth - use different cognitive and behavioral strategies in this process - weigh the cost and benefits of the health behavior change
health belief model
- model suggesting that individuals will change a behavior because they perceive a threat of disease if they do not change - self-efficacy and cues to action are important concepts
What were the sizes of the validity coefficient (rxy) and the prediction errors when this equation was applied to the cross-validation sample (i.e., what is the group predictive accuracy of the equation)?
- moderately high validity coefficient (>0.80) and an acceptable prediction error - assessed by SEE and the total error TE
Explain the relationship between physical inactivity and low back pain.
- muscular weakness or imbalance - could be brought by frequent bending at the waist, twisting, accommodating loads carried high on the body, heavy and repeated lifting, and holding awkward positions - poor posture results and low back pain develops when you don't have strong enough muscles
Was the prediction equation cross-validated on another sample from the population?
- must be tested on other samples
ST segment depression
- myocardial ischemia - mitral valve prolapse - hypothermia - tachycardia - needs to be on the same line as the p-wave
art and science of exercise prescription
- need to be creative and flexible - able to modify the exercise prescription based on clients' goals, behaviors, and responses to the exercise - increase probability your clients will make long-term commitments to include physical activity and exercise
type 2 diabetes
- non-insulin dependent diabetes, caused by decreased insulin receptor sensitivity - associated with sedentary time
identify the cutoff values for classifying resting BPs
- normal: SBP less than 120 and DBP less than 80 - elevated: SBP - 120-129 and DBP less than 80 - stage 1 hypertension: SBP is 130-139 and DBP is 80-89 - stage 2 hypertension: SBP greater than 140 and DBP greater than 90
anemia
- not having enough healthy red blood cells or hemoglobin to carry oxygen to the body's tissues
How were the variables measured by the researchers who developed the prediction equation?
- not only knowing which variables, but also how each one was measured - need to be measured according to the descriptions provided by the researchers who developed the equation
physical inactivity risk factors
- not participating in 30 minutes of activity for at least 3 days for 3 months
Eight diseases that it affects
- obesity - depression - anxiety - low back pain - bone fractures - coronary heart disease - hypertension - breast cancer - lung cancer - colon cancer
stop testing if
- onset of angina - shortness of breath, wheezing, leg cramps - noticeable change in heart rhythm - failure of HR to rise with increased workload - nausea, cold clammy skin, dizziness, pallor
LDL-C cutoff values
- optimal: less than 100 - near or above optimal: 100-129 - borderline high: 130-159 - high: 160-189 - very high: greater than 190
Triglycerides cutoff values
- optimal: less than 150 - borderline high: 150-199 - high: 200-499 - very high: greater than 500
cutoff values: TC
- optimal: less than 200 - borderline high: 200-239 - high: greater than 240
palpation
- palpated at brachial artery, carotid artery, radial artery, or temporal artery - 30 to 60 for resting - 6 to 10 second count for exercise - use tips of middle and index fingers - count the first beat as zero if you start the stopwatch simultaneously - method used to measure heart rate by feeling the pulse at specific anatomical sites
diabetes mellitus
- pandemic level - major contributor to other conditions, such as heart disease, stroke, kidney failure, cognitive disability, and some cancers - risk of post-exercise hypoglycemia and transient hyperglycemia
describe the proper positioning of the wrist for assessing resting blood pressure with a wrist cuff
- patient should be sitting or standing - client should not be holding anything - bare arm, palm up, should be resting on a solid surface
To whom is the prediction equation applicable?
- physical characteristics of the sample - can be population specific or generalized - don't use population-specific for those for whom it was not created
auscultation
- place bell of stethoscope over third intercostal space to the left of the sternum - 30 or 60 seconds - count heartbeats - method used to measure heart rate or blood pressure by listening to heart and blood sounds
demographic and biological
- positive factors: eductation, gender, socioeconomic status - negative: age, race, overweight or obesity
psychological, cognitive, and emotional
- positive factors: enjoyment of exercise, expected benefits of exercises, perceived health and fitness, self-efficacy, self-motivation - negative: barriers to exercise, mood disturbance
environmental
- positive: access to exercise facilities, satisfaction with exercise facility, exercise equipment at home, enjoyable scenery, observing other exercising, neighborhood safety - negative: climate or season, urban location
behavioral
- positive: activity history during adulthood, healthy dietary habits - negative: smoking
program
- positive: exercise leadership and supervision, variety of exercise modes and activities - initial exercise intensity, perceived effort
social-cultural
- positive: physician influence, support from spouse, family, friends, or peers - negative: social isolation
Explain how regular physical activity affects each of the CHD risk factors as well as overall CHD risk.
- positively affects lipid metabolism and lipid profiles - increases HDL-C - reduce blood pressure - reduces stroke risk by 8% to 14% - reduces weight - reduces triglycerides - reduces type 2 diabetes by improving glucose control
population-specific equations
- prediction equations intended only for use with individuals from a specific homogeneous group
generalized prediction equations
- prediction equations that are applicable to a diverse, heterogenous group of individuals
sympathetic nerve inhibitors
- prevent constriction of arterioles
resting ECG detects
- previous myocardial infarction - conduction defects - ischemic ST segment changes - left ventricular hypertrophy - baseline data
Exercise Prescription for individuals with hypertension
- primarily endurance activities - moderate-intensity endurance exercise - duration is 30 minutes or more of continuous aerobic physical activity with 2 sets of resistance training for each major muscle group - all days for aerobic exercise, 2 to three days for resistance training
sensitivity
- probability of a test correctly identifying individuals with risk factors for a specific disease
stages of motivational readiness for change model
- psychological theory of behavior change - ability to make long-term behavior change is based on client's emotional and intellectual readiness - stages: 1. precontemplation 2. contemplation 3. preparation 4. action 5. maintenance
social cognitive model
- psychological theory of behavior change - based on concepts of self-efficacy and outcome expectation - greater than 70% believe they have the knowledge and skill to exercise successfully - educate clients fully understand their beliefs - performance mastery: techniques and allowing them to practice these, modeling (role models), positive reinforcement, and emotional arousal (education)
behavior modification model
- psychological theory of change - clients become actively involved with the change process by setting short and long-term goals - provide clients with feedback and revise the plan - adopt physical activity into their lifestyle, develop a social support system, and implement behavior counseling strategies such as keeping a diary - setting goals
WORKOUT: vigorous intensity
- race walking, jogging, running, or vigorous lap swimming - tennis (singles) - dancing (folk, line, competitive ballroom) - bicycling 10 mph or faster - jumping rope - backpacking - circuit training (resistance based with some aerobics and minimal rest intervals)
strategies to increase exercise program adherence
- recruit physician support of the exercise program - prescribe moderate-intensity exercise to minimize injury and complications - advocate exercising with others. - offer a variety of enjoyable exercise and fitness activities. - provide positive reinforcement through periodic testing. - recruit support for the program from clients' families and friends. Add optional recreational games to the conditioning program. - use progress charts to record exercise achievements. - establish a reward system to recognize participant accomplishments. - provide qualified exercise professionals who are well trained, innovative, and enthusiastic.
calcium channel blockers
- reduce heart contractility and dilate arteries
active workstations
- reduced sitting time - increased daily activity
identify two BP devices that are best suited for assessing BP during exercise
- requires manual BP assessment with auscultation 1. sphygomanometer 2. stethoscope - before, during, and after exertion - PRACTICE!
diuretics
- rid the body of excess salt and fluids
manual blood pressure assessment: reducing error
- select proper cuff size - allow undisturbed seated rest first - proper earpiece positioning - proper cuff placement - proper arm position - proper inflation and deflation rate - proper positioning of pressure gauge - round to previous even number - no odd numbers - PRACTICE!
nocturnal dyspnea
- sensation of shortness of breath that awakens the patients, often after 1 or 2 hours of sleep - usually relieved in the upright position
high HDL-C risk factor
- serum HDL-C greater than 60 - if that is there, you can actually take a risk factor off! - this is a very good thing - highly affected by exercise - diet affects LDL
Was the average predicted score similar to the average reference score for the cross-validation sample?
- should yield similar mean values for the actual (measured or reference) and predicted scores of the cross-validated sample - constant error is the difference - compared using a paired t-test - significant difference: bias
increasing duration
- slowly increased by 5-10 minutes every 1 to 2 weeks for at least a month - for most clients, should not exceed 60 minutes
maintenance stage
- stage of exercise program designed to maintain level of fitness achieved by end off improvement stage; should be continued on a regular, long-term basis - amount of exercise required to maintain is less than that needed to improve - jogging for 5 can be reduced to 2 o3 three and be replaced with swimming, rowing, or sport activities
initial conditioning stage
- stage of exercise program used as a primer to familiarize client with exercise training - usually lasting four weeks - or 1 to 6 weeks - stretching exercises, light calisthenics, and low-intensity aerobic or resistance exercises - increase duration first
limits of agreement
- statistical method used to assess the extent of agreement between methods - also known as the Bland and Altman method
line of identity
- straight line with a slope equal to I and an intercept equal to 0 - used in a scatter plot to illustrate the differences in the measured and precited scores of a cross-validation sample
heart rate testing: causes of HR fluctuations
- stressors - medication - caffeine - time of day - body position - meals - smoking - drinking
manual blood pressure technique
- supine and exercise positions - don't grip the exercise apparatus or my shoulder - stand where the client can keep the arm in the sagittal plane as much as possible - identify location of brachial artery - earpieces properly positioned - inflate cuff rapidly 20 mmHg above estimated SBP - controlled deflation: 2-3 mmHg - listen carefully while watching guage - mentally note SBP and DBP sounds - release pressure (leave cuff in place during exercise)
global positioning system (GPS)
- system that uses 24 satellites and ground stations to calculate geographic locations and accurately track a specific activity - line-of-sight requirement - intensity of physical activity and calories expended - GPS unit and environment within which it is used: accuracy - GPS, accelerometer, cost-effective way
"Exercise is Medicine" initiative
- targets primary care physicians and other health care providers - focus on including physical activity in treatment plans - initiative to include exercise in medical treatment
inactive children...
- tend to become inactive adults - called exercise deficit disorder
Which is more important: test validity or test reliability? Explain your choice
- test reliability affects test validity - tests with poor reliability also have poor validity because unreliable tests fail to produce consistent test scores - possible to have excellent reliability but poor validity
ankle edema
- the abnormal buildup of fluid in the ankle - circulation problems - sign of heart failure perhaps?
dialysis
- the clinical purification of blood by dialysis as a substitute for the normal function of the kidney
dose-response relationship
- the volume of physical activity is directly related to health benefits from that activity - response = health benefits - some MVPA better than none - exceeding the recommended dose magnifies the response - exceeding the recommended dose by a factor of 10 is not harmful
self-determination theory
- theory describing how the presence or absence of specific psychological needs affects behavior - amotivation: no intention - other-determined motivation: outside factors - self-determined extrinsic motivation: outward things, but the person decides to like them - intrinsic motivation: sheer enjoyment
decision-making theory
- theory stating that individuals decide whether or not to engage in a behavior by weighing the perceived benefits and costs of that behavior - clients in early stages of motivational change tend to perceive more disadvantages rather than clients in later stages - 16-item self-report tool
theory of reasoned action
- theory that proposes a way to understand and predict an individual's behavior; intention is the most important determinant of behavior - focuses on how other people perceive them, too
test interpretation
- to classify your clients' physical fitness, compare test scores against established norms - use lay language when telling
physical examination
- to detect signs and symptoms of disease - blood chemistry - blood pressure - aerobic capacity - conducted by medical provider - ePARmedX+
blood chemistry profile
- to determine if client has normal values for selected blood values - values of blood cholesterol panel are used in the coronary risk factor analysis: LDL, HDL, total cholesterol - blood glucose and triglycerides are also looked at - typically done by medical doctor
blood pressure assessment
- to determine if client is hypertensive - these values are also used in the coronary risk factor analysis
Coronary Risk Factor Analysis
- to determine the number of coronary heart disease risk factors for client - it provides an assessment of an individual's blood chemistry values and other factors known to be associated with CVD
12-lead electrocardiogram
- to evaluate cardiac function and detect cardiac abnormalities that are contraindications to exercise - two dimensional view of depolarization and repolarization - electrodes read the electrical activity of the heart - pairs of electrodes form unique leads - 10 electrodes form 12 leads
Signs and Symptoms of Disease and Medical Clearance
- to identify individuals in need of medical referral and to obtain evidence of physician approval for exercise testing and participation - no longer done through risk factor criteria - now based on current exercise habits and signs of 3 diseases: cardiovascular, renal, and metabolic
Lifestyle evaluation
- to obtain information about client's living habits - smoking, physical activity, diet - Fantastic Lifestyle Checklist or Lifestyle Evaluation
beta-blockers
- to reduce heart rate and cardiac output
interindividual variability principle
- training principle - individual responses to training stimulus are variable and depend on age, initial fitness level, and health status
specificity principle
- training principle - physiological and metabolic responses and adaptations to exercise training are specific to type of exercise and muscle groups involved
reversibility principle
- training principle - physiological gains from training are lost when an individual stops training (detraining)
overload principle
- training principle - physiological system must be taxed beyond normal to stimulate improvement
progression principle
- training principle - training volume must be progressively increased to impose overload and stimulate further improvements
diminishing returns principle
- training principle: as genetic ceiling is approached, rate of improvement slows or evens off
initial values principle
- training principles - the lower the initial value of a component, the greater the relative gain and faster the rate of improvement in that component - the higher the initial value, the slower the improvement rate
tips to enhance exercise motivation
- try to understand why the client is there - create opportunities to experience competence - create opportunities for autonomy - create opportunities for relatedness
cardiorespiratory endurance modes
- type: aerobic exercise - walking, jogging, cycling, rowing, swimming, stair climbing, simulated cross-country skiing, aerobic dance, step aerobics, elliptical activity
body composition modes
- type: aerobic exercise and resistance exercise - modes: same modes listed for cardiorespiratory endurance and muscular strength
balance modes
- type: balance training - tai chi, yoga, pilates, balance exercises
muscular strength and muscular endurance modes
- type: resistance exercise - free weights, exercise machines, body weight exercises, exercise bands
flexibility modes
- type: stretching exercise - mode: static stretches, PNF stretches, yoga, tai chi, Pilates
bone strength modes
- type: weight-bearing, high-impact aerobic exercise and resistance exercise - load-bearing calisthenics, high-intensity cardio, plyometrics, free weights, body weight exercises, exercise machines, whole-body vibration, walking for femoral neck strength
automated blood pressure technique
- use proper cuff size (may not be the one that came with the machine) - follow manufacturer guidelines - cuff snuggly on skin - allow undisturbed seated rest - machine handles inflation and deflation - record of the calculated SBP and DBP values - reduces likelihood of white coat effect
SCORE system
- used to estimate 10 yr risk of first fatal cardiovascular disease - based on data from European countries - need to know the following: 1. total cholesterol 2. systolic blood pressure 3. smoking status 4. sex
WORKOUT: moderate intensity
- walking briskly - skateboarding (noncompetitive) - water aerobics and water calisthenics - bicycling slower than 10 mph - tennis - ethnic and cultural dancing - general gardening - yoga
idiopathic
- we don't know - hypertension - the main reason that people get this people don't know - we know things that CONTRIBUTE to it, but not much else
pretest instructions
- wear comfortable clothing, socks, and athletic shoes - plenty of food - don't eat, smoke, or drink 3 hrs before - not strenuous physical activity - get adequate sleep
What types of exercise are effective for counteracting bone loss due to aging?
- weight-bearing exercises - vigorous intensity exercise helps - bone-strengthening for children is the key to adult prevention
Where to feel the HR pressures
- when feeling for the carotid pulse under the angle of the jaw, use very light pressure - the radial pulse is felt on the wrist, just under the thumb
Explain the obesity paradox
- when you have hypertension, atrial fibrillation, and heart failure, - prognosis improved for those who are overweight or mildly obese as compared with leaner clients
describe the effects of miscuffing on BP readings
- you could overestimate the BP, cuff hypertension - on the other hand, overcuffing makes the BP become underestimated.
palpatations
- your heart is fluttering
at minimum, a pretest health screening should include four items. Name these
1. PAR-Q+ 2. medical history questionnaire 3. lifestyle evaluation 4. informed consent form
the pyramid
1. activities of daily living 2. resistance exercise and aerobic exercise 3. balance activities and flexibility exercise 4. sports and recreational activities
pulmonary diseases or disorders that limit exercise performance
1. asthma 2. coughing up blood 3. breathlessness during or after mild exertion
name methods for measuring heart rate and some tips
1. auscultation 2. palpation 3. heart rate monitors (usually involve a chest strap) 4. ECG recordings - resting HR is NOT equal to high cardiorespiratory fitness! - also, allow 5 min rest before HR assessment
categories of positively related and negatively negatively related factors associated with physical activity participation
1. demographic and biological 2. psychological, cognitive, and emotional 3. behavioral 4. social-cultural 5. environmental 6. program
name three methods for measuring BP. Which one is considered the gold standard? Is each method accurate at high altitude?
1. direct measurement of intra-arterial BP: gold standard 2. auscultation 3. oscillometry
cardiovascular diseases or disorders that limit exercise performance
1. hypertension 2. heart murmurs 3. palpitations
Name the three stages of an exercise program. On average, how long should each stage last?
1. initial conditioning stage 2. improvement stage 3. maintenance stage
identify the three elements of an exercise prescription. For older or less fit clients, which of the elements should be increased first during the initial stage of their exercise programs?
1. intensity 2. duration 3. frequency - the first one to increase should be duration
metabolic diseases or disorders that could impact exercise performance
1. obesity 2. thyroid disease 3. glucose interolerance
musculoskeletal diseases or disorders that could impact exercise performance
1. osteoporosis 2. low back pain 3. swollen joints
What is the recommended sequence of testing for administering a complete fitness test battery?
1. resting blood pressure and heart rate 2. body composition and balance 3. cardiorespiratory endurance 4. muscular fitness 6. flexibility
training principles
1. specificity-of-training principle 2. overload training principle 3. principle of progression 4. principle of initial values 5. principle of interindividual variability 6. principle of diminishing returns 7. principle of reversibility
top cancers
1. women: breast 2. men: lungs 3. colon
coronary heart disease (CHD)
Disease of the heart caused by a lack of blood flow to heart muscle, resulting from atherosclerosis.
stage 1 hypertension
SBP: 130-139 DBP: 80 - 89
stage 2 hypertension
SBP: greater than 140 DBP: greater than 90
augmented unipolar leads
Three ECG leads (aVF, aVL, aVR) that compare voltage across each limb lead to the average voltage across the two opposite electrodes
select one physical fitness component and explain how you can determine the relative worth or predictive accuracy of a field test developed to assess this component
To test muscular strength, I would first ask questions: 1. what reference measure was used to develop the prediction equation? 2. how large was the sample used to develop the prediction equation? 3. what is the ratio of sample size to the number of predictor variables in the equation? 4. what were the sizes of the Rmc and the standard error of estimate for the prediction equation? 5. To whom is the prediction equation applicable? 6. How were the variables measured by the researchers who developed the prediction equation? 7. Was the prediction equation cross-validated on another sample from the population? 8. What were the sizes of the validity coefficient and the prediction errors when this equation was applied to the cross validation sample (i.e., what is the group predictive accuracy of the equation)? 9. Was the average predicted score similar to the average reference score for the cross-validation sample? 10. How good is the prediction equation for estimating reference values of individual clients (i.e., what is the individual predictive accuracy of the equation)?
autophagy
a cell-level recycling program that sequesters damaged organelles and misfolded proteins, breaks them down into smaller pieces, and reuses those smaller components to support cellular viability
sedentarism
a lifestyle lacking in physical activity and dominated by excessive time spent sitting
dsylipidemia
abnormal blood lipid profile
total cholesterol (TC)
absolute amount of cholesterol in the blood
white coat effect
acute elevation of blood pressure when measured in the doctor's office regardless of usual blood pressure readings outside of that environment or antihypertensive medication prescription status
genome-wide association studies (GWAS)
an investigation across the human genome that compares DNA variants of individuals presenting different phenotypes for a disease or trait; typically involves use of control group (disease or trait not present) and affected group with the disease or trait.
angina pectoris
chest pain
HDL-cholesterol (HDL-C)
cholesterol transported in the blood by high-density lipoproteins
LDL-cholesterol (LDL-C)
cholesterol transported in the blood by low-density lipoproteins
masked hypertension
condition in which individuals exhibit elevated BP readings outside the physician's office but have normal BP values in the office
white coat hypertension
condition in which individuals have normal blood pressure and are not taking any antihypertensive medications but become hypertensive when blood pressure is measured by a health professional.
multiple correlation coefficient (Rmc)
correlation between reference measure and predictor variables in a prediction equation
sphygmomanometer
device used to measure blood pressure manually, consisting of a blood pressure cuff and a manometer.
noncommunicable diseases (NCDs)
diseases that cannot be transmitted from one person to another; cardiovascular disease, diabetes, obesity, chronic respiratory disorders, and most cancers
hyperlipidemia
excess lipids in blood
hypercholesterolemia
excess of total cholesterol, LDL-cholesterol, or both in blood
myocardial infarction
heart attack
systolic blood pressure (SBP)
highest pressure in the arteries during systole of the heart
bias
in regression analysis, a systematic over-or-underestimation of actual scores caused by technical error or biological variability between validation and cross-validation samples - constant error
what were the sizes of the Rmc and the standard error of estimate for the prediction equation?
it is important to focus on the size of the prediction error than on the Rmc because magnitude of Rmc is greatly affected by sample size and variability of the data
myocardial ischemia
lack of blood flow to the heart muscle
very low-density lipoprotein (VLDL)
lipoprotein made in the liver for transporting triglycerides
osteopenia
low bone mineral mass; precursor to osteoporosis
diastolic blood pressure (DBP)
lowest pressure in the artery during the cardiac cycle
age criteria risk factors
men greater than 45, women greater than 55
oscillometry
method for measuring blood pressure that uses an automated electronic manometer to measure oscillations in pressure when the cuff is deflated
lipoprotein
molecule used to transport and exchange lipids among the liver, intestine, and peripheral tissues
cuff hypertension
overestimation of blood pressure caused by use of a bladder that is too small for the arm circumference
Define obesity and overweight relative to BMI
overweight: 25-29.9 obese: 30kg/m2 or more - fifth leading cause of death globally - high prevalence for adults and children - threatens longevity and quality of life - associated with CHD risk factors - prevalence varies by race/ethnicity
claudication
pain in your thigh, calf, or buttocks that happens when you walk a certain distance
low back pain
pain produced by muscular weakness or imbalance resulting from lack of physical activity
T wave
part of ECG tracing corresponding to ventricular repolarization
QRS complex
part of ECG tracing reflecting ventricular depolarization and contraction
ST segment
part of ECG tracing reflecting ventricular repolarization; used to detect coronary occlusion and myocardial infarct.
PR interval
part of ECG tracing that indicates delay in the impulse at the atrioventricular node
P wave
part of ECG tracing that reflects depolarization of the atria
Explain how physical inactivity differs from sedentary behavior
physical inactivity is a contributor to disease; it is more specifically for health , as a factor - sedentary is performing activities less than 1.5 METs while in a sitting or reclining posture. It is a separate risk factor. It is a lifestyle
identify the positive and negative risk factors for CHD. specify the criteria for each of these risk factors
positive: 1. age 2. family history 3. cigarette smoking 4. hypertension 5. dyslipidemia 6. diabetes 7. obesity 8. physical inactivity negative 1. high HDL-C
low-density lipoprotein (LDL)
primary transporter of cholesterol in the blood; product of very low-density lipoprotein metabolism
normotensive
referring to normal blood pressure, defined as values less than 120/80 mmHg
line of best fit
regression line depicting relationship between reference measure and predictor variables in an equation
telomeres
repeated DNA sequences that determine structure and function of chromosomes
tachycardia
resting heart rate is greater than 100 bpm
bradycardia
resting heart rate is less than 60 bpm
chest leads
six ECG leads (V1 to V6) used to measure voltage across specific areas of the chest
miscuffing
source of blood pressure measurement error caused by use of a blood pressure cuff that is not appropriately scaled for the client's arm circumference
improvement stage
stage of exercise program in which client improves most rapidly; - frequency, intensity, duration are systematically increased - usually lasts 4 to 8 months - frequency, intensity, and duration are systematically and slowly advanced, one element a time, until fitness goal is reached
Bland and Altman method
statistical approach used to asses the degree of agreement between methods by calculating the 95% limits of agreement and confidence in intervals - used to judge the accuracy of a prediction equation or method for estimating measured values of individuals in a group
terminal digit bias
tendency of the technician to round BP values to the nearest 0 or 5 mmHg
exercise deficit disorder (EDD)
term associated with children who do not engage in at least 60 min/day of moderate-to-vigorous-intensity physical activity
limb leads
three ECG leads (I,II,III) measuring the voltage differential between left and right arms (I) and between the left leg and right (II) and left (IIII) arm.
chylomicron
type of lipoprotein derived from intestinal absorption of triglycerides
high-density lipoprotein (HDL)
type of lipoprotein involved in the reverse transport of the cholesterol to the liver
overcuffing
using a blood pressure cuff with a bladder too large for the arm circumference, leading to an underestimation of blood pressure
undercuffing
using a blood pressure cuff with a bladder too small for the arm circumference, leading to an overestimation of blood pressure
cholesterol
waxy, fatlike substance found in all animal products
