KIN 415 Final Exam

Endurance

- Ability for the muscle to repetitively contract of a sustained period of time -Ultra-Marathoners -Triathletes -Distance runners

Other Training Changes

- Blood Lactate Concentration: extending level of exercise intensity before OBLA - Body Composition: reduces body mass and body fat - Body Heat Transfer: larger plasma volume and more responsive thermoregulatory mechanism.

Connective Tissue consists of

- Cells: Produce extracellular matrix - Extracellular matrix: consistency determines CT physical properties - ground substance (viscous) - fibers - collgen - Elastic

Hypertrophy

Muscular enlargement - Increase Cross sectional area, - positive relation with strength Result of increased synthesis of actin and myosin plus number of myofibrils

What is the effect of Ex on blood flow tot he heart with those with atherosclerosis?

Narrowed arteries do not meet the blood flow demands of Ex, resulting in less blood flow during Ex.

Blood Pressure

Systolic BP - 90-130 (normal) - 90-110 (endurance exercise effect) - 110-130 (resistance exercise effect) Diastolic BP - 60-80 (normal) - 60-70 (endurance exercise effect ) - 70-80 (resistance exercise effect)

What muscles would you want to target for patients with COPD?

Targeting major muscle groups is always important, but respiratory muscle training is important.Target inspiration muscles.

Thrombus

Technical term for blood clot

Primary Risk Factors for CVD

hypertension hyperlipidemia physical in activity obesity - all factors can be controlled

Fascia

- Connective tissues play an important role in human function. - 16% of total body weight and stores 23% of total water composition - It connects all the tissues of the human body together including the muscles, organs, nerves and vessels of the body. - Fascia is a dynamic connective tissue that changes based on the stresses placed on it.

Deep Fascia

- Deep fascia is a continuous connective tissue sleeve that covers the muscles throughout the body •Fascia is integral to individual muscle fibers - Epimysium - Perimysium - Endomysium •Fascial recoil works synergistically with their muscles - plyometric training

Factors affecting remodeling

- Drugs - Hormones - Genotype - Local tissue interaction - Mechanical loading - Metabolic Factors - Disease

Enhancement of GXT Accuracy

- Duration, longer the test greater accuracy - MET level, higher is better - SBP response - HR max, compare to predicted (at least 85%) Heart Rate Recovery ➢RPP, higher is better ➢Symptoms of angina and/or dyspnea ➢Radionucleotide imaging

Fibers in the matrix affect mechanical characteristics of CT

- Elastin fibers - branched and wavy - contain proteins elstin - low tensile strength (stretch a lot) but return to original length - Collagen fibers: most numerous - Long, slightly wavy and unbranched - Bundle of protein collagen - Provides high tensile strength (resists stretch)

Properties of Muscle

- Excitability: capacity of muscle to respond to a stimulus - Contractility: ability of a muscle to shorten and generate pulling force - Extensibility: muscle can be stretched back to its original length - Elasticity: the ability of a muscle to recoil to original resting length after stretched

Intensity of Training

- Exercise intensity represents the most critical factor for successful training.

Specialized Connective Tissue cells

- Fibroblasts: Cells produce matrix of loose connective tissue (skin, tendons, & ligaments) - Chonodroblasts: Cells produce matrix of cartilage (transform to chondrocytes) - Osteoblasts: Cells produce matrix of bone (transform to osteocytes)

Fatigue

- Inability to maintain a given workload exercise intensity (% VO2max) - No one identifiable cause of fatigue Associated phenomena -Task specific -Causes seem to be multifocal -Peripheral (local) fatigue, no CNS etiology -Diffuse central factors (psychological fatigue) -Environmental factors: heat, humidity

Anaerobic Training

- Main type of fiber to benefit: Intermediate (FOG) - Increased Phosphorylase (break glucose from glycogen) - Increased Phosphofructokinase (glycolysis rate limiting) - Increased Glycogen synthetase (builds glycogen from glucose) - Facilitation of both synthesis and breakdown of glycogen - Time course changes: T(1/2)=7-10 days (longer for CV) - Losses proceed rapidly T(1/2)= 5-8 days -Myoglobinlosses: not as rapid - Resistance of aerobic ability during detraining - Three main, rate-limiting enzymes are enhanced: 1.) Phosphorylase 2.) PFK 3.) Glycogen Synthet

Reversibility

- Most metabolic and cardiorespiratory benefits gained through exercise training are lost within a relatively short period of time after training is stopped. - In one experiment, VO2max, maximal stroke volume, and cardiac output decreased roughly 1% per day during 20 days of bed rest.

3. Teaching Techniques

- Personal contact - Motivational (positive feedback for continuation) - Variety - Encouragement - Progression - Counseling: referral to others

5. Termination Criteria for an Exercise Program

- Pleasant fatigue, not exhaustion - Should be able to recover in a few hours - Logistics of facilities/client's work schedule

Connective Tissue

- Provide support - Transmit forces - Maintain structural integrity

Individual Traits

- Relative fitness level at beginning of training. - Trainees respond differently to given exercise stimulus.

Continued Metabolic Calculations

- S = speed in m*min -1 - M = body mass in kgG = percent grade in fraction - W = is power in watts - f = is stepping frequency in min -1 - H = is step height in meters - Leg Cycling: Appropriate for power outputs between 50 and 200 W (300 and 1200 kg*m*min-1) VO2= 1.8 (work rate) * M-1+ 7 - Arm Cycling: Appropriate for power outputs between 25 and 125 W (150 and 750 kg*m*min-1) VO2 = 3 (work rate) * M-1+ 3.5 ◼VO2is in ml*kg-1min-1 ◼work rate is in kg*m*min-1 ◼M is the subject's body mass in kg

High-Intensity Interval Training

- Specialized form of IT Short intervals of max intensity exercise to low to moderate intensity exercise - Similarities to traditional interval training - Differences include: Increased EPOC Burn more fat Limits muscle loss - To get the benefits from HIIT push past the upper end of the aerobic zone and allow the body to replenish the anaerobic energy system during the recovery intervals - HIIT involve maximum effort, not simply a higher heart rate - There are many different approaches to HIIT different numbers of high and low intensity intervals different levels of intensity during the low intensity intervals different lengths of time for each intervaldifferent numbers of training sessions per week

Strength and Power

- Strength -maximal force that a muscle or group of muscles can generate - Power -maximal force exerted as fast as possible -EXPLOSIVE!

Roles of Fascia

- The fascia plays a major role in the circulation of blood and lymph -The fascia is important for the nutrition and metabolism of every cell in the body. - The fascia is the first line of defense in immune function - Disruptions and restrictions within the fascia are associated with disease and movement impairments - Interrupts the flow of blood and lymph - Can cause pain and poor compensatory patterns. The fascia is a major contributor of both sensory and proprioception - Matrix of communication between all cells, organs and whole-body systems -Provide a tensile support for muscles important to generate force - Embryology helps explain how all the fascial system connects all major systems including the nervous system - The cells in early in development differentiate into three germ layers: - Ectoderm: nervous system and the skin - Mesoderm: bones, muscles, fascial tissue and CV system - Endoderm: various internal organs and endothelial linings

Metabolite Depletion:

ATP-CP - Maximal depletion of CP - Tension development related to CP level

Volume of Training

- Training adaptations are best achieved when optimal amount of work in training sessions - Optimal amount of work varies individually - Training volume can be increased by either duration or frequency - Improvement depends in part on kcals per session and work/week

Connective Tissue Ground Substance

- Viscous watery gel that provides a scaffold that creates the framework for collagen and various cells - Important for the diffusion of nutrients and waste products - Provides lubrication between collagen fibers - Glycoaminoglycans helps maintain interfiber distance - Proteoglycans: assist (GAGs) by binding water

Therapeutic approaches to elevated non-HDL cholesterol

-Intensify therapeutic lifestyle changes -Intensify LDL-lowering drug therapy -Nicotinic acid or fibrate therapy to lower VLDL

Normal Axis Range

0-120 degrees

Fatigue Contributors:

1. Decreased CNS activation 2. T-tubules ➢Calcium regulation not appropriate ➢Decreased force generating capacity of myofibrils 3. Decreased ATP production rate 4. Substrate depletion (glycogen) 5. End product accumulation (hydrogen ion) 6. Cellular acidosis Increased temperature Related to workload and fiber type recruitment (type II, higher temperature) Overly cooled muscle = decreased energy flux Change in water Lose bodyweight through dehydration Increase in fatigue 5% body-water loss, stop activity

Six major substructures of the musculoskeletal system are

1. Fascia 2. Tendons 3. Ligaments 4. Cartilage 5. Bone 6. Muscle

Training: Chronic

1. Increase in thickness of ligaments/tendons 2. Increase in OH-proline synthesis -Infra-structure of tendons/ligaments -Amino acid that helps structure 3. Individual fibers become thicker 4. Increase in turnover of collagen →greater elasticity (collagen stiffer in older adults) 5. Increase in thickness of hyaline cartilage (articular surfaces) 6. Increase in cross-hatching of fibrils (basketweave = stronger)

Bone: Training

1. Increase inorganic compound (calcium) 2. Increase in organic compound (OH-proline) 3. Increase content of collagen 4. Increase bone enzyme systems (occur as quickly as 3 weeks; enzymes include alkaline phosphatase which helps to precipitate calcium hydroxyapatite)

Increased Aerobic Enzymes Directly Responsible for Favorable Shift To

1. Increased combustion of fat rather than CHO 2. Given VO2 attained with much smaller depletion of Phosphagen (ATP, CP) stores 3.Lesser intramuscular build-up of fatigue products: AMP, ADP, Phosphate, NH4

Isometric or High Resistance Training

1. Main response: synthesis of protein 2. Main Fibers: Type II (FG + FOG) 3. "Fiber splitting": general expansion/growth of existing fibers - Some new muscle cells possible over time; - Research is currently determining if new fibers occur in humans; - Requires large stretch eccentrics in animal models - Increased amount of contractile protein due to fiber loading (functional overload) - Protein synthesis is slowed for first few hours (muscle restoration) - Supra-normal rates of synthesis observed within 24 hrs. (may be due to increased sarcolemmaRNA)

Training effects of skeletal muscle (type of training dependent)

1. Muscle strength: max amount of a muscle force that a particular muscle or muscle group can exert against a resistance. 2. Muscle endurance: (local endurance) ability of a muscle or a group of muscles to perform work either isometric, concentric (both allodynamicand isodynamic) contraction or lengthening action over a given amount of time. 3. Muscle tone: facilitation of neural component to the neuromuscular unit resulting in increase resting tension. 4. Flexibility: increase usefulness of myotatic (stretch) reflex to increase force production, increase and maintain greater range of motion. -muscles that are not used start to go into static flexion (contractures)

Overtraining Signs Underlying mechanisms:

1. Muscular soreness: - subcellular injury - disruptive connective tissue/muscle (esp. muscle-tendon junction) 2. Increased OH (hydroxy) - proline/creatine ratio 3. Mitochondria swelling, destruction of cristae (internal damage) 4. Progressive depletion of minerals/glycogen 5. Disturbances in intercellular fluid volume or ionic composition

Determination of NSR

1. PR interval: 0.12-0.20 seconds 2. QRS interval: 0.06-0.12 seconds 3. p-wave morphology 4. QRS morphology 5. Normal Rate (60-100 bpm) 6. P-P' = R-R'7. No ST segment Elevation or depression 8. No previous MI: Deep-wide Q wave or QS wave 9. normal axis

Overtraining Signs:

1. Scratchy sore throat upon awakening related to heavy sleep (air movement across throat) 2. Increased early morning resting heart rate 5-10 bpm above normal 3. Legs heavy 4. Increased amount of sleep needed 5. Insomnia 6. Increased respiratory rate (norm: 12-16 breaths/min) 7. Diffuse muscle and joint pain 8. Nausea 9. Persistent head cold symptoms

Training Effects: Neuromuscular change may be attributed to

1. increased acetylcholine at n-m junction 2. increased terminal branching of nerve to muscle 3. increase collateral branching of nerve to muscle 4. combinations of above

Immediate stimuli of protein synthesis

1.Acute tension: induced degradation (breakdown) of protein 2.Increased influx of amino acid via stretched sarcolemma 3.Liberation of catecholamines 4.Amplifiers (during exercise): growth hormone, testosterone, thyroid hormone, [insulin (post exercise)]

Lactate Tolerance May be a Function of

1.Increased tissue buffering capacity 2.Increased pain tolerance

Calculate the MET cost of running on the treadmill at 6.5 mph/4% grade

12.7 METs

Interval Training Recovery Interval

1:3 (work: recovery) for training immediate energy systems 1:2 for training glycolytic energy systems 1:1 or 1:1½ for training aerobic energy systems

Calculate the MET cost of walking on the treadmill at 2.5 mph/6% grade

4.98 METs

How long (minutes) would it take the subject in question #2 to expend the number of kcals in one lb of fat, if they exercised at the MET load from question #1.

536 minutes

Calculate the Kcal expenditure (kcal.min-1) for a 75 kg man performing at the MET load in question #1.

6.53 kcals

Training Methods

Acceleration Sprints: gradual increases from slow to moderate to full sprinting in 50-100 m segments followed by 50 m light activity. Sprint Training: Repeated sprints at maximal speed with complete recovery (5 minutes or more) between repeats. Only 3 to 6 bouts in a session. Interval Training: Repeated periods of work alternated with periods of relief.

Secondary Risk factors for CVD

Age Sex race Family Hx Diabetes

Arm Ergometer Metabolic Calculations

Arm Ergometer: ml/min = R + H + V R = 3.5 ml*kg-1*min-1* BW (kg) H = none V = kg*m/min * 3 Arm Ergometer Comments: 1. For work rates between 150 -750 kg *m/min 2. Kg*m/min = kg * m/rev * rev/min 3. Multiply resting component by body weight (kg) to convert to ml/min Metabolic equations for gross VO2 in metric units Arm Ergometry:VO2 = (18*W* M-1) + 3.5

Left Axis Deviation:

Axis vector < 0 degrees. indicates ischemia

Right axis deviation

Axis vector > 120 degrees. indicative of pulmonary issues.

Beta Blockers

Block the effects of Norepinephrine and catacholemines to the heart. These lower heart rate and vasodilate the vessels. This means blood is flowing through the vessels at a slower rate, and with less force.

In the body comp. lab, what compartment model was used for the measurement techniques?

Bod Pod, UWW, and skinfold testing all measured a 2-compartment model, assessing lean mass and fat mass

Beta blocker effect with exercise

Can cause myopathy (weakness) of the skeletal muscle. Norepineprine is blocked to the muscle, so the muscles fatigue quicker

Elevated Triglycerides

Causes of Elevated Triglycerides •Obesity and overweight •Physical inactivity •Cigarette smoking •Excess alcohol intake •High sugar diet Decreased: Immediately affected by exercise Increased: High sugar diet

Fascia at a Cellular Level

Cells include: - Fibroblast: synthesize collagen, elastin, reticulum and ground substance - Fibrocyte: mature fibroblast that maintains connective tissue - Macrophage: cells active during inflammation and infections to assist in cleaning up cellular waste products and foreign antigens - Mast Cells: secrete histamine (vasodilator) and heparin (anticoagulant) - White blood cells: destroy antigens and produce antibodies in response to infection

4.Environmental and Clothing Considerations

Changes based on the weather

Brilla's 3 C'sfor Compliance (adherence)

Commitment: person's own motivation Cohort: peers Charisma: exercise leader

Fascial Response to Stretching

Comprised mostly of water - Ground substances are very hydrophilic •During stretching fascia water initially is squeezed out but as it relaxes more will enter •The higher composition of water increases fascial stiffness - Assist in the muscles to generate more force.

Cartilage:

Covers bone at joints •Unique aspect: devoid of nerves and blood vessels. -nourished by diffusion •limits thickness •influences healing •Damage -osteoarthritis -"torn" cartilage •hyaline cartilage •bony surfaces at movable articulation - reduces friction within the joint •fibrocartilage: - dense collagen fibers - distributes load at the joint - absorbs shock •intervertebral disks •menisci

Hypertension

Defined as chronic, persistent elevation in BP •Causes injury to lining of vascular walls •CAD is 6X as great in hypertensives (HTN) •Incidence of stroke and heart/kidney failure is directly related to HTN •Most causes of HTN are not known (inflammation?)

HYPERLIPIDEMIA

Desired Blood Lipid Levels: Total Cholesterol < 200 mg/dl LDL-C < 130 mg/dl (<100 is target for treatment) HDL-C > 35 mg/dl Triglycerides < 150 A poor lipid profile will accelerate the atherogenic process.

ELECTROCARDIOGRAPHY

Determination of Normal Sinus Rhythm: PR interval: 0.12-0.20 sec. QRS interval: 0.06-0.12 sec. P-wave morphology similar ("bunny ears"?) QRS wave morphology similar Q-wave 1/3 depth of R-wave: evidence of old MI ST segment not elevated or depressed Rate (atrial and ventricular) P-P' = R-R'

Fascial Tonicity

Fascia appears to have smooth muscle located in the following: -1. ligaments and tendons -2. dura mater -3. meniscus and intervertebral discs -4.visceral ligaments -5.bronchial connective tissue -6. ganglia of the wrist

Fascial Receptors

Fascia roles as a sensory organ was originally postulated by A. T. Still in 1899 •The sensory role is critical for proprioception and giving the brain a 3 - dimensional construct of the body •Studies demonstrate there are 4 major types of infrafascialmechanoreceptors ( Schleip) -Golgi -Pacini -Ruffini -Interstitial

What conditions covered in class are under the classification of "cardiovascular disease?

Hypertension Stroke Coronary Heart (artery) Disease

What are the degree markings of leads I-aVF?

I: 0 degrees II: 60 degrees III: 120 degrees aVR: -150 degrees aVL: -30 degrees aVF: 90 degrees

Specificity of Training

In order for a training program to be beneficial, it must develop the specific physiological capabilities required to perform a given sport or activity. ❖Metabolic ❖Mode of Exercise ❖Muscle Group ❖Movement Pattern SAID: specific adaptation to imposed demand.

Training: Acute

Increase thickness of support systems (e.g.increase thickness of medial meniscus during squat exercise)

PVC's on an EKG

Indicated by a QRS complex soon after a T-wave with a pause until the next regular beat.labeled as frequent or infrequent along with NSR

Overload Training

Induce hypertrophy, increase size of individual muscle fibers 1.Increased total mount of myosin and actin 2.Increased number of contractile elements (cross-bridges) 3.Related increase in thickness of connective tissue 4.Increase number and size of mitochondria 5. Large increase in phosphagen stores above rest 6. Increased glycogen over time, with adequate recovery 7. Increased enzymes: creatine kinase, phosphofructokinase (PFK) 8. No real reduction in vascular supply 9. Increased neuromuscular junction impulses 10. Related to slow movement training

What ExRx would be helpful for patients with COPD?

Interval training. A patient with COPD will perceive the work as more difficult, and they require rest in between bouts of Ex.Aerobic exercise is contraindicative to COPD.Supplemental Ex. is also helpful for those with severe COPD.

Ischemia

Lack of blood flow. Can be felt as chest pain during Ex.

Left Hemiblock

Leads II, III, and aVF are all negative. Physiologically represents the lack of conduction of the anterior half of the left bundle branch. Noted in LAD.

Leg Ergometer Metabolic Calculations

Leg Ergometer: ml/min = R + H + V R = 3.5 ml*kg-1*min-1* BW (kg) H = none V = kgm/min * 2 Leg Ergometer Comments: 1. For work rates between 300-1200 kgm/min 2. Kgm/min = kg * m/rev * rev/min 3. Multiply resting component by body weight (kg) to convert to ml * min -1 4. Monarch = 6 m/revTunturi = 3 m/revBodyGuard = 3 m/rev Metabolic equations for gross VO2 in metric units Leg Ergometry: VO2 = (10.8*W*M-1) + 7

TRAINING PRINCIPLES

Major objective in exercise training is to cause biological adaptations. Specificity: Progression Overload Reversibility Trait

Maximal Blood Pressure

Normal Exercise Levels ➢SBP = 160-200 ➢DBP = 50-90 Hypertensive ➢SBP >225 ➢DBP >90 Discontinue if: •SBP >225 •DBP >120 •Hypotensive response: especially in severe IHD or heart failure •Inadequate increase in SBP •(<20 from rest) •Fall in SBP below rest •Drop in SBP (20 or more indicates poor ventricular function), terminate •GXT or exercise prescription •Isolated increase in DBP also prediction of underlying CAD (>25mmHg)

Progressive Overload

Overload must be progressive to continue to prompt training adaptations. - Exercising at a level above normal brings biological adaptations that improve functional efficiency. - In order to overload aerobic or anaerobic systems, training must be quantified. - Quantity of Training: intensity and volume (frequency and duration).

Interval Training

Physiological effects: @ low end of training range: working aerobically @ high end of training range: HR increases, breathing harder, more anaerobic Reasons to do interval training: improve recovery HR weight-loss plateau bored Allows one to workout harder, longer, and burn more calories 8-10min warm up and 5 min cool-down after intervals

Risk Factors for MI

Primary: Hypertension Additional RF: Hyperlipidemia Physical inactivity

Nutritional Considerations

Proper hydration: the main ingredient in all tissues •Key electrolytes and vitamins - B vitamins, Na, K, Ca and Mg play important roles in muscle physiology •Processed foods are deficient in many of the nutrients necessary for all types of cellular and enzymatic function. - Artificial sweeteners are known stimuli for myofascial disorders •A variety whole nutrient rich foods provide the body with all the nutrients known to be important in tissue physiology - Provides nutrients in an appropriate ratios which humans have evolved to metabolize

Metabolic Calculations

Rationale: Provide the connection between metabolic and mechanical workloads Conversions: •1mph = 26.8 m/min •1L O2= 5 kcal •1 Watt = 6 kgm/min •1 kgm= 1.8 mL O2 •1 MET = 1 kcal.kg-1.hr-1 •1 MET = 1 mph (horizontal) •1 lb. (fat) = 3500 kcal

Intervention for LDL

Reduce amount of fat in diet Relative Risks: ▪2 Trans fatty acid ▪1.5 Saturated fatty acid ▪1 Polyunsaturated fatty acid ▪0.7 Monounsaturated fatty acid

Coronary artery disease

Reduction or blockage of blood flow to the heart due to occluded coronary arteries

Running metabolic calculation

Running: ml*kg-1*min-1 = R + H + V R = 3.5 ml*kg-1*min-1 H = m/min * 0.2 V = grade (fraction) * m/min * 0.9 Running Comments: 1. For speeds > 134 m/min (>5.0 mi/h) 2. If truly jogging (not walking), this equation can also be used for speeds between 80 and 134 m/min (3-5 mi/h) 3. Formula applies to level running off the treadmill, but not to grade running off the treadmill Metabolic equations for gross VO2 in metric units Treadmill and Outdoor Running: VO2 = (0.2*S) + (0.9*S*G) + 3.5

Stepping Metabolic Calculations

Stepping: ml*kg-1*min-1 = R + H + V R = included in horizontal and vertical components H = steps/min * 0.35 V = m/steps * steps/min * 1.33 * 1.8 Stepping Comments: 1. 1.33 includes both positive components of going up (1.0) + negative component of going down (0.33) 2. Stepping height in meters Metabolic equations for gross VO2 in metric units Stepping:VO2 = (0.2*f) + (1.33*1.8*H*f) +3.5

What is the first symptom of a MI?

Sudden death. 50% of those with MI survive

Patterns of Training

Sustained endurance activity •Interval training •Repeated isometric contractions (or heavy load isotonic) •Induced biochemical changes that favor aerobic or anaerobic metabolism

Myofascial Trigger Points

There may be dysfunction within the muscles and their associated fascia. •Trigger points are discrete, hypersensitive nodules within tight band of muscle or fascia. •Classified as latent or active •Latent trigger point - Does not cause spontaneous pain unless palpated - May restrict movement or cause muscle weakness •Active trigger point - Causes pain at rest and when palpated. •Palpation with referred pain helps determine if it is a tender point vs. trigger point -Found most commonlyin muscles involved in postural support. •Develop as the result of mechanical stress -Either acute trauma or microtrauma •Trigger point development theories: ATP deficit, increases Ach, decreases cholinesterase, increases Ca++release from SR, ANS dysfunction (stress) •Note that theories are similar to those for fatigue

Prescription Attributes

Training Time: rate of work during the work interval (e.g.200-m in 28 seconds) Repetitions: number of work intervals per set (e.g.six200-m runs) Sets: a grouping of work and recovery intervals (e.g.a set is six 200-m runs @ 28 sec, 1:24 rest interval) Work-Recovery Ratio: time ratio of work and recovery (e.g., 1:2 means recovery is twice work) Type of Recovery: rest or light to mild exercise

Overload

Training occurs in response to the stimulus of a mechanical over load

What is nitroglycerine used for?

Used to treat chest pain in CVD patients

Walking Metabolic Calculations

Walking: ml*kg-1*min-1= R + H + V R = 3.5 ml*kg-1*min-1 H = m/min * 0.1 V = grade (fraction) * m/min * 1.8 Comments: 1 mi/hr = 26.8 m/min Metabolic equations for gross VO2 in metric units Walking:VO2 = (0.1*S) + (1.8*S*G) + 3.5

What does a drop in BP during Ex indicate?

congestive heart failure

Pallar & Cyanosis

pale, lack of color, blue looking skin

Atherosclerosis Pathology

the progressive accumulation of fatty plaque and smooth muscle all the walls of blood vessels 1. Vascular damage 2. Healing and Clotting 3. Growth of smooth muscle 4. decreased lumen diameter

Metabolite Accumulation: Lactic acid

~ Circumstantial evidence related to fatigue ~ Associated with decreased pH ~ Decreased enzyme activity -(PFK -glycolysis controlling)

Metabolite Accumulation

~ Glycogen reduced ~ Maybe related to selective recruitment during high-intensity exercise ~ Blood glucose reduced -Increased duration = decreased blood glucose ~ Displace calcium from troponin: - Decreased amount of cross bridging - Decreased force (tension) leads to fatigue ~ Stimulates pain receptors ~ Decreased lipase activity ~ Decreased fatty acid release (fuel) ~ Use glycogen (increase depletion rate) ~ Calcium ion ~ From sarcoplasm into mitochondria ~ Decreased oxidative phosphorylation (uncoupled) ~ O2 used but decreased production of ATP ~ Calcium ion ~ Oxygen waste -Reach same VO2but workload does not equal initial workload

Conduction ABNORMALITIES

• 1st degree AV block PR interval >0.20 sec • 2nd degree AV block Dropped beats • 3rd degree AV block No association between P's and QRS's Bundle branch block (BBB) • W's or M's QRS waves • QRS interval 0.10-0.12 sec (incomplete) • QRS interval >0.12 sec (complete) incomplete bundle branch block BBB - QRS: 0.10-0.12 sec, end of the normal range of the - QRS complex Complete BBB • QRS> 0.12 seconds • W's or M's QRS waves Right BBB: • R-wave in V1 is tall and wide • QRS> 0.12 seconds • W's or M's QRS waves Left BBB: • R-wave in V6 is tall and wide • QRS> 0.12 seconds • W's or M's QRS waves

A determination of the axis requires magnitude and direction

• Leads I, II, III, aVR, aVL, and aVF are used to measuring the vector • From the EKG, magnitude is measured in mV (10 mm=1.0 mV), and the greatest positive or negative value is taken from each lead • II, III, aVFall negative: Left hemiblock

Acupuncture Points

•Acupuncture points appeared to correlate with areas of greater amounts of connective tissue •These points are located where nerves artery and veins collectively penetrate the fascia •Twisting the needle appears to manipulate the fascia which help reduce pain -Body work also appears to work in this way The majority (82%) of perforation points are topographically identical with the 361 classical acupuncture points in traditional Chinese acupuncture.

Tendons

•Attach muscle to bone •Transmit tensile loads from muscle to bone Structure and Function •sustain high tensile forces •flexible

Ligaments

•Augment the mechanical stability of joints •Guide joint motion •Prevent excessive motion Structure and Function •Pliant and flexible •Strong and inextensible/inelastic

Wolff's Law (1892)

•Bone is deposited where needed and resorbed where not needed-bone remodels in response to applied stress •Bone hypertrophy occurs in areas where stress and strain are increased. •Bone atrophy occurs in areas where stress and strain are decreased.

Tendons and Ligaments

•Both are viscoelastic tissues •Visco -a small amount of load results in quite a bit of deformation (relative) •Elastic-refers to Elastic Region •Importance of viscoelastic qualities?

Perpetuating factors

•Chronic mechanical stress and postural habits -The body lays down fascia based on repetitive use patterns - Inefficient movement patterns elicits abnormal muscle tonus •Overuse of a specific muscle group- -a tennis player gets lateral epicondylitis •Psychological distress or sleep deprivation - SNS reduces blood flow to skin and fascia - Reduced NO needed for smooth fascial muscle to relax

Properties of Fascia

•Collagen fibers: - tensile strength - elastic fibers contribute to its ability to recoil •Ground substance: - Allows the fascia to compress and expand •The amount of collagen, elastic, and ground substance varies in different types of tissue - ITB , subcutaneous fascia of gluteus maximus, and ligamentum flavum.

Myocardial Infarction: Heart Attack

•Complete blockage of blood flow through an artery •All cells "downstream" will die without blood supply •Can occur due to blood clot (thrombus) •First symptom of Infarct?... -SUDDEN DEATH (only 50% survive)

Composition

•Dense connective tissue (parallel-fibers of collagen) - Sparsely vascularized •Cellular (fibroblasts) - 20 % •Extracellular (80%) - 70% H2O-30% solids - collagen, ground substance, elastin •Collagen-ligaments -75% of solids -tendons -75%+ of solids

High Density Lipoproteins (HDLs)

•Different types, some more active than others •Carry cholesterol AWAY from vessel walls and to liver for emulsification in bile •Very low HDLs are a significant risk! Even if cholesterol levels are not high •TC/HDL ratio better measure of risk than TC

Hyperlipidemia

•Elevated lipids (cholesterol, triglycerides) •Elevated total cholesterol (due to diet, or over-producing liver-genetics) •Cholesterol is carried on special proteins in the blood (HDLs, LDLs) •Excess cholesterol speeds atherosclerosis - Desired levels: <200 - Borderline high: 200-239 -Very high: >240 •*mg.dl-1 or mg%

Physical Inactivity

•Epidemic proportions!•Linked to obesity, higher fat, high blood pressure, higher stress, higher overall death rates •Mortality significantly reduced with 2,000 kcals per week of exercise •Moderate exercise is most recommended

Dynamic Spirometry

•FEV1.0: forced expiratory volume in 1 sec •VC: Vital capacity •Ratio should be >80% •<80%: lung obstruction, resistance to airflow -asthma, cold, smoking •MVV: maximal voluntary ventilation -measured at rest -sampled 12-15 sec, extrapolated to 1 min •MVVpredicted - FEV x 40: Use 35 for older individuals - FEV x 35 in individuals over 50 •Breathing Reserve •MVV -VE(max)= x, form ratio to MVV •[MVV - VE(max)]/MVV •More improvement possible in sedentary vs. athletes • MVV - Ve. used in ratio to MVV to indicate an individuals ability to use the airspace available to them

Fascial Summary

•Fascia is continuous from head to toe •Muscles and associated fascia are richly innervated with various receptors making it the largest sense organ - important for proprioception and motor control •Injury and poor posture can create imbalances which can contribute to chronic injuries •Fascial research in still in its infancy Fascia: separates muscles and organs •More proprioceptive receptors than any other structure •Contains more elastin fibers Fascia: Damage •Damage: irritation and swelling -plantar fasciitis -shin splints -iliotibial band syndrome

Rate Pressure Product

•HR x SBP •Indication heart's VO2-determine workload of heart •Angina pectoris (WL = RPP) •Subject can exercise below RPP without angina •Can be used to prescribe Ex to those with chest pain

ABNORMALITIES

•Hypertrophy •Right ventricular hypertrophy: R(V1) > R(V5) •Left ventricular hypertrophy: [S(V1)+R(V5)] > 35 •Previous MI Q-waves deep, wide •Ischemia ST segment depression >1 mm depressed 0.08 sec after last identifiable part of the S-wave

RPE

•Important if the subject is on medication that lowers HR •Range: 11-16 (6-20 scale) or 3-5 (0-10 scale) •Rating of perceived exertion. •Exertion scale used during exercise if the subject is on a medication that lowers HR. •Can also be helpful in measuring exertion in deconditioned people.

Generalized effect

•Increase mitochondrial proteins •Increase enzyme activity

Tobacco use (smoking, chew)

•Increases fibrinogen levels (increase blood clots) •Vasoconstricts: increase damage to vessel walls and increase BP •Increases HR •Increases O2 use by the heart, while limiting O2 supply to the heart

Multidimensional Nature of Fitness

•Inherited limits: VO2Max •Environmental Factors: extreme heat, wetness •Dynamics: how hard one pushes his/herself •General health base •Individual goals

Injury Mechanisms

•Injury occurs when tissue is loaded beyond its physiological range •Microfailure occurs before the yield point is reached.

2. Qualities of an Exercise Leader

•Interest in participants •Get to know them •Ask open-ended questions (no y/n answer) •Reinforcement and performance feedback •Honor special achievements •"report" or "progress" (tangible) •Enthusiasm and example •Understand reasons for exercise •Understand reasons for dropping out (50-60% dropout rate)

Dynamic Nature

•Low - Bobsledding, Archery - Auto racing, Diving - Rock climbing, Sailing - Throwing, Billiards - Bowling, Curling, Golf •Moderate - Bodybuilding, Alpine skiing - Gymnastics, Wrestling - Figure skating, Football - Rugby, Baseball - Softball, Tennis-dubs, Volleyball •High - Boxing, Track - Cycling, Rowing, - Sprinting, Basketball - Ice hockey, Soccer, Swimming - Nordic skiing, Running, - Field hockey, Tennis-singles Aerobic ▪Krebs Cycle ▪ET Chain Anaerobic ▪ATP-PCr ▪Glycolysis

Factors affecting Properties

•Maturation - →20 →# and quality of cross-links increase → increase tensile strength and increase collagen fiber diameter (hypertrophy) •Aging - collagen content decrease → decrease stiffness, strength and ability to withstand deformation •Pregnancy and postpartum - tensile strength and stiffness in tendons decrease •Physical Training - Increase tendon tensile strength and ligament-bone interface strength -ligaments become stronger and stiffer, collagen fibers increase in diameter •Immobilization - Decrease tensile strength of ligaments, more elongation, less stiff - Decrease in cross-links - Decrease After 8 weeks of immobilization →12 months to recover strength and stiffness •NSAIDS -Increase tensile strength possibly due to increase cross-linkage •Local Cortisone -alters collagen organization in tendon -random versus parallel

Clinical Categories of Ligament Injury

•Negligible Clinical Symptoms (Grade 1) -no joint instability can be detected clinically •Severe Pain (Grade 2) - joint instability can be detected clinically - strength and stiffness decreases by 50% - instability can be masked by muscle involvement •Severe Pain (Grade 3) - severe pain experienced during the injury with less pain after the injury - joint is completely unstable - most collagen fibers have ruptured

Non-HDL Cholesterol

•Non-HDL cholesterol = VLDL + LDL cholesterol= (Total Cholesterol -HDL cholesterol) •VLDL cholesterol:denotes atherogenic remnant lipoproteins •Non-HDL cholesterol: target of therapy when serum triglycerides are > 200 mg/dL(esp. 200-499 mg/dL) •Non-HDL cholesterol goal: LDL-cholesterol goal + 30 mg/dL

Bone Remodeling

•Osteocytes: hard bone cell •Osteoblasts form bone ==> osteocytes •Osteoclast resorbs bone

Contributors to Low HDL Cholesterol (<40 mg/dL)

•Overweight and obesity •Physical inactivity•Elevated triglycerides •Type 2 diabetes •Cigarette smoking •Very high carbohydrate intakes (>60% energy) •Certain drugs (beta-blockers, anabolic steroids, progestational agents)

Mechanoreceptors

•Pacini: Respond to rapid pressure changes •They are located in deep capsular layers, spinal ligaments, and muscle-tendon -They play a major role in proprioceptive feedback-Stimulate them with: •high velocity adjustments •rocking, shaking •vibratory tools and rhythmic joint compression •Ruffini: respond to lateral shearing -Inhibit the sympathetic activity in the entire body -Located in ligaments of peripheral joints, dura mater, outer capsular layers-Slow steady shearing pressure is needed Golgi: located in muscle tendons, aponeuroses, ligaments and joint capsules - Stimulated with slow sustained stretching close to muscular attachments - Active movements may be more effective in stimulating these receptors •Myofascial and active release techniques can stimulate these receptors •Active stretching: yoga, Feldenkrais, and myofascial unwinding

Exercise Testing Stopping Codes:

•Progressive angina •Ventricular tachycardia, onset of 2nd or 3rd degree AV block, PVCs (multifocal or >6/min) •PVCs, QRS falls on T, Supraventricular tachycardia, LBBB, HR escalation •BP: rapid rise (e.g.130-140 => 200-250 mmHg) • > 20 mmHg drop in SBP •Light headedness, confusion, ataxia, pallor, cyanosis, nausea •Circulatory insufficiency •Early onset of horizontal or down-sloping ST segment (0.08 sec after QRS) •Exercise increases in BP (SBP >250, DBP >120 mm Hg) •Chronotropic impairment (>35 bpm, compared to predicted) •Subject requests to stop •Failure of monitoring systems or equipment

Low Density Lipoproteins (LDLs)

•Proteins that carry high amounts of cholesterol •May damage lining of artery walls •Also deposit cholesterol stores within injured sites •Linked to high triglycerides •Different types (i.e.small dense particle, buoyant), men tend to have the worst kind

Functions of bone

•Provide support •Allow movement •Protection •Mineral storage - 99% of body Ca in bone •Blood cell formation

Normal EKG Responses To Exercise

•Rate related shortening of QT interval •Superposition of P and T waves •Decreased amplitude of R wave (an increased distance of electrodes due to air in lungs) •Increased amplitude of septal Q and T waves •Progressive positive ST upslope

Treatment for Hypertension

•Reduced Na+diet (Na+may constrict vessels and increase fluid volume); may only be effective in salt-sensitive •MODERATE exercise* •Body fat reduction •Reduce alcohol intake •Drugs (diuretics, beta blockers, ACE inhibitors)

Pulse Pressure

•SBP-DBP •Indicates amount of perfusion through the body (blood flow)

Abnormalities to Exercise

•ST depression and delayed repolarization •Widely accepted criteria for myocardial ischemia •Classic pattern varies:horizontal, down sloping •Onset, duration, and magnitude correlates with severity, later in GXT not as bad as beginning

Fascia can be divided into different types (3 Superficial types)

•Superficial layer - adipose connective tissue and collagen fibers . •Membranous layer - collagen and elastic fibers run parallel to the skin •Deep superficial layer - Loose connective tissue - Anchors superficial fascia to deep fascia.

Primary Risk Factor #1: Hypertension

•The new categories (November 2017) - Normal blood pressure remains less than 120/80 - Elevated blood pressure, a new category: systolic 120 to 129 with normal diastolic (<80). - Stage 1 hypertension: systolic 130 to 139 or diastolic 80 to 89. - Stage 2 hypertension: systolic 140 or higher or diastolic 90 or higher.

O2 Pulse

•VO2/HR •Indicates stroke volume estimate

Specific Dyslipidemias

•Very High LDL Cholesterol (190 mg/dL) •Elevated Triglycerides Classification of Serum Triglycerides •Normal <150 mg/dL •Borderline high 150-199 mg/dL •High 200-499 mg/dL •Very high: > 500 mg/dL

1. Components of Exercise Program

•Warm-up •Strength/flexibility •Aerobic/cardio •Cool-down

Management of Low HDL Cholesterol

•Weight reduction and increased physical activity •Consider nicotinic acid or fibrates(for patients with CHD or CHD risk equivalents)

Remodeling: lifestyle

•success ?? - hormonal levels (estrogen) - mechanical stress •activity vs inactivity - available nutrient •(calcium, etc. without above factors has no effect)

Cardiorespiratory Resting Assessment: Heart Rate

▪Depends on lifestyle 60-100 bpm (athletes 40-80 bpm) ▪Affected by medications: ▪Beta-blockers prescribed for: cardiac problems, non-cardiac-migraine headaches, decrease with beta-blockers ▪Increased with nitroglycerine (angina pectoralis)

Effects of Endurance Training

❖ Increased size and number of mitochondria (MITO protein increase 60%) ❖ Increase in complexity of mitochondria internal structure ❖ Increased cristal folds ❖Augmented activity of mitochondrial enzymes ❖ex. Kreb'scycle enzymes (SDH), respiratory chain (OX PHOS) protein-cytochromes ➢Myoglobin concentration (up to 80%) ➢Facilitates local storage and transport of oxygen ➢Increased glycogen stores ➢Increased reservoir ATP + CP ❑Increased circulatory adjustments -increased perfusion during contractions ❑Decreased lactate accumulation (increased removal at any given intensity of effort) ❑Increased lactate tolerance: especially in response to interval training

Excessive intensity/volume of physical activity:

❖Children (inhibit bone growth) ❖Increase risk of stress fractures ❖>60miles/week → increase risk of osteoporosis ❖Men: spine; Women: spine, hip, wrist osteoporosis →related to inactivity /space travel

Cholesterol Ratio Important (total cholesterol: HDL)

➢ <4 good ➢ 4-5 borderline ➢ >5 high risk Exercise may not affect total cholesterol but will affect HDL