Physical inactivity exam 1

indirect methods

- densitometry (foundation of H2O weighing) -NO -anthropometric measures (SKF, WHR, BMI)- NOT mesasurements ofCOMPOSITION -skin fold is - others (DEXA, BIA ...)

Direct assessment:

- requires the dissection of human cadavers - only 40 analyzed for BC studies (since 1945) - not used to validate commonly used laboratory techniques

Frequency of training Pollock et al.

-16 and 20 wks training study (2*vs 4*wk) -Men 30 - 45 yrs -Intensity: 85 - 90 HRR -Duration: 30 min -Result: Mid study test showed similar improvement End study tests showed significant greater VO2 in 4* grp, but 2* grp also improved 15%

Wingate Test for Anaerobic Power

-30 sec cycle ergometer test -Count pedal revolutions -Calculate peak power output, anaerobic fatigue, and anaerobic capacity

Maintenance of the training effect

-A significant reduction in cardiorespiratory fitness occurs after 2 wk of detraining, with participants returning to near pre-training levels of fitness after 10 wk to 8 months of detraining. -A loss of 50% of their initial improvement in VO2max has been shown after 4-12 wk of detraining. -Bottom Line...To maintain the training effect, exercise training volume must be maintained

Muscular Strength and Endurance are Health Related Components of Physical Fitness, which may improve...

-Bone Mass (i.e. osteoporosis) -Glucose Tolerance (i.e. Type-2 Diabetes) -Musculotendinous Integrity (i.e. lower risk of injury; low back pain) -Improved QOL by increased Physical Function (i.e. ADL's) -Increased FFM (i.e. more favorable body comp.)

Flexibility Tests

-Flexibility is the capacity of a joint to move fluidly through its full range of motion. -The major limitation to joint flexibility is tightness of the soft tissue structures (joint capsule, muscles, tendons and ligaments). -The muscle seems to be the most important and modifiable structure in terms of improving flexibility. -Good flexibility is known to bring positive benefits in the muscles and joints; aids with injury prevention, helps minimize muscle soreness (DOMS) and improves efficiency in all physical activities. -Increasing flexibility can also improve quality of life and functional independence (Nelson and Kokkonen, 2007; Stretching Anatomy).

Cardiovascular fitness and body composition

-Frequency of Training: 3-5 d/wk -Intensity of Training: 55/65% - 90% HRmax 40/50% - 85% VO2R or HRR -Duration of Training: 20 - 60 min of continuous or intermittent aerobic activity -Mode of Activity: Any activity that uses large muscle groups, and can be maintained continuously and is rthyhmic in nature

Global and Regional Burden of Disease: Causes of Death Majid Ezzati, Alan D. Lopez, Anthony Rodgers, Christopher J.L. Murray

-GBD Classification System -Group I, Communicable Disease Infectious, Maternal, Perinatal, Nutritional (acute) -Group II, Non-communicable Disease CVD, CA, DM, etc. (chronic) -Group III, Intentional or Unintentional Injuries

Intensity, Duration and Frequency

-It is the TOTAL VOLUME of TRAINING that is the important factor in improvement of fitness -How does this relate to our clients and patients??

Tests for Muscular Fitness

-One minute bent-knee sit-ups -Partial curl-ups -Pull-ups -Push-ups -Grip strength -1-RM bench press -YMCA bench press test for muscle endurance -Parallel bar dips -Sit and reach flexibility test -Shoulder flexibility test -Trunk rotation flexibility test -Vertical jump

anaerobic power test

-Quebec 10 s Test -Standing broad jump -Vertical jump -40 yd. sprints -Wingate Test

Perceived Exertion to Gauge Exercise Intensity

-RPE has become a valid tool in the monitoring of intensity in exercise training programs. -RPE correlates well with blood lactate, heart rate, pulmonary ventilation, and the VO2 responses to exercise. -RPE is generally considered an adjunct to heart rate in monitoring relative exercise intensity, but once the relationship between heart rate and RPE is known, RPE can be used in place of heart rate. -This would not be the case in certain patient populations in which a more precise knowledge of heart rate may be critical to the safety of the participant.

Muscular Strength and Endurance, Body Composition, and Flexibility

-Resistance Training Number of Sets: 1 set of 8 - 10 exercises aimed at conditioning the major muscle groups Number of Reps/Set: 8 -12 repetitions (10 - 15 if over 50yrs) Number of Exercises: 8 - 10 different exercise to provide a stimulus for all major muscle groups Frequency of Training: 2 - 3 d/wk -Flexibility Training Flexibility exercises should be incorporated to develop and maintain optimal range of motion 2-3 reps per stretch; holding for 30-45 seconds Frequency of Training: 2 - 3 d/wk Types?? Static, Ballistic (Dynamic), PNF, AIS

Strength Testing Safety

-Strict Posture (i.e. good technique on the squat) -Consistent Repetition Duration (i.e. movement speed) -Full Range of Motion -Use of Spotters with submax and maximal weight (you never know what may happen!!!!) -Equipment Familiarization Warm Up Properly (i.e. static stretch warmup = 'decreases performance')

Frequency

-The amount of improvement increases with frequency of training, but the magnitude of change is smaller and plateaus when the frequency of training is increased above 3 d/wk -The value of the added improvement that occurs with training more than 5 d/wk is minimal to none -In contrast the incidence of injury increases exponentially

how to do 1 RM

-Warm-up by completing a number of sub-max reps (i.e. 3*5 reps with estimated 40%). -Determine 1RM within 4 trials with 3-5 mins rest b/t trials. -Initial weight (~50-70%). -Increase weight 2.5-20 kg, or until cannot complete full range of motion or technical failure. -You can also derive a 1 RM from a 3-5+ RM...

Issues with hydrostatic weighing

-lung residual volumes (RV) must be calculated accurately -variability of bone density --age --gender --ethnic background --physical activity level -prediction equations (e.g. Brozek, Siri) underestimate %BF in African Americans overestimate %BF for elderly, children

skeletal muscle

-sarcopenia -disuse atrophy

fat

.9 g/cc

lbs-> kg

1 lbs= .45 kg

Setting Goals for body weight

1) determine % BF 2) determine fat mass: FM = BW x %BF 3) determine lean mass: LM = BW - FM 4)determine a desired %BF females 16-25 males12-18 5) determine a target body weight (TBW) LM/ (1.0 - desired %BF)

muscle

1.g/cc

inches-> m

1in = .0254 m

Does Physical Inactivity Cause Disease

2016 was the first year for Physical Activity to have an official Research/Disease Label from NIH, with an allocation of $392 million; It does not appear Mississippi has an approved application within this area; Current allocation for 2017 and 2018 is $407 and $314 million; These monies are funding mostly multidisciplinary programs aimed at both reducing inactivity and raising activity in a variety of human conditions

duration of training Milesis et al., Res. Quart., 1976

3*wk, 20 wks 20-35yrs College Men Intensity: 85-90% HRR Duration: 15, 30, 45 min Result: 8.5, 16.1, 16.8 % in VO2max

Skin-fold sites: 3 males

3-site: Males = Chest, Ab, and Thigh.

Inadequate Physical Activity and Health Care Expenditures (Carlson et al. 2015)

35 Unhealthy Conditions Precipitated by Physical Inactivity contributing to 11.1% or $33,000,000,000 of US Health Care Costs Physical Inactivity causes 9% of premature mortality, or more than 5·3 of 57 million deaths globally (Lee et al Lancet 2012) In the US this equates to ~300,000 deaths/yr or nearly one quarter of all preventable deaths! ....but given the fact 75% of US adults are inactive these numbers are a huge under-estimation

Global and Regional Burden of Disease: Causes of Death Majid Ezzati, Alan D. Lopez, Anthony Rodgers, Christopher J.L. Murray

50.5 million deaths/yr Reliable info. on causes of death are essential to the dev. of health policies 8 Regions: -Established market economies -Former socialist economies of Europe -Latin America and -Caribbean -China -India -Middle Eastern Crescent -Asia and Islands -Sub-Saharan Africa

Association of Work Activity and Coronary Artery Disease Pomrehn et al. (1982)

61,922 deaths Farmers vs. nonfarmers 1964 and 1978 Iowa men, 20-64 yrs Death from IHD Farmers had significantly less mortality than expected

Par Q

7questions survey which will help determine if you should test the person or if you should refer them to a physician to get clearance Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? Do you feel pain in your chest when you do physical activity? In the past month, have you had chest pain when you were not doing physical activity? Do you lose your balance because of dizziness or do you ever lose consciousness? Do you have a bone or a joint problem that could be made worse by a change in your physical activity? Is your doctor currently prescribing drugs for your blood pressure or heart condition? Do you know of any other reason why you should not do physical activity?

muscular endurance

= muscle's ability to continue to perform for successive exertions or many repetitions (i.e. Lance Armstrong).

Contraindications to exercise testing (Absolute)

A recent significant change in EKG Recent complicated MI Unstable Angina Uncontrolled ventricular dysrhythmia's Uncontrolled atrial arrhythmia which compromises cardiac function Acute CHF Active myo- or pericarditis Recent emboli Acute infections Significant emotional distress Severe aortic stenosis Suspected or known aneurysm Third degree block

medial calf skinfold

A vertical skinfold on the inside of the calf at the level of maximum circumference

Hydrostatic Weighing

Archimedes' Principle when a body is immersed in water, it will be buoyed by a counter force equal to the volume of water displaced

Intensity of Exercise (but equal Kcal expenditure) Cureton '69, Pollock '72, Wenger '86, ETC

As long as a person trains above the minimum training threshold, programs that vary in intensity but similar Kcal expenditure report similar improvements in aerobic capacity

Caloric expenditure, life status, and disease in former male athletes and non-athletes Quinn TJ, Sprague HA, Van Huss WD, Olson HW, Med Sci Sports Exerc 1990 Dec;22(6):742-50

Association between aerobic, caloric expenditure and mortality in former athletes and non-athletes. Initial survey done in 1952. Follow-up surveys of respondents were done in 1960, 1968, 1976, and 1984. A total of 348 subjects (185 ATH, 163 N-ATH) were assessed and caloric expenditure groups established by kilocalories of aerobic exercise per week; 0 kcal (grp 1), 1-399 kcal (grp 2), 400-899 kcal (grp 3), 900-1499 kcal (grp 4), 1500-2499 kcal (grp 5), and 2500+ kcal (grp 6). Death rate was highest in groups 1 and 2. College athletic status and 1976 exercise level were not significantly related to mortality.

Total Energy Expenditure and Breast Cancer in the College Alumni Health Study (United States) Sesso HD, Paffenbarger RS Jr, Lee IM Cancer Causes Control 1998 Aug;9(4):433-9

BACKGROUND: It is unclear whether physical activity is associated with a reduced risk of breast cancer. METHODS: A prospective cohort study among 1,566 University of Pennsylvania alumnae (mean age, 45.5 years), initially free of breast cancer, from 1962 until 1993. Physical activity at baseline was assessed by asking women about stairs climbed, blocks walked, and sports played. Relative risks of breast cancer was 0.92 among women expending 500-999 kcal/wk and 0.73 for those expending 1,000+ kcal/wk, compared with women expending < 500 kcal/wk. CONCLUSIONS: These data support an inverse association between physical activity and breast cancer among postmenopausal women.

Total Energy Expenditure and Risk of Lung Cancer Lee IM, Sesso HD, Paffenbarger RS Jr Int J Epid 1999 Aug;28(4):620-5

BACKGROUND: Physical activity has been proposed to decrease lung cancer risk; however, few data are available. METHODS: A prospective cohort study among 13,905 male Harvard University alumni (mean age, 58.3 years), free of cancer. Men reported their physical activity on baseline questionnaires in '77, and the occurrence of lung cancer on follow-up in '88 and '93. Relative risks of lung cancer associated with <4200, 4200-8399, 8400-12 599 and > or =12 600 kJ/week of estimated energy expenditure at baseline were 1.00 (referent), 0.87, 0.76, and 0.61, respectively CONCLUSIONS: These data indicate that physical activity may be associated with lower risk of lung cancer among men.

BIA (Bioelectrical Impedance Analysis)

BIA assumes that tissues high in water content conduct current better than those low in water content Fat tissue contains little water and will therefore impede (block) the flow of electrical current

Body Mass Index (Quetelet index )

BMi= kg/m squared BMI is a quick and easy way to determine if one's weight is appropriate for your height It does not differentiate between lean tissue and fat There is a correlation between elevated BMI and negative health consequences

Effect of a change in Physical Activity on Mortality Blair et al. (1995), J.A.M.A.

Blair et al. (1995), J.A.M.A. n=9,777 US men, 20-82yrs Measure of Fitness: SL-GXT, 5.1 yr. follow-up Inverse Association (Dose-response), For each min improvement on GXT, 8.6% decrease in CVD mortality

Contraindictions to exercise testing (Relative)

Blood pressure (>200 mmHg or >115 mmHg) Moderate valvular disease Electrolyte imbalance Frequent or complex ventricular ectopy Ventricular aneurysm Uncontrolled metabolic disease Chronic infectious disease Orthopedic disorders that are worsened by exercise Advanced pregnancy

Physical examination

Body Weight (possible body comp) Pulse Rate and Regularity Resting BP Supine and Standing Auscultation of the Lungs Palpation of the Cardiac Apical Impulse Auscultation of the Heart Palpation and Auscultation of the Carotid, Abdominal and Femoral Arteries Palpation and inspection of Lower Extremities for Pulses and Edema Neurologic function, inc Reflexes Orthopedic function

densitometry

Body density = Body mass /Body volume Body mass = measured on a regular scale Body volume = measured using hydrostatic (underwater) weighing accounting for water density and air trapped in lungs % body fat = (495 ÷ body density) - 450

Are the guidelines realistic? Let's consider moderate exercise

Cardio: 150min/week for >5 d/wk = 30min/session; RTR: 2 to 4 sets, 8 to 12 reps, 2 to 3 d/wk, 8-10 exercises, 2 to 3 min rest between exercises @ 2 sets, 12 reps, 8 exercises, 3 d/wk = 30min/session Neuromotor: 20min/session Flexibility: 10min/session This means the guidelines recommend a person has to exercise 3 sessions/week for ~90min, and an additional 2 sessions/week for another 30min to attain the minimal requirements.

Are the guidelines realistic? Let's consider vigorous exercise

Cardio: 75min/week, 3 sessions = 25min/session; RTR: 2 to 4 sets, 8 to 12 reps, 2 to 3 d/wk, 8-10 exercises, 2 to 3 min rest between exercises @ 2 sets, 12 reps, 8 exercises, 3 d/wk = 30min/session @ 4 sets, 12 reps, 10 exercises, 3 d/wk = 60min/session Neuromotor: 20min/session Flexibility: 10min/session This means the guidelines recommend a person has to exercise 3 sessions/week for 90 to 115 min, to attain the requirements.

7-site skin fold

Chest, Midax., triceps, subscap., Ab, suprailiac, and thigh.

Cholera and Tuberculosis

Cholera and Tuberculosis were not controlled by campaigns directed towards the individual, but by structural changes including civil engineering and the development of clean water and sewage systems. (Wishnow & Steinfeld, 1976);

History offers several examples where structural changes in a society have more impact on health than any group interventions or sophisticated discovery strategies

Cholera and Tuberculosis; Cuba's economic crisis of 1989-2000; Germany East and West

Contributing Factor to Physical Inactivity: Change in Occupational Energy Expenditure Church et al. (2011)

Church et al. (2011) estimate a 100 kcal decrease in EE/day has contributed significantly to the increase in the mean US body weight over 5 decades

AHA Risk-Stratification Classification Class A

Class A: Apparently Healthy No evidence of increased risk. This classification includes (1) individuals under age 40 who have no symptoms or known presence of disease or major risk factors, and (2) individuals of any age without known heart disease or major risk factors and a normal exercise test Activity guidelines: No restrictions other than basic guidelines ECG and BP monitoring: not required Supervision: not required

Class B

Class B: Presence of Known, Stable Cardiovascular Disease with Low Risk for Vigorous Exercise but Slightly Greater Than for Apparently Healthy Individuals Moderate exercise is not believed to be associated with increased risk. This classification includes individuals with (1) CAD (MI, CABG, PTCA, AP, Abnormal Exercise Test, and Coronary Angiogram) whose condition is stable; (2) Valvular heart disease; (3) Congenital heart disease; CM; and (5) abnormalities that do not meet criteria C Activity guidelines: Individualized exercise prescription ECG and BP monitoring: Only 6-12 sessions Supervision: Medical supervision until individual can monitor self

Class C

Class C: Moderate-to-High Risk This classification includes individuals with CAD with the following clinical characteristics (1) CM; (2) Valvular heart disease; (3) Exercise test abnormalities; (4) Previuos episodes of v-fib or cardiac arrest; (4) Complex dysrhythmia's; (5) 3-vessel disease; (6) low EF (less than 30%) Activity guidelines: Individualized exercise prescription ECG and BP monitoring: Only 6-12 sessions Supervision: Medical supervision until individual can monitor self

Class D

Class D: Unstable Disease No Activity Recommended

Exercise Prescription for Cardiorespiratory Fitness and Weight Control

Components: -Frequency, Intensity, Duration, and Mode of Exercise, and initial level of fitness -Volume of training is the key!!!!!! -Improvement in VO2max is directly related to frequency (10 studies), intensity (13 studies), and duration (11 studies) -Improvement in VO2max range from 10 to 30% (23 studies) -Improvements of LT or VT can be independent of VO2max and range from 10 - 20% following moderate to vigorous activity -Human variability in trainability of VO2max is related to one's genetic make-up and current activity status (Bouchard!!!)

DEXA (Dual-Energy X-Ray Absorptiometry)

Criterion Measure for Body Composition DEXA involves low dosage x-ray beams used to scan the body Assumes a three compartment model: (fat, bone mineral, and non-bone lean tissue) Each compartment has a different density Errors are reported to be 1.2 to 4.8% most often used research and clinical assessments

MAP

DBPplus 1/3 pressure pulse

Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men Lee CD, Blair SN, Jackson AS. Am J Clin Nutr 1999 Mar;69(3):373-80

DESIGN: This was an observational cohort study. 21925 men, aged 30-83 y, who had a body-composition assessment and a maximal treadmill exercise test. There were 428 deaths (144 from CVD, 143 from cancer, and 141 from other causes) in an average of 8 y of follow-up (176742 man-years) RESULTS: After adjustment for age, examination year, cigarette smoking, alcohol intake, and parental history of ischemic heart disease, unfit (low cardiorespiratory fitness as determined by maximal exercise testing), lean men had double the risk of all-cause mortality of fit, lean men (relative risk: 2.07; 95% CI: 1.16, 3.69; P = 0.01) CONCLUSIONS: The health benefits of leanness are limited to fit men, and being fit may reduce the hazards of obesity.

Suprailiac Skinfold

Diagonal fold just above iliac crest at the midaxillary line.

Subscapular skinfold

Diagonal fold just below the inferior angle of scapula

Chest Skinfold

Diagonal fold, between anterior axillary fold and nipple, taken one inch from anterior axillary fold

Diastolic BP

Diastolic Blood Pressure represents the last or disappearance of Korotkoff sounds.

Validity

Does the test measure the characteristics I am interested in evaluating? Consistency: reliability of results and objectivity of tester A test can be reliable and objective but not valid A test can not be valid if not reliable and objective

Progression of Training Kilocalories Expended/Session

Early stage (1): 4-6 weeks, kc expended/session ~150+ for young adult...... ~100+ for elderly..... ~85+ for patients Progressive (2): 6-20 weeks, kc expended/session... ~200-400 for young adult.... ~115-230 for elderly.... ~100-200 for patients Maintenance (3): 3-24 months, kc expended/session.. ~400 for young adult... ~275-300 for elderly.... ~215-300 for patients

AHA/ACSM Joint Statement: Recommendations for Cardiovascular Screening, Staffing, and Emergency Policies at Health/Fitness Facilities continuation

Efforts to promote physical activity will result in an increasing number of persons with and without heart disease joining the more than 20 million persons who already exercise at health/fitness facilities. Current market research indicates that 50% of health/fitness facility members are older than 35 yr, and the fastest-growing segments of users are those older than 55 yr and those aged 35-54 yr. With increased physical activity, more people with symptoms of or known cardiovascular disease will face the cardiovascular stress of physical activity and possible risk of a cardiac event. More than one fourth of all Americans have some form of cardiovascular disease. Moderately strenuous physical exertion may trigger ischemic cardiac events, particularly among persons not accustomed to regular physical activity and exercise. Siscovick et al. examined the incidence of primary cardiac arrest in men aged 25-75 yr after excluding those with a history of clinically recognized heart disease. Although the risk was significantly increased during high-intensity exercise, the likelihood for primary cardiac arrest during such activity in a clinically healthy population was estimated at 0.55 events/10,000 men per year. Overall, the absolute incidence of death during exercise in the general population is low. Each year approximately 0.75 and 0.13/100,000 young male and female athletes and 6/100,000 middle-aged men die during exertion.

BIA

Electrodes are placed on each hand and foot and a small current is passed through the body. The fall in voltage is used to calculate BF%

Summary of Epidemiological Studies Regarding Physical Inactivity Physical activity at work and coronary artery disease, 31,000 london transport workers

Epidemiological studies over the past 65 years prove physically inactive groups have increased prevalence, that often range from 30 to 50%, for major causes of death, including cardiovascular disease, T2D, and Alzheimer's disease

Summary lec 1

Excess Sitting and Physical Inactivity is killing us (actually, financially and economically); Recent recognition of a causal link has forced increased funding through NIH; -Need for causality research and training; -Need for translational research and training, but understanding cultural/environmental influences; -Need for collaborative research and engagement; Inclusion of Exercise Science within Population Science is as natural as the human body's need for activity; A greater understanding of Exercise Science will contribute to solving significant health problems in society;

Too little fat tissue can also increase health risks

FAT is necessary for normal physiological function: cell membrane thermal insulation metabolic fuel store vitamin transportation nervous and reproductive system

Skin-fold sites: 3 female

Females = Tricep, Suprailiac, Ab

Frequency of Training How about multiple sessions/day Fisher and Ebisu (MSSE, 1980)

Fisher and Ebisu (MSSE, 1980) 10 wks training study (3*wk) College Men Intensity: 80 HRmax Grp I, 1* day, Grp II, 2* day, Grp III, 3* day, Mileage the same Result: Similar improvement

valsalva maneuver

Forced expiration against a closed glottis causes an abrupt increase in intrathoracic pressure that is transmitted to the arterial tree and accompanied by a concurrent increase in CSF This mechanism is in balance with the increase in pressure upon the walls of the vasculature Hence, a low transmural pressure difference across the vasculature is maintained

Evidence statements and summary of recommendations for the individualized exercise prescription: Cardiorespiratory Exercise

Frequency recommend- 5 days a week of mod exercise - 3 days a week of vigorous exercise - 3-5 days a week of mix Intensity-moderate and/or vigorous recommended for adults - light to moderate beneficial in deconditioned people Time-30-60 min/d (150min/w) of moderate exercise - 20-60min/d (75min/w) of vigorous exercise - or combo of moderate& vigorous per day is recommended for adults - <20 min/d (<150 min/wk) can be beneficial especially to sedentary people Type-regular, purposeful exercise - major muscle groups - continuous - rhythm in nature Volume- target of >500-1000 METs min/w is recommended - steps increasing- >2000 steps/day - daily count >7000 steps/day beneficial Pattern- continuous session per day or in multiple sessions of >10 min to accumulate - d & v Progression- adjusting intensity, duration, and/or frequency 60-90% HR reserve 50-85% VO2 Sets: 2-4, Reps 8-12, amount 10 /major muscle groups

frequency of training Gettman et al. (1976)

Gettman et al. (1976) 20 wks Training Study (1* vs 3* vs 5* wk) Men 20 - 35 yrs Intensity: 85 - 90 HRR Duration: 30 min Result: Dose response VO2max increased 8, 13, and 17% respectively Consider life-time training ???

Consider initial level of fitness Gledhill, 1972

Gledhill, 1972 5*wk, 20 min. for 5 wks College Men Intensity: 120,135, or 150 b/min Result: Improvements in all grp, but low fit people improved at all intensities. *High fit people only improved at in 150 grp

1 Rm

Greatest Resistance that can be moved through a full range of motion in a controlled manner with good form.

Total Daily Energy Expenditure and Coronary Artery Disease Paffenbarger et al. (1978 and 1984)

Harvard Alumni, n ~17,000 men Entered between 1916-1950, Followed from 1962-1978 Physical Activity Index, Kcal/wk Death due to CHD 2000+ Kcal/wk had lowest risk Inverse association with caloric expenditure

Pre-test instructions

Health Questionnaires -PAR Q: Low Intensity. Useful for referring those who need medical attention, but excludes few from activity -Health Status Questionnaire: Moderate Intensity. Diagnosed medical problems, behavior component, dictates level of fitness testing and supervision Medical History Physical Examination

intensity of exercise

High-intensity exercise is important for competition, but because it is also related to increased musculoskeletal injuries, and cardiovascular symptoms and events, and has been found to be somewhat unattractive psychologically to noncompetitive middle-aged and older adults, it is not generally recommended for the average person." (Pollock)

Midaxillary Skinfold

Horizontal fold taken on midaxillary line at level of xiphisternal junction.

Test environment

Important for test validity and reliability Quiet and private Stable temperatures Be confident in the eyes of your client

"Chronic diseases are diseases of long duration and generally slow in progression."

Inactive parents provide their offspring with genes and environment, which both produce physical inactivity. Physical inactivity interacts with inherited gene predisposition of offspring to produce pathophysiology, which, in turn, interacts with risk factors to establish probability for chronic disease and mortality.

Content validity

Indicates the test seems to be good based on logic, expert opinion, and widespread use

Criterion Validity

Involves having an externally valid criterion measure ex. DEXA is the criterion measure for skin-folds

Check list Individual

Is the individual ready Read and understands test procedures Signed informed consent Is familiar with testing (practice??) Understands the starting and stopping criteria Understands expectations before, during and after the test Has complied with pre-test instructions Diet, Exercise, Rest, Medications, Smoking, etc. Is free of any acute illness

Check list tester

Is the tester ready? Tests to be performed are outlined Equipment in working order and calibrated Supplies etc. ready Testing assistants understand responsibilities Sequence of testing set End-points clearly defined Emergency procedures reviewed and ready to go Post test activities and responsibilities set Environment adequately controlled

Frequency of Training Why not more than 5 * wk

It has been estimated that ~95% of the improvement in aerobic capacity can be attained in jog-run programs of 4 to 5 * wk (Pollock, ESSR, 1973) Orthopedic injuries increase exponentially with increased frequency of training (Pollock, MSSE, 1977) *Realistic commitment

Is it possible to implement all the components of exercise training in a single exercise session?

KISS Principle Do not worry about maximizing the adaptation within a single component of fitness; Instead consider the individuals deficiencies and weakness; Focus on building a foundation; Add intensity as tolerated; Add complexity as tolerated; Alter modality as tolerated or indicated; Alter the approach if the individual has a desire to focus more on a specific component of fitness.

Association of Work Activity and Coronary Artery Disease Kahn (1963)

Kahn (1963) n=2,240 (USA) Postal Workers between 1906 and 1940 Inverse relationship Difference became undistinguishable within 5 yrs after an individual left a physically active job Benefits from physical activity can not be stored Inverse Mail deliver- safer Office- financial gain yet loss of health

Intensity of Exercise Karvonen et al. Ann. Med. Exp. Bio., 1957

Karvonen et al. Ann. Med. Exp. Bio., 1957 5*wk, 30 min. College Men Intensity: <135 b/min or >153 b/min Result: Improvements only in grp that trained >153 b/min

Cardiorespiratory Fitness Testing

Laboratory Tests Maximal vs. submaximal Treadmill vs. bike vs. you name it. Field Tests Cooper test (12-min run) 1.5 mile run step tests

Weakness

Lack of standardization of protocols (testing and training) Lack of reproducibility, reliability and validity Comparison of results between studies complicated by factors such as: Initial level of fitness length of training regimen specificity of testing and training Few long-term studies Other factors????? (Women, elderly, genotype, socioeconomic, level of education, race, etc.)

Benefits of Single Set Training

Less time-consuming Messier & Dill reported that the time required to complete a 3-set weight resistance program averaged 50 min compared to 20 min for 1-set Improves compliance Similar health benefits Less chance for overuse injuries Magnitude of difference between single and multiple sets is small (Is it worth it?) Dr. Pollock would have vehemently opposed the change in the current guidelines from 1 set to multiple sets of RTR Individuals who desire to engage in more advanced or extensive resistance training regimens aimed at achieving greater muscular strength and hypertrophy are referred to the relevant ACSM Position Stand

ACSM Risk Stratification

Low Risk Younger individuals who are asymptomatic and meet no more than one risk factor threshold. Moderate Risk Older individuals (men>45; women >55) or those who meet the threshold for two or more risk factors. High Risk Individuals with one or more signs/symptoms or known cardiovascular, pulmonary, or metabolic disease.

Bone Mineral Density[Lumbar and Thoracic]

Lumbar: RSTS: Base: 1.050, 4wks: 1.086, 12wks: 1.092; AET: Base: 1.050, 4wks: 1.064, 12wks: 1.050g/cm2; Thoracic RSTS: Base: 0.979, 4wks: 0.997, 12wks: 1.040; AET: Base: 0.979, 4wks: 0.996, 12wks: 0.980g/cm2

Leisure-Time Activity and Coronary Artery Disease Leon et al. (1997) Int J Sports Med Jul;18 Suppl 3:S208-15

MRFIT (Multiple Risk Factor Intervention Trial) 16-year follow-up Men were classified into deciles based on average min/d of LTPA reported at baseline, which were compared with cumulative CHD and all-cause mortality endpoints at the 16-year follow-up Men in the least-active decile of LTPA who averaged 4.9 min/d of LTPA (range 0 to .9 min/d) had excess age-adjusted mortality rates of *29% and 22% for CHD and all-causes, respectively, as compared to those in combined deciles 2 to 4, who averaged 22.7 min/d of predominantly light and moderate LTPA

Medical history

Medical Diagnoses Previous Physical Examination findings History of symptoms Recent Illness/Hospitalization etc. Orthopedic problems Medications used/ Drug allergies Other Habits (Tobacco, Alcohol, Caffeine etc.) Exercise history Work History Family History

2011- Fourth revision of the ACSM Position Statement

Medicine & Science in Sports & Exercise. 43(7):1334-1359, July 2011

Association of Cardiorespiratory Fitness and Overall Mortality Arraiz et al. (1992)

Men and women from Canada Measure of Fitness: Est. Exercise Capacity, 7 yr. follow-up Inverse Association (adjusted for age, BMI, sex, and smoking)

Association of Cardiorespiratory Fitness and Overall Mortality Sandvik et al. (1993)

Men and women from Norway (Age 40-59) Measure of Fitness: Est. Exercise Capacity, 16 yr. follow-up Inverse Association

Changes in physical activity, mortality, and incidence of coronary heart disease in older men. Wannamethee SG, Shaper AG, Walker M Lancet 1998 May 30;351(9116):1603-8

Men who were initially sedentary and who began at least light activity had significantly lower all-cause mortality than those who remained sedentary, even after adjustment for potential confounders (risk ratio=0.55 [0.36-0.84]). Physical activity improved both cardiovascular mortality (0.66 [0.35-1.23]) and non-cardiovascular mortality (0.48 [0.27-0.85]). The relation between physical activity, changes in physical activity, and mortality were similar for men with pre-existing cardiovascular disease. INTERPRETATION: Maintaining or taking up light or moderate physical activity reduces mortality and heart attacks in older men with and without diagnosed cardiovascular disease

Physical Activity Defined

Minimal requirements for adults is 150 minutes of moderate aerobic activity or 75 minutes of vigorous-intensity aerobic activity throughout the week; Moderate-Intense Physical Activity is ~3 to 6 times the intensity of rest; Vigorous-Intense Physical Activity is >6 times the intensity of rest; Intensity is oft-defined in terms of MET (metabolic equivalents) where 1 MET represents Oxygen Consumption (VO2) at rest, which = 3.5 ml O2/min

AHA/ACSM Joint Statement: Recommendations for Cardiovascular Screening, Staffing, and Emergency Policies at Health/Fitness Facilities

Moderate (or higher) levels of physical activity and exercise are achieved in a number of settings, including more than 15,000 health/fitness facilities across the country. A survey of 110 health/fitness facilities in Massachusetts found that efforts to screen new members at enrollment were limited and inconsistent. Nearly 40% of responding facilities stated that they do not routinely use a screening interview or questionnaire to evaluate new members for symptoms or history of cardiovascular disease, and 10% stated that they conducted no initial cardiovascular health history screening at all.

Association of Work Activity and Coronary Artery Disease Morris et al. (1953)

Morris et al. (1953) n=31,000, 35-64 yrs, all men "Sedentary" drivers vs. "Active" conductors 30% decrease of manifestations of CAD 50% fewer Myocardial Infarction Flaw: "selective trial"?

Leisure-Time Activity and Coronary Artery Disease Morris et al. (1973)

Morris et al. (1973) n=16,882 Executive grade civil servants First CHD event 48-hr recall of leisure activity RR among vigorous group =0.33 compared to non-vigorous group

Let's consider the evidence for the guidelines: Neuromotor Training

NOne

risk of exercise

Numerous physiologic, psychologic and metabolic health/fitness benefits result from participation in regular PA. However, there are documented risks associated with PA, such as acute musculoskeletal injury. The major concern is the increased risk of sudden death due to MI, that is sometimes associated with vigorous physical exertion.

The Human Genome is sensitive to physical inactivity: Immediate consequence

Olsen RH, et al. JAMA. 2008 Mar 19;299(11):1261-3 A reduction in steps per day (>6000 to <1400) resulted in significant increases in insulin resistance, inflammatory markers, and intra-abdominal fat and a decrease in fat free mass within 2 weeks.

Single versus multiple sets in long-term recreational weightlifters

PURPOSE: The purpose was to determine the effects of increasing training volume from 1 to 3 sets on muscular strength and endurance in recreational weight lifters METHODS: Forty-two adults who had been performing 1 set using a 9-exercise circuit (RTC) for 1 yr. Subjects continued to perform 1 set or 3 sets of 8-12 repetitions to muscular failure 3 d/wk for 13 wk using RTC. One RM's were measured for leg extension (LE), leg curl (LC), chest press (CP), overhead press (OP), and biceps curl (BC). Muscular endurance was evaluated for the CP and LE as the number of repetitions to failure using 75% of pre-training 1-RM. RESULTS: Both groups significantly improved muscular endurance and 1 RM strength (EX-1 by: 13.6% LE; 9.2% LC; 11.9% CP; 8.7% OP; 8.3% BC; and EX-3 by: 12.8% LE; 12.0% LC; 13.5% CP; 12.4% OP; 10.3% BC) (P < 0.05). Both groups significantly improved lean body mass (P < 0.05). No significant differences between groups. CONCLUSION: Both groups significantly improved muscular fitness and body composition following 13 wk of training. The results show that 1-set programs are still effective even after a year of training and that increasing training volume over 13 wk does not lead to significantly greater improvements for adult recreational weight lifters.

Effect of a change in Physical Activity on Mortality Paffenbarger et al. (1993), NEJM

Paffenbarger et al. (1993), NEJM Harvard Male Alumni who were sedentary in'62 or '66 Physical Activity Index, 11yr. follow-up Those who took up moderately intense sports activity had a 23% lower death rate vs. sedentary

physical inactivity

Physical inactivity is the spectrum of any decrease in bodily movement that produces decreased energy expenditure toward basal level Importantly, many of the underlying biochemical and molecular mechanisms of physical inactivity are not simply the converse of physical activity. Instead, mechanisms of physical inactivity in some cases employ totally different pathways than those used in physical activity.

Cardiorespiratory Fitness Testing

Pre-test -12 lead ECG in supine and exercise postures -HR, BP in supine and exercise postures Exercise -12 lead ECG during last minute of every stage -BP during last minute of every stage -Symptom ratings during last minute of every stage -Or as needed Post-test -12 lead ECG, BP, symptom ratings immediately post exercise and every 1-2 minutes for up to 10 minutes

informed consent

Prior to testing the participant should be informed about all the possible risks and benefits associated with the tests Although an informed consent is not a legal binding document it is a federal/state law. However, if a patient, subject or volunteer gets hurt because of negligence on your part Morris Bart will come and get you!!!!!

Sitting Time and All-Cause Mortality Risk van der Ploeg et al. Arch Intern Med. 2012;172(6):494-500

Prolonged sitting is a risk factor for all-cause mortality, independent of physical activity

tips for increasing test accuracy

Properly instruct the person prior to testing Properly prepare the person prior to testing Organize the testing session Watch the little details

The law of LaPlace or the issue of transmural pressure

Pt=Pi-Po

Total Energy Expenditure and Stroke Incidence: the Harvard Alumni Health Study Lee & Paffenbarger (1998) Stroke Oct;29(10):2049-54

Purpose was to examine the association between physical activity and stroke risk Prospective study of 11,130 Harvard University alumni (mean age, 58 years) without CVD and cancer at baseline, 1977 Stroke occurrence was assessed in 1988 Relative risks of stroke associated with <1000, 1000 to 1999, 2000 to 2999, 3000 to 3999, and >/=4000 kcal/wk of energy expenditure at baseline were 1.00 (referent), 0.76, 0.54, 0.78, and 0.82 CONCLUSIONS: Physical activity is associated with decreased stroke risk in men. A decreased risk was observed at energy expenditures of 1000 to 1999 kcal/wk, with further risk decrement seen at 2000 to 2999 kcal/wk but not beyond

Progression and Regression of Coronary Atherosclerotic Lesions Hambrecht R et al. J Am Coll Cardiol (1993) Aug;22(2):468-77

Purpose: Define the effect of different levels of leisure time physical activity on cardiorespiratory fitness and progression of coronary atherosclerotic lesions n=62; patients with CAD; Prospective, randomized design Energy expenditure estimated from questionnaires and from participation in group exercise sessions After 1 year, repeat coronary angiography Patients in the intervention group increased VO2max 14%, whereas controls showed a significant decrease Regression of CAD noted in 8 patients (28%), progression of disease in 3 (10%) and no change in coronary morphology in 18 (62%) (Intervention) Progression in 45%, no change in 49% and regression in 6% (Control) Lowest level of leisure time physical activity was noted in patients with progression of disease (1,022 +/- 142 kcal/week) as opposed to patients with no change (1,533 +/- 122 kcal/week) or regression of disease (2,204 +/- 237 kcal/week)

Tests for Muscular Endurance

Push up test- test for 1 min or max reps pull test- max number curl-up or "crunch test" -max number or number of reps in 1 min -20 rep bench press max -20 rep leg press max

Test Order

Questionnaires Vitals Physicals** Body Composition Cardiorespiratory Endurance Muscular fitness Flexibility **Performed by physician (Possible Laboratory Tests included)

Regional Specific Training Stimulus Combined strength (Upper and Lower Body)

RSTS: Base: 384.97, 4wks: 432.37, 12wks: 502.28; AET: Base: 384.97, 4wks: 394.58, 12wks: 441.64kg).

Gene Expression following Unloading and Reloading in Rat Soleus (Bey et al. Physiol. Genomics 13:157-167, 2003

Rapid changes in gene expression during unloading and reloading indicates a profound effect of too much sitting -HSP70, involved in protein synthesis; -GLUT1, glucose transport; -MUK, cell death, muscle remodelling; -Proteases, protein degradation; -IL6, protein degradation

Body composition

Refers to the relative percentages of body weight comprised of fat and fat-free body tissue

Precision

Reliability Refers to the reproducibility of a measurement. You quantify reliability simply by taking several measurements on the same subjects. Poor reliability degrades the precision of a single measurement and reduces your ability to track changes in measurements in the clinic or in experimental studies. Validity You quantify validity by comparing your measurements with values that are as close to the true values as possible. Poor validity also degrades the precision of a single measurement, and it reduces your ability to characterize relationships between variables in descriptive studies.

Vitals

Resting hemodynamic measures such as Heart Rate (HR) and Blood Pressure (BP) can have prognostic value, and can help determine baseline intensity. Manual HR techniques: Radial or Carotid? Peripheral "Brachial Blood Pressures" can be acquired with a sphygmomanometer and a stethoscope

pulse pressure

SBP -DBP

Procedure for Assessment of Resting Blood Pressure

Seated for 15 minutes; with feet flat on the floor. Cuff Size? Wrap cuff firmly around upper arm. Place Stethoscope over antecubital fossa over artery. Inflate cuff past first Korotkoff sound; slowly release 2-5 mmHg per second

risk benefit ratio

Since a major public health goal is to increase individual participation in regular, moderate-vigorous PA, we do not want to establish any barriers in participation. However, we want to identify individuals who are at an elevated risk for developing adverse exercise-related events.

Let's consider the evidence for the guidelines: RTR

Single vs. Multiple Sets The rationale for this remains controversial Is multiple set training justified for the population targeted through the guidelines?

Keep in mind that

Some techniques are better than others None is likely to be 100% accurate For the best results: - consider validity/reliability issues - choose population-specific prediction equations/norm charts for interpretation - use same method for pre-post comparisons - be gentle when consulting clients - focus on individual changes over time

Issues with BIA

Standard error up to 4% is reported little data w/non- Caucasians and different age groups does not produce accurate results for those with: amputations muscular atrophy severe obesity severe dehydration Hydration levels have significant effect Pacemakers Metal plates MRI- metal heats up

Emphasis on the Biological Mechanistic Evidence: Muscle

Studies of the specific modes of physical activity that are most effective in preventing the age-associated decline in skeletal muscle mass and function are needed; I nvestigations should identify the underlying mechanisms that limit the capacity for muscle hypertrophy in response to resistance exercise with advancing age. Design large RCTs to determine whether physical activity can prevent or delay the onset of functional limitations.

Why then do we recommend 3* and not 2*wk????

Subjects in 2* grp did not decrease wt or fat Studies that showed benefit in VO2 were in fairly young men Intensity of training was high High intensity but infrequent bouts may increase risk for injury etc.

Cardiorespiratory Fitness Testing Submaximal Tests

Submaximal tests make several assumptions: -A steady-state heart rate is obtained for each exercise work rate. -A linear relationship exists between heart rate and work rate. -The maximal heart rate for a given age is uniform. -Mechanical efficiency

Mid-BP

Sum of SBP and DBP divided by 2

Systolic BP

Systolic Blood Pressure represents the first Korotkoff sound heard.

Skinfold tips

Take skinfold measurements on the right side of body. Do not take measurements when the subject's skin is moist. Also do not take measurements immediately after exercise or when the person being measured is overheated because the shift of body fluid to the skin will inflate normal skinfold size. To reduce error during the learning phase, skinfold sites should be precisely determined, marked, and verified by a trained instructor. The largest source of error in skinfold testing is inaccurate site selection. Firmly grasp the skinfold with the thumb and index finger of the left hand, and pull away. Hold the caliper in the right hand, perpendicular to the skinfold and with the skinfold dial facing up and easily readable. Place the caliper heads ¼-½ inch away from the fingers holding the skinfold. Try to visualize where a true double-fold of skin thickness is, and place the caliper heads there. Read the caliper dial to the nearest 1 millimeter within 4 seconds. During the measurement, ensure that the left thumb and forefinger maintains the shape of the skinfold. Take a minimum of 2 measurements at each site (at least 15 seconds apart). If the 2 values are within 10% of each other, take the average.

Purpose and Objectives of a test

Testing for the purpose of developing the exercise prescription Collecting baseline and follow-up data that allows evaluation of progress Motivation of participants Education of participants Risk Stratification Pre-discharge Testing Post-discharge Testing after MI, PTCA, CABG, etc. Diagnostic Testing Functional Testing Testing for Disease Severity and Prognosis

Is it possible to implement all the components of exercise training in a single exercise session?

The ACSM recommends a comprehensive program of exercise including cardiorespiratory, resistance, flexibility, and neuromotor exercise of sufficient volume and quality as outlined in this document for apparently healthy adults of all ages.

Cardiorespiratory Fitness Testing

The Concept of Maximal Oxygen Uptake Criterion measure of cardiorespiratory fitness If a direct measure of VO2peak is not feasible or desirable, a variety of other protocols are available which can be used to estimate . Test validation association between the measured and estimated VO2peak. Association between test performance measure and measured VO2peak.

1990 - Second revision of the ACSM Position Statement

The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness in Healthy Adults Limited mention of strength and no mention of flexibility

1998 - Third revision of the ACSM Position Statement

The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults Well-rounded program emphasized

1978 - First ACSM Position Statement

The Recommended Quantity and Quality of Exercise for Developing and Maintaining Fitness in Healthy Adults Only mentions cardiovascular fitness

Predictive Validity

The criterion should be measured over the course of time ex. Risk factors have been validated over time as people develop CAD

Physical Inactivity is a Major Societal Problem

The five leading global risks for mortality in the world are high blood pressure, tobacco use, high blood glucose, physical inactivity, and overweight and obesity. (The World Health Organisation (2010); Physical Inactivity levels continue to rise in many countries; Physical inactivity actually causes risk factors that, in turn, increase morbidity and mortality.

Single Set Training

The literature supports the recommendation of prescribing single-set programs for attaining benefits; And is not limited to older and novice exercisers; The preponderance of evidence suggests that for training durations of 4 to 25 weeks there is no significant difference in the increase in strength or hypertrophy as a result of training with single versus multiple sets; The key is to ensure the set is performed to with good form, through a full range of motion and to fatigue; *Quality over quantity

Low cardiorespiratory fitness and physical inactivity as predictors of mortality in men with type 2 diabetes Wei M, Gibbons LW, Kampert JB, Nichaman MZ, Blair SN, Ann Intern Med 2000 Apr 18;132(8):605-11

The long-term association between physical activity and mortality in Type II DM is unknown Prospective cohort study of 1263 men. Cardiorespiratory fitness measured by a GXT, self-reported physical inactivity at baseline, and subsequent death using the National Death Index During an average follow-up of 12 years, 180 patients died. Men in the low-fitness group had an adjusted risk for all-cause mortality of 2.1 compared with fit men. Low cardiorespiratory fitness and physical inactivity are independent predictors of all-cause mortality in men with type 2 DM. Physicians should encourage patients with type 2 DM to participate in regular physical activity and improve cardiorespiratory fitness.

skinfolds

The most widely used body composition estimate is the skinfold measurement technique. When performed correctly, skinfold measures provide a fairly good estimate of percent body fat (r ≥ 0.80 with underwater weighing). The goal is to measure a double fold of skin and subcutaneous tissue (with sides of skinfold approximately parallel). The thicker the fat layer, the wider the fold

The Human Genome is sensitive to physical inactivity: Environmental Circumstance

The plight of the US Pima Indian is a very high prevalence of type 2 diabetes US and Mexican Pima Indians share a common ancestry and share a very similar gene pool

Let's consider the evidence for the guidelines: RTR

The pressor response to a sustained contraction of even a small group of muscles is, apparently, a powerful one.

Fourth revision of the ACSM Position Statement

The purpose of this Position Stand is to provide scientific evidence-based recommendations to health and fitness professionals in the development of individualized exercise prescriptions for apparently healthy adults of all ages; When appropriately evaluated and advised by a health professional, these recommendations may also apply to persons with certain chronic diseases or disabilities, with modifications required according to an individual's habitual physical activity, physical function, health status, exercise response, and stated goals; This document supersedes the 1998 ACSM Position Stand In fact, the 1998 PS has been retired

Waist-to-hip

The ratio of waist-to-hip circumference (WHR) has been used to determine android vs. gynoid type of obesity. The waist circumference is the smallest circumference below the rib cage and above the umbilicus. The hip circumference is the largest circumference of the buttocks-hip area. The waist circumference alone is more commonly used than the WHR.

Construct validity

The test should respond in ways one would expect the test to respond (Discriminate/Differentiate) ex. Step tests differentiate between fit and unfit people

Why body composition

To assess the changes in body fat weight that occurs in response to a weight-management program. To help athletes determine the best body composition for performance. To monitor fat and FFM in patients with disease. To track long-term changes that occur in body-fat and FFM with aging.

Strength testing modality

Upperbody: -bench press -military press (shoulder press) -lat row (barbell or dumbbell) Lower body: -leg press (single or bilateral -squat -dead-lifts

Swain method

VO2 max -VO2rest =VO2reserve VO2reserve*training %=product product+VO2rest= VO2@ targeted work load VO2@targeted work load/ 3.5= METs

Conceptof VO2

VO2= HR * SV *(a-v diff)

Thigh skinfold

Vertical fold on anterior thigh, midway between inguinal crease and proximal border of patella.

Triceps Skinfolds

Vertical fold on posterior aspect of arm, midway between lateral projection of acromion process and inferior margin of olecranon process.

Ab skinfold site

Vertical fold, one inch to the right side of and ½ inch below the navel.

Physical Inactivity is Pandemic

WHO minimal requirements for physical activity; Or 244,000,000 Americans are physically inactive; Globally, 2.5 billion would be considered inactive by U.S. physical activity guideline standards.

Pretest instructions

Wear comfortable clothing Avoid food, tobacco, alcohol, and caffeine 3 hours prior to test Avoid strenuous exercise 24 hours prior to the test Get adequate rest prior to the test

Precision of measurement

When you plot test and retest values, it's obvious that the closer the values are to a straight line, the higher the reliability. A retest correlation is therefore one way to quantify reliability: a correlation of 1.00 represents perfect agreement between tests, whereas 0.00 represents no agreement whatsoever. In our example the correlation is 0.95, which represents very high reliability.

Consent to participate in a test

Who is doing the test? Where is the test being conducted? What is the purpose of this test? What will happen to you if you take part in the test? What are the possible risks and discomforts? What are the possible benefits? If you do not want to take part in the test, are there other choices? If you have any questions or problems, whom can you call? Can your taking part in the test end early? What charges will you have to pay?

Major Categories of Epidemiological Evidence to Support the Effects of Sustained Physical Activity

Work related Activity Leisure Time Activity Combined Total Daily Energy Expenditure Current Fitness Levels Changing Activity Levels

Slide 57

aerobic vs resistance

reproduction

breast cancer endometrial cancer polycystic ovary syndrome gastational diabetes pre-esampsia erectile dtsfunction

ACSM recognizes the potential health benefits of regular exercise performed more frequently and for a longer duration

but at a lower intensity, i.e. 40 - 49% of VO2R or HRR or 55 - 64% of HRmax

nervous

cognitive dysfunction depression anxiety

densitometry (H2O weighing) is based on

dividing the body into 2 compartments -Fat mass -fat free mass

Cuba's economic crisis

following the collapse of the USSR reduced energy intake from 2,899 calories to 1,863 Kcals (Rodrıguez-Ojea et al. 2002; Esquıvel & Gonzalez 2010); Proportion of physically active adults increased from 30% to 67%; Prevalence of obesity declined from 14% to 7%; Deaths attributed to diabetes (51%), coronary heart disease (35%), stroke (20%) and all causes (18%) declined

cardiorespiratory diseases

heart disease Myocardial infarcation hypertension stroke hemostasis congestive heart failure endothelial dysfunction atherosclerosis peripheral artery disease deep vein thrombosis

Evidence indicates that individuals with an android pattern have an increased risk for:

hypertension, CAD, Type II diabetes, hyperlipidemia, premature death

endocrine

insulin resistance metabolic sydrome type 2 diabetes obesity

Rate of Perceived Exertion

look at scale - MHR%

Lower levels of physical activity (esp. intensity)

may reduce the risk for certain chronic degenerative diseases but may not be sufficient to increase VO2max

VO2

mg/ kg/ ml

Bone and muscle are

more dense than fat

Association of Cardiorespiratory Fitness and Overall Mortality Blair et al. (1989 and 1995)

n>10,000 men, 3000 women from USA Measure of Fitness: Est. Exercise Capacity (VO2max), 8.1 yr. follow-up Inverse Association (Dose-response) Highest exercise capacity had lower prevalence of disease

digestive

nonalcoholic fatty livr colerectal cancer diverticultis constipation

Android obesity

obesity describes excess fat in the abdominal region-thoracic cage- issues around organs

Gynoid obesity

obesity: excess fat in the lower portions (hips and thighs)

bone

osteoporosis osteoarthritis balance fracture/falls

isometric

production of force but no movement. Pure strength... important in older people with life expectancy and functionality

Anthropometric Measures

refers to size and proportion of body often used to predict body composition does not distinguish between fat and lean mass monitor body shape and size used to identify disease risk: -Waist-to-Hip Ratio (WHR) -Body Mass Index (BMI)

immune

rheumatoid arthritis pain

isotonic

same force over range of motion

isokinetic

same speed at which you perform force -testing- popular in PT, not true valid test for stength

vertical jump

tests for muscular power of the legs

the ACSM recognizes the dose-response to exercise by which benefits are derived

through varying quantities of physical activity ranging from 700-2000+ kcal/wk

obesity

too much FAT tissue is the issue reduces life expectancy increases disease risk approximately 25% of US public are classified as obese...