CSEP-CEP

What are some consequences of uncontrolled Type II diabetes?

Vision loss, foot heath (result in amputation), nerve damage, kidney disease, stroke

5 lead EKG

Green - right lower ribs White - right inferior to clavicle Black - left inferior to clavicle Red - left lower ribs Brown - 4th intercostal space

What is metabolic syndrome?

Group of risk factors that increase risk of CVD, diabetes and all-cause mortality

What is the HRR method?

Karvonen method HRR = ((MHR - RHR) x training %) + RHR Used to determine intensity

What are some of the interventions for CAD?

Pharmacological (ACE inhibitors, statins, antiplatelets) Bypass grafting (open heart surgery to repair damaged tissue) Stent (open up narrowed arteries)

What is the PCr system?

Phosphocreatine system Used in short bursts of energy (<30 secs)

What are some signs/symptoms of over training?

Physical - decreased performance, increased perceived effort during exercise, excessive fatigue, loss of appetite, chronic injury, excessive weight loss Emotional - agitation, depression, low motivation Physiological - abnormal HR or BP, low HR variability

What is the PAR-Q used for?

Physical activity readiness questionnaire Used to screen if medical clearance is needed to exercise

What is the nerve supply of the upper limb?

MSK - anterior of arm Median - anterior of forearm Radial - posterior arm and forearm Axillary - rotator cuff Ulnar - 4th and 5th digits, anterior forearm

What are some risk factors for falls?

Mental impairment, confusion, impaired vision, low mobility, slow reflex response, inability to use arms to reduce energy of fall, impaired neuromuscular coordination + neurological diseases (hemiplegia, Parkinson's disease), reduced soft tissue padding

What is Motivational Interviewing?

Method of eliciting a client's motivations and concerns with a certain behavior change

What is excitation-contraction coupling?

Mechanism where an action potential causes muscle fiber contraction

Tinnel's sign

Median nerve compression in carpal tunnel syndrome Tap over the carpal tunnel - tingling in the thumb or index finger indicates a positive test

What are the waist circumference values associated with risk?

Men: 94-102 cm and 102+cm Women: 80-88cm and 88+cm

What is the recommended intake of protein?

0.8g/kg/day 1-2g/kg/day if athletes

What should blood glucose be before meals?

4.4-7.2 mmol/L

What are the recommended weight gain guidelines for pregnancy?

A normal BMI woman should gain 25-35 lbs Increase in weight should gain less

Thompson Test

Achilles' tendon; patient lies prone with leg relaxed, squeeze the calf muscles - no plantar flexion indicates a torn Achilles

How to identify the anaerobic threshhold?

Blood lactate levels (will suddenly spike) RER level (>1.1 is maximal effort) Ventilatory threshhold (increases rapidly compared to O2 consumption)

How is BP affected during pregnancy?

Drops during 1st trimester and then returns to normal

What are the ROM for the shoulder?

Flexion - 0-180 Extension - 0-50 Abduction - 0-150 Internal rotation - 0-70 External rotation - 0-90

Provide 4 examples of social determinants of health

Gender Income Race Education and literacy Social supports Culture Employment conditions

What is tertiary disease prevention?

Reduces disability from disease (chronic disease management programs)

Function of AV node

Signal goes to bundle of His, splits into Purkinje fibres, and causes the ventricles to contract

What is a pyramid set?

Start with high reps and lower weight, drop down reps while increasing weight (gradual warm-up)

What is sleep paralysis?

State during waking or falling asleep, in which a person is aware but unable to move or speak, often including hallucinations, may also include hearing sounds or sensations and intense emotions

At what point should the client be at during the last minute of the Ebbling Treadmill test?

Steady state heart rate If not, add another minute

Describe continuous training

Steady state training, work is performed continuously without intervals Effective at improving VO2 max and endurance, Effective for increasing baseline fitness; can be done with no equipment, can become boring/monotonous Doesn't develop anaerobic system

What is the mCAFT test?

Step test used to predict VO2 max

An ending of -kast, -erol, -asone indicate what kind of medication?

Steroidal anti-inflammatories and bronchodilators

What is spondylolysis?

Stress fracture in pars interarticularis of vertebral arch; occurs mostly in lumbar

Exercise for essential tremor

Stretching and flexibility training can help relax tense muscles RE may help reduce severity of tremor

What are some beneficial exercises for scoliosis?

Stretching and strengthening can help reduce abnormal angles in the spine

Exercises for tendinitis

Stretching and strengthening supporting muscles can be beneficial to relieve pressure on the tendon

What are some beneficial exercises for sciatica?

Stretching for glutes, hips, lower back, hamstrings

What kind of exercises are beneficial for disc herniation?

Stretching helps reduce back tension Back/core strengthening exercises

What is a hemmorhagic stroke?

Stroke due to bleeding in the brain

What are the different methods of cancer treatment?

Surgery Radiation Chemotherapy Hormone therapy Immunotherapy Active surveillance

What is a spinal fusion surgery?

Surgery that joins vertebrae; used to relieve pain due to disc degeneration, scoliosis, spinal fractures, kyphosis; lifting not recommended until 12 weeks post

How to prevent exercise induced asthma?

Thorough warm-up is performed, avoid extreme temperatures, ensure adequate hydration

Describe the Balke Protocol

Treadmill test using constant speed and increasing grades to measure VO2 max Increase the grade according to protocol until the test is finished or stopped

What is metformin used for?

Treatment of diabetes

What is FEV1 in a normal patient?

0.8

What is triplegia (CP)?

3 areas are affected in cerebral palsy

What is the kcal equivalent of consuming 1L of O2 while burning fats?

4.7kcal/L

An ending of -artan indicates what kind of medication?

ARB's

Residual volume and size

Air remaining in lungs that prevents collapse (1200mL)

What is a complete spinal cord injury?

All function is lost below level of injury

What does a muscular endurance test assess

Amount of force that can be maintained over a period of time

An ending of -olol indicates what kind of medication?

Beta blockers

Alpha receptor blockers

Block adrenergic receptors to induce vasodilation and lower BP

An ending of -pine indicates what kind of medication?

Calcium channel blockers

What is scoliosis?

Curvature of the spine in the frontal plane; can cause pain in back and shoulders, may also cause respiratory/cardiac issues and limited mobility

What is a spinal cord injury?

Damage to spinal cord causing change in function, could be motor, sensory, autonomic function

What is central hearing loss?

Damage to the brain, auditory information cannot be processed

What is emphysema?

Destruction of alveolar walls

How are lung volumes impacted during pregnancy?

ERV and RV decreased due to displacement caused by the growing fetus

What is dysarthria?

Facial muscles used to produce speech are weakened or paralyzed

How would exercise testing differ in elderly patients?

Focus on functional fitness rather than performance Performance may be limited by psychological factors (fear of falling or injuring themselves) Patients with devices (pacemakers) may not respond well to quickly increasing intensity exercise tests due to response of pacemaker Elderly patients may be taking medications (beta-blockers, ACE inhibitors) that will impact BP/HR response to exercise

What is FEV1?

Forced expiratory volume in 1 second

What is FVC?

Forced vital capacity, total volume the patient can force ably exhale in one breath

What is FRAX?

Fracture risk assessment tool 10-year probability of hip fracture and 10-year probability of major osteoporotic fracture Takes into account: age, gender, previous fractures, BMD, other risk factors

What is a fragility fracture?

Fracture that results from minimal trauma (fall from a standing height) or no identifiable trauma at all

What are the planes and axis of the body?

Frontal plane (anterior and posterior) Sagital plane (left and right) Transverse plane (superior and inferior) Frontal axis (runs left to right) Longitudinal axis (runs up and down) Sagital axis (runs anterior to posterior)

What is silent angina?

Heart does not receive enough blood but does not present typical symptoms; more common in women

What is hyperplasia?

Increase in the number of cells

2 types of obesity mangements

Meridia, Xenical

What are cues for PJC?

Narrow QRS Absent or inverted P wave

Exercises for sprain

Progress from mobilization to strengthening Eccentric and concentric exercises

What are the ECG changes associated with MI?

ST segment elevation/depression Abnormal Q waves

What are the time frames of the boxes on an ECG?

Small box is 0.04 seconds Big box is 0.2 seconds

What is a closed chain movement?

The segment distal from the body is fixed and cannot move Typically multi joint/planar movement Squat

What is the order of the cardiac valves?

Tricuspid, pulmonary, mitral, aortic

What should blood glucose be after meals?

less than 10 mmol/L

Corticosteroids

treats allergies, asthma, COPD, skin conditions, cancer

CO = ...

SV x HR

MAP = ...

((DBP x 2) + SBP) / 3

In what order should a workout be planned?

1.Release - Foam rolling and SMR 2.Reset - Prehab and breathing exercises 3.Readiness - RAMP warm-up 4.Reactive - Speed and power work 5.Resistance - Strength work 6.Resiliency - Energy systems development 7.Recovery - Foam rolling, mobility, flexibility and breathing

What are the adult calcium and vitamin D requirements?

1000mg Ca, 400-1000 IU Vitamin D

Normal breaths per minute

12-16

What are the older adult calcium and vitamin D requirements?

1200mg Ca, 800-2000 IU Vitamin D

What are the movement guidelines for older adults?

150min/week of moderate physical activity or 75 minutes of vigorous physical activity, including 2x week resistance training and balance training

Provide examples of muscular power tests

1RM power clean Vertical jump

Provide examples of muscular strength tests

1RM squat, bench Grip strength

What HR equation should be used for children and adults over 40?

208 - 0.7 x age

Cruciate ligament injury

ACL (prevents anterior translation; most injuries occurs through a cut and plant movement (sudden change in speed and direction); audible pop/crack at time of injury, feeling of initial instability, episodes of giving way on pivoting or twisting motions, swelling, restricted movement PCL (prevents posterior translation; caused by direct blow to anterior tibia, hyperextension/flexion or rotation; feeling of instability, may not present with symptoms if an isolated injury

Lachman's Test

ACL injury Patient in supine with affected knee extended, stabilize femur and hold knee slightly flexed at 30 degrees, tibia is moved anteriorly - excessive laxity and soft end feel indicate ACL injury

Anterior Drawer Test (Knee)

ACL laxity Patient in supine with knee flexed, tibia is pulled anteriorly - excessive movement indicates laxity and possible tears

What is anaerobic power

Ability to produce high forces very quickly

What is cerebral palsy?

Abnormal brain development/damage that results in impaired movement, balance and coordination Typically includes other issues (visual impairment, hearing loss, speech problems, osteoporosis, behavior problems, learning disabilities)

What do premature atrial contractions appear as on an ECG?

Abnormally shaped P wave

What is the process of drug metabolism?

Absorption Distribution Metabolism Excretion

An ending of -pril indicates what kind of medication?

Ace inhibitors

What is an obstructive lung disease?

Airway obstruction causes increase in resistance; volume of each breath gets smaller (asthma, bronchitis), air is trapped in the lungs (results in hyperinflation)

How are the volumes and capacities changed in a restrictive lung disease?

All capacities are reduced due to reduced compliance of the lung

What is quadriplegia (CP)?

All limbs are affected in cerebral palsy

How is DLCO testing scored?

As a degree of severity when comparing your scored value and a normative value

What are the 5A's of Health Pregnancy Weight Gain 2013?

Ask Assess Advise Agree Assist

What does a muscular power test assess?

Assesses how quickly high force can be produced

What are the obstructive lung diseases?

COPD Chronic bronchitis Emphysema Asthma Cystic fibrosis

Why are calcium and iron important parts of nutrition?

Calcium - vital role in bone density Iron - helps ensure O2 transportation, deficiencies can lead to fatigue and weakness

What are the risks of pre-eclampsia?

Can cause seizures and increase risk of stroke; May lead to pre-term or stillborn babies, lack of blood flow may lead to malnourished and small for age babies

How much does CO increase during exercise?

Can increase 15-25L/min in untrained individuals

What are the cues of a 3rd AV block?

Chaotic PR interval Wide QRS complex Regular P and R waves but irregular

When should blood glucose be checked when exercising?

Checked immediately before, immediately after, and 2-3 hours following exercise

What is FEV1 GOLD stages?

Compares FEV1 test values to normative values for age group to evaluate severity of obstruction

What is MS?

Degeneration of the myelin sheath in the brain

What is vertebral disc herniation?

Degeneration of the outermost layer of the vertebral disc resulting in the inner layers slipping out; results in pain, tingling, numbness, can compress spinal cord

What are some signs of hyperemesis gravidarum?

Dehydration, headaches, confusion, fainting, jaundice, extreme fatigue, low BP, rapid HR

What is the role of pre-screening?

Determines if the client is ready and able to perform physical activity Identifies contraindications, medications, other conditions

What is rate pressure product (RPP)?

Determines myocardial workload Resting HR x SBP Value > 10'000 risk for heart disease, useful for progress tracking, impacted by age, sex, medications

What is an acquired disability?

Developed during person's lifetime as a result of accident or illness

What is atrial flutter?

Development of re-entry circuit, circuit loops around and around, rapid atrial depolarization

If FEV1/FVC is greater than 0.8...

Either normal or restrictive

What are some of the tools used in evoking change talk in MI?

Evocative questions, importance ruler, querying extremes, looking back/forward, exploring goals and dreams

Exercise for nerve compression

Exercise in a comfortable ROM

Describe circumference protocol

Explain the purpose of the measurement Explain measurement procedures to client Measure circumference on R side of body, at eye level Landmark site, position tape to use inferior edge and ensure it is straight Make measurement at end of normal expiration (waist) to nearest 0.5cm Administer 2 trials within 1cm

Describe skinfold protocol

Explain the purpose of the test Explain the test procedures Measure skinfolds on right side of body at eye level Lift fold 1 cm above desired site, place calipers directly over desired site Position calipers perpendicular to site of measurement Administer 2 trials within 1mm Measure skinfolds in rotational order DO NOT REMOVE FINGERS PINCHING WHILE MEASURING

Why is WC used with BMI?

Explains additional component of obesity-related mortality, predicts risk to higher degree vs BMI alone

What is the only controlled act a CSEP-CEP can perform?

Finger prick blood sampling

What are the cues of a Mobitz II?

Fixed PR interval Narrow QRS Occasional dropped beats Regular P waves Irregular R waves

Pes planus

Flat foot Can be caused through foot and ankle injury May cause foot pain due to strained muscles and connecting tissues Inability or pain upon attempt to perform single-leg heel rise, inward turned ankles (weight bearing deviated medially), could result in abnormal lower limb biomech (predispose arch, calf, knee, hip, lower back and legs to pain)

What is dynamic stretching?

Functionally based that uses sport-generic/specific movements to prepare body for activity; places emphasis on movements of the activity; actively performed in a controlled ROM; not as effective for increasing ROM

What is junctional tachycardia?

HR above 100 due to AV node

What are common fragility fracture sites?

Hip Vertebrae Wrist Proximal humerus

Patrick's Test

Hip or SI joint affection, tightness of adductors or iliopsoas Patient lies supine with test leg foot on opposite leg knee, knee of test leg is lowered to table while stabilizing pelvis - test leg's knee remains above opposite leg indicates a positive test, negative test would show test leg knee falling to table or parallel

Client records should be...

Identifiable Comprehensive Accurate and timely Legible and understandable Accessible and retrievable Secure and confidential

Glenohumeral instability

Inability to hold humeral head in glenoid fossa; may be a result of traumatic or atraumatic (repetitive) forces; due to laxity in ligaments

Carpal tunnel syndrome

Increased pressure and compression of the median nerve in the carpal tunnel Due to repetitive wrist motions; tingling or numbness in median nerve distribution of affected hand, aggravation of symptoms with static gripping, at night or early in the morning, burning pain, weakness and atrophy of muscles of the thenar eminence

What is hyperventilation?

Increased rate of breathing Causes lower CO2 levels Causes respiratory alkalosis

What happens to blood volume during pregnancy?

Increases by 30-40%

How would the presence of a chest port impact exercise?

Infection can occur, ensure cleanliness No more than 10bs should be lifted 1 week post insertion, after 1 week, exercise as normal

What is bursitis?

Inflammation of a bursa; may cause joint stiffness and pain with movement; caused by trauma, repetitive strain and overuse

Greater trochanter bursitis

Inflammation of subglute med bursa (above greater trochanter and underneath insertion of glute med) or subglute max bursa (between greater trochanter and insertion of glute med and glute max) Chronic pain or hip tenderness of hip (may radiate down thigh), snap felt in lateral aspect of hip, pain ascending stairs, lower back pain

What is a stress fracture?

Injury that causes partial fractures in overused bones caused by repetitive submax loading

What is the process of the Health Action Process Approach?

Intention, Planning, Action

What are the ROM for the foot?

Inversion - 0-20 Eversion - 0-10

What is essential tremor?

Involuntary rhythmic contractions and relaxations (twitching movements) of certain muscle groups in body of unknown cause Occurs during voluntary movements

What is premature junctional complex?

Irritation of the AV junction

3 types of nitrates

Ismo, Imdur, Monoket, Dilatrate, Isordil, Sorbitrate, Nitrostat, NitroQuick, Nitrolingual, Nitrogard, Nitrong, Nitrocine, Nitroglyn, Nitro-Bid, Minitran, Nitro-Dur, Transderm-Nitro,, Deponit, Nitrodisc, Nitro-Derm, Nitro-Bid, Nitrol

What happens when insulin in injected into muscle?

It is absorbed faster, results in faster metabolism and possibly hypoglycemia

Brand name of cardiac glycoside

Lanoxin

What is degenerative disc disease?

Loss of function and degeneration of the intervertebral discs; causes discs to become thinner and vertebrae are closer together; can cause pain in the back, legs (worsened with movement)

What is Alzheimer's disease?

Loss of neurons and synapses in brain, deposition of amyloid plaques and tau protein tangles that result in neurological decline

What is ST segment depression an indication of?

MI

What are the 4 components of social cognitive theory that improve self efficacy?

Mastery experience (success increases SE) Vicarious experience (observation increases SE) Social persuasion (communication/feedback increases SE) Emotional state (positive mindset increases SE)

What is anaerobic capacity

Maximal rate of energy production by ATP-Pc/anaerobic glycolytic energy systems for moderate-duration activities

What is SBP

Maximum pressure in arteries when the heart contracts

Why may BORG and RPE be used in elderly patients vs HR/BP

May be taking medications that can impact the response to exercise

Why is chronological age a poor predictor of abilities in older adults?

Multiple dimensions of health mean that there's a spectrum of health at each age not limited by ageing; Individuals age differently with different capabilities

What is the sliding filament theory?

Muscle fibres contract by sliding myosin heads past actin binding sites, shortening the muscle, and causing contractions

What is nerve compression?

Nerve loses mobility, flexibility, or becomes compressed by surrounding tissues; can cause pain and loss of function

Resistance training adaptations

Neural (increased firing rates, synchronization, neural drive, decreased inhibition) Muscular (hypertrophy)

What are cues for atrial fibrillation?

No P wave Chaotic, narrow QRS Irregular rhythm

Describe the return to play protocol for concussion

No activity Light aerobic exercise Sport specific exercise Non contact training drills Full contact practice Return to game

How would the presence of an ostomy bag impact exercise?

No heavy lifting 3 months post op After that, no restrictions

What are the cues of a 1st AV block?

PR interval greater than 0.20 Regular P and R waves Narrow QRS complex

What is local pain?

Pain at the site of injury

What is social cognitive theory?

People learn through experiences, different factors may influence how behavior outcomes Based on interaction between individual, their environment and their behaviors

What is the anaerobic threshhold?

Point where the body switches from aerobic to anaerobic metabolism

What is the ventilatory threshold?

Point where ventilation rises rapidly compared to O2 consumed

What is Torsades de Pointes (TdP)?

Polymorphic ventricular tachycardia Irregular rhythm Very dangerous

What are some of the non-motor symptoms associated with Parkinson's?

Postural hypotension (common due to lack of autonomic NS regulation) Sleep deficits (may be due to medications, nocturnal akinesia, nocturia, insomnia) Sensory deficits (sense of touch, smell may be lost) Hallucinations/confusion (common, may be due to changes in neurotransmitters or that patients are at a higher risk of dementia)

What are the steps of the trans-theoretical model?

Precontemplation Contemplation Preparation Action Maintenance

What is a premature atrial contraction?

Premature heartbeats that begin in atria; caused by increased age, hypertension, high cholesterol

What is preparatory and mobilizing change talk?

Preparatory - pre-contemplative talk (will talk about Desires, Abilities, Reasons, Needs) Mobilizing - express readiness to change (will talk about Activation, Commitment, Taking Steps)

What tests are done in a typical fitness assessment?

Prescreening/risk stratification Resting HR, BP, height, weight, BMI, ECG Body composition (WC, skinfold assessment) Cardiorespiratory fitness Muscular strength Muscular endurance Flexibility

Anti-arrhythmic agents

Prevent abnormal rhythms through Na/K/Ca/sympathetic NS configuration

What is progression?

Progression of exercise to continue to improve performance; can be done through increasing weight, number of reps/sets, decreasing rest time

What is primary progressive MS?

Progression of the disease with no relapse in symptoms

What is a 1st AV block?

Prolonged transition of impulse through AV junction

Describe the McMaster protocol

Protocol is based on height / graded workload / workload is followed until end of protocol of test warrants stopping

Functional Residual Capacity

RV + ERV

What is taper?

Reducing intensity and amount of exercise done; typically done before competition, also known as "deload", used to achieve super compensation and improve performance

What is disuse process (atrophy)?

Reduction in skeletal muscle due to disuse/inactivity Protein degradation > protein consumption Can be completely reduced with diet and exercise Muscles need mechanical loading and protein in order to maintain mass

What is physical inactivity?

Refers to not meeting the physical activity guidelines

What is the difference between tissue regeneration in MSK vs neurological tissue?

Regeneration does not occur in nerve tissue, lost axons are replaced by the formation of a glial scar MSK tissue will regenerate after injury

What is a discectomy?

Removal of a portion of the intervertebral disc; done when protruding discs presses on spinal cord

Function of HDL

Removes excess cholesterol from bloodstream back to liver

What is a simple concussion?

Resolve progressively without complication over 7-10 days

What is RER?

Respiratory exchange ratio CO2 expired / O2 inspired to estimate the percentage of carbs and fats being metabolized Over 1.1 indicates anaerobic threshold

Exercises for bursitis

Rest is recommended until swelling has decreased

If FEV1/FVC is greater than 0.8 and FVC is less than 0.8...

Restrictive disease

What is a ventilatory impairment?

Restrictive lung expansion, resulting in decreased lung volume, increased work of breathing, and inadequate ventilation

What is a and what are the signs of a RIGHT bundle branch block?

Result of CAD, pulmonary hypertension V1 lead has terminal positive (last inflection point of QRS is upwards), looks like an M

What is a and what are the signs of a LEFT bundle branch block?

Result of cardiomyopathy, CAD V1 lead has terminal negative (last inflection point of QRS complex is downwards)

What is respiratory alkalosis?

Result of hyperventilation, pH is too high

Why would RPE be used in place of 1RM?

Safer for clients Easier than 1RM protocol Can be used for more isolated exercises

What are some issues in exercise testing in patient's with altered neurological status?

Safety Consent What is being assessed Timing of test

What is the MRC Dyspnea scale?

Scale used to assess severity of shortness of breath and basic functional impairment

What is hyperemesis gravidarum?

Severe nausea, vomiting, weight loss, electrolyte imbalance during pregnancy Caused by change in hormone levels

What is static stretching?

Slow and constant stretch, held for 15-30 seconds; improves ROM; typically done post exercise (muscles are warm and are more receptive to stretching)

Type I muscle fibers

Slow twitch Long duration and low amounts of force High mitochondrial count High concentrations of myoglobin Less myosin/actin per CSA Low myosin ATPase

What kind of medications are used as anti-arrhythmias?

Sodium channel blockers Beta blockers Calcium channel blockers Potassium channel blockers

What is an incomplete spinal cord injury?

Some motor or sensory function still exists below the level of injury

What is conductive hearing loss?

Sound doesn't reach the inner ear, may be due to external ear canal malformation, dysfunction of eardrum or malfunction of bones of middle ear

What are SMART goals?

Specific Measurable Attainable Realistic Timely

What is summation?

Successive twitches when muscle does not have time to recover after increased frequency of stimuli

Immunosuppressant

Suppresses immune system, treats autoimmune diseases

What is congestive heart failure with reduced LV ejection fraction?

Systolic heart failure; heart does not contract as efficiently, and less blood is pumped out; ejection faction of less than 40%

What are the cut points for: TLC, RV, ERV, IRV, TV?

TLC: 6L RV: 1.2L ERV: 0.7-1.2L IRV: 1.9-3.3L TV: 0.5L

Inspiratory capacity

TV + IRV

Vital capacity

TV + IRV + ERV

What is supraventricular tachycardia?

Tachycardia induced from AV node

Name some ways of reducing sedentary time

Taking frequency stretch breaks during working Standing while working Take the stairs instead of the elevator Walk/bike to work

lateral epicondylitis

Tennis elbow Tendinopathy of extensor tendons due to overuse, common in repetitive one-sided movements Pain produced by palpation on extensor muscles origin on lateral epicondyle, can radiate upwards along upper arm and downwards along outside of the forearm, often seen that flexibility and strength in wrist extensor are deficient

What happens to the following hormones during exercise and what do they do: testosterone, insulin, glucagon, cortisol, human growth hormone, estrogen

Testosterone - levels rise, increase protein synthesis Insulin - levels decrease, sensitivity increases Glucagon - levels increase, mobilizes glucose Cortisol - levels rise, promotes breakdown of tissue HGH - levels rise, increases protein synthesis and enhances gluconeogenesis Estrogen - levels vary in response to differing VO2 levels

How does DLCO testing work?

Tests the amount of CO breathed in vs breathed out to assess the diffusion capacity of the lungs CO adheres better than O to RBC's

What is an open chain movement?

The segment distal from the body is free and can move with the movement Better at isolating muscles Bench press

A ventilation-perfusion ratio of less than 1 means?

There is more blood flow than ventilation Not enough ventilation occuring

A ventilation-perfusion ratio of greater than 1 means?

There is more ventilation than blood flow Gases are not being exhanged

Factors that determine RE programs in youth

Training age Overuse injuries Biological age

Give examples of anaerobic power tests

Vertical jump 1RM power clean Standing long jump

How is the Astrand-Rhyming test scored?

Using average HR and workload used, as well as an age adjustment

How is the Balke Protocol scored

Using minutes completed

Acromial clavicular joint injury and separation

Usually seen in contact sports; pain often felt radiating to neck and deltoid, AC joint may become swollen, UE held in adduction with acromion depressed, may cause clavicle to be elevated

What are cues of sinus arrhythmia?

Variable R interval Narrow QRS complex

Nitrates

Vasodilator used to treat angina

What is ventricular fibrillation?

Ventricles not contracting properly resulting in no blood flow from heart

Forced vital capacity

Volume of gas that can be exhaled as forcefully and rapidly as possible after a maximal inspiration

What are some methods of aerobic training?

Walking Running Biking Swimming Jump rope Erging Elliptical

Exercise for a discectomy

Walking highly recommended to prevent scar tissue adhesion; key is to remain mobile

What are cues for idioventricular rhythm?

Wide QRS complex Absent P wave HR of 20-40

What are cues for ventricular tachycardia?

Wide QRS complex No P wave HR greater than 100

What are cues for PVC?

Wide QRS complex No P wave T wave in opposite direction of R wave

How many extra calories per day are needed while pregnant?

300kcal

When does cardiac output peak in pregancy?

3rd trimester

90% 1RM is how many reps?

4

Iron deficiency

Can result in decreased RBC, weakness/fatigue, dizziness

What is overload?

Increasing difficulty (increase weight/reps/sets, decrease rest) in order to progress strength

What is tetanus?

Individual contractions that blend into a single sustained contraction, results in coordinated muscle contraction

What are some characteristics associated with Down Syndrome in terms of health and exercise?

Individuals are at a higher risk of obesity; common to have hearing and vision disorders, heart defects Poor muscle strength, agility and balance; higher risk of chronic conditions due to inactive lifestyle; overall health and risk can be improved with exercise

What is tendonitis?

Inflammation of the tendon; causes pain and difficulty with activity; occurs with overuse or repetitive actions

Adhesive capsulitis

Inflammatory condition causes fibrosis of GH joint capsule, accompanied by progressive stiffness and significant ROM restriction; painful and progressively restricted active and passive glenohumeral ROM

Antiplatelets

Inhibit clotting through platelet aggregation

What is secondary progressive MS?

Initial relapsing-remitting MS with progressive decline between acute attacks without definite periods of remission

What is a regular rhythm?

R waves occurring at a regular rate, same distance between each one

What are the 5 circumference points?

- Arm (midpoint between acromian and olecranon) - Waist (midpoint of iliac crest and ribs) - Hip (furthest protrusion of glutes) - Thigh (midpoint of inguinal crease and patella) - Calf (furthest protrusion)

Function of SA node

- Cells depolarize and cause AV node and Bachman's bundle to depolarize - Atria then contract and the signal is sent down the left and right branches to the AV node - Pacemaker of the heart

What is the valsalva maneuver?

- Exhalation against a closed airway, creates an increase in intra-abdominal pressure increase in pressure creates a lack of blood flow - HR and BP increase to compensate for lack of flow - expiration results in sudden increase in flow and dramatic drop in BP

What are the 7 skinfold sites?

- Tricep (midpoint of acromian and olecranon) - Bicep (belly of bicep) - Scapula (3cm inferior) - Waist (3cm superior of iliac crest) - Stomach (3cm lateral and 1cm inferior of belly) - Thigh (midpoint of inguinal crease and prox patella) - Calf (widest medial point)

What are the stages of learning?

1) cognitive, goal identification 2) fixation, focus on producing effective movements 3) autonomous, effortless movements

What 3 factors contribute to impaired exercise performance in heat?

1- accelerated muscle fatigue due to increased rate of glycogen breakdown 2- cardiovascular dysfunction due to increased HR, decreased SV and reduced muscle blood flow 3- CNS dysfunction (reduced mental drive for motor unit recruitment, neural feedback from fatiguing muscle exerts inhibitory influences on central motor drive resulting in decreased recruitment of motor units)

What are the MET intensity classifications?

1.5 - 3 = light intensity 3 -6 = moderate intensity >6 = vigerous intensity

What is the kcal equivalent of consuming 1L of O2 while burning carbs?

5kcal/L

What is a twitch contraction?

Contractive response of muscle after application of a single stimulus

What is the unlucky triad?

ACL, MCL, meniscus tear

Beta blockers

Block epinephrine receptors to reduce HR and BP

What is ballistic stretching?

Active muscular effort using bouncing-type movement, end position not held; typically used pre-exercise; potential to induce injury if not controlled

What's the difference between an acute and chronic injury?

Acute - injury occurs after an accident or trauma Chronic - injury occurs due to repetitive use over period of time; repetitive stress wears out tissues

How to classify acute vs chronic back pain?

Acute - lasts less than 6 weeks Chronic - lasts more than 12 weeks

What are some contraindications of performing an exercise stress test?

Acute MI (4 days) Unstable angina Brady/tachycardia or other abnormal rhythms Acute myo/pericarditis

What is tetraplegia?

All limbs affected by injury; severity depends on which level of spinal cord was injured (may require a ventilator or may have partial movement in limbs)

What is double hemiplegia (CP)?

All limbs are affected in cerebral palsy, one side more so

What is a standard set?

All sets of an exercise are performed with rest between

Tidal volume and size

Amount of air moving in and out of lungs in a normal breath (500mL)

Expiratory reserve volume and size

Amount of air that can be forcefully exhaled after a normal breath (700-1000mL)

Inspiratory reserve volume and size

Amount of air that can be inhaled following a normal inhalation (1900-3200mL)

What does a muscular strength test assess

Amount of force that can be produced

What is unstable angina?

Angina that occurs at rest, is severe, worsens over time; occurs due to reduction in coronary flow because of platelet aggregation on endothelium

What are some methods of measuring atherosclerosis?

Angiography (measures artery vaso-responsiveness in response to endothelium-dependent agonists) Flow-mediated dilation (high-resolution ultrasound to assess changes in brachial artery diameter) Carotid intimamedia thickness (measurements of carotid intimamedia (layers of arterial walls) thickness measured with ultrasonography)

What is ASD?

Autism spectrum disorder May have difficulty with communication and interaction, restricted interests, repetitive behaviors Range of capabilities depending on the person

How does PNF stretching work?

Autogenic inhibition (relaxation in muscle experiencing tension) Reciprocal inhibition (relaxation in opposite muscle)

What is multiple sclerosis?

Autoimmune disease that attacks myelin, resulting in disrupted nerve transmission and nerve damage

What are the ABC's of behavior?

Antecedents (environmental stimuli), Behavior (what the person does), Consequence (outcomes of the behavior)

What is rheumatoid arthritis?

Autoimmune disorder that causes body to attack joints; results in painful, swollen joints; often co-diagnosed with CVD, osteoporosis, cancer, fibrosis Exercise is important (stronger muscle can better support joints), may help with fatigue related to RA, may help reduce pain

Considerations for Cerebral Palsy

Avoid activities in conflict with rehab programs Focus on inhibiting abnormal reflex activity, normalizing muscle tone, developing reactions to increase equilibrium, functional outcomes and performance Training programs should be adapted continuously to accommodate changing conditions Medical interventions (Botox) may change the functional potential of the individual Persons with CP are more susceptible to overuse injuries because of higher incidence of inactivity and associated conditions

Purpose of functional fitness?

Assess common movements that are needed to perform activities of daily living

3 types of ARB's

Atacand, Teveten, Avapro, Cozaar, Benicar, Micardis, Diovan

3 types of bronchodilators

Atrovent, Combivent, Proventil,Alupent, Maxair, Serevent, Advair, Brethine, Theo-Dur, Singulair, Accolate, Zyflo, Intal, Tilade, Xolair

What are some considerations when working with cancer patients?

Avoid dislodging PICC lines or catheters May experience muscle weakness Vestibular issues Limited ROM due to surgeries No exercise if chemo was received in past 24 hours Radiation may impact cardiac function (reduced diastolic volume) Radiation increases stiffness Increased risk of skeletal fractures with advanced disease Exercise tolerance will vary from session to session

Considerations for Arthritis

Avoid strenuous exercise during flares and periods of inflammation Progression in duration of activity should be emphasized over increased intensity Adequate warm-up and cool-down periods of 5 to 10 minutes are critical for minimizing pain. Inform individuals with arthritis that some discomfort during or immediately after exercise can be expected If joint pain persists for 2 hours after exercise and exceeds pain severity before exercise, duration or intensity should be reduced Encourage exercise during time when pain is least severe or in conjunction with peak activity of pain meds Appropriate shoes that provide shock absorption and stability are important for people with arthritis Incorporate functional exercises to improve control, balance, and maintenance of ADL's For water exercise, temperature should be 28C-31C, warm water helps to relax muscles and reduce pain

An RER of 1.0 indicates what?

Body is relying 100% on carbs

An RER of 0.7 indicates what?

Body is relying 100% on fats

What is BMI and how do you calculate it?

Body mass index, determines weight classifications and risk Kg/height in m2

What is the stress/rest principle?

Body needs certain amount of time to recover post workout; 48 hours between workouts that stress same muscle systems

What happens when blood pH is too low?

Body will decrease H in blood by producing carbonic acid from H and bicarbonate and then CO2 and H2O, will excrete CO2

What happens when blood pH is too high?

Body will increase H in blood by producing H and bicarbonate from carbonic acid and excreting the bicarbonate

What are some accommodations that could help someone with a visual impairment?

Bolded lines Reduced lighting or glare Increased text size

Branches of the aorta

Brachiocephalic R and L common carotid R and L subclavian Descending aorta

What is Parkinson's disease?

Brain cell death resulting in decreased dopamine production that typically affects movement

What is osteoarthritis?

Breakdown of cartilage and bone at joints that causes pain, swelling, inflammation; typically occurs with age, obesity and genetics, can be caused by overuse May be at an increased fall risk due to weight bearing joint degeneration

What is the glycolytic system?

Breakdown of glucose into lactate and pyruvate Used in 30 secs to 2 mins

What is chronic bronchitis?

Bronchial inflammation resulting in mucus hyperexcretion and chronic cough

What is atherosclerosis?

Buildup of plaque in the arteries; can lead to reduced blood flow and hardened arteries

What can a CSEP-CEP NOT do?

Cannot diagnose based on assessments or pathology

As a CEP, what can I not do?

Cannot diagnose injuries or conditions Cannot draw blood unless delegated

Increasing exercise intensity shifts metabolism towards using...

Carbs

What are the recommended percentage intakes for macros?

Cards 40-65% Protein 10-35% Fats 20-35%

What are cues for ventricular fibrillation?

Chaotic rhythm No QRS

What is atrial fibrillation?

Chaotic rhythm No organized contraction in atria Elderly and diseased patients

What is sciatica?

Characterized by shooting pain from lower back traveling down the leg Caused by compression of the sciatic nerve; can be caused by herniation, piriformis syndrome, risk factors

What are some treatment related effects of cancer?

Chemo brain Lymphedema Reduced bone density Low muscle mass (cachexia) Psychosocial impacts

What is angina pectoris?

Chest pain caused by ischemia May be stable or unstable

What is stable angina?

Chest pain occurs with increasing stress (exercise), occurs predictably and can elicit it; symptoms disappear during rest or after medications are taken

What are the WHO physical activity recommendations?

Children: 60min/day moderate/vigorous physical activity, resistance exercise 3x week Adults: 150min/week moderate/vigorous physical activity, resistance exercise 2x week Older adults: 150min/week moderate/vigorous physical activity, resistance exercise 2x week and balance activity to prevent falls

What is a developmental disability?

Chronic conditions due to mental or physical impairment that arise before adulthood; impairment in physical, learning, language, or behavior areas

What are some factors contributing to fracture risk?

Chronic disease (osteoporosis, arthritis, diabetes), history of smoking/drinking, low BMI, corticosteroid use, age, gender

What is disease process (atrophy)?

Chronic illness induced muscle atrophy without disuse Commonly seen in older people admitted to intensive care, cancer patients (cancer cachexia) Cannot be fully reversed Chronic inflammatory diseases are commonly associated with muscle weakness)

What is asthma?

Chronic inflammation of the airways

What is narcolepsy?

Chronic neurological disorder that affects brain's ability to control sleep-wake cycles, typically fall asleep unwillingly in the middle of the day

What is visual acuity?

Clarity of vision and ability to see small detail; may be able to see detail from further away or closer up

What should be considered when exercising with a patient who uses supplemental O2?

Client is focused on deep breathing, making sure they have enough time to inhale/exhale and aren't hyperventilating Can't adjust O2 flow but ensure that it is set to the prescribed level Watch for signs of respiratory distress during exercise that may indicate something wrong with supplemental O2 Typically ranges from 94-96%

What is the spirit of MI?

Collaboration Acceptance Compassion Empathy

What is idioventricular rhythm?

SA or AV nodes not firing quick enough or not firing at all

What is intra-abdominal pressure and why is it used?

Created by bracing core to create high amount of pressure through contractions; results in high BP Can help stabilize and unload spine during lifting (flexion and standing tasks); can also help reduce compressive forces on the spine

Compartment syndrome

Critical pressure increases within confined compartment causing decline in perfusion pressure to tissue within compartment Caused by swelling or bleeding within compartment due to improper drainage; pain on palpation of involved muscles, pain with passive stretching of muscles, feeling of firmness, excessive overpronation *can cause tissue death if not treated*

What is a 2nd AV block?

Cyclical and progressive conduction delay through AV junction, can be caused by myocardial ischemia or drugs

IT band syndrome

Overuse injury resulting in inflammation of IT band Repetitive activities involving knee flexion-extension cause pain, burning pain at lateral femoral epicondyle, sharp pain on outer aspect of knee when heel strikes floor, tenderness over knee

What is ventricular tachycardia?

Dangerous rhythm, can be caused by myocardial ischemia HR over 100 that originates in ventricles

Achilles Tendinopathy

Overuse or trauma injury resulting in degeneration and inflammation in the Achille's; morning pain is a strong cue, may be stiff, localized tenderness

What are some cognitive deficits associated with stroke?

Difficulty concentrating, following directions, organizing or prioritizing, making decisions, understanding what is safe, problem-solving, remembering information or events

What is insomnia and its signs?

Difficulty falling or staying asleep Signs include tiredness, unable to focus/concentrate, irritability

What is DLCO?

Diffusion capacity for carbon monoxide Used to test for Restrictive diseases

Vasodilators

Dilate blood vessels to reduce BP

Bronchodilator

Dilates bronchioles to help with breathing

What is spondylolisthesis?

Displacement of spinal vertebra, typically if fracture in the pars interarticularis widens; may experience muscle spasms and difficulty walking and standing

Calcium channel blockers

Disrupt movement of Ca to reduce HR and BP

An ending of -ide or -one indicate what kind of medication?

Diuretics

3 types of diuretics

Diuril, Microzide, Hydrodiuril, Oretic, Lozol, Mykron, Zaroxolyn, Renese, Bumex, Edecrin, Lasix, Demadex, Midamor, Dyrenium, Inspra, Aldactone

What are some common treatments for cystic fibrosis?

Coughing/huffing Active cycle of breathing (controlled breathing, chest expansion exercises and forced expiration to force mucus out) Autogenic drainage (varying breathing speeds and inhaling to different levels, adjusting exhaled breath to move mucus) Postural drainage (chest physical therapy)

What is sensorineural hearing loss?

Dysfunction of inner ear due to cochlea/transmitting nerve (impulses from cochlea to hearing centre), damage to hair cells in cochlea

What are some of the movement characteristics associated with Parkinson's

Dyskinesia (involuntary, unintentional movements) Shuffling gait (may lean unnaturally forwards in stooped position, lean sideways when standing, head dropped forwards, steps taken on front of feet, feet dragging on ground, reduced stride length) Freezing of gait (start hesitation when walking) Micrographia (small hand writing) Hypophonia (soft speech) Speech festination (tendency to speed up when speaking)

Exercise for laminectomy

Enforce good posture and strength of core/back

What are the 4 steps of MI?

Engaging Focusing Evoking Planning

How would the presence of a catheter impact exercise?

Ensure catheter is secured properly during exercise

Describe the protocol for taking BP

Ensure client has been resting for 5 minutes Palpate for brachial artery Wrap appropriately sized cuff around arm just above brachial artery Palpate for the radial pulse Inflate cuff rapidly to 70mmHg Inflate cuff until radial pulse is no longer felt Insert stethoscope and position just over brachial pulse Inflate cuff to 20-30mmHg above estimate Release pressure slowly until 1st Korokoff sound is heard Continue to release until last Korokoff sound is heard Repeat and compare to 1st trial

Radial and ulnar nerve entrapement

Entrapment of the nerves due to repetitive compression (leaning on elbow, throwing or overhead activities); tingling in fingers, weak grip strength, pain and sensitivity, localized tenderness

What are some risks associated with exercise training in youth?

Epiphyseal plate injury and fractures in young athletes Soft tissue injuries Most injuries due to over training, no supervision, too heavy of a load, poor technique

How is capacity for consent assessed?

Evidence of confused/delusional thinking Person is unable to make a choice about service Person is experiencing severe pain/acute fear/anxiety Person appears to be severely depressed Person appears to be impaired by alcohol/drugs Observations that give rise to concern about person's capacity, including behaviour or communication

Increasing exercise duration shifts metabolism towards using...

Fats

What are some risk factors for pre-eclampsia?

Excessive gestational weight gain Obesity Diabetes

What are the ROM for the hip?

Flexion - 0-120 Extension - 0-30 Lateral rotation - 0-45 Medial rotation - 0-45 Abduction - 0-40 Adduction - 0-30

What are the ROM for the knee?

Flexion - 0-135 Extension - 0

What are the ROM for the elbow?

Flexion - 0-150 Extension - 0-10 Pronation - 0-90 Supination - 0-90

What are the ROM for the wrist?

Flexion - 0-75 Extension - 0-70 Abduction - 0-20 Adduction - 0-30

Describe the FEV1 Gold Stages

GOLD 1 - mild, FEV1 >80% predicted GOLD 2 - moderate, FEV1 50 - 80% predicted GOLD 3 - severe, FEV1 30 - 80% predicted GOLD 4 - very severe, FEV1 <30% predicted

3 types of anti-diabetic agents

Glucophage, Riomet, Glucovance, Glyset, Starlix, Prandin, Gluconorm, Diabinese, Diamicron, Amaryl, Glucotrol, DiaBeta, Glynase, Micronase, Tolinase, Orinase, Byetta, Actos

What is the significance of HbA1C values?

Glycated hemoglobin levels Higher the value the higher the risk of developing diabetes related complications Goal is 6.5% or 48mmol/mol

Without insulin, what happens to the body's energy balance?

Goes into a negative state Fatty acids and protein may compete with insulin for metabolism

What are the values for blood LDL levels?

Good - <3.36 Moderate - 3.36-4.11 High - >4.11

Describe the Bruce protocol

Graded treadmill test designed to measure VO2 max Each stage is 3 minutes long with a certain speed and grade, patient lasts as long as possible or until contraindications exists

What is the GMFCS?

Gross Motor Function Classification System Used in cerebral palsy to classify movement abilities

What variables are recorded during the Astrand-Rhyming cycling test?

HR and RPE each minute BP at the end of the 4 minute mark

What variables are recorded during the Bruce Protocol?

HR and RPE every minute BP at 2:15 of each stage

What variables are recorded during the Ebbling Treadmill test?

HR and speed every minute

What variables are measured during the mCAFT?

HR at the end of each stage

What is pre-eclampsia?

High BP during pregnancy; typically presents with protein in urine and edema, may also include headache, abdominal pain, visual changes

What are some causes of bradycardia?

High CRF (athletes) Drug use Heart disease Absence of electrical impulses

What are the symptoms of concussion?

Headaches, dizziness, vomiting, nausea, lack of motor coordination, difficulty balancing, light sensitivity, blurred vision, double vision, tinnitus, confusion, amnesia, difficulty sleeping, agitation, loss of interest

What is tachycardia?

Heart rate above 100 bpm

What is bradycardia?

Heart rate below 60bpm

What is the Cancer Grade?

How abnormal the cells look when compared to healthy cells - Grade 1: Tumor cells look like healthy cells/tissue; called well-differentiated tumors and are low grade - Grade 2: cells/tissue somewhat abnormal, moderately differentiated (intermediate grade tumor) - Grade 3: Cancer cells/tissue look very abnormal, poorly differentiated with no architectural structure or pattern (high grade) - Grade 4: undifferentiated cancers have most abnormal looking cells, highest grade and grow and spread faster than lower grade tumors

Describe 1RM, when it's used and why it's used

How much weight can be lifted for 1 rep Commonly used for compound lifts (squat, bench) Helps with load and rep prescription Requires high technique and experienced lifters

3 types of insulin

Humalog, Humulin R, Novolin R, Iletin II R, Humulin L, Humulin N, Iletin II Lente, Iletin II NPH, Novolin L, Nivalin N, Humalog Mix, Humalog 50/50, Humalog 70/30, Novolin 70/30, Humulin U, Lantus injection, Levemir

Considerations for Diabetes

Hypoglycemia is most common problem Rapid drops in blood glucose may occur with exercise The timing of exercise should be considered in individuals taking insulin or hypoglycemic agents. Avoid injecting insulin into exercising limbs, use an abdominal injection site Risk for retinal detachment and vitreous hemorrhage associated with vigorous-intensity exercise Monitor BP following exercise to manage hypotension and hypertension associated with vigorous-intensity exercise

What is primary osteoporosis?

Imbalance of bone resorption and formation leading to bone mass deficits resulting in increased fracture risk

Cardiac Glycosides

Increase CO through alteration of Na/K pump to allow higher Ca concentrations to prevent heart failure

How are the volumes and capacities changed in an obstructive lung disease?

Increase RV, TLC Decreased ERV

What is dynamic hyperinflation?

Increase in end-expiratory lung volume (EELV) that may occur in patients with airflow limitation when minute ventilation increases (exercise) Due to reduced elastic recoil of lungs

A RIGHT shift in the O2 hemoglobin dissociation curve is associated with what changes?

Increase in temperature Increase in H ions Higher CO2

What are the benefits associated with cystic fibrosis and exercise?

Increase respiratory muscle endurance, sputum expectoration, reduce residual volume, rate of pulmonary function decline, improve fluid balance and retention of serum electrolytes

Diuretics

Increase salt secretion to promote water secretion to reduce BP

What happens to hormone levels during pregnancy?

Increase until labour, highest in 3rd trimester

What are some benefits associated with exercise training in youth?

Increased load and stress from RE provide added stimulus to neural proliferation occurring Increased motor activation and gains in strength compared to adults undergoing initial RE Improved perceived competence, improved academic performance and self-efficacy/self-esteem Decreased rates of fracture, MSK injuries associated with sport specific practice and competition Increased bone mineral density leading to a higher bone strength index

What are some of the risks associated with uncontrolled gestational diabetes?

Increased risk of baby being too large, having low blood sugar after birth, jaundice, stillbirth

What is the importance of a warm-up?

Increases blood flow and O2 delivery to muscles that will be working Vasodilates blood vessels to ensure adequate blood flow to muscles Increases contraction rate and rate of force development of muscles Decreases muscle and joint resistance Helps prevent injury

What is the theory of planned behavior?

Intention to act is the best predictor of behavior Based on behavioral (individual evaluation of behavior), normative (perceived expectations of others), and control (perceived control over situation) beliefs

What is Mobitz II?

Intermittent block below AV node

Self determination theory is based on what types of motivation

Intrinsic (pleasure and satisfaction) Extrinsic (external motivations for completing tasks, obligation, reward)

What are the 10 core movements in resistance training?

Knee dominant Hip Dominant Vertical push Vertical pull Horizontal push Horizontal pull Anti-flexion Anti-extension Anti-rotation Anti-lateral flexion

Patello-femoral pain syndrome

Knee pain caused by misalignment of patella due to variety of factors (overuse, muscular imbalance, anatomical abnormalities) Pain aggravated by activities that increase patellofemoral compressive forces (stairs, sitting with knees bent, kneeling, and squatting)

Different ways of providing extrinsic feedback

Knowledge of performance or knowledge of results Sensory: visual, auditory, proprioceptive, touch Timing: before, during, or after task completion Frequency: high/low, summary, faded with experience, performance, or learner determined

Varus Stress Test

LCL laxity Apply a varus pressure to the inside of the knee while holding the lower leg still - excessive laxity indicates LCL is most likely torn

What is a transient ischemic attack (TIA)?

Lack of blood flow for a short period of time that resolves itself Mini stroke

What is ischemia?

Lack of blood flow to area of tissue; results in shortage of O2 to tissue; results in tissue death

What is a myocardial infarction and what are the signs

Lack of blood flow to the heart Chest pain, shortness of breath, sweating, fainting, dizziness

What is ischemia? What does it look like on an ECG?

Lack of blood flow to tissue Appears as a downsloping ST segment

What is macrosomic delivery?

Large for gestational age baby Baby over 8lbs 13oz May cause difficulty during delivery

What is the female athlete triad?

Low energy availability Menstrual dysfunction Low bone density

SI joint injury

May be a cause of low back pain; pain aggravated by getting out of chair, prolonged standing/sitting, climbing stairs or morning stiffness

What is iron deficient anemia (pregnancy)?

May be due to lack of iron in diet due to increased needs Risk is increased if you are under 20, already have low iron stores, have a disorder that affects nutrient uptake, are having more than 1 baby

McMurray Test

Meniscus Patient in supine with knee completely flexed, tibia is medially rotated and scoured (lateral meniscus)/laterally rotated and scoured (medial meniscus) and then knee is extended - snapping or clicking with pain indicates a meniscus injury

What is DBP?

Minimum pressure in arteries when the heart is filling

Exercise for muscle strain

Mobilization important during recovery to improve regeneration

A 2nd AV block is also known as what?

Mobitz 1 Wenkeback

Meniscal injury

Most common injury is a torn medial meniscus (greater attachment area = stiffer, more common for knee to move medially vs laterally); caused by a twisting motion; knee pain, swelling, knee locking, clicking feeling, tenderness

What are some common issues associated with amputation?

Muscle weakness, blisters, joint instability, phantom limb pain

What are some physical deficits associated with stroke?

Muscle weakness, loss of stamina, drop foot (weak dorsiflexors), spasticity, contractures, sensory deficits (loss of feeling or numbness)

What are some conditions experienced post stroke?

Muscle weakness, numbness, pressure sores, pneumonia, incontinence, apraxia, speech loss, vision loss and pain

What are isokinetic exercises?

Muscles shorten at a set speed during the exercise, typically done with special machines

In order for a CSEP-CEP to perform a controlled act, what must occur?

Must be delegated to do so by a regulated health professional Must have the qualifications to perform the act

What are the criteria for being diagnosed with Metabolic Syndrome?

Must have 3 of the 5: - abdominal obesity (≥ 102 cm men, 88 cm women) - high BP (≥ 130/85 mm Hg, or on medication) - high blood glucose (≥ 5.6 mmol/L, or on medication) - high serum triglycerides (≥ 1.7 mmol/L, or on medication) - low HDL levels (< 1.0 mmol/L men or < 1.3 mmol/L women)

What is MI?

Myocardial infarction Lack of blood flow and O2 to heart tissue and tissue begins to die

What are cues for sinus bradycardia?

Narrow QRS Upright P wave HR less than 60

What is spinal stenosis?

Narrowing of the spinal canal that places pressure on the spinal cord Can result in pain, weakness or numbness in arms and legs

What is the order of fitness tests that should be used?

Non-fatiguing tests Agility tests Max power tests Sprint tests Local muscular endurance tests Anaerobic tests Aerobic tests

What are the stages of BP?

Normal - <120/<80 Prehypertension - 120-139/80-89 Stage 1- 140-159/90-99 Stage 2 - > 160/100 Hypertensive crisis >180/110

What are the T-scores associated with osteoporosis?

Normal <1.0 Osteopenia 1.0-2.5 Osteoporosis >2.5 Severe osteoporosis >2.5 with fragility fracture

Describe the normal and abnormal HR response to exercise

Normal: increase in HR depending on what type of exercise Abnormal: sudden increase in HR, increase in HR with no increase in CO

What does OARS stand for in motivational interviewing?

Open ended question Affirmation Reflection Summary

What is sinus arrhythmia?

Originates in the SA node; increasing and decreasing HR; often benign, indicator of good cardiac health

What is a MET?

Oxygen cost of an activity 3.5 mL/kg/min

What documents should your pre-screening include?

PAR-Q Informed consent form AAL-Q

Posterior Drawer Test (Knee)

PCL laxity Patient in supine with knee flexed, tibia is pushed posteriorly - excessive movement indicates laxity and possible tears

What is referred pain?

Pain at a site other than the site of the pain origin Pain in the arm during an MI or brain freeze from the vagus/trigeminal nerve stimulation

What is radicular pain?

Pain radiated down dermatome in response to inflammation/irritation of nerve root Commonly seen in lower extremity with numbness, pain and tingling down the leg

De Quervain's Tenosynovitis

Painful inflammation of tendons on side of the wrist at base of thumb; gets worse with abduction of thumb, grasping action of hand and ulnar deviation of wrist

What is a constant work test

Participant completes a set amount of work as quickly as possible

What is a constant duration test

Participant completes as much work as possible in a certain amount of time

Describe the importance of physical activity for person's with disability

People with disabilities have higher rates of chronic disease Important for cognitive, emotional and social difficulties Enhanced self-perception, reduce stress, pain, and depression Can reduce the stigmatization process and negative stereotypes Increased social integration, bonding and friendship Can prevent further declines in functioning Promote healthy ageing and the prevention of further chronic conditions associated with ageing

What is congestive heart failure with preserved LV fraction ejection?

Percentage of blood volume ejected from left ventricle with each heartbeat / volume of blood when left ventricle is maximally filled = normal Abnormal diastolic function as LV has impaired relaxation which impacts filling, may be a greater increase in systolic BP

What are some barriers associated with physical activity and people with a disability?

Physical barriers - no/blocked curb cuts, inaccessible doors/bathrooms, no parking, poor travel surfaces, obstructed travel, personal illness, no ramps - indoor gym facilities inaccessible (drinking fountains, weights area, access to parts of gym) Personal barriers - inability to pay for memberships, lack of knowledge regarding fitness, lack of support Social barriers - lack of knowledge from personal trainers/staff, negative connotations regarding persons with disabilities, lack of accommodating fitness programs

What are some methods of measuring stroke?

Physical exam (muscle weakness/paralysis) ECG (abnormal rhythms that could predict stroke) MRI/CT (detect damaged tissues/arteries caused by stroke, also rules out lesions)

What is a circadian rhythm?

Physical/mental/behavioral changes that follow a daily cycle Respond primarily to light and darkness in an environment, marked by cortisol and melatonin levels

What is specificity?

Physiologic adaptations to exercise are specific to type of exercise performed, muscles involved, movement pattern, and nature of the muscle action

3 types of blood modifiers

Pletal, Plavix, Persantine, Trental, Ticlid, Coumadin

What is premature atrial complex?

Premature beat that originates from SA node or atria

What is the immune hypothesis?

Prolonged wakefulness introduces a threat (restriction of the energy) which initiates immune defense

What are the physiological benefits associated with exercise and aging?

Promotes lean body mass, associated with better health and longevity, can help offset sarcopenia and muscle atrophy, reduces fall risk, decreased cardiovascular mortality, promotes strong executive control, promotes healthy aging and increase QOL

Why is exercise important in people with cerebral palsy?

Promotes proper muscle and bone growth which is often impacted by a lack of physical activity due to impairments

What is PNF stretching?

Proprioceptive Neuromuscular Facilitation Involves both active and passive movements performed with a partner to increase ROM; increasing ROM through reciprocal and autogenic inhibition

Describe the pros and cons of skinfold measurements

Pros: accurate for leaner subjects, multiple equations for different populations Cons: high rate of user error, taking repeated measurements can increase error, can be impacted by physical activity (level of water in muscles)/ environment (cold/hot weather), shouldn't be used for obese clients

Describe the pros and cons of bioelectrical impedance

Pros: easy to use, fairly reliable, quick results Cons: can be impacted by client age, water level, cannot be used with people with pacemakers

Describe the pros and cons of hydrostatic weighing

Pros: very accurate Cons: expensive equipment, hard to eliminate every source of error (air in lungs), timely procedure, may over/underestimate in special populations (athletes, elderly)

Describe the pros and cons of DEXA

Pros: very reliable, can highlight fat distribution Cons: movement may disrupt image, expensive, exposure to radiation

Empty Can Test

Tests supraspinatus for impingement Arms are brought into flexion and scaption, and then medially rotated (emptying a can), patient must resistance adduction - weakness or pain indicated a positive test

What is some feedback you could provide to a client while training?

Purpose of what you're doing, directions and demonstrations, precautions and safety guidelines, feedback for client performance, spotting during trials

What are some methods to determine training intensity?

RPE/BORG Scale, HR reserve method, VO reserve, MET's

Insulin can act 4 ways, what are they?

Rapid acting Intermediate acting Rapid / intermediate acting Long acting

What are cues for junctional rhythm?

Rate of 40-60 Narrow QRS Absent or inverted P wave

What is ventilation-perfusion?

Rate of gas flow to lungs compared to blood flow

What is RPE?

Rate of perceived exertion Used to quantify how many reps are left in the tank

Absolute contraindications to exercise testing

Recent change in resting ECG suggesting ischemia, recent myocardial infarction, acute cardiac event Unstable angina Uncontrolled cardiac dysrhythmias causing symptoms or hemodynamic compromise Symptomatic severe aortic stenosis Uncontrolled symptomatic heart failure Acute pulmonary embolus or pulmonary infarction Acute myocarditis or pericarditis Suspected or known dissecting aneurysm Acute systemic infection, accompanied by fever, body aches, or swollen lymph glands

Contraindications of arthritis and exercise

Recent joint replacement, significant joint damage, actively inflamed joint Avoid ballistic movements, revise program if pain persists 2 hours after or an increase in joint swelling, RA in knees should avoid stairs or weight lifting Monitor client pain throughout the workout, may have to modify exercise

What is a muscle spindle?

Receptor found in muscle that detects change in length and facilitates muscle activation

What is a golgi tendon organ?

Receptor found in tendons that detects a change in length and inhibits muscle activation Inhibitory mechanism

What variables are measured in the McMaster protocol?

Record HR, RPE every minute, pulmonary gas exchange

Thomas Test

Rectus femoris, sartorius or TFL tightness Patient lies supine on table, test knee is pulled into flexion as much as possible (modified version involves patient's opposite knee hanging off bed) - opposite leg lifting off bed indicates a positive test and iliopsoas tightness; lateral rotation of opposite leg also indicates tightness in glutes/TFL

What is hypersomnia?

Recurrent episodes of excessive daytime sleepiness or prolonged nighttime sleep, compelled to nap during the day repeatedly, are often associated with other disorders (depression, bipolar, viral infections)

Anticoagulants

Reduce blood clotting through inhibition of coagulation pathways

What is the work to rest principle?

Relative density of exercise and relief intervals in a set; different exercises and goals (strength vs endurance) will have different requirements

What is the energy depletion hypothesis?

Release of adenosine due to low energy induces sleep

What kind of exercise can help relieve pain from spinal stenosis?

Relief in biking (forward bending of spine) Increasing strength of supporting muscles in back Stretching can help loosens muscles that pull spine

What is respiratory acidosis?

Result of hypoventilation, pH is too low

During exercise, which way does the O2 hemoglobin dissociation curve shift?

Right

What arteries supply the heart?

Right coronary artery Left coronary artery

How would the presence of a surgical drain impact exercise?

Risk of becoming clogged or infected May impede mobility Ensure drain is secured before exercising Avoid activity that would affect area drain is inserted

Describe circuit training

Rotation through various exercise in a work to rest set Targets muscular endurance, aerobic endurance, and strength training Done with body weight exercise or weights/machines Effective at keeping interest, targeting multiple factors (muscular endurance, aerobic endurance), high intensity achieved in a short period of time,

What is dyspnea?

Shortness of breath Can be caused by a variety of factors (exercise, pulmonary disease, neurological issue)

What is the range of blood sugar for a diabetic before exercising?

Should be between 5.5-16.7 mmol/L

What is a junctional rhythm?

Signal originating from AV junction, no pacemaker rate, slower than SA node pace

What does SHARP stand for and what does it refer to?

Signs of inflammation Swelling Heat Altered function Redness Pain

What is the VO2 reserve method?

Similar to the heart rate reserve method Correlates well with HRR VO2 reserve = ((VO max - resting VO2) x % of target) + resting VO2

What is an ischemic stroke?

Stroke due to lack of blood flow

Give examples of anaerobic capacity tests

Wingate test 300 yard shuttle RAST 60 yard shuttle

What is the Astrand-Rhyming test?

Sub max bike test Workload is based on sex and conditioning level

What is the YMCA bike test?

Sub max bike test used to estimate VO2 max

What is the PWC 170 test?

Sub max bike test used to estimate VO2 max at a working rate of 170bpm

What is the Ebbling Treadmill test?

Sub max test used to estimate VO2 max Warm up for 4 minutes at 3.4-4 mph and 0% / increase grade to 5% and select a comfortable speed for 4 minutes / cool off at 0% for 4 minutes

What is the McMaster Multi Stage cycle ergometer test?

Sub max test used to predict VO2 in children

What are SOAP notes?

Subjective (client reports) Objective (results of tests) Assessment (your conclusion) Plan (program design)

Describe the process of the renin-angiotensin system

Sympathetic nerve activation and decreased sodium delivery to kidneys activate release of renin from JG cells Renin acts on angiotensin to produce angiotensin I Angiotensin converting enzyme produces angiotensin II Angiotensin II constricts blood vessels, stimulates transport of NaCl, stimulates release of vasopressin (anti-diuretic) and aldosterone (stimulates water and salt retention in kidneys)

What is periodization?

Systematic programming of training interventions into periods of time to induce physiological adaptations

What are the types of cerebral palsy?

Spastic (increased muscle tone, results in stiff/jerky movements) Athetoid (involuntary, uncontrolled movements)

What is Fetal Alcohol Syndrome (FAS)?

Spectrum of functioning caused by drinking alcohol during pregnancy Causes a variety of issues in physical growth, neurologic problems, behavioral problems, learning disabilities, delayed motor skills

What are the stages of cancer?

Stage 0: abnormal cells haven't spread and arn't considered cancer, could become cancerous Stage I - Stage III: cancers that haven't spread beyond primary tumor site or only spread to nearby tissue, higher the stage number, the larger the tumor and the more it has spread Stage IV: cancer has spread to distant areas of body

Describe the 4 states of Alzheimer's

Stage 1 (early) - may experience mild cognitive difficulties, still retain independence Stage 2 (mild) - may function independently; memory lapses (familiar words, object location); difficulty planning; lack of spontaneity; subtle personality changes; disorientation to time and date Stage 3 (moderate) - personality changes; increased memory loss; decreased independence; impaired cognition; restlessness and agitation; wandering; impaired judgement; inappropriate social behaviour Stage 4 (severe) - decreased response to environment; decreased ability to communicate; decreased awareness of experiences & surroundings; decreased physical functioning; indifference to food; inability to communicate; seizures

What is the Queen's College step test?

Step test used to predict VO2 max

Describe the mCAFT protocol

Use client's age to determine starting stage / follow cadence given through audio in stepping / test stops when client cannot keep up or HR exceeds 85% max

What is heavy to light reps?

Used by body builders; start with heavy reps, drop weight once volitional fatigue hits and keep going

Human growth hormone

Used in deficiencies, reduces fat mass, increases lean muscle, improves lipid/cholesterol profiles

What is the most common blood modifer?

Warfarin

Describe the YMCA protocol?

Warm up at 25W (0.5kp) for 3 minutes / 2nd, 3rd, 4th workloads (3 minutes each) based off of HR from warm up HR should be within 10bpm of 85% max

Describe the PWC 170 protocol

Warm up of 6 minutes with 50W / Workload 1 at 100W for 6 minutes / Workload 2 at 150W for 6 minutes

What is aphasia?

Wernicke's aphasia - inability to understand language, can still produce sentences but are incoherent Broca's aphasia - inability to produce language, but can still understand

What are the consequences associated with a COPD exacerbation?

Will decrease functional capacity (coughing and breathlessness worsens), may feel fatigue Contributes to higher mortality risk due to decline in lung function High chance of hospital admission; results in faster disease progression

Effect of nitrates during exercise

Will increase HR and decrease BP during exercise

Effect of diuretics on exercise

Will increase fluid loss May influence BP May cause headaches, dizziness, muscle cramps

Effect of ACE inhibitors on exercise

Will suppress BP during exercise Common to see exercise induced hypotension and orthostatic hypotension

Effect of calcium channel blockers on exercise

Will suppress HR and increase exercise tolerance May cause headache and low BP

Effect of beta blockers on exercise

Will suppress exercise HR and BP May cause lightheadedness, fatigue, breathlessness

What is gestational diabetes?

Women without diabetes develop impaired glucose sensitivity and high blood sugar levels

During quiet respiration, which part of the lungs receive more ventilation?

bottom

What is a laminectomy?

surgery that removes a portion of the lamina, typically to treat spinal stenosis

What is some info that would be found in the subjective history?

· Reason for referral · Demographic information (age, gender, ethnicity, occupation) · History of current conditions · Medical history and medications · Family history · Physical activity history · Social activity · Goals · Past interventions

What are the 2019 Canadian Guidelines for Physical Activity Throughout Pregnancy?

- Women without contraindication should be physically active throughout pregnancy - Should accumulate at least 150 min of moderate-intensity physical activity each week - Physical activity should be accumulated over a minimum of 3 days/week - Should incorporate variety of aerobic and RE activities, yoga and stretching may be beneficial - Pelvic floor muscle training may be performed on a daily basis to reduce the risk of urinary incontinence - Pregnant women who experience light-headedness, nausea or feel unwell when they exercise flat on their back should modify their exercise position

VCO2/VO2

- ventilation of CO2 and O2, can be used to estimate anaerobic threshold - CO2 will peak past O2 at threshold

What is FVC in a normal patient?

0.8

Constant vs variable practice

1 variation of the task practiced repeatedly vs multiple variations of the task

What are the stages of motor recovery in stroke?

1- Flaccidity; lack of voluntary movement, muscle will atrophy without intervention 2- Appearance of spasticity; muscles make small, spastics movements, muscle synergies occur and result from muscles coordinating movements to perform tasks (typically limit movement post stroke) 3- Increased spasticity with synergistic voluntary movement; synergy patterns start to emerge, minimal voluntary movements, PROM movements beneficial 4- Movement patterns out of synergy and spasticity begins to decrease; focus on strength and improving muscle control, assisted AROM and AROM exercises 5- More complex movements and spasticity continues to decrease; synergy patterns become more coordinated, abnormal movements decline 6- Spasticity disappears; coordinate complex movements 7- Full recovery of normal function with coordinated voluntary movements

CEP scope of practice

1- health/fitness assessment, provide coaching and lifestyle education 2- conduct pre-participation screening 3- accept referrals from licensed professionals 4- use behavior change models to facilitate physical activity/exercise participation, lifestyle modification 5- Interpret results of fitness assessment protocols to determine health and physical function 6- Monitor influence of commonly used medications on response to sub-max/max exercise 7- Use outcomes from fitness assessments to design/implement physical activity prescriptions 8- Make general, evidence-informed, dietary recommendations 9- Measure/monitor HR, ECG, BP at rest/during/post-exercise; can be used to ID irregularities 10- Conduct group physical activity/exercise sessions with appropriately screened participants

What are the set and rep schemes for training power?

1-5 reps 3-5 sets

What is mixed hearing loss?

Combination of conductive and sensorineural hearing loss

What are the set and rep schemes for training hypertrophy?

6-12 reps 3-6 sets

What should the pH of blood be?

7.35-7.45

What are some common functional fitness tests?

8 foot up and go 30 second arm curl Grip strength 10 m walk test 1 foot balance 6 minute walk test

8 reps is equivalent to what % of 1RM?

80%

What are the set and rep schemes for training strength?

<6 reps 2-6 sets

What are the set and rep schemes for training endurance?

>12 reps 2-3 sets

What is the peak (superior) VO2 max for women ages 20-29?

>41 mL/kg/min

What is the peak (superior) VO2 max for men ages 20-29?

>52.4mL/kg/min

Describe the ASIA spinal cord injury impairment scale

A - complete injury (no motor or sensory function) B - sensory incomplete (sensory function preserved below level of injury) C - motor incomplete (motor function preserved below level of injury, more than 1/2 muscles tested have a muscle grade less than 3/5) D - motor incomplete (motor function preserved below level of injury, at least 1/2 of key muscles below injury have a muscle grade of 3/5 or more) E - no motor or sensory deficits

What are the social determinants of health?

Conditions in which people are born/grow/live, shaped by distribution of money, power and resources at global/national/local levels and impact lifestyle behaviors

What are the 4 aspects of consent?

Consent must relate to the treatment Consent must be informed Consent must be given voluntarily Consent must not be obtained through misrepresentation or fraud

Blocked vs random practive

All trials of a task are completed before moving on vs different skills are practiced in a random order

What is variable/accommodating resistance?

Allows for varying resistance during movement to stress the muscle action Adding bands to a squat to increase resistance at top of the squat where there is typically the least resistance Adding chains, the higher off the ground (less resistance) more chain is pulled off the ground, (adding more resistance)

An ending of -osin indicates what kind of medication?

Alpha receptor blockeres

What is spasticity?

Altered muscle performance with combination of increased tendon reflex and stiffness; inability to control muscles; no normal fluid movement of limbs

Anterior Drawer Test (Ankle)

Anterior talofibular and tibiotalar ligaments Patient in supine with foot relaxed, stabilize tibia/fibula and flex foot into slight plantar flexion, pull foot anteriorly - laxity and significant translation indicate ligament insufficiencies

An ending/beginning of -statin, -fibr-, or cole- indicates what kind of medication?

Antilipemic agents

What types of exercises should be avoided during pregnancy?

Any sort of high impact, rotational, ballistic activity that could increase risk of injury or falling Any activity that increases risk of abdominal injury After 4 months, activity that involves lying on your back (weight of baby can compress blood vessels) Heavy lifting

What is a normal FEV1/FVC ration?

Anything over 0.7

During exercise, which part of the lung receives more ventilation?

Apex

What is mean arterial pressure?

Average pressure in arteries during one cardiac cycle (65-110)

What are some methods of assessing body composition?

BMI, WC, skinfold, circumfrence, DEXA, CT, MRI, bio electrical impedance

What are objective pre-screening tools?

BP HR WC and BMI

What variables are measured during the PWC 170 test?

BP and HR at the end of every workload

What are some common injection sites for insulin?

Back of arm Butt Thigh Abdomen

Describe some of the components of motor fitness?

Balance Coordination Agility Speed Power

How is blood pressure monitored by the body?

Baroreceptors - detect arterial stretching Metaboreceptors - detect buildup of metabolites in the blood

How is the Bruce Protocol scored?

Based on minutes of completion

What are some considerations for working with patients with cerebral palsy?

Baseline performance lower than the same able bodied population due to lack of involvement in physical activity and impairments Higher risk of fractures, impaired balance, lack of hand-eye coordination, poor respiratory control, stiff/jerky movements Familiarization with exercises important (common lack of physical activity in people with cerebral palsy) Modify tests in order to accommodate muscle weakness/spasticity Aerobic/anaerobic testing impacted by poor respiratory control; involuntary limb movements impact O2 uptake

What are cues of PAC?

Beat appears sooner than expected Narrow QRS Upright P wave or different morphology

3 types of steroidal anti-inflammatories

Beclovent, Qvar, Pulmicort, AeroBid, Flovent, Advair Diskus, Azmacort

What is the trans theoretical model?

Behavior change is a process that includes steps an individual passes through

What is sedentary behavior?

Behavior characterized by energy expenditure ≤1.5 METs while in a sitting/lying posture

What is self-determination theory?

Behavior is self-motivated and determined, individuals seek out challenges and success that satisfy autonomy, competence, relatedness

Antihistamines

Block histamine receptors to reduce swelling and vasodilation

What is a bundle branch block?

Block in conduction does not allow signal to rest of heart, depolarization occurs slowly, L and R blocks

ARB's

Block the angiotensin II receptor to reduce BP

ACE inhibitor

Blocks production of angiotensin II to prevent vasoconstriction and reduce BP

Ischial tuberosity bursitis

Bursa located over ischium and between Glute Max and Ischial tuberosity; pain aggravated by sitting, tenderness, limited mobility, swelling

Effect of insulin during exercise

Can induce hypoglycemia

Calcium deficiency

Can result in osteoporosis, cramping, fatigue

What is the CAROC?

Canadian Association of Radiologists and Osteoporosis Canada risk assessment 10 year absolute fracture risk

Considerations for Cancer

Cancer-related fatigue in patients receiving chemo and radiation may prevent/restrict ability to exercise High-impact activities and contact sports should be avoided to minimize fracture risk Cachexia or muscle wasting is prevalent in individuals with incurable cancer and is likely to limit the exercise Patients with bone-marrow transplants and those with low white blood cell counts should avoid exercise in public places that have high risk of infection Avoid swimming for patients with indwelling catheters or central lines and feeding tubes, receiving radiation Patients receiving chemotherapy may experience periods of sickness during treatment cycles that require modifications to exercise prescription

3 types of calcium channel blockers

Cardizem CD, Cardizem LA, Dilacor XR, Tiazac, Calan, Isoptin, Calan SR, Isoptin SR, Covera HS, Verelan PM

Phalen's Test

Carpal tunnel test Flex patient's wrists and push them together for 1 min - tingling in the thumb or index finer indicates a positive test

How would an episiotomy affect exercise prescription?

Chronic pain and infections, anorectal dysfunction, urinary incontinence, pelvic organ prolapse are possible long term side effects Pelvic floor exercises can help with healing and strengthen muscles; ensure client pays attention to how hard they are working

What is O2 saturation?

Comparison of O2 saturated hemoglobin vs total hemoglobin in blood 95-99%

What is the FEV1/FVC ratio?

Comparison of volume of air exhaled in one second vs total volume Used to test for obstructive disease

What is a 3rd AV block?

Complete block of impulse from AV node, ventricle takes over pacemaker

What is oxidative phosphorylation?

Complete breakdown of fats and glucose through mitochondria Powers long duration activities

What is restrictive lung disease?

Compliance of lung is reduced, increases stiffness of lung and limits expansion; greater pressure than normal required to give the same increase in volume

Thoracic Outlet Syndrome

Compression of neurovascular structures as they exit through thoracic outlet Pain anywhere between neck, face, occipital region, chest, shoulder, UE, paresthesia in UE, altered or absent sensation, weakness, fatigue, feeling of heaviness in arm and hand, skin may be blotchy or discolored Signs and symptoms worse when arm is abducted overhead and externally rotated with head rotated to same or opposite side (overhead throwing, painting a ceiling, driving, or typing may exacerbate symptoms)

What are cues for SVT?

HR greater than 150 Indistinguishable P wave Narrow QRS Regular rhythm

What is sinus bradycardia?

HR less than 60, can be caused by certain medications, common in athletes

What variables are taken during the Balke Protocol

HR, RPE, BP every minute

What variables are measured during the Queen's College step test

HR at the end of the 3 minutes

What is accelerated junctional rhythm?

HR between 60-100 from AV node

What variables are recorded during the YMCA test?

HR every minute Watts worked at

Talar Tilt Test

Deltoid/calcaneofibular ligaments Patient sits with feet relaxed and dangling, ankles are inverted (CFL) and everted (deltoid ligament) - pain and excessive laxity indicate ankle sprain and ligament insufficiencies

What are the signs associated with stroke?

Facial drooping, arms numb/tingling, slurred speech are the typical signs, confusion, trouble seeing or walking, or a severe headache

Effect of cancer drugs on exercise

May impact fatigue, nausea, anemia, loss of coordination

Statins

Decrease cholesterol synthesis and increase reuptake

A LEFT shift in the O2 hemoglobin dissociation curve is associated with what changes?

Decrease in temperature Decrease in H ions Lower CO2

What are some normal ECG changes during exercise?

Decreased R-R interval P wave magnitude increase Decreased PR interval

Describe the physiological exercise response in people with cerebral palsy

Decreased aerobic/anaerobic response, muscular endurance Physical activity increases energy expenditure due to effort needed to voluntary move rigid or spastic muscles (physical activity is exhausting)

What are some typical changes observed in normal aging?

Decreased attention span, working memory, executive functioning Decreased muscle mass and force production and increased intramuscular fat mass Decreased organ function, bone density, loss of vision and hearing Increased BP and HR

What happens to pulmonary circulation in asthma?

Decreased pulmonary circulation Decreased O2 concentration results in vasoconstriction to maintain BP, overtime leads to pulmonary hypertension Can lead to thickening of ventricles to keep up with workload Arrythmias Blood clots

What is hypoventilation?

Decreased rate of breathing Causes higher CO2 levels Causes respiratory acidosis

What happens to gas exchange rates in asthma?

Decreased rate of gas exchange due to decreased ventilation; results in high CO2 and low O2 in blood

How are blood gases and acid-base balance impacted during pregnancy?

Decreasing CO2 levels Higher pH

What are some ways that anti-diabetic agents work?

Decreasing glucose production Inhibiting glucose absorption Stimulating pancreatic islet cells Increase insulin sensitivity

Carpometacarpal joint arthritis

Degenerative condition of hand that causes pain, stiffness, weakness; decreased strength and ROM (may have difficulty opening jars or doing up buttons)

Plantar fasciitis

Degenerative irritation of plantar fascia origin at medial calcaneal tuberosity of heel Local tenderness along the medial tuberosity of os calcis, pain upon dorsiflexion of phalanges, activity that increases fascia stretching (walking barefoot without arch support, climbing stairs, or toe walking), limited dorsiflexion, tight Achilles

What is DOMS?

Delayed onset muscle soreness Caused by microscopic tears in tissue, causing Ca to leak and activate proteases to degrade tissues, also initiating inflammatory process

Function of LDL

Delivers cholesterol to cells

Describe the concept of consent for people with intellectual disabilities

Depends on the client's capabilities to understand the information presented If it is thought that patient isn't capable of consenting, member is expected to inform the patient (should include patient/client as much as possible); then obtain consent from a substitute decision maker

What are some of the common conditions associated with MS?

Depression and unstable mood, visual impairments (double vision, blind spots, hazy vision), cognitive deficits (difficulty processing information, memory loss, planning, attention and concentration), symptomatic fatigue

What are some of the side effects associated with hormone replacement therapy (estrogen)?

Depression, headaches, breast tenderness, skin irritation, weight gain; increased risk for breast cancer, stroke, CVD, venous thromboembolism (blood clots)

What information should an incident report form contain?

Details of the person involved (age, sex), what happened (injury sustained, how it happened, details of event, location), care provided to them (CPR, splints), witnesses

What is idiopathic osteoporosis?

Development of osteopenia/fractures with minimal/no trauma in young, healthy individuals who are not postmenopausal or have identifiable secondary causes of osteoporosis

What are the muscles used in respiration?

Diaphragm Intercostals Scalene Pectorals

How is pain detected?

Nociceptors can detect chemical (bradykinin, prostaglandins, capsaicin) signals that indicated pain or through mechanoreceptors

What is informed consent?

Dictates that consent given has been based upon clear appreciation and understanding of facts, implications, and future consequences of an action/treatment Individual concerned must have adequate reasoning faculties and in possession of all relevant facts at time consent is given; may be verbal, written, implied

What are some limitations of BMI?

Does not take into account age, muscle mass, ethnicity, frame size Can overestimate in athletes and muscular individuals

What are the ROM for the ankle?

Dorsi flexion - 0-20 Plantar flexion- 0-50

Signs of an MI on a ECG?

Downsloping ST segment and pathologic Q waves

3 types of alpha receptor blockers

Doxazosin, Tamsulosin, Prazosin, Hytrin

What are some methods of measuring MI?

ECG (ST segment elevation, abnormal Q wave), Angiogram (uses dye to highlight blocked arteries), Cardiac markers (presence of markers indicate MI has occurred, enzymes leak from myocardial cells when damage occurs), Physical exam (increased respiration, cool/pale skin, fever, elevated/decreased BP, irregular pulse)

What is secondary disease prevention?

Early intervention and treatment after evidence (screening tests and exams)

What are some key aspects of preventing spinal injuries?

Education on proper posture (prevent rounding of the back and neck), education on lifting technique (lifting with legs vs back), exercise (strengthening of the core and back to maintain a strong support system and protect vertebrae)

What is the neural plasticity hypothesis?

Emphasizes importance of maintaining postsynaptic excitability at stable level by regulating synaptic strength During waking, more synapses are formed and during sleep they are downscaled

Describe multi joint exercises

Encompasses multiple joints, full body movements, large group of muscles Longer recovery time More efficient at improving strength More natural movements Harder to perfect technique

Describe single joint exercise

Encompasses only a single joint, isolation exercises, smaller group of muscles Quicker recovery time More restrictive in movement

SV = ...

End diastolic volume - end systolic volume

What is a gas exchange impairment?

Excess or deficit in oxygenation or CO2 elimination at alveolar-capillary membrane Abnormal arterial blood gasses, abnormal arterial pH, decreased CO2, dyspnea, elevated BP, hypoxia

What is kyphosis?

Excessive convex curvature of the thoracic spine; can be caused by slouching, result of trauma or injury (osteoporosis) or congenital; may cause pain

What is a muscle strain?

Excessive stretching or tearing of muscle tissue; due to overstretching, powerful eccentric contraction; will cause swelling, redness, pain at rest, weakness of muscle

How does visceral fat contribute to risk?

Excretes adipocytes that can impair glucose sensitivity Releases FFA's and inflammatory proteins into blood, sent to liver which increases risk of dyslipidemia

How is CAD diagnosed?

Exercise stress test (based on METS achieved) Angiography

What are some methods of measuring ischemia?

Exercise testing (undergo exercise to increased factors that would result in ischemia, measured through imaging/symptoms/ECG) Dobutramine (medication stimulates increase in HR/BP/myocardial contractility, measured with ECG) Adenosine stress test (injection of adenosine to increase HR/BP, measured through ECG)

How does exercise impact drug metabolism?

Exercise will shunt blood away from organs and into muscles, causing longer metabolism periods

Medial Tibial Stress Syndrome

Exercise-induced pain along posteromedial tibial border caused by repetitive loading stress during running and jumping Caused by overuse, foot arch abnormalities, hyper-pronation Dull pain at the distal two third of the posteromedial tibial border that worsens with contact, often disappears during exercise

What are isotonic exercises?

Exercises that change the length of the muscle

What are isometric exercises?

Exercises that don't change the length of the muscle

What are eccentric exercises?

Exercises that lengthen the muscle

Describe functional exercises

Exercises that mimic real world movement patterns Usually multi joint and multi planar

What are concentric exercises?

Exercises that shorten the length of the muscle

Why is FEV1 used to assess obstructive lung diseases?

Expiration is impaired due to obstruction, so expiration rates are decreased

What is expiratory flow limitation?

Expiratory flow cannot increase despite increasing expiratory efforts Predisposes to hyperinflation due to air trapping Presents commonly in obstructive diseases (slope of expiration is decreased because of obstruction)

What is premature ventricular complex?

Extra beat that begins in ventricle due to irritation

What is a premature ventricular contraction?

Extra, abnormal heartbeats that begin in ventricles Perceived as skipped beat or palpitations May cause chest pain, fatigue, hyperventilation May be caused by low electrolytes

What are the signs and symptoms of MS?

Extreme fatigue, lack of coordination, weakness, tingling, impaired sensation, vision problems, bladder problems, cognitive impairment and mood changes

Describe the importance of accurate charting and understandable reporting

Facilitate safe and quality care; ensure clients have access to up-to-date, accurate info; ensure continuity of care; demonstrate judgment, reasoning and adherence to practice standards; meet requirements mandated by organizations

Type IIa fibers

Fast oxidative/glycolytic muscle Mix of properties

type IIx fibers

Fast twitch High amounts of power in a short period Small mitochondrial count High myosin ATPase activity High myosin/actin count per CSA High fatigue rate

What is visceral fat?

Fat deposits that lie within and between organs in the abdominal cavity; linked to obesity and other health issues (CVD, diabetes, high blood pressure)

What is subcutaneous fat?

Fat that lies just under skin; still contributes to obesity and increases risk of CVD disease, diabetes, etc

What should you monitor during exercise in a patient with MS?

Fatigue levels

What is the nerve supply of the lower limb?

Femoral - anterior of thigh Sciatic - posterior of thigh Obturator - adductors Gluteal - glutes Tibial + peroneal - lower leg

What are some reasons for stopping an exercise test?

HR exceeds 85% of age predicted max Tester feels the need to stop Patient feels the need to stop Patient feels dizzy, lightheaded, faint

What is sinus tachycardia?

HR greater than 100

What are cues for sinus tachycardia?

HR greater than 100 Narrow QRS Upright P wave

Medial epicondylitis

Golfer's elbow Tendinopathy of flexor tendons due to overuse Pain in elbow with radiation up/down arm, tenderness over medial epicondyle, stiffness of elbow, weakness in hand and wrist, pain evoked by resisted flexion of wrist and pronation, accompanied by weak grip

What are the values for blood cholesterol levels?

Good - <5.2 Moderate - 5.3-6.2 High - >6.2

Describe the MRC Dyspnea scale

Grade 0 - only breathless with vigerous exercise Grade 1 - short of breath hurrying or walking up a hill Grade 2 - walk slower than people of same age due to breathlessness or have to stop for breath Grade 3 - stop for breath after 100m Grade 4 - too breathless to leave the house or when dressing

What are the categories of concussion?

Grade 1 (Concussion with confusion and mental abnormalities lasting less than 15 minutes) Grade 2 (Concussion with confusion and mental abnormalities lasting more than 15 minutes) Grade 3 (Concussion with LOC, either brief or prolonged)

Branches of the inferior vena cava

Hepatic Renal Iliac

Describe the influence of exercise on BP and HR in SCI

High thoracic and cervical injuries can induce bradycardia, arterial hypotension, autonomic dysreflexia HR response is blunted during exercise

Describe interval training

High work rate followed by recovery period Used with anaerobic and aerobic work Effective at improving VO2 max and lactate threshold Effective at reducing overall risk andimproving health May increase risk of injury, develop foundational fitness before jumping into high intensity intervals

Hawkins-Kennedy Test

Impingement test Arm is flexed to 90 degrees forearm is then medially rotated - pain indicates a positive test

Neer's Test

Impingement test Arm is medially rotated and fully elevated in scaption (30 degrees from frontal plane) - pain indicates a positive test

What is primary disease prevention?

Implemented before evidence of disease (vaccination)

Exercise for a stress fracture

Important to cool down, warmup, stretch properly for prevention

What is the Health Action Process Approach?

Initiation, adoption and maintenance of behaviors is a process that includes a motivation (deliberation fosters intention) and a volition (intention fosters planning) phase

What is a whiplash injury?

Injuries to the neck (ligaments, muscles) that occur with sudden movement to the neck and head; associated with excessive extension and flexion

What is apraxia?

Inability to perform learned movements on command Command is understood and there is a willingness to perform the movement Can occur with movements or speech

Describe the inflammatory response

Injury to cells, chemical mediators released, vascular response (vasoconstriction followed by dilation), platelets and leukocytes adhere to cell wall, phagocytosis, platelet formation

What is a sprain?

Injury to ligament, causes excessive stretching and possibly tearing of ligament; range from mild - severe

Rotator cuff tendinopathy

Injury to rotator cuff tendons; pain and weakness, experienced with external rotation and elevation, consequence of excessive load on rotator cuff tissues

How is HR affected by pregnancy?

Increases in resting and exercise

How is minute volume impacted in pregnancy?

Increases in the 1st trimester

Describe the process of tissue healing

Inflammatory response (1-4 days) - may be acute (plasma-like fluid exudes out of tissue or capillaries and composed of protein/granular leukocytes) or chronic (prolonged duration, involves presence of nongranular leukocytes and production of scar tissue) Proliferation (2-3 weeks) - fibroplasia and growth of new connective tissue/micro-vessels Maturation/remodeling (4+ weeks) - results in organized, functional scar similar to previous tissue

What are some of the difficulties that may be encountered with someone with Parkinson's?

May have difficulty changing movements, or with dual motor tasks May have a shortened attention span or recall May need multiple practices

What is paraplegia?

Legs are affected by injury; degree of movement depends on level of spinal cord injury

Describe the GMFCS scales

Level 1 (walks and climbs stairs without limitations, speed, balance and co-ordination reduced) Level 2 (walks with limitations, climbs stairs holding on to rail, limitations walking on uneven surfaces/inclines, in crowds or confined spaces) Level 3 (walks using hand held mobility device, climbs stairs holding onto railing, may require self-propelled wheelchair with longer distances, outdoors) Level 4 (self-mobility with great limitations and may use powered mobility) Level 5 (Physical impairments restrict voluntary control of movement, no means of independent mobility, transported in manual wheel chair)

What kind of exercises are beneficial to whiplash injuries?

Light, repetitive exercise (neck + shoulders) beneficial to recovery

Describe the role of sedentary behavior in disease

Linked to higher rates of chronic disease Reduces glycemic control, insulin sensitivity, increases triglyceride levels, increasing risk of developing diabetes, obesity

What are the 5 steps of reading an ECG?

Locate P wave and QRS complex Get measurements Regular vs irregular Determine HR Interpret rhythm

What are the cues of a 2nd AV block?

Long PR interval Dropped QRS complex (P wave with no QRS) Irregular and narrow QRS, irregular P wave

What is LTAD?

Long Term Athlete Development Active Start, FUNdamentals, Learn to Train, Train to Train, Train to Compete, Train to Win, Active for Life

3 types of ACE inhibitors

Lotensin, Capoten, Inhibace, Vasotec, Monopril, Zestril, Prinivil, Univasc, Aceon, Accupril, Altace, Mavik

What are some of the recommendations from the new food guide?

Lots of fruits and veggies Water as a drink of choice Whole grains Plant based protein sources Foods low in saturated fats and high in unsaturated fats

What are the risk factor classifications?

Low - <1 factor Moderate - >2 risk factors High - symptomatic or diagnosed (cardiac, metabolic or pulmonary disease)

What are the categories used in the CAROC?

Low <10% risk, lifestyle measures sufficient for those without additional risk factors for rapid BMD loss Moderate 10%-20% risk, treatment should be individualized and may include pharmacologic therapy/lifestyle measures with monitoring High >20% risk, >50 years who have had a fragility fracture of hip/vertebra and those who have had more than 1 fragility fracture

What is secondary osteoporosis?

Low bone mass leading to fragility fractures in presence of underlying disease/medication

What are some beneficial exercises for disc degneration?

Low impact is key; stretching and strengthening may help relieve pain

Effects of statins on exercise

May cause exercise induced myopathy, fatigue, cramps

Collateral ligament injury

MCL (due to a valgus force on the knee while foot is fixed; causes pain swelling, may hear a popping noise, joint laxity and instability) LCL (due to a varus force on knee or a lateral rotation; causes swelling, pain, lateral joint line pain, pain with varus stress test, reduced ROM, difficulty weight bearing, weakness of quadriceps, instability

Valgus Stress Test

MCL laxity Apply a valgus pressure to the outside of the knee while holding lower leg still - excessive laxity indicates MCL is most likely torn

How would vaginal delivery affect exercise prescription?

May experience abdominal pain, hemorrhoids, perineum soreness, urinary incontinence Exercise post-pregnancy can helps strengthen pelvic floor muscles, prevent post-partum depression, facilitate recovery, increase energy levels Pay attention to abnormal symptoms such as nausea, highly increased HR/BP, headaches

Exercising with osteoarthritis

May only be capable of performing a couple minutes at a time, will gradually increase Modified activities to accommodate pain Muscle strengthening can help relieve pain Avoid during flareups

What is diffusion capacity?

Measures the diffusion of air in and out of the lungs

Name some contraindications when working with cancer patients

Monitor hematologic abnormalities (low platelets, hemoglobin level) MSK disorders (recent bone/back/neck pain; muscular weakness; extreme fatigue) GI disorders (severe nausea, vomiting/diarrhea) CV disorders (chest pain, elevated resting HR, elevated BP, irregular heartbeat, lymphedema) Pulmonary disorders (severe difficulty breathing, coughing/wheezing) Neurological disorders (decline in cognitive status, dizziness, disorientation, blurred vision)

5 steps of designing a training program?

Needs analysis Training frequency Training intensity Work to rest ratio Progression

Describe the normal and abnormal BP response to exercise

Normal: increase in systolic BP and a slight increase in diastolic BP Abnormal: no increase in BP, severe hypotension post exercise, large increase in DBP

3 types of anti-arrhythmics

Norpace, Ethmozine, Pronestyl, Procan SR, Quinora, Quinidex, Quinaglute, Quinalan, Cardioquin, Xylocaine,Mexitil, Dilantin, Tonocard, Xylocard, Tambocor, Rythmol, Cordarone, Bretylol, Betapace, Tikosyn, Beta blockers, Calcium channel blockers

Topographical classification of cerebral palsy classifies based on what?

Number of limbs affected

If FEV1/FVC is less than 0.8 and FVC is less than 0.8...

Obstructive and possible restrictive

If FEV1/FVC is less than 0.8...

Obstructive disease

What is asthma?

Obstructive disease Long term inflammation of the airways resulting in narrowing Triggered through environmental conditions (pollen, dust, extreme heat or cold), exercise Treated through bronchodilators, steroids

What is FEV1 in restrictive and obstructive diseases?

Obstructive: reduced Restrictive: slightly reduced

What is FVC in obstructive and restrictive lung disease?

Obstructive: slightly decreased or unchanged Restrictive: decreased

What is monoplegia (CP)?

One limb is affected in cerebral palsy

What is self-efficacy?

One's belief in their personal abilities

What is vertebral disc protrusion?

Outermost layers of intervertebral discs of the spine bulge when the discs are under pressure; may compress nerves and cause pain or numbness

What are the 7 tests and 3 clearance tests used in FMS?

Overhead squat Inline lunge Hurdle step Shoulder mobility (shoulder clearance) Trunk stability push up (Press up clearance) Straight leg raise Rotatory stability (Posterior rocking clearance)

What are some factors to consider when designing an exercise program?

Participant interest Access to facilities Goals Healthy history Fitness testing results

What is a constant power test

Participant maintains constant power until exhaustion

Considerations for Hypertension

Patients with severe/uncontrolled BP should exercise only after being evaluated by their physician and being prescribed antihypertensive medication For patients with documented CVD, vigorous-intensity exercise training is best initiated in rehabilitation centers under medical supervision If resting SBP 200 mmHg/DBP 110 mmHg, do not exercise Beta blockers and diuretics may affect thermoregulatory function and cause hypoglycemia in some individuals Beta blockers may reduce submax and max exercise capacity Antihypertensive medications may lead to sudden reductions in postexercise BP For individual with documented episodes of ischemia during exercise, the exercise intensity should be set (10 beats/min) below ischemic threshold. Avoid Valsalva maneuver during resistance training

What is sleep apnea?

Pauses in breathing or periods of shallow breathing during sleep, pause can last for a few seconds to a few minutes and a choking sound may occur as breathing resumes

What is a super set?

Performing 1 set of an exercise immediately followed by another set stressing the antagonist's muscles

What is a complex concussion?

Persistent symptoms that recur with exercise, convulsions, prolonged LOC, prolonged cognitive impairment

What is clinically isolating MS?

Person has attack suggestive of demyelination, but doesn't fulfill criteria for MS

What is Down Syndrome?

Person is born with trisomy of chromosome 21 Associated with intellectual and cognitive deficiencies but commonly presents as a spectrum, as each individual has a range of capabilities

Describe the progression of client records that could occur throughout their training

Personal information and background sheet, PARQ and other relevant forms, consent form, SOAP notes from assessment, results from assessment, training plan, progression through training and updates to program

What are some issues associated with spinal cord injury and exercise?

Post exercise hypotension (reduced circulation) Blunted HR response Fractures (low bone density) Autonomic dysreflexia (sudden high BP, T6 injury)

Considerations for patients with cystic fibrosis

Progressive incremental protocols, continuously incremental (ramp) protocols and protocols in which each stage lasts 1 min are very efficient in providing exercise responses in a short amount of time Monitor O2 (identifies exercise-induced hypoxemia) and ventilation and pulmonary gas exchange (allows best evaluation of aerobic capacity and factors limiting exercise tolerance)

What is sarcopenia?

Progressive loss of skeletal muscle mass and strength in the aging population Multifactorial causes (environment, disease triggers, inflammatory pathway activation, mitochondrial abnormalities, loss of neuromuscular junctions, hormonal changes)

Provide examples of muscular endurance tests

Push ups Chin ups Plank Single leg stance

VO2 = ...

Q x A-VO2

Length of: QRS complex, PR interval, QT interval, RR interval

QRS - 0.12-0.2 PR - 0.8-0.1 QT - 0.4-0.43 RR - 0.6-1

What are the segments of the EKG?

QRS complex - ventricular depolarization P - atrial depolarization T - ventricular repolarization ST segment - time between ventricular depolarization and repolarization

How does a premature ventricular contraction appear on an ECG?

QRS complex won't be preceded by a P wave

What are some tools for measuring sedentary behavior and their pros/cons?

Questionnaires: lots of resources to tailor the questionnaire to situation, recall bias (client might over/underestimate, not remember or lie on the questionnaire) Fitness trackers: can accurately measure amount of time sedentary through accelerometery, expensive (unable to afford for every client) Logbooks: : easy for client to write down, (client may lie or not track accurately)

3 types of anti-lipemic

Questran, Cholybar, Prevalite, Welchol, Colestid, Atromid, Tricor, Lofibra, Lopid, Lipitor, Lescol, Mevacor, Advicor, Pravachol, Crestor, Zocor, Caduet, Niaspan, Nicobid, Slo-Niacin, Zeta, Vytorin

Branches of the superior vena cava

R and L brachiocephalic R and L subclavian R and L internal/external jugular

What is a regularly-irregular rhythm?

R waves are variable but with a pattern

What is an irregularly-irregular rhythm?

R waves are variable with no pattern

What are the relative contraindications to exercise during pregnancy?

Recurrent pregnancy loss; history of spontaneous preterm birth; gestational hypertension; symptomatic anaemia; malnutrition; eating disorder; twin pregnancy after the 28th week; mild/moderate cardiovascular or respiratory disease; other significant medical conditions.

What are some considerations when working with individuals with cystic fibrosis?

Reduced mitochondrial efficiency - reduced exercise capacity Lower respiration due to deadspace in lungs Reduced muscular strength and capacity

Importance of a cool down?

Regulate blood flow post exercise to prevent pooling in muscles Prevent DOMS Reduce buildup of lactic acid/metabolic by-products Actively slows down BP/HR Recovery of respiratory variables

What are the absolute contraindications to exercise during pregnancy?

Ruptured membrane; premature labour; unexplained persistent vaginal bleeding; placenta praevia after 28 weeks; pre-eclampsia; incompetent cervix; intrauterine growth restriction; high-order multiple pregnancy (triplets); uncontrolled type I diabetes, hypertension or thyroid disease; other serious cardiovascular, respiratory or systemic disorder

What are cues for atrial flutter?

Sawtooth P waves (up and down) that occur frequently Narrow QRS May occur as a 2:1 ratio with flutter and QRS complexes

3 Types of beta blockers

Sectrala, Tenormin, Kerlone, Zebeta, Brevibloc, Lopressor SR, Toprol XL, Corgard, Levatola, Viskena, Inderal, Betapace, Blocadren

What is PD SAFEx

Sensory attention focused exercise designed to improve brain function and motor symptoms Uses proprioceptive feedback to focus on coordination, balance, spatial awareness of bodies (using dimmed lights, gait exercise, closed eyes)

How does obstructive disease shift the flow volume loop?

Shifted to the left (RV is increased due to air trapping) Expiration is not as steep (FEV1 decreased due to obstruction) Expiration is decreased (Reduced ERV)

How does restrictive disease shift the flow volume loop?

Shifted to the right (reduced RV) Decreased expiration (Reduced ERV) Smaller figure (Reduced VC and TLC)

What are the phases of rehabilitation?

Stage 1 - (4-6 days); limitation of tissue damage, pain relief, control of inflammatory response, and protection of affected area; control pain and swelling Stage 2 - (5 days - 4 weeks); tissue repair; limitation of impairment and recovery from functional losses; joint ROM and muscle conditioning; Stage 3 - (4 weeks - 3 months); replacement of damaged tissue with collagen fibers; functional and activity specific training

Describe the starting procedures for VO2 max exercise testing

Take resting HR Calculate heart rates (age-predicted HR max, 85% of age-predicted HR, other variables needed) Explain the purpose of the test Explain criteria for stopping a test: subject feels faint/dizzy/short of breath, subject may end test at any time, steady state HR >85% of age predicted max HR, assessor may end test at any time according to their discretion Adjust bike seat if needed

Drop arm sign

Tests supraspinatus and infraspinatus for rotator cuff tears Arms are brought into 90 degree abduction and externally rotated, patient must hold position without support - inability to hold position indicates a positive test

What are the 4 ways diuretics work?

Thiazides Loop Potassium sparing Aldosterone blocker

What are the cardinal motor symptoms of Parkinson's?

Tremor (may occur during rest or during voluntary movements, resting tremor often stops during voluntary movements) Rigidity (increase muscle tone causing resistance to movement, can cause pain and muscle cramps) Bradykinesia (slowness of movement particularly in execution, will have difficulty with rapidly repeating movements) Akinesia (absence of movement or failure to initiate a movement) Postural instability (impaired balance, will often experience falls)

What is the TNM staging of cancer?

Tumor, Nodes, Metastasis Primary tumor (T) - TX: Main tumor cannot be measured - T0: Main tumor cannot be found - T in situ: tumor is still within confines of normal glands and cannot metastasize - T1, T2, T3, T4: size and extent of main tumor; higher the number, the larger the tumor or the more it has grown into nearby tissues Regional lymph nodes (N) - NX: Cancer in nearby lymph nodes cannot be measured - N0: no cancer in nearby lymph nodes - N1, N2, N3: Refers to number and location of lymph nodes that contain cancer, higher the number, the more lymph nodes that contain cancer Distant metastasis (M) - MX: Metastasis cannot be measured. - M0: Cancer has not spread to other parts of body - M1: Cancer has spread to other parts of body

What is diplegia (CP)?

Two limbs are affected in cerebral palsy

What are the BMI classifications?

Underweight - <18.5 Normal - 18.6-24.9 Overweight - 25-29.9 Obese 30-34.9 Obese II - 35-39.9 Obese III - >40

What is relapse-remitting MS?

Unpredictable relapse followed by period of quiet remission with no signs of disease activity, deficits that occur may resolve or leave issues

How would a C-section affect exercise prescripton?

Until a doctor says that resuming activity is safe (4-6 weeks), recommended to avoid strenuous exercise, lifting heavy objects May need to avoid core exercises

What is the functional movement screen?

Used to assess full body mobility and motor control, can be used to focus on areas of improvement and measure improvement

What is the role of subjective history?

Used to obtain information from the client regarding past medical history, family medical history, physical activity levels, sedentary behavior, goals, current conditions/limitations

Immunoglobulins

Used to treat immunodeficiencies

Describe the Queen's college step test protocol

Using a 16.25 inch box, client steps up and down at set pace (22 F, 24 M) for 3 minutes

What are some methods of progressing resistance exercise?

· Lifting same load/volume with better form, more control, and less effort (efficiency) · Lifting same load for more reps (volume) · Lifting heavier loads (intensity of load) · Lifting same load and volume with less rest · Lifting load with more speed and acceleration · More work in same amount of time (density) · Doing same work in less amount of time (density) · Doing more sets with same load and reps (volume) · Lifting same load and volume more often throughout the week (frequency)