CSEP CEP

Define and describe the relationships between METs and kilocalories with respect to physical activity.

1 MET is the amount of energy expended during seated rest. Individual differences are not taken into account in this estimate. 1 MET ≈1.2 kcal/min for a 70 kg person

Calculate the energy cost of exercise in oxygen consumption, METs and kilocalories for given intensities of stepping, cycling, horizontal and graded walking, running, etc.

1 MET=3.5 ml O2/kg/min If you have the METs you can figure out the VO2, and if you have the weight and time exercised you can determine the absolute O2 consumed - convert to L O2. Using the RER if given or assuming the RER was 1 you can determine the number of calories burned. RER ≈1=5kcal/LO2

Know how exercise intervention can promote neuromuscular coordination, contraction/relaxation and healing.

???This is important in terms of healing as the opposite occurs when you do not use the muscles. Immobilization causes decreased neuromuscular efficiency. It causes motor nerves to become less effective in recruiting and stimulating fibres. It takes about 1 week for the normal motor neuron discharge to return. It is therefore important to reestablish neuromuscular control. Reestablishing neuromuscular control requires many repetitions of the same movement through a step by step progression from simple to complex movements. Strengthening exercises particularly those that are functional are important in this portion of the rehabilitation. There are 4 main elements to neuromuscular control: proprioception and kinesthesia dynamic stability preparatory and reactive muscle characteristics conscious and unconscious functional motor patterns

Define the major components of motor fitness: agility, speed, balance, coordination, psycho-motor aspects of movement, neural aspects of movement and power.

Agility o The power of moving quickly and easily; nimbleness: exercises demanding agility. The ability to think and draw conclusions quickly; intellectual acuity. • An example of agility is the ability to move side to side very quickly and change directions upon command. Speed o Is the ability to move from one point to another in the shortest amount of time possible. • That is the definition of being fast, but speed is the amount of distance travelled for a time increment. Example: A car's speed is going 60km/hr. • It is more specifically the rate at which someone or something is able to move or operate. • Balance o Is an even distribution of weight enabling someone or something to remain upright and steady. • The ability to maintain balance in motor fitness is the ability to adapt to a sudden movement and shift one's body weight in order to maintain their original position. Coordination o This is the organization of the different elements of a complex body or activity so as to enable them to work together effectively. • From a motor fitness perspective is the ability to use different parts of the body to move smoothly and efficiently. • This can be developed through practice. Psychomotor aspects of movement o The psychomotor aspect of movement incorporates the relationship between cognitive functions and physical movements. o Psychomotor learning is demonstrated in all sorts of movements such as: coordination, manipulation, dexterity, strength, speed, grace etc. • An example could be driving a car, throwing a ball or playing an instrument. • This is the ability to learn how to coordinate all parts of the body (hands, feet, fingers etc.) to initiate the movement (without verbal cues) Neural Aspects of movement and power o https://www.youtube.com/watch?v=d8ZPnUfGNmI (this is for exercise and elderly, benefits of exercise) o https://www.youtube.com/watch?v=mJW7dYXPZ2o (This is for exercise and the brain) o The frontal and parietal cortext are intimately involved in the representation of goal-directed movements, but the crucial neuroanatomical sites are not well established in humans. o The neural system is essential for highly skilled movements such as movement and power. • The frontal and parietal lobes are responsible for storing the information about how a movement is performed. The body must be able to retrieve that information from the brain to initiate the movement of speed, direction etc. • Each portion of the brain has different roles to initiate movements. • Cerebellum: coordination of movement • Brain stem: basic movements • Hippocampus: memory • Parietal lobe: movement • Frontal lobe: planning. o Exercise is also important to prevent cognitive decline. o With regards to power and strength, neurological factors are involved in motor unit activation and the timing of muscle firing.

Explain why blood pressure should be monitored at rest, post-exercise, during exercise testing and exercise training

Before blood pressure should be measured be fore exercise to make sure it is safe to exercise. Blood pressure increases with exercise so if the blood pressure is really high >144/94, then the excessive pressure on the blood vessels could cause a rupture. During During exercise it is important to monitor blood pressure as a drop in SBP >10 mmHg below resting values or a failure to increase with greater intensity is correlated with myocardial ischemia, left ventricular dysfunction and an increased risk of subsequent cardiac events. BP >250/115 is also a reason to stop exercise, due to the excessive pressure on the blood vessels After Finally you want to measure the blood pressure after exercise, as it is common that the blood pressure drops below resting values and you want to make sure that they don't have excessive post exercise hypotension especially those who are on blood pressure lowering medication.

Definitions cardiac output, stroke volume, ejection fraction, lactic acid, oxygen uptake, hyperventilation, SBP, DBP, mean arterial pressure, RPP, ischemia, angina pectoris, tachycardia, bradycardia, myocardial infarction.

Cardiac output: is the amount of blood pumped out in a minute. Computed as: stroke volume x heart rate. In healthy adults it increases linearly with increased work rate from 5 L/min to 20 L/min Stroke volume: the volume of blood ejected per heartbeat computed as: end systolic volume - end diastolic volume. Normal upright resting values 60-100 ml/beat. Stroke volume increases with exercise to a maximum at about 50% of aerobic capacity Ejection Fraction: the percentage of the end diastolic volume that leaves the ventricle during systole. Computed as: SV/EDV. Lactic acid: byproduct of anaerobic glycolysis. Lactic acid undergoes constant turnover and can be used as an energy source when there is enough mitochondria available, in the crebs cycle or through gluconeogenesis in the liver. However during short high intensity anaerobic activity, lactic acid can build up, converting to lactate. Lactate causes an accumulation of H+ ions. The H+ ions disrupt the glycolysis process and can disrupt the coupling of actin-myosin cross-bridges, which decrease contractile force. In the end the H+ ions cause fatigue during high intensity anaerobic activity (not marathon running) Oxygen uptake: the oxygen consumed - meaning the capacity for aerobic resynthesis of ATP Hyperventilation: ???????? Systolic blood pressure: the greatest arterial blood pressure, resulting from systole (the contracting phase of the heart) Diastolic blood pressure: the lowest arterial pressure, resulting from ventricular diastole (the resting phase) Mean arterial pressure: represents the average pressure exerted by the blood as it travels through the arteries. Computed as: HR × SV × (length×viscosity)/〖radius〗^4 - therefore diameter of the blood vessel has a big impact on the vascular resistance. At rest you can estimate MAP with this equation 2/3 DBP + 1/3 SBP. Rate-pressure product: myocardial oxygen demand. Computed as: HR x SBP. This is used to look at the strain on the heart Ischemia: a lack of blood flow relative to the tissue needs Angina pectoris: chest pain or discomfort that is caused by myocardial ischemia. Often described as substernal pressure, heaviness or burning that is sometimes accompanied by shortness of breath. Chronic stable angina is often elicted by physical or emotional stress and is relieved by rest or nitrate medication. Unstable angina pectoris may result from coronary vasospasm or transient occlusion and is relieved by spontaneous arterial relaxation and or thrombolysis Tachycardia: heart rate over 100 beats per minute. Signs and symptoms that may be present are: chest palpitations; difficulty breathing, severe chest pressure, chest pain, shortness of breath while exercising Bradycardia: heart rate under 60 beats per minute. Signs and symptoms that may be present are: chest pain, shortness of breath, fatigue, exercise intolerance, hypotension, decrease in BP when standing Myocardial infarction: the death of myocardial tissue resulting from prolonged ischemia

Stability

Centre of mass: Point at which an object is evenly distributed about In anatomical position is around the belly button Centre of gravity: The point at which the force of gravity is said to act - can be outside the body Base of support: the surface area in contact with the ground Stability limit: area a person can move their line of gravity within the BOS

Design a balanced, integrated physical activity/exercise program for apparently healthy clients given factors such as: participant interests, access to facilities and equipment, client characteristics and goals

Depending on their fitness level and health status begin with an aerobic program and add in flexibility and strength training. Aerobic training: should use large muscle groups non weight bearing activities are recommended for obese or diabetics with neuropathy walking, swimming, cycling, are good examples Strength training: keep in mind their goals, are they trying to get stronger and for what purpose, or do they just want to maintain a healthy lifestyle are they familiar with a gym and do they have access to a gym or do they prefer a different workout do they like to workout in a group or individually in most cases you will begin with lighter weights and correct technique, it is better to start with machines and work towards free weights. for those who don't have access to a gym there are many exercises you can do with body weight, some elastic bands and a couple of dumb bells in most cases you will start with twice a week, full body exercise of about 8-12 different exercises Flexibility training: start with 3 times a week focus on major muscle groups 8-10 exercises most effective if done every day

Explain the differences in the cardiorespiratory responses to static exercise compared with dynamic exercise; include possible hazards of static exercise (eg. Valsalva maneuver)

Dynamic Exercise Heart rate response: increase equivalent to exercise intensity Blood flow: Blood pressure: natural increase in SBP and a maintenance or slight decrease in DBP - therefore pulse pressure increases Oxygen uptake: increase equivalent to exercise intensity Blood flow: Static exercise Above 20% of maximal contraction: Heart rate response: increase in proportion to the intensity Blood pressure: combination of vasoconstriction and increased cardiac output causes a disproportionate increase in SBP, DBP, and mean BP. Oxygen uptake: Blood flow: does not significantly increase to the non-active muscles probably because of mechanical vasoconstriction imposed by the contracting muscles. Vasoconstriction in the peripheral vascular beds occurs due to the sympathetic drive Cardiac output: moderate increase Danger with static exercise: - increase blood pressure excessively - put more demands on the heart valsalva maneuver - when a lifter holds his breath during effort and contracts the muscles of exhalation without allowing air to escape, intrathoracic pressure rises, resulting in a large increase in systemic arterial blood pressure. The increased arterial pressure can pose a hazard to individuals with underlying cardiovascular disease and may result in damage to the blood vessels. The increased intrathoracic pressure limits venous return to the heart, which then decreases cardiac output, arterial pressure and reduces the blood flow to the brain. Sometimes causing light-headedness. This problem can be avoided by breathing out continuously during the concentric (lifting) phase.

Describe how the following differ from the norm: dyspnea, hypoxia, hyperventilation, hypoventilation, orthostatic hypotension, premature atrial contraction and premature ventricular contraction

Dyspnea: unpleasant sensation of having difficulty breathing. Different from an increase in normal breathing due to exercise and at high altitudes because of the discomfort level. Feels like running out of air, can't breath deep and fast enough Hypoxia: a low level of oxygen in the tissues (brain, liver, muscles etc.) symptoms include: change in skin color, confusion, cough, fast heart rate, rapid breathing, shortness of breath, sweating, wheezing. Causes include: COPD, asthma, chronic bronchitis, emphysema, heart problems, anemia Hyperventilation: rapid or deep breathing greater than metabolically produced, causing more carbon dioxide to be expelled than produce therefore causing a low blood concentration of carbon dioxide. The decrease in carbon dioxide causes the blood vessels to heading to the brain to constrict, decreasing the amount of blood to the brain. This causes symptoms such as lightheadedness and tingling. This causes the pH of the blood to be more basic. Causes of hyperventilation include metabolic acidosis, which are caused by excessive ingestion of acids (ethanol, methanol, aspirin), poorly controlled diabetes, hypoglycemia, chronic renal failure, anxiety or panic. COPD and asthma are also big contributors to hyperventilation. Treatment - breath through pursed lips, into a paper bag or cup your hands and breath into them. Focus on taking slower breaths Hypoventilation: common with people who have COPD because of a decreased responsiveness to hypoxia (low oxygen levels in the tissues) and hypercapnia (excessive carbon dioxide in the blood). There are two types of hypoventilation 1. Obesity hypoventilation 2. Obstructive sleep apnea. Symptoms include: daytime drowsiness, fatigue, mood disorders, nocturnal or morning headaches. Can cause pulmonary hypertension, right ventricular hypertrophy, cardiac ischemia, arrhythmias and stroke. Treatment for this is oxygen; exercise and weight loss can also help in the long term. The supine position exasperates the condition so exercises in the supine should be avoided. Orthostatic hypotension: Premature atrial contraction: premature atrial contractions occur when the electrical impulse is sent from somewhere other than the SA node causing an abnormal p wave followed by an early QRS complex. Isolated or short runs of PACs are common and require no special attention.

Describe how heart rate, blood pressure and oxygen uptake responses change with adaptation to chronic exercise training and how men and women may differ as they age

Heart rate: resting heart rate decreases, submaximal heart rate decreases at the same absolute intensity, maximal heart rate stays the same Blood pressure: blood pressure does not change in healthy people, but has been shown to decrease slightly in borderline or moderately hypertensive individuals at rest, blood pressure is reduced during submaximal exercise intensity, at maximal intensity systolic is increased and diastolic is decreased. Oxygen uptake: maximal oxygen uptake increases mainly due to increase in cardiac output but there is an increase in (a-v)O2 difference attributable to a more effective arterial blood distribution and an increased ability for active tissues to uptake oxygen Stroke volume: stroke volume increased at rest, during and after exercise in trained athletes Sex differences: cardiovascular and respiratory changes that accompany cardiorespiratory endurance training do not appear to be sex specific. Women experience the same relative increases in VO2max as men with cardiorespiratory endurance training. Men tend to have bigger hearts, larger lungs and more fat free mass giving them a larger absolute VO2max.

Understand the oxygen dissociation curve and the effect of exercise on it.

Oxygen is transported by hemoglobin (98%) Each molecule of hemoglobin can carry 4 oxygen molecules Binding of oxygen to hemoglobin depends on the PO2 in the blood and the bonding strength of the oxygen and hemoglobin. At high PO2 - like the lungs large drops in PO2 cause little change in hemoglobin saturation. Below a PO2 of 40mmHg little changes in PO2 cause relatively large changes in saturation

Demonstrate how to adapt to exercise prescriptions for progressive resistive exercise, flexibility or range of motion (ROM), neuromuscular exercise, aerobic exercise and functional activity.

Progressive Resistive exercise With progressive resistance training it is important to have a sense of a 1 rep-max. You should pick a weight that you can lift comfortably 8 times. Each session the goal is to increase the number of repetitions by 1. If and when you reach 15 reps you should increase the weight and start again at 6 to 8 reps. In order to improve strength each muscle group should be worked 2-3 times per week with at least 48 hours between sessions. Each set being completed 2-4 times with adequate time between sets. (might need to be looked over) Flexibility or Range of Motion (ROM) In order to increase range of motion the program should have the individual moving through pain free range of motion in each axis of the joint. Static stretching should be completed at least 2-3 days/week. It is important to stretch to the point of tightness and no further. Do not bounce as that can cause you to go further than the muscle can handle. Each static stretch should be held for 30-60 seconds and should be repeated 2-4 times in one session. PNF stretching can also be used if you are trained in assisting someone through that. It is also possible to strengthen the agonist muscle in order to help increase range of motion. Neuromuscular Exercise Aerobic Exercise It would be ideal to workout 3-5 days per week, at an intensity between 60-85% HRR for 20-60 min each session. Any large muscle group aerobic activity would be good to achieve this goal. Functional Activity

Able to understand how to apply the exercise principles of specificity, grading, progression, intensity, and duration to enhance the health and reduce impairments and disabilities of clients.

Specificity Specificity is one of the most basic concepts to incorporate in all training programs. It refers to the method whereby an athlete is trained in a specific manner to produce a specific adaptation or training outcome. Example: To strengthen the chest muscles, need to incorporate the bench press that recruits the pectoralis major. Specificity is sometimes used interchangeably with the acronym SAID. Specific, Adaptation to, Imposed, Demands. The underlying principle is that the type of demand placed on the body dictates the type of adaptation that will occur. For instance, athletes training for power in high-speed movements (e.g. baseball), should attempt to activate or recruit the same motor units required by their sport at the highest velocity possible. Specificity also relates to the sport season itself. By using this training principle, it will enhance health and reduce impairments and disabilities of clients within their specific field. By preparing them ahead of time for the sport itself, the client is better trained, has a better opportunity to perform well and less chance of injury. Grading ??? Progression If the training program is to continue producing higher levels of performance, the intensity of the training must become progressively greater. Progression, when applied properly, promotes long-term training benefits. Normally this is seen with the amount of resistance used, but can also be raised by progressively increasing the number of weekly sessions, adding more drills or exercises to each session, changing the type or difficulty of the drills or exercises, or increasing the training stimulus. This is to be introduced systematically and gradually, based on the training status of the athlete. This will enhance the health and reduce impairments of the athlete by constantly allowing them to be better and not allowing them to plateau. And if a plateau were to occur, then to change something up. Intensity Duration

Describe how blood pressure responds to static and dynamic exercise and changes in body position

Static A combination of vasoconstriction and increased cardiac output causes a disproportionate increase in SBP, DBP, and mean BP. The valsalva maneuver can further increase blood pressure with increased intrathoracic pressure putting more pressure on the blood vessels. Dynamic The systolic blood pressure increases linearly with intensity as the stoke volume increases.

Describe the expected cardiorespiratory response to static and dynamic exercise in terms of heart rate, blood flow, blood pressure and oxygen uptake.

Static exercise Below 20% of maximal voluntary contraction: Modest increase in SBP, DBP, and HR Above 20% of maximal contraction: Cardiac output: moderate increase Blood flow: does not significantly increase to the noncontracting muscle probably because of mechanical vasoconstriction imposed by the contracting muscles. Vasoconstriction in the peripheral vascular beds occurs due to the sympathetic drive Blood pressure: combination of vasoconstriction and increased cardiac output causes a disproportionate increase in SBP, DBP, and mean BP. Heart rate response: increases in proportion to the intensity Oxygen uptake: Dynamic exercise Heart rate response: increase equivalent to exercise intensity Blood pressure: natural increase in SBP and a maintenance or slight decrease in DBP - therefore pulse pressure increases Oxygen uptake: increase equivalent to exercise intensity Blood flow:

Understand the advantages, applications and limitations of dynamic movement, static stretching and proprioceptive neuromuscular facilitation flexibility exercises as they relate to clinical care and health maintenance.

The degree of movement that occurs at a joint is called range of motion (ROM). Flexibility is a measure of ROM and has static and dynamic components. Static flexibility is the range of possible movement about a joint and its surrounding muscles during a passive movement. Static flexibility requires no voluntary muscular activity, an external force such as gravity, a partner, or a machine provides the force for a stretch. In this stretch the muscle relaxes, versus dynamic, where it doesn't. Dynamic flexibility refers to the available ROM during active movements and therefore requires voluntary muscular actions. Dynamic ROM is generally greater than static and dynamic ROM is unresolved, therefore the direct transfer between measures of static flexibility and ROM cannot be determined. PNF (proprioceptive neuromuscular facilitation) is another type of stretch. This type of stretching has been expanded into athletics to increase flexibility. PNF technique is usually performed with a partner and involves both passive and active (concentric and isometric) muscle actions. Suggested that this is the best kind of stretching because it facilitates muscular inhibition, although evidence for this has not been consistently shown. Most PNF stretching is impractical because most of the stretches require a partner and some expertise. (This being one of the limitations). During a PNF stretch, 3 specific muscle actions are used to facilitate the passive stretch. Both isometric and concentric muscle actions of the antagonist (muscle being stretched) are used before a passive stretch of the antagonist to achieve autogenic inhibition. The isometric muscle action is referred to as the hold and the concentric muscle action as contract. A concentric muscle action of the agonist, called agonist contraction, is used during a passive stretch of the antagonist to achieve reciprocal inhibition. Each technique also involves passive, static stretches referred to as relax. PNF stretching goes into 3 phases: Hold-relax Then, Contract-relax Followed by, Hold-relax with agonist contraction. With regards to performance, each sport requires different levels of flexibility. For example, a gymnast may require plenty of flexibility, while a powerlifter may not require as much. One limitation would be if the athlete is outside the range of "ideal" flexibility, this may increase the chance of injury. Therefore, if an athlete is too flexible for their sport, they can get injured as easily as an athlete being too tense. Also, if there are imbalances in flexibility, this could also predispose the individual to an increased risk of injury. With each different type of stretch, there comes advantages and limitations. As mentioned above, one limitation for PNF stretching is that it requires a partner with some sort of expertise. An advantage would be that it is the most effective stretch to increase flexibility. With regards to dynamic stretching, one limitation is that chance of injury is increased (same as PNF). An advantage being that it can be sport specific and be really good for warm-ups. Performing dynamic stretching similar to the actions performed in the sport, will decrease the risk of injury by appropriately warming the muscles. For static stretching, one limitation is that the stretches must be held for 30 seconds for them to be effective. It is also controlled through the discretion of the participant. Therefore, if they do not stretch themselves appropriately, they could either injure themselves (over stretching) or have no benefits (not stretching far enough). The participant is to stretch until there is mild discomfort and hold that position. An advantage for static stretching is that it can be performed by anyone. There is no equipment needed (or minimal).

Explain specific activities to promote neuromuscular coordination in the areas of balance and gait.

There are specific activities that can be performed to promote neuromuscular coordination in the areas of balance and gait. The manipulation of variables, such as surface stability, vision, and speed can help improve one's neuromuscular control. Examples being mini-trampolines, balance boards, stability balls can be used to create unstable surfaces for upper and lower extremity training. Athletes can also perform common exercises such as squats and push-ups on uneven surfaces to improve neuromuscular control. In general, exercises that are performed with the eyes closed, thus removing visual input, will further challenge balance and help strengthen that target area. Walking across a balance beam is an activity that would improve gait pattern. One can first start off with heel-to-toe walking and further progress to a balance beam. Finally, the last variable to be adjusted is that of speed. This would further challenge the neuromuscular system.

Contrast the cardiorespiratory responses to acute graded exercise in trained and untrained clients.

They may experience peripheral fatigue before cardiorespiratory fatigue???

Calculate anaerobic threshold using data from gas analysis (eg. Intersection point of the ventilator equivalents, breakaway ventilation). Define and describe the implications of such bloodless estimates of anaerobic threshold (eg. As it relates to physical conditioning programs and cardiorespiratory fitness).

Ventilatory equivalents method: Plot a graph with VO2 (ml/min) on the x axis and ventilator equivalents on the Y axis (the ventilator equivalents being Ve/CO2 and Ve/VO2). Ve/CO2 - should typically stay the same because as your carbon dioxide increases so does the air you breath out Ve/VO2 - will be straight and then suddenly increase V-slope method: Plot VO2 (ml/min) on the x axis and VCO2 (ml/min) on the y axis. Draw a line through the lower points and the higher points where that intersects is the ventilator threshold. VCO2 suddenly increases more than VO2 and this should be the point where the 2 lines intersect. The increase in ventilation is due lactic acid build up which gets buffered into sodium lactate, water and carbon dioxide. The increase in carbon dioxide in the blood stream triggers the body to breath more increasing the ventilation. The ventilatory equivalents method has been found to be accurate enough that you don't have to take invasive blood measurement to find the lactate threshold. This allows for less invasive measurements and more accurate training as the ventilatory threshold can be used to estimate the lactate threshold.

Describe contraindications to exercise or inappropriate exercise responses which would result in termination of the exercise session or program according to the current health status of the participant (i.e. cardiopulmonary/metabolic, musculoskeletal condition).

angina or angina like symptoms excessive rise in BP: SBP>250mmHg, DBP>115mmHg drop in systolic BP 10mmHg with increase intensity shortness of breath, wheezing, leg cramps or claudication signs of poor perfusion: lightheadedness, dizziness, pallor, cyanosis, nausea, cold or clammy skin failure for HR to rise with increased intensity change in HR rhythm (ST segment elevation above 1mm, ST segment depression below 2mm, triplets of PVCs, multifocal PVCs, heart block, bradyarrhythmias) participant does not want to continue severe fatigue equipment malfunction

An understanding of the relationship between the exercise prescription and its' implementation with respect to behavioural and physiological change.

behavior change it is important that the client continues on with his/her every day life and does not compensate for the exercise prescription by doing less in his/her daily life because if they are compensating by not doing their usual chores they are not expending as much energy and not getting the full benefit of the exercise prescription(don't know if this is what they are looking for) starting with small changes and small bouts of exercise will help someone stay with the exercise program, and prevent them from being overwhelmed it is important to keep encouraging them and showing them the progress they have made in order to keep them motivated and stick with the routine physiological change it is important that the stimulus is great enough that it will cause a physiological change

The ability to develop and prescribe progressive resistive exercise programming (i.e. isokinetic, isotonic, isometric, open chain, closed chain) for rehabilitation in a variety of settings.

isometric exercises are often used at the beginning of a rehabilitation program after immobilization, or strength training when going through the full range of motion would make the injury worse. Isometric exercises increase the static strength and decrease the atrophy. Progressive resistance training are the most commonly used strengthening exercise. Can be done with free weights, machines, rubber tubing. Uses isotonic contractions in which force while the muscle is changing length. Isotonic contractions may either be concentric or eccentric. Concentric exercises are a good starting point, but eccentric exercises are just as important, especially for an athlete. Eccentric contractions help slow down the body, which is a very important function in the prevention of injury. Isokinetic exercises are used at the end of a rehabilitation program. They use a fixed speed, providing maximal resistance throughout the entire range of motion. These exercises are often used to see if an athlete is ready to return from an injury. Isokinetic machines allow people to move at more functional speeds. Training at higher speeds seems to show more improvement because there are less negative effects on the joint. Closed chain exercises are preferred to open chain exercises as they tend to be more functional.

Understand how to modify exercise prescriptions to specific conditions and disorders.

osteoporosis 3-5 times/week weight bearing exercises (if pain free) - if painful start with non-weight bearing exercise and move to weight bearing exercise 20-30 min/session progress slowly 2-3 d/week resistance training - better to do less reps at a higher intensity avoid explosive movements avoid twisting, bending or compression of the spine teach correct forms of ADL to avoid vertebral fractures improve balance osteoarthritis 3-5 days/week preferably daily flexibility daily aerobic activities that put least stress on joints are recommended (non weight bearing) start with short bouts according to the patient's pain level and progress to longer bouts joint stability is compromised resistance training is recommended avoid stop and go actions (such as tennis) avoid exercise during flare ups pain during and immediately after exercise is common (2 hr pain rule) water temperature should be warm rheumatoid arthritis 3 times/week limited ROM should be considered in activity selection resistance training 2-3d/week joint stability is compromised balance and flexibility exercises are beneficial cardiovascular disease max heart rate is at least 10 beats below ischemic threshold avoid having both arms overhead at the same time (cardiac output has to increase to supply the lungs therefore putting more stress on the heart) avoid valsalva maneuver avoid isometric contractions as it could raise BP heart failure exercise preferably every day (decrease duration/intensity to allow for this) train like you would for endurance training because that is their major limitation start resistance training 1-2 months after continuous aerobic exercise as it will help them in their daily activities avoid both arms over head at the same time avoid the valsalva maneuver peripheral artery disease need to do weight bearing exercise as that triggers the claudications resistance training can also help build up strength they should use a pain scale if the pain becomes too much they should stop, wait for it to subside and start again hypertension higher frequency, lower intensity, higher volume increase volume before intensity at least 1 month of aerobic exercise before beginning a resistance training program avoid both arms overhead at the same time avoid valsalva maneuver COPD vigorous aerobic exercise if tolerated, without symptoms and a dyspnea score of 2-3 below 88% O2 sat. supplemental oxygen may be needed important to focus on muscles of the shoulder girdle because of the greater dyspnea while using them diabetes mellitus should train 3-7 days per week greater improvements can be seen with increasing the exercise intensity because it helps with glucose uptake resistance training is important - beware of retinopathy otherwise it is good to challenge them avoid valsalva maneuver pregnancy start low and gradually increase slow in first trimester - risk of miscarriage avoid exercise in hot humid environments non-weight bearing or low impact endurance exercise beware of joint laxity avoid supine position after 4 months avoid valsalva maneuver avoid isometric contractions

Define physiological and training terms and principles including: overload, specificity of exercise conditioning, use-disuse, progressive resistance, isotonic, isometric, isokinetic, concentric, eccentric, atrophy, hypertrophy, sets, repetitions, plyometrics, valsalva maneuver, work-to-rest principle, stress/rest principle, hyperplasia.

overload: the body must be challenged beyond a physiological threshold in order to stimulate adaptation. The exercise needs to be more challenging than everyday activity. specificity of exercise conditioning: the type of training you do will indicate the adaptation on the body meaning the system you use (cardiovascular, musculoskeletal and the energy system) will get stronger but it will be specific only to that system. use-disuse: progressive resistance: isotonic: isometric: isokinetic: concentric: eccentric: atrophy: hypertrophy: sets: repetitions: plyometrics: valsala maneuver: work-to-rest principle: stress/rest principle: hyperplasia:

Given a written case study (with sufficient health history, risk factor, lifestyle, medical information, results of a graded exercise test and/or field test), design an appropriate physical activity/exercise program based on health appraisal, goals and/or exercise test results.

step 1. calculate risk factors and medical history - determine whether you can work with this person step 2. gather medical information and lifestyle information - this is important for when looking at exercise test results (medication such as beta blockers will affect an exercise test) step 3. Look at results of the exercise test (what was their max heart rate, what was the reason the test was stopped, what stage/how many METs did the person get to). It is also important to know if the person was on any medication during the test, if so is this the same medication as current. step 4. Based on health risks, exercise test and interests design an exercise program.

Understand the relationship of neuromuscular processes to optimal healing and health maintenance.

strength cannot be built without neural adaptations therefore neuromuscular training is important for rehabilitation and for healthy strength training changes may occur in the connections between motor neurons allowing motor units to contract more synchronously and enabling the muscle to generate more force. or more motor units may be recruited without necessarily acting in unison. these changes may occur because of an increase in neural drive to alpha motor neurons during maximal contraction. This could increase the frequency of discharge or rate of coding of motor units, which eventually causes a muscle to reach tetanus or producing peak force. It is also possible that the inhibitory impulses are also reduced inhibitory mechanisms such as golgi tendon organs prevent muscles from exerting more force than the connective tissues and bones can handle. This is referred to as autogenic inhibition. when tension on muscle tendons exceeds the threshold of the golgi tendon organ motor neurons to that muscle are inhibited preventing the muscle from contracting further. This is done by the brainstem and cerebral cortex working together to propagate inhibitory impulses. with training though it is possible to gradually counteract these inhibitory responses, allowing the muscle to reach greater levels of strength. this is important because even though one might not see any change in muscle size, they may be making progress with neuromuscular adaptations and be increasing in strength. neural adaptations are the major source of strength gains in the first 8-10 weeks of a resistance training program, and during the most intensive training months of a season.

Describe the structure and function of skeletal muscle fiber and the motor unit

• Every muscle fiber is composed similarly with a muscle, fascicles, fiber, sarcoplasmic reticulum, fibril, myofibril. • The muscles increase in diameter and length by addition of sarcomeres • There are different types of muscle fibers: o Type 1: These are the slow oxidative fibers (motor unit type) • This is the smallest type of muscle fiber • The force is small and speed is slow • They are slow to fatigue and have low glycogen content • Their capillary supply, density and myoglobin content is high. o Type 2a: These are the fast oxidative/glycolytic • The speed is fast, with a medium twitch force • Resistance to fatigue is medium, they have high glycogen content • They are capillary rich and have high myoglobin content • The capillary density of these fibers is intermediate. o Type 2b: These are the fast glycolytic • These are fast muscle fibers, with large force twitch (production) • Glycogen content is high, with poor capillary supply • The myoglobin content is low and it is not mitochondrial or capillary dense. • Motor Units: o The motor units are mentioned above. (Slow oxidative, fast oxidative/glycolytic and fast glycolytic). o They are recruited by their size from smallest to the largest in order to prevent from fatigue. • The recruitment of motor units is the responsibility of the neuromuscular system.