Exam 1

The algorithm follows these steps to determine if an individual should seek medical clearance prior to exercise:

1) Identify if the individual currently participates in regular exercise. - Exercising at least 30 minutes on 3 or more days per week at a moderate intensity for at least 3 months. 2) Identify if the individual has been diagnosed with CVD, metabolic disease, or renal disease. 3) Identify if the individual has any signs or symptoms suggestive of the same diseases 4) Identify the individual's desired exercise program intensity.

Standard child/adolescent aerobic recommendations

60 minutes or more of moderate- to vigorous-intensity activity

physical activity

Bodily movements that result in energy expenditure

Pre-exercise Evaluation: Medical History and CVD Risk Factor Assessment

CVD risk factors should be identified and controlled to/for: •Aid in development of individual's ExRx•Lifestyle modification•Disease prevention and management •The following steps should be followed: 1) Determine if patient meets any positive risk factors from Table 3.2.•If patient does not know if he or she meets the criteria for a risk factor, it should be counted. 2) Sum the positive risk factors. 3) If client meets negative risk factor from Table 3.2, subtract one from the total of positive risk factors.

Physical activity and chronic diseases

Chronic diseases - Diseases that develop overtime and are not infectious - The World Health Organization (WHO) promotes physical activity for the improvement or maintenance of chronic diseases.

Physical activity and cancer

Exercise has been shown to benefit individuals with several types of cancer, including lung, breast, colon, and pancreatic.

Inactivity

Individuals or groups of individuals not meeting a certain threshold of moderate to vigorous activity•

Intensity of physical activity defined

Light-intensity physical activity is <3.0 METs. - Example: walking Moderate-intensity physical activity is 3.0-5.9 METs. - Example: jogging Vigorous-intensity physical activity is ≥6.0 METs - Example: running

Physical activity and stroke

Meta-analysis data displays an 11% reduction in the risk of stroke with moderate-intensity exercise and a 19% reduction with vigorous-intensity exercise.•

Physical activity and all-cause mortality

Numerous studies underscore the relationship between physical activity and reduced all-cause mortality. Example: Harvard Alumni Health Study

Physical activity and obesity

Physical activity is associated with weight loss and/or the prevention of weight gain.

Physical activity and disabilities/aging

Physical activity is recommended to all persons, including the aging population and to those with disabilities.

Prevalence of Physical Activity

Physical inactivity is considered a global pandemic. - One in 4 adults are insufficiently physically active. Health equity - Every individual has the opportunity to "attain his or her full health potential." Health disparities - National physical activity data reveals health disparities exist due to all of the following: - Sex, race/ethnicity, age, educational attainment, family income, family type, country of birth, disability status, geographic location, health insurance status, sexual orientation, and marital status

Four physical activity domains

Recreation -Exercise and recreation activities Transport Occupation Household

Deconditioning

Reduction or cessation in exercise and increases in physical inactivity that results in partial or complete reversal of physiological adaptations to activity Common causes - Reduced physical activity, bed rest, casting, paralysis, and aging•

Benefits of Physical Activity and Chronic Disease

Regular physical activity can attenuate the prevalence, mortality, or morbidity of many leading causes of death.

Physical activity and diabetes

Regular physical activity promotes glycemic control and insulin action. - This improves blood glucose, lipids, blood pressure control abnormalities, and weight loss/maintenance.

Sedentary behavior and diabetes/metabolic disease

Sedentary behavior is linked to lipoprotein lipase (LPL) activity in skeletal muscle, which can lead to higher plasma glucose levels.

physical fitness

Set of attributes relating to physical activity performance

Sedentary behavior (1)

Sitting or reclined while engaging in ≤1.5 METs

exercise

Subset of physical activity

Physical activity and cardiovascular disease (CVD)

The positive relationship between physical activity and cardiovascular health has been well established.

Sedentary behavior (2)

Waking behaviors that take place while in a sitting or reclined position and result in an energy expenditure of ≤1.5 METs - 1 MET = energy cost of resting quietly (VO2 = 3.5 mL · kg−1 · min−1) - Light-intensity activity: seated or nonseated activities with an energy expenditure for 1.5-3 METs Can be assessed with survey data, accelerometers, and/or inclinometers

physical fitness can be measured with

exercise testing protocols - Time-consuming but reliable and valid

Physical activity can be measured with

large-scale surveys or objective monitoring devices. - More feasible and cost-effective but less accurate

Exercise is Medicine

•A global initiative to decrease population levels of inactivity •Primary stakeholders include the following: - Health care providers, exercise professionals, and community resources

The most common self-guided screening form is the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+).

•A recent update to the traditional PAR-Q, which now includes several follow-up questions. •The updated form was created to reduce barriers to exercise and the number of false positive screenings. •It will also allow the exercise professional to better tailor an exercise prescription (ExRx) based on the individual's medical history.

Pre-exercise Evaluation: Blood Pressure

•A resting blood pressure (BP) measurement is a vital component of any prescreening evaluation. •BP is typically classified as follows: •Normal BP = <120 systolic blood pressure (SBP) and <80 diastolic blood pressure (DBP) •Prehypertension = 120-139 SBP or 80-89 DBP •Stage 1 hypertension = 140-159 SBP or 90-99 DBP •Blood pressure is typically measured using auscultation. •Exercise professional listens for the sounds of Korotkoff. •BP cuff is inflated to a suprasystolic pressure, which occludes the brachial artery. •As cuff is deflated, pulsatile flow is reestablished and is accompanied by sounds, which can be heard with a stethoscope. •Typically, five Korotkoff sounds can be heard (Box 3.2). •In order to avoid BP assessment errors, all of the following should be considered: •Appropriate testing procedures (Box 3.3) •Type of instrument used-Ausculatory or oscillometric •Posture of subject-Supine, seated or standing •Common sources of assessment error (Box 3.4)

Physical Activity Recommendations - 2008 Physical Activity Guidelines for Americans

•Adults should avoid inactivity. •Adults should engage in at least 150 minutes per week of moderate-intensity or 75 minutes per week of vigorous-intensity activity. •For more extensive benefits, this recommendation should be extended to 300 minutes per week of moderate-intensity or 150 minutes per week of vigorous-intensity •Adults should engage in muscle-strengthening activities on at least 2 or more days per week.

Physical Activity Recommendations - American Heart Association (AHA) and ACSM's Recommendations

•All adults (18-65 yr) need moderate-intensity aerobic activity for 30 minutes on at least 5 days per week or 20 minutes of vigorous activity on at least 3 days per week •Combinations of moderate and vigorous activity can be used to meet this goal. •Exceeding the minimum recommendation may help to: Further improve fitness Reduce risk of chronic disease Prevent unhealthy weight gain

The informed consent should include the following:

•Comprehensive explanation of the risks and benefits associated with exercise testing •Indication that the participant is free to withdraw without consequence •Statement that "emergency procedures and equipment are available" •The form should be explained verbally. •The individual should be given time to ask questions. •If the participant is a minor, the parent or legal guardian provides consent, whereas the minor provides assent.

Pre-exercise Evaluation: Patient Participation

•Detailed instructions should be provided to participants prior to exercise testing. •Instructions should include the following: •Avoid eating and smoking 3 hours prior to testing. •Wear comfortable footwear and loose-fitting clothing. •Directions for medication usage prior to testing •Avoid unusual physical efforts for 12 hours prior to testing. •Preparticipation screening and physical exam should be completed. •Contraindications to exercise testing should be determined (see Chapter 4, Box 4.1). •Informed consent should be reviewed and signed.

Sedentary behavior and obesity

•Long-term weight gain associated with obesity occurs when caloric food intake exceeds total energy expenditure (TEE). •Activity thermogenesis can be divided into exercise activity thermogenesis (EAT) and nonexercise activity thermogenesis (NEAT). - NEAT includes active transport, work-related activity, nonexercise leisure activity, and/or ADLs. - Benefits to TEE can be achieved by converting sedentary time to activity time, including both NEAT and EAT.

Standard adult aerobic recommendations

•Moderate intensity: ≥30 minutes per day on ≥5 days per week for a total of ≥150 minutes per week •Vigorous intensity: ≥20 minutes per day on ≥3 days per week for a total of ≥75 minutes per week •or a combination of the two Resistance training, neuromotor, and flexibility exercises are also recommended.

Physical inactivity

•Not meeting the following activity recommendations •30 minutes of moderate-intensity activity on at least 5 days per week •20 minutes of vigorous-intensity activity on at least 3 days per week •Equivalent combination achieving 600 MET-minutes per week

Sedentary behavior and overall mortality

•Numerous studies have displayed a link between sedentary behavior and mortality. - Meta-analysis of 18 studies determined sedentary behavior was associated with a 49% increase in all-cause mortality.

Detraining

•Process by which adaptations to exercise are gradually lost or reduced •Specific to exercise, thus it is the form of deconditioning most relatable to inactivity •Linked to numerous comorbidities and poor health outcomes

Sedentary behavior and cardiovascular disease

•Recent meta-analyses have shown the link between screen time and CVD. - One suggested that CVD risk increased by 17% with each 2 hour increase in screen time per day.

A more in-depth screening process is needed for individuals in cardiac rehabilitation or medical fitness facilities.

•Risk stratification criteria outlined in Box 3.1 from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). •Provides telemetry monitoring and exercise supervision recommendations •Recommendations do not take into account the comorbidities.

Sedentary behavior goals and guidelines

•Sedentary behavior reduction should be seen as a complement to, without becoming a replacement for, setting exercise goals. •Reductions in sedentary behavior may be a more accomplishable proximal goal. - Especially for individuals not meeting prescribed levels of physical activity •No standardized protocols for reducing sedentary behavior exist - Some organizations and national governments have adopted general guidelines related to sedentary behavior.

Prevalence of Inactivity

•Self-reported survey data suggests 45%-75% of U.S. adults are physically inactive. •Accelerometer data suggests: - 58% of youth (6-11 yr) are physically inactive. - 90% of adolescents (12-19 yr) are physically inactive. - 95% of adults (>20 yr) are physically inactive.

Sedentary physiology (inactivity physiology)

•Study of the body's responses to short-term and long-term sedentary behavior - Focus on identifying mechanisms that are distinct from the biological basis of exercising •Sedentary behavior and exercise can be viewed as regions along a continuous scale of MET values. - Known as the movement continuum

Physical Activity Recommendations - Healthy People 2020 (Box 1.1)

•The nation's health agenda sets a goal to improve health, fitness, and quality of life. •Includes 36 delineated objectives related to the promotion of physical activity across the lifespan •Objectives are categorized based upon the target population. - Adults and/or children