final exam for nutrition ch. 9 and 10, chapter 2

What is my plate consumer messages help communicate the 2015 DGAs

All food and beverage choices matter—focus on variety, amount, and nutrition • The right mix can help you be healthier both now and in the future • Start with small changes to make healthier choices you can enjoy • Find your healthy eating style and maintain it for a lifetime

what is aging the accumulation of diverse harmful changes in cells and tissues

Consequences of aging • Decreased physical and mental capacity • Increased risk of disease and death • Physiological changes • Cardiovascular system • Renal system • Musculoskeletal system • Nervous system • Respiratory system • Gastrointestinal system

what foods contribute to water intake

Current consumption patterns indicate that fluids provide about 80% of our total water intake, with plain water making up about 45% of those fluids and other beverages making up the rest. Food provides the remaining 20% of water toward meeting daily needs.

What is unprocessed or minimally processed foods

Edible parts of plants and animals after separation from nature or preserved by minimal processes (no substances added)

what are iodine functions

Essential component of thyroid hormone • Required for normal function of thyroid gland • Thyroid-stimulating hormone (TSH) - Secreted by the pituitary gland - Regulates the thyroid: - Increases iodine uptake from blood - Stimulates thyroid hormone production and release • Thyroid hormones - Regulate energy metabolism and protein synthesis - Play critical roles in the development of the fetal skeleton and brain • Iodine deficiency especially problematic during pregnancy

what are osteoporosis and bone mass

Peak bone mass is established at around age 30, so it is important, during the formative years of bone development, to consume adequate amounts of calcium and vitamin D. If intake is low or absorption is impaired, bone loss occurs because the body uses the calcium in bone to maintain blood levels and support calcium-dependent bodily functions.

what are dietary sources of potassium

Potassium is found in a wide range of minimally processed foods, particularly fruits and vegetables.

what is potassium

Primary electrolyte within cells • Functions: - Maintains fluid balance (along with sodium and chloride) - Acts as a cofactor for certain enzymes - Plays a role in nutrient transport - Helps nerves transmit and muscles contract - Helps maintain electrical activity of the heart to sustain a steady heartbeat • May counter the effects of excess sodium on blood pressure

what does the ACSM recommend?

four different types of physical exercise to promote health and prevent disease injuries

what is within the DASH diet

grains, fruits, vegetables, milk, sweets, fats, oils, nuts, seed

what are the functions of trace minerals: cofactors for enzyme function

harden tooth enamel components of thyroid hormones bone health growth and wound healing antioxidant activity required for enzyme functions may enhance insulin function

What are the major changes in the DGAs

he 2020-2025 guidelines are the first to offer guidance for healthy dietary patterns by what we call "life stages," since people at different ages should be consuming different diets. • The new guidelines also offer advice for pregnant and lactating women. • One major change in the guidelines is around the introduction of egg and peanut products for young children: The guidelines note that "infant and young children" should be introduced to "potentially allergenic foods" like egg, peanut, tree nut, shellfish and soy products with other complementary foods. • Another big change: Avoid foods and beverages with added sugars for those younger than age 2.

what are surveys show that most women do not meet the RDA for iron

increases the risk for iron-deficiency anemia • Iron needs are higher for females than for males due to the need to replace losses from menstruation • RDA for vegans and vegetarians is nearly double (nonheme iron) • Athletes may have a 30% higher requirement due to increased losses Gender/Age Iron RDA Children 1-3 7 mg Children 4-8 10 mg Children 9-13 8 mg Males/14-18 11 mg Females/14-18 15 mg Males/19+ 8 mg Females/19-50 18 mg Females/51+ 8 mg

what are sources of calcium and absorption

• AI for calcium at 1000 milligrams per day for men and women aged 19 to 50 years • Most studies indicate that calcium from food is better absorbed than calcium from supplements. • This is likely due to improved absorption with meals and the tendency of people to consume smaller amounts of calcium more frequently, which likely improves absorption efficiency. Tofu 300 mg Yogurt 450 mg Sp nach 250 mg Cheese 200 mg Almonds 80 mg Salmon 200 mg Milk 300 mg Sardines Cabbage Yogurt Drink 370 mg 30 mg 300 mg Brocco 180 mg Bok Choy 40 mg

what is calcium toxicity

• Combined with dietary sources, calcium supplements may push intake over recommended levels • Upper tolerable intake level (UL) = 2500 mg • Can cause: - Constipation - Interfere with iron absorption - Hypercalcemia

what is maintaining fluid balance in the body

• Electrolytes - electrically charged minerals (ions) dissolved in bodily fluids • Sodium (Na+), potassium (K+), and chloride (Cl-) • Maintain fluid balance • Transmit nerve impulses • Muscle contraction • Transport nutrients

what are sources of potassium

sweet and white potatoes in skin, avocado, edamame, cantaloupe, dried apricots, oranges, tomatoes, coconut water, salmon, butternut squash, watermelon, white beans, mushrooms, spinach, greens

what are ways to fuel the body

when a person exercises, muscles experience increased demand for energy to contract, this energy comes from carbohydrates (glucose) and fats (fatty acids), energy to fuel working muscles comes from two main sources: carbs and fats, must be converted to usable form of energy: ATP

what is magnesium

• 50% to 60% is found in bones • Functions: - Cofactor in more than 300 chemical reactions - Role in the transport of ions across cell membranes for muscle contraction, nerve impulse conduction, and maintaining heart rhythm - Involved in extracting energy from carbohydrates, proteins, and fats - Role in protein production - Necessary in activating vitamin D - Bone health

what is sodium overconsumption

• Increases risk of hypertension • Studies show blood pressure rises progressively with sodium intake > 2,300 mg/day • American Heart Association: - Now defines high blood pressure > 130/80 mmHG - ~46% adults have high blood pressure • Major risk factor for cardiovascular disease and stroke

what is calcium

• Most abundant mineral in the body • 99% in bone and teeth - Structural component - Reservoir of calcium • 1% in body cells and tissues - Blood clotting - Hormone secretion - Muscle contraction - Nerve transmission

What is Whole Foods

• Nothing added, nothing taken away • No unhealthy fat, sugar or salt added • No vitamins, minerals or fiber taken away •Examples: •fresh fruits/vegetables •whole grains •nuts, legumes, egg

what is magnesium toxicity

• Rare from food sources alone • High intake from supplements can result in - Diarrhea, nausea, and abdominal cramping • Toxicity reported with very large doses of magnesium-containing laxatives and antacids

what is roles of water in the body

• Regulates body temperature • Transports nutrients and oxygen • Lubricates joints • Present in mucus and salivary juices • Helps delicate tissues • Acts as a solvent • Removes waste

what are properties of minerals

• Solid, stable, inorganic elements that are essential with diverse regulatory and structural functions • Cannot be broken down into smaller constituents • Cannot be destroyed by heat, light, cooking, or digestion • Minerals are ions - elements with positive or negative charge - Unequal number of protons and electrons - Allow minerals to participate in chemical reactions and bond with other molecules

what is excess iron intake

• UL for men and women ≥ 19 years = 45 mg - Can cause gastrointestinal distress: diarrhea, constipation, nausea, and vomiting - Iron toxicity causes apathy, fatigue, liver damage, and immune problems • Iron poisoning - Major cause of unintentional death in children • Nausea, vomiting, diarrhea, constipation, rapid heartbeat, dizziness, shock, and confusion - Men are at higher risk than women as are those with hemochromatosis (iron overload disease)

what is a magnesium deficiency

• ~60% of American adults do not consume recommended amount of magnesium • Deficiency symptoms rare - Kidneys excrete less when intake is low and body may absorb more • May increase osteoporosis risk • May also increase risk of: - Atherosclerosis - Type 2 diabetes - Hypertension

what is trace minerals

(<100 mg/day) iron zinc copper iodine selenium molybdenum manganese fluoride chromium

what is major minerals

(>100mg/day) sodium potassium chloride calcium magnesium phosphorus sulfur

What are the structure/function claims

-must no make any links to a disease or health condition -they cannot be misleading or have to be truthful -not reviewed or authorized by the FDA -When on a dietary supplement label

What are the four categories of food classification system based on industrial processing

1. Unprocessed or minimally processed foods 2. Processed culinary ingredients 3. Processed foods 4. Ultra processed foods

what percentage of older adults will make up the US population by 2060?

24%

what percent of the body is minerals composed of

4%

How often are the dietary guidelines for American updated?

5 years

Does everyone have access to a healthy diet? What is a food desert

A food desert is an urban or rural area where availability of affordable healthy, fresh foods is limited -filled with processed or ultra processed foods -in urban areas, people not living within 1 mile of a grocery store -in rural areas, people that do not live within 10 miles 25-30 million Americans live in food deserts Food deserts lead to poor diets and obesity type 2 diabetes and heart disease Southern states are most affected ex alabama louisiana, and nc due to poverty, health, and access

what is sodium intake and sources

AI (19-50 years) = 1,500 mg/day• UL (age 19 and over) = 2,300 mg/day• 1 teaspoon table salt (NaCl) = 2,400 mg sodium

what is Al for potassium

AI for Potassium• In 2019, a NASEM committee updated the DRIs for potassium (and sodium). The committee found the data insufficient to derive an EAR for potassium

what does water make up 60-70% of our bodies

Adult male has more total body water than an adult female • Ratio of water in body's organs varies - Muscle 75% water - Heart and brain 73% water - Adipose tissue 15% water - Bone 10% water

what is an iron deficiency

Anemia - Oxygen-carrying capacity of red bloods cells is inadequate • Iron deficiency leading cause • Iron-deficiency anemia (microcytic hypochromic anemia) - Affects as many as 30% of world's population - Caused by blood loss, insufficient iron intake, or poor absorption of iron - High-risk groups: children, pregnant, and menstruating women • Symptoms - Tired, out of breath, poor performance, and slow cognitive and social development

What is health claims

Approved by FDA, may or might

what is physiological factors of aging

decreased taste and smell, slower gastric emptying and prolonged satiety, reduced lean body mass and energy expenditure

what are the nutrient recommendations involving seniors and vitamin B

B6, B12, Iron, Zinc

what is mineral absorption and bioavailability

Bioavailability affected by nutritional status: • Deficiency in a mineral = increased absorption • Increased need = increased efficiency of absorption • Adequate amounts in body = less absorption (but doesn't stop) • Presence of binders in foods inhibits absorption - Phytates - Oxalates - Polyphenols • Competition with other minerals • Presence of vitamins

what is the psychological factors of aging

depression, loneliness, grief/loss

what is calcium homeostasis

Calcium blood levels are tightly regulated • Bone remodeling is necessary not only to maintain blood calcium levels, but also during bone growth in the young and in bone maintenance throughout life to allow bone to adapt to strain and to repair the microscopic damage that occurs daily. • When calcium levels fall: - The parathyroid gland releases parathyroid hormone (PTH) - PTH stimulates production of active vitamin D • Increases calcium absorption in the intestine - PTH and activated vitamin D mobilize calcium from the bone and decrease calcium excretion from the kidneys

What are the nutrients content claims

DV, reduced or lights, healthy fat or healthy cholesterol

what is DASH diet

Dietary Approaches to Stop Hypertension (DASH) Diet Effective approach in helping lower blood pressure and reduce the risk of heart disease Recommended by the American Heart Association and American College of Cardiology

what are minerals in food

Food source reflects amount of minerals available:• Plants• Animal foods• Whole, unprocessed foods• Tap water

what is iron sources and absorption

Food sources - Heme iron: red meats, poultry, and fish - Nonheme iron: plant foods, meat, and fish • Lentils, beans, dried fruits, and fortified grain products • Absorption - Heme is better absorbed - Nonheme absorption • Enhanced by vitamin C or an unidentified factor in meat, fish, or poultry (MFP factor) • Inhibited by soy protein, phytates, and polyphenols - Calcium may reduce absorption of both types

What is ultra process foods

Formulations of several ingredients that include original or chemically modified foods and substances obtained with the fraction in of the Whole Foods and additives used to make the final product palatable

What is processed foods

Group 1 food modified with addition to group 2 ingredients aiming food preservation and/or enhancement of its sensory qualities

what are blue zones areas in the world with increased longivity

Have a higher number of individuals who live to be at least 100 years old • Include parts of Japan, Italy, Canada, and Costa Rica • Also include Seventh-Day Adventist communities

What diets include foods that are good sources of a number of nutrients in relation to amount of calories

Healthy diets Nutrient-dense foods - Provide healthy nutrients in appreciable amounts relative to calories • Energy-dense ("empty calorie") foods - Provide calories and low amounts of nutrients • It is easier to build an adequate and healthy diet around nutrient-dense foods than around empty calorie foods

What is healthy adequacy, balance, variety, and moderation are the core characteristics of a healthy diet?

Healthy diets have common qualities: • Adequate amounts of essential nutrients • Balanced across food groups and macronutrients • Variety of foods • Moderation and not overindulging

what are short term benefits of exercise

Helps people lose body fat Builds muscle mass Helps people become physically fit

what are the trace minerals within the body

Include iodine, iron, zinc, copper, selenium, molybdenum, fluoride, manganese, and chromium - Need significantly less than major minerals - Daily requirement < 100 mg/day

what is iodine

Iodine content in food depends on iodine content of environment it comes from • A U.S. salt company began to add iodine to salt - 15% of U.S. salt intake is now iodized • Sources of iodine - Seafood - Milk - Processed grains

Why are dietary guidelines for Americans updated every 5 years?

Issued by the U.S. Department of Agriculture (USDA) and U.S. Department of Health and Human Services (HHS) • Evidence-based guidelines to promote health and reduce risk for major chronic disease - Intended for health professionals to help people age 2 and older consume a healthy diet and prevent chronic disease - Intended for policy makers as basis for federal food and nutrition policies, programs, and education

Why does the new food label format make it easier to reflect upon scientific information regarding diet and health

It is easy to identify the calories, serving, fats, added sugars,

what is the seventh day Adventist communities

Live longer on average • Men: 7 additional years • Women: 4½ additional years •Several key behaviors and lifestyle choices • Do not smoke • Rarely drink alcohol • Many are vegetarians or vegans • Emphasize fresh, minimally processed foods • Regularly consume nuts • Physically active • Healthy BMI

what are dietary sources of magnesium

Magnesium is present in small quantities in all food groups. Nuts, whole grains, and leafy greens are good sources. oatmeal, brown rice, quinoa, almonds, cashews

what is sodium

Major positively-charged ion in extracellular fluid • Functions: - Maintaining fluid balance - Regulating blood pressure - Transmitting nerve impulses - Contracting muscles - Involved in nutrient transport - Indirectly needed to maintain the body's acid- base balance and a stable pH

what do omega 3 fatty acids mean

May reduce symptoms of rheumatoid arthritis • May slow the progression of age-related macular degeneration • May reduce the risk of Alzheimer disease

What is the dietary guidelines for American overview

Overarching guidelines to steer the population toward a healthy eating pattern - 2015 and 2020 edition focuses more on eating patterns than on individual food groups or dietary components • Key Guidelines: - 1. Follow a healthy dietary pattern at every life stage. - 2. Customize and enjoy nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations. - 3. Focus of meeting food group needs with nutrient-dense foods and beverages and stay within calorie limits. - 4. Limit foods and beverages higher in added sugars, saturated fat, and sodium and limit alcoholic beverages.

what is potassium deficiency

Mild forms (common in the U.S.) - Increase risk of hypertension, stroke, and heart attacks • Severe depletion causes hypokalemia - Usually from excessive fluid loss through vomiting, diarrhea, use of diuretics, or kidney disorders - Fatigue - Muscle weakness - Abnormal heart rhythms - Increased calcium excretion - Reduced insulin production

what is iron

Most abundant trace mineral in the body • Crucial component of hundreds of enzymes and other proteins • Required for body processes including: - Energy metabolism - Antioxidant actions - Immune response - DNA synthesis • Important in reproduction, growth, and healing • Heme iron o Hemoglobin and myoglobin • Nonheme iron

how to find sodium in foods

Most of the sodium in our diet comes from prepared or packaged foods. You really have to read the Nutrition Facts label to find the sodium. Try to eat foods that have 5%DV (or less) of sodium.

Does the typical American diet align with recommended limits or goals of a healthy diet?

No Excessive amounts of energy-dense foods - Fat, sugar, and alcohol tend to increase energy density, - Fluid (water) and fiber tend to decrease energy density • Insufficient amounts of nutrient-dense foods

what are the diets and exercise certainly important and other factors also contribute to longer life

Nutrition • Legumes and nuts • Activity • Psychosocial factors • Social connectedness • Having a plan or purpose

What are the possible risks of an ultra processed diet

Processed and ultra-processed foods are of lower dietary quality in general. • Nutrients that were lower in processed and ultra- processed foods following adjustment for total energy intake included: n-3 PUFA, vitamins A, B12, C and E, Ca and Zn. Fiber would likely also be a concern. • Nutrients that were higher in energy-adjusted processed and ultra-processed foods compared with unprocessed foods included: Na, sugar and trans-fatty acids • This type of diet suggests risk of excess energy consumption (overweight) and deficiency of specific nutrients that could lead to lower bone-density, lower immunity, increased risk of inflammation and hypertension

what are the nutrient recommendations for seniors

Protein: slightly higher protein intakes (approximately 1.0 to 1.5 g/kg/day) in adults older than 65 years, consumption of plant proteins emphasized • Fluids: Added emphasis on getting enough • Calcium • Vitamin D

what is zinc recommendation

RDA for men ≥ 19 years = 11 mg • RDA for women ≥ 19 years = 8 mg • Recommended intake for vegetarians and vegans is twice as much • UL = 40 mg for men and women ≥ 19 years - Excessive intake can lead to: • Short-term symptoms: nausea, vomiting, diarrhea, and abdominal cramps • Longer-term effects: copper deficiency, reduced immune function, altered iron function, and lowered levels of HDL Since the body cannot store zinc, a regular daily intake is required to maintain adequate zinc status, although absorption does increase in the small intestine when intake is low. Because vegetarians absorb less zinc than nonvegetarians do, the Dietary Reference Intakes recommend that vegetarians and vegans consume twice as much zinc as do nonvegetarians.

what is potassium toxicity

Rare; likely only from supplement misuse • Symptoms - Low heart rate - Abnormal heart rhythm • Supplementation should be prescribed and monitored by a health care provider - FDA limits over-the-counter potassium supplements (including multivitamin/mineral pills) to less than 100 milligrams (2% of RDA of 4,700 milligrams) due to the risk of the side effects

what are long term benefits of exercise

Reduces the risk of heart disease, stroke, type 2 diabetes, osteoporosis, dementia, and certain cancers • Increased focus and attention • Lowers risk of premature death • Helps manage stress • Reduces anxiety and depression symptoms • Recent studies have demonstrated that moderate-intensity activity, such as jogging for as little as 10 minutes per day (most days of the week), slightly reduces the risk of cardiovascular disease and all-cause mortality, with additional exercise bringing greater benefits

what is zinc

Required for the function of more proteins in the body than any other mineral • Cofactor for more than 900 enzymes • Required for almost every essential process in the body, including: - Regulation of protein synthesis - Reproduction - Cell division - Growth and development - Immune responses - Neurological functions

what is fluoride

Role in cavity prevention by hardening and maintaining tooth enamel • Important in stabilizing bone structure • Obtain fluoride through water system (~74% of U.S.) and fluorinated dental products • AI for men ≥ 19 = 4 mg AI for women ≥ 19 = 3 mg - UL is 10 mg - Excess intake can cause fluorosis of teeth and bone -flecks, stains, pits on teeth

What is processed culinary ingredients

Substances extracted from foods or nature and used to prepare, cook, or season group 1 foods

what are the best diet choices for delay age-related disease

Sufficient but not excessive calories • Low in saturated fat • High in whole grains, legumes, fruits, and vegetables

what is a zinc deficiency

Symptoms - Impaired immune function - Appetite and weight loss - Delayed sexual maturation - Slowed growth - Severe deficiency can result in hair loss, diarrhea, infertility in men, and impaired neurological and behavioral functions • At-risk groups - Chronic alcohol abusers • Alcohol decreases absorption and increases excretion - Vegetarians • Phytates inhibit absorption - Elderly • Reduced intake and impaired absorption

what is structural roles in the body

The skeleton is an active organ made up of tissues and cells and lots of activity. • Calcium and phosphorus are the main components, but magnesium also plays a key role by contributing to strength and firmness of bones and teeth. Magnesium is essential for absorption and metabolism of calcium. • A matrix of protein, composed primarily of collagen, is the surface where you will find crystals of calcium/phosphorus. Magnesium makes up 1% of this bone matrix and is found on the surface of these crystals.

what is water balance: input must equal output

To remain in water balance, fluid input must equal fluid output. This figure shows the approximate amounts of water sources and losses for an average 20-year-old man who is sedentary and does not have extensive water loss from sweating. One of the reasons we need to drink fluids is because we lose water throughout the day and our bodies cannot store extra to fill the void. But how much water we need to drink depends on many factors.

what is water balance in the body

Two-thirds of water is intracellular • One-third of water is extracellular • Direction of movement depends on the concentration of solutes - Sodium, potassium, chloride are most important solutes - Water moves toward areas with greater concentration of solutes and lower concertation of water molecules

why is physical fitness not just for athletes

U.S. Department of Health and Human Services recommends adults participate in: - At least 2 hours and 30 minutes of moderate-intensity exercise per week or 75 minutes of high-intensity exercise per week - Muscle strengthening activities • Any amount of exercise is better than none - Even modest amounts can reduce risk of cardiovascular disease and type 2 diabetes • Lots of resources - Scientific 7-Minute Workout , based on journal article in ACSM: Klika, brett c.S.C.S., B.S.; Jordan, chris m.S., C.S.C.S., Nsca-cpt, acsm hfs/apt high-intensity circuit training using body weight, acsm's health & fitness journal: may/june 2013 - volume 17 - issue 3 - p 8-13 doi: 10.1249/fit.0b013e31828cb1e8 - YouTube • Yoga by Kassandra 10-minute Morning Yoga 30-day series • 15-minute workouts - dance, cardio, beginners, etc.

what is iodine excessive intake

UL = 1100 mcg • Excessive intake: - Can disrupt thyroid function - Cause some of same symptoms as deficiency • Goiter • Elevated TSH • Hypothyroidism

what are inadequate or excess water intake has adverse effects

Water intoxication = hyponatremia - Confusion - Nausea - Vomiting - Bloating - Swelling around the brain Deficiency = dehydration - Nausea - Dizziness - Elevated temperature - Concentrated urine

what are diverse functions of major minerals

Work in partnership with other minerals • Part of hormones and enzymes • Transmit nerve impulses • Maintain fluid balance • Support immune system • Act with enzymes as cofactors to facilitate chemical reactions

what are common nutrition related conditions in older adults

aged related macular degenration, dementia, sacropenia, impaired immune function, bacterial overgrowth, atrophia gastritis, osteoporosis, diverticulorisis

what is physical activity

any bodily movement produced by skeletal muscles, running, playing, brushing, teeth, vacuuming exercise: intentional physical exertion and promotes physical fitness

what are dietary sources of calcium

broccoli, spinach, Chinese cabbage mustard greens, almonds, tofu, peas, sardines, nonfat milk, cheddar cheese, yogurt

what are dietary sources of iodine

cheddar cheese, skim milk, beef chuck roast, tuna, egg., navy beans, shrimp, fish sticks, cod

how is energy stored

chemical bonds of glucose and fatty acids You can think of the energy in glucose and fat as the value of a gold brick: It's worth plenty of money, but you couldn't buy even a cup of coffee with it. By comparison, ATP is like bills and coins—it's the energy your cells can actually spend.

what is the socioeconomic factors of aging

isolation, poverty, difficulty purchasing and preparing food

what is the expansion of older age groups between 2015 and 2040

longer lifespans and aging baby boomer

what does happens with aging adults with calories

need fewer calories to maintain weight and power activities, but should emphasize nutrient-dense foods • Energy needs decrease with aging • Older adults are less physically active • Leads to reduced skeletal muscle mass (sarcopenia) • Physical activity can offset losses in muscle mass • Other nutrient needs remain similar to those of younger adults • The need for specific macronutrients and micronutrients does not decrease with aging (and may even increase because of other bodily changes). • As a consequence, older adults must make sure they consume a diet that is more nutritionally dense than the diet they may have eaten when they were younger. There is less room for empty calories.

what is hemoglobin

oxygen carrier in the bloodstream

what is myoglobin

oxygen supplier in muscle tissue

what factors play a role in aging

physiological factors, pathological factors, socioeconomic factors, psychological factors

what is pathological factors of aging

poor dental health, difficulty swallowing, illness, dietary restrictions, dementia, medications/GI symptoms

why is skeletal muscle mass important to recovery of illness and injury

recovery from illness and injury and for reducing risk of some chronic disease

what are the type of exercises

resistance, cardiorespiratory, neuromotor, flexibility