Cardio and MS changes (Staloch) Flashcards
What decreases with the MS system that occur as we age?
- Size of type 1 muscle fibers (less decrease than type II)
- Size of type II muscle fibers
- Fasting rate of mixed and myosin protein synthesis
- Muscle protein metabolism
- Peak anaerobic muscle power
- Elasticity of tissues - Results in decrease in ROM (more in shoulders)
- Vertebral disc heights
- Glycogen storage capacity, glycogen synthesis
- Bone mineral density - Increased osteoclastic activity
- Mm strength, power and endurance
- Mm mass (sarcopenia)
What increases in the MS system with aging?
- Mm fat
2. Mm connective tissue
What are documentation requirements for sarcopenia?
Criterion 1-low muscle mass PLUS
Criterion 2-low muscle strength OR
Criterion 3 –low physical performance
What decreases in the CV system with aging?
- Maximal aerobic capacity
- Maximal Heart Rate
- Maximal cardiac output, stroke volume, peak HR, max 02 consumption
- Endothelial reactivity – harder time dilating or constricting
- Maximal skeletal muscle blood flow
- Capillary density
- Vascular insulin sensitivity
- Heart Size
- End diastolic filling
- Compliance of large arteries
- Secretion and release of catecholamines – impact on HR
- Pacemaker cells in SA node—can lead to a slightly lower heart rate
- Sensitivity of baroreceptors leading to postural hypotension in response to stress
- Speed of red blood cell production in response to stress of illness
- HDL cholesterol
- Lioprotein lipase activity – enzyme that helps break down triglycerides
What increases in the CV system with aging?
- Prevalence of A-Fib, aortic stenosis and valvular disease as a result of - Left ventricular mass and wall thickness increases—the amount of blood the chamber can hold may actually decrease leading to heart filling more slowly; Thickening of valvular structures; Epicardial fat
- Heart rate and blood pressure response to submaximal exercise
- Peripheral vascular resistance (HTN)
- Total cholesterol, LDL cholesterol
What are the functional implications of CV changes?
- Lower HRmax
- Lower stroke volume and cardiac output
- Increased BP
- Increased cardiovascular disease
- Reduced blood flow and therefore reduced oxygen to the skeletal muscles
- Decreased VO2 max
- Reduced skeletal muscle oxidative capacity
- Reduced exercise capacity/ blunted exercise response
What decreases in the pulmonary system with aging?
- Vital capacity
- Tidal volume
- Vascular insulin sensitivity
- Maximal flow rates
- Respiratory muscle strength
- Lung Expansion
- Elastic Recoil
- Alveolar surface area up to 20%-leads to decrease in max O2 uptake
- Alveolar vascularity
- Number of Cilia - Leads to respiratory infection
- Alveoli tend to collapse sooner on expiration
- no change in TLC
What increases in the pulmonary system with aging?
- Stiffness of chest wall
- Number of mucus producing cells
- Residual volume (RV)
- Functional Residual Capacity
- Respiratory Rate
What are functional implications of pulmonary changes in older adults?
- Reduced vital capacity and maximal ventilatory capacity
- Reduced forced expiratory volume in 1 second (FEV1)
- Up to 20% increase in work of respiratory muscles
- Ventilation/perfusion mismatch
- More vulnerable to respiratory infections
- Body becomes less efficient in monitoring and controlling breathing
- Lower threshold for shortness of breath
What are MS responses to exercise adaptations from aerobic training?
- Increase in type IIA fibers
- Increase in cross-sectional area of type IA and type IIA fibers
- Increase in capillary density
- Increase mitochondrial enzymes
- Increased muscle capillaries
- Increased oxidative enzyme activity - increased ATP
- Increased muscle protein synthesis
- Decrease in type IIB fibers
- Decreased Lactate dehydrogenase activity – decreased m soreness
What are MS responses to exercise adaptations from strength training?
- Increased oxidative capacity
- Increased mitochondrial volume density
- Increased muscle mass/size
- Increased power of both type I and type II muscle fibers
- Increased endurance
- Increased functional strength
- Increased insulin action
- May help increase ROM
- Increased myofibrillar protein turnover
What are normal cardiopulmonary responses to exercise?
- A progressive decline in SBP - Possibly sharp decrease in SBP may occur due to venous pooling and should normalize in a supine position
- DBP should remain the same post exercise - A decrease could be an indicator of heart failure; An increase of > 10 mmHg during or after exercise may be associated with CAD
What are valid aerobic capacity tests to use in older adults?
- 2min WT - for those that cannot walk long durations (acute care, CHF, frail) - distance during the time
- 400m WT - elicits greater effort that 6MWT - time taken to complete
- 6min WT - most widely researched in mult pt pops - measure distance
- 2min step test - for those concerned with walking, space not available - # steps
- 3 min step test - higher fxning - recover HR
- seated step test - for low level frail adults and those who cannot stand/ walk
- 1 min STS - # STSs without hands
- treadmill 6MWT - not interchangeable with 6MWT
What are valid muscle performance tests to use in older adults?
- MMT
- Hand held dynamometer
- STS - 5x or 30s - norms only for no use of hands
- Grip strength - predictive of mortality, future disability, and postop complications
- arm curl test - 5# or 8# dumbbell - as many as they can for 30s
the application of exercise science to physical therapist exercise prescription; Developed to address how tissues, organs and organ systems adapt to varying levels of physical stress; Includes other factor that may modify level of stress as well as the response of the tissues to stress Changes in relative level of physical stress causes a predictable response in all biological tissue - Stress below maintenance level=decreased tissue tolerance to stress (atrophy), Maintenance levels=do not change tissue (no change), Stress that exceeds maintenance levels=increased tissue tolerance to stress (hypertrophy)
Physical stress theory
Principle of physical stress theory:
- Tissue must be exposed to a load not normally exposed to in order to improve function
- Applied to aerobic capacity, strength training, balance training and flexibility
- Must be individualized
- Applies to: intensity, duration, frequency and speeds
- Intensity must be sufficient to overload the cardiovascular, pulmonary, musculoskeletal and neuromuscular systems without overstraining them
Overload
