Activity Tolerance and Fatigue Flashcards
(108 cards)
1
Q
__________ _______ is defined as the process of energy expenditure for the purpose of accomplishing an effect.
A
physical activity
2
Q
________ or endurance, exercise involves the body’s ability to improve its use of oxygen for energy during prolonged strenuous exercise. It involves rhythmic changes in muscle length (contraction and elongation) during activities such as walking, running, bicycling, or swimming.
A
aerobic
3
Q
muscles that use oxygen more efficiently such that the body can do more work with less cardiac and respiratory effort, it does not promote significant increase in
A
muscle mass
4
Q
Evidence reveals multiple advantages for people who participate in sustained aerobic exercises, including _________ ______ _________
A
oxidative stress reduction
5
Q
___________ or resistance, exercise, sustained muscle contraction is generated against a stable load with no change in length of the involved muscle group or joint movement.
A
isometric
6
Q
weight lifting and repeated movement against low to moderate resistance, that improve overall muscle strength and tone and build muscle mass is
A
isometric
7
Q
true or false
both aerobic exercise and resistance training have similar effects on bone density, glucose tolerance, and insulin sensitivity.
A
true
8
Q
For weight control, _______ exercise is considered a calorie burner.
A
aerobic
9
Q
Resistance training assists the body in expending calories through an increase in what two things?
A
lean body mass and basal metabolism
10
Q
Considerable evidence suggests that ______ exercises increase tendon flexibility, improve joint range of motion, and enhance muscular performance.
A
stretching
11
Q
Exercise produces an increase in heart rate and stroke volume (amount of blood pumped with each heart beat), which in turn increases
A
cardiac output
12
Q
With anticipation of exercise, cardiovascular centers in the brain stem are stimulated to initiate an increase in ________ activity concomitant with an inhibition of _____________ mechanisms.
A
increase sympathetic
decrease parasympathetic
13
Q
Stimulation of the sympathetic nervous system produces an increase in _______ ______ and _______ _________
A
heart rate and cardiac contractility
14
Q
At the start of exercise, the heart rate increases immediately and continues to increase until a plateau is reached. This plateau, or steady-state heart rate, is maintained until exercise is terminated. Catecholamine release of _________ and _________ assists in maintaining the heart rate.
A
epi and NE
15
Q
Also contributing to the increased heart rate during exercise are mechanisms intrinsic to the heart. An increase in venous return stimulates right atrial stretch receptors that initiate an increase in heart rate, and an increase in ventricular filling stretches the myocardial fibers, resulting in a more forceful contraction and a more complete emptying of the ventricles with each beat through the
A
frank-starling mechanism
16
Q
Increased sympathetic activity constricts the resistance vessels, leading to an increase in _____ ________, and it dilates the capacitance vessels in the visceral circulation, leading to an increase in venous return to the heart and maintenance of the cardiac output.
A
blood pressure
17
Q
It is important to note that the vasoconstriction during exercise that is produced by sympathetic innervation and circulating catecholamines (i.e., epinephrine) does not occur in what three places?
A
active skeletal muscles
coronary circulation
brain
18
Q
With the onset of aerobic exercise, the ________ blood pressure increases largely due to an increase in cardiac output, whereas the ______ pressure remains relatively unchanged because of vasodilation and increased blood flow to the working muscles.
A
systolic increases
diastolic stays the same
19
Q
The increased systolic pressure that occurs in exercise along with a nearly constant diastolic blood pressure generates an increased
A
MAP
20
Q
The role of the respiratory system during exercise is to increase the rate of
A
oxygen and CO2 exchange
21
Q
With the increase in cardiac output, a greater volume of blood under slightly increased pressure is delivered to the pulmonary vessels in the lungs. This results in the opening of more pulmonary capillary beds, producing better ________ _________ and more efficient exchange of oxygen and carbon dioxide.
A
alveolar perfusion
22
Q
In addition to pulmonary perfusion being enhanced during exercise, pulmonary ventilation is increased, resulting in a more optimal ventilation–perfusion ratio. This response is controlled by ___________ —located in the brain stem, aorta, and carotid arteries—that monitor blood gases and pH.
A
chemoreceptors
23
Q
During exercise, decreases in blood oxygen and pH and increases in carbon dioxide stimulate these receptors, producing an increase in both the ____ and _____ of respiration.
A
rate and depth
24
Q
_______ _________ is defined as the ability of muscle groups to produce force against resistance.
A
muscle strength
25
_________ involves the range of movement of joints
flexibility
26
___________ _________ refers to the ability of the body or muscle groups to perform increased activity for an extended time.
muscle endurance
27
Skeletal muscle consists of two distinct types of muscle fibers based on differences in their size, speed, contractile properties, endurance, and metabolic characteristics: ______ slow-twitch (type I) and ______ fast-twitch (type II) muscle fibers.
red - slow - type 1
| white - fast - type 2
28
Both ________ and ________ influence the distribution of fast-twitch and slow-twitch fibers.
heredity and activity
Heredity appears to contribute to differences in muscle fiber composition, such that some people have considerably more fast-twitch than slow-twitch fibers, and others have more slow-twitch than fast-twitch fibers. This could determine, to some extent, the area of athletics for which a person is best suited.
29
The _____-twitch fibers, which are smaller, tend to produce less overall force but are more energy efficient. They are better suited biochemically to perform lower-intensity work for prolonged periods.
slow
30
Examples of exercising that uses ___-twitch fibers are long distance running, swimming, and cycling where endurance is desired.
slow
fatigue resistant and ideally suited for prolonged aerobic exercise or activity.
31
____-twitch fibers predominate in the large muscle groups such as the leg muscles.
slow
32
_____-twitch fibers are larger and better suited for high-intensity work, but they fatigue more easily. These fibers have high myosin adenosine triphosphatase (ATPase) activity, few mitochondria, low myoglobin concentration, and high glycolytic capacity, resulting in dependence on anaerobic metabolism to supply adenosine triphosphate (ATP) for energy.
fast
33
___-twitch fibers predominate during activities in which short bursts of intense energy are required, such as sprinting or weight lifting.
fast
34
People with _______ ______typically experience symptoms of breathlessness, exertional fatigue, and exercise intolerance resulting in atrophy of skeletal muscles. When these people engage in exercise, there is a shift toward using fast-twitch muscle fibers. This causes an early dependence on anaerobic metabolism and excessive intramuscular acidification that leads to increased fatigability.
heart failure
35
Increased blood flow to working muscles is achieved by relaxation of the arterioles and the precapillary sphincters. Chemical changes such as ________ oxygen and pH and ________ levels of potassium, adenosine, carbon dioxide, and phosphate contribute to the vasodilation during prolonged exercise and recovery from exercise
decreased o2 and ph
| increased K, adenosine, CO2, and phosphate
36
Another mechanism that increases blood flow to the working muscles is the diversion of blood from organs such as the ______ and ______ structures that are less active than the working muscles.
kidneys and GI
The amount of blood flow diverted from the visceral organs is proportional to the level of exercise, and as exercise is increased, more blood is diverted to working muscles.
37
“Trained muscles” have an increased number of _________ surrounding each muscle fiber that facilitates the delivery of oxygen to the working muscle cells during exercise. They are able to use oxygen more efficiently, probably because of enhanced enzymatic activity that increases oxidative capacity. The mitochondria appear to adapt by increasing the transport of oxygen and other substrates to the inner regions of the muscle fiber.
capillaries
38
The enzyme _____ ______catalyzes the transfer of the high-energy phosphate groups from ATP to creatine, forming creatine phosphate and adenosine diphosphate (ADP). When muscle contraction begins and ADP levels start to rise, CK catalyzes the transfer of a high-energy phosphate group back to ADP, thus forming new ATP molecules that can be used by the muscle for energy.
creatine kinase
39
During exercise, particularly aerobic exercise, the body uses its energy sources in a characteristic pattern. The first sources of energy are (3)
stored ATP, creatine phosphate, and muscle glycogen.
40
For intense, prolonged periods of activity lasting more than 40 minutes, aerobic metabolism and the use of (3) becomes essential
glucose, fatty acids, and amino acids
41
To supply the energy needed for increased activity, a person must consume a balanced diet and have adequate hydration. Although proteins are not used for energy sources during increased activity, they have an essential role in
building and rebuilding tissues and organs
42
Almost all the energy released from metabolic processes involved in muscle contraction is converted to
heat
43
Under normal resting conditions, the body is able to maintain its temperature within a set range. It does this by two mechanisms. The first mechanism used by the body to regulate temperature is to change blood flow to
skin
When the blood vessels of the skin dilate, warm blood is shunted from the core tissues and organs to the skin surface, where heat is lost more easily to the surrounding environment.
44
the second mechanism used by the body to regulate temperature during exercise is through
sweating.
the evaporation of sweat from the skin surface contributes to the loss of body heat.
45
As temperature regulation improves with training, the trained person begins to sweat sooner, often within 1 to 2 minutes of the start of exercise. Sweat production begins even before the core temperature rises, and a cooling effect is initiated soon after the start of exercise; the sweat produced is more ____ than that produced by a nontrained person.
dilute
Sweat normally contains large amounts of sodium chloride; production of a dilute sweat allows evaporative cooling to take place while sodium chloride is conserved.
46
During exercise, _______ ________ are shifted from the interstitial to the vascular compartment so that there is an increase in the amount of proteins in the blood. These proteins exert an osmotic force that draws fluid from the interstitial space into the vascular compartment. This contributes to an increase in vascular volume, which in turn is delivered to the working muscles and which also provides more efficient heat dissipation.
plasma proteins
47
During intense physical activity, blood flow is shunted away from the gastrointestinal tract toward the active skeletal muscles. As a result, gastrointestinal motility, secretory activity, and absorptive capacity are _________. This can result in heartburn or reflux, vomiting, bloating, stomach pain, and gastrointestinal bleeding. It may also cause cramping, urge to defecate, and diarrhea.
decreased
48
Light and moderate exercise can benefit people with inflammatory bowel disease and liver disease. Evidence suggests that physical activity improves ______ ______ and lowers the risk of _______ ______ and reduces the risks for diverticulosis, gastrointestinal hemorrhage, and inflammatory bowel disease.
improves gastric emptying
| reduces risk of colon cancer
49
Increased ______ levels stimulate increased fibrinolytic (i.e., breakdown of the fibrin strands in a blood clot) activity. Thus, regular strenuous exercise can result in increased fibrinolytic activity and a slowing of coagulation activity.
epi
50
A period of moderate-intensity exercise has been found to boost the immune system for several hours by producing an increase in circulating ______
WBCs including neutrophils and lymphocytes.
51
exercise increases activity of ________ ________ cells
natural killer
52
Chronic, intense, and exhausting exercise produces different effects on the immune system. Elevation in body temperature, cytokine release, and increased levels of various stress-related hormones (e.g., epinephrine, growth hormone, cortisol) may result in
temporary depression of body's innate immune defenses
53
Strenuous exercise alters mucosal immunity of
upper resp tract
This may explain why elite athletes are susceptible to illness, especially upper respiratory tract infections
54
Strenuous exercise also lowers the availability of the nonessential amino acid ______, which serves as an energy source for lymphocytes and macrophages and general immunocompetence.
glutamine
55
One method of assessing activity tolerance involves the administration of a screening tool in which participants describe their normal activities, their perceived level of activity tolerance, or their level of fatigue. An example of such a tool is the
human activity profile
56
This tool consists of nine statements that describe symptoms of fatigue (e.g., exercise brings on my fatigue; fatigue causes frequent problems for me; fatigue interferes with my work, family, social life). People are instructed to choose a number from 1 to 7 that best indicates their agreement with each statement. The tool is brief, easy to administer, and easily interpreted.
fatigue severity scale
57
________ is a procedure for determining physical performance capacity.
ergometry
The ergometer is a specific tool that imposes a constant level of work. A specified workload, expressed in terms of watts or joules per second, is imposed while the person performs the task. Two examples of ergometers include the bicycle ergometer and the treadmill ergometer.
58
Maximal heart rate is estimated by age. Tables of maximal heart rate by age are available, but as a general rule, the predicted maximal heart rate can be estimated by
220-age
59
___________ _________ can be viewed as not having sufficient physical or psychological energy reserve to endure or complete required or desired daily activities.
activity intolerance
60
_________ is the sensation that comes with having exhausted those energy reserves.
fatigue
61
true or false
Tiredness is relieved by a good night’s sleep, whereas fatigue persists despite sufficient or adequate sleep
true
62
_______ ________ is muscle fatigue with a rapid onset and duration limited to the duration of the exercise. The time it takes to develop acute fatigue at any level of exercise depends on conditioning.
acute fatigue
63
_______ _______ __________ is characterized by disabling fatigue and many nonspecific symptoms, including cognitive impairments, sleep disturbances, and musculoskeletal pain. The etiology is unknown, but it is associated with several chronic diseases such as fibromyalgia, depression, and irritable bowel syndrome.
chronic fatigue syndrome
64
_______ ________ has a rapid onset and is often defined as muscle fatigue associated with increased activity, or exercise, that is carried out to the point of exhaustion. It also is frequently associated with a viral or bacterial infection and may present with other systemic symptoms such as fever or malaise.
acute fatigue
65
____ _____ and ______ _______ are particularly sensitive indicators of activity tolerance or intolerance.
heart rate and blood pressure
66
There are several possible causes of ________ __________ such as hypothyroidism, anemia, heart disease, Lyme disease, fibromyalgia, lung disease, electrolyte dysfunction, tuberculosis, hepatitis, and cancer. It is one of the more common problems experienced by people with chronic health problems
chronic fatigue
67
_______ ________ occurs across a broad spectrum of disease states. It is a common complaint of persons with cancer, cardiac disease, end-stage renal disease, chronic lung disease, hepatitis C, arthritis, human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), and neurologic disorders such as multiple sclerosis, postpolio syndrome, and Parkinson disease.
chronic fatigue
68
Chronic fatigue is almost a universal phenomenon in people with
cancer
69
Cancer cells and the immune system appear to produce or express a number of cytokines with the potential for manufacturing many of the factors that contribute to fatigue particularly _________
interleukin-1 beta and tumor necrosis factor alpha (TNF-α)
70
______ is a condition of disabling fatigue of at least 6 months’ duration that is typically accompanied by an array of self-reported, nonspecific symptoms such as cognitive impairments, sleep disturbances, and musculoskeletal pain.
CFS
71
to diagnose CFS. there must be evidence of the concurrent occurrence of four of the following eight symptoms: sore throat, tender cervical or axillary lymph nodes, muscle pain, multijoint pain without swelling or redness, headaches, unrefreshing sleep, and postexertional malaise lasting more than ___ ______. The fatigue and concurrent symptoms must be of ____ _______ duration or longer.
24 hours
| 6 months
72
Theories of the pathogenesis of ____ include genetic expression, infections, stress and prior psychological disorders, a dysfunction in the hypothalamic–pituitary–adrenal axis, nutritional deficiencies, or increased oxidative and nitrosative stress
CFS
73
One of the most important findings in people with CFS is the complaint of fatigue. Often, the symptom of fatigue is preceded by a _____ or ______ _______. Frequently, the person describes the illness as recurring, with periods of exacerbations and remissions. With each subsequent episode of the illness, the fatigue increases.
cold or flu like illness
74
true or false.
A holistic approach to the treatment of CFS is essential. With proper treatment and support, most people with CFS still do not demonstrate improvement.
false - do improve
75
One of the most striking responses to assumption of the supine position during bed rest is the redistribution and change in
blood volume
76
A major cardiovascular manifestation of bed rest is an increased
workload on the heart
In the supine position, the normal cardiac output is 7 to 8 L/minute, compared with a cardiac output of 5 to 6 L/minute for a person in the standing position.
77
Bed rest also affects fluid balance. The increase in central blood volume results in an inhibition of ____ and _______, with a resultant water and sodium diuresis
ADH and aldosterone
78
After ___ to ___ days of bed rest, resumption of the upright position results in orthostatic or postural intolerance. Standing after prolonged bed rest results in a decrease in central blood volume. Decreases in stroke volume and cardiac output occur along with increases in heart rate and systemic vascular resistance. The signs and symptoms of postural intolerance include tachycardia, nausea, diaphoresis, and sometimes syncope or fainting.
3-4 days
79
Venous stasis in the legs results from a lack of the skeletal muscle pump function that promotes venous return to the heart. The skeletal muscle pump function decreases after assumption of the supine position, and there is mechanical compression of veins from the position of the lower extremities against the bed. This increased pressure can cause damage to the vessel intima, predisposing to
platelet aggregation and clot formation
80
The development of DVT is a major complication of bed rest. It is believed that three factors (often referred to as the Virchow triad) combine to predispose a person to DVT. These factors are:
1) . Stasis of venous flow due to inactivity of the skeletal muscle pumps
2) . A hypercoagulability state resulting from a decrease in vascular volume and an increase in blood viscosity and concentration of blood coagulation factors
3) . Vessel injury to the endothelium resulting from external pressure against the veins
81
The development of DVT also predisposes to the development of
pulmonary embolism
82
Assumption of the supine position produces changes in lung volumes and the mechanics of breathing. Respiratory complications such as a (4) are all possible outcomes if a person is lying supine and on bed rest for more than 24 hours.
telectasis, accumulation of secretions, hypoxemia, and pneumonia
83
In the supine position, breathing largely depends on the abdominal muscles rather than on movement of the chest cage. The ________ moves upward rather than downward, decreasing the size of the thoracic compartment, and chest and lung expansion are limited because of the resistance of the bed. As a result, the tidal volume and functional residual capacity are decreased, and the efficiency and effectiveness of ventilation are hindered
diaphragm
84
people on bed rest need to work harder to breathe, and consequently they take fewer deep breaths. If the person must be on bed rest, it would be better to put the person in a _____ position if he or she could tolerate it.
prone
85
poor fluid intake and dehydration may cause secretions to become thick and tenacious. Stasis of secretions provides an ideal medium for bacterial growth and increases the risk for development of pneumonia. Reduced activity and the recumbent position inhibit coughing, foster the retention of secretions, and adversely affect secretion distribution in the airways. _______ and ________ are necessary to prevent accumulation of secretions and airway collapse.
coughing and deep breathing
86
Prolonged bed rest affects the renal system by altering the composition of body fluids and predisposing to the development of
kidney stones
87
Prolonged bed rest causes muscle atrophy, protein breakdown, and decalcification of bone with the development of what two electrolyte imbalances?
hypercalcemia and hyperphosphatemia
increases risk for calcium stones
88
inadequate emptying of the bladder while the person is in the supine position can lead to what two things?
incontinence and UTI
89
_______ ________ can lead to loss of approximately one eighth of the muscle’s strength with each week of disuse.
disuse atrophy
90
true or false
The larger and the better trained the muscle, the slower the loss of muscle strength and the slower the deconditioning occurs.
false
faster loss of strength and quicker deconditioning
91
Muscle atrophy and disuse not only contribute to wasting and weakening of muscle tissue, they play a role in the development of joint
contracture
A contracture is the abnormal shortening of muscle tissue and connective tissue, rendering the muscle highly resistant to stretch. Contractures occur when muscles do not have the necessary strength to maintain their integrity (i.e., their proper function and full range of motion).
92
consequence of prolonged immobility and bed rest for the musculoskeletal system is the loss of bone __________
mineralization
93
According to the _______ law, the density of bone is directly proportional to the stress placed on it.
wolff
94
__________ function in building the osseous matrix of the bone
osteoblasts
95
_________ function in the breakdown of the bone matrix
osteoclasts
96
During immobility and bed rest, the building of new bone stops, but the osteoclasts continue to perform their function. When bone experiences a lack of stress, as occurs with bed rest or immobility, there is a greater amount of bone resorption than bone formation, resulting in loss of bone mineralization or _______ _________
disuse osteoporosis
97
true or false
permanent loss of bone mass and osteoporosis can result from long-term immobilization.
true
98
The best measure to prevent the occurrence of osteoporosis is to begin ______ _________ exercises as soon as possible
weight bearing
99
The basal metabolic rate _____ in response to decreased energy requirements of the body. Anabolic processes are slowed, and catabolic processes become accelerated, which leads to nutritional imbalance with a negative nitrogen balance. People in a negative nitrogen balance experience nausea and anorexia, which contribute to the catabolic state.
drops
100
A major hormonal change that occurs with prolonged periods of immobility is an increase in the serum _____ due to the hypercalcemia that occurs secondary to bed rest.
PTH
101
The person on bed rest also experiences an impaired responsiveness to the actions of
insulin ---> hyperglycemic and hyperinsulinemic state
102
The immune system also is subject to physiologic changes associated with bed rest including an increase in IL-1, IL-6, and TNF-α production. An increase in these mediators has been associated with
hyperinflammatory response and tissue injury
103
Loss of appetite, slowed rate of absorption, and distaste for food combine to contribute to nutritional ____________ in prolonged bed rest
hypoproteinemia
104
during bed rest, the large surface area of the skin bears weight and is in constant contact with the surface of the bed. Constant pressure is transmitted to the skin, subcutaneous tissue, and muscle, especially to those tissues over bony prominences. This constant contact causes increased pressure and impairs normal capillary blood flow, which interferes with the exchange of nutrients and waste products. the patient is at increases risk for development of
tissue ischemia --> necrosis
| pressure ulcers
105
During the first 3 days of bed rest, one of the first changes to occur is a massive _____
diuresis
106
By days 4 to 7, there are changes in the hemolytic system. Fibrinogen and fibrinolytic activity increase, and clotting time is prolonged. The cardiovascular system responds with a decrease in _____ and _____
CO and SV
107
Additional effects on the hemolytic system are observed on days 8 to 14. Red blood cell number is _____, and the phagocytic ability of leukocytes is _______.
RBCs decreased
| phagocytic ability decreased
108
There is a decrease in lean body mass, and after 15 days of bed rest, _________ and hypercalciuria occur.
osteoporosis
