Flashcards in Bergdahl- Chapter 31 and 32 Deck (62):
how does exercise affect the amount of medication one has to take ?
moderate exercise reduces the level of diabetic, hypertensive, and cholesterol medication
what is the pathophysiology of coronary heart disease ?
degenerative changes in tunica intima or inner lining of the larger arteries that supply the myocardium
basically damage to arterial walls due to a immunologically mediated inflammatory response to injury (smoking, hypertension, etc)
how does heart disease relate to cholesterol ?
1/2 of CHD patients have normal or near-normal cholesterol levels
what is a crucial component in the genesis of atherosclerosis ?
what are 3 things to include in diet to favorably affect cholesterol and lipoprotein levels ?
1) water-soluble fibers
2) more polyunsaturated fatty acids
3) more omega-3 fatty acids and less trans fatty acids
how does a single exercise session produce changes in lipids ?
only transient changes
how do multiple exercise sessions produce changes in lipids and cholesterol ?
small reductions in LDL
effect on HDL
no effect on cholesterol
how does exercise stimulate the immune system ?
Regular exercise may stimulate the immune system to inhibit agents that facilitate arterial disease
what does homocysteine do ?
Homocysteine, a highly reactive, sulfur-containing amino acid, causes blood platelets to clump, fostering blood clots and deterioration of smooth muscle cells that line the arterial wall
Numerous conditions are linked to high homocysteine levels: Heart attack, stroke, dementia, venous thrombosis, osteoporosis, recurrent early miscarriage, birth defects, premature delivery, low birth weight
what is the most important modifiable CVD risk factor
Smoking is the single most important modifiable and preventable cardiovascular disease risk factor and one of the strongest predictors of premature CHD
what kind of exercise would you not prescribe someone with hypertension / kidney failure ?
resistance training, it would increase BP too much
what kind of exercise recommendation would you give someone who has a right side blood problem (bad venous return)?
blood pooled in legs, needs to lie down in exercise
what are 2 ways aerobic exercise may lower BP ?
decreases by 6-10 mmHg in those previously sedentary
1) reduced SNS decreases peripheral resistance to blood flow
2) altered renal function facilitates kidney's elimination of sodium, reducing fluid volume
what effect does long term resistance training have on blood pressure ?
even if BP goes up during exercise, doesn't long term elevate it
what is angina pectoris ?
chest pain, occurs in 30% of initial manifestations of CHD
inadequate coronary blood flow
what is the cause of a myocardial infarction ?
sudden insufficiency in myocardial blood flow, usually from coronary artery occlusion
what is a transient ischemic attack ?
precursor for something worse
develops when you cant get enough O2 in heart, like due to vascular occlusion
what is congestive heart failure ?
when the heart can't pump adequately to meet other organ needs
can lead to kidney failure
what are the three causes of congestive heart failure ? what does this produce ?
2) intrinsic myocardial disease
3) structural defects
gives a LV with a low ejection fraction and failure to increase HR with exercise
what is an effective treatment for congestive heart failure ?
what kind of exercise to treat CHF ?
40-60% VO2peak (light to somewhat hard)
exercise duration can increase to 20-40 min 3x/week
what is stenosis ?
narrowing that prevents heart valves from opening fully
what is insuffiency ?
heart valve closing improperly, blood moves back into chamber
what is prolapse ?
enlarged valve in mitral valve bulges backwards into left atrium during ventricular systole
what is dysrhythmia ?
affects the heart's electrical function
what should be included in screening for participation ?
1) exclude people with contraindications
2) identify people who need in depth eval due to age, symptoms, etc
3) identify people with clinically significant disease
what is ACSM low risk ?
asymptomatic with 0 or 1 risk factors
what is ACSM moderate risk ?
more than 2 risk factors
what is ACSM high risk ?
more than one sign or symptom of CV/pulmonary disease
what are radionuclide studies ?
injecting radioactive isotope into circulation in rest/exercise
what are pharmacologic stress tests?
they benefit individuals unable to undergo routine exercise stress tests
receive intravenous drug infusion every 3 minutes, and then look for changes in wall motion abnormalities, coronary perfusion limitations
what is cardiac catheterization ?
catheter inserted in a vein or artery, passes through heart to sample blood and assesses pressure differentials within chambers
what is coronary angiography ?
radiography that images coronary circulation by injecting a dye that flows into vasculature
is the gold standard for assessing coronary blood flow
cannot be applied during exercise
cannot evaluate blood flow within portions of the myocardium
what is echocardiography ?
pulses of reflected ultrasound assessing the functional and structural characteristics of the myocardium
(diagnose heart murmurs, lesions, defects)
what is a CT scan ?
10 min non invasive electron CT beam to assess calcium deposition within plaque in coronary arteries
to see how to treat blood lipid abnormalities and other CHD risk factors
what provides a reliable, quantitative index of someone's functional impairment ?
graded exercise stress test
what are 5 absolute contraindications for graded tests ?
1) ECG suggests acute cardiac disease
2) recent complicated MI
3) unstable angina pectoris
4) uncontrolled ventricular arrhythmias
5) uncontrolled atrial arrhythmias that compromise cardiac function
can an acute CHF patient do a graded test ?
can a 3rd degree AV block with a pacemaker do a graded test ?
what is the BP that is a relative contraindication for stress test ?
what are 6 exercise induced indicators of CHD ?
1) angina pectoris
2) ECG abnormalities- insufficient myocardial oxygen supply shown by significant ST segment depression which means there is a severe obstruction in 1+ coronary arteries
3) cardiac rhythm abnormalities
4) hypotensive exercise response
5) hypertensive exercise response
6) abnormal HR response
what does resistance training do in cardiac rehab ?
it's good, restores muscles, promotes FFM, increases glucose tolerance and insulin sensitivity
is it better to combine resistance and aerobic training for heart patients
yep ! more pronounced adaptations
what are 7 contraindications to resistance exercise for cardiac patients ?
1) unstable angina
2) uncontrolled arrhythmias
3) LV outflow obstruction
4) recent history of CHF
5) severe valvular disease
7) poor LV function
what is a contraindication to resistance training in exercise with an exercise capacity below 5 METS
anginal symptoms or ischemic ST segment depression
what should cardiac patients use in resistance training ?
light resistance (bands, pulleys, cuffs)
how many weeks should a MI patient wait before starting resistance training ? before starting barbells and machines ?
what is the volume and intensity needed for cardiac patient resistance training ?
1 set 10-15 reps RPE 11-14
8-10 different exercises
2-3 days/ week
what are 5 ways 1h physical activity daily reduces tumor formation ?
1) lowers circulating levels of blood glucose and insulin
2) increases corticosteroid hormones
3) increases cytokines
4) augments insulin-receptor expression in T cells
5) promotes interferon production
how does regular physical activity prevent tumor formation ? (4 ways)
1) glycogen synthesis
2) leukocyte function
3) improves ascorbic acid metabolism
4) beneficial effects on provirus or oncogene activation
why is it wrong for cancer patients to do high intensity sport ?
they're too tired, + it will stimulate angiogenesis, which will supply more oxygenated blood to tumor cells
6 risk factors for breast cancer
1) family history
2) personal cancer history
3) first menstrual period early
4) menopause late
5) first child born after 30 or no child
6) high fat diet
what is the difference between obstructive and restrictive pulmonary disease ?
obstructive : obstruct airflow (asthma, COPD)
restrictive: reduction in ventilation, decreased, less compliance of lung
what are the intensity and duration recommendations for exercise for patients with moderate lung disease ?
intensity no more than 75% of ventilatory reseve
what kind of exercise prescription for patients with severe lung disease ?
symptom-limited walking speed and distance
eg resistance training of ventilatory musculature through a positive airway pressure device or aerobic training
what is asthma characterized by ?
hyperirritability of pulmonary airways
what helps prevent asthma attacks during exercise ?
a warm up
what is a stroke ?
reduction in brain's blood flow from ischemia or hemmorrhage
what kind of exercise is ideal for MS patients ?
climate controlled area that provides stable temperatures, level surface, rest frequently
3x/week for minimum 30 min (10 min periods)
what movements are recommended for PD patients ?
slow, controlled movements that are functional
what is the main symptom of renal disease ?
retention in the blood of waste products normally excreted in urine