Chapter 14: Exercise and Special Populations Flashcards
General Characteristics of Coronary Artery Disease (CAD) and the contributions of Atheroscerosis, Dyslipidemia, and Physical inactivity
- aka atherosclerotic heart disease
- characterized by a narrowing of the coronary arteries that supply the heart muscle with blood and oxygen-the narrowing is an inflammatory response within the arterial walls resulting from an initial injury (due to high blood pressure, elevated levels of low-density lipoprotein -LDL-, cholesterol, elevated blood glucose, or other chemical agents such as those produced from cigarettes) and the deposition of lipid-rich plaque and calcified cholesterol
- heart attacks (or myocardial infarctions) or the release of thrombin substances (blood clotting) can be the result
- Atherosclerosis is the underlying cause and peripheral vascular diseases (manifestations of it include angina, heart attack, stroke, and intermittent claudication)
- Dyslipidemia (blood lipid disorder) also greatly contributes to it. Estimated that about 15.4 million Americans have CAD
- Inactivity is a big risk of getting this-people participating in moderate amounts of exercise have a 20% lower risk, while those undertaking higher amounts of exercise have a 30% or more reduction in the risk of developing it
The role of exercise in treatment and prevention of CAD
-progressive physical activity reduces the mortality and morbidity among patients with CAD. It is essential. Being inactive to “recover” will increase the risk of more blood clots, muscle wasting etc.
CAD Risk Factors
Clients with low risk:
-an uncomplicated clinical course in the hospital
-no evidence of resting or exercise induced ischemia
-functional capacity great than 7 METs (metabolic equivalents) three weeks following any medical event or treatment that required hospitalization
-normal ventricular function with an ejection fraction greater than 50%
-no significant resting or exercise induced arrhythmias (abnormal heart rhythms)
Abnormal signs/symptoms:
-angina
-dyspnea
-lightheadedness or dizziness
-pallor
-rapid heart rate above established targets
General Characteristics of Hypertension and the contributions of Age, Prehypertension, Diet, Physical inactivity, Antihypertensive medications
- one of the most chronic diseases in the US, aka “Silent Killer”
- one in three US adults have high blood pressure, defined as having systolic blood pressure (SBP) greater or equal to 140 mmHg or diastolic blood pressure (DBP) greater than or equal to 90 mmHg or taking antihypertensive medication
- just over 37% of US pop aged 20 years or older have prehypertension (untreated SBP of 120 to 139 mmHg or an untreated DBP of 80 to 89 mmHg
- prehypertensive individuals have twice the risk of developing high blood pressure compared to those with normal values
- Approx. 69% of people who have a first heart attack, 77% who have a first stroke, and 74% who have CHF have blood pressure higher than 140/90 mmHg (it’s estimated that each 20 mmHg rise in SBP or 10mmHg rise in DBP doubles the risk of developing cardiovascular disease
The role of exercise in the treatment of hypertension
- regularly performing 150min of exercise per week is shown to reduce SBP by an average of 2 tp 6 mmHg with the greatest reductions occurring in hypertensive adults
- has an acute post-exercise on both SBP and DBP (related to peripheral vascular resistance that is not compensated for by an increase in cardiac output and can persist for up to 22 hours
- both prehyper and hyper pees should participate in 30min or more of exersie at least 5 times a week(walking swimming, using ergometers and great and should be supplemented with resistance training-should avoid isometric exercise and tach/emphasize appropriate technique and breathing-circuit training utilizing low to moderate resistance and high reps are great as opposed to heavy lifting)
Magnitude of post-exercise hypotension (PEH)
post-exercise hypotension (PEH) can be of magnitude of 15 and 4 mmHg for both BPs, and emphasizes the potential benefits of daily activity
General Characteristics of Hypertension and the contributions of Diet, Physical inactivity, Antihypertensive medications
- aka silent killer, one of the most prevalent chronic diseases in US, 1 in 3 adults have high blood pressure (systolic BP greater than or equal to 140 mmHg or a DBP over or equal to 90 mmHg or those who take antihypertensive meds), just over 37% of US 20 yo or older are prehypertensive (untreated SBP of 120-139 or untreated DBP of 80-89)
- sodium reduction, reduced fat intake, and alcohol intake help
- regularly performing 150min of exercise per week has been consistently shown to reduce SMP by average of 2-6 mmHg, exercise also has an cute post-exersie effect on both SBP and DBP
- post exorcise hypotension can be of equal magnitude of 15 and 4 mmHg for SBP and DBP
- both prehyper and hyper peeps should exercise 30 min five days a week at least (aerobic activities and supplemented with resistance-should avoid isometric exercise and should mostly focus on technique and breathing)
- circuit training using low to moderate resistance and high reps, as opposed to heavy lifting, is a great choice
- Medications: beta blockers and calcium channel blockers can alter HR response and cause orthostatic hypotension and PEH (clients should be taught about RPE, with gradual and prolonged cool-down period); those on diuretic meds need to be extra hydrated, especially in warmer environments
- should always measure the pre and post workout BP; exercise should be stopped if SBP or DBP rise to 250 mmHg or 115 mmHg or if SBP fails to increase with increasing workload or drops greater than or equal to 20 mmHg; yoga and tai chi are great, as well (except avoid isometric muscle contractions and inverted positions (head below level of heart)
- Examples of exercises: low impact endurance training (walking, cycling, swimming, ergometers should be primary-significant isometric components should be avoided), low resistance and high number of reps, as in circuit training, intensity should be lower (just as effective, if not more effective than high intensity), duration- gradual warmup and cool down lasting longer than 5min, gradually increase total duration to as much as 40-60min (can be continuous or intermittent-each section performed at a minimum of 10min and a total of 30-60min for each day), four to seven days a week, daily is advised
Stroke:
- Types
- Risk factors
- Disability after stroke
- Warning signs of stroke
- Types
- ischemic stroke: when blood supply to the brain is cut off
- hemorrhagic stroke: when a blood vessel in the brain bursts (80% are ischemic, t-PA must be administered within the initial three hours of the stroke to prevent significant damage or reduce it) - Risk Factors
- high blood pressure
- smoking
- heart disease
- previous stroke
- physical inactivity
- transient ischemic attacks (TIA)- momentary reductions in oxygen delivery to the brain, possibly resulting in sudden headache, dizziness, blackout, and/r temporary neurologic dysfunction - Disability
- can dramatically reduce quality of life
- can rob the ability to speak and the movement of facial, arm, and leg muscles
- can cause metabolic disorders (like impaired glucose tolerance and type 2 diabetes) and significantly increase risk of recurrent stroke and myocardial infarction- these are typically worsened with lack of physical activity - Warning signs
- sudden numbness or weakness of face, arms, or legs
- sudden confusion or trouble speaking or understanding others
- sudden trouble seeing in one eye or both
- sudden walking problems, dizziness, or loss of balance and coordination
- sudden severe headache with no known cause
Stroke:
- Role in exercise in treatment and prevention
- Impact of exercise in cardiovascular disease risk for stroke patients
rehabilitation focus on optimizing basic basic activities of daily living skills (balance, coordination, and functional independence); improved functionality has come from results of various exercise modalities like bicycle ergometer, water exercise, and weigh-supported treadmill exercise as well as gait, balance, and coordination activities
; exercise has been shown to reduce overall risk of CAD (SBP, lipid profiles, insulin sensitivity, glucose metabolism, and body composition), recurrent stroke, and fibrinolytic activity (system responsible for dissolving blood clots)
-Exercise examples: guidelines must come from physical, occupational, and/or recreational therapist; activities vary depending on each condition (cycle ergometers, walking/treadmill training, water exercise, and other exercise classes can be modified); activities that include balance and coordination can also be helpful
1. Mode-walking, stationary bike, recumbent bicycling, upper extremity ergometers, and water exercise; balance exercises and light resistance should be implemented
2. Intensity: light to moderate depending
3. Duration: should begin with shorts bouts of exercise (3-5min) and gradually build to 30min over time (should consider using intermittent exercise with rest periods as needed
4. Frequency: preferably 5 days a week, however some should begin with three and work their way unto five
* (RPE 4 or 5)
Peripheral Vascular Disease:
- Risk factors
- Peripheral artery occlusive disease (POAD)
- Peripheral Vascular occlusive disease (PVOD)
- Claudication pain and the use of subjective grading scale for PVD
*it’s caused by the atherosclerotic lesions in one or more peripheral arterial and/or venous blood vessels and is an important medical concern because of high risk of concomitant coronary and cerebral artery disease
1. Risk Factors
-hyperlipidemia
-smoking
-hypertension
-diabetes
- family predisposition
-physical inactivity
-obesity
-stress
(smoking and diabetes are most important)
2. PAOD: results from atherosclerosis of arteries in lower extremities (most common sites are in abdominal aorta and the iliac, femoral, popliteal, and tibial arteries); consequently, blood flow distal to lesion is reduced, significantly impacting ambulation
3. PVOD: characterized by muscle pain caused by ischemia, or lack of blood flow to the muscle
4. (this pain is usually the realist of spasms or blockages and is referred to as claudication-most claud is brought on by physical activity, but some with more severe cases can have it as rest); the pain associated with PVOD is described as a dull, aching, cramping pain, and is usually reproducible at a given exercise workload (many who have it can only walk a limited distance before needing to rest)
Peripheral Vascular Disease:
- The role of exercise in the treatment and prevention
- Impact of exercise in CVD risk for PVD patients
- shown to improve ambulation distances in peeps with PVD (changes in blood viscosity and capillary and mitochondrial density, along with increases in oxidative and glycolytic enzymes, all of which improve oxygen utilization
- helps to lower overall risk for CVD patients in addition to improving blood flow and overall cardiovascular endurance
*guidelines for exercise should come from physician
Exercise examples: walking (to the point of intense pain -Grades II and III- before stopping; then the client rests until the pain subsides, then they repeat it), this should be repeated for a total of 20-30min with gradual progression to 30-60min sessions (initial workload intensity should stimulate claudication pain within 2-6min of walking, when 8-12min of continuous walking can be tolerated, consider increasing the walking pace or progressing the total activity time), other low intensity, non-weight bearing activities can also be helpful, light upper extremity resistance training is also good with moderate intensities (RPE 4 or 5) and are taught lifting technique
-proper footwear is important, should not exercise in cold air or water to reduce the risk of vasoconstriction
-Exercise examples: - Mode: nono-impact endurance exercise such as swimming, cycling, and other ergometer use, may allow for longer and higher intensity exercise; can recommend weight bearing activities such as walking that are shorter in duration and lower in intensity with more frequent rest periods, to improve walking distance and delay pain onset
- Intensity: for aerobic, low to moderate intensities depending; walking is carried out until intense pain, can gradually increase intensity once there is improvement
- Duration: longer and more gradual warmup and cool downs (longer than 10min), gradually increase total duration to 30-60min depending
- Frequency: daily is recommend, as functional capacity improves, can be reduced to 4-5 days a week
Dyslipidemia:
- Primary lipoproteins
1. Low-Density lipoprotein (LDL)
2. Very low-density (VLDL)
3. High-density (HDL)
4. Non-HDL cholesterol (non-HDL)
- elevated levels of total cholesterol and LDL cholesterol are well-recognized as lipid parameters with the highest correlation to CVD along with suboptimal levels of HDL cholesterol and elevated levels of triglycerides
- cholesterol travels through the body attached to a protein, referred to as a lipoprotein
1. major carrier of cholesterol in the circulation, containing 60-70% of the body’s total serum cholesterol. it’s frequently referred to as the “bad” cholesterol because of its role in atherogenesis, the early stages of atherosclerosis
2. the major carrier of triglyceride, contains 10-15% of the body’s total serum cholesterol. Triglyceride is a major form of fat the tends to be associated with low levels of HDL and elevated levels of LDL
3. often referred to as “good” cholesterol, produced in the intestine and liver and normally contains 20-30% of the body’s total cholesterol, HDL levels are inversely correlated to CAD, meaning that the higher the level of HDL, the lower the risk of developing CAD
4. defined as total cholesterol minus HDL, or the sum of the LDL, VLDL, and intermediate density lipoprotein (IDL), its strongly associated with the development of CVD and its levels appear to be equal or better than LDL levels at identifying atherogenic particles
Dyslipidemia:
2002 National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) Classification of LDL, total cholesterol, HDL cholesterol, and triglycerides
~ATP III Class of LDL, TC, and HDL~ -LDL Cholesterol- Optimal: <100 Near optimal: 100-129 Borderline high: 130-159 High: 160-189 Very high: >_190
-Total Cholesterol-
Desirable: <200
Borderline high: 200-239
High: >_240
-HDL-
Low: <40
High: >_60
~Class of Tri~ Normal: <150 Borderline high: 150-199 High: 200-499 Very high: >_500
Dyslipidemia: Diet and Exercise effect, sample exercise
- modifications of both help manage high serum cholesterol and triglyceride levels, and are particularly effective in elevating low HDL levels
- Aerobic exercise…
- may reduce LDL cholesterol by 3.0 to 6.0 mg/dL on average
- May reduce non HDL cholesterol by 6 mg/dL on average
- Has no consistent effect on TG
- Has no consistent effect on HDL cholesterol - Moderate-intensity resistance training (70% 1-RM, three days a week, nine exercises performed for three sets and 11 reps) may reduce LDL cholesterol, TG, and on-HDL by 6mg/dL to 9mg/dL on average and has no effect on HDL cholesterol (biggest impact on lipid profiles is made when there is a decrease of body fat through nutrition)
~Exercise Sample~
- Mode: aerobic (like walking, jogging, cycling, or swimming) are good unless other health conditions interfere; resistance training twice a week using light to moderate weights at 10-12 reps may provide additional benefit
- Intensity: Clients should begin at a low to moderate intensity with a focus on duration, especially over weight clients. Some may be able to progress to short bouts of vigorous-intensity exercise, depending on medical history and overall condition
- Duration: depending on client status, workouts should begin at 15min and build up to 30-60min per day (goal: total of 150-200min each week)
- Frequency: five days a week is appropriate
Diabetes:
- Definition
- Manifestations of diabetes (type 1, 2, and gestational)
- a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both
- T1: aka-insulin-dependent diabetes mellitus (IDDM) develops when the body’s immune system destroys pancreatic beta cells that are responsible for producing insulin, can occur at any age, most frequent in children and young adults, require insulin through injections or a pump to regulate blood glucose levels, in adults T1 accounts for 5-10% of all diagnosed cases of diabetes
- T2: non-insulin dependent diabetes mellitus (NIDDM), most common (90-95% of all diagnosed cases, initially presents as insulin resistance in which the cells do not use insulin properly, as demand for it rises, pancreas gradually loses its ability to produce it, combo of insulin resistance ad impaired insulin leads to frequent states of hyperglycemia, initial treatment usually includes weight loss, diet modification, and exercise, about 75% are obese or have a history of it , many are placed on oral and (sometimes) injectable medications
- Gestational: a form of glucose intolerance that occurs during pregnancy, of the 4million women who give birth every year in the US, approx. 7% get this, its increasing as obesity and older age pregnancy is becoming more common, higher risk if there’s a family history of if you’re of a particular nationality (Hispanic, Native American, South or East Asian, African American, or Pacific Islands descent), women who have this are at higher risk for gestational hypertension, preeclampsia, and C-section delivery, and have a sevenfold increased risk of developing diabetes later in life
Diabetes: Signs/Symptoms
T1: excessive thirst and hunger, frequent urination, weight loss, blurred vision, and recurrent infections, elevated blood glucose level (hypoglycemia)
Diabetes: Chronic health problems associated with it
higher risk at developing heart disease, stroke, kidney failure, nerve disorders, and eye problems
Diabetes: Benefits of Exercise
- T1: role of exercise in controlling glucose levels in type 1 has not been well demonstrated, however-can improve their functional capacity, reduce their risk for CAD, and improve insulin-receptor sensitivity, more about having positive life behavior with multiple benefits rather than a cure
- T2: substantial benefits including prevention of CAD, stroke, peripheral vascular disease, and others, shown to improve lipid profiles and hypertension fibrinolysis and reduce elevated body weight
Diabetes: Exercise Routine Sample
- Mode: can include walking, cycling, swimming, and recreational sports, depending on client’s age and condition, essential to gradually warmup and cool down, twice a week resistance training i good for those without complications using 8-10 exercises at 8-12 reps, clients should monitor blood glucose before and after exercise
- Intensity: should train at moderate intensity (RPE of 5-6), for type 1 and 5-7 for type 2
- Duration: T1- should gradually work up to 30min or more per session, while 40-60min is recommended for T2
- Frequency: 5-6 days a week is good for most, initial goal is to establish a regular pattern of exercise then gradually progress to higher levels of intensity
Metabolic syndrome:
- cluster of conditions that constitute the criteria for MS
- lifestyle interventions recommended as initial strategies for the treatment of MS
- characterized by: abdominal obesity, atherogenic dyslipidemia, increased blood pressure, insulin resistance, prothrombotic state, and pro inflammatory state, identified as the presence of three or more of the following…
- Elevated waist circumference (Men: >= 40in, Women: >=35inches)
- Elevated triglycerides (>=150mg/dL)
- Reduced HDL cholesterol (Men: <40 mg/dL, Women: <50mg/dL)
- Increased blood pressure (>=130/85 mmHg)
- Elevated fasting blood glucose (>=mg/dL) - weight loss, increased physical activity, healthy eating, and tobacco cessation
Metabolic syndrome:
- Role of exercise in treatment and prevention
- Impact of obesity on the performance of exercise for individuals with MS
- those who are inactive are much more likely to get it- not surprising because it has shown to help prevent hypertension, insulin resistance, obesity,, elevated lipids, and low HDL, level of cardio has been shown to independently influence the risk of premature mortality in people with increased body weight and/or the presence of MetS
- BMI of >=25 kg/m^2 and >=30kg/m^2, exercise must adhere to obesity guidelines, additional factors such as underlying CAD, hypertension, and dyslipidemia, and others should be evaluated before exercise
Metabolic syndrome: Sample Exercise Routine
- Mode: should begin with low-impact actives (walking, elliptical, low-impact aerobics), consider using non-weight-bearing activities (like water exercise and cycling) for those who are obese or have musculoskeletal challenges, twice a week resistance is appropriate and beneficial for those who are without complications using 8-10 exercises at 8-12 repetitions, also important to incorporate an active lifestyle (stairs, gardening, housework, and other recreational activities)
- Intensity: RPE of fairly light to somewhat hard (5-6 or7), being at low intensity and gradually progress as conditioning improves and weight loss occurs, should initially work on increasing duration rather than intensity to optimize caloric expenditure
- Duration: should target 200-300min a week using gradual progression, intermittent short exercise bouts (10-15min) throughout the day may be easer and more beneficial for some in maximizing weight loss
- Frequency: at least 3-5 days a week, preferably daily
Asthma:
- Characteristics (symptoms and triggers)
- Exercise induced asthma (EIA)
- its a chronic inflammatory disorder that is characterized by variable and recurring symptoms such as shortness of breath, wheezing, coughing, and chest tightness (typically set off by environmental factors like allergens, (animal dander, dust mites, cockroaches, and mold), irritants (cigarette smoke, air pollution, strong odors/sprays, and pollens), viruses, stress, cold air, and exercise)…these can activate an inflammatory response that leads to airway hyper-responsiveness and airway obstruction due to contraction of smooth muscle around the airways, swelling of mucosal cells, and/or increased secretion of mucus
- 80% experience asthma attacks from exercise… typically occurs after ventilation of large quantities of air, especially dry, cld air that contains environmental allergens and/or pollutants…severity of responses depends on the intensity of the exercise and environmental factors…typically occurs during or shortly after vigorous activity, and can easily be brought on by sudden intense exercise for some individuals…symptoms usually peak 5-10min after the person stops exercising and can last 20-30min…some will also develop a hacking cough 2-12 hours after exercise that can last for 1-2 days…approx. 50% incurring an EIA episode experience a relative refractory period, lasting up to 2 hours, during which another exercise bout will not produce and EIA attack or will result in a less intense reaction…late asthmatic responses 6-8 hours after the initial bronchospasm also occur in approx. half the EIA population…they are typically mild in nature
Asthma:
- Role of exercise in treatment and prevention
- Medications used to treat and prevent asthma
- Hyperventilation
- need to see a physician beforehand, doc typically knows what the triggers are and what to do when they occur, they also provide meds to prevent/lessen EIA…most people will benefit from exercise…can hep to reduce the ventilatory requirement fr various tasks, making it easier for them to participate in more every day activities, recreational events, and competitive sports…can reduce the number and severity of EIA asthma attacks…should be encouraged to undertake gradual and prolonged warm-up and cool-down periods…this will allow some to use the refractory period to lessen the bronchospastic response during subsequent higher-intensity exercise
- bronchodilators, anti-inflammatory agents, prophylactic treatment
- EIA is brought on by this…need gradual and prolonged warm ups and cool downs
