Exam

Question 1

Aerobic metabolism

Answer 1

Requires oxygen
Utilizes carbs, fats, proteins
Byproduct: water, CO2
Yields 36 ATP/glucose
Types of cells: heart, CNS, PNS, skeletal muscle (slow twitch)

Question 2

Anaerobic metabolism

Answer 2

O2 not required
Utilizes ONLY carbohydrates
By-product: lactic acid
Occurs in cytoplasm
Yields 2 ATP/glucose
Types of cells: CT (bone, cartilage, RBC), skeletal muscle fast twitch

Question 3

Anaerobic threshold

Answer 3

No longer able to perform work solely via aerobic
~55% VO2max (+/- training and detraining)

Question 4

VO2 max

Answer 4

Max capacity of the body to transport and use oxygen with exercise

Question 5

Factors that affect VO2

Answer 5

Age
Sex
Genetics (muscle fiber type)
Body composition
Endurance training
Diseases that affect oxygen transport

Question 6

Name meds with exercise implications to MITIGATE FALL RISK due to INCREASED BLEEDING RISK?

Answer 6

Anticoagulant (a-fib)
Platelet aggregation inhibitor (PAD)

Question 7

Which medication has side effects of hypotension and bradyarrhythmia?
How does this affect exercise?

Answer 7

Med: Metoprolol (beta blockers)
Use RPE in conjunction with HR

Question 8

Which med has side effects of tachycardia, palpitation, and tremors?
This leads to exercise implication of __.

Answer 8

Medication: Albuterol (fast-acting bronchodilator)
Use RPE in conjunction with HR

Question 9

Which medication has side effects of increased MI and CVA?

Answer 9

Ipratropium (anticholinergic bronchodilator)

Question 10

Which medication has side effects of hypernatremia and psychiatric distress?
How does it affect exercise?

Answer 10

Medication: Prednisone (adrenocortical steroid)
Monitor mental health and electrolyte balance with exercise (e.g. dry mouth)

Question 11

Which medication blocks enzyme needed to make cholesterol and has side effects of increased glucose/HbA1c levels, myalgia/arthralgia, and tendon rupture?
How does this impact exercise?

Answer 11

Medication: Atorvastatin (HMG-COA reductase inhibitor)
Monitor arthralgia/myalgia and dysglycemia
NO EFFECT ON HR/BP

Question 12

Which medication is used to treat GI ulcers and GERD and has side effects of increased fracture risk?
How does this affect exercise?

Answer 12

Medication: Omeprazole (proton pump inhibitor)
Mitigate fall risk due to increased fracture risk

Question 13

Which medication is used for anxiety and has side effects of hypotension, palpitations, ataxia?
How does this affect exercise?

Answer 13

Alprazolam (benzodiazepine)
Mitigate fall risk due to syncope and hypotension

Question 14

Which medication is used to treat intermittent claudication and side effects of palpitations and myalgia?
How does this impact exercise?

Answer 14

Medication: Cilostazol (platelet aggregation inhibitor)
Mitigate fall risk due to increased bleeding risk

Question 15

Assumptions of submax testing (5)

Answer 15

1. Steady state HR obtained
2. HRmax given age is uniform (220-age)
3. Mechanical efficiency same for everyone
4. Linear relationship between HR and workload
5. HR varies depending on fitness level

Question 16

Karvonen formula

Answer 16

THR = (HRmax-HRrest)*(%intensity) + HRrest

Question 17

High intensity rehab contraindications conditions <6 weeks

RAC-Pact

Answer 17

Rhabdo
Acute cardiac event (MI, vtach/vfib, CABG, pacemaker placement)
CVA
PE
Cerebral aneurysm treated any size

RAC-Pact

Question 18

High intensity contraindications SEVERE/PROLIFERATIVE conditions (3)
“SPR of the moment, bc you will die soon with these conditions”

Answer 18

Severe mitral/aortic stenosis
Severe pulmonary HTN (pulmonary map <55)
Proliferative diabetic retinopathy

Question 19

High intensity contraindications miscellaneous (5)
U DUMM

Answer 19

Unstable angina
Decompensated HF (worsening edema, fatigue, SOB at rest)
UNTREATED cerebral aneurysm
Mitral/aortic stenosis ANY SEVERITY WITH hx of syncope and WITHOUT corrective surgery
MD-order of no strenuous activity

Question 20

High intensity precautions
LAMA - soc

Answer 20

Limb specific conditions
Abdominal precautions (e.g. hernia)
Moderate-severe NON-PROLIFERATIVE diabetic retinopathy
Aortic aneurysm
Severe osteoporosis/compression fracture

Question 21

High intensity precautions limb specific (5)
OOF-DA

Answer 21

Osteomyelitis
Fracture
DVT within 6 weeks with anticoag
Avascular necrosis
Osteosarcoma/bone mets

Question 22

Precautions for aortic aneurysm

Answer 22

No lifting >75lbs
Bp <150/100
No valsalva

Question 23

Precautions for mod-severe (non-proliferative) diabetic retinopathy

Answer 23

Maintain BP <150/100
No valsalva

Question 24

Normal vitals response to exercise

Answer 24

RR — increase
SBP — increase, but SBP <200, DBP <110
DBP — minimal to no change (0-10)
HR — increase

Within 5 mins of rest, BP and HR should return within 10 of baseline

Question 25

Concerning exercise responses CV System

Answer 25

SBP >200, DBP >110 SBP fails to rise or drops >10 HR decreases

Question 26

Concerning exercise responses Integumentary system

Answer 26

Cyanosis Pallor Diaphoresis Clammy skin

Question 27

Concerning exercise responses Neuro

Answer 27

Dizziness/lightheadedness Confusion Ataxia Shaking/tremors

Question 28

Concerning exercise responses Pain

Answer 28

Leg cramps or severe claudication Chest/arm/jaw pain Mod-severe angina

Question 29

Concerning exercise responses Respiratory

Answer 29

Dyspnea <5 words (mod-severe) Abnormal breathing <88% O2 or 10%+ drop from baseline

Question 30

Concerning exercise responses GI

Answer 30

Hypoglycemic response Nausea/vomiting

Question 31

Greatest CV change due to age?

Answer 31

Decreased contractility of heart’s LV wall = pumping capacity reduced

Question 32

High intensity resistance training in PACE

Answer 32

Increased SPPB and gait speed

Question 33

High intensity resistance training in home health

Answer 33

No significant difference on gait speed compared to usual care, both showed improvement

Question 34

High intensity resistance training in telerehab

Answer 34

Increased performance on step test

Question 35

High intensity resistance training in SNF

Answer 35

Increased SPPB, gait speed, discharge home, and LOS

Question 36

Unstable vs. chronic angina

Answer 36

Unstable: can happen for any reason, even at rest. Increased risk of MI Chronic: happens regularly, induced with exercise, heavy meal and/or stress

Question 37

A-fib uncontrolled vs. controlled

Answer 37

Uncontrolled >100 bpm Controlled <100 bpm A-fib = HR does not work, greater clot risk

Question 38

Ventilation =

Answer 38

tidal volume x respiratory rate Both increase with activity

Question 39

Gait/balance signs of failure

Answer 39

Further level of assistance Unintentional speed decrease Unintentional change in how body moves in space

Question 40

Gait/balance goal vs. progress

Answer 40

Goal: 80% OR LESS of success If patient shows more than 80% success with gait/balance exercise, signals time to progress

Question 41

Gait speed as a determinant

Answer 41

Leg strength Trunk muscle endurance Timing and coordination Self-efficacy

Question 42

Endurance exercise effect on older adult

Answer 42

Primarily to improve CV health, not so much for muscle endurance since they typically have more type I fibers than type II

Question 43

High intensity strength exercise effect on older adult

Answer 43

Decrease osteoporosis Offset age-related loss of muscle mass and strength