Exercise perscription/physiology Flashcards
(94 cards)
1
Q
What is ‘public health’?
A
The art and science of preventing disease, prolonging life and promoting health through organised efforts of society (Acheson, WHO, 1988).
2
Q
What physical activity does the CMO reccomend for adults aged 19-64?
A
Any activity is better thannone.
Do activities to develop or maintain strength of major musclegroups.
Accumulate 150 minutes of moderate activity OR
75 minutes of vigorous activity.
3
Q
What physical activity does CMO reccomend for adults over 65?
A
Participate in daily physical activity.
Improve or maintain muscle strength, balance and flexibility twice a week.
Accumulate 150 minutes of moderate activity OR 75 minutes vigorous.
Break up prolonged periods of sedentary behaviour.
4
Q
What is the ICF?
A
The International Classification of Functioning, Disability and Health (ICF) is a framework for describing and organising information on functioning and disability. It provides a standard language and a conceptual basis for the definition and measurement of health and disability
5
Q
Define ‘body functions’
A
The physiological functions of body systems (including psychological functions).
6
Q
Define ‘body structures’
A
Anatomical parts of the body such as organs, limbs and their components.
7
Q
Define ‘impairments’
A
Problems in body function and structure such as significant deviation or loss.
8
Q
Define ‘activity’
A
The execution of a task or action by an individual.
9
Q
Define ‘participation’
A
Involvement in a life situation.
10
Q
Define ‘activity limitation’
A
Difficulties an individual may have in executing activities.
11
Q
Define ‘participation restrictions’
A
Problems an individual may experience in involvement in life situations.
12
Q
Define ‘environmental factors’
A
The physical, social and attitudinal environment in which people live and conduct their lives. These are either barriers to or facilitators of the person’s functioning.
13
Q
Define ‘functioning’
A
Functioning is an umbrella term for body function, body structures, activities and participation.
It denotes the positive or neutral aspects of the interaction between a person’s health condition(s) and that individual’s contextual factors (environmental and personal factors).
14
Q
Define ‘disability’
A
Disability is an umbrella term for impairments, activity limitations and participation restrictions.
It denotes the negative aspects of the interaction between a person’s health condition(s) and that individual’s contextual factors (environmental and personal factors).
15
Q
Give the 4 ICF components
A
- Body functions and structures of people, and impairments thereof (functioning at the level of the body)
- Activities of people (functioning at the level of the individual) and the activity limitations they experience;
- Participation or involvement of people in all areas of life, and the participation restrictions they experience (functioning of a person as a member of society); and
- Environmental factors which affect these experiences (and whether these factors are facilitators or barriers).
16
Q
Define ‘physical activity’
A
Body movement that uses skeletal muscles and results in an increase in calories required. This should be over and above the resting energy expenditure.
17
Q
Define ‘exercise’
A
A type of physical exercise but is planned and includes repetitive movements to improve or maintain components of physical fitness (ACSM, 2016).
18
Q
Define ‘phsyical fitness’
A
The ability to meet the planned and unplanned tasks in day-to-day life. These should be undertaken with ‘vigor and alertness’ (ACSM, 2016).
19
Q
List the key components of physical fitness
A
- Cardiovascular Endurance
- Strength
- Muscular Endurance
- Flexibility
- Balance
- Power
- Speed
- Reaction Time
- Agility
- Coordination
20
Q
Give the benefits of physical activity/exercise
A
-Improved CV and respiratory function
-Reduced CVD risk factors
-Decreased all cause morbidity and mortality
-Reduced depression and anxiety
-Improved cognitive function
21
Q
Briefly explain exercise physiology in terms of ATP production
A
- Exercise demands oxygen and a substrate are increased.
- Chemical, mechanical and thermal stimuli affect alterations in function.
- The body firstly uses immediately energy sources that include ATP.
- Alternatively, utilisation of the Adenylate Kinase Reaction as well as the Phosphocreatine system are important.
- Resynthesis of ATP from energy-dense substrates via Glycolysis and fat metabolism.
22
Q
What are the FITT principles?
A
Frequency
Intensity
Time
Type
…of each exercise
23
Q
List the key aerobic principles
A
- Specificity
- Progressive Overload
- Reversibility (use it or lose it)
- The Individual / Variability
24
Q
Give examples of exercises
A
Pendular exercises
Stretching
Active Assisted exercises
Sit-to-Stand
Isometric exercises
25
Describe the power stroke of muscle contraction and why ATP is an important energy storage molecule
* Actin-myosin cross-bridge cycling
* ATP-energised myosin head attaches to the exposed actin binding site
* Power-stroke occurs as one Phosphate ion dissociates (ATP => ADP + Pi)
* ADP dissociates from the cross-bridge but the actin-myosin link remains intact
* New ATP releases the myosin head from actin site & cycle starts again
* ATP is essential part of muscle contraction
* Continued muscle contraction requires continual supply of ATP
Chemical energy is contained within the high-energy phosphate bond and it is converted to mechanical energy during the power-stroke.
Some ATP also required by the Ca2+ pump to pump calcium back into the sarcoplasmic reticulum against the concentration gradient during muscle relaxation.
26
Why is muscle contraction required even at rest
Maintaining tone, postural muscles
27
Why is little ATP stored in muscles
Significant amount of ATP not stored in muscle due to the volume required (which would make the weight prohibitive). For example, to run a half marathon, 90kg of ATP would be required.
Therefore, only very few ATP molecules are stored within the muscle, instead rapidly and continuously synthesysed.
28
What is phosphocreatine?
* Stored locally in the muscle
* Very fast & powerful but short-lived system
* Initial 2-10s of exercise
29
Briefly outline anaerobic glycolysis
* Degradation of glucose to pyruvate
* Quite fast & powerful, 10s-2mins
* During onset of exercise or high intensity exercise, pyruvate is converted to lactate (anaerobic pathway)
Glycolysis can use glucose or glycogen. Glycogen stores are greater in Type 2 (fast) muscle fibres.
Anaerobically, pyruvate is converted to either ethanol or lactate, so isn’t available for the Krebs cycle. Therefore anaerobic respiration doesn’t involve either the Krebs cycle or the electron transfer chain. The ATP that can be produced by anaerobic respiration is therefore formed by glycolysis only.
30
Describe aerobic ATP synthesis
* Occurs exclusively in the mitochondria
* Can metabolise carbohydrates, lipids or proteins
* Primary energy source during sustained, moderate activity
* Oxygen is the final electron acceptor in the electron transport chain
* Most efficient & sustainable system
* Slowest system
* Reliant on oxygen delivery to the cells
* Very minimal energy from proteins under normal exercise circumstances.
31
Why is oxygen important to respiration
Oxygen is the final acceptor of electrons and hydrogen ions/protons in the electron transfer chain. Without it the electrons would accumulate along the chain and respiration would cease. Neither the Krebs cycle nor electron transfer chain can continue because soon all the NAD and FAD will be reduced. No NAD or FAD will be available to take up the H+ produced during the Krebs cycle and so the enzymes stop working. This leaves only the anaerobic process of glycolysis to produce ATP.
32
In an indvidual exercises for longer than 2 minutes what type of respiration is undertaken?
Aerobic
33
Describe the relationship between workload and oxygen uptake
As the workload increases, the oxygen uptake by the tissues increases (hence the delivery of oxygen to the tissues needs to increase).
34
Describe the relationship between workload and carbon dioxide production
The production of C02 also increases with work rate (hence the removal of C02 from the tissues needs to increase).
35
Define VO2max
Point at which no further increase in oxygen consumption can occur despite further increases in work performed
36
Define anaerobic threshold
The addition of anaerobic glycolysis to ATP resynthesis increases CO2 Production
37
Define oxygen debt
Oxygen uptake during recovery
At the onset of exercise, there will be a “lag” in oxygen delivery. This combined with any other anaerobic work done during exercise (particularly during high intensity exercise) is “repaid” during the recovery period. This is why breathing and heart rate remain elevated after exercise stops.
38
How do you calculate arteriole oxygen content?
Oxygen bound to haemoglobin + oxygen dissolved in plasma
39
How do you calculate cardiac output?
Heartrate x stroke volume
40
What is DO2?
Oxygen delivery
41
What is VO2?
Oxygen uptake
42
How do you calculate VO2?
(CaO2 - CvO2) x cardiac output
43
Which factors influence oxygen upatke?
-Muscle blood flow
-Capillary density
-Mitochondrial density
-Bohr affect (oxygen affinity)
-Muscle mass
-Muscle fibre type
-Nutrition availbility
44
What is CaO2-CvO2?
The difference between Arterial & Venous oxygen content = how much oxygen is used (extracted) by the tissues.
45
If patients have fixed problems with their heart and lungs what would they need to do to increase VO2?
Muscle strengthening exercises
46
Desrcibe the respiratory response to exercise?
* Minute ventilation (RR x TV) increases:
* 8 Litres/min at rest
* >200 Litres/min during exercise
* Depth of breath increases before the rate of breath
* Respiratory muscle uses:
* 2% of total VO2 at rest
* 11% of total VO2 during exercise
* Up to 50% of VO2 during exercise in the obese
* Ventilatory reserve exists beyond the observed ventilation during maximal exercise in healthy individuals.
* Response is thought to be due to afferent feedback from the proprioceptors in the exercising joints and muscles.
* PCO2, pH & H+ remain relatively constant during most exercise intensities – minimal role for the chemoreceptors during exercise.
* At VO2 max, the respiratory system still has reserve, it is not the main limitation to exercise in healthy individuals.
* Anticipatory response: RR & TV increase in advance of actual task
47
Describe the cardiovascular response to exercise
* CO (HR x SV) increases up to 5 x during exercise (5 L/min to 25 L/min)
* HR increases linearly with work rate up to 3 x
* SV increases rapidly at first then plateaus < 2 x
* Cardiac Output is the limiting factor to oxygen delivery in the healthy individual
* Most people will have a cardiac limitation to their maximal exercise tolerance. This is why heart rate targets are used as estimates of exercise intensity in the healthy population.
48
Describe the coronary circulatory response to exercise
* Coronary arteries receive blood during diastole
During exercise:
* Increased flow to coronary arteries (due to increased Cardiac Output)
* Vasodilation of coronary vessels
* Reduced duration of diastole with increased HR
During maximal exercise:
* 6 x increase in oxygen demand from the left ventricle
* 5 x increase in coronary circulation
Remainder of demand is met through increased oxygen uptake by the myocardium. Less time to receive the blood but in health, the vasodilation and increased CO are adequate to meet demand until maximal exercise capacity.
49
Describe the peripheral circulatory response to exercise
* Blood flow is redistributed from non-vital organs to the muscles
* Blood flow to the skin increases for heat dissipation
* Arterioles vasodilate => up to 25 x increased blood flow
* Mean arterial pressure (blood pressure) remains fairly constant, e.g. digestive tract uses approx. 25% VO2 at rest falling to 5% during vigorous exercise
* Skin reddens during exercise as blood redistributed.
* Vasodilation due to Heat, ⇓pH, CO2, NO
* Moderate increases in systolic BP may be observed.
* Increased vasodilation, increases peripheral resistance, therefore the mean arterial pressure remains constant even when heart rate increases.
50
How is mean arteriole pressure calculated?
Cardiac outpput x total peripheral resistance
51
List some benefits to High Intensity Interval training
- Increased VO2 peak
-Decreased systolic and diostolic blood pressure
-Increased high density lipoproteins
-Decreased triglycerides
-Increased cardiac function
-Increased quality of life/enjoyment
52
GIve benefits to exercise overall
increase mitochondrial density
improve T2DM
increased quality of life
reduced blood pressure
reduces risk of diseases e.g. type 2 diabetes
maintains healthy weight
improves self esteem
reduces depression/anxiety
53
GIve benefits to exercise overall
increase mitochondrial density
improve T2DM
increased quality of life
reduced blood pressure
reduces risk of diseases e.g. type 2 diabetes
maintains healthy weight
improves self esteem
reduces depression/anxiety
54
Define 'exercise'
Physical activity consisted of planned, structured, repetitive bodily movement to improve/maintain one or more elements of physical fitness.
55
Give examples of health related fitness
Cardioresp endurance, body composition, muscular strength/endurance, flexibility
56
Give examples of skill related fitness
Agility, coordination, balance, power, speed
57
Give examples of conditions regular exercise can prevent
Premature mortality, CVD, hypertension, stroke, diabetes T2, cancer, osteoporosis, falls, depression etc.
58
What should exercise perscription consider
◦ Should consider key aspects such as current activity levels (ACSM, 2016) physiological response, pathology and preferences.
◦ Should commence with exercise testing (where possible) to ensure exercise is safe and effective.
59
Describe the ACSM guidelines surrounding exercise testing
* ACSM (2016) recommends the exercise preparticipation health screening process reviews a participant's current PA level, presence of any pre-existing cardiovascular, metabolic or renal disorder along with the intended exercise intensity.
* Provides a guideline to follow.
* Preparticipation health screening questionnaire include e.g. PARQ
* Conducted to ensure the exercise is safe and effective.
* Risks: MSK injury/cardiovascular complications.
* MSK injuries linked to exercise intensity/nature of activity, pre-existing conditions, MSK abnormalities
* Cardiovascular complications: Myocardial infarction risk, cardiac death- usually associated with rigorous intensity exercises
60
List the main physiological markers
BP- Blood pressure
HR- Heart Rate
RR- Respiratory Rate
SpO2 - Oxygen saturations
LDLS/HDLS
Body composition
61
How is body composition measured?
BMI/skinfold measurement
62
What is a 'maximal test'
Under full lab conditions with risk management in place
63
What is a 'sub-maximal test'
64
Give the principle elements to exercise testing
◦ Purpose
◦ Pathology
◦ Physical Fitness element being tested.
◦ Equipment needed
◦ Space required
65
Describe the chester step test
-Sumaximal test
-Step on/off a 30cm step at set rate
-Multi-staged, rate of step increases every 2 mins
-Requires HR monitor, CD, player, appropriate height step
66
Describe the Multi Stafe Fitness Test (MSFT)
-Submaximal test
-Run shuttles between bleeps which become increasingly faster paced
-Multi-staged
-Requires 20m distance, CD and player
67
Describe the 6 minute walk test
-Submaximal test of aerobic capacity and endeurance
-Used for an array of populations
-Standardised instructions/encouragement
-Requires stopwatch, 30m distance, cones, marking tape, pulse oximeter and RPE scale
68
How often should aerobic exercise be done a week?
Moderate to vigorous intensity should be done 3 – 5 times a week
69
How often should resistance training be done a week?
Each muscle group 2 – 3 times a week
70
How often should flexibility training be done a week?
Each muscle group 2 – 3 times a week
71
If patients are deconditioned would they exercise more or less frequently?
Extremely weak or deconditioned patients then more frequency, reduce intensity to reduce load are usually recommended.
72
How is max heartrate calculated?
220 – age
not completely accurate can over/underestimate a personas heartrate max.
73
Explain the overload principle of training
Overload principle of training states exercise below a minimum intensity threshold will not challenge the body sufficiently to change the physiological markers.
74
Which level of exercise requires anaerobic respiration?
Between moderate and heavy
75
What % effort is required for very light exercise?
50-60%
76
What is the effect of very light exercise?
Improves overall health and helps recovery
77
What % effort is required for light exercise?
60-70%
78
What is the effect of light exercise?
Improves basic endurance and fat burning
79
What is the % effort required for moderate exercise?
70-80%
80
What is the effect of moderate exercise?
Improves aerobic fitness
81
What is the % effort required for hard exercise?
80-90%
82
What is the effect of hard exercise?
Increases maximum performance capacity
83
What is the % effort required for maximum exercise?
90-100%
84
What is the effect of maximum exercise?
Develops maximum performance and speed
85
Which RPE (Rate of Percieved Excersion) are patients usually advised to work within?
11-13
86
What factors does the time of exercise depend on?
Depends on patient goal, type and intensity of exercise being prescribed.
E.g. aiming to improve endurance= recruiting type 1 muscle fibres, oxidative phosphorylation, so patients will exercise longer.
87
Outline and describe the SPORT principles
* Specificity: Exercise prescribed to achieve specific goal, requires individualistic approach.
* Progressive Overload: Gradually increase weight, frequency, reps, often seen in strength training. Challenges body to allow MSK system to get stronger. Prevents plateau in results
* Reversibility: Use it or lose it. Gains will be lost if repetition is not implied, exercise has to be sustainable so patients can maintain.
* Individuality: Each person responds differently to same stimuli, Variability in training exercise to prevent boredom and stress fractures.
88
How much exercise does the CMO advise each week?
-150 mins moderate intensity OR 75 mins vigorous intensity (or combination)
-Strengthening 2 days a week
-Balance training 2 days a week
89
Give the components of an exercise training session
Warm up, conditioning/exercise, cool down, stretching
90
How long should the warm up be for and what should it consist of?
8-10 mins light-mod intensity, include Cardioresp and muscular endurance. Improves ROM, reduces injuries
91
How long should conditioning last?
20-60mins targeted exercise
92
How long should the cool down be and what should it consist of?
5-10 mins light-mod intensity, include Cardioresp and muscular endurance. Recovery period for physiological markers, remove metabolic end products, eg. Lactate built up in conditioning.
Stretching after cool down.
Allows body to adjust slowly to changing demands.
93
Describe progression
Modifying the exercise to make it harder, in line with the patients' physiological responses and in line with the principles of exercise prescription.
94
Describe regression
Modifying the exercise to make it easier, in line with the patients' physiological responses and in line with the principles of exercise prescription.
