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Flashcards in Healthy Active Living Deck (54):
1

What are the most common injuries seen in boxing?-most common injury?

Facial fractures, closed head injuries, neck injuries since in boxing, you're INTENTIONALLY punching someone in the head/face-most common injury: concussion, followed by open wounds/cuts, then fractures

2

What is the most common cause of death in amateur and professional boxers?

Acute subdural hematoma

3

What is a long term neurological consequence of repeated blows to the head in boxing?

Chronic traumatic encephalopathy (occurs in up to 20% of professional boxers)-can also occur in football/soccer/hockey, etc, wherever there are repetitive blows to the head

4

What are important psychosocial contributors to obesity?

Basically any stressors that trigger emotional eating:1. Being bullied: can increase emotional eating and also lead to an avoidance of physical activity as they don't want to be seen exercising2. Suffering neglect and maltreatment3. Living situation where consistency, limit setting and supervision are lacking4. Inadequate sleep thus leading to overeating5. High levels of stress: impedes consistent physical activity, overactivated hypothalamic-pituitary axis results in increased cortisol which induces intra abdominal adiposity, insulin resistance and metabolic syndrome6. Poverty

5

What is "weight bias"?

Tendency to make unfair judgements based on a person's weight

6

What are parental responsibilities in promoting healthy active living in their children? (6)

1. Purchasing healthy foods for food consumption2. Good role modeling3. Setting limits4. Keeping to healthy family routines (eating meals and exercising together)5. Effective time and money management6. Ensure that a divorce or separation remains as untraumatic as possible

7

What are psychosocial sequelae from being obese? (8)

1. Depression2. Teasing/bullying3. Social isolation4. Discrimination5. Diminished self-esteem6. Behavioural problems7. Dissatisfaction with body image8. Reduced quality of life

8

True or false: immigrants who have lived in Canada for 10 or more years have been shown to have a higher risk of developing obesity than recently arrived immigrants.

True!

9

True or false: prevalence of obesity is significantly higher in children and youth who miss breakfast.

True!

10

What are the health consequences of childhood obesity? (8)

1. Type 2 DM2. Dyslipidemia3. Hypertension4. OSA5. Nonalcoholic steatohepatitis6. Insulin resistance7. Lowered self esteem8. Lowered quality of life

11

Which of the following is false:a. children spending > 2 hr screen time/day are 2x as likely to be overweight or obese than peers watching

B is false! Early childhood sedentary behaviour patterns WORSEN with age!

12

Which subgroups in the pediatric population are more likely to be less physically active? (5)

1. Older children2. Females3. Aboriginal children4. Children who are not involved in or dislike sport/recreation programs5. Children with disabilities or live in public housing

13

What are the physical activity guidelines for:-infants-toddlers-preschoolers (3-4 yo)-what is the recommended screen time for children < 2 yo?-what about children 2-4 yo?

**Overall, minimize the time infants/toddlers spend being carried/sitting in a stroller, etc. Should not be > 1 hr at a timeInfants:-infants < 1 yo of age should be physically active several times daily through interactive floor based playToddlers 1-2 yo and preschoolers 3-4 yo: accumulate at least 3 hours of physical activity AT ANY INTENSITY spread throughout the day!*****Children < 2 yo: screen time NOT recommended! -for children 2-4 yo: limit screen time to < 1 hr/day**Ex of activities: walking with family, supervised water play, running, dancing, tumbling, throwing and catching

14

What are the physical activity guidelines for children > 5 yo?-how much screen time should they get?

For health benefits:-need to accumulate at least 60 minutes of moderate-vigorous intensity physical activity DAILY including: virogous intensity activities at least 3 days/week, activities that strengthen muscle and bone at least 3 days/week-screen time should be limited to no more than 2 hrs/day-limit transportation in a car/bus, limit time spent indoors

15

An adolescent patient presents to your clinic and is concerned about obesity and would like to pursue a healthy active lifestyle. What questions will you ask on history?

1. Screen for medical causes of obesity: hypothyroidism, OSA2. Screen for sleep disturbance3. Determine amount of caloric intake4. Determine current physical activity level5. Determine extent of sedentary behaviours6. Determine how much junk food is eaten, including sugar-sweetened drinks7. Determine level of screen time per day8. Assess desire for change

16

What are strategies to improve healthy active living for families in terms of reducing sedntary activities?

1. Counsel families to remove TVs and computers from bedrooms2. Avoid eating in front of the TV3. Replace screen time with physical activity4. Avoid sitting for prolonged periods of time5. Increase active transportation6. Engage families to mentor young children so they can develop suitable PA skills

17

An obese patient of yours would like to get more physical activity but they say they have no time. What recommendations can you make?

1. Build activity into each day - ie. walk to school/work2. Take the stairs3. Get off bus a stop early4. Take physical education in school5. Play active games with friends

18

What are the benefits of exercise in children with JIA?

1. Lowers obesity risk and thus decreases joint load2. Reduces loss of proteoglycans and cartilage damage, optimizes bone mineral density3. Increases range of motion, strength of joint4. Decreases disease activity5. Improves energy level and quality of life***overall, physical activity does NOT exacerbate disease

19

What are the physical activity recommendations for children with JIA?-what about for children with JIA of the neck or TMJ or uveitis?

1. Can safely participate in sports without disease exacerbation2. Should participate in moderate fitness, flexibility and strengthening exercises3. Can participate in impact activities and competitive contact sports if the disease is well controlled and they have adequate physical capacity4. Should be encouraged to be physically active as tolerated (if too painful, then don't do it)5. Should take individualized training within a group exercise format-for children with neck arthritis: need to have cervical spine xray before participation in collision/contact sports to decrease risk of spinal injury-TMJ arthritis: need appropriately fitted mouth guards to prevent jaw and dental injury-uveitis: should wear appropriate eye protection during activities with ocular injury risk to decrease further compromising vision

20

Why might a person with hemophilia have arthritis of joints?

This is known as hemophilic arthropathy!-Repeated joint hemorrhage causes synovitis, leading to joint degeneration and arthropathy-causes joint contractures, limited ROM and chronic pain-most commonly affects knees, ankles and elbows

21

What are the benefits of exercise in a patient with hemophilia?-risks?

1. May transiently increase factor 8 levels2. Strengthens joints and muscles to decrease risk of hemophilic arthropathy3. Reduces frequency of hemorrhageRisks:1. Chronic hemophilic arthropathy may lead to impaired neuromuscular function, decreased muscle strength/endurance and thus increase risk of injury and bleeding

22

What are the recommendations for physical activity in children with hemophilia?

1. Should receive appropriate factor prophylaxis to reduce risk of bleeding in sport2. Should undergo vigilant assessment of joint and muscle function before sport selection. May need restricftions3. Should be carefully assessed before participation in contact or collision sports (consult with sports med or peds hematologist)4. Require written strategies before sport participation t prevent or treat bleeds5. Should wear protective equipment, undergo physical therapy or take prophylactic factor replacement therapy6. Require factor replacement, ice, splinting and rest to manage acute bleeds and avoid physical activity until joint pain or swelling has resolved

23

How can you diagnose exercise induced bronchospasm?

Do an exercise challenge PFT: if there is a drop in 10-15% in FEV1 from baseline following virorous exercise x 6-8 minutes, this is diagnostic of EIB

24

True or false: bronchial hyper-responsiveness decreases with decreasing hours of exercise per week in asthmatic patients.

FALSE!!! It's the opposite! The more you exercise per week, the less your bronchioles will be hyper-responsive! Exercise increases the threshold for triggering bronchospasm. So exercise is good for children with asthma

25

What are the physical activity recommendations for children with asthma?

1. Can participate in any physical activity if symptoms are well controlled. Know that swimming is less likely to trigger exercise induced bronchospasm than running2. Keep an accurate history of symptoms, trigger exposures, treatments and course of recovery from episodes of bronchospasm3. Should get an exercise challenge PFT to formally diagnose EIB4. Use leukotriene inhibitors, inhaled corticosteroids and long acting beta 2 agonists for optimal long term disease control and avoid overuse of short acting beta 2 agonists5. Should take ventolin 15-30 mins before exercise6. Should not scuba dive if they have asthma symptoms or abnormal PFTs7. Those who compete nationally/internationally require therapeutic use exemption with confirmation of their asthma to use certain meds

26

What testing is recommended in athletes to diagnose exercise induced bronchospasm?

Eucapnic voluntary hyperventilation testing

27

What are the potential benefits of exercise in CF patients?-potential risks?

1. High aerobic fitness results in slower deterioration in lung function and greater survival rates2. Enhanced lung mucous clearance during intense exercise3. Improves strength of resp musclesPotential risks:1. Oxygen desaturation/CO2 retention2. Cardiac dysfunction from CF resulting in lower cardiac output3. Decreased exercise tolerance due to decreased muscle mass/strength from chronic malnutrition4. Hyponatremic dehydration from sweat-related salt losses5. CF related diabetes causing hypoglycemia6. Portal hypertension and splenomegaly increases risk of splenic damage during contact or collision sports

28

What are the physical activity recommendations for children with CF?

1. Should be encouraged to participate in any physical activity. Consult sports med or peds resp first2. Should have individualized exercise programs that include strength training3. Require home exercises that increase HR by 70-80% of max to increase aerobic exercise tolerance4. Don't stop activity just because they're coughing5. Should ABSOLUTELY 100% avoid scuba diving (increases risk of air embolism/pneumothorax)6. Those with severe CF should undergo exercise testing first7. Should drink flavored sodium chloride containing fluids above thirst levels to prevent hyponatremic dehydration8. Avoid contact or collision sports if enlarged spleen or diseased liver from portal hypertension

29

What are ways to prevent and treat hypoglycemia while at school?

1. Reguarly scheduled meals and snacks with adequate time to eat them2. Adjust food intake or insulin doses for increased physical activity. This will mean an extra glucose check and/or snack before physical activity3. Clean area for blood glucose checks where hands can be cleaned with a sharps container to discard test strips and lancets4. Supervising young children in ways that help them recognize, treat and prevent hypoglycemia5. All children need easy access to their emergency kit (with glucose meter, fast acting sugar source, extr snacks, etc.)6. For older teens/children, may need accommodations for tests or exams since hypoglycemia affects test performance

30

What are 4 potential barriers to safe and effective management of hypoglycemia in schools?

1. Incomplete training of school personnel2. Unscheduled activity and inactivity3. Altered meal or snack times4. Lack of rapid access to emergency kit

31

True or false: school absenteeism is significantly higher in children with diabetes compared with other children.

FALSE!!! It is not significantly higher, with the exception of absences for regular medical appointments

32

What can health care providers give to parents to give to schools to ensure a child with T1DM gets the best possible care?

Individual care plan should be up to date and provided to the schools!!!-should clearly outline roles and responsibilities of school personnel, parents and the child with diabetes and this should occur before the start of the school year

33

How much time should a student with T1DM who has just experienced a hypoglycemic episode during an exam be given to recover before being expected to get back to the test?

30-60 minutes-should always keep an emergency kit at their desk during an exam

34

What are the 3 leading causes of injury-related deaths?

1. Motor vehicle collisions2. Drowning3. Threats to breathing

35

What is the leading injury cause of hospitalization for children?

Falls

36

What is the CPS recommendation on body checking in youth hockey?

1. Eliminating bodychecking from all recreational, non elite competitive male ice hockey2. Delaying the introduction of bodychecking in elite male competitive leaves until players are 13-14 yo (bantam level)3. Recommend that boys play in recreational/non elite hockey leagues that do not allow body checking***Girls and young women leagues already have no bodychecking rules

37

What is the most common cause of hockey-related injuries?

Bodychecking

38

What is the definition of a concussion?

Pathophysiological process affecting the brain induced by biomechanical forces resulting in the rapid onset of short-lived neurological impairment that resolves spontaneously.

39

In adults and older adolescents, how long do concussion symptoms take to resolve? In younger children?

-Most resolve in 7-10 days-In younger children, can take weeks to months

40

What are the cognitive effects of concussion (3)?

1. Decreased attention and concentration2. Reduced information processing speed3. Impaired memory and learning

41

What is malignant brain edema syndrome?

-aka second impact syndrome-Rare complication of head injury in children and adolescents-caused by loss of autoregulation in brain's blood supply causing increased ICP and brain stem herniation

42

If there is loss of consciousness following a head injury, what should be suspected?

-Cervical spine injury-Should take appropriate cervical spine precautions on transfer to hospital

43

On history-taking for possible concussion, what are key questions to ask in order to identify patients at higher risk for prolonged recovery (5)?

1. Previous history of head or facial injuries (including diagnosed concussions)2. History of headaches or migraines in the patient and in the family3. Mental health issues4. Sleeping difficulties5. Learning disabilities or ADHD

44

When should athletes be allowed to return to sport after a concussion?

When symptom free and medically cleared-concussed athletes may increase risk for having another concussion or injury given cognitive impairments

45

How long should a concussed athlete be monitored by an adult and for what signs (3)?

-Need to be monitored for 24-48 hrs after injury-Counsel to look for severe headache, persistent vomiting, seizure activity-Should check on them during the night but don't wake them unless there is vomiting, seizure activity or difficulty breathing

46

When should you order structural imaging for a patient with concussion (3)?

1. Focal neurological deficit2. Prolonged unconsciousness3. Seizure activity

47

What is the thought on neuropsychological testing in concussion?

Routine baseline testing is not recommended since kids are always developing rapidly and thus baseline tests would have to be repeated every 6 months for post-test to be useful

48

In which concussion population would you recommend Neuropsychological testing?

-Multiple concussions-Prolonged postconcussive symptoms

49

What are the stages of graduated return to learn protocol?

OVERALL, RETURN TO LEARN SHOULD PRECEDE RETURN TO SPORT1. Cognitive rest - no school, limit cognitive tasks and screen time at home2. Increase cognitive tasks - slowly increase cognitive tasks at home in 15-20 min increments3. Resume modified school attendance - half-days or only certain classes (avoid gym, music, shop). Homework x 15-20 min blocks4. Increase school attendance - full days with specific accommodations (frequent breaks, tests with unlimited time)5. Return to play - once symptom-free and back to full-time school without accommodations, can start with graduated return to play

50

What are the stages of graduated return to play protocol?

1. No activity - for recovery (should do this until symptom free for 7-10 days)2. Light aerobic exercise - increase heart rate (walking, swimming, stationary cycling)3. Sport-specific exercise - add movement (drills)4. Noncontact training drills - more complex drills5. Full contact practice - following medical clearance6. Return to play - normal game play

51

What factors may result in prolonged or persistent concussion symptoms (3)?

1. Younger age2. History of multiple concussions3. Learning disability or ADHD

52

When should an athlete with a concussion consider retiring from a particular sport or to a less risky position to avoid recurrent head injury (4)?

When a concussion:1. occurs with less force2. results in more severe symptoms3. is more likely because of an athlete's playing style, position or sport4. occurs in the setting of a concomitant learning disability or persistent cognitive symptoms

53

Does protective equipment (helmet, mouth guard) prevent concussion?

NO! Certified helmets have been shown to protect against other head injuries though (ie. skull fracture)

54

What is CBPR?

Community based participatory research