KIN 311 Flashcards
(142 cards)
1
Q
What is fitness?
A
A set of attributes or characteristics individuals have or achieve that relates to their ability to perform physical activity
2
Q
What is health related fitness?
A
is typically thought of as attributes that are related to mortality or morbidity
3
Q
What is the difference between mortality and morbidity?
A
mortality= related to the occurrence of death
morbidity= related to the occurrence of illness
4
Q
What is health
A
a state of complete physical, mental, and social well being, not merely the absence of disease
5
Q
What are some purposes of fitness and health assessment?
A
- to identify an individual’s strengths and weaknesses
- Provide baseline data for an exercise/training prescription or intervention such as a rehabilitation program
- provide feedback for evaluating the effectiveness of a particular program or intervention
provide information that can be compared to norms, acceptable standards, health status or competitive standing
6
Q
What are some tell tale signs of a good assessment
A
- safe
- reliable
- valid
- practical
- conducted in a professional manner z
7
Q
What is standard deviation?
A
is a measure of variability within the cohort being assessed
8
Q
What is standard error?
A
Represents the accuracy of the true mean
- used when we want to generalize our mean to other similar cohorts or the entire population
9
Q
What are the factors influencing variability?
A
- Biological variability
- technical variability
- testing variability
- environmental variability
- unknown factors
10
Q
What is biological variability?
A
the inherent physiological and psychological fluctuation of the individual
11
Q
what is technical variability?
A
precision and accuracy of the instruments
12
Q
What is testing variability?
A
Instructions and manner of administering the test
13
Q
What are odds ratios
A
What are the odds of something happening given a particular exposure or intervention compared to control
14
Q
What’s the difference between validity and reliability?
A
validity = accuracy, correctness
reliability = precision, repeatability
15
Q
What is logical (face) validity?
A
Can be claimed when the measure appears to be obviously assess the target variable or performance
e.g. balance test of standing on one foot; it obviously is measuring balance
16
Q
What is content validity?
A
- similar to logical validity and attempts to measure the desired parameter or a defined domain of content
- usually applies to written tests or questionnaires
- often no statistical verification is usually required
e.g. visual rating scale for body composition
17
Q
What is construct validity?
A
- claimed when the measures permit inferences to be made about an underlying traits
- variable of interest is multi-factorial/multi-dimensional
e.g. sportsmanship, cardio-respiratory fitness, cardiovascular health
18
Q
What is criterion validity?
A
The extent to which the results of a standard test can be compared to some criterion
i.e. usually another test which seeks to measure the same construct) or used to predict a practical outcome.
19
Q
What is a systemic error?
A
- situations that result in a unidirectional change in scores on repeated testing
e.g. bias, learning, fatigue
20
Q
What is random error?
A
- variability may, in a random manner, both increase and decrease test scores on repeated testing
e.g. imprecision, biological
21
Q
What is inter-rater? (testing reliability)
A
- comparison of same measure between 2 (or more) testers
22
Q
What is intra-rater? (testing reliability)
A
- comparison of 2 (or more) measures made by the same tester (tests the “measure-er”)
23
Q
What is test-retest? (testing reliability)
A
- repeated testing on 2 or more occasions
- Used to test the reliability of the technique (repeatability)
24
Q
What ensures repeatability of a test?
A
- same experimental tools
- the same observer
- the same measuring instrument, used under the same conditions
- the same location
- repetition over a short period of time
- same objectives
25
What is correlation?
- describes the strength of the relationship between 2 variables of interest
26
What is a regression?
- describes the numerical relationship between 2 variables
27
What is a Bland-Altman test
used to describe agreement between two quantitative measurements
28
What is a meta-analysis?
- used to get at a bigger question
- strict defined process for conducting analysis
29
What are some important details about informed consent?
- it is given voluntarily
- it is informed
- can be withdrawn at any time
- it should address confidentiality
- should be in writing
- signed prior to any administration
30
What are some important details about waivers?
- used to mitigate risks
- signed statement
- must adhere to the same issues as a consent form
- not legally binding
31
What are some common allegations of negligence?
- pre-existing injuries or medical conditions when developing the training
- provide appropriate types of exercises/tests
- Limit the weights lifted or length of cardiac exercises
- properly supervise the client
32
Important things to do as a healthcare professional regarding liability:
- be a professional
- pre-screening actions and intentions are important
- pre-screening paperwork is important
- don't make up as you go along
33
Important things to do as a healthcare professional regarding mitigation:
- ask before you do
- explain before you do
- listen, answer questions
- get real acknowledgement from participants
34
What are some before testing considerations?
- Prior activity
- nutrition
- hydration
- recent travel
- recent illness
- sleep
35
What is the difference between the PAR-Q & You (CSEP) and the PAR-Q+?
PAR-Q & You
- Self assessment
- for general population (not children and elderly)
PAR-Q+
- removes the age guidelines
- the wording changes for the questions
36
What is the Get Active Questionnaire?
- updated version of PAR-Q+
- self-assessment tool
- indented for all ages
- includes parental assessment for children/minors
37
What are the 2 aspects of the basic physiological assessments ?
Heart rate
- to identify cardiac irregularities
Blood pressure
- to identify hypertension (or hypotension)
38
What are the preliminary instructions for physiological screening?
- abstain from smoking at least 2 hours prior to the test
- abstain from alcohol at least 6 hours prior to the test
- abstain from caffeine products at least 2 hours prior
- avoid a heavy meal 2 hours prior to the test
- avoid vigorous exercise within 6 hours of the test
39
What are the cutoffs for heart rate?
- if 99 bpm or less (<100bpm), proceed with appraisal
- if > 99 bpm have individual sit quietly for an additional 5 minutes
- If individual's heart rate is >99 bpm after second reading, physician clearance is recommended
- elevated HR = Tachycardia (100bpm)
40
What are the cutoffs for blood pressure?
- if systolic pressure is < 160 mmHg and diastolic pressure is < 90 mmHg proceed with appraisal
- If either systolic pressure is > 160 mmHg or diastolic pressure >90 mmHg have individual sit quietly for an addition 5 min
41
Signs of white coat hypertension:
○ When people get assessed they may become stressed out
○ May show that they are hypertensive due to the assessment
○ This is BP that is high only in a "doctor's office", but otherwise, a normal ambulatory BP (ABP)
○ May be due to "nervousness" or anxiety but could signal early cardiovascular risk
○ Should not be ignored
○ Check BP at rest, during and after exercise
Stop test at any time and refer to physician with a report
42
Explain the ACSM pre-screening
- Conducted by a health/fitness professional
- Initially stratified by exercise status
- Follows a "logic" model for clarity
- Secondary consideration is presence of cardio/metabolic/renal dysfunction
43
What is the purpose of a secondary risk assessment?
Provides the health/fitness, clinical exercise, and health care professionals with important information for the development of an individuals exercise prescription
44
What is a secondary risk assessment important for?
- Important when making decisions about:
- The level of medical clearance
- The need for pre-exercise testing
- The level of supervision for exercise testing and exercise
program participation
- Scope of practice
45
What is the difference between signs and symptoms?
signs
- something that you can measure, something that you can see
symptoms
- you have to get the information from the patients themselves
46
What is the new ACSM exercise pre-participation health screening process?
1) The individuals current level of physical activity
2) Presence of signs or symptoms and/or known cardiovascular, metabolic, or renal disease
3) Desired exercise intensity
47
What are some things that blood pressure is influenced by?
Blood volume
- contracted vs open blood vessels
- Vascular resistance (dilation vs. constriction)
- cardiac output
48
what does blood pressure do to the afterload?
It increases the afterload of the heart
49
What is afterload?
it is the pressure the heart needs to overcome to eject blood during systole
50
What is stroke work?
Work that the heart does in one beat
- stroke volume x mean arterial pressure
51
What is cardiac work?
stroke work x heart rate
52
What is the auscultation method of taking blood pressure?
What we use in lab
- listening to bodily sounds using a stethoscope
53
What are we listening for when using the auscultation method (blood pressure)
Korotkoff sounds
- vibrations of brachial artery
- not going to get a sound until you cut off blood flow
54
What are the 3 main steps to take blood pressure (auscultation method)
1) Pump cuff up to stop blood flow
2) Identify at what pressure blood is able to squeeze into the arm (systole)
3) Identify at what pressure the cuff no longer impeded blood flow (diastole)
55
What are the specific phases of Korotkoff sounds and what do they sound like
Phase 1: Clear tapping (Systolic pressure)
Phase 2: Softer tapping
Phase 3: Clear tapping (mean arterial pressure)
Phase 4: Muffled tapping
Phase 5: Tapping disappears (Diastole)
56
What are some problems with the indwelling arterial catheter?
- complicated
- invasive
- specialized scope of practice
- not practical in most situations
57
Do systolic and diastolic pressure tend to be underestimated or overestimated when taking blood pressure
Systolic = underestimating
Diastolic= overestimating
58
What's the difference between electrocardiograph and electrocardiogram?
- Electrocardiograph
○ The machine
○ Oscilloscope/chart recorder
- Electrocardiogram
- The tracing
59
What is a lead?
A lead consists of 2 "terminals" (e.g. a pair of electrodes) that form an axis to provide a different view or tracing of the heart's electrical activity
60
What is the orientation of a lead
The orientation of the lead (vector) in relation to the electrical current of the heart is what produces the ECG waveform
61
What planes does a 12-lead ECG provide?
12-lead ECG provides spatial information about the heart's electrical activity in 2 orthogonal plans:
Right- Left
Superior- Inferior
Anterior- posterior
62
How many limb leads are there?
- 3 limb leads
- Creates 6 vectors from these
63
What are leads 1-3 referred to as
bipolar leads
64
What are augmented (unipolar) limb leads
use 2 electrodes to create a "null point" which is compared to the 3rd electrode
65
What are precordial leads?
- 12 lead ECG
- Goes around heart in horizontal plane
- "Look" at the heart at the horizontal plane
- Leads are "unipolar"
- Located in close proximity to the heart, the precordial - leads measure the change in electrical potential along - a vector from the heart towards the electrode
66
What is P in a electrocardiography?
Atria depolarization
67
What is QRS in a electrocardiography?
Ventricle depolarization
68
What is T in a electrocardiography?
Ventricle repolarization
68
What is U in a electrocardiography?
Repolarization of purkinje cells and/or papillary muscle of valves. Hard to see and difficult to pick up
69
What is R-R in a electrocardiography?
1 Heart beat
70
What is the J point in electrocardiography?
transition point between the QRS complex and the ST segment
71
What is the PR interval electrocardiography?
0.12- 0.20 seconds
<2.5 mm in size
72
What is the ST segment electrocardiography?
- Ventricular refractory period
- Should be smooth and gradual before repolarization
- This can be elevated/depressed depending on which lead you are looking at
73
What is the QT interval electrocardiography?
- Should be <1/2 the distance of R-R interval
- ECG part that shortens during exercise
74
What is tachycardia
Rapid beating greater than 100 b/min at rest in an untrained adult
75
What is bradycardia
Beating < 60 b/min at rest in an untrained adult (symptomatic < 50 b/min)
76
What is arrthmia
- Refers to abnormal rate, rhythm or conduction of electrical impulse in the heart
- Cause is multifaceted and there are several types and is related to fever, dehydration, shock, hormonal imbalance, stress, various types of cardiac abnormalities and heart failure
77
What is premature ventricular contractions (PVCs)
- Extra beat occur under influence of autorhythmic cells other than the SA node
- The QRS complex and T waves will look abnormal compared to a normal ECG
78
What happens during S-T depression?
- S-T segment depression/elevation of >1.0mm 0.08s after J point
- Can tell you about the arteries in heart
- Heart attack probably
- May indicate Myocardial Ischemia
79
What is fibrilation?
Uncoordinated atria or ventricle contractions caused by re-entry of electrical impulses and requires defibrillation
80
What is an ECG used
- ECG, is highly recommended in exercise testing centers especially with untrained, older, diseased individuals
- Establish a resting ECG looking for abnormalities
- Record a tracing every workload during exercise
- Stress test
81
What is pulmonary function testing used for
- Used to identify general breathing difficulties at rest and during exercise
- Commonly assessed with an spirometer
- Measures volumes (static) and flow (dynamic) while inhaling and exhaling
82
What is spirometry
- Resting forced vital capacity test (FVC and FEV1) (volume and rate)
- FEV1/FVC is a measure of expiratory ability and general resistance to expiration, expressed as a %
83
What is PL (dynamic forced ventilation)
pressure generated by lung recoil
84
What is Ppl (dynamic forced ventilation)
pleural pressure generated by active inspiration or expiration
85
What is alveolar pressure
Alveolar Pressure is the sum of PL and Ppl and expressed relative to atmospheric pressure
86
What is exercise spirometry
- Used to investigate breathing difficulties during exercise
- Perform resting FVC test
- Perform a single stage exercise test of 6-8 min duration at 80-90% of HR max (or predicted HR max)
- High intensity, people will be breathing hard
- Perform post-exercise FVC tests at 5, 10, 15 and 20 minutes
- May be latent result
87
What is the eucapnic voluntary hyperventilation test
- Also used to assess breathing difficulties
- Designed to mimic an exercise challenge
- Perform resting FVC test
- Perform 6 minutes of hyperventilation (air +5% CO2)
- Forced hyperventilation
- Tidal volume fixed at 85% of TLC of FEV1
- Mimic exercise ventilation
- Breathing rate fixed at 30 bpm
- Perform post-exercise FVC tests at 5,10,15 and 20 minutes
88
What is an emphysema
- problem with alveoli
89
What is COPD- pathophysiology
- Breakdown and loss of lung tissue/structure
- Narrowing and compression of small airways
- Airway obstruction
90
Explain type 1 diabetes
Primarily a result of pancreatic beta cell destruction causing impaired insulin secretion
91
Explain type 2 diabetes
Insulin resistance (insulin less effective at facilitating glucose uptake)
92
Explain gestational diabetes
Glucose intolerance onset during pregnancy
93
What is the normal blood glucose (fasting)
3.9 and 5.5 mmol/L (70 to 100mg/dL)
94
What is the normal blood glucose (not fasting)
<11.1 mmol/L (<200 mg/dL)
95
What are some absolute contraindications when being pregnant
*Ruptured membranes, premature labour *Unexplained persistent vaginal bleeding *Placenta praevia >28 weeks
*Preeclampsia
*Incompetent cervix or cervical insufficiency *Intrauterine growth restriction
*High order multiples (triplets or higher)
*Uncontrolled type 1 diabetes, hypertension or thyroid disease
*Other serious cardiovascular/respiratory/systemic disorders
96
What are some relative contraindictions when being pregnant
*Recurrent pregnancy loss
*History of spontaneous preterm birth (<37 weeks) *Gestational hypertension
*Symptomatic anaemia
*Malnutrition
*Eating disorders
*Twin pregnancy after 28 weeks
*Mild/moderate cardiovascular or respiratory disease *Other significant conditions
97
Explain the get active questionnaire for pregnancy
–Self administered; and
–Screens in the majority of pregnant women.
- Used as a communication tool with the health care provider for women who are identified as potentially having a contraindication to prenatal exercise.
–No signature required by the physician.
98
What is glycated hemoglobin?
Glucose (a type of sugar) molecules in the blood normally become stuck to hemoglobin molecules - this means the hemoglobin has become glycosylated. As a person's blood sugar becomes higher, more of the person's hemoglobin becomes glycosylated
99
What is phlebotomy?
A phlebotomy is a procedure to remove a specific amount of blood from a vein in your arm
100
What is anthropometry?
Science that deals with measurement of size, weight and proportion of the body
101
What is body composition?
Focusing on techniques to measure body fat and lean body mass or fat free mass
102
What is weight bias
- Is the (active or passive) formation unreasonable judgments based on a person's weight
- How we view individuals
103
What is stigma?
Is the social implication carried by a person who is a victim of prejudice and weight bias
104
What does BAOP stand for? (assessment of potential weight bias)
Beliefs about obese persons scale
105
What does ATOPS stand for? (assessment of potential weight bias)
Attitudes toward obese peoples
106
What are some desirable terms when referring to body weight?
Weight, Excess weight, BMI
107
What are some undesirable terms to refer to body weight
Fatness, heaviness, excess fat, unhealthy BMI, Unhealthy body weight, Large size, Weight problem
108
What are some important things to have when assessing individuals with excess weight
- Private space for assessment
- Large size gowns
- Sturdy armless chairs
- Large and extra large adult and though blood pressure cuffs
- Wide based scale that measures > 350 pounds
109
How to ensure sensitivity and privacy when assessing individuals with excess weight?
- Ensure that weighing procedures take place in a private location that protects confidentiality of individuals
- Record the individual's weight without judgment or comments
- Offer individual the choice of not seeing the results if they prefer
110
What is the BMI equation?
BMI= body mass (kg) / Height (m)
111
What are some important things to consider with BMI
- It is reliable but validity is questionable
- Calculation is age-independent and the same for both sexes (interpretation may vary)
- Reasonable for use in health screening and in large populations
- Poor for athletes and active individuals
- Reliable due to consistency of height and weight
- Validity is questionable
- BMI doesn't tell us anything about body composition
112
waist circumference test
Risk associated with visceral fat accumulation ("apple" shape)
113
What can affect BMI?
Ethnicity, age, sex, height
114
Explain the waist to hip ratio
- Circumference of hips as well as the waist (W/H in cm)
- Accounts for differences in overall body size
- Ration provides an index of relative fat distribution: i.e. how much is carried viscerally
- The greater the ratio, the higher the visceral fat in proportion to lower body and increased risk disease
E.g. Men > 0.89 and women > 0.78 ratios, health risk
115
What are the cutoffs for men and women for waist to hip ratio?
E.g. Men > 0.89 and women > 0.78 ratios, health risk
116
Explain the length and breadths procedure
- Measuring a limb length/breadth is by strictest definition, a test of anthropometry
- Used to refine BMI as they are import estimators of bone and muscle components of fat-free mass
- Segmental lengths are used to predict height in clinical situations
117
What is the procedure for the seated height test
- Client should be seated erect on a bench, with legs hanging freely
- May need to adjust posture to reinforce the erect position
- Head and back against wall
- Looking straight ahead, head in the Frankfort plane - deep breath (should hold subject/client in this plane)
118
What is the procedure to test wing span
- Measuring tape places horizontally from a corner or wall edge,
- Fingers of one hand at fixed wall edge, and extends arms horizontally
Tips: Hold anchor hand in position to get the most reach
119
What is peak height velocity
- Is the Maximum rate of growth in stature during the growth spurt
- Determined using charting of height, sitting height and arm span
- Can be used by coaches for tracking developmental age of children and allows planning of training of fitness components around growth
120
How to directly measure body composition
Chemical or cadaver analysis
121
How to indirectly measure body composition
Hydrostatic/densiometry, DEXA, Ultrasound or other compartment based approaches
122
Double indirect measure of body composition
Skinfolds derivations, height/weight/circumference derivations, circumference/breadth derivations
123
Explain the 2 compartment model
○ Divides body into 2 components
○ Assumes
§ Fat has a density of 0.900 g/ml
§ FFM has a density of 1/100 g/ml
○ Fat vs Fat Free Mass (essential fat removed) or Lean Body Bass (includes essential fat). Essential fat is intra organ/muscle/other tissues
○ Not FFM and LBM includes muscle, bone, organs etc.
○ This induces error into any technique based on this assumption
124
Explain the multiple compartment model
○ The greater number of body compartments accounted for, the greater the reduction of error
○ e.g. Dual Energy X-Ray Absorptiometry (DEXA)
3 compartments: fat, bone, soft tissue
125
What is the various compartment model?
2-6 components
every time you go up in components, it divides your body into that many components
126
What is hydrostatic weighing
- Based on Archimedes' Principle:
○ "any object immersed in a fluid is buoyed up by a force equal to the weight of the fluid displaced by the object"
- Not to be confused with the volume of fluid displaced by an object!
127
What do you calculate residual volume with? How do you calculate it?
- Residual volume - calculates based on height, age, sex
Men: RV (L) = 0.019*ht+0.0155*age - 2.24
Women: RV (L) = 0.032*ht= 0.009*age- 3.90
128
What is the hydrostatic weighing technique?
- Minimum equipment required:
○ Body of water, accurate hanging scale, thermometer, water density table/calculator
○ May need weights to assist with submersion
○ Body density (BD) calculation:
§ BD = Dry weight/ (((Dry weight - Wet weight)/water density) - total gas volume)
- Full end expiration and submersion for 5-10s
○ Minimize movement
Repeat 5-10 times A
129
What are some limitations to hydrostatic weighing?
- Assumption of the constant density of body fat and LBM
- Assumption of the magnitude of trapped air: GI tract, lung, body cavity
- Variability in body mass determination
- Number of trials performed
130
Explain a Bod Pod
- Air Displacement Plethysmography
- Same theory as hydrostatic weighing, but uses air displacement
- Automated
- Need to minimize air displacement (clothing, swim cap)- but not full expiration
- Can be used in many populations
- Concurrent validity with UWW: r= 0.94
Test-retest reliability: r= 0.96
131
What does DEXA stand for?
"DEXA" = Dual Energy X-Ray Absorption
132
Explain a DEXA
- Assumes a "3 compartment model" : lean soft tissue, fat soft tissue and bone
- Uses a "low" type of radiation to scan whole body
- Can provide regional data with respect to fat distribution
- Inter-day reliability, r= 0.90 to 0.99 reported
- Concurrent validity with U.W., r= 0.90
Claim is that the error is less than around 3% for fat
133
What are some limitations for a DEXA
- Relatively expensive
- Need technical certification (Alberta) to operate
- Due to radiation, cannot be used in some populations (pregnancy)
- Can only accommodate individuals of a certain size
- Metallic implants will interfere with measurements
Other radiological tests may interfere with measurements/results
134
What is the most accurate way to determine body composition?
MRI
135
Limitations to MRI
- Very expensive, limited accessibility (hospital, universities, etc.)
Limitations with respect to size of individuals (bore diameters)
136
Explain the variability in skinfolds
○ Type of caliper used
○ "jaw" tension
○ Landmarking of site
○ Amount of fat pinched
○ Time taken to read measurement
# of sites or formula used
137
What is bioelectrical impedance?
- a regular scale
- Easy to use, non-invasive, practical, fast
- Uses a low level electrical current and measures the "impedance" (opposition to current flow)
- Since water/electrolytes conduct electrical current with less impedance, tissue that contains more water will have lower opposition to current flow
i.e. muscle because it is around 70% water
138
What are some assumptions for bioelectrical impedance?
○ Requires strict adherence to pre-test guidelines:
§ No eating or drinking within 4 hours of test
§ No exercise within 12 hours
§ Must urinate within 30 minutes
§ No alcohol within 48 hours
§ No diuretic type medications within 7 days
No testing at certain days of the menstrual cycle
139
What is a near-infrared interactance?
- Measures optical density of "near-infrared light" of 2 wavelengths for the bicepof the dominant arm. At the 2 wavelengths used, fat absorbs light and LBM reflects light
- A sensor measures the difference between amount of light emitted an reflected back
- Uses formulas that have a variety of assumptions to predict % fat
- Underestimation of body fat up to 10% and is worse is obese clients
Validity is questionable; reliability can be good
140
How do you choose what method to determine body composition to use?
○ Consider validity and reliability of technique
○ Application with respect to performance or health
○ Practicality and cost
Risk
141
how to calculate OR
OR= Odds of an outcome in the "exposed" group / odds of an outcome in the "control group"
