HES 405 Lecture Notes - Lecture 1: Coronary Artery Disease, Glucose Test, High-Density Lipoprotein
405 Clinical Exercise Physiology Lecture Notes
(Textbook references in blue, but not all of these notes have them)
(Most electrocardiogram notes are not included)
• Guidelines = suggestions, not absolute
• FITTVPP (Table 6.5, page 162)
o Frequency
o Intensity
o Time
o Type
o Volume
▪ Total aout of ok thats doe
▪ Quantity
▪ Product of frequency, intensity, and time
▪ Minimum 500-1000 MET-min/wk
▪ Use to estimate energy expenditure
• Ex: 70 kg male jogs (7 METS) for 30 min, 3x/wk
o 7 METS × 30 min × 3x = 630 MET-min/wk
o [(7 METS × 3.5 ml/kg/min × 70 kg)/1000] × 5 = 8.575 kcal/min
o 8.575 kcal/min × 30 min × 3x = 771 kcal/min (not significant weight
loss without diet change)
o Pattern
▪ Type of activity in any given day
▪ # of times you exercise in the day (e.g. twice per day)
o Progression
o (Supervision)
o Everything should be given in ranges
• Prescription for apparently healthy 20-year-old?
o Easy! 3-4 days, 60-80% HRmax, 30 min, aerobic & strength
o Not so easy for 48-year-old obese man (will get to later)
• Evidence-based practice
o Best research evidence
o Clinical expertise
o Patient values and preferences
• Atherosclerosis – coronary artery disease, plaque
• Atherothrombosis – piece of plaque fractures and fully occludes distal part of artery; most common
cause of fatal atherosclerosis; likely due to unaccustomed vigorous exercise
• Plaque risk factors:
o Hypertension
o Bad diet
o Insulin resistance
o Inactivity
o Smoking
o Stress
• Endothelial dysfunction – inability of artery to contract and relax
o The endothelium is the inner lining of the artery
o Begins with foam cells (fat-laden macrophages)
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o First decade is asymptomatic period
• Physical activity – any bodily movement produced by skeletal muscle that results in energy
expenditure
• MVPA – moderate-vigorous physical activity
• Exercise – a structured training program designed to improve fitness
• Physical fitness – a set of attributes that relates to the ability to perform physical activity
• Components of physical fitness (Box 1.1, page 2)
o Health-related physical fitness
▪ Cardiovascular endurance
▪ Muscular strength
▪ Muscular endurance
▪ Flexibility
▪ Body composition
o Skill-related physical fitness
▪ Agility
▪ Balance
▪ Coordination
▪ Speed
▪ Power
▪ Reaction time
• Metabolic equivalents (METS) – indication of energy expenditure
o 1 MET = 3.5 ml/kg/min
o Light: < 3.0
o Moderate: 3.0-5.9
o Vigorous: 6.0
o Example problem: 68-year-old, VO2max of 25 ml/kg/min. Max MET capacity:
▪ 25/3.5 – 7.1 METS
• Exercise prescription should be 40-60% of this maximum, so 3-4 METS
• Commonly used abbreviations:
o ADL – activities of daily living
o BMD – bone mineral density
o CABG – coronary artery bypass graft (surgery)
o COPD – chronic obstructive pulmonary disease
o DEXA – dual-energy X-ray absorptiometry
o DM – diabetes mellitus
o FEV – forced expiratory volume
o FBG – fasting blood glucose
o HRR – heart rate reserve
o Hs-CRP – high-sensitivity C-reactive protein (marker of inflammation)
o HTN – hypertension
o IFG – impaired fasting glucose
o LDL & HDL – low-density & high-density lipoproteins
o OA – osteoarthritis
o RA – rheumatoid arthritis
o EDD – exercise deficit disorder
▪ Condition, individuals do not meet physical activity guidelines (30 min/day, 5
days/wk)
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• Dose-response curve for physical activity
o Benefits are largest at the lower end of activity status
o So the GOAL: get out of the sedentary category
• ACSM-AHA physical activity recommendations for adults (Box 1.2, page 4)
o Moderate intensity 30 min, 5x/wk
o Vigorous intensity 20 min, 3x/wk
o Combine both
o Accumulate 10 min bouts
o Strength train 2x/wk
• History of exercise physiology
o Jeremy Morris, 1958 – first epidemiologist
▪ London Bus Driver study
▪ Higher rates of CAD in bus drivers vs ticket takers
o Harvard Alumni study
▪ Done by questionnaire
▪ As caloric expenditure decreases, all-cause death rates increase
▪ greatest increase in death rate is when you get out of the sedentary category
▪ its possile too uh exercise will increase death rate (your body is being broken
down, maybe chronic inflammation)
o D. Ke Coope, fathe of aeois
▪ Cooper Clinic Study
▪ As fitness levels increase, all-cause death rates decrease
▪ Biggest decrease is low to moderate
• 1 hour of physical activity eliminates the detrimental effects of 8 hours of inactivity
o Similar to that of smoking and obesity in terms of mortality risk
• Atherosclerotic CVD risk factors (Table 3.1, page 48)
o ‘eee its isk fato pe atego
o 1. Age
▪ Men 45 years
▪ Women 55 years
o 2. Family history
▪ Mother, father, brother, sister (immediate family only)
▪ Male before 55 years
▪ Female before 65 years
o 3. Cigarette smoking
▪ Current or quit within 6 months
▪ Exposure to environmental tobacco smoke
o 4. Hypertension
▪ SBP 140 and/or DBP 90
▪ Or on hypertensive medication
▪ (Will change to 130/80 limit next year)
o 5. Dyslipidemia
▪ LDL 130 mg/dl or
▪ HDL < 40 mg/dl
▪ Cholesterol 200 mg/dl or
▪ On lipid-lowering medications
▪ Note: triglycerides <150 mg/dl is normal, but this is not an official risk factor
o Diabetes
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find more resources at oneclass.com
Document Summary
405 clinical exercise physiology lecture notes (textbook references in blue, but not all of these notes have them) (most electrocardiogram notes are not included: guidelines = suggestions, not absolute, fittvpp (table 6. 5, page 162) Age: men (cid:1096) 45 years, women (cid:1096) 55 years, 2. Family history: mother, father, brother, sister (immediate family only, male before 55 years, female before 65 years, 3. Cigarette smoking: current or quit within 6 months, exposure to environmental tobacco smoke, 4. Hypertension: sbp (cid:1096) 140 and/or dbp (cid:1096) 90, or on hypertensive medication (will change to 130/80 limit next year, 5. [(200-70) 0. 60] + 70 = 148 (ex rx hr: benefits of regular physical activity. Increased exercise threshold for the accumulation of lactate in the blood: reduction in cvd risk factors, bp & dbp, hdl, t(cid:396)igl(cid:455)(cid:272)e(cid:396)ides, total (cid:271)od(cid:455) fat, i(cid:374)suli(cid:374) (cid:374)eeds, (cid:271)lood platelet adhesi(cid:448)e(cid:374)ess (cid:894)su(cid:272)h as (cid:449)ith fi(cid:271)(cid:396)i(cid:374)oge(cid:374)(cid:895, i(cid:374)fla(cid:373)(cid:373)atio(cid:374) (cid:894)su(cid:272)h as (cid:449)ith hs-crp)
