HLTH 102 Chapter Notes - Chapter 5: Embase, Osteoporosis, Google Scholar

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31 Jan 2017

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2016-02-05 3:56:00 am: goal of 30 mins of moderate-intensity exercise at least 5 days per week, weight management = 60 mins or more per day. Acsm exercise recommendations for fitness development in healthy adults: exercise to develop and maintain cardiorespiratory endurance and body. Intensity of training: 65-90% of maximum heart rate for fit individuals, 55%-64% of maximum heart rate for unfit individuals, average individuals 70-85% of heart rate. Time (duration of training) 20-60 minutes of continuous or intermittent aerobic activity: low intensity activity should be conducted over a longer time (30+ mins) Type (mode of activity) any activity that uses large-muscle groups can be maintained continuously and is rhythmic and aerobic in nature: exercise to develop and maintain muscular strength and endurance, Resistance training one set of 8-10 exercises that condition the major muscle groups at least 2 days per week (should perform exercise to the point of fatigue)

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Medical History:
A 31 yr old man, a two pack per day smoker, presented to the emergency department complaining of sudden-onset, 10/10 crushing substernal chest pain associated with shortness of breath and diaphoresis that began 30 min prior to arrival. He had no previous history of cardiovascular disease.
Physical exam: Height 192 cm, weight 153.8 kg, BMI 41.6 kg Â· mâ2 (class III obesity); blood pressure 178/101 mmHg, pulse 75 beats Â· minâ1, respiratory rate 20 breaths Â· minâ1, temperature 36.7 âC; normal heart sounds, lungs clear to auscultation, normal peripheral pulses
Electrocardiogram: Normal sinus rhythm, rate 72 beats Â· minâ1; ST-segment elevation V1-V4
Chest radiograph: Normal Blood work: Elevated cTn and CK-MB; glucose normal; blood lipids: total cholesterol 200 mg Â· dlâ1, HDL-C 45 mg Â· dlâ1, LDL-C 134 mg Â· dlâ1, triglycerides 104 mg Â· dlâ1
Chest CT: No evidence of aortic dissection Echocardiogram: Left ventricular ejection fraction 45%, hypokinesis of the anteroseptal wall, borderline left ventricular enlargement, normal diastolic function, normal cardiac valves

Diagnosis:
Acute anterior wall STEMI.

Treatment:
1. Emergent cardiac catheterization (began 46 min after initial presentation to the hospital): total occlusion of the proximal left anterior descending (LAD) coronary artery, mild diffuse narrowing of the circumflex and right coronary arteries. The LAD occlusion was treated with thrombectomy, percutaneous coronary angioplasty, and placement of a drug-eluding stent, with good result.
2. Medical treatment: Aspirin, heparin, intravenous nitroglycerin, clopidogrel, abciximab, atorvastatin, carvedilol, lisinopril, nicotine patch.
3. Nicotine dependence consultation.
4. Referral to outpatient cardiac rehabilitation. Complications: None Hospital dismissal: Occurred approximately 48 h after admission; appointments made to see primary physician and to begin outpatient cardiac rehabilitation program in 5 d; follow-up blood work, ECG, and cardiology appointment in 8 wk Dismissal medications: Carvedilol, aspirin, clopidogrel, lisinopril, nicotine patch, simvastatin

Outpatient Exercise Test Results (Performed 8 D after Hospital Dismissal)
8.0 min duration (treadmill), normal blood pressure and electrocardiographic responses, peak heart rate 164 beats Â· minâ1, V.O2peak = 3.04 L Â· minâ1 (20.8 ml â kgâ1 â minâ1; 47% of expected), no angina reported
Exercise Prescription:
Outpatient cardiac rehabilitation program: Began 5 d after hospital dismissal; initial evaluations included assessments of neuromuscular function (normal), depression (normal), and potential sleep apnea (abnormalBerlin questionnaire, abnormal overnight oximetry resulted in referral for a sleep consultation); meeting with registered dietitian.
Exercise prescription: Goals included weight loss, increased aerobic and muscular fitness; frequency of three supervised sessions per week in cardiac rehabilitation facility plus three or four independent sessions per week (total frequency of six or seven sessions each week); average intensity using target heart rate 130 to 140 beats Â· minâ1 (60-70% heart rate reserve), RPE 12 to 14; high-intensity intervals (to begin 2 wk after starting cardiac rehabilitation) using RPE 17, heart rate <160 beats Â· minâ1; duration initially set at 10 to 15 min (not including warm-up, cool-down, strength training), gradually increasing to 45 to 60 min per session; types of exercise to include outdoor or treadmill walking, elliptical trainer; resistance training (to begin 2 wk after starting cardiac rehabilitation) using free weights and weight machines, initially one set of 8 to 15 slow repetitions, exercises for the major muscle groups, two or three sessions per week; lifestyle or general physical activity including walking short distances during the day, yard work, physical activity at work (return to work as restaurant equipment installer 4 wk after myocardial infarction).

Outcomes from 11 WK of Cardiac Rehabilitation Program
Medication compliance: Excellent (self-report) Exercise training: Frequency six or seven sessions per week (two or three supervised sessions per week); aerobic exercise duration 50 to 60 min per session; aerobic interval training two or three sessions per week (initially treadmill grade walking for 30 s progressing to slow jogging on treadmill for up to 4 min, three to five high-intensity intervals per session); resistance training two or three sessions per week, two or three sets of 8 to 15 repetitions, major muscle groups. Body weight: Stopped eating fast food and desserts, had more fruit, vegetables, poultry, fish; weight loss = 20.8 kg (BMI still excessive, 33.8 kg Â· mâ2). Repeat cardiopulmonary exercise test: 10.5 min duration (treadmill), normal blood pressure and electrocardiographic responses, peak heart rate 162 beats Â· minâ1, V.O2peak = 4.16 L Â· minâ1 (31.2 ml â kgâ1 â minâ1; 71% of expected), 37% increase in V.O2peak (L Â· minâ1), no angina reported. Tobacco use: One or two cigarettes daily. Blood pressure: 126/80 mmHg. Blood lipids: Total cholesterol 126 mg Â· dlâ1, HDL-C 33 mg Â· dlâ1, LDL-C 80 mg Â· dlâ1, triglycerides 65 mg Â· dlâ1. Recommendations: Stop smoking; continue medications, exercise program, and heart-healthy eating habits; continue efforts for weight loss; return appointment with cardiac rehabilitation team in 3 mo.

Discussion:
This patient was extremely young and was fortunate to realize the importance of promptly seeking medical attention with the onset of symptoms. His hospital course included standard diagnostic testing for acute myocardial infarction with subsequent timely coronary angiography with PCI of the infarct-related artery. Fortunately he did not develop serious complications and was discharged from the hospital after only 2 d. He enrolled in outpatient cardiac rehabilitation 1 wk after his MI. Of concern, he was markedly obese and may have had obstructive sleep apnea based on his abnormal Berlin questionnaire; he was referred for further evaluation in the Sleep Clinic. His course during rehabilitation was very favorable, and he did not experience post-infarction angina. He was successful in exercise and weight loss and demonstrated a remarkable increase in aerobic capacity. His challenge will be to continue taking his medications, stop smoking completely, eat a healthy diet, maintain his exercise program, and control his other coronary risk factors.

Questions:
1. What were this patientâs coronary risk factors?

2. What clinical tests were used to make the diagnosis of an acute ST-segment elevation anterior wall myocardial infarction?

3. What classes of cardiovascular medications were prescribed for this patient?

4. Compare the two cardiopulmonary exercise tests for this patient. What were the similarities? What were the differences?

5. Review the patientâs exercise prescription and program. Were the established goals achieved? Would you alter the exercise program in any fashion?

6. How effective was the patient in controlling his coronary risk factors by the time he completed 11 wk in the outpatient cardiac rehabilitation program?

7. What is his most important remaining coronary risk factor?

8. What component of the recommendations given to him at the completion of 11 wk of cardiac rehabilitation will potentially help him in sustaining his efforts at secondary prevention?

Question 2

The DSM-IV describes an "Eating Disorder Not OtherwiseSpecified" as:

self-starvation that leads to severe nutrient deficiencies

compulsive eating disorder

a variety of atypical eating behaviors used to maintain or lowerbody weight

recurrent episodes of extreme overeating followed byself-induced vomiting

Question 3

The nutrition paradox refers to:

coexistance of underweight and obesity in the same region

too mucn vitamin A in foods rich in vitamin C

poor countries that have excessive rates of obesity

obese children from nonobese parents

Question 4

Which of the following represents a nutrition transition?

decreased reliance on carbohydrates

increased consumption of sugar

increased availibility of maize over corn

lower-fat subsistence crops

Question 5

Which of the following is NOT part of the GOBI initiative?

breast-feeding

obesity control

immunization

growth monitoring

Question 6

Which of the following is a response to the drawbacks of theGreen Revolution?

WIC

high yield varities of grains

sustainable agriculture

biotechnology

Flag this Question

Question 70.5 pts

Worldwide, the major cause of undernutrition is:

unequal distribution of food

diseases (like AIDS)

poor farming practices

overpopulation

Question 8

Which agency monitors all confirmed causes of food-borneillness?

EPA

FDA

CDC

USDA

Question 9

In which of the following environments does Clostridiumbotulinum flourish?

acidic

alkaline

<40 degrees F

> 140 degrees F

Question 10

Which of the following is an example of food intoxication?

Norwalk virus

Salmonella

hepatitis A

Clostridium botulinum

Question 11

All of the following describe characteristics of the femaleathlete triad EXCEPT

menstrual dysfunction

disordered eating

hypertension

osteoporosis

Question 12

Impulsive, low self-esteem, seeks attention, extroverted, anderratic describe personality traits of:

bulemia nervosa

binge-eating disorder

obesity

anorexia nervosa

Question 13

Obsessive-compulsive, perfectionism, socially inhibited,compliant, and emotionally restrained describe personality traiatsof

binge-eating disorder

anorexia nervosa

bulimia nervosa

obesity

Question 14

The Institute of Medicine recommends a minimum of ________minutes of physical activity each day for adults.

Question 15

Regular exercise reduces the risk of type 2 diabetes by all butwhich of the following?

decreases the cellular uptake of blood glucose

delays the onset of complications of type 2 diabetes

increases control of blood glucose

enhances the action of insulin

Question 16

What is meant by the overload principle?

stretching a muscle group beyond the joint's healthy range ofmotion

improving fitness by placing extra physical demand on thebody

complete depletion of the body's glycogen

subjecting the body to inappropriately high stress

Question 17

The acronym FIT stands for:

fatigue, intensity, and training.

flexibility, increase, and training.

fitness, increase, and time.

frequency, intensity, and time.

Question 18

To achieve cardiorespiratory fitness it is recommended thattraining should occur ________.

3-5 days a week

daily

more than 5 days a week

2-3 days a week

Question 19

To achieve and maintain physical fitness, exercise intensityshould be ________ of the maximal heart rate.

35-50%

15-25%

25-30%

50-80%

Question 20

In which of the following types of exercise would CP (creatinephosphate) be an important source of energy?

biking up a mountain

sprinting in the 100-meter race

running a 10-kilometer road race

playing in a football game

Question 21

Which is NOT an advantage of aerobic metabolism over anaerobicmetabolism?

Much more energy is produced for every fuel molecule.

Aerobic metabolism acts more quickly.

Harmful metabolites do not accumulate as quickly.

A greater fuel supply is available.

Question 22

An unwanted effect of an overly vigorous warm-up is:

increased muscle temperature.

glycogen depletion.

increased body temperature.

reduced stress levels.

Question 23

Each day Bill power-walks for 45 minutes. Which fuel source(s)provide(s) energy during this activity?

amino acids

glucose

fatty acids

fatty acids and glucose

Question 24

The main disadvantage of using fat as a fuel is:

the body's limited storage capability.

its low energy density.

its slow metabolic breakdown.

the limitation of anaerobic metabolism.

Question 25

Joseph plays basketball for his high school team and he isconcerned that he is not consuming enough kilocalories to supporthis activity. Which of the following would be the best indicatorthat he is not consuming adequate kilocalories?

His hemoglobin is low.

His blood glucose levels are low.

His performance has been impaired.

He is losing weight.

Question 26

Rachel is a gymnast who trains 2 hours/day on average. Shesupports her daily activity by consuming 2,500 kilocalories perday. How many kilocalories should she be consuming fromcarbohydrate sources?

1,500-1,625 kilocalories

1,125-1,300 kilocalories

1,300-1,500 kilocalories

1,625-1,750 kilocalories

Question 27

The best time to replenish glycogen stores is:

the day after exercising.

a few hours before exercising.

the day before exercising.

right after exercising.

Question 28

In which of the following events would carbohydrate loading bethe most beneficial?

cross country skiing

baseball game

weight lifting

100-yard dash

Question 29

Osteoporosis, eating disorders, dehydration, and heat illnessare all possible consequences of:

the Zone diet.

carbohydrate loading.

inadequate dietary intake.

overtraining.

Question 30

Which of the following is the most potentially harmful?

heat syncope

heatstroke

heat cramps

heat exhaustion

Question 31

Which of the following athletes would be LEAST likely to developiron deficiency anemia?

a female marathon runner

a male basketball player who is a vegan

a female gymnast

a male distance swimmer

Question 32

Amenorrhea, sometimes seen in female athletes, is:

the onset of menstruation.

osteoporosis.

the loss of the menstrual cycle.

frequent diarrhea.

Question 33

Some athletes believe that caffeine can enhance athleticperformance because it has been shown to:

increase the transport of amino acids to exercising muscle.

increase muscle flexibility and strength.

increase the use of fatty acids as a fuel source.

regenerate ATP for energy.

Question 34

Which of the following ergogenic aids has been shown to enhanceshort-term exercise and resistance training?

chromium picolinate

creatine

carnatine

ephedrine

Question 35

Consuming processed foods as opposed to whole foods decreasesthe risk of contracting a food-borne illness.

True

False

Question 36

Regular physical activity can increase HDL-cholesterol.

True

False

Question 37

Nearly 1 in 6 American adults reports getting no physicalactivity at all.

True

False

Question 38

Lactic acid is a by-product of high-intensity exercise.

True

False

Question 39

Training can enhance the ability to store glycogen.

True

False

Question 40

The primary fuel source utilized in both anaerobic and aerobicexercise is protein (amino acids).

True

False

Question 41

Studies suggest that athletes need to consume more than 2grams/kg of protein each day to maintain muscle strength.

True

False

Question 420.5 pts

Refigerating or freezing foods will kill any bacteria present inthe food.

True

False

Question 43

Most athletes do not consume enough protein to support theiradded physical activity.

True

False

Question 44

Thirst is a very reliable indicator of dehydration.

True

False

Medical History and Physycal E x a m i n a t i o n:
At age 7, Mr. AT suffered a series of seizures, and after a physical e x a m, lab tests, and electroencephalography, he was diagnosed with epilepsy and put on epileptic medication. He has gained 25 lb (11 kg) over the last 2 yr. He complains about excessive postural sway and loss of balance while walking and therefore uses his fatherâs cane. He has no history of smoking or alcohol consumption, but he has a familial history of diabetes. At a recent physical e x a m his low-density lipoprotein cholesterol (LDL-C) was 178 mg Â· dlâ1, high-density lipoprotein (HDL) was 61 mg Â· dlâ1, fasting glucose was 88 mg Â· dlâ1, and waist circumference was 42 in. (107 cm). He is currently on Carbatrol (carbamazepine) and baclofen.

Diagnosis:
Mr. AT, now 28 yr old, was born prematurely along with his twin sister at 34 wk. His mother experienced a severe infection early in her pregnancy and was hospitalized for several days; upon birth he had an Apgar score of 4. At age 1 he was diagnosed with spastic hemiplegia.

Exercise Test Results:
Because Mr. AT is ambulatory but has balance difficulties, leg cycle ergometry was chosen as the method of aerobic exercise testing. His resting blood pressure and heart rate in a seated position were 134/80 mmHg and 82 beats Â· minâ1, respectively. A small face mask was used to provide an adequate seal. A toe clip on his right side was used to maintain proper foot positioning on the pedals, and an adaptive glove was used to help his right hand grip the handlebar throughout the test. Mr. AT performed a 2 min warm-up without resistance. The leg cycle ergometry test began at 25 W at a cadence of 50 to 60 rpm. The protocol consisted of 2 min stages with an increase of 15 W per stage. The following data were collected during the exercise test.
The exercise test was terminated at 5:15 because of increased hip adductor spasticity and inability to maintain speed of 50 rpm, and by request of the participant because of shortness of breath. No signs of electrocardiogram abnormalities were present during the test. His V.O2 at 5:00 was 16 ml Â· kgâ1 Â· minâ1. The RER was <1.00 and the heart rate and V.O2 failed to reach peak. This was not a valid peak V.O2 test.
Because of the termination of the clinical leg cycle ergometry test, a more functional approach was chosen. The Timed Get Up and Go test was used as a baseline measure. This test used the following protocol.
Test Instructions
1. Starting position: Sit upright against the chair.
2. Stand up from the chair (time start).
3. Move quickly along the line toward the opposite end.
4. Touch the end and pivot back toward the chair.
5. Move quickly all the way back to the chair.
6. Pivot.
7. Sit back down (time end).
The total distance was 10 ft (3.05 m). The test was performed three times. Mr. ATâs scores were 42 s, 38 s, and 40 s. (A score over 30 s suggests a higher risk of falls.) Mr. AT used his assistive device during all testing.

Exercise Prescription:
Using the information presented in the medical history and exercise testing sections and in tables 27.9 through 27.11, develop an exercise prescription that encompasses aerobic, strength, flexibility, and neuromuscular training. Consider the different modes for each of the exercise training domains and the frequency, duration, intensity, and progression of each.

Questions:
1. How would the clinical exercise physiologist best determine the appropriate resistance levels to prescribe for this person?

2. What factors represented in the ICF model should the clinical exercise physiologist take into consideration to increase the adherence level and success of this client?

3. What fall prevention strategies should be incorporated into the exercise prescription for an individual who is at increased risk for falls?

4. Is the assistive device described in this case study appropriate for use by Mr. AT?

5. How should the clinical exercise physiologist incorporate weight loss strategies into the goals for this client?

HLTH 102 Chapter Notes - Chapter 5: Embase, Osteoporosis, Google Scholar

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