Exercise Prescription Exam 1

• Physical Activity: bodily movements that result in energy expenditure
• Exercise: planned, structured, repetitive, with a goal of improving or maintaining physical fitness
• Physical fitness: set of attributes relating to physical activity performance; can be health or skill related 
• What is the relationship between health outcomes and physical activity? 

  Both physical activity and exercise show an inverse dose-response relationship with health outcomes. More physical activity, lower risk of disease
• Know the components that define sedentary behavior 

  Awake, sitting, reclined, or lying down while engaging in <1.5 Mets
• Know what physical inactivity is:

  Individuals who are not meeting a threshold of moderate to vigorous physical activity 
• Know the MET cut-points that define light, moderate, and vigorous physical activity 

  Light: <3 METs

  Moderate: 3-5.9 METs

  Vigorous: >6 METs
• Know the four domains of physical activity

  Recreation, transport, occupational, household
• Know the aerobic and muscle-strengthening activity guidelines for adults (2018) 

  Adults should move more and sit less throughout the day. Some physical activity is better than none. Adults who sit less and do any amount of moderate to vigorous physical activity gain some health benefits.
• Know the aerobic and muscle-strengthening activity guidelines for adults (2018) 

  For substantial health benefits, adults should do at least 150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate intensity, or 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 minutes) a week of vigorous intensity aerobic physical activity, or an equivalent combination of moderate and vigorous intensity aerobic activity. Preferably aerobic activity should be spread throughout the week
• Know the aerobic and muscle-strengthening activity guidelines for adults (2018) 

  additional health benefits are gained by engaging in physical activity beyond the equivalent of 300 minutes of moderate intensity physical activity a week
• Know the aerobic and muscle-strengthening activity guidelines for adults (2018) 

  adults should also do muscle strengthening activities of moderate or greater intensity and that involve all major muscle groups on two or more days a week as these activities provide additional health benefits
• Know the top 3 causes of death by risk factor for 2017 

  high blood pressure, smoking, and high blood sugar
• Know the demographic that meets the activity guidelines at the highest rate 

  • males meet recommendations more than women
  • native Hawaiian or other pacific islander
  • younger adults aged 18 to 24 years
  • for adults 25 years or older, those with higher educational attainment
• Know the demographic that meets the activity guidelines at the highest rate 

  • those who live in a family with higher income
  • adults who had a spouse or partner were active than single, two-parent family with a child or children
  • adults born in the united states
  • individuals without activity limitations
• Know the four most prevalent chronic diseases

  Cardiovascular diseases, cancers, chronic respiratory disease, and diabetes
• Know the protective mechanisms that physical activity provides for stroke 

  • Reduced hypertension and risk of atherosclerosis
  • Improved lipid profiles and endothelial function
  • Antithrombotic role (reduces blood viscosity, fibrinogen levels, platelet aggregation) 
• Exercise confers health benefits to individuals with which types of cancer?

  Exercise has been shown to benefit individuals with lung, breast, colon, and pancreatic cancer and reduce the overall risk of colon and breast cancer (possibly lung)
• How many days (and for how many minutes) should school-aged children and adolescents engage in aerobic physical activity? 

  Most of the 60 minutes or more per day should be either moderate or vigorous activity intensity aerobic physical activity and should include vigorous intensity physical activity on at least 3 days a week 
• How many days should children and adolescents engage in muscle-strengthening activities? 

  Children and adolescence should include muscle-strengthening physical activity on at least 3 days a week.
• How do activity guidelines for older adults differ from adults?

   

  • Key guidelines for adults also apply to older adults and include:
  • As part of their weekly physical activity, older adults should do multicomponent physical activity that includes balanced training as well as aerobic and muscle strengthening activities.
• How do activity guidelines for older adults differ from adults? 

  • Older adults should determine their level of effort for physical activity relative to their level of fitness
  • older adults with chronic conditions should understand whether and how their conditions affect their ability to do regular physical activity safely
  • when older adults cannot do 150 minutes of moderate intensity aerobic activity a week because of chronic conditions, they should be as physically active as their abilities and conditions allow
• What are the aerobic physical activity guidelines for pregnant women? Is vigorous-intensity aerobic activity contraindicated? 

  • Women should do at least 150 minutes (2 hours and 30 minutes) of moderate intensity aerobic activity a week during pregnancy and the postpartum period. Preferably, aerobic activity should be spread throughout the week
  • Women who habitually engage in vigorous intensity aerobic activity or who were physically active before pregnancy can continue these activities during pregnancy in the postpartum period
• What are the aerobic physical activity guidelines for pregnant women? Is vigorous-intensity aerobic activity contraindicated? 

  • women who are pregnant should be under the care of a health care provider who can monitor the progress of the pregnancy. Women who are pregnant can consult their health care provider about whether or how to adjust their physical activity during pregnancy after the baby is born
• Know the term “deconditioning” and several causes for it 

  Partial or complete reversal of psysiological adaptations to activity. A state. 

  Common causes:

  Reduced physical activity, bed rest, casting, paralysis, aging; increased physical inactivity
• According to 2003-2006 NHANES accelerometer data, what percentage of U.S. adults are physically inactive? 

  95% of adults (>20 yr) are physically inactive 
• What are the limitations associated with surveys and accelerometers? 

  • Wide differences in measurement results 

  o   Biased survey questions

  o   Biased survey responses (recall and reactivity bias)

  §  Light physical activity easily forgotten 

  §  Sometimes people are lead to an answer or report inaccurately 

  o   Measurement of behavior vs. actual bodily acceleration 

  • Accelerometer measures changes in acceleration 

  o   Do not have the backstory of what is actually going on 

  o   Limited to ambulatory actives (no swimming, biking, etc.)
• Identify primary stakeholders for the initiative Exercise is Medicine 

  Healthcare providers, exercise professionals, and community resources
• What kind of relationship explains the link between sedentary behavior and cardiovascular disease and mortality? 

  Sedentary behavior is associated with a 49% increase in all-cause mortality and a 17% increased risk of cardiovascular disease with each 2-hour screen time per day
• As it relates to diabetes, sedentary behavior plays a role in the activity of which enzyme found in skeletal muscle? 

  Lipoprotein lipase (LPL)

   
• Be familiar with the goals of preparticipation screening 

  • To identify those who should receive medical clearance prior to initiating or progressing an exercise program 
  • To identify those with clinically significant disease
  • To identify those with medical conditions who should be restricted from exercise participation 
• What does participation screening collect?

  • Current physical activity level
  • Individuals with signs and symptoms of cardiovascular disease, metabolic disease, and renal disease
  • Individuals with diagnosed cardiovascular disease, metabolic disease, and renal disease
  • Individual’s desired exercise program intensity 
• What volume of activity classifies someone as participating in “regular exercise” 

  Exercising for at least 30 minutes on 3 or more days per week at a moderate intensity for at least 3 months
• Be familiar with signs and symptoms of cardiovascular disease, metabolic, and renal disease 

  • Pain or discomfort in the jaw, neck, chest, arms or other areas that may cause myocardial ischemia 
  • Shortness of breath at rest with mild exertion (Dyspnea)
  • Dizziness or syncope 
  • Orthopnea or paroxysmal nocturnal dyspnea (Dyspnea occurring at rest in the recumbent position that is relieved promptly by sitting up or standing) 
  • Ankle edema
  • palpitations of tachycardia (unpleasant awareness of the forceful or rapid beating of the heart)
• Be familiar with signs and symptoms of cardiovascular disease, metabolic, and renal disease 

  • Intermittent claudication (Pain that occurs in the lower extremities with an inadequate blood supply)
  • Known heart murmur 
  • Unusual fatigue or shortness of breath with usual activities 
• What is the self-guided screening method to assess activity readiness? 


  The most common self-guided screening form is the physical activity readiness questionnaire for everyone (PAR-Q+) 
• Know the components of an informed consent document (three) 

  • Comprehensive explanation of the risks and benefits associated with exercise testing
  • Indication that the participation is free to withdraw without consequence
  • Statement that “emergency procedures and equipment are available” 
• What is the negative risk factor discussed in class? What is the criteria for it? 

  HDL (≥ 60 mg/dL cholesterol) 
• Be familiar with the positive risk factors and their associated criteria 

  • Age: Men ≥ 45 yr, women ≥ 55 yr
  • Family history: Myocardial infraction, coronary revascularization, or sudden death before 55 yr In father or other male first-degree relative or below 65 yr in mother or other female first-degree relative
  • Cigarette smoking: Current smoker or those who quit within the previous 6 month or exposure to environmental tobacco smoke
• Be familiar with the positive risk factors and their associated criteria 

  • Physical intensity: Not participating in at least 30 minutes of moderate-intensity physical activity on at least 3 days a week for at least 3 months 
  • Obesity: Body mass index ≥ 30 kg/m^2 or waist girth > 102 cm (40 in)  for men and > 88 cm for women (35 in) for women
  • Hypertension: Systolic blood pressure ≥ 40 mm Hg and/or diastolic ≥ 90 mm Hg, or on antihypertensive medication