1
Q
Factors affecting VO2 max
A
- Hereditary
- Gender (men tend to have higher)
- Training state
- Body composition
- Age (muscles decrease, thoracic cavity decreases)
- Exercise mode (specificity, make cyclist go on bike machine)
- Clinical limitations
2
Q
VO2 base line for living
A
12-15ml/kg/min
3
Q
How much O2 is spent per MET?
A
3.5ml/kg/min
4
Q
Type, fuel, limitation, engage, end,
ATP-PC
A
Type: Immediate - Short duration
Fuel: phosphocreatine
Limitation: amount stored
Engage: Instantly
End: 5-8s
5
Q
Type, fuel, limitation, engage, end
Lactic Acid System/ Rapid Glycolysis/ Anaerobic Glycolysis
A
Type: Short-term energy
Fuel: Glucose
Limitation: Lactic acid
Engage: 10s
End: 60-180s
6
Q
Type, fuel, limitation, engage, end
Aerobic/Krebs cycle/ citric acid cycle
A
Type: Long term
Fuel: O2 and Acetyl-CoA
Limitation: Adequate O2 (enzymes and substrates)
Engage: 180s
End: 2hrs
7
Q
Where in the cell is energy produced?
A
Cytosol - Anaerobic - glycolysis
Mitochondria - Aerobically - Citric acid cycle
8
Q
What is the trainability of the three energy systems?
A
Immediate - Limited trainability (supplements)
Short-term - Trainable (shift lactate threshold - more suited for athletes)
Long-term - Trainable
9
Q
What are the adaptations by short-term & immediate energy systems?
A
- Increased levels of anaerobic substrates (i.e. ATP and PCr)
- Increased quantity and activity of key enzymes in short-term energy system (not to the magnitude of those observed w/ oxidative enzymes w/ aerobic training)
- Increased capacity to generate high levels of lactate w increased enzymes and ‘pain’ tolerance
10
Q
What are the adaptations by long-term energy system?
A
- Increase in mitochondrial size and number
- Increase in required enzymes (2x increase in aerobic system enzymes)
- Improved fat catabolism (improved ability to oxidize fatty acids, particularly fat stored within active muscles during steady rate exercise)
-Improved CHO catabolism (enhanced ability to oxidize CHOs) - Muscle fiber type and size (aerobic adaptation of slow and fast twitch muscle fibers)
11
Q
Max. expiration at end of tidal expiration
A
ERV - Expiration reserve volume (m1200mL/w800)
12
Q
Volume in lungs after maximal expiration
A
RLV - Residual lung volume (m1200/w1000)
13
Q
Max inspiration at end of tidal inspiration
A
IRV - Inspiration reserve volume (m3000/w1900)
14
Q
Volume in lungs after tidal expiration
A
FRC - functional reserve capacity (m2400/w1800)
15
Q
Max. volume expired after max. inspiration
A
FVC - Functional vital capacity (m4800/w3200)
16
Q
Max. volume inspired following tidal expiration
A
IC - Inspiration capacity (m3600/w2400)
17
Q
Volume inspired or expired per breath
A
TV - Tidal volume (m600/w500)
18
Q
Volume in lungs after max inspiration
A
TLC - Total lung capacity (m6000/w4200)
19
Q
Factors affecting static lung volume
A
- Genetics
- Sex (men tend to have larger lungs)
- Height (taller = larger lungs)
- Obesity (lower lung capacities)
- Chronic disease
- Aging (stiff chest cavity)
20
Q
What determines whether O2 and Hb are combined or disassociated (separated)?
A
PO2 is main driver
- high PO2 –> Hb binds O2
- low PO2 –> Hb releases O2
The oxyhemoglobin dissociation curve shows this relationship
21
Q
Why does Hb combine with O2 in the lungs and release O2 at the tissues?
A
- in the lungs, PO2 is high (~100mmHg), so Hb is almost fully saturated with O2
- in the tissues PO2 is much lower (~40mmHg at rest, even lower with exercise)
- that drop in PO2 drives O2 off-loading from Hb to the cells that need it
22
Q
How can variable amounts of O2 be released at the tissues, depending on the level of tissue activity?
A
- The lower, steep portion of the curve makes Hb very responsive to tissue demand
- At rest: only a small fraction of O2 is released (plenty in reserve)
23
Q
What is minute ventilation?
A
The volume of air breathed each minute
- VE = breathing rate x tidal volume
- Breathing rate: bpm
- Tidal volume: L
- Average (at rest male) = 12 bpm x 0.5L = 6L/min
- Can be increased by increasing the rate or depth of breathing
24
Q
What is Alveolar ventilation?
A
The portion of minute ventilation that mixes with air in the alveolar chambers
- Alveolar ventilation = (TV - dead space) x breathing frequency
- TV: tidal volume: L
- Dead space: anatomical + physiologic
- occurs at level of alveoli in the lungs
25
What is anatomical dead space
- nose + mouth + trachea + all other non-diffusible conduction portions of resp. tract
- no air exchange can happen despite being apart of resp. tract
- this is a fixed value (~150mL per breath avg.)
26
What is physiologic dead space
- a portion of alveolar volume with poor tissue regional perfusion of blood or inadequate ventilation with air
- changeable value
- important to consider with positioning and how it affects blood perfusion in lungs + how well air is conducted
- small and negligible amount
27
What are some anatomical changes with long-term aerobic training?
1. Training duration affects cardiac size and structure - bigger heart
2. endurance athletes average 25% larger heart volume than sedentary counterparts
3. increase mass and volume
4. increase size of left ventricle cavity - more blood in and out
5. modest increase in left ventricle wall thickness
6. increase in left ventricle end diastolic volume (EDV) at rest and during PA
7. increase in number of mitochondria
28
Equation for Cardiac Output
(CO)
CO = HR x SV
29
What is the first thing to get better with training?
Stroke volume (SV)
EDV - ESV = SV
(end diastolic volume, end systolic volume)
30
What are the 4 general training principles?
1. Overload - Stress the system
2. Specificity - Stresses intended to be similar to training
3. Individual Differences Initial values - Individualize the program depending on the start point
4. Reversibility (de-training) - use it or lose it - 1-2 weeks of detraining results in lost metabolic and exercise capacities.
31
ACSM screening approach
1. classify current PA levels
2. Identify known cardio, metabolic, or renal disease and symptoms suggesting disease
3. desired exercise intensity - medial or chronic will change
32
3 exercise intensities
1. light (30-39%HR reserve, 2-2.9 METs, RPE 9-11, slight increase in HR and bpm)
2. moderate (40-45%HRR, 3-5.9 METs, RPE 12-13, noticeable increase in HR and bpm)
3. Vigorous (>60% HRR, >6 METs, RPE >14, substantial increase in HR and bpm)
33
What are the three layers of connective tissue
- Endomysium (wraps around each muscle fiber)
- Perimysium (bundles up to 150 fibers to form a fascicle)
- Epimysium (surrounds entire muscle bodies - strong tissue connects to the muscle to bone)
34
What is in a Sarcomere?
- Actin (thin filaments)
- Myosin (thick filaments)
35
Where is tension developed within?
- Myofibre - then transmitted to the load-bearing connective tissue
36
What is the optimal sarcomere length?
- greatest interaction between actin and myosin filaments
37
What are the two types of muscle forms?
- Fusiform (fibers straight up and down)
- Pennate (oblique)
38
What are the 3 pennation forms
- unipennate
- bipennate
- Multipennate
39
Characteristics of fusiform
- longer fibers
- more longitudinal
- faster working velocity
- longer working range
40
Characteristics of Pennate
- shorter fibers
- more angled
- HIGHER PEAK FORCE
- shorter working range
41
Slow twitch (Type I) fiber characteristics
- slow contraction speed
- low force
- high aerobic (oxidative) capacity
42
Fast twitch (Type II) fiber characterisitics
- Fast contraction speed
- High force (rapid cross bridge turnover)
- High anaerobic capacity - more fatigue
43
Henneman's size principle
- Motor units are recruited from small to large
1. Motor unit recruitment - number of motor units active
2. Rate coding - modulation of firing rate of a motor unit (frequency of motor unit discharge)
- As firing rate increases, summation occurs, initial small twitch --> constant higher force contraction
44
How is force modulated?
- expectation of task - do task, instant modulation depends on actual requirement
- Muscle spindles afferent feedback
- Feedback loop
- Sensory stimuli - respond to various stimuli of actual exercise and enviornment
45
What happens to muscle with paresis following a stroke
- Switch in muscle content - Type II --> Type I
- Type II fibers that are abandoned gets innervated by Type I
- Orphaned fibers gets picked up by recruitment of larger units, slowed down
46
What is a motor unit
Consists of a single motor neuron and all the skeletal muscle fibers it innervates, acting as the fundamental functional unit of skeletal muscle contraction
47
What is the ratio of muscle fibers per motoneuron generally related to?
Muscle movement function
48
What is CA's current PA recommendation?
- 150-300 mins of mod intensity
-75-150 vig
- 2 days strengthening
- 7-9 hrs of sleep
(ppl over 65 + balance)
49
FITT? Aerobic
Frequency
Intensity (most important)
Time
Type
50
FIT anaerobic
Frequency
Intensity
Type
(Time is not important)
51
FITT - progression
Gradual increase!
change one component at a time (start by progressing 'time' 5-10 mins every 1-2 weeks for 4-6weeks)
usually takes 4-6 weeks to see improvement
52
How to prescribe intensity for aerobic exercise?
1. Maximal heart rate (HRmax) method (Target HR = HRmax x % desired intensity
2. Heart rate reserve (HRR) method [(HRmax - HRrest) x % desired intensity] + HRrest
3. Rating of perceived exertion (RPE) - easiest
53
What age is considered middle childhood?
Starts when they enter school and goes until adolescence (puberty)
54
Genes are static - True or false?
False - Genes lie dormant and wait for an environment trigger to be expressed
55
What are the general changes in motor development in middle childhood?
Motor = refinement
56
What is an epigenome?
Chemical markers that accumulate on DNA. It determines how much a gene is expressed. Different experiences rearrange it
57
Impact of early experiences
- Change whether, when, and how genes get released
- early experiences can change the gene expression and influence future capacity
- impact early learning, readiness to succeed in school, and LIFELONG physical and mental health (cardiovascular, depression, anxiety etc.)
58
When and why should there be early childhood health promotion?
- Begins PRENATALLY and goes to early childhood
- Supportive relationships and rich learning experiences generate positive epigenetic signatures that activate genetic potential and can impact future generations
59
What is child development?
- Process that involves learning and mastering skills. Relatively permanent
- Not the same as growth
60
4 key areas of child development
Cognitive
Social-Emotional
Communication
Motor
61
What is motor development?
- Process of acquiring skills to use muscles and control movement
- Relatively permanent
- Interaction with environment is important
62
Normal motor skill development pattern in children
- Reflexive to voluntary
-Cephalo to caudal
- proximal to distal (develop larger muscles first)
- General (gross motor) to specific (fine motor)
63
What is serve-and-return?
- interactions that are a continuous give- and-take with a human partner
- Helps build the environment of the relationship
64
Connection to land
- youth on the land
- Play is so important with different environments
- connecting past, present, and future selves
65
What is maturational theory?
- Born with the genetic sequence and it is a fixed sequence which occurs at a steady rate
66
What is dynamic systems theory?
- made up of body, mind, physical environment, and social environment.
- Lots of variation
- experience matters, genetics matter, and environment matters
67
what is neuro-maturational theory?
- predetermined set of genetics and sequence
- motor development is due to maturation of CNS
- spinal cord, brainstem, midbrain, cortex
68
What does a newborn do in a day?
-14-17hrs sleeping
-primarily waking up to eat
-sleep in physiological flexion
-movements that do occur are primarily -reflexive
69
What is the babies position in the womb?
Physiological flexion
-hip flexion and ER
- Flexible flat feet
-Plantarflexion
-Forefoot add.
-IR tib
-Knee flex
-Elbow flex
-hands fisted
-head turned
- neck and trunk flex
-Forearms across chest
70
What are primitive reflexes? Why is it important?
Neonatal reflexes that slowly integrate
-rooting
-galant
-babinsky
-plantar
-plantar grasp
-placing or stepping
-tonic labyrinthine
-moro
-plamar grasp
-asymmetrical tonic neck
Important - can impact development - indicate underlying neuro disorder
71
What are permanent reflexes?
Stay with us for life
-breathing
-eyeblink
-pupillary
72
When does the placing/stepping reflex integrate? how to get them to do it? what does it look like?
-2 months
- hold baby upright and bring feet in contact with surface
-looks as if they are stepping
73
When does the rooting reflex integrate? how to get them to do it? what does it look like?
-3-4months
-touching cheek or side of mouth
- turn head to side with mouth open (supports feeding)
74
When does the galant reflex integrate? how to get them to do it? what does it look like?
-3-6 months
-stroke the paraspinals on one side of the body
-lateral flexion towards stimulated side (supports trunk rotation)
75
When does the Asymmetric Tonic Neck reflex integrate? how to get them to do it? what does it look like?
- 4-6 months
- turn head
- Extremities on the facial side extend and other side contralateral side flex (supports hand-eye coordination)
76
When does the moro reflex integrate? how to get them to do it? what does it look like?
- 4-6 months
- dropping the head back into extension
-Arms abd. with fingers open, then cross trunk into add. (protection from falling)
77
When does the tonic labryinthine reflex integrate? how to get them to do it? what does it look like?
- 6 months
- flexing or extending the neck (prone = flex, supine = ext.)
- corresponding flex or ext. of limbs (helps prepare for early movements)
78
When does the palmar grasp reflex integrate? how to get them to do it? what does it look like?
-6 months
-apply pressure to palm
-grasping fingers
79
When does the plantar grasp reflex integrate? how to get them to do it? what does it look like?
-9 months
-apply pressure to base of toes
- grasp with toe flexion
80
When does the babinski sign/ plantar reflex integrate? how to get them to do it? what does it look like?
- 1-2 years
- stroke lateral plantar aspect of foot from heel upwards
- extension of the big toe, fanning of the others, and withdrawal of the leg
81
Students Remember Gross Anatomy, Master Techniques, and Practice Physiotherapy Brilliantly
Stepping - 2 months
Rooting - 3-4 months
Galant - 3-6 months
ATNR - 4-6 months
Moro - 4-6 months
Tonic labyrinthine 6 months
Palmar Grasp 6 months
Plantar Grasp 9 months
Babinski 1-2 years
82
Transitional postural reactions
Landau - present 3-4 months - 8-12 months (elicit by putting in tummy time - head, chest, and legs also extend)
Symmetrical tonic neck reflex - present from 4-6 months to 8-12 months (appears as TLR integrates - elicit by holding baby in 4 point and extend head (results with arms ext. legs flex.) or flex head (results with arms flex. legs. ext.) pre-crawling)
83
What is a righting reaction? and the 3 types?
Align the head and trunk with the body and gravity as infants grow
1. Optical (aligns head to vertical using visual input) - permanent
2. Labyrinthine (aligns head to vertical using vestibular input) - permanent
3. Segmental (aligns segments of body using somatosensory input- HOB, BOH, BOB) - integrates by 5years
84
What is equilibrium reactions?
- help to maintain balance by shifting the centre of mass or BOS
- occur from internal or external changes (internal = standing on a foot and grabbing, external = someone pushes you)
- develops sequentially --> prone, supine, sitting, standing
85
What is Protective reactions?
Goal is to protect person during a fall
- develop sequentially in different positions
- forwards, lateral, backwards (last protection reaction), downward (jumping/landing)
86
CDC motor milestones at 2 months
- holds head up when on tummy
- moves both arms and both legs
- opens hands briefly
87
CDC motor milestones at 4 months
- holds head steady without support when you are holding them
- holds a toy when you put in their hand
- uses their arm to swing at toys
- brings hands to mouth
- pushes up onto elbows/forearms when on tummy
88
CDC motor milestones at 6 months
- rolls from tummy to back
- pushes up with straight arms when on tummy
- leans on hands to support themself when sitting
89
CDC motor milestones at 9 months
- gets to a sitting position by themself
- moves things from one hands to the other hand
- uses fingers to "rake" food towards themself
- sits without support
90
CDC motor milestones at 12 months
- pulls up to stand
- walks, holding on to furniture (cruising)
- drinks from a cup without a lid as you hold it
- picks things up between thumb and pointer finger, like small bits of food (pincer grasp)
91
CDC motor milestones at 15 months
- takes a few steps on their own
- uses fingers to feed themself
92
CDC motor milestones at 18 months
- walks without holding onto anyone/thing
- scribbles
- drinks from a cup without a lid and may spill
- feeds themself with their fingers
- tries to use a spoon
- climbs on and off a couch without help
93
CDC motor milestones at 2 years
- kicks a ball
- runs
- walks up a few stairs with or without help
- eats with a spoon
94
CDC motor milestones at 30 months
- uses hands to twist things, like turning doorknobs or unscrewing lids
- takes some clothes off by himself, like loose pants or an open jacket
- jumps off the ground with both feet
- turns book pages, one at a time, when you read to them
95
CDC motor milestones at 3 years
- strings items together, like large beads or macaroni
- puts on some clothes by themself like loose pants or jacket
- uses a fork
96
CDC motor milestones at 4 years
- catches a large ball most of the time
- serves themself food or pours water with adult supervision
- unbuttons some buttons
- holds crayon or pencil between fingers and thumb (not a fist)
97
CDC motor milestones at 5 years
- buttons some buttons
- hops on one foot
98
early reach and grasp
starts with gross movement then gets more specific and targeted, see what we want to reach for and target it
99
What is immature walking
- short steps
- flat foot contact
- wide base of support
- unpredictable balance
- arms in high guard - ready for a fall
- short swing phase
- unable to maintain single stance
100
What is elementary walking?
- step length increases
- heel toe contact
- arms down to side with limited swing
- no reciprocal pattern yet faster
101
Mature walking
- reflexive arm swing (contralateral)
- narrow base of support
- heel-toe contact well defined
102
What is required for walking?
- muscle strength to support body weight
- ability to balance when shifting
- adaptation to changing environmental conditions
103
What is toe walking?
- walking on tippy toes and no heel contact (equinus)
- common until age 3
- persistence of this is often idiopathic
- associated with neuro conditions
104
Early communication
infants - cry when in need of something
4 months - coo
6 months - makes sounds
9 months - babbles
12 months - 1-2 word vocab
2 years - 50+ words & uses 2 words together
3 years - 200+ words & uses 3 word phrases
4 years - 4 word sentences, 4+ sentences to tell a story
A lot of self talk in kids
105
Act early if ... then ...
- missing milestones
- baby or child has lost skills they once had
- caregiver is concerned
then - provide appropriate suggestions, arrange for a screening using valid assessment tool
106
LE at birth
Foot = flat, increased ROM, metatarsus adductus
Tibia = Internal torsion
Knees = Varum (tibia angles medially
Hips = flexed, ER>IR, femoral anteversion
107
LE at 2 years
Foot = arches developing, increased DF, Forefoot neutral
Tibial = internal torsion
Knees = neutral
Hips = neutral, IR = ER, femoral anteversion
108
LE >3 years & 8-11yrs
Foot = arches visible, typical ROM, forefoot neutral
Tibia = neutral
Knees = Valgum (tibia angled laterally)
Hips = Neutral, IR>ER, femoral anteversion
8-11 years = adult presentation
109
What is In-toeing?
- common in peds
- rotational variation - apart of development
- three main causes
1. metatarsus adductus (birth - 1year)
2. internal tibial torsion (walking - 3 years)
3. femoral anteversion (>3 years)
- most resolve with typical development
110
What is out-toeing?
- less common
- femoral retroversion is rare (especially in kids)
- Ex. tibial torsion - does not improve with development
- Much more likely to be pathological
- Flat feet may look like out-toeing
111
Middle childhood motor development
- less of it but, taller, faster, stronger
HUGE cognitive changes
112
Reasons for middle childhood kids to play games with rules
- encourage cooperation
- encourage competition with minimal risk
- rules reflect society - expectations of how to move in the world
(focus on effort = joy, more effort to improve, more confident)
112
Middle child brain development
- increase in white matter esp. in pre. frontal cortex
- increased synaptic connections and peak in gray matter volume
Parietal lobes = hand eye coordination
Corpus collusum = bridge of brain L&R, hands & feet
113
Cognitive, language, and social development in Middle Childhood
- master academic tasks
- spatial reasoning
- more reflective than egocentric
- consider feelings and perspectives of others
- improved social understanding
(improved grammar and pronunciation, BIG increase in vocab)
Shift from family to peer, learns to cooperate
114
Physical changes during adolescence
- growth spurts
-increase muscle size and strength
- secondary sex characteristics
115
Osgood-Schlatter Disease
- Overuse condition at upper growth plate of tibia caused by constant pulling on patella tendon (bones grow faster than muscle)
- P with activity
- P on tib tub
- p when kneeling, resisted knee ext. passive knee flex.
- fix with balance of relative rest (activity without pain) and stretching
116
Sever's Disease
- Overuse condition on achilles and calc
- p with activity
- swelling and redness
- stiff in the morning
- fix with balance of relative rest (activity without pain) and stretching
117
What changes occur in the brain during adolescence?
- White matter increases + synaptic pruning = more efficient
- Amygdala volume increases (reward)
- enhanced striatal activity in response to rewards (dopamine release - highest point it will ever be)
- Prefrontal cortex development lags behind limbic system
- executive functioning is lagging behind the area that responds to emotion
- puts them at risk of high risk behaviour to fit in with peers
118
What is the impact of social context in adolescence?
- motivation to avoid social risks (want to fit in)
- preoccupied with self and what others think of them
- increased influence of peers
119
Social determents of adolescent health
- national wealth
- income inequality
- access to education
- safe and supportive families and schools are essential to help ppl develop into full potential
120
What is motor learning?
- the relatively permanent acquisition of a motor skill attained through practice or experiences
121
What is the difference between explicit and implicit motor learning measured?
Explicit requires cog
122
What is the difference between motor learning and motor performance?
motor learning = integrated in different environments over time
Motor performance = what we see on a given day
123
What are Fitts and posners stages of motor learning?
- perceptual motor perspective
- Cognitive (early stage, learning what to do, lots of errors and cog effort)
- Associative (more refined, decreased cog effort, fewer errors
- Autonomous (skill has been learned, able to perform in various environments
124
What are Bernsteins stages of motor learning?
- Motor control and biomechanics perspective
- Reduced degrees of freedom (fewer motions of body requiring conscious control)
- Release degrees of freedom (more degrees of freedom allowed, performance improvements, more adaptability)
- Exploit passive dynamics (take advantage of energies - gravity, momentum, recoil)
125
What are 3 types of practice organization?
- repetitive practice (mental or physical)
- whole vs part practice (full movement or breaking it down into components)
- Variable (A1 - A2 - B - C) vs constant (ABC practice)
Make practice more "real life" = improves retention but slows down acquisition
126
PHTH 517
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