1
Q
function of lungs
A
- ventilation - transport O2 to alveoli and transport CO2 from tissues to atmosphere
2
Q
respiratory tree
A
3
Q
ventilation =
A
- ventilation = TV x RR
- (tidal volume x respiratory rate)
- TV and RR increase with activity
4
Q
changes in titdal volume with increase VE
A
- TV increase at expense of inspiratory reserve volume (IRV) and expiratory reserve volume (ERV)
5
Q
chronic obstructive pulmonary disease (COPD)
A
- major types - affect 21 million in US
- 3 million emphysema
- 11 million chronic bronchitis
- 4th leading cause of death
6
Q
chronic bronchitis
A
- over production of mucus causes an occlusion of airways - makes O2 exchange difficult
- blue bloaters - shutdown of systems not oxygenated, skin takes on blue tint
7
Q
emphysema
A
- pink puffers - O2 sats higher than chronic bronchitis
- destruction of elastic fibers in lungs
- after expiration, fibers and alveoli unable to bound back - barrel chest
- inhibition of alpha 1-antitrypsin leads to destruction of elastic fibers surrounding alveoli
- mostly due to long term smoking - damaged airways (80-90%)
- some hereditary parts
8
Q
signs/symptoms of COPD
A
- shortness of breath
- dyspnea on exertion
- orthopnea (only able to breathe in upright position)
- wheezing
- increased RR
- peripheral cyanosis
- digital clubbing
- pursed-lip breathing
- malaise
- chronic cough
- barrel chest
- weight loss
- use of accessory muscles of respiration
- prolonged expiratory period (with grunting)
- decreased FEV1/FVC ratio - due to blockage, decreased ability to forcefully expel air quickly as proportion to total lung capacity
- anxiety/depression
9
Q
how PTs assess lung function
A
- O2 saturation
- cyanosis
- pulmonary function tests (FVC, FEV1, FEV1/FVC)
pulmonary function tests differential for lung function
10
Q
how PTs assess lung function
A
- O2 saturation
- cyanosis
- pulmonary function tests (FVC, FEV1, FEV1/FVC)
pulmonary function tests differential for lung function
11
Q
exercise in COPD
A
- obstructive disease impedes lung emptying (requires more time)
- increased breathing leads to hyperinflation and small tidal volumes
- impairment of gas exchange
- decreased efficiency
12
Q
pulmonary function test criteria for determination of pulmonary degree of impairement in patients with COPD
A
13
Q
effects of exercise training for COPD
A
- CV reconditioning
- desensitazation to dyspnea
- improved ventilatory efficiency
- increased muscle strength
- improved flexibility
- improved body composition
- better balance
- enhanced body image
14
Q
restrictive lung diseases
A
- diminished lung volumes
- etiologies
- neuromuscular disorders (DMD, ALS, guillian barre, SC disorders) - not muscle to support lung function
- chest wall disorders: kyphoscoliosis, ankylosing spondylitis, obesity, compression fractures
- pleural disorders: fibrosis, effusion
15
Q
some pathologies/conditions affecting the pulmonary circulation
A
- body position
- stenosis or incompetence of heart valves
- congestive heart failure (CHF)
- pulmonary congestion/edema: edema backs up into lungs due to pressure and interferes with O2 transfer
- pulmonary embolus
16
Q
supplemental O2
A
- if oxygen saturation is < 88%, then oxygen supplementation is necessary to improve survival and cognition
- less clear on O2 need with exercise
- do know that patients need exercise to improve functional capacities, even if O2 drops some - greater support for allowing O2 to drop transiently for short periods to achieve exercise benefits
17
Q
patient is in bed and might need to use the bathroom soon, just not right now. how can you start HI strength training while patient is still in room
A
- bed mobility
- STS
18
Q
patient has poor safety awareness but is able to STS without UE support. how do you integrate safety and education while challenging to failure during STS exercise?
A
- slow down
- use UE support
19
Q
patient is “too tired” and keeps requesting breaks
A
- coordinate with OT
- limite to 1 minute break between sets
- combo - mix in squats while walking
- add in patient ed
20
Q
patient with knee OA has trouble with standing exercises. how can you integrate HI strength during session?
A
- more open chain activities
- assist in concentric phase (eccentric usually less painful)
- smaller ROM STS
- patient ed
- intervals/circuits
21
Q
patient “too old and tired for this”
A
- switch exercises between sets
- pt ed and pt goals - never too old to get stronger, data
- family involvement
22
Q
muscle strength vs power
A
- strength: amount of force a muscle or group of muscles can generate at a given velocity
- power: amount of work a muscle or groups of muscles can produce per unit of time
23
Q
force vs velocity relationships
A
as you increase speed, you reduce force
24
Q
contributions to muscle power
A
- maximal rate of force development (RFD)
- force production at slow and fast contraction velocities
- stretch shortening cycle performance (efficiency)
- coordination of movement pattern and skill
25
power =
* power = force and velocity
* force: heavy resistance training with slow velocities - increases max force production
* velocity: power training, light to mod loads at high velocities - increases force output at higher velocities
26
training parameters for power development
* traditional strength training
* general recommendations: multi-joint, 0-60% 1 RM LE, 30-60% 1 RM UE, 3-6 reps (not failure), 1-3 sets
* advanced training: heavy loading, 85-100% 1 RM, 1-6 reps, 3-6 sets
* advanced training: fast contraction velocity, 0-60% load 1 RM LE, 30-60% 1 RM UE, performed at fast contraction velocity, 1-6 reps, 3-6 sets
* rest 1-2 minutes, 2-3 ih HI
27
low load (40% 1 RM) power training and high load (70% 1 RM) power training are [ ] for muscle power/functional performance
* equivocal
* BUT higher loads superior for maximal strength and endurance
* low loads for postural control/balance
* choice of low vs high load depends on: patient preference, task specificity, direction
28
muscle power in adults
* loss of muscle cross-sectional area with age: sarcopenia and weakness
* greater and faster loss of type II muscle fibers
29
why train muscle power
* muscle power declines faster than muscle strength in older adults
* deficit is early predictor of functional decline
* asymmetrical differences in muscle power strongly predict fallers vs non fallers
* functional connections
* power training = slightly larger gains in physical function and muscle power than traiditional resistance training in highly controlled trials
30
power training examples
31
training specificity
* specificity: train at the speed you want to improve
* loaded jump squats with 30% of 1RM have been shown to increase vertical jump performance more than traditional back squats and plyometrics
* lower limb muscle power at 40% 1RM has a greater relationship to gait speed than power at 70% of 1 RM
32
joint specificity and power training
* knee extensors very responsive to speed-specific training
* knee flexors not as receptive
* ankle dorsiflexors have similar increases in power during both high-speed and low-speed training
* plantar flexors respond better to low speeds
33
measuring power
* isokinetic dynamometry
* functional tests
* expressed in units equivalent to work/time
34
equipment for power training
35
safety for power training
* may require more easing into protocols
* similar precautions/contraindications to HI strengthening
* monitor vital signs and response
36
high-intensity aerobic training
| and karvonen
* 60s all out (75-85% MHR) with 30-60s rest (active recovery preferred) x 20 minutes
* karvonen if patient on beta blockers: MHR = 164 - (0.7 x age)
* want 6-8 modified borg for high intensity, 14-16
* shorter rest is better
37
examples of HIIT aerobic trianing
38
importance of rest period
* mitigate fatigue
* improve CV safety
* critical power: lactate threshold (75-85% MHR) not sustainable
* active recovery preferred
39
HIIT benefits
* reduce subcutaneous fat/total body mass
* improve VO2 max
* improve insulin sensitivity
* improved endothelial function
* decrease LDLs/vLDLs, increase HDLs
* decrease BP
* decrease risk CV event
* decreasing barriers to exercise: shorter time commitment
40
HIIT vs moderate intensity continuous exercise (MICT)
41
physiology of HIIT
* high level of T2 muscle fiber recruitment
* enhanced mitochondrial enzyme expression
* decrease rate glycogen utilizaiton, increase resting glycogen content
* decrease lactate production
* increase glucose transporter
* increase lipid oxidation (reduction in lipid droplets in T2 muscle fibers)
42
CV/HIIT exercise and the brain
* angiogenesis, neurogenesis, synaptic plasticity
* improved and efficient cerebral perfusion/metabolism
* maintenance/improvement cognitive, corticomotor activation, increased BDNF
43
benefits with HIIT
* 12-week HIIT protocol vs usual care (pulm rehab program: improved VO2, improved quad strength, improved daily step count, decreased time in sedentary activities, improved HR-QoL
* CVA: improved ventilatory threshold, O2 utilizaiton, gait speed, stride length
44
costs of HIIT
* HIIT not as helpful as strengthening, balance, and coordination for reducing fall risk
* transient increase in fall risk (between 10-29 minutes) following session
45
safety and HIIT
* among individuals with CAD, MI, and HR, there have been 2 nonfatal cardiac arrests in more than 46,000 hours of HIIT
* may need to ease into protocol starting with moderate exercise
* hypotension
* may need ECG exercise testing prior to participation
* check vitals, signs of dehydration, ask about nutrition
* rest after
46
precautions and contraindications for HIIT
47
peripheral circulation roles
* transport blood to the body
* transport O2 to the tissues
* transport O2 from the tissues to the lungs, to atmonsphere
48
arteries
* transport blood to tissue
* more elasti: made of elastic fibers and smooth muscles
* tunia externa/adventitia: attaches arterty to surrounding tissue, dense tissue near tunica media but looser closer to periphery of vessel
* tunica media: smooth muscle, support for vessel and controls diameter to **regulate blood flow and BP**
* tunica intima: simple squamous epithelium, surrounded by connective tissue, basement membrane with elastic fibers
49
veins
* transport blood from tissue
* have same 3 layers as arteries but with less connective tissue and smooth muscle
* makes walls of veins thinner - related to lower BP in veins
* also lets veins hold more blood - almost 70% of blood in veins at one time
* medium and large veins have valves like semilunar valves of heart - prevent retrograde flow, especially in arms and legs
50
blood flow to exercising muscles
* brings: oxygen, nutrients (glucose and FFA)
* removes: CO2, lactic acid, leads to heat dissipation
51
oxygen hemoglobin dissociation curve
| how tightly O2 is bound to Hgb
* shift right due to increased temperature or decreased pH - leads to decreased affinity of O2 bound to Hgb, leading to greater O2 release
52
pathologies affecting transport of O2 in the vasculature
* peripheral vascular disease (PVD) AKA peripheral arterial disease (PAD) affects 12-20% of Americans age 65 and older
53
claudication scale
* measure clinical impact of PAD/PVD
* grading discomfort of physical activity
54
arterial-brachial index
* measures degree of atherosclerotic plaque formation resulting in occlusion/decreased blood flow in LEs due to PAD/PVD
* ABI is measured by placing patient in supine for 5 minutes
* systolic BP measured in both arms - higher value is used as denominator of ABI
* systolic BP then measured in dorsalis pedis and posterior tibial arteries by placing cuff above the anking - using a doppler ultrasound
55
ABI measuring
* difference should be < 10 mmHg between arms
* significant difference represents stenosis
56
DVT vs PAD pain
* DVT - painful at rest
* PAD - painful with activity
57
how do PTs assess vasculature
* **signs**
* pulse
* skin color, nail and hair growth
* venous engorgement
* ulceration
* ABI segmental blood pressures (for arterial assessment)
* **symptoms**
* claudication
* lightheadedness
58
walking speed indicators
* predictive of health and disease
* evaluative of abnormal gait speed
* simple and feasible for normative data and meaningful change
59
normal walking speed changes
60
red flag walking speed is
* < 0.6 m/s
61
yellow flag walking speed is
* 0.6-1.0 m/s
62
green flag walking speed is
* > 1.0 m/s
63
walking speeds and functions
64
to safely cross, critical speed =
* critical speed = total distance/available time
65
considerations with gait speed and crossing road
66
walking speed is predictive
of mortalities
67
predictive life span increases as
predictive life span increases as gait speed increases
68
feasibility of walking speed use
* safe
* no significant cost to assessment
* easy - no additional equipment, in 2 minutes
* easy to calculate and interpret based on published norms
69
10M walk test
* "walk at a comfortable pace as if you are walking in the park"
* 6 meter path - central 4 meters timing area
* 4M and 10M WTs have excellent reliability but should not be used interchangeably
70
self-selected vs fast WS
* **self-selected WS**
* numerous studies show preferred speed is associated with mortality and disability
* feasible
* predictor of disability outcomes
* established cutpoints with excellent reliability
* energy efficient, minimizes metabolic cost per unit distance walked
* **fast WS**
* protrays larger deficits that might be missed at SSWS
* suggests muscle strength and power losses more so than submax WSs
* index of functional capacity - reserve
* allows individuals to meet demands of activity and environment
| have similar rates of decline
71
most common MDC for walking speed
* 0.1 m/s
applied exercise science
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