Exercise Testing and PrescriptionPET 4551Study Guide Exam 11. Know the modifiable and non-modifiable risk factors for heart disease. How does exercise improve the risk factors? How else can individuals modify their risk factors? Know how to determine someone’s risk factor for cardiovascular disease. What are the emerging risk factors? Make sure you know the updated risk factors presented in class this summer.Modifiable Risk Factors1. Hypertension2. Dyslipidemia (LDL > 130mg/dl , HDL <40 mg/dl)3. Obesity4. Impaired Fasting Glucose5. Smoking6. Physical Inactivity Non-modifiable Risk Factors1. Advancing Age2. Male Gender3. Family History:- Male first degree relative ≤55 years- Female first degree relative ≤ 65 yearsEmerging Risk Factors 1. Triglycerides2. Lipoprotein (a)3. Lipoprotein Remnant4. Small LDL Particles (can penetrate endothelial lining and cause damage)5. HDL subspecies6. Apolipoproteins7. Total Cholesterol to HDL Ratios8. Homocysteine9. Inflammatory Markers (C-reactive proteins)10. Thrombogenic and Hemostatic FactorsIdentifying Risk Factors for Cardiovascular Disease- Age men ≥ 45 years, women ≥ 55 years- Family historyo Before 55 for father or first degree male relativeo Before 65 for mother or first degree female relative- Smoking or those who quit within 6 months or exposure to environmental tobacco- Sedentary lifestyle, not participating in at least 30 min of moderate intensity (40-60% VO2) on al least 3 days per week for at least 3 months- Obesity: ≥ 30 kg/m2 or waist girth men >102 cm (40in); women > 88 cm (35in)- Hypertension: >140/90 mmHg or on blood pressure meds; confirmed on 2 occasions- Dyslipidemia: ≥130 mg/dl LDL or on lipid lowering meds or HDL < 40 mg/dl; if total serum cholesterol is all that is available use ≥ 200 mg/dl- Pre-Diabetes: Impaired Fasting Glucose ≥100 mg/dl but ≤ 126 mg/dl or Impaired Oral Glucose Tolerance ≥ 140 mg/dl but < 200 mg/dl confirmed on 2 occasions. - Negative risk factor- High Serum HDL cholesterol ≥ 60 mg/dlOther Important Risk Factors- Stress- Type A personality: hostility2. What are the sources of injury that can happen to the endothelium of the arteries? What is Nitric Oxide?Sources of Injury- Dyslipidemia (LDL, Cholesterol)- Hypertension- Immune Response- Smoking- Vasoconstrictor Substances (Nicotine)- Viral or Bacterial Infection- Homocysteine (High Red Meat Intake)- High Level of Glucose (Diabetes)- Loss Estrogen (Menopause)Note: Atherosclerosis (hardening of the arteries from plaque buildup) Smoking is the biggest factor. Others are high LDL, low HDL, or obesity. Nitric Oxide: causes vascular smooth muscle relaxation, resulting in arterial vasodilation and increasing blood flow.3. What are the range of values for cholesterol, HDLs, LDLs, triglycerides, hematocrit, hemoglobin, fasting glucose, oral glucose tolerance and HbA1C, blood pressure, BMI, and waist circumference?CholesterolDesirable <200 mg/dlBorderline High 200-239 mg/dlHigh ≥240 mg/dlHDLsLow <40 mg/dlLDLsOptimal <100 mg/dlNear Optimal 100-129 mg/dlBorderline High 130-159 mg/dlHigh 160-189 mg/dlVery High ≥190 mg/dlTriglyceridesNormal <150 mg/dlBorderline High 150-199High 200-499Very HighHematocritMen 40-52%Women 36-48%HemoglobinMen 13.5-17 g/dlWomen 11.5-15.5 g/dlFasting glucoseNormal < 100 mg/dlPrediabetes 100-125 mg/dlDiabetes ≥ 126 mg/dlOral glucose tolerance Normal < 140 mg/dlPrediabetes 140-199 mg/dlDiabetes ≥ 200 mg/dlHbA1CPrediabetes 5.7-6.4%Diabetes ≥6.5%Blood pressureSystolic DiastolicNormal <120 mmHg <80 mmHgPrehypertension 120-140 mmHg 80-90 mmHgHypertension Stage 1 140-160 mmHg 90-100 mmHgHypertension Stage 2 >160 mmHg >100 mmHgBMI Normal 18.5-24.9 kg/m2Overweight 25.0-29.9 kg/m2Obesity Class I 30.0-34.9 kg/m2Obesity Class II 35.0-39.9 kg/m2Extreme Obesity > 40.0 kg/m2Waist circumferenceMen >40 inches= 102 cmWomen ≥35 inches= 88 cm4. What blood tests are used to check the health of the kidneys and liver? Kidney Tests: Blood Urea Nitrogen (BUN),Creatine TestLiver Tests: Bilirubin Serum Glutamic-Oxaloacetic Transaminase (SGOT) Serum Glutamic-Pyruvic Transaminase (SGPT)5. What are some health and fitness benefits of regular physical activity? Improvement in Cardiovascular and Respiratory Disease- Increased maximal oxygen uptake resulting from both central and peripheral adaptations- Decreased minute ventilation at a given absolute submaximal intensity- Decreased myocardial oxygen cost for a given absolute submaximal intensity- Decreased heart rate and blood pressure at a given submaximal intensity- Increased capillary density in skeletal muscle- Increased exercise threshold for the accumulation of lactate in the blood- Increased exercise threshold for the onset of disease sign or symptoms (ex. Angina) Reduction in Coronary Artery Disease Risk Factors- Reduced resting systolic/diastolic pressure- Increased serum high-density lipoprotein cholesterol and decreased serum triglycerides- Reduced total body fat, reduced intra-abdominal fat- Reduced insulin needs, improved glucose tolerance- Reduced blood platelet adhesiveness and aggressionDecreased Morbidity and Mortality- Primary preventiono Higher activity and/or fitness levels are associated with lower death rates from coronary artery diseaseo Higher activity and/or fitness levels are associated with lower incidence rates for combined cardiovascular disease, coronary artery disease, stroke, type 2 diabetes, osteoporotic fractures, cancer of colon and breast and gallbladder disease- Secondary preventiono Based on meta-analyses, cardiovascular and all-cause mortality are reduced in post myocardial infarction patients who participate in cardiac rehabilitation exercise training, especially as a component of multifactorial risk factor reductiono Randomized controlled trials of cardiac rehabilitation exercise training involving post myocardial infarction patients do not support a reduction in the rate of nonfatal reinfarction. 6. What is a PAR-Q test? PAR-Q: Physical Activity Readiness Questionnaire- Minimal standard for entry into moderate intensity exercise program- Yes/No question- If a Yes answer, physician clearing is needed7. What are the components of a medical history and informed consent? Medical History- Medical diagnosis- Previous findings on physical examinations- History of symptoms, allergies- Recent illness and surgical procedures- Orthopedic problems- Medications (Prescribed and Over
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