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.Risk Factors for Cardiovascular DiseaseRisk + or - CharacteristicsDyslipidemia +• ≥200 mg/dL total cholesterol• ≥130 mg/dL LDL• <40 mg/dL HDL• Or on medicationSmoking +• Active Smoker• Quit w/in the last 6 monthsHypertension +• Systolic >140• Diastolic >90Obesity +• BMI ≥ 30 kg/m2• Waist circ: M >40in ; F >35in• Hip to Waist Ratio: M >0.95 ; F >0.86Physical Inactivity +• Physical activity of less than 30 minutes a day 3 days a week Impaired Fasting Glucose +• ≥100 mg/dL but <126mg/dl • Oral glucose levels: >140 but <200 Family History (MI, Revascularization, death, etc)+• History of CV disease• Primary male relative before age 55• Primary female relative before age 65Age +• Men > 45 years old• Women > 55 years oldHigh HDL -• High HDL of > 60mg/dL• Negates a positive risk factor• Maximum amount of risk factors a person can have is 8!• Minimum amount of risk factors a person can have is -1• Stress and Type A personality (hostility) also increase likelihood of CVDModifiable Risk Factors of CV/CAD disease• Hypertension• Hyperlipidemia• HDL < 40mg/dL• Obesity• Impaired fasting glucose (stages of diabetes)• Smoking• Physical inactivity*physical inactivity= exercising less than 30 minutes 3 times a w week for three monthsNon-Modifiable Risk Factors of CV/CAD disease• Advancing age• Sex (males at higher risk)• Family history (of first degree relatives)o Male first degree relative < 55 yearso Female first degree relative < 65 years Emerging Risk Factors of CV disease• Triglycerides• Lipoprotein A• Lipoprotein remnants• Small LDL particles• HDL sub-species• Apolipoproteins• Total cholesterol to HDL level Ratio• Homocysteine • Inflammatory markers• Thrombogenic and Hemostatic factors (fibrinogen)Effects of Exercise on Risk FactorsExercise reduces BP, increases HDL levels, improves glucose tolerance, reduces/eliminates physical inactivity, can reduce BMI, can help reduce serum cholesterol levels2. What are the sources of injury that can happen to the endothelium of the arteries? What is Nitric Oxide?Sources of Injury:Dyslipidemia, Hypertension, Immune Responses, Smoking, Vasoconstrictor Substances, Viral or Bacterial Infection, Homocysteine, High levels of glucose, and loss of estrogenNitric Oxide• Potent vasodilator• If not being produced at the levels needed cannot be sufficient blood flow• Impaired synthesis can promote the risk factors of hypertension, diabetes, smoking, and hyperlipidemia• Can cause atherosclerosis• Diminished nitric oxide bioactivity may facilitate vascular inflammation that could lead to oxidation of lipoproteins and foam cell formation, the precursor of the atherosclerotic plaque.3. What are the range of values for cholesterol, HDLs, LDLs, triglycerides, hematocrit, hemoglobin, fasting glucose, blood pressure, BMI, and waist circumference?Classification of Cholesterol and Triglyceridesmg/dLOptimal/Desired(Normal)Above/Near OptimalBorderline HighHigh Very HighTotal Cholesterol<200 -- 200-239 ≥240 --LDL <100 100-129 130-159 160-189 ≥190HDLLow < 40*low is bad-- --≥60*high is good--Triglycerides (Fasting)<150 -- 150-199 200-499 ≥500Hypercholesterolemia: for ages 20 and above is 127 mg/dL which is just below borderline high rangeCholesterol pills may take up to 6 months to work. Blood Pressure• Hypertensive if systolic or diastolic numbers are high (don’t have to be both)Systolic BP Diastolic BPLifestyle ModificationNormal (Optimal) <120 <80 EncouragePre-Hypertension 120-139 80-89 yesHypertensionStage 1140-159 90-99 yesHypertensionStage 2≥160 ≥100 yes• Systolic BP=max pressure in the arteries during contraction of the heart, first sound heard through the stethoscope • Diastolic BP=min pressure in the arteries during the relaxation of the heart, complete disappearance of the sound *During exercise diastolic BP stays the same or decreasesObesityBMINormal 18.5-24.9Overweight 25-29.9Obese: Class 1 30-34.9Obese: Class 2 35-39.9Obese: Extreme (Class 3) ≥40Waist circumferenceMales >40 in (102 cm)Females >35 in (88 cm)Waist to Hip RatioMales ≥0.95Females ≥ 0.86• BMI=kg/m2, weight/ (height) 2• Kg = lb/2.2 ; Cm = inches x 2.54 ; m = cm/100*Hematocrit (%) men: 40-52 and women: 36-48*Hemoglobin (g/dl) men: 13.5-17 and women: 11.5-15.5*Fasting Glucose (mg/dl): 60-99*Impaired Glucose Tolerance (IGT) (or prediabetes) and Impaired Fasting Glucose (IFG):• IGT is defined as a blood glucose of 140-199 mg/dL in response to an OGTT• IFG is defined as a fasting blood glucose of 100-125 mg/dLo Major risk factor for NIDDM*Diagnostic Criteria for Diabetes:• When fasting glucose of >126 mg/dL• Confirmed blood glucose of > 200 mg/dL in response to an oral glucose tolerance test (OGTT) using 75g of glucose.• Confirmed non-fasting blood glucose of > 200 mg/dL in the presence of symptoms of diabetes• Symptoms are: polyuria (frequent urination), polydipsia (frequent thirst) and unexplained weight loss.4. What blood tests are used to check the health of the kidneys and liver?Kidney Tests: Blood urea nitrogen (BUN); creatinineLiver Tests: Bilirubin, SGOT (Serum Glutamic Oxaloacetic Transaminase), SGPT (Serum Glutamic Pyruvic Transaminase)5. What are some health and fitness benefits of regular physical activity?Reduction of CVD risk factors, increase HDL, increase bone mineral density, increase nerve conduction, improved functionality, increase in functional capacity, weight control, increase glucose tolerance and insulin sensitivity, decrease in blood pressure in people with hypertension, decrease in blood lipids, increase in fibrinolytic capacity, control of coronary vasospasm, and increase endothelial function6. What is a PAR-Q test?• Physical Activity Readiness – Questionnaire for people age 15-68• Minimal standard for entry into moderate intensity exercise program• Series of yes and no questions• If answered yes to one or more questions, should talk to a doctor7. What are the components of a medical history and informed
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