Exercise Testing and Prescription PET 4551 Study Guide Exam 1 1 Know the modifiable and non modifiable risk factors for heart disease a Non modifiable advancing age male gender family history male first degree if relative 55 yrs female first degree if relative 65 yrs b Modifiable hypertension dyslipidemia HDL 40 mg dl obesity impairing fasting glucose smoking physical inactivity 2 How does exercise improve the risk factors a Exercise reduces blood pressure strengthens the heart and can raise HDL and lower LDL levels 3 How else can individuals modify their risk factors a Reduce dietary fat especially saturated fat and cholesterol reduce total calories to promote weight loss increase physical activity limit alcohol intake no more than 1 oz day reduce sodium intake 2 3 grams of sodium or 6 grams sodium chloride maintain electrolyte balance stop smoking reduce saturated fat and cholesterol 4 Know how to determine someone s risk factor for cardiovascular disease a There are many risk factors listed in point 1 above The amount of these factors that a person possesses determines their risk factor b These classifications are outlines in point 13 below c Patients should be screened to find out this information 5 What are the emerging risk factors a Emerging risk factors triglycerides lipoprotein A lipoprotein remnants small LDL particles HDL subspecies apolipoproteins total cholesterol to HDL ratios homocysteine inflammatory markers thrombogenic and hemostatic factors b Make sure you know the updated risk factors presented in class this summer 6 What are the sources of injury that can happen to the endothelium of the arteries What is Nitric Oxide a Sources of injury dyslipidemia hypertension immune responses smoking vasoconstrictor substances viral or bacterial infection homocysteine high levels of glucose loss of estrogen b Nitric oxide is a molecule with the chemical structure NO It is a radical gas It plays a key role in biological communication as a messenger Specifically the endothelium uses nitric oxide to tell the smooth muscle surrounding blood vessels to relax 7 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 a Cholesterol Level mg dl b Classification c e g 200 200 239 240 LDL Level mg dl 100 100 129 130 159 160 189 190 150 150 199 200 499 500 Triglyceride Level mg dl d f h desirable borderline high hight Classification Optimal Near optimal Borderline high High Very high Classification Normal Borderline high High Very high Blood Pressure Classification Optimal Pre hypertension Hypertension stage 1 Hypertension stage 2 Systolic 120 120 139 140 159 160 You are classified by whichever measurement puts you at the highest category HDL Level mg dl 40 60 Classification Low High Assorted ranges Hemoglobin g dL 1 Hematocrit Fasting glucose mg dL 1 Men 13 5 17 5 40 52 60 99 High HbA1C is a sign of diabetes Having a value of 6 5 or higher is a diagnostic criteria for diabetes Pre diabetes is classified as having a value of 5 7 6 4 Diastolic 80 80 89 90 99 100 Women 11 5 15 5 36 48 60 99 For individuals with BMI of 25 39 9 waist circumference is strong predictor of risk for CVD Men 40 inches and women 35 inches at risk 8 What blood tests are used to check the health of the kidneys and liver a Kidney tests blood urea nitrogen BUN test Creatinine test b Liver tests Bilirubin SGOT serum glutamic oxaloacetic transaminase SGPT serum glutamic pyruvic transaminase tests 9 What are some health and fitness benefits of regular physical activity a Inverse relationship between physical activity and CVD hypertension stroke osteoporosis type 2 diabetes obesity colon cancer breast cancer anxiety and depression b Improvement in cardiovascular and respiratory function reduced blood pressure increased serum HDL and decreased triglycerides Reduced body fat insulin needs and blood platelet aggregation Decreased morbidity and death 10 What is a PAR Q test a Physical Activity Readiness Questionnaire sets minimal standard for entry into moderate intensity exercise program yes no questions any yes answers should warrant a visit to doctor 11 What are the components of a medical history and informed consent a Medical history medical diagnosis previous findings on physical examinations history of symptoms and allergies recent illnesses and surgical procedures orthopedic problems medications other habits exercise history work history family history b Informed consent purpose and explanation of procedures or test risks and discomforts responsibilities of the participant benefits to be expected inquiries use of medical records freedom of consent 12 Know signs and symptoms of cardiovascular and pulmonary disease a Pain in chest shortness of breath at rest or with exertion dizziness or syncope orthopnea lay down problems with breathing nocturnal dyspnea ankle edema palpitation or tachycardia intermittent claudication known heart murmur unusual fatigue or shortness of breath 13 How do you classify individuals as low moderate or high risk Know the new guidelines presented this summer a Low risk asymptomatic men and women who have 1 CVD risk factor b Moderate risk asymptomatic men and women who have 2 CVD risk factors could have all 8 risk factors but can t be symptomatic c High risk individuals with signs symptoms listed OR have known cardiovascular pulmonary and metabolic disease diabetes 14 When should a doctor be present during a submaximal or maximal test a A doctor isn t needed for either test if the subject is of low risk For moderate risk subjects a doctor is recommended for maximal tests For high risk subjects a doctor is recommended for both maximal and submaximal tests 15 When starting a moderate or vigorous exercise program when does one need a physical exam or clearance from a physician a An exam is not recommended for low risk subjects It is only recommended for vigorous exercise in moderate risk subjects It is recommended for both moderate and vigorous exercise in high risk subjects 16 Know systolic diastolic and mean arterial pressure Know how to calculate all three formulas of MAP Know formulas for PP and RPP a Systolic blood pressure is the pressure on the arteries and veins when the heart contracts Diastolic blood pressure is the pressure in the veins and arteries when the heart is resting Mean arterial blood pressure is the average blood pressure in an individual b MAP Q
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