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Exercise Testing and Rx Exam I Review Guide 1 Know modifiable and non modifiable risk factors for heart disease Modifiable o Hypertension o Dyslipidemia o Obesity o Impaired fasting glucose o Smoking o Physical inactivity o HDL 40 mg dL Non modifiable o Advancing age o Male gender o Family history Male 1st degree 55 years old Female 1st degree 65 years old Manage identifiable risk factors Regular physical activity o Reduces BP and risk for CVD Reduce dietary fat saturated fats and cholesterol Loss of weight if overweight Limit alcohol intake Reduce Na Maintain electrolytes Stop smoking 2 How does exercise improve risk factors How else can individuals modify their risk factors 3 Know how to determine someone s risk factor for cardiovascular disease It does not matter how many in one category just one positive risk factor there are 8 total and one negative risk factor Age o Men 45 o Women 55 Family history of MI vascularization death o Before 55 for father or 1st degree male o Before 65 for mother of 1st degree female Smoking or those who quit within the last 6 months or exposed to it Sedentary lifestyle o Not participating in at least 30 mins of moderate intensity on at least 3 days for 3 months Obesity o BMI 30 kg m 2 o Waist girth Men 102 cm Women 88 cm Hypertension confirmed on two occasions o 140 90 or on blood pressure medicine Dyslipidemia o 130 LDL or on lipid lowering meds OR o 40 mg dL o If total serum cholesterol is available use 200 mg dL Pre diabetes confirmed on two occasions o impaired fasting glucose 100 mg dL but 126 mg dL o Impaired oral glucose tolerance 140 mg dL but 200 mg dL Negative risk factor HDL 60 mg dL 4 What are emerging risk factors Triglycerides Lipoprotein a and remnants Small LDL proteins HDL subspecies Apolipoproteins Total cholesterol to HDL ratios Homocysteine Inflammatory markers Thrombogenic and homeostatic factors Oxide Sources of injury o Dyslipidemia abnormal levels o Hypertension o Immune responses o Smoking o Vasoconstrictor substances o Viral or bacterial infection o Homocysteine o High levels of glucose o Loss estrogen 5 What are sources of injury that can happen to the endothelium of the arteries What is Nitric NO in the heart decreases contractility and heart rate to allow relaxation also improves circulation There is less NO in people with diabetes which leads to decreased blood flow to the extremities as it acts as a neurotransmitter 6 What are the range of values for cholesterol HDLs LDLs triglycerides hematocrit hemoglobin fasting glucose blood pressure BMI waist circumference and hip to waist ratios Cholesterol Desirable Borderline High 200 mg dL 200 239 mg dL 240 mg dL Low HDLs 40 mg dL LDLS Optimal Near optimal Borderline high High Very high 100 mg dL 100 129 mg dL 130 159 mg dL 160 189 mg dL 190 mg dL Normal Borderline high High Very high 150 mg dL 150 199 mg dL 200 499 mg dL 500 mg dL TGLs Blood pressure Optimal Prehypertensive Stage 1 Stage 2 Systolic 120 120 139 140 159 160 Diastolic 80 80 89 90 99 100 Hematocrit o Men 40 52 o Women 36 48 Hemoglobin o Men 13 5 17 g dL o Women 11 5 15 5 g dL Fasting glucose o 60 99 mg dL BMI Normal Overweight Class I Class II Extreme 18 5 24 9 25 0 29 9 30 0 34 9 35 0 39 9 40 0 Waist circumference know both o Men 40 in OR 102 cm 7 What blood tests are used to check the health of the kidneys and liver o Women 35 in OR 88 cm Waist to hip ratio o Men 0 95 o Women 0 86 Kidney Liver o Blood urea nitrogen test o Creatinine o Bilirubin o SGOT o SGPT 8 What are some health and fitness benefits of regular physical activity We first need to understand what physical activity is because it is different from exercise Physical activity is any bodily movement produced by the skeletal muscles that results in increased energy expenditure It is made up of cardiovascular fitness muscular strength and endurance flexibility and body composition Increased functional capacity Weight control Improved glucose tolerance and insulin sensitivity Reduces blood pressure in persons with hypertension Lower blood lipids Increase HDL Increased fibrinolytic capacity Control of coronary vasospasm Improved endothelial function 9 What is a Par Q test Physical activity readiness questionnaire Minimal standard for entry to moderate intensity program 10 What are the components of a medical history and informed consent Informed consent o Purpose and explanation of procedures or test o Risks and discomforts o Responsibilities of participant o Benefits expected o Inquiries o Use of medical records o Freedom of consent o Place to sign Medical history o Ask questions to know about a person s past to determine what type of exercise program that particular person needs o Medical diagnosis o Previous findings on physicals o History of symptoms allergies o Recent illness and surgical procedures o Orthopedic problems o Medications other habits o Family history o Work history o Exercise history 11 Know the signs and symptoms of cardiovascular and pulmonary disease Pain in the chest Shortness of breath at rest or w mild exertion Dizziness or syncope Orthopnea or nocturnal dyspnea Unusual fatigue or shortness of breath Ankle edema Palpitation or tachycardia Immediate claudication Known heart murmur 12 How do you classify individuals as low moderate or high risk o Asymptomatic people who have 1 CVD risk factor o Asymptomatic people who have 2 CVD risk factors Refer to number 2 Low risk Moderate risk High risk disease o With signs and symptoms or have known cardiovascular pulmonary or metabolic 13 When should a doctor be present during a submax and max test Submax Text Maximal Test Moderate Risk Low Risk Not necessary Not necessary Not necessary Recommended High Risk Recommended Recommended 14 When starting a moderate or vigorous exercise program when does one need a physical exam or clearance from a physician Moderate Exercise Vigorous Exercise Moderate Risk Low Risk Not necessary Not necessary Not necessary Recommended High Risk Recommended Recommended 15 Know systolic diastolic and mean arterial pressure Know how to calculate all three formulas of 16 Know how to calculate BMI Know how to make conversions from English measurements to 17 Know the different ECG leads chest leads limb leads precordial extremity unipolar bipolar Bipolar leads not actual leads placed on body but are made up of two leads Moderate exercise is 3 6 METs MAP Know formulas for PP and RPP MAP CO x TPR o Indirectly measured using Systolic CO Diastolic TPR MAP when HR 100 o


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FSU PET 4551 - Exam 1

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