Exercise Testing and Prescription Exam 1 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 Risk Factors for CVD Non modifiable Advancing Age Gender o Male 45 o Female 55 If a first degree relative male died at age 55 this is a risk factor If a first degree relative female died at age 65 this is a risk factor Family history if 1st degree relative has a CVD Risk Factors for CVD Modifiable Smoking Hypertension even if on BP meds this is considered a risk factor 140 90 Dyslipidemia still a risk if on cholesterol meds b c without the medication they re out of whack o LDL 130 o HDL 40 o HDL 60 is a negative risk factor Sedentary Lifestyle less than 30 min day x 3 days week Obesity BMI 30 waist circumference of 40 is also a risk Impaired Fasting Glucose diabetes pre cursor o Oral fasting Glucose tolerance test 200 o Fasting hypoglycemia is a concern for Type 1 diabetics Men 45 yr Women 55 yr estrogens protective effect is now gone Cigarette Smoking Obesity BMI 30 Waist circumference 40 is also a risk Dyslipidemia LDL 130 HDL 40 remember though that HDL 60 is a NEG risk factor KNOW THESE Family History did 1st degree relative have CVD Sedentary Lifestyle 30 min day x 3day week Hypertension 140 90 If someone is on a Beta blocker we label them as Hypertensive Prediabetes can be based off of fasting glucose If impaired fasting glucose is 100 125 126 is criteria for DM diagnosis Oral glucose tolerance test 200 Know how to determine someone s risk factor for cardiovascular disease What are the emerging risk factors Other Risk Factors Lipoprotein A Remnant Lipoproteins from metabolism of chylomicrons Triglycerides a high TG level implies a high LDL level Total Cholesterol to HDL ratio normal ratio is 3 5 1 Anything higher is abnormal this could mean one of two things either HDLs are abnormally low 40 or TC is abnormally high 200 Inflammatory Markers C Reactive Protein for atherosclerosis remember IL 6 IL 8 TnT Thrombosis Markers 1 Exercise Testing and Prescription Exam 1 Hyperhomocysteinemia this is a genetic defect from enzymes breaking down This is also seen in people with low folate Nitric Oxide levels are impaired What are the sources of injury that can happen to the endothelium of the arteries What is Nitric Oxide Nitric Oxide is a local vasodilator NO blocks platelet aggregation LDL oxidation superoxide radical elaboration smooth muscle cell proliferation and monocyte adhesion SO If Nitric Oxide is blocked than these negative things that would normally be blocked can occur Sources of Injury we can alter many of these Immune Responses Dyslipidemia irregularity in LDL HDL levels Hypertension 140 90 Bacteria or Viral Infection microorganisms can increase thrombosis and inflammation responses Homocysteine Decreases Vasodilation High levels of Glucose hyperlipidemia Our lipid metabolism slows and builds up Smoking any smoking is a risk Vasoconstrictor substances Low Estrogen post menopause women are at risk because Estrogen has a protective factor What are the range of values for cholesterol HDLs LDLs triglycerides hematocrit hemoglobin fasting glucose blood pressure BMI waist circumference and hip to waist ratio LDL and HDL Cholesterol Values LDL Optimal Near Optimal above Borderline High High Very High HDL Low 100 100 129 Negative risk factor 130 159 160 189 190 40 60 Note If someone is for HD risk maybe we will want LDLs even lower i e 70 LDLs instead of 100 Ideally we would like HDLs 40 Note 2 out a risk factor as it has cardio protective effects in that HDL is what we use for reverse transport Though our main target is to lower LDLs HDL 60 constitutes as a negative risk factor this cancels Classification Desirable Borderline High High Very High Cholesterol and Triglycerides Total Cholesterol 300 200 239 240 TGI 150 150 199 200 499 500 2 Exercise Testing and Prescription Exam 1 BP Classifications Classification Normal Prehypertensive Stage 1 Hypertension Stage 2 Hypertension Systolic 120 120 139 140 159 160 Diastolic 80 80 89 90 99 100 Note if either number is in a higher range or only one is normal this patient is still counted as a risk Obesity Normal 18 5 24 9 kg m2 Overweight 25 29 9 kg m2 Obese o Class 1 30 34 9 o Class 2 35 39 9 o Extreme 40 Abdominal Obesity for those who are overweight BMI 25 and above is a strong predictor of risk for CVD and other diseases For men 40 inches and for women 35 inches Waist to hip ratio can also indicate high risk for CVD Men 95 and for women 86 Blood Values we NEED TO KNOW Hemoglobin g dL normal for men 13 5 17 women 11 5 15 5 athletic women are at a risk for iron deficiency and lower Hg values Hematocrit normal for men 40 52 women 36 48 Fasting Glucose mg dL 60 99 Fasting Glucose greater than 100 is a risk for diabetes Normal Range for Hemoglobin A1c is 6 Normal range is 4 5 6 5 7 6 4 is a Prediabetes risk What blood tests are used to check the health of the kidneys and liver Kidney Tests o Blood Urea Nitrogen BUN o Creatinine Liver Tests These tests are REQUIRED of a pt taking Statins as statins can affect liver fxn o Bilirubin 1 5 mg dL RBC breakdown o AST Aspartate transaminase SGOT Serum Glutamic Oxaloacetic Transaminase o ALT Alanine Transaminase SGPT Serum Glutamic Pyruvic Transaminase these are liver enzymes that can indicate liver damage What are some health and fitness benefits of regular physical activity Physical Activity any bodily movement produced by the skeletal muscles that results in increased energy expenditure Contains Cardiovascular fitness muscular strength and endurance flexibility and body composition 3 Exercise Testing and Prescription Exam 1 Exercise planned structured and repetitive bodily movement for the purpose of improving or maintaining one or more components of physical fitness not doing 30 min of exercise then 8 hours of sitting SO Exercise is a type of physical activity but not all physical activity is exercise Benefits of Regular Physical Activity Lower Blood lipids Higher HDL affects HDL more than LDL More fibrinolytic capacity Control of coronary vasospasm Vasospasms cause CP Weight control Reduced BP in hypertensive pts Improved glucose tolerance and insulin sensitivity Improved endothelial fxn Increased fxnl capacity What is a PAR Q test The PAR Q is a type of Self Administration Health Screening These are the BASIC health screening methods 1 PAR Q Physical Activity Readiness Questionnaire a
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