3.5.08 Kids

I took awful notes for this one. I would suggest going over the packet pages. They seemed to be comprehensive. Sorry.

2.27.08 Female Athlete Triad

2007 Position Statement

Also read osteoporosis. Active, not necessarily athletes.

3 Interrelated Syndromes:

Disordered Eating- not eating disorders necessarily (those are clinical, medical diagnosis)
Will lead to amenorrhea (irregular menstrual cycle). As few as three missed periods will damage bones. Osteoporosis is a bone mineral density that is below normal.

If a woman has disordered eating, if affects her energy needs. Negative caloric balance- chronic negative calorie diet will cause amenorrhea. Normal cycle is 28 days.

Causes- pressure associated w/competition, emotionally vulnerable women, self image, cultural association w/ thinness, media/family/friends, mother's obsession with her own weight (#1 reason for poor body image).

Women w/ 1 component of the triad should be screened for the other two.

If a young woman exercising twists her ankle and fractures it, she should be screened for osteoporosis.

Much more prevalent than one would think. General population, not just athletes.

Energy Availability problems pg. 1869
Dietary intake-exercise output = +/-

Woman may have normal body fat level and her calorie intake may still be inadequate. May be intentional, inadvertent, or psychopathalogical.

Disordered Eating: low calorie intake significant enough to lead to problems with menstrual cycle.

May purge: laxatives, purging, diet pills, excessive exercise, diuretics.

Eating Disorders: Anorexia Nervosa, bulimia nervosa, ED-NOS (eating disorder, not otherwise specified)

Anorexia Nervosa-
Mortality rate is high: 10-18%
slow suicide-years

1. Starvation
2. Electrolyte imbalance
3. Low bp
4. Low HR
5. Arrythmia
6. orthostatic hypotension
7. low RBC and WBC count that lead to increased infections
8. Constipation
9. abdominal pain
10. high blood cholesterol
11. underweight <18% BMI- body comp as over fat
12. fine light hair growth

Bulimia-
Binge.purge cycles

1. Electrolyte imbalance
2. GI complications from stomach acid
3. Tooth decay from stomach acid
4. Russel's sign (knuckle scaring from finger down the throat)
5. hypertrophy of salivary glands
6. normal body weight/normal % body fat

General Disordered Eating
see nutrition book

1. Are you happy with your present weight? Why or why not?

2. What would you like to weight?

Prevalence of Disordered Eating
as young as 7 years old
40% of 9-10 year old females are trying to lose weight- major factor is mother's obsession with her own weight.80% of women dislike their body by age 18.

least like body- Caucasian
most comfortable with body- African American

40% of female body builders have disordered eating

15-62% of athletes depending on sport

Get professional help- team approach. Never overstep or contradict medical professional working with your client.
Appendix G- be careful of what you say and how you say it. Emphasize health, not weight.

Different Amenorrheas

Primary Amenorrhea- absence by age 15. 1st menses is the end of puberty usually.

Secondary amenorrhea- absence for more than 90 days in someone who has an established cycle.

Amenorrhea is never a natural cause from intense exercise.

Oligo: between 35-90 days without period

Eumenoria- normal period of 28 days

Cause- significant weight loss or low body fat. not alone responsible.
And in very obese women.
loss of specific body fat stores
excessive exercise accompanied by weight loss
nutritional deficiency- a lot of vegans.

Health Consequences:

directly related to osteoporosis. 3 months without a period with affect bone mineral density. 6 months will cause an irreversible bmd deficiency.

Decrease training 10-20% and increase calorie intake, and resistance. 1000-1300 mg of Ca and avoid fiber supplements.

Osteoporosis: generalized throughout whole skeleton but manifests in thoracic bones, wrist, hips.

pg. 223-225 ACSM

HTN Defininitions for the Quiz

For all you slackers :)

Neurohumoral:The heart and vasculature are regulated, in part, by neural (autonomic) and humoral (circulating or hormonal) factors. Neural mechanisms primarily involve sympathetic adrenergic and parasympathetic cholinergic branches of the autonomic nervous system. In general, the sympathetic system stimulates the heart and constricts blood vessels resulting in a rise in arterial pressure. The parasympathetic system depresses cardiac function and dilates selected vascular bed. There are several very important humoral mechanisms including circulating catecholamines, the renin-angiotensin system, vasopressin (antidiuretic hormone), atrial natriuretic peptide, and endothelin. Each of these humoral systems directly or indirectly alter cardiac function, vascular function, and arterial pressure.

http://www.cvphysiology.com/Blood%20Pressure/BP007.htm

Essential HTN: The cause of the HTN is unknown by Dr.'s

White-coat HTN: The person's BP is normal when taken at home but increases in a clinical setting. This is thought to be brought on by anxiety of "white-coats" or hospital settings.

Ambulatory: Having to do with walking or moving about.

normotensive: having normal blood pressure

Regression analysis: I'm not touching this one. I'm going to let you look it up on wikipedia: http://en.wikipedia.org/wiki/Regression_analysis

Systemic Vascular Resistance: resistance, offered by the peripheral circulation, to flow that must be overcome to push blood through the circulatory system.
http://en.wikipedia.org/wiki/Vascular_resistance

attenuate: reduce

2.20.08 High Blood Pressure

High Blood Pressure

See Pkt.

HTN: Hypertension
HBP: High Blood Pressure

Resting: SBP > or = 140 and/or DBP > or = 90
Or normal but on hypertensive medication

New Category" Pre-hypertensive
Research shows that ppl with these BPs have a significantly increased risk of CVD. Must change lifestyle.
SBP 120-139
DBP 80-89

ACSM Position stand- Quiz on this, very difficult to read
AHA Science advisory- just an FYI for us, no quiz over it

Prevalence
Increased BP affects 58.4 million Americans
90-95% of hypertensives- Dr.s don't know what it is due to. Called essential hypertension.
Increased prevalence in males, older adults, African Americans.

Stage 2-Stage 3 HBP
SBP > or = 160
DBP > OR = 100
Increased risk for CVD
Inc. CHF
Inc. peripheral artery disease- claudication (harding of leg arteries)
Inc. renal failure

Quiz question on stages
Risk Factors
Lifestyle modifications= non-medication ways
1. Endurance program
2. Body weight loss
(SEE LIST)
3. Eating a DASH diet (semi-vegetarian)- high fruits, high veg, protein in the form of low-fat dairy

Response to Exercise
With increasing level of exercise, SBP goes up, DBP stays fairly level.
Automatic termination of GXT if SBP > or = 250 (Anyone), DBP > or = 115

Medications
BP: Anti hypertensives
heart rhythm (which affects BP)
Force of L ventricular contraction (also affects BP)
May affect response to exercise
Must know what medications do to exercise:
type
dosage
time as it relates to time of exercise
DR.'S OKAY

Vein dilation
Brain- sympathetic and parasympathetic nervous systems
Kidneys play a major role

ACE INHIBITORS
affect kidneys to lower BP
Blocks kidney enzyme-prevents constriction hormone
does not cause changes in heart rate
unresponsive to other medications-very potent drugs
if the person is exercising, this should be the drug of choice

ALFA BLOCKERS
decrease peripheral nervous system to dilate veins
Do not cause changes in heart rate
suffer more from sudden hypotension because of poor blood flow back to the heart- cool down is important

ALFA SIMULATORS
increase parasympathetic to dilate blood vessels

BETA BLOCKERS
also used for angina (chest pain), migraines, and CAD
Compete for same receptor site at catacolomens so they can't increase BP (ventricular contraction)
affect heart and lungs (difficulty breathing)
go back to Dr. if this happens
affects person's ability to exercise (use RPE)
decreased resting and exercise HR
decreased blood pressure
decreases body's ability to dissipate heat. (climate controlled environment).
can cause hypoglycemia
only do testing on correct dosage of medication (the dosage on which they will be during your exercise program)
Chest pain- BBs allow them the work out at higher intensities without chest pain

CALCIUM CHANNEL BLOCKERS
chest pain, arrhythmia, HBP
Block Ca Dependant contraction of muscles
increase, decrease or do not affect HR (depends on which type)
decreased BP- cool down is important (blood pooling)
does not affect THR (Can use Karvonen formula)
ACSMs treatment of choice for very active ppl.

DIGITALIS
anti-arrhythmic
flutter of atria- increased vigor of contractions
decreases HR
does not affect BP

DIURETICS
anti-hypertensive/Congestive HF (CHF)
decreases water in the body
lowers BP
Does not affect HR
Can cause dehydration
hypocalimia- lose a lot of K. this can cause arrhythmia, potatoes have 3 x more K than bananas
hypoglycemia
historical the 1st type of drugs given
aren't as potent
not necessarily 1st given anymore

NITRATES
address chest pain
lower BP
Nitro-glycerin
relaxes smooth muscle
Increase RHR
Increase or do not affect Exercising HR
Decreased RBP
Decrease or do not affect Exercising BP
Increase work capacity at point of chest pain

PERIPHERAL VASODILATORS
RHR/EHR is not affected, or increases
hypotension
tachycardia > 100 RHR

Regular Endurance Training
FITT
Frequency: Most, if not all days per week
Intensity: 40- < 60 % VO2 reserve
Time (Duration): > or = 30 min. of continuous activity
Type (Mode): Aerobic w/supplemental resistance. Can decrease BP by 5-7 points with endurance training in normal AND HBP people.

VO2R= % I (VO2max- VO2rest) + VO2rest
must understand METs well to use this

When you aerobically exercise, it lowers BP for about 22 hours.

If overweight or obese, exercise to burn 300 additional kcals.

Decreases RBP in non-HBP and HBP ppl.
Decreased D and I can still help
Chronic aerobic exercise does NOT lower HBP in children and teens
Fat loss is a better way to lower BP.

Resistance training should not be the primary mode- usually never performed to RM (only to volitional fatigue)

Recommendations for Resistance Training
8-12 Reps
10-15 for Older Adults
8-10 exercises
1 Set
2-3 days per week

CWT-Circuit Weight Training
8-12 diff. exercises
50% RM (20 reps)
has been shown to benefit

Fat loss is the best way
in an obese person, 22 lbs. of fat loss has been shown to decrease SBP by 15 points, and DBP by 10 pts. Additional weight lost is added onto those point values.

If someone has a normal BP but has an elevated response to exercise, they have a high risk in the future and should be recommended to make lifestyle changes.

2.13.08 Pregnancy

The minute a woman comes to you pregnant it is an automatic doctor's approval.

See all class notes in the packet.

1985
1994
2002
Statements

Must go w/Dr.'s restrictions even if they are from the 1985 statement which is the most restrictive.

Test Question definitions:
Morphology (according to dictionary.com)- 6. the study of the form or structure of anything. (basically meaning the size, form and shape of the pregnant woman)

Postpartum: (according to dictionary.com)- of or noting the period of time following childbirth; after delivery.

Changes start at conception and do not reverse until about 6 weeks postpartum. This is only if she isn't breastfeeding and there were not complications.

How does pregnancy change the ability to exercise?

1. Blood flow- must share O2 and blood with fetus (extra blood flow to uterus)

2. Cardiac Output (Q)- Increases 20-23% at rest (amount of blood pumped by the heart per min.)

Pregnancy is like a low level exercise just at rest. Increased HR by 15-20 bpm.
increased SV to support Q (stroke volume=the amount of blood pumped by the Left ventricle per beat)

Use RPE instead of HR. DO NOT USE HR to rate intensity of exercise.

Increased VO2 by 15-30%
1. For baby
2. support extra weight

Usually same BP
but Increase in Left ventricle thickness (good) -see this in resistance trained athletes.

see pkt. Blood vessels get bigger, return vessels become larger in diameter (ie varicose veins).

Blood pooling- in lower extremities- swelling, cannot return blood to heart efficiently.

As the uterus grows (to 6000x its original size), it puts pressure on the inferior vena cava- minimizing blood flow return. Avoid prolonged standing in one position, elevate legs (recumbant bike is good)

Be aware of postural hypotension- minimize sudden position changes (up to down and back up again).

Emphasis cool down to facilitate blood flow return to heart.

Increased plasma V by 45% (like in sports amemia -good)-increased water in blood

Increased red blood cell count by 30%

Joints relax-hormone relaxin -for the pelvis it is good for birthing, but not great for exercise. The hormone is not site specific-it relaxes ALL ligaments.

DO NOT be aggressive with flexibility and be very careful if doing any at all.
Be careful about pelvic dislocation.

Postural Changes (major)
Spinal changes

change in center of gravity-decreases balance significantly.

NO BALANCE work all together.

No fall risk/No abdominal trauma risk

Good- standing pelvic tilt (NOT supine)
cat back stretch (on all fours)

Increased frequency of urination (exercise incontinence)

Fetal Response

FHR increases 1 bpm for mother's 10. 80% of HRmax does not produce abnormal FHR.

Jarring is not detrimental, may actually be soothing, fluid acts as a shock absorption.

Difficulty because of weight gain, increased risk of injury.

Sheep studies- reproductive system is almost identical, even closer to us than monkeys.
Increased core Temp of 104 has been shown to be detrimental to fetus.

See ex. effects on Pregnancy pkt. (APGAR is a score given to newborns to quantify vitality moment to moment)



Women who exercise 3d/w before conception can increase their VO2max by 18% while pregnant, ie they are still trainable.

Just by being physically active you can improve glucose tolerance-need very little exercise.

General Recommendations 2002
Not a time to begin aggressive exercise (gradually increase)

For already trained women, 1st 3-4 monts-do not restrict exercise- women will naturally decrease Intensity/Duration with increased length of pregnancy.

Do not train to exhaustion

All suggestions extend 4-6 weeks postpartum.

Relative to mother's fitness level SEE PKT. LISTS!!
Know absolute contraindications
Know relative contraindications.

1.30.08 Diabetes

see pkt. pgs. on diabetes

Diabetes is not just a CHO problem.

Diabetics are unable to regulate blood glucose levels.
1. insulin availability- pancreas is not producing enough insulin or producing it incorrectly (non-recognizable to muscle and fat cells)

2. Insulin Resistance- insulin is fine, pancreas producing enough but muscles cells are not recognizing it.

80% of all type 2 diabetics are obese (esp. android fat)
Usually insulin resistant

Body is starving for glucose even with plenty of blood glucose. serum= blood

Diabetes is a disorder of CHO, fat, and protein metabolism resulting in...pg. 2 of pkt.
Why fat and protein? if body is starving for CHO, must rely too much on protein and fat for energy needs.

Brain- since the brain needs CHO to survive but the body cannot provide the CHO to the brain, it must produce a CHO-like product known as ketones from fat. Ketone build up in the body can kill you.

Memorize pg. 3 pkt.

[60]70-100mg/dl Ideal fasting level
>140mg/dl hyperglycemia
<50 mg/dl hypoglycemia

CHO is the primary fuel for the brain, nervous system, and retina. Blood glucose levels are controlled by hormones.

pkt. pg. 6 Tells us why [aerobic] exercise is critical to addressing type II diabetes.

3 critical Aspects
1. aerobic exercise
2. diet
3. medication (anti-diabetic medication)

When exercising, your muscle uses 7-12 times more Blood glucose than at rest.

During exercise, insulin is not required to open muscles to accept Blood glucose.-must have a quick source.

Immediately after up to about 72 hours. after exercise these affects last.
Exercise reduces body's need for insulin.

Liver breaks down glycogen to glucose = glycogenolysis

Blood glucose gets low ---> liver, when liver gets low --->amino acids (&fats &lactate) -break down into a CHO like molecule (to feed to brain) which is called gluconeogenesis.

(when CHO is in excess you can convert it into amino acids)

counter-regulatory hormones-opposite function of insulin (glucagon esp.) helps us use fat better





Pancreas overproduces insulin when it goes over 140 and drops the blood glucose level to hypoglycemic levels. To normalize this back within normal values, the body produces glucagon.

normal person= eat 2-3 hours before a race so that levels are normal or 10-15 min. before (simple sugar) because this is not enough time to get into hyperglycemic state so insulin will not kick in.

Type 1: IDDM : Insulin Dependant diabetes mellitus 10% of all diabetics

absolute insulin deficiency: pancreas doesn't make any or enough insulin OR insulin is non-recognizable. Characterized by elevated BG levels but body is still starved for CHO. Body has to use fat and protein making the person slim.

Ketones are acidic and therefore dangerous at high levels (low pH).

Cause: genetics/environmental trigger (mumps, rubella, chemical toxins-nitrosamines...beef jerky, pesticides)

All need insulin injections.
The injections are reverse catabolic-prevent the break down of fat and protein in lue of glucose. prevents ketosis.

Exercise is not good for managing type 1 diabetes.

Characteristics of Type 2: NIDDM 90% of all diabetics
40% take insulin injections (consistently or just sometimes)
80% are obese
7% of population that knows they are diabetic (7% that don't know-according to research)

Fasting hyperglycemia dispite available insulin. Adequate to prevent lipolysis -protein catabolism, but inadequate to lower blood glucose levels.

60% of all type 2 have high blood pressure.
High incidence of bad blood profile
Most do not need insulin shots

Exercise is critical in the management of type 2 diabetes.

Major Medical Complications

Diabetic Ketoacidosis- only using fatty acids- will find ketones in urine, blood, organs.

BG >250-check ketones
Never let them exercise with ketones in their urine.

1.16.08 First Four Articles

1.16.08
Special Pops

Housecleaning notes: Term Project will be EITHER a research paper OR service learning.
Paper can be on a special pop we do not talk about in class but must be cleared with Tom.
Service Learning location can only be at an approved site. See Tom for more details.

4 quizzes next class on first 4 articles in readings pkt.

Pg. 1 of Class Notes Pkt.
Exercise guidelines for improved fitness - Goes with 1st article
Fitness, NOT health
Measures of fitness are increased VO2 max, Increased 1 RM, etc.
FITT and FIRMS principles
Apparently Healthy Adult is a legal term and we will learn what that is later.
Pg. 1 is according to ACSM 1998 position statement

*Addendum added 2007 (changes to 1998 statement)
Flexibility- Only static stretching (as the other forms are too dangerous)
2-4 reps
15-30 sec
Point of tightness without inducing discomfort
2-3 days/week (same but ideally every day)

READ ALL FOUR ARTICLES

2nd article: 1995 Position Statement

The next year (1996) the Surgeon General Came out with their statement with the same title. This was a big deal considering the last one was on Smoking. Read it on your own time. A must read for PFTs.

This article corresponds with pg. 2 of class notes pkt. Metabolic Fitness/Health (interchangeable terms)

Goal: Indicate how physically active a person needs to be to improve health.
Health is best measured by metabolic fitness- blood profile

Memorize: Every US Adult should accumulate 30 min. or more of moderate-intensity physical activity on most, preferably all, days of the week. (adult= 18-65).
Can accumulate 30-60 min. by performing 8-10 min. of exercise at bouts throughout the day.
Moderate Intensity = 3-6 METS (walking 3-4mph) 200 kcals (~2 miles/day)
Most= 5 days
daily living activities count in this (gardening, taking stairs, etc.)
As of 1995, 22% of Americans met this standard.

3rd article 2007 Update on the 1995 Position Statement
Clarifies and Updates previous statement.
Clarifies that Most days= 5 days/week

1. 5 days 30 min. Moderate Intensity
OR 2. 3 days 20 min. Vigorous Intensity ( > 6 METS, > 4mph)
Must accumulate time in 10 min. bouts NOT 8-10.
Daily living activities do NOT count.

Talks about resistance training- 2-3 days/week, 8-10 exercises, large muscle groups, 8-12 [RM] reps resulting in substantial fatigue.
To maintain Fat loss 60-90 min. of moderate exercise ALL days (5-7).

Creeping Obesity- aging decreases metabolic rate, gain a few pounds a year despite no changes in eating or training.
To prevent creeping obesity- 60 min. of mod-vigorous physical activity 5-7 days/week

Metabolic Fitness- 30 min. of moderate 5 days OR 3 days 20 min. mod-vigorous

(Met* min)/week (when combing the two types of MF training above)
450-750 Metmin/week



4th article - Older Adults (65 and up) Update of 1995 to include older adults
or 50-65 year olds with functional limitations

There are two scales of Perceived Rating of Exertion:

6-20 scale
and the 0-10 scale (ACSM focuses on 0-10 scale)
Where 5-6 is moderate Intensity
7-8 is vigorous

Resistance Training - 1 set, 2-3 days/week, 10-15 RM (for bone health) and a lot more time on flexibility.
Flexibility - bare min. 2 days/week, 10 min., 3-4 reps of each stretch, hold for 10-30 sec.
Fall Prevention Program- no guidelines but they say that all older adults should be in a fall prevention program
Addressing ADLs to stay independent (Activities of daily living).

First Post

Hello,

Welcome back to everyone who used the blog last semester. Hope everyone had a good break. And welcome to my blog of notes, for those of you who are new this semester.

A few notes on changes from last semester:

To make things much more simple, I've created two different blogs, one for Nutrition and one for Special Pops (both separate from fittprogramnotes from last sem.). You can go between these easily without having to type separate addresses by clicking on the "View my profile" link under my photo. This will take you to a page with my name, etc. and a list of all my blogs. You'll see the one from last semester and the two for this one. This will make things a little less confusing and a little easier.

Good luck in the new year and a new semester with Tom! See you all in class.