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Exercise Physiology Oral Final Conversation

Terms in this set (81)

Children:
- Skeletal muscle accounts for almost half of total LBM between 6- 12 y/o
- improved muscle strength & motor + sport-specific performance in response to structured exercise programs

Young Adult (YA):
- RT increases muscle strength in YA, due to increases in muscle size (hypertrophy) & neuromotor activation
- Hypertrophy response to RT exercise is due to a net increase in muscle protein synthesis relative to protein breakdown
- Increased muscle strength during youth is associated with better health in adulthood

Middle-Age:
- By 50 y/o, muscle loss in both genders is apparent; loss comes primarily from the larger muscles of the lower body
- Both the quantity and quality of muscle are diminished with age
- muscle quality = fat deposition, both within and outside
the muscle, which is associated with loss of strength
- Changes in endogenous hormone production, metabolism, and PA during midlife also contribute to loss of muscle
- Muscle loss is gradual, with reductions of 3%-8% observed each decade after 30 y/o
- Loss of skeletal muscle with age is termed sarcopenia (loss of muscle with aging)

Older Adults:
- Risk of sarcopenia increases with advancing age
- Older adults who maintained
normal muscle mass during midlife are LESS likely to develop sarcopenia & are MORE likely to remain functionally independent during old age
- "Dynapenia" = a loss of muscle strength in the elderly that is not related to neurological or muscular disease
- Inadequate E intake contributes to progressive loss of muscle with age
- Inflammation contributes to loss of muscle quantity and quality
- Less than 15% of older adults meet recommendations for RT

Menopause:
- Decreased muscle quality is reflected in lower RMR and resting EE per unit of LBM
(1) Fatigue
- Most common side effect
- Over 90% of patients experience fatigue during treatment
- Will persist for many years for as many as 60% of cancer survivors
- Associated with elevated cytokines
- Manifests as reduced exercise tolerance and reduced motivational drive
- Adjusting exercise prescription may improve compliance
- Regular symptom-limited exercise can be an effective countermeasure

(2) Pain
- Common in patients with metastatic disease
- Can result from: surgery, radiation therapy, chemotherapy, and antiestrogen hormonal therapies
- Modifications or omission of individual exercises that exacerbate pain may be necessary
- Bone pain can be an initial sign of skeletal metastasis
- Arthralgias and myalgias are common side effects of aromatase inhibitor therapy for breast cancer
- Exercise has shown to be an effective therapeutic strategy to reduce chronic musculoskeletal pain.

(3) Lymphedema
- Disruption of the lymphatic system can weaken its ability to properly clear lymph fluid from surrounding tissues --> Lymph build up in the affected area
- Common result of surgery and sometimes radiation
- Onset of lymphedema can vary
- Not a contraindication to exercise
- RT may be helpful in restoring normal lymph function in affected limbs
- CEP should monitor the patient for exacerbation of symptoms
- 10-90% of breast cancer survivors can have upper limb lymphedema

(4) Muscle Weakness
- Common post cancer treatment due to overall deconditioning
- Chemotherapy may cause a small loss of lean muscle mass
- Treatments may compound age-related muscle weakness and sarcopenia
- CEP's should...
○ Tailor the exercise program to each patient's relative capacity
○ Progress the exercise program gradually;
RT may be particularly important
○ Exercises should focus on functional movements

- Men with prostate cancer who are treated with androgen deprivation therapy (ADT), develop weakness as a result of muscle loss
In response to acute exercise:
- Adaptive immune system largely unaffected by athletic endeavors
- Innate immune system responds differentially to the chronic stress of acute exercise
- Suppressed neutrophil function
- Enhanced NK cell activity

NK cell activity:
- increased at the initiation of an exercise session
peak within 30 minutes of endurance training &
remain elevated for up to 3 hours
- NK cell mobilization and activation during exercise may promote breakdown of cancer tumors
- Induces recruitment of cells expressing NK cell markers to the circulation

- Neutrophil concentrations increase during and after exercise
- Lymphocyte concentrations increase during exercise, but fall below pre exercise values afterward
- The increase in lymphocytes early on in the
exercise bout is the result of greater recruitment of
these cells to vascular components

During exercise:
- Memory lymphocytes are mobilized to the blood
- Lymphocytes recruited from peripheral compartments (ex.spleen) instead of bone marrow

Cessation of exercise:
= decline of circulating NK cells

During recovery:
- T lymphocytes decrease, with T1h decreasing more than T2h, explaining the increased sensitivity to infections after heavy exercise

Immune suppression:
- as a result of exhaustive exercise is transitory and the immune system recovers quickly

Submaximal exercise:
- Doesn't have an effect on IgA
- Prolonged increase in WBC's occur after acute and prolonged exercise bouts

Moderate exercise:
- boosts neutrophil functions, including chemotaxis, phagocytosis, and oxidative burst activity

Exhaustive exercise:
- reduces these functions, except chemotaxis and degranulation
- high intensity >1 hr
○ decrease in circulating lymphocytes after
exercise
○ Blood lymphocyte concentration decreases in
recovery period only if the exercise is intense
○ lymphocyte function is impaired
- "Open window": state of altered immunity
between 3 and 72 hours
- Prolonged and high-intensity training generates greater susceptibility to infections compared to moderate intensity
(Body temperature MUST STAY < 106°F-108°F)

(1) Thermoregulation & Obesity:
- Data suggests that obese individuals have an increased risk for heat illness
○ Proposed mechanism:
- Excess adipose tissue (subcutaneous) creates layer of insulation that impairs body heat dissipation
- Direct thermoregulatory comparisons between obese and non-obese individuals actively or passively exposed to heat have mixed conclusions.
- Obese females do show impaired skin blood flow or sweating responses yet similar core temperatures than non-obese females, which adds to confusion.

(2) Thermoregulation & Diabetes:
- Individuals with DM are not considered to tolerate heat stress in a similar manner as those without
- The extent of thermoregulatory dysfunction depends on the progression of the disease
- Decreased skin blood flow is seen in individuals with T1DM and T2DM when passively heated
- Impaired sweating responses are seen in individuals with T2DM BUT results are mixed in those with T1DM when passively heated
- Exercise intensity influences whether or not an individual with DM experiences thermoregulatory dysfunction
→ During mild exercise (40% of VO2max), individuals with T1DM showed similar thermoregulatory control and responses than those without diabetes
→ At 60% of VO2max individuals with T1DM
& T2DM had a lower sweating response which could lead to increased internal temperature.

(3) Thermoregulation and Aging:
Aging in older adults:
- leads to physiologic maladaptations of the cardiovascular and thermoregulatory systems
- During passive heat exposure at rest, older adults have a delayed sweating response and reduced sweat rate due to a reduced sweat output per gland rather than less activated sweat glands
- Skin blood flow during passive and active heating is attenuated in older adults
- The ability for cutaneous blood vessels to
vasodilate decreases with age
- majority of deaths during heat waves occur in older adults and are attributed to cardiovascular causes secondary to thermal stress
- greater cardiovascular stress in older adults reflects their smaller SV
- Cannot sufficiently increase to meet the
cardiovascular demand of thermoregulation
- Decreased thirst in older individuals can lead to greater dehydration, which increases cardiovascular strain
- Dehydration reduces blood volume which is a
major predictor of SV
- Older adults also have increased markers of myocardial damage in heat related deaths relative to younger adults

Aging in children:
- Like older adults, children adapt to exercise in hot environments LESS effectively than young adults primarily due to three factors:
1) Children have a greater SA-to-body mass ratio than adults which causes a > heat gain in hot air & > heat loss in cold air
2) Children are less efficient than adults during walking/ running which produces more metabolic heat per kg of body mass.
3) Maximal sweating capacity of children is considerably lower than adults which results in reduced cooling via evaporation
- Only when temperature > 95°F, do children have lower exercise tolerance than adults
- Children seem to be especially affected by very humid environments

(4) Thermoregulation and Cardiovascular Disease
- Chronic HTN leads to vascular changes that may alter vasoconstriction and vasodilation
- When exercising in heat, those with mild HTN do not experience the same vasodilation in cutaneous blood vessels as those without HTN, even with significantly elevated core temperature
- Local and whole-body sweat rate and increases in core temperature are similar between those with and without HTN
- Those with stage 2 HTN may manifest thermoregulatory dysfunction according to some research
- Individuals with impaired cardiac function may not have the appropriate cardiac response and/or have an increased risk of CV event during heat exposure.

(5) Thermoregulation and Multiple sclerosis
- With active and/or passive heat exposure 60-80% of patients with MS experience a worsening of symptoms ○ Signs & symptoms: fatigue, pain, dizziness, numbness, and cognitive dysfunction
○ Symptoms due to heat stress are easily reversible
- MS affects the thermoregulatory system in multiple ways:
○ When heat stressed, MS patients have reduced sweating response that is not improved with exercise training which can increase core temperature and excess heat exposure should be avoided.
○ Skin blood flow is intact and may be enhanced when MS patients are heat stressed.

(6) Thermoregulation and Skin Grafts
- When exposed to heat stress, grafted skin does not allow increased skin flow or sweating
- Because the procedure to treat severe burns involves the removal of the epidermis and all/part of the dermis which disrupts the vascular bed and the associated neural connections, thus sweat glands are removed or disrupted.
- Whole -body hyperthermia:
- can occur during passive or exercise heat stress. - Amount of skin grafted determines level of impairment
- Individuals with < 1.0 m2 of non-grafted skin have
the greatest impairment seen in increased core
temperature with exercise
- Exercise is encouraged in individuals with well-healed skin grafts because they tend to be less fit than non-grafted individuals
- Exercise in the heat should be monitored if a large portion of body is covered in skin grafts.

(7) Thermoregulation and Spinal Cord Injury
- Compared to healthy adults, individuals with SCI have greater increases in core temperature during active heat stress
- Neural disruption related to the injury impairs sweating response and increases skin blood flow
(1) Carbon Monoxide (CO)
- a colorless, odorless gas produced from the burning of fossils fuels and cigarette smoke
- Peak levels of CO occur in the morning and afternoon during automobile traffic
- Higher levels of CO in the winter compared to summer
- CO has a strong affinity for Hb
- Hb combines with CO to form
carboxyhemoglobin (HbCO)
- blocks O2 binding sites on Hb and decreases O2 transport capacity & inhibits the release of O2 in tissue capillaries
- formation of blood HbCO results in cognitive and physiological effects, including visual impairment, reduced maximal work capacity, headache, and decrements of cardiac function
- effect of increased HbCO levels --> higher submaximal HR and lower VO2max consumption

(2) Sulfur Dioxide (SO2)
- is the primary sulfurous-by-product of fossil fuel combustion
- An upper respiratory tract irritant that can produce bronchoconstriction, leading to increased airway resistance when breathing
-At rest, exposure to SO2 increases ventilation, which augments the total volume of air inspired.
- At rest, SO2 also decreases the effectiveness of nasal scrubbing, which is an action that removes gas when breathing through the nose, which further increases airway resistance.
- Individuals with asthma who are exercising are more sensitive to the bronchoconstrictive effects of SO2.
- Air temperature and humidity affect bronchoconstrictive effects
(cold-dry air increases bronchospasms compared to
warm-moist air)

(3) Nitrogen Dioxide (NO2)
- an air pollutant produced during automobile and aircraft engine combustion
- Acute exposure to NO2 increases airway resistance, impairs pulmonary diffusion capacity, induces hypoxemia, irritates the upper respiratory tract, and impairs pulmonary mucociliary activity in humans
- In healthy adults, short term low-level NO2 exposure does not induce adverse effects on pulmonary function or physical performance during submaximal exercise
- Patients with chronic bronchitis, COPD, and asthma are more susceptible to the adverse effects of NO2 exposure
- Not enough research has been done but it has been suggested that exercise may reduce airway responsiveness to NO2 in individuals with asthma

(4) Ozone (O3)
- is a major constituent of smog and a secondary pollutant that is primarily produced by the atmospheric reaction between UV solar radiation and exhaust from internal combustion engines
- Highest levels in the afternoon year round
- are markedly higher in the summer than winter, due to more intense solar radiation.
- short term O3 exposure induced a cough, SOB, nausea, headache, and impaired pulmonary function during exercise, decreased endurance exercise performance and VO2 max
- Exposure of O3 for 2 hours during intermittent exercise increased systemic and pulmonary markers of inflammation, impaired pulmonary function, & produced unfavorable changes of HR variability and cardiac repolarization in healthy adults
- In adults with asthma, O3 exposure induced a greater pulmonary inflammatory response compared to non-asthmatics
- Over 200K women are diagnosed with breast cancer every year in the US.
- the median age of diagnosis is 62 y/o

Prognosis:
- The 5-year relative survival rate for breast cancer is 89%, and 99% if cancer was not spread beyond the breast area.

Treatment:
- surgeries
- e.g. lumpectomy, breast-conserving surgery, or
mastectomy, or reconstructive surgery
- Women who undergo mastectomy may also undergo reconstructive surgery such as free-flap reconstruction
= autologous transplantation from the latissimus
dorsi or transverse abdominis muscles or silicone
implants that are generally placed under the
pectoral muscle.
- chemotherapy, radiation therapy, hormonal therapy, or immunological therapies

Health Implications:
- linear relationship between the # of lymph nodes removed and the risk for breast cancer related lymphedema, which is described as swelling in the breast, torso, and arm on affected side
- Lymphedema occurs in 20-30% of all survivors
-Either the initial or reconstructive surgery can alter the way the latissimus dorsi, abdominal muscles, and/or pectoral muscles and shoulder girdle function.
-There may be imbalances and weakness after surgical recovery, and time periods where upper body exercise is not possible which can result in an extended period of immobility which is a major factor in the common outcome of shoulder immobility among breast cancer survivors
- Some chemotherapies and immunotherapies for breast cancer may cause long term damage to the heart, leading to cardiac myopathies and heart failure
- It is reported that survivors have lower maximal aerobic capacity than their age matched peers
- Some chemotherapy agents like taxanes are associated with peripheral neuropathy which may adversely affect balance
- Arthralgias are another common treatment side effect of hormonal therapies due to reduction of female reproductive hormones, principally estrogen
- Many breast cancer survivors report weight gain post treatment, of which specific causes are still unclear

CEPs are highly encouraged to obtain as much information as possible about the treatments each breast cancer survivor patient has undergone, and understand their short-term and long-term effects prior to evaluation and exercise prescription with so many health related implications for this special pop.
- Include those cancers of the ovarian, fallopian tube, endometrial corpus, endometrial cervix, vaginal, and vulvar regions
- most common gynecologic cancer is endometrial corpus cancer, and is the second largest cancer survivor population among women

Prognosis
- 5-year relative survival rate for endometrial cancer is 82%, and 95% among the two thirds that are diagnosed with early stages
- 5-year survival rate for cervical cancer is 68% and 46% for ovarian cancer

Treatment:
- vary by tumor site and Ds extent, and may include a combination of surgery, chemotherapy, radiation, hormonal therapy, and biological therapy

Health Implications:
- Obesity is strongly associated with endometrial cancer risk
- Some surgical treatments will include lymph node removal and thus, induces risk for lymphedema in the pelvis and lower extremities
- About 36% of gynecologic cancer survivors experience lower extremity lymphedema
- Radiation treatment of the pelvic area may contribute to increasing lymphedema risk and may result in long-term difficulties with urination and/or defecation, bone or hip pain, altered range of motion, non-bone pelvic pain, and sexual dysfunction
- Platinum-based chemotherapies include long-term side effects such as permanent peripheral neuropathy in the hands and feet and tinnitus or hearing loss
- Patients undergoing these treatments will often exhibit poor balance
- Some hormonal therapies may have the same risk for arthralgias that may mimic or exacerbate arthritis

CEPs are urged to gather medical records regarding gynecologic cancer treatments and consider their risk and side effects that may limit physical function and performance, such as joint pain, limited range of motion, and poor balance.
Signs of lung cancer include:
- persistent coughing, wheezing, shortness of breath
- Can be found on a chest x-ray or low-dose computed tomography (LDCT)
○ LDCT- new screening tool for people at risk of lung cancer which may lead to earlier diagnosis and a decrease of death rates over time, currently targets adults aged 55-74 years old with a strong history of smoking.

Diagnosis and location:
- based on obtained information from biological samples (lung biopsy and imaging tests)
- Staging is based on features of tumor (where the cancer has spread beyond the lungs)

Prognosis:
- Rarely diagnosed at a curable stage, but treatments can extend a person's life for many years
- Survival depends on the stage that it is diagnosed
- 5-year overall survival rate is 17%
○ Localized- 55%
○ Regional- 27%
○ Distant-staged- 4%.

Treatment:
- Rarely curative, but it is life-extending and works to improve quality of life.

- Localized stage 1 disease- surgery and radiation therapy
○ May cause compromised pulmonary function. - Locally advanced or regionally spread- radiation and chemotherapy
○ Chemotherapy- platinum-based agents are used, have neurotoxic side effects
○ Tumors may not be able to be removed surgically.
- Distant (stage IV) disease
○ chemotherapy, other biologic therapies to control the growth of the cancer

Health Implications:
- Surgical removal of tumor causes compromised pulmonary function (reduced total lung capacity and/or damage to lung tissues and pulmonary structures)
○ Results in reduced exercise tolerance and persistent fatigue
- Chemotherapy and radiation can cause cardiotoxicity. - Metastatic disease have complications to distant organs (brain, bones, etc.) and treatment may accelerate aging.
- Risk of recurrence is high even when cancer is detected early