Unit 1

Metabolic Pathways for Energy

• Metabolic pathways, both aerobic and anaerobic, convert carbohydrates and fats into energy for exercise
• Oxygen consumption is measured at rest, during submaximal exercise, and at maximal exercise
• Interpret VO2 values from resting and exercise measurements
• Heart rate, blood pressure, VO2, VCO2, respiratory exchange ratio, blood flow, and ANS activity change in response to various activities
  • Progressively increasing workload endurance activity
  • Steady state endurance activity
  • Interval work
  • Resistance exercise
  • Flexibility exercises

Muscle Metabolism

• Exercise starts with muscle contraction, which needs ATP
• Glucose is absorbed from the intestines in the blood
• Liver glycogen becomes glucose

Energy Systems and Exercise

• Phosphagen (ATP-PC) provides short, quick energy bursts within the first 30 seconds of intense exercise
• Anaerobic Glycolytic provides moderate intensity energy for short durations of 30-90 seconds
• Aerobic system predominates after 2 minutes of exercise
• Short bursts of intense activity lasting less than 30 seconds uses the ATP-PC system and adaptation offers muscle strength and power
• Intense activity lasting 1-2 minutes uses the ATP-PC and anaerobic glycolytic systems and adaptation offers anaerobic power
• Submaximal activity lasting 3-5 minutes repeats after rest uses the ATP-PC and anaerobic glycolytic and adaptation offers aerobic power and endurance
• Short bursts of intense activity and the need to rest and completely recover uses the ATP-PC
• Submaximal intensity lasting longer than 20-30 minutes uses the aerobic system and adaptation offers endurance
• Anaerobic metabolism produces ATP 2.5 times faster, but aerobic metabolism supports exercise longer
• Anaerobic metabolism involves glycolysis, where glucose converts to lactate, yielding only 2 ATP per glucose
• Aerobic metabolism converts carbohydrates to ATP via glycolysis, the citric acid cycle, and the ETS pathways, yielding 30-32 ATP per glucose
  • Fatty acids undergo beta oxidation, with ATP production determined by fatty acid length

Aerobic vs Anaerobic Metabolism

• Anaerobic metabolism is fast but not efficient, yielding only 2 ATP
• Aerobic metabolism is slower but more efficient, yielding 30-32 ATP, and requires adequate O2

Substrate Use

• At lower exercise levels (less than 70% oxygen consumption), the body uses 60% fats and 40% glucose for energy
• At higher levels of exercise (greater than 70% oxygen consumption) the body uses carbohydrates (glucose)
• Hormones regulate metabolism during exercise
• Insulin secretion is suppressed during exercise
• Muscles do not use insulin for glucose uptake, instead using GLUT4 transporters

Oxygen Consumption

• Determines which energy system is being used
• Determines how ATP is used
• VO2 max refers to the maximum volume of O2 able to be taken in, transported and utilized
• Oxygen consumption quantifies exercise intensity
• Resting oxygen consumption measures approx. 3.5 ml/kg/min.
• Maximal oxygen consumption measures an individuals cardiorespiratory fitness

Maximal Oxygen Consumption

• VO2 max is the product of maximal cardiac output and a-vO2 difference.
• Maximal oxygen consumption (VO2 max) measures a body's capacity to use oxygen
• Maximal oxygen consumption (VO2 max) is the maximum rate of oxygen consumption attainable during physical exertion
• Maximal oxygen consumption (VO2 max) is expressed relative to bodyweight in mL/kg per minute
• One MET (metabolic equivalent) equals oxygen consumption at rest
  • 2 METs is consuming oxygen at twice the resting rate (7 ml/kg/min)
  • 3 METs is consuming oxygen at three times the resting rate (10.5 ml/kg/min)
• VO2 max is measured using open circuit spirometry, which performs a graded exercise test to exhaustion
• Field tests are a practical way to estimate VO2 max to assess aerobic fitness without specialized equipment
  • Cooper Walk/Run Test involves running or walking as far as possible in 12 minutes
  • 1.5 Mile Run Test involves running 1.5 miles as quickly as possible
  • Step Test involves stepping up and down on a platform for 3 minutes
  • Rockport Walk Test involves walking one mile as quickly as possible

Introduction to Therapeutic Exercise

• Therapeutic exercise seeks to define key terms related to physical function
• Therapeutic exercise seeks to understand the purpose of therapeutic exercise
• Therapeutic exercise seeks to understand components of effective prescription of therapeutic Exercise
• Therapeutic exercise seeks to review exercise training principles, including overload, SAID, reversibility, and individual differences

Physical Function

• Physical function entails balance, cardiopulmonary endurance, coordination, flexibility, mobility, muscle performance, neuromuscular control
• Physical function entails postural control, postural stability, equilibrium, and stability

Therapeutic Exercise

• Therapeutic exercise systematically performs/ executes planned physical movements/activities that enable clients/patients to:
  • Remediate/prevent body structure/function impairments
  • Enhance activities/participation
  • Prevent/reduce health-related risk factors
  • Optimize overall health status, fitness, and well-being
• Management Model of Therapeutic Exercise entails referral/consultation, diagnosis, prognosis, examination, evaluation, intervention, outcomes, and APTA guidlines

Therapeutic Interventions

• Therapeutic interventions include aerobic capacity/endurance conditioning or reconditioning, flexibility exercises, strength, power, and endurance training, balance training
  • Includes neuromotor development training, gait and locomotion training, relaxation, posture training, and graded motor imagery

Role of PT

• Addressing impairments does not guarantee improvements in performance or quality of life
• Tasks the patient/client aims to perform should include exercises specific to the tasks

Therapeutic Exercise Prescription

• How do we prescribe therapeutic exercise?
• ICF Framework
• FITT-VP
• Contextual factors
• Using principles of science (physiology and biomechanics)
• Using best evidence from research

ICF Framework

• ICF Framework starts with patients Goals includes participation restrictions
• ICF Framework entails activity limitations
• ICF Framework entails body structures/function impairments
• ICF Framework entails contextual factors such as Environmental Factors, Personal barriers and facilitators

Patient Goals

• Disorders or disease states are health conditions that limit the individual to engage in life situations, work, social, chores or recreation/ play.
• Health Conditions include activity limitations
  • This is then inability of performing certain task/ functions in daily life. E.g Cannot sit at a desk, Cannot hold a tennis racquet, Cannot ascend flight of stairs

ICF Definitions

• Body structres/functions are anatomic and physiological impairments that limit specific functions
• Contextual factors refer to social, physical, and attitudinal Environmental/ Personal factors or a persons life
• STG is active shoulder flexion in order to lift dishes into the kitchen overhead cabinet within two weeks
• Activity compontents must be measurable
• Improves AROM related activity/participation. Goal is to improve overhead reach

Impact of Impairments

• Decreased Isometric Strength results in difficulties stooping and kneeling
• Reduced peak power is linked with slower walking speeds.
• ICF framework highlights interaction between all aspects of functioning/ disability
• Responses to health conditions influenced by unique factors

Principles of Exercise Training

• Exercise aims to achieve positive adaptation in physical function by linking each prescribed exercise and a specific goal
• Principles for exercise training includes overload, and Specificity/Specific Adaptation to Impose Demands, SAID as well as Reversibility, and individual differences
• Overload refers to Stress greater than the stress encountered in daily activites is applied during exercises.
  • Overload applies during both aerobic, and resistance exercises
• SAID,Specific Adaptations to Imposed Demands is a framework of specificity to necessary foundation on which exercise programs should be built
  • Specific adaptive effects of training the training include ascending and descending stairs climbing if it involves clients goal
• Adaptive training effects should include training method, strength v power v endurance should the effects should include specificity
• "Use it or lose it" is reversibility principle in that if adaption are maintained activities can be incorporated into routine activities
• Individuals respond to exercise differently due age, genetic differences and initial fitness levels

Components of Exercise

• How hard should a person exercise?, is the level of intensity,
• Volume is refers amount of total exercises and is measured through frequency, and number of secessions per week, as well as repetition Time refers length amount of time or 20 minutes, and can me measured in sets and repetitions
• Volume consists of 150 minutes of volume per week of moderate intensity Volume also considers other physical stresses The progression component of exercise is referring to dosage of Increasing exercise load Progressive must implement assessments

FITT-VP

• The acronyn FITT-VP abbreviates a classic exericse prescription with Time, Type, Frequency and Intensity
• These guidelines are used to extend testing and prescriptions of ACSMS A useful memory aid for creating FITT-VP during exericse

Prescribing Exercise

• Wand is recommended implement AAROM, while being seated.
• End range discomfort should be
• During prescribing frequency in exercises at 3xF/day

How do we prescribe therapeutic exercise?

• Contextual Factors such as Biological, and height/ weight relationships, genetics with family history.

Activity Limitation and Participation Restriction

• Decreased isometric strength in lower extremities correlates with difficulties in stooping and kneeling
• Reduced peak power in lower extremities is linked to slower walking speeds and challenges moving from sitting to standing
• Not all impairments consistently lead to activity limitations
• Increased joint space narrowing in osteoarthritis patients did not consistently correlate with increased activity limitations in a 2-year study
• Severity and complexity of impairments must reach a critical, person-specific level to significantly impact functioning
• Findings support the ICF framework, highlighting that environmental and personal factors interact with all aspects of functioning and disability
• Individual responses to health conditions are unique and influenced by various factors