KINE 1020: A Brief History of Exercise as Medicine

A Brief History of Exercise as Medicine Susruta (600 BCE) of India First doctor to prescribe daily exercise as medicine for his patients. Hippocrates (460-370 BCE) Emphasized the importance of balance in exercise and nourishment: “If we could give every individual the right am...

A Brief History of Exercise as Medicine Susruta (600 BCE) of India First doctor to prescribe daily exercise as medicine for his patients. Hippocrates (460-370 BCE) Emphasized the importance of balance in exercise and nourishment: “If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” Aristotle (The Father of Kinesiology) – 350 BCE Pondered the relationship between health and activity: “The exercise of walking is said to produce better health, or does the possession of better health produce the ability to walk? If walking does not produce better health, then walking would be in vain.” Edward Stanley (1873) Stressed the importance of physical activity: “Those who think they have no time for bodily exercise will sooner or later have to find time for illness.” Relationships between Lifestyles and Health are Complex People who exercise regularly tend to eat better. Smokers are less likely to engage in physical activity during their leisure time. Note: Increasing physical activity does not usually lead to quitting smoking, except for those aiming to be highly trained. No clear relationship exists between physical activity and alcohol consumption. Regular exercise is linked to being leaner and having fewer chronic diseases. However, proving exercise prevents disease is challenging, as diseases might limit one’s ability to move. The link between physical activity levels and obesity is complex. It is possible to be "fat and fit." A Brief History of ‘Firsts’ in Exercise Physiology 1737: Luigi Galvani (Italian physician) discovers that electricity stimulates muscle contraction. 1847: Carl Ludwig (German physician and physiologist) measures human blood pressure. 1887: Augustus Desiré Waller (British physiologist) records the electrical activity of the human heart (EKG). 1920: Archibald V. Hill (British physiologist) describes maximal oxygen uptake (VO2 max).  1957: Andrew F. Huxley (British physiologist) theorizes about muscle cross-bridges in contraction. 1. Physical Fitness vs. Health Physical Fitness refers to: 1. The capacity to live an optimal life. 2. A functional quality of well-being influenced by and associated with participation in physical activity. 3. The ability to perform muscular work satisfactorily, determined by attributes like cardiovascular endurance, muscular strength, flexibility, and body composition. Health is not necessarily the same as fitness but rather relates to a state of overall well-being. Components of Physical Fitness 1. Body Composition: The proportions of muscle, fat, bone, and other tissues that make up your body. 2. Musculoskeletal Fitness: Includes muscular strength and endurance, essential for movement and overall functionality. 3. Cardiorespiratory Fitness: The efficiency of the heart, lungs, and vascular system in supplying oxygen to the body during sustained physical activity. 4. Flexibility: The range of motion available at a joint, which impacts overall mobility and helps in injury prevention. 2. Types of Fitness Health-Related Fitness: ○ Fitness components that allow you to perform daily activities without excessive fatigue, such as being able to walk your dog or carry a hose up the stairs. Performance-Related Fitness: ○ Fitness components that enable optimal work or sport performance, like doing cartwheels on a balance beam or maintaining peak physical condition for athletic events. Pop Quiz: Understanding the Differences Health-Related Fitness Examples: ○ Walking your dog ○ Having a normal body weight Performance-Related Fitness Examples: ○ Doing cartwheels on a balance beam Both Health and Performance-Related: ○ Being able to touch your toes 3. The Health Continuum Describes the range of health from poor ("Unhealthy") to optimal ("Optimally Healthy and Fit"). Traditional Health Care focuses on: ○ Disease or Death: Treating diseases using professionals like doctors and nurses. ○ Prevention and Rehabilitation: Addressing the absence of disease symptoms, preventing illness, and helping individuals recover from conditions. ○ Optimum Health and Wellness: Enhancing fitness and overall health beyond just treating or preventing disease. Definitions Health: ○ Defined by the World Health Organization (WHO) as a state of complete physical, mental, and social well-being, not merely the absence of disease. ○ The highest attainable health is considered a fundamental human right. Wellness: ○ The practice of healthy habits daily to improve physical and mental health outcomes. It is about thriving, not just surviving. ○ Health is about "being" while wellness is about "doing." Examples Even someone who "looks healthy" (e.g., fit appearance) might not be healthy. For example, Chadwick Boseman, who appeared fit but was diagnosed with colon cancer in 2016 and passed away in 2020. Mental health also plays a crucial role, as shown by Naomi Osaka's withdrawal from tennis tournaments, emphasizing athletes' mental health. 4. Causes of Death and Life Expectancy in Canada Leading Causes of Death (Pre-Pandemic): ○ 2018: Cancer, heart disease, and accidents. ○ 2020: Heart disease, cancer, followed by COVID-19. Life Expectancy: ○ 2021: 82.66 years in Canada. ○ Trends show gradual improvement year-over-year. ○ Global Comparisons: Longest Life Expectancy: Japan. Shortest Life Expectancy: Central African Republic. Health-Adjusted Life Expectancy (HALE)  Refers to the number of years in full health an individual can expect to live. Uses the Health Utility Index (HUI) to weigh years lived in good health higher than years lived in poor health. 5. Determinants of Health Physical Determinants: Factors that affect health, such as living conditions, income level, and access to healthcare. Lifestyle and Environment (Lalonde Report, 1974): ○ Introduced a significant health concept where health is impacted by factors inside and outside of individual control. Built Environment: ○ Physical spaces such as parks, gyms, and walkways contribute significantly to health and encourage physical activity. ○ York University utilizes built environments to promote health, providing facilities like the Tait McKenzie Centre to support student fitness. 6. Summary of Key Concepts Physical Fitness is the capacity to perform physical tasks and live a healthy life, while health refers to the broader state of complete well-being. Health-Related Fitness helps individuals perform daily activities, while Performance-Related Fitness enhances athletic performance. The Health Continuum illustrates the journey from being unhealthy to achieving optimal health. Wellness involves proactive daily actions to improve health outcomes. Awareness of leading causes of death and life expectancy trends helps understand the importance of proactive health management. Determinants of Health such as lifestyle, environment, and social factors play a significant role in influencing overall health. 1. The Lalonde Report (1974) Canadian Health Care Concept (Lalonde Report): ○ Published by Marc Lalonde, Canada's Minister of National Health and Welfare. ○ The report transformed the way the world thinks about health, emphasizing factors beyond medical care. ○ It remains a foundational document in the field of health promotion. Key Insight: ○ Health is influenced by both internal and external factors. This means that lifestyle choices (like diet and exercise) as well as environmental factors (like pollution or access to healthcare) play significant roles in determining one’s health. 2. Determinants of Health (World Health Organization) Physical Determinants of Health: ○ Health is affected by factors such as where people live, the quality of their environment, genetics, income, education level, and their relationships with friends and family. ○ Determinants are often categorized into social, economic, environmental, and behavioral factors. 3. Life Expectancy and Wealth (Preston Curves) The Preston Curve shows the relationship between wealth (GDP per capita) and life expectancy. ○ As wealth increases, life expectancy tends to increase, but the effect diminishes at higher levels of wealth. ○ Economic conditions play a significant role in improving health and longevity. 4. Built Environment and Community Health Built Environment: Physical surroundings such as buildings, parks, and transportation systems. ○ It significantly influences physical activity and, thereby, public health. ○ York University is an example of how institutions can create a supportive built environment to promote health and well-being. Role of Communities: ○ Communities are crucial in promoting and sustaining physical activity by providing safe spaces like parks and gyms for people to engage in healthy behaviors. 5. Canadian Health Care System Primary, Secondary, and Tertiary Care: ○ Primary Care: First point of consultation, typically through a family physician or general practitioner. ○ Secondary Care: Specialized medical care, often in hospitals, provided by specialists like cardiologists or urologists. ○ Tertiary Care: Advanced medical investigation and treatment, such as cancer treatment or surgery, offered at specialized hospitals. OHIP (Ontario Health Insurance Plan): ○ Provides health coverage for residents of Ontario, Canada. ○ Eligibility: Must be a Canadian citizen or permanent resident, live in Ontario for 153 days in any 12-month period, and make Ontario their primary residence. 6. Regional Medical Models: UK vs. USA Regionalized Model (UK and Canada): ○ Health care follows a structured path from primary care (family physician) to specialized care (hospital treatment).  ○ Example: Basil's Case - A patient who visits his general practitioner for health issues and is then referred to specialists for advanced care. Dispersed Model (USA): ○ Patients often consult multiple specialists independently, without a family physician overseeing the entire process. ○ Example: Polly's Case - A patient with private health insurance visits several different specialists for various issues, and each specialist treats her without a central coordinator. 7. Public vs. Private Health Care Advantages of Private Health Care: ○ Pros: Faster care, more options for procedures, ability to choose doctors, and better doctor-patient ratios. ○ Cons: Inequality, higher costs, refusal of complex cases, profit-driven motives that may lead to unnecessary tests. Advantages of Public Health Care: ○ Pros: Equal access to healthcare for everyone, affordability as it’s non-profit. ○ Cons: Longer wait times, fewer choices, higher patient loads for healthcare workers. 8. Health Promotion and Disease Prevention Programs Health Promotion: ○ The First International Conference on Health Promotion (Ottawa, 1986) led to the Ottawa Charter for Health Promotion. ○ The charter emphasizes five key action areas: Build healthy public policy. Create supportive environments for health. Strengthen community action for health. Develop personal skills. Reorient health services. ○ Three Basic Health Promotion Strategies: Advocate: Promote conditions favorable to health. Enable: Reduce health inequalities and ensure opportunities for all to achieve full health potential. Mediate: Require coordinated action from governments, industries, and communities to achieve health goals. Disease Prevention Programs: ○ Significant spending has been allocated for health initiatives: Anti-tobacco programs: $480 million (2005). Diabetes strategy: $90 million (2005). ParticipACTION renewal: $5 million (2005). Children’s Fitness Tax Credit: Up to $500 (2007). COVID-19 vaccine and health support: Over $17.6 billion (2020-21). 9. Spending on Health Care in Canada Canada invests heavily in health care initiatives to address a wide range of issues:  ○ Mental Health, Injury Prevention, Child Health, Pregnancy, Infection Control, and Violence Prevention. ○ For COVID-19 specifically, approximately $11.5 billion was spent in 2020 for testing, treatment, and recovery. Summary of Key Concepts The Lalonde Report emphasized that health is not just determined by medical care but also by lifestyle and environment. Health Determinants include social, economic, and environmental factors. The Preston Curve illustrates the relationship between wealth and life expectancy. Built environments and community roles are essential for promoting physical activity. The Canadian health care system offers a structured model of care through primary, secondary, and tertiary services. There are pros and cons to both public and private health care systems, influencing accessibility and quality of care. Health Promotion efforts focus on enabling, advocating, and mediating to improve health, as detailed in the Ottawa Charter. Canada spends extensively on health promotion and disease prevention programs to enhance public health. 1. What is Time Management? Definition: ○ Setting effective goals, creating workable plans, and finding balance. ○ Time management is about allocating time and energy to the goals you value. Time Management IS: ○ Setting achievable goals. ○ Working with your natural energy levels. ○ Finding balance and reducing stress. Time Management is NOT: ○ Micromanaging every moment. ○ Filling every second with productivity. ○ Increasing anxiety by unrealistic expectations. 2. Time Awareness Understand How You Spend Your Time: ○ Each day has 24 hours; each week has 168 hours. Evaluate how you are currently allocating this time. ○ Identify activities like sleeping, eating, commuting, studying, exercising, and how much time they take up. Align Time with Personal Goals: ○ Reflect on whether your time use aligns with your priorities and goals. ○ Re-direct energy to focus more on important areas. 3. Setting SMART Goals SMART Goals: ○ Specific: Clear and well-defined. ○ Measurable: Able to track progress. ○ Attainable: Realistic and achievable. ○ Relevant/Realistic: Aligned with your objectives. ○ Time-based: Have a deadline. 4. Pro-Active Time Management Strategies 1. Structure and Routine: ○ Establish a daily routine for consistency (e.g., sleep and study schedules). ○ Use routine to minimize decision-making and free up mental energy for studying. 2. Use Planning Tools: ○ Plan by term, week, and day using: 4-month calendar for the big picture. Weekly planning sessions to organize time. Daily plans with flexibility. 3. Break Down Tasks & Space Them Out: ○ Break large tasks into smaller parts (e.g., essay writing: research, outline, drafting). ○ Use spaced practice: Give yourself more time than you need to complete tasks to reduce stress. 5. In-the-Moment Strategies Calm Your Mind: ○ Adjust your mindset with positive self-talk and adopt a growth mindset. ○ Take short movement breaks (stretch, walk, etc.) to refocus. The Pomodoro Method: ○ Work in intervals: 25 minutes of focused work followed by a short break. ○ After every 4 intervals, take a longer break. Prioritization: ○ Say "no" based on your priorities. ○ Use the ABC Method: A (must-do), B (should-do), C (nice-to-do). ○ Use the Time Management Matrix to decide on task urgency. 6. General Advice on Time Management Words of Wisdom: ○ Break tasks into small steps. ○ Schedule buffer time and stay flexible. ○ Proactive approach: Plan ahead rather than react to deadlines. ○ Time management is a skill that improves with practice. 1. Factors Contributing to Mental Illness (Bio-Psycho-Social Model)  Biological Factors: Includes genetic vulnerability, such as a predisposition to disorders like schizophrenia. Psychological Factors: Personality vulnerabilities and individual psychological responses. Social-Environmental Factors: Cultural influences, social interactions, and environmental factors. 2. Schizophrenia and Drug Treatments First Generation Antipsychotic Drugs (1950s): Helped patients manage psychosis, but often caused severe side effects like tardive dyskinesia. Second Generation Antipsychotic Drugs (1990s): Medications like clozapine were introduced but carry risks like agranulocytosis (1% of cases). 3. Environmental and Cultural Influences on Mental Health Television and Mental Health in Fiji (1990s): After television was introduced, eating disorders became prevalent. Body Image: Cultural expectations, like comparing oneself to Instagram models, have led to increased body dissatisfaction and eating disorders, especially among women. 4. Leading Causes of Disability (Ages 15-44, WHO) Major causes include depression, alcohol use, and road traffic accidents. Differences in leading causes for men and women highlight gender-specific health issues, like schizophrenia and bipolar disorder. 5. Case Study on Psychological Vulnerability A 32-year-old woman with driving fears and trauma after an accident. Psychological symptoms include phobic avoidance, nightmares, and startle reactions. Diagnosis likely post-traumatic stress disorder (PTSD), requiring psychotherapy and gradual exposure therapy. 6. Sources of Stress Life Events: Major events like marriage and death of a spouse contribute significantly to stress. Daily Hassles: Minor irritations can impact mental health, such as academic stress or relationship problems. 7. Coping with Stress Relaxation Techniques: Mindfulness and meditation help reduce stress. Support Systems: Social support plays a crucial role in coping, as seen in the community of Roseto, Pennsylvania, where a sense of community led to lower rates of mental and physical health issues. 8. Cognitive Appraisal and Coping Strategies Cognitive Appraisal: Viewing situations as either stressors (negative) or challenges (positive). Automatic Thoughts and Rational Responses: Replace negative thoughts (e.g., "I am a failure") with rational responses (e.g., "I've succeeded before, I can improve"). 9. COVID-19 and Mental Health Impact on Students: Increased anxiety, loneliness, and hopelessness were reported, especially among students with pre-existing mental health concerns. 10. Roseto Phenomenon In Roseto, Pennsylvania, a strong community, low competitiveness, and social connections contributed to exceptionally good health, demonstrating the importance of social support for mental and physical well-being. 1. Health Care Models: Regionalized vs. Dispersed The Regionalized Model (UK and Canada) ○ Example: Basil, a 60-year-old in London, goes to his general practitioner (Dr. Prime) for most health issues. After experiencing transient ischemic attack (TIA) symptoms, Dr. Prime refers him to specialists and arranges for a carotid endarterectomy in a specialized hospital. ○ Key Features: Centralized care. Referral system: Patients are first seen by general practitioners, who refer them to specialists. Specialized procedures are performed only in designated hospitals. The Dispersed Model (USA) ○ Example: Polly, a 55-year-old in the USA, has private health insurance and sees multiple specialists independently. For a breast lump, Polly consults a gynecologist and is referred to a surgeon and an oncologist, all within her local area. ○ Key Features: Decentralized care. Patients can directly access specialists. Flexibility in choosing where to receive treatment. 2. Public vs. Private Health Care: Advantages and Disadvantages Full Private Health Care: ○ Pros: Faster care, more options for procedures, choice of doctor, better doctor-patient ratios, and more privacy. ○ Cons: Inequality in access, potential refusal to treat complex cases for profit, high costs, and insurance limitations.  Full Public Health Care: ○ Pros: Equal healthcare access, more affordable due to the non-profit approach. ○ Cons: Longer wait times, fewer choices, and higher patient loads for healthcare workers. 3. Health Promotion and the Ottawa Charter (1986) The First International Conference on Health Promotion held in Ottawa led to the Ottawa Charter for Health Promotion. Key Action Areas in Health Promotion: ○ Build Healthy Public Policy. ○ Create Supportive Environments for Health. ○ Strengthen Community Action for Health. ○ Develop Personal Skills. ○ Reorient Health Services. Three Basic Health Promotion Strategies: ○ Advocate: Promote conditions that favor health through political and social advocacy. ○ Enable: Reduce health inequalities and ensure equal opportunities for health. ○ Mediate: Coordinate actions across various sectors to promote health. 4. Health Spending and Disease Prevention Programs Health Promotion Focus Areas: ○ Mental health, injury prevention, child health, pregnancy, infection, violence, and anti-smoking programs. Examples of Disease Prevention Programs: ○ Anti-tobacco programs: $480 million (2005). ○ Diabetes Strategy: $90 million (2005). ○ Children’s Fitness Tax Credit: Up to $500 (2007). ○ Mental Health Programs: $27 million (2011), and $100 million (2022-2024). ○ COVID-19 Support: >$17.6 billion for vaccine procurement, deployment, and administration (2020-21). 5. Evidence-Based Medicine (EBM) vs. Complementary/Alternative Medicine Evidence-Based Medicine (EBM): ○ Involves the integration of the best available research evidence with clinical expertise and patient values. ○ Emphasizes the use of peer-reviewed research and clinical trials to guide medical decisions. ○ Example of Evidence Levels: Level I: Evidence from properly designed randomized controlled trials (RCTs) and meta-analyses. Level II: Evidence from well-designed controlled trials (non-randomized), cohort, or case-control studies.  Level III: Opinions from respected authorities or descriptive studies. Problems with Evidence-Based Medicine: ○ Variability in patient outcomes. ○ Limited applicability (e.g., differences between humans and animal models). ○ Over-reliance on results without considering individual patient differences. 6. Understanding Levels of Evidence Level I Evidence: ○ Derived from randomized controlled trials (RCTs). ○ Example: A study to determine the effect of estrogen therapy on heart disease risk through random assignment. Level II Evidence: ○ From well-designed controlled trials but without randomization or cohort studies. ○ Example: Observational studies showing women on estrogen therapy have a lower heart disease risk compared to those who are not. Level III Evidence: ○ Based on expert opinions or clinical experience. ○ Provides lower reliability compared to Level I or II due to a lack of systematic controls. 1. Introduction to Complementary and Alternative Medicine (CAM) Definition: CAM refers to diverse medical and health care systems, practices, and products that are not part of conventional (Western) medicine. Prevalence: About 80% of Canadians reported using some form of CAM at least once in their lifetime (Fraser Institute, 2016). The use of CAM is on the rise, especially therapies like massage, yoga, acupuncture, chiropractic, osteopathy, and naturopathy. 2. Types of CAM Categories of CAM: ○ Natural Products: Includes dietary supplements that are nonvitamin, nonmineral (e.g., Echinacea, fish oils), probiotics, and botanical medicines. ○ Mind and Body Medicine: Practices like yoga and meditation. ○ Manipulative and Body-Based Practices: Includes chiropractic and acupuncture. 3. Natural Health Products (NHPs) Regulation: Natural Health Products Regulations came into effect on January 1, 2004. NHPs must be safe and available over the counter, not requiring a prescription. Difference from Food and Drugs: ○ Food: Anything consumed for nutrition (e.g., chewing gum). ○ Drug: Substances used for diagnosis, treatment, mitigation, or prevention of disease, and to modify functions in humans or animals. ○ NHP: Naturally occurring substances intended to maintain or restore health. 4. Case Studies of CAM Products Oscillococcinum: ○ Approved in Canada as a treatment for colds and flu. ○ Made from duck liver and heart, highly diluted (200C). The final dilution is so extreme that it’s unlikely any original substance remains. ○ Approved by Health Canada as "safe and effective," but it's essentially a sugar pill (lactose and sucrose tablets). Horny Goat Weed (Epimedium sagittatum): ○ Used traditionally in Chinese medicine for sexual dysfunction, weak back, and knees, among other uses. ○ Limited research supports its efficacy, with only a few studies showing improvements in animals or in vitro. ○ Contraindicated in patients with specific deficiencies, and potential side effects like dizziness and vomiting are noted. 5. Risks of Using Natural Health Products While NHPs are generally safe and have fewer side effects than conventional drugs, they are not without risk. Risks include: ○ Manufacturing Problems: Potential for contamination, incorrect ingredients, or improper dosage. ○ Unproven Claims: Using unverified products may delay proper treatment for serious conditions. ○ Lack of Information: Inadequate instructions or warnings. ○ Interactions: Can interact with prescription drugs or other NHPs, causing adverse effects. ○ Unwanted Side Effects: Allergic reactions or other health issues. 6. Effectiveness of Common Natural Products Garlic: ○ Evidence Level III: Half to one clove daily can lower cholesterol by up to 9%. ○ Aged Garlic Extract: May have anti clotting effects and reduce blood pressure modestly. Ginseng: ○ Some evidence suggests benefits in chronic consumption for glycemia, but not for improving circulation. Ginger: ○ Evidence Level II: Helpful in reducing arthritic knee pain but less effective than ibuprofen. Chamomile: ○ Moderate antioxidant and antimicrobial activities; antiplatelet effects in vitro. ○ Human studies are limited, with no clinical trials on its sedative properties. Ginkgo: ○ Questionable for memory loss and tinnitus; some benefits for dementia and claudication. St. John's Wort:  ○ Effective for mild to moderate depression but has serious drug interaction risks. Echinacea: ○ Might help in treating or preventing upper respiratory infections, though the data is not fully convincing. Kava: ○ Effective for short-term anxiety treatment but not free from adverse effects. 7. Health Canada's Approach to NHPs Evidence for NHPs: Health Canada requires proof of safety, efficacy, and quality for homeopathic products. This can range from clinical trials to evidence of traditional use. Old Standard: Homeopathic products could be approved based on "materia medica" (anecdotal evidence), including information from herbalists or elders to confirm traditional use for at least 50 years. Regulatory Approval: Products without a DIN (Drug Identification Number), NPN (Natural Product Number), or DIN-HM (Homeopathic Medicine Number) are not approved, meaning their safety and efficacy are not verified. 8. Concerns with Natural Health Products Many imported products may lack proper labeling or contain unlisted ingredients (e.g., heavy metals like lead, arsenic). To get reliable information on a supplement: ○ Consult a doctor or pharmacist. ○ Look for findings from scientific research (e.g., National Center for Complementary and Alternative Medicine). ○ Contact the manufacturer for detailed information on their claims. 9. The Myth of "Natural" Equals "Safe" Being "natural" does not guarantee safety. For example: ○ Nightshade (Solanum) is natural but poisonous. ○ High doses of certain substances, like concentrated green tea extract, can cause health issues (e.g., liver damage), unlike consuming green tea as a beverage. 10. CAM and Pharmaceuticals Many pharmaceuticals originate from natural substances. Examples: ○ A compound from wildflowers (ICT2588) shows potential against tumors. ○ Exendin-4 derived from lizard spit is effective for diabetes. 1. Definition and Types of Stress Definition of Stress (Selye, 1974): ○ Stress is the "nonspecific response of the body to any demand made upon it." Types of Stress:  ○ Eustress (Positive Stress): Stress that motivates or improves performance. Examples: Getting a promotion, playing sports, going on a date. ○ Distress (Negative Stress): Stress that leads to anxiety or poor health. Examples: Death of a friend, job interviews, academic pressure. 2. Physiological Response to Stress Stress Axis: ○ Stress activates the Hypothalamic-Pituitary-Adrenal (HPA) axis, leading to the production of cortisol, a stress hormone. ○ Corticotropin Releasing Factor (CRH) triggers the pituitary gland to release hormones that stimulate cortisol production. Acute Stress (Fight or Flight Response): ○ Leads to increased alertness, higher heart rate, increased breathing, and higher blood pressure. ○ Blood Flow: Directed to muscles, away from skin and digestion to prepare the body for physical action. ○ Increased Glucose: Provides energy for immediate action. ○ Stress Hormones: Increased secretion to help fight or flee. Chronic Stress (Prolonged Acute Stress): ○ Prolonged exposure to stress can lead to negative health outcomes. ○ Negative Health Effects: Brain: Headaches, anxiety, disrupted sleep, poor cognition, and learning ability. Cardiovascular System: Hypertension and chronic heart problems due to consistently high blood pressure. Stomach: Blood is directed away from digestion, leading to upset stomach and ulcers. Skin: Conditions like eczema and psoriasis can worsen. Endocrine System: Diabetes and increased fat storage; decreased immune function and reproductive problems. ○ Cushing's Syndrome: Chronic elevated cortisol can lead to symptoms such as muscle weakness, weight loss, fatigue, low blood sugar, irritability, and depression. Addison's Disease: ○ Characterized by the lack of stress hormones. ○ Symptoms include muscle weakness, weight loss, fatigue, low blood pressure, and irritability. 3. Locus of Control and Stress Locus of Control: ○ Refers to whether individuals believe they control their own fate (Internal Locus of Control) or if it is controlled by external forces like luck, fate, or other people (External Locus of Control). Internal Locus of Control: ○ Associated with higher academic achievement, self-motivation, and less susceptibility to peer pressure.  ○ Individuals with an internal locus of control tend to work harder and believe in the importance of effort. ○ Disadvantages: Can lead to arrogance, poor risk management, and psychological instability if not paired with competence, self-efficacy, and realistic expectations. External Locus of Control: ○ Individuals with an external locus of control believe that outcomes are due to luck or external factors. ○ Advantages: Less short-term stress due to failure and better followers. ○ Disadvantages: Can lead to long-term issues like anxiety, hopelessness, and underachievement. 4. Mental Health Assessment Tools The Short Form (36) Health Survey (SF-36): ○ A common psychometric tool to evaluate health, focusing on aspects such as social functioning and role limitations due to emotional problems. ○ Social Functioning Questions: Extent of emotional interference with normal social activities in the past four weeks. Frequency of emotional interference with social activities (e.g., visiting friends or relatives). ○ Role Limitation Questions: Assess whether emotional problems cause reduced work or school performance. 5. Coping with Stress Types of Coping Mechanisms: ○ Problem Solving: Actively addressing and resolving the source of stress. ○ Acceptance: Learning to accept what cannot be changed. Relaxation Techniques: ○ Breathing Exercises: Simple techniques to calm the mind and reduce stress. ○ Progressive Relaxation Therapy: Alternating tensing and relaxing different muscle groups. ○ Imagery: Replacing negative thoughts with positive ones. ○ Physical Exercise: Acts as a stress reliever, promoting relaxation and better mental health. 6. Relationship Between Stress and Diet Study on Mice: Mice subjected to stress combined with a high-sugar, high-fat diet developed obesity and increased abdominal fat. Stress alone or poor diet alone did not lead to these outcomes. Implication: Stress, in combination with unhealthy eating habits, increases the risk of obesity. 7. Misconceptions about Stress  "No Stress is Best" - False: Stress, in moderation, can be beneficial (eustress). It motivates and helps people meet challenges. Acute Stress Benefits: Can lead to increased energy, better focus, and improved performance in certain situations. Chronic Stress Risks: Chronic stress without effective coping mechanisms can lead to severe health issues, including cardiovascular diseases, mental health disorders, and weakened immune function. 1. Introduction to Nutrition Amount of Food Consumed Over a Lifetime: ○ Water: ~45,300 kg ○ Fat: ~2,300 kg (21 million kcal) ○ Carbohydrates (CHO): ~8,000 kg (31 million kcal) ○ Protein: ~1,900 kg (7 million kcal) 2. Classes of Nutrients Essential Nutrients: 45 nutrients necessary for human health that must be consumed through diet. Non-Essential Nutrients: Phytochemicals and antioxidants are beneficial but do not have strict dietary requirements. Six Main Classes of Nutrients: ○ Macronutrients: Carbohydrates, fats, proteins, water. ○ Micronutrients: Vitamins, minerals. Macronutrients: Energy-yielding components that provide the body with energy. ○ Carbohydrates (CHO), fats, and proteins are the primary energy sources. ○ Alcohol provides calories but is not a nutrient. 3. Energy Needs in Humans Factors Influencing Energy Needs: Body weight, height, age, sex, physical activity. ○ Age: Energy needs peak between 18-25 years and decline with age. ○ Sex: Males typically need more energy due to more lean mass and larger bodies. ○ Pregnancy and Breastfeeding: Energy needs increase by ~250 kcal/day during the 2nd and 3rd trimesters of pregnancy and 550-650 kcal during breastfeeding. Total Energy Expenditure (TEE): Calculated as BMR (Basal Metabolic Rate) x PAL (Physical Activity Level). ○ Harris-Benedict Equations (to estimate BMR): Males: 66.5 + [13.75 x weight (kg)] + [5.003 x height (cm)] – [6.775 x age (yr)] Females: 655.1 + [9.563 x weight (kg)] + [1.850 x height (cm)] – [4.676 x age (yr)] ○ Physical Activity Levels (PAL): 1.2: Chair or bed bound. 1.6-1.7: Seated office work without leisure activity. 1.8-1.9: Standing work.  2.0-2.4: Strenuous work or high leisure activity. 4. Macronutrients Carbohydrates: ○ Provide 4 kcal/g. ○ Simple Carbohydrates (simple sugars): Monosaccharides: Glucose, fructose, galactose. Disaccharides: Maltose, sucrose, lactose. ○ Complex Carbohydrates: Polysaccharides: Glycogen and starch are storage forms of glucose found in muscles, grains, tubers, and legumes. Dietary Fiber: Non-starch polysaccharides that are mostly undigested. Soluble Fiber: Forms gels, decreases cholesterol, feeds gut bacteria. Examples: psyllium, beta-glucan, apples, legumes. Insoluble Fiber: Bulking fiber, relieves constipation, may prevent colon cancer. Examples: wheat bran, cellulose. Glycemic Index (GI): ○ Measures how different carbohydrate foods affect blood glucose levels compared to a reference (50g glucose or white bread). ○ Useful for managing diabetes. Sugars: ○ Health Canada's Recommendations: Maximum 100g total sugars per day (natural and added). ○ WHO/FDA Recommendations: Free Sugars: 100 bpm. ○ Bradycardia: HR < 60 bpm.  ○ Atrial Fibrillation and Ventricular Fibrillation: Serious conditions caused by irregular electrical activity. 9. Coronary Circulation Function: Supplies oxygen and nutrients to the heart muscle (myocardium) and removes waste products. Coronary Arteries: Provide critical blood flow; restricted blood flow can lead to ischemia or heart attacks. Maximum Coronary Flow: Occurs during diastole, as coronary vessels are compressed during systole. 1. Key Cardiac Measures Heart Rate (HR): ○ The number of beats per minute (bpm). ○ Measurement: Can be measured by palpation (feeling the pulse) or through technology (e.g., heart rate monitors). ○ Influencing Factors: Pacemaker Cells: SA node and AV node influence resting HR. Exercise: Increases HR to supply more oxygen. Autonomic Nervous System: Sympathetic Nervous System (SNS): Increases HR during “fight or flight.” Parasympathetic Nervous System (PNS): Decreases HR during rest. Other Stimulants/Depressants: Drugs, environmental factors like heat or cold. Stroke Volume (SV): ○ The amount of blood ejected by the ventricles per beat. ○ Determinants: Preload: The amount of blood filling the ventricles before contraction. Afterload: The resistance that the heart must overcome to eject blood. Contractility: The force of ventricular contraction. ○ Measurement: Echocardiography: Imaging technique used to visualize heart function. Direct via Arterial Catheter: Used in clinical settings. Cardiac Output (Q): ○ The total amount of blood ejected from the heart per minute. ○ Formula: Q=HR×SV ○ Normal Values: At rest: 5 L/min. During maximal exercise: 20 - >35 L/min. ○ Factors Affecting Cardiac Output:  Anything that affects HR or SV, such as exercise, environmental conditions, and heart health. 2. Structure and Function of Blood Vessels Arteries: ○ Carry oxygenated blood away from the heart (except for the pulmonary arteries). ○ Operates under high pressure due to the need to deliver blood throughout the body. ○ Key Properties: Elasticity (Compliance): Allows for expansion and contraction with the heartbeat. Surrounded by smooth muscle, which helps regulate blood flow. ○ Layers of the Arterial Wall: Tunica Externa: Structural support, made of collagen. Tunica Media: Contains smooth muscle, important for vasoconstriction and vasodilation. Tunica Intima: The innermost layer, composed of endothelium, involved in exchange processes. Veins: ○ Carry deoxygenated blood back to the heart (except for the pulmonary veins). ○ Operate under lower pressure and can easily expand to hold more blood (capacitance vessels). ○ Key Properties: Less elastic and rigid compared to arteries. Contain valves to prevent the backflow of blood. ○ Layers of the Venous Wall: Similar to arteries: Tunica Externa, Tunica Media, Tunica Intima. Capillaries: ○ The smallest blood vessels, where the exchange of gasses, nutrients, and waste products occurs. ○ Composed of a single layer of endothelial cells, which facilitates efficient exchange. ○ Blood Flow: Slow to allow for effective exchange. 3. Blood Vessel Function: Vasoconstriction and Vasodilation Vasoconstriction: ○ The narrowing of blood vessels, which increases blood pressure and total peripheral resistance (TPR). ○ Triggered by sympathetic stimulation, certain hormones, and environmental factors (e.g., cold temperatures). Vasodilation: ○ The widening of blood vessels, which decreases blood pressure and TPR. ○ Triggered by parasympathetic stimulation, heat, and the release of specific chemicals (e.g., nitric oxide). 4. Blood Pressure (BP) Definition: The force that blood exerts on the walls of blood vessels. Formula: BP=Q×TPR ○ (Blood Pressure = Cardiac Output × Total Peripheral Resistance). Regulation: ○ Autonomic Nervous System (ANS): The SNS increases BP through vasoconstriction and increased HR. The PNS decreases BP by reducing HR and causing vasodilation. ○ Renin-Angiotensin-Aldosterone System (RAAS): Hormonal system that regulates blood volume and systemic vascular resistance, thus controlling BP. ○ Baroreceptors: Located in the carotid arteries and aorta. Detect changes in BP and communicate with the brain to adjust ANS activity. Act like a thermostat for BP—when BP increases, baroreceptors signal to decrease HR and promote vasodilation, and vice versa. 5. Measuring Blood Pressure Why Measure BP?: ○ Important for diagnosing cardiovascular conditions, monitoring health, and assessing the impact of interventions (e.g., exercise, medication). Components of BP: ○ Systolic BP (SBP): Pressure in arteries during ventricular contraction. ○ Diastolic BP (DBP): Pressure in arteries during ventricular relaxation. Measurement Methods: ○ Manual: Using a stethoscope and sphygmomanometer (cuff). ○ Automated Devices: Often used in clinical settings for convenience. 6. Composition and Function of Blood Components: ○ Red Blood Cells (RBCs): Make up 45% of blood volume, carry oxygen using hemoglobin. ○ Buffy Coat ( O₂ Pressure in Capillaries: O₂ moves from the alveoli into the blood. O₂ Pressure in Blood > O₂ Pressure in Peripheral Tissue: O₂ moves from blood into tissues. ○ Carbon Dioxide Diffusion: CO₂ Pressure in Capillaries > CO₂ Pressure in Alveoli: CO₂ moves from the blood into the alveoli. CO₂ Pressure in Peripheral Tissue > CO₂ Pressure in Blood: CO₂ moves from tissues into the blood. Transport of Gases: ○ CO₂: 85% travels as bicarbonate (HCO₃⁻), playing a crucial role in maintaining acid-base balance. A small portion binds to hemoglobin or dissolves in the plasma. ○ O₂: 95% is bound to hemoglobin in red blood cells. The remaining 5% dissolves in plasma. ○ Hemoglobin: Each hemoglobin (Hb) molecule can bind four O₂ molecules. 4. The Oxyhemoglobin Dissociation Curve Reflects the relationship between oxygen saturation of hemoglobin (SaO₂) and partial pressure of arterial oxygen (PaO₂). The curve can shift based on various physiological conditions. ○ Shift to the Right: Facilitates O₂ offloading to tissues, often due to increased CO₂, acidity, or temperature (conditions typical during exercise). ○ Shift to the Left: Increases O₂ affinity, making it harder to release O₂ to tissues, typically during lower CO₂ levels or decreased temperature. 5. Measuring Pulmonary Function Pulmonary Volumes: ○ Measurements that indicate lung health and capacity. Important for assessing exercise performance and diagnosing chronic diseases like COPD, bronchitis, and emphysema. Key Pulmonary Volumes: ○ Total Lung Capacity (TLC): Total amount of air when lungs are fully inflated. ○ Vital Capacity (VC): Maximum air exhaled after a maximal inhalation. ○ Tidal Volume (TV): Volume of air inhaled/exhaled during normal breathing. ○ Inspiratory Reserve Volume (IRV): Extra air that can be inhaled after a normal inhalation.  ○ Expiratory Reserve Volume (ERV): Extra air that can be exhaled after a normal exhalation. ○ Residual Volume (RV): Air left in the respiratory tract after maximum exhalation. Factors Affecting Pulmonary Volumes: ○ Body Size: Larger individuals have greater lung volumes. ○ Sex: Males generally have larger lung volumes compared to females. ○ Fitness Level: Athletes may have greater lung capacity. ○ Airway Obstructions: Conditions like asthma reduce lung capacity. ○ Ventilatory Muscle Strength: Stronger muscles improve lung function. Spirometry: A common method for measuring both volumes and rates of airflow in and out of the lungs. 6. Problems in the Respiratory System What Happens When Issues Arise? ○ Compromised Respiratory Function: Can lead to reduced oxygen delivery, increased CO₂ retention, and acid-base imbalances. ○ Examples of Respiratory Conditions: Chronic Obstructive Pulmonary Disease (COPD): Reduced airflow due to obstructed airways. Pulmonary Embolism: A blockage in the pulmonary artery impairs blood flow, decreasing gas exchange efficiency. 1. Pulmonary Volumes Pulmonary Volumes refer to different measures of air in the lungs during various phases of the breathing cycle. Importance: ○ They help evaluate lung health and capacity, which is crucial for assessing exercise performance and diagnosing chronic respiratory diseases such as bronchitis, asthma, COPD, and emphysema. Key Pulmonary Volume Measures: ○ Total Lung Capacity (TLC): The total volume of air the lungs can hold when fully inflated. ○ Vital Capacity (VC): The maximum amount of air that can be exhaled after a full inhalation. ○ Tidal Volume (TV): The amount of air inhaled or exhaled during normal, relaxed breathing. ○ Inspiratory Reserve Volume (IRV): The additional volume of air that can be inhaled after a normal inhalation. ○ Expiratory Reserve Volume (ERV): The additional volume of air that can be exhaled after a normal exhalation. ○ Residual Volume (RV): The volume of air that remains in the lungs after a maximum exhalation, ensuring that the lungs do not collapse. Factors Affecting Pulmonary Volumes: ○ Body Size: Larger individuals have greater lung capacity. ○ Sex: Males tend to have larger lung volumes than females.  ○ Fitness Level: Athletes often have larger lung capacities due to increased lung efficiency. ○ Function of Ventilatory Muscles: Stronger respiratory muscles improve lung capacity. ○ Airway Obstructions/Restrictions: Diseases like asthma or COPD reduce lung capacity. 2. Main Types of Respiratory Diseases Pulmonary Circulation Diseases: Involves issues with blood flow between the heart and lungs, such as pulmonary embolism. Restrictive Lung Diseases: Conditions that limit lung expansion, affecting lung structure and making it difficult to take a deep breath. ○ Examples: Pulmonary fibrosis, sarcoidosis, and severe obesity. ○ Effects: Increased work of breathing, increased oxygen demand, reduced tidal volumes, and shallow breathing. Fibrosis also impairs gas transfer at the alveolar-capillary surface. Obstructive Airway Diseases: Conditions where airway obstruction makes it hard to exhale all the air in the lungs. ○ Examples: Asthma, chronic bronchitis, and emphysema. 3. Pulmonary Embolism (PE) Definition: Occurs when a blood clot (often originating from a deep vein thrombosis, DVT) travels to the pulmonary arteries, blocking blood flow in the lungs. Risk Factors: ○ Cancer, injury, or surgery that leads to prolonged immobility. ○ Deep Vein Thrombosis (DVT): Clots usually develop in the lower extremities and can travel to the lungs. Symptoms: ○ Sudden shortness of breath. ○ Chest pain that worsens with breathing or coughing. ○ Cough (sometimes with blood). ○ Rapid pulse and lightheadedness. Treatment: ○ Anticoagulants (blood thinners) to prevent clot growth. ○ Oxygen therapy to alleviate respiratory symptoms. ○ Surgical removal or filtering of clots in severe cases. 4. Restrictive Lung Diseases Pulmonary Fibrosis: ○ A chronic disease characterized by scarring and thickening of lung tissue, making it stiffer and harder to expand. ○ Causes include infections, environmental agents like asbestos, and chronic inflammation. ○ Symptoms: Increased work of breathing, reduced tidal volume, increased lung oxygen demand, and impaired gas exchange.  ○ Treatment: There is no cure, but treatments focus on managing symptoms. Options include medications to reduce inflammation and in some cases, lung transplantation. 5. Asthma Definition: A chronic condition in which the airways become inflamed and narrowed, making breathing difficult. Cause and Risk Factors: ○ Triggered by environmental factors (e.g., cold weather, chemicals, pollen). ○ Family history and other respiratory infections can also increase risk. ○ Allergies, obesity, and exposure to irritants like tobacco smoke are common risk factors. Physiological Changes: ○ Inflammation of the airways, increased mucus production, and bronchospasm (constriction of the smooth muscle surrounding the airways). Symptoms: ○ Wheezing, breathlessness, tight chest, and coughing. ○ Emergency Symptoms: Bluish lips, severe anxiety, rapid pulse, and extreme difficulty breathing. Treatment: ○ Preventers: Inhaled corticosteroids to reduce inflammation. ○ Controllers: Long-acting anti-inflammatory medications. ○ Relievers: Quick-acting bronchodilators for immediate symptom relief. Physical Activity: ○ Individuals with asthma may avoid physical activity due to symptoms, but regular aerobic exercise improves lung function and reduces symptom severity. 6. Chronic Obstructive Pulmonary Disease (COPD) Definition: An umbrella term for chronic bronchitis and emphysema, characterized by long-term breathing problems and poor airflow. Prevalence: It is the 5th leading cause of death in Canada. Types: ○ Chronic Bronchitis: Involves inflammation and thickened bronchial tubes, resulting in excessive mucus production and obstructed airflow. ○ Emphysema: Damages the alveolar sacs, reducing the surface area available for gas exchange. Symptoms: ○ Chronic cough, shortness of breath, wheezing, chest tightness, and fatigue. Treatment: ○ Quit smoking (essential for managing symptoms). ○ Bronchodilators and steroids to reduce inflammation. ○ Oxygen therapy and pulmonary rehabilitation to improve quality of life. ○ Techniques like pursed-lip breathing to improve airflow and reduce breathlessness. 7. Cystic Fibrosis (CF) Definition: A genetic disorder characterized by the production of thick, sticky mucus that clogs the airways and leads to lung infections. Prevalence: Most common in Caucasians; 60% are diagnosed by age 2. Symptoms: ○ Persistent coughing, increased mucus, fatigue, very salty sweat, and recurrent pneumonia. Treatment: ○ Antibiotics to treat lung infections. ○ Mucus-thinning medicines and bronchodilators. ○ Airway Clearance Techniques: Such as chest physiotherapy, clapping, and vest therapy. ○ No cure, but lung transplants may be an option in severe cases. Exercise in CF: ○ Aerobic exercise helps improve lung function. ○ Precautions: Dehydration and salt loss are concerns; hydration and salt supplements are important during exercise. 1. Overview of Energy Metabolism The cardiorespiratory system plays a crucial role in delivering oxygen to tissues and utilizing it for energy production. The lecture covers key concepts like oxygen extraction, energy systems, fuel utilization during exercise, and metabolic measures like VO₂. 2. Composition of Air and Oxygen Extraction Composition of Air: ○ Inhaled Air: Contains 21% oxygen, 0.03% carbon dioxide, and 78% nitrogen. ○ Exhaled Air: Contains 17% oxygen, 3.3% carbon dioxide, and 78% nitrogen. ○ The difference in oxygen concentration between inhaled and exhaled air is due to oxygen extraction by the body. Oxygen Extraction: ○ Oxygen follows the pressure gradient (from high to low pressure) by diffusion. ○ Blood Flow in Capillaries: Arterioles bring oxygenated blood to tissues, and venules carry deoxygenated blood back. Oxygen extraction depends on capillary blood flow and tissue demand for oxygen. ○ Limited Area and Transit Time: There is limited time for diffusion as blood moves through the capillaries, which can affect the efficiency of oxygen delivery during intense exercise. 3. Measuring Oxygen Consumption (VO₂)  VO₂ represents the volume of oxygen taken up and utilized by the body for energy metabolism. Fick’s Equation for Calculating VO₂: ○ VO2(ml/min/kg)=HR(bpm)×SV(ml)×(CaO2−CvO2) ○ HR (Heart Rate): Number of beats per minute. ○ SV (Stroke Volume): Amount of blood pumped per beat. ○ CaO₂ - CvO₂: Represents the arterial-venous oxygen difference, indicating how much oxygen is extracted from the blood by tissues. Exercise Intensity and VO₂: ○ VO₂ Increases with Workload: Oxygen uptake rises with increasing exercise intensity. ○ Oxygen Deficit and Oxygen Debt: During the initial phase of exercise, VO₂ lags behind the energy requirements, leading to an oxygen deficit. After exercise, oxygen debt (or EPOC - Excess Post-exercise Oxygen Consumption) helps restore the body to a resting state by replenishing oxygen stores. 4. Energy Systems During Exercise VO₂ and Exercise: ○ As exercise intensity increases, the body must deliver more oxygen and extract a greater proportion of it from the blood. ○ This is done by increasing heart rate, stroke volume, and oxygen extraction (a-v O₂ difference). Heart Rate and Exercise: ○ Heart Rate (HR) increases during exercise through: Parasympathetic withdrawal (increasing HR to about 100-110 bpm). Sympathetic activation, which gradually raises HR towards its maximum. ○ Age-Predicted Maximum Heart Rate: 220−age Used as an estimate for setting exercise intensity. Stroke Volume and Exercise: ○ Stroke Volume (SV) increases with exercise due to: Greater contractility: Stronger heart contractions as a result of the Frank-Starling mechanism. Reduced peripheral resistance: Due to vasodilation, allowing more blood to be pumped out with each beat. Ejection Fraction: The percentage of blood pumped out of the heart during systole, which increases with exercise, especially in elite athletes. 5. VO₂max and Exercise VO₂max: The maximum rate of oxygen consumption during intense exercise, a marker of aerobic fitness. Measurement of VO₂max:  ○ Conducted through tests like ergospirometry, which measures oxygen and carbon dioxide levels during exercise. ○ Expressed in units like ml/kg/min, indicating the volume of oxygen used per kilogram of body weight per minute. Significance of VO₂max: ○ An indicator of cardiovascular and aerobic fitness. ○ Declines with age, typically losing 5-10% every 10 years after age 40. MET (Metabolic Equivalent of Task): ○ 1 MET = 3.5 ml O₂/kg/min (the amount of energy used at rest). ○ MET values are used to estimate the energy cost of various physical activities. 6. Fuel Utilization During Exercise Types of Fuels: ○ Carbohydrates: Stored as muscle glycogen, liver glycogen, and plasma glucose. ○ Fats: Stored in muscle and adipose tissue; used more during prolonged and moderate-intensity exercise. ○ Proteins: Only a small contribution during exercise, mostly from whole-body proteins. Fuel Use Depends on Exercise Intensity: ○ Low-Intensity Exercise: Higher proportion of energy from fat oxidation. ○ High-Intensity Exercise: More energy from carbohydrate oxidation because it can generate ATP faster. ○ Respiratory Exchange Ratio (RER): Represents the ratio of carbon dioxide produced (VCO₂) to oxygen consumed (VO₂). Ranges from 0.7 (indicating predominant fat use) to 1.0 (indicating predominant carbohydrate use). Fat Oxidation: ○ The highest absolute rate of fat oxidation occurs at around 55% of maximal aerobic capacity, not at rest. ○ Fatmax: The exercise intensity where fat oxidation is highest. 7. Practical Applications for Exercise and Fat Burning To Burn Fat: ○ Exercise at a moderate intensity (50% VO₂max) for a prolonged duration (e.g., more than 2 hours) to maximize fat burning. ○ Consistency and frequency of exercise are key to increasing fat utilization over time. 2. Factors Influencing Physical Activity (PA) Participation Participation in physical activity can be influenced by multiple factors, which often fall within these categories: 1. Demographic Factors: Age, sex, income, and education level can significantly affect an individual's likelihood of participating in physical activity.  2. Personal Characteristics: Intrapersonal Factors: Personal motivations, self-efficacy, and attitudes toward physical activity. Interpersonal Factors: Influence of family, friends, and social networks. 3. Program/Policy Factors: The availability of supportive programs or policies in the community that encourage physical activity. 4. Environmental Factors: Accessibility of facilities, safety of neighborhoods, and available infrastructure for physical activity. 3. Behaviour Change Theory: The Transtheoretical Model (TTM) Also known as the Stages of Change model, the TTM helps to understand an individual's readiness and motivation for changing behavior, such as becoming more physically active (Prochaska, DiClemente, & Norcross, 1992). The model consists of five stages: 1. Precontemplation - Not Intending to Make Changes: ○ Characteristics: Not currently intending to change behavior. Lack of awareness or incomplete awareness of the benefits of physical activity. May feel demoralized, and the pros for not changing outweigh the cons. ○ Intervention Goals: Increase awareness of the importance of physical activity. Highlight the benefits to make the pros more appealing. Help individuals think about their habits and initiate conversations about change. ○ Focus: Encourage reflection on "why" they are not changing. 2. Contemplation - Considering a Change: ○ Characteristics: Intending to make a change within the next six months. May feel ambivalent about making changes. More open to consciousness-raising regarding physical activity. Self-confidence may be low. ○ Intervention Goals: Address ambivalence and increase the intention to take action. Highlight specific benefits and build self-efficacy. ○ Focus: Emphasize abilities and reassure them that "you can do it." 3. Preparation - Ready to Change in the Near Future: ○ Characteristics: Planning to take action within the next 30 days. May have already started modifying behavior or tried changing in the past year. ○ Intervention Goals: Develop a concrete plan and set a specific target date. Focus on the pros of changing and identify helpful resources. ○ Focus: Establish commitment and reinforce readiness to act.  4. Action - Actively Engaging in a New Behavior: ○ Characteristics: Have implemented changes within the last six months. Risk of relapse is high during this stage. Requires significant mental support. ○ Intervention Goals: Provide ongoing support to prevent relapse. Teach individuals how to manage lapses effectively. Encourage the involvement of social support. ○ Focus: Reinforce efforts with extrinsic rewards to maintain motivation. 5. Maintenance - Sustaining the Behavior Change: ○ Characteristics: Confidence in the new behavior is high. The maintenance phase lasts for six months or longer. Strategies for dealing with potential lapses are well-developed. ○ Intervention Goals: Continue support to ensure the individual maintains their behavior change. Prepare them for potential relapses and refine the activity program to add variety. ○ Focus: Transition from extrinsic to intrinsic rewards to foster long-term motivation. 4. Factors Affecting Participation in Physical Activity 1. Health Benefits: ○ Beliefs about health benefits are shaped by personal experiences, observation of others, and information from the media. ○ The value an individual places on these beliefs influences their intention to engage in physical activity. 2. Enjoyment/Pleasure: ○ Physical activity that is enjoyable has a higher likelihood of being maintained. ○ Enjoyment can be derived from the feeling of physical well-being, psychological benefits, achievement, and success. ○ Social Involvement: Engaging in activities with others often enhances enjoyment. Social support from friends and family is crucial for sustained participation. 3. Body and Self-Image: ○ Concerns about body image can motivate individuals to start or maintain physical activity. ○ Positive changes in body composition can reinforce continued participation. 4. Practical Considerations: ○ Environmental aspects such as accessibility to facilities, availability of equipment, and safe spaces for exercise are important. ○ Time and money can also significantly impact participation rates. 5. Barriers and Motivators for Behaviour Change  Barriers: Factors that prevent individuals from engaging in physical activity. These may include lack of time, resources, motivation, or social support. Motivators: Factors that encourage individuals to start or maintain physical activity, such as improved health, social interaction, enjoyment, and achieving personal goals. 2. Benefits of Physical Activity Physical Health Benefits: ○ Increased life expectancy. ○ Decreased risk of cardiovascular disease, stroke, certain cancers (breast, colon, prostate), type II diabetes, and osteoporosis. ○ Improved cardiac function and blood pressure. ○ Enhanced blood lipid profiles. ○ Better oxygen delivery to tissues. ○ Improved posture and body mechanics. ○ Lower risk of injury and lower back pain. ○ Faster recovery from illness and injury. Fitness Benefits: ○ Improved cardio-respiratory fitness, muscular strength, muscular endurance, flexibility, and body composition. Mental Health Benefits: ○ Stress relief and improved sleep. ○ Increased energy levels and mental resilience. ○ Enhanced self-image, quality of life, and cognitive function. ○ Decreased risk of Alzheimer's and Parkinson's disease. 3. Setting Goals for Physical Activity Goals should be SMART: ○ Specific, Measurable, Achievable, Relevant, Time-bound. ○ Examples of SMART vs. Poor Goals: Poor Goal: "I want to look like Thor." SMART Goal: "Lift weights 4 times per week." Poor Goal: "Run faster." SMART Goal: "Run a marathon in less than 2.5 hours." Goals should also be Focused: ○ Consider intrinsic versus extrinsic motivations. ○ Intrinsic Goals: Based on personal desire, self-motivation, and things under your control. ○ Extrinsic Goals: Dependent on external factors or the desire to meet others' expectations. 4. The FITT Principle for Exercise Prescription Frequency: How often should the individual exercise? Intensity: How intense or vigorous should the exercise be? Time: How long should each exercise session last? Type: What kind of exercise or modality should be done? 5. Key Principles of Exercise Prescription Specificity: ○ Training should be specific to the desired outcomes (e.g., cardio, strength, endurance). ○ The SAID Principle (Specific Adaptations to Imposed Demands) emphasizes that training should align with the specific adaptations desired. ○ Importance of specificity increases with higher fitness or performance levels, but maintaining a balanced approach with a variety of movement patterns is also crucial. Progressive Overload: ○ Overload: Imposing a stimulus greater than what the body is accustomed to. ○ Linked to adaptation: Improvements occur only if the stimulus exceeds habitual levels. ○ Overload is induced through: Adjustments to FITT components. Changes in training load and variation. ○ Progression: The need to gradually increase the stimulus to continue adaptations. If progression is not implemented, accommodation occurs, where the body becomes accustomed to the stimulus, leading to decreased adaptation. Training and Detraining: ○ Training Adaptations: Improvements in strength, power, and muscular endurance due to consistent training. ○ Detraining: Decrease in adaptations after stopping or reducing training. ○ Longer periods of detraining result in greater losses, requiring longer retraining periods to regain adaptations. ○ This concept is referred to as "Reversibility"—fitness gains are lost when training is reduced or stopped. Recovery: ○ Recovery is crucial for adaptations to occur. ○ Without appropriate rest, the risk of injury, overtraining, burnout, fatigue, and reduced performance increases. ○ Overtraining: Can occur due to too much volume, insufficient rest, or too much intensity. ○ Active Recovery: Recovery does not mean being sedentary. Instead, active rest involves reducing volume and intensity by 33-50% and performing light-intensity alternative activities. 6. Creating Physical Activity Programs: The 6-Step Process 1. Step 1: Explore Initial Expectations and Exercise Objectives: ○ Understand what the client wants to achieve and their expectations for exercise. 2. Step 2: Set Personalized and Realistic Goals:  ○ Establish goals that are achievable and relevant to the individual, using the SMART framework. 3. Step 3: Provide Feedback and Monitor Goals: ○ Regular feedback helps maintain motivation and ensures that the program stays aligned with the individual’s progress. 4. Step 4: Use Rewards and Incentives: ○ Rewards can be used to reinforce positive behavior and adherence to the exercise plan. 5. Step 5: Use Problem Solving to Overcome Obstacles: ○ Identify potential barriers to physical activity and develop strategies to overcome them. 6. Step 6: Promote Long-term Adherence: ○ Encourage habits that lead to sustained participation in physical activity beyond the initial intervention. 2. Review of Key Principles of Exercise Prescription Specificity / SAID Principle (Specific Adaptations to Imposed Demands): ○ Training should be specific to the desired adaptations or fitness goals. Progressive Overload: ○ To continue improving fitness, one must gradually increase the intensity, duration, or frequency of exercise. Training/Detraining: ○ Consistent training is needed to maintain adaptations; stopping leads to detraining or loss of fitness. Rest & Recovery: ○ Recovery is essential to allow the body to adapt and reduce the risk of overtraining. 3. Supercompensation Supercompensation refers to the body's adaptive response following exercise. ○ It is linked to acute training load, recovery, and the timing of the subsequent exercise stimulus. Concept: ○ After a workout, the body undergoes recovery and adapts to perform at a level above the previous baseline. This is the supercompensation phase. ○ To maximize training benefits, the next exercise stimulus should be timed to coincide with the peak of supercompensation. 4. Misconceptions About Training The phrase "No pain, no gain!" is a common fallacy. ○ Pain is a sign of a problem and not a benefit. ○ There is a clear difference between discomfort (which is expected during intense exercise) and pain (which signals injury). ○ The approach should be: “If in doubt, do less and take more rest” and “Train smarter, not harder”. 5. Components of a Complete Training Program 1. Warm-Up: ○ Importance: Increases body temperature and blood flow to muscles. Improves muscle pliability, reduces injury risk, and enhances mental preparation. ○ Characteristics of a Good Warm-Up: Should be dynamic and elevate core and muscle temperature. Typically lasts 10-20% of the planned workout time (e.g., 6-12 minutes for a 60-minute workout). Should be rhythmic and continuous, starting slow and progressively increasing in intensity. Static stretches after the warm-up should be less than 6 seconds, and the focus should be on dynamic flexibility and sport-specific movements. 2. Cool Down: ○ Importance: Helps reduce injury risk and allows for a gradual return to resting state. ○ Characteristics of a Good Cool Down: Should be gradual and mimic the warm-up in reverse order. Typically includes static stretching and lasts approximately 10% of the workout time. 3. Main Components of Training: ○ Aerobic: Improves cardiovascular fitness. ○ Resistance/Strength Training: Enhances muscle strength and endurance. ○ Flexibility: Improves the range of motion and reduces injury risk. ○ Balance: Often overlooked but crucial for overall fitness, especially in older adults. 6. ACSM Guidelines for Aerobic Exercise Frequency: ○ At least 3-5 times per week, including both moderate and vigorous intensity. ○ Less than 2 days may offer some health benefits but not significant improvements in cardiovascular fitness (CRF). Intensity: ○ Moderate to vigorous intensity is recommended. ○ Lower intensity can improve fitness only in unfit individuals and is helpful for building exercise tolerance. Time: ○ 30-60 minutes per day for a total of 150 minutes per week of moderate to vigorous exercise. ○ Can be accumulated in 10-minute bouts. Type:  ○ Should involve major muscle groups and be rhythmic (e.g., cycling, jogging). Volume: ○ Gradually increase step count by 2000 steps per day until reaching a minimum of 7000 steps. ○ This volume can be achieved in one continuous session or broken into multiple 10-minute bouts. 7. Threshold for Increasing Aerobic Fitness The threshold refers to the minimum level of exercise intensity required to elicit improvements in aerobic fitness. Intensity Levels Based on Initial Fitness: ○ Poor-Fair: Light-to-moderate intensity, 20-40% Heart Rate Reserve (HRR), or 35-55% HRmax. ○ Good: Moderate intensity, 40-60% HRR, or 55-70% HRmax. ○ Very Good: Moderate-to-vigorous intensity, 60-80% HRR, or 70-85% HRmax. ○ Excellent: Vigorous intensity, 60-90% HRR, or 70-95% HRmax. 8. Sample Aerobic Progression Program Start-Up Stage (Weeks 1-4): ○ Frequency: 3 sessions per week. ○ Intensity: 40-60% HRR. ○ Duration: Gradually increase from 10-25 minutes. Improvement Stage (Weeks 5-20): ○ Frequency: Increase to 3-5 sessions per week. ○ Intensity: 60-85% HRR. ○ Duration: Gradually increase to 35-40 minutes per session. Maintenance Stage (After Week 24): ○ Maintain frequency of 3-5 sessions per week. ○ Intensity remains at 70-85% HRR. ○ Duration: 30-60 minutes per session. 9. High-Intensity Interval Training (HIIT) Definition: ○ Involves periods of increased intensity alternating with lower-intensity recovery. Structure: ○ Bouts of 15 seconds to 4 minutes. ○ Can be structured or unstructured. Benefits: ○ Improves VO₂max and shifts the anaerobic threshold. ○ Can be more effective for improving aerobic fitness compared to continuous moderate exercise. 2. High-Intensity Interval Training (HIIT)  Definition: HIIT involves continuous exercise broken up by periods of increased intensity. ○ It can be structured (e.g., planned durations of high and low intensity) or unstructured. ○ Bouts usually last from 15 seconds to 4 minutes. Types of HIIT: ○ Sprint Approaches: Typically 4-6 bouts of 30 seconds or less of "all-out" sprinting. Each sprint is followed by a 4-minute recovery. Total high-intensity time is approximately 2-3 minutes. The entire workout is about 20 minutes. ○ Longer Duration Approaches: The 4X4 Approach involves 4 bouts of 4 minutes at high intensity (85-95% HRmax). Each bout is followed by 3 minutes of rest. Total high-intensity time is 16 minutes; total workout time is about 25 minutes. Benefits of HIIT: ○ Enjoyment and the intensity achieved. ○ Health and fitness outcomes, such as increased cardiorespiratory fitness (CRF) and improved anaerobic thresholds. ○ It is well-tolerated by many individuals and is time efficient. Negatives of HIIT: ○ Increased adverse event risk. ○ High perceived intensity and difficulty may discourage some participants. ○ HIIT is more labor-intensive due to the need for intensity monitoring and precise timing. 3. Components of a Training Program A complete training program includes the following components: 1. Warm-Up: Prepares the body for exercise by increasing temperature and blood flow to the muscles. 2. Aerobic Exercise: Activities that increase heart rate and improve cardiovascular fitness. 3. Resistance/Strength Training: Exercises aimed at improving muscular strength and endurance. 4. Flexibility: Stretching exercises to enhance the range of motion. 5. Cool-Down: Gradually returns the body to resting state and prevents injury. 4. ACSM Guidelines for Resistance Training Frequency: Each major muscle group should be worked 2-3 times per week. Intensity: ○ 60-70% 1RM for novice and intermediate exercisers. ○ >80% 1RM for advanced strength trainers. ○ 40-50% 1RM for elderly or previously sedentary individuals.  Type: Exercises should target major muscle groups and can include a variety of equipment, including body weight, isometric, and isotonic exercises. Volume (Sets/Reps): ○ 8-20 reps, depending on training goals and fitness level. ○ 2-4 sets; ≤2 sets for novice or elderly individuals. ○ Rest Periods: 1-3 minutes between sets; at least 48 hours between training the same muscle group. 5. Determining Resistance Intensity: One Repetition Maximum (1RM) 1RM Calculation: ○ 1RM represents the maximum weight a person can lift for one repetition of a given exercise. ○ To determine 1RM: Use the formula: 1RM = \text{Weight Lifted} / (\text{%1RM value from table} / 100). Example Calculation: If a person completes 7 reps at 30 lbs, and 83% of 1RM corresponds to 7 reps, then: 1RM=30/(83/100)=36.11RM=30/(83/100)=36.1 lbs. 6. Strength Training Summary Table Training Status and Intensity Guidelines: ○ Novice: Strength: 60-70% 1RM, 1-3 sets, 8-12 reps, 1-3 min rest. Hypertrophy: 65-80% 1RM, 1-3 sets, 8-12 reps, 30 sec - 1.5 min rest. Muscular Endurance (M.E.): ≤65% 1RM, 1-3 sets, 10-15 reps, 30 sec - 1 min rest. ○ Intermediate: Strength: 70-80% 1RM, 2-3 sets, 6-12 reps, 2-5 min rest. Hypertrophy: 65-85% 1RM, ≥3 sets, 6-12 reps, 30 sec - 1.5 min rest. M.E.: ≤70% 1RM, ≥3 sets, 10-15 reps, 30 sec - 1 min rest. Power: 30-60% 1RM, 1-3 sets, 3-6 reps, 2-5 min rest. ○ Advanced: Strength: 80-100% 1RM, 2-6 sets, 1-12 reps, 2-5 min rest. Hypertrophy: 65-85% 1RM, ≥3 sets, 6-12 reps, 30 sec - 1.5 min rest. M.E.: ≤75% 1RM, ≥3 sets, 10-25 reps, 30 sec - 1 min rest. Power: 30-70% 1RM, 3-6 sets, 1-6 reps, 2-5 min rest. 7. Progression in Resistance Training: Load Increases Guidelines for Increasing Load: ○ Novice Exercisers: Upper Body: Compound Exercises: Increase weight by 2.5-5 lbs or 2.5% of 1RM.  Isolation Exercises: Increase weight by 1.25-2.5 lbs or 1-2% of 1RM. Lower Body: Compound Exercises: Increase weight by 10-15 lbs or 5% of 1RM. Isolation Exercises: Increase weight by 5-10 lbs or 2.5-5% of 1RM. ○ Intermediate/Advanced: Upper Body: Increase weight by 5-10 lbs or 2.5-5% of 1RM. Lower Body: Compound Exercises: Increase weight by 15-20 lbs or 5-10% of 1RM. Isolation Exercises: Increase weight by 10-15 lbs or 5-10% of 1RM. 8. Exercise Order Considerations When planning a strength training routine, consider: ○ Fatigue-inducing potential: Begin with exercises that are more demanding. ○ Whole Body vs. Split Routine: Choose between full-body workouts or splitting muscle groups across sessions. ○ Fundamental (Compound) vs. Isolation Exercises: Start with compound movements before moving to isolation exercises. ○ Agonist/Antagonist Balance: Maintain balance between opposing muscle groups. ○ Consider the experience and fitness level of the individual. 9. Timing of Aerobic vs. Resistance Training Aerobic First: ○ Pros: Increased energy expenditure and perceived energy during aerobic work. ○ Cons: May deplete energy stores needed for resistance exercise and reduce motivation. Resistance First: ○ Pros: Ensures full availability of energy for resistance exercises. ○ Cons: Muscle soreness and stiffness may reduce effectiveness of subsequent aerobic activity. 2. Applied Kinesiology and Exercise Physiology Key Areas of Application: ○ Health: Focus on managing chronic disease, improving function, and enhancing quality of life. ○ Performance: Applied to sports, occupational settings, and recreational activities to improve physical performance. 3. What Makes a Good Fitness Test? A good test should meet the following criteria: 1. Validity: The test must measure what it is supposed to measure. Should be compared against an established gold standard. 2. Reliability: Should produce consistent results across multiple trials (test-retest reliability). Inter- and intra-rater reliability are important for consistency when different assessors are involved. 3. Sport/Movement Specific: The test should be relevant to the specific sport or movement being assessed. 4. Practicality: Should be feasible to conduct in controlled settings. Needs to be repeatable at regular, predetermined intervals. Must allow for proper interpretation of results. 4. Importance of Athlete Assessment Why Assess Physical Fitness in Athletes?: ○ Work Rate: Understanding an athlete's ability to sustain high work rates. ○ Concentration: Assessing how physical fitness can affect an athlete's mental focus. ○ Technical Performance: Evaluating how physical conditioning impacts skills. ○ Tactical Judgment: How fitness influences decision-making during competition. ○ Susceptibility to Injury: Assessing risk factors for injury and implementing preventive measures. Using Assessment Results: ○ Establish Norms: Helps in selecting athletes by comparing their performance to established norms. ○ Baseline Data: Provides a reference point to track training progress. ○ Monitor Effectiveness: Determines how effective training programs are in improving performance. ○ Motivate Athletes: Used to motivate athletes by providing clear evidence of their progress. Pre-Testing Considerations: ○ Identify which fitness components are important for the specific sport. ○ Integrate the knowledge and experience of coaches. ○ Use scientific analysis to develop testing strategies. 5. Technology in Exercise Science Examples of wearable technologies used for assessment: ○ Triaxial Accelerometers/Pedometers: Track movement in three dimensions. ○ Heart Rate Monitors: Measure cardiovascular responses during exercise.  ○ Fitness Trackers/Smartwatches: Monitor various physiological metrics, such as heart rate, respiration, and sleep patterns. ○ GPS: Track movement, speed, and location. ○ eTextiles: Incorporate sensors into clothing for physiological monitoring. 6. Types of Physiological Assessment Lab-Based vs. Field-Based Assessments: ○ Lab-Based: Conducted in controlled environments, minimizing external factors. Often more expensive but highly precise. ○ Field-Based: Conducted in more realistic environments, often at a lower cost. Useful for larger groups of athletes and may better mimic real competition scenarios. Direct vs. Indirect Assessments: ○ Direct Assessments: Use advanced technology/instrumentation to measure performance. ○ Indirect Assessments: Rely on estimation methods and are often less costly. ○ Consider factors such as cost, training/skill of the assessor, and the availability of equipment. 7. Examples of Athlete Assessment Tools Team Tracking and Video Analysis: ○ Tools like video analysis and team tracking systems (e.g., using GPS) are employed to track performance metrics and assess tactical decisions. Virtual Reality in Athlete Assessment: ○ STRIVR is an example of immersive performance training. ○ Developed at Stanford University, it is used by elite teams in the NFL, NHL, and NCAA. ○ Advantages include enhanced mental preparation, visualization, and the ability to practice without physical demands or injury risks. 8. Constructing an Athlete Assessment Battery Choosing the Right Tests: ○ Consider the sport's characteristics and which fitness components are crucial for performance. ○ Use a mix of laboratory tests, laboratory-like tests, and field tests. ○ Recognize practical limitations such as equipment availability, number of athletes, and cost. Practical Limitations: ○ Equipment and Facilities: Availability and access may limit the types of tests that can be used. ○ Support Personnel: Number and expertise of those administering the tests. ○ Level of Competition: Assessments may need to be adjusted based on the competitive level of the athletes.  ○ Cost and Frequency of Testing: Testing needs to be cost-effective and scheduled appropriately. 9. Example: Testing Protocol for Soccer Players Sport Characteristics: ○ Involves specific actions like headers, changes in direction, sprints, and long-distance running. ○ A typical soccer match includes 100-200 high-intensity sprints and total distances of 10-12 km traveled. Matched Testable Skills: ○ Jump Ability: Measured using the Vertical Jump Test. ○ Agility: Measured using the T-Test. ○ Linear Sprint: Assessed through timed sprints. ○ Repeated Sprint Ability: Tests designed to measure the ability to perform multiple sprints with minimal rest. ○ Aerobic Fitness: Estimated using a VO₂max test. 10. Interpreting and Providing Feedback on Results Results should be: ○ Easy to Understand: Presented in a way that athletes and coaches can interpret easily. ○ Objectively Measured: Results should be based on evidence-informed interpretations using comparative data. ○ Feedback Process: Should help athletes understand their strengths and areas needing improvement. 11. NHL Entry-Draft Combine Example Top 110 Players are invited for evaluations, which include: ○ Medical Evaluations: Medical History, orthopedic exam, physical exam, cardiac assessment. ○ Physical Evaluations: Body Composition: Height, weight, wingspan, skinfold measurements. Muscular Fitness: Tests include grip strength, push-pull exercises, sit and reach, push-ups, curl-ups, vertical jump, bench press, and others. Anaerobic Fitness: Evaluated using the Wingate Test. Aerobic Fitness: Assessed via a VO₂max test. ○ Interview: Includes a personal interview to assess various aspects of the athlete beyond physical capabilities. 2. What is a Bona Fide Occupational Requirement (BFOR)? Definition:  ○ A BFOR is a qualification or requirement that is essential for carrying out a specific job, particularly in physically demanding occupations. ○ BFORs may include specific fitness standards that must be met to ensure that the employee can safely and effectively perform the duties of their job. Key Considerations for BFORs: ○ Applicable to any physically demanding occupations where failure to perform the job effectively could result in the loss of life or property. ○ Employers must demonstrate that the fitness standards are necessary for the job's purpose and that it would be impossible to accommodate the worker without undue hardship. 3. The Meiorin Decision (1999, Supreme Court of Canada) Case Overview: ○ Tawney Meiorin was dismissed from her firefighter job for failing a minimum fitness standard (a running test). ○ Ms. Meiorin argued that the aerobic standard discriminated against women under the Bri