Midterm Notes - KINE 1020

KINE 1020 ___________________________________________________________________ MIDTERM NOTES WHAT IS HEALTH? SUSRUTA (600 BCE) ● From India ● First doctor to prescribe daily exercise as medicine for his patients ● Main idea is to not over exert yourself HIPPOCRATES (460-370 BC) ● Nutrition and exerci...

KINE 1020 ___________________________________________________________________ MIDTERM NOTES WHAT IS HEALTH? SUSRUTA (600 BCE) ● From India ● First doctor to prescribe daily exercise as medicine for his patients ● Main idea is to not over exert yourself HIPPOCRATES (460-370 BC) ● Nutrition and exercise to maintain health and fitness ● Physical activity and nutrition to prevent disease ARISTOTLE (350 BC) ● Father of kinesiology ● All things are interconnected; there is no one answer for health ● Cause and effect EDWARD STANLEY (1873) ● If you cannot prioritise your health, you will be taking time for illness LIFESTYLE FACTORS IN HEALTH (COMPLEX RELATIONS) ● People that exercise regularly tend to eat healthier ● People who smoke are less likely to engage in physical activity during leisure ● People who increase their physical activity do not generally stop smoking (except those interested in being highly trained) ● No clear relationship between physical activity and alcohol consumption ● People who exercise regularly tend to be leaner and have less chronic diseases, disease might limit the ability the move so proving that exercise prevents disease is a challenge ● The link between physical activity levels and obesity is complex, it is possible to be fat and fit HISTORY OF ‘FIRSTS’ IN EXERCISE PHYSIOLOGY Luigi Galvani (1737) (Italian Physician) ● discovers electricity stimulates muscle contraction Carl Ludwig (1847) (German physician and physiologist) ● measures human blood pressure Augustus De'sire Waller (1887) (British physiologist) ● records the electrical activity of the human heart (EKG) Archibald V. Hill (1920) (British physiologist) ● describes maximal oxygen uptake (VO2 max) Andrew F. Huxley (1957) (British physiologist) ● theorizes about muscle cross-bridges in contraction PHYSICAL FITNESS ● Body Consumption (Fitness & Health) ● Musculoskeletal Fitness ● Cardiorespiratory FItness ● Flexibility **Could be physically fit but not healthy (eg. steroids)** PHYSICAL FITNESS The ability to perform muscular work satisfactorily. It is determined by the level of several attributes which are influenced by activity such as cardiovascular-respiratory endurance, muscular strength, muscular endurance, flexibility and body composition. HEALTH RELATED FITNESS ● Components of fitness that allow you to do activities of daily living PERFORMANCE RELATED FITNESS ● Components of fitness that enable optimal work/sport performance THE HEALTH CONTINUUM ● Health is a spectrum; very hard to measure ● Strive to achieve optimum health, fitness, and wellness Health Promotion ● Vaccines ● Hand washing ● Exercise classes WELLNESS ● The act of practising healthy habits on a daily basis to attain better physical and mental health, to thrive ● Physical, mental, and social wellbeing ● Health is the BEING ● Wellness is the DOING WHAT IS BEING HEALTHY? ● A connection between BODY, MIND, and SPIRIT ● World Health Organization describes health as: a state of complete physical, mental, and social well-being, not merely the absence of disease ● The WHO does not imply that good healthcare is not always available everywhere LIFE EXPECTANCY ● Health-adjusted life expectancy (HALE): number of years in full health that a person can expected to live given current morbidity and mortality conditions, it uses the Health utility index (HUI) to weigh years lived in good health than years lived in poor health INTRODUCTION TO FITNESS AND HEALTH THE CANADIAN HEALTH CARE CONCEPT (1974 Lalonde Report) ● Lalonde Framework is the model for what health is: ○ Human Biology ○ Health Care Organization ○ Environment ○ Lifestyle LIFE EXPECTANCY AND WEALTH ● Life expectancy can be determined by wealth ● GDP (gross domestic product) ● There is an unequal distribution of health in poorer countries ● Environment will impact health: ○ Air Pollution ○ Inadequate Water/Sanitation ○ Chemicals ○ Radiation ○ Community Noise ○ Occupational Risks ○ Agricultural Practices ○ Built Environments ○ Climate Change ● Within a country wealth still matters ● Population density ● Lifestyle and access to greenspace WHO: MAIN DETERMINANTS OF HEALTH ● Physical Determinants of Health: ○ Nutrition ○ Lifestyle ○ Environment ○ Genetics ○ Medical Care ● Social Determinants of Health: ○ Education ○ Healthcare ○ Economic Stability ○ Social and Community Context ○ Neighbourhood and Built Environment UNIVERSAL HEALTH CARE (PUBLIC) ● All have access to healthcare system in Canada ● Publicly funded through taxes PRIVATE HEALTH CARE ● Prescriptions and some therapies (dentistry, chiropractor) are not covered under healthcare LEVELS OF CARE ● Primary care ○ Family doctor ○ Dentist ○ pharmacist ● Secondary care ○ Hospital clinic ○ Specialist doctor ● Tertiary care ○ Hospital ○ National specialist services (SickKids) OHIP (ONTARIO HEALTH INSURANCE PLAN) ● Primary residence in Ontario, Canada ● Must be physically present in Ontario for 153 days in any 12 month period TIME MANAGEMENT TIME MANAGEMENT IS: ● Setting goals that work for you ● Creating a workable plan to get there ● Dealing with reality ● Playing to your strengths ● Finding balance and energy ● Decreasing anxiety and stress TIME MANAGEMENT IS NOT: ● Scheduling and micromanaging ● Filing every second with productivity ● Trying to become someone your not ● Increasing anxiety and stress Time Management: The skill of making smart decisions about how to allocate your TIME and ENERGY to GOALS you value and have clearly identified for yourself GET TO KNOW YOUR BODY & WORK WITH IT ● Schedule your more focused work during time of day you focus best ● Sleep is essential for academic success ○ Can’t think clearly with insufficient sleep ○ Studying for 1 hour well rested is better than 3 hours with tired brain ALIGNING TIME SPENT WITH PERSONAL GOALS ● How time spent is in relation to priorities ○ Any areas that are neglected/taking more time CREATE STRUCTURE & ROUTINE ● Structure day and week ○ Doing the same thing everyday/sequentially ● Build daily routine MENTAL HEALTH BIOLOGICAL FACTORS -GENETIC ● Eg: Schizophrenia PSYCHOLOGICAL FACTORS -PERSONALITY ● Eg: PTSD SOCIAL ENVIRONMENTAL FACTORS -CULTURAL INFLUENCE ● Eg: television → eating disorders COPING ● Stress checklist ● Relaxation ● Support ● Overcoming stigma HEALTH PROMOTION ADVANTAGES OF PUBLIC VS PRIVATE HEALTH CARE Full Private Pros ● ● ● ● ● Cons ● ● ● ● ● ● Full Public Faster Care More Options for Procedures Can choose doctor Better doctor-patient ratios More privacy ● Inequality Not all will get health care Refuse to treat complex cases (to increase profit) Even with insurance, care may not be covered 100% More Expensive Profit may undermine patient interests (order more tests than needed for profit) ● ● ● ● Everyone can get the SAME healthcare Care is more affordable (non-profit) Longer Wait Times Fewer Choices Higher patient loads for healthcare workers ADVOCATE ● Political, economic, social, cultural, environmental, behavioural and biological factors can all favour health or be harmful to it ● Making these conditions favourable ENABLE ● Achieving equity in health ● Supportive environment, access to information, life skills and opportunities for making healthy choices. MEDIATE ● Health in Canada cannot be ensured by the health sector alone ● Professional and social groups and health personnel have a major responsibility to mediate between differing interests in society for the pursuit of health THE TRADITIONAL CANADIAN MEDICAL MODEL PRIDES ITSELF ON EVIDENCE-BASED MEDICINE Evidence-based medicine (EBM): is the integration of best research evidence with clinical expertise and patient values. ● The practice of EBM means integrating individual clinical expertise with the best available external clinical evidence from systematic research ● “Evidence based practice (EBP) is the conscientious use of current best evidence in making decisions about patient care.” –Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000 ○ It includes the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimum clinical care to patients ● Used to determine the “strength” or “weight” of the scientific evidence for a type of care (medicinal and non medicinal) ○ It focuses more on clinically effectiveness (efficacy) ○ But not so much on cost effectiveness ● ● ● EBM is the use of current “best evidence” in making decisions about the care of individual patients Evidence comes from peer reviewed original published manuscripts/journals Meta Analyses -statistics EVIDENCE BASED RECOMMENDATIONS ● Based on “quality of evidence” and thus study design ○ Level I: Evidence obtained from at least one properly designed RANDOMISED CONTROL TRIAL and Meta-analysis. ○ ○ Level II: Evidence obtained from well designed controlled trials but without RANDOMIZATION or well-designed COHORT or CASE-CONTROL studies and meta-analysis. Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees. OBSERVATIONAL STUDY Retrospective Prospective LIMITATIONS OF EVIDENCE-BASED MEDICINE ● Randomised trials are not always ethical/applicable ● Does not replace the doctor-patient relationship ● Does not account for individual genetic/environmental differences ● Doctor recommendations and insurance coverage may differ STUDENT COUNSELLING, HEALTH & WELL-BEING WALK-IN COUNSELLING Purpose ● Walk-in counselling is intended to provide students timely access to a qualified counselling professional in a safe and positive space Process In-Person ● ● ● Student arrives in-person at SCHW’s office. Reception creates the client account and books the session for the student Reception sends the forms to the student for completion Student meets with a counsellor for approximately 50 minutes. During this time, determine a goal for the session and collaborate on concrete, tangible next steps Virtual ● ● ● Students arrive at SCHW’s website. Student creates the client account and books a same-day virtual session Reception sends the forms to the student for completion Student meets with a counsellor for approximately 50 minutes. During this time, determine a goal for the session and collaborate on concrete, tangible next steps COMPLEMENTARY/ALTERNATIVE MEDICINE (CAM) COMPLEMENTARY & ALTERNATIVE MEDICINE ● Group of diverse medical and health care systems, practices, and products; not considered part of conventional medicine ● Research conducted in 2016 states 80% of Canadians use a form of CAM in lifetime ● Usage on the rise CAM ● In 2016, massage was most common type ○ Chiropractic care ○ Yoga ○ Relaxation techniques ○ Acupuncture ○ Osteopathy ○ naturopathy ● Majority of Canadians that use complementary and alternative therapies continued to do so for “wellness”, prevent future illness and maintain health TYPES OF CAM Natural products ● Dietary supplements, are nonvitamin, nonmineral, probiotics, herbal and botanical “medicines” Mind and body medicine ● Yoga ● Meditation Manipulative and body-based practices ● Chiropractic’s ● Acupuncture WHATS THE DIFF? Food ● Any article manufactured, sold or represented for use as a food or drink for human beings ● Includes chewing gum Drug ● Includes any substance or mixture of substances manufactured, sold, or represented for use in: ○ Diagnosis, treatment, mitigation, or prevention of a disease, disorder, or abnormal physical state, or its symptoms, in human beings/animals ○ Restoring, correcting, or modifying organic functions in human beings or animals ○ Disinfection in premises in which food is manufactured, prepared or kept Natural Health Product (NHP) ● Naturally occuring substances used to restore/maintain good health CASE STUDY: OSCILLOCOCCINUM ● HOMOEOPATHIC MEDICINE ● Approved in Canada ● Treatment for colds and the flu ● Active ingredients contain a barbary ducks liver and heart ● Very little science behind the drug Preparation of Oscillococcinum ● Decapitate duck ● Remove 35g of heart and 15g liver ● Mix with pancreatic juice and glucose ● Allow to ferment for 40 days ● Dilute ● Homoeopathy based on the active ingredient, dilute it with water to help fix How Dilute? ● Ratio 200C:100200 duck:water ● Final dilution is dripped on tablets of lactose and sucrose ● Volume of tablets need to be greater than mass of entire universe would need to be consumed ● There is a chance that there is no duck heart/liver in final product ● Health Canada approved product as “safe and effective” for recommended use ○ Relieve flu symptoms: fever, chills, body aches, headaches HEALTH CANADA’S EVIDENCE FOR NATURAL HEALTH PRODUCTS: GUIDANCE DOCUMENT EVOLUTION ● Homoeopathic products must include evidence to support the “safety, efficacy, and quality” ● Health canada accepts levels of evidence, from clinical trials to “traditional use” Old Standard ● Homoeopathic manufacturers can use materia medica (anecdotal information) ● With herbal remedies traditional use claims are accepted ○ If product has been in use for specific condition for over 50 years it is deemed “effective” for that purpose ● If no documentation, assurance from 3 people is acceptable DIN (Drug Product) ● Most prescription/OTC products ● Meets more stringent drug regulations NPN (Natural Health Product, not Homoeopathy) ● Grab bag of products ● Efficacy claims can be based on essentially anecdotes DIN-HM (Homoeopathy) ● Likely no medicinal ingredients at all ● No credible evidence of efficacy EN ● Registered but not fully assessed for safety, efficacy, and quality CASE STUDY: HORNY GOAT WEED ● Leaf of the plant Epimedium Sagittatum ● Approved by Health Canada’s Natural Health Product Directorate ○ Used to tonify kidney ○ Fortify the yang ● Help symptoms: ○ Frequent urination ○ Forgetfulness ○ Withdrawal ○ Painful cold lower back and knees ● Only 17 papers published as of 2021 ● Not credible/reliable source ARE THERE RISKS TO USING NATURAL HEALTH PRODUCTS ● Manufacturing problems (contamination, incorrect ingredients or dosage) ● Unproven claims, can lead people to use the wrong products for serious conditions/delay proper treatment ● Not enough information to make an informed choice (like incorrect instructions/no warnings that a product may not be suitable for certain groups) ● Interaction with prescription drugs/other natural health products ● Unwanted side effects, like allergic reactions COMMON HEALTH FOODS/PRODUCTS Garlic (Level III evidence) ● half to one clove (or equivalent) daily has a cholesterol-lowering effect of up to 9%. • Aged Garlic Extract (Level III evidence) ● 7.2 g has anticlotting (in-vivo studies), as well as modest reductions in blood pressure effects (an approximate 5.5% decrease in systolic blood pressure). Ginseng ● four studies suggesting a benefit on glycaemia if consumed chronically. None for improving circulation. Ginger (Level II evidence) ● ameliorating arthritic knee pain; however less effective than ibuprofen. Chamomile ● has moderate antioxidant and antimicrobial activities, and significant antiplatelet activity in vitro. ○ Anti Inflammation, antimutagenic and cholesterol-lowering activities from animal studies. ○ Human studies are limited, and clinical trials examining the purported sedative properties of chamomile tea are absent Ginkgo ● is of questionable use for memory loss and tinnitus, but has some effect on dementia and intermittent claudication (pain/cramping in legs). St. John's wort ● is efficacious for mild to moderate depression, but serious concerns exist about its interactions with several conventional drugs. Echinacea ● may be helpful in the treatment or prevention of upper respiratory tract infections, but trial data are not fully convincing. Kava ● efficacious short-term treatment for anxiety. None of these herbal medicines is free of adverse effects. Because the evidence is incomplete, risk–benefit assessments are not completely reliable, and much knowledge is still lacking. OTHER CONCERNS ● Many products imported from other countries may not have all the ingredients listed Some may also be contaminated with other compounds (drugs, nickel, lead, arsenic…who knows) ● To get reliable information about a particular supplement: ○ Ask your doctor or pharmacist. ○ Look for scientific research findings. Two good sources include the National Center for Complementary and Alternative Medicine (NCCAM) and the Office of Dietary Supplements. ○ Contact the manufacturer. If you have questions about a specific product, call the manufacturer or distributor. Ask to talk with someone who can answer questions such as what data the company has to substantiate its products' claims. CAM CAN HEALTH -MANY PHARMACEUTICALS ARE DERIVED FROM NATURAL SUBSTANCES ● Eg: aspirin made from tree bark ● Some compounds found from environment ● Eg: antibiotics STRESS MOTIVATION & LOCUS OF CONTROL Motivation ● Triggered by internal and external factors ● Comes from within (intrinsic- you must care) ● Comes from outside (extrinsic- you feel accountable) Locus of control ● Internal ● External ● Continuum LOCUS OF CONTROL A High Internal Locus of Control ● Related to higher academic achievement ● Self-motivated ● Higher self esteem, less likely to fall for peer pressure ● Internals earn better grades and work harder ○ People believe working hard will pay off The Disadvantages of an Internal Locus of Control ● Can sometimes be psychologically unhealthy/unstable ● More likely to ti be arrogant that can strain relationships ● Poor risk management ● Inability to accept failure ● Needs to be matched by competence, self-efficacy and opportunity ● Neurotic, anxious, and depressed ● Need to have realistic sense of circle and influence in order to experience success External Locus of Control ● Success due to luck, failure is decided by fate ● Less likely to set goals and more likely to be underachievers ● Place blame on external factors ● Less likely to be stressed in short-term by negative events, long term can lead to anxiety and hopelessness ● Good follower, less conflict WHAT IS STRESS? ● Negative stress (distress) ● Positive stress (eustress) STRESS AXIS ● Activates the hypothalamic-pituitary adrenal (HPA) axis to eventually produce cortisol (stress hormone) WHEN IS HPA NORMALLY ACTIVATED? ● During times of stress ● Every morning when you wake up ● Wunder under stress ● Curing intensive exercise ACUTE STRESS: FIGHT OR FLIGHT ● More alert ● ● ● ● Increased heart rate, breathing, blood pressure Blood directs to muscles and away from digestion, skin and brain Increased circulating glucose Increased stress hormones CHRONIC STRESS: CUSHING’S SYNDROME ● Muscle weakness ● Skin ulcers ● Osteoporosis ● Obesity ● Diabetes Affected Area Acute Chronic Brain ➔ More alert ➔ Decreased blood flow ➔ ➔ ➔ ➔ Cardiovascular ➔ Increased Heart rate and blood pressure ➔ Blood directs to muscles ➔ Hypertension Stomach ➔ Blood directed and away from digestion ➔ Upset stomach and ulcers Skin ➔ Blood directed and away from skin ➔ Eczema and psoriasis Endocrine ➔ Increased circulating glucose ➔ Decrease appetite ➔ Diabetes ➔ Increased appetite and fat storage Other Headaches Anxiety Disrupted sleep Poorer cognition and learning ➔ Decreased immune function ➔ Reproductive problems NO STRESS: ADDISON’S DISEASE ● No stress hormones ● Muscle weakness and fatigue ● Weight loss/decreased appetite ● Low blood pressure/fainting ● Low blood sugar (hypoglycemia) ● Nausea, diarrhoea/vomiting ● Irritability ● Depression STRESS & PERSONALITY ● Have some control over reaction to stress ● Learn to relax and reverse the body’s hormonal response to stress ● Learn to cope with stress (problem solve/acceptance) with healthy mechanisms Is Stress Hazardous For Your Weight? ● Mice with stress and high-sugar-fat diet got obesity and more abdominal fat ● Only combination of stress and a poor diet together caused obesity ● Stress and good diet is okay ● No stress and junk food is also okay Stress Relaxation Skills ● Breathing exercises (lab 2) ● Progressive relaxation therapy ● Imagery (replace bad thoughts with good ones) ● Physical exercise INTRODUCTION TO NUTRITION FOOD PROVIDES NUTRIENTS ● 45 nutrients are ESSENTIAL to human life and must be supplied by diet ● Others are NON ESSENTIAL ○ Phytochemicals ○ Antioxidants ● 6 main classes of nutrients ○ Carbohydrates ○ Fats ○ Proteins ○ Water ○ Vitamins ○ Minerals Macronutrients ● Energy-yielding nutrients ● PROTEINS, CARBOHYDRATES, FATS ● ALCOHOL (provides energy) (provides 7 calorie per gram) ● WATER (doesn’t provide energy) ENERGY NEEDS IN HUMANS ● Relate to BODY WEIGHT, AGE, SEX ● Energy (calorie) needs increase with age and peak at 18-25 years of age, then decline ● Energy needs are higher with greater body weight and physical activity levels ● Males have higher energy need than females (lean mass, big bodies) ● Pregnancy during second/third trimester increase energy needs by about 250 kcal per day ● Breastfeeding can increase energy needs by 550-650 kcal CALCULATING ENERGY NEEDS ● “Energy out” TEE (total energy expenditure) = BMR (basal metabolic rate) x PAL (physical activity levels) ● TEE = BMR x PAL ● Need to know WEIGHT, HEIGHT, AGE ● Basal metabolic rate is lowest amount of energy body needs to survive MACRONUTRIENTS Dietary Carbohydrates ● 4 kcal/g ● Provide energy Simple Carbohydrates (simple sugars) ● MONOSACCHARIDES: glucose, fructose, galactose ● DISACCHARIDES: maltose, sucrose, lactose Complex Carbohydrates ● POLYSACCHARIDES: glycogen and starch ● Storage forms of glucose ● Found in human muscle, and in grains, tubers and legumes ● The grain: ○ Endosperm = starch only = more refined (‘white flour’) ○ Whole grain = Endosperm + Germ + Bran = nutritious! ● Other polysaccharides = fibre (‘non-starch polysaccharides’) ○ Mostly undigested DIETARY FIBRE ● Non-starch polysaccharide/complex CHO Soluble Fibre ● Viscous (form gels), fermentable ○ Psyllium, beta-glucan, apples, legumes ○ Lowers Gl, decrease cholesterol, feeds gut bacteria (prebiotic) ○ Gel traps cholesterol, and helps excrete Insoluble FIbre ● Non-viscous, bulking ○ Wheat, bran, cellulose ○ Increases faecal bulk, relieves constipation (promote regularity), may prevent colon cancer Functional Fibres ● Fibres added to foods ● Purified and processed ○ Meta-mucil, benefiber GLYCEMIC INDEX ● Carbohydrate classification tool ● Assess how a standard amount (50g) of different CHO foods affects blood glucose response after eating them, compared to reference (50g glucose/white bread) ● Useful for those with diabetes SUGARS ● Health Canada’s “Nutrients to limit” ○ Maximum 100g total sugars/day ○ Natural and added ● WHO and FDA recommends: ○ Free sugars <10% of the total calories/day ○ Added sugar <5% of the total calories/day ○ ○ ○ Maximum ~50g/day free sugar 200 kcals = 10% daily E of a 2000 kcal diet Main sources of free sugars: sugar-sweetened beverages, baked goods and sweets MACRONUTRIENTS Dietary Fat ● 9 kcal/g ● Provide energy ● Fatty acids = basic form ● Stored as TRIGLYCERIDES ● Different degrees of saturation ○ SATURATED ○ MONOUNSATURATED ○ POLYUNSATURATED ESSENTIAL FATTY ACIDS - PUFA ● ESSENTIAL: must be provided by endogenously because they cannot be synthesised in the body yet are necessary for health ● Balance between the two (need both) Linoleic Acid (Omega-6) ● LA: 18:2 n-6 ● Plant seed oils (safflower, corn, sunflower) ● Excessiveness in the North American Diet is associated with increased disease Alpha-Linolenic Acid (Omega-3) ● ALA: 18:3 n-3 ● Plant seed oils: Canola, flax, also some green vegetables, walnuts ● Associated with decrease in blood clots, decrease in inflammation, decrease in blood pressure ESSENTIAL FATTY ACIDS - OMEGA 3 ● Docosahexaenoic acid (DHA) ○ 22:6 n-3 ● Eicosapentaenoic acid (EPA) ○ 20:5 n-3 ● Fish oils ○ Salmon, trout, seafood ● Health benefits ○ Decrease in blood clots, decrease in inflammation, decrease in blood pressure ○ Brain health **Can be synthesised in small amounts from ALA** TRANS FATTY ACIDS ● Unsaturated fats (trans config.) ● Naturally occurring Trans FAs ○ Meat and milk – not same risk (e.g., CLA) ● Artificial Trans FAs = bad (partially hydrogenated oils) ● ● ● ○ Make PUFAs behave like SFAs Used in baked goods, packaged foods, fried foods (“ultra-processed foods”) ○ Improve texture/taste of foods ○ Extend shelf-life Increase risk of heart disease (atherogenic) Artificial trans fats were officially banned from Canada's food supply in 2018 INTRODUCTION TO NUTRITION 2 MACRONUTRIENTS Dietary Protein ● 4 kcal/g ● Amino acids (20) make up polypeptides ○ Essential (9) and non-essential (11) ● Required for growth, maintenance and repair body, regulation of body process (enzymes and hormones), fluid balance, pH balance AMINO ACIDS ● ● ● ● Central carbon + hydrogen atoms Amino group Carboxyl (acid) group Side chain (“R”) ○ Different properties (acid, base, polar, non-polar, thiol, ring) Essential Conditionally Non-Essential Non-Essential Histidine Arginine Alanine Isoleucine Cystine Asparagine Leucine Glutamine Aspartate Lysine Glycine Glutamate Methionine Proline Serine Phenylalanine Tyrosine Threonine Tryptophan Valine MACRONUTRIENTS Water ● It is required in large amounts ○ Does not provide energy ● 60% of human body weight ● Can live weeks without food, only few days without water ● Functions: ○ Lubricant, transport fluid, regulator of body temperature, aqueous medium for most biochemical reactions ● ‘Recommended’ intake is about 2 litres (8 cups)/day MICRONUTRIENTS ● Required in small amounts ● Provide no energy but are necessary for proper functioning ○ Regulate metabolism/growth, coenzymes/cofactors, antioxidants Vitamins ● Organic molecules ● Fat soluble: Vitamin E,D,A,K ● Water Soluble: Vitamin C, B(1,2,3,5,6,12, Biotin, Folate) ● Some foods naturally LACK certain vitamins ● Fortification: process of artificially adding nutrients to foods ○ Vitamin D in milk ○ B vitamins/folate in grains Minerals ● Inorganic molecules (do not contain carbon) ● 6 major minerals (Na, P, Cl, Mg, K, Ca) ● Many trace minerals/elements ○ Eg: Fe, Zn, Se, Cu, Co ● Some foods contain ANTI-NUTRIENTS ○ Phytates, oxalates, fibres ○ Affects bioavailability ○ Eg: calcium (in milk, vegetables) NUTRITION RECOMMENDATIONS FOR CANADIANS DIetary reference Intakes (DRIs) ● NUTRIENT BASED ● Designed to promote health and prevent nutrient deficiencies ● Joint venture between USA and Canada ● For research methods Canada’s Food Guide (2019) ● FOOD-BASED ● Designed to promote health and a balanced diet ● Based on DRIs ● For public knowledge DIETARY REFERENCE INTAKES (DRIs) ● 4 sets of values: 1. Estimated Average Requirement (EAR): average daily nutrient requirement for 50% of population 2. Recommended Dietary Allowance (RDA): recommended daily target intake of nutrient to meet needs of most people (2SD>EAR) 3. Adequate Intake (AI): estimate, insufficient evidence 4. Tolerable Upper Intake Level (UL): maximum daily intake of a nutrient unlikely to cause adverse health effects DRIs: ENERGY (MACRONUTRIENTS) Estimated Energy Requirement (EER) ● Used to calculate total energy intake needed to maintain body weight (energy balance) ○ Need to know age, weight, height, sex, PA to calculate ○ TEE calculations Acceptable Macronutrient DIstribution Range (AMDR) ● Range for healthy intake as a percent of total calories ○ Carbohydrate (45 to 65%) ○ Protein (10 to 35%) ○ Fat (20 to 35%) DIETARY GUIDELINES FOR CANADIANS ● Designed to provide advice on FOODS, FOOD GROUPS, and DIETARY PATTERNS ● To provide the REQUIRED NUTRIENTS to the general public to PROMOTE OVERALL HEALTH and PREVENT CHRONIC DISEASE History ● 1942 – Canada’s Official Food Rules from the Department of National Health and Welfare (Nutrition Division) ○ To dictate what to eat to prevent ‘nutritional deficiencies’ during war time ■ War-time rationing, reducing malnutrition amid widespread poverty ■ Milk, cheese (as available) ■ Liver, heart, kidney once a week ■ Vegetables: in addition to one serving of potatoes ● 1944 – Canada’s Food Rules ○ More indulgent ■ Portion sizes increased for milk and potatoes ■ Eat liver frequently ■ Butter on bread ■ More variety of meat alternatives ■ Vitamin D recommendation to adults and children (1942 and 1944) ● 1961, Canada’s Food Guide (not rules) ○ Different foods were emphasised (more eggs, cheese, butter, less liver) ● 1977, Canada’s Food Guide ○ Fruit and Vegetables combined = ‘4 food groups’ ○ “Eat a variety of foods from each group every day ● 1992, Canada’s Food Guide ○ 4 food groups displayed as rainbow ○ food groups not to be eaten in equal portions ■ Need more of some foods than others ○ Culturally-specific items (rice + chopsticks, meat kebabs) ● 2007-2018 Canada’s Food Guide ○ F&V on outside ○ More prescriptive (servings) ○ Eating the recommended foods (by age and sex) promote health and reduce risk of chronic disease ○ Food choices: low in fat, low in sugar, low in sodium and high in fibre. ○ Physical activity ○ Food labels ○ Intake of unsaturated oils/fats 2019 Canada’s Food Guide ● Eat a variety of healthy foods each day ● 3 food groupings in relative proportions ● Flexible, simple, not prescriptive ● General advice ● Support different eating patterns ● ‘Choose plant-based foods more often’ (health, sustainability) ● Removed Milk & alternatives and Meat & alternatives food groups ● Water is the drink of choice ● Healthy eating is more than the foods you eat ● Be mindful of eating habits ● Cook more often ● Enjoy your food ● Eat meals with others ● Use food labels ● Be aware of food marketing INTRODUCTION TO NUTRITION 3 DIETARY GUIDELINES FOR CANADIANS Problems/Criticisms/Issues with new CFG? ● Too expensive to follow ● ● ● ● ○ Fresh only? Frozen and dried foods? Not enough time to follow Standards for use in assessments are needed Snapshot not nutritionally adequate ○ Missing food groups? What is a plant-based diet? FOOD MARKETING TO KIDS Why is this such a problem? ● Kids are highly influenced ● Kids are impulsive ● Kids are an easy to reach audience ● Kids want to fit in ● Kids don’t really understand the purpose of marketing… ● HEALTH CANADA to amend the Food and Drug Regulations to restrict advertising to children under 13 yrs of foods that contribute to excess intakes of sodium, sugars and saturated fat ● Affects labelling, packaging and advertising directed at children ● Cannot depict or use child-directed cartoonish characters, animals, creatures, mascots or celebrities. ● Cannot offer vouchers or coupons for free or discount food or beverage that meets the nutrient criteria ● Applies to stores, schools, restaurants, public transit, recreation centres, television and online ● WHO’s Commission on Ending Childhood Obesity “There is UNEQUIVOCAL EVIDENCE that the marketing of unhealthy foods and sugar-sweetened beverages has a negative impact on childhood obesity, and recommended that any attempt to tackle childhood obesity should include a reduction in the exposure of children to marketing” Food categories frequently advertised to Canadian children (OBESOGENIC ENVIRONMENT): ● Candy ● Desserts ● Chocolate ● snack foods ● baked goods ● restaurant foods ● sweetened dairy products ● sugar-sweetened beverages ● sweetened breakfast cereals HEALTH CANADA -FRONT-OF-PACK (FOP) LABELLING ● For packaged foods ● Easier for Canadians to make healthier choices. ● Exemptions: ○ Health-related exemptions (foods that have a recognized health protection benefit, e.g., milk, eggs, nuts, fish) ○ ● Technical exemptions (raw foods/foods without a package/don’t have nutrient facts table) ○ Practical exemptions (foods where it would be redundant, e.g., table salt, sugar, honey, maple syrup, butter) Similar to other countries (e.g., Chile FOP labels, UK ‘Traffic light’, Australia ‘Health Star rating’) NUTRIENTS OF CONCERN VS. SHORTFALL NUTRIENTS Nutrients of Concern – Sodium, Sugars, Saturated Fat ● Associated with increased disease (hypertension, diabetes, heart disease, obesity) ● Sodium <2300 mg/d ● SFA limited to <10% dietary fat intake (…as low as possible) ● Sugars <100g/d total sugars Shortfall Nutrients – Nutrients typically under-consumed ● CCHS – Canadian Community Health Survey 2015 (20,487 respondents) NUTRITION LABELLING NUTRITION FACTS TABLE (NFT) SERVING SIZES INGREDIENT LISTS NUTRIENT CONTENT CLAIMS Food Label Meaning Calorie-free ● Less than 5 kcal per serving Low in Calories ● ● 40 kcal or less per serving 120 kcal or less per 100 g, if a prepackaged meal Lower in Calories light ● At least 25% less energy than original product light Fat Free ● Less than 0.5g of fat per serving No Fat Zero Fat Low in Fat ● ● 3g or less of fat per serving 30% or less of the energy is from fat, If a prepackaged meal Reduced in fat Lower Fat Less Fat ● At least 25% less fat than original product 100% Fat Free ● Less than 0.5g of fat per 100g; contains no added fat INTRODUCTION TO NUTRITION 4 ORGANIC FOODS ● ORGANIC: the way agricultural products are grown and processed using environmentally and animal friendly farming methods ● Under the Safe Food for Canadians Regulations (SFCR), any food, seed, or animal feed that is labelled organic is regulated by the Canadian Food Inspection Agency (CFIA) ● REGULATIONS by CFIA: Only products with ≥95% organic content can use this logo ○ Multi-ingredient products with 70-100% organic content may have the declaration “contains x% of organic ingredients” but cannot use the logo ORGANIC FOODS CANNOT… ● Be genetically engineered (GMO) or irradiated ● Be grown with synthetic pesticides ● Be grown with chemical fertilisers or composted plant and animal material that contains a prohibited substance ● Contain chemical/synthetic processing substances (e.g., nitrates, sulphates, other preservatives, synthetic dyes, etc.) ● Contain synthetic growth regulators (e.g., hormones) ● Be cloned animals *ORGANIC FOODS STILL CONTAIN PESTICIDES (ORGANIC PESTICIDES)* IS ORGANIC CANADIAN MILK BETTER? Highlights ● Significantly higher levels of certain nutrients; not clear if differences are clinically important ● No evidence to suggest organic products provide health benefits from conventionally produced foods ● Factors including feeding regimen affect nutritional content of milk/milk products ● Artificial growth hormones (AGH) not permitted for use in any milk production GENETICALLY MODIFIED FOODS Pros ● Increased crop yield (bacteria-resistance) ● Help meet global food challenges ● ● ● Cons ● Decrease chemical use (less pesticides) Better shelf-life Increased nutritional value The unknown ○ How it affects humans, the food ○ Gene deletion/insertion COMMON GM FOODS ● Soy ● Corn ● Canola oil ● Alfalfa ● Cotton ● Papaya ● Zucchini/squash ● Sugar beets ● Milk (not in Canada, EU, Aus/NZ) ● Meat is not (but their feed can be!) THE CASE FOR CARROTS ● CAROTENOIDS: give carrots their orange colour and is also what make them healthy (carotenoids/ β-carotene = source of vit A) ● Carrot DNA = >32,000 genes ● White → Yellow → Orange ● Farmers SELECTIVELY BREAD for the mutation that concentrated carotenoids in the carrot NATURAL HEALTH PRODUCTS ● “Complementary" or “Alternative" medicines, and supplements include: ○ ERGOGENIC AIDS (SPORTS SUPPLEMENTS) ○ AMINO ACIDS (PROTEINS) AND FATTY ACIDS ○ Vitamins and minerals ○ Herbal/plant remedies ○ Homoeopathic medicines ○ Traditional medicines like Chinese and East Indian ○ Probiotics ○ like certain toothpastes, antiperspirants, shampoos, facial products and mouthwashes ● NHPs must be safe to use as over-the-counter products and do not need a prescription to be sold SPORT ERGOGENIC AIDS ● Sodium bicarbonate: augments extracellular buffering capacity by raising the extracellular pH in the blood ● Beta-alanine: augments intracellular buffering capacity. Both can potentially benefit sustained high-intensity exercise performance ● ● ● ● ● ● ● Caffeine: CNS Stimulant. Probably the most widely-used sport supplement. Can help to elicit greater power outputs, shorter race times, and higher running intensities Creatine: enhances short-term, high-intensity exercise capacity. Augmenting the rate of PCr resynthesis so you can do more high-intensity work BCAAs: Specifically Leucine. Preferentially turn on muscle protein synthesis (MPS), particularly in conjunction with exercise Protein supplementation: helps with repair and regeneration of muscle, post-exercise Sports drinks/gels/bars: provide exogenous CHO to the system so you do not have to use your endogenous stores of muscle/liver glycogen. Also replenishes electrolytes lost with sweat Beetroot juice (nitrate): Enhances nitric oxide (NO) bioavailability. Which has a vasodilatory effect, which can increase blood flow (and nutrients) to the muscle Antioxidants: generally help to quench free radicals and oxidative stress that can be produced by our energy systems with exercise IOC CONSENSUS STATEMENT ● Dietary supplement: A food, food component, nutrient, or non-food compound that is purposefully ingested in addition to the habitually consumed diet with the aim of achieving a specific health and/or performance benefit ● Nutrition usually makes a small but potentially valuable contribution to successful performance in elite athletes ● Supplement use is widespread ○ Manage micronutrient deficiencies ○ Convenient forms of energy/macros ○ Aids that directly benefit performance ○ Aids that directly benefit training CONTAMINATION OF NUTRITIONAL SUPPLEMENTS ● international Study ● Tested 634 non-hormonal nutritional supplements from 13 countries, 215 suppliers (e.g., creatine, AAs, carnitine, HMB, Vitamins, Minerals) ● 94 (15%) contained hormones that were not declared on the label• 49 contained 1 steroid while 8 contained 5 or more ● Excretion studies → positive urine tests for nandrolone metabolites PHYSICAL ACTIVITY Physical Activity ● Ecompasses all movement creating energy expenditure ○ ADL - Activities of Daily Learning ○ LTPA - Leisure Time Physical Activity ○ Occupation Exercise ● Subset of PA that is planned, structured, and repetitive with the INTENTION of improving physical fitness Remember… ● 2 main types of fitness FITNESS INDUSTRY ORIGINS Traditional Exercise Mentality ● “No pain no gain” ● Fitness movement 70’s-80’s ○ Running ○ Aerobics ○ Bodybuilding LIST OF HEALTH BENEFITS: PA PARTICIPATION Physical ● ● ● ● ● ● ● ● ● Life expectancy Decreased CVD risk Improved insulin sensitivity Improved blood lipid profile Reduced cancer risk Increased functional capacity Lower injury risk Improved immunity Energy levels Mental ● ● ● ● ● ● Improved mood Reduced risk of depression Improved self efficacy Reduced risk of dementia Improved cognitive function Improved job/ AMOUNT OF PA FOR BENEFITS? ● Quantity and intensity of PA needed to promote health is less than that needed to maintain/improve fitness AMOUNT OF PA FOR BENEFITS: DOSE RESPONSE ● ● Not the same dose (or response) for all biomarkers to see improvement The dose changes based on your BASELINE FITNESS LEVELS ○ Eg: An unfit person has a greater “window of opportunity” for achieving benefits at a lower intensity ○ Link to “tolerance” of PA ○ We all have a “ceiling” or upper level beyond which adding PA only has marginal benefits UPDATED TRENDS: ECONOMIC ● The costs of physical inactivity ○ $6.8 billion in total health-care costs2 ○ $ 2.4 billion in direct costs ○ $4.3 billion in indirect costs ● Getting just 10% of people living in Canada to move more would: ○ Increase workplace productivity ○ Decrease absenteeism ○ Inject a minimum of $1.6 billion into the economy ○ Reduce health-care spending on chronic disease by $2.6 billion UPDATED TRENDS: GUIDELINE ACHIEVEMENT (YOUTH) ● Only 28% of kids and teens (5-17 years) are meeting national physical guidelines 4 ○ Less than 60% of young children 3-4 years of age are meeting national physical activity guidelines ○ Levels of physical activity decrease by 7% per year among 10- to 19year-olds ○ Boys (52%) are twice as likely as girls (26%) to meet physical activity guidelines OTHER LIFESTYLE FACTORS Youth ● Screen time and sleep ○ 80% of 3- to 4-year-olds engage in more than one hour of screen viewing per day ○ Only 18% of 5- to 17-years-olds are meeting the two-hour recommendation of recreational screen-viewing per day ○ 75% of 5- to 17-year-olds meet national sleep recommendations Adults ● The majority of adults are not meeting national physical activity guidelines ○ 83% of adults believe physical inactivity is a more serious health issue than tobacco and alcohol use ○ 74% of adults state they enjoy being active ● Too much screen time ○ Adults are sedentary for 9.6 hours per day, excluding sleep time ○ Adults spend 25 hours per week on screens PHYSICAL ACTIVITY 2 ADULTS ● Majority of adults are not meeting national physical activity guidelines ○ 83% of adults believe physical inactivity is a more serious health issue than tobacco and alcohol use ○ 74% of adults state they enjoy being active ● Too much screen time ○ Adults are sedentary for 9.6 hours per day, excluding sleep time ○ Adults spend 25 hours per week on screens ● Sleep ○ On average adults get 7.2 hours of sleep on average per night GUIDELINES Original Guidelines ● Only healthy adults ● 20+ minutes of continuous aerobic activity ● 3-5 days per week ● Vigorous ● Does not include strength training and only recognises for healthy adults Current Guidelines ● Shift towards 24 hours ● Adults (18-64) ○ Minimising sedentary time ■ 8 hours or less/day ■ 3 hours of recreational screen time/day ○ Physical activity ■ Moderate to vigorous intensity ■ 150 minutes/week ○ Sleep well ■ 7-9 hours/day ● Older Adults (65+) ○ Benefits are larger compared to smaller risk ○ Minimising sedentary time ■ 8 hours or less/day ■ 3 hours of recreational screen time/day ○ Physical activity ■ Light physical activities (RELATIVE DOSE) ■ 150 minutes/week ○ Sleep well ■ 7-8 hours/day HOW ARE WE DOING? Adults ● Canadians are doing better than the past ● Majority of adults are still not meeting the guidelines ● We have opportunities that are seeking for movement in the field Children (0-4) ● Infants (<1 Yr) ○ Be active in floor-based interactive play ○ 14-17 hrs of sleep (including naps) • Not being restrained for more than 1hr at a time (stroller/high-chair) ● Toddlers (1-2 Yrs) ○ 180 min in a variety of physical activities at any intensity ○ Energetic play – more is better ○ 11-14 hours of sleep (including naps) ○ Screen time not recommended at all under 2 yrs ○ If over 2, should be less than 1hr (less is better) ● Preschoolers (3-4 Yrs) ○ 180 min in a variety of physical activities at any intensity ○ Energetic play >60 min – more is better ○ 10-13 hours of sleep (including naps) ○ Less than 1 hr of screentime (less is better) Children (5-17) ● SWEAT ○ Moderate-to-vigorous Activity ○ AT LEAST 60 min per day ○ Vigorous activity + Muscle Strengthening Activities 3+ Days per week ● STEP ○ “Several hours of a variety of structured and unstructured light PA” ● SLEEP ○ Quality, uninterrupted sleep ○ Consistent wake-up and bed-time ○ 5-13 yrs – 9-11 hours ○ 14-17 yrs – 8-10 hours ● SIT ○ No more than 2 hours of recreational screen time ○ Limit sitting for extended periods SPECIAL POPULATIONS Pregnancy ● All women without contraindication should be physically active throughout pregnancy ○ Subgroups for closer examination: ○ Previously inactive women ○ Women with gestational diabetes ○ Women classified as overweight/obese (pre-pregnancy BMI >25) ● 150 min of moderate intensity PA each week ● ● Spread over a minimum of 3 days per week Include aerobic + resistance training ○ adding yoga and/or gentle stretching may be beneficial ● Pelvic floor training (kegels) may be performed on a daily basis to lower risk for urinary incontinence ● Pregnant women who experience light-headedness, nausea, or feeling unwell when exercising on their back should modify their exercise position to avoid supine positions ● Women with ABSOLUTE CONTRAINDICATIONS should not participate in strenuous activities ● Women with RELATIVE CONTRAINDICATIONS should discuss advantages and disadvantages of moderate-vigorous intensity physical activity Spinal Cord Injury ● Starting level ● Advanced level ● Movement is challenging, mobility issues CARDIOVASCULAR PHYSIOLOGY ● Involves both the circulatory system and the respiratory system CARDIAC OUTPUT ● How much blood flow is leaving the heart at standard time (/min) ● At rest is generally about 5-6L/min ● During peak exercise (highest in cross-country skiers) heart can pump over 40L/min ● Blood pumping out of left ventricle ● HEART RATE and STROKE VOLUME determine how much blood is pumped ● PULMONARY VEIN and PULMONARY ARTERY (*Differentiate*) THE HEART What Is It? ● Hollow muscular organ about the size of your fist Where Is It? ● Between sternum and vertebrae What Does It Do? ● Dual - Pump ● Delivery mechanism ● Suction device ● Performance Engine What Is Unique/Interesting About It? ● Fully automatic ● Highly adaptive ● Incredible endurance HEART STRUCTURE & ANATOMY ● Divided into right and left halves, the heart has 4 chambers (2 hold deoxidized blood and 2 hold oxygenated blood) Atria (x2) ● ● ● ● ● Upper chambers Receive blood returning to heart and transfer it to lower chambers Thinner walls (compared to ventricles) Deliver blood to the 2 ventricles Septum ○ Dividing wall ○ Foramen Ovale* (hole between left and right atria before birth) Ventricles (x2) ● ● ● ● Lower chambers that pump blood from heart either to the lungs (right side) or the rest of the body (left side) Primary pump for the heart… Right ventricle sends blood to the lungs for oxygenation, left ventricle is the delivery driver for all essential organ systems Thicker walls are more muscular and generate greater force of contraction ○ Force of contraction is known as “Contractility” ○ The LV is most powerful chamber Larger volumes compared to atria ○ They can handle and deliver huge volumes of blood during exercise MYOCARDIUM ● ● ● Heart is a muscle with 3 layers ○ Endocardium ○ Myocardium ○ Epicardium Unique aspects of cardiac muscle ○ Involuntary ○ Endurance specialist! ○ Isn’t found anywhere else in the body What do muscles need? ○ An electrical signal to contract ○ A coronary blood supply (oxygen, nutrients) ○ Maximum coronary blood flow occurs only when the ventricles are filling (cardiac diastole) and flow to the heart muscle itself is restricted when the heart contracts (cardiac systole) CORONARY CIRCULATION ● Coronary vasculature ○ Supplies oxygen and nutrients ○ Removes metabolic by-products ○ ESSENTIAL for heart function ○ Site of ischemia / plaque formation / heart attacks BLOOD FLOW THROUGH THE HEART THE CARDIAC CYCLE ● Alternating contraction and relaxation ○ Systole (Ventricular Contraction – ‘ejection’) ○ Diastole (Ventricular Relaxation - ‘filling’) ● Valves play a major role ○ Ensure 1-way flow of blood through the heart Atrio-Ventricular Valves ● Right = Tricuspid ● Left = Bicuspid (mitral) ● Chordae Tendineae ○ Prevent eversion ○ Papillary muscles Semilunar Valves ● Aortic (LV→ AORTA) ● Pulmonary (RV → PULMONARY ARTERIES) ● Both have 3 flaps ● 4 Main Phases: 1. Ventricular Filling Period (diastole) ● AV Valves open, blood flows into ventricles ● Enhanced by “Suction” ● End of this phase includes Atrial contraction to “top up” ventricles ○ About 80% of filling is passive 2. Isovolumetric Contraction Period ● Occurs from electrical conduction system stimulation ● Immediate increase in pressure ● Temporary moment when pressure doesn’t exceed that needed to open semilunar valves 3. Ventricular Ejection Period (systole) ● ● Systole Semilunar valves are open and blood flows freely into Aorta and Pulmonary artery ● Atria fill during this time 4. Isovolumetric Relaxation Period ● Brief moment when ventricles are relaxed and atrioventricular valves are closed ● As soon as the pressure in the atria exceeds that of the ventricles, the cycle repeats CONTROL OF HEART RATE ● Control of Heart Rate ○ Autonomic nervous system ○ Sympathetic vs Parasympathetic ○ Fight or Flight! ○ Gas and Brakes ○ Go and Slow ● Other factors ○ Exercise! ○ Drugs ○ Environmental Factors ■ Toxins ■ Altitude ■ Heat / Cold ELECTRICAL SYSTEM/CONDUCTION SYSTEM OF THE HEART ● KEY Pacemakers of the Heart ○ Non-contractile cells responsible for autorhythmicity ○ Sinoatrial Node (SA Node) ■ Primary Pacemaker (Typical range from 60-100 bpm at rest) ■ Sets HR because impulse happens more frequently than the other nodes ○ Atrioventricular Node (AV Node) ■ Only pathway for electrical signals to reach the ventricles ■ Designed for one-way signalling From Atria to Ventricles ■ If the SA node isn’t working properly the AV can also be a pacemaker (~40 bpm) ● Act as the seeds of conduction THE ELECTROCARDIOGRAM ● ECG/EKG ○ Provides an electrical representation of atrial and ventricular contraction and relaxation ● Measurement ○ 12 lead ECG ● Normal sinus rhythm ○ Tracing ○ Waves ARRHYTHMIAS ● ​When rhythms go wrong! ● Changes to the conduction system can be serious or even fatal ● Tachycardia (>100 bpm) ● Bradycardia (<60 bpm) ● Atrial fibrillation ● Ventricular fibrillation CARDIOVASCULAR PHYSIOLOGY 2 KEY CARDIAC MEASURES ● Heart Rate aka “HR” ○ Number of beats per minute (bpm) ○ How is it measured? ■ Palpation or via Technology ● Affected by? ○ Pacemaker cells ○ Exercise ○ Nervous system ○ Other stimulants/depressants / toxins ○ Hot/Cold ○ Environment ● Stroke Volume aka “SV” ○ Amount of blood ejected by ventricles per beat ○ Determined by: ■ Preload – blood filling ventricles ■ Afterload – resistance to ejection ■ Contractility – force of contraction ● How is it measured? ○ Echocardiography ○ Direct via arterial catheter ● Cardiac Output aka “Q” ○ Total amount of blood ejected from the heart per minute ○ Reflects the heart's ability to meet the body’s needs for blood flow Q (L/min) = HR (bpm) X SV (ml) ● What effects it? ○ Anything that affects HR or SV ○ Exercise ○ Pericardium WHAT ARE NORMAL VALUES? ● HR ○ Rest: 40-80 bpm ○ During Max Exercise: HRmax = 220 - age ● SV ○ Rest: 50-70ml ○ During Max Exercise: 120 - >200ml ● Q ○ Rest: 5L/min ○ During Max Exercise: 20- >35L/min ARTERIES ● ● Carry blood away from the heart Mostly oxygenated blood ○ Except for ● Higher pressure tolerance ● Regulate blood pressure ● Secrete chemical/electrical signals to Tunica Media Key Properties ● Elastic (compliance) ● Surrounded by smooth muscle ● 3 Primary Layers Tunica Externa ● Key for structure ● Collagen Tunica Media ● Muscular layer Tunica Intima ● Basement membrane ● Endothelium ○ Reduce saturated fat/simple carbohydrates to preserve ○ Smoking damages cells (chemicals) ○ Genetic toxins ○ Exchange layer VEINS ● ● Carry blood back to the heart Mostly deoxygenated blood ● Capacitance Vessels (can enlarge/expand easily to store/hold blood) ○ Depending on pressure ● Pressure is low Key Properties ● Less elastic and rigid vs arteries ● Contain valves ● 3 Primary Layers Tunica Externa ● Key for structure ● Collagen Tunica Media ● Muscular layer Tunica Intima ● Basement membrane ● Endothelium ● Exchange layer CAPILLARIES & ENDOTHELIUM Capillaries ● Smallest vessels ● Blood flow is significantly slower ○ To give vessels time to exchange gases and nutrients Endothelium ● Innermost layer of all blood vessels ● Single cell thickness ● Primary contact for transport / exchange ○ Gas ○ Nutrients ○ Metabolic waste ● Important role in blood pressure control ● Governs vasodilation and vasoconstriction ○ Releases chemical signals into the bloodstream in response to ■ Exercise ■ Stress ■ Sympathetic stimulation ■ Drugs VASOCONSTRICTION/VASODILATION OF THE ARTERIES BLOOD PRESSURE ● Force that blood exerts on the walls of the vasculature ● BP = Q x TPR (Blood pressure = Cardiac output X Total Peripheral Resistance) ● What systems / organs are primarily involved? ○ Brain, heart, Vessels, Kidneys, Neurons, blood ● How is it regulated? ○ Autonomic Nervous System ○ Renin Angiotensin Aldosterone System (RAAS) ■ Kidneys and Hormones control fluid intake and excretion ■ Alter blood volume and pressure ○ Blood vessels – constriction & dilation ○ Baroreceptors ■ By the heart and in the neck ■ Send signals out when blood pressure drops ■ Connected to autonomic nervous system BLOOD PRESSURE CHANGES To High To Low BLOOD PRESSURE ● Typical factors affecting BP responses ○ External Factors ■ Exercise ■ Postural changes ■ External agents / environmental stimuli ■ Drugs ■ Stress ○ Vascular Properties ■ Arterial compliance ■ Blockages ○ Blood properties ■ Viscosity, clotting factors, blood volume MEASURING BP ● When is it advisable or important to measure BP? ● What number does it tell us? ○ Systolic and Diastolic BP ○ Millimetres of Mercury (mmHg) ○ SBP / DBP ● How can we measure blood pressure? ○ Manual ○ Stethoscope + Cuff (sphygmomanometer) ○ Automated ● The Riva-Rocci/ Korotkov method ○ Using a stethoscope and sphygmomanometer BLOOD ● Contents ○ Red Blood Cells (45%) ○ Buffy Coat (<1%) ○ White Blood Cells ○ Platelets ○ Plasma (55%) Plasma ● Yellowish colour ● Fluid portion of blood – 90% of plasma is water ● Contains ○ electrolytes, glucose, proteins, vitamins, nutrients, gases, urea (waste) Blood Volume ● How much is in the body? ○ ~5L in normal adults ○ Can be up to 10L in elite endurance athletes ● Factors affecting Blood Volume? ○ Sodium (Na) and Fluid retention (Kidneys and RAAS) ○ Aerobic training! ○ Altitude training – promotes long term adaptation ● Why is it important? ○ Link to performance ■ More BV means more RBCs (link to O2 carrying capacity!) ■ Greater SV and Q ○ Link to Blood Pressure RESPIRATORY PHYSIOLOGY RESPIRATORY SYSTEM FUNCTION ● ● ● Point of entry Upper Respiratory Tract (RT) CONDUCTIVE PATHWAY ○ Nasal Cavity ■ Warms and cools air to body temp ■ Humidifies air ■ Filters air ■ Eliminates dust / other particles via mucous ■ Sense of smell ○ Pharynx ■ Junction of oral and nasal cavities ■ Warms / cools ■ Humidifies air ■ Also part of digestive system ○ Larynx ■ Vocal cords ■ Protects the lungs ■ Coughing and throat clearing reflexes LOWER RESPIRATORY TRACT ● From Upper RT to the Lungs ○ Trachea ○ Primary Bronchus ○ Secondary Bronchus ○ Tertiary Bronchus ○ Bronchiole ○ Terminal Bronchiole ○ Respiratory Bronchiole ○ Alveoli LOWER RT- ZONES Conductive Zone ● Transport of air ● No gas exchange ● AKA “anatomical dead space” ● ● ● ● ● ● Respiratory Zone ● Area of gas exchange Trachea Primary Bronchus Secondary Bronchus Tertiary Bronchus Bronchiole Terminal Bronchiole THE CONDUCTING VS RESPIRATORY ZONE ALVEOLI ● ● Respiratory Bronchiole Alveoli ● Alveolus ○ Sac like structure ○ Primary site of gas exchange ○ Tightly networked with capillaries ○ Wall is coated with surfactant ■ Lowers surface tension ■ Keep alveoli from over or under inflating RESPIRATORY SYSTEM ● ● Pulmonary circulation Air and blood SPEED both slow down to maximise tie for gas exchange GAS EXCHANGE ● Movement of gases is called DIFFUSION ● Driven by ○ Differences in pressure ○ AKA pressure gradient ■ High to low Oxygen Diffusion Carbon Dioxide Diffusion GAS EXCHANGE ● When CO2 is travelling through the body, it is mostly in the form of; ○ Bicarbonate (85%) (HCO−3) ○ Key in Acid-Base changes in the body ○ Small portion binds to haemoglobin ○ Small portion dissolves into the blood (plasma) ● When O2 is travelling through the blood; ○ 95% is bound to Haemoglobin in red blood cells ○ 5% dissolves into blood (plasma) ● Haemoglobin (Hb) ○ Every Hb molecule has 4 binding sites for O2 molecules ○ Millions of Hb molecules in every RBC THE OXYHEMOGLOBIN CURVE ● ● The oxyhemoglobin dissociation curve reflects the relationship between the oxygen saturation of haemoglobin (SaO2) and the partial pressure of arterial oxygen (PaO2). It can shift (Figure 1) depending on various factors. In normal physiology the body needs to offload oxygen to the tissues and muscles and, in contrast, also pick up oxygen within the lungs that is stored on our haemoglobin (Hgb) for future tissue oxygenation PULMONARY VOLUMES ● ● What type of volumes may we measure? ○ Normal breathing ○ Inhaling / Exhaling ○ Total lung capacity Why are they important? ○ Exercise performance ○ Chronic diseases ■ COPD ■ Bronchitis ■ Emphysema PULMONARY VOLUME MEASURES ● How are they measured? ○ Spirometry ○ Volumes AND Rates ● Total Lung Capacity ○ Total amount of air if lungs fully inflated ● Vital Capacity ○ Maximum amount of air exhaled after maximal inhalation ● Tidal Volume ○ Volume of air in/out during normal breathing ● Inspiratory Reserve Volume ○ Amount of air that could be inhaled after tidal volume inhale ● Expiratory Reserve Volume ○ Amount of air that could be exhaled after tidal volume exhale ● Residual Volume ○ Amount of air left in respiratory tract after maximum exhale ● Factors affecting pulmonary volumes? ○ Body size ○ Sex ○ Fitness ○ Airway obstructions ○ Function of ventilatory muscles RESPIRATORY FUNCTION & DYSFUNCTION MAIN TYPES OF RESPIRATORY DISEASE PULMONARY CIRCULATION DISEASES ● Pulmonary circulatory disease ● Begins in circulatory, causes issues with lungs Pulmonary Embolism (PE) ● What happens when a clot occludes arteries in t