PHTH 652 Final Definitions PDF

PHTH 652 FINAL DEFINITIONS 1. **What's the difference between movement/mobility/functional mobility, physical activity and exercise?** Movement/mobility/functional mobility: Change in the position of the body and its components, for the purpose of changing location of the body Physical acti...

PHTH 652 FINAL DEFINITIONS 1. **What's the difference between movement/mobility/functional mobility, physical activity and exercise?** Movement/mobility/functional mobility: Change in the position of the body and its components, for the purpose of changing location of the body Physical activity: Any form of body movement generated by skeletal muscle contraction that results in a significant metabolic demand and energy expenditure Exercise: Planned purposeful physical activity with repetitive body movement for health and fitness purposes 2. **Define physical fitness** Set of characteristics that individuals have that relates to their ability to perform physical activity These characteristics are grouped into health related or skill related 3. **What are the health related components of physical fitness? Define each** Cardiorespiratory endurance: ability of circulatory and respiratory system to supply oxygen to sustain physical activity Muscular strength: ability of muscle to exert force Muscular endurance: ability of muscle to continue to perform without fatigue Flexibility: range of motion available at a joint Body composition: amount of fat, bone, muscle and other vital parts of the body 4. **How do you address the health related components of physical fitness?** Through aerobic, strength and flexibility exercises 5. **What are the skill related physical fitness components of physical fitness? Define each** Agility: Ability to change position of the body in space with speed and accuracy Coordination: ability to use senses like sight and hearing with your body parts to perform a task smoothly and accurately Balance: maintain equilibrium while stationary or moving Power: ability or rate that work is performed Reaction time: time elapsed between stimulation and beginning of the reaction Speed: ability to perform a movement within a short period of time 6. **What are the three core recommendations of the Canadian 24 hour movement guidelines?** Move more: doing mod to vigorous physical activity Reduce sedentary time Sleep well 7. **What's the only difference between the Canadian 24 hour movement guidelines for people aged 18 -- 64 and people aged 65+?** In people aged 65+, include physical activities that challenge balance 8. **What's associated with a lower risk of mortality?** Any form of physical activity regardless of intensity Less time spent sedentary 9. **What's the dose-response relationship between physical activity and health?** The more exercise you do, the more benefits except if you overtrain in which case the benefits diminish 10. **What are the health benefits that regular physical activity is associated with?** Improved diabetic control Improved hypertension control Improved lipid profile Improved musculoskeletal health Improved psychological well being Improve health related quality of life Weight loss Reduction of all cause mortality Reduction of cardiovascular events Reduced health care use 11. **What's the link between physical inactivity and chronic diseases?** Parents provide genes and lifestyle Physical inactivity interacts with genes to produce pathophysiology Pathophysiology interacts with risk factors to establish the probability of chronic disease 12. **What contributes to the incidence of chronic diseases?** Tobacco use Physical inactivity Use of alcohol Unhealthy diet 13. **What's the difference between comorbidity and multimorbidity?** Comorbidity: 1 or more additional disorders which co-occurs with a primary disorder Multimorbidity: co-existence of 2 or more chronic conditions in the same person without one being a primary disorder 14. **What are some barriers to exercise?** Lack of time Lack of energy Lack of motivation Fear of injury Lack of skill Lack of resources Weather Family obligations PRINCIPLES OF CLINICAL EXERCISE TESTING AND PRESCRIPTION 1. **What should be included in a comprehensive exercise program?** Aerobic training Resistance training Flexibility training Maybe some neuromotor and or balance specific training 2. **TRUE OR FALSE: THERE IS VARIABILITY IN INDIVIDUAL RESPONSES TO A STANDARD DOSE OF EXERCISE?** TRUE 3. **What is the SAID principle? How does this relate to the way you prescribe exercise?** Specific Adaptation to Imposed Demand This principle says that exercises should have Progressive overload Exercise specificity Variation/periodization 4. **What are the mechanisms of adaptation?** Neurological Metabolic morphological 5. **What are the neurological effects of exercise?** Increased synthesis and release of: Neurotransmitters Neurotrophic factors Neurogenesis Angiogenesis Synaptogenesis Synaptic potentiation (stronger synaptic transmission) Spinal motoneuron excitability Motor cortex reorganization 6. **What are the functional effects of neurological adaptation?** Improved muscle coordination Improved muscle recruitment Improved muscle activation 7. **What are the metabolic effects of exercise?** Skeletal muscle adaptations Cardiovascular adaptations 8. **What are the specific skeletal muscle adaptations of exercise?** Increased capillaries per muscle fiber Increased blood flow Increased surface area for gas exchange Increased number and size of mitochondria and enzymes Increased oxidative capacity Decreased use of glycogen stores and lactate production for a given exercise intensity 9. **What are the specific cardiovascular adaptations of exercise?** Increased plasma and total blood volume Lower blood viscosity and increased blood flow Increased blood flow and oxygen delivery Increased end diastolic volume Increased elastic recoil of left ventricle Increased ventricular muscle mass and dilatation Increased ejection fraction and stroke volume Decreased resting heart rate Increased maximal cardiac output Decreased resting and submaximal systolic and diastolic blood pressure 10. **What are the morphological effects of exercise?** Skeletal muscle adaptations Muscle fiber hypertrophy More type 2 fibers compared to type 1 Myofibril growth and proliferation Increased muscle fiber and myofibril density Increased quality of tendon and myofascial Maybe modifications in muscle architecture 11. **What's the main mechanism of adaptation in cardiovascular exercise?** Metabolic 12. **What's the FITT-VP^2^ principle?** Frequency Intensity Time Type Total volume Pattern Progression First three make up the volume 13. **What's the exercise volume recommendation for health individuals?** Moderate intensity: 30 min/day, 5 days/week Vigorous intensity: 20 or more min/d. 3 days/week Light to moderate intensity: 20 or more min/d, 3-5 days/week may be beneficial for sedentary or deconditioned people 14. **What's the dose response relationship with the different frequencies of exercise?** Non linear improvement in VO2max with increased frequency For high intensity training: Plateau between 3 and 5 days/week Training less than 2x/week will have no meaningful improvement in VO2max 15. **What's the intensity threshold?** There is a minimal training intensity for improvement Varies with training level but is around: RPE borg of 12 or OMNI of 5 Moderate intensity 55 -- 65% of HRmax 40 -- 50% of VO2r or HRR May be lower for very deconditioned individuals like: RPE borg 9 or OMNI of 4 Light intensity 57 -- 74% of HRmax 30 -- 40% of VO2r or HRR 16. **What's the intensity target for cardiorespiratory fitness?** Borg of 12 -- 17 OMNI 5 -- 8 Moderate to vigorous 64 -- 96% of HRmax 40 -- 90% of HRR or VO2r 17. **What should be the time of aerobic training?** 30 -- 60 min mod 20 -- 60 min vigorous Or combo Less than 20 min can be beneficial for sedentary individuals 18. **What constitutes as a good type of aerobic training?** Anything that uses large muscle groups, is rhythmic and can be maintained for 10 or more minutes 19. **What's the difference and benefits of cross training vs interval training?** Cross training: Favours training effects in multiple muscle groups Decreases risk of injuries Comparable VO2max training effects for lots of activities Interval training: Varied intensity within the same bout of exercise 20. **What is intermittent aerobic training?** Accumulated throughout the day Minimum duration of 10 minutes per session Less than 10 min initially beneficial for deconditioned individuals 21. **What are the different ways to calculate heart rate?** Predicted: HRmax: 220 -- age Direct: better for people with low fitness levels, taking meds that affects the heart rate and cardiovascular or pulmonary disease Heart rate reserve: HRmax -- Hrrest Target HR: HRR x % intensity + HR rest 22. **What are the different ways to calculate VO2?** VO2reserve: VO2max -- VO2rest Target VO2: (VO2r x % intensity) + VO2rest 23. **How do you calculate METs?** VO2 divided by 3.5 since 1 MET = 3.5 ml/kg/min 24. **What is the general exercise prescription for strength in adults** Novice: 2 -- 3d/week 2 -- 4 sets 60 -- 70% 1RM (8 -- 12 reps) Intermediate: 3 (full body) or 4 (split) x/week 3 -- 4 sets 60 -- 80% 1RM (8 -- 12 reps) Advanced: 4 -- 6 x/week (split) 8 or less sets Cycle loads up to 80 -- 100% 1RM 25. **What is the general exercise prescription for strength in older adults?** 2 -- 3x/week 1 -- 4 sets 40 -- 70% 1RM (8 -- 12 reps) 26. **What's the general exercise prescription for strength in youth?** 2 -- 3x/week 1 -- 3 sets 6 -- 15 reps 27. **What's the general exercise prescription for power in adults?** Novice 2 -- 3 x/week 1 -- 3 sets 3 -- 6 reps at 30 -- 60% 1RM (UE) or 0 -60% 1RM for lower body Intermediate 3 (full body) or 4 (split) x/week 1 -- 3 sets 3 -- 6 reps at 30 -- 60% 1RM (UE) or 0 -60% 1RM for lower body Advanced 4 -- 6 (split) x/week 3 -- 6 sets 85 -- 100 % 1RM 28. **What's the general exercise prescription for power in older adults?** 2 -- 3x/week 1 -- 3 sets 6 -- 10 reps at 30 -- 60% 1RM 29. **What's the general exercise prescription for power in youth?** 2 -- 3x/week 1 -- 3 sets 3 -- 6 reps 30. **What's the general exercise prescription for local muscular endurance in adults?** Novice 2 -- 3x/week 1 -- 2 sets 15 -- 20 reps Intermediate: 3 full body or 4 split x/week 1 -- 2 sets 15 -- 20 reps Advanced 4 -- 6 split x/week 3 -- 6 sets 10 -- 25 reps 31. **What's the general exercise prescription for local muscular endurance in older adults?** 2 -- 3 x/week 1 -- 3 sets 10 -- 15 reps 32. **What are the primary and secondary variables in resistance training?** Primary: frequency, intensity, number of sets Secondary: muscle action, rest periods, tempo, type, exercise order 33. **What's the recommendation for muscle action in resistance training?** Concentric, eccentric and isometric muscle action should be included for clients of all experience levels 34. **What's the rest period recommendation for strength and power?** 48 -- 72h between sessions Core and multijoint exercises: 2 -- 3 min or more between sets 1 -- 2 min between sets for other exercises 35. **What's the rest period recommendation for local muscular endurance?** 1 -- 2 min for high reps (15 -- 20 reps) Less than 1 min for moderate sets (10 -- 15 reps) Circuit training: time needed to get to next station 36. **What's the recommendation for tempo in strength and power?** Novice: 2:4 and 1:2 Intermediate: 1: 2 37. **What's the recommendation for tempo in local muscular endurance?** Slow velocities for 10 -- 15 reps Moderate to fast velocities above 15 reps 38. **Which type of exercise is linked to the rate of force development?** Isometric training 39. **What should be the exercise order for resistance training?** Large muscles before small Multi joint before single joint High intensity before low intensity Alternate upper and lower body or agonist and antagonist 40. **Why would someone be given flexibility to maintain or increase range of motion following an acute injury or in a painful irritable condition?** Promote circulation and remove swelling Maintain functional range of motion and soft tissue mobility Maintain joint health Promote tissue remodeling 41. **What factors should you consider if you're giving someone with an acute condition flexibility?** Phase of healing Inflammatory and early proliferative: no tissue stress Late proliferative phase: gentle tissue stress Remodeling phase: progressive tissue stress Patient's ability to move and contraindications Pain and irritability\ pain shouldn't increase by more than 2 points on 10 Pain should return to below baseline within 1- 2 hours 42. **How can flexibility help increase ROM of a hypomobile joint?** Increases functional range of motion by promoting gradual adaptive changes in periarticular tissues Maintains joint health 43. **What's the absolute minimum number of times a week to do stretching to see a long term change in a hypomobile joint?** 2x/week 44. **How can flexibility help increase a short muscle** Increases muscle fiber length and adaptations in myofascia 45. **TRUE OR FALSE: STRETCHING CAN LEAD TO PAIN AND SORENESS THE NEXT FEW DAYS** FALSE IT SHOULD NEVER DO THAT 46. **What's the length of a typical health related fitness program\>** Warm up: 5 -- 10 min of light to mod intensity Conditioning: 20 -- 60 min of aerobic, resistance Cool down: 5 -- 10 min of light to mod Stretching: at least 10 min REVIEW OF EXERCISE TESTING 1. **What are the four major components of physical fitness testing?** Body composition Flexibility Muscular fitness Cardiorespiratory endurance 2. **What is excess body fat associated with?** Hypertension Metabolic syndrome Type 2 diabetes Stroke Cardiovascular disease dyslipidemia 3. **What's the body fat composition norm?** Men: 10 -- 22% Women: 20 -- 32% 4. **What are the ways to test body composition?** Anthropometric method: BMI Body circumference Skinfold measurements Densitometry Body volume 5. **What are the ways to measure flexibility?** ROM Sit and reach test 6. **What does flexibility depend on?** Joint capsule Muscle Ligaments tendons 7. **How do you test strength?** 1RM 10 -- 15RM (recommended for patients at high risk or has health conditions) Isometric or isokinetic strength tests 8. **How do you determine 1RM?** Warm up with submax repetitions Determine the 1RM within 4 trials with rest periods of 3 -- 5 min between trials Select an initial weight that's within the person's perceived capacity Progressively increase resistance by 5.5 -- 44 lbs until the person can't complete the repetitions 9. **What are ways to test endurance?** Crunch test Pushup test 10. **What is VO2max? What's it dependent on?** Maximum amount of oxygen an individual can consume Body's ability to deliver, extract and use the oxygen 11. **What's VO2peak?** Maximum oxygen an individual can use in one minute per kilogram of body weight (mL/kg/min) at peak exercise Used in individual's with impaired function 12. **What's the criteria for achieving a true VO2max?** No increase in oxygen consumption with increasing workload This means that the person is now relying on anaerobic metabolism to meet the higher energy demand to do the work HR is 10 beats or less/min of the age predicted maximum Respiratory exchange ratio is greater than 1.10 Peak post exercise blood lactate concentration is 8 mM or higher RPE is 9/10 or 17 or higher /20 13. **What's the Fick equation?** Used to determine the rate that oxygen is being used during physical activity 14. **What's the gold standard for maximal aerobic capacity?** CPET 15. **What are the indications for cardiopulmonary exercise testing?** Differential diagnosis Measuring impairment for disability evaluation Evaluation of occupational health Rehabilitation Assessing pre-operative risk Grading severity and prognosis in cardiopulmonary disease Assess effectiveness of therapy or progression of a disease Assess functional capacity before discharge 16. **What are the pros and cons of using a treadmill for maximal exercise testing?** Pros: Natural activity Familiar with exercise Can increase speed or incline Cons: Work rate hard to quantify if they hold on to handrail Risk of loss of balance or injury Difficult to get blood sample and blood pressure 17. **What are the pros and cons of using a cycle ergometer for maximal exercise testing?** Pros: Safety Ability to vary the work rate Minimal movement artifact on ECGs Easy to get blood sample and blood pressure Body weight is supported Cons: Lack of familiarity Uncomfy seat 18. **What's the difference in clinical values between treadmill and cycle ergometer testing?** Treadmill: VO2 peak is 10% higher and O2 saturation is lower 19. **What are the absolute contraindications for maximal exercise testing?** Recent ischemia, myocardial infarction within 2 days or other acute cardiac event Unstable angina Uncontrolled cardiac dysrhythmias Symptomatic severe aortic stenosis Uncontrolled symptomatic heart failure Acute pulmonary embolus or pulmonary infarction Acute myocarditis or pericarditis Suspected or known dissecting aneurysm Acute systemic infection 20. **What are the relative contraindications to a maximal exercise testing?** Main coronary artery stenosis Moderate stenotic valvular heart disease Electrolyte abnormalities Severe hypertension (over 200/110) Tachydysrhythmia or bradydysrhythmia Hypertrophic cardiomyopathy Neuromotor, musculoskeletal or rheumatoid disorders which are made worse with exercise 2^nd^ or 3^rd^ degree AV block Ventricular aneurysm Uncontrolled metabolic disease Chronic infectious disease Mental or physical impairment 21. **What are the indications to stop an exercise test?** Onset of angina or angina like symptoms Drop in SBP of 10 or more mmHg with an increase in work rate or if SBP decreases below the value obtained in the same position before testing Excessive rise in blood pressure (250/115) Shortness of breath, wheezing, leg cramps or claudication Signs of poor perfusion: light headedness, confusion, ataxia, pallor, cyanosis, nausea or cold and clammy skin Failure of heart rate to increase despite increase in exercise intensity Noticeable change in heart rhythm Subject wants to stop Failure of testing equipment Physical or verbal manifestation of severe fatigue 22. **Other than CPET for aerobic exercise tests, what else can you use?** Field walking tests or submaximal tests 23. **What does a comprehensive health assessment include?** Pre screening Resting heart rate, blood pressure, height, weight, BMI, Body composition Cardiorespiratory fitness Muscular strength Muscular endurance flexibility 24. **What are examples of functional tests?** Step test Sit to stand Timed up and go 25. **What are examples of submax tests?** 6 minute walk test Incremental shuttle walk test Step and stair climbing test Endurance shuttle walk test PRE-EXERCISE EVALUATION 1. **When should informed consent be collected** Before collecting any personal and confidential information Before any fitness testing Before exercise participation 2. **What composes informed consent?** Purpose and explanation of the test Risks and discomfort Responsibilities of the participant Benefits Inquiries Use of medical records Freedom of consent 3. **What is the ACSM preparticipation health screening?** Identifies people who are at risk for adverse exercise related cardiovascular events Tells you which people need medical clearance Algorithm is based on current level of exercise participation, presence of signs and symptoms and or known disease and anticipated or desired exercise intensity 4. **What are cardiovascular disease risk factors?** Age Family history Cigarette smoking Physical inactivity Body mass index and waist circumference Blood pressure Lipids Blood glucose 5. **When should the PAR-Q+ be used?** In the absence of professional assistance 6. **Who can clear you for exercise?** Any healthcare professional who has knowledge and expertise in exercise BEHAVIOURAL THEORIES 1. **Is providing knowledge and promoting awareness of exercise prescription enough to produce behaviour change?** no 2. **What are non-modifiable factors that correlates to who may engage in regular exercise?** Age Gender Socioeconomic status Education ethnicity 3. **What do behavioural theories focus on?** Modifiable factors like FITT Self-efficacy Motivation knowledge 4. **Behavioural theories are used to...** Enhance exercise adoption and maintenance 5. **Regarding the FITT principle, how can flexibility help with adherence?** Frequency and time: You allow the individual to self-select their frequency and time Intensity: Individuals with more exercise experience are better suited for a higher intensity program and less experienced may be better suited for a moderate intensity program Type: studies show greater adherence to home based programs 6. **What is self-efficacy?** One's belief in his or her capability to successfully complete an action 7. **What's the SMARTS principle?** Specific Measurable Action oriented Realstic Timely Self determined 8. **What other strategies can help with adherence?** Positive reinforcement Social support Self monitoring Problem solving Identify barriers and brainstorm ways to overcome Relapse prevention 9. **What are the types of behavioural theories?** Social cognitive theory Transtheoretical model Health belief model Self determination theory Theory of planned behaviour Social ecological models 10. **What is the transtheoretical model?** Most popular approach for promoting exercise Recognizes that individuals are at different stages of readiness to make a behavioural change which requires individual interventions 11. **What are the stages of the transtheoretical model?** Precontemplation No interest in change Cons outweight the pros and self efficacy is low Contemplation Thinking about changing Pros outweight the cons and self efficacy is increasing Preparation Pros outweigh the cons by a lot and self efficacy is increasing Action Pros outweigh the cons by a lot and self efficacy is high maintenance 12. **What is brief counseling and motivational interviewing?** Can be based on any behaviour theory Person centered method of communication where the professional and client work together 13. **How is the professional's approach in motivational interviewing?** Non judgemental, empathetic and encouraging Help the individuals realize what motivators they have that can lead to positive change through open ended questions, empathetic responses and reflective listening skills 14. **What topics does motivational interviewing explore** Why people aren't active 15. EXERCISE TESTING AND PRESCRIPTION FOR INDIVIDUALS WITH COPD 1. **Why do people with COPD have bad balance?** Because the lack of oxygen to their muscles causes skeletal muscle dysfunction causing weaker muscles and an increased risk of loss of balance 2. **What is pulmonary rehabilitation?** Intervention based on patient assessment followed by patient therapies including Exercise Education Behaviour change Meant to improve the physical and psychological condition of people with a chronic respiratory disease and to promote long term adherence 3. **What are the steps of management of COPD in relation to disease severity?** Self management education and smoking cessation Short acting bronchodilators Long acting bronchodilators Pulmonary rehab Inhaled corticosteroids Oxygen surgery 4. **Is pulmonary rehabilitation available in Canada?** Barely. Only 0.4% of Canadians with COPD And there are waitlists of 7 weeks, 12 weeks 5. **At a minimum, pulmonary rehab assessment should include?** Exercise capacity (CPET, walk tests) Health related quality of life Dyspnea (MRC, borg scale) Can also include Physical activity level Self efficacy ADL Balance Nutritional status Anxiety and depression 6. **Why should you measure fitness?** Quantify the impact of the disease Gives us baseline to perform ADLs Predictor of survival Prescribe exercise program Look for comorbid conditions Evaluate an intervention 7. **What's the gold standard of exercise testing?** Cardiopulmonary exercise testing 8. **What are some lab based values that you can get from exercise testing?** Peak rate of oxygen uptake Heart rate Minute ventilation SpO2 Respiratory frequency Dynamic hyperinflation Breathing pattern Lactate threshold 9. **What are the advantages and disadvantages of lab based tests (CPETs)?** Pros: very informative, identify cause of limitation, precise Cons: expensive, complicated and time consuming, low clinical usefulness 10. **What are field based tests used for?** Developed to use instead of lab based testing To evaluate functional capacity To monitor treatment effictiveness To establish prognosis 11. **What are the pros and cons of field based tests?** Pros: inexpensive, minimal equipment needed, easy to administer, easy to interpret, meaningful to patient Cons: limited information 12. **What are the common field based tests in pulmonary rehab?** Six minute walk test Incremental shuttle walk test Endurance shuttle walk test 13. **What are the characteristics of the 6-minute walk test and describe the test?** Administered in an indoor unpopulated corridor Instructed to cover as much ground as possible in 6 minutes Allowed to rest Clear, concise and specific instructions Avoid walking with patients cause that sets the pace 2 practice walks required for learning effect Give standardized encouragement Use the same track layout 14. **What are the outcomes of the 6 minute walk test?** Distance walked Number and duration of rests Modified Borg rating of dyspnea and leg fatigue Heart rate Oxygen saturation 15. **What's the interpretability of the 6MWT?** Minimal important difference = 30m for people with respiratory disease 16. **How does SPO2, heart rate and oxygen uptake compare between field based and lab based exercise testing?** The 6MWT, incremental shuttle walk test and endurance shuttle walk test all require similar cardiac and oxidative demands to the cycle ergometer test and can therefore be used for prescribing exercise intensity 17. **Which tests are more sensitive for detecting oxygen desaturation?** Functional tests 18. **How does low intensity vs high intensity training compare in terms of benefits?** Lower limb exercise training at a higher intensity produces greater physiological benefits than lower intensity 19. **What is a general rule for training intensity in COPD?** Aim for training intensities that exceed 60% of an individual's peak work rate Or a borg dyspnea/fatigue score of 4 -- 6/10 or an RPE of 12 - 14 20. **What are the most common modalities of lower limb endurance training?** Walking Cycling 21. **How do we set initial training intensities that comply with current guidelines?** It is recommended that initial training intensities be based on the results of the exercise tests 22. **What is the most common test to measure exercise capacity before initiating exercise in Canada?** 6 minute walk test 23. **How can we use the 6MWT to prescribe walking based training intensity?** Prescribe initial walking based training intensities as a % of the average walking speed achieved during the 6MWT 24. **How can we use the results of an incremental cycle ergometry test to prescribe cycle based training intensity?** 60% of maximum work rate achieved during incremental cycle ergometry test 25. **Can you use a 6MWT to prescribe a cycle based training program intensity?** Yes there's an equation 26. ELDERLY, FRAILTY AND EXERCISE 1. **What does the impact of chronic diseases and conditions affect?** ADLs Reduced quality of life Increased mortality risk 2. **Define frailty** State of vulnerability arising of many bodily functions which result in failure to maintain homeostasis and causes vulnerability to intervening acute stressors A medical condition that includes reduced function and health 3. **What can frailty be associated with?** Inactivity Poor nutrition Social isolation polypharmacy 4. **How is frailty dangerous?** Reduces person's ability to cope with minor illnesses Minor stressors can make the person deteriorate quickly 5. **What are the characteristics of frailty?** Loss of muscle mass and strength (sarcopenia) Decreased mobility and less endurance Slower walking speed and movements Reduced activity level Unintentional weight loss of 10 lbs or more within one year fatigue 6. **What are the associated risks with frailty?** Falls Memory loss Autonomy loss Functional decline General weakness Frequent hospitalizations Loneliness and depression Increased mortality 7. **What's the frailty 5 checklist?** Feelings Flow Function and falls "farmacy" Future and family 8. **How do you prevent frailty?** Early detection is key Regular exercise Good nutrition Vitamin D Medication check up Social network 9. **TRUE OR FALSE: FRAILTY IS AN INEVITABLE PART OF AGING** FALSE 10. **What's the fried frailty phenotype?** Assesses physical frailty through 5 criteria: Unintentional weight loss Weakness or poor handgrip strength Self reported exhaustion Slow walking speed Low physical activity Score of 3 -- 5 is defined as frail. 1 -- 2 is prefrail. 0 is non frail 11. **How can you assess frailty other than a questionnaire?** Short physical performance battery 12. **What is sarcopenia?** Loss of skeletal muscle mass Loss of function Frailty and sarcopenia overlap 13. **What are the risks of sarcopenia?** Falls Fractures Functional dependence Longer hospital stays and need for home care Earlier death 14. **How can you prevent sarcopenia?** Resistance training Sustained exercise that raises your heart rate (aerobic and endurance) walking 15. **How does resistance training prevent sarcopenia?** muscle fiber tension results in growth signals that lead to increased strength. It increases actions of growth promoting hormones signals cause muscle cells to grow and repair themselves by making new proteins and activating satellite cells Resistance training is the most direct way to increase muscle mass and prevent loss 16. **How does walking prevent sarcopenia?** Increases muscle mass 17. **What is osteoporosis and its risks?** Bone mineral is gradually lost Bone becomes weaker and more prone to fractures Fractures most commonly at: hip, spine, wrist, shoulder 18. **Osteoporosis fractures are called...** Fragility fractures Occur spontaneously or easily while reaching, bending, twisting, coughing or sneezing or during a minor injury like a fall from a standing height or less at walking speed or slower 19. **What can increase the risk of osteoporosis and or fall risk?** Medications like Blood pressure Diuretics Synthetic glucorticoids Prostate or breast cancer drugs Heartburn drugs Narcotics Medical conditions like COPD Diabetes Chronic liver disease Chronic kidney disease Malabsorption syndromes Neurological disorders Untreated hyperthyroidism 20. **How does exercise help osteoporosis?** Weight bearing aerobic exercises Must reach an intensity that produces an important ground reaction force Strength and resistance exercises Must be a higher force than what's done day to day Only increases muscle mass and bone mineral density in the regions worked Multicomponent exercises Combo of Aerobics, strengthening, balance, dance Whole body vibration 21. **Does walking improve bone mass?** Not really, but it can limit loss 22. **What is the most effective intervention for bone mineral density at the spine?** multicomponent 23. **What is whole body vibration exercise?** Individual stands, sits or lies on a machine with a vibrating platform When the machine vibrates, it transmits energy to the body which will stimulate the muscles to contract and relax dozens of times each second This can reduce back pain, reduce bone loss and improve strength and balance in older adults 24. **Which tools can be used to identify people at risk of falling?** Fall risk assessment tool Berg balance scale Timed up and go 25. **Evidence shows that preventing falls requires interventions that target..** More than one risk factor 26. **What is the otago exercise program?** Effective individually or in groups 52 week home based program Warm up 5 minutes Strength and balance training 30 minutes Walking training 10 min 27. **Who is the Otago exercise program most effective for?** 80 year and older living in the community History of falls in the previous year with or without walking aid Who suffer from moderate to severe decreased strength and balance caused by osteoarthritis, deconditioning and inactivity No significant cognitive impairment 28. **The otago exercise program is proven to...** Decrease falls Help reduce mortality risk 29. **What are the general benefits of exercise for the elderly?** improved brain function improved sleep quality improved mobility flexibility and balance improved cardiovascular health improved muscle mass improved bone density improved immune system and resistance to chronic illness mental health 30. **Why the need to exercise?** Weight loss Reduced stress Restoring bone mass Reduce risk of chronic disease such as Stroke Diabetes High blood pressure 31. **What's the difference between dementia and delirium?** Dementia is a gradual neurodegenerative process, more persistent and with chronic progression Delirium is normally an acute confusion, usually has an abrupt onset, fluctuates and develops over days to weeks They have different prognosis and management but they can often co-exist, it's just hard to differentiate the two especially in patients without a prior history of dementia 32. **What is altered mental status related to?** Dementia Delirium depression 33. **What is delirium? What's the tool to diagnose?** Change from patient's baseline mental status Confusion assessment method (CAM) 3D-CAM 34. **What are the 4 main features of the CAM?** Acute onset Fluctuating course of symptoms Inattention Disorganized thinking or altered mentation 35. **What's the 3D-CAM?** Provides a brief assessment on: 3 orientation items 4 attention items 3 symptom probes 10 observational items 36. **What are the possible causes of delirium?** Medication side effects or interactions Medical condition like stroke, heart attack or worsening of lung or liver disease Post fall injury Imbalance in the body like low sodium or low calcium UTI, pneumonia, flu, CVODI Exposure to a toxin like carbon monoxide Poor nutrition or loss of too much body fluid Pain Lack of sleep or severe emotional distress Surgery Alcohol or drug use withdrawal 37. **What is dementia?** General term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with life 38. **What's the most common cause of dementia?** Alzheimer's 39. **What are the types of dementia** Alzheimer's Vascular Lewy body Frontotemporal Mixed dementia 40. **What is the mini mental state examination?** Used to screen for cognitive impairment in older adults and estimate the severity and follow the course of cognitive changes in an individual over time Assesses different cognitive status Attention Language Memory Orientation Visuospatial proficiency 41. **What's the scoring for the mini mental state exam?** Severe: 0 -- 17 Mild: 18 -- 23 No cognitive impairment: 24 - 30 42. **Prior to assessing and treating patients, you should determine their ability to...** Answer questions Follow commands Learn and progress Retain information Determine best time for sessions 43. **If there is a cognitive impairment, what would be things you can do?** Involve family members if needed Inform staff of any changes in behaviour or mental status 44. **What is the short physical performance battery?** Used to assess functional mobility Looks at balance, lower limb strength, functional capacity in older adults above 65 years old 3 different domains: walking, sit to stand, balance Around 10 min to administer Score 0 - 12 45. **What are the items of the short physical performance battery?** Balance Side by side stand Semi tandem stand Tandem stand Gait speed Chair stand test in 1 minute 46. PREHABILITATION PROGRAM 1. **What elements should you look at prior to surgery?** Physical and functional status Nutritional status Mental status Poor life style Uncontrolled medical condition 2. **What is prehabilitation?** Process that occurs between the time of diagnosis and the beginning of acute treatment and includes physical, metabolic and psychological assessments to establish a functional baseline, identify impairments and provide interventions that promote physiological and psychological health to reduce incidence and severity of future impairments 3. **What's the idea behind prehab?** Increase physiological reserve to overcome the stress of surgery and accelerate recovery 4. **What's the screening for individuals who can benefit from prehab?** 6MWT under 40m or gait speed under 0.8 m/s 5. **SKIPPED SLIDE 14** 6. **What is involved in the assessment for prehab?** Body composition Physical and functional capacity Self reported questionnaires Blood work 7. **What is a normal FFMI for males? Females?** Males: 17 k/m2, females 15kh/m2 8. **What's the purpose of grip strength and how is the test administered?** To test isometric strength of hand and forearm Elbow 90 degrees flexed, pt seated, inhale before then exhale as you're squeezing dynamometer 9. **What's the purpose of the arm curl test and how is the test administered?** Measures upper body strength 30 seconds do as many curls 10. **What's the purpose of the sit to stand test and how is it administered?** To assess lower body strength Chair against wall Cross arms on chest 30 seconds sit to stand as many as you can 11. **What's the purpose of the timed up and go and how Is it administered? What's the interpretation?** To assess mobility, balance and locomotor performance Time starts when I say go and stops when you sit Less than 10s completely independent Less than 20s independent for main transfers Less than 30s requires assistance in most activities 12. **What's the purpose of the one leg stance and how is it administered?** To assess balance Barefoot hands crossed on shoulders stand on one leg focus on point in front time starts when patient lifts foot maximum 45 seconds Stop time when arms are moved, raised foot touches floor or moves towards or away from other limb, weight bearing foot is moved to keep balance If patient loses balance in first 3 seconds allow second try 13. **What's the purpose of the 6mwt? What happens if 6MWT is under 400m?** Measures functional capacity, endurance, fatigue and cardiovascular fitness If under 400 perform CPET 14. **What's the FITT principle for prehab patients?** Aerobic: Frequency: what the patient is comfortable with but everyday is recommended Intensity: 5 -- 6/10 Time: 30min/d minimum Resistance: Frequency: every other day 3 -- 4 d/week Intensity: 5 -- 6/10 Time: 1 -- 2 sets, 8 -- 10 exercises 15. **What is the exercise prescription for cancer patients?** Cardio or resistance training Inspiratory muscle training Balance Gait training Functional exercises 16. **What's the exercise prescription for non cancer patients?** General conditioning Resistance training Lifestyle modification 17. **Why should you prep your muscles via exercise and nutrition?** Because this gives you reserve A patient with very little muscle reserve has a lower threshold for a critical catabolic response like surgery 18. **What is malnutrition?** Unbalanced nutritional state resulting from poor food intake and or disease that alters mass/composition and diminishes function 19. **How does malnutrition increase the risk of morbidity and mortality?** Increases hospital stay Increases health care utilization Increases incidence of toxicity to oncology treatment Increases frequent interruption of treatments and inability to complete a scheduled treatment Decreases patient's quality of life 20. **How does exercise and nutrition help muscle growth?** Exercise is the main anabolic stimulus Amino acids potentiate the synergistic effect 21. **What are the goals of preop?** Systematic screening for surgical patients Risk stratification Optimizing nutrition, exercise, psychological interventinos Teaching 22. TELEREHABILITATION 1. **What's digital health?** Umbrella term for application of technology in the context of health 2. **What is electronic health?** Use of information and communication technology to support health related fields 3. **What is telehealth and telemedicine?** Using of electronic communications and information tehcnologies to remotely provide health care services Telehealth: services of all health care professionals and can include non clinical services Telemedicine: specifically to clinical services 4. **What is telerehabilitation?** Branch of telemedicine and can be defined as the remote provision of rehab services via telecommunication technologies 5. **What's the rationale for telerehab?** Waiting lists for rehab 6. **What's the role of telerehab?** Overcomes traditional barriers to participation like seasonal or geographical constraints Makes it more accessible 7. **What's the evidence of telerehab in chronic respiratory diseases?** Safe Produces similar results to inperson rehab People more likely to complete telerehab vs traditional rehab 8. **What are the most common conditions in telerehab?** Musculoskeletal Cardiac neurological 9. **What's the delivery of telerehab\>** Synchronous/asynchronous Zoom Hybrid Motion detection Recording of independent sessions Sensors or wearables 10. **What are the pros and cons of telerehab?** Pros More privacy At one's own pace and time No travel Higher patient independence Protect from illnesses Low cost Tailoring possible Cons Digital literacy Reimbursement Less face to face interaction Data safety and privacy Lack of legal principles Lack of social interaction 11. **What are considerations for telerehab?** Consent for recording or storing information Consent for participation of other health care providers Does insurance cover telerehab Have a safety protocol in case of an emergency 12. **What's the screening process for telerehab?** Exclude people with severe cognitive impairment Exclude people with acute or uncontrolled cardiac, musculoskeletal or neurological conditions If risk of falls is identified, second person should be present during virtual sessions and independent sessions and adapt exercise program to minimize risk 13. **What should be done during the first virtual session?** Review safety protocol and home environment Participant wears pulsox and take that each session You have their address and phone Patient has professionals phone number and told to call or email if adverse event 14. **Which exercises tests are feasible remotely?** Short physical performance battery Timed up and go 1min sit to stand 6MWT in a 10m course 15. **Which tests correlated most highly with the recommended exercise tests?** 1min sit to stand with 6MWT 4MGS with incremental shuttle walk and 6MWT 16. **What should you do in preparation for the session?** Give them instructions a couple days in advance so they can prepare the room for your exercise or testing Make them set up their camera in a place where you can see them properly Test out zoom at least one day in advance Ask if a family member is available for the day of the test 17. **TRUE OR FALSE: PHYSICAL FUNCTION TESTS MAY NOT BE USED TO PRESCRIBE EXERCISE IN TELEREHAB** TRUE 18. REHABILITATION IN INDIVIDUALS WITH LONG COVID 1. **TRUE OR FALSE: YOU CAN HAVE LINGERING SYMPTOMS OF COVID FOR WEEKS OR MONTHS FOLLOWING RECOVERY EVEN WITH MILD DISEASE?** TRUE 2. **What's the name for having mid to long term effects of covid?** Post COVID19 or long COVID 3. **What is the mechanism underlying those with long COVID?** Unique based on the tissues affected 4. **What are the characteristics of the symptoms in long covid?** Symptom onset and duration fluctuate and relapse and remit (episodic) except for fatigue which is constant Can fluctuate within the day or between weeks Symptoms may be new onset after initial recovery or persist from the initial illness Pre-existing conditions are exacerbated, especially conditions that affect similar target organs 5. **Define long covid** Conditions that occur in people with a history of COVID usually 3 months from the onset of COVID with symptoms that last for at least 2 months **(or 4 weeks according to another definition)** that cannot be explained by an alternative diagnosis common symptoms include fatigue, shortness of breath and cognitive function which impact everyday function 6. **What are the most common symptoms of long covid?** Fatigue Symptoms that get worse after physical or mental effort known as post exertional malaise Fever Shortness of breath Cough Chest pain Heart palpitations Difficulty thinking or concentrating (brain fog) Headache Sleep problems Dizziness Pins and needles Change in smell or taste Depression or anxiety Diarrhea Stomach pain Joint or muscle pain rash 7. **What are the diagnostic tests for long covid?** There aren't any 8. **What are the risk factors for long covid?** Female 40 -- 60 y.o Pre-existing chronic conditions Had a more severe COVID Hospitalized or ICU 9. **What's the hypothesized mechanism of long COVID pathogenesis?** Immune dysregulation Microbiota dysbiosis Autoimmunity and immune priming Blood clotting and endothelial abnormalities Dysfunctional neurological signalling 10. **What is the current long covid management?** Trying to manage the symptoms Rehab interdisciplinary care Medications for symptom relief 11. **Who qualifies for pulmonary rehab in long covid?** New or ongoing respiratory symptoms and functional limitations after recovery of original COVID And New or ongoing requirement for supplemental oxygen after initial recovery OR at least one of the following: Xray pulmonary abnormality after initial recovery Pulmonary function test demonstrates reduced capacity after initial recovery If they already had chronic lung disease, changes must be new or worse than baseline 12. **If one has cancer and long covid, what do you choose to treat?** cancer 13. **SLIDE 23???** 14. **What are the precautions needed in pulmonary rehab?** Myocarditis Acute deep vein thrombosis and pulmonary embolism 15. **Who does myocarditis occur in for covid patients and what are the implications?** should be considered in patients who had acute heart failure or coronary syndrome who do not have pre existing cardiovascular disease or risk factors Rehab should be delayed for at least 6 months, clinical reassessment will be needed to determine safety of exercise 16. **What are the implications for patients who had an acute deep vein thrombosis and pulmonary embolism?** Before physical activity, ensure patients are receiving anticoagulation Early ambulatory physical activity is safe Supervised exercise training at mod intensity can be considered after 4 weeks of anticoagulation 17. **What should you screen before initiating rehab in long covid and how do you screen that specific action if necessary?** Post exertional malaise Teach clients how to self monitor in the day and in the days after exercise Establish baseline symptoms pre exercise De paul questionnaire Cardiac impairment Teach clients how to self monitor for disproportionate breathlessness, tachycardia, palpitations. May need medical clearance. Stop exercise if client is in distress Readiness questionnaire (PARQ+) Oxygen desaturation Teach clients to self monitor for shortness of breath, accessory muscle use, Medical clearance may be needed Stop exercise if client Is in distress Use pulsox Dysautonomia May have lightheadedness, fainting, unstable blood pressure, abnormal heart rate in response to activity Medical clearance may be necessary Functional cognition and cognitive communication Voice and swallowing refer ear nose and throat specifialist Hearing and tinnitus refer to audiologist Psychological, social and spiritual considerations 18. **What is recommended exercoise for people with dysautonomia?** Recumbent, semi recumbent or horizontal exercise 19. **What are recommendations for rehab in long covid regarding organization and scheduling?** Use telerehab instead of clinic appointments Reduce number of appointments in a week Provide written summaries of treatments, recommendations Schedule consistent dates and times for appointments 20. **Specific to exercise, what are the recommendations for long covid?** Always screen for post exertional malaise before initiating the program but also before each session (how did they feel after last session) Individualized plan DO NOT PUSH THROUGH FATIGUE DO NOT USE GRADED EXERCISE PRESCRIPTION, go based on symptoms Teach energy conservation during exercise and after activities You may need to start with simple functional mobility exercises, seated exercises and flexibility You can do aerobic and strength exercises at a low-mod intensity 21. **What is WHO's pacing protocol?** Phase 1 RPE 0 -- 1 breathing, stretching, balance exercises, gentle walking Phase 2 RPE 2 -- 3 low intensity exercise walking, househould tasks Phase 3 RPE 4 -- 5 mod intensity exercise brisk walk, resistance exercise Phase 4 RPE 5 -- 7 high intensity exercise running, cycling, swimming, dancing Phase 5 RPE 8 -- 10 return to baseline regular activities and exercise 22. **What is the most commonly used physical performance measure for long covid?** 6MWT 23. **What education should be provided on long covid symptoms?** Respiratory care Manage breathlessness and cough Information on ambulatory and long term oxygen Information on tracheostomy care Fatigue management Sleep hygiene, pacing strategies, energy conservation Musculoskeletal problems: Manage muscle atrophy Manage neuropathy Nutritional management Swallow retraining and education on diet enrichment Psychological care Manage anxiety and depression PTSD information Delirium and cognitive impairment information Social issues Return to work 24. **What should you consider with return to work?** That it may be possible but at the risk of not participating in other life roles like familial obligations, household tasks and leisure activities 25. **What are some recommendations for return to work in long covid?** Flexible hours Rest accomodations Remote work Prolonged phased return Altered tasks (more time to complete) Reduce physical and cognitive workload Suitable workplace accomodations 26. **When should you consider a return to work with long covid?** Long term goal when they're functional at home 27. **Who is the one who manages long covid rehab?** The individual. It is a self management process 28. CANCER REHABILITATION: CONSIDERATIONS FOR PHYSIOTHERAPISTS 1. **What are the most common types of cancer?** Breast Prostate Lung colorectal 2. **What is cancer?** Rapid cell division and growth of abnormal cells Invasion of surrounding tissue and angiogenesis 3. **What are the types of cancer (not the region)** Solid tumours: named after a body part where it originates Hematological malignancies: affects blood, bone marrow and lymph node 4. **What are the steps to cancer metastasis?** Local invasion Intravasation Circulation and extravasation Proliferation angiogenesis 5. **What are the causes of cancer?** No single known cause 6. **What are the risk factors for cancer?** Age Family history Obesity Diet Sedentary lifestyle Tobacco and alcohol use Sunlight exposure Environmental substances Viral and bacterial infections immunosuppression 7. **What are the diagnostic tests and procedures for cancer?** Biopsy Endoscopy Imaging Blood tests 8. **How do you quantify or qualify cancer?** T: size of tumour (1 -- smallest, 4 -- largest) N: if cancer has extended to lymph nodes (0 -- less extension, 3 -- most extension) M: If cancer has metastasized (0 -- no metastases, 1 -- metastases present) 9. **What are the stages of cancer?** Stage 0 -- abnormal group of cells that aren't cancerous but could develop into cancer Stage 1 -- cancer relatively small and contained within organ Stage 2 -- cancer hasn't spread into surrounding tissue but tumor is larger than in stage 1 Stage 3 -- cancer is large and may have spread into surrounding tissues and lymph nodes Stage 4 -- cancer has spread through the blood or lymphatic system 10. **SKIPPED SLIDE 19** 11. **What are the clinical signs and symptoms of breast cancer?** Lump in breast Breast changes Nipples changes Nipple discharge 12. **What are the clinical signs and symptoms of prostate cancer?** Urinary changes Presence of blood or pain 13. **What are the clinical signs and symptoms of lung cancer?** Dyspnea and cough Hemoptysis and hoarseness Chest pain Recurring infections 14. **What are the clinical signs and symptoms of bone cancer?** Pain Pathologic fracture Spinal cord compression hypercalcemia 15. **What are the clinical signs and symptoms of brain cancer?** Headaches, seizures, nausea Sensory or motor changes Cognitive or behavioural changes Vision and speech changes Balance and coordination changes 16. **What are the the clinical signs and symptoms of metastasized lung cancer?** Often asymptomatic Respiratory symptoms 17. **What are the types of cancer treatment?** Surgery Chemotherapy Radiation Hormone immunotherapy 18. **What are the goals of cancer treatment?** Preventative Explorative Curative Reconstructive Control palliative 19. **What are the considerations which determine which treatment goal you are working toward?** Cancer type and stage Comorbidities Performance status Baseline function preferences 20. **What type of surgeries can be done for different types of cancer?** Surgical resection -- lung cancer or breast cancer Radical prostatectomy -- prostate cancer Surgical lymph node dissection Surgical reconstruction -- breast cancer Breast implant, reconstruction 21. **What are the surgical side effects for cancer?** Sore throat Pain Nausea vomiting Problems urinating Bleeding Wound infection Blood clots Gastrointestinal problems Lung problems Wound separation Nerve pain Nerve damage Swelling of limbs Scarring Shock Reaction to anesthetic 22. **What is chemotherapy?** Systemic therapy Cytotoxic drugs targeted at destroying cancer cells Neoadjuvant vs adjuvant vs stand alone???? Apoptosis occurs but health cells may also be affected 23. **What are the chemotherapy side effects?** Lower blood cell count Nausea vomiting Loss of appetite Skin sensitivity Peripheral neuropathy Cardiotoxicity Bone loss Brain fog 24. **What is radiation therapy?** Localized therapy with ionizing radiation DNA damage resulting in incomplete cell mitosis and cell apoptosis Can be external or internal 25. **What are radiation side effects?** Early on Skin reaction Inflammation Bone weakness Fatigue Later on Fibrosis Neuropathic and vascular damage lymphedema 26. **What is cancer related fatigue?** Persistent sense of physical emotional and or cognitive exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with function 27. **What are the potential mechanisms for cancer related fatigue?** Proinflammatory cytokines Hypothalamus-pituitary-adrenal axis dysregulation Circadian rhythm desynchronization Skeletal muscle wasting Anemia Malnutrition Psychological Physical inactivity 28. **What is chemotherapy induced peripheral neuropathy?** Injury or degeneration of peripheral nerve fibers caused by neurotoxic systemic therapy agents Symptoms start in fingers and toes and spread proximally in a glove stocking distirbution 29. **What is lymphedema?** Increased collection of lymphatic fluid (protein rich fluid) causing swelling 30. **What's the mechanism linking exercise to cancer prevention and treatment?** Exercise shown to reduce cancer incidence and inhibit tumour growth Through direct effect on tumor intrinsic factor Through whole body exercise effects Through alleviation of cancer related adverse effects Through improvement of anti cancer treatment efficacy Physical activity helps control reproductive hormones, metabolic hormones, inflammation and immune function which can all help with cancer prevention 31. **Should there be prehab for cancer?** Yes, they will have lower hospital length of stay and an improved VO2 and 6MWT 32. **Studies show what with fatigue and exercise?** Improved fatigue during and after cancer treatment with yoga and aerobic resistance and combined aerobic and resistance exercise 33. **SKIPPED SLIDE 55** 34. **Does exercise improve peripheral neuropathy?** Yes Reduces axonal degeneration Increases neurotrophic factors Anti inflammation Improves mitochondria and oxidative profile 35. **What are the effects of exercise on central nervous system?** Improves mitochondrial function, neurotrophic factors and changes in neurotransmitter systems and interoceptive brain system 36. **What are the effects of exercise on psychosocial processes?** Improves mood, anxiety and depression Increases social support Increases self-efficacy 37. **Is weight training with lymphedema or risk of lymphedema safe?** Yes, a study showed that women weight lifting intervention helped reduce the incidence of lymphedema 38. **What are the possible physiological mechanisms behind reduced lymphedema with weight training?** Lymph clearance, drainage Cardiac output, capillary density, capillary filtration and angiogenesis 39. **Should you exercise in people with advanced stage cancer?** Yes, can improve quality of life and improve fatigue 40. **What are the physiotherapy techniques that you can do in cancer?** Manual therapy Traction, mobs, manips Massage Soft tissue techniques Modalities Thermal Ultrasound Laser therapy e-stim education physical activity specialized techniques lymphedema acupuncture pelvic floor 41. CHRONIC KIDNEY DISEASE 1. **Is there a cure for end stage kidney disease?** No only dialysis or transplant 2. **What is chronic renal failure?** Structural kidney damage and progressively decreased kidney function 3. **TRUE OR FALSE, KIDNEY DISEASE CAN REMAIN STAGNANT** FALSE, TYPICALLY PROGRESSES TO END STAGE RENAL DISEASE 4. **What are the 5 stages of kidney disease?** Stage 1: GFR 90 and above normal or high functioning Stage 2: GFR 60 -- 89, mildly decreased function Stage 3A: GFR 40 -- 50 mild to mod decreased function Stage 3B: GFR 30 -- 44 mild to mod decreased function Stage 4: GFR 15 -- 29 severely decreased function Stage 5: GFR below 15 kidney failure 5. **What is glomerular filtration?** The first step in making urine The process where kidneys filter excess fluid and waste out of the blood and into the urine 6. **What are the causes of chronic kidney disease?** Diabetes (leading cause) High sugar levels in the blood can cause blood vessels to become narrow and clogged. If kidneys don't receive enough blood, they become damaged Hypertension, autoimmune diseases, chronic infection, congenital abnormalities 7. **What are characteristics of chronic kidney disease?** The progression to end stage varies The first years of the disease are silent 8. **How do you monitor the severity of chronic kidney disease?** Serum levels of blood urea nitrogen and creatinine 9. **What is creatinine?** Waste product that comes from normal wear of muscles 10. **What is the blood urea nitrogen test?** Test that measures the amount of urea nitrogen in the blood. The liver produces urea as a waste product of the digestion of protein 11. **What is uremia?** Inability to excrete substances from the blood Impairs function of other metabolic and organ systems Characterized by fatigue, nausea, malaise, anorexia and neurologic symptoms 12. **What's the medical management for chronic kidney disease?** Protein restriction until serum creatinine clearance Renal replacement therapy (dialysis or transplant) 13. **What are the 2 forms of dialysis?** Hemodialysis (most common) Process of fluid removal and clearance of excess toxic substances from the blood via a fistula in the arm Peritoneal dialysis Uses peritoneal membranes for ultrafiltration of fluids and clearance of toxic substances (placed in abdominal wall) 14. **What problems may occur with dialysis therapy?** Frailty Renal osteodystrophy Decreased growth Muscle weakness and cramping Peripheral neuropathy Hypertension Anemia Cardiovascular dysfunction Electrolyte imbalances and hormonal metabolic disorder 15. **What are some exercise testing considerations for chronic kidney disease?** Peak exercise capacity is very low Skeletal muscle fatigue limits exercise for most, not enough to stress the heart to see ECG changes THEREFORE LIMITING DIAGNOSTIC INFORMATION Most hemodialysis patients have abnormal resting ECGs because of electrolyte imbalance which may affect the interpretation of ischemia during exercise Results of an exercise test on one day may not apply to another day Blood pressure response may vary due to fluid status and antihypertensive therapy Standard tests of physical performance like gait speed, sit to stand, short physical performance battery and stairs are still recommended 16. **What are the exercise prescription considerations for chronic kidney disease with dialysis?** Train at very low level and progress gradually Exercise as soon as patient is stabilized on dialysis Following transplantation begin as soon as clinically appropriate (within 1 week) 17. **What type of exercise can you do on dialysis?** Interval Walking on non dialysis days Muscle strengthening prior to aerobic if very deconditioned Swimming (need special hygiene care) 18. **What should be the frequency of training on dialysis?** 4 -- 6 days/week (low intensity on dialysis day) Gradually increase duration of work intervals until they get to 30 min of continuous exercise 19. **How should you measure the intensity in chronic kidney disease?** RPE (because of abnormal HR response to exercise) between 12 - 16 20. **IS THERE ANY CONCERN WITH ISOKINETIC, HIGH INTENSITY ISOMETRIC AND HIGH RESISTANCE EXERCISES IN THIS POPULATION?** 21. **What's a good exercise goal for this population?** Maintenance of functioning especially since a lot of these patients will deteriorate over time 22. RHEUMATOID ARTHRITIS 1. **What is buoyancy? How is it relevant to exercise?** Upward force that works opposite to gravity Can be assistive, supportive (unloads joint) or provide resistance 2. **What is viscosity? How is it relevant to exercise?** Friction between molecules of liquid Provides resistance to exercise Related to speed of movement and area moving through water 3. **What is surface tension? How is it relevant to exercise?** Surface of a fluid = membrane under tension Tension can provide increased resistance for exercises 4. **What is hydrostatic pressure? How is it relevant to exercise?** Pressure exerted on immersed objects Increase in water density and depth of immersion will increase hydrostatic pressure Increased pressure may reduce or limit effusion and assist in venous return 5. **Why is temperature of water relevant?** Warm water helps ROM/flexibility, pain reduction, muscle relaxation Puts more demand on the cardiovascular system during aerobic exercise 6. **What are the target aerobic intensities in warm water?** Borg 11 -- 12 HR 7 -- 20 beats less than on land 50 -- 60% of max HR 7. **What pool equipment can be used for the following:** Flexibility: floating or buoyancy devices Cardiovascular: treadmill bike or arm ergometer Balance: pool noodles Strength: hand paddles 8. CARDIOVASCULAR REHABILITATION 1. **When are men diagnosed with heart diseases vs women?** Men about 10 years younger than women 2. **SKIPPED SLIDE 4** 3. **What does cardiac rehab aim to do?** Enhance or maintain cardiovascular health Prevent disease progression and recurrence of cardiac events Improve health related quality of life through individualized treatment program Reduce disability and cardiovascular risk factors Foster behaviour change Promote an active lifestyle 4. **What are the core components of cardiac rehab?** Patient assessment Nutrition counselling Weight management Blood pressure management Lipid management Diabetes management Tobacco cessation Psychosocial management Physical activity counselling Exercise training 5. **The final decisions concerning an individual patient must be made by who?** Health professional in consultation with patient and caregiver 6. **TRUE OR FALSE: YOU SHOULDN'T USE HOME BASED CARDIAC REHAB** FALSE, YOU CAN 7. **What are key recommendations for cardiac rehab?** Exercise prescription Aerobic, resistance, flexibility and balance Risk factor management Focus on controlling risk factors such as blood pressure, lipids, diabetes and smoking Education and psycosocial support Educate on lifestyle modification, mental health support and stress management Multidisciplinary approach Tea based approach including doctors, exercise physiologists, nurses, physical therapists, dietitians and menal health professionals Accessibility and referral Hybrid models to improve access Outcome monitoring Track outcomes to ensure program is working or adapt intervention 8. **What is the condition for an adult cardiovascular listing?** Inability to perform activity requiring 5 METs of energy expenditure 9. **UH-OH you don't have the patient's results of an exercise test..how can you determine their functional capacity?** From the applicant's limitations of activities of daily living described in the medical record or By the requirement for 3 or more hospitalizations during the last year to treat the cardiovascular condition Speaks to difficulty managing the condition and difficulty maintaining a job with frequent absences 10. **What should be included in the quantification of functional capacity for CV?** Aerobic capacity Muscle function 11. **What are contraindications to initiating an exercise program in CV?** Hypotension or hypertension at rest or during exercise Unstable cardiac disease Deteriorating symptoms Myocardial ischemia Severe and suboptimally treated pulmonary disease 12. **Should you do maximal exercise testing in CV?** Apparently so, preferably a stress test or CPET to see for any hemodynamic abnormalities 13. **What can you use for assessing functional capacity of CV?** Cardiopulmonary exercise test (CPET) Most expensive, least available, risk of adverse event Gives you the most details Exercise test Not as expensive as a CPET Estimation of aerobic capacity can differ by over 7mL/kg/min 6mwt Least expensive Not really used in CV 14. **What is the disability threshold in a CPET with gas analysis? Exercise test (without gas analysis)** CPET: 15mL/kg/min is a marker for disability assessment ET: 5 METs or 17.5 mL/kg/min 15. **What are the key metrics in CPETs with gas analysis?** Peak oxygen uptake to quantify aerobic capacity Monitors blood pressure, ECF, pulsox, exertion levels, angina and dyspnea 16. **What are the key metrics for exercise test (without gas analysis)?** Aerobic capacity is estimated based on peak workload May overestimate peak VO2 compared to the CPET 17. **What are the pros and cons of using a cycle ergometer for aerobic exercise testing?** Good for people with balance or orthopedic issues but results in 10-20% lower aerobic capacity than treadmill 18. **What are the exercise testing protocol choices?** Bruce: aggressive for disability assessments because of high speed and incline Ramping 19. **What does handrail use on a treadmill during exercise testing do?** Overestimates aerobic capacity 20. **What are the cutoff scores for the 6mwt?** 300m or under: poor prognosis 500m or higher: normal functional status 21. **What's the DASI?** Duke activity status index used to estimate aerobic capacity But high error margin for aerobic capacity 22. **What is crucial for accurate results of muscle function assessment?** Consistent posture Controlled speed Complete ROM Warm up 23. **What are key tests for integrated muscle performance assessments?** 30 second chair stand test Timed up and go 24. **How does cardiac rehab help aerobic capacity?** Increases capacity by 20 -- 30% 25. **What are the phases of cardiac rehab?** Phase 1 -- Acute or hospital phase Begins when patient is medically stable Phase 2 -- early outpatient or intensive monitoring phase Begins within days after discharge from hospital and lasts 6 -- 12 weeks Phase 3 -- training or maintenance phase Begins at end of phase 2 and extends indefinitely Patients exercise in larger groups Phase 4 -- Disease prevention program Individuals who are at high risk for infarction or people who wish to be followed by supervision of trained personnel 26. **What is the FITT framework for CV?** F: 3x/week 4 -- 6 d/week, or multiple short 10 -- 15 minute bouts I: warm up 5 -- 10 min low intensity aerobic exercise 27. FIBROMYALGIA 1. **What is fibromyalgia?** Generalized widespread pain 2:1 women to men Can develop at any age Influenced by biological, psychological and social factors 2. **What are common comorbidities of fibromyalgia?** Headache Dysmenorrhea TMH Chronic fatigue Irritable bowel syndrome Painful bladder syndrome Endometriosis Back and neck pain 3. **What is the etiology of fibromyalgia?** Central sensitization Decreased pain thresholds Changes in brain activation patterns Genetic factors (makes up 50% of explanation) Environmental stressors Infections, trauma, psychological stress Pyschological factors: depression, anxiety, PTSD, catastrophizing, fear 4. **What's the diagnostic criteria for fibromyalgia?** Diffuse, multifocal pain persisting longer than 3 months and not explained by other conditions Fatigue, memory problems, sleep problems, digestive problems, depression and or headache 5. **How many tender points does fibromyalgia have?** 18 6. **What's the management of fibromyalgia?** Exercise is effective Medications Cognitive behavioural therapy 7. **What are the FITT recommendations for fibromyalgia?** aerobic: 1 -- 3d/week, 30 -- 59% HRR, 30 -- 60 min Resistance: 2 -- 3d/week, 40 -- 80% 1RM, 4 -- 20 reps, 1 to 4 sets Flexibility: 2 -- 3 d/week, hold 10 -- 30s 8. **What are barriers to exercise adherence in fibromyalgia?** Poor understanding of condition and role of exercise Increased sensitivity to physical activity Poor strategies for engaging in physical activity Catastrophizing exercise and increased threat associated with movement 9. **In fibromyalgia, can you apply no pain no gain** Absolutely not Let pain be your guide rather 10. **What are strategies for overcoming barriers?** Pain education Graded activity Cognitive behavioural interventions 11. **How should you use the FITT parameters with fibromyalgia?** A discharge goal rather than parameters for initial exercise prescription 12. ALZHEIMER'S 1. **How does exercise help in alzheimer's?** Exercise is a modulator for inflammation Inflammation plays a role in alzheimer's Aerobic exercise can therefore improve outcomes of people with alzheimer's 2. **What are the 10 warning signs that physios and family members need to be aware of to help with the early diagnosis of Alzheimer's disease?** Memory changes that disrupt daily life Challenges in planning or solving problems Difficulty completing familiar tasks at home at work or at leisure Confusion with time or place Trouble understanding visual images and spatial relationships New problems with words in speaking or writing Misplacing things and losing the ability to retrace steps Decreased or poor judgement Withdrawal from work or social activities Changes in mood and personality 3. **What is the mechanism for how exercise may be associated with improved cognitive outcomes in persons with alzheimer's** Increases neurogenesis Decreases cardiovascular risk factors Decreases inflammation Decreases oxidative stress 4. **What are the most common types of dementia and what are the typical earliest symptoms and the associated screening?** Alzheimer's disease: memory and learning, screen with MoCA or MMSE Parkinson's dementia: perceptual motor function, screen with trailmaking test Vascular dementia: Apathy, executive function, screen with Stroop test Lewy body dementia: Complex attention, executive function, screen with trailmaking and Stroop 5. **What's the best way to assess effort in Alzheimer's?** Heart rate because if we did a BORG it may not be reliable REHABILITATION IN SOLID ORGAN TRANSPLANTATION 1. **Which organs can be transplanted?** Heart Lungs Pancreas Liver kidneys 2. **What's the treatment option for patients with end stage organ failure?** Solid organ transplant 3. **What's the most common transplant?** kidney 4. **What challenges are presented with solid organ transplant?** Surgery complications Infection rejection 5. **What are long term impairments of solid organ transplant?** Reduced exercise capacity Decreased muscle strength Increased cardiovascular risk But exercise can help 6. **What Is the exercise limitation before transplant in each of the following?** **Lung:** ventilatory limitation, oxygen desaturation, dyspnea **Liver:** glucose regulation and glycogen storage, cognitive impairments (encephalopathy) **Heart:** left ventricular function, endothelial function **Kidney:** vascular function, electrolyte imbalance, diabetes, hypertension 7. **What's the predominant pre transplant factor limiting exercise?** Function of the heart and lung in thoracic organ transplantation Indirect effects of severe chronic disease for kidney and liver transplantation For all organ groups 8. **Why is pre transplant exercise capacity important?** Because it influences success of transplant People can be taken off the list if they have a limited exercise capacity Exercise capacity is associated with mortality 9. **What's the impact of frailty pre transplant? Post transplant?** Increased risk of delisting or death Post transplant: delayed organ function, early hospital readmission, mortality 10. **What is allograft dysfunction?** Organ rejection 11. **What are the factors limiting exercise capacity post transplant?** Peripheral muscle dysfunction From meds From deconditioning From severe illness Indirect effects of chronic disease may be carried forward after transplant like Anemia Diabetes Cognitive impairment neuropathy 12. **Transplant patients are \_\_\_x more likely to be readmitted to acute hospital compared to other inpatient rehab populations?** 10x more likely 13. **What predicts discharge destination?** Age Pretansplant mechanical ventilation Total length of hospital stay 6MWT prior to transplant 14. **What secondary effects of transplant in the following:** **Skeletal muscle:** loss of muscle mass, muscle weakness or muscle fatigue **Bone: o**steopenia osteoporosis or increased risk of fracture **Cardiovascular:** cardiovascular deconditioning, hypertension **Endocrine/metabolic:** diabetes or weight gain 15. **What are the effects of exercise training in the following:** **Skeletal muscle**: increased muscle mass, strength and endurance **Bone**: increased bone density and strength, increased balance and decreased risk of falls **Cardiovascular**: increased aerobic capacity and decreased blood pressure **Endocrine/metabolic**: increased glucose tolerance, improved body composition and increased fat free mass 16. **What is the recommendation for exercise in solid organ transplant patients pre transplant?** Aerobic training or combined aerobic and resistance Inpatient or outpatient Mod to vigorous intensity, 3 -- 5x/week, minimum 8 weeks Early post transplant (1 -- 6 months) or medical instability: supervised exercise Late post transplant (after 6 months): unsupervised at home 17. **What are special considerations with transplant?** Long time with disease? Time on waiting list? Denervation of the heart Cardiovascular disease in kidney patients Encephalopathy in liver patients 18. **TRUE OR FALSE, REHAB PRE AND POST TRANSPLANT ARE MANDATORY** SORTA TRUE IN HEART AND LUNG 19. **What's the CAN-RESTORE?** Promotes active living after transplant Disseminate knowledge, build capacity in healthcare system, empower transplant candidates to perform exercise 20. PTSD 1. **TRUE OR FALSE, EXERCISE BUT NOT PHYSICAL ACTIVIY IS EFFECTIVE FOR PTSD AND DEPRESSIVE SYMPTOMS** FALSE PHYSICAL ACTIVITY AND EXERCISE ARE GOOD FOR PTSD AND DEPRESSIVE SYMPTOMS 2. **What can make a physiotherapy session stronger for PTSD and depressive symptoms?** Self-determination based 3. **Which of the following is not positively linked to resilience?** Denial 4. **What are some factors linked to recovery?** Purpose in life Resilience Mastery (what activities are they good at) 5. **What's a good form of exercise for PTSD?** Aerobic 6. **What's the better way to measure HR for someone with PTSD?** BORG Because there are many factors that can affect HR such as anxiety 7. **Provide motivation**