KIN 441 Final – Flashcards
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Why do differences exist between men and women regarding survival rates and CVD?
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-pre-menopausal symptoms -present with heart disease an average of 10 years later -have more comorbidities -treated less aggressively than men -not referred for diagnostic testing -90% of women present with atypical symptoms for myocardial infarctions (fatigue, nausea, abdominal pain)
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how many women die from CVD?
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1 in 3 women
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men are how much more likely to receive what as prevention of sudden cardiac death?
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2/3 more likely to receive an implantable defibrillator
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8 coronary heart disease risk factors
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1. age 2. family history- MI, coronary revascularization, sudden death (before 55 years in father, before 65 years in mother) 3. cigarette smoking 4. sedentary lifestyle- not participating in at least 30 minutes of moderate intensity PA 3 days/ week for at least 3 months 5. obesity 6. hypertension 7. dyslipidemia 8. prediabetes
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Which CHD risk factors are most prevalent in women?
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-overweight or obese (60%) -hypertension (50%) -elevated cholesterol (40%) -sedentary lifestyle (25%) -low HDL (older women) -diabetes
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ACSM recommendations for: -moderate intensity -vigorous intensity -energy expenditure in MET min/week
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-moderate intensity: cardiorespiratory training- total of 150 min/week -vigorous intensity : total of 75 min/week -total energy expenditure: 500-1000 MET min/ week +RT and neuromotor exercise
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what quantity of exercise is necessary to decrease early death risk from high to moderate?
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150 min/ week
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functional and structural adaptations that occur with exercise on vascular function
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haemodynamic forces that act on the vessel wall = frictional force that exerts shear stress on endothelium and stimulates: -nitric oxide production -vascular remodeling -blood vessel formation -eNOS and antioxidant enzymes increase
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Why is endothelial dysfunction such a health risk?
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loss of vascular homeostasis resulting in: -thrombosis -oxidative stress -coagulation -vascular inflammation associated with: -atherosclerosis -hypertension -heart failure -diabetes -aging
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Identify the negative consequences of decreased shear stress on our blood vessels and atherosclerosis.
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Decreased: -eNOS -endothelial repair -cytoskeletal/ cellular alignment in direction of flow Increased: -reactive oxygen species -leukocyte adhesion -lipoprotein permeability -inflammation
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Is there a strong relationship between hypertension and increased risk for MI?
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50% of women and 35.5% of men were hypertensive prior to MI event
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Is a combination of diet and exercise better than exercise alone for BP reduction?
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-DASH (dietary approaches to stop hypertension)= 8-14 mmHg SBP decrease -aerobic activity= decreased SBP 4-9 mmHg, decreased DBP 3-5 mmHg -combination is best
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What is the role between exercise and decreased lipids and lipoproteins?
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regular exercise stimulates lipoprotein lipase activity in skeletal muscle and adipose tissue which facilitates the clearance of triglycerides from the blood
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What exercise intensity is indicated for the reduction of LDL and increase in HDL?
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high amount, high intensity (20 miles/ week at 60-85% VO2 peak)
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why is elevated hs-CRP (high sensitivity C-reactive protein) a concern?
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Increases risk for heart attack, ischemic stroke, and peripheral vascular disease
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Why do individuals with metabolic syndrome have higher CRP levels than individuals without metabolic syndrome?
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Low grade inflammation is characteristic of the metabolic syndrome and hs-CRP is the best characterized biomarker of inflammation
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Are individuals who are obese and fit at an increased risk for CVD than an individual that is lean and unfit? Why?
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No- individuals who are obese & fit are at a decreased risk for CVD than an individual who is lean & unfit -increased fat mass predicts CVD risk (increased fat mass if unfit)
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basic AHA dietary recommendations for CHD prevention
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-saturated fat: less than 7% of total calories -cholesterol: less than 300 mg/day -no more than 1 alcoholic drink/ day -sodium: less than 2.3 g/day -trans fatty acids less than 1% of calories -eat fish twice/week (2, 6oz servings) or supplement with omega 3 fatty acids
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Why is obesity such a health concern?
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-results in greater risk for stroke and breast cancer -obesity among women has increased by almost 15% in the last decade
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What is the relationship between obesity and forms of arthritis?
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Osteoarthritis (OA) -Hand, hip, back, knee -from BMI of 25 = greater incidence steadily increases -weight loss likely to relieve symptoms and delay disease progression (of knee) Rheumatoid arthritis (RA) -related in both men and women
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Why does breast cancer increase in women that are obese?
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-increased fat cells = greater production of steroid hormones = increased cancer risk
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what is the relative risk of having an MI in a diabetic individual compared to an individual whom has already had an MI?
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-diabetics + previous MI incidence= 45% -middle aged adults, no diabetes + previous MI = 20.2% incidence of second MI -diabetics + no previous MI = 18.8% risk
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fat cell hypertrophy versus fat cell hyperplasia
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-hypertrophy: increase in the size of fat cells -hyperplasia: increase in the number of fat cells
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At what point does fat cell hyperplasia occur?
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at a fat mass of greater than 30 kg
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is less severe obesity fat cell hyperplasia or hypertrophy?
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increase in fat cell size = hypertrophy
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key differences between insulin resistance syndrome and T2D
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Insulin resistance -compensatory hyperinsulinemia- excess levels of insulin circulating in the blood relative to the level of glucose -can lead to hypertension, stroke, PCOS, NAFLD (nonalcoholic fatty liver disease) -can lead to type 2 diabetes Type 2 diabetes -"Inadequate" insulin response -can lead to retinopathy, nephropathy, neuropathy Can both lead to CVD
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What are the diagnostic criteria for metabolic syndrome?
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(at least 3 components required for diagnosis) -increased waist circumference (men- at least 40 in, women- at least 35 in) -elevated triglycerides (at least 150 mg/dL) -reduced HDL (men- less than 40 mg/dL, women- 50 mg/dL0 -elevated blood pressure (at least 130/85 mmHg) -elevated fasting blood glucose (at least 100 mg/dL)
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Identify the key characteristics associated with metabolic inflexibility.
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Inability to increase the reliance on fat oxidation in the face of reduced muscle glycogen
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How does increased fat deposition in the liver and muscle lead to insulin resistance?
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In the liver: -increased lipotoxicity -increased gluconeogenesis In the muscle: -increased lipotoxicity -decreased fat oxidation -decreased insulin action -decreased glucose uptake
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How is it possible that an individual with decreased insulin resistance can still be tested in the fasted state and present with normal blood glucose levels?
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In early stages of insulin resistance, it is possible for someone to have low levels of fasting glucose but elevated insulin levels which over time can lead to the development of diabetes and hyperglycemia
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what kind of relationship is there between exercise and disease risk?
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dose-response relationship
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Which factors respond best to exercise (insulin sensitivity, BP, HR, VO2max and HDL)? About how much exercise is required to realize these benefits?
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-insulin sensitivity and heart rate -requires about 90 minutes/ week
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Why is diet and exercise better than either diet or exercise alone?
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-approximately 75% of weight that is lost by dieting is composed of fat and 25% is fat-free mass -addition of PA can affect composition of weight loss (helps preserve fat-free mass during weight loss) -lipid profile is better with exercise and diet- 35% reduced CVD risk
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About how much exercise is necessary for consistent and long-term weight loss?
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-2500 kcal/ week -equivalent to moderate activity (brisk walking) for ~60-75 min/day or vigorous activity (aerobics, cycling, jogging) for 30 min/day
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What is the prevalence of ovarian cancer relative to breast cancer?
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-ovarian cancer (2012)- new cases= 22,280, deaths= 15,500 -breast cancer (2012)- new cases= 226,870 women & 2,190 men, deaths= 39,510 women & 410 men
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how many deaths is breast cancer responsible for?
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second highest number of deaths from cancer in women
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What are the risk factors for breast cancer?
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-genetic alterations (BRCA 1 & 2) -age birth to age 39= less than 0.5% risk 40-59= 4% risk 60-79= almost 7% risk -family history 5-10% of cancers are inherited from mother or father 90% breast cancers are due to genetic abnormalities -reproductive history -body weight -physical activity -mammographic breast density -alcohol intake -race -endogenous hormones -obesity -insulin and IGF-1 -hyperinsulinemia and insulin-resistance syndrome
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How might exercise help to diminish an individual's cancer risks?
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-maintain healthy body weight and diminish age related weight gain -improved immune function antioxidants and HSP (heat shock proteins) to repair damaged cells -less potent form of estrogen -lower hormonal levels may reduce circulating E ; P (but more likely related to lower stored fat availability)
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Are women who have gained weight over their lifetime at increased risk for breast cancer? Why?
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-weight gain of 20kg or more after age 18= increased risk of breast cancer 50 to 100% -increased risk due to increased fat cells and greater production of steroid hormones, which leads to increased cancer risk
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What does the research data suggest with respect to hours of exercise participation and decreased cancer risk?
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-18% reduced risk in cancer within pre- and postmenopausal women exercising 7 hours/week versus 1 hour/week -60% risk reduction for 4+ hours/week of vigorous activity -risk for cancer was reduced 50% in women who exercised vigorously 4 hours/week
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What risk factors are greater for pre-menopausal breast cancer?
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-menstrual and reproductive factors -genetics -radiation -insulin-like growth factors
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What risk factors are greater for post-menopausal breast cancer?
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-physical activity -obesity -energy balance -hormone replacement therapy -endogenous estrogens
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Can regular exercise improve the quality of life in cancer patients?
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yes (but may depend slightly on factors such as type, volume, and context of exercise)
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What emotional and functional variables can exercise provide for cancer patients?
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Emotional -positive changes in personality functioning -body satisfaction -mood states (anxiety, anger, depression) Functional -improvements in functional capacity -muscular strength -body composition -hematological indices -sleep patterns -nausea -fatigue -pain -diarrhea
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What is the relationship between VO2 and women with cancer compared to women without a cancer diagnosis?
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-decreased VO2 for breast cancer patient compared to healthy controls similar to 60-year-old sedentary counterpart -VO2 peak of a 50-year-old breast cancer survivor is the same as a sedentary 60-year-old woman
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How does exercise tolerance change with cancer treatment?
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Decreased exercise tolerance because of decrease in cardiorespiratory fitness
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What is the relationship between a decrease in cardiorespiratory fitness and CVD mortality?
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Inversely related- decrease in cardiorespiratory fitness = increased CVD mortality
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What central factors contribute to the decline in exercise tolerance associated with breast cancer and therapeutic interventions?
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-impaired cardiac performance with reduced and preserved diastolic dysfunction -diastolic dysfunction can occur within one week of chemotherapy initiation
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What peripheral factors contribute to the decline in exercise tolerance associated with breast cancer and therapeutic interventions?
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-pulmonary dysfunction- radiation mediated fibrosis -skeletal muscle dysfunction (cytotoxic effects, loss of skeletal muscle mass, sarcopenic obesity, impaired max twitch force and muscle relaxation -vascular dysfunction- increased arterial stiffness, endothelial dysfunction -hematologic- chemotherapy associated anemia and reduced oxygen carrying capacity of blood
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How did exercise prior to drug therapy (doxorubicin) positively influence cardiac muscle tissue? What is the significance of this finding with respect to LV mass and LV function?
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-exercise improved health and vascularization of sedentary cardiomyocyte loss -exercise cardiomyocytes showing vacuolization -exercise improved LV? 1.95 compared to 2.025
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Identify age related fiber type losses. How do these losses support the significant decline in strength and power in older adults?
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-Impaired motor unit activation partial cause in strength losses -Loss of fast twitch fibers eliminates innervation
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Explain age related changes in muscle innervation. How does this impact function?
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Diminished ability to detect a stimulus and process the information to produce a response -deterioration of end-plate structures -impaired excitation-contraction coupling -decrease in motor unit recruitment By age 60 up to a 15% reduction in nerve conduction Loss of fast twitch fibers eliminates innervation -fibers that cannot be activated gradually atrophy and become absorbed by the body Simple and complex movements are slower
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How does muscle quality decrease with aging?
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Accumulation of intra- and extra-myocellular lipids -lipid infiltration, systemic inflammation, and insulin resistance Improper folding of structural and contractile proteins Mitochondria dysfunction -decreased total volume, increased oxidative damage, and reduced oxidative capacity
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Explain the "Mitochondrial Theory of Aging" and how this contributes to a decrease in muscle quality and an increase in age related disease.
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Accumulation of somatic mutations of mitochondria DNA leading to the decline of mitochondria functionality -Impairs cellular communication leading to impaired metabolic processes -Free radicals (ROS) -Alteration of redox homeostasis -Immune responses
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The current research has identified what three areas of study to help diminish mitochondrial damage and aging in general?
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1. Dietary restriction- consuming 20-40% fewer calories than normal -preserves mitochondrial health- improves efficiency, content, and function -attenuates smooth muscle decline with age 2. CR mimetics (limiting)- targeting metabolic and stress response pathways affected by CR -drugs that inhibit glycolysis -enhance insulin action -affect stress signaling pathways 3. Exercise
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What research evidence can you provide demonstrating that age related muscle loss is a result of physical inactivity rather than functional disuse?
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-exercise training in young and old subjects improved muscle hypertrophy -exercise improved anabolic resistance which is a major contributing factor to sarcopenia
