Chapter 4 – Exercise Physiology

• DEF: Study of the anatomic, functional and physiologic responses and adaptations that
occur during and following physical activity and exercise

- ACUTE (temporary) & CHRONIC (long time) effects

– Harvard Fatigue Laboratory – established to study physiologic, psychological, and

sociologic responses of workers and military personnel to stressful stimuli

• ACUTE RESPONSES: Changes in the systems of the body that occur in response to a single
bout of physical activity or exercise
• Systems of the body control the body’s internal environment and response to increased
challenges to homeostasis

• CHRONIC ADAPTATIONS: Changes in the systems of the body that occur in response to
repeated regular physical activity and exercise
• Chronic adaptations to exercise improve functions of the body while at rest and during
exercise

• Areas of study in exercise physiology:

– Factors controlling substrate metabolism

• Interaction of fat and carbohydrate utilization

• Effects of intensity and duration

• Role of enzymes and hormones

– Muscle control of glucose uptake

• Body closely regulates energy utilization during physical activity and exercise

• Movement of glucose from the blood into the cell depends on the glucose
transport protein
• Designing exercise programs

– Goals

– Purpose of activity

– Duration

– Type

– FITT (frequency intensity time type)

• Skeletal muscle physiology

– Fibers have distinct contractile and metabolic characteristics

– Training results in fibers taking on characteristics that help meet the

requirements of the physical activity or exercise
• Bone Metabolism

– Influenced by physical activity and exercise

– Osteoporosis

• Characterized by loss of bone mineral density

• Increased risk of bone fractures

• Energy Balance and Weight Control

– Critical for promoting overall good health and optimizing performance in certain
sports and athletic competitions

– Body weight control can be described using the energy balance equation (calories in
vs. calories out – consumption < expenditure

• Assessment of energy expenditure and physical activity

– Critical for promoting weight loss or identifying the fitness requirement for a job
skill

– Most assessments of energy expenditure are indirect (Energy expenditure is the

amount of energy that a person needs to carry out physical functions such as
breathing, circulating blood, digesting food, or exercising).
• Environmental exercise

– Ensuring safety and optimizing performance in challenging environmental

conditions is important

– Exercise in hot or cold conditions, and at high altitudes, present unique challenges to
the body

• Hyponutrimia – low concentration of salt in blood

• Hypothermia – low body temperature
• Hyperinsulinemia: too much insulin in the blood
• Hyperlipidinemia: too much fat in the blood
• Hypercholesterolinia: too much cholesterol in the blood
Chapter 5 – Clinical Exercise Physiology:
• DEF: Uses physical activity and exercise to prevent or delay the onset of chronic disease in
healthy individuals

• Provides therapeutic or functional benefits to individuals with disease conditions or physical

disabilities

• Requires an understanding of how the body responds to acute and chronic physical activity
and exercise in both healthy and diseased conditions

• First use of physical activity and exercise in disease recovery can be traced to the 18 th and
19th centuries

• Morris and colleagues studied coronary heart disease in London bus drivers and conductors

• Demonstrated the relationship between physical activity and the risk of developing
heart disease
 • Initiated interest in disease risk reduction and public health epidemiology

• Cardiac rehabilitation programs first developed in the 1950s – progression of rehab

– Phase I (surgery), II(12-18 weeks rehab)and III(maintenance stage – for life /

maintaining things learned in Phase 2)

• AHA(American Heart Association) and ACSM developed testing and training procedures for
healthy and diseased individuals

• 150 minutes / week

• 5 d / weeks

• 30 minutes each day

– 1970’s advances significantly

• Late 1950s pulmonary rehabilitation programs began to use exercise

• Additional landmark events

– Publication of the Journal of Cardiopulmonary Rehabilitation

– Founding of the American Association of Cardiovascular and Pulmonary

Rehabilitation (AACVPR)

• Duties and responsibilities of professionals:

o Conducting pre-exercise screening (used to identify people who may have medical
conditions that put them at a higher risk of an adverse event during physical
activity/exercise. It's a filter or 'safety net' to help determine if the potential benefits
of exercise outweigh the risks for an individual
– Performing exercise testing and evaluation

– Developing exercise prescriptions

– Instructing individuals in proper training techniques

– Supervising exercise programs in various settings

• Graded exercise testing (GXT)

Submaximal graded exercise texts –
- predict the max, not as accurate as the max
- Baseline
- Less expensive, easier,

Maximal graded exercise training

220 – age = 200 bpm x 85% = 170bpm cut off for a sub max test
Ejection Fractions (EF) = 60-70%
120 Systolic (changes the most)
80 Dystolic

• Used to clear individuals for safe participation in physical activity and exercise

• Serves as a basis for developing exercise prescriptions

• Diagnostic testing helps assess the presence of cardiovascular or pulmonary disease

• Functional capacity helps assess an individual’s capacity to participate in physical activity and
exercise

• Performing the test

– Heart rate

– Blood pressure

– Rating of perceived exertion (RPE) (page 157)

– Electrocardiogram (display of a person’s heartbeat)

– Echocardiography (test – sound waves to produce live images of the heart)

– Oxygen consumption and functional capacity

• Performing the test

– Submaximal graded exercise tests

• Predicted heart rate max

– Maximal graded exercise testing

– Incremental progressions, stages, protocols

– Physician referral

• Emphysema is a long-term, progressive disease of the lungs that primarily causes shortness
of breath due to over-inflation of the alveoli (air sacs in the lung). In people
with emphysema, the lung tissue involved in exchange of gases (oxygen and carbon dioxide)
is impaired or destroyed.
• Plan for physical activity and exercise

• Achieve specific outcomes – improvement in fitness, reduction in disease risk, or weight loss

• Meets the interests, goals, health needs, and clinical condition of an individual

• Based on sound principles and innovative programming

• Cardiovascular disease (CVD)

– Myocardial infarction (infarct) – heart attack – lack of blood supply + blocked

coronary artery + heart muscle affected

– Coronary artery disease (CAD) – accumulation of lipid (fat) in artery – decreasing the
size of the arteries; decreases the amount of blood flow + O2

– Angina pectoris (chest pain) – pain behind the sternum radiating to the heart /
back / indigestion /acid reflux

– Cardiac arrhythmia – irregular electrical activity in the heart; atrophy

– Valvular heart disease (VHD)

– Chronic heart failure

 – Peripheral vascular disease

– Hypertension – primary hypertension & secondary hypertension

• Respiratory disease

– Obstructive pulmonary disease – difficulty breathing 1/30 Americans

– Restrictive pulmonary disease – decreased lung volume reduced in Oxygen

– Asthma – shortness of breath, chest pain, trouble sleeping

– Cystic fibrosis – inherited

• Metabolic disease

– Diabetes mellitus – type I (insulin resistance) type II (insufficient insulin) and

stational (higher risk for the other ones)

– Hyperlipidemia – high fat / lipid levels (not water soluble)  could lead to CVD

– Obesity – BMI level

o Metabolic syndrome – clustering of more diseases

• Orthopedic and neuromuscular diseases

– Arthritis - ~53mil affected;

– Osteoporosis

– Muscular dystrophy – inherited neuromuscular disease

– Multiple sclerosis

– Cerebral palsy

Chapter 6 – Athletic Training & Sports Medicine

• DEF: Involves the prevention, treatment, and rehabilitation of injuries to physically active
individuals and athletes

• Athletic trainers work closely with allied health professionals to provide care to anyone who
may have an injury caused by participation in physical activity or exercise

• Umbrella term that describes the various issues interrelated among medicine, physical
activity, exercise, health promotion, and disease prevention

• Created a balance between caring for competitive athletes and treating general patients by
promoting exercise for health and disease prevention
 • Prevention of athletic injuries

– Pre-participation physical examination

– Aware of physical, environmental, and practice conditions that could cause an

injury

• Recognition, evaluation, and assessment of athletic injuries

Primary Responsibilities of Athletic Trainers:

• Immediate care of athletic injuries – primary

• Equipment, Environment and facilities are safe

• Treatment, rehabilitation, and reconditioning of injuries

• Organization and administration

– Professional development and responsibility

– Personnel management

– Facility management

– Design, budgeting, insurance

– Providing coverage

– Legal and insurance issues

– Working with the team physician

• Guidelines for sports medicine physicians

– Team physician consensus statements guide the activities and responsibilities of the
team physician

– Each consensus statement contains important topics relevant to providing the best
medical care to athletes

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• Arthroscopic surgery

– Minimally invasive procedure used to examine and treat damage to the interior of a
joint

– Used to evaluate and treat orthopedic conditions such as torn floating cartilage, torn
surface cartilage, and torn ACL of the knee joint

• Anterior cruciate ligament (ACL) reconstruction

– Surgical procedure that uses a graft replacement for a torn ACL in the knee

– ACL reconstruction requires a tissue graft from another part of the body

– Part or all of the ACL reconstruction is performed using arthroscopic surgery

– Torn ACL decreases stability and functional ability of knee joint

 • Ulnar (elbow / forearm) collateral ligament reconstruction

– Ligament in the medial elbow is replaced with a tendon from elsewhere in the body

– Usually from stress related to motion

• Autologous chondrocyte implantation (knee affected)

– Used to repair defects in the articular cartilage of joints by injecting cultured cells
into the joint (usually the knee)

• Concussion management

– Most common sport-related concussion is the diffuse brain injury

– Occurs when a side-to-side or front-to-back motion causes the brain to be shaken

within the skull

– Increased attention to identification and removal from play

– Guidelines developed and improved of return-to-participation decisions

• Anterior cruciate ligament injuries in females

– ACL injuries in female athletes are higher than male athletes performing the same
sports; Title IX

– Reasons for the different rates of injury are unclear

• differences in structure and knee alignment

• ligament laxity

• muscle strength

EMS: emergency medical systems

Primary survey (unconscious): ABCs airway, breathing and circulation (is ems needed? / life-
threatening)
Secondary survey: are they bleeding / something broken / extensive survey / referral / skin
changing / ability to focus / making sense / oriented
ACE: American Council of Exercise
S – subjective
O – objective
A – assessment
P – plan

R – rest
I – ice
C – compress
E – elevate