Kin 204 notes PDF

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Kin 204 notes 5 A frame work Ask -get to know your client Assess- physical activity, fitness, lifestyle (gathering subjective info) Advise This is the point at where the client makes the decision to continue the prescription Agree- devise an action plan (SMART, FITT) Assist/ Arrange- provide continuing support Physical activity- any bodily movement produced by the contraction of skeletal muscles that results in energy expenditure Exercise- type of PA- consists of planned, structured and repetitive bodily movement done to improve and or maintain one or more components of physical components of physical fitness Physical Fitness- the ability to carry out daily tasks without undue fatigue -carido Body comp-muscle fat water weight and bone Muscular strength Muscular endurance Flexibility Recommended physical fitness 150min/week of moderate 75 min/ week of vigourus Muscle strength- high intensity involving all major muscle groups> 2 days a week (doesn’t have to be all at once but can be spread throughout the week Eg better to do 3 20 min cardio sessions rather than 1 60) Every clients grows in there on way in terms of improving health Physical inactivity and sedentary lifestyle may cause Metabolic disorders, cardiovascular diseases, musculoskeletal disorders, psychological disorders, pulmonary diseases, cancer Benefits of physical activity/ exercise Inverse relationship on causing: -preamture mortality -CVD/CAD -Depression -Hypertension -Cognition -stroke -osteoporosis -T2DM -Obesity -Cancer

Pre-participation health screening Screen for: 1. current PA level 2. signs/ symptoms of CV/ metabloc or renal disease 3. Exercise intensity Need medical clearance before initiating exercise programming using the ACSM screen algorithm If needed, screening should be from a health care provider family physician, cardiologist Screening 1.subjective info (readiness for PA-need physciain referral, par Q+, CSEP active questionnaire) Major signs or symptoms of CV, Metabolic an renal disease Pain in chest,neck, jaw, arms, angina, intrascapular area, if these feel worse in cold or during stress or exertion SOB at rest or daily activities Dizziness Excessive coughing Ankle swelling Tachycardia Intermittent claudication Heart murmur 2. Objective info Client measurements How to document SOAP notes Smart goals -specific measureable attainable relevant time

Behaviour change Health change methodology-promotes health literacy, shared decision making, behaviour change and self management and engages patients to act on evidence based recommendations for improved health and quality of life outcomes Use this to improve client outcome, sustainable change, clients don’t like being told what to do so have it seem like theyre telling you Look for back and forth conversation

3 essential tasks for health service providers to align conos with their clients or patients needs 1.set up a healthy working alliance (build trust) 2.identify and address motivational barriers to action(build importance) 3.Build confidence Check RICK to make a decision or take action Readiness, Importance, confidence, knowledge Above the line techniques Digging down techniques to increase importance

Posture-start posture as soon as client walks into room -the alignment of your body segements in relation to each other at any given time -static or dynamice

Posture can be affected by self esteem, stress, lifestyle, physical pain, genetics, more laxity around joints, over weigh and obesity, muscle tone can affect posture Factors that affecy posture Lacity of ligamentoustructure Musculotendinous tightness Muscle tone Pelvic angle Joint position and mobility Neurogenic inflow/ outflow Factors tht influence posture include Aging, inactivity, poor postural habits, biomechanical compensation, workspace, poor movement, injury Point of the curves in spine is to Counter balamnce and shock absorb KyphosisLordosisSoliosis is a lateral curve Anterior pelvic tilt asis is infornt / Posterior pelvic tilt \ Laterla pelvic tilt (hip drop) Upright posture is maintained by: Muscle coactivation Ligaments Look for hip drop or trendelburg pattern due to weakness of glut medius, quadratus lumborum or erector spinae Testing posture Assesment Examining alignmenet of standing. Flexibility and muscle length, and muscle strength Plumline should gor through earlobe, acromion process, lumbar bodies, greater trochanter, posterior to patella and anterior to lateral malleolus Handedness affects posture so may have more muscle definition in scapula of dominant hand Sitting posture influences intervertrebral disk pressure(sitting puts the most pressure on the disks Vertebral bodies are load bearing

Body composition -a refelction of net energy Energy consumed vs Energy expended Weight is a measure of net size Can vary by water retention, diet , exercise We measure body comp to classify disease risk Estimate healthy and unhealthy body weights Aid in nutrition and or prescription Evaluate nutrtion or prescription Monitor growth Track changes Obese men are >22% Women 35% Body comp models Two,three and four component models Two component model is density of fat =0.901 Density of fat free body =1.100g/cc Fat free mass is muscle body and water Body reference fat =15% Fat free =85% -water 73.8% -Protein 19.4% -mineral=6.8% Bone mineral may be affected by osteoporosis Measurement methods Body weight and girths Dexa CT/mri BIA ADp Skinfold Body weight plus height can measure BMI Wasit circmferance >102 cm for males and > 88cm females Waist to hip ratrio helps classify risk of CVD and metabolic diseases of central adiposity Wasit to height ratio is a predictor of obesity related diseased an waist to height ratio of > 0.50 Advantages of body wight girls Easy to measure

Little technical knowledge and easily accessible Disadvantages include Insufficient infor about compartments and muscle gain and fat loss Not very accurate or precise Skin fold method- indirect measure of subcutaneous adipose tissue Predicts an esitimaye of body density (%BF) Measure is very innacurate for lean individuals Skinfold and body density are directly related Taken on the right side Use equations to predict body fat Equations choice depends on sex age ethnicity and athletic/health status Sources of error include skill incorrect landmark calper tpe and client variability(obese, water retention) Advantages: Cheap, accessible, equations and norms available Disadvantages: Error of use and predictions, precision, client hydration, Densitometry Body density= Body weight/body volume Hydrostatic weighing Archimedes principle-body weight underwater is proportionate to volume of water displaced by body Gives estimate of body volume Limitations of hydrostatic weighing led to air displacement plethysmography -large space is need -fear of being submerged under water -need to blow airout of lungs -hair is in the way -not accurate for obese people -quickly measured Advantage: Predicts within 2% of actual BF% Disadvantages: Innacurate for obese people Positioning underwater

Air Displacement Plethysmography Boyles Law P1V1=P2V2 Body surface area is meausured from height and weight measures Need minimal or tight clothing Advantages: Within 1-2% accurate Easy to use quick less burden compared to hydrostatic weighing Disadvantages: Expensive, only in labe, overestimates body fat in women, claustrophobic Bioelectrical impedance method Low level electrical current passed through the body Adipose tissue increases resitance to the current Total body water decrease resistance to the current BIA indirectly estimates FFM and Total body water Impedance is directly related to length and inversely related to x sectiona area Tissues act as conductors or insulators Current will follow path of least resistance Must not eat or drink within 4 hours Not exercise within 12 hours Abstain of alcohol within 48 hours Sources of error: Instrumentation Hydration status, menstrul cycle Skill Environment Advantages: Easy and accessible, quick and predict FFM and FM Disadvantages: Pacemakers or electrical devices can interfere Mostly valid for clients from 20-30 May get discrepancies form type of BIA used Hydration status DXA Xrays at two energies Measures Bone mineral, fat, lean soft tissue and visceral adipose tissue Bed of machine cant hold somone over 400lbs Can give whole body image or can be separated into body parts Advantages: Provides measures of region as well as wole body Minimal compliance from the client Saf and fast as xrays are low dosage Highly precise

Limiations: Qualified indivudal Must be in supine for duration of the test Not readlt available and expensive Client cant touch other parts of body Specific of ethnicity MRI/CT scans Uses magnetic field/xray to distinguish between different tissues based on density/attenuation Can give measure of subcutaneous, visceral, intramsucualr Unaccesible, expensive Advantages: Precise Disadvantages: Expensive, clinically only, rare to get whole body, high dose of radiation Ultrasound: Uses frequencies to meaure Portable, noninvasive, no radiation Leg muscle measure can be a predictability of how well we walk or stand Accuracy- degree to which the result of a measurement conforms to the true measure or accepted reference method Precision-degree by which 2 meausrement agree with eachother Reliability- ability to repeat and reproduce findings Bias- systematic error in method Validity- ability for test to measure what it is supposed to

Flexibility and muscle length testing Kinematics-the study of movement Osteokinematics- the study of bone in space Contraindications Don’t measure if: Osteoporosis, muscle tear, movement in certain directions, dislocations, broken bone Precautions: Injury above or below the area is being worked on, medications, hypermobile joints, history of injury, pain, inflammatory, hematoma, after prolonged immobilization Rom-the full movement potential of a joint Flexibility-ability to move a joint through its complete range of motion (training flexibility aims to increase ROM) AROM-client contracts muscle to voluntarily move the body part through the ROM without resistance AAROM- client contacts msucel to voluntarilt move the body part throught the ROM without resistance, however they need assistance from a person or device PROM-client or other external force move the body part through the ROM Arthrokinematics- movement of joint surfaces Roll Glide Spin Glide and rolls occur together to allow normal joint motion to occur First asses AROM Arom gives an indication of muscle weakness as it is against gravity Then PROM PROM determines the amound of movement possible at a joint It estimates ROM at each Joint Assesing end feels Hard(bony) Soft (Soft tissue) Firm(soft tissue stretch) Capsular stretch) ROM is measured with goiniometer, flexometer or inclinometer Goiniometr is GS Always get consent for any test Indirect measurement Sit and reach Back scratch

Flexibility- ability of a joint or series of joint to move through the full ROM without injury Static flexibility-a measure of total ROM at the joint- limited by the extensibility of the musculotendinous unit(passive) Dynamic flexibility- a measure of the rate of torque or resisitance developed during stretching throughout the ROM(Active) Flexibility and Joint stability are highly dependant on: joint structure and strength and number of ligamnets spanning the joint Total reistance during ROM at joint: Joint capsule-47% Muscle and its fascia-41% Tendons and ligaments- 10% Skin-2% Muscle and fascia are te most important structures in reducing resiatcne to movement and increasing dynamic flexibility Viscoelastic properties-demonstrate both plastic and elac charcacteristics when being deformed Collagen ruptrues at 6-8% of strain and elastin ruptures at 200% of strain Muscle length is when the muscle is passively stretched across the joints crossed by the muscle When muscle is on full stretch, client may feel pulling or pain Flexibility exercise can cause acute and chronic improvement, is mot effective when muscle are warm and can increase or cause individual goals Two appropriate proprioreceptors important during stretching include muscle spindles-located within intrafusal muscle fibers that run parallel to extrafusal fibers(monitor changes in muscle length) dynamic strthces.. ballistic stretches cause stretch reflex golgitendon organs are sensitive to an increase in muscular tension when stimulated they cause auto genic inhibition- relaxation that occurs in the muscle stretch reciprocal inhibition -when you stretch your hamstring and activate your hip flexors active stretch- person stretching supplies force of stretch passice stretch- partner, decive or another limb provides external force to cause or enhance stretch types of stretching include static, dynamic, ballistic or PNF Warm up

Effects on performance:  Faster muscle contraction & relaxation (agonist & antagonist)  Improvements in the rate of force development & reaction time  Improvements in muscle strength & power  Lowered viscous resistance in muscles and joints  Increased oxygen delivery  Increased blood flow to active muscles  Enhanced metabolic reactions  Increased psychological preparedness for performance Use RAMP protocol for warm up Raise, Activiate and mobilize and potentiate

Strength

5A’s Ask Asssess Advise Agree Assist Muscle convert chemical energy into mechanical energy Muscle strength- ability of a muscle to develop maximal contractile force against a reistance in a single contraction Hypertrophy-increase whole muscle and fibre cross sectional area Hyperplasia-increase number of fibers Muscualr endurance- ability of a muscle to maintain submaximal force for extended period Strength Testing -tests the ability to generate maximal contractile force Isometric- overall length of the muscle and joint angle does not change Isotoinic(constant tension Concentric- overall length of the muscle shortnes and joint angle gets smaller Eccentric- overall length of the muscle lengthens and joint angle gets larger Isokinetic- constant velocity We measure muscle fitness to rank clients muscle capacity (strength, endurance) Track change To prescribe Factors that affect muscle capacity include: Neural control Recruitment of motor unit and the rate at which they fire Greater muscle force is produced when -more motor units are involved in the contraction -motor units greater in size -rate of firing is faster The amount of force a muscle can produce is dependtn on the cross sectional area Pennate muscles have more sarcomeres in parallel and parallel muscle have more sarcomeres in series Muscle cross sectional area Arrangement of muscle fibers Muscle length Joint angle -has an effect on the amout of torque that can be produced around a joint Muscle contraction velocity-force capability of muscle declines as velocity of contraction increases

Joint angular velocity- eccentric>isometric>concentric Strength to mass ratio-reflects an athletes ability to accelerate their body Body size- muscles maximal contractile force is fairly proportional to cross sectional area Muscle capacity can be determined with: Sping or hand hled dynanomter, strain gauges,variable speed dynamometer, manual resiatnce and free weights The weakest point in ROM is when muscle is not contracting throughout ROM and strength Strength is defined by the max weight that can be moved at the weakest point in ROM Resistance Exercise Repetitions: number of times that a movement is performed continuously prior to having a rest or ceasing the movement Set: number of times a specific number of repetitions of a given exercise is repeated( single vs multiple sets) Rest period: the time after completing a set to rest the targeted muscle 1RM 1st warm up40% Rest 1-2min 2nd warm up50-70% 3-5 reps rest 3-5min Working set can increase 90-93% Increase by 5-10% for upper body and 10-20% for lower body Rest 3-5min or until client fails 3-5 trials

Strength Prescription Motor unit- one alpha motor neuron and the muscle fibers innervated by the motor neurons axonal terminals Neural and muscular adaptaions to exercise

Neural adaptations to RT:

Improved neural firing, better able to recruit motor units Less coactivation of antagonist muscles This will result in less nueral stimulus needed to produce a given submax force, less msucles is activated to lift at a given submax load and imporved activation or more effiecient recrutitment Muscular adaptions Get beginners hypertrophy within the first 8 weeks This is due too increased size and #of contractile proteins(actin and myosin) Increase size and #of myofibrils within the muscle fiber Increased protein synthesis of structural protiens and increased size of individual muscle fibers

How hypertrophy occurs Protein synthesis= preotein degradation: muscle maintenance Protein synthesis< protein degradation: muscle atrophy Protein synthesis>protein degradation: muscle hypertrophy Factors influencing muscle protein synthesis Amino acids, protein intake, decrease rate of insulin breakdown, hormones and training status

FITT Core exercise -one or more large muscle ares involves two or more primary joints Assistance exercise -smaller muscle areas involves one primary joint Structural exercise core exercises that emphasize loading of the spine directly or indirectly. Involves muscular stabilization or posture while performing the lifting movement Power exercise- a structural exercise that is performed very rapidly or explosivelely Resistance training program design variables 1.needs analysis -client centered goals 2. exercise selection-availability, types of exercises, sport specific 3. training frequency 4.exercise order-do MJ than SJ large groups than small groups, alternate between push and pull exercises For beginners, consecutive exercises should not involve the same muscle group, minimize rest 5.Training load 6.volume 7.rest periods Superset-two exercises working two opposing muscle groups/ areas with little to no rest in between Compound-two different exercises for the same muscle group with little to no rest in between Use 2by2 rule if a client lifts 2 reps over the assigned goal 2 consecutively

Cardiorespiratory fitness -the ability of the heart, lungs and circulatory system to supply oxygen and nutrients efficiently to working muscles The ability to perform sustained physical activity People who are physically active more than 7 hours per week decrease the risk of dying early by 40% Reduce the risk of diabetes, colon cancer, breast cancer, CVD and any other chornic diseases ‘ From age 18-64 150 of moderate to vigorous a week Train major muscle groups twice For 65 years and older 150 of moderate to vigorous a wekk Major muscle groups twice Those with poor mobility should perform PA to enhance balance 12-17 60 moderate to vigorous Vigorous at least 3 times per week Activities that strengthen muscle and bone 3 days per week VO2 max – the maximal amount of oxygen that can be consumed per unit time by an individual during large muscle group activity of increasing intensity continued to exhaustion -the maximal amount of oxygen that the CR sytem can transport to the working muscle and the ability of the muscle to utilize the oxygen -a greater Vo2 max genrally indicates high capacity to take up O2 into muscle and produce ATP We determine max aerobic capacity Asses CR fitness Asses and prescribe training status Evaluate work and energy expenditure in various settings Ficks equation Direct determination of VO2max Q=VO2/(a-v))O2 difference VO2= cardiac output*(a-v)O2 difference Indirect estimate of VO2 max Open circuit spirometry -inhale room air Exhale through a tube VO2 =amount o2 inspired – expired

Compared to ramp protocols step protocols may better predict vo2 peak Max tests- 1 metabolic equivalent(MET)=3.5mL/O2/kg BW/min Or 1kcal/kg/hr This is an estimate of resting oxygen uptake Conversions factors we should know 1MET =3.5mlO2/kgBW/min 1watt=6kg.m/min 1mph=26.8m/min 1km/h=16.7m/min Determinants that VO2max has been reached Primary determinant:  VO2 plateau (< 150 ml O2/min or 2.2 ml/kg/min) Secondary criteria:  Failure of HR t...