cardiovascular disease and physical activity. chapter 21 overview forms of cardiovascular disease...
TRANSCRIPT
![Page 1: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/1.jpg)
Cardiovascular Disease and Physical
Activity
![Page 2: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/2.jpg)
CHAPTER 21 CHAPTER 21 OverviewOverview
• Forms of cardiovascular disease
• Understanding disease process
• Determining individual risk
• Reducing risk through physical activity
• Risk of heart attack and death during exercise
• Exercise training and rehabilitating patients with heart disease
![Page 3: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/3.jpg)
Introduction to Introduction to Cardiovascular DiseaseCardiovascular Disease
• Cardiovascular disease leading cause of serious illness and death in United States
• Affects over 80 million Americans
• Accounts for 1/3 of all US deaths annually
• Over $500 billion in annual costs
![Page 4: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/4.jpg)
Figure 21.1Figure 21.1
![Page 5: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/5.jpg)
Introduction to Introduction to Cardiovascular DiseaseCardiovascular Disease
• In 2006 alone, in the United States– 448,000 bypass surgeries– 1,313,000 coronary angioplasties– 2,200 heart transplants
• Death rate steadily declining since 1960s– Improved public awareness and lifestyle changes– Better and earlier diagnosis– Better treatment options
• A major health concern worldwide
![Page 6: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/6.jpg)
Table 21.1Table 21.1
![Page 7: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/7.jpg)
Forms of Cardiovascular DiseaseForms of Cardiovascular Disease
• Coronary heart disease (CHD)
• Hypertension
• Stroke
• Heart failure
• Other (peripheral, valvular, congenital)
![Page 8: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/8.jpg)
Forms of Cardiovascular Disease:Forms of Cardiovascular Disease:Coronary Heart DiseaseCoronary Heart Disease
• Accounts for half of cardiovascular deaths
• Progressive narrowing of coronary arteries– Fatty plaque formation– Atherosclerosis– Blood supply to myocardium compromised– Myocardial ischemia angina pectoris
• Leads to myocardial infarction (MI)– Heart attack
– Irreversible heart muscle cell death due to lack of O2
![Page 9: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/9.jpg)
Figure 21.2Figure 21.2
![Page 10: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/10.jpg)
Forms of Cardiovascular Disease:Forms of Cardiovascular Disease: Coronary Heart Disease Coronary Heart Disease
• Atherosclerosis begins early in life– Fatty streaks appear in infancy, childhood– Fatty streaks appear in coronary arteries in teens– Fibrous plaques develop in 20s– Combination of genetics and lifestyle
![Page 11: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/11.jpg)
Forms of Cardiovascular Disease:Forms of Cardiovascular Disease:HypertensionHypertension
• High blood pressure– Systolic ≥140 mmHg, diastolic ≥90 mmHg– Affects 32% of US adult population
• Heart must work harder to eject blood
• Places greater strain on arteries
• Causes enlarged heart, scarred/stiff arteries
• Eventually leads to atherosclerosis, MI, etc.
![Page 12: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/12.jpg)
Forms of Cardiovascular Disease:Forms of Cardiovascular Disease:HypertensionHypertension
• Prehypertension– Systolic 120 to 139 mmHg– Diastolic 80 to 89 mmHg– Affects 28% of US adult population
• More common in black Americans– 1.8 times greater rate of fatal stroke– 1.5 times greater rate of heart disease death– 4.2 times greater rate of kidney disease
![Page 13: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/13.jpg)
Table 21.2Table 21.2
![Page 14: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/14.jpg)
Forms of Cardiovascular Disease:Forms of Cardiovascular Disease:StrokeStroke
• Affects cerebral arteries– Restricts brain blood flow– 795,000 strokes in United States annually
• Ischemic stroke– Most common type
– Obstructed cerebral artery limits O2 delivery
– Cerebral thrombosis – Cerebral embolism
![Page 15: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/15.jpg)
Forms of Cardiovascular Disease:Forms of Cardiovascular Disease:StrokeStroke
• Hemorrhagic stroke– Intracerebral hemorrhage– Subarachnoid hemorrhage– Vessel in or on brain ruptures– Arises from aneurysms (secondary to hypertension
or atherosclerotic damage)
• Rupture ischemia and pressure on brain tissue death of brain tissue
![Page 16: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/16.jpg)
Forms of Cardiovascular Disease:Forms of Cardiovascular Disease:StrokeStroke
• Effect of stroke depends on region affected– Paralysis on one side most common– Each side of brain controls opposite side of body
• Strokes in right brain– Vision problems, memory loss– Quick, inquisitive behavior
• Strokes in left brain– Speech/language problems, memory loss– Slow, cautious behavior
![Page 17: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/17.jpg)
Forms of Cardiovascular Disease:Forms of Cardiovascular Disease:Heart FailureHeart Failure
• Chronic, progressive weakening of the heart– Too weak to maintain cardiac output– Results from damage to and overworking of heart– Hypertension major contributor (75% of cases)– Other causes: atherosclerosis, valve diseases, viral
infection, MI
• Causes edema, pulmonary edema
• Ultimately requires heart transplant
![Page 18: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/18.jpg)
Forms of Cardiovascular Disease:Forms of Cardiovascular Disease:Other Cardiovascular DiseasesOther Cardiovascular Diseases
• Peripheral vascular diseases– Arteriosclerosis (obliterans)– Varicose veins, phlebitis
• Valvular diseases– Often from viral infections– Rheumatic heart disease
• Congenital heart disease– Congenital defects– Can affect aorta, valve, or septum
![Page 19: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/19.jpg)
Understanding the Disease Process:Understanding the Disease Process:Coronary Heart DiseaseCoronary Heart Disease
• Pathology of CHD affects vessel wall– Tunica intima: endothelium– Tunica media: smooth muscle cells, elastin– Tunica adventitia: collagen
• Early theory: initial injury to endothelium– Platelets, monocytes adhere to injury (PDGF)– Smooth muscle cells and lipids migrate to intima– Collection of debris in intima plaque
![Page 20: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/20.jpg)
Figure 21.4Figure 21.4
![Page 21: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/21.jpg)
Figure 21.5Figure 21.5
![Page 22: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/22.jpg)
Understanding the Disease Process:Understanding the Disease Process: Coronary Heart Disease Coronary Heart Disease
• Recent theory: monocytes attach between endothelial cells– Become macrophages– Ingest oxidized LDL-C– Become large foam cells, form fatty streaks
• Endothelial cells slough off– Expose underlying connective tissue– Allows platelets to attach– Endothelial injury not always precipitating event
![Page 23: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/23.jpg)
Understanding the Disease Process:Understanding the Disease Process: Coronary Heart Disease Coronary Heart Disease
• Endothelial injury or disruption comes from– High blood LDL– Free radicals from cigarette smoke– Hypertension– High plasma homocysteine– Infectious microorganisms
• Atherosclerosis now considered to be inflammatory disease
![Page 24: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/24.jpg)
Understanding the Disease Process:Understanding the Disease Process:Coronary Heart DiseaseCoronary Heart Disease
• Plaque consists of– Smooth muscle, inflammatory cells, lipids– Fibrous cap (thick or thin)– Thin caps = more unstable = easier rupture– Rupture thrombus formation
• Rupture and thrombus account for 70% of MIs
• Plaques are dynamic (erode, repair, grow)
![Page 25: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/25.jpg)
Figure 21.6Figure 21.6
![Page 26: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/26.jpg)
Understanding the Disease Process:Understanding the Disease Process:HypertensionHypertension
• Poorly understood condition
• 90 to 95% of cases idiopathic
• Remaining 5 to 10% secondary to other issues– Kidney disease– Adrenal tumors– Congenital defect of aorta
![Page 27: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/27.jpg)
Determining Individual RiskDetermining Individual Risk
• Epidemiology of CHD and hypertension reveals relationships among disease factors– Large-scale public studies, often longitudinal– Framingham Heart Study
• Epidemiology does not define causal mechanisms of cardiovascular disease
• Epidemiology does provide researchers with valuable insights into disease risk factors
![Page 28: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/28.jpg)
Determining Individual Risk:Determining Individual Risk: Coronary Heart Disease Coronary Heart Disease
• Uncontrollable CHD risk factors– Heredity, family history– Race– Sex (male > female)– Age
• Must try to mitigate risk via controllable CHD risk factors instead
![Page 29: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/29.jpg)
Determining Individual Risk:Determining Individual Risk: Coronary Heart Disease Coronary Heart Disease
• Controllable CHD primary risk factors– Tobacco smoke– Hypertension– Abnormal blood lipid profile– Physical inactivity– Obesity, overweight– Diabetes, insulin resistance
• As number of risk factors , risk of CHD
![Page 30: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/30.jpg)
Determining Individual Risk:Determining Individual Risk: Coronary Heart Disease Coronary Heart Disease
• Other putative CHD risk factors– C-reactive protein (CRP)– Fibrinogen– Homocysteine– Lipoprotein(a)
• Inflammatory processes and markers may be involved in risk
![Page 31: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/31.jpg)
Table 21.3Table 21.3
![Page 32: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/32.jpg)
Determining Individual Risk:Determining Individual Risk: Coronary Heart Disease Coronary Heart Disease
• Blood triglycerides
• Blood cholesterol
• Lipoproteins– VLDL cholesterol (risk factor)– LDL cholesterol (risk factor)– HDL cholesterol (beneficial)
• Ratio of total cholesterol to HDL (best index)
![Page 33: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/33.jpg)
Determining Individual Risk: Determining Individual Risk: Early Detection of CHD Risk FactorsEarly Detection of CHD Risk Factors
• Early detection preventive treatment
• In boys 8 to 12, girls 13 to 15 years old– 19.8% had total cholesterol >200 mg/dL– 5.2% had abnormal resting ECGs– 37.5% had 20+ percent body fat
• High risk in childhood high risk as adult
![Page 34: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/34.jpg)
Determining Individual Risk:Determining Individual Risk:HypertensionHypertension
• Uncontrollable risks similar to those for CHD
• Controllable risk factors for hypertension– Insulin resistance– Obesity, overweight– Diet (sodium, alcohol)– Tobacco use– Oral contraceptives– Stress– Physical inactivity
![Page 35: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/35.jpg)
Determining Individual Risk:Determining Individual Risk:Metabolic SyndromeMetabolic Syndrome
• Metabolic syndrome– Also called insulin resistance syndrome– Links CHD, hypertension, abnormal blood lipids,
type II diabetes, and abdominal obesity to insulin resistance and hyperinsulinemia
– Series of correlations and associations
• Possible causes– Obesity and insulin resistance trigger cascade of
events– Systemic inflammation
![Page 36: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/36.jpg)
Reducing Coronary Heart Disease Reducing Coronary Heart Disease Risk Through Physical ActivityRisk Through Physical Activity
• Epidemiological evidence– Risk of MI 2 to 3 times higher in sedentary
populations– Both occupational and leisure activity– Similar results for both men and women
• CDC findings– Physical inactivity equal to other risk factors– Sedentary lifestyle 3 times more common than other
major risk factors (smoke, hypertension, cholesterol)
![Page 37: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/37.jpg)
Reducing Coronary Heart Disease Reducing Coronary Heart Disease Risk Through Physical ActivityRisk Through Physical Activity
• How much physical activity risk of CHD?– Physical activity versus physical fitness– Physical activity more important than fitness
• Walking and gardening—examples of low-impact, low-level activity risk
• More vigorous exercise may yield greater benefits
![Page 38: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/38.jpg)
Reducing Coronary Heart Disease Reducing Coronary Heart Disease Risk Through Physical ActivityRisk Through Physical Activity
• Exercise type and intensity related to CHD risk– Run 6 mph for 1 h per week 42% risk– Weight train 30 min per week 23% risk– Brisk walk 30 min per day 18% risk– Swimming and cycling unrelated to risk
• Higher intensity greater risk reduction
![Page 39: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/39.jpg)
Reducing Coronary Heart Disease Reducing Coronary Heart Disease Risk Through Physical ActivityRisk Through Physical Activity
• Physical fitness and physical activity may be independent risk factors for CHD– Higher fitness and activity both reduce risk– Fitness more potent than activity
• Controversial findings, merit more research
![Page 40: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/40.jpg)
Reducing Coronary Heart Disease Reducing Coronary Heart Disease Risk Through Physical ActivityRisk Through Physical Activity
![Page 41: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/41.jpg)
Reducing Coronary Heart Disease Reducing Coronary Heart Disease Risk Through Physical ActivityRisk Through Physical Activity
• Physiological adaptations to exercise that may reduce risk– Contractility via LV hypertrophy
– Diameter and capacity of coronary vessels
– Endothelial function and vasodilation
– Vascular inflammation
• Exercise enhanced cardiac and vascular function (even with atherogenic diet)
![Page 42: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/42.jpg)
Reducing Coronary Heart Disease Reducing Coronary Heart Disease Risk Through Physical ActivityRisk Through Physical Activity
• Exercise reduced risk factors– Blood pressure (systolic, diastolic)
– LDL, total cholesterol
– HDL cholesterol
– Blood triglycerides
– Total cholesterol relative to HDL
• Exercise exerts biggest effect on blood lipid profile risk factors
![Page 43: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/43.jpg)
Reducing Coronary Heart Disease Reducing Coronary Heart Disease Risk Through Physical ActivityRisk Through Physical Activity
• Effect of exercise on other risk factors– Weight control– Diabetes management– Stress reduction– Anxiety reduction
• Note: effects of exercise on blood-related risk factors also reflect exercise effects on plasma volume and body weight
![Page 44: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/44.jpg)
Reducing Hypertension Risk Reducing Hypertension Risk Through Physical ActivityThrough Physical Activity
• Effect of exercise on hypertension not as well established as effects on CHD
• Epidemiological evidence– More active people in studies had lower systolic and
diastolic pressures– Highly fit individuals less prone to hypertension– Hypertension associated with low fitness
![Page 45: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/45.jpg)
Reducing Hypertension Risk Reducing Hypertension Risk Through Physical ActivityThrough Physical Activity
• Physiological adaptations to exercise– Plasma volume (does not blood pressure)
– In overall sympathetic nervous activity
– Vasodilation and vascular remodeling
• Physiological mechanisms that lower blood pressure still poorly understood
![Page 46: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/46.jpg)
Reducing Hypertension Risk Reducing Hypertension Risk Through Physical ActivityThrough Physical Activity
• Exercise reduced risk factors– Body fat
– Blood glucose levels
– Insulin resistance
• BP unrelated to duration of training
• BP may be greater with low or moderate intensity
![Page 47: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/47.jpg)
Risk of Heart Attack and Death Risk of Heart Attack and Death During ExerciseDuring Exercise
• Infrequent but highly publicized• Risk very, very low
– Men: 1 death per 1.42 million h of exercise– Women: 1 death per 36.5 million h of exercise
• Habitual exercise risk of death• When death occurs, age affects cause
– Under 35: more often genetic abnormalities, aneurysm
– Over 35: more often arrhythmia caused by CHD
![Page 48: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/48.jpg)
Figure 21.8Figure 21.8
![Page 49: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/49.jpg)
Risk of Heart Attack and Death Risk of Heart Attack and Death During ExerciseDuring Exercise
• CPR outside of hospital increases survival of cardiac arrest by 2 to 3 times
• Bystanders rarely perform CPR– Fear of doing it wrong– Fear of legal liability– Fear of infection from rescue breathing
• Chest compressions without breathing better survival outcomes than traditional CPR
![Page 50: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/50.jpg)
Exercise and Rehabilitating Patients Exercise and Rehabilitating Patients With Heart DiseaseWith Heart Disease
• Endurance training changes that reduce work, O2 demand of heart
• Aerobic exercise helps prevent future complications– Capillary:muscle fiber ratio
– Plasma volume
– Or maintain O2 supply to heart
– Blood flow to heart
– LV function
(continued)
![Page 51: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/51.jpg)
Exercise and Rehabilitating Patients Exercise and Rehabilitating Patients With Heart Disease With Heart Disease (continued)(continued)
• Aerobic exercise helps prevent future complications– Blood pressure
– Blood lipid values
– Body fat
– Glucose control
– Stress
• Combining resistance training and aerobic exercise optimal
![Page 52: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/52.jpg)
Exercise Training and Rehabilitating Exercise Training and Rehabilitating Patients With Heart DiseasePatients With Heart Disease
• Comprehensive program consists of– Exercise, physical activity– Counseling (nutritional, psychological, sexual)– Support forums
• Exercise rehabilitation improves outcomes– 20% lower total mortality and 26% lower risk of
death from subsequent MI
• Rehabilitation patients should have medical evaluation, GXT, exercise prescription
![Page 53: Cardiovascular Disease and Physical Activity. CHAPTER 21 Overview Forms of cardiovascular disease Understanding disease process Determining individual](https://reader030.vdocument.in/reader030/viewer/2022032517/56649c9a5503460f94957bc4/html5/thumbnails/53.jpg)
Table 21.4Table 21.4