physical activity , i mmobili z ation
DESCRIPTION
Manifestation of Novel Social Challenges of the European Union in the Teaching Material of Medical Biotechnology Master’s Programmes at the University of Pécs and at the University of Debrecen Identification number: TÁMOP-4.1.2-08/1/A-2009-0011. - PowerPoint PPT PresentationTRANSCRIPT
Manifestation of Novel Social Challenges of the European Unionin the Teaching Material ofMedical Biotechnology Master’s Programmesat the University of Pécs and at the University of DebrecenIdentification number: TÁMOP-4.1.2-08/1/A-2009-0011
PHYSICAL ACTIVITY, IMMOBILIZATION
Erika Pétervári and Márta BalaskóMolecular and Clinical Basics of Gerontology – Lecture 5
Manifestation of Novel Social Challenges of the European Unionin the Teaching Material ofMedical Biotechnology Master’s Programmesat the University of Pécs and at the University of DebrecenIdentification number: TÁMOP-4.1.2-08/1/A-2009-0011
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Outline• The beneficial effects of physical
exercise• Inactivity• Immobilization syndrome – chronic
bedrest• Pressure ulcers and other
consequences
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Exercise• Helps to maintain (reach) a healthy BMI• Improves body composition, increases BMR• Trained muscles burn fat• Active muscles take glucose without insulin
(GLUT4)• Increases the rate of HDL, improves
cholesterol profile• Improves thermal adaptation
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• Adrenalin induces vasodilatation in active muscles
• Increases Peak-Bone –Mass, helps prevent osteoporosis
• Reduces stress levels• Helps prevent depression and dementia
(neural growth factor, decreased amyloid production)
• Decreases the incidence of certain types of cancer (colon, breast, uterus, esophagus, prostate) via maintenance of normal BMI and insulin sensitivity – decreased levels of insulin, estrogen levels and binding.
Exercise
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• Muscle hypertrophy may be elicited by relatively intensive training even in the elderly(12 weeks – 3 times a week +10%)
Exercise
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Inactivity0 Regular intensive physical exercise, good
level of fitness1 Sedentary lifestyle, only recreational sport2 Sedentary lifestyle, without recreational
sport3 Moderate immobilization in sitting or
horizontal position4 Total immobilization (paralysis) 5 Tilting
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• MET: metabolic unit1 MET: 3.6 mlO2/kg/min3 MET: brisk walking
• A school child has a 7 MET PE lesson 3 times a week for 10 months – 3 × 7 × 10/12 = 17.5 MET/week
• Inactivity increase BMI(difference between most and least active 30% 2.1 in Caucasians, 2.9 in Afro-americans)
• Maximal activity decreases with age:from 28-40 → 4-30 MET/week(3-22 MET/week in Afro-americans)
Inactivity
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Immobilization – chronic bed rest• Short term – beneficial; Long-term – harmful • Inactivity and somnolence is part of the
“sickness-behavior”, besides fever, anorexia, depressed water intake, apathy, lethargy, impaired grooming, enhanced sensitivity to pain…
• XIXth century: AMI – 6-week bedrest, femur fracture - 6-month bedrest
• Today: a minimum of 12-48 hours of bedrest after AMI
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Causes• Loss of both lower limbs• Spinal injuries (transection)• Amyotrophic lateral sclerosis• Late stages of Parkinson’s disease• Neuropathies/encephalopathies• Paralysis due to stroke• Coma• Extreme weakness, painful joints, severe COPD, heart
failure• Elderly (depression, isolation, fear from falling,
dementia, tranquillizers, sleeping pills, antihypertensive drugs, diuretics, orthostatic hypotension)
Immobilization – chronic bed rest
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Consequences• Adaptation of the circulation (short term – long term)• Pressure ulcers• Depressed ventilation, risk for hypostatic pneumonia• Increased risk for deep venous thrombosis,
pulmonary embolism• Muscle atrophy, contractures, constipation• Osteoporosis• Changes in metabolism, heat adaptation• Depressed immunity failure• Psychological changes
Immobilization – chronic bed rest
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Earth gravityNormal condition
Zero gravityAcute exposure
Zero gravityChronic exposure
Earth gravityUpon return
Central venouspool
Immobilization – chronic bed rest
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Pressure Ulcers• Definition
Any lesion caused by unrelieved pressure resulting in damage of underlying tissue (AHCPR, 1994).
• Can occur anywhere on body
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Pressure Ulcer Etiology• Pressure exerted by bony prominences
on the body that stop capillary flow to the tissues.
• Deprives tissues of oxygen and nutrients causing cell death.
• Pressure greater than 32mmHg exerted by bony prominences to disrupt blood flow.
Pressure Ulcers
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Causes of Pressure Ulcer• Prolonged pressure
- duration and intensity of pressure- location of pressure on body- extended pressure that
blocks flow to the tissue betweenthe source of pressure & the bone
• Shear• Friction
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Function of both time and pressure(hyperbolic curve)• 70 mmHg pressure for two hours
produces irreversible injury• greater pressure takes less time• lower pressure takes more time• obese may be much lower; emaciated
may be much higher• turning schedules must be
individualized!!!!
Pressure Ulcer
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Pressure Ulcer Staging (depth & tissue type)Stage I Persistent redness
(color pressure insensitive)Stage II Partial thickness skin lossStage III Full thickness skin loss
(subcutaneous)Stage IV Full thickness skin loss (fascia)
Pressure Ulcer
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Immobilization – chronic bed rest
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Epidermis
Subcutaneous tissue
Muscle
Dermis
Bone
Reddened area
Immobilization – chronic bed rest
Blister
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Mortality• 40% die per year• 60% die within 1 year after hospital
discharge
sources: Thomas DR JAGS 1996; 44:1435.Brandeis GH JAMA 1990;264:2905-9.
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Pain with Pressure Ulcers• 59% report some degree of pain• Only 2% receive pain medication within
4 hours of dressing change• 45% report pain as distressing or
horrible
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Immobilization – chronic bed rest(Ca and hydroxyproline loss)
Time (weeks)
Control Bedrest
Calcium
Chan
ge in
urin
ary
calci
um (m
g/da
y)
-10 -5 0 5 10 15 20
150
100
50
0
-50
OH-Proline
Chan
ge in
urin
ary
hydr
oxyp
rolin
e (m
g/da
y)
20
10
0
-10
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VO2max = Qmax x (a-v)O2 Differencemax
Adaptive responses of factors infuencing maximal oxygen uptake (VO2max) in chronic bedrest
Immobilization – chronic bed rest
HR Stroke volumeArterial O2 Venous O2âSensitivity of the arterial baroreceptor system
âBlood volume â RBC mass âMuscle mass
áSymp/parasympbalance
âAlpha-adrenergic VC â VEmaxâPerfusion pressure
in musclesâMuscle tone á V/Q âCapillary densityâMuscle mass á Diffusion áDiffusion distance in
tissueâBaroreceptor VCresponse âO2 extraction
áBeta-adrenergic activity
âSubstrate transport âSubstrate
metabolismâEnergy storesâNumber of
mitochondria