True or False
More than 80% of patients enrolled in cardiac
rehabilitation (CR) are overweight or obese, however
weight reduction of overweight and
... [Show More] obese patients
has not been a primary focus of most CR programs
True
True or False
BMI differentiates
between fat mass and fat free mass, this
limitation should be considered at the individual
level
False
BMI does NOT differentiate
between fat mass and fat free mass, this
limitation should be considered at the individual
level
Name the classifications of BMI:
Underweight BMI ≤ 18.5 kg/m²
Normal weight 18.5-24.9 kg/m²
Overweight 25.0-29.9kg/m²
Obese ≥ 30.0 and is graded into 3 classes:
- Class 1: 30.0-34.9 kg/m²
- Class 2: 35.0-39.9 kg/m²;
- Class 3: ≥ 40.0 kg/m² is referred to as morbid or extreme obesity.
BMI should be used for individuals 19 years of age and younger
False
individuals 19 years of age and younger percentiles are used
based on gender and age. The BMI classification
for adults should not be used for these ages
Under 19 years classfications for overweight and obese:
≥ 85 -< 95 percentile is classified as overweight,
and ≥ 95 percentile is classified as obese
The ________ obesity
pattern is most associated with health risks,
including hypertension, dyslipidemia,
inflammation, metabolic syndrome, type 2
diabetes, and premature coronary artery disease
and death.
Android
Android
"apple-shaped" obesity
Gynoid
"pear-shaped" obesity
Where do you measure wasit circumference?
Measurement of WC - A cloth or plastic tape
measure with a spring loaded tape measure (ie,
Gulick tape) is used to perform the measurement
which is taken ~1 inch above the umbilicus
Describe the waist circumference measurements associated with risk.
A WC of ≥ 102 cm (40.2 inches) in males and
≥ 88 cm (34.6 inches) in females is considered at
risk
__________________ utilizes both waist and
hip circumference and is calculated as waist
(cm)/hip (cm)
Waist to hip-ratio (WHR)
What WHR is considered high risk in males and female?
WHR of 0.95 is considered high risk in males and 0.86 in females.
True or False
Girth measurements should be measured on the same side?
True
Assessments should be done on same side of
body (protocols typically suggest right side of
body)
____________________ are based on the
principle that the amount of subcutaneous fat is
directly proportional to the total amount of body fat
Skinfold measurements are based on the
principle that the amount of subcutaneous fat is
directly proportional to the total amount of body fat.
Skinfold assessment can be performed rapidly, and
are portable. Additionally they are cost effective.
Once purchased, there are no ongoing maintenance
costs with skinfold calipers.
What body fat percent range is considered normal?
A body fat % range of
10-22% in males and 20-32% in females is
considered satisfactory for health. There are no agreed national standards that exist
for a specific % body fat in adults to classify
overweight and obesity.
How accurate are skin fold measurements?
Measurements using skinfolds can have accuracy
levels ± ~3% of more sophisticated techniques
Name the common skinfold sites that are vertical sites:
Vertical skinfolds sites
(caliper tongs are parallel to floor) include the
abdominals, biceps, medial calf, midaxillary, and
thigh.
Name the common skinfold sites that are diagonal sites:
Diagonal skinfold sites (caliper tongs are at
45 degree angle) include the chest, subscapular,
and suprailiac.
________ hydration
would lead to an over estimation of % body fat.
hyper-hydration
would lead to an over estimation of % body fat.
White adipocytes
Main function is to store
lipid and secrete adipokines
Brown adipocytes
Involved in thermogenesis,
smaller amount in adults compared to infants,
however evidence suggests higher levels of
brown adipocytes in adults living in colder
regions.
Explain how fat stores increase:
When energy (kilocalorie/kcal) intake from food
and beverages is greater than energy expenditure
(positive energy balance), the white portion of the
adipose organ increases in size
hyperplasia
increase in cell numbers
When you gain fat do you increase production of
pro-inflammatory cytokines?
True
An increased level of pro-inflammatory
cytokines throughout body contributes to
several disease states including
atherosclerosis. This is part due to
pro-inflammatory cytokines which lead to the
dysfunction of the adipocyte, insulin
resistance, increased circulation of blood lipids
and, the accumulation of lipid in other tissues
What is the relationship between wieght loss and BP & CVD risk?
The strength of the evidence is high in that there
is a dose-response relationship with blood
pressure (BP) levels and weight loss among
overweight or obese adults with or without
elevated CVD risk. A 5% loss of body weight
loss results in a mean weighted reduction in
systolic and diastolic BP of 2-3 mm Hg.
Additional examples are in the Obesity Guidelines
Position Statement
Under 19 years of age what percentile is considered underweight?
individuals 19 years of age and younger, a BMI
≤ 5 percentile is considered underweight
What BMI is considered underweight for adults?
adults, a BMI < 18.5 kg/m² is considered underweight
Can an underweight CVD patient be healthy?
It is possible for patients to be "underweight" and
healthy. Some individuals may have a genetic
traits predisposition for being an ectomorph or
slender.
TEE
Total Energy Expenditure
Total Energy Expenditure (TEE) consists of 3
primary components in humans:
- Resting metabolic rate (RMR) also sometimes
referred to as resting energy expenditure
(REE), refers to the energy required to maintain
the body in a resting state
- Thermic effect of food (TEF) refers to the
energy expended digesting processing food
- Physical activity energy expenditure (PA EE).
The estimated contribution of each of these
components as a % of total energy
expenditure is TEE = RMR (60-75%) + TEF
(~10%) + PA EE (15-30%).
How much weight loss a week?
As a rule, the rate of loss should be 2 pounds or less per week.
REE
Resting metabolic rate (RMR) also sometimes
referred to as resting energy expenditure
(REE),
Other factors influencing Total Energy
Expenditure include
Medication and environment
What is the calorie deficit a day for a two pound week loss in a week?
1000 kcal deficit/day will lead to 2
pound weight loss.
Calculating daily caloric (Kcal) intake
Daily kcal intake should be
≤ 500-1000 kcals than their estimated
maintenance requirements.
A simple method
endorsed in the 5th Edition AACVPR guidelines
involves multiplying baseline body weight in
pounds by 12.
If the patient weighs
200 pounds what would the estimated maintenance
requirement be? What dietary pattern should be the target for weight loss?
For example, if the patient weighs
200 pounds, their estimated maintenance
requirement would be ~2400 kcals per day thus,
the dietary pattern should target ~1400-1900
kcals /day. This is a ballpark estimate and the
kcal deficit should include a consideration for the
amount of exercise (type, intensity, duration,
frequency) and PA the patient will do. Additionally,
the plan should promote a gradual loss (to
minimize muscle loss) and should be sustainable.
Spacing of food intake can help reduce
post-prandial blood lipid increases, large changes
in blood glucose, as well as large spikes in
appetite-related hormones, including ghrelin
which increase the drive to eat
cardiac output
= heart rate X stroke volume.
What happens to cardiac rehab participants when they are dehydrated?
If a patient is dehydrated, their pre-load and left ventricle stroke volume will be reduced. To compensate to maintain cardiac output, heart rate will increase, and the client will fatigue earlier than if they were euhydrated. Additionally, dehydration can reduce energy expenditure14 and is associated with premature mortality
What is the general kcal/day ranges for men and women in a weight loss program?
energy deficit > 500 kcal/day. This deficit often
is sought by prescribing 1,200 to 1,500
kcal/day for women and 1,500 to 1,800
kcal/day for men.
Is the Atkins (high protein/high fat) diet recommended for CR patients?
high protein, high fat, low carbohydrate dietary patterns are not endorsed by the AHA, NCEP, AACVPR, the Canadian Association for Cardiopulmonary Rehabilitation (CACR), or AND
Define Low CHO diet
"low
Carbohydrate (CHO)" - 30 grams of CHO is
extremely low and difficult (virtually impossible) to
sustain. Many people proclaim to be on a "low
carbohydrate diet" however there is no consensus
on what is a low CHO diet; however the DRI is 130
g/day which is based on the minimal amount for
brain and neurological function. If a person eats
2000 kcals, CHO would be 26% of total kcals.
Based on the National Health Nutrition and
Examination Survey most adults in the U.S. average
~125-150 grams of CHO /1000 kcals
Protein increased to 25% has a ___ evidence of weight loss in a 500-750 kcal/day diet
In overweight and obese adults,
following recommendations to increase dietary
protein (25% of total kcals) as part of a
comprehensive weight loss intervention results in
equivalent weight loss as compared with a typical
protein diet (15% of total kcals) when both diets
are calorie-restricted (500-750 kcal/day deficit)
What are the concerns of following a very low CHO diet?
Concerns for when a patient
adheres to a very low CHO diet include a low
nutrient density from restriction of fruit, vegetables,
grains and whole grains, and other CHO containing
foods, all of which contain dietary fiber, vitamins,
minerals and phytochemicals.
Meal replacement bars and liquid diets with food added have a ____ evidence of affectiveness
Low
Rate of weigh loss: recommendations for loss in six months and how much in percent that is per month
The 2013 Obesity and AACVPR
guidelines recommend as an initial goal the loss of
5% to 10% of baseline weight within 6 months. On
average if a patient achieves a 1-2% weight loss
/month they will meet this recommendation. As
noted in section 5, a sustained weight loss of as little
as 3-5% of body weight can produce clinically
meaningful reductions in CVD risk factors goals for
weight loss.
CR patients and fruit consumption guidelines:
For fruit, patients
should be encouraged to eat their fruit versus the
fluid form due to ability to consume higher kcal
intakes. If patients do choose to drink juice, it
should be 100% juice and consumed in modest portions
Omni Heart Study Diet
If a patient wants to follow a low CHO and high protein diet the patient could be
encouraged to follow the high-protein diet based
on the Omni heart study.This dietary plan is
based on the original DASH diet but some of the
carbohydrate was replaced with protein (primarily
plant based protein, fish, and poultry)
Ornish Pattern also
referred to as the Lifestyle Heart Trial
is an example of a lacto-vegetarian diet
self-efficacy
confidence
Weigh loss assessment should also include a pscyhosocial assessment because
barriers to change need to be discussed and readiness for change [Show Less]