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physical activity , i mmobili z ation

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.

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physical activity , i mmobili z ation

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  1. 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 Debrecen Identification number: TÁMOP-4.1.2-08/1/A-2009-0011

  2. 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 Debrecen Identification number: TÁMOP-4.1.2-08/1/A-2009-0011 Erika Pétervári and Márta Balaskó Molecular and Clinical Basics of Gerontology – Lecture 5 physical activity, immobilization

  3. Outline • The beneficial effects of physical exercise • Inactivity • Immobilization syndrome – chronic bedrest • Pressure ulcers and other consequences

  4. 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

  5. Exercise • Adrenalin induces vasodilatation in active muscles • Increases Peak-Bone –Mass, helps prevent osteoporosis • Reduces stress levels • Helps prevent depression and dementia (neural growth factor, decreasedamyloid 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.

  6. Exercise • Muscle hypertrophy may be elicited by relatively intensive training even in the elderly(12 weeks – 3 times a week  +10%)

  7. Inactivity 0Regular intensive physical exercise, goodlevel of fitness 1Sedentary lifestyle, only recreational sport 2Sedentary lifestyle, without recreationalsport 3Moderate immobilization in sitting orhorizontal position 4Total immobilization (paralysis) 5Tilting

  8. Inactivity • MET: metabolic unit 1 MET: 3.6 mlO2/kg/min 3 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)

  9. 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

  10. Immobilization – chronic bed rest 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)

  11. Immobilization – chronic bed rest Consequences • Adaptation of the circulation (short term – long term) • Pressure ulcers • Depressed ventilation, risk for hypostaticpneumonia • Increased risk for deep venous thrombosis, pulmonary embolism • Muscle atrophy, contractures, constipation • Osteoporosis • Changes in metabolism, heat adaptation • Depressed immunity failure • Psychological changes

  12. Immobilization – chronic bed rest Central venous pool Earth gravity Normal condition Zero gravity Acute exposure Zero gravity Chronic exposure Earth gravity Upon return

  13. Pressure Ulcers • DefinitionAny lesion caused by unrelieved pressure resulting in damage of underlying tissue (AHCPR, 1994). • Can occur anywhere on body

  14. Pressure Ulcers • 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.

  15. Causes of Pressure Ulcer • Prolonged pressure • - duration and intensity of pressure • - location of pressure on body • - extended pressure thatblocks flow to the tissue betweenthe source of pressure & the bone • Shear • Friction

  16. Pressure Ulcer • Function of both time and pressure(hyperbolic curve) • 70mmHg 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!!!!

  17. Pressure Ulcer • Pressure Ulcer Staging (depth & tissue type) • Stage I Persistent redness(color pressureinsensitive) • Stage II Partial thickness skin loss • Stage III Full thickness skin loss(subcutaneous) • Stage IV Full thickness skin loss (fascia)

  18. Immobilization – chronic bed rest

  19. Immobilization – chronic bed rest Reddened area Blister Epidermis Dermis Subcutaneous tissue Muscle Bone

  20. 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.

  21. 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

  22. Immobilization – chronic bed rest(Ca and hydroxyproline loss) 20 150 10 100 Change in urinary hydroxyproline(mg/day) Change in urinary calcium (mg/day) 50 0 Calcium OH-Proline 0 Control Bedrest -10 -50 20 15 10 5 0 -5 -10 Time (weeks)

  23. Immobilization – chronic bed rest Adaptive responses of factors infuencing maximal oxygen uptake (VO2max) in chronic bedrest VO2max = Qmax x (a-v)O2 Differencemax HR Stroke volume Arterial O2 Venous O2 Sensitivity of the arterial Blood volume RBC mass Muscle mass â â â â baroreceptorsystem Symp/parasymp Alpha-adrenergic VC VEmax Perfusion pressure á â â â balance in muscles Muscle tone V/Q Capillary density â á â Muscle mass Diffusion Diffusion distance in â á á tissue Baroreceptor VC O2 extraction â â response Beta-adrenergic Substrate transport á â activity Substrate â metabolism Energy stores â Number of â mitochondria

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