The big AP Exercise therapy quiz: UK Physio

What is multi-morbidity?

According to research by Ekelund (2015) a brisk walk of how long is enough to reduce an individual's risk of early death?

Which of the following are risk factors for CV disease and stroke in hypertension?

[blank_start]Type 1 Diabetes[blank_end]: A condition from birth where the body produces insufficient insulin. Lifestyle can play a part in management, but is not causative. [blank_start]Type 2 Diabetes[blank_end]: A condition that has lifestyle factors in it's development, as well as it's management when present. Over time insulin sensitivity becomes reduced and blood sugar becomes less able diffuse out of blood vessels.

For the majority of people, normal blood sugar ranges between [blank_start]4.0[blank_end] to [blank_start]6.0[blank_end] mmol/L ([blank_start]72[blank_end] to [blank_start]108[blank_end] mg/dl) when fasting, and up to [blank_start]7.8[blank_end] mmol/L ([blank_start]140[blank_end]mg/dl) 2 hours after eating.

An individual without Diabetes Mellitus will co-ordinate hormonal and metabolic events to ensure the maintenance of [blank_start]glucose homeostasis[blank_end]. In Diabetes, [blank_start]Insulin[blank_end] and other hormonal responses do not respond in the normal manner so the balance between [blank_start]peripheral[blank_end] glucose utilisation and [blank_start]hepatic[blank_end] glucose production may be disturbed. There are many factors that will affect this response during a single bout of exercise.

Which of the following are evidence based components/considerations of Type 2 diabetes management:

Beneficial effects of a single bout of exercise on type 2 diabetes include:

Long term beneficial effects of exercise on Type 2 diabetes include

Possible risks in exercising with type 2 diabetes include: Systemic: [blank_start]Retinal[blank_end] Haemorrhage [blank_start]Increased[blank_end] proteinurea Accelaration of [blank_start]microvascular lesions[blank_end] Cardiovascular: Cardiac [blank_start]arrythmias[blank_end] Ischaemic [blank_start]heart disease[blank_end] [blank_start]Raised[blank_end] blood pressure Post exercise orthostatic [blank_start]hypertension[blank_end] Metabolic: [blank_start]Hyper[blank_end]glycaemia Ketosis Musculoskeletal: [blank_start]Foot[blank_end] ulcers Injury related to [blank_start]neuropathy[blank_end] Degenerative [blank_start]joint[blank_end] disease

What are the signs/symptoms of a hypoglycaemic episode?

Treating a hypoglycaemic episode should be done immediately. You can do this by eating or drinking [blank_start]15[blank_end] to [blank_start]20[blank_end] grams of a fast acting carbohydrate, this could include [blank_start]3[blank_end] glucose or dextrose tablets [blank_start]5[blank_end] jelly babies a [blank_start]small[blank_end] glass of a sugary (non-diet) drink a small carton of pure fruit juice a tube of [blank_start]glucose[blank_end] gel

Which of the following are CONTRAINDICATIONS to exercise in type 2 diabetes?

What are PRECAUTIONS in exercise prescription for Type 2 diabetes?

[blank_start]Chronic fatigue syndrome[blank_end] (CFS) is characterised by [blank_start]persistent[blank_end], medically unexplained fatigue, as well as symptoms such as musculoskeletal [blank_start]pain[blank_end], sleep disturbance, headaches and impaired [blank_start]concentration[blank_end] and [blank_start]short[blank_end] term memory. CFS presents as a common, debilitating and serious health problem

Graded exercise therapy is a staged approach to exercise for people with ME/CFS. Exercise is based on the person's [blank_start]current[blank_end] level of activities (ADLs, relapses, goals) and should include [blank_start]sleep[blank_end] and relaxation strategies to manage recovery and acute exercise malaise. Goals should be [blank_start]long term[blank_end], and the physiological context of exercise should be explained, including the potential to [blank_start]increase[blank_end] symptoms in the short term. Start with [blank_start]low intensity[blank_end] exercise sustainable independent of fluctuations. Frequency should be progressed first, then duration. There are [blank_start]no known[blank_end] pharmaceutical treatments to manage ME, and evidence for pacing strategies is [blank_start]insufficient[blank_end]: The ME association currently recommends pacing as the preferred approach to activity management. Strategies that should be avoided include unsupervised [blank_start]vigorous[blank_end] exercise, encouraging of exercising substantially [blank_start]less[blank_end] than full capacity to reserve energy (envelope theory), encouraging [blank_start]complete rest[blank_end] during a relapse, or having exercise guided by inexperienced practitioners.

Which of these is NOT an absolute contraindication to exercise?

[blank_start]Deconditioning[blank_end] is associated with changes in muscle (sarcopenia) and bone, cardiovascular, respiratory, and metabolic changes. Simply reducing normal activity levels results in elements of this problem: reductions in weekly weight bearing exercise result in a loss of bone mass in both men and women.

What does FITT stand for? F = [blank_start]Frequency[blank_end] I = [blank_start]Intensity[blank_end] T = [blank_start]Time[blank_end] T = [blank_start]Type[blank_end]

When performing exercise with patients that are on multiple drugs, all exercise is contra-indicated due to the possibility of adverse reactions to combined drugs.

Which of the following are psychosocial factors that may influence exercise adherence?

The most frequently cited reason for dropping out of an exercise programme is lack of [blank_start]time[blank_end]

[blank_start]Motivational interviewing[blank_end] (MI) is a counselling technique that can be modified based on target group to change [blank_start]maladaptive[blank_end] behaviours, elicit ambivalences, and [blank_start]enhance[blank_end] self-efficacy for making changes. MI is a collaborative, [blank_start]person[blank_end]-centred form of guiding to elicit and strengthen motivation for [blank_start]change[blank_end]. It is delivered over an [blank_start]extended[blank_end] period of time. It is particularly useful for helping those who are [blank_start]less[blank_end] ready to change, and has been found effective in promoting change (at least in the [blank_start]short[blank_end] term) with a wide range of health behaviours, including [blank_start]diet[blank_end] and physical activity. All health professionals can be trained in it's use. The principles of MI are illustrated by the acronym RULE. R: [blank_start]Resist the righting reflex[blank_end]. Practitioners should [blank_start]avoid trying[blank_end] to "put right" patient's behaviours. U: [blank_start]Understand[blank_end] and explore the patient's own motivations L: [blank_start]Listen with[blank_end] empathy E: [blank_start]Empower[blank_end] the patient, encouraging hope and optimism.

Which of the following are examples of CHANGE TALK and not SUSTAIN TALK

Preparing to change may contain the following components D = [blank_start]Desire[blank_end] to change - I would like to A= [blank_start]Ability[blank_end] - I would be able to R = [blank_start]Reason[blank_end] = It would enable me N = [blank_start]Need[blank_end] - I must/I cannot go on like this

Mobilising change involves C = [blank_start]Commitment[blank_end] to change - Likelihood of change "I will" A = [blank_start]Activation[blank_end] ready for change - "I am ready to" T = [blank_start]Taking[blank_end] steps - "I went to the exercise class"

Which of the following are "Evocative questions/discussions" for change:

Weighing up benefits and costs of changing a behaviour is demotivating and should never be used in clinical practice

Evidence supports the notion that one specific behavioural model should be used to elicit behavioural change. It is ineffective to focus on generic competencies and skills.

Label each of the stages in the stages of change model

What is the condition in the picture?

[blank_start]Osteoporosis[blank_end] is a common bone disease characterised by reduced bone mass which is associated with an increased risk of low trauma fractures. Fractures are an important cause of morbidity and patients who suffer hip and vertebral fractures have a decreased life expectancy.

Bone mineral density as measured at the hip (femoral neck) by Dual energy xray absorptiometry (DEXA) is used to diagnose osteopenia and osteoporosis. Measurements are in bone mass density (BMD). Fill in the blank numbers used to diagnose each condition. Osteopenia: BMD between [blank_start]1[blank_end]-[blank_start]2.5[blank_end] SD below that of a young normal adult Osteoporosis: BMD [blank_start]2.5[blank_end] SD below that of a young normal adult. Severe osteoporosis (established osteoporosis): osteoporosis in the presence of [blank_start]1[blank_end] or more fragility fractures.

Which of the following are lifestyle info/advice you can give to a person with osteoporosis to aid prevention of fragility fractures

People with osteoporosis should be encouraged to minimise exercise, as even though there are some minor benefits to bone mineral density, the risk of deadly hip fractures is far too high. Nutritional interventions should take place for at least six months before regular exercise takes place.

Bisphosphonates such as alendronate acid and risedronate sodium are types of [blank_start]antiresorptive[blank_end] medication used in the treatment of [blank_start]osteoporosis[blank_end] that reduce the risk of vertebral fracture when given with calcium and [blank_start]vitamin D[blank_end] supplements.

Label the BMI classifications (BMI in kg/m2) Classification Healthy - [blank_start]18.5[blank_end]-[blank_start]24.9[blank_end] Overweight - [blank_start]25[blank_end]-[blank_start]29.9[blank_end] Obese 1 - [blank_start]30[blank_end]-[blank_start]34.9[blank_end] Obese 2 -[blank_start]35[blank_end]-[blank_start]39.9[blank_end] Obese 3 - [blank_start]≥ 40[blank_end]

Label the risk table for BMI/Waist circumference

Label this waist-hip ratio table

The full text in this image has been removed. Complete the sentences below. The image displays a [blank_start]change ruler[blank_end] which is used to determine how ready a patient is for [blank_start]change[blank_end]. When using you can ask them how realistic or how confident they are about their response, or why 6 rather than 4, and what could help them/what support they need to score higher.

Link the description to the behaviour change theory/model: [blank_start]Cognitive dissonance theory[blank_end] - A situation involving conflicting attitudes, beliefs or behaviors produces a feeling of mental discomfort leading to an alteration in one of the attitudes, beliefs or behaviors to reduce the discomfort and restore balance. [blank_start]Diffusion of innovation theory[blank_end] - Explains how, over time, an idea or product gains momentum and spreads through a specific population or social system. The end result of this is that people, as part of a social system, adopt a new idea, behavior, or product. Adoption means that a person does something differently than what they had previously (i.e., purchase or use a new product, acquire and perform a new behavior, etc.). The key to adoption is that the person must perceive the idea, behavior, or product as new or innovative. [blank_start]Health belief model[blank_end] - Based around the foundation that health related behaviours are predicated upon 1) the desire to avoid illness and/or recover from illness, and 2) the belief that a specific health action will avoid or help recover from said illness. An individual's course of action depends on the person's perceptions of the benefits and barriers of those health behaviours. There are six components of these beliefs and barriers. 1. Perceived susceptibility. 2. Perceived severity. 3. Perceived benefits. 4. Perceived barriers. 5. Cue to action, and 6. Self efficacy. [blank_start]Motivational interviewing[blank_end] - A person centred counselling style for eliciting behavioural change by helping clients to explore and resolve ambivalence via focused and goal directed discussions. The core foundation is bringing about "change talk" and evoking patient motivation to make positive changes. The approach relies on non-judgement of the patient and accepting them how they are. [blank_start]Self efficacy[blank_end] - In essence, a person's belief in their own competence and ability to achieve/perform a given goal/task. This can interact with all aspects of a person's life, but has particular relevance when it comes to making changes to health behaviours, where without this, a person will have minimal motivation to change as they will believe it outside the scope of their capabilities. [blank_start]Social cognitive learning theory[blank_end] - A framework of learning and change based upon the observation of others within the context of social interactions, experiences, and outside media influences. "People do not learn new behaviours solely by trying them and either succeeding or failing, but rather the replication of the actions of others" [blank_start]Theory of reasoned action[blank_end] - Aims to explain the relationship between attitudes and behaviours in human action. Mainly used to predict how individuals will behave based on their pre-existing attitudes and behavioural intentions. "An individual's decision to engage in a particular behaviour is based on the outcomes the individual expects will come as a result of performing it". Transtheoretical model/[blank_start]stages of change theory[blank_end] - A framework based on the idea that individuals move through six stages of change: precontemplation, contemplation, preparation, action, maintenance and termination.