CCRP Weight Loss EXAM (GRADED A) Questions and Answers (100 out of 100)

True or False More than 80% of patients enrolled in cardiac rehabilitation (CR) are overweight or obese, however weight reduction of overweight and 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 ~ 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