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Dr. Arun G Maiya Pranjali Arora



1. abnormal cardiac findings in endurance athelets are

variants of normal.

2. Physical fatigue or psychological factors are
responsible for most complains of reducing exercise
capacity in endurance athletes.

3. THE ECGs of well trained endurance athletes may

demonstrate the AV block as well as atrial ,nodal and

even the ventricular escape rhythms.

4. Ventricular premature contraction should be judged by
cardiac company the keep
5. Healthy endur5ance athletes may have evidence of
Atrial and ventricular enlargement on ECG, Radiography.
The absolute risk of death during exercise for
symptomatic individual is low, but excretion does
transiently increase that risk for susceptible person.

Reported in kilocalories per square meter.  This energy is utilized to carry forward the basic physiological functions (breathing. digestion. RESTING METABOLIC RATE :-now instead of BMR .the more heat loss occur from skin which increases the BMR.because measurement follow the same condition but do not require individual sleep over in hospital for 12 hours . Thus they tend to have lower BMI than men. lesser the fat free mass more will be the BMI since women tend to have greater fat mass than men.BASIC METABOLIC RATE:-It is the energy expenditure of body at rest.6xLBM) where LBM is the lean body mass and P is the total heat production in body. FACTORS AFFECTING BMR  -Gender  Age  Body temperature  Psychological stress  Hormones  GENDER:-BMR is directly related to an individual’s fat free mass. .  AGE :-BMR decreases with increasing age generally because of reduction in fat free mass.  BODY SURFACE AREA:-Higher the surface area . FORMULA TO CALCULATE BMI ACCORDING TO MCARDLE KATCH  P= 370+ (21. temperature Regulating etc) of body at rest.RMR is the used terminology .200 to 2.  Psychological stress:-stress increases the sympathetic nervous system.  Measured immediately after at least 8hours of sleep and 12 hours of fasting in hospital or testing laboratory.400 kcal\day .  It ranges from 1. which increases the BMR.

BMR measurements must meet the physiological equilibrium whereas RMR measurements can be altered.  It’s transported through blood to all body tissues.  Before usage it has to be converted into fat (lipogenesis) or carbohydrate(gluconeogenesis) BIOENERGETICS:-cells generate ATP 3 different processes .  Glycogen is converted to glucose ate the time of need.1k\cal. the amount of energy released in a biological reaction can be calculated from the amount of heat produced.  Energy released from breakdown of a gram of fat is 9.  The ATP-PCR system  The glycolytic system . EXERCISE METABOLISM:-all chemical reactions occurring in body during exercise to provide fuel to body are collectively called as exercise metabolism.  Energy is released when chemical bond between –the bond that holds element together to form molecule are broken. Carbohydrate: .  It is different from BMR.  FAT:-less readily availablefor cellular metabolism.4kcal.  Ingested carbohydrate is stored in the form of glycogen in liver and muscles’ cytoplasm.  It provides energy on less intensity prolonged exercise.utilized during high intensity short duration exercise.  A gram of protein releases 4.  Amount of energy released on breaking of carbohydrate is 4.  All carbohydrate in body will ultimately be converted into glucose. PROTEIN:.  Because all energy degrades into heat.  Carbs are the primary source of energy for muscles. because it has to convert into complex stored form TRIGLYCERIDE to basic components.  Used only in case of serve energy depletion or starvation.  At rest or during exercise energy that body needs is derived from breakdown of fat and carbohydrate. GLYCEROL and FREE FATTY ACIDS.used as minor source of energy .1 k\ Cal of energy.

 The release of energy from PCR is facilitated by the enzyme creatin kinase.  Fate of cycle is decided by presence of oxygen. which acts on PCR to separate phosphate from creatin. it causes the accumulation of lactic acid in body.  The oxidative system ATP-PCR SYSTEM:.  One mole of glycogen yield 3 mole of ATP.  The energy released is used to add phosphate molecule to ADP molecule.  A high energy molecule called phosphocreatine is stored in cell.  One mole of glucose yield 2 mole of can sustain energy only for initial 3to 15 sec. GLYCOLYTIC SYSTEM  The mode of ATP production involves the breakdown of carbohydrates.  Oxidation of carbohydrate . OXIDATION OF SYSTEM The process by body breaks down the substrates with the aid of oxygen.  Limitation of anaerobic glycolysis is .  Synthesis of glycogen in body from glucose by a process called glycogenic.

nicotinamide adenine dinucleotide and Flavin adenine nucleotide.also known as citric acid cycle .a) Aerobic glycolysis b) Krebs cycle c) The electron transport chain a) Aerobic glycolysis:-the process of glycolysis is same only the fate of end product pyruvic acid will differ . one molecule of glycerol and 3 free fatty acid.  Additional hydrogen ions would combine with 2 co- enzymes . This process is called lipolysis.  At the end of the chain H+ combines with oxygen to form water.fat to be used in the form of energy has to be broken from triglyceride(store form) to its simplest the presence of oxygen pyruvic acid will be converted to acetyl co- enzyme A b)Krebs cycle:.000to 75. it would became too acidic. c) Electron transport chain: - during Glycolysis and Krebs cycle additional hydrogen ions are released. it is oxidized by through various chemical reactions into carbohydrate and water .  If the remain inside the cell.  Oxidation of fat:-fat stored inside the muscle and in fat cells can provide upto70. It is the cycle of total 8 enzymes. formed acetyl CoA will enter the Krebs cycle.000kcal. releasing 2 moles of AT P as end product. . for the Krebs cycle is coupled to series of reactions known as electron transport chain. these carry the O2 to electron transport chain.

 When amino acid is catabolized .1kcalof energy.7(WEIGHT IN KG )+5(HEIGHT IN CM)-6.  Beta oxidation:-on entering into muscle fiber they are enzymatically active from ATP.Oxidation of protein:-protein 4. 3. if an FFA originally yields 16 carbon unit beta molecule yield 8 molecules of acetyl co-enzyme  Acetyl CoA formed from beta oxidation enters the Krebs cycle. instead it get converted into urea and then excreted out from body. preparing it for catabolism into mitochondria.  In this process FFA is cleaved into separate 2 carbon units for eg.some of the released nitrogen is used to form new amino acid .8(AGE .but remaining nitrogen cannot oxidized.4. termed as Beta oxidation.8(HEIGHT IN CM).  Its oxidation id quite complex because protein contain nitrogen which cannot be oxidized.  Fat metabolism can release so much energy because FFA has more carbon than glucose thus more acetyl COA is form for metabolism.7(AGE) MEN=66+13. CALCULATION OF ENERGY EXPENDITURE BMR ACTIVITY WOMEN=655+9.6 (WEIGHT INKG) + 1.

or carbon dioxide .cycling resistance is increased buy 50w in each subsequent 5 min until the participant has cycled for at least 3incremental stages. vo2. and fat .  Calorimetry  Double labeled water technique  Accelerometer  Pedometer  Heart rate monitoring Heart rate monitoring is used to estimate energy expenditure based on the assumption of linear relationship between heart rate and oxygen consumption this relation is established by using submaximal calibration procedure typically undertaken following the assement of resting energy expenditure. average energy expenditure is used using the vo2 and vco2 values. protein .vco2 are measured using a metabolic cart in following se sequential steps:-5 min sitting .to equate the HR and EE a regressive linear line for HR and EE is used . Further while there is a very close relationship between HR and EE but not in rest and light activities. Calorimetry Human energy metabolism involves the production of energy by the combustion of carbohydrate . However this method has several limitations as well the relation between the HR and VO2 is different in upper and lower limb.5 min of low resistance cycling .ASSEMENT OF ENERGY EXPENDITURE Objectively Energy expenditure can be measured by oxygen consumption .or heat production . by measuring micronutrient . depending the level of fitness ~150 beats \min .5mins of increasing cycling resistance while marinating the cadence OF 60RMPV . even for the same activity.5 min of waling .in this process oxygen is .

.consumed and carbohydrate is produced the measurem. 2 ways of measurement direct and indirect calorimetry Measurement of heat loss from body within a close chamber is called direct calorimeter Measurement of oxygen consumption or carbon dioxide production is indirect calorimetry INDIRECT CALORIMTER.there will be the need of a close3d chamber to measure the volume of oxygen consumed and the volume of carbon dioxide release per min .to calculate the volume of oxygen inspiresd we multiple the volume of air by the fraction of that air composed of oxygen Thus Volume of air inspired (Vi) Volume of air expired (Ve) Fraction of oxygen in the inspired air (FiO2) Fraction of Co2 in the inspired air (Fico2) Fraction of oxygen in the expired air (FeO2) Fraction of co2 in the expired air (FeCO2) O2 consumption = vo2=(Vi x FiO2)-9Ve x FeO2) The co2 production VCO2= (Ve x FeCO2) – (Vi x Fi CO2) DIRECT CALORIMTER Only 40% of our energy is liberated In the metabolism of fat and carbohydrate to produce ATP the remaining 60% is converted into heat .ent of EE involves the measurement of heat production or the heat loss through body . .

thus not liberated.the difference between the elimination rates of H and O is eqvivalent to the rate of carbon dioxide production .in the chamber heat produced by the body radiates to the wall and warms the water . Advantages :.the wall of the chamber contain copper tubing through which water is passed .Person will be enclosed into insulated air tight chamber . DOUBLE LABELED WATER TECHQUINE this is applicable for vulnerable population also such as lactating mothers and pregnant ladies as well.the only advantage of it is that it measures the heat directly Disadvantages :-it cannot follow the rapid change in the energy expenditure The heat produced in the body some is stored mwithin the body. Daily urine samples are collected over 7-14 days and analyzed using isotope ratio mass spectrometer the stable isotopes are oxygen are administer via drinking and elimination of isotopes from the body is tracked .the water temperature change is recorded .

Causing the completion of cuircuit. In this device number of steps can be registered to estimate the distance walked and energy expenditure. by detecting the person’s pelvic or the upper extremity motion. USAGE . The modern pedometer works on MEMS(micro electrical mechanical system) sensor to detect the steps. Principle Distance =number of steps step length Working There are 2 type of pedometer both work differently Mechanical pedometer These pedometers use swinging pendulum to count the steps and display the Each time the person takes a step the pendulum swings to one side then back again. PEDOMETER It is the device that counts each step a person takes. ELECTRONIC PEDOMETER Normally the circuit s open and no current flow through it . this flow of current through circuit adds one to your step a person takes a step w wing s and touches the metal thus completing the circuit and allowing the current to flow. with 3 axis detection.

Theoretical Principle  Distance is to muscular force generated. Operating principle Mechanical sensing element consist of proof mass attached to mechanical Suspect ion system with respect to reference plan. the acceleration is measured Electrically with the physical changes in displacement of proof mass.  Not suited for large population study. Types . DISADVANTAGES  It does not measure the volume and intensity of work . WEARING  Tied over waist area  Directly over the mid lenght of the thigh ADVANTAGES  Ability to capture the upper extremity movement. Use to increase the physical activity levels .by acting as a fed back tool.  Results are tampering Accelerometer It is a body fixed motion sensor that measures the rate of change acceleration along the reference axis.

therefore it can sense the postures such as lying down and upright according to the magnitude of acceleration ESTIMATION OF ENERGY EXPENDITURE Accelerometer provides an estimation on energy expenditure by acceleration In anterior posterior direction.waist area . piezo resistive:-it consists of a cantilever beam and it proof mass is made up of micromachaining.Piezoelectric and piezo resistive are the most common type of accelerometer. SENSOR PLACEMENT  Sensors are commonly placed at low back . WEARING  It is tied around waist and hip area because waist area is closed to the center of mass of whole body. Piezoelectric accelerometer :. the accelerometer convert the magnitude of Acceleration into activity cou nt per defined period of time .the sensing element bend towards the applied acceleration which cause the displacement of proof mass results in output voltage. POSTURE AND MOVEMENT Tilt sensing is the basic function provided by accelerometer which respond to gravity.

 Minute by minute analysis  Useful in lab and field settings. At end MET is calculated to express the intensity of physical Activities thus analysis of GPAQ. as well as sedentary behaviour. It is divided under 4 domains . Subjective GPAQ :.e it can differentiate between running and jogging.  Some accelerometers respond to gravity provide tilt sensing with respect to the Reference physical activity questionnaire It is a subjective method to detect the person physical activity level By giving a collective information on physical activity participation In 3 settings .ADVANTAGES  It can measure the intensity and the volume of work with respect to time i. DISADVANTAGES  It cannot measure the activity in upper extremity.

Work. recreational activities .travel and sedentary. .

It is measured in kilo joules. . PHYSICAL ACTIVITY –any bodily movement produced by skeletal muscles that results in energy expenditure.Introduction Energy expenditure –act of using energy to conduct a Varity of physical process including maintaining homeostasis and practicing physical activity. Accelerometer is assumed to be most objective techquine for recording gross energy expenditure of daily activities.

To analyze energy expenditure using Globale physical activity questionnare . .Objective of the study To estimate the energy expenditure using accelerometer and global physical activity questionnaire in collage going students.

. NEED FOR STUDY Majority of student population tends to be more physically inactive therefore there is a need to estimate there energy expenditure levels.

inch tape weighing machine METHODOLOGY • Study design:-cross sectional observational study • Study population:-college students • Sample size :-21 subjects . GPAQ questionnaire. Materials and methodology MATERIAL:-Accelerometer.

18 -25 age of people College going students either genders Exclusion criteria :-lower limb fracture Wheel chair bound student due to any cause Hospitalised individuals PROCEDURE .18-25 of age college crowd EXCLUSION AND INCLUSION CRITERIA Inclusion criteria :.• Participants :.

Then an accelero- meter along with a GPAQ will be given to the subjects with Following instructions will be given to participant before handling of the getting their consent .  Constant text or reminders will be send through calls or message.subjects will be screened for inclusion exclusion criteria . once they meet the inclusion criteria . need to be body adherent and the sensor will be vertically parallel to mid clavicular written inform consent will be given to them .  Basic background information will be given to the subject about the device.  Wearing for continues 7 days.  Tell therapist when not wearing the device with satisfactory reason. GPAQ will be used to understand existing physical activity level .- Physical activity level .  Happened to be tied around your waist area.  Device has to be handled with care.College going students between the age of 18-25 are choosen randomly As a subject . for willing participation . after obtaining the consent from the subject routine evaluation will be done. OUT COME MEASURE.  Has to be removed only while sleeping and bathing. After the course of 7 days the accelerometer will be collected and A GPAQ will again be given to check any change in the physical activity level after the usage of accelerometer.

CONSENT FORM TITLE: compression between actual and perceived level of physical activity In college going crowd. I confirm I have read the participant information sheet for above study and It’s content were explained and I have had the opportunity to ask questions and received satisfactory answers. I have confirm that I have received a Copy of the participant information along with is signed and dated inform Consent form. DATA ANALYSIS Analysis will be done by descriptive analysis the actual and spear man Coefficient. I agree to take part in the above study . I understand that my participation in the study is voluntary and that I have the right to withdraw without giving any reason .without any medical care or ligeal rights being affected. Name of the research participant: Age of the research participant: Address of the research participant: .

Occupation Annual income: Address of the nominee: Signature of research subject date Name and signature of the witness date Signature of the person explain the consent date ASSESSMENT FORM NAME: WEIGHT: AGE/GENDER: HEIGHT: OCCUPATION: BMI : HOSPITAL NUMBER: BODY COMPOSITION SUBCUTANEOUS FAT .

INTIALIZATION WEEK \WEEK GPAQ QUESTIONNAIRE PHYSICAL ACTIVITY I am going to ask you about the different type of activity in a typical week please answer these questions even if you considered yourself not to be physically active person.seeking employment In answering the following questions ‘vigorous-intensity’ are the activities that require hard physical efforts and cause large increase in breathing or heart or hunting for food .harvesting food\crops . Question Response code . VISCERAL FAT TOTAL BODY FAT SKELETAL MASS RISK FACTOR OBESITY HYPERTENSION ISCHEMIC HEART DIEASES PERIPHERAL ATERIAL DISEASE ACCELEROMTER DATA: ACCELERO DATE\ TIME DATE\TIME STEPS TOTAL KILO METER OF GIVEN PER MET CALORIERS NO.’ moderate intensity activity ‘ are activities that require moderate physical efforts and cause small increase in breathing and heart rate . Think first about the time you spend doing work .think of work as the things that you have to do such as paid or unpaid work. household chores . study \ training.

In a typical week. on how many days do you do Number of days P2 vigorous intensity activities as part of your work? How much time do you spend doing vigorous Hours: minutes P3 activities at work on a typical day? Does your work moderate intensity activity . on how many days do you do Number of days P5 moderate intensity activities as a part of your work? How much time do you spend doing moderate Hours: minutes P6 intensity activities at work on a typical day? TRAVEL TO AND FROM PLACES The next question exclude the physical activities at work that you have already Mentioned Now I would like to ask you about the usual way you travel to and from places.that cause Yes 1 the small increase in P4 breathing . Do you walk or use bicycle for at least 10 minutes Yes 1 P7 continuously to get to and No 2 from places? . heart rate such No 2 as brisk walking[or carrying light loads]for at least 10 minutes continuously. No 2 lifting heavy loads . worship. Market.Does your work involve – intensity activity that cause Yes 1 P1 large increase in breathing or heart rate like [carrying .digging or construction work] for at least 10 min continuously? In a typical week.

In a typical week . volleyball at least for 10 minutes In a typical week how many days you spend doing Number of days P14 moderate intensity sports How much time do you spend doing moderate Hours: minutes P14 intensity sports on a typical day? SEDENTARY .on how many days or bicycle for at Number of days P8 least 10minutes continuously to get to and from places? How much time do you spend walking or bicycling Hours: minutes P9 for travel on a typical day? RECREATIONAL ACTIVITIES The next question exclude the work and transport activities that you have already mentioned. fitness or recreational activities? How much time do you spend doing vigorous Hours: minutes P12 intensity sports . In a typical week .on how many days do you do Number of days P11 vigorous intensity sports. fitness or recreational activities that Yes 1 P10 cause large increase in No 2 breathing or heart rate like Running football at least for 10 minutes or recreational sports in a typical day ? Do you do any moderate YES 1 intensity sports fitness or recreational . Now I would like to ask you about sports.activities such No 2 P13 as cycling swimming. fitness and recreational activities. Do you do any vigorous intensity sports.

15±1.The following question is about sitting . at home .but do not include the time spent in sleeping.getting to and from places . car. siting with friends .or with friends including time spent sitting at a desk. reading .or reclining at work.or watching television .348 GENDER .travelling in bus. How much time do you P16 usually spend sitting or Hours: minutes reclining on a typical day? TABLE --1 PARAMETERS MEAN±SD AGE 23.