The document summarizes an integrated lecture on the effects of exercise and posture on blood pressure. It includes the following key points:
1) Baroreceptors located in the carotid sinus and aortic arch detect changes in blood pressure from posture and exercise.
2) When standing, blood pools in the legs which decreases venous return and cardiac output, lowering blood pressure. Compensatory mechanisms act to increase sympathetic activity and raise blood pressure.
3) During exercise, sympathetic activity and local vasodilators in active muscles increase blood flow to working muscles while decreasing it to other organs, maintaining blood pressure.
Cardiovascular Pathophysiology In the Setting of Spinal Cord InjuryInsideScientific
Dr. Christopher West shares his research that investigates the cardiovascular and autonomic changes that occur following spinal cord injury as well as the efficacy of neuro-therapeutic interventions.
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This webinar introduces the major cardiovascular changes that have been characterized following spinal cord injury in animal models and the clinical population. Chris shares some exciting results from recent studies in which his group has tested the efficacy of novel therapies to improve cardiovascular function. Finally, he provides his outlook for the future of the field.
PHYSIOTHERAPY IN HEART TRANSPLANTATION..AneriPatwari
This power point throws the light on Heart transplantation.
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It will lighten the side of physiotherapy management for heart transplantation.
Cardiovascular Pathophysiology In the Setting of Spinal Cord InjuryInsideScientific
Dr. Christopher West shares his research that investigates the cardiovascular and autonomic changes that occur following spinal cord injury as well as the efficacy of neuro-therapeutic interventions.
Dr. West’s group uses small and large in vivo animal models to understand how the circuitry that controls the cardiovascular system changes following injury and what the downstream impact of these changes are for heart and blood vessel function. They also use these models to test the efficacy of novel therapies in the both the acute and chronic setting following injury. In the clinical and athletic spinal cord injury population, his group has conducted a number of mechanistic and applied studies to, 1) improve the understanding of how best to hemodynamically manage acutely injured patients, and 2) enhance the capacity of the cardiovascular system to enable an improved exercise response.
This webinar introduces the major cardiovascular changes that have been characterized following spinal cord injury in animal models and the clinical population. Chris shares some exciting results from recent studies in which his group has tested the efficacy of novel therapies to improve cardiovascular function. Finally, he provides his outlook for the future of the field.
PHYSIOTHERAPY IN HEART TRANSPLANTATION..AneriPatwari
This power point throws the light on Heart transplantation.
it will inform about the indications and contraindication of heart transplant.
It will tell you about the donor selection & donor-recipient matching for heart transplantation.
It will enhance the knowledge of types and complications of heart transplantation.
It will feed the need of assessment and management of heart transplant pre and post-off
It will give the information about physiotherapy assessment pre and post surgery for heart transplantation.
It will lighten the side of physiotherapy management for heart transplantation.
Short Term Outcomes after Use of Intracardiac Bone Stem Cell Transplantation ...crimsonpublishersOJCHD
Short Term Outcomes after Use of Intracardiac Bone Stem Cell Transplantation for Management of Heart Failure: A Meta-Analysis by Rohit SL in Open Journal of Cardiology & Heart Diseases
Effect of Exercise on CVS and Exercise Rx.pptxSoniya Lohana
A guide to effects of exercise on cardiovascular system and exercise prescription to conditions related to the human heart such as hypertension, CHF and even COVID.
Part 7: Adult Advanced Cardiovascular Life Support 2015 American Heart Associ...María Camila Pineda López
Part 7: Adult Advanced Cardiovascular Life Support 2015 American Heart Association Guidelines Update for ardiopulmonary. Resuscitation and Emergency Cardiovascular Care.
Jour Resp Cardiov Phy Ther. 2016; 5(1): 12-20.
�
ORIGINAL ARTICLE
EFFECTS OF CPAP ON THE PHYSICAL EXERCISE TOLERANCE OF MODERATE TO
SEVERE CHRONIC OBSTRUCTIVE PULMONARY DISEASE
!
MICHEL SILVA REIS1,2, HUGO VALVERDE REIS1,2, DANIEL TEIXEIRA SOBRAL1,2, APARECIDA MARIA
CATAI3, AUDREY BORGHI-SILVA4
!
1Research Group in Cardiorespiratory Physical Therapy (GECARE), Department of Physical Therapy, Faculty of
Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
2Physical Education Undergraduation Program, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
3Laboratory of Cardiovascular Physical Therapy, Department of Physical Therapy, UFSCar, São Carlos, SP, Brazil
4Laboratory of Cardiopulmonary Physical Therapy, Department of Physical Therapy, Universidade Federal de São
Carlos (UFSCar), São Carlos, SP, Brazil
!
!
Received September 21, 2016; accepted April 18, 2017
Objective: The aim of this study was to evaluate the effect of continuous positive airway pressure
(CPAP) on the exercise tolerance of patients with moderate to severe chronic obstructive pulmonary
disease (COPD). Methods: ten men with COPD (69 ± 9 years), FEV1/FVC (58.90 ± 11.86%) and FEV1
(40.98 ± 10.97% of predict) were submitted to a symptom-limited incremental exercise test (IT) on
the cyclo ergometer. Later, on another visit, they were randomized to perform a constant load
exercise protocol until maximal tolerance with and without CPAP (5cmH2O) in the following
conditions: i) 50% of the peak workload; and ii) 75% of the peak workload. Heart rate (HR), arterial
pressure (AP) and peripheral oxygen saturation were obtained at rest and during the exercise
protocols. For statistical procedures, Shapiro-Wilk normality test and two-way ANOVA with Tukey
post hoc (p<0.05) were performed. Results: There was a signi`icant improvement in exercise time
tolerance during the 75% of the peak workload protocol with CPAP when compared with
spontaneous breath (SB) (438±75 vs. 344±73ms, respectively). Conclusion: CPAP with 5 cmH2O
seems to be useful to improve exercise tolerance in patients with COPD.
!
!
!
!
!
!
Corresponding Author
Michel Silva Reis ([email protected])
!
Journal of Respiratory and CardioVascular Physical Therapy
KEYWORDS:
Noninvasive
ventilation;
COPD;
exercise
tolerance;
CPAP
mailto:[email protected]
Jour Resp Cardiov Phy Ther. 2016; 5(1): 12-20.
INTRODUCTON
Patients with chronic obstructive pulmonary disease
(COPD) present a reduced physical exercise tolerance that
can be determined by ventilatory and/or peripheral
mechanism1,2. Progressive increase in the expiratory
air`low resistance, which limits the tidal volume gain
beyond the expiratory and inspiratory reserve volumes,
may be accentuated because these patients ventilate ...
Short Term Outcomes after Use of Intracardiac Bone Stem Cell Transplantation ...crimsonpublishersOJCHD
Short Term Outcomes after Use of Intracardiac Bone Stem Cell Transplantation for Management of Heart Failure: A Meta-Analysis by Rohit SL in Open Journal of Cardiology & Heart Diseases
Effect of Exercise on CVS and Exercise Rx.pptxSoniya Lohana
A guide to effects of exercise on cardiovascular system and exercise prescription to conditions related to the human heart such as hypertension, CHF and even COVID.
Part 7: Adult Advanced Cardiovascular Life Support 2015 American Heart Associ...María Camila Pineda López
Part 7: Adult Advanced Cardiovascular Life Support 2015 American Heart Association Guidelines Update for ardiopulmonary. Resuscitation and Emergency Cardiovascular Care.
Jour Resp Cardiov Phy Ther. 2016; 5(1): 12-20.
�
ORIGINAL ARTICLE
EFFECTS OF CPAP ON THE PHYSICAL EXERCISE TOLERANCE OF MODERATE TO
SEVERE CHRONIC OBSTRUCTIVE PULMONARY DISEASE
!
MICHEL SILVA REIS1,2, HUGO VALVERDE REIS1,2, DANIEL TEIXEIRA SOBRAL1,2, APARECIDA MARIA
CATAI3, AUDREY BORGHI-SILVA4
!
1Research Group in Cardiorespiratory Physical Therapy (GECARE), Department of Physical Therapy, Faculty of
Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
2Physical Education Undergraduation Program, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
3Laboratory of Cardiovascular Physical Therapy, Department of Physical Therapy, UFSCar, São Carlos, SP, Brazil
4Laboratory of Cardiopulmonary Physical Therapy, Department of Physical Therapy, Universidade Federal de São
Carlos (UFSCar), São Carlos, SP, Brazil
!
!
Received September 21, 2016; accepted April 18, 2017
Objective: The aim of this study was to evaluate the effect of continuous positive airway pressure
(CPAP) on the exercise tolerance of patients with moderate to severe chronic obstructive pulmonary
disease (COPD). Methods: ten men with COPD (69 ± 9 years), FEV1/FVC (58.90 ± 11.86%) and FEV1
(40.98 ± 10.97% of predict) were submitted to a symptom-limited incremental exercise test (IT) on
the cyclo ergometer. Later, on another visit, they were randomized to perform a constant load
exercise protocol until maximal tolerance with and without CPAP (5cmH2O) in the following
conditions: i) 50% of the peak workload; and ii) 75% of the peak workload. Heart rate (HR), arterial
pressure (AP) and peripheral oxygen saturation were obtained at rest and during the exercise
protocols. For statistical procedures, Shapiro-Wilk normality test and two-way ANOVA with Tukey
post hoc (p<0.05) were performed. Results: There was a signi`icant improvement in exercise time
tolerance during the 75% of the peak workload protocol with CPAP when compared with
spontaneous breath (SB) (438±75 vs. 344±73ms, respectively). Conclusion: CPAP with 5 cmH2O
seems to be useful to improve exercise tolerance in patients with COPD.
!
!
!
!
!
!
Corresponding Author
Michel Silva Reis ([email protected])
!
Journal of Respiratory and CardioVascular Physical Therapy
KEYWORDS:
Noninvasive
ventilation;
COPD;
exercise
tolerance;
CPAP
mailto:[email protected]
Jour Resp Cardiov Phy Ther. 2016; 5(1): 12-20.
INTRODUCTON
Patients with chronic obstructive pulmonary disease
(COPD) present a reduced physical exercise tolerance that
can be determined by ventilatory and/or peripheral
mechanism1,2. Progressive increase in the expiratory
air`low resistance, which limits the tidal volume gain
beyond the expiratory and inspiratory reserve volumes,
may be accentuated because these patients ventilate ...
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In this deck, you will learn the significance of workplace discipline for organisational success. You’ll also learn
• Four (4) workplace discipline methods you should consider
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Building Your Employer Brand with Social MediaLuanWise
Presented at The Global HR Summit, 6th June 2024
In this keynote, Luan Wise will provide invaluable insights to elevate your employer brand on social media platforms including LinkedIn, Facebook, Instagram, X (formerly Twitter) and TikTok. You'll learn how compelling content can authentically showcase your company culture, values, and employee experiences to support your talent acquisition and retention objectives. Additionally, you'll understand the power of employee advocacy to amplify reach and engagement – helping to position your organization as an employer of choice in today's competitive talent landscape.
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2. The Rawalpindi Medical University
BLOOD MODULE
SKILL LAB /Physiology PRACTICAL
FIRST-YEAR MBBS BATCH 50
Effects of Exercise and Posture on Blood Pressure
Date: 7th September 2023
2
Usman
3. The Rawalpindi Medical University
Table of contents
3
Sr # Content Slide #
1 Motto, Vision 4
2 Professor Umar Model of Integrated Lecture 5
3 Bloom’s Taxonomy (Domains of learning) 6
4 Diagrammatic representation of Blooms taxonomy 7
5 Learning Objectives 8
6 Horizontal Integration 9-11
7 Core Concept 12-22
8 Vertical Integration 23-26
9 Biomedical Ethics (Lesson of the day) 27-29
10 Brainstorming (MCQs relevant with the lecture) 30-36
11 Suggested research article 37-38
12 Promoting IT and Research culture (Digital library) 39
13 References of this lecture 40
4. The Rawalpindi Medical University
Motto Vision; The Dream/Tomorrow
• To impart evidence based
research oriented medical
education
• To provide best possible
patient care
• To inculcate the values of
mutual respect and ethical
practice of medicine
5. The Rawalpindi Medical University
ProfessorUmarModel of Integrated Lecture
60%
CORE SUBJECT
20%
HORIZONTAL
INTEGRATION
Physiology
biochemistry
8%
VERTICAL
INTEGRATION
Pathology
pharmacology
7%
VERTICAL
INTEGRATION
Clinical
integration
5%
VERTICAL
INTEGRATION
Research,
professionalism
Ethics
Digital library
6. The Rawalpindi Medical University
BLOOM'S TAXONOMY : DOMAINS OF LEARNING
Sr. # Domain of
learning
Abbreviation Levels of
the domain
Meaning
1 cognition C C1 Recall / Remembering
2 C2 Understanding
3 C3 Applying / Problem solving
4 Psychomotor P P1 Imitation / copying
5 P2 Manipulation / Follows instructions
6 P3 Precision / Can perform accurately
7 Attitude A A1 Receiving / Learning
8 A2 Respond / Starts responding to the
learned attitude
9 A3 Valuing / starts behaving according to the
learned attitude
8. The Rawalpindi Medical University
LEARNING OBJECTIVES
8
Sr. # Learning Objective Domain of Learning
1 To describe the effects of exercise and posture on blood pressure
and its clinical significance.
C1
2 To identify the anatomical location of baroreceptors. C2
3 To describe the function of baroreceptors. C1
4 To explain the rationale behind postural. C2
5 To apply knowledge of effects of exercise and posture on blood
pressure in a clinical context to assist in making diagnostic
decisions
C3
9. The Rawalpindi Medical University
Horizontal integration
With Anatomy
Horizontal integration
10. The Rawalpindi Medical University
Location of Baroreceptors
Horizontal Integration
with Anatomy
13. The Rawalpindi Medical University
Effect of Posture on Blood Pressure
• The following changes occur when an
individual moves from a supine position to a
standing position:
• 1. When a person stands, a significant volume
of blood pools in the lower extremities
because of the high compliance of the veins.
(Muscular activity would prevent this pooling.)
Core
Concept
14. The Rawalpindi Medical University
Effect of Posture on Blood Pressure
• 2. As a result of venous pooling and increased
local venous pressure, Pc in the legs increases
and fluid is filtered into the interstitium. If net
filtration of fluid exceeds the ability of the
lymphatics to return it to the circulation,
edema will occur.
• 3. Venous return decreases. As a result of the
decrease in venous return, both stroke volume
and cardiac output decrease
Core
Concept
15. The Rawalpindi Medical University
Effect of Posture on Blood Pressure
A coordinated response from the vasomotor center
then increases sympathetic outflow to the heart
and blood vessels and decreases parasympathetic
outflow to the heart. As a result, heart rate,
contractility, TPR, and venous return increase, and
blood pressure increases toward normal.
6. Orthostatic hypotension (fainting or light-
headedness on standing) may occur in individuals
whose baroreceptor reflex mechanism is impaired
Core
Concept
17. The Rawalpindi Medical University
Effect of Posture on Blood Pressure
4. Arterial pressure decreases because of the
reduction in cardiac output. If cerebral blood
pressure becomes low enough, fainting may occur.
5. Compensatory mechanisms will attempt to
increase blood pressure to normal. The carotid
sinus baroreceptors respond to the decrease in
arterial pressure by decreasing the firing rate of the
carotid sinus nerves.
Core
Concept
19. The Rawalpindi Medical University
Effect of Exercise on Blood Pressure
• 1. The central command (anticipation of exercise)
originates in the motor cortex or from reflexes
initiated in muscle proprioceptors when exercise
is anticipated. Initiates the following changes:
a. Sympathetic outflow to the heart and blood
vessels is increased. At the same time,
parasympathetic outflow to the heart is decreased.
As a result, heart rate and contractility (stroke
volume) are increased, and unstressed volume is
decreased.
Core
Concept
20. The Rawalpindi Medical University
Effect of Exercise on Blood Pressure
b. Cardiac output is increased, primarily as a result
of the increased heart rate and, to a lesser extent,
the increased stroke volume.
c. Venous return is increased as a result of muscular
activity and vasoconstriction. Increased venous
return provides more blood for each stroke volume
d. Arteriolar resistance in the skin, splanchnic
regions, kidneys, and inactive muscles is increased.
Accordingly, blood flow to these organs is
decreased.
Core
Concept
21. The Rawalpindi Medical University
Effect of Exercise on Blood Pressure
2. Increased metabolic activity of skeletal muscle
Vasodilator metabolites (lactate, K+, and adenosine)
accumulate because of increased metabolism of the
exercising muscle.
These metabolites cause arteriolar dilation in the active
skeletal muscle, thus increasing skeletal muscle blood
flow (active hyperemia). As a result of the increased
blood flow, O2 delivery to the muscle is increased. The
number of perfused capillaries is increased so that the
diffusion distance for O2 is decreased.
Core
Concept
28. The Rawalpindi Medical University
The four principles of Beauchamp and Childress
• The four principles of Beauchamp and Childress have been extremely influential in the
field of medical ethics, and are fundamental for understanding the current approach to
ethical assessment in health care. 28
29. The Rawalpindi Medical University
Non-maleficence (Lesson of the day)
• The principle of non-maleficence holds that there is an
obligation not to inflict harm on others.
• Example: stopping a medication known to be harmful or
refusing to give a medication to a patient if it has not
been proven to be effective.
29
Understanding
Biomedical Ethics
31. The Rawalpindi Medical University
QUESTIONS
QUESTION 1:-
Define central venous pressure?
31
Brain Storming
32. The Rawalpindi Medical University
32
Brain Storming
Ans: The mean (average) right atrial pressure
that equals right ventricular end-diastolic
pressure (the amount of pressure at the end
of diastole-filling)
33. The Rawalpindi Medical University
QUESTIONS
• Question 2:
During exercise, total peripheral resistance (TPR) decreases because of the
effect of:
(A) the sympathetic nervous system on splanchnic arterioles
(B) the parasympathetic nervous system on skeletal muscle arterioles
(C) local metabolites on skeletal muscle arterioles
(D) local metabolites on cerebral arterioles
(E) histamine on skeletal muscle arterioles
33
Brain Storming
34. The Rawalpindi Medical University
Answer
• The answer is C.
During exercise, local metabolites accumulate in the exercising muscle and
cause local vasodilation and decreased arteriolar resistance of the skeletal
muscle. Because muscle mass is large, it contributes a large fraction of the
total peripheral resistance (TPR). Therefore, the skeletal muscle vasodilation
results in an overall decrease in TPR, even though there is sympathetic
vasoconstriction in other vascular beds
34
Brain Storming
35. The Rawalpindi Medical University
QUESTIONS
Question 3: What is the main determinant of
right ventricular preload?
35
Brain Storming
36. The Rawalpindi Medical University
Answer
The mean right atrial pressure which equals
right ventricular end-diastolic pressure - central
venous pressure
36
Brain Storming
38. The Rawalpindi Medical University
Journal of Clinical Medicine. 2022, 11(5),1161;
https://doi.org/10.3390/jcm11051161
Promoting Research
Culture
39. The Rawalpindi Medical University
HOW TO ACCESS DIGITAL LIBRARY
• Steps to Access HEC Digital Library
1. Go to the website of HEC National Digital Library.
2. On Home Page, click on the INSTITUTES.
3. A page will appear showing the universities from Public and Private Sector
and other Institutes which have access to HEC National Digital Library
HNDL.
4. Select your desired Institute.
5. A page will appear showing the resources of the institution
6. Journals and Researches will appear
7. You can find a Journal by clicking on JOURNALS AND DATABASE and enter a
keyword to search for your desired journal.
39
Link:https://www.topstudyworld.com/2020/05/access-hec-digital-
library.html?m=1
Promoting IT &
Research Culture
40. The Rawalpindi Medical University
References
Sr.# Types of
reference
material
Names/links of reference material
1 Text book Guyton AC, Hall JE. Textbook of Medical Physiology. 14th ed. Philadelphia,
PA: Saunders; 2020
2 Text book Boron WF, Boulpaep EL. Medical Physiology: A Cellular and Molecular
Approach. 3rd ed. Philadelphia, PA: Elsevier; 2017.
3 Text book Sherwood L. Human Physiology: From Cells to Systems. 10th ed. Boston,
MA: Cengage Learning; 2020.
4 Text book Widmaier EP, Raff H, Strang KT. Vander's Human Physiology: The
Mechanisms of Body Function. 16th ed. New York, NY: McGraw-Hill
Education; 2021.
5 Text book Costanzo LS. Physiology. 7th ed. Philadelphia, PA: Saunders; 2021.
6 Research
paper
https://doi.org/10.3390/jcm11051161
https://doi.org/10.1016/S1474-4422(22)00169-7
7 YouTube
Video
https://www.youtube.com/watch?v=baxNxWIWdK8&ab_channel=AMBOSS
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