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Manifestation of Novel Social Challenges of the European Union in the Teaching Material of Medical Biotechnology Masters Programmes at the University of.

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Presentation on theme: "Manifestation of Novel Social Challenges of the European Union in the Teaching Material of Medical Biotechnology Masters Programmes at the University of."— Presentation transcript:

1 Manifestation of Novel Social Challenges of the European Union in the Teaching Material of Medical Biotechnology Masters Programmes at the University of Pécs and at the University of Debrecen Identification number: TÁMOP-4.1.2-08/1/A-2009-0011

2 PHYSICAL ACTIVITY, IMMOBILIZATION Erika Pétervári and Márta Balaskó Molecular and Clinical Basics of Gerontology – Lecture 5 Manifestation of Novel Social Challenges of the European Union in the Teaching Material of Medical Biotechnology Masters Programmes at the University of Pécs and at the University of Debrecen Identification number: TÁMOP-4.1.2-08/1/A-2009-0011

3 TÁMOP-4.1.2-08/1/A-2009-0011 Outline The beneficial effects of physical exercise Inactivity Immobilization syndrome – chronic bedrest Pressure ulcers and other consequences

4 TÁMOP-4.1.2-08/1/A-2009-0011 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 TÁMOP-4.1.2-08/1/A-2009-0011 Adrenalin induces vasodilatation in active muscles Increases Peak-Bone –Mass, helps prevent osteoporosis Reduces stress levels Helps prevent depression and dementia (neural growth factor, decreased amyloid 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. Exercise

6 TÁMOP-4.1.2-08/1/A-2009-0011 Muscle hypertrophy may be elicited by relatively intensive training even in the elderly (12 weeks – 3 times a week +10%) Exercise

7 TÁMOP-4.1.2-08/1/A-2009-0011 Inactivity 0 0Regular intensive physical exercise, good level of fitness 1 1Sedentary lifestyle, only recreational sport 2 2Sedentary lifestyle, without recreational sport 3 3Moderate immobilization in sitting or horizontal position 4 4Total immobilization (paralysis) 5 5Tilting

8 TÁMOP-4.1.2-08/1/A-2009-0011 MET: metabolic unit 1 MET: 3.6 mlO 2 /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) Inactivity

9 TÁMOP-4.1.2-08/1/A-2009-0011 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… XIX th century: AMI – 6-week bedrest, femur fracture - 6-month bedrest Today: a minimum of 12-48 hours of bedrest after AMI

10 TÁMOP-4.1.2-08/1/A-2009-0011Causes Loss of both lower limbs Spinal injuries (transection) Amyotrophic lateral sclerosis Late stages of Parkinsons 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) Immobilization – chronic bed rest

11 TÁMOP-4.1.2-08/1/A-2009-0011Consequences Adaptation of the circulation (short term – long term) Pressure ulcers Depressed ventilation, risk for hypostatic pneumonia Increased risk for deep venous thrombosis, pulmonary embolism Muscle atrophy, contractures, constipation Osteoporosis Changes in metabolism, heat adaptation Depressed immunity failure Psychological changes Immobilization – chronic bed rest

12 TÁMOP-4.1.2-08/1/A-2009-0011 Earth gravity Normal condition Zero gravity Acute exposure Zero gravity Chronic exposure Earth gravity Upon return Central venous pool Immobilization – chronic bed rest

13 TÁMOP-4.1.2-08/1/A-2009-0011 Pressure Ulcers Definition Any lesion caused by unrelieved pressure resulting in damage of underlying tissue (AHCPR, 1994). Can occur anywhere on body

14 TÁMOP-4.1.2-08/1/A-2009-0011 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. Pressure Ulcers

15 TÁMOP-4.1.2-08/1/A-2009-0011 Causes of Pressure Ulcer Prolonged pressure -duration and intensity of pressure -location of pressure on body -extended pressure that blocks flow to the tissue between the source of pressure & the bone Shear Friction

16 TÁMOP-4.1.2-08/1/A-2009-0011 Function of both time and pressure (hyperbolic curve) 70 mmHg 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!!!! Pressure Ulcer

17 TÁMOP-4.1.2-08/1/A-2009-0011 Pressure Ulcer Staging (depth & tissue type) Stage IPersistent redness (color pressure insensitive) Stage IIPartial thickness skin loss Stage IIIFull thickness skin loss (subcutaneous) Stage IVFull thickness skin loss (fascia) Pressure Ulcer

18 TÁMOP-4.1.2-08/1/A-2009-0011 Immobilization – chronic bed rest

19 TÁMOP-4.1.2-08/1/A-2009-0011 Epidermis Subcutaneous tissue Muscle Dermis Bone Reddened area Immobilization – chronic bed rest Blister

20 TÁMOP-4.1.2-08/1/A-2009-0011 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 TÁMOP-4.1.2-08/1/A-2009-0011 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 TÁMOP-4.1.2-08/1/A-2009-0011 Immobilization – chronic bed rest (Ca and hydroxyproline loss) Time (weeks) Control Bedrest Calcium Change in urinary calcium (mg/day) -10-5-50510 1520 150 100 50 0 -50 OH-Proline Change in urinary hydroxyproline (mg/day) 20 10 0 -10

23 TÁMOP-4.1.2-08/1/A-2009-0011 VO 2max = Q max x (a-v)O 2 Difference max Adaptive responses of factors infuencing maximal oxygen uptake (VO 2max ) in chronic bedrest Immobilization – chronic bed rest HRStroke volumeArterial O 2 Venous O 2 Sensitivity of the arterial baroreceptor system Blood volume RBC mass Muscle mass Symp/parasymp balance Alpha-adrenergic VC VE max Perfusion pressure in muscles Muscle tone V/Q Capillary density Muscle mass Diffusion Diffusion distance in tissue Baroreceptor VC response O 2 extraction Beta-adrenergic activity Substrate transport Substrate metabolism Energy stores Number of mitochondria


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