SECTION 2

Treatment Techniques and Special Equipment

available and is considered the first step in aerobic metabolism of carbohydrates.26 11,1108 Aerobic Oxidation System The final metabolic pathway for AIT production comb: two complex metabolic processes: the Krebs cycle and electron transport chain. The aerobic oxydation sys resides in the mitochondria. It is capable of using carbo drates, fat, and small amounts of protein to produce ene (ATP) during exercise, through a process called oxidati phosphorylation. During exercise, this pathway uses o~ gen to completely metabolize the carbohydrates to prodir energy (MP), leaving only carbon dioxide and water byproducts. The aerobic oxidation system is complex requires 2 to ? minutes to adjust to a change in exer-intensity (see figure 18-1). It has an almost unlimited a ity to regenerate AIT, however, limited only by the am-of fuel and oxygen that is available to the cell. Maxi oxygen consumption, also known as Vi);max. is a me~ of the power of the aerobic energy system, and is gen~ regarded as the best indicator of aerobic fitness. J6-,0J'1 All the energy-producing pathways are active du~ most types of exercise, but different exercise types p greater demands on different pathways 'Ihe contribu* of the anaerobic pathways (creatine phosphate and glycolysis) to exercise energy metabolism is inv related to the duration and intensity of the activity, shorter and more intense the activity, the greater the tribution of anaerobic energy' production, whereas longer the activity and the lower the intensity, the greaufl the contribution of aerobic eneigy prodiuiion. In general," carbohydrates are used as the primary fuel .it the onset ofj exercise and during high-intensity work. Hut during prqj longed exercise of low to moderate intensity (longer 30 minutes), a gradual shift from carbohydrate toward increasing reliance on fat as a substrate occurs. The grea" amount of fat use occurs at about 60% of maximal aero capacity ( V D . m j l )

-iii

ri

iiiiiir

10 20 30 40 50 60 70 80 90 100110120130 Time (s) Glycolysis Oxidation

ATP

Creatine phosphate
FIGURE 18-1 Energy sources in relation to duration of contraction. Muscular metabolism available from the various substrates participating in supplying energy during the first 2 minutes of an attempted maximal contraction. The relative contribution of each substrate at any moment is indicated The intensity of metabolic activity over the 2-minute period is adjusted to the change of the isometric tension produced during a sustained voluntary maximal contraction. (Redrawn from DeLJleur Bj.Therapeutic exercise 10 develop siicngth and endurance. In Kollke rj. Slillwell GK. lehmann JF. editors K/usrn's Saundrrv with permission )

handbook of pfyMdf meffcmc unci rphnhtMofion Philadelphia. 1982.

26.101,101

Rapid Glycolysis (Lactic Acid System) ('.biolysis hsts carbohydrates primarily in tin- form of muscle glycogen as a fuel source. When glycolysis is rapid, the pathways ili.it normally use oxygen to make energy arc circumvented in favor of other, faster yet less efficient paths that do not require oxygen. As a result, only a small amount of AIT is produced anaerobically, and lactic acid is produced as a by-product of the reaction For many years, lactic acid was considered to he the waste product caused by inadequate oxygen supply lactic acid limited physical activity by building up in muscles anil lead ing to fatigue and diminished performance. Since the early i')80s. there has been a fundamental change in thought, and evidence now shows that a limited oxygen supply is not required for tactic acid production, Lactate is produced ami used continuously under fully aerobic conditions. Ibis is referred to as the cell-to-cell lactate shuttle in which lactate serves as a metabolic intermediate tying together glycolysis (as an end product) and oxidative metabolism. Once lactic acid is formed, there are two possible venues it can lake. Hie first involves conversion into pyruvic acid and subsequently into energy (ATP) under aerobic conditions (see "Aerobic Oxidation System" section below). The second involves hepatic gluconeogenesis using lactate to produce glucose, which is known as the Cori cycle Anaerobic oxidation starts as soon as high-intensity exercise begins and dominates for approximately V/i to 2 minutes (see figure i s i ) it would fuel activities such as middle distance sprints (400 . 600-. and 800-m runs] or events requiring sudden hursis ol energy such as weight lift ing.

Cardiovascular Exercise
Cardiorespiratory Physiology
The cardiorespiratory system consists of the heart, lung and blood vessels, 'iTic purpose of this system is the del" cry of oxygen and nutrients to the cells, as well as removal of metabolic waste products to maintain the int nal equilibrium.70-10VIM

Cardiac Function Heort Rote

Normal resting bean rate (IIR) is approximately 60 to bcats/min. IIR increases in a linear fashion with the ' rate and oxygen uptake during exercise. The magnitude IIR response is related to age. body position, fitness, type activity, the presence of heart disease, medications, blood volume, and environmental factors such as tcmpei.uuK

Although glycolysis is considered an anaerobic patfr it can readily participate in the aerobic metabolism w oxygen is