Lecture 1 Principles

What are the goals of exercise programs?

• Health and avoidance of disease

• Fitness

• Performance

  • Frequency, duration, intensity and type of activity vary depending on goals

How much PA is enough in terms of health?

• Moderate intensity activity, 30 min per day, 5 days per week

• Delay death, avoid disease, enjoy life, withstand challenges, improve systolic bp and lipid profiles, lose body fat

How much PA is enough in terms of fitness?

• Vigorous intensity activity, 30 to 45 min per day, 3 - 4 days per week

• Health benefits: greater reduction in risk of CVD, hypertension, enhanced glucose control, improved components of physical fitness (Cardiorespiratory fitness)

What is the difference between lifespan and healthspan?

• Lifespan: Reflects number of days of one’s life, without considering QOL

• Healthspan: reflects number of years an individual is healthy and free from debilitating disease

What are the leading causes of death in the US?

• 1: Heart, 2: Cancer, 3: Accidents

• 4- 7: Lower respiratory disease, cerebrovascular diseases (stroke, Alzheimer’s, diabetes mellitus

COVID was #3 in 2020.

What are the 3 main risk factors for major chronic diseases?

• Inherited (biological)

  • Age, sex, race, susceptibility to disease

• Environmental

  • Physical, socioeconomic, familial

• Behavioral

  • Smoking, inactivity, poor nutrition, alcohol consumption, overuse of medications, inadequate seatbelt use, stress

What are the actual behavioural causes of death?

• Smoking, poor diet, physical inactivity, consuming alcohol or using illicit drugs, being exposed to microbial and toxic agents

Naturally follows that delaying death involves refraining from tobacco exposure and improving diet and activity habits.

How do we define Physical Activity, Physical Fitness and Intensity?

PA:

• exercise is a subset of PA

PF:

• Health related

• Skill related

Intensity

• Absolute vs relative

• Moderate and vigorous

What are the improvements of PA and health?

• Cardiorespiratory, metabolic, musculoskeletal, brain health

• Reduction in types of cancers

• Improved functional ability and fall prevention

There is a sweet spot between exercise time (too little or too much result in diminishing returns)

What was the Early Physical Activity (PA) Guidelines Emphasized Intensity to improve health (70’s)?

72’

• 60% VO2 max, 3 days per week, 15 to 20 minutes

73”

• 80% VO2 max, 3 days per week, 40 to 45 minutes

75’

• 70 to 90% VO2 max, 3 to 5 days per week, 20 to 45 minutes

What did the Harvard Alumni study find?

• >2,000 kcal exoended through leisure time PA yielded a 36% decrease in the risk of experience of a heart attack

• Focus of PA shifted to

  • Activity volume (kcal expended)

  • Health outcomes

  • LTPA

What were the recommendations for health in the 90’s?

92’

• AHA declares Physical Inactivity as a major risk factor for CVD

95”

• ACSM / CDC publish public health PA recommendations

• At least 30 minutes of moderate activity 5 days per week is recommended

96”

• Focus shifts to increasing PA to improve public health

What are the different goals, organizations and guidelines of PA?

• IOM recommends 60 min of moderater PA to prevent weight gain

• IOTF recommends 60 to 90 minutes of moderate PA daily

• ACSM recommends at least 250 min per week of moderate to vigorous activity to promote long term weight loss maintenance

What is the 2007 ACSM guidelines?

• 30 min of moderate, 5 days per week

• 20 minutes of vigorous, 3 days per week

• A combination of the 2 within limits, more is better creating an increase health benefits

What were the 2008 PA Guidelines for Americans?

• Substantial health benefits at a PA volume of 500 - 1000 MET minutes per week (150 minutes of moderate activity per week or 75 minutes of vigorous activity per week)

• Dose response relation between PA and many health outcomes independent of body weight

• For preschoolers, active throughout the day, children and adolescents 60 minutes or more of moderate to vigorous activity

• Adults 150 to 300 moderate or 75 to 150 vigorous aerobic, muscle strengthening 2 days per week

• Older: Multicomponent, including aerobic exercise, muscular strengthening and balnce exercises

What differs moderate and vigorous intensity?

• 1 Vigorous minute is equal to 2 Moderate minutes

• Greater reductions in risk of CVD and greater improvements in diastolic BP, glucose control, and CRF with Vigorous (6 MET’s) then compared to moderate

What should be known about fitness in regards to fatness?

• those with low fitness levels have had a fourfold greater risk of dying with CVD than those with high fitness levels, independent weight class

• CHANGES in fitness, not fatness is the best predictor of future health outcomes

What factors affect risk of injury due to PA participation?

Personal:

• Age, level of fitness, prior experience

Type of PA:

• Contact vs. Noncontact

Changes in PA:

• Amount, intensity

Equipment

• Proper fit, maintained

Environment:

• Hot or cold, playing surface, safe area

What are the components of health related fitness?

• Body composition

• CRF

• Muscular strength and endurance

• Flexibility

What are the components of performance related fitness?

• Speed, agility, balance, power, coordination, reaction time

How do we evaluate health status?

• Fitness professionals encounter individuals with low CRF and a range of health and medical conditions

• Preactivity screening determines current health status and whether medical clearance is recommended clearance is recommended prior to fitness testing or onset of regular PA

What is informed consent?

• First step, prior to preparticipation screening

  • Documents purpose, procedures, risks and discomfort, potential benefits and participant responsibilities, treatment of data, participant questions, and participant’s right to withdraw

• Leads to screening (PAR - Q+, PASQ): health screening questionnaire

  • Private, confidential and secure

  • Determines level of risk to indicate whether medical clearance is recommended

  • Gathers additional info reflecting a broader medical history

• Medical History: SIGNS and SYMPTOMS

  • CVD, Metabolic Disease, Renal DIsease

  • MUST receive medical clearance, REGARDLESS IF ACTIVE ALREADY (2.1 textbook)

What are the results we evaluate in the screening process?

• Resting Data

• Submaximal Graded Exercise Test

• Muscular strength and endurance, flexibility and functional fitness

• Test results compared to normative data or tracked over time to chart progress

• Developing an individualized exercise prescription considers: health status, personal goals and fitness test results

What should be done after the initial assessment?

• Periodically repeat fitness tests and health screening questionnaire

• Make changes in exercise prescription or supervision

• Perform follow up testing after 3 months of regular exercise for beginners, and then every 6 months, annual testing may be sufficient for established exercisers

What classifies an exerciser?

• A person who has been performing, planned structured PA for at least 30 minutes a day, 3 or more days a week for the past 3 months

What is the determined desired level of activity?

• Light <40% VO2R

• Moderate 40 to 59% VO2R

• Vigorous: >60% VO2R

What are the fitness program decisions?

• Clients may be referred to a physician for consent or consultation

• Recommendations may include

  • Clinical or supervised program

  • Vigorous intensity exercise

  • Unsupervised PA

What is important regarding CVD risk factors?

• Those with CVD need to know their risks before engaging in Physical Activity for overall CVD prevention and effective management

• Each risk in specificty is important

What are diuretics and calcium channel blockers?

• Diuretics: increase excretion of electrolytes and water

• Calcium Channel Blockers: interfere with calcium movement during polarization of the heart

What are ACE inhibitors and ARB’s?

• Angiotensin Converting Enzyme

  • Decrease production of the powerful vasoconstrictor angio II

• Angiotensin II receptor blockers

  • Block the action of angiotensin II

What are beta blockers and aldosterone receptor antagonists?

Beta blockers:

• Compete with epi and NE on target organs

Aldosterone receptor antagonists

• Compete with receptors in the kidneys

What are Central alpha 2 agonists and direct vasodilators?

• Central alpha 2 agonists

  • Reduce effects of NE in the CNS

• Direct vasodilators

  • Dilate arteries

What are nitrates?

• used for angina, relax smooth muscle to reduce workload and oxygen requirements of the heart

What are the medications for hyperlidemia?

• Sequestering agents

• Niacin

• Fibrates

• Statins (potential muscle problems)

What are the medications for Lowering risk of blood clots?

• Anticoagulants

  • Direct oral (DOAC’s)

  • Vitamin K

• Antiplatelet

  • P2Y inhibitors

What are the medications for diabetes?

• Oral hypoglycemic agents

  • Biguanide, thiazolidines, SGLT2 inhibitors, DPP - 4 inhibitors, sulfonylureas, GLP - 1 RA

• Insulin

  • Various types with different onset of action and duration of action

What are the medications for depression and anxiety?

• Selective serotonin reuptake inhibitors

• Serotonin and NE reuptake inhibitors

What are the medications for pain?

• Nonsteroidal anti inflammatory drugs (NSAID’s)

  • Decrease inflammation, alleviate pain, reduce fever

• Opioids

  • Activate opioid receptor in CNS to achieve pain relief

  • Most are class II medications (potential for abuse or misuse leading to death)

What are the medications for Chronic Obstructive Pulmonary disease and asthma?

• Inhalers

  • Long acting inhalers ( beta 2 agonists, muscarinic antagonists and inhaled corticosteroids)

    • Used for maintenance therapy to prevent breathing issues

  • Short acting inhalers

    • Used as needed to treat asthma attacks or breathing issues

• Oral steroids

  • Used for exacerbations for severe, persistent asthma

What medications for ADHD?

• Consists of stimulant medications that raise dopamine and NE levels enhancing behavioral activity

Medications for Tobacco cessation?

• Nicotine gums, nasal sprays and patches

  • Stimulate CNS and PNS, reducing risk of nicotine withdrawal