Chapter1

physical activity

any bodily movement produced by skeletal muscles that result in an increase in energy expenditure above resting rate

how is physical activity different than exercise

exercise is subset of physical activity that is planned, structured and repetitive and has as a final or an intermediate objective the improvement or maintenance of physical fitness

physical fitness

a set of outcomes or traits that relate to the ability to perform physical activity

skill and sports related fitness

• agility

• balance

• coordination

• power

• reaction time

• speed

health related fitness

• body composition

• flexibility

• muscular endurance

• muscular strength

• aerobic fitness

physical inactivity risk=

smoking +obesity combined

regular physical activity

guards against noncommunicable disease

• protection against 25+ chronic medical conditions

• numerous other health benefits

• inactive children tend to become inactive adults

dose response relationship

• dose= volume of activity

• response=health benefits

• some MVPA better than none

• exceeding the recommended dose magnifies the response

• exceeding the recommended dose by a factor of 10 is not harmful

active workstations

• reduced sitting time

• increased daily activity

CHD risk factors

1. age

2. family

3. hypercholesterolemia

4. hypertension

5. current cigarette smoking

6. prediabetes

7. obesity

8. physical inactivity

cardiovascular disease myth

• its a man’s disease

• its an older person’s disease

cardiovascular disease risk factors

• worsened by physical inactivity

• improved by physical activity

• improvement is directly related to aerobic capacity

• improvement also from regular resistance training

AHA’s key measure for improving and maintaining cardiovascular health

1. eat better

2. be more active

3. quit tobacco

4. get healy sleep

5. manage weight

6. control cholesterol

7. manage blood sugar

8. manage blood pressure

hypertension

• leading preventable cause of premature death for age < 70

• if unchecked, it is a primary risk factor for other conditions

  • stroke

  • heart attaack

  • heart failure

  • kidney failure

  • COPD

  • dementia

  • blindness

• categorizing BP values for risk factor analysis

  • use highest SBP or DBP average of at least two measurements

  • measurements acquired in two separate visits

  • best of assess BP in both arms

  • optimal to record avaerage values from arm having higher values

Exercise prescription for individuals with hypertension

Typer: primarily endurance activities supplemented by resistance exercise

intensity: moderate intensity endurance (40%-59% VO2R) rate of perceived exertion 12 to 13 and resistance training (40-80% 1rm)

Duration: 30 min or more of continuous or accumulate aerobic physical activity per day, and a minimum of two sets (8-12 reps) of resistance training exercise for each major group

frequency: most days of the week for aerobic exercise 2 to 3 days/ wk for resistance training

hypercholesterolemia

elevation of total cholesterol

dyslipidemia

abnormal blood lipid profile

lipoprotein categories

• chylomicron

• vldl

• ldl

• hdl

• benefits of aerobic exercise and resistance exericse

hypercholesterolemia

strong predictor of CHD

tobacco

• cigar, cigarette usage

  • decreasing in many not all countries

  • preventable risk factor for many chronic diseases and premature death

  • second hand smoke hazard

  • electronic cigarette risk not yet known

  • quitting has health benefits within weeks

    • risk declines 50% in the first years

    • relative risk of stroke and CHD death is similar to that of a nonsmoker in 15 years

diabetes mellitus

• pandemic level

  • among top 10 causes of death in U.S.

• Major contributor to other conditions

  • heart disease

  • amputations of leg or foot

  • stroke

  • kidney failure

  • blindness

  • cognitive disability

  • some cancer

• diabetics have risk of postexericse hypoglycemia and transiet hyperglycermia

diabetes mellitus

• prediabetes condition identified by fasting blood glucose and HbA1c levels

• type 1 diabetes associated with sedentary time

  • etiology differs

  • response to exercise differs

• risk of type 2 diabetes associated with sedentary time

• those with diabetes have risk of post-exercise hypoglycemia and transient hyperglycemia

obesity and overweight

• classified in terms of BMI cut points

  • Pros: BMI has utility as a simple index of obesity

  • cons: cannot identify relative fatness or site of fat storage; traditional cut point do not work for all races/ ethnicities

  • fifth leading cause of death globally is obesity

  • high prevalence for adults and children

  • threatens longevity and quality of life

obesity and overweight

• obesity is associated with CHD risk factors

• obesity paradox: prognosis for survival from CVD is better for those who are overweight or mildly obese (BMI=25-27ish)

• prevalence of obesity varies by race/ethnicity

metabolic syndrome

• adult prevalence

  • highest in the united states

  • underestimated globally

• underlying factors

  • age

  • physical inactivity

  • genetics

• increases risk of other conditions

  • stroke

  • CVD

  • type 2 diabetes

metabolic syndrome

• cluster of CVD risk factots

• must have three of the following risk factors

  • HTN

  • dyslipidermia

  • insulin resistance

  • Abdominal obesity

• waist circumference helps not abdominal obesity

cancer

• leading cause of death globally

• primary risk factors

  • tobacco and alcohol use

  • unhealthy food choices

  • physical inactivity

  • high bmi

  • chronic or systemic inflammation

• inverse relationship between many cancers and LTP

• Physically active patients have better survival rates

musculoskeletal diseases and disorder

• osteoporosis

  • preceded by osteopenia (low bone mineral mass)

• osteoarthritis

• fragility fractures

  • primary sites: hip, spine, wrist, shoulder

• connective tissue tears

• low back syndrome

Musculoskeletal Diseases and Disorders

• •Related to physically inactive lifestyle

• •Osteoporosis (primary and secondary)

  • •More prevalent in women

  • •Fracture may be first clue and indicator of future fractures

  • •Prevalence varies by race, age, sex

• •Diagnostic criteria for osteoporosis

  • •Low BMD of hip or lumbar spine

  • •History of site-specific low trauma fracture

  • •FRAX score ≥ cut-point values for intervention for low BMD

Musculoskeletal Diseases and Disorders

• Weight-bearing exercise modalities = preventative

• Targeted effect varies by exercise intensity

• Adequate vitamin D and calcium sources

• Bone-strengthening for children is the key to adult prevention

Aging

• Life expectancy directly related to physically active life

  • May delay onset or development of many chronic diseases

  • May reverse or limit effects of existing chronic diseases

  • Regular LTPA and exercise may increase telomere length

• Short telomeres associated with numerous chronic diseases

  • Target 40- to 60-year-olds for increasing LTPA

Cognitive Performance

• Can be improved with exercise interventions

• Inverse relationship between PA and cognitive function

  • MVPA = higher cognitive function scores

  • Lots of sedentary time = lower cognitive function scores

  • Prepubertal and mid-to-late life are influential periods

• Exercise for cardiovascular system protects the brain

• Not one best exercise modality

Exercise as Medicine

• Dose-response relationship in terms of health benefits

• Delays onset of chronic NCDs

• Inactivity is a better predictor of mortality than are hypertension, diabetes, blood lipid levels, and smoking

• Exercise Is Medicine initiative

  • Targets primary care physicians and other health care providers

  • Focus on including physical activity in treatment plans

  • Global initiative

Documented Benefits of Exercise

• Inflammation

• Cognitive function

• Vitality

• Social function

• Blood lipids

• Blood glucose

• Insulin sensitivity

• Body composition