Physical Activity and Health Pr

					Physical Activity and Health /
Pre-Ex Health Screening and
Risk Stratification

    Mr. Cheng Yuk Chuen, Joshua
    Director of Training Program
    Hong Kong Physical Fitness Association
               Physical Fitness
Motor skill-related        Health-related
                          Cardiovascular endurance
  Agility 敏捷                     心肺耐力
  Balance 平衡           Muscular strength and endurance
                              肌肉力量與耐力
Coordination 協調              Muscular flexibility
                             肌關節柔軟度
  Power 肌爆炸力
                             Body composition
Reaction time 反應時間           身體脂肪百分比
                         [Neuromuscular Relaxation]
     Speed 速度                 肌神經鬆馳程度
Changes of Physical Fitness
Changes of Physical Fitness
Effect of 12-week Strength Training
                Effect Aerobic Ex on VO2max




Foss 1998, Fox Ex Physiology, p. 329
Benefits of Regular Exercise

 • Improvements in Cardiovascular and Respiratory
  Function
   – Increased maximal oxygen uptake due to both central
     and peripheral adaptations

   – Lower minute ventilation at a given submaximal
     intensity

   – Lower myocardial oxygen cost for a given absolute
     submaximal intensity
• Improvements in Cardiovascular and Respiratory
 Function (cont’)

   – Lower heart rate and blood pressure at a given
     submaximal intensity

   – Increased capillary density in skeletal muscle

   – Increased exercise threshold for the accumulation of
     lactate in the blood

   – Increased exercise threshold for the onset of disease
     signs or symptoms (e.g., angina pectoris, ischemic
     ST-segment depression, claudication)
Benefits of Regular Exercise

• Reduction in Coronary Artery Disease Risk Factors

  – Reduced resting systolic/diastolic pressures

  – Increased serum high-density lipoprotein cholesterol and
    decreased serum triglycerides

  – Reduced total body fat, reduced intra-abdominal fat

  – Reduced insulin needs, improved glucose tolerance
• Decreased Mortality and Morbidity
  – Primary prevention (I.e.,intervention to prevent an
    acute cardiac event)

    1. Higher activity and/or fitness levels are
       associated with lower death rates from coronary
       artery disease

    2. Higher activity and/or fitness levels are
       associated with lower incidence rates for
       combined cardiovascular diseases, coronary
       artery disease, cancer of the colon, and type 2
       diabetes
– Secondary prevention (i.e. interventions
  after a cardiac event [to prevent another])

  1. Based on meta-analyses (pooled data across
    studies), cardiovascular and all-cause mortality are
    reduced in post-myocardial infarction patients who
    participate in cardiac rehabilitation exercise training,
    especially as a component of multifactorial risk
    factor reduction

  2. Randomized controlled trials of cardiac rehabilitation
    exercise training involving post-myocardial
    infarction patients do not support a reduction in the
    rate of nonfatal reinfarction
Postulated benefits

• Decreased anxiety and depression
• Strengthen physical function and independent
  living in elderly
• Enhanced feelings of well being
• Enhanced performance of work, recreational
  and sports
Evidence for Dose-Response Relationship between
Physical Activity and Health Outcome

• No-it does not indicate the absence of a
  favorable relationship
• Category B- only a limited number of
  randomized clinical trials, few randomized trials
  exist, small in size.
• Category C- non randomized or uncontrolled
  clinical trials
Evidence for Dose-Response Relationship
between Physical Activity and Health
Outcome
Positive Risk Factors for CHD ACSM (2006)
 Family History
 • Myocardial infarction, coronary revascularization (bypass
     surgery) or sudden death before :
        – the age of 55 years in father or other male first degree relative
          (i.e. brother or son)
        – the age of 65 years in mother or other female first degree
          relative (i.e. sister or daughter)
 Cigarette smoking
 • Current cigarette smoker or those who have quit in the
     last six months
 Hypertension
 • Client on Hypertensive medications
 • Resting SBP > 140 mmHg and/ or DBP > 90 mm Hg
 Fasting Glucose
    Fasting blood glucose of >100mg/dL (5.6mmol/L)
Positive Risk Factors for CHD               ACSM (2006)
Dyslipidemia
• Total serum cholesterol > 200mg/dL (5.2 mmol/L) or
• High density lipoprotein (HDL) < 40mg/dL (1.03 mmol/L)
• Low density lipoprotein (LDL) > 130mg/dL (3.4mmol/L)
Obesity
• Body Mass Index (BMI) > 30 kg/m2 or
• Waist girth >= 102 cm (M); >= 88 cm (F) or
• Waist/hip ration >= 0.95 (M); >= 0.86 (F)
Sedentary Lifestyle
• Not participating in a regular exercise program
• Accumulating less than 30 minutes moderate intensity
  exercise 3-5 days weekly
Negative Risk Factors for CHD               ACSM (2006)
High level of HDL
• HDL cholesterol > 1.6 mmol/L (60 mg/dl)
Initial Risk Stratification
• Low risk
  – Men<45 years of age and women <55 years of age
  – Younger individuals who are asymptomatic and meet
    no more than one risk factor threshold
• Moderate risk
  – Older individuals (men 45 years of age; women  55
    years of age) or those who meet the threshold for two
    or more risk factors
• High Risk
  – Individuals with one or more signs/symptoms or
    known cardiovascular, pulmonary, or metabolic
    disease
ACSM Recommendations for: Pre-participation
 screening Algorithm
ACSM Recommendations for: Pre-participation
 screening Algorithm cont’
       Current Recommendation of PA
            for Health Promotion
1996 U.S. Surgeons’ General Report: Physical Activity and Health
(USDHHS / CDC / ACSM)

  Accumulating at least 30 minutes of any kind of
  moderate intensity physical activity on most days
  of the week
  would effectively reduce the risk of coronary heart
  disease, type 2 diabetes, hypertension, stroke and
  some kinds of cancer
  Maintain a regular longer duration or vigorous
  intensity derive to greater benefit
Conclusion
 Physical inactivity is one of the most
 important public health problems and
 it is important to develop an action
 plan to address this issue
    – Policy makers
    – Public health professionals
    – Health service providers
    – Educators
    – Grassroots activists
The End
Thank You

				
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