Health Benefits from Regular Exercise
DECLINE IN DEATHS
Harvard Alumni Study (1985)
Mortality
Amount of physical activity
Exercise and Chronic Diseases
Regular exercise reduces risk of or benefits: • atherosclerosis and coronary heart disease
– TC, LDL-C, HDL-C, TG, heart strength
DEVELOPMENT OF ATHEROSCLEROSIS
The first step of atherosclerosis is • • • • • Inflammation Injury Cancer Diabetes More cancer
ARTERY COMPARISONS
Coronary Artery Disease
• Atherosclerosis—progressive narrowing of arteries due to build up of plaque • Coronary artery disease (CAD)— atherosclerosis in the coronary arteries • Ischemia—deficiency in blood to heart caused by CAD • Myocardial infarction—heart attack due to ischemia
AMERICANS AT INCREASED CAD RISK
Did You Know…?
Atherosclerosis begins in infancy and progresses at different rates, depending primarily on heredity and lifestyle choices such as smoking history, diet practices, physical activity, and stress.
Exercise and Chronic Diseases
Regular exercise reduces risk of or benefits: • atherosclerosis and coronary heart disease
– TC, LDL-C, HDL-C, TG, heart strength
• hypertension
– BP
Hypertension
• chronically elevated blood pressure • causes the heart to work harder • places strain on arteries causing them to become less elastic over time • affects ~25% of adult Americans
– half of these are unaware they have hypertension
Classification of Blood Pressure for Adults, Age 18 Years and Older
Category
Normal High normal Systolic (mmHg) < 130 130-139 Diastolic (mmHg) < 85 85-89
Hypertension Stage 1 (mild)
Stage 2 (moderate) Stage 3 (severe) Stage 4 (very severe)
140 140-159
160-179 180-209 210
90 90-99
100-109 110-119 120
Exercise and Chronic Diseases
Regular exercise reduces risk of or benefits: • atherosclerosis and coronary heart disease
– TC, LDL-C, HDL-C, TG, heart strength
• hypertension
– BP in hypertensive (but doesn’t normalize)
• colon and breast cancer
Exercise and Chronic Diseases
Regular exercise reduces risk of or benefits: • atherosclerosis and coronary heart disease
– TC, LDL-C, HDL-C, TG
• hypertension
– BP in hypertensive (but doesn’t normalize)
• colon and breast cancer • diabetes mellitus
– exercise need for insulin
Exercise and Chronic Diseases
• obesity
– energy expenditure
Obesity and Overweight in the US
prevalence dramatically past 30 y prevalence in children markedly since 1980 >33% of adult population is overweight average adult gains 1 lb/yr after age 25 y average adult loses 0.5 lb of muscle and bone mass each year after age 25 y
Obesity Trends* Among U.S. Adults BRFSS, 1985
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends* Among U.S. Adults BRFSS, 1986
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends* Among U.S. Adults BRFSS, 1987
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends* Among U.S. Adults BRFSS, 1988
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends* Among U.S. Adults BRFSS, 1989
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends* Among U.S. Adults BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends* Among U.S. Adults BRFSS, 1991
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends* Among U.S. Adults BRFSS, 1992
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends* Among U.S. Adults BRFSS, 1993
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends* Among U.S. Adults BRFSS, 1994
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends* Among U.S. Adults BRFSS, 1995
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends* Among U.S. Adults BRFSS, 1996
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends* Among U.S. Adults BRFSS, 1997
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends* Among U.S. Adults BRFSS, 1998
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends* Among U.S. Adults BRFSS, 1999
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends* Among U.S. Adults BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends* Among U.S. Adults BRFSS, 2001
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends* Among U.S. Adults BRFSS, 2002
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults BRFSS, 2003
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults BRFSS, 2004
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults BRFSS, 2005
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Prevalence of Overweight Among U.S. Children and Adolescents (Aged 2 –19 Years) National Health and Nutrition Examination Surveys (NHANES)
20% 15% 10% 5%
0%
1971-74
1976-80
1988-94
2003-04
Non-Hispanic whites Non-Hispanic blacks Mexican Americans
Fat Distribution
Upper-body (android) obesity • Fat stored in upper body and abdominal area (apple shaped) • Occurs more frequently in men • Carries greater risk for CAD, hypertension, stroke, and diabetes
Lower-body (gynoid) obesity • Occurs more frequently in women • Fat stored in the lower body around the hips, buttocks, and thighs (pear shaped)
BODY CHANGES, DIET, AND EXERCISE
Exercise and Chronic Diseases
• obesity
– energy expenditure
• low-back pain
– a leading cause for missed work
• mental health
– mental well-being
• osteoporosis
– weight-bearing exercise bone mineral density
Bone Turnover and Age
AGE (yr) < 20 20-40 > 40 Bone Turnover Bone Gain > Bone Loss Bone Gain = Bone Loss Bone Gain < Bone Loss
Bone Mineral Density
osteoporosis
Mechanical loading on bone stimulates bone absorption of Ca2+
Are you looking at a 65-year-old woman with osteoporosis?
Exercise Interventions in Pre-pubertal Children
Comparison of Impact Exercise vs. Weight Training on Changes in BMD of Postmenopausal Women
• Ca2+ supplemented at 1500 mg/d
• 3 d/wk; 45 min sessions for 11 mo • jogging / stair climbing vs. weight training
Kohrt et al., J Bone Miner Res 12:1253, 1997
Summary
• Maintaining good bone health is a lifelong process
• Exercise (and proper nutrition) are vital in enhancing peak BMD in childhood and in maintaining or increasing BMD in adults
Exercise Prescription
Components of Fitness • cardiovascular • body composition • muscular strength and endurance • flexibility
Exercise Prescription Cardiovascular Fitness • 1995 CDC/ACSM health recommendation:
– ―at least 30 minutes of moderate intensity exercise on most or preferably all days of the week‖
• expend at least 1000 kcal/week (= to 30 min of brisk walking 5-6 days/week)
• minimal fitness recommendations:
– expend 2000-3500 kcal/week
• equal to 120-220 min/week of moderate-intensity running (9-min/mile pace)
Exercise Prescription
Cardiovascular Fitness • exercise mode • exercise intensity
– – – – 50-70% of HRmax 45-60% of VO2max RPE of 11-12 ―talk‖ test
• exercise duration • exercise frequency • rate of progression
Classification of Exercise Intensity
Based on 30-60 minutes of continuous exercise
% H R m ax <30 3 0 -4 9 5 0 -6 9 7 0 -8 9 >90
% V O 2m ax <25 2 5 -4 4 4 5 -5 9 6 0 -8 4 >85
RPE <9 9 -1 0 1 1 -1 2 1 3 -1 6 >16
C la s s ific a tio n V e ry lig h t L ig h t M o d e ra te Heavy V e ry h a rd
Exercise Prescription
Flexibility • connective tissue primary cause of inflexibility • primary concern is flexibility of lower back and hamstrings
Exercise Prescription Muscular Strength and Endurance • general recommendations
– one set of 8-12 repetitions – set resistance to reach volitional fatigue – at least 2 days/week – performed at moderate-to-slow speeds – full range of motion – do not alter normal breathing