Exercise: A Way to Living - PowerPoint PPT Presentation

Loading...

PPT – Exercise: A Way to Living PowerPoint presentation | free to view - id: abe9e-YjUxY



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Exercise: A Way to Living

Description:

Exercise: A Way to Living – PowerPoint PPT presentation

Number of Views:125
Avg rating:3.0/5.0
Slides: 79
Provided by: jamesd105
Category:
Tags: exercise | living | way

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Exercise: A Way to Living


1
ExerciseA Way to Living
  • Anthony Beutler, M.D.
  • Brian K. Unwin, M.D.
  • Jeff Goodie, Ph.D.
  • Department of Family Medicine
  • Uniformed Services University
  • Bethesda, MD

2
Overview
  • Inactivity obesity related-disease epidemic
  • Understanding Exercise Terminology
  • How to Write an Exercise Prescription
  • Considerations for adults, youth and seniors
  • Provide you facts and tools to use in FP SM
    clinics

Objective
3
Overview
  • Inactivity obesity related-disease epidemic
  • Understanding Exercise Terminology
  • How to Write an Exercise Prescription
  • Considerations for adults, youth and seniors

4
Obesity EpidemicNHANES Adult Obesity
80 70 60 50 40 30 20 10
66 Overwt
31 Obese
1962 1972 1978
1992 2002
Hedley et al, JAMA 291(23) 2004
5
Obesity Epidemic Modifiable Risk FactorsActual
Causes of Death
Top 3 Behavoiral
Mokdad, JAMA, 2004
6
Obesity Epidemic Why Providers Dont Discuss
Behavior Change
  • For Example - Smoking Cessation
  • Too time-consuming (42)
  • Not effective (38)
  • No confidence in ability (22)
  • Unpleasant personal experience (18)
  • Low confidence in knowledge (16)

Vogt, Addiction, 2005
7
Overview Physicians, their Patients Exercise
  • 47 of primary care physicians include an
    exercise history as part of their initial
    examination
  • Only 13 of patients report physicians giving
    advice about exercise
  • Physically active physicians are more likely to
    discuss exercise with their patients

(Self Report)
Eakin, Am J Prev Med, 2005 Abramson, Clin J Sport
Med, 2000 Walsh, Am J Prev Med, 1999
8
BMIs of US FM Docs 19 24 43 25 30 40
gt31 17 (Females more likely to have normal
BMI than males) Prelim AIM Physician BMI project
AAFP 2005
Bias?
9
Overview Shifting the Paradigm
Exercise
Activity
  • Exercise Training

Activity Play, Fun, Functional Fitness
Stephens, USUHS, 2001
10
Overview Why Exercise?
11
Overview Why Exercise?
  • Be Active
  • To Lose Weight
  • Penance for Bad Food Choices
  • Because I Have To
  • Treat Disease X

I exercise because I want to and I like to enjoy
life
12
Overview
  • Inactivity obesity related-disease epidemic
  • Understanding Exercise Terminology
  • How to Write an Exercise Prescription
  • Considerations for adults, youth and seniors

13
Definitions of Exercise Intensity
  • Physical Activity Body movement by contraction
    of skeletal muscle which substantially increases
    energy expenditure
  • Exercise Physical activity that can provide
    health benefits and improve fitness
  • Low
  • Moderate
  • High

Heart Rate, VO2max, METs, RPE
14
Definitions
  • Max Heart Rate (MHR)
  • 220- age MHR (/- 15 bpm)
  • Heart Rate Reserve (HRR)
  • HRR MHR - Resting HR(RHR)
  • Target Heart Rate (THR)
  • THR HRR X TI RHR
  • TI - Training Intensity, usually 40-60 for
    moderate exercise

15
What is VO2max?
16
Definition of VO2max
  • Functional aerobic capacity Maximal ability of
    the body to take in, transport and use oxygen
  • Fick Equation

VO2max (HRmax x SVmax) x (CaO2max -CvO2max)
17
FICK EQUATION
VO2max (HRmax X SVmax) X (CaO2max - CvO2max)
18
METS
19
Metabolic Equivalents
  • One MET is equivalent to the amount of oxygen
    used while resting in the sitting position (3.5
    ml O2/kg/min)
  • Wide individual range of variation
  • Higher the skill level, wider the variation
  • Based on 70 kg person
  • Widely used in cardiac rehabilitation

20
Energy Expenditure Activities
  • Running (5 mph) 8-12
  • Sex 5
  • Shuffleboard 2
  • Soccer 10
  • Swimming 6
  • Tennis 8
  • Volleyball 5
  • Walking 2-6
  • Bowling 3
  • Cycling (lt10 mph) 4
  • Dancing 5
  • Desk Work 6
  • Golf (walking) 2
  • Fishing (sitting) 1.5
  • (standing) 4
  • Lawn Mowing 3-8

21
Relative Perceived Exertion
  • God gives us our relatives--thank God we can
    choose our friends.
  • - Michel de Montaigne

22
Relative Perceived Exertion Scale (Borg)
Add zero to RPE HR
Add zero to C-RS MHR
RPE Scales. Original (6-20) on left, and Revised
Scale (1-10) on rightcorrelates with HR and VO2
Borg GA Medical Science in Sports and Exercise
143377-389, 1982
23
Putting It All Together
Exercise Intensity
HRmax lt30 30-49 50-69 70-89 ? 90
VO2max lt25 25-44 45-59 60-84 ? 85
RPE lt10 10-11 12-13 14-16 ? 17
METS lt2.5 2.5-4.4 4.5-5.9 6.0-8.4 ? 8.5
Low
Moderate
High
24
Overview
  • Inactivity obesity related-disease epidemic
  • Understanding Exercise Terminology
  • How to Write an Exercise Prescription
  • Considerations for adults, youth and seniors

25
Exercise prescription doesnt work without
addressing behavioral aspects!
26
Motivational CounselingTool 1 Scaling
Questions
Rollnick S. Health Behavior Change a guide for
practitioners. Edinburgh Churchill Livingstone
2000
27
Motivational Counseling SMART Goal Setting
  • Specific
  • Where, when, how
  • Measurable
  • How much? How many?
  • Attainable
  • Realistic
  • Track

28
Motivational Counseling TOOL 2 Importance and
Confidence
  • FOLLOW-UP!!
  • Use stepped-care approach
  • Consider resources
  • Physical Therapy
  • Behavior change specialists
  • Psychologists, Social Work, Psychiatry
  • Community resources
  • Support groups

Scaled Confidence Question
Patient Action Plan!
Other behavioral interventions!
SMART Goal Setting
MacGregor K et al. J Am Board Fam Med 2006 19,
215-223
29
The Exercise (Activity) Prescription1 - Assess
Baseline Fitness
  • Ways to Establish Patients Baseline Fitness
  • SCE (Sub-maximal Cycle Ergometry)
  • GXT/ETT
  • AIM
  • LOOK-501

Tool 3 - Americans In Motion
30
The Exercise (Activity) Prescription1 - Assess
Baseline Status
  • Establish Patients Baseline Fitness
  • SCE
  • GXT
  • AIM
  • LOOK-501
  • Establish Goals, Realities Outcomes
  • What does the patient want?
  • What does the patient need?
  • What does the patient already do?

31
The Exercise (Activity) Prescription1 - Assess
Baseline Status
  • Establish Patients Baseline Fitness
  • SCE
  • GXT
  • AIM
  • LOOK-501
  • Establish Goals, Realities Outcomes
  • What does the patient want?
  • What does the patient need?
  • What does the patient already do?
  • Evaluate and Control Risk Factors
  • Orthopedic risk
  • Cardiovascular risk

32
The Exercise (Activity) Prescription2 - Assess
Cardiovascular Risk
Does My Patient Need A Treadmill Test?
33
The Exercise (Activity) Prescription2 - Assess
Cardiovascular Risk
ACSM Guidelines
  • Moderate Risk
  • Older individuals
  • ? 2 risk factors
  • High Risk
  • Signs/Symptoms of cardiac dz
  • Known cardiac, pulmonary or metabolic (DM)
    disease
  • Low Risk
  • Men lt 45, Women lt55
  • No cardiac symptoms
  • ?1 risk factor
  • Cardiac Risk Factors
  • Cigarette smoking
  • Fam Hx. of early CAD
  • LDL gt130 or HDL lt35
  • Hypertension
  • Impaired fasting gluc
  • (gt110mg/dL)
  • Obesity (BMI gt30)
  • Sedentary lifestyle

Positive Factor High serum HDL (gt60)
34
The Exercise (Activity) Prescription2 Does My
Patient Need an ETT?
  • Always Screen
  • Patents with known CAD
  • Patients with symptoms of CAD
  • Anyone with known medical disease
  • Moderate risk patient for vigorous exercise

35
The Exercise (Activity) Prescription3 Write
the Prescription
  • Which Guideline to Use?
  • American College of Sports Medicine (ACSM)
    American Heart Association
  • CDC
  • Surgeon General Guidelines
  • National Cholesterol Education Program
  • American Geriatrics Society
  • American Diabetes Association

36
The Exercise (Activity) Prescription
  • Mode
  • Duration
  • Frequency
  • Intensity
  • Timely Follow Up
  • Therapy (Preventive and/or Therapeutic)

The MD FITT Prescription
37
The Exercise (Activity) Prescription3 Write
the Prescription
  • 2007 ACSM Guidelines For Adults 18-65

Vigorous Intensity (jogging) 20 minutes 3 times
per week
Moderate Intensity (brisk walk) 30 minutes 5
times per week
Or
MODE
And
DURATION
FREQUENCY
Strength Building Exercise (weight/resistance
training) 8-10 exercises 2 times per week
Haskell, Med Sci Sports Exerc, 2007
38
The Exercise (Activity) Prescription3 Write
the Prescription
2007 ACSM Guidelines For Adults 18-65
Intensity
Vigorous (gt6 METs) Jogging Heavy
loads Competitive Swimming Tennis Volleyball S
kiing Bicycling Etc
Light (lt 3 METs) Walking in home Light
household Leisure
Moderate (3-6 METs) Brisk walking Heavy
household Recreational Basketball
Bicycling Dancing Swimming Volleyball
39
The Exercise (Activity) Prescription
  • Mode
  • Duration
  • Frequency
  • Intensity
  • Timely Follow Up
  • Therapy (Preventive and/or Therapeutic)

The MD FITT Prescription
40
Exercise (Activity) Prescription in Adults
Orthopedic Injury vs. VO2max GainIn Vigorous
Exercise
Gettman, Med Sci Sports Exerc, 1977
41
The Exercise (Activity) PrescriptionTool 4 The
AIM Fitness Prescription
Mode
Duration Frequency Intensity
Paradigm Kids Activity Adults Fitness Older
Adults Functional Fitness
Timely Followup
42
Overview
  • Inactivity obesity related-disease epidemic
  • Understanding Exercise Terminology
  • How to Write an Exercise Prescription
  • Considerations for adults, youth and seniors

43
Exercise Prescription in AdultsNational Health
Interview Survey 2006
X
  • One in three adults reports regular leisure time
    physical activity
  • Women have higher rates of inactivity than men
  • Race/Ethnicity differences
  • Hispanics (22.6)
  • White (33.7)
  • Black (25.3)
  • Less active with aging (17 _at_ 75 and older)

www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelea
se200706.pdf
44
Exercise (Activity) Prescription for AdultsNew
Hopkins Projections
  • By 2015
  • 75 of adults overwt or obese
  • 41 will be frankly obese

Epidemiologic Reviews. 2007. 29(1) 6-28
45
Exercise (Activity) Prescription for AdultsThe
Adult Weight Cycle
46
Overview Why Exercise?
  • Be Active
  • To Lose Weight
  • Penance for Bad Food Choices
  • Because I Have To
  • Treat Disease X

I exercise because I want to and I like to enjoy
life
47
Good News for Your Patients
Exercise (Activity) Prescription for
AdultsAdults, Exercise Mortality Good News
for Your Patients
Relative Risk of Total Mortality
Normal Weight (BMI 18 24)
Overweight (BMI 25-30)
Obese (BMI 31- 36)
From Lee, Am J Clin Nutr, Mar 1999
48
Overview
  • Inactivity obesity related-disease epidemic
  • Understanding Exercise Terminology
  • How to Write an Exercise Prescription
  • Considerations for adults, youth and seniors

49
Exercise (Activity) Prescription for
KidsBenefits of Exercise in Children
  • Behavioral
  • Scholastic performance
  • Teen-pregnancy rate
  • Smoking
  • Sense of self-efficacy
  • Health
  • Obesity DM, HTN, CAD
  • Osteoporosis

50
Exercise (Activity) Prescription for KidsTrends
in Youth Exercise
How are we doing over the past 15 years?
  • TV watching
  • Biking
  • Smoking
  • Obesity

Up 100
Down 45
Still Up from 1991
Wanna Guess?
  • 45 of new DM cases in 10-19 yo are DM type 2

MMWR 51(19) 409-12 Alberti, Diabetes Care, 2004
51
NHANESPrevalence of Overweight Youth Ages 2-19
52
Exercise (Activity) Prescription for KidsTrain
Up A Child
  • 25 of obese preschoolers become obese
  • 80 of obese 14 year-olds remain obese
  • 70 of obese children who lose weight will
    maintain that loss as adults
  • BMI at 18 years stronger predictor of DM2 than at
    ANY other age

Train up a child in the way he should go and
when he is old, he will not depart from it. -
Proverbs 226
Allen, J Pediatr, 2007 Flegal, Physiol Behav,
2005
53
Exercise (Activity) Prescription for
KidsExercise Works for Children
Factors that Alter Body Fat, Body Mass, and
Fat-Free Mass in Pediatric Obesity LeMura LM,
Mazeikas MT
  • Meta-analysis of 30 RCT
  • Ages 5 - 17
  • Pre post intervention body composition
  • Exercise highly effective treatment for
    pediatric obesitylow intensity, long duration
    exercise
  • Aerobic exercise combined with resistance
    training

Med Sci Sports Exerc, 2002
54
Exercise (Activity) Prescription for KidsWhy
Exercise Works in Kids
55
Exercise (Activity) Prescription for
KidsGuidelines for Pediatric Exercise
  • 60 minutes of activity each day (minimum)
  • Moderate-to-vigorous activity
  • Can accumulate in small bouts, wide variety of
    sports activities
  • - American Academy of Pediatrics
  • - American College of Sports Medicine

56
Exercise Training in ChildrenStrength Training
in Children
  • Myths Facts
  • Recommendations for Strength Training in Children
  • Final Cautions

57
  • Not my fault being the biggest and the strongest.
    I dont even exercise.

58
Exercise Training in ChildrenStrength Training
Myth 1
  • Myth
  • Children cant build muscular strength until
    after puberty
  • Vrijens Med Sport 1978
  • Fact
  • 22-74 strength gains in boys girls after 8
    weeks of training
  • Faigenbaum, Ramsay, Lillegard and others

59
Exercise Training in ChildrenStrength Training
Myth 2
  • Myth
  • Weightlifting will stunt a childs growth
  • Kato, Jap Un Sport Sci, 1964
  • Fact
  • No decrease in stature, improved bone density
    with proper nutrition weightlifting
  • Arendt, Clarke, Morris

60
Exercise Training in ChildrenStrength Training
Myth 3
  • Myth
  • Weightlifting provides only anaerobic exercise
  • Fact
  • Heart rate sustained at 130 - 150 bpm for 30
    minutes in 12-15 yo weightlifters
  • Faigenbaum, Clin Sport Med, 2000

61
Exercise Training in ChildrenStrength Training
Myth 4
  • Myth
  • Growth plate injuries are common in prepubescent
    and adolescent weightlifters
  • - NEISS reports
  • Facts
  • Rare case reports only
  • No reported growth plate injuries in over 100
    studies of weightlifting in chidren
  • Micheli, Clin Sport Med, 2000

62
Exercise Training in ChildrenStrength Training
Myth 5
  • Myth
  • I dont want my baby hanging out with a bunch of
    half-naked, iron-pumping hooligans
  • Facts
  • Improved self-efficacy and self-esteem in 12-16
    yo girls who participated in 12 weeks of strength
    training
  • Holloway, J Appl Psych, 1998
  • Facts
  • You can pick your friends and your kid can pick
    his nose, but you cant pick your kids friends
  • - Chris Farley, noted philosopher

63
Exercise Training in ChildrenRecommendations
for Strength Training
  • Begin with 1 set of 10-15 reps
  • 6-8 exercises, mix of upper and lower body
  • Both single and multi-joint exercises
  • Emphasize proper technique

64
Exercise Training in ChildrenRecommendations
for Strength Training
  • Progression based on individual needs and goals
  • 1 to 3 sets
  • 8-15 reps per set
  • 2-3 nonconsecutive training sessions per week
  • Increase resistance 5-10 as strength improves

65
Exercise Training in ChildrenFinal Cautions in
Weightlifting
  • Qualified Adult Supervision
  • No Pain, No Gain... No Way!
  • Focus on Proper Technique
  • Beware the dreaded Add-On

66
Overview
  • Inactivity obesity related-disease epidemic
  • Understanding Exercise Terminology
  • How to Write an Exercise Prescription
  • Considerations for adults, youth and seniors

67
Exercise (Activity) Prescription for Older
AdultsDis-fitness Cycle
68
Exercise (Activity) Prescription for Older Adults
Fitness and Functional Status
Normal
Healthy Adults
Function
Near Frail
THRESHOLD
Poor
Frail Adults
Strength
Low
High
Established Populations for Epidemiologic Studies
of the Elderly (EPESE) . J Gerontology,
199449(3)M109-15
69
Exercise (Activity) Prescription for Older Adults
Exercise and Aerobic Capacity
Active
Active Aging
Reduced Activity Weight Gain
VO2 Max
Sedentary
Exercise Intervention
80
20
Age
70
Exercise (Activity) Prescription for Older Adults
Strength Use It Lose Less of it
  • Losses
  • Gains
  • Sedentary people lose large amounts of muscle
    mass (20-40)
  • 6 per decade loss of Lean Body Mass (LBM)
  • Lean body mass increases 1-3 kg
  • Resistance training improves strength by a range
    of 40-150
  • Muscle fiber area 10-30

Aerobic Activity IS NOT sufficient to stop this
loss!
  • BOTTOM LINES
  • MUSCLE STRENGTHENING EXERCISES REQUIRED
  • MUST INCLUDE BALANCEFLEXIBILITY IN OLDER ADULTS
  • FEWER FALLS, FRACTURES, DISUSE, FRAILTY AND
    SARCOPENIA

71
Exercise (Activity) Prescription for Older
AdultsWhats Different for Older Adults?
2007 ACSM Guidelines For Older Adults
Intensity Rating 5-6/10 Intensity is relative
to level of fitness
Balance Exercise (not specified) 3 times per week
Moderate Intensity (brisk walk) 30 minutes 5
times per week
Vigorous Intensity (jogging) 20 minutes 3 times
per week
Flexibility Activities (static stretch) 10
minutes 10-30 seconds/stretch 3-4 repetitions All
days of the week
Strength Building Exercise (weight/resistance
training) 8-10 exercises 2 times per week
72
Exercise (Activity) Prescription for Older
AdultsA little more about balance
Dynamic
Static
Intensitysensory or time
73
The MD FITT Prescription (for the older adult)
  • Mode
  • AerobicStrength BalanceFlexibility
  • Duration
  • Frequency
  • Intensity
  • Touch gt No Touch gt Eyes Closed for balance
  • 5-6/10 self-perceived exertion
  • Timely Follow Up
  • Therapy (Preventive and/or Therapeutic)

74
Exercise (Activity) Prescription for Older Adults
Tool 5
http//www.nia.nih.gov/NR/rdonlyres/8E3B798C-237E-
469B-A508-94CA4E537D4C/0/NIA_Exercise_Guide407.pdf
75
Finish Line!
  • Obesity and chronic disease epidemic
  • Ours and Theirs Problem
  • Motivational counseling technique
  • Scaled Questions
  • Importance and Confidence

76
Finish Line!
  • Basics of the exercise Rx
  • Paradigms (Activity and Fitness)
  • Assess baseline fitness
  • Assess risks
  • MD FITT
  • Mode, Duration, Frequency, Intensity, Timely
    follow up and Therapy (Preventive and
    Therapeutic)

77
Finish Line!
  • Exercise Rx for
  • Youth
  • Adults
  • Seniors
  • Components
  • Aerobic Strength Flexibility

78
Questions?
Exercise Prescription From Eight to Eighty
Activity
Brian Unwin, MD Colonel, USA, MC Department of
Family Medicine Uniformed Services University
Anthony Beutler, MD Major, USAF, MC Department of
Family Medicine Uniformed Services University
Washington D.C. Stretch Limo
Preston, Idaho Stretch Limo
About PowerShow.com