Exercise, fitness and health: research strategies for a changing society

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Exercise, fitness and health research strategies
for a changing society

• David Brodie
• Professor of Health Studies
• Faculty of Health Studies
• Buckinghamshire Chilterns University College
• United Kingdom

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Cardiovascular Health

• Process of cardiac rehabilitation
• -Acute and chronic changes in cardiac
  enzymes
• -Changes in heart rate variability
• -Changes in cardio-respiratory
  function
• In all cases the research team has shown
  beneficial changes as a result of exercise-based
  cardiac rehabilitation

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Method-Training Threshold

• Post-MI patients over a wide age range
• Cardiac rehabilitation
• Range of cardio-respiratory variables
• Maximum heart rate is often calculated from
  220-Age
• Training threshold is 70-85 max. heart rate
• Beta-blockade drugs lower heart rate

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Measurement of oxygen consumption
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Cardiac Power Output

• Cardiac power output is equivalent to the
  rate at which the heart imparts hydraulic energy
  into the arterial system to maintain the
  circulation of the blood
• Combines pressure and flow

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Cardiac power output

• Calculated from mean arterial pressure, cardiac
  output and a correction factor (10-3).
• Measurement of CPO offers a major advantage over
  simply measuring cardiac output
• Pressure and flow, gives a more complete
  representation of the heart

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Treadmill testing

• Subjects were required to undertake a maximal
  exercise test, where peak VO2,VCO2, VE and blood
  pressure are recorded.
• Subjects then have a 40 minute recovery period.

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Carbon dioxide rebreathing

• Subjects are then taken back up to their peak
  exercise intensity achieved in the first test.
• The subject rebreathes a mixture of gases from an
  anaesthetic bag.
• The rebreathing trace is captured by a
  capnograph.
• Cardiac output is then calculated from the
  capnograph tracing.

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PVD Patients

• Functional capacity
• Impaired free living and ambulation
• Risk of coronary and cerebral event
• Purpose of research
• Examine cardiovascular and respiratory dynamics
• Provide evidence on the mechanisms by which the
  increase in maximal walking distance is achieved

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Measurements

• Maximal walking time
• Peak oxygen consumption
• Cardiac output
• Mean arterial pressure
• Cardiac power output
• Quality of life

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Baseline Results
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Intervention Groups

• 12 weeks of either
• Home based exercise
• 30 minutes of walking, three times per week
• Supervised exercise
• 30 minutes of hospital supervised exercise twice
  weekly
• Control
• No formal exercise training

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Cardiopulmonary variables

• No significant changes in for any group
• Peak oxygen consumption
• Cardiac output
• Mean arterial pressure
• Cardiac power output
• Significant changes in
• Maximal walking distance for the supervised group
  (p 0.00)
• Post hoc analysis revealed significant changes
  occurred between week 1-6 and week 1-12, but not
  between week 6-12

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Heart Rate Variability

• The beat to beat variability of the heart rate as
  a reflection of its overall nervous control

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Heart Rate Variability.

• A simple non-invasive tool that can provide
  quantitative information regarding cardiac
  autonomic modulation.
• Historically, two types of measurements created
  from analysis of RR interval.
• Time domain measures
• SDNN - global measurement
• Pnn50 - vagal indicator
• Frequency domain measures
• Increased use due to automated data editing and
  processing packages.

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Heart Rate Variability
3.0 seconds of heart beat data
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Control of Heart Rate Variability
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Past/Current Applications of HRV

• Healthy subjects at rest
• Healthy subjects during exercise (steady state)
• PVD patients at rest
• Post MI patients during incremental exercise

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Current/Future Applications of HRV

• LVAD (explanted) patients
• Chronic heart failure patients
• Healthy, age-matched controls
• Dynamic analysis of non-stationary tachograms via
  wavelet analysis
• Post MI patients during cardiac rehab. exercise
  classes

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Agreement and ReliabilityInstrumentation.

• CardioPerfect ST software using the Medical
  Graphics CardO2 CP stress system (CP).
• Cardiotens 24-hour ambulatory ECG recorder (CT).
• TF5 HRV analysis instrument (TF5).

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Main Findings

• Good agreement between systems (R gt 0.75).
• Variable reliability.
• Dependent on a number of factors
• System used
• Position measured
• Statistical measure
• Recommended that specific reliability
  coefficients be determined by researchers.

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HRV During Exercise.

• The use of standard HRV measures is problematic.
• Behaviour of spectral bands does not conform to
  their assigned roles at rest.
• Especially true at higher exercise intensities.
• Adapted frequency bands are more useful.
• Development of wavelet analysis

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PVD Findings.

• Low HRV levels at baseline.
• Similar to those reported in patients at high
  risk of sudden cardiac death.
• Resting HRV was not increased by 12 weeks
  home-based or supervised walking exercise.
• RR interval and HF increased during exercise at
  equal absolute exercise intensity.
• Slower HR and increased vagal modulation
• More electrically stable environment
• Safer exercisers

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Does Bridging to Recovery Normalise Autonomic
Activity Heart Failure?
Standing
Supine
Controlled Breathing
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Exercise, the best medicine in the world
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Benefits of Exercise - 1

• Cancer
• - certain types (colon, breast reproductive
  tract)

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Benefits of Exercise - 1

• Cancer
• - certain types (colon, breast reproductive
  tract)
• Diabetes
• - improved sensitivity of muscles to insulin
• - reduced risk of development in middle age

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Benefits of Exercise - 1

• Cancer
• - certain types (colon, breast reproductive
  tract)
• Diabetes
• - improved sensitivity of muscles to insulin
• - reduced risk of development in middle age
• Hypertension
• - regular exercise reduced SBP by 13 and DBP by
  10mm Hg

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Benefits of Exercise - 2

• Coronary Artery Disease
• - halve the risk
• - increases HDL cholesterol

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Benefits of Exercise - 2

• Coronary Artery Disease
• - halve the risk
• - increases HDL cholesterol
• Arthritis
• - improved level of mobility in sufferers

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Benefits of Exercise - 2

• Coronary Artery Disease
• - halve the risk
• - increases HDL cholesterol
• Arthritis
• - improved level of mobility in sufferers
• Obesity
• - regular exercise results in fat loss of 0.5 kg
  per week

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Benefits of Exercise - 2

• Coronary Artery Disease
• - halve the risk
• - increases HDL cholesterol
• Arthritis
• - improved level of mobility in sufferers
• Obesity
• - regular exercise results in fat loss of 0.5 kg
  per week
• Stroke
• - reduced risk by x3 with regular therapy

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Benefits of Exercise - 3

• Depression
• - equal to one form of psychotherapy superior
  to another in treatment of moderate depression
• - equally effective as time limited and time
  unlimited psychotherapy, meditation-relaxation
  group psychotherapy

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Benefits of Exercise - 3

• Depression
• - equal to one form of psychotherapy superior
  to another in treatment of moderate depression
• - equally effective as time limited and time
  unlimited psychotherapy, meditation-relaxation
  group psychotherapy
• Anxiety
• - lowered levels

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Benefits of Exercise - 4

• Osteoporosis
• - reduction in hip fractures by 50
• - 4.2 increase in midshaft radius bone mineral
  content (2 in controls)

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Benefits of Exercise - 4

• Osteoporosis
• - reduction in hip fractures by 50 (E)
• - 4.2 increase in midshaft radius bone mineral
  content (2 in controls)
• Intermittent Claudication
• - better outcome than arterial reconstruction

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Benefits of Exercise - 4

• Osteoporosis
• - reduction in hip fractures by 50 (E)
• - 4.2 increase in midshaft radius bone mineral
  content (2 in controls)
• Intermittent Claudication
• - better outcome than arterial reconstruction
• Behavioural Benefits
• - higher abstinence rates in alcohol treatment
• - dose response relationship with smoking

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Benefits of Exercise - 5

• Back Pain
• - weak association with reduced back pain
• - no evidence of prevention
• - decreased absenteeism from low back pain in
  those using therapy regularly

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Benefits of Exercise - 5

• Back Pain
• - weak association with reduced back pain
• - no evidence of prevention
• - decreased absenteeism from low back pain in
  those using therapy regularly
• Multiple Sclerosis
• - daily therapy maintains remission

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Benefits of Exercise - 5

• Back Pain
• - weak association with reduced back pain
• - no evidence of prevention
• - decreased absenteeism from low back pain in
  those using therapy regularly
• Multiple Sclerosis
• - daily therapy maintains remission
• Alzheimers disease
• - reduction by 50

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So why isnt everyone exercising?
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Is it necessary in China compared with the West?

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Is it necessary in China compared with the
West?Rural to urban economyOne child
familyMacDonalds

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So why isnt everyone exercising?

• Im too fat

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So why isnt everyone exercising?

• Im too fat
• I might get injured

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So why isnt everyone exercising?

• Im too fat
• I might get injured
• Im too old

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So why isnt everyone exercising?

• Im too fat
• I might get injured
• Im too old
• I might get cold

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So why isnt everyone exercising?

• Im too fat
• I might get injured
• Im too old
• I might get cold
• I might get wet and muddy

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So why isnt everyone exercising?

• Im too fat
• I might get injured
• Im too old
• I might get cold
• I might get wet and muddy
• Im too busy

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So why isnt everyone exercising?

• Im too fat
• I might get injured
• Im too old
• I might get cold
• I might get wet and muddy
• Im too busy
• Ive young children to look after

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So why isnt everyone exercising?

• Im too fat
• I might get injured
• Im too old
• I might get cold
• I might get wet and muddy
• Im too busy
• Ive young children to look after
• I havent the right clothes

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So why isnt everyone exercising?

• Im too fat
• I might get injured
• Im too old
• I might get cold
• I might get wet and muddy
• Im too busy
• Ive young children to look after
• I havent the right clothes
• Ive no one to exercise with

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No one to run with ?
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Themes
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Themes

• Clinical applications of research into
  cardiovascular health

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Themes

• Clinical applications of research into body
  composition and cardiovascular health
• Benefits of exercise

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Themes

• Clinical applications of research into body
  composition and cardiovascular health
• Benefits of exercise
• Equipment development and validation

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...but you should all walk your dog for 30
minutes every day.
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even if you do not have one.
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and finally,

• 
  
  
  

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• Thank you all for listening to big nose and
  panda eyes so patiently.

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