Physical Activity, Exercise, and Fitness In Deok Kong, M.D., PhD Department of Physiology Yonsei University Wonju College of Medicine

Physical Activity and Exercise is defined as bodily movement that is produced by the contraction of skeletal muscle and that substantially increases energy expenditure. Exercise: a type of physical activity, is defined as planned, structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness.

Physical Fitness Physical fitness is a multidimensional concept that has been defined as a set of attributes that people possess or achieve that relates to the ability to perform physical activity, is comprised of skill-related, health related, and physiologic components. Both health-related and physiological fitness measures are closely allied with health promotion and disease prevention and can be modified through regular physical activity and exercise.

Skill-related components of physical fitness include agility, balance, coordination, speed, power, and reaction time, and are associated mostly with sports and motor skill performance. Health-related components of physical fitness include cardiovascular endurance, muscular strength and endurance, flexibility, and body composition. Physiological fitness include metabolic fitness, morphologic fitness, and body integrity.

Compendium of Physical Activities: An Update of Activity Codes and MET Intensity The Compendium provides a coding scheme that links a five-digit code, representing the specific activities performed in various settings, with their respective metabolic equivalent (MET) intensity levels. XX-XXX-X.X Major Heading-Specific Activity-MET Intensity

Major types of activities in version 2 of the compendium of physical activities 01-Bicycling 02-Conditioning Exercise 03-Dancing 04-Fishing and Hunting 05-Home Activities 06-Home Repair 07-Inactivity 08-Lawn and Garden 09-Miscellaneous 10-Music Playing 11-Occupation 12-Running 13-Self Care 14-Sexual Activity 15-Sports 16-Transportation 17-Walking 18-Water Activities 19-Winter Activities 20-Religious Activities 21-Volunteer Activities

The Compendium of Physical Activities Tracking Guide

Classification of Physical Activity Intensity

Benefits and Risks Associated With Physical Activity 1. The current public health recommendations for physical activity 2. The health and fitness benefits associated regular physical activity and/or exercise 3. The risks associated with exercise

Divergent Physical Activity Recommendations “Some activity is better than none, and more activity is better than less.” Surgeon General’s Report: 30 min of brisk walking for days of the week ACSM (2001): 45 min of exercise per day (200-300 min/week) IASO (2003): 45 to 60 min of moderate physical activity per day

Evidence for Dose-Response Relationship Between Physical Activity and Health Outcome All-cause mortality (+) Cardiovascular and coronary heart disease (+) Blood pressure and hypertension (-) Blood lipids and lipoproteins (±) Coagulation and hemostatic factors (±) Overweight, obesity, and fat distribution (+) Type 2 diabetes mellitus (+) Colon cancer (+) Low back pain, osteoarthritis, and osteoporosis (±) Depression and anxiety (-) Quality of life (+)

Benefits of Regular Physical Activity and/or Exercise Improvement in cardiovascular and respiratory function Reduction in coronary artery disease risk factors Decreased morbidity and mortality

Risks Associated With Exercise Sudden death among young individuals: only one death per year for every 133,000 men and 769,000 women, respectively Exercise events in those with sickle cell trait: African Americans Exercise-related cardiac events in adults: only one death per year for every 15,000 to 18,000 individuals Risk of cardiac events during exercise testing: per 10,000 tests Risk of cardiac events during cardiac rehabilitation

Health Screening and Risk Stratification Purposes: Identification and exclusion of individuals with medical contraindications to exercise Identification of individuals at increased risk or disease because of age, symptoms, and/or risk factors Identification of persons with clinically significant disease who should participate in a medically supervised exercise program Identification of individuals with other special needs

Coronary artery disease risk factor thresholds for use with ACSM risk stratification <Positive risk factors> Family history Cigarette smoking Hypertension: >140/90 mmHg Dyslipidemia: total>200 mg/dl, LDL>130 mg/dl, HDL<40 mg/dl Impaired fasting glucose: >100 mg/dl Obesity Sedentary lifestyle <Negative risk factor> High-serum HDL cholesterol >60 mg/dl

Major signs or symptoms suggestive of cardiovascular, pulmonary, or metabolic disease Pain, discomfort in the chest, neck, jaw, arm, or other areas that may result from ischemia Shortness of breath at rest or with mild exertion Dizziness or syncope Orthopnea or paroxysmal nocturnal dyspnea Ankle edema Palpitation or tachycardia Intermittent claudication Known heart murmur Unusual fatigue or shortness of breath with usual activities

ACSM Risk Stratification Categories Low risk: Men<45 years of age and women <55 years of age who are asymptomatic and meet no more than one risk factor threshold Moderate risk: Men>45 years and women>55 years or those who meet the threshold for two or more risk factors High risk: Individuals with one or more signs and symptoms or cardiovascular, pulmonary or metabolic disease

American Heart Association (AHA) Risk Stratification Class A: Apparently healthy individuals Class B: Presence of known, stable cardiovascular disease with low risk for complications with vigorous exercise, but slightly greater than for apparently healthy individuals Class C: Those at moderate to high risk for cardiac complications during exercise and/or unable to self-regulate activity or understand recommended activity level Class D: Unstable disease with activity restriction

AHA/ACSM Health/Fitness Facility Preparticipation Screening Questionnaire

Pre-Exercise Evaluations Medical history, Physical examination Laboratory tests Blood pressure Lipids and lipoproteins Blood profile analyses Pulmonary functions

Classification and management of blood pressure on adults

ATP III Classification of LDL, Total, and HDL Cholesterol (mg/dl)

Typical ranges of normal values for selected blood variables in adults

Schema for determining the severity of both obstructive and restrictive lung diseases from PFTs

Health-Related Physical Fitness Testing Purposes: Educating participants about their present health-related fitness status relative to health-related standards and age- and sex-matched norms Providing data that are helpful in development of exercise prescription to address all fitness components Collecting baseline and follow-up data that allow evaluation of progress by exercise program participants Motivating participants by establishing reasonable and attainable fitness goals Stratifying cardiovascular risk

A Comprehensive Health Fitness Evaluation Prescreening/risk stratification Resting HR, BP, height, body mass, ECG Body composition Cardiorespiratory fitness Muscular strength Flexibility

Body Composition Basic body composition can be expressed as the relative percentage of body mass that is fat and fat-free tissue using a two-compartment model. Body composition can be estimated with both laboratory and field techniques that vary in terms of complexity, cost, and accuracy. Before collecting data for body composition assessment, the technician must be trained, routinely practiced in the techniques, independent of the technique being used.

Measurements of body composition Anthropometric methods: Body Mass Index Circumferences Skinfold measurements Densitometry Hydrodensiometry (underwater) weighing Plethysmography Conversion of body density to body composition Other techniques Dual energy x-ray absorptiometry (DEXA) Total body electrical conductivity (TOBEC) Bioelectrical impedence anaylsis (BIA) Near-infrared intercadence

Body Composition (% Body Fat) for Men

Body Composition (% Body Fat) for Women

Cardiorespiratory (CR) Fitness CR fitness is related to the ability to perform large muscle, dynamic, moderate-to-high intensity exercise for prolonged period. Performance of such exercise depends on the functional state of the respiratory, cardiovascular, and skeletal muscle system. The assessment of CR fitness is an important part of a primary or secondary intervention program.

Mode of Testing Field tests Motor driven treadmills Mechanically braked cycle ergometers Step testing

Muscular Strength and Endurance Muscular strength and endurance are health-related fitness components that may improve or maintain the following: Bone mass Glucose tolerance Musculotendinous integrity The ability to carry out the activities of daily living The fat-free-mass and resting metabolic rate

Muscular Strength refer to the ability of the muscle to exert force-Upper Body Strength.

Leg Strength

Fitness categories by age groups and gender for partial curl-up

Flexibility is the ability to move a joint through its complete range of motion.

Fitness categories by age groups for trunk forward flexion using a sit-and-reach box (cm)

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