Author name here for Edited books chapter 1 1 Physical Activity, Health, and Chronic Disease chapter

Objectives 1.Understand the importance of regular physical activity 2.Understand dose–response relationships 3.Understand the concept of training volume 4.Identify risk factors for cardiovascular disease and sources of musculoskeletal disorders and disease 5.Appreciate the role of different exercise types in optimizing health

Importance of Physical Activity Regular physical activity (PA) confers many health benefits and helps prevent chronic diseases National health objective is to increase the number of U.S. adults engaging in regular PA to 30% (continued)

Importance of Physical Activity (continued) Target PA goal for the national health objective − Minimum of 30 minutes − Moderate intensity − Most if not all days of week

Figure 1.1

Importance of Physical Activity <50% of U.S. adults meet minimum moderate-intensity activity recommendations ~25% of U.S. adults report no leisure time physical activity (LTPA) Fewer women than men meet recommendation Younger adults (18-24 yr) are more likely than elderly (  65 yr) to meet recommendation

Global Challenge Physical inactivity is a global problem. Your goal: educate and motivate clients to adopt a physically active lifestyle. Physical inactivity may be the most important health problem of the 21st century.

CDC and ACSM Recommendations 1995 recommendation: Every U.S. adult should accumulate –  30 min, –moderate-intensity PA, –on most, preferably all, days of the week. (continued)

CDC and ACSM Recommendations (continued) The 1995 recommendation was updated in 2007: –Recommended PA is in addition to ADLs –Intensity is expressed in METs –Definitions for moderate- and vigorous-intensity PA –Resistance training recommendation –Balance and flexibility suggestion for older adults

AHA and ACSM Definitions Moderate intensity: –3 to 6 METs or 5 to 6 on 10-point rating of perceived exertion (RPE) scale –Results in noticeable increase in heart rate (HR) and lasts >10 min (continued)

AHA and ACSM Definitions (continued) Vigorous intensity: –>6 METs or 7 to 8 on 10-point RPE scale –Results in rapid breathing and substantial increase in HR

Current AHA and ACSM Recommendations Adults (  18 years) –At least 30 minutes moderate-intensity aerobic PA 5 days a week or –20 minutes vigorous-intensity aerobic PA 3 days a week –Minimum 2 days a week moderate- to high-intensity resistance training 8 to 12 repetitions maximum (RM) for 18 to 64 years 10- to 15RM for older (  65 years) adults –Balance and flexibility for those  65 years (continued)

Current AHA and ACSM Recommendations (continued) Resistance training repetition recommendations for adults (  18 years) –8 to 12 repetitions maximum (RM) for 18 to 64 years –10 to 15 RM for older (  65 years) adults

2008 PA Guidelines for Americans Key message: 150 minutes a week of moderate- intensity (~1.000 kcal/week) or 75 minutes a week vigorous-intensity aerobic exercise = substantial health benefits for adults. Adults of all ages should include muscle strengthening at least 2 days a week. (continued)

2008 PA Guidelines for Americans (continued) Children need 60 min PA daily: – Primarily moderate- or vigorous-intensity PA – Minimum 3 days a week vigorous-intensity PA – Minimum 3 days a week muscle- and bone- strengthening PA

Health Benefits of PA 1.Lowers risk of premature death and chronic conditions 2.Reduces depression, anxiety, abdominal obesity 3.Helps control weight 4.Improves sleep quality 5.Improves cognitive function 6.Maintains and improves bone density 7.Prevents falls 8.Increases functional health

Benefits based on training volume Dose–response relationship: what kcal/wk expenditure required for specific improvement Additional potential benefits for exceeding minimum recommended PA levels How Much PA is Enough?

1,000 kcal/wk –Sufficient to reduce disease risk –A great initial goal for some –Enough to move from sedentary to low PA level –Insufficient to maintain healthy body weight –Insufficient to experience full health benefits Dose-Response Relationship

IOM Recommends Greater dose (~2,000 kcal/wk) required to − maintain healthy body weight, − prevent weight gain, − provide additional health benefits, and − move a person from a sedentary to active PA level.

Figure 1.3

Cardiovascular Disease (CVD) Major cause of death in U.S. and Europe Includes hypertension, heart disease, congestive heart failure, and stroke No longer a disease of men or the elderly Associated with inactivity and sedentarism (lack of cardiorespiratory fitness)

Coronary Heart Disease (CHD) CHD is –more prevalent for African Americans and Latino Americans than Whites, –a resulting imbalance between coronary oxygen supply and demand, –attributable to physical inactivity and sedentarism, and –more favorably countered by high cardiorespiratory fitness level than by a physically active lifestyle. (continued)

Coronary Heart Disease (CHD) (continued) Imbalance between O 2 supply and demand –Attributed to atherosclerosis –May result in angina pectoris (chest discomfort and pain) and myocardial infarction (heart attack)

CHD Risk Factors Age Family history Hypercholesterolemia Hypertension Current cigarette smoking Prediabetes Obesity Physical inactivity

Hypertension High blood pressure –Major contributor to stroke and heart attack, –SBP  140 mmHg or –DBP  90 mmHg or –on medication(s) for blood pressure. (continued)

Hypertension (continued) Prehypertension –SBP between 120 and 139 mmHg or –DBP between 80 and 89 mmHg (continued)

Hypertension (continued) Likelihood of having hypertension increases with age, race, geographic location. Inverse relationship exists between hypertension and PA level.

Hypercholesterolemia and Dyslipidemia Hypercholesterolemia = high total cholesterol (TC) Also known as hyperlipidemia (high blood lipid levels) (continued)

Hypercholesterolemia and Dyslipidemia (continued) Dyslipidemia = abnormal blood lipid level –High TC and/or –high low-density lipoproteins (LDL-C) and/or –low high-density lipoproteins (HDL-C)

Largest preventable cause of disease and premature death –Smokers’ risk of heart attack is 2 times nonsmokers’, –Smoking is linked to CHD, stroke, chronic lung disease, and several cancers. Cigarette Smoking (continued)

Risk for CHD declines rapidly with quitting –Risk declines 50% in the first year. –Relative risk of stroke and CHD death is similar to that of nonsmokers in 15 years. Cigarette Smoking (continued)

Usually occurs before age 30 However, can develop at any age Not as common as type 2 Exercise prescriptions should follow specific guidelines Type 1 (IDDM) Diabetes

Most common form of DM Risk factors for NIDDM related to age, family history, diet, above-normal body weight and body fat Healthy lifestyle choices decrease risk Type 2 (NIDDM) Diabetes

Categories defined by body mass index (BMI) –BMI = [kg/(m 2 )] –Overweight = BMI between 25 and 29.9 kg/m 2 –Obese = BMI  30 kg/m 2 Obesity and Overweight (continued)

Obesity shortens life expectancy and increases risk for the following: –CHD –DM –Hypercholesterolemia –Hypertension –Osteoarthritis –Some cancers Obesity and Overweight (continued)

Some evidence for genetic source Majority of evidence points to environment Causes of Obesity and Overweight (continued)

Restricting caloric intake and increasing caloric expenditure are good ways to –control weight, –decrease body fatness, and –normalize blood lipids and blood pressure. Causes of Obesity and Overweight (continued)

Cluster of specific CVD risk factors Must have at least 3 of those risk factors Increases risk of CHD and DM Prevalence highest for older (>60 yr) and obese people Metabolic Syndrome

Table 1.4

A leading cause of death worldwide Key risk factors include physical inactivity To reduce cancer risk: –45 to 60 minutes a day of moderate-intensity PA, at least 5 days a week for adults –60 minutes a day, moderate- to vigorous-intensity PA at least 5 days a week for children and adolescents –Maintain healthy weight Cancer

Sedentarism and physical inactivity contribute to musculoskeletal diseases and disorders Osteoporosis Osteopenia Low back pain Musculoskeletal Issues

Origins may be functional, not structural. Poor lifestyle choices increase the likelihood of experiencing low back pain. Low Back Pain