Chapter 1 Benefits and Risks Associated with Physical Activity

Physical Activity and Fitness Terminology Any bodily movement produced by the contraction of skeletal muscles that results in a substantial increase over resting energy expenditure Exercise A type of physical activity consisting of planned, structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness 2

Physical Activity and Fitness Terminology (cont.) Physical fitness A set of attributes or characteristics that people have or achieve that relates to the ability to perform physical activity 3

Physical Activity and Fitness Terminology (cont.) Box 1-1 4

Physical Activity and Fitness Terminology (cont.) Box 1-1 5

Reasons to measure each component of health-related fitness Educate individuals about their current health-related physical fitness Use data to individualize exercise programs Provide baseline and follow-up data to evaluate exercise programs Motivate individuals towards more specific action/exercise Help with client’s risk stratification

Physiologic fitness Similar to health-related fitness but includes nonperformance components that relate to biological systems influenced by habitual activity. Physiological fitness includes: Metabolic fitness – status of metabolic systems (predictive of risk for diabetes and CVD) Morphologic fitness – status of body compositional factors like body fat content, circumferences and body fat distribution Bone integrity – status of bone mineral density

Morphologic Fitness

Physical Activity and Fitness Terminology (cont.) Table 1-1 9

Physical Activity and Fitness Terminology (cont.) Table 1-1 10

Physical Activity and Fitness Terminology (cont.) Table 1-1 11

Physical Activity and Fitness Terminology (cont.) Table 1-2 12

Public Health Perspective for Current Recommendations (cont.) A meta-analysis of 23 gender-specific cohorts of physical activity or fitness representing 1,325,004 person-years of follow-up clearly showed the dose-response relationship between physical activity, physical fitness, and the risks of coronary artery disease and cardiovascular disease. Additional amounts of physical activity or increased physical fitness levels provide additional health benefits. 13

Public Health Perspective for Current Recommendations (cont.) There is also evidence for an inverse dose-response relationship between physical activity and: all-cause mortality, overweight, obesity and fat distribution, type 2 diabetes, colon cancer, and quality of life and independent living in older adults. 14

Public Health Perspective for Current Recommendations (cont.) Two important conclusions from the U.S. Surgeon General’s Report that have impacted the development of these guidelines: Important health benefits can be obtained by including a moderate amount of physical activity on most, if not all, days of the week. Additional health benefits result from greater amounts of physical activity. People who maintain a regular program of physical activity that is longer in duration or is more vigorous in intensity are likely to derive greater benefit. 15

Public Health Perspective for Current Recommendations (cont.) Primary recommendations from the ACSM-AHA update: All healthy adults aged 18 to 65 years need moderate-intensity aerobic physical activity for a minimum of 30 minutes 5 d·wk, or vigorous activity for a minimum of 20 minutes 3 d·wk. Combinations of moderate- and vigorous-intensity exercise can be performed to meet this recommendation. 16

Public Health Perspective for Current Recommendations (cont.) Moderate-intensity aerobic activity can be accumulated toward the 30-minute minimum by performing bouts each lasting 10 or more minutes. Every adult should perform activities that maintain or increase muscular strength and endurance a minimum of 2 days each week. 17

Public Health Perspective for Current Recommendations (cont.) Because of the dose-response relationship between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities, or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity. 18

Benefits of Regular Physical Activity and/or Exercise Table 1-3 19

Benefits of Regular Physical Activity and/or Exercise (cont.) Box 1-2 20

Benefits of Regular Physical Activity and/or Exercise (cont.) Box 1-2 21

Benefits of Regular Physical Activity and/or Exercise (cont.) Box 1-2 22

Benefits of Regular Physical Activity and/or Exercise (cont.) Box 1-2 23

Sudden Cardiac Death Among Young Individuals Congenital and hereditary abnormalities including: hypertrophic cardiomyopathy, coronary artery abnormalities, and aortic stenosis 24

Sudden Cardiac Death Among Young Individuals (cont.) Absolute risk of exercise-related death among high school and college athletes: One per 133,000 men One per 769,000 women It should be noted that these rates, while low, include all sports-related nontraumatic deaths. Of the 136 total identifiable causes of death, 100 were caused by cardiac disease. 25

Exercise-Related Cardiac Events in Adults Absolute risk of sudden cardiac death during vigorous physical activity has been estimated at one per year for every 15,000 to 18,000 individuals. Another study reported a risk estimate of 0.3 to 2.7 events per 10,000 person-hours for men and 0.6 to 6.0 events for women. 26

Exercise Testing and the Risk of Cardiac Events The risks of various cardiac events include acute myocardial infarction, ventricular fibrillation, hospitalization, and death. These data indicate that in a mixed population the risk of exercise testing is low, with approximately six cardiac events per 10,000 symptom-limited maximum tests. 27

Risks of Cardiac Events During Cardiac Rehabilitation In one survey, there was one nonfatal complication per 34,673 hours and one fatal cardiovascular complication per 116,402 hours of cardiac rehabilitation. More recent studies have found a lower rate, one cardiac arrest per 116,906 patient-hours, one myocardial infarction per 219,970 patient-hours, one fatality per 752,365 patient-hours, and one major complication per 81,670 patient-hours. The mortality rate appears to be six times higher when patients exercised in facilities without the ability to successfully manage cardiac arrest. 28

Prevention of Exercise-Related Cardiac Events Healthcare professionals should know the pathologic conditions associated with exercise-related events so that physically active children and adults can be appropriately evaluated. Active individuals should know the nature of cardiac prodromal symptoms and seek prompt medical care if such symptoms develop. 29

Prevention of Exercise-Related Cardiac Events (cont.) High school and college athletes should undergo preparticipation screening by qualified professionals. Athletes with known cardiac conditions should be evaluated for competition using published guidelines. 30

Prevention of Exercise-Related Cardiac Events (cont.) Healthcare facilities should ensure that their staffs are trained in managing cardiac emergencies, have a specified plan, and have appropriate resuscitation equipment. Active individuals should modify their exercise program in response to variations in their exercise capacity, habitual activity level, and the environment. 31