Exercise Benefits No. 1: Weight control No. 2: Decreases incidence of cancer No. 3: Lowers risk of CV disease No. 4: Improves mood No. 5: Live longer No. 6: Promotes better sleep No 7: Improves QOL
30-60 min moderate x 5 days ~ or~ 20 min vigorous x 3 days
AND Strength training x 2 days
CDC 2013 Don’t have time Family responsibilities/kid s Boring/Hate it/not enjoyable Too hard Too long
Exercise-How much do I really need? (v1.0) Robert M. Pepper, DO, FAAFP
METS 1 MET = energy produced of an average person seated at rest
METS Walking 4.0 mph(15:00 min/mile)= 5 METS Walking 5.0 mph (12:00 min/mile)= 8 METS
1: 5 METS 2: 7 METS 3: 10 METS
Cardiovascular evaluation of middle- aged individuals engaged in high- intensity sport activities: implications for workload, yield and economic costs Menafoglio, et al Br J Sports Med doi: /bjsports
785 (age 35-65) asymptomatic athletes Hx/PE/ECG/SCORE Abnormals:112 (14.3% total) 5.1% “pathologic” ECG 4.1% SCORE >5% 4.7% abnormal PE 1.6 % red flag PMH/FHx
Where did this lead? 22/785 (2.8%) Dx with new CV problem ZERO had an abnormal exercise stress test 100 % exceeded > 10 METS
Sitting is the new smoking? Television viewing time and reduced life expectancy: a life table analysis Veerman et al Br J Sports Med 2012;46:
AHA SIHD Guidelines 2012 A moderate or high dose of a statin therapy should be prescribed.. (Level of Evidence: A) Treatment with aspirin 75 to 162 mg daily should be continued indefinitely (Level of Evidence: A) J Am Coll Cardiol. 2012;60(24)
5 METS=Minimum Walking 4.0 mph (15:00 min/mile)=5 METS
6 METS Brisk walking 4.5 mph (13:20 min/mile)=6 METS
9 METS Wogging 5.0 mph (12:00 min/mile)=9 METS
ideal speeds: requiring least amount of energy
Wogging? 4.5 mph (13 min/mile), metabolic efficiency was at its lowest
Fast not so fast
Treadmill Conversions Mph: 5.0=12:00 0% /speed fixed 3%:10:32 5%:9:38 8%:8:38
Move to And then to
Exercise-How much do I really need? (v2.0) 2014-current
2014:Best Study of the Year
3 major findings: Runners had consistently lower all cause mortality vs non-runners low doses and low speeds had significant mortality benefits Persistent running over time (6 years) was more strongly associated with mortality reduction
Quick Summary 15 years 55,000 adults ages (24%runners) Reduction all cause mortality 29% Reduction CV mortality 50%
Quick Summary cont. 3 year added life expectancy benefit Persistent runners reduction AC/CV of 29%/50%
That’s way too much work!
This is not me!
For less than 10K a week (7-10 min/day) x 6 years 29% reduction in all cause mortality 50% reduction in cardiovascular mortality
>50 yoa 538 runners/ 423 non-runners Matched age, sex, functional ability 39% reduction in all cause mortality Reduced disability and mortality among aging runners: a 21-year longitudinal study. Arch Intern Med 2008;168
pleiotropy
Exercise Rx?
Last Time-How much do I really, really need? (v3.0- Biohack)
maximum rate of 02 consumption (Ml(O2)/kg∙min) surrogate of cardiorespiratory fitness
Wingate Sprints: Pitfalls High exertion Strong motivation Too strenuous for sedentary (Hawley and Gibala 2009) Total time > 20 minutes 2-3 min sprints, warm-up, recovery intervals (Garber et al 2011)
Cardiac Remodeling in Response to 1 Year of Intensive Endurance Training Arbab-Zadeh, A et al 2014 Oct 3.:CIRCULATION.AHA
Rx transforms the heart of a slacker into one of an elite athlete
Plan:
“doability” 3-4 x a week, min low level exercise After nine months, long runs added Max 7-9 hours/week
Results: RV mass and volume immediate ↑ Add intense intervals eccentric hypertrophy of LV VO2max↑an average of 20%.
2015: Where are we now?
Exercise as Rx Absence of Fitness= Smoking Goals: 9 METS F/10 METS M Small changes in fitness provide at least as much benefit as statins, ASA, and ACE-I
CV, live longer, time, bored Running provides significant benefits- even at relatively low levels HIIT is very effective and doesn’t have to be 100% all out
handouts Assessing CRP/VO2 max Calculate daily energy expenditure METS calculator VO2 max tables Treadmill conversion