The Miracle of Exercise J. Kelly Smith, M.D., F.A.C.P.

Benefits Decreases all cause mortality Cardiovascular disease Cancer Helps prevent overweight, obesity Lowers risk of type 2 diabetes mellitus Lowers lipid levels Lowers blood pressure Lowers myocardial oxygen demands Lowers risk of osteoporosis Improves general health Improves physical working capacity Improves skin health Improves mental outlook and acuity

Exercise target Age bpm Calculate maximum heart rate (MHR = 220 – age) 40-50% of MHR Target = 70-85% of MHR Target ≥ 30 minutes/day 5 days/week

Atherogenesis

Exercise & mononuclear cell function Six months of moderate intensity exercise Decreased atherogenic cytokine production by peripheral blood mononuclear cells by 58.3% (P<0.001) Increased atheroprotective cytokine production by peripheral blood mononuclear cells by 35.9% (P<0.001) Decreased CRP levels by 35% Smith JK, Dykes R, Douglas JE, Krishnaswamy G, Berk S. JAMA 1999:281;

Exercise & atherogenesis

Exercise & VEC function Augments endothelial nitric oxide-dependent vasodilatation Aids in normalizing shear stress effects on VEC function and on arterial remodeling Reduces risk factors that adversely effect VEC function Reduces proinflammatory effects of white adipose tissue on VEC function Habitual moderate intensity aerobic exercise stimulates an an atheroprotective VEC phenotype

A Quid Pro Quo Relationship Exercise & atherogenesis

Exercise & HIV

Exercise & Obesity

Adaptive thermogenesis

Exercise target Age bpm Calculate maximum heart rate (MHR = 220 – age) 40-50% of MHR Target = 70-85% of MHR Target ≥ 30 minutes/day 5 days/week