Physical Activity and Health / Pre-Ex Health Screening and Risk Stratification Mr. Cheng Yuk Chuen, Joshua Director of Training Program Hong Kong Physical Fitness Association

Agility 敏捷 Balance 平衡 Coordination 協調 Power 肌爆炸力 Reaction time 反應時間 Speed 速度 Motor skill-related Cardiovascular endurance 心肺耐力 Muscular strength and endurance 肌肉力量與耐力 Muscular flexibility 肌關節柔軟度 Body composition 身體脂肪百分比 [Neuromuscular Relaxation] 肌神經鬆馳程度 Health-related Physical Fitness

Changes of Physical Fitness

Effect of 12-week Strength Training

Effect Aerobic Ex on VO2max Foss 1998, Fox Ex Physiology, p. 329

Benefits of Regular Exercise Improvements in Cardiovascular and Respiratory Function Improvements in Cardiovascular and Respiratory Function – Increased maximal oxygen uptake due to both central and peripheral adaptations – Lower minute ventilation at a given submaximal intensity – Lower myocardial oxygen cost for a given absolute submaximal intensity

– Lower heart rate and blood pressure at a given submaximal intensity – Increased capillary density in skeletal muscle – Increased exercise threshold for the accumulation of lactate in the blood – Increased exercise threshold for the onset of disease signs or symptoms (e.g., angina pectoris, ischemic ST-segment depression, claudication) Improvements in Cardiovascular and Respiratory Function (cont’) Improvements in Cardiovascular and Respiratory Function (cont’)

Reduction in Coronary Artery Disease Risk Factors Reduction in Coronary Artery Disease Risk Factors – Reduced resting systolic/diastolic pressures – Increased serum high-density lipoprotein cholesterol and decreased serum triglycerides – Reduced total body fat, reduced intra-abdominal fat – Reduced insulin needs, improved glucose tolerance Benefits of Regular Exercise

Decreased Mortality and Morbidity Decreased Mortality and Morbidity – Primary prevention (I.e.,intervention to prevent an acute cardiac event) 1. Higher activity and/or fitness levels are associated with lower death rates from coronary artery disease 2. Higher activity and/or fitness levels are associated with lower incidence rates for combined cardiovascular diseases, coronary artery disease, cancer of the colon, and type 2 diabetes

– Secondary prevention (i.e. interventions after a cardiac event [to prevent another]) 1. Based on meta-analyses (pooled data across studies), cardiovascular and all-cause mortality are reduced in post-myocardial infarction patients who participate in cardiac rehabilitation exercise training, especially as a component of multifactorial risk factor reduction 2. Randomized controlled trials of cardiac rehabilitation exercise training involving post-myocardial infarction patients do not support a reduction in the rate of nonfatal reinfarction

Postulated benefits Decreased anxiety and depression Decreased anxiety and depression Strengthen physical function and independent living in elderly Strengthen physical function and independent living in elderly Enhanced feelings of well being Enhanced feelings of well being Enhanced performance of work, recreational and sports Enhanced performance of work, recreational and sports

Evidence for Dose-Response Relationship between Physical Activity and Health Outcome No-it does not indicate the absence of a favorable relationship No-it does not indicate the absence of a favorable relationship Category B- only a limited number of randomized clinical trials, few randomized trials exist, small in size. Category B- only a limited number of randomized clinical trials, few randomized trials exist, small in size. Category C- non randomized or uncontrolled clinical trials Category C- non randomized or uncontrolled clinical trials

Evidence for Dose-Response Relationship between Physical Activity and Health Outcome

Positive Risk Factors for CHD ACSM (2006) Family History Myocardial infarction, coronary revascularization (bypass surgery) or sudden death before : Myocardial infarction, coronary revascularization (bypass surgery) or sudden death before : – the age of 55 years in father or other male first degree relative (i.e. brother or son) – the age of 65 years in mother or other female first degree relative (i.e. sister or daughter) Cigarette smoking Current cigarette smoker or those who have quit in the last six months Current cigarette smoker or those who have quit in the last six monthsHypertension Client on Hypertensive medications Client on Hypertensive medications Resting SBP > 140 mmHg and/ or DBP > 90 mm Hg Resting SBP > 140 mmHg and/ or DBP > 90 mm Hg Fasting Glucose Fasting blood glucose of >100mg/dL (5.6mmol/L)

Dyslipidemia Total serum cholesterol > 200mg/dL (5.2 mmol/L) or Total serum cholesterol > 200mg/dL (5.2 mmol/L) or High density lipoprotein (HDL) < 40mg/dL (1.03 mmol/L) High density lipoprotein (HDL) < 40mg/dL (1.03 mmol/L) Low density lipoprotein (LDL) > 130mg/dL (3.4mmol/L) Low density lipoprotein (LDL) > 130mg/dL (3.4mmol/L)Obesity Body Mass Index (BMI) > 30 kg/m 2 or Body Mass Index (BMI) > 30 kg/m 2 or Waist girth >= 102 cm (M); >= 88 cm (F) or Waist girth >= 102 cm (M); >= 88 cm (F) or Waist/hip ration >= 0.95 (M); >= 0.86 (F) Waist/hip ration >= 0.95 (M); >= 0.86 (F) Sedentary Lifestyle Not participating in a regular exercise program Not participating in a regular exercise program Accumulating less than 30 minutes moderate intensity exercise 3-5 days weekly Accumulating less than 30 minutes moderate intensity exercise 3-5 days weekly Positive Risk Factors for CHD ACSM (2006) High level of HDL HDL cholesterol > 1.6 mmol/L (60 mg/dl) HDL cholesterol > 1.6 mmol/L (60 mg/dl) Negative Risk Factors for CHD ACSM (2006)

Initial Risk Stratification Low risk Low risk – Men<45 years of age and women <55 years of age – Younger individuals who are asymptomatic and meet no more than one risk factor threshold Moderate risk Moderate risk – Older individuals (men  45 years of age; women  55 years of age) or those who meet the threshold for two or more risk factors High Risk High Risk – Individuals with one or more signs/symptoms or known cardiovascular, pulmonary, or metabolic disease

ACSM Recommendations for: Pre-participation screening Algorithm

ACSM Recommendations for: Pre-participation screening Algorithm cont’

1996 U.S. Surgeons’ General Report: Physical Activity and Health (USDHHS / CDC / ACSM) Accumulating at least 30 minutes of any kind of moderate intensity physical activity on most days of the week would effectively reduce the risk of coronary heart disease, type 2 diabetes, hypertension, stroke and some kinds of cancer Maintain a regular longer duration or vigorous intensity derive to greater benefit Current Recommendation of PA for Health Promotion

Conclusion Physical inactivity is one of the most important public health problems and it is important to develop an action plan to address this issue – Policy makers – Public health professionals – Health service providers – Educators – Grassroots activists

The End Thank You