1. Physical Activity, Exercise, and Fitness
In Deok Kong, M.D., PhD
Department of Physiology
Yonsei University Wonju College of Medicine

2. Physical Activity and Exercise
is defined as bodily movement that is produced by the contraction of skeletal muscle and that substantially increases energy expenditure.
Exercise:
a type of physical activity, is defined as planned, structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness.

3. Physical Fitness
Physical fitness is a multidimensional concept that has been defined as a set of attributes that people possess or achieve that relates to the ability to perform physical activity, is comprised of skill-related, health related, and physiologic components.
Both health-related and physiological fitness measures are closely allied with health promotion and disease prevention and can be modified through regular physical activity and exercise.

4. Skill-related components of physical fitness include agility, balance, coordination, speed, power, and reaction time, and are associated mostly with sports and motor skill performance.
Health-related components of physical fitness include cardiovascular endurance, muscular strength and endurance, flexibility, and body composition.
Physiological fitness include metabolic fitness, morphologic fitness, and body integrity.

5. Compendium of Physical Activities: An Update of Activity Codes and MET Intensity
The Compendium provides a coding scheme that links a five-digit code, representing the specific activities performed in various settings, with their respective metabolic equivalent (MET) intensity levels.
XX-XXX-X.X
Major Heading-Specific Activity-MET Intensity

6. Major types of activities in version 2 of the compendium of physical activities
01-Bicycling
02-Conditioning
Exercise
03-Dancing
04-Fishing and
Hunting
05-Home Activities
06-Home Repair
07-Inactivity
08-Lawn and
Garden
09-Miscellaneous
10-Music Playing
11-Occupation
12-Running
13-Self Care
14-Sexual Activity
15-Sports
16-Transportation
17-Walking
18-Water Activities
19-Winter Activities
20-Religious Activities
21-Volunteer Activities

7. The Compendium of Physical Activities Tracking Guide

8. Classification of Physical Activity Intensity

9. Benefits and Risks Associated With Physical Activity
1. The current public health recommendations for physical activity
2. The health and fitness benefits associated regular physical activity and/or exercise
3. The risks associated with exercise

10. Divergent Physical Activity Recommendations
“Some activity is better than none,
and more activity is better than less.”
Surgeon General’s Report: 30 min of brisk walking for days of the week
ACSM (2001): 45 min of exercise per day ( min/week)
IASO (2003): 45 to 60 min of moderate physical activity per day

11. Evidence for Dose-Response Relationship Between Physical Activity and Health Outcome
All-cause mortality (+)
Cardiovascular and coronary heart disease (+)
Blood pressure and hypertension (-)
Blood lipids and lipoproteins (±)
Coagulation and hemostatic factors (±)
Overweight, obesity, and fat distribution (+)
Type 2 diabetes mellitus (+)
Colon cancer (+)
Low back pain, osteoarthritis, and osteoporosis (±)
Depression and anxiety (-)
Quality of life (+)

12. Benefits of Regular Physical Activity and/or Exercise
Improvement in cardiovascular and respiratory function
Reduction in coronary artery disease risk factors
Decreased morbidity and mortality

13. Risks Associated With Exercise
Sudden death among young individuals: only one death per year for every 133,000 men and 769,000 women, respectively
Exercise events in those with sickle cell trait: African Americans
Exercise-related cardiac events in adults: only one death per year for every 15,000 to 18,000 individuals
Risk of cardiac events during exercise testing: per 10,000 tests
Risk of cardiac events during cardiac rehabilitation

14. Health Screening and Risk Stratification
Purposes:
Identification and exclusion of individuals with medical contraindications to exercise
Identification of individuals at increased risk or disease because of age, symptoms, and/or risk factors
Identification of persons with clinically significant disease who should participate in a medically supervised exercise program
Identification of individuals with other special needs

15. Coronary artery disease risk factor thresholds for use with ACSM risk stratification
<Positive risk factors>
Family history
Cigarette smoking
Hypertension: >140/90 mmHg
Dyslipidemia: total>200 mg/dl, LDL>130 mg/dl, HDL<40 mg/dl
Impaired fasting glucose: >100 mg/dl
Obesity
Sedentary lifestyle
<Negative risk factor>
High-serum HDL cholesterol >60 mg/dl

16. Major signs or symptoms suggestive of cardiovascular, pulmonary, or metabolic disease
Pain, discomfort in the chest, neck, jaw, arm, or other areas that may result from ischemia
Shortness of breath at rest or with mild exertion
Dizziness or syncope
Orthopnea or paroxysmal nocturnal dyspnea
Ankle edema
Palpitation or tachycardia
Intermittent claudication
Known heart murmur
Unusual fatigue or shortness of breath with usual activities

17. ACSM Risk Stratification Categories
Low risk: Men<45 years of age and women <55 years of age who are asymptomatic and meet no more than one risk factor threshold
Moderate risk: Men>45 years and women>55 years or those who meet the threshold for two or more risk factors
High risk: Individuals with one or more signs and symptoms or cardiovascular, pulmonary or metabolic disease

18. American Heart Association (AHA) Risk Stratification
Class A: Apparently healthy individuals
Class B: Presence of known, stable cardiovascular disease with low risk for complications with vigorous exercise, but slightly greater than for apparently healthy individuals
Class C: Those at moderate to high risk for cardiac complications during exercise and/or unable to self-regulate activity or understand recommended activity level
Class D: Unstable disease with activity restriction

19. AHA/ACSM Health/Fitness Facility Preparticipation Screening Questionnaire

21. Pre-Exercise Evaluations
Medical history,
Physical examination
Laboratory tests
Blood pressure
Lipids and lipoproteins
Blood profile analyses
Pulmonary functions

22. Classification and management of blood pressure on adults

23. ATP III Classification of LDL, Total, and HDL Cholesterol (mg/dl)

24. Typical ranges of normal values for selected blood variables in adults

25. Schema for determining the severity of both obstructive and restrictive lung diseases from PFTs

26. Health-Related Physical Fitness Testing
Purposes:
Educating participants about their present health-related fitness status relative to health-related standards and age- and sex-matched norms
Providing data that are helpful in development of exercise prescription to address all fitness components
Collecting baseline and follow-up data that allow evaluation of progress by exercise program participants
Motivating participants by establishing reasonable and attainable fitness goals
Stratifying cardiovascular risk

27. A Comprehensive Health Fitness Evaluation
Prescreening/risk stratification
Resting HR, BP, height, body mass, ECG
Body composition
Cardiorespiratory fitness
Muscular strength
Flexibility

28. Body Composition
Basic body composition can be expressed as the relative percentage of body mass that is fat and fat-free tissue using a two-compartment model.
Body composition can be estimated with both laboratory and field techniques that vary in terms of complexity, cost, and accuracy.
Before collecting data for body composition assessment, the technician must be trained, routinely practiced in the techniques, independent of the technique being used.

29. Measurements of body composition
Anthropometric methods:
Body Mass Index
Circumferences
Skinfold measurements
Densitometry
Hydrodensiometry (underwater) weighing
Plethysmography
Conversion of body density to body composition
Other techniques
Dual energy x-ray absorptiometry (DEXA)
Total body electrical conductivity (TOBEC)
Bioelectrical impedence anaylsis (BIA)
Near-infrared intercadence

30. Body Composition (% Body Fat) for Men

31. Body Composition (% Body Fat) for Women

32. Cardiorespiratory (CR) Fitness
CR fitness is related to the ability to perform large muscle, dynamic, moderate-to-high intensity exercise for prolonged period.
Performance of such exercise depends on the functional state of the respiratory, cardiovascular, and skeletal muscle system.
The assessment of CR fitness is an important part of a primary or secondary intervention program.

33. Mode of Testing Field tests Motor driven treadmills
Mechanically braked cycle ergometers
Step testing

34. Muscular Strength and Endurance
Muscular strength and endurance are health-related fitness components that may improve or maintain the following:
Bone mass
Glucose tolerance
Musculotendinous integrity
The ability to carry out the activities of daily living
The fat-free-mass and resting metabolic rate

35. Muscular Strength refer to the ability of the muscle to exert force-Upper Body Strength.

36. Leg Strength

37. Fitness categories by age groups and gender for partial curl-up

38. Flexibility is the ability to move a joint through its complete range of motion.

39. Fitness categories by age groups for trunk forward flexion using a sit-and-reach box (cm)

40. exercise.yonsei.ac.kr