1. 1 Physical Activity, Health, and Chronic Disease chapter 1 chapter
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2. Objectives Understand the importance of regular physical activity
Understand dose–response relationships
Understand the concept of training volume
Identify risk factors for cardiovascular disease and sources of musculoskeletal disorders and disease
Appreciate the role of different exercise types in optimizing health

3. Importance of Physical Activity
Regular physical activity (PA) confers many health benefits and helps prevent chronic diseases
National health objective is to increase the number of U.S. adults engaging in regular PA to 30%
Target PA goal for the national health objective
Minimum of 30 minutes
Moderate intensity
Most if not all days of week
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4. Figure 1.1

5. Global Challenge Physical inactivity is a global problem.
Your goal: educate and motivate clients to adopt a physically active lifestyle.
Physical inactivity may be the most important health problem of the 21st century.

6. CDC and ACSM Recommendations
1995 recommendation: Every U.S. adult should accumulate which was updated in 2007:
30 min,
moderate-intensity PA,
on most, preferably all, days of the week.
Recommended PA is in addition to ADLs
Intensity is expressed in METs
Definitions for moderate- and vigorous-intensity PA
Resistance training recommendation
Balance and flexibility suggestion for older adults
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7. AHA and ACSM Definitions
Moderate intensity:
3 to 6 METs or 5 to 6 on 10-point rating of perceived exertion (RPE) scale
Results in noticeable increase in heart rate (HR) and lasts >10 min
Vigorous intensity:
>6 METs or 7 to 8 on 10-point RPE scale
Results in rapid breathing and substantial increase in HR
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8. Current AHA and ACSM Recommendations
Adults (18 years)
At least 30 minutes moderate-intensity aerobic PA 5 days a week or
20 minutes vigorous-intensity aerobic PA 3 days a week
Minimum 2 days a week moderate- to high-intensity resistance training
8 to 12 repetitions maximum (RM) for 18 to 64 years
10- to 15RM for older (65 years) adults
Balance and flexibility for those 65 years
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9. 2008 PA Guidelines for Americans
Children need 60 min PA daily:
Primarily moderate- or vigorous-intensity PA
Minimum 3 days a week vigorous-intensity PA
Minimum 3 days a week muscle- and bone-strengthening PA

10. Health Benefits of PA
Lowers risk of premature death and chronic conditions
Reduces depression, anxiety, abdominal obesity
Helps control weight
Improves sleep quality
Improves cognitive function
Maintains and improves bone density
Prevents falls
Increases functional health

11. How Much PA is Enough? Benefits based on training volume
Dose–response relationship: what kcal/wk expenditure required for specific improvement
Additional potential benefits for exceeding minimum recommended PA levels

12. Dose-Response Relationship
1,000 kcal/wk
Sufficient to reduce disease risk
A great initial goal for some
Enough to move from sedentary to low PA level
Insufficient to maintain healthy body weight
Insufficient to experience full health benefits
Greater dose (~2,000 kcal/wk) required to
maintain healthy body weight,
prevent weight gain,
provide additional health benefits, and
move a person from a sedentary to active PA level.

13. Figure 1.2 Dose-response relationship for health benefits and volume of physical activity.

14. Figure 1.3

15. Cardiovascular Disease (CVD)
Major cause of death in U.S. and Europe
Causes 17.5 million deaths worldwide each year
Accounted for 36.3% of deaths in US (1 out of every 3)
Includes hypertension, heart disease, congestive heart failure, and stroke
No longer a disease of men or the elderly
Associated with inactivity and sedentarism (lack of cardiorespiratory fitness)

16. Coronary Heart Disease (CHD)
CHD is
Myocardial ischemia - imbalance between coronary oxygen supply and demand,
Attributable to physical inactivity and sedentarism, and
Attributed to atherosclerosis
May result in angina pectoris (chest discomfort and pain) and myocardial infarction (heart attack)
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17. CHD Risk Factors Age Family history Hypercholesterolemia Hypertension
Current cigarette smoking
Prediabetes
Obesity
Physical inactivity

18. Hypertension High blood pressure Prehypertension
Major contributor to stroke and heart attack,
SBP  140 mmHg or
DBP  90 mmHg or
on medication(s) for blood pressure.
Prehypertension
SBP between 120 and 139 mmHg or
DBP between 80 and 89 mmHg
Inverse relationship exists between hypertension and PA level.
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19. Hypercholesterolemia and Dyslipidemia
Hypercholesterolemia = high total cholesterol (TC)
Also known as hyperlipidemia (high blood lipid levels)
Dyslipidemia = abnormal blood lipid level
High TC and/or
high low-density lipoproteins (LDL-C) and/or
low high-density lipoproteins (HDL-C)
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20. Cigarette Smoking
Largest preventable cause of disease and premature death
Smokers’ risk of heart attack is 2 times nonsmokers’,
Smoking is linked to CHD, stroke, chronic lung disease, and several cancers.
Risk for CHD declines rapidly with quitting
Risk declines 50% in the first year.
Relative risk of stroke and CHD death is similar to that of nonsmokers in 15 years.
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21. Type 1 (IDDM) Diabetes Usually occurs before age 30
However, can develop at any age
Not as common as type 2
Exercise prescriptions should follow specific guidelines

22. Type 2 (NIDDM) Diabetes Most common form of DM
Risk factors for NIDDM related to age, family history, diet, above-normal body weight and body fat
Healthy lifestyle choices decrease risk

23. Obesity and Overweight
Categories defined by body mass index (BMI)
BMI = [kg/(m2)]
Overweight = BMI between 25 and 29.9 kg/m2
Obese = BMI  30 kg/m2
Obesity shortens life expectancy and increases risk for the following:
CHD DM
Hypercholesterolemia
Hypertension
Osteoarthritis
Some cancers
(continued)

24. Causes of Obesity and Overweight
Some evidence for genetic source
Majority of evidence points to environment
Restricting caloric intake and increasing caloric expenditure are good ways to
control weight,
decrease body fatness, and
normalize blood lipids and blood pressure.
(continued)

25. Metabolic Syndrome Cluster of specific CVD risk factors
Must have at least 3 of those risk factors
Increases risk of CHD and DM
Prevalence highest for older (>60 yr) and obese people

26. Cancer A leading cause of death worldwide
Key risk factors include physical inactivity
To reduce cancer risk:
45 to 60 minutes a day of moderate-intensity PA, at least 5 days a week for adults
60 minutes a day, moderate- to vigorous-intensity PA at least 5 days a week for children and adolescents
Maintain healthy weight

27. Musculoskeletal Issues
Sedentarism and physical inactivity contribute to musculoskeletal diseases and disorders
Osteoporosis
Osteopenia
Low back pain
Origins may be functional, not structural.
Poor lifestyle choices increase the likelihood of experiencing low back pain.