2. 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

3. 30-60 min moderate x 5 days ~ or~ 20 min vigorous x 3 days

4. AND Strength training x 2 days

5. CDC 2013 Don’t have time Family responsibilities/kid s Boring/Hate it/not enjoyable Too hard Too long

9. Exercise-How much do I really need? (v1.0) Robert M. Pepper, DO, FAAFP

10. METS 1 MET = energy produced of an average person seated at rest

11. METS Walking 4.0 mph(15:00 min/mile)= 5 METS Walking 5.0 mph (12:00 min/mile)= 8 METS

12. 1: 5 METS  2: 7 METS  3: 10 METS

13. 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:10.1136/bjsports-2014-093857

14. 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

15. Where did this lead? 22/785 (2.8%) Dx with new CV problem ZERO had an abnormal exercise stress test 100 % exceeded > 10 METS

16. Sitting is the new smoking? Television viewing time and reduced life expectancy: a life table analysis Veerman et al Br J Sports Med 2012;46:927-930

17. 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)

20. 5 METS=Minimum Walking 4.0 mph (15:00 min/mile)=5 METS

21. 6 METS Brisk walking 4.5 mph (13:20 min/mile)=6 METS

22. 9 METS Wogging 5.0 mph (12:00 min/mile)=9 METS

23. ideal speeds: requiring least amount of energy

25. Wogging? 4.5 mph (13 min/mile), metabolic efficiency was at its lowest

26. Fast not so fast

28. Treadmill Conversions Mph: 5.0=12:00 Min/Mile @ 0% /speed fixed 3%:10:32 5%:9:38 8%:8:38

29. Move to And then to

30. Exercise-How much do I really need? (v2.0) 2014-current

32. 2014:Best Study of the Year

35. 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

36. Quick Summary 15 years 55,000 adults ages 18-100 (24%runners) Reduction all cause mortality 29% Reduction CV mortality 50%

37. Quick Summary cont. 3 year added life expectancy benefit Persistent runners reduction AC/CV of 29%/50%

38. That’s way too much work!

39. This is not me!

42. For less than 10K a week (7-10 min/day) x 6 years 29% reduction in all cause mortality 50% reduction in cardiovascular mortality

43. >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

46. pleiotropy

47. Exercise Rx?

51. Last Time-How much do I really, really need? (v3.0- Biohack)

53. maximum rate of 02 consumption (Ml(O2)/kg∙min) surrogate of cardiorespiratory fitness

56. 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)

60. Cardiac Remodeling in Response to 1 Year of Intensive Endurance Training Arbab-Zadeh, A et al 2014 Oct 3.:CIRCULATION.AHA

61. Rx transforms the heart of a slacker into one of an elite athlete

62. Plan:

63. “doability” 3-4 x a week, 30-45 min low level exercise After nine months, long runs added Max 7-9 hours/week

65. Results: RV mass and volume immediate ↑ Add intense intervals  eccentric hypertrophy of LV VO2max↑an average of 20%.

66. 2015: Where are we now?

67. 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

68. 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

69. handouts Assessing CRP/VO2 max Calculate daily energy expenditure METS calculator VO2 max tables Treadmill conversion