1. Daniel Roth, DO, MBA, MS Thomas Straub, PA-C, MS, CSCS

2. What is Exercise Medicine?  The practice of prescribing an exercise program that is designed to meet the specific needs of each patient.  A prescription for exercise for every patient, every visit, every time. www.exerciseismedicine.org

3. Exercise Medicine The guiding principles of Exercise Medicine are as follows:  Exercise and physical activity are important to health and the prevention and treatment of many chronic diseases  More should be done to address physical activity and exercise in healthcare settings  ACSM and AMA are making efforts to bring a greater focus on physical activity and exercise in healthcare settings www.exerciseismedicine.org

4. America’s Obesity Epidemic CDC - 2010

5. Obesity is Common 69.2% of adults age 20 years and over are overweight (includes obesity) 35.9% of adults age 20 years and over are obese 18.4% of adolescents age 12-19 years are obese 18.0% of children age 6-11 years are obese CDC (2009-2010)

6. Obesity has Consequences  Obesity is linked to more than 60 chronic diseases.  According to the American Cancer Society, 572,000 Americans die of cancer each year, about 33% of these cancer deaths are linked to excess body weight, poor nutrition and/or physical inactivity.  Over 75% of hypertension cases are directly linked to obesity.  Approximately 66% of U.S. adults with type 2 diabetes are overweight or obese. http://www.obesitycampaign.org/obesity_facts.asp

7. Obesity has Consequences  66% of adults with arthritis are overweight or obese compared to 15.9% who are under/normal weight.  Arthritis is the #1 cause of disability among U.S. adults and has been for the past 15 years. http://www.cdc.gov

8. Obesity is Costly  Full-time workers in the U.S. who are overweight or obese miss an estimated 450 million additional days of work each year compared with healthy workers resulting in an estimated cost of more than $153 billion in lost productivity annually.  Medical expenses for obese employees are 42% higher than a person with a healthy weight.  The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008. http://www.obesitycampaign.org/obesity_facts.asp

9. Number of Persons with Diabetes in the US http://www.cdc.gov/diabetes/statistics/prev/national/figpersons.htm

10. Cost of Diabetes to the US Economy  Diabetes is highly associated with complications such as stroke, MI, limb loss, retinopathy, nephropathy, and neuropathy.  The total estimated cost of diagnosed diabetes in 2012 is $245 billion, including $176 billion in direct medical costs and $69 billion in reduced productivity. http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html

11. How to Prescribe Exercise  Four primary variables to consider:  Mode  Frequency  Intensity  Duration

12. Divisions of Exercise  Two primary divisions of exercise:  Cardiovascular Training (Aerobic) – Walking, Jogging, Swimming, Biking, X- Country Skiing, Etc.  Resistance Training (Anaerobic) – Body Weight Exercises, Free Weights, Machines, Resistance Bands, Etc.

13. Benefits of Cardiovascular Training  Improved cardiac output  Improved blood pressure  Improved functional capacity  Weight loss  Increased lean muscle mass  Decreased blood sugar levels  Decreased rates of depression  Decreased rates of OA  Improved body image

14. How to Determine Cardiovascular Intensity  Karvonen formula to determine target HR: Max HR = 220-Age (+/- 10 bpm) Target HR = Max HR x 50-85%

15. How to Determine Cardiovascular Intensity Target HR = Max HR x 50-85% Example: 30 year old runner Target HR = 220-30 = 190 x 75% = 143 bpm Example: 60 year old S/P MI Target HR = 220-60 = 160 x 55% = 88 bpm

16. How to Prescribe Cardiovascular Exercise  Cardiovascular Training Guidelines: For Overall Cardiovascular Health: At least 30 minutes of moderate-intensity aerobic activity at least 5 days per week for a total of 150 minutes OR At least 25 minutes of vigorous aerobic activity at least 3 days per week for a total of 75 minutes; or a combination of moderate- and vigorous-intensity aerobic activity For Lowering Blood Pressure and Cholesterol An average 40 minutes of moderate- to vigorous- intensity aerobic activity 3 or 4 times per week www.heart.org

17. Benefits of Resistance Training  Increased muscle/tendon strength  Increased functional capacity  Increased lean muscle mass  Increased metabolic rate  Increased cardiac output  Increased bone density  Increased balance  Decreased blood sugar levels  Decreased rates of depression  Improved body image

18. Resistance Training Programs  Resistance Training: Phase 1: Anatomical Adaptation Phase (8 weeks) Goal: Tendon strength/general conditioning Mode: perform 6-8 exercises (compound exercises) Intensity: 55-60% of 1 rep max. Duration: 3 sets x 15 reps/set Rest: 1-2 minutes between sets Frequency: 3-5 days/week

19. Resistance Training Programs  Resistance Training: Phase 2: Muscle Hypertrophy Phase (8-12 weeks) Goal: Muscle Hypertrophy/Strength Mode: perform 6-8 exercises Intensity: 70-80% of 1 rep max. Duration: 3 sets x 8-12 reps/set Rest: 2-3 minutes between sets Frequency: 3-5 days/week

20. Resistance Training Programs  Resistance Training: Phase 3: Strength Phase (8 weeks) Goal: Strength Mode: perform 6 exercises Intensity: 85+% of 1 rep max. Duration: 3 sets x 4-6 reps/set Rest: 5 minutes between sets Frequency: 3-4 days/week

21. Putting it All Together  For optimal results and additional health benefits, a combination of cardiovascular and resistance training should be prescribed.  All programs should consider exercise goals, current fitness levels, and total estimated time for exercise.  Avoid excessive exercise demands, overtraining, and burnout.

22. Putting it All Together  As a general rule limit total exercise time to 60-75 minutes.  A combination of cardiovascular and resistance training typically is optimal for each workout.  Cardiovascular training is usually performed prior to resistance training.  Always start at low intensities.  “Use pain as your guide”