1. Health Benefits from Regular Exercise

2. DECLINE IN DEATHS

3. Coronary Artery Disease Atherosclerosis—progressive narrowing of arteries due to build up of plaque Coronary artery disease (CAD)— atherosclerosis in the coronary arteries Ischemia—deficiency in blood to heart caused by CAD Myocardial infarction—heart attack due to ischemia

4. DEVELOPMENT OF ATHEROSCLEROSIS

5. Occlusion of right coronary artery

6. ARTERY COMPARISONS

7. Major Risk Factors of Coronary Heart Disease Age Gender Race Family history (genetics) Physical inactivity Smoking Hypertension Dislipidemia Untreated diabetes Obesity Stress

8. Americans at Risk for Coronary Heart Disease

9. Dislipidemia (abnormal blood lipid levels) High Total cholesterol (>180 mg/dL) High LDL-cholesterol (>130 mg/dL) Low HDL-cholesterol –men <40 mg/dL –women <50 mg/dL TG (triglycerides) (>150 mg/dL)

10. Treatment of Dislipidemia Modify diet –Reduce intake of saturated fats and cholesterol –Increase intake of unsaturated fats, particularly monounsaturated fats –Increase intake of water-soluble fiber Reduce weight Increase exercise Drug therapy –statins –niacin

11. Harvard Alumni Study (1985) Amount of physical activity Mortality

12. Did You Know…? Atherosclerosis begins in infancy and progresses at different rates, depending primarily on heredity and lifestyle choices such as smoking history, diet practices, physical activity, and stress.

13. The real reason dinosaurs became extinct

14. Hypertension Normal <120/80 mm Hg –Prehypertensive 120-139/80-89 mm Hg –Hypertensive >140/90 mm Hg causes the heart to work harder (increases afterload) strains arteries causing them to become less elastic over time affects ~25% of adult Americans –half of these are unaware they have hypertension Risk factors include family history, obesity/diet –Body mass index (BMI) = weight / height 2 BMI > 30 considered overweight

15. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

16. Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

17. Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

18. Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

19. Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

20. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

21. Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

22. Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

23. Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

24. Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

25. Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

26. Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

27. Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

28. Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

29. Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

30. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

31. Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

32. (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

33. Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

34. Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

35. Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

36. Obesity and Overweight in the US  prevalence dramatically  past 30 y  prevalence in children  markedly since 1980  >33% of adult population is overweight  average adult gains 1 lb/yr after age 25 y  average adult loses 0.5 lb of muscle and bone mass each year after age 25 y

37. Prevalence of Overweight Among U.S. Children and Adolescents (Aged 2 –19 Years) National Health and Nutrition Examination Surveys (NHANES) 1971-741976-801988-942003-04 20% 15% 10% 5% 0% Non-Hispanic whites Non-Hispanic blacks Mexican Americans

38. Fat Distribution Upper-body (android) obesity Fat stored in upper body and abdominal area (apple shaped) Occurs more frequently in men Carries greater risk for CAD, hypertension, stroke, and diabetes Lower-body (gynoid) obesity Occurs more frequently in women Fat stored in the lower body around the hips, buttocks, and thighs (pear shaped)

39. Exercise will reduce the risk of: colon and breast cancer diabetes mellitus –exercise  need for insulin low-back pain (a leading cause for missed work) osteoporosis –diet and weight-bearing exercise  bone mineral density

41. Bone Turnover and Age AGE (yr)Bone Turnover Bone Loss 20-40Bone Gain = Bone Loss > 40 Bone Gain < Bone Loss

42. Bone Mineral Density osteoporosis

43. Mechanical loading on bone stimulates bone absorption of Ca 2+

44. Are you looking at a 65-year-old woman with osteoporosis?

45. Exercise Prescription Components of Fitness cardiovascular body composition muscular strength and endurance flexibility

46. Exercise Prescription Cardiovascular Fitness 1995 CDC/ACSM health recommendation: –“at least 30 minutes of moderate intensity exercise on most or preferably all days of the week” expend at least 1000 kcal/week (= to 30 min of brisk walking 5-6 days/week) minimal fitness recommendations: –expend 2000-3500 kcal/week equal to 120-220 min/week of moderate-intensity running (9-min/mile pace)

47. Exercise Prescription Cardiovascular Fitness exercise mode exercise intensity –50-70% of HR max –45-60% of VO 2max –RPE of 11-12 –“talk” test exercise duration exercise frequency rate of progression

48. Classification of Exercise Intensity Based on 30-60 minutes of continuous exercise

49. Exercise Prescription Flexibility connective tissue primary cause of inflexibility primary concern is flexibility of lower back and hamstrings

50. Exercise Prescription Muscular Strength and Endurance general recommendations –one set of 8-12 repetitions –set resistance to reach volitional fatigue –at least 2 days/week –performed at moderate-to-slow speeds –full range of motion –do not alter normal breathing