1. The Miracle of Exercise J. Kelly Smith, M.D., F.A.C.P.

3. Benefits Decreases all cause mortality Cardiovascular disease Cancer Helps prevent overweight, obesity Lowers risk of type 2 diabetes mellitus Lowers lipid levels Lowers blood pressure Lowers myocardial oxygen demands Lowers risk of osteoporosis Improves general health Improves physical working capacity Improves skin health Improves mental outlook and acuity

4. Exercise target Age 2030405060708090100 bpm140- 170 133- 162 126- 153 119- 145 112- 136 105- 128 98- 119 91- 111 85- 103 Calculate maximum heart rate (MHR = 220 – age) Start @ 40-50% of MHR Target = 70-85% of MHR Target ≥ 30 minutes/day 5 days/week

5. Atherogenesis

8. Exercise & mononuclear cell function Six months of moderate intensity exercise Decreased atherogenic cytokine production by peripheral blood mononuclear cells by 58.3% (P<0.001) Increased atheroprotective cytokine production by peripheral blood mononuclear cells by 35.9% (P<0.001) Decreased CRP levels by 35% Smith JK, Dykes R, Douglas JE, Krishnaswamy G, Berk S. JAMA 1999:281;1722-1727

9. Exercise & atherogenesis

11. Exercise & VEC function Augments endothelial nitric oxide-dependent vasodilatation Aids in normalizing shear stress effects on VEC function and on arterial remodeling Reduces risk factors that adversely effect VEC function Reduces proinflammatory effects of white adipose tissue on VEC function Habitual moderate intensity aerobic exercise stimulates an an atheroprotective VEC phenotype

12. A Quid Pro Quo Relationship Exercise & atherogenesis

13. Exercise & HIV

21. Exercise & Obesity

23. Adaptive thermogenesis

24. Exercise target Age 2030405060708090100 bpm140- 170 133- 162 126- 153 119- 145 112- 136 105- 128 98- 119 91- 111 85- 103 Calculate maximum heart rate (MHR = 220 – age) Start @ 40-50% of MHR Target = 70-85% of MHR Target ≥ 30 minutes/day 5 days/week