1. Exercise: what the experts say Darwin Deen, MD, MS AECOM Aug. 2002

2. This presentation and all of Dr. Deen’s PowerPoint presentations can be found at: http://www.aecom.yu.edu/famil y/ugdeenpresents.htm

3. Healthy People 2010 lists Physical Activity as a Leading Health Indicator

4. Exercise and Health In spite of the known health benefits of exercise (reduction in all-cause mortality, CVD, DM, colon CA, depression & anxiety), less than half of adolescents and young adults engage in regular vigorous exercise.

5. Exercise and Health All-cause mortality is reduced up to 40% by an increase in weekly energy expenditure from 500 kcal to 2000 kcal.

6. In 1999 65% of adolescents engaged in the recommended amount of physical activity. The 2010 goal is 85%.

7. In 1997 only 15% of adults performed the recommended amount of physical activity. 40% reported no leisure-time physical activity. The 2010 goal for adults is 30%.

8. Healthy People 2010 What is “recommended”? For adolescents: vigorous physical activity that promotes cardiorespiratory fitness 3 or more days per week for 20 or more minutes per occasion. For adults: regular (preferably daily), moderate physical activity for at least 30 minutes.

9. Exercise and Chronic Disease Evidence-based Guidelines

10. Joint National Committee VI Regular aerobic physical activity—adequate to achieve at least a moderate level of physical fitness— can enhance weight loss and functional health status and reduce the risk for cardiovascular disease and all-cause mortality. When compared with their more active and fit peers, sedentary individuals with normal blood pressure have a 20- to 50-percent increased risk of developing hypertension.

11. Joint National Committee VI Blood pressure can be lowered with moderately intense physical activity (40 to 60 percent of maximum oxygen consumption), such as 30 to 45 minutes of brisk walking most days of the week. Most people can safely increase their level of physical activity without an extensive medical evaluation. Patients with cardiac or other serious health problems need a more thorough evaluation, often including a cardiac stress test, and may need referral to a specialist or medically supervised exercise program.

12. NCEP - ATP III Physical inactivity is a major risk factor for CHD. Increased emphasis on regular physical activity. Has clear benefits for the management of the metabolic syndrome. The purposes of regular exercise are: to promote energy balance to maintain healthy body weight, to alleviate the metabolic syndrome, and to independently reduce baseline risk for CHD.

13. NIH Consensus Conference: Guidelines for the Evaluation and Treatment of Obesity Evidence Statement: Physical activity, i.e., aerobic exercise, in overweight and obese adults results in modest weight loss independent of the effect of caloric reduction through diet. Evidence Category A.

14. NIH Consensus Conference: Guidelines for the Evaluation and Treatment of Obesity Evidence Statement: Physical activity in overweight and obese adults modestly reduces abdominal fat. Evidence Category B.

15. NIH Consensus Conference: Guidelines for the Evaluation and Treatment of Obesity Evidence Statement: Physical activity in overweight and obese adults increases cardio-respiratory fitness independent of weight loss. Evidence Category A.

16. USPSTF: Guide to Clinical Preventive Services Being sedentary doubles CVD risk and getting active results in a 41% decrease in mortality (smoking cessation causes a 44% reduction). The risk of HT is also half in those who exercise and the risk of weight gain leading to obesity is less. There is a 6% decrease in the risk of Type II DM for each 500 cal expended per week. Exercise is associated with less osteoporosis risk and improved mental health.

17. Moderate physical activity is that which can be sustained for an hour. Vigorous physical activity results in exhaustion after 30 minutes.

18. Metabolic Equivalents Caloric expenditure during exercise is expressed as METs (multiples of REE). Shooting baskets only 4.5. Baseball & recreational football ~5. A 70 kg person would burn ~6 kcal/min in a 5 MET activity. Biking4-10 METS* Walking3.5-6 Running8-13 Basketball~8 Swimming~8 Tennis~8 ranges depend upon speed

19. Examples of Sedentary and Active Energy Expenditures for Common Activities SEDENTARYkcalACTIVEkcal Using remote control device to change television channel <1Getting up and changing channel 3 Reclining for 30 min of phone calls 4Standing for 3 10-min phone calls 20 Using garage door opener<1Raising garage door 2x/d2-3 Hiring someone to clean and iron 0Ironing and vacuuming each for 30 min 152 Waiting 30 min for pizza delivery 15Cooking for 30 min25

20. Examples of Sedentary and Active Energy Expenditures for Common Activities SEDENTARYkcalACTIVEkcal Buying pre-sliced vegetables0Washing, slicing, chopping vegetables for 15 min 10-13 Using a leaf blower for 30 min 100Raking leaves for 30 min150 Using a lawn service0Gardening and mowing each for 30 min/wk 360 Using car wash 1x/mo18Washing and waxing car, 1 h/mo 300 Letting dog out the back door 2Walking dog for 30 min125

21. Examples of Sedentary and Active Energy Expenditures for Common Activities SEDENTARYkcalACTIVEkcal Riding escalator 3x2Climbing 1 flight of stairs, 3x/wk in mall 15 Shopping online 1 h30Shopping at mall, walking 1 h 145- 240 Sitting in car at drive-in window, 30 min 15Parking and walking inside, 3x/wk, total of 30 min 70 Paying at the pump0.6Walking into station to pay, 1x/wk 5 Sitting and listening to lecture, 60 min 30Giving lecture70

22. Anaerobic vs. Aerobic Anaerobic Glucose - > Pyruvate Aerobic Pyruvate - > CO2 + H2O

23. Muscle Metabolism Lipids are the preferred fuel for muscle cells at up to 25% of maximum work. At 65%, glycogen is burned preferentially. At high intensities, the longer the duration of exercise, the greater proportion of fat is metabolized. With training, muscle burns relatively more fat and less CHO.

24. Distribution of carbohydrate energy in an average 80-kg person

25. Distribution of fat energy in an average 80-kg person

26. The Exercise Prescription Type of exercise Resistance exercise to improve strength Aerobic training to improve aerobic capacity Frequency: 3-5 days/week Intensity: 60-85% of maximal oxygen consumption (maximal heart rate =220- age) Duration: 20-60 min

27. Physical Activity Counseling Little or no desire to engage in additional physical activity “I know I should exercise but right now I have too much going on to even think about it.” Explain the benefits, specific to the individual. Encourage patient to express their reservations. Precontemplation

28. Physical Activity Counseling “I’ve never been very athletic, and at this stage of my life, it does not seem like a good time to begin.” Define how much activity they need for health benefits. Give clear advice r.e. how important it is. Precontemplation

29. Physical Activity Counseling Patients understand the benefits but lack the skills, support, or confidence to initiate action. Practice active and reflective listening. Use information provided by the patient to motivate. Contemplation

30. Physical Activity Counseling “I want to, I just haven’t gotten started.” Explain how the patient can work exercise into their daily routine. Help the patient develop a specific plan with realistic goals. Contemplation