L24 - Role of PA in Lifestyle Related Diseases

• PA & All-Cause Mortality:

  • Inverse relationship
  • Non-linear & independent of adiposity
  • (Means that more PA, doesn’t = more longevity)
  • Risk of mortality decreased by ~30% in the most fit vs the least fit
  • Leisure-time PA assessed in most studies
  • Overall volume of energy expended is important
  • Minimus 2 - 2.5 hr of moderate intensity activity per week needed for risk reduction
  • “Some is good; more is better”
  • But anything better than nothing
  • Vigorous intensity PA provides additional risk reduction compared to moderate intensity PA
• Lifestyle diseases:

  • Share risk factors to 3 modifiable lifestyle behaviours:

  1. Inactivity
  2. Smoking
  3. Unhealthy/poor diet

  • Also have biggest influence into chronic diseases
• Chronic Disease Caused by, or associated with a Sedentary Lifestyle:

  • Many such as:
  • Angina
  • Colon, prostate, pancreatic, breast cancer
  • High blood triglycerides + Low HDL & high LDL cholesterol
  • Obesity
  • Peripheral vascular disease
  • Stroke
  • Heart attack
  • Congestion heart failure
  • Hypertension
  • Osteoporosis + stiff joints
  • Physical frailty
  • Type 2 diabetes
  • Coronary artery disease
  • Depression
  • Poor cognitive function
  • Poor quality of life + premature mortality
  • Sleep apnea + Gallstone
• A Drug Called Exercise:

  • PA is better at reducing BP that medication
  • Goal/initiative to make this apart of health care
  • Connects healthcare with PA resources
  • PA creates optimal health
• A Drug Called Exercise:

  • Generic name: PA
  • Other Brand names: walking, jogging, hiking, swimming, aerobic, biking, tennis, basketball, soccer, dancing, gardening, etc
  • Dosage: optimum 150 mins per week in adults; 60 min per day in children has proven efficacy
  • Even low doses have been shown to have benefits
  • Advice to start with low dose & advance as tolerated
• A Drug Called Exercise:

  • Indications & Usage:
  • Prevent obesity & mitigate its risks
  • Reduce development & improve management of diabetes
  • Prevent & treat heart disease
  • Lower risk of cancer (breast & colon)
  • Treatment of hypertension
  • Prevent osteoporosis & fractures
  • Manage depression & anxiety
  • Reduce risk of dementia
  • Recreational uses
  • Decrease risk of premature death
• A Drug Called Exercise - Dose Response Curve:

  • If sedentary & start PA, big increase in initial weeks where most gains are made (no matter clinical background)
  • Still some small improvements but will plateau
  • More PA you do more risk & harms as well
  • Recommended range good balance
• Exercise is a wonder drug, Physicians should prescribe, Patients should take!

  • Exercise is Medicine that can prevent & treat chronic disease & those who take it live longer
  • If there was a pill that conferred the proven health benefits of exercise, physicians would prescribe it to every patient & healthcare systems would find a way to make sure every patient had access to this wonder drug
  • Everyone has some access to PA gotta think of best way to incorporate that
• Exercise Capacity Spectrum in Health & Disease:

  • 14-18
  • <18 most likely not living independently
  • If have 14 threshold for poor prognosis
  • Important for clinical
  • If need surgery, need specific VO2 max to recover from that surgery
  • If under 14 most likely not have enough ex capacity to recover from surgery
  • Have prehabilitation before surgery to get into better shape so can recover from surgery
• What is Clinical Exercise Physiology?

  • Examines…
  • How one’s ability to exercise is affected by a chronic disease or health problem
  • How exercise training can be used to treat chronic disease
  • 2 aspects:
  • 1) how to do it safely; & how disease affects their exercise
• Clinical Exercise Physiology:

  • In 60s told just to rest = is detrimental to health
  • Still the belief for some older people
  • eg of good: after heart attack best thing can do is actually beneficial
  • Now even bigger shift
  • Rehab right after
  • Takes long time to get there
• Knowledge:

  • Clinical Exercise Physiology focus on:
  • Exercise Prescription
  • Behaviours Medicine
  • Counselling
  • Disease Patho-physiology
  • Chemistry
  • Biology
  • Anatomy
  • Physiology
• When Designing ExRx for Clinical Populations… have to consider safety:

  • Take into account client’s needs
  • Set the goals
  • Design a comprehensive ExRx to have effects on different components of health-related fitness
  • Follow current ExRx guidelines
  • Select appropriate exercise modes & intensity
  • Start low, progress slow (very important)
  • Monitor for signs & symptoms of exercise intolerance
  • Take into account special considerations
  • Clinical more focus on guidelines esp major societies (cancer society, have specific evidence based guidelines)
• Aerobic training in clinical: special considerations

  • Initial fitness level
  • Important thresholds
  • Some things not suitable
  • Increase risk of injury with higher intensity
  • Medical conditions
  • Medications (when dose & timing are changed) + side effects
  • esp BP lowering drugs have fatigue as a side effect → if take at 9am in at 10am = fatigued
  • Will have to adapt/change to suit that timing of taking meds
  • Individual preferences & personal goals
  • Target PA EE
  • Min = 1,000 kcal/week
  • 2,000 kcal/week for weight loss
  • If weight loss important (for surgery) → monitor exercise tolerance
• Aerobic training in clinical populations: special considerations

  • Monitor for signs & symptoms of exercise intolerance:
  • Shortness of breath (dyspnea)
  • Dizziness
  • Drop in blood pressure (if can’t measure don’t exercise)
  • Electrocardiographic (ECG) abnormalities (if available)
• Resistance Training in Clinical Populations: General Guidelines

  • Weight client can handle for 10 reps without strain
  • Perform 2 to 3 circuits:
  • As exercises become easier, gradually increase to 15 reps
  • When can perform 15 reps easily, increase weight slightly & decrease reps to 10
  • Emphasis breathing during exercises
  • Valsalva manoeuvre increases BP majorly
  • For us is fine
  • Those already with high BP becomes very dangerous, so avoid valsalva manoeuvre (not breathing)
• Resistance Training in Clinical Populations: Special Considerations

  • Monitor blood pressure, after & during resistance training session
  • Familiarise clients with equipment
  • Emphasise correct lifting technique - to decrease risk of injury
  • Avoid Valsalva manoeuvre (holding breath)
  • Breathe out (exhale) during the lifting phase
  • Breathe in (inhale) during the recovery phase
  • Controlled movement throughout ROM
  • Monitor for signs & symptoms of exercise intolerance
  • Instruct clients always to train with a partner - so if something does go wrong someone their to help
• Benefits of PA & fitness in clinical populations - benefits outweigh the risks:

  • Pre-disease is reversible → have to be careful & take into account considerations
  • Being PA & fit very important for those who have clinically relevant risk factor levels or chronic disease
• Benefits of PA & fitness in clinical populations - benefits outweigh the risks:

  • It is important for practitioners & their patients to NOT judge the health benefits of regular PA soley by its effects on conventional risk factors
  • Goes way deeper than that such as mental
  • Exercise is medicine!
  • Practitioners should counsel their patients that regular activity is beneficial weather or not it improves their lipid profile, BP, weight, or glucose tolerance
• vBenefits of PA & fitness in clinical populations - benefits outweigh the risks:

  • PA is going to be beneficial no matter if it is immediate
  • Going to be beneficial no matter what
  • Takes a little while for effects to become a chronic effect
• A Drug Called Exercise:

  • Side effects (good): decrease BP, pulse & blood sugar; stronger muscles & bones, weight loss; improved mood, confidence, self esteem & concentration; Bowel & sleep habits improved; Look & feel better
  • Adverse Reactions: sweating, injury (overdose), sudden death (extremely rare)
  • Administration: self administer or with others
  • Start off slow, add mins & intensity PRN, Change formulations to decrease boredom & improve compliance
  • Take outdoors or indoors any time of day