Exercise Physiology Lecture Notes PDF

​ Cartoon ○​ Season starts next week, haven’t played in 4 months, can I play my way into shape? ○​ No, probably not ○​ Game participation is intense, need time between games to recover, won’t be able to catch up on training ○​ Bad habits of...

​ Cartoon ○​ Season starts next week, haven’t played in 4 months, can I play my way into shape? ○​ No, probably not ○​ Game participation is intense, need time between games to recover, won’t be able to catch up on training ○​ Bad habits of not training out of season cna stay in season too The Annual Training Plan for Sport ​ A training program organized and planned over a year is a necessary requirement inn order to maximize the improvement in an athletes performance ​ The main objective to ensure physical and psychological peaking for the main competition of the year Annual Training Plan ​ Schedule that breaks the year into distinct segments ○​ The training emphasis of each segment differs ​ Training load within each segment differs ​ Includes periodization ​ Goal is to optmize performance for main competition ○​ Mentally and physiclaly ​ Initially developed for track and field ​ Still probably most ideal for individual sports? ​ Important questions ○​ How does it differ across sports? ​ Why might it be problematic for team sports ​ How might it be more problematic for pro sports Advantages of Anuual Training Plan ​ Avoids total off-season “de-conditioning” ​ Avoid pre season crash training ​ Avoid the play your way into shape syndrome ​ Allow for tapering and peaking during in season ​ Allow for season to season improvement ​ Provides variety ​ Avoid overuse or injury ​ Avoid overtraining syndromes Main Segments of the Annual Training Plan  ​ Off-season ○​ Time between end of one competitive season and next ​ Recovery, building and prep phase ​ Pre-season ○​ Time between the off-seaon and in-season ​ A bridge between off season and in-season ​ Transition phase (general to specific) ​ In-Season ○​ The competitive season ​ Teams ​ Regular schedule of games ​ Individuals ​ Intermittent series of competitions Off-Season Training Goals? ​ Recover and heal from previous season ○​ Physio, rehab, surgery? ​ Provide mental and physical break from sport ○​ Cross training ​ Good time to improve “weaknesses” ○​ Strength train ​ Maintain general fitness ○​ Establish fitness foundation ​ Maintain playing weight ○​ Diet? ​ The term off-season is a misnomer ○​ This is when the most work is done Pre-season Training Goals ​ Transition from general fitness to game conditioning ○​ Get ready for training camp ​ How is it done? ○​ Increase training intensity ○​ Change training type ​ To increase training specificity ​ For most sports teams ○​ Shift from aerobic to anaerobic training ​ Incorporate high intensity interval training ​ Best time to incorporate sprint interval training ○​ To increase specificity ​ Go on the ice In-Season Training Goals  ​ Important to start competitive season in ‘game shape’ ○​ Game play should maintain conditioning ○​ Recall that if intensity is high ​ Fitness can be maintained at 50% volume ​ This approach allows you to focus on: ○​ Rest and recovery ○​ Skill development ○​ prehab/rehab ○​ Strength maintenance ​ Before after and between games ​ Provides ‘reserve’ fitness ○​ In case of injury or other Summary ​ Off-season ○​ Detrain specific fitness ○​ Maintain general fitness ○​ Retrain deficiencies in fitness ​ Pre-season ○​ Attain specific fitness ​ In-season ○​ Sustain specific fitness ​ Training load should change throughout the calendar year ○​ Depending on acute needs Why You Should Train in the Off-Season ​ What you do or don’t do in the off-season eventually shows up during the season ○​ Doug gilmour one of the best in NHL, decided to change off season training ​ Lead to rough start in season ​ E.g. ​ Gary roberts, rob brindamour, teemu selanne, scott neidermeyer The Play-off Problem ​ If you get to th eplayoffs that’s up to 2 months longer in the in-season, off-season is shorter, pre-season is the same ○​ Not enough recovery? The Playoff Problem  ​ Why repeating is difficult in any sport ○​ More games ○​ Most intense games ○​ More injuries ○​ Less time for surgery/recovery ○​ Less time to retrain ○​ More parties, less training ​ “Each NHL final subtracts a year from your career” Overtraining Implications ​ April 10, 1982, game 3 NHL quarter finals ​ Kings overcame largest deficit (5-0) in NHL history to win a playoff game (6-5 OT) ​ Oilers finished 48 points ahead of Kings ​ Kings knocked Oilers out of the running due to overtraining Tapering: What ​ Practice of reducing training load prior to competition ○​ Proper taper period essential for optimal performance ​ The average performance increase is 3% ○​ But large variations are possible, why? ​ Best taper vaires by sport? ​ Inter- and intra-individual differences present ○​ Fitness level x experience x age interactions ​ Individual vs. team athletes ○​ Straight forward for individual athletes ​ More complicated for team athletes ​ Not practical for pro’s, why? Tapering: How to: ​ Tapering doesn’t mean you stop training ○​ What do you change? ​ ~14 days prior to important event ○​ Reduce training volume by 50% in first 3-4 days ​ Reduction should be progressive ○​ Maintain frequency of training ​ Cut duration by 40% (step-wise) ○​ Maintain or even increase intensity ​ Emphasize quality over quantity ○​ Make training as specific as possible ​ No cross-training? Tapering: Why? ​ Proposed mechanisms ○​ Fatigue dissipation ​ Chronic vs. acute ○​ Damaged tissues repaired ​ Injury ○​ Contractile protein function enhanced? ​ Increased calcium sensitivity ○​ Energy reserves replenished ​ Muscle glycogen? ○​ Better hormonal balance for performance ​ Growth hormone, testosterone, etc. ○​ skills/technical training ​ Variation? Periodization of Training ​ Defined ○​ The practice of varying the training program at regular time intervals in an attempt to bring about optimal gains in strength, power, motor performance and/or muscle hypertrophy ​ Method? Divide training time into discrete ‘blocks’ ○​ The training load is regularly changed ○​ Alternate periods of overload with periods of underload Cartoon ​ Does massage increase bloodflow? ​ Been proven it does not ​ Found massage after exercise decreases bloodflow and decreases lactate removal Periodization: Historical ​ Anciet greeks may have employed periodization methods ○​ Resurrected by germans for berlin olympics ​ Modern practice refined by eastern-block nations ○​ Starting in 1950s, politically driven ​ Matveyev did theoretical groundwork ○​ Popularized in west by Tudor Bompa (york uni) ○​ More holistic approach to training ​ Now mainstream for ○​ Individuals ○​ Teams ​ Issues with this? Basics of periodization ​ Short and longterm manipulation of the training load ○​ Systemically vary training volume ○​ Systemically very training intensity ○​ Systemically vary training type ​ Benefits of peridized training ○​ Improves adherence to training regimen ○​ Allows for constant progression ○​ Helps avoid fitness plateaus ○​ Reduces occurrence and severity of injuries ○​ Prevents overtrainng ○​ Allows for peaking ​ Found via meta analysis ​ Different periodization patterns ○​ Linear vs. non-linear ○​ Frequent vs. infrequent Periodization: Theory ​ A more holistic approach to training? Periodization: Theory 1 ​ Repeating pattern of increased and decreased stress over time ○​ Overload ○​ Overload ○​ Underload ○​ Overload ​ These short and long term variations in training load ○​ Allow athlete to adapt and habituate while avoiding maladaptation ​ Because training load (stress) is increased over time ○​ Maximizes training effect and minimizes injury ​ Evidence for efficacy of periodization? ○​ Rhea and alerman 2004 ○​ Ronnestad 2014 Training Cycles ​ Each period of overload or underload should last ~2 weeks ○​ Performance tends to decrease during overload ○​ Performance tends to increase during underload ​ Underload provides recovery ○​ From chronic fatigue, muscle damage, glycogen depletion, inflammation etc (thus performance increases) Types of Periodization ​ Cardiovascular ​ Strength ​ Flexibility ​ Balance Training Models ​ Non-periodized ○​ Random ○​ Constant ​ Periodized ○​ Linear ○​ non-linear Non-Periodized: Random ​ Most typical of non-athletes ○​ ‘Weekend warriors’ ​ There are changes in training load over time ○​ Random not systemized ○​ Cycles of detraining and retraining ​ What are the consequences? ○​ Difficult to maintain performance ​ Difficult to progress performance ​ Leads to injuries ​ May be suitable for increased health and fitness ○​ Not optimal for competitive athletes Non-Periodized: Constant ​ The training load remains relatively constant over time ○​ Training volume or training intensity may vary somewhat ○​ But overall training load stays similar ​ Advantages ○​ Can be used to achieve recommended activity levels ​ Can improve or maintain fitness ​ Disadvantages ○​ Not suitable for competitive athletes ​ Difficult to progress performance ​ Increases risk for overuse or injury ​ Compliance issues? Periodized Training: Linear ​ Training load steadily increases over time ○​ Only overload (no underload) ​ Can produce max gains in short term ○​ Not beneficial long term ​ Cannot increase training load indefinitely ○​ Without cause for injury or overtraining ​ Due to critical need for underload ○​ Occasional rest/recovery ​ What situations warrant a linear model ○​ Short term only Periodized Training: Non-linear ​ Not intended to continually improve performance ○​ But to peak performance for most import competition ​ Considers big picture ​ Short term variations in training load ○​ Do not produce maximum gains in fitness over short term ○​ Evokes involution and devolution ​ Long term variations in training load ○​ Eventually produces large scale and increase in fitnes/performance ○​ Can incorporate tapering and peaking ○​ Competition can be a part of training Big Picture: Annual Plan, periodization and peaking ​ In an ideal world training would be organized into: ○​ Off-season, pre-season, and in-season phases ​ With distinct differences in training load ​ Within different seasons training should be periodized ○​ In practice much easier for individual than team training ​ Taper should be performed before major evens ○​ Ideal for individual athletes ​ Not so ideal for team athletes Microcycles, mesocycles, and macrocycles ​ Macrocycles ○​ The longest training unit, consists of mesocycles ○​ Represents overall training period of interest ​ Olympic athletes = 4 years, NHL athlete = 1 year ​ Mesocycle ○​ A training phase consisting of several microcycles ​ Duration varies but general 2-6 months ​ Training load gradually increases over mesocycle ​ Microcycle ○​ Consists of daily training sessions, short duration ○​ Training load varies from cycle to cycle ​ Includes periods of overload and underload Periodization Findings: General ​ Rhea and alderman (2004) ○​ Meta-analysis examining various strength training responses ​ Periodized is superior to non-periodized training ​ Why is periodization > non-periodization (fleck, 1999) ○​ Simply due to more training volume ○​ Or due to improved training compliance ​ O’bryant (1984) and ronnestad (2014) ○​ Effect independent of greater volume/intensity ○​ Variation of volume and intensity vital factors ​ For maximal benefits of periodizatoin ○​ The more variation the better for increased strength and power ○​ Daily > weekly > monthly Why do some studies not show effect? ​ Baker et al. 1994 ○​ Most studies comparing periodized to non-periodize ​ Examine differences over short time frame ​ Periodization designed for long-term training ​ Most studies use linear periodization ○​ But non-linear is superior to linear ​ Studies using only untrained? ○​ Both groups will improve a lot ○​ Making it difficult to identify effect ​ Studies only using highly training? ○​ Neither group will improve much ​ Making it hard to identify effect Rhea and Alderman (2004) ​ Examined efficacy of periodized vs. non-periodized training ○​ strength/power training (weeks) ○​ Volume, frequency, intensity controlled between groups ​ Effect size greater for periodized than for non-periodized training ○​ Moderating variables included age, training status and training duration ○​ Both men and women ○​ Different experience levels ○​ Different ages ​ Effect size sensitive to variations in: ○​ Training volume, intensity, frequency ​ Progression of load added to effet size Ronnestad (2014) ​ Compared periodizatoin to traditional training using trained cyclists ○​ 4 weeks of training with HIT and LIT ​ Block periodized group ○​ Training changed weekly ​ Traditional training group ○​ Same training weekly ​ Periodization improved relative performance more than traditional ○​ Periodizatin superior to traditional acutely when volumes are equal Periodization: Lingering Questions ​ Is periodization better for men for women? ○​ Strength gains are similar ​ Is periodizatoin better for young or old? ○​ Effective in all age groups ○​ More effective in young than old ​ Is periodization limited to strength? ○​ No Lecture 8 - March 14 ​ Obese people do not have lower metabolic rates than non ○​ Obese people have higher absolute metabolic rates ​ Factors affecting this: ​ Larger organs (mean they work harder) ​ More muscle mass (carrying extra weight) ​ More eating = more digestion ​ Higher energy cost of movement ​ Basal metabolic rate higher via adaptive thermogenesis ○​ Relative metabolic rate is lower ​ Extra fat is not using much energy in overall mass What is Obesity? ​ An increase in body adipose tissue mass ​ A condition in which the bodies energy stores are too large ​ Defined as BMI >30 Why is Obesity a problem? ​ Complicates or leads to other cardimetabolic diseases ○​ Including coronary artery disease and type II diabetes ​ Increased risk in premature morbidity and mortality ​ Also metabolic syndrome (aka Syndrome X) ○​ Combination of insulin resistance + leptin resistance ​ Dysfunctions in hormonal signalling ​ Metabolic syndrome disrupts ability to regulate weight ○​ Is this why obesity is so difficult to reverse? ​ Incidence of metabolic syndrome ○​ ~25% US population ○​ Increases with age and inactivity What causes Obesity ​ Eating too much and moving too little ​ If you consume high amounts of energy, particularly fat and sugars but do not burn off the energy through exercise and physical activity, much of the surplus energy will be stored by the body as fat ​ Chronic energy imbalance accounts for most cases of obesity in genetically suseptible individuals ​ Metabolic disorders or didease account for only 1% of obesity Genetic Susceptibility? ​ Fat mass and obesity-associated gene (FTO) ​ Those homozygous (16% of pop.) have 1.7 fold increased risk of obesity 2 alleles > 3 kg of extra fat mass ○​ 1 allele >1.2 kg extra ​ Studies in humans and rodents have suggested that the FTO may predispose to obesity by influencing food intake and or satiety ​ Phenotypic and molecular differences between rats selectively bread to voluntarily run high vs. low nightly differences Familial Factors ​ Children of obese parents do not have major defects in energy expenditure compared to those from nonobese parents ○​ Doesn’t discount a genetic influence ○​ But genetics x environment a vital factor Energy Over-Consumption: main Cause of Obesity ​ There are many reasons for over consumption of energy relative to energy requirements, including genes ​ But why can’t expenditure keep up? ​ Isit because we live in an increasing obesogenic environment? Are we living in an obesogenic environment? ​ An environment that makes unhealthy choices the easy choices ​ We live in an environment in which it is increasingly difficult to not become obese Obesogenic environment: intake vs. expenditure ​ Engineered declines of physical activity ○​ Increased household automation ○​ PC driven work world ○​ Car oriented ​ Easy availability of energ dense foods/beverages ○​ Servings sizes have odubles ○​ Acceptance of fast food despite low nutritional value ○​ Drive through calories Creeping Obesity ​ A sow but gradual gain of body fat over a prolonged period of time ○​ Relationship betwen excess daily kcal and BMI ​ BMI 30 - excess 382 kcal/day ​ BMI 40 - excess 1000kcal/day Epigenetics and Obesity ​ Balance of energy expenditure genes and energy storage genes Concept of Total Energy Thermogenesis ​ The bodies generation of heat is knwn as thermogenesis ​ The bodies total requirements (kcal/day) are compartmentalized: ○​ BMR ○​ TEF ○​ TAT Total Energy Thermogenesis ​ Basal metabolic rate (BMR) ○​ Minimum rate of metabolism to sustain life ○​ Predictive formula ○​ Resting metabolic rate ​ Thermic effect of food (TEF) ○​ Energy cost of digestion ○​ 10% food energy ​ Total activity thermogenesis (TT) ○​ Exercise activity thermogenesis (EAT) ​ Energy cost of exercise ○​ Non-exercise activity thermogenesis (NEAT) ​ Energy cost of non-exercise activity Predictive Equations ​ Simple: based on mass ​ Important point: do not differentiate between fat mass and muscle mass ​ Precision increased by modifiers Estimating BMR ​ (14.7 x body weight) + 496 kcal = 1378 kcal (female) ​ (15.3 x body weight) + 679 kcal = 1903 kcal male) ​ For minimal or no extra thermogenic activity BMR = RMR) Body Composition and BMR? ​ Because formulae are based solely on body mass ○​ They do not take into account differences in metabolic activity between fat free and fat mass ○​ Fat free mass is more metabolically active than fat mass (muscle > adipose) ​ Formulae that factor into body composition ○​ Katch-mcardle formulae (BMR) ○​ Cunningham formula (RMR) Factoring in Activity Level ​ Harris-benedict formula ○​ Moderately active: ○​ BMR x 1.25 ○​ Very active: ○​ BMR x 1.5 The Truth about Total Energy Thermogenesis ​ Resting metabolic rate is dynamic: inter and intrapersonal differences exist ○​ Could it be adaptive thermogenesis? Adaptive Thermogenesis ​ Total energy termogenesis changes in response to changes in diet ○​ BMR changes in same direction as energy intake changes ○​ TEF changes in same direction as energy intake changes ​ Makes energy balance dynamic ​ A negative feedback system ○​ Decreases aloric expenditure during caloric deficits ​ A positive feedback system ○​ Increases caloric expenditure during caloric surplus Adaptive Thermogenesis = Survival ​ Increased BMR, increased TET, increased TEF ○​ Prevents or slows weight gain when dietary input is high ​ Decreased BMR, decreased TET, decreased TEF ○​ Prevents or slows weight loss when dietary caloric input is low ​ Hormonally regulated by adipokynes ○​ Adipose ecretes hormones (e.g. leptin) Evidence? ​ Without adaptive thermogenesis, even a 5% error between kcal in and kcal out would resultin significant weight gain Clinical Studies ​ Levine (1999) examined relationship between increased kcal and increased BMR ○​ Fed 16 subjects an extra 1000kcal a day for 8 weeks ○​ Average weight gain was ~5kg ​ Changed variables: ○​ Fat mass increased ○​ Muscle mass increased ○​ RMR, TEF, NEAT all increased A loss of Adaptive thermogenesis Can the Loss of Adaptive Thermogensis explain Obesity? ​ What regulates adaptive thermogensis ​ Is it better at keeping us fat than thin? Cat Scans ​ Abdominal (visceral) fat is very endocrinic ​ More adipose meansmore adipokynes (right nex to major organs) ○​ Why abdominal fat is bad, lots of hormone secretion around important organs Adipokynes ​ Adipose derived hormones (adiponectin) ○​ Enter the circulation and interact with various brain centers ​ Hypothalamus ​ Regulate adaptive thermogenesis ○​ By modifying appetite ○​ By modifying activity (EAT/NEAT) ○​ By modifying metabolic set point and TEF Leptin ​ Leptin is classic example (=thin) ○​ Circulating levels equivalent to adiposity ​ Provides information to brain regarding energy storage ​ Increased leptin secretion initiates negative feedback ○​ Decreased appetite and increase activity ​ In mice - leptin deficiency = obesity Leptin Deficiency in Humans ​ Is rare ○​ Causes 1% of obesity ​ Leptin therapy the magic bullet? ○​ Limited success - ciruclating leptin was only ½ the problem ​ Lpetin deficiency vs. leptin resistance ○​ Loss of leptin sensitivity = leptin resistance Leptin Resistance ​ Occurs in response to chrnoically high leptin levels ○​ Due to high adipose tissue levels ○​ Disrupts adaptive thermogensis ○​ Links obesity with metabolic syndrome ​ Importance of physical activity ○​ Prevents leptin resistance by maintaining leptin signalling Cartoon ​ How much extra muscle to boost BMR by 100 kcal/day? ​ RMR of skeletal muscle is every low, 10-15 kcal/kg/day ○​ Boost BMR by 100kcal, add 6-7kh of muscle ​ Bulking up can’t help stay thin but can help avoid creeping obesity The Dish on Diet for Weight Loss ​ Diet is more important than exercise for weight loss ○​ Deficit of >500 kcal a day is needed for acute weight loss ​ Kcal restriction most important factor ○​ No diet composition per se ​ Macronutrient recommendation? ○​ Decrease fat intake to decrease cardiometabolic risk factors ○​ Decrease simple carbs ○​ Increase complex carbs ​ But because adaptive theromgenesis ○​ Exercise is needed to sustain weightloss The Turth about Calories ​ A kcal is a kcal, source doesn’t matter Gardner et al. 12018 ​ Examined effect of low fat vs low carb diet ​ Mean age 40 years ○​ BMI average = 33 ​ Participants randomized into two diets ○​ Low fat ○​ Low CHO ​ Weight loss was not significantly different between groups Exercise Intensity and Diet ​ Low intensity superior to high intensity? ○​ Although lower intensities oxidize more fat, total kcal expended is most imporant ​ High itensity superior to low? ○​ Expends more kcal per time unit ​ But CHO vs FFA dependent ​ Recovery fat oxidation increases (to replace CHO) ​ Exercise intensity x diet interactions? ○​ Low-moderate intensity activity ​ Produces proportional increased kcal intake ○​ High intensity activity ​ Does not cause proportional increased kcal intake Wewege 2017 ​ MICT better for body composition measure ​ Both reduced fat mass and waist circumference ​ HIIT more time efficient? Best advice for lifespan ​ Value of exercise in weight management ○​ 3-4 hours/week ​ Maintains ○​ Combines exercise with diet ​ Increases weight loss ○​ Combined with severe diet ​ Does not increase weightloss ​ Value of exxercies in maintaining healthy weight ○​ 500 kcal a day prevents long term weight gain ​ Value of exercies for decreased disease ○​ Decreased cancer risk and cardiometabolic risk Steps vs. Reps ​ Resistance work can prevent creeping obesity ​ Not effective to induce weight loss Lecture 9 - March 21 Exam ​ 5 long answers (one from each lecture) ​ 5 definitions ​ Redraw graphs, one is from today and talked about* -​ We use the term to burn calories, it’s a misnomer -​ Calories = heat (but they don’t burn) -​ In order to lose fat mass, you have to lose the carbons that make the fat -​ When we use fat as fuel we break is down and we exhale the carbons via CO2​ -​ Comes from kerbs cycle What is Epidemiology? ​ Latin for “what is upon the people” ○​ The study of factors affecting health and illness ​ In distinct populations ​ Evidence based medicine used to ○​ Identify disease causation and transmission ​ Old vs. young ​ Nationalities ​ Active vs inactive ​ Key terms are epidemic vs endemic ○​ Diseases that are visited upon vs those that reside within a population ​ Dr. John Snow ○​ London cholera epidemic of 1854 ○​ Mapped around contaminated well, found source Importance of Epidemiology ​ A cornerstone of public health ○​ Clinica practice based on epidemiolog ​ Shapes policy decisions and logic for interventions ○​ Made in the interest of public health ​ Evidence based approach used to identify ○​ Risk factors of disease ○​ Impact of disease on longevity ○​ Targets for preventative health care ○​ Optimal treatments for disease ​ Helps develop methodologies used in ○​ Medicla practice and exercise prescription Glossary ​ All cause mortality ○​ A measure of the total number of deaths from any cause in a specific group of people over a specific period of time ​ Cardiometabolic health ○​ Interrelated risk factors including hypertension, elevates fasting blood sugar and or triglycerides, and obesity ​ Hazard ratio ○​ A measures of how often a partocular event happens in one group compared to how often it happens to another group over time ​ Mortality ○​ The state of being susceptible to death, the opposite of immortality ​ Primary prevention ○​ Any intervention that decreases appearance of adverse health effects (vaccinations, exercise, risk behaviour modification etc.) ​ Risk factor ○​ Variable associated with increased rate of infection, disease or death ​ Sedentarism ○​ A term describing a state of low energy consumption *Exercise is primary prevention Exercise Prescription for Lifespan Health ​ Epidemiology ○​ Definition, description, importance ​ Hazards of inactivity quantified ○​ Sedentarism as risk factor ○​ PA guidelines ○​ Screentime and non-movement behaviour ​ Can we compensate ​ Effect of exercise and fitness on mortality ○​ Fitness as primary prevention ○​ Cross-sectional vs. longitudinal evident ​ Exercise and mortality ○​ Best activities for avoiding CAD, cancer? ○​ Best types, times, amounts? Hippocrates ​ If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safeset way to health ​ Everything in excess if opposed to nature Global Pandemic of Inactivity ​ Considerable evidence suggests that physical inactivity may be the greatest threat to health in the 21st century ​ Moreover, low levels of cardiorespiratory fitness may be one of the strongest risk factors for cardiovascular diseases What are the PA guidelines? ​ US and WHO ○​ 150mins/week of moderate intensity ○​ 75mins/week of vigorous intensity ​ 7.5 MET hrs/week ○​ 2015 self report indicates that 50% meet these requirements Metabloic Equivalents and Exercise Benefits of More Activity? ​ All fell 30-60%: ○​ All-cause mortality ​ Being active is good, being fit is better ○​ Cardiovascular disease ○​ Colon cancer ○​ Type 2 diabetes ○​ Stroke ○​ Hypertension ○​ Breast cancer ○​ Osteoporosis ​ Y axis is risk of all-cause death ​ X-axis is level of activity ○​ Seen reduction in risk as you exercise more (30% from 1st to 2nd) Rao et al. 2016 (does the PA guidelines prevent sedentarianism enough) ​ Examined interaction between nonmovement behaviour and physical activity ○​ Canadian health measures survey ​ Screen time and sedentarism are nonmovement ​ For those who did not meet physical activity guidelines ○​ Increased risk of metabolic syndrome when nonmovement was >2.1 hours ​ Those whose met guidelines ○​ No amount of nonmovement behaviour associated with metabolic syndrome (obesity, diabetes, etc.) ​ Conclusions? ○​ Meetings physical activity guidelines moderates risk Summary: Hazards of Inactivity ​ Inactivity is a moajor contributor to morbidity and mortality ○​ Greater than all other risk factors combones ○​ Sedentarism represents global pandemic ​ Minimum physical activity guidelines rarely met ○​ 150min/week moderate ○​ 75min/week intense ​ 7.5 MET a week ​ Concept of non-movement behaviours ○​ Recreational screentime and sitting ○​ Increased risk of met syndrome, inflammation, CAD, cancer ​ Physical activity guidelines x sedentarsm ○​ Rao et al. 2016 Critical Importance of Fitness ​ Functional capacity defined ○​ Ability to maintain homeostasis in response to stress ​ Diminished ability to adapt to stress increases likelihood of death ​ A low functional capacity ○​ As low VO2 max or as low muscle mass/strength ○​ A biomarker for early death *cardiorespiratory fitness matters for primary prevention Evidence for Exercise ​ Fitness predicts future morbidity and mortality ○​ True when you compare different populations ​ Based on fitness levels, cross sectional ○​ True when you compare same people over time ​ Based on fitness level change, longitudinal The Case for Cardiorespiratory: Cross-sectional ​ Cross sectional studies comparing people with different levels of CRF ○​ Find that mortality decreases as cardiorespiratory fitness ​ Independent of other risk factors ​ Lee et at. 2009 ○​ Found inverse relationship between cardio fitness and all cause mortality ​ When comparing those with highest and lowest fitness ​ Female AC mortality decreased by 113% ​ Male AC decreased by 75% ​ Lavrie et al. 2009 ○​ Found inverse relationship between cardio fitness and CAD ​ Females 2.5 fold improvement ​ Males 8.5 fold improvement ​ Thus a strong inverse relationship found in cross-sectional studies between cardiorespiratory fitness (as Vo2 max) and mortality across the lifespan, what is the dose-response relationship? Arem et al. 2015 ​ Leisure time PA and mortality ​ What is dose-response relationship between physical activity and mortality? ○​ Is there an upper limit of exercise for the benefits? ​ Compared to no PA (0 MET/week) ○​ The decrease in all cause mortality ​.1-7.5 MET = 20% reduction in risk ​ 7.5-15 MET = 31% ​ 15-22.5 MET = 37% ​ 22.5-75 MET = 39% ​ >75 MET = 31% The case for Cardiorespiratory: Longitudinal ​ Blair et al. 1995 ○​ Evaluated relationship between CRF anf AC mortality ○​ Tested twice over ~5 year span ​ How did VO2 max/VO2 max change, relate to mortality? ○​ Lowest VO2 max at both tests had highest mortality rate ​ 122/10,000 man years ○​ Highest VO2 at both tests had lowest mortality rate ​ 40/10,000 man years ○​ Increasing VO2 decreased mortality by 44% ​ 68/10,000 man years ​ Each minute increased in treadmill time, decreased mortality risk by 8% Lee et al. 2011 ​ Long term effects of changes in CRF, BMI on AC and CVD mortality ​ Examined effect of changes in CRF and BMI on hazard ratios for: ○​ All cause (AC) mortality and cardiovascular (CV) disease mortality ​ Compared with fitness loss, the HRs of all-cause and CVD mortality: ○​.7 and.73 for ‘stable’ fitness ○​.61 and.58 for fitness gain ​ For every 1 MET increase in fitness across lifespan ○​ Decreased AC mortality by 15% ○​ Decreased CVD mortality by 19% ​ Independent of BMI change Clausen et al. 2018 ​ Assessed association between CRF and mortality ​ 5107 men stratified into 4 categories ○​ Least fit ○​ Normally fit ○​ Most fit ​ Life expectancy by VO2 max fitness? ○​ Normal vs. lowest ~ 2.5 years ○​ Highest vs. normal ~ 2.5 yeats ○​ Highest vs. lowest ~ 5 years ​ CRF related to longevity over 40 year lifespan ○​ Each unit increase in VO2 Max = 45-day increase in life Fitness and Longevity ​ VO2 max increase from 20-40 ml kg/min ○​ = 20x45 = 900 days Williams (2001) ​ Assessed role in PA and fitness ○​ Reduced risk for CAD (cornary artery disease) ​ Found the risk of CAD decreases linearly with ○​ Increased levels of activity (up to 20%) ○​ Increased levels of fitness (up to 40%) ​ Independent factors ○​ Its a dose response relationship for both ​ Significant difference in risk reduction ○​ Being physically active decreases CAD risk ○​ Being physically fit significantly reduces CAD risk ○​ Be 10th percentile and higher for some protection (don’t be bottom 10%) for activity, be above 15% for fitness (a 40% drop!) ​ See how the lines are parallel after the threshold and have an asymptote Tanasescu et al. (2002) ​ Activity types and patterns correlated with coronary heart disease ○​ Tracked 44.5k men ​ General findings ○​ Total activity as running, walking, RT, rowing ​ All inversely related to risk of CAD ​ But not all activities are equal ○​ Running > PRT > rowing = walking ​ Threshold for time differed between activities ○​ Swimming, cycles, racquet sports ​ Exercise intensity was critical variable ○​ Reduced risk independent of volume Tanasescu et al. (2002) Mode and intensity specific findings: ​ > 1 hours of running a week decreased risk of heart disease by 42% ○​ Compared to non-exercisers ○​ Largest independent effect ​ >30 minutse of weight lifting a week decreased heart disease by 23% ○​ Compared to nonexercisers ○​ Lowest time threshold (first study to show decrease) ​ > 1 hour of rowing/week ○​ By 18% compared to nonexercisers ​ 30 minutes of brisk walking a day decreased heart disease risk ○​ By 18% compared to nonexercisers 10,000 steps: Banach et al. (2023) ​ Relationship between step count and mortality ​ Compared reference of 2337 steps ○​ 3982 steps decreased cardiovascular mortality by 16% ○​ 6661 steps decreased cardiovascular mortality by 49% ○​ 10413 steps decreased cardiovascular mortality by 77% ​ Increased step cout progressively decreased both cardiovascular and all cause mortality ○​ Non-linear dose-response relationship Ed Whitlock ​ Oldest person to run toronto waterfront marathos under 4 hours ​ Already one person over 70 to run marathon under 3 hours Running vs. Walking: Lavie et al. 2015 ​ Running 45 minutes a day can reduce risk by 45% Lee et al. 2014 ​ Examined association between running and AC and CV mortality risk ​ What was the overall benefit of running? ○​ 30% decrease for AC mortality ○​ 45% decrease for CV mortality ​ 3-year life expectancy benefit compared to non-runners ​ How much running did it take? ○​ Time ( soccer = football SADS ​ The sudden and unexpected death of a “healthy” individual during exercise or sport (within 4 hours) Most Famous Example? ​ Pheidippides ○​ Ran the 236km between Athens and Sparta after battle of marathon (spartathlon) ○​ 490 BC Cardiomyopathy and SADS ​ What are the main causes of SADS ○​ 33% due to occult cardiac disorders ○​ 20% due to commotio cordis ​ Sudden arrhythmic death caused by chest wall impact ​ Occurs most often in athletes between ages 8-18 playing sports with projectiles (hockey, baseball) ​ How Darcy Robinson died ​ Damar hamilin died from this ○​ 20% due to coronary heart disease Drugs? ​ Collapsed at resident due to cardiac arrest following cocaine use ​ Gijs verdic ○​ Double heart attack ○​ Dutch cyclist ​ Tom simpson ○​ Died in 13th stage of tour de france Exercise induced Hyperthermia ​ Body produced or absorbs heat during exercise ○​ Thermoregulatory mechanisms fails ○​ Core temperature climbs uncontrollably ○​ Core temp exceeds 40 degrees ​ May lead to encephalopathy ○​ Alteration of brain structure/function ​ Confusion, convulsions, coma ​ Also hyperpyrexia ○​ When core temp is set above 40 egress ○​ Allows fever state ​ Dangerous exercise x heat ​ Interaction with drugs ○​ Ecstasy or fentanyl increases probability 2007 Chicago Marathon ​ 49 people hospitalized ​ Chad schieber (35) collapsed and died of cardiac arrest at mile 18 ○​ Race called off at 11:30 a.m. Cardiomyopathy and SADS ​ Known vs occult? ○​ 35 years = CAD Occult Cardiac Disorders (OCD) ​ Undiagnosed (occult) congenita defect ○​ May not produce exercise intolerance ○​ First symptom is often sudden death (detected via genetic screening) ​ Main occult cardiac disorder? ○​ Familial cardiac hypertrophy (FCH) ​ Leading cause of sudden cardiac death < 35 years ​ Incidence ~ 1 in 500 (= 0.2% pop) ○​ Impaired contractility → compensatory hypertrophy ​ Penetrance of disease variable ​ May eventually cause ventrivular fibrillation What Are They? ​ Arrhythmia (general) ○​ A generic term for any abnormal electrical activity ○​ Can be non-pathological ​ Includes fibrillations (atrial or ventricular) ​ Atrial fibrillation ○​ Can be chronic condition, treatable ​ Ventricular fibrillation ○​ Common cause of cardiac arrest ​ Fatal if not reversed by defibrillatoin (actuely) ​ Examples of sudden athletic death due to OCD Lab Exam ​ MC ​ Graphs ○​ Any graph in PDFs and presentations in fair game ​ Calculations ○​ Any in PDF or presentations in fair game ​ Review all PDF’s, assignments, slideshows Calculations ​ Karvonen’s formula ○​ To prescribe continuous aerobic intensity ○​ ((MHR-RHR) x training %) + RHR ​ Uth Equation ○​ VO2 max = 15(MHR/RHR) ​ Cooper Test ○​ VO2 Max = (d12-505)/45 ○​ D12 = distance travelled in 12 minutes ○​ Gives relative value ○​ Ml kg/min ​ 1 RM = weight lifted / (1.0278 - (0.0278xreps)) ○​ Kg or lbs, what you put in is what you get ​ BMI ○​ Weight (kg) / height (m^2) General Content ​ W:R ○​ Work to rest ratio ○​ In regards to interval training ​ Intensity for continuous exercise (lab 1,2,3)  ○​ Possible ways to prescribe intensity ​ %MHR, %VO2 Max, kovernons etc. ​ Plyometric guidelines ○​ Intensity table to prescribe plyometric exercise ○​ Safety considerations, group considerations, when to prescribe it etc. ​ Muscle balance ratios across joints ○​ Table gave idealized ratios ○​ What do the ratios mean, how can it indicate risk etc. Graphs ​ Plyometric graph (force velocity curve) ​ Nomogram in astrand-rhyming test ○​ Tests for VO2 Max  ​ Recommended training zones for age ○​ E.g. age 20 should train in 140-180bpm ​ As you increase %MHR the %VO2 max increases, using %MHR to determine VO2 max ○​ Almost linear ​ Assuming you have 2 people with same MHR, one is fit and one is unfit, fitter someone is the lesser the slope, their HR rises slower, leading to higher work rate Final Exam ​ 35% of mark ​ 23rd, 2-4 ​ Lectures 1-11, weighted more to 7-11 ​ 40 MC (cartoons, readings) ​ Definitions (choose 5) (25) ​ Long answer (choose 3) (45) ​ Graphs (40) ○​ Some from early lectures ○​ 4 graphs ​ Fill in blank (25 w/ word bank)