Improving Health Through Exercise PDF

AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 1  Improving Health through Exercise MODULE 4 Frates B, Bonnet JP, Joseph R, Peterson JA. Improving...

AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 1  Improving Health through Exercise MODULE 4 Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:119-175. Disclaimer ACLM abides by strict professional and clinical standards with published evidence-based positions and guidelines on the therapeutic approaches that make up Lifestyle Medicine. These standards are posted for public review at www.lifestylemedicine.org/aclm-standards. Members and certified professionals are authorized to use ACLM branding, presentations and approved messaging for the enhancement of our stated mission and vision. ACLM is not responsible nor accountable for individual deviations, misrepresentations and misinterpretations. Faculty members utilizing this slide deck must acknowledge any slides or content that have been added as it may represent the viewpoint of the presenter and not the viewpoint of ACLM. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 3 Acknowledgements Editors: Kaitlyn Pauly MS, RDN, DipACLM; Shannon Worthman; Monami Brierley Reviewers: Brenda Rea MD, DrPH, PT, RD; Wayne Dysinger MD, MPH, FACLM; Amanda McKinney MD; Susan Benigas, MS This PowerPoint was created under the umbrella of the Lifestyle Medicine Pre-Professional Member Interest Group AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 4 Learning Objectives By the end of this module, participants will be able to: List the definitions of exercise Recall the physical activity guidelines Utilize a framework to make exercise prescriptions Discuss the benefits and risks of exercise and review the risk stratification system developed by the American College of Sports Medicine AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 5  Guiding Questions What are the primary benefits of exercise? What are some less commonly known benefits of exercise? How does exercise affect the 11 systems of the body? What are the risks of exercise? Why don’t people exercise? How can physical activity become part of daily life in the twenty-first century? What is the evidence that physical activity affects health? Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:119. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 6  Important Terms Exercise Exercise Prescription Physical Activity Physical Fitness Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:120. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 7 Exercise Prescription Signed by Dr. Robert Sallis (Past President of the American College of Sports Medicine) AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 8  John Dryden Influential English Poet (1631-1700) “Better to hunt in fields, for health unbought, Than fee the doctor for nauseous draught. The wise, for cure, on exercise depend. God never made his work for man to mend.” “The wise, for cure, on exercise depend.” ett J. Bartlett’s Familiar Quotations, 15th and. In: Boston: Little, Brown; 1982. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 9  Physical Activity "Physical activity is any bodily movement produced by skeletal muscles that results in an expenditure of energy." American College of Sports Medicine. Guidelines for exercise testing and prescription. Williams & Wilkins; 1991. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 10  Exercise American College of Sports Medicine. Guidelines for exercise testing and prescription. Williams & Wilkins; 1991. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 11  Physical Fitness “Physical fitness is a set of attributes that people have or achieve that relates to the ability to perform physical activity.” 1) cardiorespiratory endurance (aerobic fitness): 2) muscular strength, 3) muscular endurance, 4) flexibility, 5) body composition. American College of Sports Medicine. Guidelines for exercise testing and prescription. Williams & Wilkins; 1991. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 12 Exercise has many benefits for the body and the mind Circulatory Nervous Digestive Reproductive Endocrine Respiratory Immune Skeletal Dermatologic Renal/Urinary Muscular AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 13  RESEARCH SPOTLIGHT Goodyear LJ. The exercise pill—too good to be true? New England Journal of Medicine. 2008;359(17):1842-1844. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 14  THE IMPACT OF EXERCISE ON THE 11 SYSTEMS OF THE BODY AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 15  Impact of Exercise Circulatory System Raises “good” cholesterol - HDL Reduces “bad” cholesterol – LDL Lowers heart rate in the long-term Reduces blood pressure Protects against heart attacks, strokes, and diabetes Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:122. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 16  Impact of Exercise Digestive System Dependent on how close a person eats to when they exercise and what and how much is consumed, it can lead to digestive disorders and symptoms Regular light to moderate-intensity exercise can protect against constipation, diverticular disease, and colon cancer Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:122. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 17  Impact of Exercise Endocrine System Production of human growth hormone Lowers blood sugar levels Improves insulin levels Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:122. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 18  Impact of Exercise Immune System Probably strengthens the immune system Overtraining can temporarily suppress immune function Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:123. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 19  Impact of Exercise Dermatologic System Cools the body as heat dissipates through skin pores as skin blood flow increases Keeps the skin looking more youthful Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:122. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 20  Impact of Exercise Muscular System Short-term, with rest, allows the muscles to grow and rebuild Long-term, strengthens muscles, develops muscular endurance Enhances flexibility Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:123. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 21  Impact of Exercise Nervous System Facilitates new brain cell development Increases the number of pathways for oxygen, energy, and waste product removal from the brain Improves cognitive function Enhances alertness Reduces stress Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:123-124. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 22  Impact of Exercise Reproductive System Female excessive exercise can lead to “female athletic triad” Moderate physical activity has a positive impact on female reproductive health, menstrual regulation, ovulation, and fertility Male endurance exercise may decrease serum testosterone and reduced ability to repair muscle damage, and lead to overtraining syndrome Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:125. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 23  Impact of Exercise Respiratory System Short-term, increases heart rate Increases rate and depth of breathing Long-term, improves reparation function Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:125. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 24  Impact of Exercise Skeletal System Increases synovial liquid keeping joints healthy Increases density, size, and weight of bones Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:125-126. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 25  Impact of Exercise Renal/Urinary System Diminishes blood flow to kidneys Maintains fluid balance Helps maintain acid-base balance in the body Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:124. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 26  The Benefits of Exercise MEDICAL MODEL MENTAL HEALTH MODEL Helps prevent cardiac disease and Improve sleep stroke Increase interest in sex Reduces blood pressure Better endurance Controls blood glucose Stress Relief Controls weight and helps prevent Improvement in mood obesity Increased energy and stamina Helps prevent bone loss Reduced tiredness that can increase Can increase self-esteem and energy, mental alertness improve mood, and decrease stress. Weight reduction Reduced Cholesterol and improved cardiovascular fitness Sharma A, Madaan V, Petty FD. Exercise for mental health. Primary care companion to the Journal of clinical psychiatry. 2006;8(2):106-106. Hwang M. Why you should exercise. The Journal of the American Medical Association, 281 (4), 394. 1999;395. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 27 MORE THAN JUST THE BODY AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 28  Depression and Anxiety Routine exercise decreases depression and anxiety Routine exercise increases quality of life Regular exercise routine is important as it takes time to see the full mental health benefits of exercise Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:126. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 29  Brain Derived Neurotrophic Factor Protein produced by the brain “Miracle-Gro” for the brain: John Ratey, MD Hippocampus (involved with consolidating memories and learning) increases in volume with regular exercise Exercise enhances working memory, spatial awareness, attention, and planning (executive functions) Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:127. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 30  RESEARCH SPOTLIGHT Griffin ÉW, Mullally S, Foley C, Warmington SA, O'Mara SM, Kelly ÁM. Aerobic exercise improves hippocampal function and increases BDNF in the serum of young adult males. Physiology & behavior. 2011;104(5):934-941. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 31  Brain Derived Neurotrophic Factor in College Students Baseline BDNF and memory performance Shown photos of faces and names of strangers Recall tested ½ rode stationary bike and ½ rested Both groups asked to recall names from photos Improved performance on memory test in exercise group Increased levels of BDNF in exercise group Griffin ÉW, Mullally S, Foley C, Warmington SA, O'Mara SM, Kelly ÁM. Aerobic exercise improves hippocampal function and increases BDNF in the serum of young adult males. Physiology & behavior. 2011;104(5):934-941. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 32  Brain Scans Most Active Least Active Hillman CH, Buck SM, Themanson JR, Pontifex MB, Castelli DM. Aerobic fitness and cognitive development: Event-related brain potential and task performance indices of executive control in preadolescent children. Developmental psychology. 2009;45(1):114. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 33  Exercise and Dose Response of BDNF Protein and BDNF mRNA Gómez-Pinilla F, Ying Z, Roy RR, Molteni R, Edgerton VR. Voluntary exercise induces a BDNF-mediated mechanism that promotes neuroplasticity. Journal of neurophysiology. 2002;88(5):2187-2195. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 34  Cognition Exercise, brain, and cognition across the lifespan Improved memory-Hippocampus Improved multi-tasking, planning and inhibition-pre-frontal cortex- Voss MW, Nagamatsu LS, Liu-Ambrose T, Kramer AF. Exercise, brain, and cognition across the life span. Journal of applied physiology. 2011;111(5):1505-1513. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 35  RESEARCH SPOTLIGHT Boström P, Wu J, Jedrychowski MP, et al. A PGC1-α-dependent myokine that drives brown-fat-like development of white fat and thermogenesis. Nature. 2012;481(7382):463-468. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 36  Do myofibrils produce hormones? 2012- Nature by Bruce Spiegelman’s group at Dana Farber Cancer Center A PGC1-alpha-dependent myokine that drives brown fat like development of white fat thermogenesis. Irisin-chemical messenger (Iris) Direct and powerful effects on adipose or fatty tissue—subcutaneous deposits of white fat that store excess calories and contribute to obesity. Boström P, Wu J, Jedrychowski MP, et al. A PGC1-α-dependent myokine that drives brown-fat-like development of white fat and thermogenesis. Nature. 2012;481(7382):463-468. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 37  Telomeres “At the ends of the chromosomes are stretches of DNA called telomeres, which protect our genetic data, make it possible for cells to divide, and hold some secrets to how we age and get cancer.” cs. Genetic Science Learning Center. http://learn.genetics.utah.edu/content/chromosomes/telomeres/. Updated 2016. Accessed May 7, 2020. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 38  RESEARCH SPOTLIGHT Rana KS, Arif M, Hill EJ, et al. Plasma irisin levels predict telomere length in healthy adults. Age. 2014;36(2):995-1001. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 39  Irisin and Telomere Length 2014- AGE Rana and colleagues Plasma irisin levels predict telomere length in healthy adults. Irisin is released from muscle after bouts of exercise. Higher levels of irisin correlated to longer telomeres. Rana KS, Arif M, Hill EJ, et al. Plasma irisin levels predict telomere length in healthy adults. Age. 2014;36(2):995-1001. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 40  Brain Health Three sessions a week, minimum 30-60 minutes each session. Increased heart rate and respiratory rate (moderate intensity) Aerobic exercise “most tested and most apparent benefits.” Strength training- promising seedling studies Elderly population: 1-2 times strength training for one year-improved selective attention and conflict resolution Fernandez A, Goldberg E. The sharpbrains guide to brain fitness: 18 interviews with scientists, practical advice, and product reviews, to keep your brain sharp. Sharpbrains, Incorporated; 2009. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 41 “Mens Sana In Corpore Sano” mind in a “A sound/healthy sound/healthy body.” AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 42  Runner’s High Euphoric type of feeling that can occur with exercise Presumed to be related to endorphin release Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:127. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 43  Exercise Mental Health Benefits Alpha brain waves increases- relaxation Serotonin is released- enhances mood Increases norepinephrine- improves focus an attention Increases dopamine- reward, motivation, and pleasure Improved learning and focus Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:126. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 44  Why Exercise? Wise FM. Coronary heart disease: The benefits of exercise. Australian family physician. 2010;39(3):129. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 45 Why Exercise? http://kryski.com/gallery-2/ AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 46  UNDERSTANDING THE VALUE OF EXERCISE AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 47  A Little Exercise Can and Does Go a Long Way Individualized program Keep track of progress Let the body adapt to the exercise Lifetime commitment More than just appearance Improves how someone feels and functions Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:128. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 48  A Little Exercise Can and Does Go a Long Way Small steps can have a major impact Live longer and better Improve ability to do activities of daily living Assists with weight maintenance at the desired level Improves mood Positive impact on sex life Reduces risk of contacting certain diseases and medical conditions Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:128. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 49 EXERCISE IS MEDICINE AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 50 Quote #2 “Exercise is bunk. If you are healthy, you don't need it: if you are sick you should not take it.” Henry Ford (1863- 1947) AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 51 Quote #3 “In the 1940’s..many physicians..pooh- poohed the need for exercise.” Howard Knuttgen, PhD Harvard Medicine: Winter/Spring 2014 Spaulding Department of Physical Medicine and Rehabilitation AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 52  Dr. Robert Sallis and the Exercise as Medicine Campaign www.exerciseismedicine.org AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 53 LIVE AND LEARN LIVE AND LEARN Working with Sedentary Patients AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 54  Sedentary Lifestyle as Risk Factor Sedentary Behavior Sitting, laying down, and expending very little energy The American Heart Association (1992) recognized “sedentary lifestyle” as a primary controllable cardiac risk factor. The prevalence of sedentary lifestyle is at least twice that of smoking, hypertension and elevated Fletcher GF, Blair SN, Blumenthal J, et al. Statement on exercise. Benefits and recommendations for physical activity programs for all Americans. A statement total for health serum by the Committee on. professionals cholesterol Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart association. Circulation. 1992;86(1):340-344. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 55  Risks of Sedentary Behavior Reduced functional capacity Osteoporosis Obesity Anxiety and depression Hypertension Cardiovascular disease Colon cancer Thromboembolic stroke Breast cancer Type 2 diabetes mellitus Kesaniemi YA, Danforth E, Jensen MD, Kopelman PG, Lefèbvre P, Reeder BA. Dose-response issues concerning physical activity and health: an evidence-based symposium. Medicine & Science in Sports & Exercise. 2001;33(6):S351-S358.. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 56  RESEARCH SPOTLIGHT arr E, Healy G, et al. Television viewing time and mortality: the Australian diabetes, obesity and lifestyle study (AusDiab). Circulation. 2010;121(3):384. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 57  Is sitting the new… Harvard Business Review Blog by Nilofer Merchant 1/14/13 “Excessive sitting is a lethal activity.” Circulation article 8,800 Australians Each additional hour of television watched per day translated to an 11% increase in allobesity rr E, Healy G, et al. Television viewing time and mortality: the Australian diabetes, cause mortality. and lifestyle study (AusDiab). Circulation. 2010;121(3):384. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 58 Quote # 4 “We are under exercised as a nation. We look instead of play. We ride instead of walk. Our existence deprives us of the minimum of physical activity essential for healthy John F. living.” Kennedy (1917-1963) AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 59 MAKING A FIRM COMMITMENT TO TOTAL FITNESS AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 60 What is Total Fitness? Cardiorespiratory fitness – aerobic fitness Muscular fitness Flexibility Body composition Making Exercise Work AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 61 ASSESSING FITNESS AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 62 THE KEY TO SUCCESSFUL TESTING AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 63 HOW AEROBICALLY FIT IS THE PATIENT? AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 64 HOW AEROBICALLY FIT IS THE PATIENT? Cardiorespiratory fitness – “aerobic fitness” How much physical activity a person can do before becoming fatigued Safety PAR-Q+ Physical Activity Readiness Questionnaire for Everyone AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 65 Physical Activity Readiness Questionnaire AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 66 HOW MUSCULARLY FIT IS THE PATIENT? AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 67 HOW MUSCULARLY FIT IS THE PATIENT? Muscular strength Muscular endurance AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 68 HOW FLEXIBLE IS THE PATIENT? AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 69 HOW FLEXIBLE IS THE PERSON? AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 70  Flexibility At least two or three days each week to improve range of motion. Each stretch should be held for 10-30 seconds to the point of tightness or slight discomfort. Repeat each stretch two to four times, accumulating 60 seconds per stretch. Static, dynamic, ballistic and PNF (proprioceptive neuromuscular facilitation) stretches are all effective. Flexibility exercise is most effective when the muscle is warm. Try light aerobic activity or a hot bath to warm the muscles before stretching. Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334-1359. doi:10.1249/MSS.0b013e318213fef AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 71 HOW MUCH FAT IS TOO FAT? AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 72 HOW MUCH FAT IS TOO MUCH FAT? Skinfold testing Circumference measurements Bioelectrical impedance analysis Waist-to-hip ratio AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 73  Losing Weight 30-60 minutes of moderate intensity physical activity a day Frequent activity over long periods of time at low intensity will bring benefits for weight loss and health. Volume of physical activity = (frequency) X (intensity) X (duration) Egger G, Binns A, Rossner S. Lifestyle medicine: managing diseases of lifestyle in the 21st century. 2011. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 74  Maintaining Weight Loss (post obesity) 60-90 minutes of moderate intensity physical activity per day Nutrition Guidelines for Preventing Excess Weight Gain and Obesity World Health Organization. Accessed June 25, 2020. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 75 SETTING EXERCISE GOALS AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 76 SETTING EXERCISE GOALS What is a fitness goal? How should fitness goals be set? How can fitness goals be prioritized? How can the target be hit? A health account for life AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 77 SMART Goals S = Specific M = Measurable A = Action oriented R = Realistic T = Time sensitive AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 78 LIVE AND LEARN LIVE AND LEARN AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 79 CHOOSING THE RIGHT EXERCISE AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 80 CHOOSING THE “RIGHT” EXERCISE Making a suitable choice Making the “right” choice AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 81  S.S.A.F.F.E.E. Scientifically documented benefits Safe Appropriate Functionally sound Feel Effective Enjoyment Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:148. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 82 Exercise Progression Start low and go slow “Gradual progression of exercise time, frequency and intensity is recommended for best adherence and least injury risk.” (ACSM) AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 83 Cross Training Benefits Reduced risk of injury Enhanced weight loss Improved total fitness Enhanced exercise adherence Variety reduces boredom AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 84  Improving Fitness with HITT High Intensity Interval Training Increased intensity Decreased frequency Cardiovascular and fitness benefits Usman M. HIIT And Cardiovascular Diseases. Australian family physician. 2012;41(12):960-962. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 85  AVOID TURNING A POSITIVE INTO A NEGATIVE AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 86  AVOID TURNING A POSITIVE INTO A NEGATIVE Taking a bite out of reality - Eating disorders More is not better - Excessive exercise Too much of a good thing Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:149-150. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 87  Effects of “too much” exercise Injury Stress fractures, injured muscles Female triad Disordered eating, amenorrhea/oligomenorrhea, and osteoporosis/osteopenia Exercise “Addiction” Inflammation Ironman Triathlon study** Low grade inflammation for 5 days Neubauer O, König D, Wagner K-H. Recovery after an Ironman triathlon: sustained inflammatory responses and muscular stress. European journal of applied physiology. 2008;104(3):417-426. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 88  Over-training Excessive marathons for years Cardiac problems Overstretching the heart’s chambers Thickening the walls of the heart Altering the electrical signaling that can lead to arrhythmias Increased coronary artery calcifications Large artery wall stiffening Frates B, Bonnet JP, Joseph R, Peterson JA. Improving health through exercise. In: Frates B, ed. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:148. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 89 PRESCRIBING EXERCISE AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 90  US Department of Health and Human Services: 2018 First Federal guidelines were released October 7, 2008 This second edition of the Physical Activity Guidelines for Americans provides science-based guidance to help people ages 3 years and older improve their health through participation in regular physical activity. It reflects the extensive amount of new knowledge gained since the publication of the first Physical Activity Guidelines for Americans, released in 2008. , Troiano RP, Ballard RM, et al. The physical activity guidelines for Americans. Jama. 2018;320(19):2020-2028. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 91  USHHS Physical Activity Guidelines for Americans: Adults 150 minutes of moderate intensity physical activity per week OR 75 minutes of vigorous physical activity per week (bouts of at least 10 minutes) Piercy KL, Troiano RP, Ballard RM, et al. The physical activity guidelines for Americans. Jama. 2018;320(19):2020-2028. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 92  More extensive health benefits 300 minutes of moderate intensity physical activity OR 150 minutes of vigorous intensity physical activity Piercy KL, Troiano RP, Ballard RM, et al. The physical activity guidelines for Americans. Jama. 2018;320(19):2020-2028. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 93  Strength Training Twice a Week on Non-Consecutive “ Days “Adults should also do muscle-strengthening activities of moderate or greater intensity and that involve all major muscle groups on 2 or more days a week, as these activities provide additional health benefits “ Piercy KL, Troiano RP, Ballard RM, et al. The physical activity guidelines for Americans. Jama. 2018;320(19):2020-2028. 2018 PA Guidelines AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 94  Exercise Frequency and Relative Risk of All Cause Mortality “Even low amounts of moderate-to-vigorous intensity physical activity reduce the risk of all-cause mortality. A large benefit occurs when a person moves from being inactive to being insufficiently active. Adapted from data found in Moore SC, Patel AV, “ Matthews CE. 2012 Piercy KL, Troiano RP, Ballard RM, et al. The physical activity guidelines for Americans. Jama. 2018;320(19):2020-2028. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 95  Guidelines for children Adolescents ages 6 through 17 years should do 60 minutes (1 hour) or more of moderate-to-vigorous physical activity daily Piercy KL, Troiano RP, Ballard RM, et al. The physical activity guidelines for Americans. Jama. 2018;320(19):2020-2028. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 96  Physical Activity Guidelines for School-Aged Children and Adolescents Aerobic: Most of the 60 minutes or more per day should be either moderate- or vigorous-intensity aerobic physical activity and should include vigorous-intensity physical activity on at least 3 days a week. Muscle-strengthening: As part of their 60 minutes or more of daily physical activity, children and adolescents should include muscle- strengthening physical activity on at least 3 days a week. Bone-strengthening: As part of their 60 minutes or more of daily physical activity, children and adolescents should include bone- strengthening physical activity on at least 3 days a week. Physical Activity Guidelines for School-Aged Children and Adolescents. Centers for Disease Control and Prevention. https://www.cdc.gov/healthyschools/physicalactivity/guidelines.htm#:~:text=Children%20and%20adolescents%20ages%206%20thro ugh%2017%20years%20should%20do,to%2Dvigorous%20physical%20activity%20daily. Published 2019. Accessed June 27, 2020. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 97 RISK STRATIFICATION SYSTEM AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 98  Exercise poses some risk. 1. Musculoskeletal 2. Cardiac AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 99 Prevent musculoskeletal injuries Warm up Start low Go slow Cool Down Stretch after AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 100  There is a risk stratification system. American College of Sports Medicine Low risk Moderate risk High risk American College of Sports Medicine. ACSM's health-related physical fitness assessment manual. Lippincott Williams & Wilkins; 2013: 15-20. AMERICAN COLLEGE OF LIFESTYLE MEDICINE JULY 2020. ALL RIGHTS RESERVED. 101 Low risk Low Risk = Men < 45 and Women