prof dr maha and prof dr hanan diploma lecture 8 september 2023.pdf

OBESITY AND PHYSICAL ACTIVITY DR SAIF MEHMED PT,MSc,Phd. [email protected] Consultant of [email protected] 01555536541 Physical therapy 01091702729 ,Cardiopulmonary & Geriatric Rehabilitation  Obesity, Inflammation,...

OBESITY AND PHYSICAL ACTIVITY DR SAIF MEHMED PT,MSc,Phd. [email protected] Consultant of [email protected] 01555536541 Physical therapy 01091702729 ,Cardiopulmonary & Geriatric Rehabilitation  Obesity, Inflammation, and Chronic Disease 1 Inflammation is the cornerstone for many chronic diseases. In atherosclerosis, chronic inflammation promotes pathological remodeling of the blood vessel walls, resulting in a plaque that occludes blood flow. Blood vessel plaques can eventually rupture, resulting in vascular events including heart attacks, strokes, and peripheral vascular events. Obesity promotes inflammation and may accelerate the disease process. Blood markers of inflammation can be predictive of pathological processes that cause chronic diseases. © McGraw Hill 2  Obesity, Inflammation, and Chronic Disease 2 Low-grade chronic inflammation. High levels of inflammatory cytokines. TNF-a, IL-6, CRP. Adipocytes secrete cytokines. Adiponectin is anti-inflammatory. IL-6 and TNF-a are inflammatory. © McGraw Hill 3  Obesity, Inflammation, and Chronic Disease 3 Visceral fat secretes more inflammatory cytokines. Interfere with action of insulin (insulin resistance). Leads to type 2 diabetes, CVD, & metabolic syndrome. C-reactive protein (CRP). Marker of inflammation. © McGraw Hill 4  Inflammation Leading to Atherosclerosis Adapted from Libby, P., “Atherosclerosis: The New View,” Scientific American, May 2002, p. 46–55. Access the text alternative for slide images. Figure 15.9 © McGraw Hill 5  Drugs, Diet, and Physical Activity-impact on Chronic Inflammation Statin drugs. Lower LDL-C and CRP. Can reduce risk of cardiovascular disease and death. Mediterranean diet. Fruits, vegetables, legumes, whole grains, olive oil. Reductions in CRP and IL-6. Physical activity and/or fitness. Lower levels of inflammation. IL-6 produced has an anti-inflammatory effect. © McGraw Hill 6  How does Exercise Training Reduce Chronic Inflammation in Obesity? Adapted from You T., Arsenis, N. C., Disanzo, B. L., and LaMonte, M. J., “Effects of Exercise Training on Chronic Inflammation in Obesity,” Sports Medicine 43: 243–256, 2013. Access the text alternative for slide images. Figure 15.10 © McGraw Hill 7  Web of Causation for Atherosclerosis A web of causation shows how genetic, environmental, and behavioral factors interact to cause atherosclerosis. © McGraw Hill 8  Risk Factors for Coronary Heart Disease (CHD) Associated with atherosclerosis. Thickening of the inner lining of arteries. Leading pathological contributor to heart attack and stroke death. Associated with risk factors. Each risk factor magnifies the risk of CHD. Eliminating a risk factor causes a reduction in risk. © McGraw Hill 9  Coronary Atherosclerosis Figure 15.5 © McGraw Hill 10  Risk Factors for Coronary Heart Disease (ACSM) Age.* Family History.* Cigarette Smoking. Sedentary Lifestyle. Obesity. Hypertension. Dyslipidemia. Prediabetes. * Cannot be changed. © McGraw Hill 11  Sedentary Behavior and All-Cause Mortality 1 Sedentary behavior defined as: Waking activity performed in sitting, reclining or lying posture. < 1.5 METs. Physical inactivity defined as: Not achieving recommended amounts of moderate-vigorous physical activity (M V P A). © McGraw Hill 12  Sedentary Behavior and All-Cause Mortality 2 Sedentary and physically active It is possible to be mostly sedentary throughout the day but to also achieve the recommended amount of MVPA. Being both sedentary and active is problematic because: Highly sedentary people are a at higher risk for all-cause mortality. Being physically active does not completely counter negative effects of being highly sedentary. © McGraw Hill 13  MVPA, All-Cause Mortality, and Daily Sitting or TV Watching Access the text alternative for slide images. Figure 15.6 © McGraw Hill 14  The Risk of Physical Inactivity Versus the Benefits of Being Active Most adults are either inactive or insufficiently active Inactivity is an independent risk factor for CHD. Relative risk of CHD due to inactivity is similar to other risk factors. Smoking. High cholesterol. High blood pressure. © McGraw Hill 15  U S Population at Risk of CHD Access the text alternative for slide images. Figure 15.7 © McGraw Hill 16  Physical Activity and Hypertension Physical activity among the most potent non-pharmacological interventions to treat hypertension. Exercise training can lower resting SBP by an average of 5-8 mm Hg. © McGraw Hill 17  Categorization of Blood Pressure in Resting Adults Blood Pressure Systolic Blood And/or Diastolic Blood Category Pressure Pressure Normal 5% initial body weight). Requires exercise volume and intensity that is hard for many obese and overweight persons to achieve desired weight loss. >1,200 to 2,000 weekly Kcal expenditures required. Exercise counters the negative effects of obesity and overweight independent of weight loss. © McGraw Hill 22  Physical Activity and Dyslipidemia Dyslipidemia. An unhealthy cholesterol and triglyceride profile. Promotes atherosclerosis. Can be improved by regular exercise, a healthy diet, and pharmacologic drugs called “statins”. Exercise dose may alter these effects. Some evidence to suggest >450 to 500 Kcals/session. Exercise + statins may have additive effects for improving cholesterol profiles. © McGraw Hill 23  Metabolic Syndrome Metabolic syndrome is a cluster of risk factors that promote the development of coronary heart disease. An individual that has three or more of the following risk factors is considered to have the metabolic syndrome: Abdominal obesity. Waist circumference >102 cm (men) and >88 cm (women). Hypertriglyceridemia. ≥150 mg/dl. Low HDL cholesterol. prediabetics > normal. Post-O G T T insulin levels rise. © McGraw Hill 35  Clinical Progression of Type 2 Diabetes 2 Normal response peaks within 30 minutes. Prediabetics have an exaggerated, time-delayed response. Insulin release is overcompensating. Less severe diabetics have a time-delayed response with “normal” insulin levels. Insulin release can no longer overcompensate. Severe diabetics have a very blunted response. © McGraw Hill 36  Oral Glucose Tolerance in Type 2 Diabetics and Prediabetics Data from Taylor S, Accili D, and Imai Y Insulin resistance of insulin deficiency: which is the primary cause of NIDDM?, Diabetes 43: 735–740, 1994 Access the text alternative for slide images. Figure 15.13 © McGraw Hill 37  Physical Activity, Lifestyle Modifications, and Type 2 Diabetes Type 2 diabetes is treated and improved by: Regular physical activity and exercise. 150+ minutes of weekly physical activity, preferably daily. Strength exercise. Combined aerobic and strength exercise. Dietary restrictions. Weight loss. © McGraw Hill 38  Cancer Cancer caused by an uncontrolled division of cells. 2nd leading cause of death worldwide. More than 100 types of cancer exist. Cancer cells invade normal tissues, alter normal physiologic function. © McGraw Hill 39  Physical Activity, and Cancer Prevention and Occurrence Cancer incidence is heavily influenced by lifestyle factors. Inactivity linked to increased cancer incidence. 3% of all cancers attributable to inactivity. 5% to 8% of cancers related to being overweight. Being physically active linked to cancer prevention. Lowers the risk of many major forms of cancer by 12% to 25%. © McGraw Hill 40  Table 15.3: The Relationship Between Physical Activity and Relative Risk Reduction for the Development of Certain Types of Cancer Cancer Type Strength of Relative Risk Does Response Evidence Reduction (%) Bladder Strong 15% Yes Breast Strong 12% to 21% Yes Colon Strong 19% Yes Endometrial Strong 20% Yes Esophageal Strong 21% No Gastric Strong 19% Yes Renal Strong 12% Yes Lung Moderate 21% to 25% Yes Source: Adapted from McTiernan A Friedenreich C, Katzmarzyk P, Powell K, Macko R, Buckner D, et al, Physical activity and cancer prevention and survival: A systemic review, Medicine and Science in Sports and Exercise 51: 1252-1261, 2019 © McGraw Hill 41  Physical Activity and Cancer Treatment and Survival Cancer treatment and survival. A wide variety of treatment options/combinations. Chemotherapy, radiation, surgery, hormone therapies, immunotherapies. Common outcome - cancer patients experience a drop in aerobic capacity and muscular strength. Survival odds are improved in those who are physically active. Aerobic capacity and muscular strength losses are minimized with exercise training. © McGraw Hill 42  Muscle and Bone Health in Cancer Patients Muscle and bone mineral density (BMD) loss due to necessary cancer treatments is considered to be collateral damage. Losses in muscle mass and BMD also influenced by cachexia signals from cancer cells. BMD declines in cancer patients is a co-morbidity associated with cancer. Increased falls and fractures in cancer patients. © McGraw Hill 43  Physical Activity and Cancer Recurrence Physically active cancer survivors have lower rates of cancer recurrence. 35% lower recurrence for all types of cancer. 28% to 44% lower mortality rates for various types of cancer. © McGraw Hill 44  Physical Activity and Exercise during Chemotherapy Physical activity and exercise now recognized to benefit chemotherapy patients. Limits fatigue associated with treatment. Preserves muscle mass. Preserves bone mineral density. 90 minutes of combined aerobic and strength exercise, 3 times/week recommended. Clinically-based cancer rehabilitation programs becoming more popular. © McGraw Hill 45  Physical Activity and Terminally 3 Cancer Patients Physical activity can improve the quality and duration of life in terminally ill cancer patients. Slows cachexia, preserves lean body mass. Improves sleep quality. Improves mood states. Limits fatigue symptoms. Limits depression incidence and severity. © McGraw Hill 46 © McGraw Hill 47 © McGraw Hill 48 © McGraw Hill 49 © McGraw Hill 50 © McGraw Hill 51 © McGraw Hill 52 © McGraw Hill 53 © McGraw Hill 54 © McGraw Hill 55 © McGraw Hill 56 © McGraw Hill 57 © McGraw Hill 58 © McGraw Hill 59 © McGraw Hill 60 © McGraw Hill 61 © McGraw Hill 62 © McGraw Hill 63 © McGraw Hill 64 © McGraw Hill 65 © McGraw Hill 66 © McGraw Hill 67 Assessment of exercise intensity: 1. Maximum o2 consumption (V02 max) 2. Maximum heart rate (HR max) 3. Rate of perceived exertion (RPE) FORMULA FOR ESTIMATING TARGET HEART RATE Formula for estimating maximum heart rate (HRmax): HRmax = 220 - Age Formula for estimating target (training) heart rate: HRmax X exercise intensity, i.e. 50%, 60%, 70%, 80% etc.  VO2 max is expressed either as an absolute rate in litres of oxygen per minute (l/min) or as a relative rate in millilitres of oxygen per kilogram of bodyweight per minute (ml/kg/min). The latter expression is often used to compare the performance of endurance sports athletes. In general clinical and athletic testing, this usually involves a graded exercise test (either on a treadmill or on a cycle ergometer) in which exercise intensity is progressively increased while measuring ventilation and oxygen and carbon dioxide concentration of the inhaled and exhaled air. VO2 max is reached when oxygen consumption remains at steady state despite an increase in workload.  Rate of perceived exertion Borg scale 6-20: 6 No exertion at all 7 Extremely light 8 9 Very light - (easy walking slowly at a comfortable pace) 10 11 Light 12 13 Somewhat hard (It is quite an effort; you feel tired but can continue) 14 15 Hard (heavy) 16 17 Very hard (very strenuous, and you are very fatigued) 18 19 Extremely hard (You can not continue for long at this pace) 20 Maximal exertion  How to Use the Perceived Exertion Scale While doing physical activity, we want you to rate your perception of exertion. This feeling should reflect how heavy and strenuous the exercise feels to you, combining all sensations and feelings of physical stress, effort, and fatigue. Do not concern yourself with any one factor such as leg pain or shortness of breath, but try to focus on your total feeling of exertion. Look at the rating scale below while you are engaging in an activity; it ranges from 6 to 20, where 6 means "no exertion at all" and 20 means "maximal exertion." Choose the number from below that best describes your level of exertion. This will give you a good idea of the intensity level of your activity, and you can use this information to speed up or slow down your movements to reach your desired range. Try to appraise your feeling of exertion as honestly as possible, without thinking about what the actual physical load is. Your own feeling of effort and exertion is important, not how it compares to other people's. Look at the scales and the expressions and then give a number. In the late 1980’s and early 1990’s one of the more popular theories or prescriptions for exercise was to promote low intensity exercise to increase the loss of body fat. The theory was that lower intensity exercise iS better for using the body’s fat stores.  Components of exercise program: Intensity Duration PER TRAINING SESSION Frequency NUMBER OF TRAINIG DAYS PER WEEK MODE AEROBIC ,ANAEROBIC, HIGH INTERVAL TRAINING ,CIRCUIT TRAINING PROGRESSION GENERAL SPEAKING IN PROGRESION OF EXERCISE THE FIRST TO DETERMINE IS THE INTENISTY AND IT IS THE LAST ONE TO BE PROGRESSED OR INCREASED SO WE CAN PROGRESS FIRST BY FREQUNCY AND DURATION THEN THE INENISTY CAN BE INCREASED THIS IS PARTICULARY IN SEDENTARY ,OBESE AND LOW FITNESS LEVEL PERSONS>  WE STILL HAVE TO KNOW ABOUT 1. Training Zones – Myths, Misconceptions 2. Determine types of weight-loss interventions that contribute to successful outcomes and to define expected weight-loss outcomes from such interventions.”EXECISE IS OUR CONCERN”. 3. Effects of the Amount of Exercise on Body Weight, Body Composition, and Measures of Central Obesity. 4. High versus low intensity Effect of exercise training intensity on abdominal visceral fat and body composition 5. How much physical activity is enough to prevent unhealthy weight gain? 1. Training Zones Myths,Misconceptions In the late 1980’s and early 1990’s one of the more popular theories or prescriptions for exercise was to promote low intensity exercise to increase the loss of body fat. The theory was that lower intensity exercise is better for using the body’s fat stores. While a greater percentage of fat is utilized during exercise at lower intensities, higher intensity exercise will use more calories, which will include more carbohydrate and more fat. The key ingredient is intensity, the harder you work the more calories and fat you will lose. Source : Sports Dietitian Fact Sheet 4 March 1999  2. Determine types of weight-loss interventions that contribute to successful outcomes and to define expected weight-loss outcomes from such interventions.”EXECISE IS OUR CONCERN”. BMI is the standard for clinical guidelines designed to select among treatment modalities. In general: BMI 20 to 25 normal : diet, exercise and lifestyle change 25 to 30 : diet, exercise and lifestyle change (DEL) 30 to 35: DEL + pharmacotherapy 35 to 40: DEL + pharmacotherapy or surgery (if co- morbidity) > 40: DEL + pharmacotherapy or surgery  Weight-Loss Outcomes: A Systematic Review and Meta-Analysis of Weight-Loss Clinical Trials with a Minimum 1-Year Follow-Up Marion J. Franz, MS, RD, Jeffrey J. VanWormer, MS, A. Lauren Crain, PhD ,Jackie L. Boucher, MS, RD,Trina Histon, PhD,William Caplan, MD, Jill D. Bowman, Nicolas P. Pronk, PhD Objective to determine types of weight-loss interventions that contribute to successful outcomes and to define expected weight- loss outcomes from such interventions.  The primary outcomes were a measure of weight loss at 6, 12, 24, 36, and 48 months. Eight types of weight-loss interventions 1. —diet alone. 2. exercise alone, 3. meal replacements, 4. very-low-energy diets, 5. weight-loss medications (orlistat and sibutramine), 6. and advice alone  A mean weight loss of 5 to 8.5 kg (5% to 9%) was observed during the first 6 months from interventions involving a reduced-energy diet and/or weight-loss medications with weight plateaus at approximately 6 months. In studies extending to 48 months, a mean 3 to 6 kg (3% to 6%) of weight loss was maintained with none of the groups experiencing weight regain to baseline. In contrast, advice-only and exercise-alone groups experienced minimal weight loss at any time point. CONCLUSION Weight-loss interventions utilizing a reduced- energy diet and exercise are associated with moderate weight loss at 6 months. Although there is some regain of weight, weight loss can be maintained. The addition of weight- loss medications somewhat enhances weight- loss maintenance. 3. Effects of the Amount of Exercise on Body Weight, Body Composition, and Measures of Central Obesity. Effects of the Amount of Exercise on Body Weight, Body Composition, and Measures of Central Obesity STRRIDE—A Randomized Controlled Study Cris A. Slentz, PHD; Brian D. Duscha, MS; Johanna L. Johnson, MS; Kevin Ketchum, MS; Lori B. Aiken, BS; Gregory P. Samsa, PHD; Joseph A. Houmard, PHD; Connie W. Bales, PHD, RD; William E. Kraus, MD Arch Intern Med. 2004;164(1):31-39. doi:10.1001/archinte.164.1.31  Background Obesity is a major health problem due, in part, to physical inactivity. The amount of activity needed to prevent weight gain is unknown. Objective To determine the effects of different amounts and intensities of exercise training.  Design Randomized controlled trial (February 1999–July 2002). Setting and Participants Sedentary, overweight men and women (aged 40-65 years) with mild to moderate dyslipidemia Interventions Eight-month exercise program with 3 groups: (1) high amount/vigorous intensity (calorically equivalent to approximately 20 miles [32.0 km] of jogging per week at 65%- 80% peak oxygen consumption); (2) low amount/vigorous intensity (equivalent to approximately 12 miles [19.2 km] of jogging per week at 65%-80%), and (3) low amount/moderate intensity (equivalent to approximately 12 miles [19.2 km] of walking per week at 40%-55%). Subjects were counseled not to change their diet and were encouraged to maintain body weight.  Results dose-response relationship between amount of exercise and amount of weight loss and fat mass loss. The high-amount/vigorous-intensity group lost significantly more body mass (in mean [SD] kilograms) and fat mass (in mean [SD] kilograms) (−2.9 [2.8] and −4.8 [3.0], respectively) than the low-amount/moderate-intensity group (−0.9 [1.8] and −2.0 [2.6], respectively), the low-amount/vigorous- intensity group (−0.6 [2.0] and −2.5 [3.4], respectively), and the controls (+1.0 [2.1] and +0.4 [3.0], respectively). Both low-amount groups had significantly greater improvements than controls but were not different from each other. Compared with controls, all exercise groups significantly decreased abdominal, minimal waist, and hip circumference measurements. There were no significant changes in dietary intake for any group.  conclusion In nondieting, overweight subjects, the controls gained weight, both low-amount exercise groups lost weight and fat, the high-amount group lost more of each in a dose-response manner. These findings strongly suggest that, absent changes in diet, a higher amount of activity is necessary for weight maintenance and that the positive caloric imbalance observed in the overweight controls is small and can be reversed by a modest amount of exercise. Most individuals can accomplish this by walking 30 minutes every day There was an initial ramp period of 2 to 3 months in which exercise duration (in minutes) and exercise intensity were gradually increased until the appropriate exercise prescription was obtained. The initial ramp was followed by 6 additional months of training at the appropriate exercise prescription. The present study suggests, the first 6 to 7 miles (9.6-11.2 km) of exercise per week may be necessary just to prevent further weight gain. Ross et al,22 who for the first time compared an exercise amount that was designed to increase energy expenditure by the same number of kilocalories as the diet intervention decreased energy consumption (ie, 700 kcal/d). They found identical weight loss (ie, both groups lost 7.5 kg [8%] of body weight), with the exercise group losing significantly more fat mass than the diet group. With regard to exercise, weight change is all about the degree of caloric imbalance created through the exercise program. the high amount of weekly exercise (caloric equivalent of 17 miles [27.2 km]/wk) resulted in a combined (gain by controls − loss by exercise groups) –4-kg body mass change, a −5.2-kg fat mass change, and a −4.6-cm (almost 2-in) reduction in the abdominal waist circumference compared with what would have occurred without exercise.  improvements in insulin sensitivity and fasting plasma glucose,27 This amount of exercise can be achieved by most sedentary individuals (81% in this study) by accumulating approximately 3.5 hours of vigorous intensity exercise per week. However, it is important to understand that the amount of time required to accumulate the equivalent of approximately 17 to 18 miles (27.3-28.8 km)/wk varies based on fitness levels. For this reason, to get the exercise stimulus used in this study, we recommend that total amount of activity be the goal rather than a certain amount of time per week 1500 kcal/wk was adequate to prevent weight regain in men who had previously lost an average of 12 kg by diet plus exercise. It was shown that in women who lost weight through 6 months of diet and exercise, those who averaged approximately 280 min/wk (40 min/d) maintained their weight loss over an additional 12 months. Mayer hypothesis that a minimal amount of physical activity is necessary for appropriate weight control.minimal level may be as low as 6 miles (9.6 km) of walking (or other equivalent caloric expenditure) per week. Additionally, this study revealed a clear dose-response effect between amount of weekly exercise and decreases in measurements of central obesity and total body fat mass. Our findings suggest that: a modest amount of exercise can prevent weight gain with no changes in diet. and more exercise may lead to important weight loss in initially overweight individuals.  4- High versus low intensity Effect of exercise training intensity on abdominal visceral fat and body composition High versus low intensity Effect of exercise training intensity on abdominal visceral fat and body composition Brian A. Irving, Ph.D., Christopher K. Davis, M.D., Ph.D., and Arthur Weltman, Ph.D Purpose To examine the effects of exercise training intensity on abdominal visceral fat (AVF) and body composition in obese women with the metabolic syndrome.  Methods 16-week aerobic exercise interventions computed tomography scans obtained at the L4-L5 disc-space and mid-thigh were used to determine abdominal fat and thigh muscle cross-sectional areas. Percent body fat was assessed (i) No Exercise Training (Control): Seven participants maintained their existing levels of physical activity, (ii) Low-Intensity Exercise Training (LIET): eleven participants exercised 5 days · week-1 at an intensity ≤ lactate threshold (LT) (iii) High-Intensity Exercise Training (HIET): nine participants exercised 3 days · week-1 at an intensity > LT and 2 days ·week-1 ≤ LT. Exercise time was adjusted to maintain caloric expenditure (400 kcal·session-1).  Results HIET significantly reduced total abdominal fat (p30 km/w is better than moderate amount exercise in weight reduction and fat burning. 2. Low amount exercise moderate intensity give better results than high intensity in fat burning and weight maintenance. 3. Lower limits of exercise amount for weight control =8 km/week. 4. 1600 kcal /week is higher than the target for weight maintenance and the target is 280 minutes of exercise per week. 5. Fat burning and weight reduction are dose response relation ship.  PREVIOUS HOME MESSAGE WAS EXERCISE IS IMPORTAN FOR WEIGHT LOSS AND CONTROL AND IN ALL BMI DIGESTION IS AN EXERCISE AND PHYSICAL ACTIVITY SO DON’T MISS YOUR MEAL. MORE OF THE WEIGHT LOSS BY DIETING ALONE IS FROM LEAN BODY MASS AEROBIC EXERCISE AT LOWER INTENISTY UTILIZE FAT AS AMEAN SOURCE OF FUEL. ANAEROBIC EXERCISE AFFECT BODY WEIGHT THROUGH EXCESS POST EXERCISE O2 CONSUMPTION (EPOC) AND INCREASE BASAL METABOLIC RATE. HIGH INENSITY INTERVAL TRAINING (HIIT) IS A MODE OF EXERCISE THAT USE AEROBIC AND ANAEROBIC MODES.  WHEN THERE IS NO TIME TO EXERCISE WE CAN PROGRESS BY INCREASING INETNISTY OF EXECISE THROUGH FIXING THE TIME AND INCREASING THE DISTANCE WALKED LATER OR USE(HIIT). RATE OF PERCIEVED EXERTION (RPE) MEANS HOW HARD THE EXERCISE IS AND IS AGOOD MEASURE OF EXERCISE INTENISTY IN PATIENT WITH AUTONOMIC NEUROPATHY AND /OR THOSE TAKING BETA BLOCKER. 6-20 POINT SCALE ARATING OF 12 WOULD CORRESPOND TO APPROXIMATELY.55% OF THR ZONE AND 16 TO APROXIMATELY.85% OFTRAINING ZONE TO UTILIZE FAT AS AFUEL WE ASK THE PATIENT TO USE SCORE FROM 10 TO 12  OBESE AND OVER WEIGHT WITH OSTEOARTHRITIC PAIN OR LOW BACK PAIN CAN GET BENEFIT FROM EXERCISE IN STATIONARY BIKE RATHER THAN ON TREADMAIL SWIMMING WHEN AVAILABLE IS AGOOD EXERCISE FOR OBESE GETTING THE BENEFIT OF WATER LIFTING BODY AND NO MUSCOLSKELETAL INJURY. IT IS BETER NOT TO HOLD YOUR BREATH DURING EXERCISE AS O2 IS THE FAT BURNER. WARMING UP AND CALLING DOWN ARE IMPORTANT AND IT IS BETER TO START WITH LOWER LIMB EXERCISE ?  ATEAM WORK WILL RESULT IN PATIENT BENEFIT AND TIME SAVING AND KNOWLEDGE TRANSFER SO HERE ARE MY DATA TO TRANSFER KNOWLEDGE OR PARTICIPATE IN A TEAM WORK SAIF RAGAB TEACHING ASSISSTANT FACULITY OF PHYSICAL THERAPY CAIRO UNIVERSITY DEPARTMENT OF: CARDIOPVASCULAR/ RESPIRATORY DISORDER AND GERIATRICS [email protected] MOBILE : -00201091702729.  NOW THE HOME MESSAGE IS THE TARGET IS 1. KNOWLEDGE FROM EVIDENCE BASED PRACTICE. 2. design exercise program to decrease and maintain the weight.  1- true 2,3>>false 4,5 >>true.  Combined Strength and Endurance Training Program (Concurrent Training) Combined strength and endurance training may limit strength gains vs. strength training alone. Depends on: Training state of subject. Volume and frequency of training. Way the two methods are integrated. Endurance training ≥3 days per week and 30 to 40 minutes per day. Perform strength and endurance training on alternate days for optimal strength gains. Athletes whose sport requires maximal strength should avoid concurrent training. © McGraw Hill 105  Carbohydrate Availability and Endurance Training Adaptations Low muscle glycogen is a positive influence on endurance training-induced adaptations. Promotes increased protein synthesis and mitochondria formation. Due to higher activation of PGC-1α. Two approaches. Restrict dietary carbohydrates. May cause fatigue and limit training. Train twice per day (every other day). Second training session with lower muscle glycogen. © McGraw Hill 106  Protein Availability and Muscle Protein Synthesis Ingesting protein increases rate of protein synthesis post- training. For both endurance and resistance training. Plan protein intake around workouts. Both protein amount and timing. © McGraw Hill 107  Supplementation with Mega Doses of Antioxidants Exercise promotes formation of free radicals. May damage cells and contribute to fatigue. Antioxidant supplements may prevent damage and fatigue. However, high doses of antioxidants may block training adaptations. Free radicals activate signaling pathways involved in muscle adaptation to training. © McGraw Hill 108  Muscle Soreness Delayed onset muscle soreness (DOMS). Appears 24 to 48 hours after strenuous exercise. Due to microscopic tears in muscle fibers or connective tissue. Results in cellular degradation and inflammatory response. Not due to lactic acid. Eccentric exercise causes more damage than concentric exercise. Slowly begin a specific exercise over 5 to 10 training sessions to avoid DOMS. © McGraw Hill 109  Steps Leading to DOMS Strenuous muscle contraction results in muscle damage. Membrane damage occurs. Including sarcoplasmic reticulum. Calcium leaks out of SR and collects in mitochondria. Inhibits ATP production. Activates proteases which degrade contractile proteins. Results in inflammatory process. Increase in prostaglandins/histamines/free radicals. Edema and histamines stimulate pain receptors. © McGraw Hill 110  Steps Leading to Delayed Onset Muscle Soreness Access the text alternative for slide Figure 20.11 image © McGraw Hill 111  Treatment of DOMS Clinical Applications 20.1 Common treatments for DOMS include: Rest, ice, compression, and elevation (RICE) along with the use of nonsteroidal anti-inflammatory drugs (examples: aspirin, ibuprofen, or naproxen). RICE treatment recommended for minor soft tissue (example: skeletal muscle). Strategy reduces swelling/inflammation. Lessens pain. Anti-inflammatory drugs also reduce severe DOMS- associated pain. Specific type of drug, dosage, and treatment pattern that is most effective in lessening DOMS pain is debated. © McGraw Hill 112  The Repeated Bout Effect Research Focus 20.2 An unfamiliar exercise bout results in DOMS. Following recovery, another bout of same exercise results in minimal injury. Theories for the repeated bout effect. Neural theory. Recruitment of larger number of muscle fibers. Connective tissue theory. Increased connective tissue to protect muscle. Cellular theory. Synthesis of “protective proteins” within muscle fiber. © McGraw Hill 113  Theories to Explain the “Repeated Bout Effect” Research Focus 20.2 Source: Adapted from McHugh, Malachy P., Declan A. J. Connolly, Roger G. Eston and Gilbert W. Gleim. “Exercise-Induced Muscle Damage and Potential Mechanisms for the Repeated Bout Effect.” Sports Medicine 27, no. 3 (March 1999): 157–170. Access the text alternative for slide Figure 20.12 image © McGraw Hill 114  Common Training Mistakes Overtraining. Workouts that are too long or too strenuous. Greater problem than undertraining. Undertraining. Performing non-specific exercises. Do not enhance energy capacities used in competition. A lack of a long-term training plan. Misuse of training time. Failure to taper before a performance. Inadequate rest; compromises performance. © McGraw Hill 115  Symptoms of Overtraining Overtraining symptoms include: Elevated heart rate and blood lactate levels. At same submaximal work rate. Loss in body weight. Due to reduction in appetite. Chronic fatigue. Psychological staleness. Multiple colds or sore throats. Decrease in performance. © McGraw Hill 116  Common Symptoms of Overtraining Access the text alternative for slide Figure 20.14 image © McGraw Hill 117  Tapering Tapering: Is the short-term reduction in training load prior to competition. Allows muscles to resynthesize glycogen and heal from training- induced damage. Improves performance in both strength and endurance events. Athletes can reduce training load by 60% without a reduction in performance. © McGraw Hill 118 © McGraw Hill 119 © McGraw Hill 120 © McGraw Hill 121 © McGraw Hill 122 © McGraw Hill 123 © McGraw Hill 124 © McGraw Hill 125 © McGraw Hill 126 © McGraw Hill 127  THANK YOU © McGraw Hill 128