Exercise

Question 1

Exercise - History

Answer 1

Claudius galenus AD131 promoted his belief that everyone could benefit from exercise

Many ancient cultures recognised the role of PA in promoting health of body & mind - document written between 800-1000BC recommended massage & exercise in treatment of rheumatism

1950s- Paul Dudley White prescribed exercise as part of treatment for patients with CHD

1980s onwards - growing awareness of contribution of moderate PA to health & fitness

Question 2

London Bus Stud

Morris et al 1953

Answer 2

First epidemiological PA study

double decker bus conductors=active, climbing stairs etc = decr risk of CHD

Drivers = mostly sedentary = incr risk of CHD

1st study to show assoc b/ PA and risk of HD

Question 3

Physiological benefits of exercise

Answer 3

20-30% decr risk of premature death

50% decr risk of developing chronic diseases

Incr QOL & incr independence in later life

Decr obesity - link with other essay

Approx 9% deaths avoidable if sedentary people did at least 30 mins exercise 5d/wk incl >1/3 deaths due to CHD

Question 4

BMJ Article Fentem 1994

Answer 4

Skeletal musc functions enhanced: ↑metabolic capacity & nutrient blood supply, ↑strength & contractility

Tendon & connective tissue functions enhanced: ↑strength, supportive function, joint stability

Joint functions enhanced by exercise: lubrication, range of movement and maintenance of flexibility

Question 5

Cardiovascular function & cardiac function

Answer 5

Aim of rehab is to increase patients general capacity for physical work via a programme of regular exercise

regular exercise incr heart health in two ways:

1. ↓HR w/ improvement in aerobic fitness = energy req of heart less
2. Systematic arterial BP ↓ = also ↓ heart muscle workload

Maximal myocardial performance is ↑ allowing more exercise to be taken than before

Active cardiac rehab = physiologically sound

Hazard of exercise for patients but benefits outweigh the risks

Pts should be encouraged to ↑intensity of exercise cautiously. Increments every 8-10 weeks

Question 6

Exercise & T2D: Colberg et al 2010

Answer 6

PA is key element in T2D prevention & management but many with the disease do not become/remain physically active

Participation in reg PA improves blood glucose and can orevent/delay T2D

positively affects lipids, BP, CV events, mortality and QOL

Structured interventions combining PA and modest weight loss have been shown to ↓T2D risk by ~58% in high risk pops

Question 7

Exercise & T2D: Colberg et al 2010

concl.

Answer 7

Exercise plays a major role in the prevention and control of insulin resistance, prediabetes, GDM, type 2 diabetes, and diabetes-related health complications.

Both aerobic and resistance training improve insulin action and can assist with the management of BG levels, lipids, BP, CV risk, mortality, and QOL, but exercise must be undertaken regularly to have continued benefits and likely include regular training of varying types.

Most persons with type 2 diabetes can perform exercise safely as long as certain precautions are taken. The inclusion of an exercise program or other means of increasing overall PA is critical for optimal health in individuals with type 2 diabetes

Question 8

Exercise psychological beenfits:

BDNF

Answer 8

BDNF plays a significant role in neurogenesis. BDNF acts on certain neurons of the CNS & PNS, helping to support survival of existing neurons & encourage the growth and differentiation of new neurons and synapses.

active in the hippocampus, cortex & basal forebrain - areas vital to learning, memory and higher thinking. It is important in long-term memory.

Serum brain-derived neurotrophic factor levels before and after 8 weeks of training- (threefold) increase BDNF synthesis in the human brain, a phenomenon which is partly responsible for exercise-induced neurogenesis and improvements in cognitive function.

Question 9

BDNF Rat study

• Exercise has an anti-depressive effect - Russel Neustadt et al., 2001

Answer 9

• Rats assigned to 4 groups :

1. Engaged in ‘voluntary running’ on a wheel
2. Given anti-depressants
3. Both
4. Neither

Rats then underwent a 2-day forced swimming procedure

Results: BDNF levels in untreated animals were depressed, animals in physical training or anti-depressants had BDNF restored to baseline, animals with both showed increase in hippocampal BDNF well above baseline.

Question 10

Exercise provides “The Feel Good Factor”

Answer 10

• Distraction
• Relaxation/Stress
• Healthier Coping

Cross-sectional studies have consistently associated high self-reported levels of habitual physical activity with better mental health. The correlation of habitual exercise level with low depression in adolescents (Norris, Carroll, & Cochrane, 1992) is hard to interpret because control variables were omitted.

Using a similar, but large (N = 5,061) cohort, Steptoe and Butler (1996) showed that vigorous exercise participation was related to lower emotional distress, after controlling for social class and health status.

in 16,483 university undergraduates, reported exercise correlated with lower depression, after controlling for age and sex only. (Steptoe et al 1997)

Question 11

Opioid Mechanisms in effects of exercise

Answer 11

• Opioids – associated with increased mood and decreased pain sensations endorphins etc. – exercise increase these and is considered to be linked to post exercise mood enhancement.

Stress also activates central (and peripheral) opioid systems and this accounts for some instances of the analgesia which is caused by stress. Spontaneous exercise shares these effects, increasing endogenous opioid activity in the peripheral and central nervous system (Harber & Sutton, 1984);

Opioid mechanisms have also been implicated in mood improvement by running in regular runners; the opioid antagonists, naloxone, attenuated this effect (Allen & Coen 1987)

Question 12

Determinants of exercise adherence

Answer 12

Higher socio-economic status

Being male

Higher levels of enjoyment of PA

Greater belief in benefits of PA = “perceived benefits” - link to health belief mofel = more likely to take action

Reporting fewer barriers to PA

Higher levels of self-efficacy towards PA -overweight people likely to believe that they cannot do it. Low self-efficacy = feelings of hopelessness

Embarrassment = Obesity linked with low self-esteem – they have low self-efficacy but may also have experienced negative reaction to them exercising e.g people staring/laughing Classical conditioning?

Having had a physically active childhood – habits/routine – watching parents – social learning

Lower BMI = lower weight= physically easier

Question 13

Barriers to PA

Answer 13

Internal triggers: hunger/cravings/emotions & unhelpful thoughts – creating justifications like “ive worked hard, ill have a break today”
External triggers: It is starting to rain outside so don’t leave house to exercise
No time/too tired - stressful job/commuters/chronic fatigue etc

expensive to join gym/buy gymwear

Question 14

Transtheoretical Model: Exercise

Answer 14

STAGES OF CHANGE
• Precontemplation: Not currently taking regular physical activity and have no intention to change in the next 6 months
• Contemplation: Not currently taking regular physical activity but seriously intend to change in the next 6 months
• Preparation: Intention to start taking regular physical activity towards a criterion in the next month
• Action: Increases in physical activity have occurred over the last 6 months
• Maintenance: The period after the action stage until termination has been achieved

Question 15

TM PROS

Answer 15

• Intuitively appealing model which is popular in practice
• Broad-based and has identified many useful processes involved in physical activity behaviour change
• Predicts change in physical activity behaviour

Question 16

Application of TM to Exercise

Answer 16

TM has allowed researchers to identify and work with sedentary populations as an individual does not need to be an exerciser to fit the model

In helping somebody to modify a behaviour their SOC would be established and then the processes of change most applicable tot hat SOC would be uses to design an intervention - provides exercise consultant with an effective way of helping an individual to adopt a physically active lifestyle

Research has demonstrated that an integration of the stages and processes of change can provide a useful guide for physical activity interventions

Question 17

Woods et al 2002
Scottish Youths

Applying TM to exercise

Answer 17

PA levels in young adults in Scotland were low, research supports use of TM in designing PA interventions

Study used pre-post randomised control design to investigate the effectiveness of a self-instructional intervention for helping sedentary young adults to initiate PA

Post-intervention, significantly more of experimental group (68%) improved their exercise SOC from baseline (P<0.05)

Stage improvers scored significantly higher on all of the behavioral and four out of five of the cognitive processes of change

This inexpensive, self-instructional intervention, based on the TM and the `active living message’, is an effective method of assisting sedentary young adults to progress through the exercise SOC.

Question 18

Theory of planned Behaviour

Ahmad et al 2014

Answer 18

study found that – through the application of TPB – participation of subjects in doing exercise was mostly influenced by attitude among men and subjective norm among women

. “Not motivated to perform exercise” was a specific factor that affected attitude toward exercise in men; meanwhile, family and friends were the important supporters to engage exercise among women

An understanding of these motivational forces and barriers is invaluable in the planning and implementation of effective strategies and intervention programs to gain good compliance toward exercise among elderly individuals.

Our subjective norms are infuenced by our attitudes and perceived behavioural control, which leads to our intention e.g. norms in society, then our intention influences our behaviour.

Question 19

TPB Pros

Answer 19

• Intentions sometimes predict physical activity behaviour
• Highlights social norms
• Perceived control (e.g. childcare) often the most important factor
• Allows comparison of different aspects of physical activity behaviour e.g. perceived control for walking versus structured exercise
• Develops our understanding of attitudes and physical behaviour

Question 20

TPB cons

Answer 20

• Does not adequately address environmental influences (e.g. access to gym), social support, adoption versus maintenance of exercise behaviour.
• Intentions often do not predict behaviour

Question 21

HBM Pros

Answer 21

• Allows comparison of different influences on physical activity behaviours
• Identifies barriers to physical activity (e.g. lack of time, lack of social support) as being the most important, and threat as being least important.

Question 22

HBM Cons

Answer 22

• Threat does not predict physical activity behaviour
• Leaves out emotions, habit, social norms (e.g. friend starts exercising), and other motivations (e.g. appearance)
• Has intuitive appeal, but its application to physical activity has not been clearly demonstrated
• Does not define how to test relationships between different elements in the model

Question 23

How is exercise promoted in the UK?

Answer 23

• QA framework for GP exercise referral schemes
• Health Action Zones
• Local Policy e.g. Primary Care Trusts
• National Campaigns - free swimming, LEAP, media
• Environment restructuring

Question 24

Levels of intervention

Answer 24

Levels of intervention:
Individual: Allows tailoring, flexible scheduling, labour intensive
Group: Added group dynamics, ‘buddying’, less tailoring, less labour intensive
Organisational/community: (e.g. schools, corporate fitness, primary care): wide impact, existing infrastructures, lack of facilities and trained staff, often favours those who need it last
Societal: (e.g. mass media campaigns, transport policy, environment, PE currFiculum, insurance incentives: widest impace

Question 25

CBT for exercise counselling

Answer 25

Cognitive Behavioural exercise counselling:
• Decision balance sheets
• Goal setting: SMART (Specific, measurable, attainable, relevant, time based). Goal must be specific to physical activity - mode/type, intensity, duration, frequency e.g. to do a little HIIT session for 10 minutes in the morning before uni 3 times a week.
• Monitoring (e.g. diaries)
• Relapse prevention plans

Question 26

LEAP

Local Exercise Action Plans

Answer 26

• LEAP aimed to find the most effective type of interventions for getting the general population to initiate and maintain regular moderate intensity PA and o reduce no.s of sedentary adults & children

LEAP = £2.6million programme jointly funded by DOH, Countryside agency & Sport England

Each LEAP site piloted one or more PA interventions incl:

• Exercise referral
• Classes and groups
• Motivational interviewing
• Peer mentoring
• Campaigns & directories
• Outdoors and transport
• Training leaders and co-ordinators
• 5 LEAP sites ran community wide awareness raising campaigns aimed at general public

Question 27

LEAP Conclusions

Answer 27

• LEAP interventions were affordable, cost effective - offer potential savings to NHS & a worthwhile investment
• Economic analysis suggests LEAP is good value for money

Question 28

LEAP:

Wandsworth cycling campaign

Answer 28

‘active living’ map designed to encourage people to make PA a part of their day - gives info on local opportunities to be physically active

major strand of LEAP is to promote active travel e.g. walking/cycling - doesnt have to be all or nothing, can be getting off bus a stop earlier etc

^ The best way to encourage people to take exercise is to build physical activity into their daily routine

Question 29

Outdoor Gyms: Southwark

Answer 29

According to Sport England the main barriers to PA are cost and access:

Members of the public found indoor gyms put them under pressure. The outdoor gyms are free, flexible and closer to home - removed some barriers facing those of lower income

Question 30

adiZones - olympic legacy programme

Answer 30

outdoor gym compant delivered olympic legacy programme - adiZones - 40 adizones rolled out for the price of one swimming pool - cheaper and much wider reach as more barriers exist for accessing swimming pool than outdoor gym

In Summer 2010 478 interviews were carried out across 10 UK adiZones, covering a mix of ages, genders and ethnic groups

62% agreed that the adiZone has helped them become more active in sports and exercise. This shift was even more apparent in younger respondents; 73% of under 16 year olds, and 67% of 16-24 year olds.

Indoor gyms can be intimidating – those with low self-efficacy less likely to go

Question 31

Age & Exercise

Answer 31

• As age progresses we are getting less active – daily routine is becoming more sedentary e.g. sitting at a computer at work, watching TV at home, driving or getting public transport everywhere rather than walking etc.

Question 32

Heyn at al 2004 - exercise/dementia meta-analysis

Answer 32

Exercise training increases fitness, physical function, cognitive function, and positive behavior in people with dementia and related cognitive impairments.

Question 33

Ahlskog et al, 2011

Hippocampapl volumes - exercise

Answer 33

Brain gray matter volumes decrease with age, seen via MRI

A recent RCT in a large cohort of seniors documented significantly larger hippocampal volumes after 1 year of aerobic exercise, compared with the control intervention of simple stretching and toning.

This finding was associated with significant improvement in the primary cognitive outcome measure of spatial memor

Question 34

Gschwind et al, 2013

Falls prevention

Answer 34

Falls = common in elderly and can lead to serious fractures e.g. hip which then lead to more serious health conditions and sometimes elderly do not recover

implementing light regular exercise intervention in elderly resulted in improved balance and gait, improved muscle power and strength and a decrease in falls