Introduction to Physical Activity and Health

Question 1

What do physical therapists do?

Answer 1

• assess/improve function
• decrease pain
• combination of these activities

Question 2

Overarching Prevailing Principle of PT

Answer 2

• balance physiological stress of disease, injury, therapeutic intervention
• with patient’s ability to recover

Question 3

The Problem

Answer 3

• life in 21st century US: marked by prevailing poor nutrition, physical inactivity, and poor fitness
• current US activity levels: 23% of adults report exercising vigorously; greater than or equal to 50% VO2max for 20+ minutes 3+ times/week
• 38% of adults report fully sedentary lifestyles
• inactivity disparities worse based on race, socioeconomic status, disability

Question 4

Inactivity and the Obesity Epidemic-Definitions

Answer 4

• obesity: BMI greater than or equal to 30
• BMI: measure of adults weight in relation to height
• adults weight in kilograms divided by height in meters

Question 5

The Impact of Inactivity on Physiology

Answer 5

• people today don’t just look different, they are different
• activity–>physiological adaptation, cessation of activity–>physiological adaptation, “acute” inactivity, “chronic” inactivity
• “use it or lose it”
• this presents challenges: decreased quality of life for the individual, increase in health-care associated costs for individual, taxpayers, business, etc

Question 6

Challenge of Understanding Inactivity vs. Aging

Answer 6

• early research in aging: emphasized average age-related losses and neglected the substantial heterogeneity (treated everyday like they were the same) of older persons
• the effect of the aging process itself were exaggerated
• the modifying effects of diet, exercise, personal habits, and psychosocial factors were underestimated
• “usual vs. successful aging”
• point: some disease processes parallel consequences of inactivity
• counter point: some diseases are obviously related to inactivity-studies on younger subjects also inform; elderly show percent increases equal to much younger subjects

Question 7

Inactivity and Cognitive Function

Answer 7

• impact on inactivity on the nervous system are particularly extreme in the elderly
• linked to decreased function: performance on intellectual tests; verbal fluency, color discrimination, reversible figures
• disrupted EEG pattern of sleep
• increased incidence of depression, anxiety, and irritability
• changes reversible with activity/exercise

Question 8

Inactivity and GI System

Answer 8

• decreased motility with inactivity
• increased incidence of obesity
• disruption of hunger and satiety
• changes reversible with activity/exercise

Question 9

Inactivity and Integumentary System

Answer 9

• decreased thermoregulatory capacity: decreased oral and skin temperature, increased clinical relevance in the elderly
• increased incidence of skin breakdown with BR
• changes reversible with activity/exercise

Question 10

Inactivity and Cardiovascular System

Answer 10

• increased vitals at given sub max load
• with BR: increased HR after 1 week, decreased total blood volume, increased risk of orthostatic hypotension
• changes reversible with activity/exercise

Question 11

Inactivity and Respiratory System

Answer 11

• decreased oxygen delivery to working tissues
• decreased reserve capacities
• oxygen demand exceeds supply
• exacerbates: decreased cilial efficacy in aging for removing waste products, decreased mechanical function
• changes reversible with activity/exercise

Question 12

Inactivity and Musculoskeletal System

Answer 12

• decreased balance and coordination
• decreased bone mineral density and metabolic function
• decreased muscular strength and endurance
• increased formation of connective tissues adhesions–>contractures
• changes reversible with activity/exercise

Question 13

Interventions Aimed at Inactivity

Answer 13

• community-based health and wellness programs
• clinically-based therapeutic interventions: strengthening, AROM, cardiovascular, transfer training, gait training
• most inactivity-related frailty can be largely reversed in relatively short time frames
• key is to optimize the training stimulus!

Question 14

The Solution

Answer 14

• numerous calls for increased physical activity and fitness levels
• Physical Activity and Health: A Report of the Surgeon General
• NIH Consensus Conference on Physical Activity and Cardiovascular Health
• Health and Medical Organizations (AHA, ACSM)
• Dietary Guidelines for the Nation
• Healthy People 2020

Question 15

Healthy People 2020

Answer 15

• national health goals
• increase span of “healthy” life
• eliminate health disparities
• increase access to information and services for all people

Question 16

Physical Activity and Health: A Report of the Surgeon General

Answer 16

• recommendations include
• people of all ages include a minimum of 30 minutes of physical activity of moderate intensity (such as brisk walking) on most, if not all, days of the week
• acknowledge that for most people, greater health benefits can be obtained by engaging in physical activity of more vigorous intensity or of longer duration”

Question 17

ASCM Guidlines

Answer 17

• American College of Sports Medicine
• general recommendations include
• aerobic activity (5d/wk or more moderate intensity exercise; 3d/wk or more vigorous intensity exercise
• muscle strengthening activity: 2d/wk
• flexibility activity: at least 2 d/wk
• balance exercises: for frequent fallers or those with mobility impairment, 2-3 d/wk

Question 18

Practical Application in Exercise Prescription

Answer 18

• clear, consistent scientific evidence that physical activity
• improves: function of the body’s systems, fitness, health, wellness
• reduces risk of disease states such as: MI, stroke, metabolic syndrome, diabetes, cancer, osteoporosis, obesity
• but how does one appropriately apply this science in individual cases?

Question 19

General Adaptation Syndrome

Answer 19

• popularized by the work of Hans Selye
• described as: “a common residual (psychoneurophysiological) response that is nonspecific in regard to its cause”
• “elicited with such diverse agents as cold, heat, x-rays, adrenaline, insulin, tubercle, bacilli, or muscular exercise)

Question 20

Stages of GAS

Answer 20

• the alarm stage
• the resistance or adaptation stage
• the stage of exhaustion
• selye argued that the stage of exhaustion marked the onset of certain diseases of adaptation
• examples include: repetitive motion injuries, coronary heart disease, cancer, diabetes

Question 21

The Essence of Successful Exercise Prescription

Answer 21

• the role of stressors:
• lifestyle associated disease
• overuse
• fatigue
• depression
• lowered immunity
• burnout
• injury
• poor general fitness
• the role of recovery:
• “it’s not how much training you can do, it’s how much training your body can accommodate”
• carries over from athletics to all areas of exercise and testing and

Question 22

Gross Factors Affecting Physiological Recovery

Answer 22

• genetics
• diet
• quantity and quality of sleep
• general health
• age
• sex
• spiritual health
• occupation

Question 23

Specific Factors Affecting Recovery

Answer 23

• physiological: i.e. VO2max
• biomechanical: i.e. limb status
• psychological: i.e. motivation level
• epidemiological: i.e. pima indians
• sociological: i.e. neighborhood safety
• financial: i.e. intervention costs

Question 24

Professional Self-Assessment

Answer 24

• we each must:
• consider GAS
• balance stress and recovery
• manage this client’s PT

Question 25

Take Home Messages

Answer 25

• many health conditions are linked to the lifestyle of an increasingly sednetary society
• physical therapy programs provide a great opportunity for health professional to educate, and serve, the public
• a strong knowledge base in exercise physiology plays an important role in providing such client care
• theory such as GAGS suggest that stressors: come from many sources, play a large role in the disease process
• successful PT balance stress and recovery in their clients