P3. p 185-196 & glossary Flashcards
In terms of moderate-to-vigorous physical activity & all-cause mortality:
1) Is there a lower threshold for benefits ?
2) How much time/week is required to obtain most of the benefits
3) At what level of METS are 70% of benefits reached
4) Is there increased risk at the high end ?
US 2018 Physical activity guidelines (slide 15/41)
1) No lower threshold for benefits from physical activity
2) Most benefits attained with at least 150-300 minutes of moderate activity/week
3) 70% of benefits reached at 8.25 MET-hrs/wk
4) No evidence of increased risk at the high end.
(See slide for graph)
In terms of sedentary behaviour:
1) Is it related to mortality (2)
2) Is it related to the risk of cancer ?
3) Is it related to the risk of other diseases ?
4) List cancers related to physical activity
Sedentary behavior increases risk of:
1) All-cause & CV mortality
2) Colon, endometrial & lung cancers (all emit blood)
3) NIDDM & CV disease
4) Physical activity => 8 cancers: Esophagus, stomach, colon, lung, breast, endometrium, kidney, bladder (3 GI, 2 GU, 2 GYN, 1 Lung)
- GI within reach of EGD/Csc
In terms of proven interventions to increase physical activity, list what works:
1) For individuals or small groups (3)
2) For communities (5)
Proven to work:
Individuals/small groups (GST-Trudeau):
G - Guidance from peers or professionals
S - Support from others
T - Technology
Communities: (POSD- walking David)
P - Point of decision prompts
O - Outdoor recreational facilities
S - School policies & practices
D - Design of communities & campaigns
In terms of the cost of not meeting the key guidelines for aerobic & muscle strengthening activity for adults
1) Does this affect premature mortality ?
2) What proportion of the US adult population meets the guidelines
3) Is there a gender difference in proportion meeting the guidelines ?
1) 10% of premature mortality due to not meeting physical activity GL
2) Approx 20% of US population meets GL
3) Rate (2016) approx: men 25%, woment 18%.
In terms of childhood obesity
1) What has happened to childhood obesity rates since the 1970s ?
2) What proportion of youth 17-24 yrs are disqualified from military service due to obesity ?
1) Since 1970s childhood obesity has tripled
2) 1/3 of youth 17-24yo disqualified from military service due to obesity
In terms of the US 2018 Guidelines for physical activity
1) What 6 demographic groups are addressed ?
2) What 2 types of exercise are addressed
3) List the guidelines
4) Strength recs for those > 65 yo
5) Guidelines for children, pregnant, chronic disease
US 2018 Physical Activity Guidelines
Groups: 3-5 yo, 6-17 yo, adults 18-64, > 65, pregnant (post-partum), with chronic diseases
Exercises: Aerobic, Strength (resistive)
See link or slides for guidelines
> 65 yo: 10-15 reps (x1) of v low intensity, >= 2/wk
In a meta-analysis comparing exercise to medication for multiple medical conditions:
1) For what types of illness is exercise better / same / worse than medication ?
BR 190
Exercise > Medication:
Post stroke Rx
Exercise = Medication:
- 2’ prevention of CAD, pre-diabetes
Medication > Exercise:
- Rx of heart failure
- but exercise has a better side-effect profile
- probably best to use exercise in COMBINATION w medications
Mn: debate w JK & RT
What is the difference between primary, secondary and tertiary prevention
Prevention:
Primary: At population level
- eg diet, exercise, immunization
Secondary: In people at increased risk (eg pre-diabetic, family history of CAD)
- also includes early Dx - eg screen for colon or breast cancer
Tertiary: Once disease developed, decrease recurrence (eg diet after a heart attack)
- also rehabilitation post MI, stroke
In terms of attributable fraction of all-cause mortality, how does physical inactivity compare with the following:
Smoking, hypertension, high cholesterol, diabetes, obesity
BR 191
Aerobics Center Longitudinal Study
Attributable fraction of all-cause mortality:
Physical inactivity 16%
Smoking 8%
Htn 15% men; 7% women
High cholesterol 4% men; 1% women
Diabetes 4% men, 1% women
Obesity 2% men; 3% women
What proportion of the following diseases are due to physical inactivity:
CAD, NIDDM, breast & colon cancer
BR 191
Percent of burden of diseases attributed to physical inactivity:
=> 5-10%:
CAD - 6%
NIDDM - 7%
Breast CA 10%
Colon CA 10%
In terms of reduction in all-cause mortality from moderate (ie non-vigorous) physical activity,
1) What is the reduction with 2.5 vs 7 hrs of exercise per week
2) Is there a difference between types of exercise
BR 191, Int J Epidem 2011:40(1):121-38 (ref 13)
1) Results of meta-analysis of 22 studies in 7,569,742 people:
2. 5 hrs (150 min/wk) => dec MR by 19% => 20%
7 hrs/wk => dec MR by 24% => 25%
ie only gain 5% dec MR by going form 2.5 to 7 hrs per week
2) Walking is less effective than more strenuous forms of exercise (see here)
In terms of sedentary behaviour:
1) Can it be cancelled by leisure time exercise
2) What is its prevalence vs smoking, Htn, inc lipids
3) What proportion of all-cause mortality is due to sitting
4) In prolonged sitters, can any type of exertion cancel out the risk wrt [glu] or [insulin]
5) In those exercising 7 hrs/wk, is TV watching bad ?
1) No - sitting is an indep risk factor even in those meeting physical activity guidelines
2) Inactivity is at least twice smoking, htn, inc lipids
3) 7% of all-cause mortality is due to sitting (all ages, genders, disease groups)
4) 2 min per 20 min of low or mod intensity walking cancels the risk
5) In this gp, TV watching wrt all-cause mortality HR ~ 1.5 X
In terms of physical activity:
1) What is the Physical Activity Vital Sign & how can it be used ?
How often should it be assessed ?
2) Does physical activity affect all-cause mortality ? Years of life lost ?
3) Does #2 apply to all weight categories ?
BR 192
PAVS
- to quickly assess one’s physical activity level
= day/week x minutes per day that “you perform physical activity where your heart is beating faster and your breathing is harder”
- should measure at every visit.
2) Affects both all-cause mortality & YOL lost
3) #2 applies to all weight categories
List approach to PAVS (physical activity vital sign) in pts who are:
A) Meeting the standard for aerobic & resistance exercises
B) Insufficiently active
C) Sedentary
BR 193
Meeting std:
- congratulate pt
- consider flexibility, intensity, balance (F-I-B)
Insufficiently active
a) Guide pt to acknowledge insufficiency
b) “How can we get you more active?”
c) Establish follow-up
Sedentary
a) Guide pt to acknowledge insufficiency + have a brief discussion
b) Relate health problems to physical inactivity is appropriate
c) Offer support
d) Assess & FU at future visits.
When writing an exercise prescription
1) What is the usual format ?
2) What should the goal of subsequent exercise prescriptions be ?
BR 193
1) Formatt - FITT:
F -frequency
I - intensity
T - type of exercise
T - time (duration)
2) Continue to build up to meeting guidelines, reduce sedentary behaviour, include movement throughout the day.
As per 2015 ACSM guidelines:
1) Name 2 groups who should receive medical clearance before initiating exercise (or increasing intensity):
2) What is the goal of exercise screening
3) What groups of medical conditions are/not a concern
BR 195
1) Medical clearance for:
a) Those with clinically significant disease => would benefit from medically supervised exercise programs.
b) Those with uncontrolled medical conditions that require treatment or control before further exercise should be initiated.
2) Screening is to reduce exercise-related CV events
3) (+) concern if CV, metabolic, renal diseases. Not if pulmonary.
