P5. p208-217 Flashcards
In terms of Worksite Wellness Programs:
1) Do they improve employee health ? increase productivity ? yield a return on investment ?
2) For each $ 1 spent, what is the median ROI ?
3) What type of programs produce the highest/lowest returns on investment ?
4) Give examples from the Motorola experience
BR 210
1) Worksite wellness programs improved employee health, increase productivity, and yield a (+) ROI
2) For each $ 1 spent median ROI is $ 3.14
3) Highest ROI for disease managment programs; lowest is for educational and disease prevention programs.
4) Motoroloa: 3 yr study of 56,000 employees:
- in 2000, every $ 1 invested saved $ 3.92
- annual inc in healthcare costs: 2.5% vs 18% for non-participants
List 2018 Physical activity guidelines for:
1) Healthy older adults (> 64 yo)
2) Pregnant women
3) Post-partum women
4) Individuals with obesity, CAD, diabetes, cancer, disability, stroke
BR 211-213
See slides
In healthy older adults who are obese, what is the best way to improve physical function ?
BR 212
Weight loss in combination with exercise improves physical function better than either alone.
In terms of muscle mass & quality:
1) What does quality of muscle refer to ?
2) In terms of preventing early death, discuss the RELATIVE roles of muscle mass & quality
3) In terms of maintaining mobility, discuss the role of muscle mass & quality
BR 212
1) Muscle quality refers to having low amounts of intramuscular fat
2) Muscle quality is more important than mass wrt preventing early death
3) Muscle quality is more important than mass wrt maintaining mobility
In terms of exercise in pregnancy:
1) What sort of positions & exercises should be avoided (6)
2) What proportion of women are overweight at the start of pregnancy ? What are the health implications ?
3) Based on meta-analyses
a) Do lifestyle interventions aimed at body weight work in pregnancy ?
b) Name two types of interventions which were found to be effective
BR 2121
1) Avoid in pregnancy:
- lying on back after first trimester (pressure on IVC)
- activities which can increase the risk of falling:
- contact/collision sports
- horseback riding
- downhill skiing
- soccer
- basketball
2) 1/3 of women overweight at start of pregnancy => more likely to gain excess weight and have adverse maternal and infant health outcomes.
3a) Physical activity results in less weight gain than in a control group
3b) *Supervised* physical activity & diet interventions are most effective.
In terms of physical activity
1) Does it reduce the risk of primary coronary heart disease ? How much exertion is effective ?
2) Does active commuting (biking, walking) count ?
3) Does becoming physically active affect outcomes in pts with CAD, heart failure, stroke, PVD ?
BR 212-213
1) Physical activity of moderate intensity decreases risk of 1’ CAD in active men by 20-30% (vs inactive). At 550 cal per week from exercise see a dramatic risk decrease of CAD (for men & women)
2) Meta of active commuting (bike/walk) showed HR 0.89 for active commuting irrespective of modality.
3) Becoming physically active affect outcomes in pts with CAD, heart failure, stroke, PVD is assoc w fewer complications and lower mortality rates.
In terms of exercise & DM prevention
1) Is there a threshold dose for risk reduction ?
2) In cohort studies of exercise, what is the role of BMI in exercise & DM prevention ?
3) What did the DPP show ?
4) What do meta of structured exercise training regimens show ?
a) About physical activity advice ?
b) About aerobic vs resistance exercise & HbA1c ?
c) [HbA1c] and duration of exercising
BR 213
Exercise & DM prevention
1) Threshold dose is 150 minutes of moderate-intensity physical activity per week
2) BMI accounts for about half the decreased risk: 31% dec s BMI, 17% decrease accounting for BMI
3) DPP - RCT of DM prevention in pre-diabetics, n=3300. Saw that lifestyle intervention (exercise & healthy diet with goal of 7% weight redn) was better than metformin for preventing incident of DM
4) Meta structured exercise regimens:
a) Physical activity ADVICE ONLY WORKS IN COMBINATION WITH DIETARY ADVICE
b) Structured aerobic exercise, resistance training, combo were assoc w dec HbA1c
c) Saw greater regression of HbA1c if exercise training exceeded 150 minutes/week
1) Is there a relationship between exercise & risk of colon cancer ?
BR 213
See approx 25% decreased risk with exercise.
- [exercise] is probably around 3-4 hrs of moderate-vigorous activity /week
In terms of exercise & breast cancer:
1) Is there a signal for prevention ? Magnitude ?
2) What about recurrence of CA breast ? Mortality ?
BR 213
1) 25% decreased risk of CA breast comparing most vs least active people
2) Exercise also prevents reoccurrence
3) Exercise decreases mortality from breast cancer
Name 3 aspects of cancer treatment & their relationship with exercise (DURING treatment)
BR 213
Exercise important during cancer Rx because it
1) Improves cardiorespiratory fitness + body composition
2) Improves symptoms + quality of life during treatment
3) Improves survival
In a study of 195 Parkinson’s pts RND to tai chi, resistance training, and stretching for 60 min 2x/wk for 24 weeks, what were the outcomes in terms of stability ?
BR 214
In a RCT in 195 Parkinson’s pts x 6 mos, saw a greater improvement in stability with tai chi than with stretching or resistance training.
Mn: HR doing Tai Ch
Does physical activity work to lose weight ?
If not, name 4 outcomes it does help
BR 214
Physical activity does NOT result in weight loss.
It helps:
H - Heart (dec diastolic BP, Triglycerides, CV disease)
P - Pancreas (dec fasting glucose)
Mn: “HP no weight - wait”
What are the Am Coll of Sports Medicine guidelines re Physical activity for weight maintenance (use FITT format)?
In terms of weight maintenance, is there value to aerobics ? resistance ?
BR 214
F - Freq - strength/resistance 2/week
I - Intensity - > 250 min of moderate intensity (may prevent weight gain) with 60-90 min /day
T - Type - aerobic (above) & resistance
Time: > 250 min/week with 60-90 min/day
Aerobic are more effective than resistance/strength exercises for weight maintenance.
What are the roles / benefits of diet vs exercise for weight LOSS and/or maintenance
If someone only does physical activity, what are the results in terms of weight loss.
BR 214-215
1) Diet is necessary to lose weight, but physical activity is needed to maintain weight loss
2) If physical activity alone is used, there is no significant weight loss
3) Physical activity is a strong predictor of long term weight maintenance & lead to better weight stabilization than diet alone.
Regardless of weight loss outcome, what can be said about the following:
1) Health outcomes in obese subjects who exercise regularly
2) Moderate physical activity & mortality risk
3) Is there a relationship between all-cause mortality & physical activity ? Does adiposity modify this?
BR 215
1) Obese subjects who exercise regularly have:
Improved CV function
Lower CV risk
Less loss of muscle mass
2) Moderate to high levels of physical activity reduce mortality risk
3) There is an inverse relationship between physical activity & all-cause mortality. This is independent of adiposity.
Compare/constrast the effect of exercise in subjects who are overweight (BMI 25-30) vs obese (BMI > 30) in terms of years of life lost (YOL)
Does an obese person who exercise lose years of life ?
BR 215 & here
Result of achieving physcial activity guidelines in groups of subjects:
Overweight (BMI 25-30): No years of life lost vs subjects who are normal weight & physically active
Obese (BMI > 30): Same # years of life lost (~ 5 yrs) normal weight with NO exercise.
