Physical Activity Science and Prescription Flashcards
List 4 overall health benefits of physical exercise
1) higher health related fitness
2) control / maintenance of healthy weight
3) less risk of disabling medical conditions
4) reduced rates of chronic disease in those who are physically active than those inactive
Define “physical activity”
Any movement on the body made by muscle contraction that causes energy expenditure greater than baseline
Define “exercise”
purposeful physical activity that is organised, planned, recurring and done with intent of improving / maintaining one of more component of health
Define “fitness”
Ability to perform activities of daily living, respond to emergencies and enjoy leisure-time activities with vigour and without excess fatigue
Components of physical fitness include:
five
5 component s physical fitness:
1) cardiorespiratory endurance
2) muscle strength
3) muscle endurance
4) body composition
5) flexibility
The state of health that results from being physically inactive and leads to functional loss (leading to morbidity and mortally) is know as what?
Deconditioning
For each additional day of physical activity studies have shown a decrease in health care costs of what %?
4.7%
Which is more cost effective brief advice (phone, in person, e-mail) regarding PA or supervised activities?
Brief advice
Improved flexibility helps improve what?
ROM at joint
Most health benefits associated with physical exercise are achieved with how many minutes of weekly moderate-intensity exercise?
150
or 75mins vigorous-intensity / combo of 2
Vigorous-intensity physical activity only has a modest additional benefit to moderate-intensity PA re reducing mortality / cardiovascular risks - True or False
True
Beyond benefits to cardiovascular health / weight maintenance what other health & daily living/functional benefits have been proven to result from physical activity? (5)
Improved:
- sleep
- executive function
- mood (reduced depressive Sx and less anxiety)
- QoL
- reduced rates of cancer (colon, bladder, breast, endometrial, oesophageal, kidney, lung, stomach)
In the elderly specifically what benefits have been demonstrated in assoc with increased PA? (4)
more independence
fewer falls
improved bone health
increased ability to complete tasks of daily living
A SINGLE episode of exercise has been shown to improve what health and wellbeing parameters? (6)
SINGLE episode of exercise benefits:
BP sleep anxiety insulin sensitivity mental function reduces risk of dementia and cognitive decline
Physical function scores have improved within what time-frame once regular PA is initiated?
days to weeks
What 3 chronic disease processes benefit particularly from regular PA?
T2DM, osteoarthritis, HTN
Moto for safe initiation of physical activity in individuals who are inactive?
“start low and go slow”
Physical activity throughout the day for children aged 3-5 helps promotes what?
Growth and development
How much moderate-vigorous activity should those aged 6-17 undertake on a daily basis?
At least 60 mins / day
How many days a week should 6-17yr olds undertake VIGOROUS exercise specifically?
3 days / week
How much moderate / vigorous activity should adults (18-64) undertake each week?
(same for >64 as far as possible)
150mins moderate physical activity / week
75mins vigorous physical activity / week
(or combination of the two)
For additional (moderate) health benefits how long should adults partake in mod / vigorous physical activity?
300 mins (5 hours) moderate PA
150 (2.5hrs) vigorous PA
(some additional benefit beyond this even!)
What is the minimum recommended continuous period of physical activity used to make up the daily / weekly recommendation?
10 mins
The same physical activity recommendations are true for adults with chronic disease as for those without - True or False?
True
So long as they have the physical ability to do so - advice is that they should do as much as possible according to their ability to avoid being sedentary
How many hours / week should 6-17 yr olds spend on muscle / bone strengthening activities?
At least 1 hour 3x/week
How often should adults (18-64) do strengthening activities weekly?
2-3 times / week (as for those with chronic disease)
at least 2 - ensuring they do not work on the same muscle group for 2 consecutive days
How often should older adults (>64) do strengthening activities weekly?
twice / week
start very-low / low intensity - more repetitions
The Healthy adults stretching program suggests adults should do how much flexibility training / week?
10 mins, 2-3 days / week
How long should a stretch for a particular muscle group be held for an how many reps for adults?
10-30seconds - 2-4 reps to = 60secs each group
older adults should aim 30-60secs per stretch
How many mins should an adult dedicate to balance / proprioception exercise a week?
20-30 mins / day!
Adults >65 should do balance training how many times a week to help reduce falls?
BALANCE >65:
3 or more days / week
A meta-analysis involving 305 RCTs and 339,000 subjects showed exercise to be more effective than medication for which one of the following:
a) post-stroke treatment
b) 2ndry prevention CAD and pre-diabetes
c) heart failure
A
Exercise more effective than medication in reducing mortality rates post-stroke
A meta-analysis involving 305 RCTs and 339,000 subjects showed exercise to be equally as effective as medication for reducing mortality in:
a) post-stroke treatment
b) 2ndry prevention CAD and pre-diabetes
c) heart failure
B
Secondary prevention of CAD and pre-diabetes
A meta-analysis involving 305 RCTs and 339,000 subjects showed medication to be more effective than exercise for:
a) post-stroke treatment
b) 2ndry prevention CAD and pre-diabetes
c) heart failure
C
heart failure
(note: likely best for meds and exercise to be used in combination)
What is the number 1 cause for preventable deaths from all-cause mortality on 40, 842 men and women in the Aerobics Centre Longitudinal Study?
Low cardiorespiratory fitness (CRF)
NB physical inactivity is 4th leading risk factor for global mortality!
Poor cardiorespiratory fitness ranks more highly than what 5 other lifestyle related conditions / habits that are attributable to all-cause mortality?
Smoking HTN High cholesterol Diabetes Obesity
Define the term ‘attributable fraction’ in terms of lifestyle related all-cause mortality
the attributable fraction is the estimated number of deaths in the study population the could have been avoided if the health behaviour had not been present
? in 10 premature deaths is attributable to physical inactivity?
1 in 10
Worldwide the % burden of disease attributed to physical inactivity is what for the following:
1) CHD
2) T2DM
3) Breast cancers
4) Colon cancers
1) 6% CHD
2) 7% T2DM
3) 10% breast cancer
4) 10% colon cancer
A series of studies involving >7 million people found that 2.5hrs/150mins moderate intensity exercise / week reduced mortality risk by how much?
19%
7 hours reduced mortality risk by 24%
Which group of individuals has fewer years of life lost:
a) Physically active obese
b) Physically inactive normal weight
Physically active obese (4.5yrs lost, compared to 4.7)
What % of all-cause mortality is attributable to sitting:
i) 5.8%
ii) 6.9%
iii) 7.5%
6.9%
(across genders, age,BMI,physical activity level - even some who met PA guidelines sitting found to be an independent risk factor!)
In a study of sitting overweight and obese individuals bouts of 2-min moderate-intensity walking every 20 mins was found to have increased benefits over light-intensity walking every 20mins - True or False?
False
Equal benefits were seen on movement every 20mins regardless of intensity
In the study on walking every 20mins during periods of sitting what health benefits were identified on both light and moderate activity?
reduced blood glucose and insulin levels
What does the acronym FITT stand for in terms of cardiovascular exercise prescriptions?
Frequency
Intensity
Type (of exercise)
Time (duration)
Which of the following is an appropriate example of a cardiovascular exercise prescription:
1) walk at moderate intensity for 30 mins 5 days / week
2) run every day for 20mins
1
the second option fails to address intensity
Guidelines suggest what 3 exercise parameters should aim to be met through exercise prescriptions (usually in gradual stepwise fashion)?
1) 150 mins exercise / week
2) Resistance training twice / week
3) Avoid prolonged sitting throughout the day
(promote movement at regular intervals)
Risk of death due to exercise is rare!
In what two groups / circumstances is risk increased?
1) those with known disease signs and symptoms
2) sudden intense exercise
What is the goal of medical screening prior to exercise?
To reduce risk of cardiovascular events
In 2015 the American College of Sports Medicine changed its guidelines on risk classification and medical clearance. What two main factors does it now advise ought to be considered when identifying those in need to medical clearance?
1) those who are physically inactive
2) those with signs and symptoms to cardiovascular, metabolic or renal disease
In those who participate in REGULAR physical activity which of the following patients require medical clearance:
1) Asymptomatic with no known cardiovascular, metabolic or renal disease
2) Asymptomatic with known cardiovascular, metabolic or renal disease before moderate-intensity exercise
3) Asymptomatic with known cardiovascular, metabolic or renal disease before gradual progression to vigorous-intensity exercise
4) Symptomatic with no known disease cardiovascular, metabolic or renal disease
4
If symptomatic, regardless of known disease status - discontinue exercise and seek medical clearance
In those who DO NOT participate in REGULAR physical activity which of the following patients require medical clearance:
1) Asymptomatic with no known cardiovascular, metabolic or renal disease
2) Asymptomatic with known cardiovascular, metabolic or renal disease before moderate-intensity exercise
3) Symptomatic with no known disease cardiovascular, metabolic or renal disease
2 and 3 - if clear may progress to light to moderate exercise, and potentially higher intensities as per ACSM guidelines
Describe the 3 stages of exercise progression as per the American College of Sports Medicine guidelines
Initial Stage: (1-6 weeks) moderate-intensity aerobic activities 40-60% of HRR in interval format. Starting at 15mins and progressing to 30mins 3-4x/week
Improvement stage: (4-8months) Duration steadily increased no more than 20% every week until 20-30mins cont mod-vig exercise achieved. Intensity should increase no more than 5% of HRR every 6th session (intensity usually inc only once duration / frequency achieved)
Maintenance stage: once reached pre-established goals - should be within 50th percentile in all health-related parameters
List 5 benefits of resistance exercise using the descriptors reduced / decreased
Resistance / strength exercise reduces / decreases:
1) Injury
2) Fatigue
3) Body fat
4) Pain and disability
5) liver fatty lipids (improving NAFLD) despite no change in visceral adipose tissue volume / whole body fat mass
List 5 benefits of resistance / strengthening exercise using the descriptions improved / increased
Resistance / strength exercise increases / improves:
1) Basal metabolic rate
2) Sleep
3) performance and muscle strength
4) QoL, endurance and BMD (early-post menopause)
5) (improves)Cholesterol levels, glucose tolerance/control and cardiac muscle function
What are the 4 components of resistance / strength activity?
1) Intensity
2) Frequency
3) Repetitions
4) Sets
on the 10-point scale what intensity should you aim for with resistance exercises and how how may reps?
5-6 on 10-point scale
Aim 8-12 reps
(NB separate workouts for same muscle group by 48hr)
Flexibility exercise True or False:
1) Best done in cooler environments
2) Increases muscle length and ROM
3) Aligns collagen fibres in healing muscles
4) Significantly helps prevent injury if done pre-PA
5) Increases fasting blood sugar, post-prandial sugars, A1c and BMI
1) False - best in warmer environments
2) True (increase muscle length and ROM)
3) True (aligns collagen fibres in healing muscles)
4) Mixed evidence for pre-PA stretching & injury prevention
5) False - Improvements in BM, post-prand sugars, A1c and BMI
How long should each stretch be held?
10-30secs (2-4 reps to achieve 60secs total)
Balance exercise is intend to do what?
Improve ability to withstand postural sway / destabilising stimuli
In a systematic review on fall prevention in older people what 4 areas of decreased risk did balance exercise evidence?
1) 37% reduction in injuries from falls
2) 30% reduction in injuries resulting in medical care
3) 43% reduction in severe injury
5) 61% decrease in falls resulting #
3 steps of balance training introduction and progression
1) start with hand-hold support
2) progress to remove support
3) stand on unstable surface (e.g. foam board)
(quick balance assess - stand on one leg)
Does physician exercise performance and patient exercise performance correlate?
Yes - Israel Health study suggests physicians who perform aerobic / strength exercise are more likely to counsel on it which increases pt following recommendations
What is a Metabolic Equivalent of a Task (MET)?
Ratio of the metabolic rate during a task compared with standard resting metabolic rate
(Metabolic rate during task / Resting metabolic rate)
What is the definition of the Metabolic Rate?
Amount of oxygen consumed to convert nutritional intake into energy
What is the Basal Metabolic Rate approx?
BMR: (approx)
3.5ml oxygen / kg body weight / min
What is the MET of sleep?
0.9
What is the MET of 3mph walking?
3 METS (running 10.9mph = 18 METS)
How are MET hours per week calculated?
Brisk walk equates to 3.3 METs per hour
Multiply this number by number of hours spent doing the activity to get MET hours per week
e.g. 3.3 x 4hours per week = 13.2 MET hours per week
Within what range of MET hours per week physical activity is one considered to gain most benefit?
10-20 MET hours per week
Studies into the benefits of merely standing have demonstrated a 10% drop in all-cause mortality associated with what period of standing / day?
2 hours per day
Standing or sitting and fidgeting rather than taking stairs, for example, is considered what? And is associated with what?
Non-exercise physical activity and is associated with reduced mortality
Health benefits are associated with both purposeful exercise and regular non-exercise PA (and combination of both)
The Nurse’s Health Study showed significant risk reduction in all-cause mortality (RR 0.82) with as little as how much mod-vigorous exercise / week?
1-1.9hrs
NB no significant benefits gained beyond 7hours / week, only slight
Cardiovascular disease risk reduction has been demonstrated with as little as how many mins of mod exercise a day?
15mins / day
or 90mins / week
(Low-active group had 3 years longer life expectancy than inactive!)
90-150 mins brisk walking / week equates to how many years of life gained in people >40yrs?
2.5yrs
400 mins brisk walking / week equates to how many years of life gained in people >40yrs?
4yrs
In a study of Hispanic 20yr old men what benefit in terms of years gained per hour of exercise with vigorous vs moderate exercise?
Hispanic 20yr old men:
- per 1hr moderate intensity exercise = 2.6hrs life gained
- per 1hr vigorous exercise = 5.2hrs life gained
What is HIIT training?
High Intensity Interval Training
brief intermittent bursts of vigorous activity interspersed with periods of rest / low-intensity activity
What benefits does current research demonstrate as a result of HIIT?
Improved:
1) VO2 max
2) endothelial function
3) hydrogen ion buffering
4) resting muscle glycogen concentration
5) time to exhaustion
6) greater loss of abdo fat / total fat
Good for already fit individuals looking to decrease time spent training to improve cardiovascular conditioning
(need for longer term studies though!)
List 6 exercise intensity tools
Exercise intensity tools:
1) Talk test
2) RR
3) Perceived exertion (Borg scale; 1 to 10 short version)
4) HRR (heart rate reserve)
5) maximal heart rate %
6) METs
How can the talk test assess for: 1) v. light to light 2) moderate 3) vigorous physical activity?
1) V. high to light - can talk and sing
2) mod - can talk but not sing
3) vigorous - can barely talk
HRR ?
Max HR - resting HR = HRR
What is the recommended exercise intensity in terms of % of HRR?
40-85%
Maximal HR percentage - what %s equate to:
1) low intensity
2) Moderate intensity
3) Vigorous intensity
1) low intensity - <64% max HR
2) moderate intensity - 64-75% max HR
3) vigorous intensity - >76% max HR
What key test can be used as a marker of functional capacity?
6 min walk test - stopwatch, pulse ox & measuring device
useful if taken before and after intervention
What tests are there for cardiorespiratory fitness? (a-d)
Tests of cardiorespiratory fitness:
a) indirect testing VO2 max
b) Step testing (3 mins to metronome, HR comp to age, gender norms)
c) Submaximal talk test for ventilatory threshold (VT1)
d) Rockport fitness walking test (1mile)
What is the FRIEND database?
Fitness registry and the importance of exercise national database (gives ref ranges per decade for VO2 max - helpful for counselling pts)
What is the sub maximal talk test for VT1?
When blood lactate is high enough to make you blow off CO2 to buffer acidosis, RR increases and becomes difficult to talk (this is the first ventilatory threshold)
Approx the highest level of intensity sustainable for 1-2hrs
What tests are there for cardiorespiratory fitness? (a-d)
a) Indirect testing VO2 max
b) Step testing (3 mins to metronome, HR comp to age, gender norms)
c) Submaximal talk test for ventilatory threshold (VT1)
d) Rockport fitness walking test (1mile)
What is the FRIEND database?
Fitness registry and the importance of exercise national database (gives ref ranges per decade for VO2 max - helpful for counselling pts)
How may body composition be measured?
1) skin-fold thickness with calipers (+/-3.5% accuracy)
Taken from RIGHT abdo, tricep, bicep, pec, medial calf, mid-axillary, sub scapular, supra-iliac, thigh.
2) Densitometry - either hydrodensitometry, DEXA or multi-compartment measuring
Flexibility may be tested using sit and reach test. This measures flexibility for which areas?
Hamstrings and lower back (very consistent, moderate accuracy for hamstrings, poor accuracy for low back! Particularly inaccurate in low back pain)
What are the optimal body fat % for men and women according to ACSM guidleines?
10-22% men
20-32% women
How may body composition be measured?
1) skin-fold thickness with calipers (+/-3.5% accuracy)
Taken from RIGHT abdo, tricep, bicep, pec, medial calf, mid-axillary, sub scapular, supra-iliac, thigh.
2) Densitometry - either hydrodensitometry, DEXA or multi-compartment measuring
Activity Counselling Trial (ACT) demonstrated % of GPs who gave advice, how long it took and their experience. What were the % results for the following:
1) % Pts that received advice
2) % that spend <5-6mins
3) % that kept to recommended 3-4 mins
4) % that found little-no increase in appointment length
5) % reporting it to be an asset to their clinic
1) its received: 99%
2) <5-6mins: 86%
3) <3-4mins: 46%
4) no increase in apt time: 63%
5) asset to clinic: 83%
2009 cluster randomised trial on effectiveness of physicians’ advice on PA:
- Control group (no advice)
- Intervention group received PA counselling
- Subgroup 30% also received PA prescription
Summarise the results
-Advice ONLY had a small effect on older pts (18mins more exercise / week) but no significant effect on younger adults
- Advice + prescription: >50s PA increased by 131min / wk
- Doubled mod-vig PA - <50s increased PA by 31mins / wk.
7% higher probability of meeting guidelines
NNT = 26
Meta-analysis on office-based counselling on PA
Pts self-reporting effect on PA - suggest significant improvement in PA by 12 months - what was the NNT?
12
Of the 33% of hypertensive patients that received PA counselling in NHANES-II (‘88-‘94) what % of those followed recommendations?
71%
What is the most effective way of improving Public Health matters according to Cecchini? (particularly regarding diet, PA and obesity)
Physician counselling
What are the 5As for counselling patients on PA?
Assess Advise Agree Assist Arrange
5As - ASSESS
What should you assess?
beliefs
behaviours
knowledge
5As - ADVISE
How?
Provide specific info about health benefits of change
Stage match advice
Tailor to specific problems
e.g.
-obese prescribe non-weight-bearing activites such as swimming / biking
-Arthritis - resistance training
-difficulty sleeping - aerobic exercise
5As - AGREE
What?
Prescription -> FITT (frequency, intensity, type, time)
SMART goals
5As - ASSIST
in what?
Identify barriers
Develop strategies / brainstorm ideas to increase PA ADL
Help to find problem-solving techniques
Identify social / environmental support
5As - ARRANGE
What?
Follow up plan
> beneficial to offer interim support via phone/e-mail
What is the ABC of problem solving?
NB important to identify high risk situations and focus where possible on cognitive restructuring (relapse prevention)
A - Antecedent (an event that precedes another)
B - the Behaviour that follows
C - Consequence of that behaviour
When it comes to health promotion a study involving 66 primary care providers demonstrated that giving physical resources e.g. print outs / pedometers increased patient recall of receiving advice by how much?
31%
List 4 groups of professionals that would be useful to involve in improving patient PA?
Physios (limited availability) Exercise physiologists (as above and cost) Coaches (wellness, fitness, health coaches - variable) Personal trainers (cost / variable knowledge)
Worksite wellness programs have bene shown to have what 3 benefits?
1) improve employee health
2) improve productivity
3) yield better returns
e. g. Motorola - every $1 invested saved $3.93
2. 5% increased annual health cost compared to 18%
There is strong evidence that exercise benefits:
- what 2 chronic conditions
- what 2 types of cancer
- (reduces) what cause of mortality?
1) all-cause mortality
2) CHD
3) T2DM
4) Colon cancer
5) Breast cancer
What type of exercise may be especially important in older adults than younger?
Weight resistance training and balance exercises
- > maintain and improve balance, prevent falls and injuries
- > Stretching also good to maintain ROM
Weight loss in combination with exercise improves what in obese older adults?
physical function (better than weight loss or exercise alone)
Muscle quality is better than muscle mass.
What makes for better muscle quality?
Reduced intramuscular fat
-> more important in preventing early death
What are the exercise guidelines for Pregnancy?
- 150 mins moderate intensity spread across week
- if vigorous exercise pre-pregnancy may continue but adjust as pregnancy develops
- avoid exercise which involves lying on back after 1st trimester
- avoid activities which increase risk of falling on abdomen e.g riding, ski-ing, contact sports
Excess weight during pregnancy is a risk factor for maternal and infant ill-health. Physical activity interventions showed less weight gain compared with control by how much (kg/lbs) during pregnancy?
0.9kg (2lbs)
NB supervised PA and diet most effective for reducing weight gain in overweight pregnant women
moderate intensity exercise reduces risk of CHD in men and women by what %?
20-30%
Physically active commuting (cycling/walking) decreases hazard ratio of CHD to what?
HR = 0.89 (for CHD with active commuting)
Form of activity less important than doing it!
Patients with CHD, HF, stroke and PVD that become physically active have fewer ___ and lower ___.
Fewer complications
Lower mortality rates
Evidence has shown that how much PA /wk is sufficient to reduce the risk of diabetes?
150mins of moderate intensity PA / wk
Cohort studies have shown that PA (150mins mod-intensity / week) decreased risk of T2DM by what %:
- without accounting for BMI
- accounting for BMI?
- Without accounting for BMI: 31% decreased risk
- accounting for BMI: 17% decreased risk T2DM
In the Diabetes Prevention Program lifestyle interventions proved more or less effective than metformin for preventing incidence?
Lifestyle = more effective than metformin in preventing diabetes incidence
Meta-analysis of structured exercise training regimen in diabetes has shown what 2 effects relating to HbA1c?
1) PA advice reduced HbA1c if combined with diet advice
2) structured exercise (aerobic & resistance) decreased HbA1c with greater regression >150mins/wk
In terms of colon and breast cancer risk reduction how many hours / wk mod-vig exercise appears to be effective?
3-4 hours / week
Clear dose-response relationship
What % reduced risk of colon and breast cancer has been proven with PA?
- 17-30% for colon ca
- 25% for breast (comparing most and least active)
Increased PA decreases probability of mortality from breast Ca
What 3 things have been demonstrated to improve with exercise during cancer treatment?
1) cardiovascular fitness
2) symptoms and QoL
3) survival
In those with a disability - what is the general guidance on PA?
To follow the adult PA guidelines as much as possible
There is good evidence that PA is helpful in diverse conditions including…? (9)
Dementia Intellectual disability MS
Stroke / spinal cord injury Mental illness
Muscular Dystrophy Parkinson’s Limb Amputation
Cerebral palsy / traumatic brain injury
What 3 elements make up the Short Physical Performance Battery?
(objective tool to assess lower limb functionality in elderly)
1) Gait speed
2) Balance test
3) Chair rise test
(structured programs to improve the above help those with disabilities maintain independence longer)
A study of 195 Parkinson’s patients showed which of the following to best improve stability:
- Stretching for 60mins twice / week
- Tai Chi 60mins twice / week
- Resistance training 60mins twice / week?
Tai Chi 60mins x 2 / week
In obesity what PA recommendations are there to maintain and prevent re-gain of weight?
i) >250mins / week of mod-intensity PA (may prevent weight re-gain)
ii) 60-90mins daily (to include strength and resistance twice / week)
NB aerobic more beneficial in wgt maintenance
What has been demonstrated with PA alone in terms of health benefits and weight?
Improved: -Diastolic BP -Triglycerides -Fasting glucose and reduced CVD risk
HOWEVER: Little to no reduction in weight
What must be combined with PA to lose weight and maintain it?
reduced caloric intake
PA levels = strong predictor of longterm wgt maintenance / stabilisation than diet alone!
How many years of life lost were demonstrated for:
a) overweight who met PA guidelines compared to normal weight physically active?
b) obese who met PA guidelines compared to normal weight inactive?
a) overweight PA vs Normal weight PA = 0 years lost
b) obese PA vs Normal weight inactive = same yrs lost
The largest prospective study (National Weight Control Registry) on weight loss maintenance shows PA to be critical. On average how many hours/mins per week do individuals on the NWCR exercise?
NB: these are individuals selected for maintaining weight loss over long periods of time
=/>420 mins / week
At least an hour a day
