Section 6: Physical Activity Science and Prescription Flashcards
Physical Inactivity and All Cause Mortality
1 in 10 premature deaths
6% coronary heart disease
7% type 2 DB
10% Breast Cancer
10% Colon Cancer
Only 1 in 3 adults reach recommended physical activity in a week
Prolonged activity and sitting
Blood glucose is reduced if walking every 20min when sitting, both light or moderate intensity of walking
NEAT
Non Exercise Activity Thermogenesis
Fitness
ability to perform one’s activity of daily life with sufficient energy and vitality without excess fatigue
Physical fitness includes:
cardio respiratory endurance
Muscle strength
Muscle Endurance
Body Composition
Flexibility
FITT
Frequency: number of days
Intensity: light, moderate, vigorous
Type (of exercise): aerobic, strength, balance, flexibility
Time (duration): how long, hours and min.
Volume (amount): how much total exercise per week or month
Progression
Example: walk (type) at 60 steps per min. or pace where you feel like you are breathing faster than normal (intensity) for 30 min (time) 5 days per week (frequency)`
Physical Activity Guidelines for Americans (PAGA)
- 150 min per week of moderate intensity physical activity OR 75 min. vigorous intensity activity or an equivalent combination
- The more physically active, the more benefits, and any amount of exercise is better than none.
Physical Activity benefits in children 3-6 yrs age
Improved bone health and weight status
Physical Activity benefits in children 6-13 yrs age
Improved cognitive function
PA Benefits in Adults, All ages (Main Ones)
Lower incidence of cancer:
- Bladder, breast, colon, prostate, endometrium, esophagus, kidney, stomach, lung cancers
Brain:
- reduce dementia, improve cognitive function following bouts of aerobic activity, improved quality of life, improved sleep, reduced feelings of anxiety and depression
- Reduce incidence of fall related injuries
- Reduce risk of gestational diabetes
- Reduce risk of postpartum depression
- improved walking and fitness in multiple sclerosis
Updates form 2018 Guidelines
- Single episodes of PA imbrove brain executive function, etc.
- Within days to weeks of initiating regular exercise, the risk of disease starts decreasing
PA Guidelines in Different Ages
3-5 yrs:
- Physically active throughout the day, encourage active play
6-17 yrs:
- 60min or more per day of mod to vigorous intensity (vigorous at least 3 days per week)
Adults 18-64 yrs:
- 150 min mod per week or 75 min vigorous per week, or combination
- 10min per session or less is also beneficial
Age 65 yrs and older:
- Should follow guidelines, if unable, should be physically active as possible
Woman during pregnancy or postpartum without exercise contraindications:
- 150min moderate intensity exercise per week
- Vigorous activity is okay if exercised before pregnancy
Adults with chronic conditions or diseases:
- 150-300 min of moderate per week or 75-150min of vigorous per week
- If unable, as much exercise as possible to avoid sedentary
Strength Training Guidelines
6-17 yrs:
- participate in strengthening and bone strengthening activities that place force or impact on bones for at least 1 hours or 3 days a week (tug of war, jumps, climbing)
- Resistance training with heavy loads done under supervision
18-64 yrs:
- 2-3 times a week on non consecutive days
Adults age 65 or older:
- 2 times a week or can follow guidelines
Adults with chronic condition:
- 2-3 times a week
Flexibility Guidelines
- Benefits of flexibility to reduce injury are unproven, but can help perform activities requiring greater flexibility
- Healthy adults: 10 min 2-3 days per week, greatest benefit if performed daily
Adults age 65 or older:
- Should do balance training 3 or more days per week
Isreali Health Study
Physicians health screening and vaccination practices influence the practices of their pxs
MET
(Metabolic Equivalent of a Task)
Ratio of metabolic rate of task vs resting metabolic rate. Ratio is metabolic rate of task divided by standard metabolic rate of 1 MET
Sitting: 1.0 MET
Sleeping: 0.9 METs
3mph walking: 3 METs
Climbing two flight of stairs: 5 METs
Running at 10.9 mph (17.5 kmph): 18 MET
MET
(Metabolic Equivalent of a Task)
One MET is defined as 3.5 mL O2/kg/min and is the amount of oxygen consumed during quiet rest or sitting. Sleeping is considered 0.9 METs.
Ratio of metabolic rate of task vs resting metabolic rate. Ratio is metabolic rate of task divided by standard metabolic rate of 1 MET
Sitting: 1.0 MET
Sleeping: 0.9 METs
3mph walking: 3 METs
Climbing two flight of stairs: 5 METs
Running at 10.9 mph (17.5 kmph): 18 MET
Moderate intensity: 3-5.9 METs
Vigorous intensity: >6 METs
METs are absolute. If px adapts, they can be lower.
Physical Activity Guidelines for Obese from American College of Sports Medicine
Weight Maintenance
- >250 min. per week of moderate intensity (to prevent weight re-gain)
- 60-90 min per day of mod intensity daily exercise
Minimum level of exercise
- The most benefit is 10-20 MET hours per week of physical activity
- Mortality decreases with increased in MET, but plateau around 80 MET per hour
- Standing for 2 hours per day is associated with a 10% reduction in mortality of all causes
Shanghai Women’s Health Study:
-20-40% risk reduction among active individuals (standing, taking stairs, etc)
Nurse Health Study
- 1-1.9 hours of vigorous PA per week, significant reduction in all cause mortality
Week end warrior
- 1-2 days per week of activity there is decreased mortality
- But 150min of PA in a day may increase injury
Maximum level of exercise
Additional activity has further and extensive health benefits
- Further reduction in all cause mortality beyond 150min of mod or 75 min vigorous activity per week (or 300 min mod per week/150 min vig per week)
Years of life gained brisk walk vs sedentary:
- 75 min brisk walk per week: 1.8 years of life gained
- 90-150 min per week: 2.5 years
- 200 min. per week: 3 years
- 400 min per week: 4 years
- 500 min per week: 4.5 years
- Participating in PA provides:
1 hour mod intensity - 2.6 hours of life
1 hour vig intensity - 5.2 hours of life
Physical Activity Assessment Tools
PAV - Physical Activity Vital Signs
Equation: days per week with PA x min of PA per day= min of physical activity per week
Interpret:
If standard PA met - congratulate px
If insufficient - guide them to acknowledge insufficiency
If sedentary - lead px to acknowledge sedentary behavior, related health problems to physical inactivity, etc.
Exercise intensity assessment Tools
- Talk test - least objective, but easiest to measure.
a. Very light to light intensity: heart rate 63% or less of maximum, able to talk and sing
b. moderate intensity: heart rate 64-76% maximum, able to talk but not sing
c. vigorous to max intensity exercise - 77-100% of max, unable to talk
- Respiratory rate - overlaps with talk test
- Rating of perceived exertion (RPE)
- Borg Scale: 12-13 moderate intensity, 14 and above up to 20 only - vigorous - Heart rate reserve (HRR)
- HRR = max heart rate - resting heart rate
- recommended exercise intensity is 40-85% of HRR - Maximal heart rate % (refer to no. 1)
- Meabolic Equvalents of a Task (METs)
Assessing Functional Capacity
6 min. walk test
- walk as far as possible within 6 min. at submax level
- How to: long hallway (30 meters or 100 feet), stopwatch. Monitor px as they walk as far as possible for 6 min.
- Most useful when comparing with previous test before and after an intervention
Assessing components of Fitness
- Cardiorespiratory fitness test:
a. Step testing: 12 inch step, metronome, stopwatch. Subject steps for 3 min. to the timing of metronome and then rests for 1 min. Then HR is auscultated and palpated. Then compared to calculated norms for age and gender. - Submaximal talk test for ventilatory threshold (VTG1) - requires machine monitoring
- Rockport fitness walking test (1 mile or 1.6 km), Walk as fast as possible then pulse recorded and estimated with equation.
Body Composition
Gold standard:
Hydrodensitometry (underwater weighing) and Dual Energy X-Ray Absorptiometry (DEXA) scan
Medical Screening for Exercise by Health Care Provider
- Risk of death during PA is very rare except with px with known diseasee.
ACSM recommends PAR-Q (Physical Activity Readiness Questionnaire for Everyone)
Guidelines: px that should receive medical clearance before initiating exercise or increasing intensity:
- Group 1: Those with clinically significant diseases who would benefit from medically supervised exercise programs.
- Group 2: Those with uncontrolled medical conditions that require tx or control before further exercise should be initiated
Goal of screening: reduce exercise related CV events
ACSM guidelines:
- If person is physically inactive + signs or symptoms of cardiovascular, metabolic, renal disease - medical clearance is recommended before initiating mod to vigorous intensity PA.
- Pulmonary disease does not require medical clearance, BUT with uncontrolled lung disease should be evaluated to see if changes in medical therapy is needed
- there is lack of evidence that clearance mitigates risk
Exercise Stress Testing
US Preventive Services Task Force recommends against routine testing or exercise electrocardiography in asymptomatic individuals
Unless: symptoms suggestive of ischemic heart disease, chest pain but negative cardiac enzymes, to evaluate heart function in at risk px with syncope. avlavular disease, arrhytmias, medical or surgical intervention
- Not recommended for px who are low risk or high risk
- contrindicated in recent MI, hypertensive emergency, acute infections, decompensated heart failure, stenosis
Algorithm for exercise pre participation screening process
- Px currently exercises regularly
- Asymptomatic wit no know CV, metabolic, renal disease - NO CLEARANCE NEEDED. may participate in mod to vig intensity exercise
- Asymptomatic with KNOWN CV, metablic, renal disease - NO CLEARANCE for MODERATE intensity, with gradual progression to vigorous intensity if one remains asymptomatic
- If signs or symptoms occur, then it’s REQUIRED
- Symptomatic regardless of diseases status: SEEK MEDICAL CLEARANCE, if cleared, px may continue exercise program
- Px DOES NOT exercise regularly
- Asymptomatic with no disease - NO CLEARANCE NEEDED, light to moderate exercise recommended
- Asymptomatic with KNOWN disease - NEED CLEARANCE. Once cleared, light to mod intensity recommended the progress as needed
- Symptomatic regardless of disease - NEED CLEARANCE,
Algorithm for exercise pre participation screening process
- Px currently exercises regularly
- Asymptomatic wit no know CV, metabolic, renal disease - NO CLEARANCE NEEDED. may participate in mod to vig intensity exercise
- Asymptomatic with KNOWN CV, metablic, renal disease - NO CLEARANCE for MODERATE intensity, with gradual progression to vigorous intensity if one remains asymptomatic
- If signs or symptoms occur, then it’s REQUIRED
- Symptomatic regardless of diseases status: SEEK MEDICAL CLEARANCE, if cleared, px may continue exercise program
- Px DOES NOT exercise regularly
- Asymptomatic with no disease - NO CLEARANCE NEEDED, light to moderate exercise recommended
- Asymptomatic with KNOWN disease - NEED CLEARANCE. Once cleared, light to mod intensity recommended the progress as needed
- Symptomatic regardless of disease - NEED CLEARANCE, Once cleared, light to mod intensity recommended the progress as needed
ACSM 3 Stages of Exercise Progression
Initial stage: 1-6 weeks - designed to minimize muscle soreness, discomfort, and injury. 3-4 times a week
Improvement stage (4-8 months)
- HRR = MHR - RHR
- MHR = 220 minus a person’s age (220- age)
- Maximum heart rate per exercise should be increased no more than 5% of one’s heart rate reserve every 6th session
Maintenance stage (indefinitely)
5A’s in Practice
- Assess: beliefs, behaviors, knowledge
- Advise: provide specific information about health benefits of chagne
- Agree: collaboratively set goals based on patient’s interest and confidence in their ability to change behavior (use SMART goal)
- Assist: identify personal barriers, strategies, problem solving techniques or social/environmental support
- Arrange follow up plan.
Resource for Sustainable behavior change
- Self monitoring: pedometer, etc.
- Problem solve:
- Identify barriers as to why goals were not met
- ABC: Antecedent, behavior, consequence
- Develop solutions
- Act and assess - Relapse prevention
- Identify high risk situations (i.e. holidays, travel)
- Plan for potential lapses
- Cognitive restructuring (identify unhelpful thought patterns, encourage px not to abandon goals - Health promotion clinic, wellness programs. worksite wellness
Exercise as medication
Randomized control trial by DIabetes PRevention PRogram Research
- 150 min physical activity per week (7% weight loss goal)
- metformin decreased incidence of DB by 31%, while LM intervention reduced by 58%
PA in special population
- Even 100 year old px can increase muscle mass
- Pregnancy without contraindication: 150 min of mod intensity per week
DM:
150 min per week of moderate intensity of PA is sufficient to reduce risk of T2DM
- Colon cancer: 17-30% decrease in risk with PA
Breast cancer - Breast cancer: 25% risk reduction , PA prevents reoccurence and primary onset
Smoking vs PA
Smoking no. 1 preventable cause of death
Physical Inactivity - 4th
Aerobic Center Longitudinal Study
Findings: In this prospective study of 56,175 healthy participants at baseline, followed-up for a mean of 14.5 years, ≥100 PAI score/week was associated with significant 21% lower risk of all-cause and 30% lower risk of CVD mortality in comparison with inactive people.
PA Vital Sign
1) On average, how many days/week do you engage in moderate to strenuous exercise?
2) On average, how many minutes do you engage in exercise at this level?
Min. Recommended MET of PA
The amount of weekly time engaged in exercise is important with a goal exercise load of approximately 500-1000 MET-min/week.
