Chapter 01 Physical Activity, Health, and Chronic Disease Whats the Problem? Although physical activity plays an important role in prevention of chronic diseases, an alarming percentage of adults in the United States report no physical activity during leisure time. One of the national health objectives for 2020 is to get approximately 48% of the population to engage in moderate physical activity at least 3x/week. Physical Inactivity Individuals who do not exercise regularly are at greater risk than others of developing chronic diseases such as coronary heart disease, hypertension, hypercholesterolemia, cancer, obesity, and musculoskeletal disorders Individuals who do not exercise regularly are at greater risk than others of developing chronic diseases such as coronary heart disease, hypertension, hypercholesterolemia, cancer, obesity, and musculoskeletal disorders Physical activity was identified as a national health objective (U.S. Department of Health and Human Services 1996 / Surgeon General Report). This report identified physical inactivity as a serious nationwide health problem, provided clear cut scientific evidence linking physical activity to numerous health benefits Physical activity was identified as a national health objective (U.S. Department of Health and Human Services 1996 / Surgeon General Report). This report identified physical inactivity as a serious nationwide health problem, provided clear cut scientific evidence linking physical activity to numerous health benefits Figure 1.1 Role of physical activity and exercise in disease prevention and rehabilitation. Healthy People 2020 Addressing Physical Activity Healthy People 2020 Physical Activity Objectives Healthy People 2020 Physical Activity Objectives Goal Improve health, fitness, and quality of life through daily physical activity. Overview Released in 2008, the Physical Activity Guidelines for Americans (PAG) is the first-ever publication of national guidelines for physical activity. The Physical Activity objectives for Healthy People 2020 reflect the strong state of the science supporting the health benefits of regular physical activity among youth and adults, as identified in the PAG. Regular physical activity includes participation in moderate and vigorous physical activities and muscle-strengthening activities.Physical Activity Guidelines for Americans Healthy People 2020 Factors positively associated with adult physical activity include: Postsecondary education Higher income Enjoyment of exercise Expectation of benefits Belief in ability to exercise (self-efficacy) History of activity in adulthood Social support from peers, family, or spouse Access to and satisfaction with facilities Enjoyable scenery Safe neighborhoods Healthy People 2020 Factors negatively associated with adult physical activity include: Advancing age Low income Lack of time Low motivation Rural residency Perception of great effort needed for exercise Overweight or obesity Perception of poor health Being disabled Older adults may have additional factors that keep them from being physically active, including lack of social support, lack of transportation to facilities, fear of injury, and cost of programs. ACSMACSM and AHA Exercise Recommendations AHA ACSMAHA Table 1.1, page 3 (next slide), summarizes the ACSM and AHA physical activity recommendations for adults. Table 1.1, page 3 (next slide), summarizes the ACSM and AHA physical activity recommendations for adults. The intensity of exercise is expressed in metabolic equivalents (METs). A MET is the ratio of the persons working (exercising) metabolic rate to the resting metabolic rate. (3.5 ml/kg/min) The intensity of exercise is expressed in metabolic equivalents (METs). A MET is the ratio of the persons working (exercising) metabolic rate to the resting metabolic rate. (3.5 ml/kg/min) For adults (18-65 yr) and older adults (65 yr use RPE), the ACSM and AHA recommend a minimum of 30 min of moderate-intensity (3-6 METS) aerobic activity 5 days per week, or 20 min of vigorous-intensity aerobic exercise 3 days per week. For adults (18-65 yr) and older adults (65 yr use RPE), the ACSM and AHA recommend a minimum of 30 min of moderate-intensity (3-6 METS) aerobic activity 5 days per week, or 20 min of vigorous-intensity aerobic exercise 3 days per week. See also recommendations for Strength and Flexibility/Balance See also recommendations for Strength and Flexibility/Balance ACSM / AHA Physical Activity Recommendations Physical Activity Guidelines (2008) U.S. Dept. Health and Human Services Children and Adolescents (aged 617) Children and adolescents should do 1 hour (60 minutes) or more of physical activity every day. Most of the 1 hour or more a day should be either moderate- or vigorous-intensity aerobic physical activity. As part of their daily physical activity, children and adolescents should do vigorous-intensity activity on at least 3 days per week. They also should do muscle-strengthening and bone-strengthening activity on at least 3 days per week. The term Exercise Deficit Disorder has been used to identify children who do not attain at least 60 minutes of moderate-vigorous activity per day. Physical Activity Guidelines (2008) Adults (aged 1864) Adults should do 2 hours and 30 minutes a week of moderate- intensity, or 1 hour and 15 minutes (75 minutes) a week of vigorous- intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity. Aerobic activity should be performed in episodes of at least 10 minutes, preferably spread throughout the week. Additional health benefits are provided by increasing to 5 hours (300 minutes) a week of moderate-intensity aerobic physical activity, or 2 hours and 30 minutes a week of vigorous-intensity physical activity, or an equivalent combination of both. Adults should also do muscle-strengthening activities that involve all major muscle groups performed on 2 or more days per week. Physical Activity Guidelines (2008) Older Adults (aged 65 and older) Older adults should follow the adult guidelines. If this is not possible due to limiting chronic conditions, older adults should be as physically active as their abilities allow. They should avoid inactivity. Older adults should do exercises that maintain or improve balance if they are at risk of falling. Getting Started with Exercise (ACSM) Videos for promoting activity Beginning Aerobic Exercise Beginning Aerobic Exercise Beginning Aerobic Exercise Beginning Aerobic Exercise Beginning Strength Aerobic Exercise Beginning Strength Aerobic Exercise Beginning Strength Aerobic Exercise Beginning Strength Aerobic Exercise Flexibility Flexibility Flexibility There are many mechanisms available to promote physical activity Physical Activity and Health Improvements in health benefits depend on the exercise volume. Exercise volume is a dose-response relationship. (Volume = Frequency/Intensity/Duration) Improvements in health benefits depend on the exercise volume. Exercise volume is a dose-response relationship. (Volume = Frequency/Intensity/Duration) Improvements in health (increasing activity levels) can lead into exercise for fitness activities Improvements in health (increasing activity levels) can lead into exercise for fitness activities Figure 1.2: Dose-response relationship for health benefits and volume of physical activity. Source: The Canadian Physical Activity, Fitness and Lifestyle Approach: CSEPHealth & Fitness Programs Health-Related Appraisal and Counseling Strategy, 3rd edition Reprinted with permission of the Canadian Society for Exercise Physiology. Schematic developed by N. Gledhill and V. Jamnik of York University. Figure 1.3: The Exercise and Physical Activity Pyramid Adapted with permission of the Metropolitan Life Insurance Company. The Exercise and Physical Activity pyramid illustrates a balanced plan of physical activity and exercise to promote health and improve physical activity. Cardiovascular Disease AHA AHA Coronary Heart Disease Coronary Heart Disease Atherosclerosis Myocardial Ischemia Angina Myocardial Infarction Peripheral Vascular Disease Peripheral Vascular Disease Claudication TIA Stroke Atherosclerosis Myocardial Ischemia and Angina Myocardial Ischemia : A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). Angina pectoris: Chest pain that is typically severe and crushing with a feeling just behind the breastbone (the sternum) of pressure and suffocation, due to an inadequate supply of oxygen to the heart muscle. The term "angina pectoris" comes from the Latin "angere" meaning "to choke or throttle" + "pectus" meaning "chest". Angina pectoris was first described by the English physician William Heberden ( ) and may be referred to simply as angina. Myocardial Infarction Definition Definition Definition Video Video Video Peripheral Vascular Disease (PVD) PVD and Treatment Risk Factors Definitions PVD Claudication Transient Ischemic Attack (TIA) Cardiovascular Disease CHD Risk Factors CHD Risk Factors CHD Risk Factors CHD Risk Factors Family History Hypercholesterolemia Hypertension Cigarette Smoking Impaired blood glucose Obesity Physical Inactivity Physical Activity and CHD 6% worldwide CHD deaths related to physical inactivity 6% worldwide CHD deaths related to physical inactivity Lower incidence of MI and CHD mortality Lower incidence of MI and CHD mortality Reduce relative risk of CHD by x Reduce relative risk of CHD by x Benefit of exercise independent of other risk factors Benefit of exercise independent of other risk factors Hypertension ASH, NHLBI ASHNHLBI ASHNHLBI Prehypertension is an American classification for where a person's blood pressure is elevated above normal but not to the level considered to be hypertension (see chart). The seventh report of the Joint National Committee (JNC 7) proposed a new definition of blood pressure values below 140/90 mm Hg. Prehypertension is considered to be blood pressure readings with a systolic pressure from 120 to 139 mm Hg or a diastolic pressure from 80 to 89 mm Hg. Readings greater than or equal to 140/90 mm Hg are considered hypertension. Classification of blood pressure is based upon two or more readings at two or more separate occasions. (wiki)hypertensionsystolicdiastolic Hypertension Hemodynamics Hemodynamics Heart Rate - central Stroke Volume - central Peripheral Vascular Resistance - peripheral Blood pressure may be adjusted by modifying any of the hemodynamic determinants. Blood pressure may be adjusted by modifying any of the hemodynamic determinants. Medications target the hemodynamics of blood pressure Medications target the hemodynamics of blood pressure Exercise and Hypertension Position Stand ACSM Position Stand ACSM Position Stand ACSM Position Stand ACSM Epidemiology Studies - There is an inverse relationship between resting blood pressure and physical activity level Epidemiology Studies - There is an inverse relationship between resting blood pressure and physical activity level Regular activity helps prevent hypertension Regular activity helps prevent hypertension Exercise can lower blood pressure and thereby reduce CVD risk, and stroke risk. Exercise can lower blood pressure and thereby reduce CVD risk, and stroke risk. See Generic HTN Ex Rx on p.9., text. See Generic HTN Ex Rx on p.9., text. Hypercholesterolemia and Dyslipidemia Hypercholesterolemia and Dyslipidemia Defined Hypercholesterolemia and Dyslipidemia Defined Hypercholesterolemia A.K.A. Hyperlipidemia Lipoproteins Lipoproteins Chylomicrons Chylomicrons VLDL VLDL LDL LDL HDL HDL * Recommended Cholesterol LevelsRecommended Cholesterol Levels Exercise and Hypercholesterolemia Physical Fitness is inversely related to Triglyceride levels Physical Fitness is inversely related to Triglyceride levels Exercise is more effective in reducing blood cholesterol when combined with dietary modifications Exercise is more effective in reducing blood cholesterol when combined with dietary modifications Exercise increases HDL and improves HDL to total cholesterol ration Exercise increases HDL and improves HDL to total cholesterol ration Fat mass loss and lean mass gain tend to improve HDL levels Fat mass loss and lean mass gain tend to improve HDL levels Diabetes Mellitus Diabetes Mellitus IDDM and NIDDM Defined IDDM and NIDDM Defined IDDMNIDDM IDDMNIDDM Hormones that influence blood glucose level Hormones that influence blood glucose level Hormones that influence blood glucose level Hormones that influence blood glucose level Exercise and Blood Glucose Regulation Exercise and Blood Glucose Regulation Improvements in Insulin Sensitivity Improvements in Insulin Sensitivity Regular physical activity reduces ones risk of developing NIDDM through its association with weight loss Regular physical activity reduces ones risk of developing NIDDM through its association with weight loss The reduction in diabetes risk, however, appears to be associated with the frequency of exercise. The reduction in diabetes risk, however, appears to be associated with the frequency of exercise. ObesityObesity and Overweight Obesity Obesity and Overweight Defined Obesity and Overweight Defined BMI indicators (BMI = wt (kg) / height (m 2 ) ) Over weight BMI = 25 to 29.9 kg/m 2 Obese BMI = >30 kg/m 2 Co-morbidity Co-morbidity Diabetes, Hypertension, CHD, Metabolic Syndrome, Cancer, Musculoskeletal Disorders including osteoarthritis Obesity Rates in U.S. No state had a prevalence of obesity less than 20%. Five states and the District of Columbia had a prevalence of obesity between 20% and