FINAL PPTS - Flexing the Nations Muscle Lecture 1 Waging War on Modern Chronic Diseases The Enemy Modern Chronic Disease Definition A disease slow in

FINAL PPTS - Flexing the Nations Muscle Lecture 1 Waging...

This preview shows page 1 out of 322 pages.

You've reached the end of your free preview.

Want to read all 322 pages?

Unformatted text preview: Flexing the Nation’s Muscle Lecture 1 Waging War on Modern Chronic Diseases The Enemy Modern Chronic Disease – Definition: A disease slow in its progress and long in its continuance (in some instances it may originate from neonatal). – The manifestation of the disease generally appear years after the original cause of the disease has taken effect. – It is therefore important to develop preventative strategies in order to fight the enemy sooner. Are we beating the enemy? NO Statistics: Casualties and Projected Losses Cardiovascular Disease – since 1900 the number one enemy every year – ~1.5 million deaths (39%) in 2000; Number 1 cause of mortality as of 2006. – ~81.1 million American adults have 1 or more types of CVD. – Nearly 2,600 Americans die of CVD each day, an average of 1 death every 33 seconds; CVD causes more deaths than following diseases combined. Type 2 Diabetes Mellitus (DM) – The prevalence of diabetes rose from 4.9 percent in 1990 to 7.3 percent in 2000, an increase of 48 %. – a 10-fold increase in adolescents between 1982 and 1994 – According to AHA DM killed 210,000 Americans in 2000 – At least 65% of people with DM die of some form of heart disease or stroke. Statistics: Casualties and Projected Losses Obesity – 112,000 deaths are associated with obesity each year in the United States. (JAMA 2005; 293:1861-1867) – In 1988-1994 63% of men and 55% of women were classified as overweight or obese (BMI) – The rate of class I obesity (BMI 30 - 35) rose 66% from the early 60s to the early 90s – Obesity contributes to a significant number and severity of diseases including CVD, HTN, DM, Osteoarthritis, Gallbladder disease, Gout, Cancer, etc. Discovering the Environmental Root(s) of Chronic Disease: The Fight against Physical Inactivity Establishing one true causal effect is difficult, but … Physical Inactivity is a likely culprit*** In fact, with the possible exception of perhaps diet intervention, we know of no single intervention with greater promise than physical exercise to reduce the risk of virtually all chronic diseases simultaneously. Exercise is Common Sense “If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health” Hippocrates 460 - 370 BC Others say exercise is senseless Mark Twain: "I have never taken any exercise except sleeping and resting.” Henry Ford: “Exercise is bunk. If you are healthy, you don't need it: if you are sick you should not take it.” Anthony Hopkins: “I have a punishing workout regimen. Every day I do 3 minutes on a treadmill, then I lie down, drink a glass of vodka and smoke a cigarette.” Screening and Testing – Health Risk Appraisals – Vitals – Physicals – Body Composition – Cardiorespiratory Endurance – Muscular fitness 1 RM or field test – Flexibility ACSM Risk Stratification Low Risk – Younger individuals who are asymptomatic and meet no more than one risk factor threshold. Moderate Risk – Older individuals (men>45; women >55) or those who meet the threshold for two or more risk factors. High Risk – Individuals with one or more signs/symptoms or known cardiovascular, pulmonary, or metabolic disease. Cardiorespiratory Fitness Recommendations – Frequency of Training: 3-5 d/wk – Intensity of Training: 55/65% - 90% HRmax 40/50% - 85% VO2R or HRR – Duration of Training: 20 - 60 min of continuous or intermittent aerobic activity – Mode of Activity: Any activity that uses large muscle groups, and can be maintained continuously and is rhythmic in nature Muscular Strength and Endurance Recommendations – Resistance Training Number of Sets: 1 set of 8 - 10 exercises aimed at conditioning the major muscle groups Number of Reps/Set: 8 -12 repetitions (10 - 15 if over 50yrs) Number of Exercises: 8 - 10 different exercise to provide a stimulus for all major muscle groups Frequency of Training: 2 - 3 d/wk Kilocalories Expended/Session Progression of Training Stage 1 Stage 2 500 Early Progressive Stage 3 Maintenance 400 300 Recommended Zone 200 •Healthy Young •Elderly •Patients 100 4 6 8 10 12 Weeks 20 9 12 18 Months 24 Key Issue: Volume of Training Moral of the story: Individualized Exercise Prescriptions Do not treat your patients like cattle. Physiological Adaptations Cardiovascular Metabolic Skeletal System Magnitude of Adaptation Rate of Adaptation and Deconditioning Cardiovascular ct i un F o al n A lit y bi MS System Rate of Adaptation Time-Course of Modification of Single Conduit Arterial Reactivity percent and absolute Allen et al. (MSSE May 2003) 12 † 10 BAFMD Peak Change (%) * * † * * * 8 6 4 2 TR UTR 0 (*=p<0.05 as compared to baseline, †=p<0.10 as compared to baseline) The study suggest flow mediated dilation is modified early in a training program with evidence of a significant improvement in the percent change in BAFMD following 4 days of training. Small Victories: Limited But Promising Research on the Biology of Physical Inactivity (Booth et al.) Another example of biologically mechanistic research in the field of physical activity/inactivity relates to contractile proteins in skeletal muscle. Translational increases in protein synthesis preceded any increases in rRNA in hypertrophying skeletal muscle. Likewise, translational reductions in myofibrillar protein synthesis preceded any reduction in skeletal -actin and myosin heavy chain mRNAs when loading of skeletal muscle was reduced. These latter findings are particularly important when we consider that the annual costs of disabilities, to a large extent including skeletal muscle atrophy (sarcopenia), approach $300 billion. Paffenbarger et al. (1993), NEJM – Harvard Male Alumni sedentary in‘62 or ‘66 – Physical Activity Index, 11yr. follow-up – Those who took up moderately intense sports activity had a 23% lower death rate vs. sedentary Blair et al. (1995), J.A.M.A. – n=9,777 US men, 20-82yrs – Measure of Fitness: Exercise Test, 5.1 yr. follow-up – For each min improvement on the exercise test there was an 8.6% decrease in mortality The link between physical inactivity and modern chronic disease "Warning: The Surgeon General Has Determined That Cigarette Smoking Is Dangerous to Your Health." "Warning: Cigarette Smoking Is Dangerous to Health and May Cause Death from Cancer and Other Diseases." "Quitting Smoking Now Greatly Reduces Serious Risks to Your Health." "Warning: The Surgeon General Has Determined That Physical Inactivity Is Dangerous to Your Health." "Warning: Physical Inactivity Is Dangerous to Health and May Cause Death from Cancer and Other Diseases." "Engaging in Physical Activity Now Greatly Reduces Serious Risks to Your Health." Bottom Line!! "It's like starting out on a journey. You start with a single step.” Gradually build up to include all four areas: endurance, strength, balance, and flexibility You don't have to do strenuous exercises to gain health benefits; moderate exercises are effective, too. "Exercise is like a savings account. The more you put in, the more you're going to get out of it.” We do not stop exercising because we grow old, we grow old because we stop exercising. -Dr. Kenneth Cooper; Cooper Institute. Waging War on Modern Chronic Disease Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it. -Plato Multidisciplinary Rehabilitation Independence Functional Ability Dependence Psychosocial and Nutritional Counseling Daily Activity & Exercise Training Riskfactor and Comorbidity Management Medical Evaluation and Management SELECT A HEALTH & FITNESS TRAINER AS IF YOUR HEALTH DEPENDS ON IT! use qualified health and fitness professionals to get yourself started Exercise in Health and Disease: Trends and Definitions of Physical Activity Lecture 2 Eating alone will not keep a man well; he must also take exercise. For food and exercise, while possessing opposite qualities, yet work together to produce health. For it is the nature of exercise to use up material, but of food and drink to make good deficiencies. And it is necessary, as it appears, to discern the power of various exercises, both natural and artificial, to know which of them tends to increase flesh and which to lessen it; and not only this, but also to proportion exercise to bulk of food, to the constitution of the patient, to Hippocrates. Regimen: Book 1, 400 the the age of the individual, to the season of the year, toBC changes in the winds, to the situation of the region in which the patient resides, and to the constitution of the year The Physical Activity Continuum Physical Inactivity Apparently Healthy Low Risk CDC/ACSM HP2010 SGR Diseased Moderate to High Risk Physical Activity, Risk Reduction and Health Apparently Healthy Low Risk ACSM AAHPERD AHA NSCA AHA ACSM AACVPR Diseased Moderate to High Risk Physical Fitness Athletic Org. Coaches Individual Occupational Advanced Physical or Athletic Performance AHA ACSM AACVPR AHCPR The 1990’s brought a historic perspective to exercise, fitness and physical activity by shifting the focus from intensive vigorous exercise to a broader range of health-enhancing activities. Research has demonstrated that virtually all individuals will benefit from regular physical activity. -U.S. Dept. of Health and Human Services, Healthy People 2010 Physical Activity Defined… Physical Activity has been defined as any bodily movement produced by skeletal muscles that results in energy expenditure. (Nieman, 2007) Exercise is a subcategory of physical activity that is planned, structured, repetitive, and purposive, in the sense that improvement or maintenance in physical fitness and functionality is an objective. (Nieman, 2007) The 2008 Physical Activity Guidelines for Americans describes the major research findings on the health benefits of physical activity: Regular physical activity reduces the risk of many adverse health outcomes. Some physical activity is better than none. For most health outcomes, additional benefits occur as the amount of physical activity increases through higher intensity, greater frequency, and/or longer duration. Most health benefits occur with at least 150 minutes (2 hours and 30 minutes) a week of moderate-intensity physical activity, such as brisk walking. Additional benefits occur with more physical activity. The 2008 Physical Activity Guidelines for Americans Both aerobic (endurance) and muscle-strengthening (resistance) physical activity are beneficial. Health benefits occur for children and adolescents, young and middle-aged adults, older adults, and those in every studied racial and ethnic group. The health benefits of physical activity occur for people with disabilities. The benefits of physical activity far outweigh the possibility of adverse outcomes. …Are We Active Enough? The map displays the prevalence of people in each state meeting physical activity recommendations (at least 150 minutes of moderate intensity aerobic physical activity, 2 hours and 30 minutes each week; or 75 minutes,1 hour and 15 minutes a week, of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorousintensity aerobic activity). Chronic inactivity is physiologically abnormal… We believe that human bodies fail to function properly to maintain health in many different ways when there is a loss of adequate amounts (historically ‘‘normal’’ amounts) Booth, et al. 2002 of physical activity. -Booth 2002 In other words, our genes expect the body to be in a physically active state if they are to function normally. In evolutionary terms, inactivity elicits an abnormal phenotypic expression of our genes. Global Burden of Disease Study Causes of Death Murray & Lopez. Lancet 1997 May 3;349(9061):1269-76 50.5 million deaths/yr Reliable info. on causes of death are essential to the dev. of health policies 8 Regions: – Established market economies – Former socialist economies of Europe – Latin America and Caribbean – China – India – Middle Eastern Crescent – Asia and Islands – Sub-Saharan Africa Global Burden of Disease Study Causes of Death Murray & Lopez. Lancet 1997 May 3;349(9061):1269-76 GBD Classification System – Group I, Communicable Disease Infectious, Maternal, Perinatal, Nutritional – Group II, Non-communicable Disease CVD, CA, DM, etc. – Group III, Intentional or Unintentional Injuries Global Burden of Disease Study Causes of Death Murray & Lopez. Lancet 1997 May 3;349(9061):1269-76 All Causes 50,467 (*103) 1. IHD 6,260 11. Malaria 856 2. CVD 4,381 12. Suicide 786 3. Resp. Inf. 4,299 13. Cirrhosis 779 4. Diarrhea 2,946 14. Stomach Ca 752 5. Perinatal 2,443 15. Congenital 589 6. COPD 2,211 7. TBC 1,960 16. DM 571 8. Measles 1,058 17. Violence 563 9. Accid. 999 21. War Inj. 502 10. Lung Cancer 945 29. Breast Ca. 30. HIV 322 312 Howley and Franks Physical Activity and Health: a report of the Surgeon General “This report is a passport to good health for all Americans. Its key finding is that people of all ages can improve the quality of their lives through a lifelong practice of moderate physical activity” Donna E. Shalala, Secretary of Health and Human Services Physical Activity and Health A report of the Surgeon General Published: 1996 Historical Background Physiologic responses and long-term adaptations to exercise The effects of physical activity on health and disease Patterns and trends in physical activity Understanding and promoting physical activity Findings of the Surgeon General Only 15% of US adults engage regularly (3*week*20mins) in vigorous physical activity during leisure time. Approx 22% adults engage regularly (5*week*30min) in sustained physical activity of any intensity during leisure time Approx 25% adults report NO physical activity in leisure time Findings of the Surgeon General Physical inactivity is more prevalent in women than men blacks & hispanics than whites older adults than younger adults less affluent than more affluent The most popular leisure-time activities among adults are walking and gardening/yard work Findings in Young Adults Only 50% (12-21yrs) regularly participate in vigorous physical activity 25% report no vigorous activity Only 25% walk or bicycle everyday 14% no physical activity (in 1996) Males are more likely to participate in vigorous activity, strengthening, bicycling etc. Findings in Young Adults Participation in all types of physical activity declines strikingly as age or grade in school increases In high school PE daily attendance declined from approx 42% to 25% in the first half of the ‘90’s Only 19% of all high school students report being physically active for 20 mins or more in daily physical ed class Physical Activity and Health: a report of the Surgeon General People of all ages benefit from regular physical activity Significant health benefits can be obtained by including a regular amount of physical activity on most, if not all, days of the week Additional health benefits can be gained through greater amounts of physical activity Physical activity reduces the risk of premature mortality in general, and of coronary artery disease, hypertension, colon cancer, and diabetes mellitus in particular. Physical activity also improves mental health and is important for the health of muscles, bones, and joints SGR Major Categories of Epidemiological Evidence to Support the Effects of Sustained Physical Activity on Overall Quality of Life… Work related Activity,- active job, survival increases Leisure Time Activity,- active leisure time, life increases Combined Total Daily Energy Expenditure,-energy used more throughout the day Increased Activity in the Presence of Disease, Current Fitness Levels, Changing Activity Levels.- shows cause and effect between activity and death Physical Activity at work sites is directly related to Vitality. The more you move, the longer you live. Association of Work Activity and Coronary Artery Disease Morris et al. (1953) – n=31,000, 35-64 yrs, all men (England) – “Sedentary” drivers vs. “Active” conductors – 30% decrease of manifestations of CAD – 50% fewer Myocardial Infarction – Flaw: “selective trial”? Association of Work Activity and Coronary Artery Disease Kahn (1963) – – – – n=2,240 (USA) Postal Workers between 1906 and 1940 Inverse relationship Difference became undistinguishable within 5 yrs after an individual left a physically active job – Benefits from physical activity can not be stored Association of Work Activity and Coronary Artery Disease Pomrehn et al. (1982) – – – – – 61,922 deaths Farmers vs. nonfarmers 1964 and 1978 Iowa men, 20-64 yrs Death from IHD Farmers had significantly less mortality than expected A similar Trend has been shown with Leisure Time Activity; it’s just as important. Leisure-Time Activity and Coronary Artery Disease Morris et al. (1973) – – – – n=16,882 Executive grade civil servants First CHD event 48-hr recall of leisure activity RR among vigorous group =0.33 compared to nonvigorous group Leisure-Time Activity and Coronary Artery Disease Leon et al. (1997) Int J Sports Med Jul;18 Suppl 3:S208-15 – MRFIT (Multiple Risk Factor Intervention Trial) 16year follow-up – Men were classified into deciles based on average min/d of LTPA reported at baseline, which were compared with cumulative CHD and all-cause mortality endpoints at the 16-year follow-up – Men in the least-active decile of LTPA who averaged 4.9 min/d of LTPA (range 0 to .9 min/d) had excess ageadjusted mortality rates of 29% and 22% for CHD and all-causes, respectively, as compared to those in combined deciles 2 to 4, who averaged 22.7 min/d of predominantly light and moderate LTPA Total Daily Energy Expenditure and Mortality… Total Daily Energy Expenditure and Coronary Artery Disease Paffenbarger et al. (1978 and 1984) – – – – – – Harvard Alumni, n ~17,000 men Entered between 1916-1950, Followed from 1962-1978 Physical Activity Index, Kcal/wk Death due to CHD 2000+ Kcal/wk had lowest risk Inverse association with caloric expenditure Caloric expenditure, life status, and disease in former male athletes and non-athletes Quinn TJ, Sprague HA, Van Huss WD, Olson HW Med Sci Sports Exerc 1990 Dec;22(6):742-50 Association between aerobic, caloric expenditure and mortality in former athletes and non-athletes. Initial survey done in 1952. Follow-up surveys of respondents were done in 1960, 1968, 1976, and 1984. A total of 348 subjects (185 ATH, 163 N-ATH) were assessed and caloric expenditure groups established by kilocalories of aerobic exercise per week; 0 kcal (grp 1), 1-399 kcal (grp 2), 400-899 kcal (grp 3), 900-1499 kcal (grp 4), 1500-2499 kcal (grp 5), and 2500+ kcal (grp 6). Death rate was highest in groups 1 and 2. College athletic status and 1976 exercise level were not significantly related to mortality. Increasing activity even in the presence of disease may regress condition and improve vitality. Progression and Regression of Coronary Atherosclerotic Lesions Hambrecht R et al. J Am Coll Cardiol (1993) Aug;22(2):468-77 Purpose: Define the effect of different levels of leisure time physical activity on cardiorespiratory fitness and progression of coronary atherosclerotic lesions n=62; patients with CAD; Prospective, randomized design Energy expenditure estimated from questionnaires and from participation in group exercise sessions After 1 year, repeat coronary angiography Patients in the intervention group increased VO2max 14%, whereas controls showed a significant decrease Regression of CAD noted in 8 patients (28%), progression of disease in 3 (10%) and no change in coronary morphology in 18 (62%) (Intervention) Progression in 45%, no change in 49% and regression in 6% (Control) Lowest level of leisure time physical activity was noted in patients with progression of disease (1,022 +/- 142 kcal/week) as opposed to patients with no change (1,533 +/- 122 kcal/week) or regression of disease (2,204 +/- 237 kcal/week) Physical activity and stroke incidence: the Harvard Alumni Health Study Lee...
View Full Document

  • Fall '09
  • MICHEALWELSCH
  • kinesiology, physical activity, body fat percentage

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture