Exercise for Health
Exercise for Health Benefit of Regular Exercise <ul><li>Improve mood </li></ul><ul><li>Combat chronic disease: HT, Dyslipi...
Types of exercise <ul><li>Aerobic Exercise  (Isotonic or dynamic) </li></ul><ul><ul><ul><li>Low to moderate intensity with...
Types of Aerobic Exercise   Type of Anaerobic Exercise * Aerobic dance   * Strength training * Bicycling   * Weight traini...
Hemodynamic Response to Exercise  <ul><li>Aerobic exercise </li></ul><ul><li>Decrease systemic vascular resistance and inc...
Athlete’s Heart <ul><li>A spectrum of abnormalities that reflect physiologic </li></ul><ul><li>adaptation to training </li...
Cardiovascular manifestation in Athlete’s Heart  Physical Examination: <ul><li>Resting bradycardia, generally between  30-...
ECG <ul><li>Sinus bradycardia and sinus arrhythmia with sinus pause up to  </li></ul><ul><li>2.5  sec with frequent juncti...
Chest x-ray <ul><li>Cardiomegaly, globular in shape </li></ul><ul><li>Cardiothoracic ratio between  0.5-0.6 </li></ul>Echo...
Exercise and Sudden Death  <ul><li>Annual incidence of sudden death: </li></ul><ul><ul><li>Under age  30  :  2-7 / 100,000...
Causes of Exercise-Related Death 85-97  %   structural cardiac disease was identified Young age (<  35  yrs)   Older age (...
Whether exercise conditioning protects against  cardiovascular death ? <ul><li>The product of HR x BP for submaximal work ...
EST (Bruce protocol) <ul><li>Resting HR  48   Max. HR  151 </li></ul><ul><li>Max SBP   274   Max DBP   47   HR x BP   3945...
 
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Exercise

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Exercise

  1. 1. Exercise for Health
  2. 2. Exercise for Health Benefit of Regular Exercise <ul><li>Improve mood </li></ul><ul><li>Combat chronic disease: HT, Dyslipid, DM, </li></ul><ul><li>Osteoporosis </li></ul><ul><li>Help managed weight </li></ul><ul><li>Strengthen heart and lung </li></ul><ul><li>Promote better sleep </li></ul><ul><li>Improve sex life </li></ul>
  3. 3. Types of exercise <ul><li>Aerobic Exercise (Isotonic or dynamic) </li></ul><ul><ul><ul><li>Low to moderate intensity with long duration </li></ul></ul></ul><ul><li> ( > 20 minutes) and uses large muscle groups </li></ul><ul><ul><ul><li>Relies mainly on oxygen from the lung </li></ul></ul></ul><ul><ul><ul><li>Use carbohydrate and fat as fuel </li></ul></ul></ul><ul><ul><ul><li>Essential for weight loss, cardiovascular fitness, </li></ul></ul></ul><ul><li>body-shaping </li></ul><ul><li>Anaerobic Exercise (Isometric or static) </li></ul><ul><ul><ul><li>Short-intensive activities lasting ≤ 1-2 minutes and </li></ul></ul></ul><ul><li>uses selective muscle groups </li></ul><ul><ul><ul><li>Relies on anaerobic pathway in muscles </li></ul></ul></ul><ul><ul><ul><li>Use carbohydrate as fuel </li></ul></ul></ul><ul><ul><ul><li>Essential for strength building and muscle gain </li></ul></ul></ul>
  4. 4. Types of Aerobic Exercise Type of Anaerobic Exercise * Aerobic dance * Strength training * Bicycling * Weight training * Running * Football, baseball * Jumping rope * Wrestling * Fitness walking * Sprinting * Stair climbing * Swimming * Skating and skiing
  5. 5. Hemodynamic Response to Exercise <ul><li>Aerobic exercise </li></ul><ul><li>Decrease systemic vascular resistance and increase venous return </li></ul><ul><li>Increase HR, stroke volume, cardiac output </li></ul><ul><li>Increase systolic BP but diastolic BP remain unchange or </li></ul><ul><li>slightly decrease </li></ul><ul><li>Significant increase blood flow to the muscles (30 folds) and </li></ul><ul><li>coronary A (4 folds) </li></ul><ul><li>Chronic adaptation occur if sustained dynamic exercise is </li></ul><ul><li>performed ≥ 1 hour, ≥ 5 times / week at least 4-6 weeks: </li></ul><ul><li>increase oxygen extraction by muscles and increase cardiac </li></ul><ul><li>dimension (Athlete’s heart) </li></ul><ul><li>Anaerobic exercise </li></ul><ul><li>Increase systemic vascular resistance, may decrease venous return, </li></ul><ul><li>decrease stroke volume and exaggerated increase HR and </li></ul><ul><li>mean arterial pressure. </li></ul>
  6. 6. Athlete’s Heart <ul><li>A spectrum of abnormalities that reflect physiologic </li></ul><ul><li>adaptation to training </li></ul><ul><li>It must be distinguished from real cardiac disease, </li></ul><ul><li>such as sick sinus syndrome or cardiomyopathy </li></ul>
  7. 7. Cardiovascular manifestation in Athlete’s Heart Physical Examination: <ul><li>Resting bradycardia, generally between 30-60 /min with </li></ul><ul><li>exaggerated respiratory variation </li></ul><ul><li>Left ventricular enlargement </li></ul><ul><li>1 st and 2 nd heart sound are normal, but S3, S4 are heard in </li></ul><ul><li>up to 50 % </li></ul><ul><li>Short, midsystolic murmur at precordial are </li></ul><ul><li>quite common </li></ul>
  8. 8. ECG <ul><li>Sinus bradycardia and sinus arrhythmia with sinus pause up to </li></ul><ul><li>2.5 sec with frequent junctional escape beats </li></ul><ul><li>1 st degree AV block ( 20 %) ,Mobitz I AV block may be observed and </li></ul><ul><li>disappear with exercise </li></ul><ul><li>Increase P wave voltage suggested LAE, RAE are common </li></ul><ul><li>Increase QRS voltage suggesting LVH ( 50 %) and often </li></ul><ul><li>associated with T wave inversion in inferior lead </li></ul><ul><li>Early repolarization and juvenile T wave pattern are common </li></ul><ul><li>ST-T change indicating strain pattern are unusual, but may occur </li></ul><ul><li>particularly in person who perform predominantly </li></ul><ul><li>isometric exercise. </li></ul>
  9. 9. Chest x-ray <ul><li>Cardiomegaly, globular in shape </li></ul><ul><li>Cardiothoracic ratio between 0.5-0.6 </li></ul>Echocardiogram <ul><li>Slight increase wall thickness (usually ≤ 14 mm) </li></ul><ul><li>and usually symmetry </li></ul><ul><li>Slight increase diastolic dimension </li></ul><ul><li>Normal or slight decrease systolic dimension </li></ul>
  10. 10. Exercise and Sudden Death <ul><li>Annual incidence of sudden death: </li></ul><ul><ul><li>Under age 30 : 2-7 / 100,000, 8 % are exercise-related </li></ul></ul><ul><ul><li>Over age 30 : 50-60 / 100,000, 2-3 % are exercise-related </li></ul></ul>
  11. 11. Causes of Exercise-Related Death 85-97 % structural cardiac disease was identified Young age (< 35 yrs) Older age (> 35 yrs) *Congenital anomalies of *CAD (up to two-thirds) coronary A. ( 35 %) *Hypertrophic cardiomyopathy * Other: cardiomyopathies, 22 % valvular HD, aortic disease, *Other: CAD ( 5 %), MVP (4 % ) primary arrhythmia dissection aorta (3 % ), dilated cardiomyopathy and myocarditis ( 1 %), arrhythmogenic RV dysplasia Pre-exercise evaluation : Pre-exercise evaluation : PE,CXR, ECG PE,CXR,ECG, EST
  12. 12. Whether exercise conditioning protects against cardiovascular death ? <ul><li>The product of HR x BP for submaximal work load is </li></ul><ul><li>lower  decrease myocardial oxygen demand </li></ul><ul><li>Coronary capillary and capacitance may increase </li></ul><ul><li>Enhance myocardial oxygen extraction </li></ul><ul><li>Diminish platelet aggregation, increase HDL </li></ul><ul><li>Relative risk for symptomatic CAD decrease 50 % </li></ul>
  13. 13. EST (Bruce protocol) <ul><li>Resting HR 48 Max. HR 151 </li></ul><ul><li>Max SBP 274 Max DBP 47 HR x BP 39456 </li></ul><ul><li>Total Exercise time 12 : 13 MET 12.8 </li></ul><ul><li>Observation </li></ul><ul><li>The patient can reach exercise stress test at Bruce’s </li></ul><ul><li>step 5 . Total duration is 12.13 minute. Maximum HR </li></ul><ul><li>is 142 /min. Target HR is 139/ min. Max. predicted HR 164 / min 92 % max HR. The patient has no chest pain and </li></ul><ul><li>stop exercise due to dyspnea. There is no significant ST </li></ul><ul><li>depression in all leed. But there are sinus arrest during </li></ul><ul><li>recovery period and there are occasionally PVC. </li></ul>
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