Dr. Mark Stoutenberg of University of Miami Health System discussed the importance of physical activity and exercise at the 2011 WellBeingWell Conference.

1. Eat Right… Feel Right Exercise?? Mark Stoutenberg, Ph.D.Research Assistant Professor Department of Epidemiology & Public Health University of Miami Miller School of Medicine

2. What if there was one prescription that could prevent and treat dozens of diseases, such as diabetes, hypertension and obesity? THE MAGIC PILL?

3. We know adequate amounts of Physical Activity: Reduces blood pressure Reduces cholesterol Reduces risk of diabetes Reduces risk of cancer Reduces excess body fat Reduces risk of osteoporosis Reduces risk of heart attack Reduces anxiety Reduces depression Improves memory Improves functional abilities

5. Brain size increased

6. Increased ability to rationalize and solve-problems

7. Led to tool development, industrialization and, ultimately Physical Inactivity!

8. Energy Balance

9. Thermic Effect of Exercise Jeukendrup and Gleeson. Sport Nutrition: An Introduction to Energy Production and Performance, 1st Edition.

10. Daily Energy Balance Jeukendrup and Gleeson. Sport Nutrition: An Introduction to Energy Production and Performance, 1st Edition.

11. What is Physical Activity? Physical Activity (PA) - any movement of the body that results in energy expenditure Physical Activity Exercise

12. Physical Activity Occupational & Lifestyle PA Leisure-Time Physical Activity Physical Transportation Exercise Sport Fitness Health-Related Fitness Performance-Related Fitness

13. Who is the Most Active? A person who moves around all day but does not do any formal exercise A person who has a desk job and goes to the gym for 1 hour each night

15. Does not substantially raise heart rate

16. Light daily activities that include:

17. Shopping

18. Cooking

19. Doing the laundry

20. Moderate Intensity (MET = 3.0 – 6.0)

21. Raises heart rate and hard enough that it causes break a sweat

22. Examples include:

23. Brisk walking

24. Water aerobics

25. Bike riding

26. Pushing a lawn mower

28. Results in a hard, fast breathing rate and an elevated HR

29. Examples:

30. Jogging or running

31. Swimming laps

32. Riding a bike fast or on hills

34. Lifetime PA & Breast Cancer Nurses’ Health Study II (2008) 64,777 eligible women Length of follow-up = 6 years 550 cases of BCa in premenopausal women Total lifetime PA associated with 25% decrease in risk in BCa Higher levels of leisure-time PA during ages 12–22 were extremely important Regardless of PA levels during later years in life Maruti, S.S., et. al. J Natl Cancer Inst. 2008; 100: 728-737.

36. Pre- to post-diagnosisIrwin, M.L., et. al. J Clin Oncol. 2008; 26: 3958-3964.

38. Asked respondents, “Can you think of anything people can do to reduce their chances of getting cancer?”

39. Of the 5,586 respondents, only 25.1% cited exercise as a cancer prevention strategy

40. Those who cited exercise as a prevention strategy were more likely (65.6%) to report exercising at least once a weekHawkins, N.A., et. al. Health Educ Behav. 2010; 37(4): 490-503.

41. Exercise & Neurogenesis Exercise may prevent depression related to aging and decreasing levels of neurogenesis Neurogenesis results in higher cognitive function Rats that run 3-8km per night show 2-3 times greater neurogenesis (Fabel et al., 2008) Increase in number & enhanced maturation of newly developing neurons (van Praag et al., 2008)

42. Exercise & Depression Exercise reduces depressive(Rethorst et al., 2008) and anxiety symptoms (Wipfli et al., 2009) Suggestions that exercise may be equally effective in treating depression as psychotherapy(Klein at al., 1985) and anti-depressant medication(Babyak et al., 2000; Blumenthal et al., 2007) Exercise has been shown to be successful both as a monotherapy and in addition to other treatments Decreased interaction effect with other treatments

44. Based on the neurotransmitter called dopamine

45. Continued surges of dopamine causes the brain to:

46. Produce less dopamine - or -

47. Reduce the number of dopamine receptors that receive signals

48. The ability to experience any pleasure is reduced

51. Cocaine & Methamphetamine abusers

52. Vigorous intensity walking on a treadmill 3x a week

54. Your “Exercise” Prescription

55. Determinants; Risk & Protective Factors Disease Processes Genetic Diabetes Biological (e.g., food & brain, reward system) CVD Physical Activity Positive/ Negative Energy Balance Psychological (e.g., stress, depression) Obesity & Undernutrition Cancer Social Ecological / Environmental (e.g., built environment) Infectious Disease Metabolic Syndrome Diet Economic Cultural Policies Disease Processes Determinants; Risk & Protective Factors

57. Lifestyle Modifications Convenient, less intimidating, less structured Increase likelihood of remaining active over a longer duration Integrating activities into daily life No set patterns of activity or training or dose of exercise Use of behavior modification strategies include: Self-monitoring Problem-solving Self-management Stimulus control

59. Primary goal was to increase daily PA

60. Lifestyle PA:

61. Significant reduction in BP

62. Improvement in cardiorespiratory fitness

63. Reduction in BF%

64. Changes were maintained over 24 months!

65. Now called the “Active Living Every Day” program Dunn AL et al. Comparison of Lifestyle and Structured Interventions to Increase Physical Activity and Cardiorespiratory Fitness. JAMA. 1999, 281(4).