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Staying Active - Dr. Stoutenberg
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Staying Active - Dr. Stoutenberg



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

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



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  • Performance = Speed, Power, Balance, Agility, SpeedHealth = Cardiovascular Fitness, Flexibility, Body Composition, Muscular Strength, Muscular Endurance
  • HINTS: developed by NCI to describe cancer-related knowledge, beliefs, attitudes and behaviors
  • Exercise is slower than SSRI’s

Staying Active - Dr. Stoutenberg Staying Active - Dr. Stoutenberg Presentation Transcript

  • Eat Right…
    Feel Right
    Mark Stoutenberg, Ph.D.Research Assistant Professor
    Department of Epidemiology & Public Health
    University of Miami Miller School of Medicine
  • What if there was
    one prescription
    that could
    prevent and treat
    dozens of diseases,
    such as diabetes, hypertension
    and obesity?
  • 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
  • Evolutionary Paradox
    We won the war on against physical work
    but are losing to disease!!
    As evolution increased our ability to:
    • Move and think improved
    • Brain size increased
    • Increased ability to rationalize and solve-problems
    • Led to tool development, industrialization and, ultimately
  • Energy Balance
  • Thermic Effect of Exercise
    Jeukendrup and Gleeson. Sport Nutrition: An Introduction to Energy Production and Performance, 1st Edition.
  • Daily Energy Balance
    Jeukendrup and Gleeson. Sport Nutrition: An Introduction to Energy Production and Performance, 1st Edition.
  • What is Physical Activity?
    Physical Activity (PA)
    - any movement of the body that results in energy expenditure
    Physical Activity
  • Physical Activity
    Occupational & Lifestyle PA
    Leisure-Time Physical Activity
    Physical Transportation
    Health-Related Fitness
    Performance-Related Fitness
  • 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
  • PA Intensity
    • Low Intensity (MET < 3.0)
    • Does not substantially raise heart rate
    • Light daily activities that include:
    • Shopping
    • Cooking
    • Doing the laundry
    • Moderate Intensity (MET = 3.0 – 6.0)
    • Raises heart rate and hard enough that it causes break a sweat
    • Examples include:
    • Brisk walking
    • Water aerobics
    • Bike riding
    • Pushing a lawn mower
    • Raking leaves
  • PA Intensity
    • Vigorous Intensity (MET > 6.0)
    • Results in a hard, fast breathing rate and an elevated HR
    • Examples:
    • Jogging or running
    • Swimming laps
    • Riding a bike fast or on hills
    • Playing singles tennis or basketball
  • Health Benefits of Exercise
  • 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.
  • PA & Cancer Survival
    • Women who decreased their PA levels are at an approximately 4-fold increased risk of death
    • Pre- to post-diagnosis
    Irwin, M.L., et. al. J Clin Oncol. 2008; 26: 3958-3964.
  • Cancer Prevention Strategies
    • Health Information National Trends Survey (HINTS)
    • Asked respondents, “Can you think of anything people can do to reduce their chances of getting cancer?”
    • Of the 5,586 respondents, only 25.1% cited exercise as a cancer prevention strategy
    • Those who cited exercise as a prevention strategy were more likely (65.6%) to report exercising at least once a week
    Hawkins, N.A., et. al. Health Educ Behav. 2010; 37(4): 490-503.
  • 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)
  • 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
  • Brain Reward Pathway
    • Middle of the brain  “Reward Pathway”
    • Based on the neurotransmitter called dopamine
    • Continued surges of dopamine causes the brain to:
    • Produce less dopamine - or -
    • Reduce the number of dopamine receptors that receive signals
    • The ability to experience any pleasure is reduced
    • More drug is needed to try and bring their dopamine function back up to normal
  • Exercise “High”
    Exercise increases plasma dopamine (Van Loon et al., 1979)
    Chronic wheel running prevents decreases in affinity of dopamine receptors in aging mice (McRae et al., 1987)
    Dopamine turnover is increased following acute bout of exercise (Hattori et al., 1994)
  • Exercise & Drug Abuse
    STimulant Reduction Intervention using Dosed Exercise
    • Addition of exercise to residential drug treatment programs
    • Cocaine & Methamphetamine abusers
    • Vigorous intensity walking on a treadmill 3x a week
    • To compare the difference in % days abstinence between an exercise interventionon stimulant use
  • Exploratory Goal of STRIDE
    Individuals who suffer from addiction often have one or more accompanying medical issues including:
    Lung disease
    CVD / Stroke
    To determine if there are additional healthbenefits to using exercise augmentation inthe treatment of substance use disorders
  • Your “Exercise” Prescription
  • Determinants;
    Risk & Protective
    Disease Processes
    (e.g., food & brain,
    reward system)
    Physical Activity
    (e.g., stress, depression)
    Obesity & Undernutrition
    Ecological / Environmental
    (e.g., built environment)
    Infectious Disease
    Metabolic Syndrome
    Disease Processes
    Risk & Protective
  • Current Recommendations?
    • Moderately intense cardio 30 minutes a day, 5 days a week;
    • Vigorously intense cardio 20 minutes a day, 3 days a week;
    • Do 8 - 10 strength-training exercises, 8 - 12 repetitions of each exercise 2x / week.
    2008 Physical Activity Guidelines for Americans
  • 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:
    Stimulus control
  • Project Active
    • Lifestyle PA program vs. a structured, gym-based program (24 month program & study)
    • Primary goal was to increase daily PA
    • Lifestyle PA:
    • Significant reduction in BP
    • Improvement in cardiorespiratory fitness
    • Reduction in BF%
    • Changes were maintained over 24 months!
    • 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).