During his presentation on 2/25/14, Eldon Jones, director of health & fitness at Mercy Medical Center in Canton, Ohio, explains how exercise often is as effective as medication in treating certain chronic serious health conditions, including heart disease, diabetes and more.
Eldon also covered how a medical fitness center differs from a tradition gym or health club.
Other topics covered in the presentaton:
* The importance of prescribing exercise
* US Physical Activity Guidelines
* Cardiac rehabilitation and how it works
* Components of ExRx for risk factor reduction
* FITT principle
* Stages of conditioning
* Strength training
2. Exercise is Medicine
“If we had a pill that contained all the benefits of exercise,
it would be the most widely prescribed drug in the
world”….. Ronald M. Davis, M.D. President AMA
3. Coronary Heart Disease
•Affects > 82,000 Americans
•1 in 3 adults have 1 or more CHD risk factors
•1 person dies every 39 seconds from CHD
•CHD kills more women than the next 14 causes of death
combined
•Estimated 250,000 premature deaths in U.S. annually
directly attributable to physical inactivity
•Source: AHA update 2012
4. Lifestyle-related Risk Factors and
Risk of Future Nursing Home Admissions; 6462 Adults
Risk Factor
45-64 years
Hazard Ratio (95% CI)
Smoking
1.56 (1.23-1.99)
Physical Inactivity
1.40 (1.05-1.87)
BMI ≥30.0
1.35 (0.96-1.89)
High BP
1.35 (1.06-1.73)
High Cholesterol 1.14 (0.89-1.44)
Diabetes
Valiyeva E et al. Arch Int Med 2006; 166:985
3.25 (2.04-5.19)
5. Cooper Clinic Study 2012
41,000 men monitored for average of 17 yrs
Study found high degrees of fitness substantially reduced
risk of death from CHD regardless of LDL level
Conclusion included persons with LDL of <100 and poor
fitness had higher risk for death than LDL > 190 and high
level of aerobic fitness
6. Exercise Research
Direct relation between inactivity and cardiovascular
mortality. Inactivity is an independent risk factor for
of CAD.
Exercise capacity is a more powerful predictor of
mortality among men than other established risk
factors for CAD.
Physical fitness has been clearly associated with
improvements in lipid profiles.
7. Hypertension (AHA) 2005
Studied cardiovascular effects of aerobic exercise in
resistant hypertension
Resistant hypertension defined as BP >140/90 mmHg
despite use of 3 antihypertensive agents
Findings..exercise significantly SBP&DBP ambulatory
BP by 6+12 & 3+ 7 mmHg respectively
Conclusions: low responsiveness to drug therapy doesn’t
equate to low responsiveness to non-pharmacological
approach..i.e. EXERCISE
8. Exercise As Medicine
•
•
Tremendous health benefits are seen with even low levels of exercise.
Amount of exercise needed to benefit health is much lower than amount
needed for fitness.
Regular physical activity at the correct intensity:
• Reduces the risk of heart disease by 40%.
• Lowers the risk of stroke by 27%.
• Reduces the incidence of diabetes by almost 50%.
• Reduces the incidence of high blood pressure by almost 50%.
• Can reduce mortality and the risk of recurrent breast cancer by almost
50%.
• Can lower the risk of colon cancer by over 60%.
• Can reduce the risk of developing of Alzheimer’s disease by one-third.
• Can decrease depression as effectively as Prozac or behavioral therapy.
10. When Doctors Prescribe
Exercise
Spanish study in Archives of Internal Medicine looked at
4000 patients half given general advice on exercise, the
other half given an actual prescription to do so. In 6 mo.
Ex Rx group was significantly more active
65% of patients surveyed would be more interested in
exercising if prescribed by their MD
41% of physicians talk to their patients about exercise but
don’t offer suggestions as to best ways to be physically
active
11. Power of the Pad
Clear distinction between doctor’s advice & doctor’s
orders
Basis of “Exercise is Medicine” campaign
Exercise truly is a form of treatment
Choosing specific goals vs “get some exercise”
12. U.S. Physical Activity Guidelines
Age
150 minutes per week of
moderate-intensity
physical activity
• Choose your own schedule
• For example: 30 minutes of
moderate-intensity exercise,
five days per week OR three
10-minute sessions per day,
five days per week
No Chronic Conditions
Chronic Conditions
Children &
Adolescents
(6-17)
60 minutes or more of physical
activity every day (moderate*- or
vigorous**-intensity aerobic
physical activity).
Develop a physical activity
plan with your health care
professional. Avoid inactivity.
Refer to the Your
Prescription for Health
series.
Vigorous-intensity activity at least
3 days per week.
Muscle-strengthening and
bone-strengthening activity at
least 3 days per week.
Adults
(18-64)
150 minutes a week of moderateintensity, or 75 minutes a week of
vigorous-intensity aerobic
physical activity
Muscle-strengthening activities
that involve all major muscle
groups performed on 2 or more
days per week.
Develop a physical activity
plan with your health care
professional. Be as
physically active as possible.
Avoid
inactivity
Refer to the Your
Prescription for Health
series.
Older Adults
(65+)
Follow the adult guidelines, or be
as physically active as possible.
Avoid inactivity.
Exercises that maintain or
improve balance if at risk of
falling.
Develop activity plan with
health care professional.
Refer to the Your
Prescription for Health
series.
From the 2008 Physical Activity Guidelines for Americans
For more information on these guidelines, visit
www.acsm.org/physicalactivity.
13. What is Cardiac
Rehabilitation?
Medically supervised
Lifestyle modification
Monitored progressive exercise/activity
Inpatient-Outpatient-Lifetime
Individualized, typically 3x/week, up to 12 weeks
Physician Referral Required
13
14. Goals of Cardiac Rehab
Identify, modify, and manage risk factors to reduce
disability/morbidity & mortality
Improve functional capacity
Alleviate/lessen activity related symptoms
Educate patients about the management of heart
disease
Improve quality of life
14
15. Lifestyle Benefits:
Risk Factor and Lifestyle Modification
Smoking cessation
Lipid improvement
Blood pressure control
Exercise guidance
Weight management
Diabetes control
Stress management
15
16. Circulation 2013
Study of 846 patients that underwent CABG
Looked at survival after 10 yrs post-op, CR yes or no
At end of 10 yrs had 45% in mortality for CR attendees
vs non-attendees
17. Circulation 2012
Studied CR attendance & outcomes for CAD patients
>5800 patients, compared completion vs non completion
of CR over a 14 yr period
Findings: CR completion was associated with risk of
mortality & frequency of all cause & cardiac specific
hospitalizations.
18. Components of ExRx for
Risk Factor Reduction
Aerobic exercise
Strength training
19. F.I.T.T. Principle
Frequency
3-5 x/week
Intensity
HR 50-75% of HRR, 60-80% of VO2Max
Conversation Pace
RPE
RHR + 20
Time
15-60 min/session
Type
22. Strength Training
Significant correlation between muscle strength and;
Independence
Performance of ADL
Preferred walking speed
23. Strength Training
Start with resistive bands, light weights, cans of food
Chair exercises
10-15 reps of 5-7 exercises 2-3x/week
Lift 2 sec, lower 4 sec
Focus on large muscle groups
Precautions
24. Summary
•
Evidence is now overwhelming on the health burden of physical
inactivity.
•
The benefits of exercise in the treatment and prevention of chronic
disease cannot be denied.
•
We cannot continue to ignore this evidence when formulating treatment
plans for our patients.
•
No patient should leave a doctor’s office without an assessment of
his/her physical activity and proper prescription of an exercise program,
or a referral to a certified fitness professional.
25. Mercy’s Solution
Mercy Health Fitness Program…only certified program in
area by Medical Fitness Assoc (MFA)
Cardiac Rehab Program certified by AACVPR
Medical approach to fitness/wellness programming
Staff all degreed in exercise science
Easy referral process