Exercise Is Medicine: How a Medical Fitness Center Differs from a Health Club

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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

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Exercise Is Medicine: How a Medical Fitness Center Differs from a Health Club

  1. 1. Exercise is Medicine Are you getting the right dose?
  2. 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. 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. 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. 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. 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. 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. 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.
  9. 9. Decision Time
  10. 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. 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. 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. 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. 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. 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. 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. 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. 18. Components of ExRx for Risk Factor Reduction Aerobic exercise Strength training
  19. 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
  20. 20. Stages of Conditioning  Initial Phase  Duration: 4-6 weeks  Goal: to increase frequency, proper form, & develop “good habits”  Improvement Phase  Duration: 4-6 mos.  Goal: to gradually increase intensity & duration  Maintenance Phase  Duration: after 6 mos  Goal: maintain CV fitness, avoid overuse injuries
  21. 21. Strength Training  Positive impact on;  Muscle mass & strength  Bone density  Metabolism  Balance
  22. 22. Strength Training  Significant correlation between muscle strength and;  Independence  Performance of ADL  Preferred walking speed
  23. 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. 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. 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

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