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Exercise
and Health
Dr. Fathi Neana, MD
Chief of Orthopaedics
Dr. Fakhry & Alrajhy hospital
April ,4 – 2017
‫قال‬ ‫عنه‬ ‫هللا‬ ‫رضي‬ ‫هريرة‬ ‫أبي‬ ‫عن‬:
‫وسلم‬ ‫عليه‬ ‫هللا‬ ‫صلى‬ ‫هللا‬ ‫رسول‬ ‫قال‬:
((ٌ‫خير‬ ‫القوي‬ ‫المؤمن‬
‫من‬ ‫هللا‬ ‫إلى‬ ‫وأحب‬
‫وفي‬ ،‫الضعيف‬ ‫المؤمن‬
،‫خير‬ ٍ‫ل‬‫ك‬،‫ينفعك‬ ‫ما‬ ‫على‬ ‫احرص‬
‫أصابك‬ ‫وإن‬ ،‫تعجز‬ ‫وال‬ ‫باهلل‬ ‫واستعن‬
‫تقل‬ ‫فال‬ ٌ‫ء‬‫شي‬:‫وك‬ ‫كذا‬ ‫فعلت‬ ‫أني‬ ‫لو‬‫ذا‬
‫قل‬ ‫ولكن‬ ‫وكذا‬:‫شاء‬ ‫وما‬ ‫هللا‬ ‫قدر‬
‫فإن‬ ،‫فعل‬(‫لو‬)‫الشيطان‬ ‫عمل‬ ‫تفتح‬))
(‫مسلم‬ ‫رواه‬)
Physical inactivity pandemic
Obesity
Effect of Nonesterified free fatty acids (NEFA) -Triglycerides
Obesity
Free fatty acids (NEFA)
Triglycerides
Calorie overload
Hyperglycemia
Hyperinsulinemia
Systemic Insulin
resistance
Systemic Insulin
resistance
DM 2
Kidney
Skeletal
Vessels
Metabolic syndrome
Phagocytosis + Pro
inflammatory mediators
triggering adipose tissue
inflammation
Local insulin resistance
Adipose tissue
Macrophages
Liver
Local insulin
resistance
Triglycerides
Diabetes & Inflammation—the Vicious Cycle
Anatomy of the Vicious Cycle Dr. Richard K. Bernstein
Chronic low-grade inflammation plays a role in all major diseases including musculoskeletal manifestations
Inflammatory
mediators
Adipokines
leptin (pro-inflammatory)
adiponectin (anti-
inflammatory).
Sedentary Lifestyle
High sugar-carbohydrate - Lack of
exercises - Stress – Sleep - etc
Muscle
Obesity
Effect of Nonesterified free fatty acids (NEFA) -Triglycerides
“In view of the prevalence, global reach and health effect of physical inactivity, the issue should be
appropriately described as pandemic, with far-reaching health, economic, social and Environmental
consequences.”
Physical inactivity pandemic
Obesity
Coronary artery disease
Diabetes
Hypertension
Cancer
Depression and anxiety
Arthritis
Osteoporosis
Etc, etc, etc…
Global Epidemic of Inactivity
WHO. Global health risks: mortality and burden of disease attributable to selected major risks. 2009.
http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.
The 15 leading causes of death in 2013 were:
1. Heart Disease
2. Malignant neoplasms (cancer)
3. Chronic lower respiratory diseases
4. Cerebrovascular diseases (stroke)
5. Accidents (unintentional injuries)
6. Alzheimer’s disease
7. Diabetes
8. Nephritis, nephrotic syndrome and nephrosis (kidney disease)
9. Influenza and pneumonia
10. Intentional self-harm (suicide)
11. Septicemia
12. Chronic liver disease and cirrhosis
13. Essential hypertension and hypertensive renal disease
14. Parkinson’s disease
15. Pneumonitis due to solids and liquids
Leading Causes of Death in the U.S.
Fracture neck femur in the elderly
Elderly >75years old
Non operative treatment (Physical inactivity)
(financial vs medical causes)
Hype about hip fractures?
Published in The New York Times, May 10, 2010,
Company With Osteoporosis Treatment Wins the ‘Super Bowl’ By LORA KOLODNY
Courtesy of McCombs School of Business, Texas Venture Labs
Biologics MD team competing at Global Moot Corp.
All-Cause Death Rates by CRF Categories –
3,120 Women and 10,224 Men
0
10
20
30
40
50
60
70
Low Moderate High
Ageadjdeathrate/10,000PY
Cardiorespiratory Fitness Level
Women
Men
Blair SN. JAMA 1989
Cardio Respiratory Fitness (CRF) & Mortality
0
2
4
6
8
10
12
14
16
18
Men
Women
40,842 men & 12,943 women from the Aerobic Cooper Longitudinal Study
Effect of CRF on Mortality
Attributable Fractions (%) for All-Cause Deaths
Blair SN. Br J Sports Med 2009; 43:1-2.
• Obesity
• Coronary artery disease
• Diabetes
• Hypertension
• Cancer
• Depression and anxiety
• Arthritis
• Osteoporosis
• Etc, etc, etc…
Patients & Physicians
The answer is NO ! WHY NO ?
Physical inactivity pandemic
Do You Think We have a Chance
Without Exercise?
Countless Benefits of Exercise ?
Exercise is any bodily activity that enhances or maintain
physical fitness and overall health
Exercise is a one prescription that could prevent
and treat dozens of diseases, such as diabetes,
hypertension and obesity…
Robert E. Sallis, M.D., FACSM,
EIM Global Center Chairman
If exercise could be packed in a pill, it would be the
single most widely prescribed and beneficial
medicine in the nation.
Robert N. Butler, M.D.
Former Director, National Institute on Aging
1- A state of chronic low grade inflammation
plays a role in all major diseases including musculoskeletal manifestations
Dr. Richard K. Bernstein
Diabetes & Inflammation—the Vicious Cycle
Anatomy of the Vicious Cycle
2- Mitochondrial dysfunction, not the genetic make
up
that cause cancer, nearly all chronic diseases & accelerated aging
Dr. Ron Rosedale
Breakthrough views on clinical metabolic biochemistry
Root cause of Chronic diseases, Cancer and
Aging
What causes Mitochondrial
dysfunction ??
Dr. Rosedale : Defective metabolic processes in mitochondria, not the genetic make up That
cause cancer and nearly all other chronic diseases, including accelerated aging
What causes Mitochondrial dysfunction??
What causes Defective metabolic processes in mitochondria??
Mitochondria
Mitochondrial
dysfunction
1- Harmful Effects of too much
Sugar & Protein
A- Too many net carbs
->> Insulin and leptin receptor resistance
->> Free radicals (ROS) 90% Mitochondria
B- Too much protein
->> Activation of the mTOR metabolic signaling
pathway
2- Physical inactivity
1- Mitochondrial Metabolic Therapy
(MMT) 2017 vs Ketogenic diet
Similar to a ketogenic diet (epilepsy 30-50%)
MMT is a high fat, moderate protein, low carb eating plan
Unlike a ketogenic diet,
MMT emphasizes on high-quality, unprocessed whole foods
Salvage of Mitochondrial dysfunction?? (1)
2- Exercise is one of the most powerful signals for PGC 1-alpha, which is the
primary signal for mitochondria to reproduce and multiply, a process called
Mitochondrial biogenesis
1- With exercise the body Burn fat as its primary fuel, as
with using a ketogenic diet and MMT (Mitochondria
metabolic therapy)
2- Role of Regular Exercise
A- Burn of fat as MMT & Ketogenic diet
B- Improve insulin sensitivity
C- Peak rise of Human growth hormone
(HGH-GH) – strenuous exercise
D- Mitochondrial Biogenesis
Salvage of Mitochondrial dysfunction?? (2)
Exercise substantially lower cancer risk in 13 of the 26 cancers
examined.
The research involved a mega-pool of 1.44 million men and women from
a dozen large European and U.S.
prospective cohort studies (groups of participants who’d been followed
for several years).
Participant age, body mass index, gender, self-reported data on
exercise, smoking status and, if applicable, any cancer diagnoses, were
analyzed to determine the effect exercise had on various cancers.
A total of 186,932 primary cancers were diagnosed during the follow-up
period, which had a median length of 11 years.
Exercise for Cutting Cancer Risk (1)
Large Study 2016 Underscores Value of Exercise for Cutting Cancer Risk
Journal of the American Medical Association Internal Medicine 2016;
176(6): 816-825
Regardless of the person’s weight or smoking history, the data
suggested physical activity cut their risk of cancer.
Exercise slashed the risk of cancer
for example
Kidney cancer by 23 percent
Lung cancer by 26 percent
Liver cancer by 27 percent
Esophageal adeno carcinoma by 42 percent
Exercise for Cutting Cancer Risk (2)
Large Study 2016 Underscores Value of Exercise for Cutting Cancer Risk
Journal of the American Medical Association Internal Medicine 2016;
176(6): 816-825
Alleviate anxiety,
depression, low mood
and stress Bolster bone health
Build muscle strength
and improve range of
movement
Fuel your appetite Help you sleep better
Maintain a healthy
weight
Prevent constipation
Reduce fatigue and
improve your energy
levels
Sustain your heart
health
Exercise Is an Important Part of Cancer
Prevention & Care
March 24, 2017 | 62,429 views
Oxygenating of Tissues may Booster Effectiveness of Chemo and Radiation
Aerobic exercise increase the flow of oxygen-rich blood to tissues
Exercise is a vital part of nearly every cancer-treatment program
Exercise overcome the most common side effects of conventional cancer treatment
1- Weight bearing activities
stimulate Osteoblasts. It acts
like parathyroid hormone in
small doses by stimulating
steoblasts (Ratio of OPG >
RANKL)
(Teriparatide – Fortio)
2- Its anabolic effect, may at
the same time stop or reverse
osteoporosis
3- 60% reduction in fracture
incidence
Role of Exercise in Osteoporosis
Bone Mass and Activity
80
85
90
95
100
105
110
115
%SedentaryControl
Row Volleyball Basketball Swim Run Weights
Sports
Exercise improve Insulin sensitivity
The metabolic syndrome - Insulin Resistance syndrome -
Syndrome X - Deadly quartet - Reaven’s syndrome
The metabolic syndrome -
Insulin Resistance syndrome
Co-occurrence of several known
cardiovascular risk factors
Type 2 Diabetes
Central Obesity
Atherogenic dyslipidemia
Hypertension
These conditions are interrelated
and share underlying mediators,
mechanisms and pathways
Insulin resistance syndrome
Hyperinsulinemia
High circulating insulin
Insulin toxicity
1- Directly damage blood vessels
2- Cause high blood pressure
3- Heart disease and heart failure
4- Obesity (abdominal obesity)
5- Osteoporosis
6- Certain types of cancer as
colon, breast, and prostate cancer
Increasing Insulin Sensitivity
Updated September 10, 2015, Published December 3, 2008 by Sheri R. Colberg, PhD
Timeline of Tissue Breakdown
Intermittent fasting
Fasting Period
(8 h glucose & glycogen)
8h ---- fat –---36h
(36 - 48 hours protein)
Fasting for > 8 hours (14 – 20 h) force the
body to burn body fat when blood sugar
or carbs drop
Rapid loss of fat by fasting 14 to 20 hours
per day (even without ex & dietary regimes)
Exercise -> rapid depletion of
glycogen ->> burning fat as the
primary fuel in < 8h
36-48 hours before significant
amounts of protein start being
broken down
Simplified View of Insulin Action
Graphic originally published at
http://weightology.net/weightologyweekly/
?page_id=319
Metabolic syndrome (No Cure) With Drugs
Can be Cured with
Bariatric surgery
Intermittent Fasting (IF)
Very low carb diet (MMT)
+
Exercise
Muscles replenish their glycogen stores with
glucose from the blood stream. The more
glycogen that is burned the longer the body’s
insulin sensitivity is improved.
Exercise improve Insulin sensitivity
The metabolic syndrome - Insulin Resistance syndrome -
Syndrome X - De adly quartet - Reaven’s syndrome
Central regulator of cell metabolism, growth,
proliferation and survival.
1- The mTOR pathway is activated during various cellular processes (e.g.
tumor formation and angiogenesis, insulin resistance, adipogenesis and T-
lymphocyte activation)
2- The mTOR pathway is deregulated in human diseases such as cancer and
type 2 diabetes.
Growing use of mTOR inhibitors (rapamycin) and its analogues (rapalogues)]
in pathological settings, including the treatment of solid tumors, organ
transplantation, coronary restenosis and rheumatoid arthritis.
The mammalian target of rapamycin (mTOR)
Discoveries that have been made over the last decade
mTOR function in skeletal muscle a focal point for overnutrition and exercise
Nutrients and Exercise have the capacity to converge at the mTOR protein
complexes and subsequently modify mTOR function
Donato A. Rivas,a Sarah J. Lessard,b Vernon G. Coffeya
aExercise Metabolism Group, School of Medical Sciences, RMIT University, Bundoora, Victoria 3083ailartsuA ,.
bThe Research Division, Joslin Diabetes Center and Department of Medicine, Harvard Medical School, Boston, MA 02215ASU ,.
Corresponding author (email: vernon.coffey@rmit.edu.au)
Published on the web 6 October 2009.
Received March 29,2009yaM detpeccA .26,2009.
Exercise & Human Growth Hormone
HGH-GH
Produced by the pituitary gland
key role in growth, body composition, cell repair
and metabolism
HGH boosts muscle growth, strength and exercise
performance
Helping recovery from injury and disease
Lower HGH levels negatively impact quality of life,
increase risk of disease and gain fat
Important during weight loss, recovery from injury
and to boost athletic performance
Diet & lifestyle choices affect HGH levels
Having Optimal HGH Levels is Important
As with other key hormones, like testosterone and estrogen
Exercise & Human Growth Hormone HGH-GH
1- Lose Body Fat
2- Fast Intermittently
3- Reduce Sugar Intake
4- Don't Eat a Lot Before Bedtime
5- Exercise at a High Intensity
6. Optimize Your Sleep
7. Take a Melatonin Supplement
8- Try an Arginine Supplement
9- Take a GABA Supplement
10- Take Beta-Alanine and/or a
Recovery Shake Around Your
Workouts
11. Other Natural Supplements
Glutamine, Creatine, Ornithine, L-dopa,
Glycine
These may increase your HGH levels in the
short-term
11 evidence-based ways to increase human growth
hormone (HGH-GH) levels naturally
11 evidence-based ways to increase human growth
hormone (HGH-GH) levels naturally
11 evidence-based ways to increase human growth
hormone (HGH-GH) levels naturally
11 evidence-based ways to increase human
growth hormone (HGH-GH) levels naturally
11 evidence-based ways to increase human growth
hormone (HGH-GH) levels naturally
Adding running intervals to
your walking workouts
At about 12:30 per mile, walking hits a point where
it burns about the same calories/mile as running.
Running faster or slower than 10:00 pace doesn't make
much difference in your calorie-burn per mile
In order to get any benefit from a workout, it has
to be one that you enjoy and will do day after day.
If you love to run, run. If you hate to run but love
to walk, walk
Increases in walking speed
dramatically raise calorie burn per
mile as well as per minute.
It burn more fat + Spike Growth
hormone production
Walking vs. Running Calorie Burning Comparisons
Chase Jarvis/Taxi/Getty Images
By Wendy Bumgardner
Updated March 29, 2017
‫الفتح‬ ‫عام‬ ‫وسلم‬ ‫عليه‬ ‫هللا‬ ‫صلى‬ ‫النبي‬ ‫خرج‬
‫أصحابه‬ ‫من‬ ‫المشاة‬ ‫إليه‬ ‫فاجتمع‬
‫فقالوا‬:‫فقال‬ ‫السفر‬ ‫علينا‬ ‫اشتد‬
:‫عليكم‬‫بالنسالن‬‫عنكم‬ ‫يقطع‬ ‫فإنه‬
‫األرض‬‫له‬ ‫وتخفون‬.
‫علينا‬ ‫أخف‬ ‫فوجدناه‬ ‫فنسلنا‬ ‫قالوا‬.
‫خزيمة‬ ‫بن‬ ‫رواه‬2335‫له‬ ‫وعنون‬ ‫صحيح‬ ‫بسند‬
‫اإلعياء‬ ‫عند‬ ‫المشي‬ ‫في‬ ‫النسل‬ ‫إستحباب‬ ‫باب‬–
‫االلبانى‬ ‫صحيح‬.
‫هو‬ ‫والنسالن‬:‫وهو‬ ‫اإلسراع‬ ‫مع‬ ‫الخطو‬ ‫مقاربة‬
‫الماشي‬ ‫يزعج‬ ‫ال‬ ‫الذي‬ ‫الخفيف‬ ‫الجري‬
“Runner’s high.” Release of endorphins
Neurotransmitter, or Chemical messenger
Relieve pain and stress.
Dopamine, Norepinephrine, and Serotonin
Regulating mood, appetite and sleep cycles
Opposite effect of Depression.
Stress hormones, such as adrenaline
Crucial role in fight-or-flight response
But too much of it can damage health.
Exercise, Depression, and the Brain
Written by Ryan Collins
Medically Reviewed by Timothy J. Legg, PMHNP-BC, GNP-BC, CARN-AP, MCHES
on Mar 29, 2016
Exercise and Brain chemistry
Endorphins and other neurotransmitters Dopamine, Norepinephrine, Serotonin
Exercise, Depression, and the Brain
Written by Ryan Collins
Medically Reviewed by Timothy J. Legg, PMHNP-BC, GNP-BC, CARN-AP, MCHES
on Mar 29, 2016
“Runner’s high.” Release of endorphins
Neurotransmitter, or Chemical messenger
Relieve pain and stress.
Dopamine, Norepinephrine, and Serotonin
Regulating mood, appetite and sleep cycles
Opposite effect of Depression.
Exercise and Brain chemistry
Endorphins, Dopamine, Norepinephrine, Serotonin
‫األصلي‬ ‫الالتيني‬ ‫النص‬:
orandum est ut sit mens sana in corpore
sano.
fortem posce animum mortis terrore
carentem,
qui spatium vitae extremum inter munera
ponat
naturae, qui ferre queat quoscumque
labores,
nesciat irasci, cupiat nihil et potiores
Herculis aerumnas credat saevosque
labores
et venere et cenis et pluma Sardanapalli.
monstro quod ipse tibi possis dare; semita
certe
tranquillae per virtutem patet unica vitae.
– ‫جوفينال‬ ‫الروماني‬ ‫الشاعر‬(10.356-64)
‫جوفينال‬ ‫الروماني‬ ‫الشاعر‬
‫سليم‬ ‫جسم‬ ‫في‬ ‫سليم‬ ‫عقل‬ ‫أجل‬ ‫من‬ ‫صل‬
‫الموت‬ ‫يخشى‬ ‫ال‬ ‫شجاع‬ ‫قلب‬ ‫اطلب‬
‫قمية‬ ‫الطبيعة‬ ‫نعم‬ ‫أقل‬ ‫العمر‬ ‫طول‬ ‫ويرى‬
‫نوع‬ ‫أي‬ ‫من‬ ‫صعوبات‬ ‫أي‬ ‫يتحمل‬ ‫قلب‬
‫الرغبة‬ ‫أو‬ ‫الحنق‬ ‫يمسسه‬ ‫وال‬
‫الشاقة‬ ‫وأعماله‬ ‫هرقل‬ ‫محن‬ ‫أن‬ ‫يرى‬ ‫قلب‬
‫ومأدباته‬ ‫ساردانابالوس‬ ‫حب‬ ‫من‬ ‫أحسن‬
‫الوثيرة‬ ‫ووسائده‬.
‫لنفسك‬ ‫أكتبه‬ ‫ما‬ ‫توفر‬ ‫أن‬ ‫لك‬
‫هو‬ ‫سالمة‬ ‫لحياة‬ ‫الوحيد‬ ‫الطريق‬ ‫بالتأكيد‬ ‫ألنه‬
‫الفضيلة‬.
”‫السليم‬ ‫الجسم‬ ‫في‬ ‫السليم‬ ‫العقل‬“
‫شهيرة‬ ‫التينية‬ ‫عبارة‬ ‫ترجمة‬ ‫هي‬.
Mens sana in corpore sano
Exercise and the Health Triangle
• Health is the measure of
our body’s efficiency and
over-all well-being.
• The health triangle is a
measure of the different
aspects of health.
• The health triangle consists
of: Physical, Social, and
Mental Health.
Physical Benefits of Exercise
• Improved body shape - including muscle
tone and posture
• Strengthens bones and muscles
• Reduces the chance of illness so increasing
life expectancy
• Improves endurance, flexibility and
overall fitness
Physical health has many components including: exercise,
nutrition, sleep, alcohol & drugs, and weight management.
• Helps you to deal with stress and tension
• Improves self-confidence
• Increases motivation
• Gives you something to aim for - a
challenge
Mental Benefits of Exercise
• Mental heath deals with how we think, feel and cope with
daily life.
• Mental health encompasses learning, stress management, and
mental illnesses or disorders.
• Helps you meet new people and
make friends
• Improves your teamwork and
cooperation
Social Benefits of Exercise
• Social Health deals with the way react with people within
our environment.
• This includes: public health, family relationships, and peer
relationships.
Exercise Guidelines
Exercise Guidelines
The amount of exercise will vary depending on
physical fitness and long-term goals.
For example, if you have not exercised for a while
or ever before, have been ill or are reaching middle
age or older you need to start slowly.
If your aim is to run a marathon you will need to do
more training than someone who is aiming to walk
down the road without getting out of breath.
Exercise Guidelines
Exercise in the early morning or evening
 Wear a minimum amount of light,
loose-fitting clothes.
 Avoid rubberized or plastic suits.
 Drink a glass of water before you start.
 Carry water with you when you exercise.
 Drink a glass every 30 minutes.
 You can walk or exercise even indoors!
 Exercise five days a week
Exercise Guidelines
• Start gently and gradually increase the time and
intensity of your exercise as it gets easier
• Exercise often - 20 minutes three times a week is
better than 60 minutes once a week
• Don't overdo it - exercise shouldn't be painful or
make you ill or overly tired afterwards.
Aerobic exercises
Dr.Siva, Aden Refinery Hospital, Little Aden,
Yemen
Warm up & Cool down
Dr.Siva, Aden Refinery Hospital, Little Aden,
Yemen
Dr.Siva, Aden Refinery Hospital, Little Aden,
Yemen
Dr.Siva, Aden Refinery Hospital, Little Aden,
Yemen
Dr.Siva, Aden Refinery Hospital, Little Aden,
Yemen
Dr.Siva, Aden Refinery Hospital, Little Aden,
Yemen
Exercise while at Office
Exercise program
• Aerobic exercises
• Muscle stretching exercises
• Swimming
• Spinal extension & flexion
exercises
• Neck exercises
Conclusions
Countless Benefits of Exercise ?
Exercise is any bodily activity that enhances or maintain
physical fitness and overall health
Exercise is a one prescription
Prevent and treat dozens of diseases
Such as diabetes, hypertension, obesity…
Robert E. Sallis, M.D., FACSM,
EIM Global Center Chairman
If exercise could be packed in a pill
It would be the single most widely prescribed
and beneficial medicine in the nation
Robert N. Butler, M.D.
Former Director, National Institute on Aging
Exercise is a Medicine
Physicians should prescribe it,
Patients should take it!
• Exercise may be the long sought vaccine to
prevent chronic disease
• Are we reaching a point where NOT prescribing
physical activity should be consider patient
neglect?
• Exercise is Medicine® is a global initiative to
establish physical activity as a standard in
healthcare.
• Improved sense of well-being
• Less depression and anxiety
• Improved lung capacity to use
oxygen
• Stronger more efficient heart
muscle
• Slower resting pulse rate
• Increased muscle strength
• Improved blood supply
• Increased mobility and flexibility
• Maintains bone strength
• Delays development of
osteoporosis
• Improves performance
• Reduces risk of injury
• Helps reduce stress.
• Reduces muscle soreness
• Increases blood and nutrients to the tissues.
• Improves your coordination and
reduces accidents
• Less body fat
• More lean body tissue
• Lower blood sugar level
• Improved reaction time
• Better balance
• More efficient body cooling
• Higher HDL
• Lower triglyceride level
• Improved blood flow
• Lower blood pressure
Countless Benefits of exercise
How to avoid Lifestyle diseases
Healthy lifestyle VS. medicines
Managing stress
Healthy eating
Proper sleep
Regular exercise
Proper posture
Avoid Pollutants
1- Live a Biological life as far as you can
(Anti inflammatory and Natural Life style)
2- Take knowledge from trusted sources then
Calibrate with the absolute truth
3- Attach to the absolute truths in the sayings
of almightly ALLAH and his Messenger (peace
and blessings be upon him)
4- Avoid Mankind processed deviations &
inherited Myths
How to avoid Lifestyle diseases
My long life experience precious advice is
• Obesity
• Coronary artery disease
• Diabetes
• Hypertension
• Cancer
• Depression and anxiety
• Arthritis
• Osteoporosis
• Etc, etc, etc…
The answer is NO! WHY NO? Already answered
Physical inactivity pandemic
Do You Think
We have a Chance Without Exercise?
Exercise and health

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Exercise and health

  • 1. Exercise and Health Dr. Fathi Neana, MD Chief of Orthopaedics Dr. Fakhry & Alrajhy hospital April ,4 – 2017
  • 2. ‫قال‬ ‫عنه‬ ‫هللا‬ ‫رضي‬ ‫هريرة‬ ‫أبي‬ ‫عن‬: ‫وسلم‬ ‫عليه‬ ‫هللا‬ ‫صلى‬ ‫هللا‬ ‫رسول‬ ‫قال‬: ((ٌ‫خير‬ ‫القوي‬ ‫المؤمن‬ ‫من‬ ‫هللا‬ ‫إلى‬ ‫وأحب‬ ‫وفي‬ ،‫الضعيف‬ ‫المؤمن‬ ،‫خير‬ ٍ‫ل‬‫ك‬،‫ينفعك‬ ‫ما‬ ‫على‬ ‫احرص‬ ‫أصابك‬ ‫وإن‬ ،‫تعجز‬ ‫وال‬ ‫باهلل‬ ‫واستعن‬ ‫تقل‬ ‫فال‬ ٌ‫ء‬‫شي‬:‫وك‬ ‫كذا‬ ‫فعلت‬ ‫أني‬ ‫لو‬‫ذا‬ ‫قل‬ ‫ولكن‬ ‫وكذا‬:‫شاء‬ ‫وما‬ ‫هللا‬ ‫قدر‬ ‫فإن‬ ،‫فعل‬(‫لو‬)‫الشيطان‬ ‫عمل‬ ‫تفتح‬)) (‫مسلم‬ ‫رواه‬)
  • 3.
  • 4.
  • 5.
  • 7. Obesity Effect of Nonesterified free fatty acids (NEFA) -Triglycerides
  • 8. Obesity Free fatty acids (NEFA) Triglycerides Calorie overload Hyperglycemia Hyperinsulinemia Systemic Insulin resistance Systemic Insulin resistance DM 2 Kidney Skeletal Vessels Metabolic syndrome Phagocytosis + Pro inflammatory mediators triggering adipose tissue inflammation Local insulin resistance Adipose tissue Macrophages Liver Local insulin resistance Triglycerides Diabetes & Inflammation—the Vicious Cycle Anatomy of the Vicious Cycle Dr. Richard K. Bernstein Chronic low-grade inflammation plays a role in all major diseases including musculoskeletal manifestations Inflammatory mediators Adipokines leptin (pro-inflammatory) adiponectin (anti- inflammatory). Sedentary Lifestyle High sugar-carbohydrate - Lack of exercises - Stress – Sleep - etc Muscle
  • 9. Obesity Effect of Nonesterified free fatty acids (NEFA) -Triglycerides
  • 10. “In view of the prevalence, global reach and health effect of physical inactivity, the issue should be appropriately described as pandemic, with far-reaching health, economic, social and Environmental consequences.” Physical inactivity pandemic Obesity Coronary artery disease Diabetes Hypertension Cancer Depression and anxiety Arthritis Osteoporosis Etc, etc, etc…
  • 11. Global Epidemic of Inactivity WHO. Global health risks: mortality and burden of disease attributable to selected major risks. 2009. http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.
  • 12. The 15 leading causes of death in 2013 were: 1. Heart Disease 2. Malignant neoplasms (cancer) 3. Chronic lower respiratory diseases 4. Cerebrovascular diseases (stroke) 5. Accidents (unintentional injuries) 6. Alzheimer’s disease 7. Diabetes 8. Nephritis, nephrotic syndrome and nephrosis (kidney disease) 9. Influenza and pneumonia 10. Intentional self-harm (suicide) 11. Septicemia 12. Chronic liver disease and cirrhosis 13. Essential hypertension and hypertensive renal disease 14. Parkinson’s disease 15. Pneumonitis due to solids and liquids Leading Causes of Death in the U.S.
  • 13. Fracture neck femur in the elderly Elderly >75years old Non operative treatment (Physical inactivity) (financial vs medical causes)
  • 14. Hype about hip fractures? Published in The New York Times, May 10, 2010, Company With Osteoporosis Treatment Wins the ‘Super Bowl’ By LORA KOLODNY Courtesy of McCombs School of Business, Texas Venture Labs Biologics MD team competing at Global Moot Corp.
  • 15. All-Cause Death Rates by CRF Categories – 3,120 Women and 10,224 Men 0 10 20 30 40 50 60 70 Low Moderate High Ageadjdeathrate/10,000PY Cardiorespiratory Fitness Level Women Men Blair SN. JAMA 1989 Cardio Respiratory Fitness (CRF) & Mortality
  • 16. 0 2 4 6 8 10 12 14 16 18 Men Women 40,842 men & 12,943 women from the Aerobic Cooper Longitudinal Study Effect of CRF on Mortality Attributable Fractions (%) for All-Cause Deaths Blair SN. Br J Sports Med 2009; 43:1-2.
  • 17. • Obesity • Coronary artery disease • Diabetes • Hypertension • Cancer • Depression and anxiety • Arthritis • Osteoporosis • Etc, etc, etc… Patients & Physicians The answer is NO ! WHY NO ? Physical inactivity pandemic Do You Think We have a Chance Without Exercise?
  • 18. Countless Benefits of Exercise ? Exercise is any bodily activity that enhances or maintain physical fitness and overall health Exercise is a one prescription that could prevent and treat dozens of diseases, such as diabetes, hypertension and obesity… Robert E. Sallis, M.D., FACSM, EIM Global Center Chairman If exercise could be packed in a pill, it would be the single most widely prescribed and beneficial medicine in the nation. Robert N. Butler, M.D. Former Director, National Institute on Aging
  • 19. 1- A state of chronic low grade inflammation plays a role in all major diseases including musculoskeletal manifestations Dr. Richard K. Bernstein Diabetes & Inflammation—the Vicious Cycle Anatomy of the Vicious Cycle 2- Mitochondrial dysfunction, not the genetic make up that cause cancer, nearly all chronic diseases & accelerated aging Dr. Ron Rosedale Breakthrough views on clinical metabolic biochemistry Root cause of Chronic diseases, Cancer and Aging What causes Mitochondrial dysfunction ??
  • 20. Dr. Rosedale : Defective metabolic processes in mitochondria, not the genetic make up That cause cancer and nearly all other chronic diseases, including accelerated aging What causes Mitochondrial dysfunction?? What causes Defective metabolic processes in mitochondria?? Mitochondria Mitochondrial dysfunction 1- Harmful Effects of too much Sugar & Protein A- Too many net carbs ->> Insulin and leptin receptor resistance ->> Free radicals (ROS) 90% Mitochondria B- Too much protein ->> Activation of the mTOR metabolic signaling pathway 2- Physical inactivity
  • 21. 1- Mitochondrial Metabolic Therapy (MMT) 2017 vs Ketogenic diet Similar to a ketogenic diet (epilepsy 30-50%) MMT is a high fat, moderate protein, low carb eating plan Unlike a ketogenic diet, MMT emphasizes on high-quality, unprocessed whole foods Salvage of Mitochondrial dysfunction?? (1)
  • 22. 2- Exercise is one of the most powerful signals for PGC 1-alpha, which is the primary signal for mitochondria to reproduce and multiply, a process called Mitochondrial biogenesis 1- With exercise the body Burn fat as its primary fuel, as with using a ketogenic diet and MMT (Mitochondria metabolic therapy) 2- Role of Regular Exercise A- Burn of fat as MMT & Ketogenic diet B- Improve insulin sensitivity C- Peak rise of Human growth hormone (HGH-GH) – strenuous exercise D- Mitochondrial Biogenesis Salvage of Mitochondrial dysfunction?? (2)
  • 23. Exercise substantially lower cancer risk in 13 of the 26 cancers examined. The research involved a mega-pool of 1.44 million men and women from a dozen large European and U.S. prospective cohort studies (groups of participants who’d been followed for several years). Participant age, body mass index, gender, self-reported data on exercise, smoking status and, if applicable, any cancer diagnoses, were analyzed to determine the effect exercise had on various cancers. A total of 186,932 primary cancers were diagnosed during the follow-up period, which had a median length of 11 years. Exercise for Cutting Cancer Risk (1) Large Study 2016 Underscores Value of Exercise for Cutting Cancer Risk Journal of the American Medical Association Internal Medicine 2016; 176(6): 816-825
  • 24. Regardless of the person’s weight or smoking history, the data suggested physical activity cut their risk of cancer. Exercise slashed the risk of cancer for example Kidney cancer by 23 percent Lung cancer by 26 percent Liver cancer by 27 percent Esophageal adeno carcinoma by 42 percent Exercise for Cutting Cancer Risk (2) Large Study 2016 Underscores Value of Exercise for Cutting Cancer Risk Journal of the American Medical Association Internal Medicine 2016; 176(6): 816-825
  • 25. Alleviate anxiety, depression, low mood and stress Bolster bone health Build muscle strength and improve range of movement Fuel your appetite Help you sleep better Maintain a healthy weight Prevent constipation Reduce fatigue and improve your energy levels Sustain your heart health Exercise Is an Important Part of Cancer Prevention & Care March 24, 2017 | 62,429 views Oxygenating of Tissues may Booster Effectiveness of Chemo and Radiation Aerobic exercise increase the flow of oxygen-rich blood to tissues Exercise is a vital part of nearly every cancer-treatment program Exercise overcome the most common side effects of conventional cancer treatment
  • 26.
  • 27. 1- Weight bearing activities stimulate Osteoblasts. It acts like parathyroid hormone in small doses by stimulating steoblasts (Ratio of OPG > RANKL) (Teriparatide – Fortio) 2- Its anabolic effect, may at the same time stop or reverse osteoporosis 3- 60% reduction in fracture incidence Role of Exercise in Osteoporosis
  • 28. Bone Mass and Activity 80 85 90 95 100 105 110 115 %SedentaryControl Row Volleyball Basketball Swim Run Weights Sports
  • 29. Exercise improve Insulin sensitivity The metabolic syndrome - Insulin Resistance syndrome - Syndrome X - Deadly quartet - Reaven’s syndrome The metabolic syndrome - Insulin Resistance syndrome Co-occurrence of several known cardiovascular risk factors Type 2 Diabetes Central Obesity Atherogenic dyslipidemia Hypertension These conditions are interrelated and share underlying mediators, mechanisms and pathways Insulin resistance syndrome Hyperinsulinemia High circulating insulin Insulin toxicity 1- Directly damage blood vessels 2- Cause high blood pressure 3- Heart disease and heart failure 4- Obesity (abdominal obesity) 5- Osteoporosis 6- Certain types of cancer as colon, breast, and prostate cancer Increasing Insulin Sensitivity Updated September 10, 2015, Published December 3, 2008 by Sheri R. Colberg, PhD
  • 30. Timeline of Tissue Breakdown Intermittent fasting Fasting Period (8 h glucose & glycogen) 8h ---- fat –---36h (36 - 48 hours protein) Fasting for > 8 hours (14 – 20 h) force the body to burn body fat when blood sugar or carbs drop Rapid loss of fat by fasting 14 to 20 hours per day (even without ex & dietary regimes) Exercise -> rapid depletion of glycogen ->> burning fat as the primary fuel in < 8h 36-48 hours before significant amounts of protein start being broken down Simplified View of Insulin Action Graphic originally published at http://weightology.net/weightologyweekly/ ?page_id=319
  • 31. Metabolic syndrome (No Cure) With Drugs Can be Cured with Bariatric surgery Intermittent Fasting (IF) Very low carb diet (MMT) + Exercise Muscles replenish their glycogen stores with glucose from the blood stream. The more glycogen that is burned the longer the body’s insulin sensitivity is improved. Exercise improve Insulin sensitivity The metabolic syndrome - Insulin Resistance syndrome - Syndrome X - De adly quartet - Reaven’s syndrome
  • 32. Central regulator of cell metabolism, growth, proliferation and survival. 1- The mTOR pathway is activated during various cellular processes (e.g. tumor formation and angiogenesis, insulin resistance, adipogenesis and T- lymphocyte activation) 2- The mTOR pathway is deregulated in human diseases such as cancer and type 2 diabetes. Growing use of mTOR inhibitors (rapamycin) and its analogues (rapalogues)] in pathological settings, including the treatment of solid tumors, organ transplantation, coronary restenosis and rheumatoid arthritis. The mammalian target of rapamycin (mTOR) Discoveries that have been made over the last decade mTOR function in skeletal muscle a focal point for overnutrition and exercise Nutrients and Exercise have the capacity to converge at the mTOR protein complexes and subsequently modify mTOR function Donato A. Rivas,a Sarah J. Lessard,b Vernon G. Coffeya aExercise Metabolism Group, School of Medical Sciences, RMIT University, Bundoora, Victoria 3083ailartsuA ,. bThe Research Division, Joslin Diabetes Center and Department of Medicine, Harvard Medical School, Boston, MA 02215ASU ,. Corresponding author (email: vernon.coffey@rmit.edu.au) Published on the web 6 October 2009. Received March 29,2009yaM detpeccA .26,2009.
  • 33. Exercise & Human Growth Hormone HGH-GH
  • 34. Produced by the pituitary gland key role in growth, body composition, cell repair and metabolism HGH boosts muscle growth, strength and exercise performance Helping recovery from injury and disease Lower HGH levels negatively impact quality of life, increase risk of disease and gain fat Important during weight loss, recovery from injury and to boost athletic performance Diet & lifestyle choices affect HGH levels Having Optimal HGH Levels is Important As with other key hormones, like testosterone and estrogen Exercise & Human Growth Hormone HGH-GH
  • 35. 1- Lose Body Fat 2- Fast Intermittently 3- Reduce Sugar Intake 4- Don't Eat a Lot Before Bedtime 5- Exercise at a High Intensity 6. Optimize Your Sleep 7. Take a Melatonin Supplement 8- Try an Arginine Supplement 9- Take a GABA Supplement 10- Take Beta-Alanine and/or a Recovery Shake Around Your Workouts 11. Other Natural Supplements Glutamine, Creatine, Ornithine, L-dopa, Glycine These may increase your HGH levels in the short-term 11 evidence-based ways to increase human growth hormone (HGH-GH) levels naturally
  • 36. 11 evidence-based ways to increase human growth hormone (HGH-GH) levels naturally
  • 37. 11 evidence-based ways to increase human growth hormone (HGH-GH) levels naturally
  • 38. 11 evidence-based ways to increase human growth hormone (HGH-GH) levels naturally
  • 39. 11 evidence-based ways to increase human growth hormone (HGH-GH) levels naturally
  • 40. Adding running intervals to your walking workouts At about 12:30 per mile, walking hits a point where it burns about the same calories/mile as running. Running faster or slower than 10:00 pace doesn't make much difference in your calorie-burn per mile In order to get any benefit from a workout, it has to be one that you enjoy and will do day after day. If you love to run, run. If you hate to run but love to walk, walk Increases in walking speed dramatically raise calorie burn per mile as well as per minute. It burn more fat + Spike Growth hormone production Walking vs. Running Calorie Burning Comparisons Chase Jarvis/Taxi/Getty Images By Wendy Bumgardner Updated March 29, 2017 ‫الفتح‬ ‫عام‬ ‫وسلم‬ ‫عليه‬ ‫هللا‬ ‫صلى‬ ‫النبي‬ ‫خرج‬ ‫أصحابه‬ ‫من‬ ‫المشاة‬ ‫إليه‬ ‫فاجتمع‬ ‫فقالوا‬:‫فقال‬ ‫السفر‬ ‫علينا‬ ‫اشتد‬ :‫عليكم‬‫بالنسالن‬‫عنكم‬ ‫يقطع‬ ‫فإنه‬ ‫األرض‬‫له‬ ‫وتخفون‬. ‫علينا‬ ‫أخف‬ ‫فوجدناه‬ ‫فنسلنا‬ ‫قالوا‬. ‫خزيمة‬ ‫بن‬ ‫رواه‬2335‫له‬ ‫وعنون‬ ‫صحيح‬ ‫بسند‬ ‫اإلعياء‬ ‫عند‬ ‫المشي‬ ‫في‬ ‫النسل‬ ‫إستحباب‬ ‫باب‬– ‫االلبانى‬ ‫صحيح‬. ‫هو‬ ‫والنسالن‬:‫وهو‬ ‫اإلسراع‬ ‫مع‬ ‫الخطو‬ ‫مقاربة‬ ‫الماشي‬ ‫يزعج‬ ‫ال‬ ‫الذي‬ ‫الخفيف‬ ‫الجري‬
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  • 42. “Runner’s high.” Release of endorphins Neurotransmitter, or Chemical messenger Relieve pain and stress. Dopamine, Norepinephrine, and Serotonin Regulating mood, appetite and sleep cycles Opposite effect of Depression. Stress hormones, such as adrenaline Crucial role in fight-or-flight response But too much of it can damage health. Exercise, Depression, and the Brain Written by Ryan Collins Medically Reviewed by Timothy J. Legg, PMHNP-BC, GNP-BC, CARN-AP, MCHES on Mar 29, 2016 Exercise and Brain chemistry Endorphins and other neurotransmitters Dopamine, Norepinephrine, Serotonin
  • 43. Exercise, Depression, and the Brain Written by Ryan Collins Medically Reviewed by Timothy J. Legg, PMHNP-BC, GNP-BC, CARN-AP, MCHES on Mar 29, 2016 “Runner’s high.” Release of endorphins Neurotransmitter, or Chemical messenger Relieve pain and stress. Dopamine, Norepinephrine, and Serotonin Regulating mood, appetite and sleep cycles Opposite effect of Depression. Exercise and Brain chemistry Endorphins, Dopamine, Norepinephrine, Serotonin
  • 44. ‫األصلي‬ ‫الالتيني‬ ‫النص‬: orandum est ut sit mens sana in corpore sano. fortem posce animum mortis terrore carentem, qui spatium vitae extremum inter munera ponat naturae, qui ferre queat quoscumque labores, nesciat irasci, cupiat nihil et potiores Herculis aerumnas credat saevosque labores et venere et cenis et pluma Sardanapalli. monstro quod ipse tibi possis dare; semita certe tranquillae per virtutem patet unica vitae. – ‫جوفينال‬ ‫الروماني‬ ‫الشاعر‬(10.356-64) ‫جوفينال‬ ‫الروماني‬ ‫الشاعر‬ ‫سليم‬ ‫جسم‬ ‫في‬ ‫سليم‬ ‫عقل‬ ‫أجل‬ ‫من‬ ‫صل‬ ‫الموت‬ ‫يخشى‬ ‫ال‬ ‫شجاع‬ ‫قلب‬ ‫اطلب‬ ‫قمية‬ ‫الطبيعة‬ ‫نعم‬ ‫أقل‬ ‫العمر‬ ‫طول‬ ‫ويرى‬ ‫نوع‬ ‫أي‬ ‫من‬ ‫صعوبات‬ ‫أي‬ ‫يتحمل‬ ‫قلب‬ ‫الرغبة‬ ‫أو‬ ‫الحنق‬ ‫يمسسه‬ ‫وال‬ ‫الشاقة‬ ‫وأعماله‬ ‫هرقل‬ ‫محن‬ ‫أن‬ ‫يرى‬ ‫قلب‬ ‫ومأدباته‬ ‫ساردانابالوس‬ ‫حب‬ ‫من‬ ‫أحسن‬ ‫الوثيرة‬ ‫ووسائده‬. ‫لنفسك‬ ‫أكتبه‬ ‫ما‬ ‫توفر‬ ‫أن‬ ‫لك‬ ‫هو‬ ‫سالمة‬ ‫لحياة‬ ‫الوحيد‬ ‫الطريق‬ ‫بالتأكيد‬ ‫ألنه‬ ‫الفضيلة‬. ”‫السليم‬ ‫الجسم‬ ‫في‬ ‫السليم‬ ‫العقل‬“ ‫شهيرة‬ ‫التينية‬ ‫عبارة‬ ‫ترجمة‬ ‫هي‬. Mens sana in corpore sano
  • 45. Exercise and the Health Triangle • Health is the measure of our body’s efficiency and over-all well-being. • The health triangle is a measure of the different aspects of health. • The health triangle consists of: Physical, Social, and Mental Health.
  • 46. Physical Benefits of Exercise • Improved body shape - including muscle tone and posture • Strengthens bones and muscles • Reduces the chance of illness so increasing life expectancy • Improves endurance, flexibility and overall fitness Physical health has many components including: exercise, nutrition, sleep, alcohol & drugs, and weight management.
  • 47. • Helps you to deal with stress and tension • Improves self-confidence • Increases motivation • Gives you something to aim for - a challenge Mental Benefits of Exercise • Mental heath deals with how we think, feel and cope with daily life. • Mental health encompasses learning, stress management, and mental illnesses or disorders.
  • 48. • Helps you meet new people and make friends • Improves your teamwork and cooperation Social Benefits of Exercise • Social Health deals with the way react with people within our environment. • This includes: public health, family relationships, and peer relationships.
  • 50. Exercise Guidelines The amount of exercise will vary depending on physical fitness and long-term goals. For example, if you have not exercised for a while or ever before, have been ill or are reaching middle age or older you need to start slowly. If your aim is to run a marathon you will need to do more training than someone who is aiming to walk down the road without getting out of breath.
  • 51. Exercise Guidelines Exercise in the early morning or evening  Wear a minimum amount of light, loose-fitting clothes.  Avoid rubberized or plastic suits.  Drink a glass of water before you start.  Carry water with you when you exercise.  Drink a glass every 30 minutes.  You can walk or exercise even indoors!  Exercise five days a week
  • 52. Exercise Guidelines • Start gently and gradually increase the time and intensity of your exercise as it gets easier • Exercise often - 20 minutes three times a week is better than 60 minutes once a week • Don't overdo it - exercise shouldn't be painful or make you ill or overly tired afterwards.
  • 53. Aerobic exercises Dr.Siva, Aden Refinery Hospital, Little Aden, Yemen
  • 54. Warm up & Cool down Dr.Siva, Aden Refinery Hospital, Little Aden, Yemen
  • 55. Dr.Siva, Aden Refinery Hospital, Little Aden, Yemen
  • 56. Dr.Siva, Aden Refinery Hospital, Little Aden, Yemen
  • 57. Dr.Siva, Aden Refinery Hospital, Little Aden, Yemen
  • 58.
  • 59. Dr.Siva, Aden Refinery Hospital, Little Aden, Yemen
  • 60.
  • 61.
  • 62.
  • 64. Exercise program • Aerobic exercises • Muscle stretching exercises • Swimming • Spinal extension & flexion exercises • Neck exercises
  • 66. Countless Benefits of Exercise ? Exercise is any bodily activity that enhances or maintain physical fitness and overall health Exercise is a one prescription Prevent and treat dozens of diseases Such as diabetes, hypertension, obesity… Robert E. Sallis, M.D., FACSM, EIM Global Center Chairman If exercise could be packed in a pill It would be the single most widely prescribed and beneficial medicine in the nation Robert N. Butler, M.D. Former Director, National Institute on Aging
  • 67. Exercise is a Medicine Physicians should prescribe it, Patients should take it! • Exercise may be the long sought vaccine to prevent chronic disease • Are we reaching a point where NOT prescribing physical activity should be consider patient neglect? • Exercise is Medicine® is a global initiative to establish physical activity as a standard in healthcare.
  • 68. • Improved sense of well-being • Less depression and anxiety • Improved lung capacity to use oxygen • Stronger more efficient heart muscle • Slower resting pulse rate • Increased muscle strength • Improved blood supply • Increased mobility and flexibility • Maintains bone strength • Delays development of osteoporosis • Improves performance • Reduces risk of injury • Helps reduce stress. • Reduces muscle soreness • Increases blood and nutrients to the tissues. • Improves your coordination and reduces accidents • Less body fat • More lean body tissue • Lower blood sugar level • Improved reaction time • Better balance • More efficient body cooling • Higher HDL • Lower triglyceride level • Improved blood flow • Lower blood pressure Countless Benefits of exercise
  • 69. How to avoid Lifestyle diseases Healthy lifestyle VS. medicines Managing stress Healthy eating Proper sleep Regular exercise Proper posture Avoid Pollutants
  • 70. 1- Live a Biological life as far as you can (Anti inflammatory and Natural Life style) 2- Take knowledge from trusted sources then Calibrate with the absolute truth 3- Attach to the absolute truths in the sayings of almightly ALLAH and his Messenger (peace and blessings be upon him) 4- Avoid Mankind processed deviations & inherited Myths How to avoid Lifestyle diseases My long life experience precious advice is
  • 71. • Obesity • Coronary artery disease • Diabetes • Hypertension • Cancer • Depression and anxiety • Arthritis • Osteoporosis • Etc, etc, etc… The answer is NO! WHY NO? Already answered Physical inactivity pandemic Do You Think We have a Chance Without Exercise?