We all know that exercise is important in our daily lives, but we may not know why or what exercise can do for us.

1. The Importance of ExerciseThe Importance of Exercise
Dr Reed A BergerDr Reed A Berger

2. Today, why do people exercise?
Athletic/Artistic Performance Physical appearance
HealthHow can we increase exercise for health reasons?
education - require PE for schools?
support - physicians, family
research
Human beings have evolved with movement as a necessity for survival
e.g. to obtain food, to escape predators
thus, numerous systems in the body are sensitive to movement.

3. Benefits of ExerciseBenefits of Exercise
 Increased strength and muscularIncreased strength and muscular
enduranceendurance
 Increased BMD—osteoporosisIncreased BMD—osteoporosis
 Aging—decreased falls, increasedAging—decreased falls, increased
independence, increased ADLindependence, increased ADL
 Increased BMR—LBMIncreased BMR—LBM
 Appearance, self esteemAppearance, self esteem

4.  Technology—fewer demands placed onTechnology—fewer demands placed on
musculoskeletal and CV systemsmusculoskeletal and CV systems
 2-3 generations ago—manual labor2-3 generations ago—manual labor
 Stairs, elevators, carsStairs, elevators, cars
 Recreation—playing ball, jumping, hide-n-Recreation—playing ball, jumping, hide-n-
seek vs. video games, internetseek vs. video games, internet
 Convenience and fast foodsConvenience and fast foods

5.  Automation—decreased muscularAutomation—decreased muscular
demandsdemands
 Body adapts—increased fast, weakerBody adapts—increased fast, weaker
 Scheduled exercise used to not beScheduled exercise used to not be
needed with manual laborneeded with manual labor
 Today, have to “give back” the leisure timeToday, have to “give back” the leisure time
gained thru technology and purposelygained thru technology and purposely
stress the muscular systemstress the muscular system

6. I. Basics of Exercise Physiology
Exercise is a complex molecular, cellular and systemic
physiological stimulus
With every single bout of exercise, skeletal muscles, heart, brain, vascular
tissue, bone, liver, etc. experience some form of environmental “stress”.
The type and magnitude of an adaptation or response to exercise thus
results from a sum total of all these contributing factors.
Some examples include:
- mechanical, stress/strain
- temperature
- pH
- redox state
- free radical production
- hormones/growth factors
- calcium

7. Specificity of Exercise: Adaptations that occur in response to
training are specific to the nature of the training stimulus
Cardiovascular fitness: requires that the person
train in a manner that challenges heart rate, cardiac
output, capillarity … with the underlying change being
improved oxygen delivery to working tissues
Muscular strength: requires that the person train in a manner
that challenges the recruitment and force output of specific
muscle groups … with the underlying change being increased
muscle mass.
The corollary to this is that training for endurance will not
augment strength or vice versa.

8. Cardiovascular fitness - endurance type activities: fuel challenging
large muscle mass
repetitive
lower intensity
walking, running, swimming, cycling
Muscular strength: high resistance, high force output
focus on muscle groups not on systemic “exercise”
e.g. knee extensors vs. flexors
Can a type of exercise be both strength and endurance?
yes BUT the effectiveness of any one form of activity to elicit
a specific adaptation is dependent on the endurance/strength starting
state of the individual.

9. Basic Principles of Exercise Training
Frequency - how often is the exercise performed
each week? For cardiovascular training effects
3-4x per week is suggested
Intensity - the exercise must be performed at a level that
challenges the cell/tissue/system for adaptations to occur.
Totally dependent on starting state. Lower the starting fitness
level the lower the starting intensity. Must build to continue
adaptations. Most important variable in training regimen for most.
Duration - length of each training session. For cardiovascular
Adaptations it is suggested to start at 30 minutes/session
MORE IS NOT NECESSARILY BETTER!
overtraining/system failure

10. Known adaptations to endurance exercise
Skeletal Muscle
⇑ mitochondria
⇑ capillary density
⇑ oxidative enzymes
Heart
⇑ heart volume
⇑ max stroke volume
⇑ max cardiac output
♣ resting heart rate
⇔ blood pressure
Brain (very new studies)
⇑ neurogenesis
⇑ protection from seizures, injury
Bone
⇑ density? Type of exercise

11. What is Maximum Oxygen Uptake?
VO2 Max
Maximal amount of oxygen consumption per minute
The more muscle used the higher the oxygen use
Predictor of performance?
Correlates with changes in cardiac output
Training will result in an increase
cardiac indices (CO, SV)
skeletal muscle contribution (mito)
ventilatory contribution?

12. Known adaptations to resistance exercise
Brain/Neural
⇑ improved recruitment
Skeletal Muscle
⇑ Fiber size
⇑ Mitochondria?
Bone
⇑ density

13. Role of exercise in weight and/or body fat control
Exercise can increase caloric expenditure
Exercise can spare loss of lean body mass during
times of caloric deficit
Increases in lean body mass will increase basal metabolic rate
BUT …. 10lbs of lean body mass will lead to about 70-80kcal/day
ALL forms of exercise will burn fat, even at Max VO2
Amount of fat burned during exercise is NOT important.
Total calories used during exercise IS important
For patients/clients, pick an exercise/activity modality that
they will do and do regularly. Type of exercise less important
Calories in vs. Calories out


14. Exercise prescriptionExercise prescription
 To treat various diseasesTo treat various diseases
 Primary prevention—PE classPrimary prevention—PE class
 Clinically—discuss exerciseClinically—discuss exercise
 Work—corporate wellnessWork—corporate wellness
 End of college, athletic endeavors—needEnd of college, athletic endeavors—need
to have scheduled exerciseto have scheduled exercise
 60 min daily60 min daily

15.  Aerobic and resistanceAerobic and resistance
 ConvenientConvenient
 TravelingTraveling
 PedometerPedometer
 Minutes per dayMinutes per day
 Intensity, duration, frequency (need toIntensity, duration, frequency (need to
vary)vary)

16. Routine exerciseRoutine exercise
 Improves tissue oxygen uptakeImproves tissue oxygen uptake
 HDLHDL
 LDLLDL
 TGTG
 BPBP
 Glycemic controlGlycemic control

17. Decreased risk of CADecreased risk of CA
 EndometrialEndometrial
 BreastBreast
 ColonColon
 prostateprostate

18. Cognitive benefitsCognitive benefits
 Better adjustedBetter adjusted
 Cognitive testsCognitive tests
 Decreased CV response to stressDecreased CV response to stress
 AnxietyAnxiety
 DepressionDepression
 People who were active and became inactivePeople who were active and became inactive
were 1.5x more likely to become depressedwere 1.5x more likely to become depressed
 CAD and depressionCAD and depression

19. Cognitive cont’dCognitive cont’d
 Improves self confidenceImproves self confidence
 Self esteemSelf esteem
 Decrease CV and neurohormonalDecrease CV and neurohormonal
response to stressresponse to stress
 Short bouts of exercise—cognitiveShort bouts of exercise—cognitive
improvementimprovement

20. compliancecompliance
 Long term adherence to exerciseLong term adherence to exercise
 Decrease with age, minorities, females,Decrease with age, minorities, females,
disabled, chronic dzdisabled, chronic dz
 Exercise program—50% cont for >6 moExercise program—50% cont for >6 mo

21. Types of exerciseTypes of exercise
 Occupational, recreational, sportsOccupational, recreational, sports
 AerobicAerobic
 Anaerobic—sprintAnaerobic—sprint
 Isometric—wtsIsometric—wts

22. Resistance trainingResistance training
 Resistance to contracting muscles toResistance to contracting muscles to
stimulate them for increased strengthstimulate them for increased strength
 Injury risk—decreasedInjury risk—decreased
 Lean tissue and agingLean tissue and aging
 Heart conditions—don’t strain or holdHeart conditions—don’t strain or hold
breathbreath

23. How to make exercise a lifetimeHow to make exercise a lifetime
activityactivity
 Pick activity that is enjoyable and usesPick activity that is enjoyable and uses
most musclesmost muscles
 Vary duration, intensityVary duration, intensity
 Group classesGroup classes
 MusicMusic
 Walk the dog!Walk the dog!
 Set goals—health, appearance,Set goals—health, appearance,
cholesterolcholesterol

24. ElderlyElderly
 Joint flexibilityJoint flexibility
 Muscle strengthMuscle strength
 LBMLBM
 BalanceBalance
 Prevention of injuryPrevention of injury

25. Pulmonary dzPulmonary dz
 Low workloads, short durationLow workloads, short duration
 Frequent intervalsFrequent intervals
 Supplemental O2Supplemental O2

26. MaternityMaternity
 MaternalMaternal
Increased CV fxnIncreased CV fxn
Decreased wt gain and fluidDecreased wt gain and fluid
Mental stateMental state
LaborLabor
RecoveryRecovery
fitnessfitness

27. maternitymaternity
 FetusFetus
Decreased fatDecreased fat
Improved stressImproved stress
Neurobehavioral maturationNeurobehavioral maturation

28. osteoporosisosteoporosis
 BMDBMD
 Muscle—balance, falls, fractureMuscle—balance, falls, fracture
 Works with estrogen, dietWorks with estrogen, diet
 Wt bearingWt bearing

29. CADCAD
 Primary and secondary preventionPrimary and secondary prevention
 Increased CV functional capacity andIncreased CV functional capacity and
decreased myocardial O2 demanddecreased myocardial O2 demand
 Lipids, DM, obesityLipids, DM, obesity
 BP—8-10 mmHgBP—8-10 mmHg
 Inactivity is independent risk factor forInactivity is independent risk factor for
CADCAD
 Sedentary have greatest CVD mortalitySedentary have greatest CVD mortality

30. - Obesity is reaching "epidemic proportions” in the United
States
- could soon cause as much preventable disease and death as
cigarette smoking.
III. Application for Health Care
Obesity
Type II Diabetes
For the vast majority of individuals, overweight and obesity
result from excess calorie consumption and/or inadequate physical activity.
Unhealthy dietary habits and sedentary behavior together account
for approximately 300,000 deaths every year.

31. Exercise and Type II Diabetes
Position statement ACSM
About 10.3 million diagnosed cases and about 5.4 million undiagnosed
Accounts for 90-95% of all cases of diabetes
Characterized by insulin resistance and moderate insulin deficiency
Skeletal muscle: site of about 80-90% of glucose uptake
insulin and contraction act INDEPENDENTLY to increase
GLUT4 translocation and glucose uptake.
Ideal target for exercise and/or pharmacological therapies

32. Acute Effects of Physical Activity
Glucose Levels
Most obese Type II diabetics experience decreases in blood
glucose following mild-moderate exercise
magnitude of effect is dependent on duration and intensity
blood glucose increases with short term high intensity exercise

33. Insulin resistance
Insulin resistant individuals have 35-40% reduction in
insulin mediated glucose uptake
Low to moderate intensity exercise improves insulin sensitivity
High intensity exercise variable response
Transient effect (about 72 hrs) so requires regular activity
not really the “trained state”

34. Physiological Benefits of Exercise for those with Type II Diabetes
Lower resting heart rate
Lower submaximal exercise heart rate
Increased stroke volume
Increased cardiac output
Enhanced oxygen extraction
Lower resting BP
Lower exercise BP
Influence lipid profile

35. Psychological Benefits of Exercise
Reduced stress response to psychosocial stimuli
Lessened sympathetic nervous system activation to cognitive stress
Reductions in depression
Improved self-esteem
Reduction in emotional perturbations to stress
Contribute to sustained behavioral changes and adherence

36. Exercise and Chronic Diseases
Booth et al., 2000
Cardiovascular Disease
Type II Diabetes
Obesity
Obesity related diseases
Aging
While all these diseases have some contribution from
genetic the rapid increases in the last 20+ years are
due to environmental factors.
Sedentary living is responsible for about 34% of deaths due to
coronary heart disease, colon cancer and Type II diabetes
CDC has concluded that “physical inactivity is one of the major
underlying causes of premature mortality in the US”

37. Take home message
1. Consider exercise/physical activity for both
disease prevention as well as treatment
2. When considering exercise think movement
or activity not athletic performance
3. Consider the importance of exercise
for children. Growing evidence for mental as well as
physical development. Educate for healthy lifestyle
• Good resource for exercise and health information
American College of Sports Medicine www.acsm.org