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The Importance of ExerciseThe Importance of Exercise
Dr Reed A BergerDr Reed A Berger
Today, why do people exercise?
Athletic/Artistic Performance Physical appearance
HealthHow can we increase exercise for he...
Benefits of ExerciseBenefits of Exercise
 Increased strength and muscularIncreased strength and muscular
enduranceenduran...
 Technology—fewer demands placed onTechnology—fewer demands placed on
musculoskeletal and CV systemsmusculoskeletal and C...
 Automation—decreased muscularAutomation—decreased muscular
demandsdemands
 Body adapts—increased fast, weakerBody adapt...
I. Basics of Exercise Physiology
Exercise is a complex molecular, cellular and systemic
physiological stimulus
With every ...
Specificity of Exercise: Adaptations that occur in response to
training are specific to the nature of the training stimulu...
Cardiovascular fitness - endurance type activities: fuel challenging
large muscle mass
repetitive
lower intensity
walking,...
Basic Principles of Exercise Training
Frequency - how often is the exercise performed
each week? For cardiovascular traini...
Known adaptations to endurance exercise
Skeletal Muscle
⇑ mitochondria
⇑ capillary density
⇑ oxidative enzymes
Heart
⇑ hea...
What is Maximum Oxygen Uptake?
VO2 Max
Maximal amount of oxygen consumption per minute
The more muscle used the higher the...
Known adaptations to resistance exercise
Brain/Neural
⇑ improved recruitment
Skeletal Muscle
⇑ Fiber size
⇑ Mitochondria?
...
Role of exercise in weight and/or body fat control
Exercise can increase caloric expenditure
Exercise can spare loss of le...
Exercise prescriptionExercise prescription
 To treat various diseasesTo treat various diseases
 Primary prevention—PE cl...
 Aerobic and resistanceAerobic and resistance
 ConvenientConvenient
 TravelingTraveling
 PedometerPedometer
 Minutes ...
Routine exerciseRoutine exercise
 Improves tissue oxygen uptakeImproves tissue oxygen uptake
 HDLHDL
 LDLLDL
 TGTG
 B...
Decreased risk of CADecreased risk of CA
 EndometrialEndometrial
 BreastBreast
 ColonColon
 prostateprostate
Cognitive benefitsCognitive benefits
 Better adjustedBetter adjusted
 Cognitive testsCognitive tests
 Decreased CV resp...
Cognitive cont’dCognitive cont’d
 Improves self confidenceImproves self confidence
 Self esteemSelf esteem
 Decrease CV...
compliancecompliance
 Long term adherence to exerciseLong term adherence to exercise
 Decrease with age, minorities, fem...
Types of exerciseTypes of exercise
 Occupational, recreational, sportsOccupational, recreational, sports
 AerobicAerobic...
Resistance trainingResistance training
 Resistance to contracting muscles toResistance to contracting muscles to
stimulat...
How to make exercise a lifetimeHow to make exercise a lifetime
activityactivity
 Pick activity that is enjoyable and uses...
ElderlyElderly
 Joint flexibilityJoint flexibility
 Muscle strengthMuscle strength
 LBMLBM
 BalanceBalance
 Preventio...
Pulmonary dzPulmonary dz
 Low workloads, short durationLow workloads, short duration
 Frequent intervalsFrequent interva...
MaternityMaternity
 MaternalMaternal
Increased CV fxnIncreased CV fxn
Decreased wt gain and fluidDecreased wt gain and ...
maternitymaternity
 FetusFetus
Decreased fatDecreased fat
Improved stressImproved stress
Neurobehavioral maturationNeu...
osteoporosisosteoporosis
 BMDBMD
 Muscle—balance, falls, fractureMuscle—balance, falls, fracture
 Works with estrogen, ...
CADCAD
 Primary and secondary preventionPrimary and secondary prevention
 Increased CV functional capacity andIncreased ...
- Obesity is reaching "epidemic proportions” in the United
States
- could soon cause as much preventable disease and death...
Exercise and Type II Diabetes
Position statement ACSM
About 10.3 million diagnosed cases and about 5.4 million undiagnosed...
Acute Effects of Physical Activity
Glucose Levels
Most obese Type II diabetics experience decreases in blood
glucose follo...
Insulin resistance
Insulin resistant individuals have 35-40% reduction in
insulin mediated glucose uptake
Low to moderate ...
Physiological Benefits of Exercise for those with Type II Diabetes
Lower resting heart rate
Lower submaximal exercise hear...
Psychological Benefits of Exercise
Reduced stress response to psychosocial stimuli
Lessened sympathetic nervous system act...
Exercise and Chronic Diseases
Booth et al., 2000
Cardiovascular Disease
Type II Diabetes
Obesity
Obesity related diseases
...
Take home message
1. Consider exercise/physical activity for both
disease prevention as well as treatment
2. When consider...
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The Importance of Exercise ppt

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

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The Importance of Exercise ppt

  1. 1. The Importance of ExerciseThe Importance of Exercise Dr Reed A BergerDr Reed A Berger
  2. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 12. Known adaptations to resistance exercise Brain/Neural ⇑ improved recruitment Skeletal Muscle ⇑ Fiber size ⇑ Mitochondria? Bone ⇑ density
  13. 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. 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. 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. 16. Routine exerciseRoutine exercise  Improves tissue oxygen uptakeImproves tissue oxygen uptake  HDLHDL  LDLLDL  TGTG  BPBP  Glycemic controlGlycemic control
  17. 17. Decreased risk of CADecreased risk of CA  EndometrialEndometrial  BreastBreast  ColonColon  prostateprostate
  18. 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. 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. 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. 21. Types of exerciseTypes of exercise  Occupational, recreational, sportsOccupational, recreational, sports  AerobicAerobic  Anaerobic—sprintAnaerobic—sprint  Isometric—wtsIsometric—wts
  22. 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. 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. 24. ElderlyElderly  Joint flexibilityJoint flexibility  Muscle strengthMuscle strength  LBMLBM  BalanceBalance  Prevention of injuryPrevention of injury
  25. 25. Pulmonary dzPulmonary dz  Low workloads, short durationLow workloads, short duration  Frequent intervalsFrequent intervals  Supplemental O2Supplemental O2
  26. 26. MaternityMaternity  MaternalMaternal Increased CV fxnIncreased CV fxn Decreased wt gain and fluidDecreased wt gain and fluid Mental stateMental state LaborLabor RecoveryRecovery fitnessfitness
  27. 27. maternitymaternity  FetusFetus Decreased fatDecreased fat Improved stressImproved stress Neurobehavioral maturationNeurobehavioral maturation
  28. 28. osteoporosisosteoporosis  BMDBMD  Muscle—balance, falls, fractureMuscle—balance, falls, fracture  Works with estrogen, dietWorks with estrogen, diet  Wt bearingWt bearing
  29. 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. 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. 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. 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. 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. 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. 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. 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. 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

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