The document discusses exercise guidelines and benefits for various medical conditions. It provides guidelines for moderate and vigorous aerobic exercise for adults, as well as reasons some people do not exercise. It then outlines strategies to motivate patients using 3M's (mentioning, modeling, motivation). The FITT principle for exercise prescription and risk stratification for exercise are also covered. Specific conditions discussed include hypertension, obesity, pregnancy, osteoporosis, and depression.

1. EXERCISE IS MEDICINE
Dr. K.D.C. Upendra Wijayasiri (MBBS, Dip.Spo.Med, M.phil (trn) )
In-charge, Sports Medicine Unit,
Colombo South Teaching Hospital,
Kalubowila.

2. Drug statistics; CSTH- 2014
Name of the Drug Amount of Drug Cost (Rs.)
1. Metformin
2. PCM
3. Diclofenac sodium
4. Glibenclamide
5. Atenolol
6. Verapamil
7. Aspirin
8. Insulin (mixtard)
9. Insulin (soluble)
106,24,000 tabs
132,60,000 tabs
21,85,000 tabs
11,60,000 tabs
15,68,140 tabs
9,69,000 tabs
4,03,000 tabs
27,000 units
3360 units
71,18,000
49,60,000
8,52,150
11,600
6,89,981
4,84,000
6,35,000
85,05,000
14,54,880

3. U.S. Department of Health and Human Services Physical Activity
Guidelines for healthy adults ages 18–65 years
 Moderate-intensity aerobic activity for
a minimum of 30 min on five days each
week
 vigorous-intensity aerobic activity for
a minimum of 20 min on three days
each week
 combination of moderate- and vigorous-
intensity activity to meet this
recommendation.
 dose–response relation between
physical activity and health.

4. Why people don’t do Exercise?
 Lack of time
 Other priorities
 Lack of confidence
 Lack of money to join a gym,
buy equipment or appropriate
clothing
 Don’t want to be sweaty or
uncomfortable
 Boredom
 Pain or injury
 “I’m too old.”
 Lack of interest
 Prefer relaxing
 Perceived benefits of remaining
 inactive
 Fear of injury
 Change in routine
 Lack of support from family or job
 Don’t know what exercise to do
 Adverse weather

5. How you can get the patient from Bed to Foot?
 Concept of 3 M’s:
1. Mentioning
2. Modeling
3. Motivation
“Motivation is mental process that connects a thought or a
feeling with an action.”

6. SMART goals
Specific
Measurable
Achievable
Realistic
Timely

7. The FITT Principle
 Frequency – How Often
 at least 3 times a week.
 eg; every other day to allow
recovery
 Intensity- How Hard
 monitor heart rate
 keep above training
threshold
 Time – How Long
 Minimum of 20 min. per
session
 Type – What Kind
 Training method

9. Risk stratification
High risk Moderate risk Low risk
Graded
Exercise
tests
available
• Typical Angina at < 5 METs
• Ventricular dysrhythmias
• ST depression > 2mm in Ex.
ECG
• Abnormal hemodynamics
• Functional capacity < 5
METs
• Angina at > 7METs
• ST depression < 2mm
in Ex. ECG
• Functional capacity
> 7METs
No
exercise
tests
available
• Resting Ejection fraction
< 40%
• Complex dysrhythmias
• Congestive cardiac failure
• Resting ejection
fraction 40% - 49%
• Resting ejection
fraction > 50%

10. Hypertension
 Benefits of ex:
• normal person 5-7mmHg reduction
• weight control
 Majority moderate intensity aerobic exercise
will be beneficial
 More risk : symptom limited graded exercise test
before schedule

12. Over weight and Obesity
 Physical activity has little impact on the amount of weight lost in the
first six months, compared to dieting (NIH/USA evidence report, 1998);
however, adequate physical activity is critical to maintaining weight
loss (Dietary guidelines for Americans, 2008).
 Individuals who have lost at least 30 kilograms and kept this weight
off for at least five years maintain weekly exercise of 2800 kcal (The
National Weight Control Registry at the University of Colorado).

13. Pregnancy
 Target to have less fatigue, toss better control of weight gain, and to possibly
experience shorter labor (Exercise during pregnancy, 2007)
 Benefits of exercise
• Maintenance of prenatal aerobic and musculoskeletal fitness levels
• Prevention of excessive maternal weight gain
• Facilitation of labor and recovery from labor
• Promotion of good posture
• Prevention of gestational glucose intolerance
• Prevention of low back pain
• Improved psychological adjustment to the changes of pregnancy

14. Osteoporosis
 Benefits of Exercise
• Decreased osteoporotic fractures by increased peak bone mass
• Slowed rate of bone loss with aging
• Reduced fall risk due to improved muscle strength/ flexibility and balance
( Robertson et al, 2002,; Bec & Snow, 2003)
 Precautions:
• Attention on the proper balance
• Exercise surface
• not beyond the pain limit and less than maximal strength
• twisting, forward bending, compression of the spine and high impact loading
should be avoided
• if severe spinal osteoporosis ─> alternative for walk

15. Depression
 Accompany many of the chronic conditions and
complicated by weight gain from many psychiatric
medications and by higher rates of smoking
 Physical activity programs reduces depression symptoms in people diagnosed as
depressed, in healthy adults, regardless of age, gender, race/ethnicity, or medical
condition (US Physical Activity Guidelines Advisory Committee Report, 2008)
 Greater initial physical fitness predicts rapid recovery from depression (Morgan et al,
1998)