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

1. Exercise is Medicine
Are you getting the right dose?

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. 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. 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. 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. 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. 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. 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. Decision Time

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. 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. 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. 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. 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
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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. 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. 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. Components of ExRx for
Risk Factor Reduction
Aerobic exercise
Strength training

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. 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. Strength Training
 Positive impact on;
 Muscle mass & strength
 Bone density
 Metabolism
 Balance

22. Strength Training
 Significant correlation between muscle strength and;
 Independence
 Performance of ADL
 Preferred walking speed

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. 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. 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