Dyslipidemia refers to abnormal blood lipid or lipoprotein levels and is linked to increased risk of cardiovascular disease. It involves high levels of triglycerides and/or cholesterol, which circulate in the bloodstream within lipoprotein particles. Lifestyle factors like diet, physical activity, smoking, and alcohol can influence lipid levels. Regular aerobic exercise of moderate intensity for 30-60 minutes per day at least 5 days per week is an effective way to improve lipoprotein profiles through increased calorie expenditure and weight control, particularly by raising HDL levels and lowering triglycerides.

1. Dyslipidemia and Exercise

2. Dyslipidemia Abnormal blood lipid / lipoprotein levels Severe dyslipidemia linked to genetic defects in cholesterol metabolism Less severe cases response to other diseases or combining a specific genetic pattern with various environmental exposures (diet, smoking)

3. Overview of Pathophysiology TG and CHL move b/t the intestine, liver and tissue A variety of environmental, genetic and pathologic factors alter TG and CHL transport High lipoprotein concentrations may alter pathways influence CAD risk Combined these factors are related to elevated lipid levels known as DYSLIPIDEMIA

4. Overview of Lipoprotein Metabolic Pathways

5. Lipids Lipids non-soluble in plasma so combines with proteins to form lipoproteins Chylomicrons: from absorption of dietary triglyceride Very-low-density-Lipoprotein (VLDL): synthesized in the liver, primary transport mechanism for synthesized triglyceride Low-density-Lipoprotein (LDL): final stage of breakdown VLDL, carier of cholesterol High-density-Lipoprotein (HDL): involved in reverse transport of cholesterol

6. Triglycerides Composed of three fatty acids and a glycerol molecule Several functions Membrane structure Eich energy source 9 calories of energy for each fat gram Found in all cell membranes

7. Cholesterol Waxy, fat-like substance produced by liver Absorbed by intestine during food digestion Dietary cholesterol is present in most food derived from animals (not in plants) Essential to body to build cell membranes, produce sex hormones, form bile acids (necessary for digestion of fats) Travels thru bloodstream as part of a larger particle called Lipoproteins classified based on thickness or density of the surrounding protein shell

8. LDL-”the bad guy” VLDL molecule with most of TriG removed; all of the chol remains Consumed by the body cells as building blocks for hormones and cell membranes Excess LDL in blood forms deposits (plaques) on artery walls which narrows them Susceptible to oxidation by free radicals which enhances the atherosclerotic process Blood clots as plaques grow leading to atherosclerosis, HD and heart attacks

9. HDL-”the good guy” Transports excess cholesterol back to the liver to be excreted (reverse chol transport) Exists in two main subclasses: HDL2 and HDL 3

10. Forms of Dyslipidemia Hypercholesterolemia elevated blood cholesterol levels Hypertriglyceridemia elevated triglyceride levels Hyperlipidema elevated chol and TG Hyperlipoproteinemia elevated lipoproteins Hypoalphalipoprotein syndrome low LDL

11. Causative Factors for Dyslipidemia Heredity/Genetics Advanced age Gender Smoking Excessive alcohol consumption Fat diet Over fat Certain meds Steroids DM, Hypothyroid Menopause

12. Video http://www.youtube.com/watch?v=hRx_i9npTDU&feature=related http://www.youtube.com/watch?v=QfaoHAIUy0g http://www.youtube.com/watch?v=R1DAjRixZKg&feature=related http://www.youtube.com/watch?v=-WhADd1GKtA&feature=related

13. Forms Dyslipidemia: Lipids General term for fat molecules from diet or produced by the body : either in the form of triglycerides or cholesterol Required for absorption of fat soluble vitamins (A,D,E,K) Insoluble in blood and must combine with proteins (lipoproteins) to circulate Excess is harmful and increases risk Some is essential for good health and normal functioning

14. Cholesterol Guidelines

15. Diagnostic and Lab Evaluations Identified thru a complete blood lipid profile following a 12-hr fast Most lab reports will provide: total cholesterol, HDL, LDL and TG National Cholesterol Education Program (NCEP) goals for both individual management of CHOL Recommends: adults over 20 have their total chol measured 1 time every 5 years

16. Treatments Intensity of treatment depends on patients overall risk status for disease Diet and exercise-3 to 6 months Pharmacological management-considered an adjunct to the above

17. Types of Medications Used Statins -most effective and most commonly used Nicotinic acid-comes with several side effects: skin irritation/flushing Bile Acid Sequestrants (reduce uptake) Fibric Acids (increase HDL) Probucol-inhibits LDL oxidation Estrogen Replacement Therapy (ERT)

18. Impact of Statins Powerful effect to lower LDL and raise HDL by blocking an enzyme needed to produce cholesterol in the liver Typical improvements: 18-55% decrease in LDL, 5-15% increase in HDL and 7-30% decrease in TG

19. Statins: Cholesterol Lowering Drugs Name Brands Crestor Lipitor* Altacor Zocor* Pravachol Zetia Advicor Mevacor* Additional Benefits: Improved endothelial function Decrease vascular inflammation Decrease potential for thrombosis Promote plaque stabilization

20. Complications HTN -drive LDL particles into the arterial wall with higher pressures Diabetes makes LDL particles more likely to stick within the arterial wall Smoking -makes arterial endothelium more permeable (vulnerable) Metabolic Syndrome

21. Effects of Exercise on Lipid Metabolism Lowering of TG’s is most consistent effect of acute and chronic exercise (better skeletal muscle uptake) HDL’s often increased with sustained aerobic exercise (exp of > 1200 cal/wk) Weight/fat loss is required for significant reductions in LDL and TCH Total amount of PA is more important than intensity to induce benefits No conclusive evidence for resistance training impact Improvement in lipid profiles is NOT universal w/ EX

22. Exercise and PA Guidelines Check with individuals physician (meds and coexisting conditions) Emphasize aerobic endurance and caloric exp 3-5x/wk for 20-60 min Progress as tolerated to 5-7x/wk for 40-60 min Ex with higher volume and intensity shown to increase HDL

23. Ex Rx Guidelines Mode: aerobic large muscle activities Intensity: moderate (40-75% of FC) Frequency: most days of week-volume Duration: as tolerated, the more the better-can accumulate thru day Total energy expenditure = 1000-1600 kcal/wk

24. Dyslipidemia: Exercise Prescription Frequency: ≥5 d·wk -1 to maximize caloric expenditure Intensity: 40% to 75% VO 2 R or HRR Time: 30 to 60 min·d -1 . However, to promote or maintain weight loss, 50 to 60 min/d -1 or more of daily exercise is recommended. Performance of intermittent exercise of at least 10 minutes in duration to accumulate these duration recommendations is an effective alternative to continuous exercise. .

25. Dyslipidemia: Exercise Prescription (cont.) Type: the primary mode should be aerobic physical activities that involve the large muscle groups. As part of a balanced exercise program, resistance training exercise should be incorporated. People with dyslipidemia without comorbidities may follow the resistance training guidelines for healthy adults.