The role of Exercise to prevent of Non-Communicable Diseases (NCDs). Recommended Weekly Allowance. Frequency, Duration, and Intensity of Physical Activity/Exercise to be Healthy, Happy and Young

1. Effect of Vitamin P

4. Vitamin eX*
Deficiency Disorders and RWA
Dr Paul T Francis, MD
Assoc. Prof.
Community Medicine
Amrita Institute of Medical Sciences, Kochi, India
paultfrancis@gmail.com
*eXercise

5. Contents
• Health benefits of regular PAeX
• Health problems due deficiency of PAeX
• Recommended PAeX dosage for different
age groups

6. Vitamin
• “Vitamin" coined in 1911 by the Warsaw-
born biochemist Casimir Funk for a ‘vital’
‘amine’
• Later the ‘e’ was removed
• Usually not synthesized by the body

7. Vitamin eX
• An essential ingredient in our daily life,
being ignored at a great cost to our health in
the modern times

8. Physical activity, Exercise, Physical
fitness
• Physical Activity is any bodily movement
produced by skeletal muscles, which results in
energy expenditure
• Exercise is a subset of physical activity that is
planned, structured, and repetitive and has as a
final or an intermediate objective the improvement
or maintenance of physical fitness.
• Physical fitness is a set of attributes that are either
health or skill-related.

9. Physical fitness
Skill related -
Power
Agility
Balance
Health related –
Cardiorespiratory endurance
Body composition
Physical fitness
Skill related -
Power
Agility
Balance
Physical fitness
Skill related -
Power
Agility
Balance
Health related –
Cardio-respiratory endurance
Body composition
Physical fitness
Skill related -
Power
Agility
Balance

10. Mary Kom
Gymnast on a balance beam

12. MET (Metabolic Equivalent)
• I MET is equal to the energy expended by
body at rest (3.5mLO2/kg/min or 1Cal/kg/hr) –
Basal Met Rate/Resting Met rate
• The energy expenditure during PAeX is
considered as multiples of MET
• Sedentary < 1.6 MET
• Low intensity 1.6 < 3 MET
• Moderate intensity 3<6 MET
• Vigorous intensity 6<9 MET

13. ‘Aerobic’ exercise
• Aerobic activity, also called endurance activity, improves
cardiorespiratory fitness. Examples: brisk walking,
running, bicycling, jumping rope, and swimming.
• Aerobic exercise stimulates heart and muscles to use more
Oxygen
• In anaerobic exercise the metabolism is only 50%
anaerobic – intense exertion - Sprint, Weight lifting
• 1. ‘Explosive Efforts’ (duration up to 6 s)
• 2. ‘High Intensity Efforts’ (efforts comprised between >6 s to 1
min)
• 3. ‘Endurance Intensive Efforts’ (for exercise bouts longer than 1
min)

14. Clean and jerk
Svetlana
Nikolayevna
2012 olympics
161 kgs

15. Aerobic exercise

16. Sedentary behaviour/physical
Inactivity
• Sedentary - characterized by much sitting
and little physical exercise
• an independent risk factor for NCDs
• Fourth leading risk factor for global
mortality
• Responsible for 6% of deaths globally –
around 3.2 million deaths per year
• Around 31% of the world’s population is
not meeting the minimum physical activity

18. PAeX
Pioneering study
on PA
by JN Morris in 1950s
compared mortality
of London bus
Drivers and Conductors

19. Physiological effects of PAeX
• Acute exertion & Exercise training
• Heart – ejection vol, size, Resting rate (-)
• Skeletal muscle – size, capillaries,
mitochondria, Glycogen and TG deposits,
fat acids are used more
• Blood – vol,
• Fat – HDL, TG (-)

20. Effects
• BP – acute exertion +, shortly after –
• Acute effects
• Immune system – decrease in immune
response few hours
• Blood coagulation – transient increase in
platelet aggregation

21. Benefits of Physical
activity/Exercise
• PAeX profoundly affects the body and the
benefits are innumerable – the whole body
benefits
• Reduction in the whole spectrum of NCDs
- 31% reduction in mortality

22. Important benefits of PAeX
• Reduces blood pressure
• Reduces serum cholesterol
• Increases muscle and bone strength
• Prevents colon and breast cancer
• Reduces depression, dementia

23. Benefits of PA/eX
• Better sleep, less mental stress
• Better immunity – less communicable
diseases!
• Secondary prevention
• Better prognosis, survival and quality of life for
those with NCD

24. How much PAeX is required to keep us
healthy?

25. A program of regular exercise that includes
cardiorespiratory, resistance, flexibility, and
neuromotor exercise training beyond
activities of daily living to improve and
maintain physical fitness and health is
essential for most adults
American College of Sports Medicine. Position Stand. Quantity and Quality of Exercise for
Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in
Apparently Healthy Adults: Guidance for Prescribing Exercise. 2011

26. Basal Metabolic Rate
• About 60% of energy is used for BMR
• EE beyond that routine EE is required to
provide health benefits.

28. Relevant for
• Cardio-respiratory health (coronary heart
disease, cardiovascular disease, stroke and
hypertension).
• Metabolic health (diabetes and obesity).
• Musculoskeletal health (bone health,
osteoporosis).
• Cancer (breast and colon cancer).
• Functional health and prevention of falls.
• Depression.

29. PAeX
• Three factors combine to form the ‘exercise
dose’
• Frequency
• Duration
• Intensity

30. Recommended Weekly Allowance
• Adequacy of PAeX is measured by the
Total time/Energy Expenditure accumulated
over a period of one week
• Lot of flexibility in doing PAeX

31. RWA
• Even small amount helps
• Benefit is dose related
• Doesn’t require expensive equipment or
facilities

32. RWA
• For three age groups
• 5-17 yrs
• 18-64 yrs
• >65 yrs

33. Children 5-17
• 60 minutes moderate to vigorous every day
• More health benefits if the duration is increased
• Vigorous intensity activity and Muscle bone
strengthening activities should be included at least
3 times a week
• PA - play, games, sports, transportation, or
planned exercise

34. 5-17 yrs
• This one hour should be beyond the
physical activity accumulated in the
course of normal daily non-recreational
activities

35. Adults 18-64 yrs
• 150 minutes of moderate intensity activity
or
• 75 minutes of vigorous intensity activity or
• An equivalent combination of moderate and
vigorous activity per week
• Plus - Strength training of major muscle
groups 2 times a week

36. Adults 18-64yrs
• Duration if doubled, will give maximum
benefits
• Beyond that is uncertain
• PA - Recreational, transportation (e.g
walking or cycling), occupational (i.e.
work), household chores, sports/games or
planned exercise

37. Distribution over a week
• 30 mts – M x 5 days
• 25 mts – V x 3 days
Minimum duration of a bout - 10 minutes

38. Combination
• 30mts x 4MET = 120 MET/day x 5 = 600
• 15m x 8M = 120 MET x 3 days = 360
+ 30m x 4M = 120 x 2 d = 240
• One day rest per week is needed
• Can you do the entire quantity in one day?
• Weekend warriors

40. Adults > 65 yrs
• 150 mts of Moderate or 75 mts of vigorous
activity or an equivalent combination of both per
week
• Muscle strengthening exercises at least 2 days a
week
• Adults with poor mobility, should do physical
activity to enhance balance and prevent falls on 3
or more days per week
• Moderate and Vigorous is relative

41. Adults >65 yrs
• For additional benefits the duration can be
doubled
• Individuals with chronic NCDs should be
active to the level their abilities and health
conditions allow
• PA - recreational, transportation (e.g
walking or cycling), occupational (if the
person is still engaged in work), household
chores, games, or planned exercise

42. Adults > 65 yrs
• If for health reasons they cannot do the
recommended duration, they must do as
much as possible

44. Talk test
• Moderate intensity activity - can talk, but
not sing
• Brisk walking
• Vigorous intensity activity - not be able to
say more than a few words without pausing
for a breath
• Jogging

45. < 5 yrs
• They should probably be more active than
the older children
• However there are not enough studies to
prescribe a minimum recommendation

46. Disabled
• The recommendations holds good for them
too
• Have to do as much physical activity
possible within the limitations imposed by
the Disability

48. Obese/overweight
• Overweight people need not despair
• Any PA reduces the risk of mortality for the
given weight
• PA can lead to reduction of body weight

50. Attaining and maintaining fitness
• 3-6 months of regular exercise is required
for attaining the level of fitness and risk
reduction
• 1-2 weeks after stopping exercise the
beneficial effect may gradually wear away
• The PAeX should be made part of our daily
life

51. Injuries
• Care should be taken to avoid injuries
• Appropriate place, dress and footwear
needed
• Roads can be really dangerous – vehicles and
dogs (music in ears can be a problem)
• Personal safety - lonely places to be avoided
• With care, benefits far outweigh the risk of
musculoskeletal injuries

52. Summary
• Physical Inactivity is a major risk factor for many
NCDs
• PAeX is essential to remain healthy and prevent
NCDs
• The basic requirement for an adult is
• 150mts of moderate or 75mts of vigorous intensity
activity or an equivalent combination every week
• Muscle strengthening sessions about 2 days a week

53. Summary
• Extra PA gives additional benefits
• Minimum duration of a bout should be 10mts
• Even small amount helps
• Those suffering from NCD will have better
prognosis if they do PAeX

54. Do not forget your weekly dose of vitamin
eX to keep yourself Healthy, Happy and
Young

55. Thank you
References
1. WHO, Global recommendations on physical activity for health, 2010
2. Physical Activity in the Prevention and Treatment of Disease,
Professional associations for physical activity, 2010, Sweden
3. Taylor RS et al, Exercise-Based Rehabilitation for Patients with
Coronary Heart Disease: Systematic Review and Meta-analysis of
Randomized Controlled Trials, American J of Med: 2004; Volume 116
683
4. Warburton D E.R., Nicol C W, Bredin S S.D, Prescribing exercise as
preventive therapy, CMAJ March 28, 2006;174(7): 961