Exercise: Good For What Ails You                            Stephen M. Pribut, D.P.M., F.A.A.P.S.M.                       ...
Physics of Exercise                                     E = MC2                                 Exercise yields:          ...
GOALS & TAKE AWAY                                 POINTS                            Exercise is “akin” to medicine        ...
Exercise Rx                                      ACSM/HHS                            30 minutes moderate x 5 days/w       ...
Details, Background                            DVD Handout                            Website:                            ...
BIG THINKS             HOW DID WE GET HERE?                     ENDURANCE EXERCISE (sustained movement)                   ...
Evolution In Thought                            200th Birth Year Anniversary of Darwin                            150th An...
Replacement of Species                            67th Birth Anniversary of Jerry Garcia                              Grat...
Exercise Is The AnswerThursday, February 14, 13
Exercise Is The Answer                            Osteoporosis        Hypertension                                        ...
Exercise Is A Means To                              Fitness                            Don’t view exercise in isolation   ...
What Me Worry?Thursday, February 14, 13
PlanningThursday, February 14, 13
Thursday, February 14, 13
Where did we start?                  Down from the trees                  Upright posture                  Chimp brain    ...
Kind and Gentle ViewThursday, February 14, 13
Modern RealityThursday, February 14, 13
Driving Forces of                                Evolution                 Mutations and adaptations                 Uprig...
Movement & Evolution                            Among driving forces of evolution                              Affects gen...
Socialization Then & Now                            Survival              Support for joint activity                      ...
Groups & Genomics:                       Pleistocene era 45K ya                            Group selection of desirable tr...
Talent & Skills                  Enhance Value To OthersThursday, February 14, 13
Developing Skills:                  Enhance Fitness PursuitsThursday, February 14, 13
Feline Grace Is Not                              Species LimitedThursday, February 14, 13
Look Backwards While Leaping Ahead                                                      (Image: Nat Rev Genet. 2007 Feb;8(...
Telomeres & Exercise                            Short Telomere - Looks like open DS DNA                            Compoun...
Aging Telomere Length                            Tick-Tock Goes The Biological ClockThursday, February 14, 13
Banging On The Biological ClockThursday, February 14, 13
CREDIT: D. FINNIN/AMNHThursday, February 14, 13
Made To Run: The First Runner                   Australopithecus afarensis compared to Homo erectus.                   Cre...
Evolution Continues                            Evolution is an incomplete and ongoing                            process. ...
Thursday, February 14, 13
Exercise & Genetics                            Genome of Kenyan Runners                            Exercise Genes         ...
Future Use Of Genomics                            Exercise Rx - may not increase VO2 Max in                            20%...
Adjusting course               Our genes are built for motion               Sitting down causes illness               Kill...
HOMO HABILIS                            2 MYA                            Handy man. Made tools.                           ...
Homo Erectus                   1.5 mya                   Hunter - Gatherer                   Larger Brain                 ...
Development                  Sexual Dimorphism in Apes (Females Smaller,                  different head shape)           ...
Correlates of brain size in primates                            R. I. M. Dunbar et al., Science 317, 1344 -1347 (2007)Thur...
Thursday, February 14, 13
In The Beginning:                              What Did We Eat?                            Hunter - Gatherers             ...
EBM of FitnessThursday, February 14, 13
Metabolic Syndrome:                Kuopio Ischaemic Heart Disease Risk Factor Study: Modified Definitions                N...
Diagnosis of The Metabolic Syndrome                            3 of the following are needed for diagnosis:               ...
Causes of The Metabolic Syndrome             •    Overweight/obesity             •    Physical inactivity             •   ...
The Insulin Resistance Syndrome                                      Clinical Manifestations                              ...
Insulin Resistance: Critical Defect of                     The Metabolic Syndrome                                         ...
Relative Risk of Death                                               Adjusted for Age                                     ...
Fitness FAIL                            Steep decline in fitness from age 16 to 36                            More inactivi...
Strength Training                            Can enhance insulin sensitivity                            Increase GLUT4    ...
The Fix: Components of TLC                                         (Therapeutic Lifestyle Change)          Component      ...
Benefit of Treating The Metabolic Syndrome:                            Finnish Diabetes Prevention Study                  ...
Modern Hunter-Gatherer                      Life Habits                            NEW STUDY: JULY 2009                   ...
On The Move:                                  12 Miles/Day                            Out of Africa                       ...
On The Move:                                  12 Miles/Day                            Out of Africa                       ...
On The Move:                                  12 Miles/Day                            Out of Africa                       ...
Chronic Diseases Should Be Mostly Avoidable                            Atherosclerotic Cardiovascular DiseaseThursday, Feb...
If you want to live,                     change your life habits.Thursday, February 14, 13
Life Habits Medicine                                   Big 4                  Healthy Lifestyle Characteristics Among Adul...
Reduce risk of CHF by 50%: JAMA JULY 2009                            regular exercise                            not smoki...
Lifetime Risk of Heart Failure According to Number of Healthy Lifestyle Factors                                           ...
Resistance to Exercise“Our patients will take rat poison to live longer. Can’twe convince them that exercise is good for t...
Cumulative survival and exercise capacity                         Kokkinos, P. et al. Circulation 2008;117:614-622  Copyri...
Sitting Disease                            Independent Risk Factor                            Sitting as Causative Agent o...
Sitting = Death                            Millions of years ago as we moved across the                            contine...
Obesity among OECD nations                               Japan        2.9%      3.3                              Sweden   ...
66%                 Obese or OverweightThursday, February 14, 13
66%                 Obese or Overweight    By 2015 - 75% Overweight           41% ObeseThursday, February 14, 13
Increasing Obesity U.S.              Bloating of Nation: more than 65 percent of                 U.S. adults either overwe...
Obesity Trends* Among U.S. Adults                                             BRFSS, 1985            Source: Mokdad A H, e...
Obesity* Trends Among U.S. Adults                         BRFSS, 2003                            (*BMI ≥30, or about 30 lb...
Unhealthiest Food            in U.S.:          Supersizing           Perfection        • Baskin Robbins Large          Cho...
Genetically Induced                               Hopelessness?                            Genetic FTO (fat mass & obesity...
Exercise And The Brain                            50% reduction in risk of dementia                            Primes brai...
“Exercise is like Miracle           Grow for the brain”         John Ratey, M.D., Harvard School           of Medicine    ...
Exercise Improves Learning                            (by increasing Neuroplasticity)                    Vascular bed - in...
Exercise Improves                                Angiogenesis                            Growth factors                   ...
Exercise Improves                                 Productivity                            17% Improvement in productivity ...
Does increased physical fitness result in                    increased academic performance?Thursday, February 14, 13
Results: California Dept. of Education                            Higher academic achievement is associated               ...
Exercise improves academic                            performanceThursday, February 14, 13
Exercise & Depression                    Exercise - primary treatment in many countries.                    Impact on neur...
Yoga                            Relaxation                            Peace of Mind                            Recovery   ...
Russian Drunk YogaThursday, February 14, 13
Pillars of Fitness                            Cardiovascular                            Musculoskeletal                   ...
Achieving Fitness                            “Cardio”                            Resistance / Strength Training           ...
Next Action List                            Remember That “Exercise is medicine”                            Give an exerci...
10,000 Steps                            Rate: 100 Steps per minute = Moderate                            Pedometer - measu...
10,000 StepsThursday, February 14, 13
10,000 StepsThursday, February 14, 13
Aerobic Fitness Programs                            10,000 Steps                            HIT                           ...
Exercise Rx                            30 Minutes Moderate Intensity x 5 Days/w                              or 20 Minutes...
Strength                            Body Weight                            Workouts                            DB Workouts...
General Concepts of                             Strength Training                            Horizontal Push-Pull         ...
Old School Workout:                                   Back                            Bent Over Rows (DB or BB) (Back - la...
Old School Workout:                                   Arms                            Arm Curl (DB or BB) (but note, bicep...
Nostaligic Old School                              Workout: Chest                             Bench Press (BB) Wide Grip (...
Old School Workout:                                Legs & Abs                            Leg Extensions or Leg Press or (c...
New School Strength                                 Training                            Core Strengthening Exercises      ...
Core Circuit                            Planks - hold 20 - 60 seconds                            Bridge - hold 30 - 60 sec...
Core Circuit (2)                            Pushups - do 5 - 20+                            Prisoner Squats (arms crossed ...
Body Weight Circuit                        Prisoner Squats - 15   Bridges                        Pushups 5 - 15           ...
DB Circuit                       DB Lunge - or BW                       Walking Lunge -      DB - Combo - Fly/DB          ...
Balance Don’t forget balance in training and balance trainingThursday, February 14, 13
Metabolic Stirring                            Higher intensity circuit workouts                            Full body worko...
Success & Fitness                            Highly Driven                            Achievers                           ...
Nutrition: Colorful FoodsThursday, February 14, 13
Start Young:                            Be ConsistentThursday, February 14, 13
Exercise Regularly                            Eat Healthy           “...teaching an individual to           exercise may b...
Was George Sheehan                                  wrong?                            Can you live better, but not longer?...
Exercise:                     Good For What Ails You                                            E = MC2                   ...
Thursday, February 14, 13
Words of Wisdom            In theory, there is no difference between            theory and practice. In practice there is....
Upcoming SlideShare
Loading in …5
×

Exercise Is Good For What Ails You

721 views

Published on

Exercise, Obesity, Evolution & More

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
721
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
6
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Exercise Is Good For What Ails You

  1. 1. Exercise: Good For What Ails You Stephen M. Pribut, D.P.M., F.A.A.P.S.M. Clinical Assistant Professor of Surgery, GWUMC Past President, AAPSMThursday, February 14, 13
  2. 2. Physics of Exercise E = MC2 Exercise yields: Musculoskeletal Fitness Cardiovascular Fitness Optimal Body Composition Fitness Truths: A body at rest tends to remain at rest. A body in motion hates to stop exercise.Thursday, February 14, 13
  3. 3. GOALS & TAKE AWAY POINTS Exercise is “akin” to medicine Good for what ails you Give each patient an exercise prescriptionsThursday, February 14, 13
  4. 4. Exercise Rx ACSM/HHS 30 minutes moderate x 5 days/w Or 20 minutes high intensity x 3 days/w + 10 min warmup and 5 min cool down 2 days per week strength trainingThursday, February 14, 13
  5. 5. Details, Background DVD Handout Website: drpribut.com/sports BlogThursday, February 14, 13
  6. 6. BIG THINKS HOW DID WE GET HERE? ENDURANCE EXERCISE (sustained movement) SPURRED EVOLUTION and BRAIN DEVELOPMENT EXERCISE IS STILL CRITICAL TO OUR HEALTH OUR GENOME FUNCTIONS BEST WHEN WE EXERCISE EVIDENCE POINTS TO LESS CHRONIC DISEASE, INCREASED LONGEVITY, DISEASE COMPRESSIONThursday, February 14, 13
  7. 7. Evolution In Thought 200th Birth Year Anniversary of Darwin 150th Anniversary of Origin of SpeciesThursday, February 14, 13
  8. 8. Replacement of Species 67th Birth Anniversary of Jerry Garcia Grateful Dead Old and In The WayThursday, February 14, 13
  9. 9. Exercise Is The AnswerThursday, February 14, 13
  10. 10. Exercise Is The Answer Osteoporosis Hypertension Obesity Sarcopenia Lean Body Mass Anxiety Alzheimers BMI DiabetesThursday, February 14, 13
  11. 11. Exercise Is A Means To Fitness Don’t view exercise in isolation Comprehensive approach needed Cardiovascular (Aerobic) Musculoskeletal (Strength) Flexibility Physiological (lipid profile, bmi, bone density)Thursday, February 14, 13
  12. 12. What Me Worry?Thursday, February 14, 13
  13. 13. PlanningThursday, February 14, 13
  14. 14. Thursday, February 14, 13
  15. 15. Where did we start? Down from the trees Upright posture Chimp brain Richer Diet Years later we sat downThursday, February 14, 13
  16. 16. Kind and Gentle ViewThursday, February 14, 13
  17. 17. Modern RealityThursday, February 14, 13
  18. 18. Driving Forces of Evolution Mutations and adaptations Upright gait Sustained movement (exercise by choice & necessity) Tremendous effect on neurochemistry, genome, survivability. Sit still & die Diet - Fire/Cooking Diversity Socialization - Successful = Reproduction + SurvivalThursday, February 14, 13
  19. 19. Movement & Evolution Among driving forces of evolution Affects genome, survivability. Alters brain chemistry VEGF, BDNF, IGF-1, Increase in CBF Diet - Fire/Cooking Diversity, protein, Dimorphism diminished. Socialization - Successful = Reproduction + SurvivalThursday, February 14, 13
  20. 20. Socialization Then & Now Survival Support for joint activity Cooperative hunting Exercise groups Protection of group Marathon training Share food Weight loss Social Skills Help You Get Facebook a Date with Your Favorite Twitter Mate Message boards Males compete Groups: Red Carpet Female selectsThursday, February 14, 13
  21. 21. Groups & Genomics: Pleistocene era 45K ya Group selection of desirable traits resulting in selection of what genes are passed on Variety of skills desired by group “Altruism” in group dynamics and warfare Rapid spread of tools, ornaments, ritualsThursday, February 14, 13
  22. 22. Talent & Skills Enhance Value To OthersThursday, February 14, 13
  23. 23. Developing Skills: Enhance Fitness PursuitsThursday, February 14, 13
  24. 24. Feline Grace Is Not Species LimitedThursday, February 14, 13
  25. 25. Look Backwards While Leaping Ahead (Image: Nat Rev Genet. 2007 Feb;8(2):104-15.)Thursday, February 14, 13
  26. 26. Telomeres & Exercise Short Telomere - Looks like open DS DNA Compounds degrade cellular contents Apoptosis and Senescence may be protective mechanisms Leisure Exercise - longer telomeres Voluntary Mice Runners - more protectionThursday, February 14, 13
  27. 27. Aging Telomere Length Tick-Tock Goes The Biological ClockThursday, February 14, 13
  28. 28. Banging On The Biological ClockThursday, February 14, 13
  29. 29. CREDIT: D. FINNIN/AMNHThursday, February 14, 13
  30. 30. Made To Run: The First Runner Australopithecus afarensis compared to Homo erectus. Credit: Laszlo Meszoly, Harvard U.Thursday, February 14, 13
  31. 31. Evolution Continues Evolution is an incomplete and ongoing process. But we can still look back to the recent past to understand what our current genome is based on.Thursday, February 14, 13
  32. 32. Thursday, February 14, 13
  33. 33. Exercise & Genetics Genome of Kenyan Runners Exercise Genes Impact of Exercise on Gene ExpressionThursday, February 14, 13
  34. 34. Future Use Of Genomics Exercise Rx - may not increase VO2 Max in 20% Exercise Rx - may not increase HDL in 30% Future - genotype may enable improvement via a personalized Rx.Thursday, February 14, 13
  35. 35. Adjusting course Our genes are built for motion Sitting down causes illness Kill the predators and live longer If it didn’t grow - you probably shouldn’t eat it.Thursday, February 14, 13
  36. 36. HOMO HABILIS 2 MYA Handy man. Made tools. Thought to possibly use fire, but not make it. Found in East Africa Made Stone ToolsThursday, February 14, 13
  37. 37. Homo Erectus 1.5 mya Hunter - Gatherer Larger Brain Controlled Fire! Cooked FoodThursday, February 14, 13
  38. 38. Development Sexual Dimorphism in Apes (Females Smaller, different head shape) Cooking - Female, Controlled Food, Got Enough to Eat Movement - Running BDNF, VEGF, Other growth factors. Brain - grew & cross connectionsThursday, February 14, 13
  39. 39. Correlates of brain size in primates R. I. M. Dunbar et al., Science 317, 1344 -1347 (2007)Thursday, February 14, 13
  40. 40. Thursday, February 14, 13
  41. 41. In The Beginning: What Did We Eat? Hunter - Gatherers Not just nuts and berries Fish and some meat, but not every day. Neanderthals - Ate terrestial herbivoresThursday, February 14, 13
  42. 42. EBM of FitnessThursday, February 14, 13
  43. 43. Metabolic Syndrome: Kuopio Ischaemic Heart Disease Risk Factor Study: Modified Definitions NCEP Definition WHO Definition At least 3 of the following: Hyperinsulinemia (upper quartile of • Fasting plasma glucose ≥110 mg/dL nondiabetic) or fasting glucose ≥ 110 mg/dL AND at least 2 of the • Abdominal obesity: (waist) following: • men: > 40” women: > 34.5” • Abdominal obesity: • Serum TG ≥ 150 mg/dL (1) waist-to-hip ratio, men > 90 cm and • Serum HDL-C, men < 40 mg/dL women > 85 cm or BMI ≥ 30 kg/m2; or women < 50 mg/dL (2) waist girth ≥ 94 cm • Dyslipidemia: Serum TG ≥ 150 mg/dL, • Blood Pressure ≥ 130/85 mm Hg or HDL-C, men < 35 mg/dL and women < medication 39 mg/dL • Blood Pressure ≥ 140/90 mm Hg or medication Lakka H-M, et al. JAMA. 2002;288:2709-2716. NCEP ATP III. Circulation. 2002;106:3143-3421. (National Cholesterol Education Program)Thursday, February 14, 13
  44. 44. Diagnosis of The Metabolic Syndrome 3 of the following are needed for diagnosis: Risk Factor Defining Level Abdominal obesity Waist circumference – Men > 102 cm (> 40 in) – Women > 88 cm (> 35 in) Triglycerides ≥ 150 mg/dL HDL cholesterol – Men < 40 mg/dL – Women < 50 mg/dL Blood pressure ≥ 130/85 mm Hg Fasting glucose ≥ 110 mg/dL NCEP ATP III did not find adequate evidence to recommend routine measurement of insulin resistance (eg, plasma insulin), proinflammatory state, or prothrombotic state in the diagnosis of the metabolic syndrome. NCEP ATP III. Circulation. 2002;106:3143-3421.Thursday, February 14, 13
  45. 45. Causes of The Metabolic Syndrome • Overweight/obesity • Physical inactivity • Genetics • Closely associated with insulin resistance − Underlying cause of diabetes − Reduced HDL-C − Elevated triglycerides − Hypertension − Abdominal obesity NCEP ATP III. Circulation. 2002;106:3143-3421.Thursday, February 14, 13
  46. 46. The Insulin Resistance Syndrome Clinical Manifestations Central obesity Glucose intolerance Hypertension Atherosclerosis Polycystic ovary syndrome Biochemical Abnormalities Carbohydrate: Lipid: Fibrinolysis: Insulin resistance High TG Increased PAI-1 Hyperinsulinemia Low HDL-C Small, dense LDL particles Brunzell JD, Hokanson JE. Diabetes Care. 1999;22(suppl 3):C10-C13; Dunaif A. Endocr Rev. 1997;18:774-800; Reusch JEB. Am J Cardiol. 2002;90(suppl):19G-26G.Thursday, February 14, 13
  47. 47. Insulin Resistance: Critical Defect of The Metabolic Syndrome Hyperglycemia Dysfibrinolysis Hypertension Macrovascular Insulin Glucose Disease Intolerance Resistance Dyslipidemia Obesity Endothelial Dysfunction Adapted from McFarlane SI, et al. J Clin Endocrinol Metab. 2001;86:713-718; Reusch JEB. Am J Cardiol. 2002;90(suppl):19G-26G.Thursday, February 14, 13
  48. 48. Relative Risk of Death Adjusted for Age CHD mortality 4.0 CVD mortality All-cause mortality 3.5 3.0 Relative Risk 2.5 2.0 1.5 1.0 0.5 0.0 NCEP NCEP WHO WHO Waist > 102 cm Waist > 94 cm WHR > 0.90 or Waist > 94 cm BMI ≥ 30 †P < 0.05; * Subjects with metabolic syndrome (n = 106–179) vs subjects without metabolic syndrome (n = 1037–1103). BMI = body mass index; WHR = waist-hip ratio. Lakka H-M, et al. JAMA.2002;288:2709–2716.Thursday, February 14, 13
  49. 49. Fitness FAIL Steep decline in fitness from age 16 to 36 More inactivity Metabolic Syndrome Development of Fatness, Fitness, and Lifestyle From Adolescence to the Age of 36 Years. Determinants of the Metabolic Syndrome in Young Adults: The Amsterdam Growth and Health Longitudinal Study. Isabel Ferreira, PhD; Jos W. R. Twisk, PhD; Willem van Mechelen, MD, PhD; Han C. G. Kemper, PhD; Coen D. A. Stehouwer, MD, PhD Arch Intern Med. 2005;165:42-48.Thursday, February 14, 13
  50. 50. Strength Training Can enhance insulin sensitivity Increase GLUT4 Myosin heavy chain IIx (MyHC IIx) suppression Triceps extensions - 8 weeks. High intensity was more effective (60% RM) than low (30%RM) GJØVAAG, T. F. and H. A. DAHL (2009). "Effect of Training with Different Mechanical Loadings on MyHC and GLUT4 Changes." Medicine & Science in Sports & Exercise 41(1) January 2009.Thursday, February 14, 13
  51. 51. The Fix: Components of TLC (Therapeutic Lifestyle Change) Component Recommendation üLDL-raising nutrients • Saturated fats Less than 7% of total calories • Dietary cholesterol Less than 200 mg/day üTherapeutic options for LDL lowering • Plant stanols/sterols 2 g per day • Increased viscous (soluble) fiber 10−25 g per day üTotal calories Adjust caloric intake to maintain desirable body weight/prevent weight gain üPhysical activity Include enough moderate exercise to expend at least 200 kcal per day NCEP ATP III (adult treatment panel). Circulation. 2002;106:3143-3421.Thursday, February 14, 13
  52. 52. Benefit of Treating The Metabolic Syndrome: Finnish Diabetes Prevention Study 25% 20% • After 4 years, risk of diabetes 15% reduced by 58% 10% 5% 0% Intervention Control With Diabetes (%) Tuomilehto J, et al. N Engl J Med. 2001;344:1343-1350.Thursday, February 14, 13
  53. 53. Modern Hunter-Gatherer Life Habits NEW STUDY: JULY 2009 Archives of Int Medicine. Active Commuting and Cardiovascular Disease Risk: The CARDIA Study. Penny PhD; Boone-Heinonen, Janne PhD; Sidney, Steve MD, MPH; Sternfeld, Barbara PhD; Jacobs, David R. Jr PhD; Lewis, Cora E. MD. Arch Int Med Volume 169(13), 13 July 2009, p 1216–1223 N = 2364. Active commuting was positively associated with fitness in men and women and inversely associated with BMI, obesity, triglyceride levels, blood pressure, and insulin level in men.Thursday, February 14, 13
  54. 54. On The Move: 12 Miles/Day Out of Africa Land bridges 12 Miles/Day 70,ooo - 10,000 yaThursday, February 14, 13
  55. 55. On The Move: 12 Miles/Day Out of Africa Land bridges 12 Miles/Day 70,ooo - 10,000 yaThursday, February 14, 13
  56. 56. On The Move: 12 Miles/Day Out of Africa Land bridges 12 Miles/Day 70,ooo - 10,000 yaThursday, February 14, 13
  57. 57. Chronic Diseases Should Be Mostly Avoidable Atherosclerotic Cardiovascular DiseaseThursday, February 14, 13
  58. 58. If you want to live, change your life habits.Thursday, February 14, 13
  59. 59. Life Habits Medicine Big 4 Healthy Lifestyle Characteristics Among Adults in the United States, 2000 Mathew J. Reeves, PhD; Ann P. Rafferty, PhD Arch Intern Med. 2005;165:854-857. No smoking Exercise 5 days per week x 30 mins 5 Fruits/Vegetables each day Healthy body weight (BMI 17.5 - 25)Thursday, February 14, 13
  60. 60. Reduce risk of CHF by 50%: JAMA JULY 2009 regular exercise not smoking moderate alcohol intake maintaining normal weight cereal, fruit, and vegetable consumption were associated with a lower lifetime risk of heart failure in male physicians Relation Between Modifiable Lifestyle Factors and Lifetime Risk of Heart Failure Luc Djoussé, MD, ScD, MPH; Jane A. Driver, MD, MPH; J. Michael Gaziano, MD, MPH JAMA. 2009;302(4):394-400.Thursday, February 14, 13
  61. 61. Lifetime Risk of Heart Failure According to Number of Healthy Lifestyle Factors >20% JULY 2009 10% Djousse, L. et al. JAMA 2009;302:394-400. Copyright restrictions may apply.Thursday, February 14, 13
  62. 62. Resistance to Exercise“Our patients will take rat poison to live longer. Can’twe convince them that exercise is good for them?Robert Salas, MD Past President ACSM, Interview 2008Thursday, February 14, 13
  63. 63. Cumulative survival and exercise capacity Kokkinos, P. et al. Circulation 2008;117:614-622 Copyright ©2008 American Heart AssociationThursday, February 14, 13
  64. 64. Sitting Disease Independent Risk Factor Sitting as Causative Agent of Disease BJSM February, 2009 TV and Obesity, DM Overweight, Obesity, Sedentary Lifestyle Major role in chronic diseaseThursday, February 14, 13
  65. 65. Sitting = Death Millions of years ago as we moved across the continents, we’d cover up to 12 miles per day. If we sat for more than a few minutes, we might become something else’s lunch. Our brains evolved with much movement. Sitting time is an independent risk factor for mortality. Sitting Time and Mortality from All Causes, Cardiovascular Disease, and Cancer. Katzmarzyk PT, Church TS, Craig CL, Bouchard C Med Sci Sports Exerc 2009 Apr 3Thursday, February 14, 13
  66. 66. Obesity among OECD nations Japan 2.9% 3.3 Sweden 10.4 9.5 10x United States 31.1 33.2 U.S. tops the scales of large countries.Thursday, February 14, 13
  67. 67. 66% Obese or OverweightThursday, February 14, 13
  68. 68. 66% Obese or Overweight By 2015 - 75% Overweight 41% ObeseThursday, February 14, 13
  69. 69. Increasing Obesity U.S. Bloating of Nation: more than 65 percent of U.S. adults either overweight or obese.Thursday, February 14, 13
  70. 70. Obesity Trends* Among U.S. Adults BRFSS, 1985 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.Thursday, February 14, 13
  71. 71. Obesity* Trends Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or about 30 lbs overweight for 5’4” person) No Data <10% 10%–14% 15%–19% 20%-24% ³25% Source: Behavioral Risk Factor Surveillance System, CDCThursday, February 14, 13
  72. 72. Unhealthiest Food in U.S.: Supersizing Perfection • Baskin Robbins Large Chocolate Oreo Shake • 2,600 calories • 135 g fat (59 g saturated)Thursday, February 14, 13
  73. 73. Genetically Induced Hopelessness? Genetic FTO (fat mass & obesity related) Studied N = 704 Old Order Amish no effect on those with above-average physical activity scores “the increased risk of obesity owing to genetic susceptibility by FTO variants can be blunted through physical activity” Rampersaud, E., B. D. Mitchell, et al. (2008). "Physical activity and the association of common FTO gene variants with body mass index and obesity." Arch Intern Med 168(16): 1791-7.Thursday, February 14, 13
  74. 74. Exercise And The Brain 50% reduction in risk of dementia Primes brain for learning Decreases depression depression with heart disease may be due to decreased ability to exercise Improved Stroke outcome - milder, recovery Increase in CBF (up to 60% VO2Max)Thursday, February 14, 13
  75. 75. “Exercise is like Miracle Grow for the brain” John Ratey, M.D., Harvard School of Medicine http://www.youtube.com/ watch?v=Bmc0ERKfjP0 “Exercise is like taking Ritalin and a bit of Prozac” (Metaphor Man)Thursday, February 14, 13
  76. 76. Exercise Improves Learning (by increasing Neuroplasticity) Vascular bed - increased O2, Glu availability, enhanced waste product removal. Increased Serotonin, Dopamine, BDNF (Miracle Gro) - strengthen interconnections IGF-1, FGF, VEGF - Body-brain interactionThursday, February 14, 13
  77. 77. Exercise Improves Angiogenesis Growth factors Blood flow - CBF Improved (latest studies) Occurs in skeletal muscle with training. Also brain, heart, and elsewhere. May enhance healing of ulcersThursday, February 14, 13
  78. 78. Exercise Improves Productivity 17% Improvement in productivity after lunchtime exercise (NASA) Below 60% of VO2Max - increase Cerebral Blood Flow. Improvement in Algebra test scoresThursday, February 14, 13
  79. 79. Does increased physical fitness result in increased academic performance?Thursday, February 14, 13
  80. 80. Results: California Dept. of Education Higher academic achievement is associated with higher levels of fitness in grades 5, 7, and 9. Students who meet minimum fitness levels in three or more physical fitness areas show the greatest gains in academic achievement. Improvement in Algebra test scoresThursday, February 14, 13
  81. 81. Exercise improves academic performanceThursday, February 14, 13
  82. 82. Exercise & Depression Exercise - primary treatment in many countries. Impact on neurochemistry Decreases anxiety Lessens depression Aging & depression 1.5X increase in depression among sedentaryThursday, February 14, 13
  83. 83. Yoga Relaxation Peace of Mind Recovery Low Budget Secret of Russian SuccessThursday, February 14, 13
  84. 84. Russian Drunk YogaThursday, February 14, 13
  85. 85. Pillars of Fitness Cardiovascular Musculoskeletal PhysiologicalThursday, February 14, 13
  86. 86. Achieving Fitness “Cardio” Resistance / Strength Training Healthy Eating Motivation - The sometime missing factorThursday, February 14, 13
  87. 87. Next Action List Remember That “Exercise is medicine” Give an exercise prescription to your patients Follow a good exercise program Make a “Next Action List” Keep a Journal Social Media DeclarationsThursday, February 14, 13
  88. 88. 10,000 Steps Rate: 100 Steps per minute = Moderate Pedometer - measuring aerobic stepsThursday, February 14, 13
  89. 89. 10,000 StepsThursday, February 14, 13
  90. 90. 10,000 StepsThursday, February 14, 13
  91. 91. Aerobic Fitness Programs 10,000 Steps HIT LSD Biking, Dance, HOT Yoga Remember to start gentlyThursday, February 14, 13
  92. 92. Exercise Rx 30 Minutes Moderate Intensity x 5 Days/w or 20 Minutes High Intensity x 3 Days/w 2 Days Strength Training per week 10 - 12 exercises of 10 repetitions Goal 3 sets of 8-12 reps Start with 1 set of 15 for 10 exercisesThursday, February 14, 13
  93. 93. Strength Body Weight Workouts DB Workouts Traditional Mix HOT Yoga PilatesThursday, February 14, 13
  94. 94. General Concepts of Strength Training Horizontal Push-Pull Vertical Push-Pull Core Body Exercises Lower ExtremityThursday, February 14, 13
  95. 95. Old School Workout: Back Bent Over Rows (DB or BB) (Back - lats) Lat Pulldown Or Cable Low Row PulldownThursday, February 14, 13
  96. 96. Old School Workout: Arms Arm Curl (DB or BB) (but note, biceps are worked with the rows in a multijoint and multi-muscle exercise, and curls are not necessary) Overhead Press (BB or DB) Optional: lateral raises or front raises Lying Triceps PulloverThursday, February 14, 13
  97. 97. Nostaligic Old School Workout: Chest Bench Press (BB) Wide Grip (Chest - Pectorals - primary, Triceps - secondary) Flies (Chest-Pectorals primary, Anterior Deltoid secondary)Thursday, February 14, 13
  98. 98. Old School Workout: Legs & Abs Leg Extensions or Leg Press or (cautiously) Squat Leg Curls Calf Raise (optional) Abdominal CrunchesThursday, February 14, 13
  99. 99. New School Strength Training Core Strengthening Exercises Body Weight Routines Free WeightsThursday, February 14, 13
  100. 100. Core Circuit Planks - hold 20 - 60 seconds Bridge - hold 30 - 60 seconds or repeat 12 times holding 2 seconds each time. Side Planks - hold 20 - 30 seconds 1 Legged Bridge - repeat 10 times on each sideThursday, February 14, 13
  101. 101. Core Circuit (2) Pushups - do 5 - 20+ Prisoner Squats (arms crossed behind your head, not too deep if you have any tendency to knee trouble) Mountain Climbers - alternating bringing legs forward to your chest. Bird Dog - On hands and knees - lift and point with opposite arm/hand and leg/foot - hold 5 seconds, repeat 10 times (optional)Thursday, February 14, 13
  102. 102. Body Weight Circuit Prisoner Squats - 15 Bridges Pushups 5 - 15 1 - Legged Bridges Jumping Jacks - Split Squat 40-50 Reverse Crunch Planks - Hold 20-45 Pull-ups with assist seconds Inverted Rows Side PlanksThursday, February 14, 13
  103. 103. DB Circuit DB Lunge - or BW Walking Lunge - DB - Combo - Fly/DB 15 each side Bench Press DB Split Squat DB - Bent over Row DB OH Press DB - Step up (optional) ( or DB Combination Squat, Crunches, Planks Curl, Press)Thursday, February 14, 13
  104. 104. Balance Don’t forget balance in training and balance trainingThursday, February 14, 13
  105. 105. Metabolic Stirring Higher intensity circuit workouts Full body workout Multiple muscle groups exercised Craig Ballantyne of Toronto: TTThursday, February 14, 13
  106. 106. Success & Fitness Highly Driven Achievers Corporate FitnessThursday, February 14, 13
  107. 107. Nutrition: Colorful FoodsThursday, February 14, 13
  108. 108. Start Young: Be ConsistentThursday, February 14, 13
  109. 109. Exercise Regularly Eat Healthy “...teaching an individual to exercise may be better than teaching them to fish...” S. PributThursday, February 14, 13
  110. 110. Was George Sheehan wrong? Can you live better, but not longer? Or can you live healthier than you thought, not have as large a chance of chronic disease, and live longer. Follow all the tenets of healthy living: Exercise regularly, don’t smoke, eat lots of vegetables.Thursday, February 14, 13
  111. 111. Exercise: Good For What Ails You E = MC2 Stephen M. Pribut, DPM, FAAPSM Past President, AAPSM Clinical Assistant Professor of Surgery, GWUMC http://www.drpribut.comThursday, February 14, 13
  112. 112. Thursday, February 14, 13
  113. 113. Words of Wisdom In theory, there is no difference between theory and practice. In practice there is. All models are wrong, but some are useful. -George BoxThursday, February 14, 13

×