Fitness: It's never too late to start


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Kara Cox, MD from Via Christi Medical Associates presented to the group Via Christi Women's Connection on how to stay fit, healthy and happy.

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  • Smokadiabesity’ reaches epidemic proportions. But low fitness still kills more Americans than smoking, diabetes and obesity combined! Blair. BJSM (43), 2009, pp 1-2
  • learning is directly correlated to what kids see and observe
  • From the 2008 Physical Activity Guidelines for Americans For more information on these guidelines, visit
  • 5 A’s used with tobacco cessation efforts. Precontemplation, contemplation, preparation, action, maintainence.
  • Fitness: It's never too late to start

    1. 1. FITNESS It’s Never Too Late Kara D Cox, MD, FAAFP Via Christi Medical Associates Family & Sports Medicine
    2. 2. Food for Thought <ul><li>What if there was one prescription that could prevent and treat dozens of diseases, such as diabetes, hypertension and obesity? </li></ul><ul><li>Would you take that prescription? </li></ul><ul><li>Certainly. </li></ul>Robert E. Sallis, M.D., FACSM, Exercise is Medicine™ Task Force Chairman
    3. 3. Goals <ul><ul><li>Definition of Fitness </li></ul></ul><ul><ul><li>Impact of Fitness on All-Cause Mortality </li></ul></ul><ul><ul><li>Exercise as Medicine </li></ul></ul><ul><ul><ul><li>Physical Activity Guidelines </li></ul></ul></ul><ul><ul><ul><li>Exercise Prescription </li></ul></ul></ul><ul><ul><li>How Do I Get Started? </li></ul></ul><ul><ul><ul><li>Lifestyle, Hobbies & Active Behavior </li></ul></ul></ul><ul><ul><ul><li>Chronic Disease & Exercise </li></ul></ul></ul><ul><ul><ul><li>Keep it going! </li></ul></ul></ul>
    4. 4. Definition <ul><li>FITNESS </li></ul><ul><li>Be Active </li></ul><ul><li>Eat Smart </li></ul><ul><li>Feel Good </li></ul>* Notice fitness is not just about the weight!!
    5. 5. Impact of Fitness LOW FITNESS SMOKING OBESITY DIABETES Which of These 4 Risk Factors Kills More People?
    6. 6. Impact of Fitness LOW FITNESS SMOKADIABESITY NOW…Which of These 2 Risk Factors Kills More People?
    7. 7. Impact of Fitness
    8. 8. Impact of Fitness (or lack of!) <ul><ul><li>Children & Fitness </li></ul></ul><ul><ul><li>Growing obesity rates in kids </li></ul></ul><ul><ul><ul><li>Lifestyles have changed </li></ul></ul></ul><ul><ul><ul><ul><li>Decreased activity levels as we age </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Super Sized calories & portion sizes </li></ul></ul></ul></ul><ul><ul><ul><li>obese children = 31% </li></ul></ul></ul><ul><ul><ul><ul><li>25% of these already have cardiovascular risk factors </li></ul></ul></ul></ul><ul><ul><li>Unfit children = Sick adults! </li></ul></ul><ul><ul><ul><li>$$ health care dollars $$ </li></ul></ul></ul><ul><ul><li>Monkey SEE: Monkey DO </li></ul></ul><ul><ul><ul><li>Adults as examples!!!! </li></ul></ul></ul>
    9. 9. Impact of Fitness (or lack of!) <ul><li>Adults & Fitness </li></ul><ul><li>Again: lifestyle changes </li></ul><ul><li>Kansas is 16 th most obese state </li></ul><ul><ul><li>Obese + Overweight numbers </li></ul></ul><ul><ul><ul><li>1995 = 47.6% 2000 = 56.6% 2010 = 64.9% </li></ul></ul></ul><ul><ul><li>“ today the state with the lowest obesity rate would have had the highest rate in 1995” </li></ul></ul><ul><ul><li>Also significantly increased rates of DM, HTN , etc. </li></ul></ul><ul><li>50% of adults don’t get enough physical activity </li></ul><ul><ul><li>25 percent are not active at all (sedentary) </li></ul></ul>
    10. 10. Impact of Fitness <ul><li>Sitting as a risk factor for DEATH </li></ul><ul><li>14 year study compared people who sit for >6 hrs/day to those who sit for <3 hrs/ day </li></ul><ul><ul><li>Increased death rate by about 40% in women (20% in men) </li></ul></ul><ul><ul><li>Increased death rate by about 94% in the least active women (48% in least active men) </li></ul></ul><ul><ul><li>Sitting = increased heart disease & cancer risk </li></ul></ul>
    11. 11. Exercise as Medicine <ul><li>Regular physical activity at the correct intensity: </li></ul><ul><li>Reduces the risk of heart disease by 40% </li></ul><ul><li>Lowers the risk of stroke by 27% </li></ul><ul><li>Reduces the incidence of diabetes by almost 50% </li></ul><ul><li>Reduces the incidence of high blood pressure by almost 50% </li></ul><ul><li>Can reduce mortality and the risk of recurrent breast cancer by almost 50% </li></ul><ul><li>Can lower the risk of colon cancer by over 60% </li></ul><ul><li>Can reduce the risk of developing of Alzheimer’s disease by one-third </li></ul><ul><li>Can decrease depression as effectively as Prozac or behavioral therapy </li></ul>
    12. 12. Exercise as Medicine <ul><li>“ If we had a pill that gave all those benefits and was readily available, we would find a way to make sure every patient took it.” - Robert E. Sallis, M.D. </li></ul><ul><li>Why isn’t this happening with exercise? </li></ul><ul><ul><li>Lack of media advocacy. </li></ul></ul><ul><ul><li>No tangible success measures. </li></ul></ul><ul><ul><li>Physicians are lacking the time to effectively counsel patients. </li></ul></ul><ul><ul><li>Physicians may lack the proper training to effectively counsel patients about exercise. </li></ul></ul><ul><ul><li>No national reimbursement policy for referrals. </li></ul></ul><ul><li>Minimal side effects : </li></ul><ul><ul><li>Overuse injuries – start low and go slow. </li></ul></ul><ul><ul><li>Sudden death – very rare. </li></ul></ul>
    13. 13. 2008 Physical Activity Guidelines
    14. 14. Are you ready to change? <ul><li>Determine Stage of Change </li></ul><ul><ul><li>Not Interested! -> On the Fence -> Ready to “test the waters” -> Moving Forward -> Keep it Moving </li></ul></ul><ul><ul><li>Use stage of change to guide fitness discussion </li></ul></ul><ul><li>5 A’s (assess, advise, agree, assist, arrange) </li></ul><ul><ul><li>1&2 - Determine PA level and educate about recommendations/benefits </li></ul></ul><ul><ul><li>3 - Mutually agree on a goal (based on stage of change) </li></ul></ul><ul><ul><li>4- Rx, written materials, self-monitoring </li></ul></ul><ul><ul><li>5 - Follow-up/referrals as needed </li></ul></ul>
    15. 15. Exercise Prescription <ul><li>Kara D Cox, MD, FAAFP </li></ul><ul><li>Family & Sports Medicine </li></ul><ul><li>Via Christi Medical Associates </li></ul><ul><li>14700 W St Teresa, Ste 130 </li></ul><ul><li>Wichita, KS 67235 316.796.7970 </li></ul><ul><li>Name Betty Joe Williams Date 8-9-2011 </li></ul><ul><li>Rx walk 30 minutes 4-5 x / week </li></ul><ul><li> at moderate-to-vigorous intensity </li></ul><ul><li>and </li></ul><ul><li>strengthening + balance exercises 2 x / week </li></ul><ul><li> Dr. Kara D Cox </li></ul>
    16. 16. Exercise Prescription <ul><li>Frequency </li></ul><ul><li>How often? Goal: every day of the week </li></ul><ul><li>Intensity </li></ul><ul><li>Moderate – to – vigorous </li></ul><ul><li>Type </li></ul><ul><li>Mix of aerobic, strengthening, and balance </li></ul><ul><li>Time </li></ul><ul><li>150 minutes / week </li></ul>
    17. 17. Exercise Prescription <ul><li>Intensity: Dose matters </li></ul><ul><li>Moderate – intensity </li></ul><ul><li>Vigorous - intensity </li></ul><ul><li>Sweat is Sweet! </li></ul><ul><li>Use the TALK TEST : Exercise to a point that you CAN still TALK (maybe a little winded!), but you can NOT SING !! </li></ul>
    18. 18. Exercise Prescription <ul><li>Type </li></ul><ul><li>Aerobic </li></ul><ul><ul><li>Walk, Jog, Swim, Cycle, Various Aerobics </li></ul></ul><ul><ul><li>Dance, Skate, Wii, Workout Videos </li></ul></ul><ul><li>Strengthening/balance exercises </li></ul><ul><ul><li>Weights, Yoga, Tai Chi, Wii </li></ul></ul>
    19. 19. Get Started! <ul><li>Fitness: Be Active, Eat Smart, Feel Good </li></ul><ul><li>Eat Smart </li></ul><ul><ul><li>Shop around the grocery store (NOT through it) </li></ul></ul><ul><ul><li>Mindful eating (most of us eat mindlessly) </li></ul></ul><ul><ul><ul><li>Eat Breakfast (fuel up for the day) </li></ul></ul></ul><ul><ul><ul><li>Eat at the table </li></ul></ul></ul><ul><ul><ul><li>Limit evening food (“no food after 7:00 P.M.”) </li></ul></ul></ul><ul><ul><li>Quality Counts </li></ul></ul><ul><ul><li>Meal Planning </li></ul></ul><ul><ul><ul><li>Nutrition consult if need ideas, ask for help!!! </li></ul></ul></ul><ul><ul><li>Set a goal meet goal (lifestyle change) set a new goal </li></ul></ul><ul><ul><ul><li>more fruits/veggies </li></ul></ul></ul><ul><ul><ul><li>smaller portions </li></ul></ul></ul><ul><ul><ul><li>less red meat </li></ul></ul></ul><ul><ul><ul><li>less fast foods </li></ul></ul></ul><ul><ul><ul><li>more whole grains </li></ul></ul></ul>
    20. 20. Get Started! <ul><li>Fitness: Be Active, Eat Smart, Feel Good </li></ul><ul><li>Feel Good </li></ul><ul><ul><li>Love yourself (step #1 and the hardest to do!) </li></ul></ul><ul><ul><ul><li>Therapy DOES HELP!!! </li></ul></ul></ul><ul><ul><li>Activity levels: more activity = less depression </li></ul></ul><ul><ul><li>Nutrition choices affect how we feel </li></ul></ul><ul><ul><ul><li>“ YOU ARE WHAT YOU EAT!” </li></ul></ul></ul><ul><ul><li>Set a goal: </li></ul></ul><ul><ul><ul><li>Don’t put yourself down any more </li></ul></ul></ul><ul><ul><ul><li>Do a good deed, a selfless act for another person </li></ul></ul></ul><ul><ul><ul><li>Take bath, get a massage, get your nails done (pamper) </li></ul></ul></ul><ul><ul><ul><li>Think more positively </li></ul></ul></ul>
    21. 21. Get Started! <ul><li>Fitness: Be Active, Eat Smart, Feel Good </li></ul><ul><li>Be Active : The key is to HAVE FUN! </li></ul><ul><ul><li>Excuses </li></ul></ul><ul><ul><ul><li>“ I’m active at my job” </li></ul></ul></ul><ul><ul><ul><li>Too busy </li></ul></ul></ul><ul><ul><li>Assess your current activities & activity level </li></ul></ul><ul><ul><ul><li>Limit screen time </li></ul></ul></ul><ul><ul><li>Sometimes your hobbies can count as physical activity: </li></ul></ul><ul><ul><ul><li>Gardening, Bike Riding, Dancing, Rec Sports (sometimes), Frisbee Golf, Kayaking, Golf (without the cart), Playing with the Kids, Playing in a Band, Hiking, Snow Sports </li></ul></ul></ul><ul><ul><li>Sometimes your hobbies are simply sedentary activity: </li></ul></ul><ul><ul><ul><li>TV (i.e watching other people be active), Computer/Video games, Listening to Music, Golf (with the cart), Fishing, Rec Sports (sometimes) </li></ul></ul></ul>
    22. 22. Active Behavior (a place to start!) <ul><li>Routine things can be more “active” </li></ul><ul><li>Take the stairs </li></ul><ul><li>Park farther away </li></ul><ul><li>Go the extra mile </li></ul><ul><li>Sitting as a risk factor </li></ul><ul><li>Pedometer (goal 10,000 steps per day) </li></ul><ul><li>Break up sedentary time </li></ul><ul><ul><li>Waist circumference 6 cm bigger in prolonged sitters compared to “breakers” </li></ul></ul><ul><ul><li>The Active Couch Potato </li></ul></ul>
    23. 23. Get Started! <ul><li>“ Start low and go slow” </li></ul><ul><ul><li>start an exercise routine slowly </li></ul></ul><ul><ul><ul><li>Only increase by 10% per week </li></ul></ul></ul><ul><ul><li>include some amount of basic conditioning and stretching </li></ul></ul><ul><ul><li>for strength training use lighter weights and more repetitions - a good way to burn calories for those who find high-impact exercise difficult </li></ul></ul><ul><ul><li>Non or low impact exercises (cycling, walking, swimming, water aerobics) </li></ul></ul><ul><ul><li>rewards should be based on the amount of exercise accomplished, not how fast it was accomplished </li></ul></ul><ul><ul><li>avoid watching the scale, and instead focus on body composition changes </li></ul></ul>
    24. 24. Arthritis <ul><li>Exercise can decrease joint swelling & pain while improving function & maintain healthy weight </li></ul><ul><li>“ MOTION IS LOTION” </li></ul><ul><li>Good warm up, gradual cool down </li></ul><ul><ul><li>Avoid overstretching </li></ul></ul><ul><li>Lower impact and varied choices </li></ul><ul><ul><li>Water activities </li></ul></ul><ul><li>Spread minutes throughout the day </li></ul><ul><ul><li>10 minutes 3 x / day </li></ul></ul><ul><li>Maximum absorption from shoes/insoles </li></ul>
    25. 25. Obesity <ul><li>Exercise can help you burn calories! </li></ul><ul><li>Be Realistic and Committed! </li></ul><ul><ul><li>Recruit friends & family to help </li></ul></ul><ul><li>Extra weight is very hard on your joints </li></ul><ul><ul><li>Choose low impact activities </li></ul></ul><ul><ul><ul><li>Aerobic: Walking, Swimming, Cycling (hand-bike?) </li></ul></ul></ul><ul><ul><ul><li>Group water classes shown to be effective </li></ul></ul></ul><ul><ul><ul><li>Strengthen: seated weights (increase lean muscle mass) </li></ul></ul></ul><ul><li>Being overweight increases your risk of overheating </li></ul><ul><ul><li>Drink plenty of water </li></ul></ul>
    26. 26. Heart disease (including high BP) <ul><li>Exercise improves cardiovascular function & lowers blood pressure. </li></ul><ul><li>“ If you don’t use it you lose it”… you’re heart is a muscle…it can be strengthened! </li></ul><ul><li>Low intensity + shorter time </li></ul><ul><ul><li>gradual increases as fitness improves </li></ul></ul><ul><li>Take breaks </li></ul><ul><li>Avoid holding breath </li></ul><ul><li>Gradual cool down (don’t stop abuptly) </li></ul><ul><li>Carry NTG w/you if prescribed </li></ul><ul><li>Caution w/extremes of weather </li></ul>*** don’t exercise if BP >200/115 ***
    27. 27. Lung diseases <ul><li>Exercise for chronic lung disease can be challenging! It can increase cardiovascular fitness, decrease anxiety, and help decrease sensitivity to dyspnea (shortness of breath) </li></ul><ul><ul><li>develop more efficient breathing patterns </li></ul></ul><ul><ul><ul><li>purse lips, diaphragm breathing, use Oxygen if needed </li></ul></ul></ul><ul><ul><li>improve your ability to perform activities of daily living </li></ul></ul><ul><li>Gradual increases </li></ul><ul><li>Perceived Exertion (adjust as needed) </li></ul><ul><li>Energy Centering & Balance Activities </li></ul><ul><ul><li>Yoga & Tai Chi </li></ul></ul>
    28. 28. Diabetes <ul><li>Exercise improves your body’s response to insulin = tighter blood sugar control, the need for less medicine, and fewer hospitalizations . </li></ul><ul><li>For each 1 hr of exercise take in extra 15 gm carbohydrate </li></ul><ul><li>Check blood sugar more frequently when beginning </li></ul><ul><ul><li>Don’t exercise if blood sugar is too high (>200) </li></ul></ul><ul><ul><li>Some diabetics will test their urine for ketones </li></ul></ul><ul><ul><li>Adrenaline/hormones released during exercise might increase blood glucose levels (temporary). </li></ul></ul><ul><li>Drink plenty of fluids </li></ul>
    29. 29. Get Started, Keep Going! <ul><li>Keep it Interesting </li></ul><ul><li>Local Gyms </li></ul><ul><li>Parks & Rec, Churches, Playgrounds </li></ul><ul><li>Accountability </li></ul><ul><li>Journal (nutrition and activity) </li></ul><ul><li>Work out buddy </li></ul><ul><li>Web sources/Phone Aps </li></ul>
    30. 30. Fitness: Its Never Too late!! <ul><li>Set a goal (one lifestyle change at a time) </li></ul><ul><li>Start low, go slow! </li></ul><ul><li>No more excuses </li></ul><ul><li>Don’t focus on the weight </li></ul><ul><li>You are what you eat </li></ul><ul><li>Active behavior, be a “breaker” </li></ul><ul><li>Think positive </li></ul><ul><li>Journal your progress </li></ul>
    31. 31. Resources <ul><li>Self Assessment & Goal Setting </li></ul><ul><li>DVD: “Make a Change for Family Fitness” </li></ul><ul><li>WEB: </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul>
    32. 32. THANKS! <ul><li>FITNESS </li></ul><ul><li>Be Active </li></ul><ul><li>Eat Smart </li></ul><ul><li>Feel Good </li></ul>