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Exercise Prescription 運動處方

Exercise Prescription 運動處方. 許世全教授 香港中文大學 體育運動科學系 香港體適能總會 副主席. Stanley Sai-chuen HUI Professor, Dept. of SSPE, CUHK Fellow, ACSM Vice-chairman, HKPFA. Changes of Physical Fitness. Changes of Physical Fitness. Effect of 12-week Strength Training. Effect Aerobic Ex on VO2max.

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Exercise Prescription 運動處方

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  1. Exercise Prescription 運動處方 許世全教授 香港中文大學 體育運動科學系 香港體適能總會 副主席 • Stanley Sai-chuen HUI • Professor, Dept. of SSPE, CUHK • Fellow, ACSM • Vice-chairman, HKPFA

  2. Changes of Physical Fitness

  3. Changes of Physical Fitness

  4. Effect of 12-week Strength Training

  5. Effect Aerobic Ex on VO2max Foss 1998, Fox Ex Physiology, p. 329

  6. Benefits of Regular Exercise • Improvements in Cardiovascular and Respiratory Function • Increased maximal oxygen uptake due to both central and peripheral adaptations • Lower minute ventilation at a given submaximal intensity • Lower myocardial oxygen cost for a given absolute submaximal intensity

  7. Improvements in Cardiovascular and Respiratory Function (cont’) • Lower heart rate and blood pressure at a given submaximal intensity • Increased capillary density in skeletal muscle • Increased exercise threshold for the accumulation of lactate in the blood • Increased exercise threshold for the onset of disease signs or symptoms (e.g., angina pectoris, ischemic ST-segment depression, claudication)

  8. Benefits of Regular Exercise • Reduction in Coronary Artery Disease Risk Factors • Reduced resting systolic/diastolic pressures • Increased serum high-density lipoprotein cholesterol and decreased serum triglycerides • Reduced total body fat, reduced intra-abdominal fat • Reduced insulin needs, improved glucose tolerance

  9. Decreased Mortality and Morbidity • Primary prevention (I.e.,intervention to prevent an acute cardiac event) 1. Higher activity and/or fitness levels are associated with lower death rates from coronary artery disease 2. Higher activity and/or fitness levels are associated with lower incidence rates for combined cardiovascular diseases, coronary artery disease, cancer of the colon, and type 2 diabetes

  10. Secondary prevention (i.e. interventions after a cardiac event [to prevent another]) 1. Based on meta-analyses (pooled data across studies), cardiovascular and all-cause mortality are reduced in post-myocardial infarction patients who participate in cardiac rehabilitation exercise training, especially as a component of multifactorial risk factor reduction 2. Randomized controlled trials of cardiac rehabilitation exercise training involving post-myocardial infarction patients do not support a reduction in the rate of nonfatal reinfarction

  11. Results of Studies Investigating the Relationship Between Physical Activity and Incidences of Selected Chronic Diseases * Few studies, probably less than 5; ** Approximately 5 to 10 studies; *** More than 10 studies.  No apparent difference in disease rates across activity or fitness categories;  Some evidence of reduced disease rates across activity or fitness categories;  Good evidence of reduced disease rates across activity or fitness categories;  Excellent evidence of reduced disease rates across activity or fitness categories, good control of potential confounders, excellent methods, extensive evidence of biological mechanisms, relationship is considered causal.

  12. Results of Studies Investigating the Relationship Between Physical Activity and Incidences of Selected Chronic Diseases

  13. Results of Studies Investigating the Relationship Between Physical Activity and Incidences of Selected Chronic Diseases

  14. Other Health Benefits • Decreased anxiety and depression • Enhanced feelings of well-being • Enhanced performance of work, recreational, and sport activities • Increased ability to perform daily living tasks • Reduced muscle and joint injury risk

  15. Other Health Benefits • Improved work performance • Enhanced self-concept and esteem • Improved socialization • Increased energy • Greater resistance to fatigue

  16. 中年少運動 　比煙民易死 • 港大家庭醫學林大慶教授 07/2004 • 2萬多個死亡的中年個案，發現20%人死於嚴重缺乏運動 • 最少一半死者生前10年完全沒有運動 懶運動額外死亡風險 • 25.3%男性死亡運動嚴重不足，女性比例則為14.4； • 身患癌病的人，若不運動，男性死亡風險額外激增45%；女性額外增加28%； • 罹患呼吸疾病而不運動，額外死亡風險男性達92%，女為75%； • 患有心血管疾病而不運動，男性額外死亡風險為52%，女性為28%。

  17. Physical Fitness Health-related Motor skill-related Cardiovascular endurance 心肺耐力 Muscular strength and endurance 肌肉力量與耐力 Muscular flexibility 肌關節柔軟度 Body composition 身體脂肪百分比 [Neuromuscular Relaxation 肌神經鬆馳程度] Agility敏捷 Balance 平衡 Coordination 協調 Power 肌爆炸力 Reaction time 反應時間 Speed 速度

  18. Health-related Physical Fitness Cardiovascular endurance 心肺耐力 Muscular strength and endurance 肌肉力量與耐力 Muscular flexibility 肌關節柔軟度 Body composition 身體脂肪百分比 [Neuromuscular Relaxation 肌神經鬆馳程度] Should be promoted for health promotion and disease prevention

  19. Pre-Exercise Participation Health Screening • for those inactive participants who wish to engage in an exercise program • for those ex participants who wish to change the intensity and volume of ex program, such as planning to engage in competition

  20. 下載區: 香港體適能總會 網頁 PAR-Q http://www.hkpfa.org.hk/document/426/parQ2002.pdf http://www.hkpfa.org.hk/document/427/parQ2002Chi.pdf PAR-Med http://www.hkpfa.org.hk/document/428/PARmedX02.pdf

  21. Positive Risk Factors for CHDACSM (2006) • Family History Myocardial infarction, coronary revascularization (bypass surgery) or sudden death before : • the age of 55 years in father or other male first degree relative (i.e. brother or son) • the age of 65 years in mother or other female first degree relative (i.e. sister or daughter) • Cigarette smoking Current cigarette smoker or those who have quit in the last six months • Hypertension Client on Hypertensive medications Resting SBP > 140 mmHg and/ or DBP > 90 mm Hg • Fasting Glucose Fasting blood glucose of 100 mg/dl (5.6mmol/L)

  22. Positive Risk Factors for CHDACSM (2006) • Hypercholesterolemia Total serum cholesterol > 200 mg/dl (5.2 mmol/L) or High density lipoprotein (HDL) < 40 mg/dl (1.03 mmol/L) Low density lipoprotein (LDL) > 130mg/dL (3.4mmol/L) Client is on lipid lowering medications • Obesity Body Mass Index (BMI) > 25 kg/m2(Asian) Waist girth >= 90 cm (M); >= 80 cm (F) (Asian) • Sedentary Lifestyle not meeting the US Gurgeon General’s guidelines Negative Risk Factors for CHDACSM (2006) High level of HDL • HDL cholesterol > 1.6 mmol/L (60 mg/dl)

  23. Initial Risk Stratification • Low risk • Younger individuals who are asymptomatic and meet no more than one risk factor threshold • Moderate risk • Older individuals (men 45 years of age; women  55 years of age) or those who meet the threshold for two or more risk factors • High Risk • Individuals with one or more signs/symptoms or known cardiovascular, pulmonary, or metabolic disease

  24. ACSM Recommendations for:(A) Medical Examination and Exercise Testing Prior to Participation, and (B) Physician Supervision of Exercise Tests Low Risk Moderate Risk High Risk A. Moderate exercise NN NN R Vigorous exercise NN R R B. Submaximal test NN NN R Maximal test NN R R NN - Not Necessary R - Recommended

  25. What to DO next ?

  26. What is Ex. Prescription ? • An individual program of exercise based on an individual’s level of fitness and health status; should consider exercise intensity, frequency per week , duration, and mode. Fit Unfit Healthy & Well Diseased

  27. A Quick Review 1st Exercise Prescription(ACSM, 1978) • 3 – 5 days per week (F) • 60 – 90% of HRmax (I) • 15 – 60 min per session (T) • Rhythmical & aerobic, large muscle activities (running, jogging, cycling …etc.) (T) CV training Fitness improvement Features Sufficient Intensity & T

  28. A Quick Review • 1990, the 1st Ex Prescription was revised • Muscular Fitness & Flexibility were added • Recognized moderate ex may have health benefits in addition to CV fitness • 1995, Joint ACSM & CDC statements on revised Ex. Prescription

  29. A Quick Review Revised Exercise Prescription(ACSM, 1998) CV Fitness and Body Composition • 3 – 5 days per week (F) • 55/65% – 90% of HRmax (I) , or 40/50% - 85% VO2R / HRR, or 12-14 RPE • 20 – 60 min per session (T) • Rhythmical & aerobic, large muscle activities (running, jogging, cycling …etc.)(T)

  30. Rate of Perceived Exertion Scale. (RPE)

  31. Revised Exercise Prescription(ACSM, 1998) Strength-Training Guidelines. Mode: 8 to 10 dynamic strength-training exercises involving the body’s major muscle groups. Resistance: Enough resistance to perform 8 to 12 repetitions to near fatigue. (10 to 15 repetitions for older and more frail individuals) Sets A minimum of 1 set. Frequency: At least 2 times per week.

  32. Revised Exercise Prescription(ACSM, 1998) Flexibility Training Guidelines. • Frequency of Exercise: • 5 to 6 times a week • Intensity of Exercise: • To a point of mild discomfort • Repetitions: • Each exercise be done four or five times, holding the final position each time about 10-30 seconds • Types of stretching • Static:Holding at the point of tension • PNF:Contract / Relax - Using reflexes to your advantage

  33. 1996 PA Recommendation 1996 U.S. Surgeons’ General Report: Physical Activity and Health (USDHHS / CDC / ACSM) Accumulating at least 30 minutes of any kind of moderate intensity physical activity on most days of the week would effectively reduce the risk of coronary heart disease, type 2 diabetes, hypertension, stroke and some kinds of cancer

  34. Previous Recommendation Emphasize on fitness Continuous 20 min / session Emphasize on structured exercise (esp. aerobic ex, strength training, stretching) Emphasize sufficient intensity 1996 PA Recommendation Emphasize on PA Any kind of PA At least 30 min Accumulated 30 min Moderate intensity (150 Kcal) Most days of week A Comparison Ex  Activity

  35. Advantages of PA Guidelines • Easier for inactive individuals • More effective for PA promotion • Health first  then fitness • Good for “BUSY” people • More effective to low overall health cost

  36. Problems of 1996 PA Guidelines • Still a bit vague to many people • What is “accumulate” means? 10+10+10 ? 5 x 6 ? 1+1+1+…etc? • What is most days? How many days exactly ? Give me a simple answer ? • What is “moderate” means ? • What is “any kind” of PA? How about home activities or labor intensive activities during work

  37. 2nd Revision of PA Guidelines, 2006 • An expert panel has been formed by CDC / USDHHS recently • Accumulate  at least 10 min / interval • most days?  5 days • Moderate?  heavy breathing yet can talk • Any kind?  as long as you don’t sit

  38. Newest PA Guidelines (2007 Aug) ACSM / AHA Consensus Statements • All healthy adults (8 to 65 yr) need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on 5 days each week or; • Vigorous-intensity aerobic physical activity for a minimum of 20 min on 3 days each week.

  39. Newest PA Guidelines (2007 Aug) ACSM / AHA Consensus Statements • Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. • For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days.

  40. Newest PA Guidelines (2007 Aug) ACSM / AHA Consensus Statements • Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. • Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate.

  41. Newest PA Guidelines (2007 Aug) ACSM / AHA Consensus Statements • In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. • Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity.

  42. Still there is a problems !! • Exercise / PA is not only a personal factor • Many external factors interact to affect one’s PA • For example: environment, public policy, school systems… • Future trends: We need guidelines for external factors …

  43. More Work to Do !! • PA Guidelines for environment • PA Guidelines for school • PA Guidelines for parents • PA Guidelines for Policy makers • …..

  44. New Technology: GPSGlobal Position SystemTracking Space of PA (i.e. environment)

  45. Best Exercise / PA Advice to Give to the Public? • Traditional, structured program--3-5 times/week, 20-60 minutes/session, relatively vigorous • Consensus recommendation--accumulate at least 30 minutes of moderate intensity exercise each day • The important question is not whether one approach is better than the other, but do both approaches work?

  46. Conclusion Physical inactivity is one of the most important public health problems and it is important to develop an action plan to address this issue • Policy makers • Public health professionals • Health service providers • Educators • Grassroots activists

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