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  1. Walking: Your Life May Depend on It! Judith A. Flohr, Ph.D. Professor, Kinesiology

  2. Walking: Your Life May Depend on It!Overview • Women: Risk for Chronic Diseases • Cardiovascular Disease • Breast Cancer • Osteoporosis • How Many Miles Must One Walk to Reduce the Risk?

  3. High Blood Pressure Smoking Cholesterol Overweight Diabetes Physical Inactivity Women: Risk for Chronic DiseasesCardiovascular Disease

  4. Women: Risk for Chronic DiseasesCardiovascular Disease-Hypertension Category Systolic(mmHg) Diastolic (mmHg) Prehypertensive 120-139 80-89 Hypertensive 140 90 Hypertension Mild 140-159 90-99 Moderate 160-179 100-109 Severe 180-209 110-119 Very Severe > 210 > 120

  5. Women: Risk for Chronic DiseasesCardiovascular Disease-Smoking CHD Mortality Ratios Albany Chicago Chicago Framingham Tecumseh

  6. Women: Risk for Chronic DiseasesCardiovascular Disease-Cholesterol Relative Risk of Death, Compared to Lowest Level of Cholesterol Relative Risk Total Cholesterol mg/dL Bray, 2000 in Physical Activity and Obesity

  7. Women: Risk for Chronic DiseasesCardiovascular Disease Blood Level (mg/dL) What it Means Total Cholesterol < 200 Desirable 200-239 Borderline high  240 High LDL (“Bad” Cholesterol) < 100 Optimal 100-129 Near Optimal 130-159 Borderline High 160-189 High > 190 Very High

  8. Women: Risk for Chronic DiseasesCardiovascular Disease- Cholesterol Blood Level (mg/dL) What it Means Triglycerides < 150 Acceptable 150-199 Borderline high  200 High HDL (“Good” Cholesterol) < 40 Low 40-59 Acceptable  60 Optimal

  9. Women: Risk for Chronic DiseasesCardiovascular Disease Overweight Mortality ratio Relative Weight % of cohort average

  10. Women: Risk for Chronic DiseasesCardiovascular Disease-Overweight Effect of weight gain since age 18 Relative risk Weight gain (kgs) 2.2 lbs = kg Body Mass Index (kg/m2) at 18 yrs

  11. Women: Risk for Chronic DiseasesCardiovascular Disease-C-Reactive Protein • Physicians Health Study • high levels of C-reactive protein • are at risk for stroke and heart attack even if they don't have traditional risk factors like smoking, high cholesterol and obesity. • Healthy postmenopausal women • C-reactive protein and 11 other substances. • The one-fourth with the highest C-reactive protein levels were 4.4 times more likely to have had a heart attack or other heart trouble than the one-fourth with the lowest levels.

  12. Women: Risk for Chronic DiseasesCardiovascular Disease-C-Reactive Protein • Ford, Earl (2002)Does Exercise Reduce Inflammation? Physical Activity and C-Reactive Protein Among U.S. Adults Epidemiology 2002:13(5): 561-568. • Sample 13, 748, • Leisure time physical activity was inversely associated with C-reactive protein concentration in a dose-response manner. • Thus, the results from this study support findings from other studies that physical activity favorably affects concentrations of acute phase reactants.

  13. Women: Risk for Chronic DiseasesCardiovascular Disease-C-Reactive Protein • Danesh, et.al. (2004) • Moderate increase • “The new findings call into question the clinical value of measuring CRP as a predictor of the risk of CHD and indicate that further research is needed to clarify the place of this approach in clinical medicine.” (Tall, NEJMp.1450, 2004)

  14. Women: Risk for Chronic DiseasesCardiovascular Disease - Blockage Heart Disease in Women Women also develop blockages in large arteries but appear more likely than men to develop “microvascular disease”- blockages in the small arteries Heart Disease in Men Blockages tend to be in the large arteries

  15. Women: Risk for Chronic DiseasesCardiovascular Disease - Plaques Heart Disease in Women Plaque is often diffused along the lining of the arteries and blood vessels Heart Disease in Men Plaque often builds to form Large blockages easily spotted By standard tests

  16. Women: Risk for Chronic DiseasesCardiovascular Disease – blood vessel malfunction • Heart Disease in Women • Endothelium-inner lining of vessels • Normal constriction and dilation • Malfunction • No dilation or • Collapse momentarily, or • Abrasion-lining erodes • Increased risk of heart attack Spasms ! !

  17. Women: Risk for Chronic DiseasesCardiovascular Disease – Heart Attack • Women Heart Attacks • Women -heart attacks 10-20 years later than men • A woman’s heart attack is likely to be fatal. • Many women do not experience feel-pain in the chest and arm • Heart attacks in women may have more to do with spasms than blocked arteries.

  18. How Many Miles Must You Walk?

  19. Age Adjusted Relative Risk of Cardiovascular Disease According to Energy Expenditure from Walking Energy Expenditure from walking (MET hr/week) Age-Adjusted Relative Risk of Cardiovascular Disease Physical Activity MET h-wk Walking @ 3.5 mph = 4 METs x 1.5 hr/wk = 6 MET hr/week Manson, JE. Walking compared with vigorous exercise For the prevention of cardiovascular events in women. N Engl J Med, Vol 347 (10) 716-725. September 2002

  20. Association of Walking and Vigorous Exercise with Age Adjusted Relative Risk of CVD Age Adjusted Relative Risk of CVD Energy Expenditure from Walking (MET hr/week) Manson, JE. Walking compared with vigorous exercise For the prevention of cardiovascular events in women. N Engl J Med, Vol 347 (10) 716-725. September 2002

  21. Multivariate Relative Risk of CVD and Relative Risk Adjusted for Age and Walking Time, According to Walking Pace Relative Risk of Cardiovascular Disease Walking Pace (mph) among Walkers

  22. US Mortality, 2001 Rank Cause of Death No. of deaths % of all deaths 1. Heart Diseases 700,142 29.0 2. Cancer553,768 22.9 3. Cerebrovascular diseases 163,538 6.8 4. Chronic lower respiratory diseases 123,013 5.1 5. Accidents (Unintentional injuries) 101,537 4.2 6. Diabetes mellitus 71,372 3.0 7. Influenza and Pneumonia 62,034 2.6 8. Alzheimer’s disease 53,852 2.2 9. Nephritis 39,480 1.6 10. Septicemia 32,238 1.3 Source: US Mortality Public Use Data Tape 2001, National Center for Health Statistics, Centers for Disease Control and Prevention, 2003.

  23. Cancer Incidence Rates* for Women, US, 1975-2000 Rate Per 100,000 Breast Colon & rectum Lung Uterine corpus Ovary *Age-adjusted to the 1970 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1973-1998, Division of Cancer Control and Population Sciences, National Cancer Institute, 2001. *Age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003.

  24. Risk Factors You Cannot Change Sex Age Genetics (mutations of BRCA1, BRCA2) Family History Personal history Previous abnormal breast biopsy Menstrual periods Early menarche < 12 Late menopause > 55 Lifestyle Related Factors Children No children, First child after 30 yr Oral contraceptives? Hormone Replacement Therapy (HRT) Alcohol 2-5 drinks/day Obesity (esp. > menopause) High Fat Diet? Physical Activity Environmental Pollution Smoking ? Women: Risk for Chronic DiseasesBreast Cancer

  25. 74,171 women age 40-79 Followed 4.7 years Women: Risk for Chronic DiseasesBreast Cancer Risk of Breast Cancer According to Past Participation in Strenuous Physical Activity (PA) at Ages 18, 35, 50 Years. # of cases McTiernan, A. et al. JAMA Vol. 290 (10):1331-1336

  26. Women: Risk for Chronic DiseasesBreast Cancer 74,171 women age 40-79 Followed 4.7 years # of cases MET hr/wk= Walk speed 2-3 mph = 3 METS Walk hours/ week = 5 MET hr/week = 15 McTiernan, A. et al. JAMA Vol. 290 (10):1331-1336

  27. Women: Risk for Chronic DiseasesOsteoporosis People with osteoporosis do not just die;they slowly break apart.” - Linda Johnson

  28. Women: Risk for Chronic DiseasesOsteoporosis

  29. Female Age Estrogen Deficiency Caucasian/Asian race Low Weight or BMI Diet Low in Calcium Alcohol Abuse Inactivity Muscle Weakness Family History Smoking History of Prior Fracture Women: Risk for Chronic DiseasesOsteoporosis-Risk factors

  30. Women: Risk for Chronic DiseasesOsteoporosis Clinical Risk Factors Independently Predict Hip Fracture Risk Hip Fracture Rate (per 1000 women years) Risk Factors Cummings et al. NEJM 332(12):767-773, 1995

  31. Women: Risk for Chronic DiseasesOsteoporosis Lifetime Risk of Hip Fracture at Age 50 WomenMen Current estimate 13.9% 4.6% Adjusting for improving Life expectancy 22.7% 11.1% Adjusting for increasing Hip fracture incidence 34.9% 17.0%

  32. Women: Risk for Chronic DiseasesOsteoporosis Physical Activity Recommendations (50+ years of age) Balance training for falls prevention Strength training 2 to 3 times per week Weight bearing exercises such as walking 30 minutes or more of moderate physical activity on most, preferably all, days of the week

  33. Summary “Lifelong physical activity promotes health and well-being for women throughout the lifecycle. Exercise benefits include the prevention of many common disorders such as heart disease, high blood pressure, non-insulin dependent diabetes, osteoporosis, and cancers of the breast, colon, and reproductive organs. Regular physical activity contributes to lifelong weight control and functional independence in old age.

  34. SummaryPhysical Activity Mental health benefits include psychological well being, the alleviation of depression,and improved body image. Education regarding the benefits of physical activity must be accompanied by access to enjoyable physical activity opportunities for girls and women of all ages and socioeconomic backgrounds.” Brehm, B.A. & J. G. Iannotta J. Hlth. Educ. Vol 29(2) p. 89