chapter 1

1. chapter1 chapter 1 Physical Activity, Health, and Chronic Disease Author name here for Edited books

2. Objectives • Understand the importance of regular physical activity • Understand dose–response relationships • Understand the concept of training volume • Identify risk factors for cardiovascular disease and sources of musculoskeletal disorders and disease • Appreciate the role of different exercise types in optimizing health

3. Importance of Physical Activity • Regular physical activity (PA) confers many health benefits and helps prevent chronic diseases • National health objective is to increase the number of U.S. adults engaging in regular PA to 30% (continued)

4. Importance of Physical Activity (continued) • Target PA goal for the national health objective • Minimum of 30 minutes • Moderate intensity • Most if not all days of week

5. Figure 1.1

6. Importance of Physical Activity • <50% of U.S. adults meet minimum moderate-intensity activity recommendations • ~25% of U.S. adults report no leisure time physical activity (LTPA) • Fewer women than men meet recommendation • Younger adults (18-24 yr) are more likely than elderly (65 yr) to meet recommendation

7. Global Challenge • Physical inactivity is a global problem. • Your goal: educate and motivate clients to adopt a physically active lifestyle. • Physical inactivity may be the most important health problem of the 21st century.

8. CDC and ACSM Recommendations • 1995 recommendation: Every U.S. adult should accumulate • 30 min, • moderate-intensity PA, • on most, preferably all, days of the week. (continued)

9. CDC and ACSM Recommendations (continued) • The 1995 recommendation was updated in 2007: • Recommended PA is in addition to ADLs • Intensity is expressed in METs • Definitions for moderate- and vigorous-intensity PA • Resistance training recommendation • Balance and flexibility suggestion for older adults

10. AHAand ACSM Definitions • Moderate intensity: • 3 to 6 METs or 5 to 6 on 10-point rating of perceived exertion (RPE) scale • Results in noticeable increase in heart rate (HR) and lasts >10 min (continued)

11. AHA and ACSM Definitions (continued) • Vigorous intensity: • >6 METs or 7 to 8 on 10-point RPE scale • Results in rapid breathing and substantial increase in HR

12. Current AHA and ACSM Recommendations • Adults (18 years) • At least 30 minutes moderate-intensity aerobic PA 5 days a week or • 20 minutes vigorous-intensity aerobic PA 3 days a week • Minimum 2 days a week moderate- to high-intensity resistance training • 8 to 12 repetitions maximum (RM) for 18 to 64 years • 10- to 15RM for older (65 years) adults • Balance and flexibility for those 65 years (continued)

13. Current AHA and ACSM Recommendations (continued) • Resistance training repetition recommendations for adults (18 years) • 8 to 12 repetitions maximum (RM) for 18 to 64 years • 10 to 15 RM for older (65 years) adults

14. 2008 PA Guidelines for Americans • Key message:150 minutes a week of moderate-intensity (~1.000 kcal/week) or 75 minutes a week vigorous-intensity aerobic exercise = substantial health benefits for adults. • Adults of all ages should include muscle strengthening at least 2 days a week. (continued)

15. 2008 PA Guidelines for Americans (continued) • Children need 60 min PA daily: • Primarily moderate- or vigorous-intensity PA • Minimum 3 days a week vigorous-intensity PA • Minimum 3 days a week muscle- and bone-strengthening PA

16. Health Benefits of PA • Lowers risk of premature death and chronic conditions • Reduces depression, anxiety, abdominal obesity • Helps control weight • Improves sleep quality • Improves cognitive function • Maintains and improves bone density • Prevents falls • Increases functional health

17. How Much PA is Enough? • Benefits based on training volume • Dose–response relationship: what kcal/wk expenditure required for specific improvement • Additional potential benefits for exceeding minimum recommended PA levels

18. 1,000 kcal/wk Sufficient to reduce disease risk A great initial goal for some Enough to move from sedentary to low PA level Insufficient to maintain healthy body weight Insufficient to experience full health benefits Dose-Response Relationship

19. IOM Recommends • Greater dose (~2,000 kcal/wk) required to • maintain healthy body weight, • prevent weight gain, • provide additional health benefits, and • move a person from a sedentary to active PA level.

20. Figure 1.3

21. Cardiovascular Disease (CVD) • Major cause of death in U.S. and Europe • Includes hypertension, heart disease, congestive heart failure, and stroke • No longer a disease of men or the elderly • Associated with inactivity and sedentarism (lack of cardiorespiratory fitness)

22. Coronary Heart Disease (CHD) • CHD is • more prevalent for African Americans and Latino Americans than Whites, • a resulting imbalance between coronary oxygen supply and demand, • attributable to physical inactivity and sedentarism, and • more favorably countered by high cardiorespiratory fitness level than by a physically active lifestyle. (continued)

23. Coronary Heart Disease (CHD) (continued) • Imbalance between O2 supply and demand • Attributed to atherosclerosis • May result in angina pectoris (chest discomfort and pain) and myocardial infarction (heart attack)

24. CHD Risk Factors • Age • Family history • Hypercholesterolemia • Hypertension • Current cigarette smoking • Prediabetes • Obesity • Physical inactivity

25. Hypertension • High blood pressure • Major contributor to stroke and heart attack, • SBP  140 mmHg or • DBP  90 mmHg or • on medication(s) for blood pressure. (continued)

26. Hypertension (continued) • Prehypertension • SBP between 120 and 139 mmHg or • DBP between 80 and 89 mmHg (continued)

27. Hypertension (continued) • Likelihood of having hypertension increases with age, race, geographic location. • Inverse relationship exists between hypertension and PA level.

28. Hypercholesterolemia and Dyslipidemia • Hypercholesterolemia = high total cholesterol (TC) • Also known as hyperlipidemia (high blood lipid levels) (continued)

29. Hypercholesterolemia and Dyslipidemia (continued) • Dyslipidemia = abnormal blood lipid level • High TC and/or • high low-density lipoproteins (LDL-C) and/or • low high-density lipoproteins (HDL-C)

30. Cigarette Smoking • Largest preventable cause of disease and premature death • Smokers’ risk of heart attack is 2 times nonsmokers’, • Smoking is linked to CHD, stroke, chronic lung disease, and several cancers. (continued)

31. Cigarette Smoking (continued) • Risk for CHD declines rapidly with quitting • Risk declines 50% in the first year. • Relative risk of stroke and CHD death is similar to that of nonsmokers in 15 years.

32. Type 1 (IDDM) Diabetes • Usually occurs before age 30 • However, can develop at any age • Not as common as type 2 • Exercise prescriptions should follow specific guidelines

33. Type 2 (NIDDM) Diabetes • Most common form of DM • Risk factors for NIDDM related to age, family history, diet, above-normal body weight and body fat • Healthy lifestyle choices decrease risk

34. Obesity and Overweight • Categories defined by body mass index (BMI) • BMI = [kg/(m2)] • Overweight = BMI between 25 and 29.9 kg/m2 • Obese = BMI  30 kg/m2 (continued)

35. Obesity and Overweight (continued) • Obesity shortens life expectancy and increases risk for the following: • CHD • DM • Hypercholesterolemia • Hypertension • Osteoarthritis • Some cancers

36. Causes of Obesity and Overweight • Some evidence for genetic source • Majority of evidence points to environment (continued)

37. Causes of Obesity and Overweight (continued) • Restricting caloric intake and increasing caloric expenditure are good ways to • control weight, • decrease body fatness, and • normalize blood lipids and blood pressure.

38. Metabolic Syndrome • Cluster of specific CVD risk factors • Must have at least 3 of those risk factors • Increases risk of CHD and DM • Prevalence highest for older (>60 yr) and obese people

39. Table 1.4

40. A leading cause of death worldwide Key risk factors include physical inactivity To reduce cancer risk: 45 to 60 minutes a day of moderate-intensity PA, at least 5 days a week for adults 60 minutes a day, moderate- to vigorous-intensity PA at least 5 days a week for children and adolescents Maintain healthy weight Cancer

41. Musculoskeletal Issues • Sedentarism and physical inactivity contribute to musculoskeletal diseases and disorders • Osteoporosis • Osteopenia • Low back pain

42. Low Back Pain • Origins may be functional, not structural. • Poor lifestyle choices increase the likelihood of experiencing low back pain.