motivation & exercise get fit series

MOTIVATION & EXERCISE GET FIT SERIES

David S. Edwards, M.D.Department of Family Medicine & Sports MedicineTexas Tech University Health Sciences Center, Lubbock

Objectives Discuss the effects of exercise on the

human body and its major organ systems.

Review common injuries and principles of treatment.

Identify “red flags” that may lead to injury or permanent disability.

Create an exercise program that is fun!

You are wonderfully made!(images: www.wikiality.com , www.newsin3D.com ) “What a piece of

work is a man! How noble in reason, how infinite in faculty, in form and moving how express and admirable, in action like an angel, in apprehension how like a god!” William Shakespeare

Top Ten New Year’s Resolutions (about.com, Powell & Powell) 1. spend more time with family & friends 2. get in shape 3. lose weight 4. stop smoking 5. enjoy life more 6. quit drinking alcohol 7. get out of debt 8. learn something new 9. help others 10. get organized

Why exercise? Improved bone density Lowering of blood pressure Improving cholesterol, LDL, and HDL Enhanced self-image Improve balance and coordination Decrease anxiety and depression Promote restful sleep

Reasons Boys Play Sports To have fun To improve skills Excitement of

competition Self-identity tied to

athletic ability

Reasons Girls Play Sports To have fun To exercise To get in shape Anatomic changes during adolescence

can be frustrating for athletes. Ballet, dance Gymnastics Figure skating

Exercise is not easy! Societal

developments over the past 20 years: Sedentary lifestyle High fat diet High refined

carbohydrate diet

Image: www.stayviolation.typepad.com

The Obesity Epidemic

• Source: CDC

Sequelae of obesity High blood pressure Impaired glucose tolerance Diabetes mellitus II Elevated cholesterol, atherosclerosis Osteoarthritis of hips and knees Non-alcoholic steatohepatitis (NASH) Airway obstruction , sleep apnea Certain cancers

Not everyone can jump into exercise.

Certain groups require preliminary cardiac stress testing.

Low risk: male<45, female <55, 1 risk factor.

Moderate risk: male>45, female >55, 2 risk factors.

High risk: signs and symptoms

Coronary artery disease risk factors(image: www.topnews.in )

Family history (male<55, female<65) Cigarette smoking Hypertension Elevated cholesterol DM II, impaired fasting glucose Obesity Sedentary lifestyle

Signs/Symptoms of coronary artery disease Dull pain: neck, chest, jaw, left arm “indigestion” Shortness of breath at rest or with mild

exertion Dizziness, syncope Orthopnea, paroxysmal nocturnal dyspnea Ankle edema Palpitations Claudication Heart murmur Recent fatigue with usual activities

The Aerobics Center Longitudinal Study – Sui X., et al

Prospective cohort of over 2600 adults > 60 from 1979-2001

Fitness measured by treadmill exercise testing periodically

Fit people had a lower mortality regardless of abdominal obesity or % body fat!

Fit people who were obese had lower mortality than non-fit people with normal weight!

Principles of Acute Soft Tissue Injury

Protection Rest / relative rest Icing Compression Elevation Mobility

Injury Treatment - Ice Useful for acute

injury Decreases swelling

and pain Chronic injury –

only after activity Ice massage with

elevation < 20 minutes, wait

at least 45 minutes before re-application

Injury Treatment - heat Relaxes and loosens soft tissues Stimulates blood flow Useful for chronic injury / overuse

before activity Contraindictions: acute injury, after

activity, altered mentation or mobility Heating pad or hot damp towel

Side Effects of NSAIDs

Images: www.medicalook.com & www.gamewood.net

Overuse Injuries Can Progress Rapidly Type I – pain after activity Type II – pain during activity, does not

limit activity Type III – pain during activity, limits

performance Type IV – pain at rest

Prevention(Image: www.ushistory.org )

“An ounce of prevention is worth a pound of cure.”

“Exercise is medicine!”

ACSM

Sites of Stress Fracture

Images www.eorthopod.com , www.fairview.org

Risk Factors for Stress Fracture Female gender, short

stature Overuse, repetitive

activity Recent changes in

training program or running surface

Mileage > 20 miles per week

Underlying disease: Osteopenia, Osteoporosis, alcoholism, kidney failure

Image www.coloradorunnermag.com

Prevention of Stress Fracture Adequate nutrition and calcium intake Proper foot wear Softer training surface Proper training

Gradual buildup in mileage Rest Cross-training

Flexibility: Maximize performance and protect your joints

Connective tissue – tendon, ligament, joint capsule, fasciae in and around muscle

Stretch – increase connective tissue length through range of motion Elastic Plastic

Temperature-dependent Jog prior to stretching

Flexibility Slow movements

Stretch reflex: rapid stretching causes protective muscle contraction

Reach maximum ROM Beware of excess

Decreased stability: joint sprain Decreased flexibility: muscle strain

Easily lost Greatest in the first two weeks of injury

Improving Flexibility Pre-season & in-season : start early Daily Static stretching – safest Stretch large muscle groups first, then

smaller groups After warm-up and after practice

Flexibility - precautions Avoid ballistic stretching Avoid stretching as a warm-up activity.

• Images: www.hsc.csu.edu, www.otda.state.ny.us, www.yoga-made-ez.com.

Preventing Injury Good posture, “sit tall” Strength and flexibility Maintain a healthy weight. Correct imbalances in muscle strength Stretch daily after a warm up and as a

cool down Must rehab old injuries Appropriate equipment / footwear

Prevention of heat illness Pre-hydrate before planned exercise. Check the weather report. Light clothing, mesh, loose-fitting,

change when soaked Adjust schedules, increased # breaks Adequate sleep Avoid oil or gel-based sunscreens that

can hinder evaporation

Prevention of Heat Illness Monitor body weight. Nude weight before and after workout Loss of > 2% of body weight affects

performance, > 3% weight loss affects thermoregulation

Monitor urine color. For every 1 lb drop, must drink 1 pint

(about 500 ml)

“Opposition is a natural part of life. Just as we develop our physical muscles through overcoming opposition – such as lifting weights- we develop our character muscles by overcoming challenges and adversity.”

-Stephen R. Covey

Resistance Exercise(image: www.medical-look.com )

Used in combination with aerobic exercise

Tone muscle Increases resting

metabolic rate Reduced blood pressure:

affects cardiac morbidity, stroke risk, overall mortality

Total fat reduction Elderly: increased

endurance, walking speed, balance, reduces falls

Benefits of Exercise Feel better

Improved energy, decrease stress & anxiety, improved mood and endurance

Improve appearance Weight control, tone muscles, improve

posture Decrease risk of disease

Reduce blood pressure and cholesterol Improve bone mass and strength

Healthy Weight Loss Dietary changes:

Reduce fat in the diet Reduce # meals eaten out Set an eating schedule Low calorie snacks Decrease use of soft drinks Eat breakfast

2007 Physical Activity Recommendations: ACSM & AHA

Healthy adults < 65 years old Moderate intensity cardiovascular exercise

for 30 mins/day, 5 days a week OR: Vigorous intensity cardiovascular exercise

20 mins/day, 3 days a week AND: strength training

8 to 10 exercises with 8-12 repetitions of each exercise.

Twice a week on non-consecutive days

2007 Physical Activity Recommendations: ACSM & AHA

Healthy adults > 65 yo, chronic illness or functional limitation in adults 50-64 yo Moderate intensity exercise 30 mins, 5x/wk OR: Vigorous intensity exercise 20 mins, 3x/wk

AND: Weight training: use weight to allow 10-15

repetitions Flexibility exercises – 10 mins daily, 2x/wk Balance exercises Have a physical activity plan.

Don’t Quit “Lack of activity destroys the good

condition of every human being, while movement and methodical physical exercise save it and preserve it.” Plato

“Don’t let what you cannot do interfere with what you can do.” Coach John Wooden

Bring a Friend(image: www.i.co.telegraph.uk , www.w2fitness.com )

Motivation Support More walk, less

talk! Accountability A.L.S.A. – 10 year

study, age 70 and older, close friendships promote longevity

Track your progress!(image: http://us.123rf.com )

What are your goals? Immediate Short term Long term

“A journey of 1,000 miles begins with a single step.” – Lao-Tzu

Journal / Training log Monitor growth and

development

Quiz All of the following are ways to reduce

risk of injury except: A. maintaining a healthy weight B. stretching consistently C. icing old injury before exercise and

applying heat after exercise D. weightlifting in a structured setting

Quiz Your 55 yo neighbor asks you about

starting an exercise program. She weighs 220 pounds and is diabetic. Your best response is:

A. Please join me for my daily exercise.B. Maybe you should see your doctor first.C. Maybe you should join a local gym.D. Maybe you should lose weight first.E. Can you watch the kids this weekend?

Additional Sources: Blanke, D. “Preseason Conditioning : Flexibility” in Team

Physician’s Handbook,3rd ed., Mellion, M. et al, editors, Hanley & Belfus, inc:Philadelphia, 2002.

Carbon, R., “ABC of Sports Medicine: Female Athletes” British Medical Journal 1994; 309: 254-258.

Cluett, J. “Ice or heat” About.com: Orthopaedics, http://www.orthopaedics.about.com , accessed 4/18/08.

Griffin, L.Y., et al. “The Female Athlete” in: Mair & Johnson eds Clinical Sports Medicine, 1st ed. Philadelphia: Mosby; 2006: 61-78.

Herring, S.A., et al. “Female Athlete Issues for the Team Physician: A Consensus Statement” 2007. www.aafp.org, accessed 9/21/07.

Sui X. et al, “Cardiorespiratory fitness and adiposity as mortality predictors in older adults” JAMA. 2007; 298: 2507-2516

Image: www.4catholiceducators.com