MISS VICTORIA HYLAND & MR DAVID WEBB

COLEG LLANDRILLO CYMRU

Chronic Disease Management and Exercise

Overview and Aims

Outline common Illnesses & Chronic Disease

Management of Illnesses & Chronic Disease through the prescription and life style changes

Pros and cons of Exercise prescription for these illnesses and health conditions

To be able to manipulate exercise to fit in with specific populations and life styles

Exercise Myths

Determinants of Health

Living and working conditions and access to facilities and services

Support and influence within communities which can sustain or damage health

Economic, cultural and environmental conditions such as standards of living

Personal behaviour and lifestyle

Lifestyle Factors

Lifestyle factors are responsible for most of the illness and deaths- Smoking Stress Alcohol Improper diet Overeating Lack of exercise

Obesity

What is obesity?

Excessive development of body fat. (Bailliere’s 2002)

BMI – Body Mass Index BMI – Weight (Kg) Height 2

(m2)Densitometry - Provides measurements of body density -body pod-Hydrostatic weighing Duel energy x-ray absorptiometry-DXA scanBioelectrical impedanceSkin fold measurements

Obesity & Physical activity facts

Average person gains 1lb (0.45kg) of fat/year after age 25 and loses 0.5 kg lean body weight/year resulting in a net gain of 0.7kg (1.5lb) of fat per year

Inactivity is a major cause of obesity, probably more important than overeating

Physical activity increases energy expenditure during the activity and for some time after when the metabolic rate remains high

Physical activity can cause a loss in fat weight/maintenance or a gain in fat free mass

ACSM (2010)

Weight Loss / Fat Reduction

To lose weight you have to create a calorie To lose weight you have to create a calorie deficit. You can do this by deficit. You can do this by decreasingdecreasing your your calorie intake and calorie intake and increasingincreasing your exercise your exercise work output.work output.

Coronary Artery Disease (CAD)

CAD

Coronary arteries are the vessels that supply oxygen rich blood to the heart.

Plaque builds up in these arteries and cause restricted blood flow to the heart.

This build up can cause plaque reduces the oxygen to the working heart muscle •Angina•Increased BP•Arrhythmias •Myocardial Infraction (MI)•Heart Failure

Reduce Risk of CAD. How?

Reduced blood pressure (Duncan et al, 1985, ACSM 2010 )

Increases HDL (Goldberg & Elliot; 1987, ACSM 2010)

Decreases LDL (Sady et al 1986; Work; 1987, ACSM 2010 )

Reduces obesity ( Bray; 1986, ACSM 2010)

WHAT ARE THE BENEFITS OF EXERCISE?

Regular aerobic exercise protects against CAD; possibly with increasing benefits as the amount of exercise increases (ACSM 2010)

Even after an MI regular exercise reduces the risk of a subsequent MI by 25% (Dargie & Grant; 1991)

Decreased risk of diabetic complications (Boule et al; 2001)

GP referral to exercise!

DIABETES

DIABETES

WHAT IS DIABETES?

Insulin Dependant Diabetes Mellitus (IDDM) or Type I Diabetes

Non-Insulin Dependant Diabetes Mellitus (NIDDM) or Type II Diabetes

IDDM

Characterised by a lack or absence of endogenous insulin production

Regular subcutaneous injections of insulin are required to prevent hyperglycaemia

Fact:Prior to the discovery of insulin Type I patients usually died

within 2 years, from ketoacidosis. (high blood glucose; often caused by illness or taking too little insulin, ketones accumulate in the blood

ACSM(2010)

NIDDM

Impairment of the pancreatic beta cells to secrete insulin in response to elevated plasma glucose concentrations

A reduced sensitivity to insulin in target organs (such as muscle, liver and adipose tissue)

Often goes undiagnosed!

PHYSIOLOGICAL IMPLICATIONS

HYPERGLYCAEMIA - elevated concentration of glucose in the blood

CAN BE CONTROLLED WITH EXERCISEOccurs if the liver releases glycogen (glucose) into

the blood stream without the presence of insulinHYPOGLYCAEMIA - Low blood sugar levels, often

causing confusion, light headedness and irritabilityCAN BE MADE WORSE BY EXERCISEOccurs if the individual has used too much insulin or

not consumed enough CHO

RISKS ASSOCIATED WITH EXERCISE

HypoglycaemiaCardiac implicationsRetinal bleedingProtein excreted in the urineChanges to BPIncreased risk of foot ulcersPossible problems with thermo-regulation

GP referral to exercise!

BENEFITS OF EXERCISE

Increase insulin sensitivity

Improved functional capacity

Enhanced sense of well-being

Reduced risk of CADReduced risk of MIDecreased ‘stickiness’ of

blood plateletsReduced risk of High BPCan reduce high BP

Decreased triglyceride levels

Increased HDL levelsDecreased LDL levelsImproved HDL / LDL

ratioDecreased Body FatDecreased risk of

OsteoporosisDecreased risk of

Diabetic associated complications

Older Population

What do you think is meant by the term “older adult” ?

ACMS (2010)

The term “Older Adult” is defined as a person

>65 years and people 50-64 years with clinically significant conditions or physical limitations that affect movement, physical fitness, or physical activity.

Benefits of physical activity

Slow physiologic changes of ageing that impair exercise capacity

Optimizing age related changes in body composition

Promoting psychological & cognitive well-beingManaging chronic diseasesReducing the risk of physical disabilityIncreasing longevity

(ACSM 2010)

However…………………

Older adults are the least physically active of all age groups.

Exception……..http://www.youtube.com/watch?v=iUvjXQHt6

QQ&feature=fvw

Exercise Recommendations

WHAT ARE THE BENEFITS OF EXERCISE?

Reduce the risk of Health Complications Reduces risk of osteoporosisReduced Body FatIncrease cross sectional muscle Decreases risk of injury Improves confidence and self esteemImproves body image

ACSM (2010)

Exercise PrescriptionExercise Prescription

Recommended by the ACSM (2010):Recommended by the ACSM (2010):

Frequency: Frequency: at least 3-4 days a week / preferably daily.at least 3-4 days a week / preferably daily.

Intensity: Intensity: Moderate (physical activity that noticeably Moderate (physical activity that noticeably increase breathing, sweating, and HR) to vigorous increase breathing, sweating, and HR) to vigorous (physical activity that substantially increase breathing (physical activity that substantially increase breathing sweating, and HR) intensity.sweating, and HR) intensity.

Time: Time: 30 minutes a day of moderate exercise build to an 30 minutes a day of moderate exercise build to an hour. hour.

Type:Type: A variety of actives that are enjoyable and A variety of actives that are enjoyable and developmentally appropriate for the developmentally appropriate for the INDIVIDEALINDIVIDEAL..

Strength

Recommended by the ACSM (2010):Recommended by the ACSM (2010):Frequency = at least 2 days a weekIntensity = Moderate and vigorous Type = Progressive weight training - Major

Muscles groups

Flexibility

Recommended by the Recommended by the ACSM (2010):ACSM (2010):Min 2 days a weeksIntensity = 5-6 intensity scaleType: Any activities that maintains orincreases flexibilityMajor muscle groupsHold for minimum 15-30 sec

SMART Goals Applied to Exercise

S - specific, significant, stretchingM - measurable, meaningful, motivationalA - attainable, agreed upon, achievable,

acceptable, action-orientedR - realistic, relevant, reasonable, rewarding,

results-orientedT - time-based, timely, tangible, trackable

What exercise do you do in a day?

In small group discuss your daily activities.

Make a list of activities.

Make a note of these activities duration.

Do they fit in with the recommendations?

Exercise Myths

Performing exercise for a specific area in an Performing exercise for a specific area in an attempt reduce body fat in that area alone.attempt reduce body fat in that area alone.

But does this work? What do you think?But does this work? What do you think?

Resistance training is any type of exercise Resistance training is any type of exercise using additional resistanceusing additional resistance

The main aim is to improve muscle strength The main aim is to improve muscle strength and endurance, usually by weight trainingand endurance, usually by weight training

Will it make females look masculine?Will it make females look masculine?

FACTS on RT

Resistance training increases Basal Metabolic rate (Mc Cartney 1993)

Alexander (2002) RT/circuits – improve body composition and weight loss. Also has a higher energy expenditure post exercise then walking and jogging.

Summary

Life style factors contribute to illness and chronic disease.

Manipulation of life style can help to maintain a health life style and prevent/manage illness and chronic disease.

Exercise provides benefits to reduce and prevention of illness and chronic disease.

Make exercise enjoyable and specific i.e. SMART Goal setting

Be happy!

Video Clip Be Happy with What You

Have.WMV

Any Questions