exercise benefits no. 1: weight control no. 2: decreases incidence of cancer no. 3: lowers risk of...
TRANSCRIPT
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What’s the best exercise?
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Exercise Benefits
•No. 1: Weight control•No. 2: Decreases incidence of cancer
•No. 3: Lowers risk of CV disease•No. 4: Improves mood•No. 5: Live longer•No. 6: Promotes better sleep•No 7: Improves QOL
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30-60 min moderate x 5 days ~or~
20 min vigorous x 3 days
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AND Strength training x 2 days
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CDC 2013 •Don’t have time•Family responsibilities/kids•Boring/Hate it/not enjoyable
•Too hard•Too long
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Exercise-How much do I really need? (v1.0)Robert M. Pepper, DO, FAAFP
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METS
1 MET = energy produced of an average person seated at rest
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METS•Walking 4.0 mph(15:00 min/mile)=
5 METS•Walking 5.0 mph (12:00 min/mile)=
8 METS
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1: 5 METS2: 7 METS3: 10 METS
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Cardiovascular evaluation of middle-aged individuals engaged in high-intensity sport activities: implications for workload, yield and economic costs
Menafoglio, et al Br J Sports Med doi:10.1136/bjsports-2014-093857
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785 (age 35-65) asymptomatic athletes
Hx/PE/ECG/SCOREAbnormals:112 (14.3% total)•5.1% “pathologic” ECG•4.1% SCORE >5%•4.7% abnormal PE•1.6 % red flag PMH/FHx
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Where did this lead?
•22/785 (2.8%) Dx with new CV problem
•ZERO had an abnormal exercise stress test
•100 % exceeded > 10 METS
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Sitting is the new smoking?
Television viewing time and reduced life expectancy: a life table analysis
Veerman et alBr J Sports Med 2012;46:927-930
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AHA SIHD Guidelines 2012
•A moderate or high dose of a statin therapy should be prescribed..
(Level of Evidence: A)•Treatment with aspirin 75 to 162 mg daily should be continued indefinitely (Level of Evidence: A)
J Am Coll Cardiol. 2012;60(24)
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5 METS=Minimum
•Walking 4.0 mph (15:00 min/mile)=5 METS
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6 METSBrisk walking 4.5 mph (13:20 min/mile)=6 METS
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9 METSWogging 5.0 mph (12:00 min/mile)=9 METS
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ideal speeds: requiring least amount of energy
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Wogging? 4.5 mph (13 min/mile), metabolic efficiency was at its lowest
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Fast not so fast
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Treadmill Conversions
Mph: 5.0=12:00 Min/Mile @ 0% /speed fixed
3%:10:32
5%:9:38 8%:8:38
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Move to And then to
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Exercise-How much do I
really need? (v2.0) 2014-current
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2014:Best Study of the Year
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3 major findings:
Runners had consistently lower all cause mortality vs non-runners
low doses and low speeds had significant mortality benefits
Persistent running over time (6 years) was more strongly associated with mortality reduction
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Quick Summary
•15 years•55,000 adults ages 18-100 (24%runners)
•Reduction all cause mortality 29%
•Reduction CV mortality 50%
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Quick Summary cont.•3 year added life expectancy benefit•Persistent runners reduction AC/CV of 29%/50%
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That’s way too much work!
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This is not me!
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Time (min)Distance (miles)
Frequency (times)Speed (miles/h)
Total amount (METS/week)
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For less than 10K a week (7-10 min/day) x 6 years
•29% reduction in all cause mortality
•50% reduction in cardiovascular mortality
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>50 yoa538 runners/ 423 non-runnersMatched age, sex, functional ability
39% reduction in all cause mortality
Reduced disability and mortality among aging runners: a 21-year longitudinal study.Arch Intern Med 2008;168
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pleiotropy
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Exercise Rx?
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Last Time-How much do I really, really need? (v3.0-Biohack)
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VO2 Max
• maximum rate of 02 consumption(Ml(O2)/kg∙min)•surrogate of cardiorespiratory fitness
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Wingate Sprints: Pitfalls
High exertion•Strong motivation•Too strenuous for sedentary(Hawley and Gibala 2009)
Total time > 20 minutes•2-3 min sprints, warm-up, recovery intervals(Garber et al 2011)
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Cardiac Remodeling in Response to 1 Year of Intensive Endurance Training
Arbab-Zadeh, A et al2014 Oct 3.:CIRCULATION.AHA
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Would you invest in this Rx?
Rx transforms the heart of a slacker into one of an elite athlete
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Plan:
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“doability”• 3-4 x a week,
30-45 min low level exercise
• After nine months, long runs added
• Max 7-9 hours/week
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Results:•RV mass and volume immediate ↑
•Add intense intervals eccentric hypertrophy of LV
• VO2max↑an average of 20%.
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2015:
Where are we now?
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Exercise as Rx•Absence of Fitness= Smoking•Goals: 9 METS F/10 METS M•Small changes in fitness provide at least as much benefit as statins, ASA, and ACE-I
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CV, live longer, time, bored•Running provides significant benefits- even at relatively low levels
•HIIT is very effective and doesn’t have to be 100% all out
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handouts
•Assessing CRP/VO2 max•Calculate daily energy expenditure
•METS calculator•VO2 max tables•Treadmill conversion