EXERCISE IS MEDICINE

Dr. K.D.C. Upendra Wijayasiri (MBBS, Dip.Spo.Med, M.phil (trn) )

In-charge, Sports Medicine Unit,

Colombo South Teaching Hospital,

Kalubowila.

Drug statistics; CSTH- 2014 Name of the Drug

Amount of Drug Cost (Rs.)

1. Metformin2. PCM3. Diclofenac

sodium4. Glibenclamide5. Atenolol6. Verapamil7. Aspirin 8. Insulin (mixtard)9. Insulin (soluble)

106,24,000 tabs 132,60,000 tabs 21,85,000 tabs 11,60,000 tabs 15,68,140 tabs 9,69,000 tabs 4,03,000 tabs 27,000 units 3360 units

71,18,00049,60,000 8,52,150 11,600 6,89,981 4,84,000 6,35,000 85,05,000 14,54,880

U.S. Department of Health and Human Services Physical Activity Guidelines for healthy adults ages 18–65 years

Moderate-intensity aerobic activity for a minimum of 30 min on five days each week

vigorous-intensity aerobic activity for a minimum of 20 min on three days each week

combination of moderate- and vigorous-intensity activity to meet this recommendation.

dose–response relation between physical activity and health.

Why people don’t do Exercise? Lack of time

Other priorities Lack of confidence Lack of money to join a

gym, buy equipment or appropriate clothing

Don’t want to be sweaty or uncomfortable

Boredom Pain or injury “I’m too old.”

Lack of interest Prefer relaxing Perceived benefits of

remaining inactive Fear of injury Change in routine Lack of support from family

or job Don’t know what exercise

to do Adverse weather

How you can get the patient from Bed to Foot? Concept of 3 M’s:

1. Mentioning

2. Modeling

3. Motivation

“Motivation is mental process that connects a thought or a feeling with an action.”

SMART goals

SpecificMeasurableAchievableRealisticTimely

The FITT Principle

Frequency – How Often at least 3 times a week. eg; every other day to

allow recovery Intensity- How Hard

monitor heart rate keep above training

threshold Time – How Long

Minimum of 20 min. per session

Type – What Kind Training method

Risk stratification High risk Moderate risk Low risk

Graded Exercise tests available

• Typical Angina at < 5 METs

• Ventricular dysrhythmias• ST depression > 2mm in

Ex. ECG• Abnormal

hemodynamics

• Functional capacity < 5 METs

• Angina at > 7METs • ST depression <

2mm in Ex. ECG

• Functional capacity >

7METs

No exercise tests available

• Resting Ejection fraction

< 40%• Complex dysrhythmias• Congestive cardiac

failure

• Resting ejection fraction 40% - 49%

• Resting ejection fraction > 50%

Hypertension

Benefits of ex:• normal person 5-7mmHg reduction • weight control

Majority moderate intensity aerobic exercise

will be beneficial

More risk : symptom limited graded exercise test before schedule

Over weight and Obesity Physical activity has little impact on the amount of weight

lost in the first six months, compared to dieting (NIH/USA

evidence report, 1998); however, adequate physical activity is critical to maintaining weight loss (Dietary guidelines for Americans, 2008).

Individuals who have lost at least 30 kilograms and kept this weight off for at least five years maintain weekly exercise of 2800 kcal (The National Weight Control Registry at the University of Colorado).

Pregnancy Target to have less fatigue, toss better control of weight gain, and to

possibly experience shorter labor (Exercise during pregnancy, 2007)

Benefits of exercise

• Maintenance of prenatal aerobic and musculoskeletal fitness levels

• Prevention of excessive maternal weight gain

• Facilitation of labor and recovery from labor

• Promotion of good posture

• Prevention of gestational glucose intolerance

• Prevention of low back pain

• Improved psychological adjustment to the changes of pregnancy

Osteoporosis Benefits of Exercise

• Decreased osteoporotic fractures by increased peak bone mass

• Slowed rate of bone loss with aging

• Reduced fall risk due to improved muscle strength/ flexibility and balance ( Robertson et

al, 2002,; Bec & Snow, 2003)

Precautions:

• Attention on the proper balance

• Exercise surface

• not beyond the pain limit and less than maximal strength

• twisting, forward bending, compression of the spine and high impact loading should be avoided

• if severe spinal osteoporosis ─> alternative for walk

Depression Accompany many of the chronic conditions and

complicated by weight gain from many psychiatric

medications and by higher rates of smoking

Physical activity programs reduces depression symptoms in people diagnosed as depressed, in healthy adults, regardless of age, gender, race/ethnicity, or medical condition (US Physical Activity Guidelines Advisory Committee Report,

2008)

Greater initial physical fitness predicts rapid recovery from depression (Morgan

et al, 1998)