EXERCISE MEDICINE

Daniel Roth, DO, MBA, MS

Thomas Straub, PA-C, MS, CSCS

What is Exercise Medicine?

The practice of prescribing an exercise program that is designed to meet the specific needs of each patient.

A prescription for exercise for every patient, every visit, every time.

www.exerciseismedicine.org

Exercise MedicineThe guiding principles of Exercise Medicine are as follows: Exercise and physical activity are important to health

and the prevention and treatment of many chronic diseases

More should be done to address physical activity and exercise in healthcare settings

ACSM and AMA are making efforts to bring a greater focus on physical activity and exercise in healthcare settings

www.exerciseismedicine.org

America’s Obesity Epidemic

CDC - 2010

Obesity is Common

• 69.2% of adults age 20 years and over are overweight (includes obesity)

• 35.9% of adults age 20 years and over are obese

• 18.4% of adolescents age 12-19 years are obese

• 18.0% of children age 6-11 years are obese

CDC (2009-2010)

Obesity has Consequences

Obesity is linked to more than 60 chronic diseases.

According to the American Cancer Society, 572,000 Americans die of cancer each year, about 33% of these cancer deaths are linked to excess body weight, poor nutrition and/or physical inactivity.

Over 75% of hypertension cases are directly linked to obesity.

Approximately 66% of U.S. adults with type 2 diabetes are overweight or obese. http://www.obesitycampaign.org/obesity_facts.asp

Obesity has Consequences

66% of adults with arthritis are overweight or obese compared to 15.9% who are under/normal weight.

Arthritis is the #1 cause of disability among U.S. adults and has been for the past 15 years.

http://www.cdc.gov

Obesity is Costly Full-time workers in the U.S. who are

overweight or obese miss an estimated 450 million additional days of work each year compared with healthy workers resulting in an estimated cost of more than $153 billion in lost productivity annually.

Medical expenses for obese employees are 42% higher than a person with a healthy weight.

The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008.

http://www.obesitycampaign.org/obesity_facts.asp

Number of Persons with Diabetes in the US

http://www.cdc.gov/diabetes/statistics/prev/national/figpersons.htm

Cost of Diabetes to the US Economy

Diabetes is highly associated with complications such as stroke, MI, limb loss, retinopathy, nephropathy, and neuropathy.

The total estimated cost of diagnosed diabetes in 2012 is $245 billion, including $176 billion in direct medical costs and $69 billion in reduced productivity.

http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html

How to Prescribe Exercise

Four primary variables to consider:

Mode Frequency Intensity Duration

Divisions of Exercise

Two primary divisions of exercise:

Cardiovascular Training (Aerobic) – Walking, Jogging, Swimming, Biking, X-Country Skiing, Etc.

Resistance Training (Anaerobic) – Body Weight Exercises, Free Weights, Machines, Resistance Bands, Etc.

Benefits of Cardiovascular Training Improved cardiac output Improved blood pressure Improved functional capacity Weight loss Increased lean muscle mass Decreased blood sugar levels Decreased rates of depression Decreased rates of OA Improved body image

How to Determine Cardiovascular Intensity

Karvonen formula to determine target HR:

Max HR = 220-Age (+/- 10 bpm)

Target HR = Max HR x 50-85%

How to Determine Cardiovascular Intensity

Target HR = Max HR x 50-85%

Example: 30 year old runner

Target HR = 220-30 = 190 x 75% = 143 bpm

Example: 60 year old S/P MI

Target HR = 220-60 = 160 x 55% = 88 bpm

How to Prescribe Cardiovascular Exercise

Cardiovascular Training Guidelines:

For Overall Cardiovascular Health:• At least 30 minutes of moderate-intensity aerobic activity at

least 5 days per week for a total of 150 minutes

OR

• At least 25 minutes of vigorous aerobic activity at least 3 days per week for a total of 75 minutes; or a combination of moderate- and vigorous-intensity aerobic activity

• For Lowering Blood Pressure and CholesterolAn average 40 minutes of moderate- to vigorous-intensity aerobic activity 3 or 4 times per week

www.heart.org

Benefits of Resistance Training Increased muscle/tendon strength Increased functional capacity Increased lean muscle mass Increased metabolic rate Increased cardiac output Increased bone density Increased balance Decreased blood sugar levels Decreased rates of depression Improved body image

Resistance Training Programs Resistance Training:

Phase 1: Anatomical Adaptation Phase (8 weeks)

Goal: Tendon strength/general conditioning

Mode: perform 6-8 exercises (compound exercises)

Intensity: 55-60% of 1 rep max.

Duration: 3 sets x 15 reps/set

Rest: 1-2 minutes between sets

Frequency: 3-5 days/week

Resistance Training Programs Resistance Training:

Phase 2: Muscle Hypertrophy Phase (8-12 weeks)

Goal: Muscle Hypertrophy/Strength

Mode: perform 6-8 exercises

Intensity: 70-80% of 1 rep max.

Duration: 3 sets x 8-12 reps/set

Rest: 2-3 minutes between sets

Frequency: 3-5 days/week

Resistance Training Programs Resistance Training:

Phase 3: Strength Phase (8 weeks)

Goal: Strength

Mode: perform 6 exercises

Intensity: 85+% of 1 rep max.

Duration: 3 sets x 4-6 reps/set

Rest: 5 minutes between sets

Frequency: 3-4 days/week

Putting it All Together

For optimal results and additional health benefits, a combination of cardiovascular and resistance training should be prescribed.

All programs should consider exercise goals, current fitness levels, and total estimated time for exercise.

Avoid excessive exercise demands, overtraining, and burnout.

Putting it All Together

As a general rule limit total exercise time to 60-75 minutes.

A combination of cardiovascular and resistance training typically is optimal for each workout.

Cardiovascular training is usually performed prior to resistance training.

Always start at low intensities. “Use pain as your guide”