Ph i lPhysiology & (??) Psychology& (??) Psychology

of Exercise

Dr. Andrew Bennett, PT

• 1• Burt  VL, Cutler  JA, Higgins M.  et al. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population: data from the health examination surveys, 

1960 to 1991. Hypertension. 1995;2660‐ 69

• 2• Rosenblatt  RA, Cherkin DC, Schneeweiss R, Hart  LG. The content of ambulatory medical care in the United Sates: an interspecialty comparison. N Engl J Med. 1983;309892‐ 897

• 3• Berlowitz DR Ash AS Hickey EC et al Inadequate management of blood pressure in a hypertensive population N Engl J Med 1998;3391957 1963• Berlowitz DR, Ash  AS, Hickey  EC.  et al. Inadequate management of blood pressure in a hypertensive population. N Engl J Med. 1998;3391957‐ 1963

• 4• Systolic Hypertension in the Elderly Program Cooperative Research Group,  Prevention of stroke by anti‐hypertensive drug treatment in older persons with isolated systolic 

hypertension. JAMA. 1991;2653255‐ 3264

• 5• Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure,  The Sixth Report of the Joint National Committee on Prevention, Detection, 

Evaluation, and Treatment of High Blood Pressure. Arch Intern Med. 1997;1572413‐ 2446

• 6• Breckenridge  A. Angiotensin converting enzyme inhibitors and quality of life. Am J Hypertens. 1991;4 ((pt 2)) 79S‐ 82S

• 7• Israili ZH, Hall WD. Cough and angioneurotic edema associated with angiotensin‐converting enzyme inhibitor therapy: a review of the literature and pathophysiology. Ann Intern Med. 

1992;117234‐ 242

• 8• Pahor M, Guralnik JM, Furberg CD.  et al. Risk of gastrointestinal hemorrhage with calcium channel antagonists in hypertensive persons over 67 years old. Lancet. 1996;3471061‐ 1065

• 9• Suissa S, Bourgault C, Barkun A, Sheehy O, Ernst  P. Antihypertensive drugs and the risk of gastrointestinal bleeding. Am J Med. 1998;105230‐ 235

• 10• Grimm  RH  Jr, Flack  JM, Grandits GA.  et al. Long‐term effects on plasma lipids of diet and drugs to treat hypertension. JAMA. 1996;2751549‐ 1556

• 1111• Weingerger MH. Antihypertensive therapy and lipids: evidence, mechanisms, and implications. Arch Intern Med. 1985;1451102‐ 1119

• 12• Pollare T, Lithell H, Berne  C. A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension. N Engl J Med. 1989;321868‐

873

• 13• Lithell H, Pollare T, Vessby B. Metabolic effects of pindolol and propranolol in a double‐blind cross‐over study in hypertensive patients. Blood Press. 1992;192‐ 101

• 14• Criqui MH, Mebane  I, Wallace  RB, Heiss G, Holdbrook MJ. Multivariate correlates of adult blood pressures in nine North American populations: the Lipid Research Clinics Prevalence

Study. Prev Med. 1982;11391‐ 402

• 15• Hickey  N, Mulcahy R, Bourke  GJ, Graham  I, Wilson‐Davis  K. Study of coronary risk factors related to physical activity in 15,171 men. BMJ. 1975;3507‐ 509

• 16• Miall WE, Oldham  PD. Factors influencing arterial blood pressure in the general population. Clin Sci. 1958;17409‐ 444

• 17• deVries HA. Physiological effects of an exercise training regimen upon men aged 52 to 88. J Gerontol. 1980;25325‐ 336

• 18• Jennings  G, Nelson  L, Nestel P.  et al. The effects of changes in physical activity on major cardiovascular risk factors, hemodynamics, sympathetic function, and glucose utilization in 

man: a controlled study of four levels of activity. Circulation. 1986;7330‐ 39

ExerciseExercise MedicationMedication

…so why aren’t we using it??…so why aren t we using it??

Mi i i B iMinimize Barriersto

Behavior Change

The 3 Barriers

DOMS Joint/muscle pain Joint/muscle pain Actual exercise is painful! (lungs, lactic acid) C biditi (A th JRA t ) Co-morbidities (Asthma, JRA, etc)

Physical Therapy ReferralPhysical Therapy Referral

PT

3x/week for 1hr=

20 mins/day 6days /week

1 episode = 22 mins

Trading Time for Calories ‐WRONG

45 mins of45 mins of Treadmill, Elliptical orElliptical, or Stairmaster

20 seconds work + 10 seconds rest+ 10 seconds rest (4 mins total)

9X more!!!

3 Types of Exercise and EFFECT3 Types of Exercise and EFFECT

3 Types of Exercise and EFFECT90

45 mins of exercise

70

80

50

60

Resting

"Cardio"

30

40 60‐80%

10

20

0

3 Types of Exercise and EFFECT3 Types of Exercise and EFFECT

Bottom line: 

• Not all exercise is created equal• Not all exercise is created equal• Smarter not HarderSmarter not Harder

….or Longer…..or Further

Mom and Dad not off the hook!Mom and Dad not off the hook!

Shaping BehaviorShaping Behavior

Trigger–Trigger–BehaviorBehavior–Reward

right trigger and right reward = behavior becomes automatic!behavior becomes automatic!

Charles DuhiggCharles Duhigg

• http://www.npr.org/2012/03/05/147192599/habhttp://www.npr.org/2012/03/05/147192599/habits‐how‐they‐form‐and‐how‐to‐break‐them

Trigger = bellyBehavior = breakroomReward = NOT SWEETS! But rather blood flow, creative, connectedness!

Parents must help link the trigger to the rewardParents must help link the trigger to the reward

Rewards are highly individualRewards are highly individual

Barriers to behavior must be < reward

Exercise and BehaviorSh i th F t f KidShaping the Future of our Kids.

(210) 646-1779

Andrew Bennett PT DPT

( )

Andrew Bennett, PT, DPTBoard Certified in OrthopaedicsFellowship Trained in Orthopaedic Manual Physical Therapy