Introduction to the Fitness Spectrum. Today we will: Review the increase of heart disease in America...
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Transcript of Introduction to the Fitness Spectrum. Today we will: Review the increase of heart disease in America...
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Introduction to the Fitness Spectrum
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Today we will:
• Review the increase of heart disease in America• Recognize the health implications of inactivity• Describe the Dr. Dean Ornish Program for Reversing
Heart Disease Exercise Prescription• Learn the benefits of the exercise guidelines• Learn how to make exercise safe• Discuss the integrated approach to success
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US Cardiovascular Disease Mortality 1979-2004
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Diabetes
• 20.8 million Americans have diabetes
• 30% are unaware • Diabetes has doubled
over the last 30 years.• 65% of people with
diabetes will die of heart disease or stroke
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1999
Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1999, 2008
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2008
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
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The Epidemic of Obesity
• Number ONE modifiable risk factor for diseases such as:– Heart disease– Cancer– Diabetes– High blood pressure– High cholesterol
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Heavy to Heavier
0
10
20
30
40
50
60
70
BMI > 25 BMI >30 BMI > 40
1999-2000
2003-2004
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The Influence of Exercise
• Only 30% of adults engage in regular physical activity.
• 70% of Americans perform less than recommended levels of physical activity.
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No Exercise
Inconsistent Exercise
RegularExercise
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Health Implications of Inactivity• Coronary Artery Disease• Obesity• High Blood Pressure• High Cholesterol• Bone Loss• Peripheral Artery Disease• Asthma
• Stroke• Cancer (colon, breast,
prostate, lung)• Diabetes• Metabolic Syndrome• Depression• High Stress
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The Risk of Inactivity
• “The relative risk of heart disease associated with physical inactivity ranges from 1.5-2.4, an increase in risk comparable to that observed for high blood cholesterol, high blood pressure or cigarette smoking.”– Source: JAMA 1995;273:402-407
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Exercise and All-Cause MortalityHarvard Alumni Health Study
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Age-Related Changes in Aerobic Capacity
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Exercise and Obesity
• 22,000 participants were followed for 8 years and evaluated for fitness (treadmill testing) and body fat percentage.
• Lean men, who were fit, had 1/3 the incidence of cardiac related death as those who were lean and unfit.
• Fit obese men had lower death rates than unfit lean men.– Source: Lee et al. Am J of Clin Nutrition 1999; 69: 373
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Benefits of Exercise
• Improves heart efficiency• Improves oxygen carrying capacity of blood• Lowers resting blood pressure• Lowers triglycerides• Increases HDL cholesterol• Lowers blood glucose (sugar)• Improves metabolism• Prevents bone loss
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Benefits of Exercise, cont.
• Decreases body fat• Improves muscle mass and density• Improves exercise capacity• Decreases mortality rate• Decreases stress level• Decreases hostility• Decreases depression• Improves overall well-being
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Exercise Prescription (Rx)
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Exercise Guidelines
• Limit passive inactive pursuits.• Add more activity into everyday life.• Exercise aerobically for a minimum of 3 hours
per week.• Perform strength training activities a minimum of
2 times per week.
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Exercise Components
Flexibility / Stretching
Aerobic / Cardiorespiratory
Resistance / Strength Training
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Format for Exercise Sessions
• Warm Up Phase (5-10 minutes):– Includes a low level cardiorespiratory component
followed by flexibility exercises
• Stimulus or Conditioning Phase (30-60 minutes):– Cardiorespiratory component within your training range– Resistance training
• Cool Down Phase (5-10 minutes):– Same as warm-up period
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Warm Up and Cool Down• The warm up helps move the body from rest to
exercise.• The low level cardio activity increases blood flow to
muscles and warms them up before stretching.• Low intensity stretching before exercise may
reduce the likelihood of musculoskeletal injuries.
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Warm Up and Cool Down, cont.
• The cool down provides a recovery period to return the body (and heart rate and blood pressure) to the resting state.
• Helps maintain adequate venous return (reduces “pooling” of blood in lower extremities) and reduces the potential for hypotension (low blood pressure) and dizziness.
• Stretching after exercise helps to maintain flexibility.
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F.I.T.T. Principle
F = Frequency How often
I = Intensity How hard
T = Time How long
T = Type What type
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Flexibility
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Guidelines for Flexibility Training
F • 3 to 7 days per week
I• To a mild tension, without
discomfort
T• Hold each stretch for 15-30
seconds
• Repeat 2 to 4 times each stretch
T• Static stretches that involve the
major muscle tendon units.
• May use yoga poses.
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Warm up before stretching.Do not bounce when stretching.
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Aerobic/Cardiorespiratory
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Activity vs. Exercise
Activity• Stop and go activities• < 45% or > 80% of maximal capacity • Doesn’t condition the cardiopulmonary system
Exercise• Continuous activity involving large muscle groups• 45-80% of maximal intensity• Conditions the cardiopulmonary system
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Activity or Exercise?
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Activity or Exercise?
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Activity or Exercise?
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Activity Versus ExerciseActivity • Gardening• Golf• Household Chores• Shopping• Cooking• Doubles Tennis• Basketball• Dancing
Exercise•Hiking•Aerobic dance•Jogging•Rowing•Rollerblading
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Exercise Monitoring: Heart Rate
Target Heart Rates• Based on the
maximum heart rate achieved during an exercise test
• Pulse taking– Wrist– Neck
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Exercise Monitoring: RPE
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BO
RG
’S R
AT
E O
F P
ER
CE
IVE
D
EX
ER
TIO
N (
RP
E)
SC
ALE
Borg RPE scale© Gunnar Borg, 1970, 1985, 1994, 1998
RATING DESCRIPTION
6 No Exertion
7 Extremely Light
8
9 Very Light
10 Light
11
12
13 Somewhat Hard
14
15 Hard / Heavy
16
17 Very Hard
18
19 Extremely Hard
20 Maxim
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Program Guidelines: Aerobic Exercise
F • 3 to 6 days per week
I • 45-80% of maximal capacity
T• 30 to 60 minutes/session• Accumulate at least 3 to 5 hours
of exercise weekly
T• Activities using large muscles
that are continuous and rhythmical in nature
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Program Guidelines for Diabetes
F • Daily preferred
I• 45-80 % of maximal capacity• Or RPE 11 to 14
T• 20 to 60 minutes/session• Accumulate at least 3 to 5 hours of
exercise weekly
T• Activities using large muscles that
are continuous and rhythmical in nature
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Source: ACSM, 2000
Aerobic Exercise
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Strength Training
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Benefits of Strength Training
fat mass• Improves cholesterol blood pressure symptoms of
depression • Improves glucose
utilization
• Improves self-confidence
• Improves bone density arthritis pain metabolism• Can help break
through a weight loss plateau
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Program Guidelines: Strength Training
F • 2 to 3 days per week
I • RPE of 10 to 15
T• 10-15 repetitions of 8 to
10 different exercises
T• Weights, resistance
bands, body weight, household items, water resistance
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Exercising Safely
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General Exercise Guidelines
• Monitor your exercise response.• Pace yourself.• Have a regular exercise routine.• Relax with stress management.• Stay hydrated.
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Exercise Guidelines for Diabetes
• Monitor glucose levels before, during and after exercise sessions.
• Do not exercise if blood glucose > 250 with urinary ketones or >300 if no ketones.
• Eat carbohydrate if blood glucose is < 100 mg/dL.
• Exercising at night may cause nocturnal hypoglycemia.
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More Guidelines for Diabetes
• Exercise with caution in extreme hot/cold weather. • Insulin, diabetes pills or other non-insulin
injectables may have to be adjusted.• Maintain good foot care and wear proper footwear
for your activity.• Exercise has an insulin-like response in the body.
Exercise daily at the same time to prevent low blood sugar (hypoglycemia).
• Hypoglycemia can occur up to 6 hours after exercise.
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Special Exercise Considerations
• Eating• Alcohol• Hot weather• Cold weather• Altitude
• Medications• Illness• Overexertion• Carbon monoxide
(smoking, smog)
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Warning Signs
• Chest pressure/pain• Severe breathlessness• Excessive fatigue• Poor recovery• Irregular heart rate
(palpitations)• Sweating with cold,
clammy skin
• Dizziness• Nausea• Fainting• Confusion• New or increased chest,
jaw, back or arm pain that does not go away with rest or nitroglycerin
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If You Have Chest Pain With Exercise…
• When you are exercising at Program sessions: – STOP exercise and let a staff member know.
• If you are exercising on your own:– STOP exercising, and follow your doctor’s instructions
regarding calling 911, seeking immediate medical attention, taking nitroglycerin or other recommendations from your doctor.
• ALWAYS let your physician and Program staff know if you have had any angina symptoms when you have been exercising on your own—especially if your symptoms are changing in intensity or frequency.
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Musculoskeletal Injury
• R Rest• I Ice the area for 20 minutes at a time• C Compression (use an ACE bandage
to hold the ice on the injured area)• E Elevate the injured area
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Pathways to Success
• Buddies • Clubs • Classes • Events • Feelings
• Fun• Time management• Confidence • Commitment
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Integrated Approach
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Love & Support
Stress Management
Fitness Nutrition
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Lifestyle Heart Trial Results
• Exercise adherence in combination with the other modalities is associated with:– Heart disease reversal– Improved blood lipids– Weight loss– Improved mood– More satisfaction and pleasure from life
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Exercise and Stress Management
• Improved flexibility• Increased awareness
and ability to focus• Improved breathing
techniques• Improved balance
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Exercise and Group Support
• Decreased hostility• Improved mood• Increased satisfaction and
pleasure from life• Exercising with a partner
or in a group can improve interpersonal relationships.
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Exercise, Nutrition and Your Eating Plan
• Aids in weight loss and maintenance of weight loss
• Moderates appetite• Helps curb binge eating
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Upcoming Exercise Support and Training• We’ll exercise twice weekly for the next 12 weeks.• We’ll add strength training around week 6.• Toward the completion of Stage I, you will have
another stress test, and we will update your exercise prescription to reflect the new test.
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Questions
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