1. Health Benefits from Regular Exercise

2. DECLINE IN DEATHS

3. Harvard Alumni Study (1985) Amount of physical activity Mortality

4. Exercise and Chronic Diseases Regular exercise reduces risk of or benefits: atherosclerosis and coronary heart disease – TC,  LDL-C,  HDL-C,  TG, heart strength

5. DEVELOPMENT OF ATHEROSCLEROSIS

6. The first step of atherosclerosis is Inflammation Injury Cancer Diabetes More cancer

7. ARTERY COMPARISONS

8. Coronary Artery Disease Atherosclerosis—progressive narrowing of arteries due to build up of plaque Coronary artery disease (CAD)— atherosclerosis in the coronary arteries Ischemia—deficiency in blood to heart caused by CAD Myocardial infarction—heart attack due to ischemia

9. AMERICANS AT INCREASED CAD RISK

10. Did You Know…? Atherosclerosis begins in infancy and progresses at different rates, depending primarily on heredity and lifestyle choices such as smoking history, diet practices, physical activity, and stress.

11. Exercise and Chronic Diseases Regular exercise reduces risk of or benefits: atherosclerosis and coronary heart disease – TC,  LDL-C,  HDL-C,  TG, heart strength hypertension – BP

12. Hypertension chronically elevated blood pressure causes the heart to work harder places strain on arteries causing them to become less elastic over time affects ~25% of adult Americans –half of these are unaware they have hypertension

13. Classification of Blood Pressure for Adults, Age 18 Years and Older Normal< 130< 85 High normal130-13985-89 Hypertension  140  90 Stage 1 (mild)140-15990-99 Stage 2 (moderate)160-179100-109 Stage 3 (severe)180-209110-119 Stage 4 (very severe)  210  120 SystolicDiastolic Category(mmHg)(mmHg)

14. Exercise and Chronic Diseases Regular exercise reduces risk of or benefits: atherosclerosis and coronary heart disease – TC,  LDL-C,  HDL-C,  TG, heart strength hypertension – BP in hypertensive (but doesn’t normalize)  colon and breast cancer

15. Exercise and Chronic Diseases Regular exercise reduces risk of or benefits: atherosclerosis and coronary heart disease – TC,  LDL-C,  HDL-C,  TG hypertension – BP in hypertensive (but doesn’t normalize)  colon and breast cancer diabetes mellitus –exercise  need for insulin

16. Exercise and Chronic Diseases obesity – energy expenditure

17. Obesity and Overweight in the US  prevalence dramatically  past 30 y  prevalence in children  markedly since 1980  >33% of adult population is overweight  average adult gains 1 lb/yr after age 25 y  average adult loses 0.5 lb of muscle and bone mass each year after age 25 y

18. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

19. Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

20. Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

21. Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

22. Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

23. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

24. Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

25. Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

26. Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

27. Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

28. Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

29. Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

30. Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

31. Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

32. Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

33. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

34. Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

35. (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

36. Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

37. Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

38. Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

39. Prevalence of Overweight Among U.S. Children and Adolescents (Aged 2 –19 Years) National Health and Nutrition Examination Surveys (NHANES) 1971-741976-801988-942003-04 20% 15% 10% 5% 0% Non-Hispanic whites Non-Hispanic blacks Mexican Americans

40. Fat Distribution Upper-body (android) obesity Fat stored in upper body and abdominal area (apple shaped) Occurs more frequently in men Carries greater risk for CAD, hypertension, stroke, and diabetes Lower-body (gynoid) obesity Occurs more frequently in women Fat stored in the lower body around the hips, buttocks, and thighs (pear shaped)

41. BODY CHANGES, DIET, AND EXERCISE

42. Exercise and Chronic Diseases obesity – energy expenditure low-back pain –a leading cause for missed work mental health – mental well-being osteoporosis –weight-bearing exercise  bone mineral density

44. Two Types of Bone Cortical (compact) 80% of skeletal mass 20% of turnover Trabecular (Cancellous) vertebral bodies femoral neck 20% of skeletal mass 80% of turnover

45. Trabecular Bone

46. Bone Remodeling

47. Bone Turnover and Age AGE (yr)Bone Turnover Bone Loss 20-40Bone Gain = Bone Loss > 40 Bone Gain < Bone Loss

48. Bone Mineral Density osteoporosis

49. Mechanical loading on bone stimulates bone absorption of Ca 2+

50. Are you looking at a 65-year-old woman with osteoporosis?

51. Exercise Interventions in Pre-pubertal Children

52. Comparison of Impact Exercise vs. Weight Training on Changes in BMD of Postmenopausal Women Kohrt et al., J Bone Miner Res 12:1253, 1997 Ca 2+ supplemented at 1500 mg/d 3 d/wk; 45 min sessions for 11 mo jogging / stair climbing vs. weight training

53. Summary Maintaining good bone health is a lifelong process Exercise (and proper nutrition) are vital in enhancing peak BMD in childhood and in maintaining or increasing BMD in adults

54. Exercise Prescription Components of Fitness cardiovascular body composition muscular strength and endurance flexibility

55. Exercise Prescription Cardiovascular Fitness 1995 CDC/ACSM health recommendation: –“at least 30 minutes of moderate intensity exercise on most or preferably all days of the week” expend at least 1000 kcal/week (= to 30 min of brisk walking 5-6 days/week) minimal fitness recommendations: –expend 2000-3500 kcal/week equal to 120-220 min/week of moderate-intensity running (9-min/mile pace)

56. Exercise Prescription Cardiovascular Fitness exercise mode exercise intensity –50-70% of HR max –45-60% of VO 2max –RPE of 11-12 –“talk” test exercise duration exercise frequency rate of progression

57. Classification of Exercise Intensity Based on 30-60 minutes of continuous exercise

58. Exercise Prescription Flexibility connective tissue primary cause of inflexibility primary concern is flexibility of lower back and hamstrings

59. Exercise Prescription Muscular Strength and Endurance general recommendations –one set of 8-12 repetitions –set resistance to reach volitional fatigue –at least 2 days/week –performed at moderate-to-slow speeds –full range of motion –do not alter normal breathing

60. Quiz 6 1.d 2.d 3.CV system less important to these events 4.c 5.High [CHO] slows fluid absorption 6.d 7.a 8.b 9. HLa production 10.c 11.c 12.d 13.c 14.b 15.c 16.a 17.6 g  9 kcal/g = 54% 18.d 19.c 20. a) BP; b) BMD; c) HDL, LDL, TC; d)  insulin needs 21. jog 3-4 X/wk at HR of 118-125; RPE of 12-13