1. Copyright © 2010 American College of Sports Medicine Metabolic Syndrome

3. Also referred to as syndrome X or the insulin resistance syndrome, describes a condition in which several coronary heart disease (CHD) risk factors are clustered together. –CHD risk factors may include: dyslipidemia, insulin resistance, elevated blood pressure, etc. –Increases risk of Type 2 Diabetes, CVD and liver disease. –Risk factors for MetS are undertreated. Is reversible.

5. MET Syndrome - 3 or more – From table 10.3 SBP > 130 or DBP > 85 mm Hg. Fasting glucose > 110 Fasting HDL < 40 for men Fasting HDL < 50 for women Fasting Triglycerides > 150 mg/dL Waist circumference > 102 cms for men Waist circumference > 88 cms for women

6. Facts WHO guidelines = 25.1% of the USA have MetS Mexican Americans – highest prevalence Primarily seen in overweight people and deconditioned individuals. By 2020 as many as 40% of the population will have MetS. Main components are the development of insulin resistance in the presence of central or visceral adiposity.

7. Copyright © 2010 American College of Sports Medicine Metabolic Syndrome (cont.) Table 10-3

8. Copyright © 2010 American College of Sports Medicine Metabolic Syndrome (cont.) Table 10-3

9. Copyright © 2010 American College of Sports Medicine Metabolic Syndrome (cont.) Table 10-3

10. Copyright © 2010 American College of Sports Medicine Metabolic Syndrome: Exercise Prescription The minimal Frequency, Intensity, Time (duration) or FIT framework is consistent with the recommendations for healthy adults regarding aerobic, resistance, and flexibility exercise. Similarly, the minimal dose of physical activity to improve health/fitness outcomes is consistent with the consensus public health recommendations of 150 min·wk -1 or 30 minutes of physical activity on most days of the week.

11. Treatment Weight loss is the primary intervention Decrease 7-10% form baseline total weight over 6- 12 months. Maintenance of weight loss. Exercise prescription that of an obese person or low to moderate intensity. Don’t overlook cardiovascular risks when considering resistance training and flexibility exercises. Resistance training is inversely related to MetS. Use 40-60% of client’s estimated 1 RM. Circuit training recommended with 30-45 seconds of rest between stations.

12. Copyright © 2010 American College of Sports Medicine Pulmonary Diseases Pulmonary diseases typically result in dyspnea or shortness of breath with exertion. As a result of dyspnea, patients with pulmonary disease limit physical activity and deconditioning results. Consequently, patients with pulmonary disease experience dyspnea even at low levels of physical exertion.

13. Copyright © 2010 American College of Sports Medicine Pulmonary Diseases (cont.) This adverse cycle can lead to eventual functional impairment and disability. Exercise is an effective intervention that lessens the development of functional impairment and disability in patients with pulmonary disease. Chronic bronchitis, emphysema, and cystic fibrosis are classified as chronic obstructive pulmonary diseases (COPDs), resulting in a permanent diminution of airflow, whereas asthma has a reversible component to airway obstruction.

15. Emphysema Definitions

18. SYMPTOMS cough sputum dyspnea EXPOSURE TO RISK FACTORS tobacco occupation indoor/outdoor pollution SPIROMETRY Diagnosis of COPD è è

19. Copyright © 2010 American College of Sports Medicine Pulmonary Diseases: Exercise Testing Assessment of physiologic function should include cardiopulmonary capacity, pulmonary function, and determination of arterial blood gases or arterial oxygen saturation (SaO 2 ) via direct or indirect methods. Modifications of traditional protocols (e.g., extended stages, smaller increments, and slower progression) may be warranted depending on functional limitations and the early onset of dyspnea. For example, in patients with severe COPD, the Naughton protocol may be modified such that only the speed but not the grade increases every 2 minutes instead of 3 minutes.

20. Copyright © 2010 American College of Sports Medicine Pulmonary Diseases: Exercise Testing (cont.) Persons with pulmonary disease may have ventilatory limitations to exercise; thus, prediction of peak VO 2 based on age-predicted HR max may not be appropriate. In recent years, the 6-minute walk test has become popular for assessing functional exercise capacity in persons with more severe pulmonary disease and in settings that lack exercise testing equipment. In addition to standard termination criteria, exercise testing may be terminated because of severe arterial oxygen desaturation (i.e., SaO 2 ≤80%)..

21. Copyright © 2010 American College of Sports Medicine Pulmonary Diseases: Exercise Testing (cont.) The exercise testing mode is typically walking or stationary cycling. Walking protocols may be more suitable for persons with severe disease who may lack the muscle strength to overcome the increasing resistance of cycle ergometers. If arm ergometry is used, upper extremity aerobic exercise may result in increased dyspnea that may limit the intensity and duration of the activity.

22. Copyright © 2010 American College of Sports Medicine Pulmonary Diseases: Exercise Prescription For individuals with well-controlled asthma or mild COPD, the following exercise prescription for cardiovascular fitness is recommended. Frequency: at least 3 to 5 d·wk -1 Intensity: presently there is no consensus as to the “optimal” exercise intensity for patients with pulmonary disease.

23. Copyright © 2010 American College of Sports Medicine Pulmonary Diseases: Exercise Prescription Time: 20 to 60 min·d -1 of continuous or intermittent physical activity Type: walking is strongly recommended because it is involved in most activities of daily living. Stationary cycling may be used as an alternate type of training. Additionally, resistance training and flexibility exercises should be incorporated into the exercise prescription.

24. Copyright © 2010 American College of Sports Medicine Pulmonary Diseases: Exercise Prescription For individuals with moderate to severe COPD, the following exercise prescription for cardiovascular fitness is recommended. Frequency: at least 3 to 5 d·wk -1

25. Copyright © 2010 American College of Sports Medicine Pulmonary Diseases: Exercise Prescription Intensity: for those patients with severe COPD whose exercise tolerance may be ventilatory limited, exercise intensities as high as 60% to 80% of peak work rates are suggested. Intensity may also be based on dyspnea ratings determined from the graded exercise test with ratings between 3 (moderate shortness of breath) and 5 (strong or hard breathing) on a scale of 0 to 10 corresponding to the desired exercise intensity that can be tolerated.

26. Copyright © 2010 American College of Sports Medicine Pulmonary Diseases: Exercise Prescription Time: persons with moderate or severe COPD may be able to exercise only at a specified intensity for a few minutes at the start of the training program. Intermittent exercise may also be utilized for the initial training sessions until the patient tolerates exercise at sustained higher intensities and durations of activity. Type: walking and/or cycling. Additionally, resistance training and flexibility exercises should be incorporated into the exercise prescription.