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Exercise
Aka: Exercise, Physical Activity, Exercise Prescription, Physical Activity Counseling
- See Also
- Strength Training
- Exercise Energy Expenditure
- Exercise in Diabetes Mellitus
- Exercise in the Elderly
- Exercise in Pregnancy
- Exercise Participation in Hypertensive Patients
- Exercising with Infection
- Exercise-Induced Bronchospasm
- Exercise-Induced Urticaria
- Exercise in Osteoporosis
- Exercise in COPD
- Exercise in Obesity
- Exercise in Arthritis
- Exercise in Chronic Pain
- Epidemiology
- Majority of United States is physically inactive
- American adults
- Completely sedentary: 25%
- Activity <30 minutes/day: 60%
- Americans age 12 to 21
- No recent Exercise: 14%
- Not vigorously active: 50%
- Americans over age 65 years
- Sedentary: 75%
- References
- (1996) USDHHS Surgeon General Report on Activity [PubMed]
- Jones (1998) Arch Fam Med 7:285-9 [PubMed]
- Efficacy: Benefits of Aerobic Exercise
- Reduces Cardiovascular Risks
- Coronary Artery Disease twice as likely in sedentary
- Improves Lipid profile
- Increases High Density Lipoprotein (HDL)
- Decreases Low Density Lipoprotein (LDL)
- Decreases Total Cholesterol
- Decreases Triglycerides
- Improves VLDL Cholesterol
- Enhances Fibrinolysis and alters platelet function
- Lowers Blood Pressure
- Decreases Systolic Blood Pressure
- Decreases Diastolic Blood Pressure
- Significantly lowers mortality in older men with CHD
- Required only light activity (walking, gardening)
- Wannamethee (2000) Circulation 102:1358-63 [PubMed]
- Benefits Diabetes Mellitus
- See Exercise in Diabetes Mellitus
- Improves Glucose Tolerance and Insulin Sensitivity
- Improves for 16 hours after each Exercise session
- Significantly decreases Disability and improves mobility in obese patients with Diabetes Mellitus
- Rejeski (2012) N Engl J Med 366(13): 1209-17 [PubMed]
- Reduces Mortality in Postmenopausal Women
- Studied 42,000 women ages 55 to 69 years over 7 years
- Moderate Physical Activity (golf or long walks)
- Exercise once weekly: Mortality reduced 23%
- Exercise 2-4 times weekly: Mortality reduced 30%
- Exercise >4 times weekly: Mortality reduced 38%
- Vigorous Physical Activity: Mortality Reduced 43%
- References
- Kushi (1997) JAMA 277:1287-92 [PubMed]
- Benefits Mental Health
- Decreases Major Depression in chronic illness (patients with most significant depression have the greatest benefit)
- Herring (2012) Arch Intern Med172(2): 101-111 [PubMed]
- Reduces Cancer risk
- Colon Cancer and Prostate Cancer reduced
- Breast Cancer risk reduced
- Study 25,624 Norwegian women ages 35-49 in 14 years
- Breast Cancer reduced 37% if 5-7 days Exercise/week
- Thune (1997) 336:1269-75 [PubMed]
- Osteoporosis benefits
- Decreases postmenopausal Bone Mineral Density loss
- Decreases hip and Vertebral fracture Incidence
- Other Benefits
- Reduces Obesity
- Improves immune function
- Improves Anxiety and Major Depression
- Improves Insomnia
- Improves self-esteem and socialization
- Improves cognitive function and Short Term Memory
- Improves Chronic Pain
- Improves Myofascial Pain
- Fibromyalgia
- Myofascial Pain Syndrome
- Type: Low to moderate level aerobic activity
- Frequency: Daily
- Duration: 30 minutes or more of cumulative activity
- May split into three ten minute activities daily
- Mild to moderate intensity
- Metabolic Energy Equivalents: 3-6 mets
- Heart Rate <55% of maximum Heart Rate
- Borg rating of exertion <11
- Caloric expenditure: 150 to 500 kcals per day
- Examples
- See Walking Program
- See practical tips below
- Walk the dog
- Yard work (use a push mower instead of a riding mower)
- Golf without a cart
- Three ten minute fast walks per day
- Walk instead of ride
- Park car at a distance from mall or office
- Take stairs instead of elevator: Up and Down
- Coordinate activities with family and children
- Family biking
- Soccer with kids
- Swim as a family
- Type: Moderate to vigorous aerobic activity
- Frequency: 3-5 times per week
- Duration: >20-30 minutes moderate intensity
- Goal Heart Rate: 60-80% of maximum Heart Rate
- Examples
- Biking (faster than 12 MPH)
- Hiking
- Dance
- Inline Skating
- Eliptical trainer
- Tennis
- Cross Country Skiing
- Soccer
- Running or Jogging
- Swimming or water aerobics
- Brisk walking for 60 minutes per day
- Management: Toning and Stretching
- Frequency: 1-3 times per week
- Stretching
- Yoga
- Tai Chi
- Toning
- Weight lifting
- Tension bands
- Management: Exercise Prescription
- Type of Exercise
- Choose sustainable activities
- Many will not keep up a structured program at the gym
- Social activities (e.g. walk with friends or family) or chores are more often maintained
- Tie Exercise to rewards (e.g. watching a movie on the treadmill)
- Mix-up activities (cross train) by alternating different Exercises (e.g. Swimming, Running)
- Take underlying comorbidity into account
- Examples: Arthritis or Peripheral Vascular Disease
- Avoid high intensity sport that injure Shoulder, knee
- Amount: Duration and Frequency are more important than intensity
- Duration: >30 minutes/day
- Can be divided into 2-3 ten-minute activities/day
- While starting, commit to sustainable duration (e.g. 5 minutes everyday without fail)
- Advance by sustainable increase each week (e.g. 1-2 minutes/day added each week)
- Frequency
- Low to Moderate Aerobic Activity: "Move daily"
- Moderate to vigorous aerobic activity: 5 times per week
- Avoid burn-out by taking 1-2 days off per week
- Intensity
- Start with low to Moderate Aerobic Activity (e.g. fast walking, yard work)
- See Practical tips below
- Start at 55% of maximum Heart Rate and slowly increase over months
- Increase frequency and duration before intensity
- Do not increase intensity more than 10% per week
- Consider more vigorous aerobic activities later (e.g. biking, Inline Skating)
- Example of an optimal program to build towards
- Low to Moderate Aerobic Activity daily for a cummulative total of 30 minutes/day and
- Moderate to vigorous aerobic activity 3-5 days weekly for >20 minutes/day and
- Toning and Stretching 1-3 times per week
- Overall goals (2008 U.S. Physical Activity Guidelines)
- Moderate aerobic Exercise (e.g. swim, bike, garden, walk>3 mph) >150 min/week (ideally >300) OR
- Vigorous aerobic Exercise (e.g. bike >10 mph, jog, hike uphill with pack) >75 min/week (ideally >150)
- Combine with Muscle Strengthening of all major muscle groups at least twice weekly
- US HHS Physical Activity Guidelines for All Americans
- http://health.gov/paguidelines/pdf/paguide.pdf
- Management: Practical Tips
- Exercise while reading or watching Television
- Americans watch television average of 30 hours/week
- Hide the remote control
- Rent movies and watch them only when exercising
- Treadmill most effective indoor Exercise (n=13)
- Highest energy use at maximal exertion
- Compared 6 types of Exercise equipment
- Treadmill
- StairMaster
- Rower
- Exercise bike
- Nordic track
- Air-Dyne (bike with rower)
- References
- Zeni (1996) JAMA 275:1424-7 [PubMed]
- Prevention: Sports related injury
- Stretching does not reduce injuries in healthy athletes
- Herbert (2002) BMJ 325:468-70 [PubMed]
- Warm-ups reduce injury rate by 50%
- Study of 1800 teen athletes in organized sports
- Sample program
- Jogging
- Specific movements (e.g. Cutting, jumping)
- Balance (e.g. wobble boards)
- Strength Exercises (e.g. hamstring, quadriceps)
- References
- Olsen (2005) BMJ 330:449-52 [PubMed]
- Resources
- Anderson (2003) Stretching
- Paid link to Amazon.com (ISBN 0936070226)
- Anderson (2002) Getting in Shape
- Paid link to Amazon.com (ISBN 0936070307)
- References
- Eriksson (1999) Sports Med 27(6):381-91 [PubMed]
- Pescatello (2001) West J Med 174:114-8 [PubMed]
- Ross (2000) Ann Intern Med 133:92-103 [PubMed]