Exercise

See Also

Epidemiology

Majority of United States is physically inactive
1. American adults
  1. Completely sedentary: 25%
  2. Activity <30 minutes/day: 60%
2. Americans age 12 to 21
  1. No recent Exercise: 14%
  2. Not vigorously active: 50%
3. Americans over age 65 years
  1. Sedentary: 75%
References
1. (1996) USDHHS Surgeon General Report on Activity [PubMed]
2. Jones (1998) Arch Fam Med 7:285-9 [PubMed]

Efficacy
Benefits of Aerobic Exercise

Reduces Cardiovascular Risks
1. Coronary Artery Disease twice as likely in sedentary
2. Improves Lipid profile
  1. Increases High Density Lipoprotein (HDL)
  2. Decreases Low Density Lipoprotein (LDL)
  3. Decreases Total Cholesterol
  4. Decreases Triglycerides
  5. Improves VLDL Cholesterol
3. Enhances Fibrinolysis and alters Platelet function
4. Lowers Blood Pressure
  1. Decreases Systolic Blood Pressure
  2. Decreases Diastolic Blood Pressure
5. Significantly lowers mortality in older men with CHD
  1. Required only light activity (walking, gardening)
  2. Wannamethee (2000) Circulation 102:1358-63 [PubMed]
Benefits Diabetes Mellitus
1. See Exercise in Diabetes Mellitus
2. Improves Glucose Tolerance and Insulin Sensitivity
  1. Improves for 16 hours after each Exercise session
3. Significantly decreases Disability and improves mobility in obese patients with Diabetes Mellitus
  1. Rejeski (2012) N Engl J Med 366(13): 1209-17 [PubMed]
Reduces Mortality in Postmenopausal Women
1. Studied 42,000 women ages 55 to 69 years over 7 years
  1. Moderate Physical Activity (golf or long walks)
    1. Exercise once weekly: Mortality reduced 23%
    2. Exercise 2-4 times weekly: Mortality reduced 30%
    3. Exercise >4 times weekly: Mortality reduced 38%
  2. Vigorous Physical Activity: Mortality Reduced 43%
2. References
  1. Kushi (1997) JAMA 277:1287-92 [PubMed]
Benefits Mental Health
1. Decreases Major Depression in chronic illness (patients with most significant depression have the greatest benefit)
  1. Herring (2012) Arch Intern Med172(2): 101-111 [PubMed]
Reduces Cancer risk
1. Colon Cancer and Prostate Cancer reduced
2. Breast Cancer risk reduced
  1. Study 25,624 Norwegian women ages 35-49 in 14 years
  2. Breast Cancer reduced 37% if 5-7 days Exercise/week
  3. Thune (1997) 336:1269-75 [PubMed]
Osteoporosis benefits
1. Decreases postmenopausal Bone Mineral Density loss
2. Decreases hip and Vertebral fracture Incidence
Other Benefits
1. Reduces Obesity
2. Improves immune function
3. Improves Anxiety and Major Depression
4. Improves Insomnia
5. Improves self-esteem and socialization
6. Improves cognitive function and Short Term Memory
7. Improves Chronic Pain
8. Improves Myofascial Pain
  1. Fibromyalgia
  2. Myofascial Pain Syndrome

Type
Low to moderate level aerobic activity

Frequency: Daily
Duration: 30 minutes or more of cumulative activity
1. May split into three ten minute activities daily
Mild to moderate intensity
1. Metabolic Energy Equivalents: 3-6 mets
2. Heart Rate <55% of maximum Heart Rate
3. Borg rating of exertion <11
4. Caloric expenditure: 150 to 500 kcals per day
Examples
1. See Walking Program
2. See practical tips below
3. Walk the dog
4. Yard work (use a push mower instead of a riding mower)
5. Golf without a cart
6. Three ten minute fast walks per day
7. Walk instead of ride
8. Park car at a distance from mall or office
9. Take stairs instead of elevator: Up and Down
10. Coordinate activities with family and children
  1. Family biking
  2. Soccer with kids
  3. Swim as a family

Type
Moderate to vigorous aerobic activity

Duration: >20-30 minutes moderate intensity (150 minutes per week)
Goal Heart Rate: 60-80% of maximum Heart Rate
Frequency: 3-5 times per week
1. Clustered activity/week (e.g. weekend warrior) is a reasonable alternative with similar cardiovascular and mortality benefits
2. O'Donovan (2017) JAMA Intern Med 177(3):335-42 +PMID: 28097313 [PubMed]
Examples
1. Biking (faster than 12 MPH)
2. Hiking
3. Dance
4. Inline Skating
5. Eliptical trainer
6. Tennis
7. Cross Country Skiing
8. Soccer
9. Running or Jogging
10. Swimming or water aerobics
11. Brisk walking for 60 minutes per day

Management
Toning and Stretching

Frequency: 1-3 times per week
Stretching
1. Yoga
2. Tai Chi
Toning
1. Weight lifting
2. Tension bands

Management
Exercise Prescription

Type of Exercise
1. Choose sustainable activities
  1. Many will not keep up a structured program at the gym
  2. Social activities (e.g. walk with friends or family) or chores are more often maintained
  3. Tie Exercise to rewards (e.g. watching a movie on the treadmill)
  4. Mix-up activities (cross train) by alternating different Exercises (e.g. Swimming, Running)
2. Take underlying comorbidity into account
  1. Examples: Arthritis or Peripheral Vascular Disease
  2. Avoid high intensity sport that injure Shoulder, knee
Amount: Duration and Frequency are more important than intensity
1. Duration: >30 minutes/day
  1. Can be divided into 2-3 ten-minute activities/day
  2. While starting, commit to sustainable duration (e.g. 5 minutes everyday without fail)
    1. Advance by sustainable increase each week (e.g. 1-2 minutes/day added each week)
2. Frequency
  1. Low to Moderate Aerobic Activity: "Move daily"
  2. Moderate to vigorous aerobic activity: 5 times per week
    1. Avoid burn-out by taking 1-2 days off per week
Intensity
1. Start with low to Moderate Aerobic Activity (e.g. fast walking, yard work)
  1. See Practical tips below
  2. Start at 55% of maximum Heart Rate and slowly increase over months
2. Increase frequency and duration before intensity
  1. Do not increase intensity more than 10% per week
  2. Consider more vigorous aerobic activities later (e.g. biking, Inline Skating)
Example of an optimal program to build towards
1. Low to Moderate Aerobic Activity daily for a cummulative total of 30 minutes/day and
2. Moderate to vigorous aerobic activity 3-5 days weekly for >20 minutes/day and
3. Toning and Stretching 1-3 times per week
Overall goals (2008 U.S. Physical Activity Guidelines)
1. Moderate aerobic Exercise (e.g. swim, bike, garden, walk>3 mph) >150 min/week (ideally >300) OR
  1. Vigorous aerobic Exercise (e.g. bike >10 mph, jog, hike uphill with pack) >75 min/week (ideally >150)
2. Combine with Muscle Strengthening of all major Muscle groups at least twice weekly
3. US HHS Physical Activity Guidelines for All Americans
  1. http://health.gov/paguidelines/pdf/paguide.pdf

Management
Practical Tips

Exercise while reading or watching Television
1. Americans watch television average of 30 hours/week
2. Hide the remote control
3. Rent movies and watch them only when exercising
Treadmill most effective indoor Exercise (n=13)
1. Highest energy use at maximal exertion
2. Compared 6 types of Exercise equipment
  1. Treadmill
  2. StairMaster
  3. Rower
  4. Exercise bike
  5. Nordic track
  6. Air-Dyne (bike with rower)
3. References
  1. Zeni (1996) JAMA 275:1424-7 [PubMed]

Prevention
Sports related injury

Stretching does not reduce injuries in healthy athletes
1. Herbert (2002) BMJ 325:468-70 [PubMed]
Warm-ups reduce injury rate by 50%
1. Study of 1800 teen athletes in organized sports
2. Sample program
  1. Jogging
  2. Specific movements (e.g. Cutting, jumping)
  3. Balance (e.g. wobble boards)
  4. Strength Exercises (e.g. hamstring, quadriceps)
3. References
  1. Olsen (2005) BMJ 330:449-52 [PubMed]

Resources

Anderson (2003) Stretching
1. Paid link to Amazon.com (ISBN 0936070226)
Anderson (2002) Getting in Shape
1. Paid link to Amazon.com (ISBN 0936070307)

References