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EXERCISE MEDICINE
Daniel Roth, DO, MBA, MS
Thomas Straub, PA-C, MS, CSCS
What is Exercise Medicine?
The practice of prescribing an exercise program that is designed to meet the specific needs of each patient.
A prescription for exercise for every patient, every visit, every time.
www.exerciseismedicine.org
Exercise MedicineThe guiding principles of Exercise Medicine are as follows: Exercise and physical activity are important to health
and the prevention and treatment of many chronic diseases
More should be done to address physical activity and exercise in healthcare settings
ACSM and AMA are making efforts to bring a greater focus on physical activity and exercise in healthcare settings
www.exerciseismedicine.org
America’s Obesity Epidemic
CDC - 2010
Obesity is Common
• 69.2% of adults age 20 years and over are overweight (includes obesity)
• 35.9% of adults age 20 years and over are obese
• 18.4% of adolescents age 12-19 years are obese
• 18.0% of children age 6-11 years are obese
CDC (2009-2010)
Obesity has Consequences
Obesity is linked to more than 60 chronic diseases.
According to the American Cancer Society, 572,000 Americans die of cancer each year, about 33% of these cancer deaths are linked to excess body weight, poor nutrition and/or physical inactivity.
Over 75% of hypertension cases are directly linked to obesity.
Approximately 66% of U.S. adults with type 2 diabetes are overweight or obese. http://www.obesitycampaign.org/obesity_facts.asp
Obesity has Consequences
66% of adults with arthritis are overweight or obese compared to 15.9% who are under/normal weight.
Arthritis is the #1 cause of disability among U.S. adults and has been for the past 15 years.
http://www.cdc.gov
Obesity is Costly Full-time workers in the U.S. who are
overweight or obese miss an estimated 450 million additional days of work each year compared with healthy workers resulting in an estimated cost of more than $153 billion in lost productivity annually.
Medical expenses for obese employees are 42% higher than a person with a healthy weight.
The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008.
http://www.obesitycampaign.org/obesity_facts.asp
Number of Persons with Diabetes in the US
http://www.cdc.gov/diabetes/statistics/prev/national/figpersons.htm
Cost of Diabetes to the US Economy
Diabetes is highly associated with complications such as stroke, MI, limb loss, retinopathy, nephropathy, and neuropathy.
The total estimated cost of diagnosed diabetes in 2012 is $245 billion, including $176 billion in direct medical costs and $69 billion in reduced productivity.
http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html
How to Prescribe Exercise
Four primary variables to consider:
Mode Frequency Intensity Duration
Divisions of Exercise
Two primary divisions of exercise:
Cardiovascular Training (Aerobic) – Walking, Jogging, Swimming, Biking, X-Country Skiing, Etc.
Resistance Training (Anaerobic) – Body Weight Exercises, Free Weights, Machines, Resistance Bands, Etc.
Benefits of Cardiovascular Training Improved cardiac output Improved blood pressure Improved functional capacity Weight loss Increased lean muscle mass Decreased blood sugar levels Decreased rates of depression Decreased rates of OA Improved body image
How to Determine Cardiovascular Intensity
Karvonen formula to determine target HR:
Max HR = 220-Age (+/- 10 bpm)
Target HR = Max HR x 50-85%
How to Determine Cardiovascular Intensity
Target HR = Max HR x 50-85%
Example: 30 year old runner
Target HR = 220-30 = 190 x 75% = 143 bpm
Example: 60 year old S/P MI
Target HR = 220-60 = 160 x 55% = 88 bpm
How to Prescribe Cardiovascular Exercise
Cardiovascular Training Guidelines:
For Overall Cardiovascular Health:• At least 30 minutes of moderate-intensity aerobic activity at
least 5 days per week for a total of 150 minutes
OR
• At least 25 minutes of vigorous aerobic activity at least 3 days per week for a total of 75 minutes; or a combination of moderate- and vigorous-intensity aerobic activity
• For Lowering Blood Pressure and CholesterolAn average 40 minutes of moderate- to vigorous-intensity aerobic activity 3 or 4 times per week
www.heart.org
Benefits of Resistance Training Increased muscle/tendon strength Increased functional capacity Increased lean muscle mass Increased metabolic rate Increased cardiac output Increased bone density Increased balance Decreased blood sugar levels Decreased rates of depression Improved body image
Resistance Training Programs Resistance Training:
Phase 1: Anatomical Adaptation Phase (8 weeks)
Goal: Tendon strength/general conditioning
Mode: perform 6-8 exercises (compound exercises)
Intensity: 55-60% of 1 rep max.
Duration: 3 sets x 15 reps/set
Rest: 1-2 minutes between sets
Frequency: 3-5 days/week
Resistance Training Programs Resistance Training:
Phase 2: Muscle Hypertrophy Phase (8-12 weeks)
Goal: Muscle Hypertrophy/Strength
Mode: perform 6-8 exercises
Intensity: 70-80% of 1 rep max.
Duration: 3 sets x 8-12 reps/set
Rest: 2-3 minutes between sets
Frequency: 3-5 days/week
Resistance Training Programs Resistance Training:
Phase 3: Strength Phase (8 weeks)
Goal: Strength
Mode: perform 6 exercises
Intensity: 85+% of 1 rep max.
Duration: 3 sets x 4-6 reps/set
Rest: 5 minutes between sets
Frequency: 3-4 days/week
Putting it All Together
For optimal results and additional health benefits, a combination of cardiovascular and resistance training should be prescribed.
All programs should consider exercise goals, current fitness levels, and total estimated time for exercise.
Avoid excessive exercise demands, overtraining, and burnout.
Putting it All Together
As a general rule limit total exercise time to 60-75 minutes.
A combination of cardiovascular and resistance training typically is optimal for each workout.
Cardiovascular training is usually performed prior to resistance training.
Always start at low intensities. “Use pain as your guide”