Lecture Topic #10: Physical Activity Recommendations

Four Criteria fro assessing endurance exercise training:

-Frequency, Intensity, Time, Type
Calculating intensity from maximal heart rate
-220-age in years
-Multiple desired intensity by maximal heart rate
-To calculate training heart rate: desired intensity (max-resting) +resting
-Maximal heart rate-resting heart rate=heart rate reserve
1978 ACSM
*78 to 90 sees an increase by 5 minutes,
strength training
1990 ACSM
*90 to 95 sees continuous time go to
accumulation

-Frequency: 3-5 days a week

-Intensity: 50-85, 50-85 HRR, 60-90 HR
-Time:15-60 min cont.
-Type: Large muscle groups, aerobic
-Frequency: 3-5 days a week
-50-85, 50-85 HRR< 60-90 HR
-Time: 20-60 miniutes
-Type: large muscle groups, aerobic and
strength training

1995 ACSM
*95 to 98 sees intensity go down but
flexibility now

-Moderate to hard intensity (brisk walk)

-Most all days of week
-Accumulate >30 minutes

1998 ACSM

-Frequency: 3-5 days/wk

-Intensity: 40-85, 55-90 HR Max
-Time: 20-60 continuous
-Type: large muscle groups, strength, and
flexibility

Lecture Topic #11: Effect of Physical Activity on Cardiovascular Fitness and Mortality
Graph on Frequency/Duration/Intensity/Injury
-Frequency: 5 day saw the biggest change from 44 to 52, Duration: 45 min saw the biggest
change from 45-53, Higher intensity better improvement in VO2 max, As time goes on injury
rate increases
Hickson 1997
-Results: 40 to 55x, not in fact, 44%
-8 sedentary aged 20-42, 10 wks/intense, 6 increase of VO2 max over 10 wks.
days/wk
-Very successful study due to the
-3 days interval (5 mins at 100% max w/
min rest)

-3 days of 30 min. running at high pace

Seals Study
-24 healthy sedentary men and women
-14 exercisers, 10 sedentary
-Studied at baseline
-6 mo/low intensity (40)
-6 mo/high intensity (70)

-LI saw an average of 14, with a range of 140

-LI to HI saw a change in 16, with a range
of 1-39
-Total was 30, with a range of 8-49

Hagberg
-47 sedentary health 70-79
-Control or resistance or endurance
exercise
-6 mo/ exercise training

-16% at 3 mo/22% at 6 mo
-No change in VO2 max in control group
-No significant VO2 max changes or
significant enough

Lee, Paffenbarger, 1995

-17,321 men, PA assessed by quest. In
62,66
-Mortality assessed in 88
-3728 deaths, 22-26 year follow up

-Not statistically significant however

exercising does decrease mortality
-Vigorous activities were associated with
greater longevity
-Only to mortality

Blair 1995
-9777 men
-Avg follow up: 5 years
-223 total deaths, 87 from CVD

-Fit quintles 2-5 from treadmill

-Unfit quintles 1 from treadmill
-Improved to adequate levels oh physical
fitness were less likely to die

Erikseen 1998
-2014 men were followed for 20 yrs
-Change in fitness: 0-100, 1-6

-As you improve fitness, relative risk

decreases
-Even small improvements are assoc. with
a sign. Lower risk of dying

Lecture #12: Effects of Physical Activity on Plasma Lipids Levels

Expectation for Lipid Changes with Physical Activity
-Cholesterol decreases 10 mg/dl
-LDL cholesterol decreases 10 mg/dl
-HDL cholesterol increases 5 mg/dl >12 wks/training
-TG decrease if initially high
Rogers et al study: 7 years exercise
-All levels decrease or got better and LDL and HDL are statistically significant
Effects of low intensity and high intensity
-TC: -6, LDL: -6, HDL: +6, TG:-28
This is from low-high intensity

Lipid changes based on initial HDL-C levels:

-Rich get richer, poor get poorer. If you start off with a better HDL- better improvement
Changes in Lipid with Diet and Diet+Exercise
-Chol: diet
-LDL: diet
-HDL: diet+exercise
-HDL2: diet+exercise, so the best for changes in lipid levels would be diet+exercise
Lecture Topic #13: Effects of Physical Activity on HBP and LVH (Left ventricular hypertrophy)
Effect of PA on Systolic and Diastolic
-76 decrease, 10.6 mmhg, 81 decrease, 8.2 mmhg

Blumenthal 1991
-99 stage 1 men and women
-Assigned to endurance/strength/flex,
control group
-BP measured before and after training

-Endurance training: -8, -6

-Strength/flexibility: -7,-6
-Control group: -9, -5

Hagberg 1989
-60-69 sedentary men and women
-Control group
-Two groups: 50 and 70 VO2 max
-3 and 9 months

-Lower intensity training lowers BP in older

hypertensives the same or more than high
intensity training

Taylor Tolbert 2000

-11 men, avg age of 60, stage 1 or 2
-BP measured for 24 hrs
-Control day
-Exercise day: 3-15 min sessions at 70

-Single bout of exercise can result in lower

BP over 24 hours

Gordon
-Sedentary/overweight with high BP or
hypertension
-Weight loss via diet, exercise training
without weight loss, exercise training
+weight loss
-12 wks, lifestyle intervention

-Exercise only: -9.9, -5.9

-Diet only: -4.3, -7.5
-Exercise +Diet: -12.5, -7.9
*All groups were effected but not significant
*Each significant on their own but not
additive

Dangel, Weight Loss and PA on BP

-9 month interventions
-97 overweight, sedentary >45 yrs

-Control: +5, -3, in regards to S and D

-Diet: -12, -8
-Exercise: -9, -7

-Control, weight loss via diet, aerobic w.out

weight loss, diet +aerobic exercise
-Controlled for sodium intake

-Diet +Exercise: -11, -9

Kokkinos 1995
-Afrian Americans with severe hyper
-Meds taken to lower DBP to <95
-Sedentary control group, aerobic
-16 and 32 wks

-16 wk: decrease by 9 and 5 respectively

-32 wk: decrease by 3 and increase by 2
-LVM in control: 150, 163 exercise
-LVM after 16 wks, control: 149, 143
exercise

Banglivo 1990
-17 male and female, 50 +/- 8 yrs
-Exercise trained for an avg. 16 mo
-Sedentary control group
-Measured BP and heart size

-LVM: exercise group: 139-126 after 16

-LVM: control group: 121-134 16 mo
-With exercise, LVM decreases

Kelennen 1990
-52 men, 18-59
-4 wk placebo screening
-2 wk run-in phase
-10wks: exercise training, 3X per week
-3 groups: placebo, BPmed 1, BPmed2

-Placebo: 123, 128, 135

-BP Med 1: 132, 131, 137
-BP Med 2: 131, 135, 146

BP Reductions with different intensities

<70% VO2 max: 9.5, 7.0
>70% VO2 max: 6.8, 6.8
BP Reductions with different lengths
-Systolic: 9.5, 11, 11
-Diatolic: 7, 9,9
*Bottom line: it happens pretty quickly
Age and BP Reductions
-Systolic: 21-40: 6.7, 41-60: 12.4, 61+: 6.8
-Diastolic: 21-40: 9.9, 41-60: 8.5, 61+: 8.8
Race/ Ethnicity on BP Reductions
-Caucasians: S: 7.3, D: 6.8
-Asian/ Pacific Islanders: S: 11.9, D: 6.6
Weight Loss and BP Changes
-Weight loss can decrease BP
-Exercise can decrease BP
-Weight loss often occurs w/ exercise

**Summary: PA and BP
-Systolic and diastolic: down by 10 mmhg
-75% reduce BP significantly
-Low to moderate training lowers BP as much or more than vigorous
-Weak evidence that middle aged respond best
-Reductions occur early in training and BP decreases slightly with longer training
-Genetics/ethnicity may affect BP
-BP decreases with training in hypertensives African americans
-Effects of weight loss and exercise training are not additive
Results to Kokkino study:
-Regular exercise +meds decreased BP more than meds alone
-Regular exercise +meds decrased LV mass more than meds alone
-Exercise reduces needs for medicine
Lecture Topic #14: Effects of Physical Activity on Obesity
Important Facts:
-1 pound of fat: 3500 kcal
-1 mile= 100 kcal
Three components of Energy Expenditure
-Resting metabolic: function of a persons skeletal muscle mass
-Thermic effect of food: function of the amount of calories ingested
-Energy expenditure from PA: amount of PA and body mass
Effects of Calorie Restriction
-Resting metabolic rate decreases
-Thermic effect of food decreases
-Energy expenditure due to physical activity may decrease
Effects of diet+exercise training on resting metabolic rate
-Exercise would reduce the decline in metabolic rate
-However, decrease in metabolic rate is the same in diet versus diet plus exercise
Effects of diet+exercise on thermic effect of food
-Not really known if thermic effect of food is different between obese and non
-Some evidence that acute may increase thermic effect of food
-Not very much is known about changes in thermic food with exercise
Effects of diet+exercise on physical activity energy expenditure
-If body mass decreases, energy expenditure of any given exercise decreases with weight loss
Effects of diet+exercise on body composition

-Lose both fat and lean body mass with weight loss
-Same weight loss as with diet only

JH Wilmore, 1983
-56 previous studies that assessed weight
and body fat changes with only exercise
-16 wks, 30-60 min, 2-5 sessions/wk

-Avg. weight loss: 2 pounds

-Body fat loss: 1.4%
-Body fat do not melt even if they maintain
a PA program

Dengel (Obesity)
-61 obese sedentary men
-3 groups: control, weight loss via diet
group, weight loss via combined diet and
exercise group
-10 mo intervention

-Control: 0.4 body weight, 0.6 lean mass,

-.2 fat mass
-Exercise/diet: -8.1 body weight, -1.3 lean
mass, 6.7 fat mass
-Diet: -9.3 body weight, -2.1 lean mass,
-6.8 fat mass. Not statistically significant
*Changes with diet and diet plus exercise
are pretty much the same

Wadden
-128 obese women, 41 +/- 9 yrs
-Randomly assigned to weight loss via diet
plus aerobic, via diet plus resistive
exercise, and via diet plus aerobic and
resistive exercise
-48 wk long intervention

-None were statistically significant

-Loss of muscle mass no matter
-No significant differences among
conditions at any time in changes in body
weight or composition

Miller 1997
-Analyzed 493 studies
-Diet, exercise, and diet +exercise
-Avg age: 40 yrs, BMI: 33
-Intervention avg. 16 wks

-Diet and exercise is the most successful,

however diet is still successful

Perri
-48 women aged 40-60 with BMI 27-45
-Home group or exercise group
-3 months for 15 months

-6 months: pretty similar

-After 12 months, home group is 2/3
-15 months, home exercise group had
greater weight loss

Wing and Hill 2001

-Enroll individuals who have maintained a
>30 lb
-Avg 45 yrs, 80% women, 97% Caucasian,
67% married
-Avg. weight loss: 66 pounds

-90% experiences unsuccessful attempts

-1/2 were overweight as obese
-1/2 one parent as obese
-Reported modifying both diet and exerc.
-Women: 2545, men: 3293
-Goal of 1000 kcal/wk

Lecture Topic #15: Effects of Physical Activity on Glucose and Insulin Metabolism
NIDDM Progression
-Normal glucose and insulin at fasting and during OGTT
-Some insulin resistance-normal fasting glucose and insulin, normal OGTT glucose and
increased OGTT insulin
-More insulin resistance, normal fasting glucose, increased fasting insulin, and increased OGTT
glucose and insulin
-More insulin resistance- high fasting and OGTT glucose, now insulin levels start to decrease
-Full blown: high fasting and OGTT glucose, low insulin levels
Seals 1984
-Master athletes: 11 yrs, 33 miles/wk
-Young athletes: 5 yrs, 30 miles/wk
-Young untrained, older untrained, older
untrained lean men

-Regularly performed vigorous exercise can

prevent deterioration of glucose

Holloszy
-21 middle to older aged men
-All cardiac rehab patients
-Screening OGTT-5 had NIDDM, 8 had
impaired, 8 had high normal
-12 mo/exercise training

-Exercise can normalize glucose and

decrease insulin resistance in some
patients
-Lost an avg of 4-5 kg, cant rule out weigt
loss
-Weight loss occurred as a result of
exercise, not dieting

Heath
-6 men, 2 women aged 22-47
-45 min, 5-7 day for 6 mo
-OGTT in AM when training
-No exercise for 10 days, weighed
themselves, no weight gain
-Than 1 bout of exercise

-No changes in glucose

-Insulin levels much higher after 10 days
-1 day of exercise returned levels down to
trained levels

Rogers 1990
-14 master athletes, 62 yrs, trained 38
miles/wk
-OGTT and body comp measured when
they were training regularly
-Remeasured after 10 days of no training
-Weighed daily to ensure they didnt gain
body weight or body fat

-Protect against development of insulin

resistance and decline in glucose tolerance
with aging
-Normalize glucose tolerance by means of
short-term effects of exercise

Rogers
-10 sedentary men, 53+/- of age

-1 day had no effect on glucose/insulin

-7 days resulted in a marked improvement

-7 diabetics, 3 with impaired glucose

-OGTT in AM
-1 bout of exercise with OGTT next AM
-6 more consecutive days with an OGTT
morning after
Brown
-12 obese sedentary hypertensive African
American women
-IVGTT in AM
-7 consecutive days
-IVGTT in AM after last day

-11 of 12 initially insulin resistant- only 6

insulin resistant after 7 days of exercise
-58% avg. increase
-No changes in body wght or body comp.

Seal 1984 Jama

-Healthy sedentary 60-69 men and women
-OGTT at baseline, 6 mo low intensity, 6
mo high intensity

-Older individuals responds to prolonged,

high intensity endurance training with an
increase in sensitivity to insulin

Summary of Effects of Exercise:

-Exercise training reduces body weight
-Benefits of acute exercise evident without changes in body weight or composition
-Exercise training with moderate weight loss can cure NIDDM
Lecture Topic #16: Physical Activity and the Primary Prevention of Diabetes and Hypertension
Helmrich
-Long term follow up of 5990 Univ. Penn
male
-Only included non-diabetics
-Asked by questionnaire if diagnosed as a
diabetic
-202 developed NIDDM
-PA Paffenbarger questionnaire

-Increased PA does prevent NIDDM

-Vigorous activity appears to be more
beneficial
-Protective benefit greatest in those at
highest risk

Manson Jama
-5yr follow up of 21,271 US male
physicians
-Not diabetic initially
-Asked if diagnosed with NIDDM
-285 new cases of NIDDM

-Vigorous physical is required to prevent

-Benefit increases progressively with more
PA
-Benefit greatest in those at highest risk

Manson et al Lancet
-87,253 free of NIDDM and CVD in 1980

-Higher levels of PA protect against

development of NIDDM

-Diagnosis assessed with questionnaire

-PA assessed with the same single
question

-Benefits evident in both high and low risk

individuals

Pan 1997 Da Qing

-520 with impaired glucose
-Followed up every 2 yrs
-Randomized to control, diet, exercise, or
diet +exercise

-Diet and or exercise intervention led to a

significant decrease in diabetes

Tuomilehto
-Age 40-65, BMI>25 with impaired Glu
-Random assigned to control or
intervention

-Lifestyle intervention, increased physical

activity was one component

US Diabetes Primary Prevention Trial

-3234 subject
-Non-diabetics with elevated fasting or
OGTT glucose
-Standard lifestyle with metformin,
intensive lifestyle, or placebo

-Trial stopped early because benefits were

already demonstrated
-Intensive lifestyle demonstrated the
greatest effects

Paffenbarger 1968
-Questionnaire 7685 UPenn male alumni
-671 diagnosed with hyper after 22-31 yrs
-All study outcomes based on persons
status when in college

-No effect of # stairs climbed

-No effect of light sport participation
-Taking part in vigorous sports were 35 less
likely
-Expended less than 2,000, 30% more
likely

Stamler
-201 middle aged men and women
-High risk for developing hyper
-Randomized to nutritional-hygienic
intervention or control
-Followed for 5 yrs
-Main outcome was how many developed
hypertension

-Moderate reduction in risk factors for

hypertension among hypertension-prone
individuals contributes to the primary
prevention of hypertension

Overall Summary: PA and NIDDM Prevention

-Habitual physical activity can reduce a persons risk of developing NIDDM
-May have the greatest benefit in those in highest risk group in men, both high and low risk
groups in women
-Fair amount of exercise and perhaps vigorous exercise is required

Lecture Topic #17 Strength Training and CVD

ACSM 1990
-8-10 exercises of major muscle groups
-2 days/ wk
-Intensity depends on patient history and
progress slowly
Berger 1962
-12 weeks of ST
-1 set: 22.4, 2 sets: 21.8, 3 sets: 25.3
-No studies show 2 sets have a greater
increase
Messier and Dill 1985
-Time to complete 3 sets was 50 mins
-Compared to 20 minutes for 1 set
Frontera 1990
-5% increase in VO2 max after 12 wks in
60-72 old men
Cornelissen and Fagard (2005)
-12 study groups
-8 groups were normotensive
-3 groups were hypertensive
-Moderate resistance training

-Changes in BP appear to be less in the

hypertensive than in the normotensive
group

Delomnico (2005)

-SBP and DBP drecreased about 4mmhg

after training

Kokinos (1988)
-37 healthy men
-10 wks training
-3 groups: control, low rep, and high rep

-No changes were statistically significant

Kokkinos (1991)
-16 men (35-57) with abnormal
-Inactive control group
-20 wks strength
-2 lipid measurements

-None of these changes were statistically

significant

Blumenthal (1991)
-50 healthy middle aged women
-12 wk circuit training

-No changes in any of the lipid

measurements

Smutok 1994
-Abnormal glucose tolerance
-20 wks AT, ST, or no exercise
-OGTT to determine glucose metabolism
changes

-ST lowered levels at 60, 90, 120 mins

-ST improved glucose metabolism
-Results were the same for AT and ST

Prately 1994
-Measured RMR and Body Comp in 13
men 50-65
-16 wks heavy ST

-Body weight did not change

-FFM increased
-RMR increased by 8%

Lemmer 2001

-Whole group increased RMR

-Men increased RMR by 9
-Women showed no significant increase

Single Set Programs

-Similarities in strength gains
-Less time consuming
- Cost efficient
-Improve program compliance
Strength Training and Blood pressure
-Saw a decrease of about 4 mmhg
Strength Training and Plasma Cholesterol Levels
-Mixed results
-Limitations include: lack of control group, studies with subjects with low risk, lack of control for
diet
Strength training and Obesity
-Strength training supplements endurance exercise in calorie burning
-Good for thermic effect of activity
-RMR (Resting Metabolic Rate) decreases with age due to a decline in fat-free mass (FFM)
Lecture Topic #18: Over Benefits of Physical Activity
US Surgeon Generals Report 1996
-Americans can improve their health with moderate amounts of exercise
Summary Statement for Arthritis and Osteoporosis
-Physical activity does help arthritis
-Appears to build greater bone mass in childhood and maintain peak bone mass
Summary Statement Mental Health, Colon Cancer, Rectal Cancer

-Improves your mental health with PA

-PA has a protective effect against risk of colon cancer
-No relationship between Rectal Cancer and PA
Summary Statement Breast Cancer, Prostate Cancer, Testicular Cancer
-PA limited support may protect against later development
-No consistent relationship
-No consistent relationship
FDA Criteria for Approving a New Drug
-What are the benefits of the drug? What is the magnitude of the benefit?
-What are the negative aspects of the drug?
-Risks: musculoskeletal injuries, dehydration, hypoglycemia, anemia, rhabdomyolysis, hazards,
cardiac events
Thune
-25,624 women, followed for 14 yrs
-Leisure time and occupational PA scored
on 4 point
-Breast cancer determined by Norway
-351 new breast cancer cases

-PA is associated with reduced breast

cancer
-OT is assosciated with it also

Dengel
-9 older sedentary, obese, hypertensive
-# CVD risk factors
-9 mo program physical activity and weight
loss

-50% reduction

Rogers
-9 men with CVD
-Plasma lipids measured
-Plasma lipids measured after 1 yr

-Exercise training continued for long

periods
-May result in even greater improvement in
CVD

Dunn 1999
-235 men and women aged 35-60
-Baseline measures
-6 mo intensive intervention followed by 18
mo maintenance intervention

-Lifestyle PA intervention is as effected as a

structured exercise program