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The Importance of Exercise

Dr Reed A Berger

Human beings have evolved with movement as a necessity for survival


e.g. to obtain food, to escape predators
thus, numerous systems in the body are sensitive to movement.

Today, why do people exercise?

Athletic/Artistic Performance

Physical appearance

How can we increase exercise for health reasons?


education - require PE for schools?
support - physicians, family
research

Health

Benefits of Exercise
Increased

strength and muscular


endurance
Increased BMDosteoporosis
Agingdecreased falls, increased
independence, increased ADL
Increased BMRLBM
Appearance, self esteem

Technologyfewer

demands placed on
musculoskeletal and CV systems
2-3 generations agomanual labor
Stairs, elevators, cars
Recreationplaying ball, jumping, hide-nseek vs. video games, internet
Convenience and fast foods

Automationdecreased

muscular

demands
Body adaptsincreased fast, weaker
Scheduled exercise used to not be
needed with manual labor
Today, have to give back the leisure time
gained thru technology and purposely
stress the muscular system

I. Basics of Exercise Physiology


Exercise is a complex molecular, cellular and systemic
physiological stimulus
With every single bout of exercise, skeletal muscles, heart, brain, vascular
tissue, bone, liver, etc. experience some form of environmental stress.
The type and magnitude of an adaptation or response to exercise thus
results from a sum total of all these contributing factors.
Some examples include:
- mechanical, stress/strain
- temperature
- pH
- redox state
- free radical production
- hormones/growth factors
- calcium

Specificity of Exercise: Adaptations that occur in response to


training are specific to the nature of the training stimulus
Cardiovascular fitness: requires that the person
train in a manner that challenges heart rate, cardiac
output, capillarity with the underlying change being
improved oxygen delivery to working tissues
Muscular strength: requires that the person train in a manner
that challenges the recruitment and force output of specific
muscle groups with the underlying change being increased
muscle mass.
The corollary to this is that training for endurance will not
augment strength or vice versa.

Cardiovascular fitness - endurance type activities: fuel challenging


large muscle mass
repetitive
lower intensity
walking, running, swimming, cycling

Muscular strength: high resistance, high force output


focus on muscle groups not on systemic exercise
e.g. knee extensors vs. flexors
Can a type of exercise be both strength and endurance?
yes BUT the effectiveness of any one form of activity to elicit
a specific adaptation is dependent on the endurance/strength starting
state of the individual.

Basic Principles of Exercise Training


Frequency - how often is the exercise performed
each week? For cardiovascular training effects
3-4x per week is suggested
Intensity - the exercise must be performed at a level that
challenges the cell/tissue/system for adaptations to occur.
Totally dependent on starting state. Lower the starting fitness
level the lower the starting intensity. Must build to continue
adaptations. Most important variable in training regimen for most.
Duration - length of each training session. For cardiovascular
Adaptations it is suggested to start at 30 minutes/session
MORE IS NOT NECESSARILY BETTER!
overtraining/system failure

Known adaptations to endurance exercise


Skeletal Muscle
mitochondria
capillary density
oxidative enzymes

Brain (very new studies)


neurogenesis
protection from seizures, injury

Heart
heart volume
max stroke volume
max cardiac output
resting heart rate
blood pressure
Bone
density? Type of exercise

What is Maximum Oxygen Uptake?


VO2 Max
Maximal amount of oxygen consumption per minute
The more muscle used the higher the oxygen use
Predictor of performance?
Correlates with changes in cardiac output
Training will result in an increase
cardiac indices (CO, SV)
skeletal muscle contribution (mito)
ventilatory contribution?

Known adaptations to resistance exercise

Brain/Neural
improved recruitment

Skeletal Muscle
Fiber size
Mitochondria?
Bone
density

Role of exercise in weight and/or body fat control


Calories in vs. Calories out
Exercise can increase caloric expenditure
Exercise can spare loss of lean body mass during
times of caloric deficit
Increases in lean body mass will increase basal metabolic rate
BUT . 10lbs of lean body mass will lead to about 70-80kcal/day
ALL forms of exercise will burn fat, even at Max VO2
Amount of fat burned during exercise is NOT important.
Total calories used during exercise IS important

For patients/clients, pick an exercise/activity modality that


they will do and do regularly. Type of exercise less important

Exercise prescription
To treat

various diseases
Primary preventionPE class
Clinicallydiscuss exercise
Workcorporate wellness
End of college, athletic endeavorsneed
to have scheduled exercise
60 min daily

Aerobic

and resistance
Convenient
Traveling
Pedometer
Minutes per day
Intensity, duration, frequency (need to
vary)

Routine exercise
Improves

tissue oxygen uptake

HDL
LDL
TG
BP
Glycemic

control

Decreased risk of CA
Endometrial
Breast
Colon
prostate

Cognitive benefits
Better

adjusted
Cognitive tests
Decreased CV response to stress
Anxiety
Depression
People who were active and became inactive
were 1.5x more likely to become depressed
CAD and depression

Cognitive contd
Improves

self confidence
Self esteem
Decrease CV and neurohormonal
response to stress
Short bouts of exercisecognitive
improvement

compliance
Long

term adherence to exercise


Decrease with age, minorities, females,
disabled, chronic dz
Exercise program50% cont for >6 mo

Types of exercise
Occupational,

recreational, sports

Aerobic
Anaerobicsprint
Isometricwts

Resistance training
Resistance

to contracting muscles to
stimulate them for increased strength
Injury riskdecreased
Lean tissue and aging
Heart conditionsdont strain or hold
breath

How to make exercise a lifetime


activity
Pick

activity that is enjoyable and uses


most muscles
Vary duration, intensity
Group classes
Music
Walk the dog!
Set goalshealth, appearance,
cholesterol

Elderly
Joint

flexibility
Muscle strength
LBM
Balance
Prevention of injury

Pulmonary dz
Low

workloads, short duration


Frequent intervals
Supplemental O2

Maternity
Maternal
Increased

CV fxn
Decreased wt gain and fluid
Mental state
Labor
Recovery
fitness

maternity
Fetus
Decreased

fat
Improved stress
Neurobehavioral maturation

osteoporosis
BMD
Musclebalance,

falls, fracture
Works with estrogen, diet
Wt bearing

CAD
Primary

and secondary prevention


Increased CV functional capacity and
decreased myocardial O2 demand
Lipids, DM, obesity
BP8-10 mmHg
Inactivity is independent risk factor for
CAD
Sedentary have greatest CVD mortality

III. Application for Health Care


Obesity
Type II Diabetes

- Obesity is reaching "epidemic proportions in the United


States
- could soon cause as much preventable disease and death as
cigarette smoking.

For the vast majority of individuals, overweight and obesity


result from excess calorie consumption and/or inadequate physical activity.
Unhealthy dietary habits and sedentary behavior together account
for approximately 300,000 deaths every year.

Exercise and Type II Diabetes


Position statement ACSM

About 10.3 million diagnosed cases and about 5.4 million undiagnosed
Accounts for 90-95% of all cases of diabetes
Characterized by insulin resistance and moderate insulin deficiency

Skeletal muscle: site of about 80-90% of glucose uptake


insulin and contraction act INDEPENDENTLY to increase
GLUT4 translocation and glucose uptake.
Ideal target for exercise and/or pharmacological therapies

Acute Effects of Physical Activity


Glucose Levels
Most obese Type II diabetics experience decreases in blood
glucose following mild-moderate exercise
magnitude of effect is dependent on duration and intensity
blood glucose increases with short term high intensity exercise

Insulin resistance
Insulin resistant individuals have 35-40% reduction in
insulin mediated glucose uptake
Low to moderate intensity exercise improves insulin sensitivity
High intensity exercise variable response
Transient effect (about 72 hrs) so requires regular activity
not really the trained state

Physiological Benefits of Exercise for those with Type II Diabetes

Lower resting heart rate


Lower submaximal exercise heart rate
Increased stroke volume
Increased cardiac output
Enhanced oxygen extraction
Lower resting BP
Lower exercise BP
Influence lipid profile

Psychological Benefits of Exercise

Reduced stress response to psychosocial stimuli


Lessened sympathetic nervous system activation to cognitive stress
Reductions in depression
Improved self-esteem
Reduction in emotional perturbations to stress

Contribute to sustained behavioral changes and adherence

Exercise and Chronic Diseases


Booth et al., 2000

Cardiovascular Disease
Type II Diabetes
Obesity
Obesity related diseases
Aging
While all these diseases have some contribution from
genetic the rapid increases in the last 20+ years are
due to environmental factors.
Sedentary living is responsible for about 34% of deaths due to
coronary heart disease, colon cancer and Type II diabetes
CDC has concluded that physical inactivity is one of the major
underlying causes of premature mortality in the US

Take home message


1. Consider exercise/physical activity for both
disease prevention as well as treatment
2. When considering exercise think movement
or activity not athletic performance
3. Consider the importance of exercise
for children. Growing evidence for mental as well as
physical development. Educate for healthy lifestyle
Good resource for exercise and health information
American College of Sports Medicine www.acsm.org