benefits/science of exercise - ild collaborative€¦ · (adapted from albert rk, spiro sg, jep jr...
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Benefits/scienceofExercise
KatyBlack,MDNovember3,2016
“Giveabouttwoofthem[hours]everydaytoexercise;forhealthmustnotbesacrificedtolearning.Astrongbodymakesthemindstrong.”
Whatisfitness?
BodyburnsoxygentodoworkBePerfitness=morework=moreoxygenused1.Pulmonarygasexchange(loadingbloodwithoxygen2.Cardiovascularperformance(deliveringbloodtobody)3.Skeletalmusclemetabolism(extracXngoxygen)
Peakexercisecapacityisdefinedas“themaximumabilityofthecardiovascularsystemtodeliveroxygentoexercisingskeletalmuscleandoftheexercisingmuscletoextractoxygenfromtheblood”.
Howdowemeasurefitness?
OxygenconsumpXon(VO2)=cardiacoutput*oxygenuse(arterial-venous
oxygencontent)
• VO2(mL/kg/min) = (SV×HR)×(CaO2−CvO2)
• VO2max = (SVmax×HRmax)×(CaO2max−CvO2max)
CardiopulmonaryexercisetesXng
• Evaluatemaximumexercisepossible=maximumexerciseconsumpXon(VO2max)
• IfVO2maxislow,determinewhetherheart/lungs/musclesareculprit
hPp://www.workwellfoundaXon.org/tesXng-for-disability/
Whathappenstobreathingduringexercise?
Exerciseandbreathing
• Faster,deeperbreaths– peakvenXlaXonincreases– Resistancetoflowstayslow– SmallerlungsatpeakexhalaXon;easiertotakenextbreath– Peakinspiratorymusclesonlyabouthalfmaxstrength
• Increasedbloodflowtolungs– Noincreaseincapacityforbloodflowwithexercise– Morebloodperheartbeatcompensatesforfasterheartrate
– IncreasedoxygendemandwithbePerfitness;mayoutstripcapacityforgasexchange(diffusingcapacity)
IncreasedresprateandXdalvolumewithexercise
hPps://www.umc.edu/EducaXon/Schools/Medicine/Basic_Science/Physiology_and_Biophysics/Core_FaciliXes%28Physiology%29/Physical_Exercise_-_VenXlaXon.aspx
Exerciseandbreathing:problems
• Fasterdeeperbreaths– Noimprovementinmusclestrengthorresistancewithexercise
– Resistancetoflowincreasesinolderlungs-hardertoexhale
– LungarehyperinflatedatexhalaXon• hardertotakenextbreath
– Peakinspiratorymusclesreachthelimitsofstrength• Increasedbloodflowtolungs
– Noincreaseincapacityforbloodflowwithexercise– Limitedcapacityforgasexchange(diffusingcapacity)– Problemforpulmonaryfibrosis
Limitsonairflow
Younghealthy Olderathlete
Reservevolumeatrest Reservevolume
inexercise
Dempsey,Johnson,Saupe,Chest,97(3Suppl.)(1990),pp.81S–87S
ReserveatrestReservevolumeinexercise
Howdoesobesityeffectbreathing?
Limitsonbreathingmuscleswithage
Younghealthyathlete Olderhealthyathlete
MaxexhalaXon
MaxinhalaXon
MaxexhalaXon
MaxinhalaXon
J.A.Dempsey,B.D.Johnson,K.W.SaupeAdapta@onsandlimita@onsinthepulmonarysystemduringexerciseChest,97(3Suppl.)(1990),pp.81S–87S
Obesitydecreaseslungvolumes
hPp://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/pulmonary-funcXon-tesXng/(AdaptedfromAlbertRK,SpiroSG,JePJR(eds):ComprehensiveRespiratoryMedicine.StLouis:Mosby,1999,p43.)
Obesitylowerslungvolumes
Vitalcapacity Totallungcapacity
BodyMassIndex BodyMassIndex
20 25304050
extremelyobeseobese
Riccardo Pellegrino et al. J Appl Physiol 2014;116:1175-1181
Obesityandbreathing
• Increasedchestwallweight=lowerlungvolumes
• OxygenconsumpXonbyrespiratorymusclesesXmated4xhigherthannonobese
• WorkofbreathingesXmated70%more
• Shipsmoreairtotopoflungs– Mismatchbetweenairandbloodflow
– Canloweroxygen
Somethingsdoimprovewithexercise
• Exercisehelpstheheart• Exercisehelpsthemuscles
• Exercisehelpsthemind(wethink)
All-cause mortality by fitness groups
Annals of Epidemiology, Volume 19, Issue 4, 2009, 253–256
2603 adults 60+ years of age.
HazardRaXofordeathduringfollowup
ExerciseimprovesheartfuncXon
Stephan Gielen et al. Circulation. 2010;122:1221-1238
DatafromTheLancet,November1953
ExerciseprotectsagainstheartaPacks:possiblemechanismsfromratstudies
Shannon L. Lennon et al. J Appl Physiol 2004;96:1299-1305
HeartmuscleacXvityassessedaperischemiainrats
HeartanXoxidantlevelsandprotecXveprotein“heatshockprotein72”alsoroseaper8daysofexercise
Bedrestleadstolossofheartmass
Todd A. Dorfman et al. J Appl Physiol 2007;103:8-16
HeaddownXltbedrestmimicsweightlessness:extremeofsedentarylifestyle
Exercisepreventedbedrest-inducedheartmassloss
Todd A. Dorfman et al. J Appl Physiol 2007;103:8-16
HeaddownXltmimicsweightlessness.ExerciseincreasedheartmassmorethannutriXonalsupplement
Exercisecanhelpreverseheartchangesseeninheartfailure
Stephan Gielen et al. Circulation. 2010;122:1221-1238
Exerciseincreasesbloodsupplytomuscles
Stephan Gielen et al. Circulation. 2010;122:1221-1238
ExerciseincreasesenergyproducXonofmuscles
• Mitochondriaprovideenergytocells
– UseoxygentomakeATP• Exerciseincreasesnumberandsizeofmusclemitochondria
• Manypossiblemechanisms
Doesexercisehelpeveryone?
Exerciseimprovesfitnessinheartfailure
Systolicheartfailure(n=25-1) diastolicheartfailure(n=26-8)
Smart et al. American Heart Journal, Volume 153, Issue 4, 2007, 530–536
Improvedqualityoflife–specificallyphysicalandfuncXonalQOL
51shortofbreathpaXentswithheartfailure;16weeksofexercisebike,thenbike+resistanceexercises
VO2max
Hearttransplant:VO2oflessthan14mL/kg/minute
ExerciseimprovedwalkdistanceILD57subjectswithILD(34IPF);8weeks
Improved6MWDNochangeinVO2max
35m=114feet
hPp://m.mlb.com/glossary/rules/field-dimensions
meanincrease35m(25minIPF,43nonIPF)
RespiraXon.2014;88(5):378-88
ExerciseimprovedQOLinILDHealth related quality of life
Chronic Respiratory Disease Questionnaire.
A E Holland et al. Thorax 2008;63:549-554
PosiXveeffectsofexercise
Stephan Gielen et al. Circulation. 2010;122:1221-1238
SXllhardtoexercise
hPps://www.blf.org.uk/support-for-you/exercise/why-is-it-important
HowtomoXvate?
Strategiesforsuccess:moXvaXonandvoliXon
• MoXvaXon:“Threatandcopingappraisal”– DoIreallyfeelworriedaboutdecondiXoning?– DoIreallybelieveexercisewillhelpme?
• VoliXon:“goalsexng,acXonplanningandcopingplanning– “GoodintenXons”vs.“implementaXonintenXons”
GollwitzerJournalofPersonalityandSocialPsychology1997,Vol.73.No.1,186-199FrenchDP1,StevensonA,MichieS.PsycholHealthMed.2012;17(2):127-35..2011Jul11.
MoXvaXon+voliXon
• MoXvaXon:readpamphlet– Toldthatheartdiseasebeginnsearlyinlife,canbepreventedby20minutesofvigorousexerciseweekly
• VoliXon:madeexerciseplan– DuringnextweekIwillpartakeinatleast20minutesofvigorousexerciseon(dayordays)_______________at_______________(Xmeofday)at/orin(place)_______________.
MilneetalBri,shJournalHealthPsychologyVolume7,Issue2May2002163–184
Results
Control MoXvaXonatXme1 QuesXonnaireXme2
MoXvatedatXme1GoalsexngXme2
Setspecificgoals,usingIf…then
• Ifit’sMonday,Wednesday,orFriday,I’llgoforatwentyminutewalkat3:30pm
• IfI’matthegrocerystore,I’llbuyapplesnotcookies.
Bereadyforobstacles
• IfitrainsonMonday,thenI’llwalkatthemall• IfImissawalkonMonday,thenI’llwalkTuesday
• IfIbuycookies,thenIwillclosethebagandbringthemtoworktogiveaway
GollwitzerJuly1999•AmericanPsychologist
StrengthenvoliXon
Lossaversion– Arrangetolosemoneyifyoudon’tmeetyourgoals
• hPp://www.gym-pact.com/
Accountability– Promisegroupyou’llbethere
Somereferences• PostgradMedJ.2007
Nov;83(985):675–682.• doi:
10.1136/hrt.2007.121558
• PMCID:PMC2734442
• Cardiopulmonaryexercisetes@nganditsapplica@on
• KAlbouaini,MEgred,andAAlahmar,DJWright
• hPp://www.nature.com/scitable/topicpage/mitochondria-14053590
• J.A.Dempsey,B.D.Johnson,K.W.Saupe
• Adapta@onsandlimita@onsinthepulmonarysystemduringexercise
• Chest,97(3Suppl.)(1990),pp.81S–87S
Referencescont
• JExercRehabil.2015Apr30;11(2):74-9.doi:10.12965/jer.150190.eCollecXon2015.
• Pulmonaryrehabilita@onandexerciseinpulmonaryarterialhypertension:Anunderu@lizedinterven@on.
• SahniS1,CapozziB2,IpikharA1,SgourasV3,OjrzanowskiM4,TalwarA5.
• JExercRehabil.2015Apr;11(2):74–79.
• RespiraXon.2014;88(5):378-88.doi:10.1159/000367899.Epub2014Oct23.
• Exercisetraining-basedpulmonaryrehabilita@onprogramisclinicallybeneficialforidiopathicpulmonaryfibrosis.
• VainshelboimB1,OliveiraJ,YehoshuaL,WeissI,FoxBD,FruchterO,KramerMR.
Improvingourhabits
THEFRAMEWORK:• Iden@fytherou@ne• Experimentwithrewards
• Isolatethecue• Haveaplan
hPp://charlesduhigg.com/how-habits-work/
Improvingourhabits
THEFRAMEWORK:• Iden@fytherou@ne:watchingTVat3pminsteadofexercising
• Experimentwithrewards:Canwatchcabletvatgym
• Isolatethecue:at3pmshowcomeson
• Haveaplan:setalarmfor2:45
hPp://charlesduhigg.com/how-habits-work/