exercise is medicine: how a medical fitness center differs from a health club
DESCRIPTION
During his presentation on 2/25/14, Eldon Jones, director of health & fitness at Mercy Medical Center in Canton, Ohio, explains how exercise often is as effective as medication in treating certain chronic serious health conditions, including heart disease, diabetes and more. Eldon also covered how a medical fitness center differs from a tradition gym or health club. Other topics covered in the presentaton: * The importance of prescribing exercise * US Physical Activity Guidelines * Cardiac rehabilitation and how it works * Components of ExRx for risk factor reduction * FITT principle * Stages of conditioning * Strength trainingTRANSCRIPT
Exercise is MedicineAre you getting the right dose?
Exercise is Medicine
“If we had a pill that contained all the benefits of exercise, it would be the most widely prescribed drug in the world”….. Ronald M. Davis, M.D. President AMA
Coronary Heart Disease•Affects > 82,000 Americans
•1 in 3 adults have 1 or more CHD risk factors
•1 person dies every 39 seconds from CHD
•CHD kills more women than the next 14 causes of death combined
•Estimated 250,000 premature deaths in U.S. annually directly attributable to physical inactivity
•Source: AHA update 2012
Risk Factor 45-64 yearsHazard Ratio (95% CI)
Smoking 1.56 (1.23-1.99)
Physical Inactivity 1.40 (1.05-1.87)
BMI ≥30.0 1.35 (0.96-1.89)
High BP 1.35 (1.06-1.73)
High Cholesterol 1.14 (0.89-1.44)
Diabetes 3.25 (2.04-5.19)
Valiyeva E et al. Arch Int Med 2006; 166:985
Lifestyle-related Risk Factors and Risk of Future Nursing Home Admissions; 6462 Adults
Cooper Clinic Study 201241,000 men monitored for average of 17 yrs
Study found high degrees of fitness substantially reduced risk of death from CHD regardless of LDL level
Conclusion included persons with LDL of <100 and poor fitness had higher risk for death than LDL > 190 and high level of aerobic fitness
Exercise ResearchDirect relation between inactivity and cardiovascular
mortality. Inactivity is an independent risk factor for of CAD.
Exercise capacity is a more powerful predictor of mortality among men than other established risk factors for CAD.
Physical fitness has been clearly associated with improvements in lipid profiles.
Hypertension (AHA) 2005Studied cardiovascular effects of aerobic exercise in
resistant hypertension
Resistant hypertension defined as BP >140/90 mmHg despite use of 3 antihypertensive agents
Findings..exercise significantly SBP&DBP ambulatory BP by 6+12 & 3+ 7 mmHg respectively
Conclusions: low responsiveness to drug therapy doesn’t equate to low responsiveness to non-pharmacological approach..i.e. EXERCISE
• Tremendous health benefits are seen with even low levels of exercise.• Amount of exercise needed to benefit health is much lower than amount
needed for fitness.
Regular physical activity at the correct intensity:• Reduces the risk of heart disease by 40%.• Lowers the risk of stroke by 27%.• Reduces the incidence of diabetes by almost 50%.• Reduces the incidence of high blood pressure by almost 50%.• Can reduce mortality and the risk of recurrent breast cancer by almost
50%.• Can lower the risk of colon cancer by over 60%.• Can reduce the risk of developing of Alzheimer’s disease by one-third.• Can decrease depression as effectively as Prozac or behavioral therapy.
Exercise As Medicine
Decision Time
When Doctors Prescribe ExerciseSpanish study in Archives of Internal Medicine looked at
4000 patients half given general advice on exercise, the other half given an actual prescription to do so. In 6 mo. Ex Rx group was significantly more active
65% of patients surveyed would be more interested in exercising if prescribed by their MD
41% of physicians talk to their patients about exercise but don’t offer suggestions as to best ways to be physically active
Power of the PadClear distinction between doctor’s advice & doctor’s
orders
Basis of “Exercise is Medicine” campaign
Exercise truly is a form of treatment
Choosing specific goals vs “get some exercise”
U.S. Physical Activity GuidelinesAge No Chronic Conditions Chronic Conditions
Children & Adolescents (6-17)
60 minutes or more of physical activity every day (moderate*- or vigorous**-intensity aerobic physical activity).
Vigorous-intensity activity at least 3 days per week.
Muscle-strengthening and bone-strengthening activity at least 3 days per week.
Develop a physical activity plan with your health care professional. Avoid inactivity.Refer to the Your Prescription for Health series.
Adults(18-64)
150 minutes a week of moderate-intensity, or 75 minutes a week of vigorous-intensity aerobic physical activityMuscle-strengthening activities that involve all major muscle groups performed on 2 or more days per week.
Develop a physical activity plan with your health care professional. Be as physically active as possible. Avoid inactivityRefer to the Your Prescription for Health series.
Older Adults(65+)
Follow the adult guidelines, or be as physically active as possible. Avoid inactivity.Exercises that maintain or improve balance if at risk of falling.
Develop activity plan with health care professional.Refer to the Your Prescription for Health series.
From the 2008 Physical Activity Guidelines for Americans
For more information on these guidelines, visit www.acsm.org/physicalactivity.
150 minutes per week of moderate-intensity
physical activity• Choose your own schedule • For example: 30 minutes of
moderate-intensity exercise, five days per week OR three 10-minute sessions per day,
five days per week
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What is Cardiac Rehabilitation?Medically supervised
Lifestyle modification
Monitored progressive exercise/activity
Inpatient-Outpatient-Lifetime
Individualized, typically 3x/week, up to 12 weeks
Physician Referral Required
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Goals of Cardiac Rehab
Identify, modify, and manage risk factors to reduce disability/morbidity & mortality
Improve functional capacity
Alleviate/lessen activity related symptoms
Educate patients about the management of heart disease
Improve quality of life
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Lifestyle Benefits:Risk Factor and Lifestyle ModificationSmoking cessationLipid improvementBlood pressure controlExercise guidanceWeight managementDiabetes controlStress management
Circulation 2013 Study of 846 patients that underwent CABG
Looked at survival after 10 yrs post-op, CR yes or no
At end of 10 yrs had 45% in mortality for CR attendees vs non-attendees
Circulation 2012Studied CR attendance & outcomes for CAD patients
>5800 patients, compared completion vs non completion of CR over a 14 yr period
Findings: CR completion was associated with risk of mortality & frequency of all cause & cardiac specific hospitalizations.
Components of ExRx for Risk Factor Reduction
Aerobic exerciseStrength training
F.I.T.T. PrincipleFrequency
3-5 x/week
IntensityHR 50-75% of HRR, 60-80% of VO2Max
Conversation Pace
RPE
RHR + 20
Time15-60 min/session
Type
Stages of ConditioningInitial Phase
Duration: 4-6 weeks
Goal: to increase frequency, proper form, & develop “good habits”
Improvement PhaseDuration: 4-6 mos.
Goal: to gradually increase intensity & duration
Maintenance PhaseDuration: after 6 mos
Goal: maintain CV fitness, avoid overuse injuries
Strength TrainingPositive impact on;
Muscle mass & strength
Bone density
Metabolism
Balance
Strength TrainingSignificant correlation between muscle strength and;
Independence
Performance of ADL
Preferred walking speed
Strength TrainingStart with resistive bands, light weights, cans of food
Chair exercises
10-15 reps of 5-7 exercises 2-3x/week
Lift 2 sec, lower 4 sec
Focus on large muscle groups
Precautions
• Evidence is now overwhelming on the health burden of physical inactivity.
• The benefits of exercise in the treatment and prevention of chronic disease cannot be denied.
• We cannot continue to ignore this evidence when formulating treatment plans for our patients.
• No patient should leave a doctor’s office without an assessment of his/her physical activity and proper prescription of an exercise program, or a referral to a certified fitness professional.
Summary
Mercy’s SolutionMercy Health Fitness Program…only certified program in
area by Medical Fitness Assoc (MFA)
Cardiac Rehab Program certified by AACVPR
Medical approach to fitness/wellness programming
Staff all degreed in exercise science
Easy referral process