Introduction to the Fitness Spectrum

Today we will:

• Review the increase of heart disease in America• Recognize the health implications of inactivity• Describe the Dr. Dean Ornish Program for Reversing

Heart Disease Exercise Prescription• Learn the benefits of the exercise guidelines• Learn how to make exercise safe• Discuss the integrated approach to success

2

US Cardiovascular Disease Mortality 1979-2004

3

Diabetes

• 20.8 million Americans have diabetes

• 30% are unaware • Diabetes has doubled

over the last 30 years.• 65% of people with

diabetes will die of heart disease or stroke

4

5

1999

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1999, 2008

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2008

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

The Epidemic of Obesity

• Number ONE modifiable risk factor for diseases such as:– Heart disease– Cancer– Diabetes– High blood pressure– High cholesterol

6

Heavy to Heavier

0

10

20

30

40

50

60

70

BMI > 25 BMI >30 BMI > 40

1999-2000

2003-2004

7

The Influence of Exercise

• Only 30% of adults engage in regular physical activity.

• 70% of Americans perform less than recommended levels of physical activity.

8

No Exercise

Inconsistent Exercise

RegularExercise

Health Implications of Inactivity• Coronary Artery Disease• Obesity• High Blood Pressure• High Cholesterol• Bone Loss• Peripheral Artery Disease• Asthma

• Stroke• Cancer (colon, breast,

prostate, lung)• Diabetes• Metabolic Syndrome• Depression• High Stress

9

The Risk of Inactivity

• “The relative risk of heart disease associated with physical inactivity ranges from 1.5-2.4, an increase in risk comparable to that observed for high blood cholesterol, high blood pressure or cigarette smoking.”– Source: JAMA 1995;273:402-407

10

Exercise and All-Cause MortalityHarvard Alumni Health Study

11

Age-Related Changes in Aerobic Capacity

12

Exercise and Obesity

• 22,000 participants were followed for 8 years and evaluated for fitness (treadmill testing) and body fat percentage.

• Lean men, who were fit, had 1/3 the incidence of cardiac related death as those who were lean and unfit.

• Fit obese men had lower death rates than unfit lean men.– Source: Lee et al. Am J of Clin Nutrition 1999; 69: 373

13

Benefits of Exercise

• Improves heart efficiency• Improves oxygen carrying capacity of blood• Lowers resting blood pressure• Lowers triglycerides• Increases HDL cholesterol• Lowers blood glucose (sugar)• Improves metabolism• Prevents bone loss

14

Benefits of Exercise, cont.

• Decreases body fat• Improves muscle mass and density• Improves exercise capacity• Decreases mortality rate• Decreases stress level• Decreases hostility• Decreases depression• Improves overall well-being

15

Exercise Prescription (Rx)

16

Exercise Guidelines

• Limit passive inactive pursuits.• Add more activity into everyday life.• Exercise aerobically for a minimum of 3 hours

per week.• Perform strength training activities a minimum of

2 times per week.

17

Exercise Components

Flexibility / Stretching

Aerobic / Cardiorespiratory

Resistance / Strength Training

18

Format for Exercise Sessions

• Warm Up Phase (5-10 minutes):– Includes a low level cardiorespiratory component

followed by flexibility exercises

• Stimulus or Conditioning Phase (30-60 minutes):– Cardiorespiratory component within your training range– Resistance training

• Cool Down Phase (5-10 minutes):– Same as warm-up period

19

Warm Up and Cool Down• The warm up helps move the body from rest to

exercise.• The low level cardio activity increases blood flow to

muscles and warms them up before stretching.• Low intensity stretching before exercise may

reduce the likelihood of musculoskeletal injuries.

20

Warm Up and Cool Down, cont.

• The cool down provides a recovery period to return the body (and heart rate and blood pressure) to the resting state.

• Helps maintain adequate venous return (reduces “pooling” of blood in lower extremities) and reduces the potential for hypotension (low blood pressure) and dizziness.

• Stretching after exercise helps to maintain flexibility.

21

F.I.T.T. Principle

F = Frequency How often

I = Intensity How hard

T = Time How long

T = Type What type

22

Flexibility

23

Guidelines for Flexibility Training

F • 3 to 7 days per week

I• To a mild tension, without

discomfort

T• Hold each stretch for 15-30

seconds

• Repeat 2 to 4 times each stretch

T• Static stretches that involve the

major muscle tendon units.

• May use yoga poses.

24

Warm up before stretching.Do not bounce when stretching.

Aerobic/Cardiorespiratory

25

Activity vs. Exercise

Activity• Stop and go activities• < 45% or > 80% of maximal capacity • Doesn’t condition the cardiopulmonary system

Exercise• Continuous activity involving large muscle groups• 45-80% of maximal intensity• Conditions the cardiopulmonary system

26

Activity or Exercise?

27

Activity or Exercise?

28

Activity or Exercise?

29

Activity Versus ExerciseActivity • Gardening• Golf• Household Chores• Shopping• Cooking• Doubles Tennis• Basketball• Dancing

Exercise•Hiking•Aerobic dance•Jogging•Rowing•Rollerblading

30

Exercise Monitoring: Heart Rate

Target Heart Rates• Based on the

maximum heart rate achieved during an exercise test

• Pulse taking– Wrist– Neck

31

Exercise Monitoring: RPE

32

BO

RG

’S R

AT

E O

F P

ER

CE

IVE

D

EX

ER

TIO

N (

RP

E)

SC

ALE

Borg RPE scale© Gunnar Borg, 1970, 1985, 1994, 1998

RATING DESCRIPTION

6 No Exertion

7 Extremely Light

8

9 Very Light

10 Light

11

12

13 Somewhat Hard

14

15 Hard / Heavy

16

17 Very Hard

18

19 Extremely Hard

20 Maxim

Program Guidelines: Aerobic Exercise

F • 3 to 6 days per week

I • 45-80% of maximal capacity

T• 30 to 60 minutes/session• Accumulate at least 3 to 5 hours

of exercise weekly

T• Activities using large muscles

that are continuous and rhythmical in nature

33

Program Guidelines for Diabetes

F • Daily preferred

I• 45-80 % of maximal capacity• Or RPE 11 to 14

T• 20 to 60 minutes/session• Accumulate at least 3 to 5 hours of

exercise weekly

T• Activities using large muscles that

are continuous and rhythmical in nature

34

Source: ACSM, 2000

Aerobic Exercise

Strength Training

35

Benefits of Strength Training

fat mass• Improves cholesterol blood pressure symptoms of

depression • Improves glucose

utilization

• Improves self-confidence

• Improves bone density arthritis pain metabolism• Can help break

through a weight loss plateau

36

Program Guidelines: Strength Training

F • 2 to 3 days per week

I • RPE of 10 to 15

T• 10-15 repetitions of 8 to

10 different exercises

T• Weights, resistance

bands, body weight, household items, water resistance

37

Exercising Safely

38

General Exercise Guidelines

• Monitor your exercise response.• Pace yourself.• Have a regular exercise routine.• Relax with stress management.• Stay hydrated.

39

Exercise Guidelines for Diabetes

• Monitor glucose levels before, during and after exercise sessions.

• Do not exercise if blood glucose > 250 with urinary ketones or >300 if no ketones.

• Eat carbohydrate if blood glucose is < 100 mg/dL.

• Exercising at night may cause nocturnal hypoglycemia.

40

More Guidelines for Diabetes

• Exercise with caution in extreme hot/cold weather. • Insulin, diabetes pills or other non-insulin

injectables may have to be adjusted.• Maintain good foot care and wear proper footwear

for your activity.• Exercise has an insulin-like response in the body.

Exercise daily at the same time to prevent low blood sugar (hypoglycemia).

• Hypoglycemia can occur up to 6 hours after exercise.

41

Special Exercise Considerations

• Eating• Alcohol• Hot weather• Cold weather• Altitude

• Medications• Illness• Overexertion• Carbon monoxide

(smoking, smog)

42

Warning Signs

• Chest pressure/pain• Severe breathlessness• Excessive fatigue• Poor recovery• Irregular heart rate

(palpitations)• Sweating with cold,

clammy skin

• Dizziness• Nausea• Fainting• Confusion• New or increased chest,

jaw, back or arm pain that does not go away with rest or nitroglycerin

43

If You Have Chest Pain With Exercise…

• When you are exercising at Program sessions: – STOP exercise and let a staff member know.

• If you are exercising on your own:– STOP exercising, and follow your doctor’s instructions

regarding calling 911, seeking immediate medical attention, taking nitroglycerin or other recommendations from your doctor.

• ALWAYS let your physician and Program staff know if you have had any angina symptoms when you have been exercising on your own—especially if your symptoms are changing in intensity or frequency.

44

Musculoskeletal Injury

• R Rest• I Ice the area for 20 minutes at a time• C Compression (use an ACE bandage

to hold the ice on the injured area)• E Elevate the injured area

45

Pathways to Success

• Buddies • Clubs • Classes • Events • Feelings

• Fun• Time management• Confidence • Commitment

46

Integrated Approach

47

Love & Support

Stress Management

Fitness Nutrition

Lifestyle Heart Trial Results

• Exercise adherence in combination with the other modalities is associated with:– Heart disease reversal– Improved blood lipids– Weight loss– Improved mood– More satisfaction and pleasure from life

48

Exercise and Stress Management

• Improved flexibility• Increased awareness

and ability to focus• Improved breathing

techniques• Improved balance

49

Exercise and Group Support

• Decreased hostility• Improved mood• Increased satisfaction and

pleasure from life• Exercising with a partner

or in a group can improve interpersonal relationships.

50

Exercise, Nutrition and Your Eating Plan

• Aids in weight loss and maintenance of weight loss

• Moderates appetite• Helps curb binge eating

51

Upcoming Exercise Support and Training• We’ll exercise twice weekly for the next 12 weeks.• We’ll add strength training around week 6.• Toward the completion of Stage I, you will have

another stress test, and we will update your exercise prescription to reflect the new test.

52

Questions

53