physical activity for life february 7, 2010 rick seip, phd research scientist, genomas, inc. &...

Physical Activity for LIFE February 7, 2010 Rick Seip, PhD Research Scientist, Genomas, Inc. & Senior Scientist (per diem) Preventive Cardiology Hartford Hospital [email protected] 860-545-5005

Who is this fitness expert? Billy Blanks, 7 time World Champion in karate Inventor of Tae Bo, combination of boxing and tae kwan do

Jack LaLanne

Overweight? Youve gotta start MOVIN!!! 10,000 counts per day Who is this fitness proponent?

Guidelines for healthy adults < age 65 Basic recommendations from ACSM and AHA (2007): http://www.acsm.org/AM/Template.cfm?Section=Home_Page&TEMPLATE=CM/HTMLDisplay.cfm&CONTENTID=7764 Do eight to 10 strength-training exercises, eight to 12 repetitions of each exercise twice a week. Do vigorously intense cardio 20 minutes a day, 3 days a week And Do moderately intense cardio 30 minutes a day, 5 days a week Or

Mortality Rates, 1900 Source: Healthy People 2010, US Dept HHS Senility Tuberculosis Heart Disease Injuries 33%

Mortality Rates, 2004 57% 10,000 counts per day Source: U.S. National Center for Health Statistics, Health, United States, 2005

Physical Activity on the JOB... 1990: only 5% of occupations require high level of physical fitness delivery person bicycle messenger airport baggage handler various laborers (farmers?) waiter, bellhop, valet 1900s: 40% of occupations developed or required a high level of fitness

Increase Your Health Span... Cardiovascular Disease Obesity & Type II Diabetes Mobility, Fall Prevention, & Osteoporosis

Risk Factors for Coronary Heart Disease Modifiable Dyslipidemia High LDL- cholesterol Low HDL-cholesterol High TGs Smoking Hypertension Diabetes mellitus Obesity Dietary factors Thrombogenic factors Sedentary lifestyle Wood D, et al. Atherosclerosis. 1998;140:199-270. Nonmodifiable Age Sex Family history of premature CHD 90% of those diagnosed with CHD have at least one of the four top risk factors Sedentary lifestyle

Development of Atherosclerotic Plaques Normal Fatty streak Foam cells Lipid-rich plaque Lipid core Fibrous cap Thrombus Ross R. Nature. 1993;362:801-809

Drug that Affect Serum Lipids Statins * 18-55% 5-15% 7-30% Fibrates 5-20% 10-20% 20-50% Nicotinic acid 5-25% 15-35% 20-50% Resins 15-30% 3-5% no Drug class LDL HDL TG NCEP ATP III. JAMA. 2001;285:2486-2497. 10,000 counts per day * Lipitor (atorvastatin), Crestor (rosuvastatin), Zocor (simvastatin), Pravastatin (pravachol), Mevacor (Lovastatin); lovastatin was isolated from Chinese red yeast rice

Hypertension Systolic BP Diastolic BP MILD HYPERTENSION > 140 mmHg 130 - 140 > 90 mmHg Systolic BP Diastolic BP 80 - 90

How can Physical Activity Improve Your Health? Cardiovascular Disease Obesity & Diabetes Osteoporosis & Fall Prevention CR Fitness, Calorie Expenditure, Low Fat diet, Stop Smoking, Active Relaxation Calorie Expenditure Dietary calcium, Vitamin D, Resistance Training, Flexibility Exercises

Walking may be the only physical activity suitable for the entire lifespan P.O. Astrand, Swedish physiologist Walking 1 mile requires 80-100 kcal energy expenditure

Energy Expenditure of Walking ( kcal per mile )

A Long-Duration (118-day) Backpacking Trip (2669 km) Normalizes Lipids Without Medication: A Case Study PRE Chol 276 Trig 319 HDLc 41 LDLc 167 189 111 68 99 DAY 89 DAY 118 Change 196 79 63 118 % - 29 - 75 + 37 - 29 Ht 5 7 Wt 188 lbs BMI 29.4 5 7 170 lbs 25.5 -13 Calories Eaten SatFat Fiber 2738 35.7 16.7 2653 3130 +14 31.9 g 48.7 +36 31.7 25.5 +52 SBP 132 DBP 98 124 -6 78 -20

Netherlands 30 18 54 Germany 12 22 1649 England 8 12 1462 Italy 5 28 1642 Canada 1 10 1474 USA 1 9 384 Netherlands 30 18 54 Germany 12 22 1649 England 8 12 1462 Italy 5 28 1642 Canada 1 10 1474 USA 1 9 384 Modal Travel in Urban Areas: Europe and North America Percent of Trips by Mode Modal Travel in Urban Areas: Europe and North America Percent of Trips by Mode Transportation Quarterly 1997; 51:31 Public CountryBicycleWalkingTransportCar Public CountryBicycleWalkingTransportCar

Highway Vehicle Miles Traveled are projected to grow 60% by 2030, in step with the growing U.S. population. http://www.rita.dot.gov/publications/transportation_vision_2030/pdf/entire.pdf Source: Transportation Vision for 2030 US Department of Transportation, January 2008

Bill Pearl, age 37 Bill Pearl, last formal pose, 1989 age 59 !! Mr. Universe, 1967 Resistance Training

Resistance Training General Guidelines

Resistance Training Tailor your Program!

Resistance Training a sample Program

Q: 1 pound of fat stores how many calories? A: 3500 10,000 counts per day???

WHAT IS YOUR BMI?

How to Find Your BMI: Height: 66 Weight: 180 lbs. BMI = 29.5 160 lbs. 26.5 140 lbs. 23

Obesity Classification Based on Body Mass Index (BMI) BMIClassification < 25 Normal (desirable) weight 25- 29.9 Overweight > 30 Obesity Class I > 35 Class II > 40 Class III

a b c c Krumm et al., J.Womens Health 15:202-10, 2006

CAN EXERCISE PREVENT TYPE II DIABETES? DPP - Results NIH news release (August, 2001) Prevalence of T2DM at three years: % diagnosed with T2DM Walking and dietary restriction

24 26 28 30 32 34 36 38 40 42 RESTRICT DIET Exercise Problem Obesity from J.S.Garrow, Acta Scand. Med. 711:67-73, 1986 Treatment Emphasis

OSTEOPOROSIS & FALL PREVENTION

Osteoporosis: The Bone Thief Helen grew up on a dairy farm in the Midwest. She drank 3 glasses of milk a day as a child. After high school she began work as a secretary in a local law office where she spent her entire career. Helen never jogged, walked as exercise, or played tennis. She went through menopause at age 47. Shortly before retirement at age 61, she slipped on a small rug in her kitchen and broke her hip. After Helen recovered, she needed a cane to walk. Ref: The National Institute of health Age Page http://www.nih.gov/nia/health/agepages/osteo.htm (2/14/01)

50 y.o. man 58 y.o. man 76 y.o. man 87 y.o. woman Snow-Harter & Marcus, ESSR, 1991

THE FRACTURE PREVENTION TRIANGLE FALL FORCE FRAGILITY Prevent the Minimize the of the fall Reduce the of bone.

Wrist Fracture V e r t e b r a l F r a c t u r e Hip fracture

LOW MOBILITYHIGH MOBILITY (Powell & Myers, J Gerontol: Med Sci 50A M28-M34, 1995.)

Falls occur because of both: Internal (host) factors External (environmental) factors

Internal factors Decreased vision Postural hypotension Impaired balance and/or gait Chronic diseases that impair mental or physical functioning Certain medications, such as sedatives and antidepressants

External (environmental) factors: Poor lighting Lack of handrails on staircases Objects in pathways Non-secured rugs

Preventing Falls Practice hand clenching, ankle pumping, dorsi/plantar flexing Balance and strengthening exercises SOLUTION Use medications properly; learn non-pharmacologic treatment for sleep disorders

Preventing Falls Review your meds with pharmacist or physician Install grab bars, handrails. Correct foot or leg problems. SOLUTION Exercises for balance and gait abnormalities

Preventing Falls through a safer environment Replace torn rugs, anchor loose edges Add non-skid back to slippery rugs. Arrange furniture so it is not obstructive Use high back chairs SOLUTION Label all medications. Ensure adequate lighting. Keep toilet seats raised. Non-skid surfaces in bath/shower Grab bars in or near commode

Nonslip wax on floors; Use assistive devices (walker, handrails). Keep wood or vinyl floors dry and clean Preventing Falls through a safer environment SOLUTION

Reducing Fragility What can You do to Improve Bone Mass? Diet rich in Calcium Adequate in Vitamin D Weight-bearing and resistance training exercises Medication approved by the Food and Drug Administration (FDA)

BECOME MORE ACTIVE 10,000 counts per day

Thank you for your Attention

EXTRA SLIDES

Cardiovascular Disease includes Heart Disease and Stroke

What is the significance of this symbol?

http://www.medslides.com/member2/Cardiology/women.ppt

GO RED FOR HEART http://www.americanheart.org VISIT THIS WEBSITE TO CALCULATE YOUR RISK FOR CARDIOVASCULAR DISEASE:

CVD, particularly coronary heart disease (CHD) and stroke, remain the leading causes of death in women in America and most developed countries Coronary heart disease claims the lives of 248,184 females annually compared with 41,394 lives from breast cancer and 65,632 from lung cancer. CVD death rate higher in black women than in white women CVD is #1 among all disease categories in hospital discharges for women 38% of women vs. 25% of men die within 1 yr after a heart attack Of the 4.8 million stroke survivors alive today, 56% are women Yet misperceptions still exist that CVD is not a real problem for women. http://www.americanheart.org/presenter.jhtml?identifier=2859 Women and CVD surprising facts:

Personal Health Family (children, spouse, parents) Household (food, cleaning,upkeep) Work Money Other commitments

Heart Attack Warning Signs Some heart attacks are sudden and intense the "movie heart attack," where no one doubts what's happening But most heart attacks start slowly with mild pain or discomfort Often people affected aren't sure what's wrong and wait too long before getting help. From: http://www.americanheart.org/presenter.jhtml?identifier=3053#Heart_Attack

Symptoms of Heart Attack: Chest discomfort Discomfort in the center of the chest that lasts more than a few minutes may go away and come back can feel like uncomfortable pressure, squeezing, fullness or pain. Discomfort in other areas of the upper body Pain / discomfort in one or both arms, the back, neck, jaw or stomach. Shortness of breath May occur with or without chest discomfort. Other signs: Cold sweat, nausea, or lightheadedness From: http://www.americanheart.org/presenter.jhtml?identifier=3053#Heart_Attack

Symptoms of heart attack may be quite different in women: As with men, women's most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain. Shortness of breath...with or without chest discomfort. Nausea and light-headedness Flu-like symptoms, including chills and cold sweats Heart palpitations From: http://www.americanheart.org/presenter.jhtml?identifier=3053#Heart_Attack

Stroke Warning Signs: Similar in Men & Women If you notice one or more of these signs, don't wait. Stroke is a medical emergency. Call 9-1-1 or your emergency medical services. Get to a hospital right away! The American Stroke Association wants you to learn the warning signs of stroke: Sudden numbness or weakness of the face, arm or leg, especially on one side of the body Sudden confusion, trouble speaking or understanding Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness, loss of balance or coordination Sudden, severe headache with no known cause

Stroke Risk Factors Stroke risk factors similar to overall CVD risk factors Risk is higher if you have existing heart disease!!

Prediction of Stroke Using the Modified Framingham Stroke Risk Profile Source: Goldstein et al. AHA/ASA Guidelines: Prevention of Primary Stroke. Stroke 37:1583, 2006.

0 1 2 3 100160220 LDL-C (mg/dL) Relative CHD Risk Over 4 years HDL-C (mg/dL) 85 65 45 25 Castelli WP et al. Can J Cardiol. 1988;4(suppl A):5A-10A. High LDL-C and Low HDL-C: Increased Risk of CHD

U.S. ADULTS About 60-70% get no exercise or not enough to maintain/increase CR fitness 10,000 counts per day

BECOME MORE ACTIVE 10,000 counts per day

Diabetes Prevention Program NIH funded study of: Prevention of diabetes, & Cost effectiveness of preventive measures CAN EXERCISE PREVENT TYPE II DIABETES?

Walking may be the only physical activity suitable for the entire lifespan P.O. Astrand, Swedish physiologist Walking 1 mile requires 80-100 kcal energy expenditure

Highway Vehicle Miles Traveled are projected to grow 60% by 2030, in step with the growing U.S. population. http://www.rita.dot.gov/publications/transportation_vision_2030/pdf/entire.pdf Source: Transportation Vision for 2030 US Department of Transportation, January 2008

Metabolic Response to 10-lb Weight Loss: Framingham Data Higgins M et al. Acta Med Scand Suppl 1988;723:23-36. Cholesterol Small changes can add up to significant changes in long-term risk Syst BP Glucose mg/dl mm Hg mg/dl Men Women

Exercise Lite Every American adult should accumulate 30 minutes or more of moderate intensity physical activity over the course of most days of the week. (recommendation of ACSM + CDC, 1993)

Guidelines for healthy adults < age 65 Basic recommendations from ACSM and AHA (2007): http://www.acsm.org/AM/Template.cfm?Section=Home_Page&TEMPLATE=CM/HTMLDisplay.cfm&CONTENTID=7764 Do eight to 10 strength-training exercises, eight to 12 repetitions of each exercise twice a week. Do vigorously intense cardio 20 minutes a day, 3 days a week And Do moderately intense cardio 30 minutes a day, 5 days a week Or

Q: 1 pound of fat stores how many calories? A: 3500 10,000 counts per day???

So What do you mean by 10,000 steps / day? GOAL: ATTAIN > 10,000 pedometer counts per day But Many people are sedentary, and most sedentary people are overweight. Sedentary people attain ~ 5,000 pedometer counts per day

Activity Categories Sedentary Low Active Moderately Active High Active Category Daily Pedometer Counts 10,000

How can I lose weight? How can a pedometer work for me?

Suppose you weigh 190 lbs. Current activity: 5,000 counts/day If you decide to increase your pedometer counts by +1,000 each day,... to attain an average of 6,000 counts/day... You will lose 5.2 lbs in one year

Calculations For a 190 lb person, walking 1 mile expends 100 kcal Since 1 mile = 2,000 counts, it follows that mile = 1,000 counts. then 1,000 counts expends ~ 50 kcal. If you increase daily pedometer counts by 1000/day, this will result in an additional expenditure of 350 kcal/week, 1,400 kcal/month, 18,200 kcal/yr. 18,200 kcal 3,500 kcal/lb = 5.2 lbs of fat lost in 1 year

Risk Factor... High Cholesterol & triglycerides High BP Diabetes Smoking Exercise Effect: Lowers TG little effect on cholesterol if do not have hi TG Lowers BP 5-10 mmHg as likely to become diabetic (?) Hard to smoke & exercise Obesity ? Walk 1 mile, burn 100 kcal

24 26 28 30 32 34 36 38 40 42 RESTRICT DIET Exercise Problem Obesity from J.S.Garrow, Acta Scand. Med. 711:67-73, 1986 Treatment Emphasis

Cardiovascular Disease Risk Major Risk Factors for Heart Disease and Stroke High levels of blood cholesterol Hypertension or high blood pressure Tobacco use Diabetes mellitus Other Risk Factors Include Physical inactivity Obesity & Poor diet (High Fat, Sat Fat)

ADOLESCENCE: A time to Learn the Adult Lifestyle of Inactivity !!! 10,000 counts per day

Current Status : Physical Activity of Children? LIFESPAN Adolesc Adulthood % of Pop. Getting Phys.Act. Sufficient to Maintain Wt. Balance Childhood ?

Kids in the 1990s less active compared to kids in the 1950s ( William Strong, editorial in Circulation, 1990) TV Viewing in 1950s: 4 hr / week 1990s: 28 hr /week more kids in day care effect: day care centers tend to restrict activity more latch key children: effect: parents stay indoors til we get home decreasing green space

Distribution of Hours of TV Per Day: NHES Youth Aged 12-17 in 1967-70 and NLSY Youth Aged 12-17 in 1990 0-1 1-2 2-3 3-4 4-5 5+ TV Hours (Youth Report)

Prevalence of Obesity by Hours of TV per Day: NHES Youth Aged 12-17 in 1967-70 and NLSY Youth Aged 10-15 in 1990

Working Hypothesis : LIFESPAN Adolesc Adulthood % of Pop. Getting Phys.Act. Sufficient to Maintain Wt. Balance Childhood Childhood Activity levels may be re-setting to a new low

New Risk Factors Ready for Prime Time? Oxidized LDL Homocysteine Lp(a) C-reactive protein (CRP)

C-Reactive Protein (CRP) What is it? Circulating protein produced by liver Marker for general inflammation How does it contribute to CVD risk? Atherosclerosis is an inflammatory disease, CRP is (partly) a marker for inflammation How to reduce your risk:

Insulin What is it? Hormone responsible for allowing blood glucose (sugar) to enter cells. Very important to muscle function; body is 40% muscle How does it contribute to CVD risk? Muscles become resistant to insulin, high insulin promotes arterial thickening How to reduce your risk: MOVE !!!!

Homocysteine What is it? Amino acid that is normally changed to another aa High level: > 12 umol/L How does it contribute to CVD risk? Disrupts thrombolysis (increased clotting) contributes to arterial thickening & aging (deficient methylation) How to reduce your risk: Increase dietary folate, vitamins B 6, B 12 Sources (9/3/03): http://familydoctor.org/handouts/249.html9/3/03 http://www.bhf.org.uk/questions/index.asp?secondlevel=370&thirdlevel=378 Christen WG et al. Arch Intern Med. 2000 Feb 28;160(4):422-34

Energy Expenditure of Running ( kcal per mile )

Women themselves may lack appreciation of their individual risk for heart disease. Women: frequently continue activities when they feel ill mistake their symptoms as not serious, or - fail to realize that they represent a cardiac condition Women present to the hospital one hour later than a man will From: http://www.womentowomen.com/LIBheartattacksymptoms.asp accessed 2/7/06

Falls and Fracture Prevention NIH ORBD~NRC News Volume 2, No. 1, December 1999 http://www.osteo.org/newsvol2no1.html To view this information on the world wide web:

Ronnie Coleman Seven time Mr. Olympia Name that bodybuilder

Adela Garcia-Freidmansky Ms. Olympia 2004 & 2006 Bev Francis 1 st woman to bench press 300 lbs.

Physical Activity and Health A Report of the Surgeon General 1996 U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and HealthPromotion Presidents Council on Physical Fitness and Sports

physical activity for life february 7, 2010 rick seip, phd research scientist, genomas, inc. &...

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