���Exercise �

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Exercise and health

• Regular physical activity and exercise enhance physical and psychological health.
• People who include physical activity in their daily routine, or exercise regularly:
• Feel better mentally and physically.
• Improve their health profile.
• Safeguard their functional independence as they go through the aging process.
• Physical activity involves:
• Exercise for cardiorespiratory health (endurance).
• Exercise for musculoskeletal health (strength, flexibility, and bone integrity).
• Body awareness (mindfulness during exercise facilitates self-inquiry and self-acceptance, helps relieve psychological stress, and prevents physical injury).

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Contributing factors to sedentary lifestyle

• Machines to do our work and provide transportation.
• Increased computer time at work and home.
• Decreased financial resources in schools, colleges, and communities for physical activity instruction, playgrounds, parks and recreation facilities, and after-school sports programs and staff.
• Decreased outdoor activity resulting from fear of crime in neighborhoods.
• Children spending increased time watching TV and playing video games.

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Physical activity=exercise…NO

• Physical activity: bodily movement that is produced by the contraction of skeletal muscle and that substantially increases energy expenditure; includes transportation and vocational and leisure-time activity. Leisure-time activity can be further categorized into sports, recreational activities, and exercise training.

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Physical activity=exercise…NO

• Exercise (exercise training): planned, structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness.

. Aerobic exercise: activity that uses large muscle groups in a repetitive, rhythmic fashion over an extended period of time to improve the efficiency of the oxidative energy-producing system and improve cardiorespiratory endurance; utilizes stored adipose tissue as major fuel source.

. Anaerobic exercise: high-intensity, short-duration activity that improves the efficiency of the phospho-creatine and glycolytic energy-producing systems and increases muscle strength, power, and speed of reactivity; utilizes phosphagens and glucose/glycogen as major fuel sources.

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Physical activity=exercise… NO

• Physical fitness: a set of attributes (cardiorespiratory fitness, muscular fitness, flexibility) that people have or achieve that relates to the ability to perform physical activity without undue fatigue or risk of injury.

. Cardiorespiratory fitness (aerobic capacity, functional capacity, and oxygen uptake VO2):

the ability to deliver and utilize oxygen throughout the body in order to allow physical activity over an extended period of time without excessive fatigue.

. Muscular fitness: the strength and endurance of muscles that allows for participation in daily activities with low risk of musculoskeletal injury.

. Flexibility: adequate muscle length and joint mobility to allow free and painless movement through a wide range of motion (ROM).

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Physical activity goals

• Reduce CHD deaths.
• Reduce the prevalence of being overweight.
• Increase number of people who engage in physical activity.
• Increase number of children and adolescents who participate in daily school physical education.
• Increase amount of school physical education class time that students spend being physically active.
• Increase number of primary care providers who routinely assess their clients regarding physical activity practices.

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Inverse relationship…physical fitness and CHD risk

• Higher levels of fitness associated with lower CHD risk.
• Increased physical activity benefits individuals with CVD [MI, angina pectoris, congestive heart failure, status after a coronary artery bypass graft (CABG), and percutaneous transluminal coronary angioplasty (PTCA) or stent].
• Benefits include: reduction in cardiovascular mortality rates, reduction of symptoms, improvement in exercise tolerance and functional capacity, and improvement in psychological well-being and quality of life.

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Inverse relationship…physical fitness and CHD risk

• Potential physiological and metabolical mechanisms:
• Increasing high-density lipoprotein (HDL) cholesterol.
• Decreasing serum triglyceride (TRG) levels.
• Decreasing high blood pressure.
• Improving glucose tolerance and insulin sensitivity.
• Decreasing obesity; altering distribution of body fat.
• Reducing the sensitivity of the myocardium to the effects of catecholamines, thereby decreasing the risk of ventricular arrhythmias.
• Enhancing fibrinolysis and altering platelet function.

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Inverse relationship…physical fitness and CHD risk

• High-density lipoprotein (HDL) and triglycerides (TRG):
• Negative correlation between CHD and plasma HDL; increases in HDL lower total cholesterol to HDL ratio, thereby reducing CHD risk.
• Exercise lowers plasma TRG evident within hours after a bout of exercise; exercise training increases lipoprotein lipase activity (an enzyme that removes cholesterol and fatty acids from the blood).
• TRG levels are lower and HDL levels are higher in physically active people than in the sedentary population

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Inverse relationship…physical fitness and CHD risk

• Hypertension (HTN):
• Low levels of fitness or not to engage in vigorous sports play is related to greater risk for developing HTN by 35%-52%.
• Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) are negatively associated with aerobic exercise.
• Exercise may be as strong a treatment modality for HTN as some medications.
• Low-to moderate-intensity endurance exercise is most effective in lowering HTN. Circuit weight training also has a positive effect on HTN. Resistance training (designed primarily to increase strength) and high-density aerobic training have minimal benefit on reducing HTN.

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Inverse relationship…physical fitness and CHD risk

• Hyperinsulinemia and glucose intolerance:
• Physical activity protects at least some people from the development of NIDDM.
• Physical activity is inversely related to the incidence of NIDDM, most evident in men at high risk for developing diabetes (those with high BMI, history of HTN, or family history of DM).
• During physical activity, contracting skeletal muscles work with insulin to enhance glucose uptake into the cells.
• With diet, weight control, and exercise, it is possible to prevent or decrease the need for oral antiglucolytic agents and insulin while maintaining normal blood glucose levels.

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Obesity

• The fatter you are, the sooner you are likely to die.
• Obesity, defined as (an excess of adipose tissue), corresponds to a weight that is equal or greater than 120% to 125% of the ideal body weight.
• Physical activity:
• Promotes a negative energy balance (burns calories).
• Increases metabolic rate for an extended period of time after the activity.
• Increases metabolic efficiency for burning calories by increasing lean body mass.
• Helps to counteract the decrease in metabolic rate associated with low-calorie diets by preserving lean body mass.
• Is a good alternative to eating when eating is a response to stress rather than to hunger.

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Obesity

• Combination of increased physical activity and nutrition management appears more effective for long-term weight regulation than either exercise or dieting alone.
• Women have a lower percent lean body mass and may not be as metabolically active as men during exercise because fat-metabolism response to exercise appears to be less in the femoral-gluteal region (fat storage in women) than in the upper body-abdominal region (fat storage in men).
• Women do not lose fat as easily as men in response to exercise because of genetic differences related to where and how fat is stored and metabolized. So, women need to increase their exercise to lose weight.

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Aging

• Biological changes of aging include increase in body fat, decrease in aerobic capacity, muscle mass, metabolic rate, strength and flexibility, bone mass, sexual function, mental performance, immune function, and sleep quality.

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• These changes are less in people who participate in regular exercise (exercise maintains function during the aging process).

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• Physical activity is associated with reductions in age-related morbidity, improvements in functional capacity, and preservation of independence.

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Aging

• A 1-to 2-year increased life expectancy for physically active men compared to physically inactive men.

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• Genetic, environmental, and accidental factors need to be considered, but the bottom line is that we have some choice in how we want to age, and exercise can help us age more gracefully.

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• Exercising for about 30 minutes 3 times a week improves aerobic capacity enough to potentially make the difference between independent living and the need for assistance.

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Osteoporosis

• The most common bone disease affecting elderly women.
• Some loss of bone occurs naturally after age 30, but severity is increased with reduced calcium, estrogen, and physical activity.
• Physical activity can help minimize bone loss and facilitate some gain in bone mineralization.
• Reductions in bone density may be prevented, or at least modified, by regular exercise, reduced smoking, adequate intake of calcium, and estrogen replacement.

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Osteoporosis

• Resistance training may be more effective than aerobic exercise in its effects on bone mass. It also improves muscle mass, strength, and balance, which decrease risk of falls in elderly.
• Resistance training cannot increase bone density significantly in osteopenic people, but it can help prevent falls and related fractures.
• Goal of exercise in younger women:

increase bone density; in elderly women 30 to 40 years past menopause: decrease risk of fractures through fall prevention, including exercise.

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Arthritis

• Although there is ongoing progression in arthritis that cannot be healed by exercise, exercise helps to restore health to synovium and cartilage, improve strength and flexibility, decrease joint vulnerability, and delay onset of dysfunction.
• Does exercise cause osteoarthritis (OA)? Long-term recreational runners have no more risk of developing OA of the hip and knee than sedentary people.
• Regular noncompetitive physical activity of the amount and intensity recommended for improving health is not harmful to joints that have no existing injuries.

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Low back pain (LBP)

• Causes of LBP:
• Poor posture.
• Weak muscles.
• Poor body mechanisms.
• Sedentary lifestyle.

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• Back injuries decrease with increasing levels of fitness.
• Increase in vertebral bone mass have been noted in women after menopause as a result of exercise program.
• Advanced age, osteoporosis, arthritis, and LBP are not reasons to exclude exercise from one’s lifestyle. In fact, they should increase physical activity to facilitate functionability throughout the aging process.

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Immune function

• Persons with impaired immune function can exercise safely without risk to their health status and can enhance their physiological and psychological well-being with regular exercise.

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• Moderate exercise decreases risk of URTI; sedentary individuals have higher risk of URTI; but high-intensity exercise may raise the risk above average
• (i.e., ultramarathoners).

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• Moderate exercise is associated with a prolonged improvement in the killing capacity of neutrophils (one of the most efficient phagocytes).

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Immune function

• Moderate exercise increases release of immunostimulatory hormones (growth hormone and endogenous opiates).
• Intensive exercise is associated with increases in ACTH and cortisol levels, which have immunosuppressive characteristics. It is also associated with muscle cell damage and inflammation.
• Reduced incidence of cancer in physically active groups-protective effect of physical activity against colon cancer; inverse relationship between physical activity and risk of breast and reproductive system cancers.

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Mental health

• People who exercise feel better, have increased self-esteem, and have a more positive outlook on life.
• Physical activity may be associated with reduced symptoms of depression and anxiety and improvements in positive affect and general sense of well-being.
• Improvements in physical health are associated with improvements in psychological health.

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Mental health

• Older people report feelings of improved physical, psychological, and social well-being after regular physical activity.
• Exercise is a moderating variable (resistance resource), along with hardiness and social support, in the stress-illness relationship; exercise protects by decreasing the physical strain of stressful events.

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How much exercise is enough?

• Many of the daily physical activities are forms of exercise, but individuals should be encouraged to also include more formal exercise training in their overall activities to promote optimal cardiorespiratory fitness and/or significantly improve muscle strength and endurance.

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How much exercise is enough?

• Parameters of exercise prescription:

1. F (Frequency):– 3 to 5 times a week of aerobic exercise; 2 to 3 times a week of resistance training.

2. I (Intensity):– moderate to vigorous, by heart rate and perceived exertion; able to complete each resistance exercise 8 to 12 repetitions without strain.

3. T (Time):– 20 to 60 minutes, plus warm-up and cool-down; 15 to 30 minutes to complete a series of 8 to 10 of resistance exercises.

4. T (Type):– aerobic (e.g., walking, jogging, biking, swimming, rowing, dancing, skating, rollerblading); resistance training (e.g., weight machines, free weights, push-ups, sit-ups, or pull-ups).

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Aerobic exercise

• Benefits of aerobic exercise are cumulative, so a frequency of 3 to 5 times a week is recommended.
• Cross-training (doing different types of exercise on different days of the week or doing different types of exercise within one exercise session) benefits in decreased risk of musculoskeletal injury, increased potential for total body conditioning, and improved long-term compliance because variety decreases boredom and eliminates exercise barrier of limited choices.
• Increase in heart rate during exercise has a strong linear relationship with exercise intensity and aerobic capacity.

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Aerobic exercise

• 20 to 60 minutes is recommended for duration of aerobic conditioning exercise; less than 20 minutes provides minimal benefit and sessions longer than 45 minutes expose for possible injury.
• Walking is the most accessible and popular form of aerobic exercise, and it is the recommended exercise of choice for people who have physical limitations.
• Individuals should be encouraged to do the types of aerobic exercise that best fit their needs, interests, and lifestyles while also providing reasonable benefits.

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Warm-up and cool-down periods

• Warm-up period usually lasts 5 to 10 minutes and may include light stretching, calisthenics, and/or performance of the chosen aerobic activity at a low intensity.
• This increases blood flow, respiration, and body temperature, and improves muscle flexibility to prepare both musculoskeletal and cardiorespiratory systems for transition from rest to exercise. These activities decrease risks of injury and potential heart irregularities.

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Warm-up and cool-down periods

• Cool-down period follows the endurance phase and usually lasts 5 to 10 minutes.
• It allows body to readjust gradually from demands of exercise back to baseline.
• Stretching and slow rhythmical movement help to increase muscle elasticity, prevent blood pooling and potential hypotension. This results in prevention of injury, light-headedness, fatigue, and muscle soreness.

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Warm-up and cool-down periods

• Yoga is an excellent exercise to use during warm-up and cool-down periods. It means (union; joining together) a body-mind connection.
• Yoga is defined as (mindful stretching). Yoga philosophy encourages an appreciation of bodily sensations, slow stretching, and maintenance of proper posture to prevent injury and promote health.
• This slow, controlled form of exercise can help individuals make healthy choices during all types of physical activity.

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Flexibility

• A basic component of physical fitness.
• A little discomfort may be felt as muscle stretches, but discomfort should never reach the point of pain.
• Stretching mindfully, as in yoga, will ensure a safe stretch. Holding the position for 10 to 20 seconds and repeating the stretch 3 to 5 times will encourage optimal flexibility.

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Resistance training

• Increases muscle strength and endurance, increases muscle mass, improves metabolic efficiency, maintains or increases bone density, prevents limitations in performance of everyday tasks, decreases the effort required to perform these tasks, and decreases the potential for injury during physical activity.
• Recommended for the general population; every individual should try to perform activities throughout the day that stimulate muscle strength and endurance.
• Activities that involve lifting, carrying, or performing repetitive movement against a resistance (vacuuming, shoveling, baking bread) help preserve lean body mass.

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Resistance training

• Purpose of weight training from a health perspective is:
• To develop toned, healthy muscles that provide the strength to do daily activities without risk of injury.
• To stimulate healthy bone.
• Some resistance exercises include chest press, bent over row, triceps extension.
• Slow, controlled movements result in greater benefits, lower risk of injury, and an appreciation of how the body feels as its muscles are challenged.

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Monitoring the inner and outer environment

• If not feeling well, individual should decrease the exercise effort or stop exercising until feeling better.
• With infection, cold, or flu, body is under stress, and overexertion will only increase that stress and possibly slow healing time.
• During acute exacerbation of chronic diseases (i.e., arthritis and HIV), activity should be limited to necessary activities of daily living (ADLs), but it is important to stay active.
• Extremes of heat and cold affect performance as body adjusts to different temperatures and wind conditions; air temperature and humidity affect muscle flexibility and ability to perspire and regulate body temperature.

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Fluid needs

• Extra fluid is needed to support physiologic homeostasis during exercise especially during hot weather.

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• It is recommended that individual drinks a cup of H2O 15 to 30 minutes before exercise; if weather is hot or indoor exercise area is very warm 4 to 8 ounces (120 to 240cc) of fluid should be taken in every 15 or 20 minutes during exercise.

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• For exercise lasting longer than an hour, a sports drink with carbohydrates and electrolytes enhances performance.

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Special considerations…CHD

• Hemodynamic and electrocardiographic response to mild to moderate weight training is similar to traditional forms of aerobic exercise.
• Even persons with severe disease can use small hand weights to increase muscle tone without risk of cardiovascular compromise.
• People who are the most deconditioned may need to exercise at lower intensities, for short durations, and more frequently throughout the day.
• Clients’ self-monitoring skills for activity tolerance: monitor pulse rate and signs and symptoms of intolerance.

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Special considerations…Diabetes

• People with NIDDM need to monitor their blood glucose levels and determine their responses to exercise.
• Diabetics are at risk for developing and should be screened for presence of retinopathy, nephropathy, cardiovascular disease, and peripheral and autonomic neuropathies because risk of these increase with exercise.
• Vital signs should be monitored and clients watched for signs of autonomic neuropathy, such as hypotension. Clients with peripheral neuropathy need to avoid trauma and high-impact activity because they are at risk for decreased sensation and neuropathic joints.

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Building a rhythm of physical activity

• The following generalities are true:
• Men are more active than women.
• Physical activity declines with age.
• Ethnic minorities are less active than the general population.
• Higher education and income are associated with more leisure-time activity.
• People who are obese are usually less active than their leaner counterparts.

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• Adherence and compliance: core desire (what motivates the individual to exercise); behavioral and attitudinal factors that influence the motivation and ability to adhere to active lifestyle are influenced by individual biopsychosocial and spiritual factors.

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Building a rhythm of physical activity

• Confidence is strongly related to participation and compliance.
• Enjoyment is another strong predictor of compliance and is associated with low-to moderate-intensity activities versus high-intensity activities and it is related to increased comfort and decreased incidence of injury.
• Creating a climate that supports exercise: people are more likely to increase physical activity if counseled to do so by health care professionals; clinicians need to serve as role models by demonstrating enthusiasm for being physically active.

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Building a rhythm of physical activity

• Social support by family and friends can be a valuable resource for behavioral change; parents can support children’s activity by having family outings and providing transportation, praise, and encouragement.
• Work sites can provide space for fitness facilities, they can make time and programs available to encourage people to be active during work hours.
• Schools need to develop strategies to facilitate increased activity in children.
• Communities should provide facilities and safe environments for regular physical activity.

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برنامج حماة المستقبل – الجامعة الهاشمية

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