Published on February 28, 2014
Exercise is Medicine Are 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
Lifestyle-related Risk Factors and Risk of Future Nursing Home Admissions; 6462 Adults Risk Factor 45-64 years Hazard 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 Valiyeva E et al. Arch Int Med 2006; 166:985 3.25 (2.04-5.19)
Cooper Clinic Study 2012 41,000 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 Research Direct 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) 2005 Studied 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
Exercise As Medicine • • 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.
When Doctors Prescribe Exercise Spanish 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 Pad Clear 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 Guidelines Age 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 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). Develop a physical activity plan with your health care professional. Avoid inactivity. Refer to the Your Prescription for Health series. Vigorous-intensity activity at least 3 days per week. Muscle-strengthening and bone-strengthening activity at least 3 days per week. Adults (18-64) 150 minutes a week of moderateintensity, or 75 minutes a week of vigorous-intensity aerobic physical activity Muscle-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 inactivity Refer 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.
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 13
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 14
Lifestyle Benefits: Risk Factor and Lifestyle Modification Smoking cessation Lipid improvement Blood pressure control Exercise guidance Weight management Diabetes control Stress management 15
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 2012 Studied 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 exercise Strength training
F.I.T.T. Principle Frequency 3-5 x/week Intensity HR 50-75% of HRR, 60-80% of VO2Max Conversation Pace RPE RHR + 20 Time 15-60 min/session Type
Stages of Conditioning Initial Phase Duration: 4-6 weeks Goal: to increase frequency, proper form, & develop “good habits” Improvement Phase Duration: 4-6 mos. Goal: to gradually increase intensity & duration Maintenance Phase Duration: after 6 mos Goal: maintain CV fitness, avoid overuse injuries
Strength Training Positive impact on; Muscle mass & strength Bone density Metabolism Balance
Strength Training Significant correlation between muscle strength and; Independence Performance of ADL Preferred walking speed
Strength Training Start 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
Summary • 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.
Mercy’s Solution Mercy 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
Calcification Inhibitors in CKD and Dialysis Patients
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