Published on February 28, 2014
Hasan Abu-Aisha, FRCP
Healthy feeding habits ◦ No extra table salt ◦ No junk food ◦ Extra vegetables and fruits Get rid of the extra weight. Stop tobacco use. No alcohol Stop worrying! Regular exercises (aerobic, resistance, flexibility).
The benefits of exercise: summary of the scientific evidence. Types of exercise. The Sudan Safe Exercises for All (SEFA) program.
Darren E.R. Warburton, Crystal Whitney Nicol, Shannon S.D. Bredin CMAJ 2006;174(6):801-9
Physical inactivity is a modifiable risk factor for cardiovascular disease and a widening variety of other chronic diseases, including ◦ ◦ ◦ ◦ ◦ ◦ ◦ hypertension, diabetes mellitus, cancer (colon and breast), obesity, bone and joint diseases (osteoporosis and osteoarthritis), and depression.
The prevalence of physical inactivity is higher than that of all other modifiable risk factors (51% of adults in Canada and 60% of USA adults, 86% of adults in Khartoum). There is evidence that physical activity is profoundly helpful in the primary and secondary prevention of : ◦ ◦ ◦ ◦ ◦ Premature death from any cause, cardiovascular disease, diabetes, some cancers and osteoporosis.
Over the last 60 years or so, numerous longterm prospective follow-up studies (in men and women) have assessed the relative risk of death from any cause and from specific diseases (e.g., CVD) associated with physical inactivity.
Both men and women who reported increased levels of physical activity and fitness were found to have 20-35% reductions in relative risk of death.
being fit or active was associated with a greater than 50% reduction in risk. Physically inactive middle-aged women (less than 1 hour of exercise per week) ◦ experienced a 52% increase in all-cause mortality, ◦ a doubling of cardiovascular related mortality ◦ and a 29% increase in cancer-related mortality compared with physically active women.
These relative risks from inactivity are similar to those for ◦ hypertension, ◦ hypercholesterolemia ◦ and obesity, and they approach those associated with moderate cigarette smoking.
Fig. 1: Relative risks of death from any cause among participants with various risk factors (e.g., history of hypertension, chronic obstructive pulmonary disease [COPD], diabetes, smoking, elevated body mass index [BMI ≥ 30] and high total cholesterol level... Warburton D E et al. CMAJ 2006;174:801-809 ©2006 by Canadian Medical Association
An increase in physical fitness will reduce the risk of premature death, and a decrease in physical fitness will increase the risk. The effect appears to be graded, such that even small improvements in physical fitness are associated with a significant reduction in risk.
Modest enhancements in physical fitness in previously sedentary people have been associated with large improvements in health status. People who went from unfit to fit over a 5year period had a reduction of 44% in the relative risk of death compared with people who remained unfit.
These protective effects were seen with as little as 1 hour of walking per week. A dose–response relation appears to exist: people who have the highest levels of physical activity and fitness are at lowest risk of premature death.
Fig. 2: Relation between changes in physical fitness and changes in mortality over time. Warburton D E et al. CMAJ 2006;174:801-809 ©2006 by Canadian Medical Association
The benefits of physical activity and fitness extend to patients with established CVD. This is important because, for a long time, rest and physical inactivity had been recommended for patients with CVD. Unlike studies of primary prevention, many studies of secondary prevention are RCTs. Several systematic reviews have clearly shown the importance of engaging in regular exercise to attenuate or reverse the disease process in patients with CVD.
Low-intensity exercise training (e.g., exercise at less than 45% of maximum aerobic power) has also been associated with an improvement in health status among patients with CVD.
Both aerobic and resistance types of exercise have been shown to be associated with a decreased risk of type 2 diabetes.
Exercise interventions are also effective in the management of DM. One prospective cohort study showed that walking at least 2 hrs /week was associated with a reduction in the incidence of premature death ◦ of 39%–54% from any cause, ◦ of 34%–53% from CVD.
Several seminal reviews published regarding the relation between cancer and routine physical activity. In over 100 epidemiologic studies, routine physical activity is associated with reductions in the incidence of specific cancers, in particular colon and breast cancer.
Weight-bearing exercise, especially resistance exercise, appears to have the greatest effects on bone mineral density. In one review,10 several cross-sectional reports revealed that people who did resistance training had increased bone mineral density compared with those who did not do such training. Furthermore, athletes who engaged in highimpact sports tended to have increased bone mineral density compared with athletes who engaged in low-impact sports.
A study involving early postmenopausal osteopenic women revealed: a 2-year intensive training program was effective in attenuating the rate of bone loss. preliminary evidence indicates that regular physical activity is an effective secondary preventive strategy for the maintenance of bone health and the fight against osteoporosis.
There is increasing evidence that enhanced musculoskeletal fitness is associated with an improvement in overall health status and a reduction in the risk of chronic disease and disability. This research has led to a shift in focus in research related to the health benefits of activities that tax the musculoskeletal system.
Fig. 3: Theoretical relation between musculoskeletal fitness and independent living across a person's lifespan. Warburton D E et al. CMAJ 2006;174:801-809 ©2006 by Canadian Medical Association
Two recent systematic reviews have revealed that enhanced musculoskeletal fitness is positively associated with: ◦ ◦ ◦ ◦ ◦ ◦ functional independence, mobility, glucose homeostasis, bone health, psychological well-being and overall quality of life and is negatively associated with the risk of falls, illness and premature death.
Currently, most health and fitness organizations and professionals advocate a minimum volume of exercise that expends 1000 kcal (4200 kJ) per week and acknowledge the added benefits of higher energy expenditures. Recently, investigators have postulated that even lower levels of weekly energy expenditure may be associated with health benefits. A volume of exercise that is about half of what is currently recommended may be sufficient, particularly for people who are extremely deconditioned or are frail and elderly.
Chronic inflammation (indicated by CRP) has been shown to be strongly associated with most of the chronic diseases. Recent RCTs have shown that exercise training may cause marked reductions in CRP levels. This may explain directly or indirectly the reduced incidence of chronic disease and premature death among people who engage in routine physical activity.
Aerobic (e.g. walking) Resistance (muscle building) Flexibility (joints and tendons) Agility (dancing, competitive games) High impact (athletes involved in combat)
Aerobic (e.g. walking) Resistance (muscle building): Flexibility (joints and tendons): Agility (dancing, competitive games): High impact (athletes involved in combat) Cardiopulmonary effects musculoskeletal effects musculoskeletal effects all all
Should be easily performable (at your own pace). Should be safe (all ages). Should not require teams/out-door activity. No equipments (no special yards/pools). No cost. Not embarrassing!
TYPE Aerobic (e.g. moving around): 30% Resistance (muscle building): 30% Flexibility (joints and tendons): 40% BENEFITS Cardiopulmonary health Muscle and Bone Health Healthy joints Overall fitness including metabolic benefits
Principles : 1. No special uniform needed. 2. No special field/platform needed. 3. No team needed. 4. No equipment needed. 5. You do not have to move to destinations. 6. You can stop anytime and then resume. 7. You do not compete with anybody else. 8. Easy protocol that you can follow.
Proper physical activity needs three independent components that need to be fulfilled: Potentiate your breathing capacity (capture more O2) and deliver the O2 to the cells. There are over 300 joints that need to be mobilized, lest they will get stiff (ankylosis, calcification). Resistance exercises to improve muscle power.
1. 2. Build muscle power by resistance (weight bearing).(30%) Activate the cardiopulmonary system by aerobic efforts. (30%)
1. Flexibility of the skeletal system: (40%) a) Cervical spine, shoulders, thoracic cage and spine, lumbar spine and mid-section, hips and pelvis. b) Stretch ligaments and tendons
Building neck muscle power by simple resistance exercise.
Stretching the long posterior tendons (t60) Forward bending (t30)
Open the pelvis (room for bowels, urinary bladder, prostate, uterus). Fights against constipation (Ca’ colon), urine problems. Improves cerebral circulation (Gravity effect: anti-demenia !)
Several groups work regular activities every week: The Green Yard, Khartoum 2/wk Manshia, Khartoum: 1/wk Police House, Khartoum 1/wk Mosques (5 in Khartoum) 1-2/wk each Kassala State North Kurdofan State North Darfur State Regular Television show (2/wk)
The Sudan Safe Exercises for All (SEFA) academy is now officially registered as an academic sports body Train the trainers Make a national program Include SEFA in PHC centers (Start with Khartoum State): collaboration with National Health Insurance Fund Include SEFA in universities (Start with Mughtaribeen and Kassala Universities) Study the effects of SEFA on community health (research proposal under structure)
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