Exercising Safely Dr. Mark Gwynne Dr. Zach Sandbulte Dr. Kyle Pope November 15, 2012

1. Exercising SafelyDr. Mark GwynneDr. Zach SandbulteDr. Kyle PopeNovember 15, 2012

2. Are you ready to exercise? • Is it safe for you to start exercising? • Most people are OK to start without medical clearance • Who needs medical clearance: • Chronic Disease: Diabetes, Asthma, Heart Disease, Arthritis, Liver or Kidney disease, • Dangerous symptoms: Chest Pain, Dizziness, Shortness of Breath, Swelling in feet • Men > 45 yo • Women > 55 yo • Smoking or recently quit • Physical Activity Readiness Questionnaire

3. What are your barriers? • I don’t have enough time • Exercise is boring • I’m too tired after work • It’s too hot/too cold • I’ve never been active • I don’t have the motivation • I don’t like exercising with other people • I’m worried about getting hurt Be honest about your barriers, write them down, find solutions Use an exercise log

4. Recommended Types of Physical Activity • Aerobic Exercise • Moderate aerobic activity for a combined total of 150 min/week, or at least 30 minutes most days of the week • 30 minutes  reduce risk of chronic disease • 30-60 min  prevent weight gain • 60-90 min  weight loss, prevent weight regain • Resistance training • Progressive resistance training for 20-30 minutes, 2 or more days of the week • Flexibility Training • Stretch major muscle groups and joints for 15-30 minutes at least 3 times a week (preferably daily)

5. What’s Moderate Exercise? Low, moderate and high intensity aerobic exercise: Maximum Heart Rate (MHR) = 220-age • Low (or Light) 40-54% MHR • Moderate 55-69% MHR • High (or Vigorous) >70% MHR Example: Moderate intensity exercise for a 50 year old woman is a heart rate of 94-118 bpm (220-50 x .55 or .69) Borg Perceived Exertion Scale

6. Low Intensity Moderate Intensity High Intensity

7. Progressive Resistance Training • Start low, go slow: 20-30 min, 2-3 days/week • Novice: • 8-12 Repetition Maximum (RM) • 2-3 days/week • Intermediate: • 1-12 Repetition Maximum (RM) • 3-4 days/week • Start with Large muscle groups Small muscle groups • Increase by 10% per week (weight or repetition)

8. Benefits of Exercise • Strong evidence • Lower risk of early death • Lower risk of coronary heart disease • Lower risk of stroke • Lower risk of high blood pressure • Lower risk of adverse blood lipid profile • Lower risk of type 2 diabetes • Lower risk of metabolic syndrome • Lower risk of colon cancer • Lower risk of breast cancer • Prevention of weight gain • Weight loss, particularly when combined with reduced calorie intake • Improved cardiorespiratory and muscular fitness • Prevention of falls • Reduced depression • Better cognitive function (for older adults) • Moderate Evidence • Better functional health (for older adults) • Reduced abdominal obesity • Moderate evidence • Lower risk of hip fracture • Lower risk of lung cancer • Lower risk of endometrial cancer • Weight maintenance after weight loss • Increased bone density • Improved sleep quality Intellectuals solve problems, geniuses prevent them.  - Albert Einstein

9. Why are we exercising? • Most of us are thinking of this !

10. Why are we exercising? • We should be thinking of this !

11. Have a goal in mind for your exercise • Health • Physique • Functionality and injury prevention • Stress reduction • Injury rehab • This will determine the duration/ type of cardio, #reps, sets, etc. • Additionally, make a schedule, stick to it.

12. The Modern Man • Workplace hazards • Poor posture = tight musculature = dysfunction = pain • Stretch • Take breaks from computer • Exercise to keep body balanced.

13. An effective workout • Most of us struggle to get dedicated exercise time, so make your sessions count. • Mix as many different exercises as possible. (legs, back, arms, cardio, core) • Avoid 1 muscle group workout days • (ex “chest day”) • Don’t ignore your least favorite areas • Have a partner, but don’t make your tongue the most exercised muscle

14. Things to consider • “Super-setting” exercises • More exercises, less rest, better cardiovascular expenditure • “Back” set, followed quickly by “Triceps” or “pushing” • Great way to do more, in less time • Can help break through barriers, and break through boredom, Endless variety

15. Fads • Work out Fads, TV info-mercials, bootcamps. • Can be great, motivating and get results • But be aware, must know your limits • Cross fit: • Intense total body fitness • No Pain, No Gain attitude • Exercise, strength needs to be increased at a slow gradual level. • Stress fractures, overuse injuries • Find something you enjoy. Zumba, swimming, water aerobics, body pump, spin classes, hiking

16. Supplements ? • What about supplements ? • Do I need them ? • One study shows that increasing dietary protein to 0.5-1.0 g/kg of body weight with strength training, does help reduce age related muscle mass • However, protein supplements have not been proven to show increased gains, when appropriate dietary protein is consumed. • Does timing with exercise matter ? A recent study shows no difference.

17. Where can I find out more ? • http://www.acsm.org(American College of Sports Medicine) • http://familydoctor.org/familydoctor/en/prevention-wellness/exercise-fitness/exercise-basics/the-exercise-habit.html (American Academy of Family Physicians) • http://www.cdc.gov/physicalactivity(Centers For Disease Control) • http://www.webmd.com/fitness-exercise/default.htm • Livestrong.com

18. Injury Prevention • Preventing muscle problems • Warm up • 5-10 mins • Walking, calisthenics. etc • Stretch (?) • Don’t stretch cold muscle • Cool down • 5-10 mins • Same as warm up

19. NY TIMES The Right Reasons to Stretch Before Exercise By GRETCHEN REYNOLDS …“stretching does not produce important reductions in muscle soreness in the days following exercise.” To Stretch or Not to Stretch? The Answer Is Elastic By GINA KOLATA … “no one really knows whether stretching helps, harms, or does anything in particular for performance or injury rates.”

20. Injury Prevention • Preventing joint problems • Respect pain • Wear proper shoes • Warm up • 5-10 minutes • Weight loss* • Regular exercise *According to one study, 10 pounds of weight loss for ten years reduces the of osteoarthritis by 50%.

21. Injury Prevention Does Running Cause Osteoarthritis in the Hip or Knee? Pamela Hansen, MD, Michael English, MD, Stuart E. Willick, MD Low- and moderate-volume runners appear to have no more risk of developing osteoarthritis than non-runners. The existing literature is inconclusive about a possible association between high-volume running and the development of osteoarthritis. University of Utah Orthopaedic Center, Salt Lake City, UT 84108, USA.

22. Injury Prevention • Preventing bone problems • Exercise strengthens bone • 30 mins/day • Gradually increase exercise, especially running

23. Treatment for muscle, tendon injury • Rest • 3-5 days or until pain resolves • Ice • 20 mins, 3-4 times per day • Compression • ACE bandage • Elevate • Elevate area of injury when not in use to help decrease swelling • Medications • Tylenol, NSAIDs (Ibuprofen, Naprosyn) to help with swelling