Exercise Prescription ( I ) 運動處方

1. Exercise Prescription ( I ) 運動處方 許世全教授 香港中文大學 體育運動科學系 香港體適能總會 副主席 • Stanley Sai-chuen HUI • Associate Professor, Dept. of SSPE, CUHK • Fellow, ACSM • Vice-chairman, HKPFA

3. Changes of Physical Fitness

4. Changes of Physical Fitness

5. Effect of 12-week Strength Training

6. Effect Aerobic Ex on VO2max Foss 1998, Fox Ex Physiology, p. 329

7. Outlines • Course structure & requirement • Benefits of regular exercise • Pre-exercise screening • Risk stratification • Guidelines for exercise intensity and physician supervised exercise test

8. Course Structure • 22 Oct: Introduction Exercise Prescription I • 29 Oct: Exercise Prescription II Ex. Pres for HTN & DM • 5 Nov: Assessment of Fitness (Ex. Attires) Practicum of Ex Training • 26 Nov: Ex Pres for Arthritis & Obesity Medical Aspect & Community Resources

9. Course Requirement Attendance : 75% Evaluation : 67% • Practicum in class – 10% (Ex experience) • Practicum outside class – 30% (Ex Presp) • Written Test (on-line) – 60% Component of Evaluation: A Certificate will be issued to those who passed the assessment, jointly by the HKMA & the HKPFA

10. Benefits of Regular Exercise • Improvements in Cardiovascular and Respiratory Function • Increased maximal oxygen uptake due to both central and peripheral adaptations • Lower minute ventilation at a given submaximal intensity • Lower myocardial oxygen cost for a given absolute submaximal intensity

11. Improvements in Cardiovascular and Respiratory Function (cont’) • Lower heart rate and blood pressure at a given submaximal intensity • Increased capillary density in skeletal muscle • Increased exercise threshold for the accumulation of lactate in the blood • Increased exercise threshold for the onset of disease signs or symptoms (e.g., angina pectoris, ischemic ST-segment depression, claudication)

12. Benefits of Regular Exercise • Reduction in Coronary Artery Disease Risk Factors • Reduced resting systolic/diastolic pressures • Increased serum high-density lipoprotein cholesterol and decreased serum triglycerides • Reduced total body fat, reduced intra-abdominal fat • Reduced insulin needs, improved glucose tolerance

13. Decreased Mortality and Morbidity • Primary prevention (I.e.,intervention to prevent an acute cardiac event) 1. Higher activity and/or fitness levels are associated with lower death rates from coronary artery disease 2. Higher activity and/or fitness levels are associated with lower incidence rates for combined cardiovascular diseases, coronary artery disease, cancer of the colon, and type 2 diabetes

14. Secondary prevention (i.e. interventions after a cardiac event [to prevent another]) 1. Based on meta-analyses (pooled data across studies), cardiovascular and all-cause mortality are reduced in post-myocardial infarction patients who participate in cardiac rehabilitation exercise training, especially as a component of multifactorial risk factor reduction 2. Randomized controlled trials of cardiac rehabilitation exercise training involving post-myocardial infarction patients do not support a reduction in the rate of nonfatal reinfarction

15. Results of Studies Investigating the Relationship Between Physical Activity and Incidences of Selected Chronic Diseases * Few studies, probably less than 5; ** Approximately 5 to 10 studies; *** More than 10 studies.  No apparent difference in disease rates across activity or fitness categories;  Some evidence of reduced disease rates across activity or fitness categories;  Good evidence of reduced disease rates across activity or fitness categories;  Excellent evidence of reduced disease rates across activity or fitness categories, good control of potential confounders, excellent methods, extensive evidence of biological mechanisms, relationship is considered causal.

16. Results of Studies Investigating the Relationship Between Physical Activity and Incidences of Selected Chronic Diseases

17. Results of Studies Investigating the Relationship Between Physical Activity and Incidences of Selected Chronic Diseases

18. Other Health Benefits • Decreased anxiety and depression • Enhanced feelings of well-being • Enhanced performance of work, recreational, and sport activities • Increased ability to perform daily living tasks • Reduced muscle and joint injury risk

19. Other Health Benefits • Improved work performance • Enhanced self-concept and esteem • Improved socialization • Increased energy • Greater resistance to fatigue

20. Physical Fitness Health-related Motor skill-related Cardiovascular endurance 心肺耐力 Muscular strength and endurance 肌肉力量與耐力 Muscular flexibility 肌關節柔軟度 Body composition 身體脂肪百分比 [Neuromuscular Relaxation 肌神經鬆馳程度] Agility敏捷 Balance 平衡 Coordination 協調 Power 肌爆炸力 Reaction time 反應時間 Speed 速度

24. Positive Risk Factors for CHDACSM (2000) Family History • Myocardial infarction, coronary revascularization (bypass surgery) or sudden death before : • the age of 55 years in father or other male first degree relative (i.e. brother or son) • the age of 65 years in mother or other female first degree relative (i.e. sister or daughter) Cigarette smoking • Current cigarette smoker or those who have quit in the last six months Hypertension • Client on Hypertensive medications • Resting SBP > 140 mmHg and/ or DBP > 90 mm Hg • Fasting Glucose • Fasting blood glucose of 110mg/dL (6.1mmol/L)

25. Positive Risk Factors for CHDACSM (2000) Hypercholesterolemia • Total serum cholesterol > 200mg/dL (5.2 mmol/L) or • High density lipoprotein (HDL) < 35mg/dL (0.9 mmol/L) • Low density lipoprotein (LDL) > 130mg/dL (3.4mmol/L) • Client is on lipid lowering medications Obesity • Body Mass Index (BMI) > 25 kg/m2 • Waist girth >= 90 cm (M); >= 80 cm (F) Sedentary Lifestyle • Accumulating less than 30 minutes moderate intensity exercise 3-5 days weekly Negative Risk Factors for CHDACSM (2000) High level of HDL • HDL cholesterol > 1.6 mmol/L (60 mg/dl)

26. Initial Risk Stratification • Low risk • Younger individuals who are asymptomatic and meet no more than one risk factor threshold • Moderate risk • Older individuals (men 45 years of age; women  55 years of age) or those who meet the threshold for two or more risk factors • High Risk • Individuals with one or more signs/symptoms or known cardiovascular, pulmonary, or metabolic disease

27. ACSM Recommendations for:(A) Medical Examination and Exercise Testing Prior to Participation, and (B) Physician Supervision of Exercise Tests Low Risk Moderate Risk High Risk A. Moderate exercise NN NN R Vigorous exercise NN R R B. Submaximal test NN NN R Maximal test NN R R NN - Not Necessary R - Recommended

28. Current Recommendation of PA for Health Promotion 1996 U.S. Surgeons’ General Report: Physical Activity and Health (USDHHS / CDC / ACSM) Accumulating at least 30 minutes of any kind of moderate intensity physical activity on most days of the week would effectively reduce the risk of coronary heart disease, type 2 diabetes, hypertension, stroke and some kinds of cancer

29. Conclusion Physical inactivity is one of the most important public health problems and it is important to develop an action plan to address this issue • Policy makers • Public health professionals • Health service providers • Educators • Grassroots activists

30. The End of Exercise Prescription ( I )