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Outline:. Early studies on connection between level of Physical activity and risk of Heart attacks and Mortality ratesQuest for Holy Grail of Fitness Reality of Aging and Chronic DiseasesRole of Exercise in treatment of 4 leading Chronic diseases: Heart Disease, Stroke, COPD, and Diabetes. E
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2. Outline: Early studies on connection between level of Physical activity and risk of Heart attacks and Mortality rates
Quest for Holy Grail of Fitness
Reality of Aging and Chronic Diseases
Role of Exercise in treatment of 4 leading Chronic diseases: Heart Disease, Stroke, COPD, and Diabetes
3. Early 20th Century Era of Infectious Diseases:
Small Pox, Polio,
Pneumonia, Diphtheria
High Infant Mortality
Tuberculosis, Typhoid
Average life expectancy 47 years (1 in 10 newborn died)
(1 in 10 newborn died)
5. Died age 93Died age 93
7. Reality of Aging Aging is a natural process – we all age: but we all age differently
Burden of Chronic Disease, genetics, environment, SES, stress and Level of Fitness influence the aging process
9. Burden of Chronic Disease Almost two-thirds of Ontarians over the age of 45 have a chronic disease, and of those, about 55% suffer from two or more
The costs of chronic disease are estimated at 55% of the total and indirect health care costs in Ontario.
So this is a big problemSo this is a big problem
12. Low level of Fitness Related to many health conditions
14. Causes of Death in Ontario 2006-2008
On this slide, you can see the 4 major causes of death in Ontario in 1999 based on Ministry of Health and Long-Term Care data
But…..
On this slide, you can see the 4 major causes of death in Ontario in 1999 based on Ministry of Health and Long-Term Care data
But…..
15. Real Causes of Death Yet, when we look at the underlying causes, we see that tobacco is responsible for approximately 20% of deaths, and poor diet and lack of exercise another 21% or so.
Yet, when we look at the underlying causes, we see that tobacco is responsible for approximately 20% of deaths, and poor diet and lack of exercise another 21% or so.
16. Heart Disease #1 Killer worldwide
12 million deaths /year
Apart from aging and Genetics
Most Risk Factors are controllable:
Smoking Hypertension
High Cholesterol Diabetes
Obesity Physical Inactivity
17.
Quest for Holy Grail of Fitness
and its relationship to mortality
18. Birth of Aerobic Doctrinein 60s VO2Max: A measure of Fitness
-Maximum amount of Oxygen that muscles can consume during endurance exercise
(Exercise Bike or treadmill).
The scientific study of exercise blossomed in the 1960s and 1970s. Its principal research tool was the maximum oxygen uptake test, which measures the amount of oxygen taken up by the lungs, pumped by the heart, and delivered to the muscles during maximal exertion on a treadmill or bicycle ergometer. Improvements in the maximum oxygen uptake, or VO2 max, quickly became the gold standard for judging the efficacy of exercise.
In 1975, the American College of Sports Medicine issued its first exercise guidelines. They called for all healthy adults to exercise at aerobic intensity (60% to 90% of maximum) continuously for 20-30 minutes at least 3 times a week. These standards were soon adopted with only minor modification by the American Heart Association and the US Department of Health, Education, and Welfare, and they remained in effect for more than 2 decades.The scientific study of exercise blossomed in the 1960s and 1970s. Its principal research tool was the maximum oxygen uptake test, which measures the amount of oxygen taken up by the lungs, pumped by the heart, and delivered to the muscles during maximal exertion on a treadmill or bicycle ergometer. Improvements in the maximum oxygen uptake, or VO2 max, quickly became the gold standard for judging the efficacy of exercise.
In 1975, the American College of Sports Medicine issued its first exercise guidelines. They called for all healthy adults to exercise at aerobic intensity (60% to 90% of maximum) continuously for 20-30 minutes at least 3 times a week. These standards were soon adopted with only minor modification by the American Heart Association and the US Department of Health, Education, and Welfare, and they remained in effect for more than 2 decades.
19. Birth of Aerobic Doctrinein 60s VO2Max: A measure of Fitness
-Expressed as ml of O2 consumed /Kg body weight/minute e.g 35ml/Kg/min
As a MET number divided by 3.5 i.e 35ml/Kg/min=10METS
-Gold standard for judging efficacy of
Exercise and level of Fitness
The scientific study of exercise blossomed in the 1960s and 1970s. Its principal research tool was the maximum oxygen uptake test, which measures the amount of oxygen taken up by the lungs, pumped by the heart, and delivered to the muscles during maximal exertion on a treadmill or bicycle ergometer. Improvements in the maximum oxygen uptake, or VO2 max, quickly became the gold standard for judging the efficacy of exercise.
In 1975, the American College of Sports Medicine issued its first exercise guidelines. They called for all healthy adults to exercise at aerobic intensity (60% to 90% of maximum) continuously for 20-30 minutes at least 3 times a week. These standards were soon adopted with only minor modification by the American Heart Association and the US Department of Health, Education, and Welfare, and they remained in effect for more than 2 decades.The scientific study of exercise blossomed in the 1960s and 1970s. Its principal research tool was the maximum oxygen uptake test, which measures the amount of oxygen taken up by the lungs, pumped by the heart, and delivered to the muscles during maximal exertion on a treadmill or bicycle ergometer. Improvements in the maximum oxygen uptake, or VO2 max, quickly became the gold standard for judging the efficacy of exercise.
In 1975, the American College of Sports Medicine issued its first exercise guidelines. They called for all healthy adults to exercise at aerobic intensity (60% to 90% of maximum) continuously for 20-30 minutes at least 3 times a week. These standards were soon adopted with only minor modification by the American Heart Association and the US Department of Health, Education, and Welfare, and they remained in effect for more than 2 decades.
22. We studied a total of 6213 consecutive men referred for treadmill exercise testing for clinical reasons during a mean (±SD) of 6.2±3.7 years of follow-up. Subjects were classified into two groups: 3679 had an abnormal exercise-test result or a history of cardiovascular disease, or both, and 2534 had a normal exercise-test result and no history of cardiovascular disease. Overall mortality was the end point. Being Fit associated with a > 50% Risk Reduction.
After adjustment for age, the peak exercise capacity measured in metabolic equivalents (MET) was the strongest predictor of the risk of death among both normal subjects and those with cardiovascular disease. Absolute peak exercise capacity was a stronger predictor of the risk of death than the percentage of the age-predicted value achieved, and there was no interaction between the use or nonuse of beta-blockade and the predictive power of exercise capacity. Each 1-MET increase in exercise capacity conferred a 12 percent improvement in survival.
Exercise capacity is a more powerful predictor of mortality among men than other established risk factors for cardiovascular disease.
We studied a total of 6213 consecutive men referred for treadmill exercise testing for clinical reasons during a mean (±SD) of 6.2±3.7 years of follow-up. Subjects were classified into two groups: 3679 had an abnormal exercise-test result or a history of cardiovascular disease, or both, and 2534 had a normal exercise-test result and no history of cardiovascular disease. Overall mortality was the end point. Being Fit associated with a > 50% Risk Reduction.
After adjustment for age, the peak exercise capacity measured in metabolic equivalents (MET) was the strongest predictor of the risk of death among both normal subjects and those with cardiovascular disease. Absolute peak exercise capacity was a stronger predictor of the risk of death than the percentage of the age-predicted value achieved, and there was no interaction between the use or nonuse of beta-blockade and the predictive power of exercise capacity. Each 1-MET increase in exercise capacity conferred a 12 percent improvement in survival.
Exercise capacity is a more powerful predictor of mortality among men than other established risk factors for cardiovascular disease.
23. Protective Effect of Fitness in Different Conditions
24. Survival of the Fittest In 1859, Charles Darwin published his theory of evolution as an incessant struggle among individuals with different degrees of fitness within a species.
Now, nearly 150 years later, in the era of evidence-based medicine and rigorous scientific method, when fitness is measured and study subjects are followed for years, the data supporting the concept of survival
of the fittest are strong and compelling
25. Medical and Technological advances in Cardiovascular Medicine: 30% reduction in death rates from acute myocardial infarction
Over 200% increase in cost component of
Health Care System
Cardiovascular Drug Expenditure
Prediction: >10.6 billion by 2020
26. Effects of Recent Advances may be short lived! More Canadians esp those >50yrs age
have higher rates of Diabetes, Hypertension, High Cholesterol, Obesity
Increase in Heart Disease expected as the population grows older
27. Importance of Risk Factor Management By
Lifestyle Changes
28. Getting Fitter through Cardiac Rehab has its benefits
30. Stroke Rehab Of every 100 people who have stroke :
15 succumb in acute phase
10 recover completely
25 recover with minor impairment or disability
40 are left with moderate to severe disability
10 severely impaired ,require long term care
Deconditioning compromises physical independence and quality of life Stroke is the number one cause of long-term adult
disability
?? Total number of stroke survivors is increasing
?? 60% of stroke survivors have residual motor impairments
that may limit physical activity
?? Deconditioning compromises physical independence an
Stroke is the number one cause of long-term adult
disability
?? Total number of stroke survivors is increasing
?? 60% of stroke survivors have residual motor impairments
that may limit physical activity
?? Deconditioning compromises physical independence an
31. Stroke Rehab Decreased physical activity severely decreases VO2
Stroke survivors have a 30-40% lower aerobic capacity than age-matched persons
Stroke survivors have to work harder at a higher relative intensity to complete the same functional tasks
Increased energy demands secondary to stroke related deficits
Low VO2 + increased energy demands =
decreased functional capacity
32. Aerobic Training in Chronic Stroke 1. Improves fitness
2. Improves glucose metabolism
3.Improves cardiac profile
4. Improves walking function
5. Enhances Quality of Life
5. Locomotor gains linked to brain plasticity
(The Brain that changes itself : Norman Doidge)
33. Effect of Aerobic training
34. CHRONIC OBSTRUCTIVE PULMONARY DISEASE COPD is generally a silent and unknown killer in Canada, and threatens to be one of the main causes of disability and death in the new millennium.
COPD is the fourth leading cause of death for men and seventh for women (LCDC, Health Canada);
A rapidly advancing disease – the number of deaths from COPD has quadrupled since 1971, and, while it is projected that male mortality will begin to stabilize into 2016, female estimates show a triple-fold increase between 1996 and 2016.
Expected to be the 3rd leading cause of death worldwide by 2020.
35. CHRONIC OBSTRUCTIVE PULMONARY DISEASE ECG of COPD:
Diagnosing Airflow obstruction
Flow Volume Loop
38. Components of Lung Rehab ! How to control breathing when short of breath
Pursed Lip Breathing
Diaphragmatic Breathing
Aerobic exercises and Resistance training
Reducing isolation/anxiety
Nutritional needs
Using medications effectively
Need for Oxygen
Remaining a non-smoker
39. Inspiratory Muscle Training Combined with General Exercise Reconditioning in Patients with COPD Respiratory muscle strength
15% increased strength
33% increased endurance
12 minute walking distance
21% increase in exercise
BUT little change in Lung Function on measurement
41. Latin American Countries
Su bSahara AfricaLatin American Countries
Su bSahara Africa
42. Diabetes:A Man Made Disease Prevention is possible
43. DPP, participants from 27 clinical centers around the United States were randomly divided into different treatment groups. The first group, called the lifestyle intervention group, received intensive training in diet, physical activity, and behavior modification. By eating less fat and fewer calories and exercising for a total of 150 minutes a week, they aimed to lose 7 percent of their body weight and maintain that loss.DPP, participants from 27 clinical centers around the United States were randomly divided into different treatment groups. The first group, called the lifestyle intervention group, received intensive training in diet, physical activity, and behavior modification. By eating less fat and fewer calories and exercising for a total of 150 minutes a week, they aimed to lose 7 percent of their body weight and maintain that loss.
44. Role of Exercise in Treatment of Diabetes
45. Structured Exercise Training and Fitness Changes in Type 2 DM N=9 RCTs; 266 subjects
40% women, mean age 55.7
average duration of DM was 4.1 years
average exercise program: 49 mins x 3.4 x per week
Duration >8 weeks (avg 20 wks)
Exercise intensity 50% to 75% of VO2max UNIVERSITY OF OTTAWA
Systematic review and meta-analysis of randomized controlled clinical trials evaluating the effects of structured aerobic exercise interventions of 8 weeks or more on CR fitness in adults with Type 2
(up to and including year 2002) pooled N = 266
7 AT studies
-3.4 times/wk, 49 minutes per session for 20 weeks
-intensity ranged from 50-75% of VO2max
Weighted mean differences in A1C of -0.71 in the exercise groups (from the 2001 JAMA article)
MECHANISMS FOR LOW VO2 AT BASELINE
IR is associated with many abnormalities in muscle tissue including (POOR UTILIZATION):
-increase muscle lipid content
-impaired glycogen synthesis
-increase in anaerobic enzymes (PFK/CS ratio)
-increase in type II muscle fibres
OR
-Oxygen delivery (decreased cardiac output, decrease in capillary density)
EXERCISE HELPS BY:
-post-insulin Rc signaling cascade
-increase glucose delivery and use by increased capillary density
-increase glycogen synthase and HK activity
-increase GLUT 4 activity
-decrease release of FFAUNIVERSITY OF OTTAWA
Systematic review and meta-analysis of randomized controlled clinical trials evaluating the effects of structured aerobic exercise interventions of 8 weeks or more on CR fitness in adults with Type 2
(up to and including year 2002) pooled N = 266
7 AT studies
-3.4 times/wk, 49 minutes per session for 20 weeks
-intensity ranged from 50-75% of VO2max
Weighted mean differences in A1C of -0.71 in the exercise groups (from the 2001 JAMA article)
MECHANISMS FOR LOW VO2 AT BASELINE
IR is associated with many abnormalities in muscle tissue including (POOR UTILIZATION):
-increase muscle lipid content
-impaired glycogen synthesis
-increase in anaerobic enzymes (PFK/CS ratio)
-increase in type II muscle fibres
OR
-Oxygen delivery (decreased cardiac output, decrease in capillary density)
EXERCISE HELPS BY:
-post-insulin Rc signaling cascade
-increase glucose delivery and use by increased capillary density
-increase glycogen synthase and HK activity
-increase GLUT 4 activity
-decrease release of FFA
46. Comprehensive Chronic Disease Care Model STENO-2 Trial
Randomized trial of diabetes care
intensive risk factor care
Diet + Exercise
Vs. Usual care
8 year follow-up
mean age 55(27%W)
Composite endpoint
CVD death
Nonfatal MI and/or stroke
Revascularization or amputation The patient population only included white Danes
The overall sample size of 160 is relatively small(*0 Control+80 intensive)
NPH and regular insulin are arguably inferior to glargine and ultra-short acting insulins in terms of risk of complications and stable management of blood glucoseThe patient population only included white Danes
The overall sample size of 160 is relatively small(*0 Control+80 intensive)
NPH and regular insulin are arguably inferior to glargine and ultra-short acting insulins in terms of risk of complications and stable management of blood glucose
47. Physicians and their Patients 47% of primary care physicians include an exercise history as part of their initial examination (self report)
Only 13% of patients report physicians giving advice about exercise
50. Fall in Muscle Mass and VO2 can be reversed to prevent effects of Chronic Diseases and live better… “ Fitter” !
52. Can one get Younger and Fitter at any age ?
53. Seniors age 60-81 32 Exercise grp 33 ControlsSeniors age 60-81 32 Exercise grp 33 Controls
54. Seniors age 60-81 32 Exercise grp 33 ControlsSeniors age 60-81 32 Exercise grp 33 Controls
56. We need to be flexible in how we look at the elderly!