The Miracle of Exercise

1. The Miracle of Exercise J. Kelly Smith, M.D., F.A.C.P.

3. Benefits • Decreases all cause mortality • Cardiovascular disease • Cancer • Helps prevent overweight, obesity • Lowers risk of type 2 diabetes mellitus • Lowers lipid levels • Lowers blood pressure • Lowers myocardial oxygen demands • Lowers risk of osteoporosis • Improves general health • Improves physical working capacity • Improves skin health • Improves mental outlook and acuity

4. Exercise target • Calculate maximum heart rate (MHR = 220 – age) • Start @ 40-50% of MHR • Target = 70-85% of MHR • Target ≥ 30 minutes/day 5 days/week

5. Atherogenesis

6. Atherogenesis

7. Atherogenesis

8. Exercise & mononuclear cell function • Six months of moderate intensity exercise • Decreased atherogenic cytokine production by peripheral blood mononuclear cells by 58.3% (P<0.001) • Increased atheroprotective cytokine production by peripheral blood mononuclear cells by 35.9% (P<0.001) • Decreased CRP levels by 35% Smith JK, Dykes R, Douglas JE, Krishnaswamy G, Berk S. JAMA 1999:281;1722-1727

9. Exercise & atherogenesis

10. Exercise & atherogenesis

11. Exercise & VEC function Habitual moderate intensity aerobic exercise stimulates an an atheroprotective VEC phenotype • Augments endothelial nitric oxide-dependent vasodilatation • Aids in normalizing shear stress effects on VEC function and on arterial remodeling • Reduces risk factors that adversely effect VEC function • Reduces proinflammatory effects of white adipose tissue on VEC function

12. Exercise & atherogenesis A Quid Pro Quo Relationship

13. Exercise & HIV

14. Exercise & HIV

15. Exercise & HIV

16. Exercise & HIV

17. Exercise & HIV

18. Exercise & HIV

19. Exercise & HIV

20. Exercise & HIV

21. Exercise & Obesity

22. Exercise & Obesity

23. Exercise & Obesity Adaptive thermogenesis

24. Exercise target • Calculate maximum heart rate (MHR = 220 – age) • Start @ 40-50% of MHR • Target = 70-85% of MHR • Target ≥ 30 minutes/day 5 days/week