-24 230 33

1. 1971-1975 1976-1980 1988-1994 -24 230 33 -11 218 -11 -34 238 79

2. 1971-1975 1976-1980 1988-1994

3. CARDIOVASCULAR DISEASE AND PHYSICAL ACTIVITY

4. Cardiovascular Diseases w Affect nearly 62 million Americans (or 1 in 5) each year w Result in 1 million deaths (1 out of every 2.5 deaths) • Cost individuals, government, and private industry over $350 billion annually • 12.6 million people have coronary heart disease • 1.1 million people suffer from a heart attack in a given year

5. LEADING CAUSES OF DEATH IN THE U.S. IN 2002

7. CAUSES OF DEATH FROM CARDIOVASCULAR DISEASES

9. DECLINE IN DEATHS, 1940 - 1990

10. Factors Contributing to Decline in Deaths w Better and earlier diagnosis w Better emergency and medical care w Improved drugs for specific treatment w Improved public awareness w Increased use of preventive measures, including lifestyle changes (exercise, diet, stress reduction, etc.)

11. Forms of Cardiovascular Disease Coronary artery disease (CAD) Stoke Hypertension Congestive heart failure Peripheral vascular disease Valvular, rheumatic, and congenital heart disease

12. Coronary Artery Disease Atherosclerosis—progressive narrowing of arteries due to build up of plaque Coronary artery disease (CAD)—atherosclerosis in the coronary arteries Ischemia—deficiency in blood and oxygen delivery to heart caused by CAD Myocardial infarction (MI)—heart attack due to ischemia and oxygen deprivation leading to muscle cell death and necrosis

13. Atherosclerosis Atherosclerosis begins in childhood and progresses at different rates, depending primarily on heredity and lifestyle choices such as smoking, diet practices, physical activity, and stress.

14. Normal vs. Atherosclerotic Artery

16. AN ARTERY WALL

20. DEVELOPMENT OF ATHEROSCLEROSIS Thrombus ↓ Embolus

22. w Blood lipids – High LDL-C – Low HDL-C – High triglycerides Primary Risk Factors for CAD Factors that can be controlled by lifestyle changes w Smoking w Hypertension w Physical inactivity w Obesity

23. Cholesterol The ratio of total cholesterol (Total-C) to high-density-lipoprotein cholesterol (HDL-C) may be the most accurate lipid index of risk for CAD. Values of 5.0 and greater indicate increased risk while values of 3.0 and lower represent low risk.

25. Secondary Risk Factors for CAD Treatable w Diabetes and high blood levels of insulin Untreatable w Family history of CAD w Male sex w Advanced age

26. Hypertension w Chronically elevated blood pressure w Causes the heart to work harder against higher afterload w Is uncommon in childhood but can appear during midadolescence w Places strain on arteries causing them to become less elastic over time: arteriosclerosis w Affects about one in every four adult Americans

27. Systolic DiastolicCategory (mmHg) (mmHg) Normal < 120 < 80 High normal 120-139 80-89 Hypertension Stage 1 140-159 90-99 Stage 2 ³ 160 ³ 100 Classification of Blood Pressure for Adults, Age 18 Years and Older

28. Controllable Risk Factors for Hypertension w Insulin resistance (type II diabetes) w Obesity w Diet—excess sodium intake w Use of oral contraceptives w Physical inactivity w Stress

29. Uncontrollable Risk Factors for Hypertension w Family history of hypertension w Advanced age w Race

30. Syndrome X It appears that hypertension, coronary artery disease, abnormal blood lipids, type 2 diabetes, and upper body obesity are linked through the common pathway of insulin resistance and hyperinsulinemia. Metabolic syndrome, syndrome X, and civilization syndrome are terms used to describe this interrelationship.

31. Stroke w Also called a cerebral vascular accident (CVA) w Cerebral infarction refers to when blood flow is blocked to one part of the brain due to a blood clot (thrombus), embolus, or atherosclerosis w Cerebral hemorrhage refers to a rupture of a blood vessel that diminishes blood flow beyond the rupture

32. Hemorrhage Infarction CEREBRAL INFARCTION AND HEMORRHAGE

33. Left brain damage Right brain damage Paralysis Right side Left side Deficits Speech, language Spatial, perceptual Behavioral style Slow, cautious Quick, impulsive Memory deficits Performance Language The Effects of Brain Damage Resulting From Stroke

34. Congestive Heart Failure w Heart muscle becomes too weak to produce cardiac output to meet oxygen demands of the body w Can result from damage to heart, hypertension, atherosclerosis, and heart attack w Blood backs up in veins causing edema, particularly in the legs and ankles and the lungs (pulmonary edema) w Can progress to irreversible damage, thus requiring a heart transplant

35. AMERICANS AT INCREASED CAD RISK

36. Physical Inactivity and CAD Epidemiological evidence shows that physical inactivity doubles the risk of CAD. Low-intensity activity or moderate fitness is sufficient to reduce the risk of this disease.

37. REDUCTION OF RELATIVE RISK Percentile of Activity Level

44. Aerobic Training Adaptations w Produces larger coronary arteries w Increases heart size w Increases heart pumping capacity w Improves circulation of blood to heart through increased collateral vessel formation w Reduces blood pressure (afterload) in individuals with moderate hypertension

45. Exercising monkey Sedentary monkey Left Main Coronary Arteries in Monkeys Fed Atherogenic Diets

46. How Exercise Reduces Risk of Disease w Improves the heart’s pumping capacity, work capacity, and circulation w Improves blood lipid profiles (↑HDL-C; ↓total-C and aLDL-C) w Controls blood pressure, weight, and blood glucose levels w Controls weight, reduces body fat, and increases muscle mass w Alleviates stress and usually results in decreased cigarette smoking w Reduces insulin resistance