Exercise is Medicine!

The importance of Regular Physical Activity on Health and Your Overall Well Being

Traye McGehee, MA, ATC

Clinical Coordinator UF Health Fitness and Wellness Center

mcgehc@shands.ufl.edu352-733-0384

Learning Objectives:

Benefits of Regular Physical Activity/Exercise

Physiological Adaptations of the Body to Exercise

Health Concerns When Beginning an Exercise Program

Normal Vital Signs and Their Importance

• Flexibility and its importance

• Exercise at Work/Exercising at Your Desk/Basic Exercises anyone can do at home

• Ergonomics and Proper Lifting Techniques/Mechanics

• Potentially Harmful Exercises and Possible Modification

• Exercise and Physical Activity for Adolescents

Fitness for AllThe Benefits of Fitness

Fitness and Health

The word health is often associated only with physical fitness, but there are other components of health.

FITNESS means “readiness”. Fit people are better equipped than non-fit people.

The level of fitness includes all aspects of health and life.

It affects physical, mental, and social health.

What is Physical Fitness?Physical Fitness is the

ability of your body systems to work efficiently. A fit person is able to carry out the typical activities of living, such as work, and still have enough energy and vigor to respond to emergency situations and to enjoy leisure time activities.

Physical Activity and ExercisePhysical activity is a

general term that includes sports, dance, and activities done at work or at home, such as walking, climbing stairs, or mowing the lawn.

When people do physical activity especially for the purpose of getting fit, we say they are doing exercise.

Health and Wellness Benefits of Physical Activity

Regular physical activity can do much to prevent disease and illness.

It can help you look your best (with proper nutrition, good posture, and good body mechanics).

Besides looking better, people who do regular physical activity feel better, do better on academic work, and are less depressed than people who are less active.

Regular physical activity results in physical fitness which is the key to being able to do more of things you want to do and enjoy life.

It allows you to be fit enough to meet emergencies and day-to-day demanding situations.

Being physically active can build fitness, which, in turn, provides you with many health and wellness benefits.

What is Fitness?Definition

Being in good Health or In Good Physical Condition

Four Health/Fitness Components

Cardiovascular Fitness

Body Composition

Flexibility

Muscular Strength and Endurance

Cardiovascular Fitness

ACSM’s RecommendationsFor those healthy adults under age 65

Do moderately intense cardio 30 minutes a day, five days a weekOR

Do vigorously intense cardio 20 minutes a day, 3 days a week

And• Do eight to 10 strength-training exercises,

eight to 12 repetitions of each exercise twice a week

Heart Rate TrainingTo find your target heart rate

220-age = Maximum Heart RateEasy: 50-60% of Max HRModerate: 75% of Max HRTraining: 85% or greater of Max HR220-40= 180 beat/min for a 40 year old

10,000 Steps/DayOne recommendation is to walk 10,000 steps

each day2000 steps equals one mileIf you are not at this point, gradually increase

your steps

10,000 Steps/Day

Receptionist 1120

Physician 2910

Physical Therapist 3820

Registered Nurse 7200

Licensed Practical Nurse 10,500

UPS Driver 18200

Grocery Stock Boy 21,000

Examples of Professions w/number of steps/day

Body CompositionBody composed of

Muscle, Bone, Blood, Organs, etc

What is Percent Body Fat?If you have 20% body fat, then you are 80%

everything else

What is fat used for?Insulates, Protects, Used as Fuel

% Body Fat: Measured with calipers, under water weighing, Electrical Impedence, Bod pod

Muscular Strength/EnduranceMuscular Strength

Ability to do a taskLift a Weight

Muscular Endurancebeing able to contract muscles over and over again

Resistance TrainingBenefits

Effect on Bone Improved bone density

Decrease risk of osteoporosisEffect on Muscle Increased muscle strength/sizeDecreased risk of injuryDecreased risk of low back injuries

Before Beginning an Exercise Program

Screening/ClearanceACSM recommends symptom-limited exercise testing before

vigorous exercise by men over 45 yo and women over 55 yoACSM recommends those who have 2 or more: major cardiac risk factorspersons with any signs or symptoms of coronary artery diseasethose with known cardiac, pulmonary, or metabolic disease

consult a MD prior to beginning an exercise program

ContraindicationsStop exercising and seek medical care if you

experience any of the warning signs during exerciseChest pain or tightnessDizziness or faintnessPain in an arm or your jawSevere shortness of breathAn irregular heartbeatExcessive Fatigue

How to Start an Exercise Program

Work out in short boutsMinimum of 10 minutes to be effective

How to Start an Exercise Program

Set a scheduleDetermine what time of the day works best for you

to trainExample: if you are a morning person, then that

may be the best time for you to train

How to Start an Exercise Program

You can train anywhereNo need to join a gymJust a pair of running or cross training shoes

and a desire to improve your wellness is all you need

How to Start an Exercise Program

Do something that you enjoyIt does not have to be a structured program

Tennis, Cycling, Gardening are all very good activities

You do not have to run to become fit

Benefits of Exercise Increase Self Esteem

Improved Mood

Boosts Energy

Strengthens Heart

Burns Calories

Improves Cholesterol Levels

Relieves Stress

Lowers risk of heart disease, hypertension, diabetes

Prevents bone loss

Decreases the risk of some cancers

Benefits of ExerciseAerobic and resistive exercise have a

very positive effect on muscle performance and overall disease control

Are you in shape?

Your aerobic fitness level, not your body weight, is the best measure of your overall health

-Cooper Institute for Aerobic Research

In terms of longevity, your fitness level is far more important than weight

Extra Benefits of Exercise

Individuals who are fit not only burn calories during exercise, but even when not exercising!!!!!!!!!!

Basics of Exercise PhysiologyExercise is a complex molecular, cellular and systemic

physiological stimulus

With every single bout of exercise, skeletal muscles, heart, brain, vascular

tissue, bone, liver, etc. experience some form of environmental “stress”.

The type and magnitude of an adaptation or response to exercise thus

results from a sum total of all these contributing factors. -

Specificity of Exercise: Adaptations that occur in response to training are specific to the nature of the training stimulus

Cardiovascular fitness: requires that the persontrain in a manner that challenges heart rate, cardiacoutput, capillarity … with the underlying change beingimproved oxygen delivery to working tissues

Muscular strength: requires that the person train in a mannerthat challenges the recruitment and force output of specificmuscle groups … with the underlying change being increasedmuscle mass.

Basic Principles of Exercise Training

Frequency - how often is the exercise performedeach week? For cardiovascular training effects3-4x per week is suggested

Intensity - the exercise must be performed at a level that challenges the cell/tissue/system for adaptations to occur.Totally dependent on starting state. Lower the starting fitnesslevel the lower the starting intensity. Must build to continue adaptations Most important variable in training regimen.

Duration - length of each training session. For cardiovascularAdaptations it is suggested to start at 30 minutes/session

MORE IS NOT NECESSARILY BETTER!overtraining/system failure

Known adaptations to endurance exercise

Skeletal MuscleÝ mitochondriaÝ capillary density

Heart Ý heart volumeÝ max stroke volumeÝ max cardiac output Decreased resting heart rateÛ blood pressure

Brain (very new studies)Ý neurogenesisÝ protection from seizures, injury

BoneÝ density? Type of exercise

Known adaptations to resistance exercise

Brain/NeuralÝ improved recruitment

Skeletal MuscleÝ Fiber sizeÝ Mitochondria?

BoneÝ density

Role of exercise in weight and/or body fat control

Exercise can increase caloric expenditure

Exercise can spare loss of lean body mass during times of caloric deficit

Increases in lean body mass will increase basal metabolic rate10lbs of lean body mass will lead to about 70-80kcal/day

ALL forms of exercise will burn fat

Amount of fat burned during exercise is NOT important.

Total calories used during exercise IS important

For patients/clients, pick an exercise/activity modality thatthey will do and do regularly. Type of exercise less important

Calories in vs. Calories out

Decreased risk of CancerEndometrial

Breast

Colon

prostate

- Obesity is reaching "epidemic proportions” in the United States- could soon cause as much preventable disease and death as cigarette smoking.

Application for Health ObesityType II Diabetes

For the vast majority of individuals, overweight and obesity result from excess calorie consumption and/or inadequate physical activity.

Unhealthy dietary habits and sedentary behavior together account for approximately 300,000 deaths every year.

Exercise and Type II Diabetes

About 10.3 million diagnosed cases and about 5.4 million undiagnosed

Accounts for 90-95% of all cases of diabetes

Characterized by insulin resistance and moderate insulin deficiency

Skeletal muscle: site of about 80-90% of glucose uptake

Physiological Benefits of Exercise for those with Type II Diabetes

Lower resting heart rateLower submaximal exercise heart rateIncreased stroke volumeIncreased cardiac outputEnhanced oxygen extractionLower resting BPLower exercise BPInfluence lipid profile

Exercise and Chronic Diseases

Cardiovascular DiseaseType II DiabetesObesityObesity related diseases

While all these diseases have some contribution from genetics the rapid increases in the last 20+ years aredue to environmental factors.

Sedentary living is responsible for about 34% of deaths due to coronary heart disease, colon cancer and Type II diabetes

CDC has concluded that “physical inactivity is one of the major underlying causes of premature mortality in the US”

1. Consider exercise/physical activity for both disease prevention as well as treatment

2. When considering exercise think movement or activity not athletic performance

3. Consider the importance of exercisefor children. Growing evidence for mental as well asphysical development. Educate for healthy lifestyle

• Good resource for exercise and health informationAmerican College of Sports Medicine www.acsm.org

Initiating an Exercise Program

Emphasize the importance of regular exercise

Look at long-term goals, exercise modalities

If a highly sedentary individual starting and exercise programbreak up exercise into 2 or 3, 10-15 minute

blocks daily

Start SimpleFind time to begin a gradual exercise program

Don’t do too much too soon, avoid injury

If deconditioned begin with 10 minutes of walking, then add 1 minute each day

It takes 12 weeks to see measurable results

Be patient, don’t do the scale dance!!

Start SimpleHealthy eating, monitor portions

5 Fruit and Vegetable servings each day

Start moving, follow ACSM guidelinesWork on your flexibilityConsult an expert on developing your exercise program

EASY TO DO ANYTIME

ANYWHERE

UPPER BODY

BICEP CURLS w/ water bottle

Hold water bottle in right hand and, with abs in and spine straight, curl bottle towards

shoulder. Repeat for other side.

TRICEP DIPS w/ chair

Make sure chair is stable and place hands next to

hips. Move hips in front of chair and bend the

elbows, lowering the body until the elbows are at 90 degrees. Push back up

and repeat.

TRICEPS EXTENSION w/ water bottle

Sit tall with the abs in and hold a full water bottle in the left hand.  Lift the bottle up to

shoulder level, pause, and then continue lifting all the

way up over the head.  When the arm is next to the ear, bend the elbow, taking the

water bottle behind you and contracting the triceps. 

Straighten the arm and lower down.

SHOULDER PRESS w/ books or bottles

Position water bottle to each side of shoulders with elbows below wrists. Press bottles upward until arms are

extended overhead. Lower to sides of shoulders and repeat.

SHOULDER SHRUGS w/ water bottles

Stand holding bottles to sides.Elevate shoulders as high as possible.

Lower and repeat.

PUSH UPS on desk, wall, or floor

Place your hands on the floor just beyond shoulder width apart. Keep your back straight and your knees straight and parallel to the floor. Slowly lower your body so as to touch your nose to the floor and then return to the start position by explosively pressing yourself upward. Again, it is

imperative to keep your back and body as straight as possible throughout this movement.

CORE

CRUNCHESLie down on the floor (you can

use a floor mat to rest on). Bend your knees and then hold your hands below the neck. Now,

while exhaling, lift the upper part of your body. Remember, do not tuck your chin in the chest, your

chin must be in a straight direction. Then while inhaling, go in the downward direction. This is the regular type of crunches, the

other types of crunches are a slight variation of this type. You must increase the count weekly, so that your body does not reach

a plateau.

RUSSIAN TWISTSBegin sitting on the floor with your

knees bent and your feet flat on the floor. Press your hands together or hold a water bottle, extending your arms out in front of you, and recline

back so that your body is angled about 45 degrees.

Keeping your lower body still, twist your body to the right and then to

the left.To increase intensity, simply lean

back. Use an angle that is comfortable, yet still gives your

abdominal muscles a challenge. 

PLANKSLie facedown on the

floor, prop yourself up on your forearms, and flex

your toes. Your body should form a straight

line from head to heels. Contract your abs and

glutes tightly. Hold.

Try SIDE PLANKS for a challenge

BRIDGES Lie flat on your back on a mat

with your knees bent pointing up to the ceiling and your arms at your sides. Simply raise your

pelvis up toward the ceiling to a point where your body will be at

a about a 45 degree angle relative to the floor. At the top of the movement, be sure to really flex your butt for a one-count.

Return to the start position and repeat.

For a challenge, try marching while you are in bridge formation

as shown.

FIRE HYDRANTSGet down on your hands and knees. Then slowly raise one knee out the side until it is parallel with the ground. Finish by slowly

lowering the leg.

Repeat 

LOWER BODY

CHAIR SQUATS

While sitting, lift up until your hips are just

hovering over the chair, arms out for balance.  Hold for 2-3 seconds,

stand all the way up and repeat.

ISOMETRIC WALL SITS

Stand against a wall. Lower into a squat (as if you're sitting into a chair), until

your knees are bent 90 degrees. Push

down into your heels and hold.

LUNGESStand with right foot forward, left foot back about 3 feet apart.Hold weights in each hand if desired and bend the knees to lower the body towards the floor. Keep the front knee behind the toes and be sure to lower straight down rather than forward.Keep the torso straight and abs in as you push through the front heel and back to starting position.Don't lock the knees at the top of the movement.

Seated LEG EXTENSIONS

Sit tall with the abs in and extend the left leg until it's level with hip,

squeezing the quadriceps. Hold for 2

seconds, lower.  Repeat on the other

side.

Standing LEG EXTENSIONSRest hands on chair.

Slowly kick right leg back, keeping knee straight.

It should be a small movement. If you start to lean forward you are

kicking too far.Do not let leg drop back to starting

position, control it's decent.Repeat 10 times with each leg.

CALF RAISESWith Water bottles in hands, raise heels by extending ankles as

high as possible. Lower heels by

bending ankles until calves are stretched.

Repeat.

HIP ADDUCTION

Place towel, firm water bottle or an empty coffee cup

between the knees as you sit up tall with the abs in. 

Squeeze the bottle or cup, release halfway and squeeze

again.

HIP FLEXION

Sit tall with the abs in and lift the left foot

off the floor a few inches, knee bent. Hold for 2 seconds, lower and repeat. 

Repeat on the other side.

Calestenics

Park in the furthest parking spot!!

If you can find time to do 10 minutes of exercise 3 times per day, you will meet the

ACSM recommendations of 30 minutes per day

Lifting Techniques

Lifting processBEFORE YOU LIFT

Plan Your Route: Path clear? Trip hazards removed? Dry?

Assess the Load: Too heavy? Can I use a hand truck or forklift? Can I slide it?

WHEN YOU LIFT

Lift It Right: Position your body close to the object. Keep your back straight.

Move It Right: Don't twist your back.

Lower It Right: When you put the load down, bend your knees not your waist.

GET HELP IF YOU NEED IT

Work Together: Don't be a hero. Communicate with your partner!

Plan ahead• Size up the load:

– Can it be split into multiple loads?

– Smaller loads cause less strain on the back.

– Can you slide it rather then lift?

• Use material handling equipment if load is too heavy:– Forklifts

– Hoists

– Dollies

9b

Plan aheadAvoid using lower rack for moderately heavy to heavy

items or awkward items.

Get help when lifting heavy, awkward, or long items.

9a

Basic rules of good lifting

• Size up the load before you lift.

• Can you lift a corner?

• Can you get to the item?

• Do you need to move something

to gain better access?

1a

Basic rules of good lifting

• Bend your knees.

• Get a good hand hold.

• Center yourself over the load.

• Lift straight up - let your legs do the work.

• Don’t twist or turn.

1b

Basic rules of good lifting

Have a clear path.

Set the load down properly.

Always push a cart or dolly.

Get help for long loads.

Split up heavy loads when you can.

Pushing a load is easier on the back; easier to control.

1c

Never twist or turn when liftingAdds strain to the back’s discs, muscles, ligaments,

tendons.

Plan your lift to avoid awkward positions.

Set load down if you’re losing your grip.

Don’t twist and turn or juggle load to regain grip.

Keep back as straight as possible.

5a

Carrying the loadEnsure a clear path.

Ensure a place where load can be set down.

Check for stability of load.

Can you get a good grip?

6a

Carrying the load

• Use mechanical equipment if load is too heavy.

• Get help if load is too heavy - lift at the same time to keep load balanced.

6c

Lowering the loadBend the knees to let leg muscles support the weight.

Slowly lower it; do not drop the load.

Avoid sudden movements.

Lower the load at the same time if working with a partner.

7a

Awkward Lifting

Lifts that are:

• Above the shoulders

• Below the knees

• At arms’ length

Principles for reducing heavy lifting

Reduce the weight

Increase the weight (to balance load)

Use mechanical assistance

Slide instead of lift

Team lifting

Reducing heavy lifting

Reduce the weight of the load

Wood pallet

60 pounds

Plastic pallet

20 pounds

Reducing heavy lifting

Slide instead of lifting

Principles for reducing frequent lifting• Use mechanical assistance

• Avoid unnecessary lifting

• Use mobile storage shelves

Principles for reducing awkward lifting/Reaching

Remove obstacles

Slide closer

Reduce shelf depth

Reduce package size

Use mechanical assistance

Team lifting

Reducing awkward lifting/

ReachingReduce package size

Principles for reducing awkward lifting/

BendingUse mechanical assistance to raise

the load

Add handles

Arrange storage

Avoid unnecessary lifting

Principles for reducing awkward lifting/ Reaching above shoulders

Arrange storage

Use mechanical assistance

Use a rolling stair or “safety ladder”

Lifting techniques trainingTeach lifting techniques to employees:

• Training alone is not effective.• Making changes to jobs and

equipment is better.• Making changes along with

training is most effective.

Lifting techniques training

• Job-specific, on-site, hands-on training is more effective than classroom.

• Have employees demonstrate proper lifting techniques before “graduating.”

Other factors in back injuriesAge of employee

Improper postures when sleeping, standing, sitting

Physical condition of employee

Repetitive motions

10a

Conclusion

• When lifting a box, think out of the box! • Is there a better way?• Don’t wait for someone to get injured before changing a job.• Just because we have done it this way. Do we have to continue to use the same method to handle loading and unloading of materials?

1. Use a good chair with a dynamic chair back and sit back in this

2. Top of monitor casing 2-3" (5-8 cm) above eye level 

3. No glare on screen, use an optical glass anti-glare filter where needed

4. Sit at arms length from monitor 5. Feet on floor or stable footrest  6. Use a document holder, preferably in-

line with the computer screen 7. Wrists flat and straight in relation to

forearms to use keyboard/mouse/input device

8. Arms and elbows relaxed close to body 

9. Center monitor and keyboard in front of you 

10. Use a negative tilt keyboard tray with an upper mouse platform or downward tiltable platform adjacent to keyboard

11. Use a stable work surface and stable (no bounce) keyboard tray

12. Take frequent short breaks (microbreaks)

            12 tips for an Ergonomic Computer Workstation

FLEXIBILITY

109

Flexibility Activity• Flexibility is an

important, but often neglected part of an exercise program.

• The importance of flexibility for health and well-being becomes more important with age.

Flexibility Fundamentals• Not the same as stretching.• The range of motion in a joint or joints is used to reflect

flexibility at that joint.– ROM= the extent and direction of movement that is

possible.– Joint specific

• Specific vocabulary is used to describe the movement of joints.– Flexion/extension, abduction/adduction, internal and

external rotation, etc.

111

Common Movements• Flexion• Extension• Abduction• Adduction• Rotation

112

Flexibility Fundamentals continued

• ROM at a joint depends on the type of joint. The unique nature of the different joints causes some to allow for greater mobility than others.– Ball-and-socket joint– Hinge joint

• Assessed– Static = without movement– Dynamic = active functional activity

113

Factors Influencing Flexibility• Anatomy

– Long “muscle-tendon units” (MTUs)– Properties of connective tissue and muscle– Type of joint

• Gender– Females more flexible

• Possibly related to:– bone structure (e.g., wider hips)– hormonal influences– physical choices (e.g., dance, gymnastics,

swimming) that require good flexibility

114

Factors Influencing Flexibility continued

• Genetics (loose joints)

• Lack of use or misuse– Lack of physical activity / muscle imbalances

• Race• Age (see next slide)

115

Influence of Age on Flexibility

10 20 30 40 50 60 70

F L E X I B I L I T Y

FLEXIBILITY

PHYSICAL ACTIVITY

AGE (years)

ACTIVITY

 

Health Benefits of Flexibility 

No ideal standard for flexibility exists.Necessary for optimal posture.Extremes of inflexibility and hyperflexibility increase the likelihood of injury.May help prevent muscle strain and such orthopedic problems as back pain (see next 2 slides).Stretching may help to relieve muscle cramps, stiffness, and some local or referred pain. 

117

Flexibility & Back Pain

• Short and tight muscles cause poor posture which leads to back pain.

118

Flexibility & Back Pain

Long and strong muscles keep the body in good alignment and reduce risk of back pain.

119

Health Benefits of Flexibility• Stretching is probably ineffective in

preventing muscle soreness.• Overstretching may make a person

susceptible to injury or hamper performance.

• Freedom of movement• Improved athletic performance

120

Stretching Methods

• Static–Active assistance–Passive assistance

• Ballistic• PNF

121

Static Stretching

• Safer and less likely to cause injury• Stretch slowly until tension • Hold stretch for 10 - 30 sec.• Relax the muscle • Increase stretch a bit more

122

Static Stretching• Active stretching• Passive stretching

See next slide (Figure 3)

123

124

Ballistic Stretching• Dynamic movement• Specificity of movement

125

Proprioceptive Neuromuscular Facilitation (PNF)

• Combines (active and passive) methods

• Most effective method forimproving flexibility

• Promotes increase in strength

126

PNF Stretching Technique

(C.R.A.C. Method)• Contract agonist isometrically• Relax muscle for a few seconds • Contract the antagonist for 15 seconds• Relax

127

How Much Flexibility is Enough?

How Much Stretching is Enough?

128

How much is enough?• Stretching exercises should be done regularly to

achieve optimal benefits.• For flexibility to be increased, you must stretch and

hold muscles beyond normal length for an adequate amount of time.Performing warm-up exercises is not the same as doing a stretching workout for flexibility development.

• The best time for stretching is when the muscles are warm.

129

FIT Formula (Static Stretching)

F 3 - 7 times per week

I 10% beyond normal length of muscle

T 15-60 seconds, 3-5 reps (rest 30 sec between reps)

130

Flexibility-Based Activities

• Yoga• Tai Chi• Pilates

131

Stretching Aids / Technology•Stretching ropes can make it easier to execute and hold stretches properly.

•Foam rollers can improve strength, balance, and flexibility.

132

Guidelines for Safe & Effective Stretching Exercise

• Do not force the stretch to the point of pain.

• Choose safe exercises.• Avoid overstretching weak muscles.• Use good technique.

133

Summary• Flexibility is often neglected• Joint specific• Many influencing factors• Many health benefits• Static stretching is the most widely

recommended.• 3-7 days per week target

Dynamic Flexibility & Strengthening

http://www.youtube.com/watch?v=E7ghNKOH9To

Potentially Dangerous Exercises

and Some Modifications

QUESTIONS????

THANK YOU!!