March 4, 2015

PHYSICAL ACTIVITY

FEU-NRMF LECTURED BY: BARBARA AMITY N. FLORES, MD, DFM, FPSHPM

GUICO, CMA

1

COMMON RISK FACTORS FOR MAJOR

NON-COMMUNICABLE DISEASES

Unhealthy diet

Physical inactivity

Tobacco use

-WHO

Non-Communicable Diseases

Cardiovascular diseases (CVDs)

Diabetes

Obesity

Cancer

Chronic Obstructive Pulmonary Disease

(COPD)

Death from NCDs

60% of 58 million deaths annually

80% of deaths occur in low and middle

income countries

o 23% WHO African Region

o 78% Americas

o 52% Eastern Mediterranean

o 86% European Region

o 54% Southeast Asian Region

o 78% Western Pacific Region

-WHO, 2008

PHYSICAL INACTIVITY

(lack of physical activity)

4th leading risk factor for global mortality

Estimated to be the main cause for

approximately

o 21-25% of breast and colon cancers

o 27% of diabetes and

o ~30% of ischemic heart disease

burden

Figure 1. Prevalance of insufficient physical

activity

PHYSICAL ACTIVITY AND HEALTH

(+) Protective effects between

physical activity and risk for several

chronic diseases

Low levels of habitual physical

activity and low levels of physical

fitness are associated with markedly

increased all-cause mortality rates.

HEALTH BURDENS THAT COULD BE

REDUCED THROUGH PHYSICAL

ACTIVITY

13.5 million people have coronary

heart disease

1.5 million people suffer from a heart

attack in a given year

8 million people have adult-onset

diabetes

95, 000 people are newly diagnosed

with colon cancer each year

250, 000 people suffer from a hip

fractures each year

50 million people have high blood

pressure

Over 60 million people are

overweight

GUICO, CMA

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Physicians, their Patients & Exercise

47% of primary care physicians

include an exercise history as part of

their initial examination

Only 13% of patients report

physicians giving advice about

exercise

Physically active physicians are

more likely to discuss exercise with

their patients

DETERMINANTS OF PARTICIPATION IN

PHYSICAL ACTIVITY

Lack of time is the most commonly cited

barrier to participation in physical

activity

Injury is a common reason for stopping

regular activity

Smokers are more likely than non-smokers

to drop out of exercise programs

DETERMINANTS OF PARTICIPATION IN

PHYSICAL ACTIVITY

Body composition (percentage of body fat)

is not a powerful predictor of physical

activity habits;

o However, persons who are obese

are usually inactive.

Strongly related:

o Confidence in the ability to be

physically active

o Perceived barriers to activity

o Enjoyment of activity

Weakly related:

o Intention to exercise

o Awareness of the benefits of

exercise

Family and friends

o Role models

o Provide encouragement

o Companions during physical activity

BARRIERS:

o Environment/ Urbanization

Fear of violence and crime in

outdoor areas

High-density traffic

Low air quality, pollution

Lack of parks, sidewalks and

sports/recreation facilities

o Technology-reduces the energy

needed for activities of daily living

Excessive television viewing/

social media/ gadgets

PHYSICAL ACTIVITY

o any bodily movement produced by

skeletal muscles that requires

energy expenditure

o includes activities undertaken while

working, playing, carrying out

household chores, traveling, and

engaging in recreational pursuits.

-WHO

Health Benefits Associated With Regular

Physical Activity

Children and Adolescents

o Strong evidence

Improved cardiorespiratory

and muscular fitness

Improved bone health

Improved cardiovascular and

metabolic health biomarkers

Favorable body composition

o Moderate evidence

Reduced symptoms of

depression

Adults and Older Adults

o Strong evidence

Lower risk of early death

Lower risk of coronary heart

disease

Lower risk of stroke

Lower risk of high blood

pressure

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Lower risk of adverse blood

lipid profile

Lower risk of type 2 diabetes

Lower risk of metabolic

syndrome

Lower risk of colon cancer

Lower risk of breast cancer

Prevention of weight gain

Weight loss, particularly

when combined with reduced

calorie intake

Improved cardiorespiratory

and muscular fitness

Prevention of falls

Reduced depression

Better cognitive function (for

older adults)

o Moderate to Strong evidence

Better functional health (for

older adults)

Reduced abdominal obesity

Moderate evidence

Lower risk of hip fracture

Lower risk of lung cancer

Lower risk of endometrial

cancer

Weight maintenance after

weight loss

Increased bone density

Improved sleep quality

FITT PRINCIPLE Basic information to maximize the potential of

physical activity and exercise

Frequency

Intensity

Time

Type of Physical Activity

FREQUENCY

How often?

Number of times per week you engage in

physical activities

INTENSITY

Difficulty or exertion level of your physical

activity

Depends on how hard you have to work to

do the activity

Determined by:

o Target Heart Rate

o Talk Test

Formula for TARGET HEART RATE

Maximum Heart Rate (MHR)

MHR = 220-age

Target Heart Rate: 50-70% of the MHR

more advanced individualstarget heart rate

70-85% of MHR

Example: 40 year old PT

Maximum heart rate:

220 - 40 = 180

Multiply 180 by 50% and 70%

Target Heart Rate:

90bpm 126bpm

TALK TEST

ability to carry on a conversation while

doing a physical activity

a person doing

o moderate intensity activity can

talk but not sing

o vigorous intensity activity cant

say more than a few words without

stopping for a breath

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LIGHT INTENSITY

MODERATE INTENSITY

VIGOROUS INTENSITY

Common daily activities that dont require much effort

Make the heart, lungs, and muscles work harder than light-intensity activities

Make the heart, lungs, and muscles work very hard.

Scale of 0-10; activity is a 5 or 6

Scale of 0-10; activity is a 7 or 8

MODERATE INTENSITY ACTIVITIES

Walking briskly (3 miles/hr or faster,

but not race-walking)

Water aerobics

Bicycling slower than 10 miles per

hour

Tennis (doubles)

Ballroom dancing

General gardening

VIGOROUS INTENSITY ACTIVITIES

Race walking, jogging, or running

Swimming laps

Tennis (singles)

Aerobic dancing

Bicycling 10 miles.hr or faster

Jumping rope

Heavy gardening (continuous

digging or hoeing)

Hiking uphill or with a heavy

backpack

TIME

How long should you exercise?

Accumulated and continuous bouts of

moderate-intensity physical activity can

provide health benefits

o 30 minutes daily moderate-

intensity activities can be done in:

Five 6-minute intervals

Three 10-minute intervals

Two 15-minute intervals

Time depends on intensity

o Light-intensity activities >

moderate-intensity activities >

high-intensity activities

o Lighter activity the more time

required

Time needed Depends on Effort

Light Effort (60 minutes)

Moderate effort (30-60 minutes)

Vigorous effort (20-30

minutes)

-Light walking -Volleyball -Easy gardening -Stretching

-Brisk walking -Biking -Raking leaves -Swimming -Dancing -Water aerobics

-Aerobics -Jogging -Hockey -Basketball -Fast swimming -Fast dancing

Physical activities do not have to be

strenuous to provide health promoting

benefits

Moving from sedentary to moderately

active provides greatest improvement

in health benefits

4 TYPES OF PHYSICAL ACTIVITY

Aerobic

Muscle-strengthening

Bone-strengthening

Stretching

Aerobic Activity

o moves large musclesarms and

legs

o Examples: running, swimming,

walking, bicycling, dancing and

doing jumping jacks

o also called endurance activity

Muscle-strengthening activities

o improve the strength, power, and

endurance of muscles

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o examples: pushups and sit-ups,

lifting weights, climbing stairs, and

digging in the garden

Bone-strengthening activities

o feet, legs, or arms support the

bodys weight

o muscles push against the bones

o examples: running, walking, jumping

rope, and lifting weights

Stretching

o helps improve flexibility and ability to

fully move joints

o examples: touching your toes, doing

side stretches, yoga exercises

How much of physical activity is

recommended?

Children and adolescents aged 5-17

years

o Should do at least 60

minutes of moderate to

vigorous-intensity physical

activity daily

o Physical activity of amounts

>60 minutes daily will provide

additional health benefits

o Should include activities that

strengthen muscle and bone,

at least 3 times per week

Figure 2. Physical Activity Pyramid For

Children

Table 1. Example of Moderate-intensity and

Vigorous-intensity aerobic

FITT Prescription: Child and Adolescent

Frequency: Daily

Intensity: moderate to vigorous

Time: 60 minutes

Type: Aerobic activity and Muscle and

bone strengthening (at least 3x a

week)

Type of Physical Activity

Age Group Children

Age Group Adults

Moderate-intensity aerobic

-active recreation such as hiking -bicycle riding -brisk walking

-active recreation such as hiking -bicycle riding -brisk walking

Vigorous-intensity aerobic

-active games including running and chasing -bicycle riding -jumping rope -martial arts such as karate -sports such as soccer, ice or field hockey , basketball, swimming, tennis -cross-country skiing

-active games including running and chasing -bicycle riding -jumping rope -martial arts such as karate -sports such as soccer, ice or field hockey , basketball, swimming, tennis -vigorous dancing -cross-country skiing

GUICO, CMA

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How much of physical activity is

recommended?

Adults aged 18-64 years

o At least 150 minutes (2 hours and

30 minutes) of moderate-intensity

physical activity throughout the

week, or

o At least 75 minutes (1 hour and 15

minutes) of vigorous-intensity

physical activity throughout the

week, or

o An equivalent combination of

moderate- and vigorous intensity

activity

o Additional health benefits:

Increase moderate-

intensity physical activity to

300 minutes (5 hours) per

week, or equivalent.

o Muscle-strengthening activities

should be done involving major

muscle groups on 2 or more days

a week

FITT Prescription: Adults 18-64 years

Frequency: 1 week

Intensity: moderate intensity

Time: 150 minutes (2 hours and 30

minutes)

Type: Aerobic activity and Muscle and

bone strengthening

How much of physical activity is

recommended?

Adults aged 65 years and above

o Additional health benefits, increase

moderate intensity physical

activity to 300 minutes per week,

or equivalent

o Those with poor mobility: enhance

balance and prevent falls, 3 or

more days per week

o Muscle-strengthening activities

should be done involving major

muscle groups, 2 or more days a

week.

FITT Prescription: Adults 65 years and

above

Frequency: 1 week

Intensity: moderate

Time: 150 minutes (2 hours and 30

minutes)

Type: Aerobic activity and Muscle and

bone strengthening; enhance

balance

OLDER ADULTS

Additional health benefits

o Greater amounts of physical

activity

o Increasing the duration, intensity,

or frequency

Care should be taken not to engage in

excessive amounts of activity risk of

injury

SEDENTARY OLDER ADULTS AND THE

OBESE

Should start with short-intervals of

moderate physical activity (5-10

minutes) and gradually build up to the

desired amount

OLDER PEOPLE

Loss of strength and stamina attributed

to aging is in part caused by reduced

physical activity

Inactivity increases with age

o By age 75, about one in three men

and one in two women engage in

no physical activity

Social support (family and friends)

o Consistently and positively related

to regular physical activity

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BENEFITS OF EXERCISE IN OLDER

PEOPLE

Helps maintain the ability to live

independently

Reduces the risk of falling and fracturing

bones

Reduces the risk of dying from coronary

heart disease and of developing high

blood pressure, colon cancer, and

diabetes

Helps those with chronic, disabling

conditions improve their stamina and

muscle strength

Reduces symptoms of anxiety and

depression

Fosters improvements in mood and

feelings of well-being

Helps maintain health bones, muscles,

and joints

Helps control joint swelling and pain

associated with arthritis

SAMPLE CASES

FITT Prescription: 8-year old James

Walks to and from school (20

minutes)

Plays actively with family (20

minutes)

Jumps rope (10 minutes)

Does gymnastics in PE class (10

minutes)

FITT Prescription: 16-year old Maria

Walks dog (10 minutes)

Plays tennis (30 minutes)

Does sit-ups and push-ups (5

minutes),

Walks briskly with friends (15

minutes)

FITT Prescription: 44-year old Helen

30 minutes of brisk walking on 2

days

60 minutes (1 hour) of social

dancing (moderate intensity) on 1

evening

30 minutes of mowing the lawn

(moderate intensity) on 1 afternoon

Heavy gardening (muscle

strengthenings on 2 days

Target Heart Rate

MHR: 220 44 = 176

THR: 176 x 50% & 70%

Target Heart Rate: 88 bpm 123 bpm

FITT Prescription: 68-year old Marvin

30 minutes of brisk walking; 5x per

week

20 minutes jogging; 2x per week

8-10 reps calf raises, sideways leg

lift; 2x/wk

Sideways walking, heel to toe walk;

3x/week

10 minutes sideways stretch, upper

body twist; hip twist; daily

10-30 seconds stretch; daily

The world breaks every one

and afterwards many

are strong at the

broken places.

-Ernest Hemingway