Exercise-How much do I really need? (v1.0)€¦ · favorite past 1.Spending times? time with family...
Transcript of Exercise-How much do I really need? (v1.0)€¦ · favorite past 1.Spending times? time with family...
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Exercise-How much do
I really need?
(v1.0) Robert M. Pepper, DO,
FAAFP
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ACSM Recommendations
30 min moderate 5x a week
Or
20 min vigorous 3x a week
AND
Strength training 2x a week
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Self reporting
(NHANES/CDC)
49% aerobic
23% aerobic +
strength
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Physical activity in the United States measured by accelerometer
Troiano,RP et al
Med sci sports exercise 2008 Jan; 40(1)
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Ages 18-59 and over age 60
3.5% and 2.5%
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BMJ
“...whilst these
guidelines may be
effective in those
that adhere, they
remain largely
ineffective at a
societal
level….fail in key
perceived barriers,
primarily lack of
time.”
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CDC 2013
•Don’t have time • Family responsibilities/kid
s
• Boring/Hate it/not enjoyable
• Too hard
• Too long
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What are
physician’s
favorite past
times? 1.Spending
time with
family
2.Exercise/phy
sical
activity
3.Travel
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Which Physicians Are the Most Overweight?
0% 10% 20% 30% 40% 50%
Dermatology
Cardiology
Family Medicine
Percent Overweight
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METS
1 MET = energy produced
of an average
person seated
at rest
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METS
•Walking 4.0
mph(15:00
min/mile)=
5 METS •Walking 5.0 mph
(12:00 min/mile)=
8 METS
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1: 4.6 METS2:
7 METS3: 10 METS
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Cardiovascular evaluation of middle-aged individuals engaged in high-intensity sport activities: implications for workload, yield and economic costs
Menafoglio, et al
Br J Sports Med doi:10.1136/bjsports-2014-093857
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785 (age 35-65)
asymptomatic athletes
Hx/PE/ECG/SCORE
Abnormals:112 (14.3% total)
• 5.1% “pathologic” ECG
• 4.1% SCORE >5%
• 4.7% abnormal PE
• 1.6 % red flag PMH/FHx
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Where did this
lead?
•22/785 (2.8%) Dx
with new CV
problem
•ZERO had an
abnormal exercise
stress test
•100 % exceeded >
10 METS
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Sitting is the new smoking?
Television viewing time and reduced life expectancy: a life table analysis
Veerman et al
Br J Sports Med 2012;46:927-930
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AHA SIHD Guidelines 2012
• A moderate or high dose of a statin therapy should be prescribed..
(Level of Evidence: A)
• Treatment with aspirin 75 to 162 mg daily should be continued indefinitely (Level of Evidence: A)
J Am Coll Cardiol. 2012;60(24)
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5 METS=Minimum
• Walking 4.0 mph
(15:00 min/mile)=5
METS
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6 METS
Brisk walking 4.5
mph
(13:20 min/mile)=6
METS
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9 METS
Wogging 5.0 mph
(12:00 min/mile)=9
METS
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Wogging?
Journal Human Evolution, 2009
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ideal speeds:
requiring least
amount of energy
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optimal speeds
for the group:
Males:8.3 mph
(7:13 min/mile)
Females:6.5 mph
(9:08 min/mile)
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Wogging?
4.5 mph (13 min/mile)
• metabolic efficiency
was at its lowest
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Treadmill Conversions
Mph: 5.0=12:00
Min/Mile @ 0% /speed
fixed
3%:10:32
5%:9:38
8%:8:38
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Move to
And then to
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V1.0 ADHERENCE
Works in the 3%
Not taken by 97%
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Exercise-How much do I
really need? (v2.0)
2014-current
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2014:Best Study of the Year
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3 major findings:
Runners had consistently lower all cause mortality vs non-runners
low doses and low speeds had significant mortality benefits
Persistent running over time (6 years) was more strongly associated with mortality reduction
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Quick Summary
•15 years
•55,000 adults ages
18-100
(24%runners)
•Reduction all
cause mortality
29%
•Reduction CV
mortality 50%
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Quick Summary
cont. •3 year added
life expectancy
benefit
•Persistent
runners
reduction AC/CV
of 29%/50%
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Reduction of
cardiovascular
mortality of 45-50%
Reduction of all
cause mortality of
29%
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That’s way too
much work!
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This is not me!
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50 minutes
@
10
min/mile
pace
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For less than 10K a week (7-10 min/day) x 6 years
• 29% reduction in all cause mortality
• 50% reduction in cardiovascular mortality
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>50 yoa
538 runners/ 423 non-runners Matched age, sex, functional ability
39% reduction in all cause mortality
Reduced disability and mortality among aging runners: a 21-year longitudinal study. Arch Intern Med 2008;168
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Copenhagen City Heart Study
• Reduction in mortality in 1,878 recreational joggers
Schnohr et al Am J Epidemiol 2013;177
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AHA Scientific Sessions 2014
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CV-Who cares? I’m 30, not 50
Aussie! Aussie! Aussie! Oi! Oi! Oi!
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V2.0
Run.
Slow, short, often.
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Last Time-How much do I
really, really need?
(v3.0-Biohack)
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• maximum rate of 02 consumption
(Ml(O2)/kg∙min)
• surrogate of cardiorespiratory fitness
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Calculating VO2
Max Treadmill Cooper test
-12 minute run
Norway method
-uses maximal and resting heart rates
(see handout)
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Wingate
Sprints: Pitfalls High exertion • Strong motivation
• Too strenuous for sedentary
(Hawley and Gibala 2009)
Total time > 20 minutes
• 2-3 min sprints, warm-up,
recovery intervals
(Garber et al 2011)
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V3.0 BIOHACK
Spare 10 minutes? Erratic?
HIIT!
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Cardiac Remodeling in Response to 1 Year of Intensive Endurance Training
Arbab-Zadeh, A et al
2014 Oct 3.:CIRCULATION.AHA
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Rx transforms the heart of
a slacker into one of an
elite athlete
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Plan:
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“doability”
• 3-4 x a week,
30-45 min low
level exercise
• After nine
months, long
runs added
• Max 7-9
hours/week
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Results:
• RV mass and volume immediate ↑
• Add intense intervals eccentric hypertrophy of LV
• VO2max↑an average of 20%.
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2015:
Where are we now?
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Exercise as Rx
•Absence of Fitness= Smoking
•Goals: 9 METS F/10 METS M
•Small changes in fitness provide at
least as much benefit as statins, ASA, and
ACE-I
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Exercise Goals: Weight
•ACSM goals
•Consistent aerobic
+strength
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CV, live
longer, time,
bored •Running provides significant
benefits- even at
relatively low
levels
•HIIT is very
effective and
doesn’t have to be
100% all out
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“To do something you’ve never done before, you have to do something you’ve never done before.”