Tim Church, M.D., M.P.H., Ph.D. Baton Rouge, LA
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1 Tim Church, M.D., M.P.H., Ph.D. Baton Rouge, LA
2 The Basics Great Exercise Resource The Environment, Activity & Weight Weight Lifting, Health & Weight Exercise Prescription for Weight Loss Regular exercise has health benefits for individuals of every weight Exercise can contribute to weight loss Exercise appears to be very important in weight loss maintenance
3
4 New York Times, Sunday May 29, 2011
5 Church et al, PLoS ONE, May 2011 Church et al, PLoS ONE, May 2011 Church et al, PLoS ONE, May 2011
6 METs Median (min, max) Activity Category Farm Jobs 3.0 (2.5, 4.5) Moderate Goods-Producing Mining and logging 3.8 (3.0, 8.0) Moderate Construction 4.0 (1.5, 7.5) Moderate Manufacturing 3.0 (1.5, 4.0) Moderate Service-Providing Trade 2.0 (1.5, 3.0) Light Information 1.5 (1.5, 1.5) Sedentary Financial activities 1.5 (1.5, 1.5) Sedentary Professional and 1.5 (1.5, 2.0) Sedentary business services Education and health 2.5 (1.5, 4.0) Light services Leisure and hospitality 2.5 (1.5, 3.5) Light Other services 2.5 (1.5, 3.0) Light Catrine Tudor-Locke et al Church et al, PLoS ONE, May daily kcals -120 daily kcals
7 Variables: Baseline weight (NHANES 1960) Change in daily occupation related caloric expenditure Calculate weight change over last 50 years & compare to NHANES data Diana Thomas at Montclair State via Corby Martin Differential equation for predicting weight change based on change in energy expenditure Focused on year old men and women & 5 day work week Baseline Church et al, PLoS ONE, May 2011 Church et al, PLoS ONE, May 2011
8 Church et al, PLoS ONE, May 2011 Given the ubiquitous removal of physical activity from the work the importance of daily physical activity (exercise) is more important than ever for both weight and health
9 Deaths per 10,000 person-years Low Moderate High Women Men Blair SN et al. JAMA 1989;262: Expected Relation 2200 Peak VO2 (ml/min) Age
10 Can you stop this decline? If yes, then how much exercise does it take? Can you reverse this decline? If yes, then how much exercise does it take? JAMA, 2007; 297: Percent Change Fitness Control 72 minutes 136 minutes 192 minutes Study Groups
11 SPH Control 72 minutes 136 minutes 192 minutes Study Groups SMH Control 72 minutes 136 minutes 192 minutes Study Groups
12 VT Control 72 minutes 136 minutes 192 minutes Study Groups 2 Change in MOS- Sleep Score * * - 12 Control 4 KKW 8KKW 12 KKW Courtesy of Chris Kline Change in MOS- Sleep Score Control 4 KKW 8KKW 12 KKW * Courtesy of Chris Kline
13 Accumulate 30 minutes a day, 5 days a week of moderate intensity physical activity Walking, walking and walking However, even 10 minute a day helps but more is better Obesity Trends* Among U.S. Adults BRFSS, 1990, 1995, 2005 (*BMI 30, or about 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%
14 Health Benefits of Aerobic & Resistance Training in Individuals with Diabetes: HART-D Tim Church, M.D., M.P.H., Ph.D. Pennington Biomedical Research Center Participants (n =262): Sedentary individuals with diabetes HbA1c: >6.5% but <11.0% Goal: Compare benefit to HbA1c of: Control group Stretching Aerobic training (AT) 12 kcal/kg/week Resistance training (RT) 3 days per week: 21 sets per day Combination of RT & AT (Combo) 10 kcal/kg/week & 1 set of 9 RT 2 days/week 3 Legitimate Programs 9 Month Intervention All exercise supervised (@ 20,000 sessions)
15 Primary Outcomes Published Church et al, JAMA Nov Primary Outcomes: Hemoglobin A1c Secondary Outcomes: Fitness and strength Fat mass and lean mass Age Mean (SD) 55.8 (8.7) Female 63.0% Ethnicity/race, % African-American 43.5% White 52.7% Other 3.8% Body Mass Index 34.9 (5.9) Waist Circumference, cm 112 (13.8) Relative VO2, ml/kg/min 19.2 (4.2) HbA1c, % Duration Diabetes, years 7.7 (1.0) 7.1 (5.5)
16 Any 97.3 Biguanides (metformin) 65% Sulfonylureas (glipizide) 24% Thiazolidinediones (glitazones) 18% Combination Drugs 16% Incretin Mimetics (exenatide) 10% DPP-4 Inhibitors (sitagliptin) 5% Meglitinides 3% Insulin 18% TOTAL (combo counted 2X) 176% Retention: 94% with follow-up data Compliant (>70% adherence): Aerobic: 72% Resistance Training: 82% Combo: 82%
17 Mean Pounds Lifted Per Week Month Aerobic Group Sessions/Week Intensity, % peak V Speed, MPH Grade, % Mean METs level Time, min/wk Combo Group 3x/wk Mod/Vig Speed ~ Grade METs Time Sessions/Week Intensity, % peak VO Speed, MPH Grade, % Mean METs level Time, min/wk Month 3 & 6 removed for presentation purposes Resistance 141 min/wk Aerobic Combo 140 ( ) min/wk RT: min/wk AT: 110 ( ) min/wk
18 Total exercise time similar across groups Delivered aerobic interventions that met current recommendations
19 * * *Different from all other groups All Sig Vs Control Sig. vs Control & RT
20 Sig. Vs. Control Sig. Vs. Control & AT Sig. Vs. AT & Combo
21 For a given amount of time a physical activity program composed of aerobic and resistance is superior to either activities alone HbA1c Fitness Muscle Mass Fat Mass The HART-D combination program consisted of: 110 minutes per week of mod/vig intensity walking 2 days of 9 resistance training exercises each 10 to 12 repetitions per exercise ~20 minutes per day Most organizations minutes per day most days minutes per week
22 Obtain at least 30 minutes per day of moderate intensity physical activity 5 or more days a week Something is better than nothing If you are gaining weigh despite this Eat less or do more exercise If you want to lose weight & KEEP IT OFF minutes per day most days has to become part of your life Must be combined with dietary changes Lifting weights is good for you Aerobic 3-4 days a week 45 to 60 minutes Interval or high intensity training at least one day per week Resistance training 1-2 days per week Stretching 3-4 days per week
23
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