Exercise-How much do I really need? (v1.0) Robert M. Pepper, DO, FAAFP

Transcription

1 Exercise-How much do I really need? (v1.0) Robert M. Pepper, DO, FAAFP

2 ACSM Recommendations 30 min moderate 5x a week Or 20 min vigorous 3x a week AND

3 Self reporting (NHANES/CDC) 49% aerobic 23% aerobic + strength

4 Physical activity in the United States measured by accelerometer Troiano,RP et al Med sci sports exercise 2008 Jan; 40(1)

5 Ages and over age % and 2.5%

6 BMJ...whilst these guidelines may be effective in those that adhere, they remain largely ineffective at a

7 CDC 2013 Don t have time Family responsibilities/kid s Boring/Hate it/not enjoyable Too hard

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9 physician s favorite past 1.Spending times? time with family 2.Exercise/phy

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11 Which Physicians Are the Most Overweight? Percent Overweight Family Medicine Cardiology Dermatology 0% 10% 20% 30% 40% 50%

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13 METS 1 MET = energy produced of an average person seated at rest

14 METS Walking 4.0 mph(15:00 min/mile)= 5 METS Walking 5.0 mph

15 1: 4.6 METS 2: 7 METS 3: 10 METS

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17 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: /bjsports

18 785 (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

19 Where did this lead? 22/785 (2.8%) Dx with new CV problem ZERO had an abnormal exercise stress test

20 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:

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24 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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29 5 METS=Minimum Walking 4.0 mph (15:00 min/mile)=5 METS

30 6 METS Brisk walking 4.5 mph (13:20 min/mile)=6 METS

31 9 METS Wogging 5.0 mph (12:00 min/mile)=9 METS

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33 Wogging? Journal Human Evolution, 2009

34 ideal speeds: requiring least amount of energy

35 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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37 Wogging? 4.5 mph (13 min/mile) metabolic efficiency was at its lowest

38 Treadmill Conversions Mph: 5.0=12:00 0% /speed fixed 3%:10:32 5%:9:38 8%:8:38

39 Move to And then to

40 Works in the 3% Not taken by 97% V1.0 ADHERENCE

41 Exercise-How much do I really need? (v2.0) 2014-current

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44 2014:Best Study of the Year

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46 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

47 Quick Summary 15 years 55,000 adults ages (24%runners) Reduction all cause mortality

48 Quick Summary cont. 3 year added life expectancy benefit Persistent runners

49 Reduction of cardiovascular mortality of 45-50% Reduction of all cause mortality of 29%

50 That s way too much work!

51 This is not me!

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56 For less than 10K a week (7-10 min/day) x 6 years 29% reduction in all cause mortality 50% reduction in cardiovascular mortality

57 >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

58 Copenhagen City Heart Study Reduction in mortality in 1,878 recreational joggers Schnohr et al Am J Epidemiol 2013;177

59 AHA Scientific Sessions 2014

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66 CV-Who cares? I m 30, not 50 Aussie! Aussie! Aussie! Oi! Oi! Oi!

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68 Run. Slow, short, often. V2.0

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70 Last Time-How much do I really, really need? (v3.0-biohack)

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73 maximum rate of 02 consumption (Ml(O2)/kg min) surrogate of cardiorespiratory fitness

74 Calculating VO2 Max Treadmill Cooper test -12 minute run Norway method -uses maximal and resting heart rates (see handout)

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79 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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82 Spare 10 minutes? Erratic? HIIT! V3.0 BIOHACK

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84 Cardiac Remodeling in Response to 1 Year of Intensive Endurance Training Arbab-Zadeh, A et al 2014 Oct 3.:CIRCULATION.AHA

85 Rx transforms the heart of a slacker into one of an elite athlete

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87 doability 3-4 x a week, min low level exercise After nine months, long runs added

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89 Results: RV mass and volume immediate Add intense intervals eccentric hypertrophy of LV VO2max an average of 20%.

90 2015: Where are we now?

91 Exercise as Rx Absence of Fitness= Smoking Goals: 9 METS F/10 METS M Small changes in fitness provide at

92 Exercise Goals: Weight ACSM goals Consistent aerobic +strength

93 CV, live longer, time, bored Running provides significant benefits- even at relatively low levels

94 To do something you ve never done before, you have to do something you ve never done before.