Keeping Your Lifetime Warranty: Physical Activity and Health

Transcription

1 Keeping Your Lifetime Warranty: Physical Activity and Health Lynn Panton, PhD FSU College of Human Sciences Nutrition, Food and Exercise Sciences Alice Pomidor, MD, MPH Department of Geriatrics FSU College of Medicine

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3 Objectives Describe the public health risks and economic impact of physical inactivity in the US Describe the relationships between types of physical activity and personal health Discuss clinical strategies for translating known research outcomes about health and physical activity to patient care settings Identify the resources available to assist health care providers with incorporating physical activity into every patient interaction

4 The 2008 estimates were modeled from the Behavioral Risk Factor Surveillance System (BRFSS), which uses self-reported data from state-based adult telephone surveys, and 2007 census information.

5 The Cost of Inactivity Estimated that 250,000 premature deaths annually in the U.S are attributed to physical inactivity. Physical activity and obesity are second only to tobacco use as the leading causes of preventable death in the U.S. Booth et al. Waging war on modern chronic diseases: primary prevention through exercise biology. JAP; 88: ; 2000.

6 Cost of Chronic Disease Chronic disease afflicts 90 million Americans. In 1990 chronic diseases cost the American public 2/3 of a trillion dollars in health care expenses. CHD, Obesity, and Diabetes alone costs us nearly 1/2 a trillion dollars each year. Booth et al. Waging war on modern chronic diseases: primary prevention through exercise biology. JAP; 88: ; 2000.

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8 Hippocrates 460 BC All parts of the body which have a function if used in moderation and exercised in labors in which each is accustomed, become thereby healthy, well developed and age more slowly; but if unused and left idle they become liable to disease, defective in growth and age quickly.

9 Surgeon General States Inactivity is detrimental to your health! Physical Activity and Health. A Report of the Surgeon General. U.S. Department of Health and Human Services

10 There is a need for a wellrounded exercise program Endurance Flexibility Balance Strength Cress et al. Best practices statement. Physical activity programs and behavior counseling in older adult populations. Med Sci Sport Exerc, 2004: Nelson et al. Physical activity and public health in older adults: recommendation from the American College of Sport Medicine and the American Heart Association.. Med Sci Sport Exerc, 8: ;2007

11 Endurance

12 Physical activity can cardiovascular disease risk factors cholesterol and good cholesterol (HDL) blood pressure blood sugar and type II diabetes weight and abdominal obesity risk of some cancers breast cancer colon cancer may risk of endometrial and lung cancer improve mental health and mood ability to perform activities of daily living balance to prevent falls risk of dementia ultimately chances of living longer disease free and improve the quality of life Booth, F. et al. Waging war on physical inactivity: using modern molecular ammunition against an ancient enemy. JAP; 93: 3 30; 2002.

13 Physical Inactivity and Health Osteoporosis/Osteoarthritis Diabetes Mellitus Prevention of Weight Gain CHD Stroke Musculoskeletal Injury Functional Health Status Activity

14 All people over the age of 2 years should accumulate at least 30 minutes of endurance type physical activity, of at least moderate intensity, on most preferably all days of the week. In the report of the Surgeon General, 1996

15 Recent research has found that 30 minutes of activity does not have to be completed all at one time. Health benefits can still be obtained when activity is accumulated throughout the day. For example 10 minutes in the morning, 10 minutes at lunch, and 10 minutes in the evening. Murphy et al. Med Sci Spots Exer 34:2002

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18 Pedometers Pedometers may be a way to help motivate and get individuals more aware of their activity levels. Recent guidelines have recommended 10,000 steps/day for health benefits in adults. It is recommended that a 2-week baseline of steps is measured and then a 10% increase in number of steps per week can be made until desired level is attained. Swartz, A.M., et al. Prev Med, 2003; 37: Tudor-Locke, C.E., et al. Patient Educ Couns; (1): 23-8

19 Flexibility

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21 Benefits of Flexibility Resistance to injuries Decreases in lower back pain Improved posture Improvement in range of motion

22 Flexibility Flexibility-related activities facilitate greater ranges of motion around the joint. Flexibility activities can be conveniently incorporated into the office routine while sitting at a computer or at home watching television.

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24 Balance

25 Balance exercises help keep individuals independent by helping to avoid disabilities that may be caused by falling.

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27 Strength

28 Strength Training can: Strength Muscle mass or maintain bone density Ability to perform ADL Resistance to injuries and falls Self-esteem Risk of some CVD risk factors Singh, M. A. F. Exercise comes of age: rationale and recommendations for a geriatric exercises prescription. J. Gerontol. A. Biol. Sci. Med. Sci. 57A:M262 M282, 2002.

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30 Nagi (1991) - 3 stages leading to disability Pathophysiology Inactivity Examples Sarcopenia - loss of muscle mass (muscle fiber composition and size) Impairments Functional Limitations Decrease in lean body mass Decrease in strength Decrease in muscle power Walking speed decreases Cannot rise from chair Cannot carry groceries Cannot get across road Disability Can no longer live independently

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33 Osteosarcopenic Obesity Bone Osteopenia/Osteoporosis Fat Obesity Physical Disability Lean Sarcopenia

34 Breast Cancer Survivors

35 Variables Healthy Controls (n=15) Breast Cancer Survivors (n=15) Age (yr) 53.5± ±9.2 Menopausal Age (yr) 52.2± ±4.5 Weight (kg) 69.0± ±11.9 BMI (kg/m 2 ) 25.2± ±5.2 Chest press (kg) 77±20 61±13* Leg Extension 91±18 70±13* Total BMD (g/cm 2 ) 1.203± ±0.122 Forearm BMD (g/cm 2 ) 0.535± ±0.063* Ulna BMD (g/cm 2 ) 0.506± ±0.063* Radius BMD (g/cm 2 ) 0.557± ±0.065* Simonavice et al. Body composition, muscular strength, and physical function in breast cancer survivors and healthy controls. Int J Body Comp Res, 9(2):57-64; 2011

36 15 to 18-Month Follow-up in Healthy Controls (n=10) and Breast Cancer Survivors (n=10) Healthy Controls Pre Healthy Controls Post Breast Cancer Survivors Pre Breast Cancer Survivors Post Age (yr) 57±4 58±4* 57±7 59±6* Weight (kg) 69±15 70±14* 67±11 75±23* Lumbar Spine (g/cm 2 ) 1.172± ±0.117* 1.082± ±0.128* Femur (g/cm 2 ) 0.936± ±0.107* 0.942± ±0.133* Forearm (g/cm 2 ) 0.539± ±0.063* 0.462± ±0.066 * Body Fat (%) 38.3± ±8.0* 38.3± ±6.2* Lean-to-fat mass 1.77± ±0.62* 1.69± ±0.56*

37 6-Month Intervention Resistance Training and Resistance Training and Dried Plums Women assigned to one treatment Stratified to groups via: Weight Age BC stage Hormone therapy Bone medications Baseline upper body strength Baseline right forearm BMD Baseline spine BMD All women instructed to maintain current level of physical activity Record steps one week, each month of the study replace current supplements with one provided 600 mg calcium & 400 IU vitamin D

38 Supervised Resistance Training Two non-consecutive days/week 2 sets of 8-12 repetitions at 60-80% 1-RM Chest press Leg press Seated row Leg extension Hamstring curl Triceps press down Lower back hyperextensions Military press Biceps curl Abdominal crunch

39 Resistance training and dried plum group consumed 90 ± 6 g daily Women were advised to adjust food intake to account for macronutrients

40 Results 27 breast cancer survivors, ages 51-74yrs (RT:63±6; RT+DP:64±7yrs) 7% (n=2) dropout rate Adherence to exercise sessions RT:95±9%; RT+DP:97±5% Adherence to dried plums 87±17%; Excluding non-compliers (n=2): 94±5% Adherence to calcium/vitamin D supplements RT:89±14% ; RT+DP:89±24% No significant change in physical activity BL:6294±3459; 6M:6132±3041 steps

41 Muscular Strength RT Group (n=14) RT+DP Group (n=13) (kilograms) Baseline 3 month 6 month Baseline 3 month 6 month 1 RM Chest Press 68 ± ± 20 a 82 ± 21 a,b 72 ± ± 23 a 96 ± 22 a,b 1 RM Leg Extension 72 ± ± 26 a 88 ± 28 a,b 77 ± ± 20 a 99 ± 19 a,b Handgrip Dynamometer 48 ± 8 49 ± 7 48 ± 8 48 ± 5 49 ± 6 48 ± 6 a Significantly different from baseline, within same group, p<0.05 b Significantly different from 3-month within same group, p<0.05

42 Continuous Scale-Physical Functional Performance Upper body strength Upper body flexibility Lower body strength Balance & coordination Endurance Total function RT Group (n=14) RT+DP Group (n=13) Baseline 3 month 6 month Baseline 3 month 6 month 65.3 ± ± ± ± ± ± ± ± ± ± ± ± ± 68.9 ± 56.2 ± 13.8 a 13.0 a,b ± ± ± ± 64.5 ± 9.4 a ± 65.8 ± 9.8 a ± 63.7 ± 10.1 a 14.1 *Scores range from 0-100; 0=worst function; 100=best function a Significantly different from baseline, within same group, p<0.05 b Significantly different from 3-month within same group, p< ± 71.6 ± 14.9 a 17.8 a 82.8 ± ± ± 68.2 ± 17.2 a 19.9 a 71.8 ± 74.4 ± 13.6 a 14.0 a 72.8 ± 75.4 ± 13.6 a 13.7 a 70.8 ± 73.6 ± 13.4 a 14.5 a

43 Body Composition RT Group (n=14) RT+DP Group (n=13) Baseline 6 month Baseline 6 month Weight (kg) 72.4 ± ± ± ± 13.7 BMI (kg/m 2 ) 27.4 ± ± ± ± 5.1 Waist girth (cm) 85.2 ± ± ± ± 14.3 Hip girth (cm) ± ± ± ± 9.4 Lean mass (kg) 38.9 ± ± ± ± 5.7 Fat mass (kg) 30.4 ± ± ± ± 8.5 Lean/fat mass ratio 1.36 ± ± ± ± 0.26 Android fat (%) 46.0 ± ± ± ± 8.2 Gynoid fat (%) 47.6 ± ± ± ± 3.5 Android/gynoid ratio 0.97 ± ± ± ± 0.15 Total body fat (%) 43.2 ± ± ± ± 4.5

44 Bone Mineral Density (BMD) RT Group (n=14) RT+DP Group (n=13) BMD (g/cm 2 ) Baseline 6 month Baseline 6 month Total body ± ± ± ± Lumbar spine ± ± ± ± Left femur neck ± ± ± ± Left total femur ± ± ± ± Right femur neck ± ± ± ± Right total femur ± ± ± ± Left radius 33% ± ± ± ± Left total radius ± ± ± ± Left total ulna ± ± ± ± Left total forearm ± ± ± ± Right radius 33% ± ± ± ± Right total radius ± ± ± ± a Right total ulna* ± ± ± ± a Right total forearm ± ± ± ± a * Significant group by time effect, p<0.05 a Significantly different from baseline, within same group, p<0.05

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46 ...or START UP? How can we help persons become more physically active?

47 Strategies for Increasing Physical Activity Begin at home Learn how to help Personal/Patient Motivation Tools & Resources

48 Provider Manual u/index.cfm?page =geriatrics.resourc es&tabid=103 Patient Manual /index.cfm?page=g eriatrics.resources &tabid=104

49 Begin at home Only 34% patients report exercise counseling at last medical visit Personal health practices of physicians assoc w/patient counseling practices re: physical activity level, wt. management Communication of personal physical activity found to increase credibility Survey of 16 med schools, class of 2003: 61% of students adherent with physical activity Highest reported perception of relevance, rates of counseling among physically active students. Frank 2008; Lobelo 2009; Zhu 2011

50 Go4Life by NIA Patient- Centered

51 Learn how to help Physical activity curriculum in only 13% of medical schools; pilot program going on at Emory Only 28% of internal medicine residents at 6 training programs felt confident of ability to prescribe exercise Nurse practitioners able to learn to administer Senior Fitness Test in minutes and use in counseling & recommendations Multiple guidelines for prescribing exercise Am College Sports Med position stand for adults 2011, British Assoc of Sport and Exercise Sciences consensus 2010 Frank 2008; Lobelo 2009; Purath 2009; Garber 2011; O Donovan 2010

52 Active Aging Toolkit-Pt/PCP

53 Personal Motivation Primary care-based physical activity promotion effective at 12 months, multiple different interventions tried, NNT 12. Prochaska s stages of change often used: precontemplation, contemplation, determination, action, maintenance, relapse Motivational Interviewing generally more effective than traditional advice-giving, demonstrated effect in approx 75% interventions Health disparity issues access, environment, cultural perceptions of exercise Orrow Martins 2009; Bautista 2011

54 Motivational Interviewing Wednesday, May 16, 9:00am- 3:30pm Heather Flynn, PhD Ken Brummel- Smith, MD Andree Aubrey, MSW, LCSW

55 Exercise is Medicine-Pt/HCP

56 Tools and Resources American College of Sports Medicine Exercise recommendations for specific conditions $60-75 depending on source

57 American Heart Assoc-Patients

58 Web Resources American Heart Associationwww.heart.org/HEARTORG/GettingHealth y/physicalactivity/physical- Activity_UCM_001080_SubHomePage.jsp Active Aging Toolkitwww.firststeptoactivehealth.com/ Go4Lifehttp://go4life.niapublications.org/ Exercise is Medicinehttp://

59 Objectives Describe the public health risks and economic impact of physical inactivity in the US Describe the relationships between types of physical activity and personal health Discuss clinical strategies for translating known research outcomes about health and physical activity to patient care settings Identify the resources available to assist health care providers with incorporating physical activity into every patient interaction

60 References Frank E, et al. Physical activity levels and counseling practices of U.S. medical students. Med Sci Sports Exer 2008; 40: Garber EC, Blissmer B, Deschenes MR, et al. American College of Sport Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exer 2011: Lobelo F, Duperly J, Frank E. Physical activity habits of doctors and medical students influence their couselling practices. Br J Sports Med 2009;43: Martins RK, McNeil DW. Review of motivational interviewing in promoting health behaviors. Clin Psychol Rev 2009;29:

61 References O Donovan G, Blazzevich AJ, Boreham C, et al. The ABC of physical activity for health; a consensus statement form the British association of sport and exercise sciences. J Sports Sci 2010; 28: Purath J, Buchholz SW, Kark DL. Physical fitness assessment of older adults in the primary care setting. J Am Acad Nurs Pract 2009;21: Orrow G, Kinmonth A, Sanderson S, Sutton S. Effectiveness of physical activity promotion based in primary care: systematic review and metaanalysis of randomised controlled trials. BMJ 2012;344: Zhu DQ, Norman IJ, While AE. The relationship between doctors and nurses own weight status and their weight management practices: a systematic review. Obesity Rev 2011;12: