The basics Great exercise resource The environment has changed Aerobic exercise What about weight lifting?

Transcription

1 The Role of Exercise in Heart Health Overview of Talk The basics Great exercise resource The environment has changed Aerobic exercise What about weight lifting? Tim Church, M.D., M.P.H., Ph.D. Baton Rouge, LA Basics of Exercise & Weight: Not Rocket Science 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 1

2 The Environment Has Changed New York Times, Sunday May 29, 211 2

3 Obesity Trends Among U.S. Adults BRFSS, 1992 Is the loss of farming jobs driving the U.S. adult obesity epidemic?? No Data <1% 1% 14% 15% 19% 2% 24% 25% 29% 3% Farming Jobs in US Current Employment Statistics (CES) Current Population Survey (CPS) % of Employed in Farm Based Jobs Church et al, PLoS ONE, May 211 3

4 Goods Producing Jobs: Manufacturing, Construction & Mining/Logging % Manufacturing 5. Construction. Mining/Logging Year Jobs in U.S. Over Last 5 Years % Year Service Jobs Goods Producing Jobs. Agricultural Jobs Church et al, PLoS ONE, May 211 Church et al, PLoS ONE, May 211 METs Median (min, max) Activity Category Farm Jobs 3. (2.5, 4.5) Moderate Goods-Producing Mining and logging 3.8 (3., 8.) Moderate Construction 4. (1.5, 7.5) Moderate Manufacturing 3. (1.5, 4.) Moderate Service-Providing Trade 2. (1.5, 3.) 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.) Sedentary business services Education and health 2.5 (1.5, 4.) Light services Leisure and hospitality 2.5 (1.5, 3.5) Light Other services 2.5 (1.5, 3.) Light % Total Private US Jobs Physical Activity Intensity Year Light (2. to 2.9 METS) Sedentary (<2 METS) Moderate ( 3. METS) Catrine Tudor-Locke et al Church et al, PLoS ONE, May 211 4

5 Daily Occupational Caloric Expenditure Occupation Related Daily Energy Expenditure (calories) Men 1,55-14 daily kcals 1,45 1,35 Women -12 daily kcals 1,25 1, Year So.. Variables: Baseline weight (NHANES 196) Change in daily occupation related caloric expenditure Calculate weight change over last 5 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 4-5 year old men and women & 5 day work week Men: Predicted Weight Change Men: Predicted vs. NHANES NHANES 95 Predicted Based on Change in Occupation Related Energy Expenditure 95 9 Predicted Based on Change in Occupation Related Energy Expenditure Weight (kg) Baseline Men Weight (kg) Baseline Men Church et al, PLoS ONE, May 211 Church et al, PLoS ONE, May 211 5

6 Women: Predicted vs. NHANES Weight (kg) The Environment has Changed 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 65 6 Baseline Women Church et al, PLoS ONE, May 211 Brief Review of Aerobic Exercise & Health CVD Mortality Rates by Fitness: Aerobic Center Longitudinal Study (ACLS) Deaths per 1, person-years Low Moderate High Women Men Blair SN et al. JAMA 1989;262:

7 Fitness and All-Cause Mortality, ACLS Men, Fitness and All-Cause Mortality, ACLS Men, Adjusted Death Rate per 1, PY % Upper Limit Expected Expected Relation Relation Adjusted Death Rate 95% Lower Limit Adjusted Death Rate per 1, PY % Upper Limit Expected Relation Adjusted Death Rate 95% Lower Limit GXT Test Performance (minutes) GXT Test Performance (minutes) Fitness and Age in Women Dose Response to Exercise in Women: DREW Peak VO2 (ml/min) Age 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? 7

8 Telephone screens (n = 4,542) Excluded: Did not meet criteria (n = 2,618) Completed assessment (n = 1,924) Excluded (n = 1,46) Did not meet criteria (n = 969) Refused participation (n = 491) Randomized (n = 464) JAMA, 27; 297: Group A (n = 12) Group B (n = 155) Group C (n = 14) Group D (n = 13) Currently active (n = 1) Completed (n = 85) Withdrawn (n = 7) Currently active (n = 28) Completed (n = 12) Withdrawn (n = 7) Currently active (n = 17) Completed (n = 74) Withdrawn (n = 13) Currently active (n = 16) Completed (n = 84) Withdrawn (n = 3) Telephone screens (n = 4,542) Excluded: Did not meet criteria (n = 2,618) Adherence Across Exercise Groups Completed Excluded (n = 1,46) assessment Did not meet criteria (n = 969) Refused participation (n = 491) (n = 1,924) Randomized 91% completed study (n = 464) Group A (n = 12) Group B (n = 155) Group C (n = 14) Group D (n = 13) Currently active (n = 1) Currently active (n = 28) Currently active (n = 17) Currently active (n = 16) Completed (n = 85) Completed (n = 12) Completed (n = 74) Completed (n = 84) Withdrawn (n = 3) Withdrawn (n = 7) Withdrawn (n = 7) Withdrawn (n = 13) Percent Change Fitness KKW 8 KKW 12 KKW Study Groups 8

9 Daily Steps Exclusive of Training Spontaneous Activity 4 KKW 8 KKW 12 KKW Months Threats to Validity of Exercise Trials Drop-out Compliance To exercise prescription Outside activity Percent Change Fitness Change in Fitness 3.8 Control 72 minutes 136 minutes 192 minutes Study Groups Quality of Life Measures 9

10 Change in Physical Health Change in Mental Health SPH SMH Control 72 minutes 136 minutes 192 minutes Control 72 minutes 136 minutes 192 minutes Study Groups Study Groups VT Change in Energy Control 72 minutes 136 minutes 192 minutes -1 Study Groups -12 Sleep Disturbances subscale Change in MOS-Sleep Score Courtesy of Chris Kline Control 4 KKW 8KKW 12 KKW * * 1

11 Change in MOS-Sleep Score Sleep Problems Index Control 4 KKW 8KKW 12 KKW * Summary: The Basic Prescription Accumulate 3 minutes a day, 5 days a week of moderate intensity physical activity Walking, walking and walking However, even 1 minute a day helps but more is better Courtesy of Chris Kline Health Benefits of Aerobic & Resistance Training in Individuals with Diabetes: HART-D JAMA, 21; 34: Tim Church, M.D., M.P.H., Ph.D. Pennington Biomedical Research Center 11

12 HART-D Participants (n =262): Sedentary individuals with diabetes HbA1c: >6.5% but <11.% 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) 1 kcal/kg/week & 1 set of 9 RT 2 days/week 3 Legitimate Programs HART-D Primary Outcomes: Hemoglobin A1c Secondary Outcomes: Fitness and strength Fat mass and lean mass 9 Month Intervention All exercise supervised (@ 2, sessions) Participants Age Mean (SD) 55.8 (8.7) Female 63.% 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.) 7.1 (5.5) Diabetes Medications Any 97.3 Biguanides (metformin) 65% Sulfonylureas (glipizide) 24% Thiazolidinediones (glitazones) 18% Combination Drugs 16% Incretin Mimetics (exenatide) 1% DPP-4 Inhibitors (sitagliptin) 5% Meglitinides 3% Insulin 18% TOTAL (combo counted 2X) 176% 12

13 Retention & Compliance Retention: 94% with follow-up data Compliant (>7% adherence): Aerobic: 72% Resistance Training: 82% Combo: 82% HART-D Training RT Group Aerobic Training: AT & Combo Mean Pounds Lifted Per Week Aerobic Group Sessions/Week Intensity, % peak V Speed, MPH Grade, % Mean METs level Time, min/wk Combo Group Sessions/Week Intensity, % peak VO Speed, MPH Grade, % x/wk Mod/Vig Speed ~ Grade METs Time Month Mean METs level Time, min/wk Month 3 & 6 removed for presentation purposes 13

14 Time Exercising HART-D Intervention Goals Achieved!!! Resistance Aerobic 141 min/wk 14 (13-15) min/wk Total exercise time similar across groups Delivered aerobic interventions that met current recommendations Combo RT: 3-4 min/wk AT: 11 (1-12) min/wk HART-D Results HbA1c by Month and Group Intention-toTreat Analysis (n=262) Control HbA1c, % Resistance Aerobic Combo Month 14

15 METs: From Speed & Grade Estimated METs METs Sig vs. Control & RT Control Resist Aero Combo METs % or 1 MET Sig vs. Control & RT Control Resist Aero Combo CVD Mortality Men with Diabetes CVD Mortality Men with Diabetes CVD Death Rate (per 1K man-year) <7 7 to to to to 1.9 Church et al, Arch Int Med, 25 Mets 11 t o to 12.9 >13 CVD Death Rate (per 1K man-year) <7 7 to to to to t o to 12.9 >13 Church et al, Arch Int Med, 25 Mets 143 to 92 36% decrease 15

16 Strength Testing Waist Circumference Strength - Biodex * * Waist Circumference, cm All Sig Vs Control -1 Control Resist Aero Combo -4 Control Resist Aero Combo *Different from all other groups Weight DEXA Data RT AT Combo Change Weight, Kg Sig. vs Control & RT RT AT Combo Change, Kg Sig. Vs. Control Fat Mass Sig. Vs. Control & AT Sig. Vs. AT & Combo Lean Mass 16

17 DEXA Data - RT DEXA Data - Aerobic Change, Kg Change, Kg Fat Mass Lean Mass -1.2 Fat Mass Lean Mass Change, Kg DEXA Data - Combo Fat Mass Lean Mass Summary 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: 11 minutes per week of mod/vig intensity walking 2 days of 9 resistance training exercises each 1 to 12 repetitions per exercise ~2 minutes per day 17

18 Exercise Prescription for Weight Loss & Prevention of Weight Re-Gain Most organizations minutes per day most days 2-3 minutes per week Summary of Exercise Made Simple Obtain at least 3 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 My Recommendations Aerobic 3-4 days a week 45 to 6 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 Exercise is Medicine 18

19 Questions? 19