N.E.A.T. How to incorporate a lasting action plan into your new lifestyle that will assist you in reaching your weight and wellness goals.

Definitions Physical Activity: any bodily movement produced by skeletal muscle resulting in Energy Expenditure. (walking, running, household chores, playing sports) Exercise: Physical activity that is planned or structured. Involves repetitive bodily movement aimed to improve physical fitness. (CV endurance, flexibility, muscle strength) Non-Exercise Activity: Physical activity involving nonvolitional exercise. Leads to Non-Exercise Activity Thermogenesis (NEAT). Includes occupational activity, leisure time activity, and household activity. (US Dept HHS. Physical Activity and Health. A Report of the Surgeon General, 1996)

Energy Balance Equation TDEE= BMR+ TEF+ Activity 70% 10% 20% TDEE = Total Daily Energy Expenditure http://science.education.nih.gov/supplements/nih4/ energy/guide/info-energy-balance.htm

Energy Balance Equation BMR + TEF + Activity Basal Metabolic Rate 70% Thermogenic Effect of Food 10% Exercise + NEAT 20% ACTIVITY = EXERCISE + NEAT 75% 25% EXERCISE = 25% of 20% = only % 5 of TEE!!

WHAT ARE THE BENEFITS OF EXERCISE?

Exercise Benefits 24% reduction in all-cause mortality 36% reduction in CV mortality Reduces emotional distress, depression and anxiety Improves blood sugar control 61% reduction in Alzheimer Disease Improves Immune System Function May reduce risk of various cancers (Hu, N Engl J Med 2004), (Blumenthal, JAMA 2005), (Scarmeas, JAMA 2009) (Paffenbarger, N Engl J Med 1993), (Keast, Sports Med 1988)

Exercise Benefits Increases Resting Metabolic Rate Helps maintain functional independence Protects against lower back pain Reduces falls Relieves arthritic pain Results in fewer hospital and doctor visits (Hu, N Engl J Med 2004), (Blumenthal, JAMA 2005), (Scarmeas, JAMA 2009) (Paffenbarger, N Engl J Med 1993), (Keast, Sports Med 1988)

Muscle Mass and Survival are directly proportional

Muscle Muscle is the factory that burns our fat Protein fuels our muscle Increased muscle mass leads to long term survival Your heart is a muscle!!!

PROTEIN MUSCLE FOR MUSCLE MAINTENANCE

If decreasing? MORE PROTEIN AND MORE EXERCISE!!!

MORE Benefits You ll feel better You ll look better You ll sleep better You ll have more energy & endurance

IS THERE A DOWN SIDE TO EXERCISE?

Misperceptions If I exercise I ll need to eat more. People burn fewer calories than they think. May lead to over compensation during energy intake. I can eat that [?] because I m going to the gym later muffin >200 calories (one large Costco muffin = 600 cal) 1 mile = 80 calories

It s not 50:50!! not even close Because we are just way too efficient! 2 oz. of chips takes 3 MILES of running to burn!!

So Mostly, EAT LESS! One cheeseburger takes 16 MILES of running to burn

Misperceptions Is there such thing as too much exercise? Yes. You may start burning muscle, or you may start over-eating because exercise does make us hungry. But remember, muscle weighs more than fat and it s hard to gain muscle, so congratulate yourself!

Church et al PLoS ONE 2009;4(2):e4515. Adapted from Corby K. Martin, Ph.D., Pennington Biomedical Research Center

Side Effects May Include.. Injury! Avoid by warm-up phase prior to exercise: increases blood flow, may reduce injury D.O.M.S.

HOW OUR LIFESTYLE IMPACTS OUR HEALTH

My research shows that the loss of NEAT from work and play can diminish our daily calorie burn by up to an astonishing 2,000 calories! --James A. Levine, MD, PHD, Director of the NEAT Center at Mayo Clinic and author of Move A Little, Lose A Lot

A Study of Old Ways vs. New Pedometer study Average Amish community man logged 18,000 steps daily 9 miles. Average Amish community woman logged 14,000 steps daily 7 miles. Average American man and woman? 5,000-6,000 steps Levine, James A. Move A Little, Lose A Lot. 2009.

Our Obesogenic Society Microsoft Office Instead of (literally) cutting and pasting presentation boards together. Folders on our (computer) desktop Instead of physically filing in cabinets Surfing Google Instead of rummaging through library books Digitally programmed alarm clocks Instead of winding up each night

ENVIRONMENT - OBESOGENIC Elevators, escalators, cars, mechanization of manual labor, etc.

ENVIRONMENT - OBESOGENIC Each 2 hr increment of SITTING increases risk of Obesity by 5% So, 8 hr desk job + 2 hr commute = 5 x 5% = 25% increased risk of Obesity

ENVIRONMENT - OBESOGENIC Each 2 hr increment of TV s risk by Avg. American watches 4 hrs/d of TV = Thus: Normal American day: 23% 46% risk drive/work sitting /drive/tv 25% + 46% = 71% d risk of Obesity!

Which Condition carries the most Cardiovascular Risk? A. Being Sedentary B. Being Diabetic A Sedentary lifestyle DOUBLES THE RISK of all-cause mortality in adults! 31

Sitting all day, only makes us want to go home and sit some more. Our brain waves fall into a slumbering state when staring at a screen. The more we do, the less we move with thanks to technology. Move A Little, Lose A Lot.

Technology Starts Early

GETTING STARTED: WHAT CAN WE DO?

WALKING One hour of brisk walking per day will DECREASE risk of OBESITY by: A. 5% B. 10% C. 15% D. 20% E. 25% 36

Non Exercise Activity Who burns more? A. An (old-fashioned) farmer doing chores over a 16 hour day B. A Marathon runner over 4 hours? ANSWER: They both burn about the same. It s intensity and therefore the time taken that s different. 37

Activity vs. Exercise Which activity burns more? A. Walking one mile B. Running one mile They both burn the same, the running just takes less time. 38

Get Creative! Short bouts of exercise count! Though they must be: At least 10 mins long each Of moderate intensity (light sweating, increased breathing) Must total up to at least 30 mins/day (eg. 3 sessions of at least 10 mins each) GOT STAIRS? 39

The Small Changes Help Non-Exercise Activity Thermogenesis (NEAT) Calories burned through physical activity not involving volitional exercise (running errands, shopping, yard work, etc.) Park car further away Use stairs instead of elevator/escalator Avoid moving platforms Pace while on the phone Do your own house cleaning Fidgeting Walk around, pace, when taking calls

Barriers I don t like running, bike riding or swimming There are countless types of activities we can do Gym memberships are expensive You can do these at home, outdoors, work, etc. I don t have time Commercial Breaks, use your commute, before/after work Use small intervals

Types of Exercise Resistance Exercise Any training that uses a resistance to the force of muscular contraction Weight Lifting Resistance Bands Aerobic Exercise Moderate levels of intensity for extended periods of time

Protein Power. Pg 70. Eades, Michael R., M.D. Eades, Mary Dan, M.D.

2005 Dietary Guidelines To prevent chronic disease: accumulate 30 mins or more of moderate-intensity physical activity on most, preferably all, days of the week. To prevent gradual weight gain: accumulate 60 mins of moderate to vigorous activity on most days of the week To sustain adult weight loss: accumulate 60-90 mins of moderate to vigorous activity on most days of the week (http://www.healthierus.gov/dietaryguidelines/)

Gym Hours SW Physical Therapy M-Th: 7am 7pm F: 7am 5pm

Different Types of Exercises ZUMBA! Dragon Boat Racing Dance! Even if it s in front of a mirror at home Wii Games Water Aerobics Roller Skating Sports Volkswalking

SMART Goals Specific Measurable Achievable Realistic Timely Gradual change leads to permanent change

Exercise Progression Increase physical activity gradually over time. Increase frequency, duration, intensity.

Exercise Maintenance The best exercise regimen for overall health and weight management is that which is most sustainable National Weight Loss Registry: People who maintained weight goals 90% exercise, on average, about 1 hr/day 62% watch less than 10 hours of TV per week 75% weigh themselves at least once a week

Helpful Hints Two 20 min. walks are just as good as a 40 min. walk Exercise 1 st thing in the morning or after work Put out your workout clothes the day before Always stretch before or after Find a friend with a similar goal phone before hand to make sure you both are using your treadmills at home If you get off track (illness or travel, etc.) plan to get back to it the day afterwards Always drink lots of water, especially the day after a good workout, and try to walk.

Take Home Messages Start with Basic exercises and tolerable duration and intensity. Goal is to gradually increase duration and frequency of exercise so that the body can tolerate higher intensity and longer duration of exercise as fitness increases. Aerobic exercise is good, resistance training is better, and a combination of aerobic exercise and resistance training is the best approach to weight loss and maintenance.

Keys to Success Be consistent, exercise regularly, preferably daily Set a goal, start slow, be realistic Use an exercise log, plan your workouts Set a reward that isn't food related Always increase the INTENSITY of your workouts