Worksite Wellness Forum, January 2007
Improving Your Risk for Heart
Disease: Fit or Fiction
Clinton A. Brawner
ACSM Registered Clinical Exercise Physiologist
Preventive Cardiology
Henry Ford Hospital
Exercise Misconceptions
Exercise and physical activity
„ Exercise intensity
„ Weight loss
„ Cholesterol & blood pressure
„ Resistance training
„
Importance of Physical Activity
Deaths per 10,000 man-yrs
100
80
60
↓ 21%
↓ 37%
40
20
<500 1000 1500 2000 2500 3000 3500
Physical Activity (kcal/wk)
Prevalence of No Leisure Time Physical Activity
(LTPA) Among Adults in the United States
Stroke
Osteoporosis
Myocardial Infarction
Low Back Pain
Emphysema
Diabetes
Heart Failure
Cancer, skin
Cancer, non-skin
Bronchitis
Asthma
Arthritis
Chronic Disease
No Chronic Disease
Overall
0
Crespo et al. Clinical Exercise Physiology, 1999.
10
20
30
40
50
Released 1996.
„
People who are usually
inactive can improve their
health and well-being by
becoming even moderately
active on a regular basis.
„
Physical activity need not be
strenuous to achieve health
benefits.
„
Greater health benefits can
be achieved by increasing
the amount (duration,
frequency or intensity) of
physical activity.
Physical Activity* in the U.S.- 2005
Michigan
„
„
„
„
Recommended= 49%
Below= 38%
Inactive= 13%
No LTPA= 22%
*Moderate activity, 30 min, 5 d/wk or
vigorous activity, 20 min, 3 d/wk
“Fitness”
„
„
Definition: The ability to
transport and utilize
oxygen.
Exercise capacity, exercise
tolerance, functional
capacity, aerobic capacity,
cardiorespiratory
endurance, cardiovascular
endurance
Relative Risk of Death
5.0
4.0
3.0
2.0
1.0
0.0
High
Low
Apparently Healthy
High
Low
Heart Disease
Fitness
Importance of Fitness
0.5
0.0
Low Fitness
1.0
Medium Fitness
1.5
High Fitness
Relative Risk of Death
2.0
High BP
Diabetes
Smoking
Risk Factors
Myers et al., NEJM. 2002.
Obesity
The Importance of Exercise is
Two-Fold
1. Being more physically active reduces your
risk of premature death and future illness.
ƒ
ƒ
…so playing golf and doing yard-work is good for your
health.
Step counters can help to monitor you daily activity.
2. Being more physically fit reduces your risk
of premature death, future illness and may
improve risk factors and symptoms of
chronic diseases.
ƒ
Structured, purposeful exercise performed with the
intention of improving your health and fitness.
6 mo
How hard
should I
exercise?
24 mo
Duncan et al., Arch Int Med. 2005.
Exercise Intensity
Benefit vs. Risk
Health/Fitness
Risk
Exercise Intensity
The Exercise Program
„
„
„
„
„
What type of exercise?
– Aerobic or cardiovascular exercise
„ Walking, biking, swimming, other
How often?
– 3 or more days a week
How many minutes?
– 30 or more
– Best if done all together, but can be split
How hard?
– How you feel: exertion, symptoms
– Heart rate
Strength training, flexibility exercises and calisthenics can
provide additional benefits.
Body Mass Index
Women
Increased risk when
waist circumference is:
Men, >40” (102 cm)
Women, >34” (88 cm)
Hu et al., NEJM. 2004.
Exercise and Weight Loss
Ross, 4mo
Ross, 4mo
Hammer, 4mo
Bertram, 4mo
Marks, 5mo
Sweeney, 6mo
Diet + Ex
Diet Only
Blonk, 6mo
Dengel, 10mo
Wood, 12mo
Stefanik, 12mo
Anderssen, 12mo
Anderssen, 12mo
0
2
4
6
8
10
Weight Loss (kg)
Wing. Med Sci Sports Exerc.
Exerc. 1999.
12
14
16
Eat Less or Exercise More?
„
„
„
„
„
Calories eaten
100 kcal, snack-size
Snickers
100 kcal, medium apple
150 kcal, 25¢ bag chips
250 kcal, candy bar
250 kcal, 20 oz pop
„
„
Calories used
100 kcal per mile
150 kcal per 30 min
exercise at 3 mph
– 450 kcal for 3x/wk
„
250 kcal for 1 hr of
house/yard work
Exercise and Cholesterol
10
8
6
“So, if you’re having a hard time
lowering your cholesterol in spite
of dieting and exercising, don’t
blame yourself...”
mg/dL
4
2
0
-2
TC
LDL
HDL
-4
-6
-8
-10
Halbert et al. Eur J Clin Nutr.
Nutr. 1999.
On average, lifestyle modifications improve cholesterol ~10%
TC of 250, might ↓ 25 to 225 (goal<200)
LDL of 130, might ↓ 13 to 117 (goal<100)
Trig
Exercise and Cholesterol
Dose Response
High
Improvement
Response
HDL Cholesterol
Total Cholesterol
Low
Low
Volume of Activity
High
Exercise and Blood Pressure
Dose Response
High
Improvement
Response
Blood Pressure
Low
Low
Volume of Activity
High
How Much Exercise is Required to
Reduce BP in People with High BP?
Ishikawa-Takata et al.
Am Heart J, 2003.
What about lifting weights?
„
„
„
„
„
„
Good in addition to
aerobic exercise
“Functional” benefits
Improved bone density
May help risk factors
May help endurance
2-3 days/wk, moderate
intensity, all major
muscle groups
Change Isn’t Easy
Making Behavior Changes
„
„
Are you ready to change?
Stages of change
–
–
–
–
„
Awareness, education
What do I need to change?
How do I change?
When do I start?….ACTION!
What will it take for you to
be ready to make a
change?
– Move past the excuses
From CDC website
Thank-you…Questions?