Step Into Fitness and Health

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Step Into Fitness and Health Don Hall, DrPH,
CHESWellsource, Inc. InStep for Life, NAD Health
Ministries
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Holy in Every Way

• May the God of peace make you holy in every way,
  and may your whole spirit and soul and body be
  kept blameless until that day when our Lord Jesus
  Christ comes again.
• God who calls you is faithful he will do it.
• 1 Thessalonians 523

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Walking Time and Heart Health
Relative risk of Heart Attack
Hours of Walking per Week
n72,000 women
The New England Journal of Medicine 341650-58
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Physical Activity and Cholesterol Level
All Cause Mortality Men n25,341 19 yrs. of
follow-up
JAMA, Vol 276. No. 3, pp.205-210
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Fitness and C-Reactive Protein

• Cooper Institute study of 722 men
• Tested fitness levels and CRP levels
• High fit men had lower C-reactive protein levels
  than low fit men

Arteriosclerosis, Thrombosis, Vascular Biology,
Nov 1, 2002
C-Reactive Protein Levels
Low fit
High fit
Fitness Level
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Activity Prevalence of Hypertension
Men with the highest activity level had lowest
rates of high BP
Hypertension (RR)
Most active
Least active
n2,54815 year study
Daily Activity Level (Quartiles)
Archives of Internal Medicine, Jan 24, 2005
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Burns Excess Calories

• Every minute of activity burns 3-12 times more
  calories than sitting.
• Notice the relative increase in calories burned
  for the various activities listed on the right

• Activity Increased Calories
• Sitting 1 X
• Calisthenics 3-8 X
• Climbing hills 5-10X
• Biking 10 mph 7 X
• Aerobic dance 3-9 X
• Walking, 4 mph 4.3 X
• Skipping rope, 70/min 9 X
• Running, 9 min/mile 11 X
• Tennis 4-9 X
• Swimming 4-8 X

Source ACSM Resource Manual
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Body Weight, Fitness Level, and Risk of
Mortality from All Causes
Relative risk, all cause mortality (n)25,714 10.
1 years of follow-up
JAMA 2821547-53
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Fitness and Diabetes Risk

• 8,633 men free of diabetes, studied for 6 years
• Highly fit men were protected against getting
  diabetes
• Low fit men were 3.7 times more likely to get
  diabetes than highly fit men
• Moderately fit men were 1.7 times more likely to
  get diabetes than highly fit men

Men
Relative Risk of Diabetes
Annals of Internal Medicine 13089-96
Fitness Level
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Walking Reduces Mortality in Diabetics
n2896, 8 year study
Hours of Walking per Week
Archives of Internal Medicine 1631440-47
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Physical Activity Protects Against Smoking
All Cause Mortality Men n25,341 19 yrs. of
follow-up
Journal Amer Med Assoc 276205-210
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Physical Activity Stroke Risk
Stroke Mortality (RR)
16,878 men, 10 yr follow-up
Med Science in Sports Exercise, 2002
34592-95
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Exercise Best Predictor
of Heart Health

• In all men, peak aerobic capacity was a better
  predictor of mortality than
• High blood pressure
• Smoking
• Diabetes
• Cholesterol levels
• Abnormal ECGs
• History of heart disease

6,124 men, 6.2 yrs follow-up
Relative Risk of Death
Least fit
Most fit
Quintile of Aerobic Fitness
NEJM, 346793-801, Mar 14, 2002
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Fitness as Preventive Medicine

• Other Conditions Benefited by
• Physical Activity

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Walking and Risk of Hip Fracture
n 61,20012 year study
Hip fracture rate (RR)
Low exercise
High exercise
Hours walked per week
JAMA 2882300-06
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Recreational Activity and Risk of Breast Cancer

• Womens Health Initiative study of 74,171 women
  followed for 4.7 years
• 30 minutes of brisk walking daily reduced cancer
  risk by 18
• 1 hour of walking per day reduced risk by 21

Breast Cancer (RR)
Daily Activity Level
JAMA 2901331-36, Sept 10, 2003
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Physical Activity and Colon Cancer

• Colon Cancer Study in Men
• 29,133 men, 12 year study
• Compared to sedentary workers, men doing light
  activity had 40 less colon cancer
• Moderate to heavy activity men had 55 less colon
  cancer
• Most active men at work and recreation had 67
  less colon cancer

Colon cancer (RR)
Cancer Epidemiol Biomarkers Prev, 10265-8
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Cardiorespiratory Fitness and Cancer

• Study 25,892 men age 30-87, followed for 10
  years
• Results High fit persons had a 55 lower cancer
  mortality rate than low fit persons even after
  controlling for smoking, age, BMI, alcohol, and
  diabetes
• Medicine Science in Sports, Exercise, and
  Fitness 34(5)735-739

All Cancer mortality (RR)
Fitness Level
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Physical Activity and Mental Health

• Physical activity
• Protects against depression
• Reduces dementia (cognitive decline with age)
• Reduces symptoms of anxiety
• Reduces feelings of distress
• Improves feelings of fatigue
• Enhances wellbeing

Summary, Physical Activity Guidelines for
Americans, 2008
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Exercise and Depression

• Study of 156 sedentary, clinically depressed
  persons
• They were randomly divided into groups
• One group received medication therapy.
• Another group ran at a moderate pace ½ hour daily
  but took no medication
• After 16 weeks their depression was reevaluated
• Exercisers improved as much as those on
  medication
• But, only exercisers showed improvement in mental
  abilities such as concentration, planning, and
  organization

Source Duke University Report, 2001
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Miles Walked/Week and Well-Being
5,230 men1,222 women
Well-Being Scores
lt1
20
lt1
10
20
1-9
Note A high well-being score is desirable
Reference Medicine and Science in Sports and
Exercise 38173-78, Jan. 2006
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Physical Activity is Good Medicine

• All who can possibly do so ought to walk in the
  open air every day, summer and winter.
• A walk, even in winter, would be more beneficial
  to the health than all the medicine the doctors
  may prescribe.
• E.G.White, Counsels on Health, 52

www.InStepForLife.com
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Physical Activity Guidelines

• 30 min of moderate activity, 5 days/wk
• 20-30 minutes of vigorous activity, 3 days/wk
• Strength training and stretching, 2-3 times/week

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Examples of Physical Activity

• Moderate
• Walking briskly, 3-4 mph
• Cycling for pleasure, 10 mph
• Swimming, moderate level
• Conditioning exercises
• Golf, carrying/pulling clubs
• Canoeing/rowing, 2-3 mph
• Mowing lawn, raking leaves, hoeing in
  garden

• Hard/Vigorous
• Walking briskly uphill or climbing stairs
• Cycling fast, 12-16 mph
• Swimming, fast crawl
• Active sports
• Tennis
• Racquetball
• Basketball
• Jogging/running

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Total Activity Time

• Its not necessary to do all of your activity at
  one time.
• You may want to break it up into
• Two 15-minute or
• Three 10-minute sessions

• Two 15-minute sessions
• Walk 1 mile briskly
• Ride the stationary bike for 15 minutes in the
  evening
• Three 10-minute sessions
• Walk 10 minutes to work
• Walk another 10 minutes at noon
• Mow lawn for 10 minutes in the afternoon

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Intensity

• Your activities should feel fairly easy to
  somewhat hard.
• Your activity should make you breathe deeply but
  not make you out of breath.
• A moderate sweat is a good indicator that health
  benefits are occurring.
• Always start and end each activity session with a
  warm-up and cool down.

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Progression

• Start with moderate activities
• activities you can do without getting out of
  breath, that are fairly light to somewhat
  hard
• Gradually build up to 30 minutes per day
• For higher levels of fitness
• add vigorous activities or
• increase activity time
• after you are used to regular physical activity

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Medical Clearance

• Most adults do not need to see their physician
  before starting a moderate intensity physical
  activity program.
• However, men older than 40 years or women older
  than 50 years who plan a vigorous program,
• Or, anyone with either chronic disease or risk
  factors for chronic disease, should consult his
  or her physician to design a safe, effective
  program.
• Source Centers for Disease Control and
  Prevention and the American College of Sports
  Medicine, JAMA, Vol 273, No. 5.

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Fitness and Longevity

• In the Good Health Practices study
• 6,900 people followed for nearly 10 years
• Level of activity was the best predictor of
  longevity
• Adventist Health Study
• 30,000 people. Physical activity level was the
  best predictor of a long life

Arch Intern Med 20011611645-52
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Harvard Alumni Study

• The higher the energy expenditure in weekly
  activity, the lower the risk of death
• Dr. Paffenbarger found that for every one hour
  the Harvard alumni exercised, they lived an
  additional 2 hours in increased longevity

Relative Risk of Death, All Causes
Exercise Calories Burned Weekly
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Physical Inactivity and Risk of Death
Compared to inactive persons, those getting
regular physical activity cut their risk of death
from any cause by 50-73.
n2,603 men and women, 12 yrs study, age 60
Fitness levels determined from treadmill testing.
High fit
Low Fit
Fitness Quintiles
JAMA 2982507-16, Dec. 5, 2007
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Do you want to be well?

• Jesus asked him, Would you like to get well?
• Jesus told him, Stand up, pick up your mat, and
  walk!
• John 56,8

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Walking Program
Program Components

• Advantages
• Nearly everyone can walk
• Safe
• Inexpensive
• Encourages social interaction

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Set Measurable Goals
Program Components

• Measurable goals
• Steps per day, e.g. 6,000-10,000 steps/day
• Miles per day, e.g.2 aerobic miles per day
• Minutes of activity, e.g.30-60 minutes of
  aerobicactivity daily

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Record Daily Activity
Program Components

• Keeps activity in mind
• Helps you work towards a specific goal
• Keeps you faithful
• Improves long term success

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Fitness Buddy
Program Components

• Invite family members to join you
• Spouse
• Son or daughter
• Nephew or niece
• Invite a friend, neighbor, or workassociate to
  join you
• Make your fitness adventure social and reach out
  to your community

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Participate in GetFit Adventures
Program Components

• Mountain trails
• JMT,PCT, AT
• Trail of the Coeur d Alenes
• Coastal hikes
• Oregon Coast
• Historic journeys
• Adventist pioneers
• American revolution
• International
• Southern Italy
• China
• Hike across Switzerland
• Bible lands
• Follow the Steps of Jesus

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Church Integration
Program Components

• Encourage church members to participate as a
  group
• Promote regularly in church
• Give monthly reports
• Participation rates
• Total group miles
• Give recognition to those achieving their goals
• Invite participants to share their experiences
• Give awards
• 500 Mile Club and the 1,000,000 step club
• Create a church culture that values activity and
  health

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How to Get Started

• Go to the InStep for Life web site
  InStepForLife.com
• Download the starter kit
• Get a pedometer
• Start walking
• Volunteer to be an InStep for Life coordinator in
  your church or organization

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We invite you to join today. Begin enjoying the
benefits of regular physical activity. www.InStep
ForLife.com