EXERCISE

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EXERCISE!

• Stanley M. Gardner, M.D.
• PREVENTIVE MEDICINE GROUP

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EXERCISEPHYSIOLOGY
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Maximal Exertion

• Increase metabolic rate of muscle 50x
• Increase metabolic rate of body 10x
• Increase cardiac output 4-6x
• Increase heart rate 3x

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Isometric Exercise

• Increase muscle tension without shortening muscle
  length
• Increase muscle bulk and strength
• Does not improve conditioning

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Example

• Support and strengthen knee in sitting position
  with leg extended -- adductors, abductors,
  hamstrings, quadriceps

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Isotonic Exercise

• Shorten muscle length with minimal muscle tension
• Improve conditioning and endurance

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Example

• Walking

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Low Intensity Exercise

• Releases adrenalin which stimulates free fatty
  acids (from triglycerides) to be metabolized as
  energy for muscle

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Aerobic Exercise

• Continuous, rhythmical using large muscle groups

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Anaerobic Exercise

• Utilizes short bursts of maximal exertion of
  muscles

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High Intensity Exercise

• Aerobic exercise uses muscle glycogen which
  breaks down into pyruvate which enters the citric
  acid cycle and produces energy.

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High Intensity Exercise (contd.)

• Anaerobic exercise uses muscle glycogen which
  breaks down into lactate which leaves lactic acid
  in the tissue and produces less energy.

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Examples of Low Intensity Exercise

• Walking 2-3 mph
• Bicycling up to 5.5 mph
• Dancing (slow)
• Table tennis

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Examples of High IntensityAerobic Exercise

• Aerobics (individual or classes)
• Dancing (fast)
• Jogging

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Examples of High IntensityAnaerobic Exercise

• Sports
• Sprinting

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PROBLEMS WITH THE STUDIES THAT EVALUATE THE
SCIENCE OF EXERCISE RISKS AND BENEFITS
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• Pre-selection bias
• Exercise questionnaires do not correlate with
  interview
• Mixed results of studies
• Difficulty defining the placebo group or control
  group of no activity
• If results do not fit preconceived notion, they
  may go unreported

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Benefits of Exercise

• Better overall feeling about self, reinforced by
  peers
• Weight loss is some people
• ¾ of exercisers quite smoking
• Able to do more of the other activities of life,
  including running away from peril
• Pleasure felt during and after exercise

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Risks of Strenuous Exercise

• Injuries
• 1/3 of serious runners sustain knee and ankle
  strain, stress fractures, muscle tears per year
• Males who bicycle more than 3 hours per week have
  3x greater incidence of erectile dysfunction

• Sudden Death

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Common Sense Risksof Exercise

• Heat exhaustion, heat stroke especially with high
  humidity hydrate, cooler part of day
• Hypothermia wind chill factor
• Exercise induced asthma, hives, anaphylaxis
• Air pollution
• High altitude

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Benign Side Effects of Exercise

• Hematuria or albuminuria in first void urine
  after exercise
• Change in menstrual regularity (does not effect
  long term fertility)
• Incontinence correlates with number of pregnancies

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COMPONENTSOFPHYSICAL FITNESS

• CARDIOVASCULAR ENDURANCE
• MUSCULAR STRENGTH
• FLEXIBILITY

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Cardiovascular Endurance

• Intensity 60-90 of maximal heart rate (maximal
  heart rate is 220 minus age)
• Duration 15-60 minutes
• Frequency 3-5 times per week

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3 Phasesof Cardiorespiratory Exercise

• Warm-up 5-10 minutes (may include light
  calisthenics, stretching)
• Conditioning
• Cool-down 5-10 minutes (light conditioning,
  stretching)

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Muscular Strength

• Intensity 5-15 repetitions
• Duration -- 1-3 sets of repetitions
• Frequency Same muscle group 2-3 days apart
  abdominals can be done daily

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Weight Lifting Guidelines

• Warm-up 50 of weight
• Controlled movement (do not throw weight)
• Breathe exhale when lifting inhale when
  lowering
• Isolate muscle group

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Flexibility Stretching

• Warm-up Light calisthenics
• Static stretch 30-60 seconds then slowly
  progressive stretch
• Release if pain

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SPECIAL CONSIDERATIONS

• Coronary heart disease Start light slowly
  increase aerobic weight training
• Hypertension Be careful of isometric exercise

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SPECIAL CONSIDERATIONScontd.

• Diabetes Increases insulin sensitivity watch
  for blood sugar drops (keep carbohydrate snack
  available)
• Obesity Low intensity, long duration, improve
  basal metabolic rate may have appetite
  suppressant effect

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SPECIAL CONSIDERATIONScontd.

• Arthritis Short duration high frequency to
  improve muscle strength and range of motion do
  not stress osteoarthritic joints (try non-weight
  bearing swimming, cycling, rowing)
• Mental Health Reduces need for medication,
  decreases stress, lessens anxiety and depression

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SPECIAL CONSIDERATIONScontd.

• Pregnancy Maintain pre-pregnancy exercise
  program avoid trauma or falls
• Chronic pain Endorphin release may modify pain
  signaling
• Low back pain High resistance without movement,
  stretching

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SPECIAL CONSIDERATIONScontd.

• Elderly All benefits are possible start low
  intensity and progress slowly
• End stage renal disease Exercise very
  important, can be during dialysis watch serum
  potassium levels
• Chronic obstructive lung disease As tolerated

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SUMMARY

• Exercise for the fun of it
• Difficult to document improvements in
  cardiovascular health longevity
• Strenuous exercisers need to listen to their body
  as injuries are real