Title: Exercise Therapy for Chronic Diseases
1Exercise Therapy for Chronic Diseases
- Instructor Michael C. Riddell, Ph.D.
- 347 Bethune College (office)
AS/SC KINE 4900 3.0
2Why Do We Care?
Canadian Fitness and Lifestyle Research
Institute's Physical Activity Monitor
3Physical Activity Statistics 19862002 No
Leisure-Time Physical Activity Trend Chart
4Why Do we Care?
5Relative Risks and Population Attributable Risks
for Physical Inactivity
- Disease RR PAR ()
- CHD 1.9 36
- Stroke 1.4 20
- Hypertension 1.4 20
- Colon Cancer 1.4 20
- Breast Cancer 1.2 11
- Type 2 Diabetes 1.4 20
- Osteoporosis 1.6 27
Katzmarzyk et al. CMAJ 200063435-1440
6Economic Costs of Physical Inactivity
Cost Due To Disease Cost
Inactivity CHD 2.5 0.9 Stroke
1.7 0.3 Hypertension 1.6 0.3 Colon
Cancer 0.3 0.07 Breast Cancer
0.3 0.03 Type 2 Diabetes 0.6 0.1 Osteoporosi
s 1.3 0.4 TOTAL 2.1 Figures are
billions.
Katzmarzyk et al. CMAJ 200063435-1440
7Physical Inactivity-Related Mortality
- N Deaths
- Disease N Deaths Due to Inactivity
- CHD 44 061 15 774
- Stroke 15 517 3 088
- Colon Cancer 4 237 843
- Breast Cancer 4 923 542
- Diabetes 5 492 1 093
- All Causes 207 408 21 340 (10.3)
Katzmarzyk et al. CMAJ 200063435-1440
8- The cost estimates are direct costs
- hospital services
- physician care
- drugs
- health research
- The indirect costs are larger
- time off work
- loss of productivity
910 Change in Inactivity
- Reducing levels of physical inactivity from 62
to 56 would result in 150 million a year in
savings
Katzmarzyk et al. CMAJ 200063435-1440
10What Can Exercise Do?
- Regular physical activity can improve health and
reduce the risk of premature death in the
following ways - Reduces the risk of developing coronary heart
disease (CHD) and the risk of dying from CHD - Reduces the risk of stroke
- Reduces the risk of having a second heart attack
in people who have already had one heart attack - Lowers both total blood cholesterol and
triglycerides and increases high-density
lipoproteins (HDL or the "good" cholesterol) - Lowers the risk of developing high blood pressure
- Helps reduce blood pressure in people who already
have hypertension - Lowers the risk of developing non-insulin-dependen
t (type 2) diabetes mellitus - Reduces the risk of developing colon cancer
- Helps people achieve and maintain a healthy body
weight - Reduces feelings of depression and anxiety
- Promotes psychological well-being and reduces
feelings of stress - Helps build and maintain healthy bones, muscles,
and joints - Helps older adults become stronger and better
able to move about without falling or becoming
excessively fatigued
11So, You Should Get More Exercise
- Like saying you should take some pills.
- What is it about your condition that makes
exercise valuable? - What kind of exercise?
- What type of apparatus?
- For how long?
- At what intensity?
- What are the risks?
- What are the expected benefits?
12Why This Course?
- There is a growing interest in the use of
exercise for individuals with chronic disease - This course provides the basic principles for
exercise testing and exercise training (or
programming) for these unique individuals. - Advanced clinical exercise physiology jobs?
13Ground rules
- Class participation is encouraged
- The only dumb questions are the ones you dont
ask - From time to time you may be called upon to
comment on - What is the most important thing you learned in
this lecture? - What portion of the lecture was most
confusing? - What question remains uppermost in your mind?
- It would be nice if you got involved by
- Bringing in newspaper clippings or journal
articles to generate discussion in class - Visiting a cardiac rehab clinic and report back
- Performing the in class group work
14Can you explain this figure by using an example?
15Core Components
- We will attempt to
- Find and discuss clinical conditions that tend to
have altered physiological responses to exercise - Provide strategies for exercise testing
- Evaluate the typical exercise response
- Develop and illustrate rationales for exercise
programming - functional capacity
- reduce disease severity
16Why Exercise Testing?Sample Case Study
- 58-year old man had been exposed to asbestos,
sandblasting, and 35 years of cigarettes. He was
not overweight and had no apparent disease. - On questioning, he admitted to grinding chest
pain, originating in the midback and radiating
around the left chest into the substernal area. - The pain, brought on when walking especially on
cold days and was relieved in a few minutes by
rest. - He denied shortness of breath. He had no abnormal
heart sounds and resting ECG was normal
17Sample Case Study
- Does this man have a disease that may be related
to physical activity? - Can exercise testing be useful to help determine
the disease or the severity of the disease? - Does physical inactivity contribute to the
disease? - Is exercise training (programming) useful as a
form of treatment for this disease?
18Historical Perspective
- A. Lavoissier (1784)- determined the energy cost
of one legged exercise (respiratory exchange). - Medically supervised exercise regimes introduced
in the 1940s and 50s for war injuries and polio
patients - Now expanded to stroke, cardiac, pulmonary and
metabolic patients.
19Historical Perspective Cont
- Approximately 99 of all exercise physiology
research has been published since 1960. - Today- large number of medical rehabilitation
facilities, health clubs, fitness centers, as
well as sports medicine disciplines. - Toronto Rehab
- Rouge Valley Health System
- The Cardiac Prevention and Rehabilitation
CentreSt. Michael's Hospital - Cardiac Wellness and Rehabilitation Centre
Trillium Health Centre
- http//www.cardiacrehabilitation.ca/rehab_centres.
php
20Link Between Research and Practice
- Objective data are available on the therapeutic
role of exercise - research vs practice
- The link is between the two is sometimes weak
- A number of clubs claim to be experts
21Exercise Rehab Definition
- Definition of rehabilitation (DeLisa et al.,
1998) - Development of a person to the fullest
physical, psychological, social, vocational, and
educational potential, within his/her
physiological or anatomic impairments and
environmental limitations. - Cardiac rehabilitation is the sum of activities
required to ensure cardiac patients the best
possible physical, mental, and social conditions
so that they may, by their own efforts, regain a
normal place in the community and lead an active,
productive life (WHO Expert Committee 1964)
22 23Rehabilitation Programs
- Do they cure individuals of disease?
- What do you think?
- Exercise programming should be carefully
assessed, medically approved, and regularly
updated and tailored to the individuals clinical
state
24Clinical Exercise Therapist Jobs
- Exercise Therapist and Personal Fitness and
Lifestyle Consultant - Health Fitness Certified Exercise Physiologist
- Canadian Society of Exercise Physiologists
(www.csep.ca/) - Registered Clinical Exercise Physiologist/Speciali
st - American College of Sports Medicine
(www.acsm.org) - is an allied health professional who works in
the application of exercise and physical activity
for those clinical and pathological situations
where it has been shown to provide therapeutic or
functional benefit
25Other Professions That May Benefit From
Information In the Course
- physicians
- researchers
- physical therapists
- occupational therapists
- recreational/sports therapists
- nurses
- exercise physiologists interested in clinical
applications of exercise
26Course Content
- Emphasis is placed on the physiological
assessment during, and adaptations to, exercise
in clinical populations - Assessment techniques and Exercise Programming
- Clinical sections
- Cardiovascular
- Pulmonary
- Metabolic
- Immunological
- Neuromuscular
27Course Objectives Cont.
- I want you to
- 1) Understand the nature of adaptations to
exercise and training - 2) Develop a basic understanding of the
pathophysiology of various clinical conditions - 3) Develop a working knowledge of testing devices
and procedures/protocols to evaluate functional
capacity - 4) Rationalize the matching of an exercise
rehabilitative program to a clinical condition - 5) Develop a knowledge of expected (realistic)
outcomes