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Exercise Therapy for Chronic Diseases

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... of Exercise Physiologists (www.csep.ca/) Registered Clinical Exercise Physiologist/Specialist American College of Sports Medicine (www.acsm.org) ... – PowerPoint PPT presentation

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Title: Exercise Therapy for Chronic Diseases


1
Exercise Therapy for Chronic Diseases
  • Instructor Michael C. Riddell, Ph.D.
  • 347 Bethune College (office)

AS/SC KINE 4900 3.0
2
Why Do We Care?
Canadian Fitness and Lifestyle Research
Institute's Physical Activity Monitor
3
Physical Activity Statistics 19862002 No
Leisure-Time Physical Activity Trend Chart
4
Why Do we Care?
5
Relative 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
6
Economic 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
7
Physical 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

9
10 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
10
What 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

11
So, 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?

12
Why 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?

13
Ground 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

14
Can you explain this figure by using an example?
15
Core 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

16
Why 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

17
Sample 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?

18
Historical 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.

19
Historical 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

20
Link 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

21
Exercise 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
  • Cardiac Rehabilitaiton

23
Rehabilitation 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

24
Clinical 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

25
Other 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

26
Course 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

27
Course 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
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