Exercise-How much do I really need? (v1.0)€¦ · favorite past 1.Spending times? time with family...
Transcript of Exercise-How much do I really need? (v1.0)€¦ · favorite past 1.Spending times? time with family...
Exercise-How much do
I really need?
(v1.0) Robert M. Pepper, DO,
FAAFP
ACSM Recommendations
30 min moderate 5x a week
Or
20 min vigorous 3x a week
AND
Strength training 2x a week
Self reporting
(NHANES/CDC)
49% aerobic
23% aerobic +
strength
Physical activity in the United States measured by accelerometer
Troiano,RP et al
Med sci sports exercise 2008 Jan; 40(1)
Ages 18-59 and over age 60
3.5% and 2.5%
BMJ
“...whilst these
guidelines may be
effective in those
that adhere, they
remain largely
ineffective at a
societal
level….fail in key
perceived barriers,
primarily lack of
time.”
CDC 2013
•Don’t have time • Family responsibilities/kid
s
• Boring/Hate it/not enjoyable
• Too hard
• Too long
What are
physician’s
favorite past
times? 1.Spending
time with
family
2.Exercise/phy
sical
activity
3.Travel
Which Physicians Are the Most Overweight?
0% 10% 20% 30% 40% 50%
Dermatology
Cardiology
Family Medicine
Percent Overweight
METS
1 MET = energy produced
of an average
person seated
at rest
METS
•Walking 4.0
mph(15:00
min/mile)=
5 METS •Walking 5.0 mph
(12:00 min/mile)=
8 METS
1: 4.6 METS2:
7 METS3: 10 METS
Cardiovascular evaluation of middle-aged individuals engaged in high-intensity sport activities: implications for workload, yield and economic costs
Menafoglio, et al
Br J Sports Med doi:10.1136/bjsports-2014-093857
785 (age 35-65)
asymptomatic athletes
Hx/PE/ECG/SCORE
Abnormals:112 (14.3% total)
• 5.1% “pathologic” ECG
• 4.1% SCORE >5%
• 4.7% abnormal PE
• 1.6 % red flag PMH/FHx
Where did this
lead?
•22/785 (2.8%) Dx
with new CV
problem
•ZERO had an
abnormal exercise
stress test
•100 % exceeded >
10 METS
Sitting is the new smoking?
Television viewing time and reduced life expectancy: a life table analysis
Veerman et al
Br J Sports Med 2012;46:927-930
AHA SIHD Guidelines 2012
• A moderate or high dose of a statin therapy should be prescribed..
(Level of Evidence: A)
• Treatment with aspirin 75 to 162 mg daily should be continued indefinitely (Level of Evidence: A)
J Am Coll Cardiol. 2012;60(24)
5 METS=Minimum
• Walking 4.0 mph
(15:00 min/mile)=5
METS
6 METS
Brisk walking 4.5
mph
(13:20 min/mile)=6
METS
9 METS
Wogging 5.0 mph
(12:00 min/mile)=9
METS
Wogging?
Journal Human Evolution, 2009
ideal speeds:
requiring least
amount of energy
optimal speeds
for the group:
Males:8.3 mph
(7:13 min/mile)
Females:6.5 mph
(9:08 min/mile)
Wogging?
4.5 mph (13 min/mile)
• metabolic efficiency
was at its lowest
Treadmill Conversions
Mph: 5.0=12:00
Min/Mile @ 0% /speed
fixed
3%:10:32
5%:9:38
8%:8:38
Move to
And then to
V1.0 ADHERENCE
Works in the 3%
Not taken by 97%
Exercise-How much do I
really need? (v2.0)
2014-current
2014:Best Study of the Year
3 major findings:
Runners had consistently lower all cause mortality vs non-runners
low doses and low speeds had significant mortality benefits
Persistent running over time (6 years) was more strongly associated with mortality reduction
Quick Summary
•15 years
•55,000 adults ages
18-100
(24%runners)
•Reduction all
cause mortality
29%
•Reduction CV
mortality 50%
Quick Summary
cont. •3 year added
life expectancy
benefit
•Persistent
runners
reduction AC/CV
of 29%/50%
Reduction of
cardiovascular
mortality of 45-50%
Reduction of all
cause mortality of
29%
That’s way too
much work!
This is not me!
50 minutes
@
10
min/mile
pace
For less than 10K a week (7-10 min/day) x 6 years
• 29% reduction in all cause mortality
• 50% reduction in cardiovascular mortality
>50 yoa
538 runners/ 423 non-runners Matched age, sex, functional ability
39% reduction in all cause mortality
Reduced disability and mortality among aging runners: a 21-year longitudinal study. Arch Intern Med 2008;168
Copenhagen City Heart Study
• Reduction in mortality in 1,878 recreational joggers
Schnohr et al Am J Epidemiol 2013;177
AHA Scientific Sessions 2014
CV-Who cares? I’m 30, not 50
Aussie! Aussie! Aussie! Oi! Oi! Oi!
V2.0
Run.
Slow, short, often.
Last Time-How much do I
really, really need?
(v3.0-Biohack)
• maximum rate of 02 consumption
(Ml(O2)/kg∙min)
• surrogate of cardiorespiratory fitness
Calculating VO2
Max Treadmill Cooper test
-12 minute run
Norway method
-uses maximal and resting heart rates
(see handout)
Wingate
Sprints: Pitfalls High exertion • Strong motivation
• Too strenuous for sedentary
(Hawley and Gibala 2009)
Total time > 20 minutes
• 2-3 min sprints, warm-up,
recovery intervals
(Garber et al 2011)
V3.0 BIOHACK
Spare 10 minutes? Erratic?
HIIT!
Cardiac Remodeling in Response to 1 Year of Intensive Endurance Training
Arbab-Zadeh, A et al
2014 Oct 3.:CIRCULATION.AHA
Rx transforms the heart of
a slacker into one of an
elite athlete
Plan:
“doability”
• 3-4 x a week,
30-45 min low
level exercise
• After nine
months, long
runs added
• Max 7-9
hours/week
Results:
• RV mass and volume immediate ↑
• Add intense intervals eccentric hypertrophy of LV
• VO2max↑an average of 20%.
2015:
Where are we now?
Exercise as Rx
•Absence of Fitness= Smoking
•Goals: 9 METS F/10 METS M
•Small changes in fitness provide at
least as much benefit as statins, ASA, and
ACE-I
Exercise Goals: Weight
•ACSM goals
•Consistent aerobic
+strength
CV, live
longer, time,
bored •Running provides significant
benefits- even at
relatively low
levels
•HIIT is very
effective and
doesn’t have to be
100% all out
“To do something you’ve never done before, you have to do something you’ve never done before.”