Exercise Prescription ( I )

運動處方

Stanley Sai-chuen HUIAssociate Professor, Dept. of SSPE, CUHK

Fellow, ACSM

Vice-chairman, HKPFA

許世全教授許世全教授香港中文大學 體育運動科學系香港中文大學 體育運動科學系香港體適能總會 副主席香港體適能總會 副主席

Changes of Physical FitnessChanges of Physical Fitness

Changes of Physical FitnessChanges of Physical Fitness

Effect of 12-week Strength TrainingEffect of 12-week Strength Training

Effect Aerobic Ex on VO2maxEffect Aerobic Ex on VO2max

Foss 1998, Fox Ex Physiology, p. 329

Outlines Course structure & requirement Benefits of regular exercise Pre-exercise screening Risk stratification Guidelines for exercise intensity and

physician supervised exercise test

Course Structure 22 Oct: Introduction

Exercise Prescription I 29 Oct: Exercise Prescription II

Ex. Pres for HTN & DM 5 Nov: Assessment of Fitness (Ex. Attires)

Practicum of Ex Training 26 Nov: Ex Pres for Arthritis & Obesity

Medical Aspect & Community Resources

Course Requirement

Practicum in class – 10% (Ex experience) Practicum outside class – 30% (Ex Presp) Written Test (on-line) – 60%

Attendance : 75%Evaluation : 67%

Component of Evaluation:

A Certificate will be issued to those who passed the assessment, jointly by the HKMA & the HKPFA

Benefits of Regular Exercise

Improvements in Cardiovascular and Respiratory Function Increased maximal oxygen uptake due to both central

and peripheral adaptations

Lower minute ventilation at a given submaximal intensity

Lower myocardial oxygen cost for a given absolute submaximal intensity

Lower heart rate and blood pressure at a given submaximal intensity

Increased capillary density in skeletal muscle

Increased exercise threshold for the accumulation of lactate in the blood

Increased exercise threshold for the onset of disease signs or symptoms (e.g., angina pectoris, ischemic ST-segment depression, claudication)

Improvements in Cardiovascular and Respiratory Function (cont’)

Reduction in Coronary Artery Disease Risk Factors

Reduced resting systolic/diastolic pressures

Increased serum high-density lipoprotein cholesterol and decreased serum triglycerides

Reduced total body fat, reduced intra-abdominal fat

Reduced insulin needs, improved glucose tolerance

Benefits of Regular Exercise

Decreased Mortality and Morbidity

Primary prevention (I.e.,intervention to prevent an acute cardiac event)

1. Higher activity and/or fitness levels are associated with lower death rates from coronary artery disease

2. Higher activity and/or fitness levels are associated with lower incidence rates for combined cardiovascular diseases, coronary artery disease, cancer of the colon, and type 2 diabetes

Secondary prevention (i.e. interventions after a cardiac event [to prevent another])

1. Based on meta-analyses (pooled data across studies), cardiovascular and all-cause mortality are reduced in post-myocardial infarction patients who participate in cardiac rehabilitation exercise training, especially as a component of multifactorial risk factor reduction

2. Randomized controlled trials of cardiac rehabilitation exercise training involving post-myocardial infarction patients do not support a reduction in the rate of nonfatal reinfarction

Results of Studies Investigating the Relationship Between Physical Activity and Incidences of Selected Chronic Diseases

* Few studies, probably less than 5; ** Approximately 5 to 10 studies;*** More than 10 studies.

No apparent difference in disease rates across activity or fitness categories;

Some evidence of reduced disease rates across activity or fitness categories;

Good evidence of reduced disease rates across activity or fitness categories;

Excellent evidence of reduced disease rates across activity or fitness categories, good control of potential confounders, excellent methods, extensive evidence of biological mechanisms, relationship is considered causal.

Disease or Condition

Number of Studies

Trends Across Activity or Fitness Categories and Strength of Evidence

All-cause mortality *** Coronary Artery Disease *** Hypertension ** Obesity *** Stroke *** Peripheral vascular disease

*

Type II diabetes mellitus ** Osteoarthritis * Osteoporosis **

Results of Studies Investigating the Relationship Between Physical Activity and Incidences of Selected Chronic Diseases

Disease orCondition

Number ofStudies

Trends Across Activity orFitness Categories andStrength of Evidence

Cancer Colon *** Rectal *** Stomach * Breast ** Prostate *** Lung * Pancreatic *

Results of Studies Investigating the Relationship Between Physical Activity and Incidences of Selected Chronic Diseases

Other Health Benefits

Decreased anxiety and depression Enhanced feelings of well-being Enhanced performance of work,

recreational, and sport activities Increased ability to perform daily living

tasks Reduced muscle and joint injury risk

Improved work performance Enhanced self-concept and esteem Improved socialization Increased energy Greater resistance to fatigue

Other Health Benefits

Agility 敏捷

Balance 平衡

Coordination 協調

Power 肌爆炸力

Reaction time 反應時間

Speed 速度

Motor skill-relatedCardiovascular endurance

心肺耐力Muscular strength and endurance

肌肉力量與耐力Muscular flexibility肌關節柔軟度Body composition身體脂肪百分比

[Neuromuscular Relaxation肌神經鬆馳程度 ]

Health-related

Physical Fitness

Positive Risk Factors for CHD ACSM (2000) Family History Myocardial infarction, coronary revascularization (bypass

surgery) or sudden death before :• the age of 55 years in father or other male first degree relative

(i.e. brother or son)• the age of 65 years in mother or other female first degree relat

ive (i.e. sister or daughter)

Cigarette smoking Current cigarette smoker or those who have quit in the la

st six months

Hypertension Client on Hypertensive medications Resting SBP > 140 mmHg and/ or DBP > 90 mm Hg

Fasting Glucose Fasting blood glucose of 110mg/dL (6.1mmol/L)

Hypercholesterolemia Total serum cholesterol > 200mg/dL (5.2 mmol/L) or High density lipoprotein (HDL) < 35mg/dL (0.9 mmol/L) Low density lipoprotein (LDL) > 130mg/dL (3.4mmol/L) Client is on lipid lowering medications

Obesity Body Mass Index (BMI) > 25 kg/m2 Waist girth >= 90 cm (M); >= 80 cm (F)

Sedentary Lifestyle Accumulating less than 30 minutes moderate intensity exercis

e 3-5 days weekly

Positive Risk Factors for CHD ACSM (2000)

High level of HDL HDL cholesterol > 1.6 mmol/L (60 mg/dl)

Negative Risk Factors for CHD ACSM (2000)

Initial Risk Stratification

Low risk Younger individuals who are asymptomatic and meet

no more than one risk factor threshold

Moderate risk Older individuals (men 45 years of age; women 55

years of age) or those who meet the threshold for two or more risk factors

High Risk Individuals with one or more signs/symptoms or

known cardiovascular, pulmonary, or metabolic disease

ACSM Recommendations for:(A) Medical Examination and Exercise Testing Prior to Participation, and (B) Physician Supervision of Exercise Tests

Low Risk Moderate Risk High Risk

A.

Moderate exercise NN NN R

Vigorous exercise NN R R

B.

Submaximal test NN NN R

Maximal test NN R R

NN - Not Necessary R - Recommended

1996 U.S. Surgeons’ General Report: 1996 U.S. Surgeons’ General Report: Physical Activity and Health Physical Activity and Health (USDHHS / CDC / ACSM)(USDHHS / CDC / ACSM)

AccumulatingAccumulating at least at least 30 minutes30 minutes of of any any kindkind of of moderate intensity physical moderate intensity physical activityactivity on on most daysmost days of the week of the week

would effectively reduce the risk of would effectively reduce the risk of coronary heart disease, type 2 diabetes, coronary heart disease, type 2 diabetes, hypertension, stroke and some kinds of hypertension, stroke and some kinds of cancercancer

Current Recommendation of PA Current Recommendation of PA for Health Promotionfor Health Promotion

Conclusion

Physical inactivity is one of the most important public health problems and it is important to develop an action plan to address this issue

Policy makers Public health professionals Health service providers Educators Grassroots activists

The Endof

Exercise Prescription ( I )