Physical Activity and Health / Pre-Ex Health Screening and Risk Stratification

Mr. Cheng Yuk Chuen, JoshuaMr. Cheng Yuk Chuen, Joshua

Director of Training ProgramDirector of Training Program

Hong Kong Physical Fitness AssociationHong Kong Physical Fitness Association

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

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

Benefits of Regular ExerciseBenefits of Regular Exercise

• Improvements in Cardiovascular and Respiratory Improvements in Cardiovascular and Respiratory FunctionFunction– Increased maximal oxygen uptake due to both central Increased maximal oxygen uptake due to both central

and peripheral adaptationsand peripheral adaptations

– Lower minute ventilation at a given submaximal intensLower minute ventilation at a given submaximal intensityity

– Lower myocardial oxygen cost for a given absolute suLower myocardial oxygen cost for a given absolute submaximal intensitybmaximal intensity

– Lower heart rate and blood pressure at a given submaxiLower heart rate and blood pressure at a given submaximal intensitymal intensity

– Increased capillary density in skeletal muscleIncreased capillary density in skeletal muscle

– Increased exercise threshold for the accumulation of lacIncreased exercise threshold for the accumulation of lactate in the bloodtate in the blood

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

• Improvements in Cardiovascular and Respiratory Improvements in Cardiovascular and Respiratory Function (cont’)Function (cont’)

• Reduction in Coronary Artery Disease Risk FactorsReduction in Coronary Artery Disease Risk Factors

– Reduced resting systolic/diastolic pressuresReduced resting systolic/diastolic pressures

– Increased serum high-density lipoprotein cholesterol and Increased serum high-density lipoprotein cholesterol and decreased serum triglyceridesdecreased serum triglycerides

– Reduced total body fat, reduced intra-abdominal fatReduced total body fat, reduced intra-abdominal fat

– Reduced insulin needs, improved glucose toleranceReduced insulin needs, improved glucose tolerance

Benefits of Regular ExerciseBenefits of Regular Exercise

• Decreased Mortality and MorbidityDecreased Mortality and Morbidity

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

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

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

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

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

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

Postulated benefitsPostulated benefits

• Decreased anxiety and depressionDecreased anxiety and depression

• Strengthen physical function and Strengthen physical function and independent living in elderlyindependent living in elderly

• Enhanced feelings of well beingEnhanced feelings of well being

• Enhanced performance of work, Enhanced performance of work, recreational and sportsrecreational and sports

Evidence for Dose-Response Relationship between Evidence for Dose-Response Relationship between Physical Activity and Health OutcomePhysical Activity and Health Outcome

• No-it does not indicate the absence of a No-it does not indicate the absence of a favorable relationshipfavorable relationship

• Category B- only a limited number of Category B- only a limited number of randomized clinical trials, few randomized randomized clinical trials, few randomized trials exist, small in size.trials exist, small in size.

• Category C- non randomized or Category C- non randomized or uncontrolled clinical trialsuncontrolled clinical trials

Evidence for Dose-Response Evidence for Dose-Response Relationship between Physical Activity Relationship between Physical Activity and Health Outcomeand Health Outcome

Positive Risk Factors for CHDPositive Risk Factors for CHD ACSM (2006)ACSM (2006) Family HistoryFamily History• Myocardial infarction, coronary revascularization (bypass Myocardial infarction, coronary revascularization (bypass

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

(i.e. brother or son)(i.e. brother or son)– the age of 65 years in mother or other female first degree relatithe age of 65 years in mother or other female first degree relati

ve (i.e. sister or daughter)ve (i.e. sister or daughter)

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

st six monthsst six months

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

Fasting Glucose Fasting blood glucose of >100mg/dL (5.6mmol/L)

DyslipidemiaDyslipidemia• Total serum cholesterol > 200mg/dL (5.2 mmol/L) orTotal serum cholesterol > 200mg/dL (5.2 mmol/L) or• High density lipoprotein (HDL) < 40mg/dL (1.03 mmol/L)High density lipoprotein (HDL) < 40mg/dL (1.03 mmol/L)• Low density lipoprotein (LDL) > 130mg/dL (3.4mmol/L)Low density lipoprotein (LDL) > 130mg/dL (3.4mmol/L)

ObesityObesity• Body Mass Index (BMI) Body Mass Index (BMI) >> 30 kg/m 30 kg/m22 or or• Waist girth >= 102 cm (M); >= 88 cm (F) orWaist girth >= 102 cm (M); >= 88 cm (F) or• Waist/hip ration Waist/hip ration >= 0.95 (M); >= 0.86 (F)>= 0.95 (M); >= 0.86 (F)

Sedentary LifestyleSedentary Lifestyle• Not participating in a regular exercise programNot participating in a regular exercise program• Accumulating less than 30 minutes moderate intensity exercisAccumulating less than 30 minutes moderate intensity exercis

e 3-5 days weeklye 3-5 days weekly

Positive Risk Factors for CHDPositive Risk Factors for CHD ACSM (2006)ACSM (2006)

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

Negative Risk Factors for CHDNegative Risk Factors for CHD ACSM (2006)ACSM (2006)

Initial Risk StratificationInitial Risk Stratification

• Low riskLow risk– Men<45 years of age and women <55 years of ageMen<45 years of age and women <55 years of age– Younger individuals who are asymptomatic and meet Younger individuals who are asymptomatic and meet

no more than one risk factor threshold no more than one risk factor threshold

• Moderate riskModerate risk– Older individuals (menOlder individuals (men 45 years of age; women 45 years of age; women 55 55

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

• High RiskHigh Risk– Individuals with one or more signs/symptoms or Individuals with one or more signs/symptoms or

known cardiovascular, pulmonary, or metabolic known cardiovascular, pulmonary, or metabolic diseasedisease

ACSM Recommendations for: Pre-participation ACSM Recommendations for: Pre-participation screening Algorithmscreening Algorithm

ACSM Recommendations for: Pre-participation ACSM Recommendations for: Pre-participation screening Algorithm cont’screening Algorithm cont’

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)

Accumulating Accumulating at least 30 minutesat least 30 minutes of any kind of of any kind of moderatemoderate intensity physical activity on intensity physical activity on most daysmost days of the week of the week

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

Maintain a regular longer duration or vigorous Maintain a regular longer duration or vigorous intensity derive to greater benefitintensity derive to greater benefit

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

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

– Policy makersPolicy makers– Public health professionalsPublic health professionals– Health service providersHealth service providers– EducatorsEducators– Grassroots activistsGrassroots activists

The EndThank You