|
|
|
|
| Transcript Kuala Lumpur, Malaysia May 2006 Exercise Prescription |
|
|
|
|
|
|
|
Lecture: Exercise Prescription
3th Annual Malaysian Anti-aging Medical Conference
April 28th, 2006
Kuala Lumpur
By Dr. James Stoxen DC
Team Doctors
Treatment and Training Center of Champions
6432 S Pulaski, Chicago Il 60629
To contact Dr James Stoxen DC
teamdoctors@aol.com
(773) 735-5200
Exercise Prescription - 10 ways it helps your patients!
1. Increased Metabolic Rate
2. Increasing and Restoring Bone Density
3. Increased Lean Muscle Mass and Muscle Strength, Power, and Endurance
4. Injury Prevention
5. Improved Balance, Flexibility, Mobility and Stability - fewer falls
6. Decreased Risk of Coronary Disease - decreasing cholesterol and lowering your blood pressure.
7. Aids Rehabilitation and Recovery - The stronger your muscles, the quicker the healing process.
8. Enhanced Performance in Sports or Exercise
9. Aging Gracefully
10. Feeling Better and Looking Better
Hollywood’s Influence - Exercise makes you “look” Better
Hollywood has a huge influence on the direction your patients take in their health
“Hollywood Exercise Approach” Because of Hollywoods influence on exercise we have exercise programs which are severely deficient causing our generation to grow up with serious arthritic and inflammatory conditions
Exercise Prescription and Anti-aging medicine
Advances in medicine have made it possible for more people to live longer, but they also want to live stronger.
• Aerobic power and muscle strength decline by as much as 10% for every decade of adult life.
• Progressive exercise prescription can enhance function by 10% to 20%
• In terms of functional capacity, conditioning can reduce biological age by 10 to 20 years
• We get weaker as we age
People in their 50s notice more aches and pains after performing the same activities that were painless in their 40s, and those in their 60s can't do as much as they did in their 50s.
We get weaker as we age? I say… That’s all up to you!
Why we don’t exercise as much:
• We drive the car
• Computers
• Xbox
• Remotes
We are too busy developing “time saving” technology that’s why we don’t have “time” to exercise!
Some patients don’t want to exercise. Why?
• Bad experience in the past
• People to see their bodies
• Not good at sports
• “No Pain – No Gain”
• Don’t want to sweat
• See exercise as work
• They don’t have time
• Some excuse…
The top ten excuses for not wanting to exercise…
• I don’t have time
• I don’t like exercise
• I have children to look after
• I work too much
• Health clubs are expensive
• I don’t want to “bulk up”
• I don’t know what to do
• Im afraid Ill have a heart attack
• Im tired at the end of the day
• I have pains
How can you change your patients minds about exercise and excuses
• Dancing
• Walking
• Swimming - laps
• Roller Skating
• Tai Chi
• Bicycling
• Tennis
• Yoga
• Tag
• Soccer
• Playing with kids
Why don’t patients want to exercise?
• Most common reason patients use for not exercising is that they are confused on how to get fit.
• In this transition phase in a patient’s life where your goal is to transition them into active exercise
Physicians need to be the leaders
• They are not tolerating doctors who tell them that they should stop running when they have medical problems.
• Instead they switch doctors for the booming field of sports medicine.
• Only 30% of the doctor population council patients on exercise plans
• A lot of exercise “experts” have begun to try to get “fancy” with exercise and that is a potential problem.
Transition your patients into an Anti-aging lifestyle with exercise
• At Team Doctors our goal is to transition every patient into exercise as soon as possible regardless of their medical condition.
• We have had a training center in our office as core part of the care process for 16 years, servicing thousands of patients.
• So far we have had no accidents, injuries or side effects from our prescriptions to report so far.
• Since then, 500 hospitals have opened up fitness centers in the last few years
Exercise is for:
• Elderly in wheel chairs
• Toddlers in diapers
• Pregnant women
• Cancer survivors
• Diabetics
• All ages
Is there a market for this in your practice?
• 4/10 Americans used alternative medicine in 1997
Visits increased by 50% from 1990 and exceeded the total visits to all U.S. primary health care doctors
• Restoring Range of Motion
• Slowing weight gain
• Relieving depression
• Fighting Fatigue
• Enhancing Immunity
• Improving Strength
• Improving Apatite
• Boosting Self Esteem
• Journal of the American Medical Association
Exercise stimulates a cascade of other positive health benefits
• Stimulates the want for more nutritious food
• Improves Sleep
• Promotes Power
• Enhances self efficiency
Components to a good activity plan
• Aerobic Fitness: The body’s ability to take in and use oxygen to produce energy. Also called cardio respiratory endurance
• Muscular Fitness: The strength and endurance of your muscles as measured by your body’s ability to exert force and perform over time.
• Flexibility: The ability to bend joints and move muscles through a full range of motion
ANTI-AGING MODEL FOR EXERCISE PRESCRIPTION - TEAM DOCTORS
• Set goals by looking at body composition:
• The lean vs. fat body mass: An estimated one half of adults and one-fourth of children in the United States are currently overweight.
• Males 12-18% : females 18-25%
• Regular aerobic exercise is the best way to burn
• The more muscle, the higher your metabolic rate and more calories burned.
• The more muscle you have, the higher your metabolic rate and the more calories your body will burn.
Pre-Participation Checklist
• Has doctor told you that you have heart trouble?
• Frequently experience chest pains
• Often feel dizzy or unsteady
• Dr told you that you have high blood pressure?
• Has doctor told you that you have bone or joint problem?
• Are you taking prescription medication?
• A reason not mentioned that may affect your ability to exercise
PART ONE
These 15 tips will keep their overall day active and the heart rate up
• Part in the farthest place
• Play actively with your kids
• Never take elevator less than three flights
• Get rid of your electric can opener – use manual
• Turn your coffee break into a walk break
• Set an “activity” timer for brief walking and/or stretching
• Wait actively (for airplane, hairdresser, dentist, doctor, restaurant table) Walk!
• Walk or bike to errands – don’t drive
• Take a minute to stretch arms, legs, back, shoulders, and neck when getting up from sitting or lying down
• Socialize actively vs. sitting with friends/family
• Walk your dog daily
• Avoid drive-throughs (bank, fast food)
• Don’t automatically drive.
• Install a chin-up bar in a convenient doorway: use it often to do chin-ups, pull-ups, or simply hang.
• Try musical housework
PART TWO
Aerobic Activity
• Choose an exercise : walk, cycle, swim, run, aerobic dancing, in-line skate, rope skip, jog, cross country ski, rowing.
• Choose a duration: for 20 to 60 minutes. Bouts of 10 minutes each can also add up to cardiovascular benefit.
• Pick a frequency: 3 to 6 days a week is crucial to achieve cardiovascular fitness.
PART THREE
Strengthening Exercises
• Performing resistance exercises two or three times a week
• Particularly important for people over 40
• With a dramatic drop in muscle mass after age 55: Very important to use good technique, since poor technique can make your workout ineffective or injurious
• For optimum strengthening benefit, pick a weight you can lift at least eight, but no more than 12 times.
• People age 50 and older may find it more appropriate to choose a lighter weight they can lift – at least ten, but no more than 15 times.
PART FOUR
Stretching
• At the end of your workout
• After warm up, but before main activity
• Whenever you get up from sitting or lying down for extended period of time.
• Any time muscles feel tense or tight.
Breathing Techniques
• Full expiration allows full filling of the lungs into the deepest regions of the lungs
• Inhale as deep as possible as you prepare to move the weight, then exhale as deep as possible on exertion completely and inhale on release.
• The important point is to never hold your breath while you’re lifting weight.
Exercise Prescription and Systemic Diseases
• Diabetes Type I
• Diabetes Type II
• Obesity
• High Blood Pressure
• Heart Disease
• Immunity
• HIV
• Colds
• Cancer
• Colon Cancer
• Pregnancy
• Asthma
• Clinical Depression
• Osteoporosis
• Sexual Dysfunction
• Chronic Fatigue
TYPE II DIABETES
• The body’s inability to make enough, or properly use, insulin
• Typically occurs after age 40.
• The risk increases with advancing age
• Alarming trend toward type II diabetes in obese, sedentary children.
• Linked with inactivity
• Patients with high levels of inflammation C-Reactive Protein and high levels of certain cytokines have a higher potential for Diabetes II
• Insulin resistance then triggers other hormonal changes that appear to contribute to high blood pressure
DIABETES AND REGULAR EXERCISE
• Exercise can dramatically reduce the risk of getting type II diabetes
• Substantial research showing that the more physically active people are, the less likely they are to develop diabetes
• Evidence indicates for every 500 calories burned each week in physical activity, risk of type II diabetes drops by 6%
DIABETES - BENEFITS OF EXERCISE
• Improving body’s ability to use glucose
• Increasing body’s sensitivity to insulin
• Aiding glucose transport
• Helping people control their weight
• Fat inflammation
• Helps prevent cardiovascular disease
• Relieves stress and enhances mood
• Exercise stimulates the desire for a better diet
Exercise may reduce – need for diabetes medication.
Weight loss reduces blood glucose levels, improves insulin sensitivity, and helps reduce risk of heart disease
• Diet without exercise
• When people try to lose weight by diet alone, the body often reacts by slowing the metabolic rate to conserve energy.
• Since exercise makes blood glucose levels fall, some people with type II diabetes who take drugs to manage their condition find that after they start exercising regularly, they are less dependant on medication.
Example of Diabetes I patient succeeding with exercise
• For example, back in late 1970’s, doctors warned Paula Harper not to run a marathon because she had type I diabetes, but the nurse and mother of three from Phoenix chose to ignore them
• The more activity I did, the less insulin I needed, says Harper, who in 1985 founded the International Diabetic Athletes Association
• Harper has completed more than 30 marathons, a 50 mile ultramarathon, 5 triathalons, and 6 bicycle races over 100 miles long
American Diabetes Association
They offer these general guidelines
• ADA recommends regular physical activity as an essential part of good diabetes control
• Use proper footwear and protective equipment
• Avoid exercise in extreme heat or cold
• Inspect your feet daily and after exercise
• Avoid exercising during periods of poor blood glucose control.
SPECIFICALLY FOR THOSE WITH TYPE II DIABETES:
• Get an exercise stress test if you are over 35 years of age.
• Be sure to monitor your blood glucose level if you take oral hypoglycemic medications for insulin.
• Check your blood sugar level before you start exercising, and if you are low, have a snack.
• Exercise for 20 to 45 minutes
• Three days per week
• Progress gradually.
• Walking is highly recommended
• Add activity into your daily life
Exercisers With type I diabetes should be sure to:
• Carry along food that is high in carbohydrates, in case you need a quick source of energy
• Exercise with a partner
• Consume plenty of fluids before, during, after exercise
• Consider checking blood glucose levels before, during and after exercise
• STOP IMMEDIATELY if you feel
• Bring some food with you
• Wear an ID bracelet indicating your diabetic condition
Exercisers with type II diabetes should:
• Wear appropriate well-fitted footwear and clean, well-fitting socks
• Prone to nerve disease
• Over-weight people run risk of developing foot injuries due to added stress placed on these joints by weight bearing activity.
Obesity
The cause is not always gluttony
• Some experts estimate that adults today expend 800 fewer calories per day than did previous generations, largely because technology has engineered much of the physical activity out of our lives
• Labor-saving devices make it possible to do housework and yard work at the push of a button.
Stress and anxiety
Exercise Improves Sleep
• Exercise also may indirectly enhance mental health by controlling weight, which impacts on self-esteem, and by helping regulate biorhythms which improves sleep and boosts energy levels, vigor, and cognitive functioning.
• Evidence indicates that exercise may be therapeutic for people with more advanced symptoms of depression and anxiety.
CLINICAL DEPRESSION
HOW EXERCISE HELPS
• Endorphin hypothesis
• “runner’s high”.
CAUTIONS ON EXCESSIVE EXERCISE CAUSING MOOD DISTURBANCES
• Excessive exercise can lead to mood disturbances such as loss of libido and appetite, fatigue and lethargy.
• Overtraining
OSEOPOROSIS
.
• One-third of American women over age 50 will eventually have a spinal fracture, as will some younger people, according to National Osteoporosis Foundation (NOF).
• Each year, about 300,000 people wind up in hospitals with hip fractures associated with osteoporosis. Half of these never go home again. 1 in 5 die from complications within 1 year
• FACT: woman has a greater likelihood of dying as a result of hip fracture then breast cancer, uterine cancer, and ovarian cancer combined.
• Survivors frequently end up in nursing homes, and even those lucky to retain independence, often life in fear of future falls.
OSTEOPOROSIS AND EXERCISE
• Physical impact and weight-bearing exercise stimulates bone formation.
• Just as a muscle gets stronger and larger, the more you use it, a bone becomes stronger and denser with regular demands.
• The best bone builders are exercisers that put force on the bone, such as weight bearing activities like running and resistance exercises like strength training.
PEDIATRIC DISEASE WITH A GERIATRIC OUTCOME
• More and more experts recognize osteoporosis prevention begins with good health habits in childhood.
• The bone bank’s withdrawal period typically begins after age 30, in men and women alike.
• Until age 50, this bone loss occurs at the relatively slow rate of about ½ a percent per year in most people.
• Some women lost up to 20% of their bone mass in the 5-8 years after their monthly cycles stop.
• After age 65, women and men tend to lose bone mass at equal rate.
Immunity
T Cells decrease with less activity or with age?
• When you compare the immune systems of old and young people, the most striking finding is the decline in T-cells., per David C. Nieman, worlds’ foremost authorities on exercise and immunology, professor of health and exercise science at Appalachia State University in Boone, North Carolina.
• Nieman’s study of highly conditioned elderly women showed that their T-cell activity was nearly equal to that of a control group of college-age women and 60% greater than another control group of elderly sedentary women. This indicates some of the decline in immune function associated with age may actually occur not from growing older, but from becoming more sedentary.
Overexertion decreases immunity
• Prolonged or excessive exercise appears to impair immune function and leave people more vulnerable to infection.
• Research on marathon runners shows that they are particularly at risk in the 6 to 9 hours following a race, with one study showing that runners who completed a marathon were 6 times more likely to get sick afterward than equally experienced runners who didn’t compete.
CANCER HIV AND AIDS - EXERCISE BENEFITS
• HIV and Aids: at this time, there’s no evidence that exercise can help prevent AIDS infection.
• But there’s significant data showing that physical activity has many benefits for individuals who are HIV positive, such as helping maintain lean body mass, avoid excessive muscle wasting, improve appetite, and enhance mood
AEROBIC ACTIVITY WHEN FIGHTING A COLD
• Exercising moderately when you have a cold does not appear to alter the severity or duration of the illness”, according to a study published in the journal Medicine & Science in Sport & Exercise.
• If you have a fever or flu symptoms, such as muscle aches, swollen lymph glands, or severe exhaustion, the ACSM experts recommend “bed rest and a gradual progression to normal training”.
• Kenyan marathon runner wins while having the flu
LIFESTYLES ROLE IN CANCER
• Throughout the world industrialized countries have the highest cancer death rates.
• Studies show that when people from 3rd world countries adopt Western lifestyles, certain types of cancers – especially colon, breast and prostate – increase.
• Lifestyle changes such as cigarette smoking, a high-fat diet, and a sedentary lifestyle
• In 1996, the American Cancer Society (ACS) added regular physical activity to the list of preventive measures
• Physically fit people tend to have a lower incidence of cancer.
Exercise role in fighting cancer
• The least fit men died from cancer 4 times more than fit men
• “The least fit women had 16 times the cancer death rate of the fit women.”
• Scientists still don’t know the precise mechanisms by which exercise appears to exert an “anticancer” effect
• Current thinking points to physical activity’s effect on the immune system, the nervous system, and the endocrine system.
COLON CANCER
• Increased fecal transit time: Exercise increases the speed by which food travels through the digestive tract.
• This shortens the time carcinogens in fecal matter come in contact with cells that line the colon.
CANCER SURVIVERS
ACTIVITY CONNECTION FOR CANCER SURVIVORS
10 million Americans live with cancer.
• Treatment is frequently based on destroying cancerous tissue through radiation, chemotherapy and surgery.
• These treatments often affect healthy tissue, which makes exercise effect very critical.
STUDYS OF EXERCISE AND CANCER RISK
• An analysis of the exercise habits of 67,800 women in the Nurses Health Study showed that women who walked an hour every day had roughly half the colon cancer risk of sedentary women.
• A study of more than 25,000 Norwegian women found that those who exercised at least 4 hours a week had 37% lower risk of developing breast cancer than did sedentary women.
• A University of California study found premenopausal women who exercised for 3-4 hours a week cut their breast cancer risk by as much as half. Women who exercised for 1-3 hours a week lowered their risk by 30%.
• Norwegian study found that the risk of prostate cancer reduced more than half in men who walked leisurely.
IMPORTANT RISK FACTORS OF HEART DISEASE
• Physical Inactivity
• Cigarette smoking
• High blood pressure
• High levels of inflammation
• High blood cholesterol
• Stress
• Diabetes
• Obesity
High Blood Pressure Risk Factors
• Physical inactivity
• Obesity
• Eating to much salt
• Alcohol
• Oral contraceptives and other medications
• Stress
• Smoking
Cautions to exercising with a heart disease
You have CAD, check with your doctor, or experience suspicious symptoms.
• Abnormal heart rhythm
• Chest pain, pressure or tightness
• Dizziness light-headedness or cold sweat
• Fatigue
Heart Disease and the exercise prescription pad
• Integrate activity into daily life
• Try a mind-body activity such s tai chi or yoga
• Do some form of aerobic activity for 30-60 minutes most days of week
• Consider doing resistance exercises to strengthen the body and “take a load off”
• Important! Heart rate may be affected by medications
Impotence, Physical and Psychological factors
Common physical causes of sexual dysfunction include:
• Chronic diseases
• Medications
• Smoking
• Hormonal Problems
• Pelvic trauma
• Pelvic surgery
• Fatigue
• Stress
• Performance anxiety
• Depression
How exercise enhances sexual function
• Lean, physically active men had a lower prevalence for ED
• Sexual declines with age may have more to do with poor health than years
• Starting an exercise program can get you in shape for sex
• Running boosts sex drive
Womens Health and Pregnancy
An athletic woman accustomed to running 20 miles a week is likely to feel unbalanced and frustrated if forced to stop when she becomes pregnant.
• Studies suggest there are no deficits” in the children.
• Exercise prescription for pregnancy should take into account 2 factors:
Pregnancy fitness level
Status of her pregnancy
Pregnancy
When exercise is contraindicated
• Incompetent cervix
• Persistent second or third trimester bleeding
• Intrauterine growth retardation
• Preterm rupture of membranes
• Preterm labor during prior or current pregnancy or both
Pregnancy
When to call the doctor
• Vaginal bleeding
• Increased uterine contractions
• Gush or leaking of fluid from vagina
• Feeling dizzy or faint
• Shortness of breath
• Heart palpitations
• Persistent nausea or vomiting
• Abdominal pain
• Persistent severe headaches and/or visual disturbances
• Back or hip pain
• Difficulty walking
• Swelling of the hands, feet, legs, ankles or face
• Numbness anywhere
• Excessive fatigue
ASTHMA AND OBESITY - EPIDEMIOLOGY
• Harvard Medical School assistant professor Carlos Camargo studies the connection and found that during the same tie period that asthma rates skyrocketed, obesity did also.
• Both diseases follow intriguing pattern: the richer the country, the more obesity and asthma. But within the richer countries, it’s the poorer people who have more asthma and obesity.
• Camargo further found that obesity increases the risk of asthma in adult women and in children. His study of 16,862 children, ages 9-14 concluded most overweight kids were 2-3times as likely to have asthma.
• Exactly how obesity increases asthma risk is unclear, Camargo says, but may be related to sedentary lifestyle
EXERCISE INDUCED ASTHMA
• When strenuous activity triggers asthma, the condition is called “exercise-induced asthma (EIA). EIA affects estimated 70-90% of asthmatics and approximately 12-15% of general population.
• EIA frequently goes undetected even among Olympic athletes.
NANCY HOGSHEAD - ASTHMA PATIENT IN THE 1984 OLYMPICS
• Nancy Hogshead would pass out after a hard workout or when her face would turn purple from exertion, she attributed problem to not trying hard enough or being out of condition.
• It wasn’t until after she won 3 gold medals and silver at the 1984 Olympics that a doctor recognized her breathing difficulties came from the increasingly recognized condition EIA.
Exercise strengthens the lungs
• Normal response to exercise is that your airways will open or dilate.
• Sedentary lifestyle can also lead to shallow breathing, which may play role in developing the condition
• Follow my breathing recommendations
EXERCISE RX FOR ASTHMA
• Swimming and aqua-aerobics are often recommended as ideal for people with asthma because the water tends to moisten the air inhaled, making it less likely to trigger symptoms.
Strategies for asthma and exercise
• Progress gradually
• Pace yourself
• Stay well hydrated
• Practice breathing and relaxation
• Plan for “bad-air” days
Thank you organizers and delegates of the
3rd Malaysian Anti-Aging Conference
Contact me anytime
I will help you with your practices!
Dr James Stoxen DC
|
|
|
|
|
|
|
