© 1998 - 2004 lifelong health® becoming more physically active week 2 – eight weeks to...

© 1998 - 2004 LifeLong Health®

Becoming More Physically Active

Becoming More Physically Active

Week 2 – Eight Weeks to Wellness™

Developed by Don Hall, DrPH, CHES

© 1997 - 2004 LifeLong Health® 2

• Sponsored by:Lassen Foundation2801 Williams Rd.Butte Valley, CA 95965

• Your name, Health Educator


The Problem – InactivityThe Problem – Inactivity

• “It is estimated that

250,000 deaths per year in

the United States,

approximately 12% of the

total, are attributed to a

lack of regular physical

activity.”

• Most people are sedentary

• Nearly 3 out of every 4 adults get little or no regular exercise

• Only 23% get regular, light-moderate activity

• And only 12% get any regular, vigorous activity

CDC, Advance Data # 325, Apr 7, 2002

JAMA, Vol 273, No. 5, 402-7


The Solution – Regular ExerciseThe Solution – Regular Exercise

• Regular physical activity reduces the risk for:

• Obesity

• High blood pressure

• Heart disease & stroke

• Diabetes

• Osteoporosis

• Many Cancers

• Anxiety & depressionJAMA, Vol 273, No. 5, 402-7


Physical Activity Level and

Risk of Heart Attack

Physical Activity Level and

Risk of Heart Attack• Nurses Health Study,

72,488 women followed for 8 years

• The risk of heart attack decreased with increasing levels of physical activity

• Heart attack risk dropped 54% in the most active women

1.00

0.77

0.65

0.54

0.46

0.0

0.2

0.4

0.6

0.8

1.0

1st 2nd 3rd 4th 5th

Quintile ofphysicalactivity

Little activity High activity

Re

lativ

e R

isk

NEJM, p.650, Aug. 26, ‘99


Physical Activity and Cholesterol LevelPhysical Activity and Cholesterol Level

All CauseMortalityMen

n=25,341

19 yrs offollow-up 0

10

20

30

40

50

Normal cholesterol High cholesterol

Low fitHigh fit

JAMA, Vol 276. No. 3, pp.205-210, 1996


Physical Activity and Blood PressurePhysical Activity and Blood Pressure

0

10

20

30

40

50

Normal BP High BP

Low fit

High fitAll Cause Mortality

Men

n=25,341

19 yrs. of follow-up

Ref. JAMA, Vol 276. No. 3, pp.205-210, 1996


Physical Activity and Smoking StatusPhysical Activity and Smoking Status

0

10

20

30

40

50

Nonsmoker Smoker

Low fit

High fitAll Cause Mortality Menn=25,341

19 yrs. of follow-up

JAMA, Vol 276. No. 3, pp.205-210, 1996


Physical Activity and LongevityPhysical Activity and Longevity

2.01.9

1.71.5 1.3

1.6

0.0

1.0

2.0

Lowfitness

Smoker High BP

Highchol

Over-weight

Highglucose

Relative Risk of Mortality from All Causes in Men

Aerobics Center Longitudinal Study


Cardiorespiratory Fitness and Cancer PreventionCardiorespiratory Fitness and Cancer Prevention

• Study 25,892 men age 30-87, followed for 10 years

• Results High fit persons had a 55% lower cancer mortality rate than low fit persons

• Controlled for smoking, age, BMI, alcohol, diabetes

Medicine & Science in Sports and Exercise, Fitness 34(5):735-739, May, 2002

1.00

0.62

0.45

0.00

0.25

0.50

0.75

1.00

Low Moderate High

Fitness Level

All

Ca

nce

r m

ort

ality

(R

R)


Physical Activity and Risk of Hip Fracture Physical Activity and Risk of Hip Fracture

1.00

0.79

0.67

0.530.45

0.00

0.25

0.50

0.75

1.00

<3 3 to 8.9 9 to 14.9 15 to 23.9 24+

Hip

frac

ture

rat

e (R

R)

Activity Level, MET hrs/weekLow exercise High exercise

JAMA Nov. 13, 2002; 288:2300-06

n = 61,20012 year study


Exercise and Blood Fat Levels Exercise and Blood Fat Levels

• Women who exercised by walking for 90 minutes on the previous day had lower blood fat levels than non exercisers:

• 19% lower fasting blood fat levels (next morning)

• 24% lower blood fat levels four hours after a high fat meal

0.8

1.7

1.0

2.3

0

1

2

3

Exercise No exercise

FastingPost meal

Blo

od

fat l

eve

ls, m

mo

l/L

Amer J Clinical Nutr 2000;71:465-71


Physical Activity and Risk of DiabetesPhysical Activity and Risk of Diabetes

1.00

0.77 0.75

0.620.54

0

0.25

0.5

0.75

1

1 2 3 4 5

Physical Activity Level (by quintile)

Re

lativ

e R

isk

of D

iab

ete

sn

=70

,10

2

Sedentary Most Active

Nurses’ Health Study, JAMA, Oct. 20, 1999


Physical Activity and Breast CancerPhysical Activity and Breast Cancer

Breast Cancer Study• 6,160 women free of

breast cancer, followed for 10 years.

• Women age 50+ who consistently had high recreational activity, compared to those who were inactive, had 67% less breast cancer.

0.33

1.00

0.00

0.25

0.50

0.75

1.00

Most active Inactive

Bre

ast

canc

er (

RR

)

Cancer Epidemiol Biomarkers Prev, July 2001


Moderate Activity and HealthModerate Activity and Health

64.0

26.320.3

0.0

20.0

40.0

60.0

Unfit Moderately fit Highly fit

Mortality rate, per 10,000 person years, all causes, Men

JAMA Vol 262:2395-2401


Moderate Activity and HealthModerate Activity and Health

39.5

16.4

7.40

15

30

Unfit Moderately fit Highly fit

Mortality rate, per 10,000 person years, all causes, Women

JAMA Vol 262:2395-2401


Physical Activity GuidelinesPhysical Activity Guidelines

Every U.S. adult should accumulate 30 minutes or more of moderate intensity physical activity on most, preferably all, days of the week.The goal is to expend 200+ calories daily, or the equivalent of a 2-mile brisk walk.Source: Centers for Disease Control and Prevention and the American College of Sports Medicine, JAMA, Vol 273, No. 5.


Institute of MedicineFitness GuidelinesInstitute of MedicineFitness Guidelines

• To prevent weight gain and to gain optimal health benefits from physical activity, 60 minutes of daily moderate intensity physical activity is recommended. Examples include:• Brisk walking (4 mph when possible)• Walk/jogging (5 mph)• Other activities equivalent to these activities

• Children also need 60 minutes or more of daily activity Nat. Academy of Sciences, IOM, 2002


Physical Activityis Good MedicinePhysical Activityis Good Medicine

“All who can possibly do so ought to walk in the open air every day, summer and winter.

A walk, even in winter, would be more beneficial to the health than all the medicine the doctors may prescribe.”

Counsels on Health, 52


Examples of Physical ActivityExamples of Physical Activity

Moderate

• Walking briskly, 3-4 mph

• Cycling for pleasure,10 mph

• Swimming, moderate level

• Conditioning exercises

• Golf, carrying/pulling clubs

• Canoeing/rowing, 2-3 mph

• Mowing lawn, rakingleaves, hoeing in garden

Hard/Vigorous

• Walking briskly uphill or climbing stairs

• Cycling fast, 12-16 mph

• Swimming, fast crawl

• Active sports:

• Tennis• Racquetball• Basketball• Jogging/Running


Total Activity TimeTotal Activity Time

• It’s not necessary to do all of your activity at one time.

• You may want to break it up into

• Two 15-minute or

• Three 10-minute sessions

Two 15-minute sessions

• Walk 1 mile briskly

• Ride the stationary bike for 15 minutes in the evening

Three 10-minute sessions

• Walk 10 minutes to work

• Walk another 10 minutes at noon

• Mow lawn for 10 minutes in the afternoon


Exercise IntensityExercise Intensity

• You need to maintain your activity for the full time planned (10-30+ minutes) without undue strain or fatigue.

• Your activities should feel “fairly easy” to “somewhat hard.”

• Your activity should make you breathe deeply but not make you out of breath.

• A moderate sweat is a good indicator that health benefits are occurring.


Walking Pace and Heart HealthWalking Pace and Heart Health

100

71

52

0

20

40

60

80

100

120

Less than 2 2 to 2.9 3 or moreWalking Pace (mph)

Re

lativ

e r

isk

of H

eart

Atta

ck

New England Jour. Medicine, Aug. 1999

n=72,000 women


ProgressionProgression

• Start with moderate activities• Activities you can do without getting out of breath, that

are ‘fairly light” to “somewhat hard”

• Gradually build up to 30+ minutes per day

• For higher levels of fitness, add vigorous activities or increase activity time to 60 minutes after you are used to regular physical activity

• If you have a heart or other serious health problem, get your doctor’s clearance first


Medical ClearanceMedical Clearance

• Most adults do not need to see their physician before starting a moderate intensity physical activity program.• However, men older than 40 years or women older

than 50 years who plan a vigorous program,• Or, anyone with either chronic disease or risk factors

for chronic disease, should consult his or her physician to design a safe, effective program.

Source: Centers for Disease Control and Prevention and the American College of Sports Medicine, JAMA, Vol 273, No. 5.


Strength and FlexibilityStrength and Flexibility

• Include strength and flexibility exercises two to three times per week for other important health benefits.

• Strength and flexibility training helps… • Protect against back pain and injuries

• Maintain bone mineral content and bone strength

• Prevent the loss of muscle mass

• Improve your figure/physique

• Prevent disability in older age


Use Proper TechniqueUse Proper Technique

• Perform each exercise through a full range of motion

• Weights should be lifted and lowered in a slow, controlled manner.

• Keep muscular balance by alternating pairs of muscles (e.g. perform a pull for each push exercise)

• Breath normally, don’t hold breath and strain

• Work in a team for safety & feedback


• Study 3933 men age 20-69, followed for 13 years

• Results Persons with low abdominal fitness and low grip strength had significantly higher mortality rates.

• Summary Strength training improves survival

2.77

1.00

1.67

1.00

0.00

1.00

2.00

3.00

Sit-ups Grip strength

LowHigh

Fitness Level

All

Ca

use

mo

rtal

ity (

RR

)

Medicine & Science in Sports and Exercise, Fitness 34(5):740-44, May, 2002

Musculoskeletal Fitness and MortalityMusculoskeletal Fitness and Mortality


Strength Test Predicts Functional Limitations 25 Years LaterStrength Test Predicts Functional Limitations 25 Years Later

• A 25-year prospective, cohort study including 3218 men, ages 45-68

• Strength assessed using hand grip test

• Groups divided into tertiles (thirds) based on strength then tested for functional capacity 25 years later

0

2

4

6

8

10

12

Poor walkingability

Difficulty risingfrom chair

High strengthMiddleLow strength

% w

ith li

mita

tion

JAMA, 1999, Vol 281, No. 6, 558-60


0

5

10

15

20

25

30

Do heavyhousework

Walk 1/2mile

Walk up 10steps

Lift 10 lbs.

High strengthMiddleLow Strength

% w

ith li

mita

tion

JAMA, 1999, Vol 281, No. 6, 558-60

Strength Predicts Limitations in Housework, Walking, and LiftingStrength Predicts Limitations in Housework, Walking, and Lifting


0

2

4

6

8

10

Dressing Bathing Toileting Eating

High strengthMiddleLow Strength

% w

ith li

mita

tion

JAMA, 1999, Vol 281, No. 6, 558-60

Strength Predicts Limitations in Personal Care TasksStrength Predicts Limitations in Personal Care Tasks


Low Strength and Relative Risk for DisabilityLow Strength and Relative Risk for Disability

Activity RR*Poor walking ability 2.8Unable to rise from

a chair 2.7Lift 10 pounds 1.9Do housecleaning 1.7*Relative risk (low strength compared to high strength) adjusting for age, weight, education, smoking, physical activity, and chronic health problems.

Grip Strength Rating* Kg

Low strength < 37Middle strength 37-42High strength Over 42

*One hand

Grip Strength Rating* Kg

Low strength < 37Middle strength 37-42High strength Over 42

*One hand

JAMA, 1999, Vol 281, No. 6, 558-60


• The bottom line is . . .

• If you want to remain independent and have fewer limitations as you grow older, it is vital to build and maintain good muscle strength now!

• Do muscle strength training exercises two to three times each week. Choose eight to 10 exercises of the major muscle groups and do eight to 10 repetitions of each exercise at near maximal effort. Increase the effort as you get stronger.

• Be careful not to overstrain.

Preventing DisabilityPreventing Disability


Case StudiesCase Studies

Ben Levensin, 103 year old sets new world record in shot put for men over 100 years old.

At the World Senior Olympics

Mavis Lindgren

90 year old marathoner

Mavis Lindgren

90 year old marathoner

• Mavis started running in her mid 60s because of health problems

• She holds records for her age division in 11 Portland marathons

• She has competed all over the world: New York, Los Angeles, San Francisco, San Diego, and London


CommitmentCommitment

“I complained about bad feet, until I met the person without feet.”

Aimee Mullins


SummarySummary

• Warm-up/Cool-down: Ease into and out of exercise.

Don’t strain. Allow your body to adjust gradually.

• Activities: Choose activities that use the large muscle

groups, that are rhythmic, and that you enjoy.

• Duration/Intensity: Exercise daily when possible.

• Intensity: Choose moderate activities to begin and

increase your activity time or vigorous activities gradually.

• Strengthening/Stretching: Do strength and stretching

exercises at least two to three times a weekCDC and the American College of Sports Medicine. JAMA, Vol . 273, No. 5


Being Active for a LifetimeBeing Active for a Lifetime

• Choose a variety of physical activities you enjoy.

• Don’t overdo it and become discouraged. Set

realistic goals.

• Do activities with your spouse or friends.

• Keep a written record, an activity log to track

progress toward your goals.

• Think of physical activity as play. Have Fun!


QuizQuiz

1. T/F 250,000 people die prematurely each year due to inactivity.

2. T/F Regular activity can cut the risk of heart disease in half.

3. T/F Regular activity can cut the risk of heart disease, stroke, high blood pressure, breast cancer, diabetes, and cirrhosis.

4. T/F Smokers who exercise regularly have a lower mortality rate than sedentary nonsmokers.

5. T/F Obesity is a stronger predictor of mortality than a low fitness level.


Quiz continuedQuiz continued

6. For best health you need ___ to ___ minutes of moderate physical activity on most, preferably all, days of the week.

7. T/F Most people do not need to see their physician before starting a moderate intensity physical activity program.

8. For best health, strengthening and stretching exercises should be done at least ___ to ___ times per week.

9. T/F The “warm up” is more important than the “cool down” period of an exercise session.

10.List two key principles for encouraging physical activity to be maintained for a lifetime.


www.LifeLongHealth.us


Physical Activity and MortalityPhysical Activity and Mortality

0.60.4

0.7 0.7

1.0 1.0

0

0.25

0.5

0.75

1

2+ times/week Occasionally Seldom or never

Entire cohort

Twin pairsRelative Risk of Heart Attack

Frequency of 30-minute physical activity sessions

Finnish Twin Cohort, JAMA, Vol 279, No. 6

(n=15,902)


Physical Activity and MortalityPhysical Activity and Mortality

1.0

0.9

0.70.7

0.6

0

0.25

0.5

0.75

1

1 2 3 4 5

Relative Risk of Heart Attack

MET Index Quintile (1=lowest intensity, 5=highest intensity)

Finnish Twin Cohort, JAMA, Vol 279, No. 6

(n=15,902)



5.9

9.8

12.4

0

3

6

9

12

15

Active Moderate Inactive

Mortality rate in 9 years (%)Men

Good Health Practices Study



2.9

5.2

9.0

0

3

6

9

12

Active Moderate Inactive

Mortality rate in 9 years (%)Women

Good Health Practices Study


HDL CholesterolHDL Cholesterol

• Factors that improve HDL

• Aerobic exercise, 12-20 aerobic miles per week

• Achieve/maintain ideal body weight

• Avoid smoking• Avoid trans fatty acids

• Note: For every 1% you increase HDL levels, you decrease CHD risk by 2-3%

223

56

107

160

0

50

100

150

75+ 74-55 54-45 44-35 <35

HDL Levels mg/dL

CH

D m

ort

alit

y r

ate

, me

n

Source: Framingham Heart Study

© 1998 - 2004 lifelong health® becoming more physically active week 2 – eight weeks to...

Documents

health educator

activenurses health

high recreational activity

lower blood fat levels

blood fat levels women

lower fasting blood

high fat mealblood fat

lower cancer mortality