physical activity and exercise: from fads and trends to reality and research

From Fads and Trends to Reality and Research / De mythes et tendances à réalite et recherche

Pierre Boulay, PhD &

Francois Cholette, MHK, R.Kin.

We have no relevant financial or nonfinancial relationships in the products or services

described, reviewed, evaluated or compared in this presentation.

TREND: A general development or change in a situation or in the way that people are behaving (http://dictionary.cambridge.org).

http://dictionary.cambridge.org/

http://dictionary.cambridge.org/

A trend - definition from fashion may last for 2-10 years and more often than not they have been a trend or fad

before in history Like Skinny jeans – popular in 1980s, slowed down and have heightened again in the 2000s.

FAD: A fashion that is taken up with great enthusiasm for a brief period. http://dictionary.reference.com)

http://dictionary.reference.com/

Reality, Research &Training principles vs

Trends and Fads

1. Overload principle 2. Progression/moderation principle 3. Specificity principle 4. Variation principle 5. Individual differences principle Other important principles to consider: 6. Diminishing Returns Principle 7. Reversibility principle

Martens, R. (2004) Successful Coaching, 3rd Edition

To improve fitness levels, an individual must do more than what their bodies are used to do.

When more is demanded, within reason, the body adapts to the increased demand.

FITT: Frequency, Intensity, Time, Type Are the guidelines meeting this principle?


Gently push your clients’ bodies to adapt to a reasonable physical stress.

Avoid overtraining Appropriate ratio of

exercise/pa : active rest even walking requires

an appropriate ratio

Linked to overload, variation & individuality principle

The running clinic.ca (2006) Martens, R. (2004) Successful Coaching, 3rd Edition

Results depends on the type of exercise.

Exercises needs to be specific to attain certain objectives. Ex. Climbing Mt Tremblant = step master, walking,

leg strength, etc.

In sports, importance of being sport-specific. Martens, R. (2004) Successful Coaching, 3rd Edition

Goals of variation Exercise/PA : Active Rest (stretching, etc); Change exercises/activities to avoid overstressing a

part of the body; Change exercises sequences to continue to

overload the body; Maintains a client’s interest in exercise/PA;

Paradox – ratio of specificity vs variation


Every athlete is different and responds differently to the same exercises/activities Factors affecting: pretraining condition; genetic

predisposition/limit ; gender and race; diet and sleep; environmental factors such as heat, cold, humidity and lifestyle, workstyle, motivation.

No one size fits all Exercise is like a medication that needs to be prescribed

with careful attention

Objectives and personal view of the client Martens, R. (2004) Successful Coaching, 3rd Edition

6. Diminishing Returns Principle - Rate of fitness improvement diminishes over time

as fitness approaches its ultimate genetic potential As fitness levels increase, more work or training is

needed to make the same gains.

7. Reversibility principle – Physical activity benefits ARE reversible Use it or lose it


Improve fitness level reduce CVD risk

Improve glycemic control Maintain muscle mass Improve mental health Improve quality of life/ADL Improve range of motion And yes, maintain weight / lose fat (if realistic) …and as you know, much more!

De mythes et

tendances

à réalite

et recherche

From Fads and

Trends to

Reality and

Research

Thompson, Walter R. (2013). Now Trending: Worldwide Survey of Fitness

Trends for 2014. Health & Fitness Journal. Dec 2013. Vol 17 (6)

Can help your organization in planning future exercise programs, group;

May help the health and fitness industry make some very important investment decisions for future growth and development.

Important business (public health) decisions should be based on emerging trends not on the latest exercise innovation peddled by late-

night television infomercials or the hottest celebrity endorsing a product.

Survey completed by 3815 health & fitness professionals ONLY ; no clients commercial (typically for-profit), clinical (including

medical fitness), community (not-for-profit), and corporate divisions of the industry

- 65% female

Australia, Austria, Barbados, Brazil, Columbia, Costa Rica, Finland, Greece, Hungary, Iceland, India, Indonesia, Israel, Jamaica, Lebanon, Mauritius, Mexico, Netherlands, New Zealand, Nigeria, Peru, Portugal, South Korea, Romania, Saudi Arabia, Serbia, Singapore, South Africa, Spain, Sri Lanka, Switzerland, Taiwan, Thailand, United Arab Emirates, United States, and the United Kingdom.

Many countries Their could be differences from countries to countries

Should ONLY be used as a guide The needs, objectives and personal view of the

client needs to be listen to (basic counselling skill).

Could be worthwhile to do an in house survey with clients participating in other programs/services.

High intensity interval training (HIIT) describes exercise that is characterized by brief, intermittent bursts of vigorous activity, interspersed by periods of rest or low-intensity exercise.

Gibala. et al. 2012. Physiological adaptations to low-volume, high intensity interval training in health and disease. J Physiol. 590:5: 1077-1084.

Summary of protocols in research typically used to compare HIIT with traditional endurance exercise training on cycle ergometers

Variable HIIT group Endurance group

Protocol Training intensity (workload) Weekly training time commitment

4-6 x 30 s (3-5 min rest) or 6 x 10 s (60 s rest) – 3 sessions/week “All out” maximal effort (500 W) Approx. 10 min (1.5 hr including rest)

40-60 min cycling (5/week) 65 % VO2peak (approx 150 W) Approx. 4.5 h

A commonly cited barrier to physical activity is lack of time. Including HIIT in a training programme implies that greater health-enhancing benefits could be gained in less time, making HIIT a more time efficient and attractive option. Moreover, short bursts of activity may address another common limiting factor, lack of motivation, as it may be a more enticing option than the prospect of continuously exercising for an extended period of time.

Gibala. et al. 2012. Physiological adaptations to low-volume, high intensity interval training in health and disease. J Physiol. 590:5: 1077-1084.

Adaptations occurring significantly more with HIIT compared to continuous endurance training

Increased VO2peak Decrease systolic and diastolic blood pressure Increased HDL, decreased TG Decreased fasting glucose Decreased oxidative stress and inflammation Increased adiponectin, insulin sensitivity and ß-cell function Increased maximal rate of Ca2+ reuptake Increased availability of nitric oxide Increased cardiac function Increased enjoyment of exercise Increased quality of life

Weston. et al. 2014. High-Intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med. 48: 1227-1234.

Suggested contraindications to high-intensity interval training (HIIT)

Unstable angina pectoris Uncompensated heart failure Recent myocardial infarction Recent CABG or PCI (< 12 months) Heart disease that limits exercise (valvular, congenital, ischemic and hypertrophic

cardiomyopathy) Complex ventricular arrhythmias or heart block Severe chronic obstructive pulmonary, cerebrovascular disease or uncontrolled

peripheral vascular disease Uncontrolled diabetes mellitus Hypertensive patients with blood pressure > 180/110 (or uncontrolled) Severe neuropathy

** the list should go on ….. and this is not evidence-based. Majority of studies done in patients with a chronic condition are low-risk and well controlled.

Weston. et al. 2014. High-Intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med. 48: 1227-1234.

Adapted from Weston. et al. 2014. High-Intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med. 48: 1227-1234.

Protocol recommendations for high-intensity interval training (HITT) for health and disease Frequency Duration Modality Intensity Interval times Warm-up Cool-down

3 times per week 30 minutes Treadmill/hill, cycle ergometer. Increasing speed or incline. Interval = 85-95 % peak heart rate Rest=low active-70 % peak heart rate 4 x 3-4 min intervals with 3 min recovery or 8-10 x 1 min with 1 min recovery 10 min @ 60 % peak heart rate 5 min @ 50 % peak heart rate

* Future research is needed to establish the optimal protocol of HITT in patients with diabetes and other chronic diseases.

Adapted from Kilpatrick. et al. 2014. High-Intensity Interval Training. A Review of Physiological and Psychological Responses. Health & Fitness Journal. 18(5): 11-16.

Recommendations for practitioners Base prescription Warm-up at a low to moderate intensity for 2 to 5 minutes.

First complete a 1-minute high-intensity work interval at about 90% of max effort. Then complete a 1-minute low-intensity recovery at about 10 % max effort. Repeat the work and recovery intervals 10 times for a total of 20 minutes. Cool-down at a low to moderate intensity for 2 to 5 min

Start slowly Increase the number of HIIT sessions into an exercise program across time.

Trial and error Encourage clients to try a variety of HIIT workouts to find one that is enjoyed. Consider manipulating the duration of the intervals to shorter or longer periods. Adjust the recovery period for more or less rest between work intervals.

Change it up Try HIIT exercises indoors and outdoors, with music and without music, alone and with workout partners, etc.

Be careful Reinforce that intense exercise increases risk and to be cautious when trying new HIIT routines, especially those that require any unorthodox movement or patterns.

This form of training fits somewhat loosely within the umbrella of vigorous exercise and therefore is only appropriate for low-risk individuals, moderate-risk individuals who have been cleared for vigorous intensities by a medical professional, and high-risk individuals who are under direct medical supervision during exercise training.

Little, JP. et al. 2014. Journal Applied Physiol. 10 May 2014

Fig 2: Two weeks of high-intensity interval training improves glycemic control. A: average blood glucose concentration measured by continuous glucose monitoring (CGM) over a 24-h period before (Pre) and after (Post) 2 wk of training. B: blood glucose concentration assessed by CGM over 24 h before (Pre; solid line) and after (Post; dashed line) training in a representative subject. Post training CGM data was collected from 48–72 h following the final training session. Values are means SD (N 7). *P 0.05. n=8, 63 yrs of age, A1C 6.9

10 x 60 sec sprint (95 % Wmax, about 100 W) with 60 sec recovery (3 min warm-up at 50 W + 2 min cool-down at 50 W for a total of 25 min). 3 x per week for total of 75 min – 6 sessions total

Conclusion The training protocol involved a total of only 30 min of high-intensity exercise/week and a total time commitment of only 75 min/wk. This is much lower than current physical activity guidelines for T2D that recommend a total of 150 min of moderate to vigorous intensity exercise each week. Given that the majority of individuals with and without T2D do not accumulate sufficient exercise to achieve health benefits and the most common cited barrier to regular exercise is lack of time, our results suggest that low-volume HIIT may be a viable, time efficient strategy to improve health in patients with T2D.

Little, JP. et al. 2014. Journal Applied Physiol. 10 May 2014

The impact of 3 small doses (6 x 1 min) of intense exercise (90% HR max) before meals

(exercise snacking) versus a single bout of (energy-matched) prolonged continuous (30

min) moderate-intensity (60% HR max) exercise in individuals with insulin resistance on

postprandial blood glucose and 24 h glycaemic control.

Francois ME. et al. 2014. Diabetologica. 10 May 2014


Conclusion “we found exercise snacking to be a novel and

effective approach to improve glycaemic control in individuals with insulin resistance. Brief, intense

(incline walking) interval exercise bouts undertaken immediately before breakfast, lunch and dinner had a greater impact on postprandial and subsequent 24h glucose concentrations than

did a single bout of moderate, continuous exercise undertaken before an evening meal.”

People with diabetes (including elderly people) should perform resistance exercise at least twice a week, and preferably 3 times per week [Grade B, Level 2] in addition to aerobic exercise [Grade B, Level 2]. Initial instruction and periodic supervision by an exercise specialist are recommended [Grade C, level 3]

Canadian Diabetes Association Clinical Practice Guidelines 2013

Canadian Diabetes Association Clinical Practice Guidelines 2013

to near fatigue

VS

Endurance resistance training (20+ reps)

Hypertrophy resistance

Training (8-12 reps)

Resistance training has become a mainstay of exercise training in type 2 diabetes. However, it remains controversial whether hypertrophy resistance training (HRT: 2 sets : 10-12 reps : 70 % 1 RM) is superior to endurance strength training (ERT: 2 sets : 25-30 reps : 40 % 1 RM) with regard to its effects on glycemic control, muscle mass and strength in older T2D patients.

Egger, A. et al. European Journal of Preventive Cardiology. 2013. 20(6): 1051-1060.

VS

In conclusion, 8 weeks of a combined programme of aerobic exercise training with HRT or ERT in T2D led to a significant reduction of body weight, glucose and subcutaneous fatty tissue, as well as a significant increase in physical work capacity and muscle mass. HRT group had sign greater improvement in muscle strength. Since differences between the two resistance training programmes were rather modest, and preferences of patients regarding training modalities and tolerability of heavy weights vary substantially, it appears warranted that training modalities should be left to the patients’ discretion in order to provide a more individualized and thus more attractive exercise training programme, which might lead to improved long term compliance.


Resistance training intensity guidelines for management of type 2 diabetes

Week 1 4 8 12 16 20 24 Goal intensity (based on % 1RM) a

50 % 55 % 60 % 65 % 70 % 75 % 80 %

Goal repetitions b 10 – 15 8 – 12 8 - 12 8 – 10 8 – 10 8 – 10 8 - 10

a 1 RM = 1 repetition maximum b Repetition schemes are not aligned with traditional intensity values.


This recent study support the guidelines and clearly demonstrated that the design of exercise training

programs used to treat individuals with type 2 diabetes will have an impact on clinical outcomes.

Combining aerobic exercise with resistance training

is the best approach.

(140 min aerobic vs 140 min of resistance vs 110 min aerobic + 30 min of resistance training)

People with diabetes should accumulate a minimum of 150 minutes of moderate to vigorous intensity aerobic exercise each week, spread over at least 3 days of the week, with no more than 2 consecutive days without exercise [Grade B, Level 2, for T2DM; Grade C, Level 3 for T1DM]

Most Canadians and people living with diabetes currently do not meet these targets.

Tudor-Locke, C and Schuna, J.M. Frontiers in endocrinology. Nov 2012; vol. 3; article 142

Source: Colley, R.C. et al. Statistics Canada, Catalogue no. 82-003-XPE. Health Reports, Vol 22, no 1 Mars 2011.

An estimated 15% of Canadian adults accumulate 150 minutes of moderate-to-vigorous physical activity (MVPA) per week; 5% accumulate 150 minutes per week as at least 30 minutes of MVPA on 5 or more days a week. Men are more active than women and MVPA declines with increasing age and adiposity. Canadian adults are sedentary for approximately 9.5 hours per day (69% of waking hours). Men accumulate an average of 9,500 steps per day and women, 8,400 steps per day. The 10,000-steps-per-day target is achieved by 35% of adults.

Savage, P.D. & Ades, P. (2008) Journal of Cardiopulmonary Rehabilitation and Prevention. 28:370-77.

Tudor-Locke et coll. 2012. A step-defined sedentary lifestyle index: < 5000 steps/day. Applied Physiology, Nutrition, Metabolism.

Step-defined sedentary lifestyle index for adults. MVPA, moderate-to-vigorous physical activity.

30 min / day

Tudor-Locke, C and Schuna, J.M. Frontiers in endocrinology. Nov 2012; vol. 3; article 142

Walk more, sit less, and exercise

Exercise prescription for health, which is more important : Exercise more, Walk more or Sit less ?

Expected trends in 2015 Based on an article from ‘The Huffingtonpost’ Opinion-based only!

http://www.huffingtonpost.com/jill-s-brown/fitness-trend-forecast-fo_b_5753458.html

1- HITT 2- Recovery/Self-Care Train Hard, Recover Harder

3- Physical activity monitors : Will this be helpful to improve behavior changes in

our society ? 4- Online Workouts 5- Short Workouts 6- Kids Fitness

Important business and public health decisions should be based on emerging trends.

Choosing the right exercise (trend) and applying the training principles to attain/reach a client’s goal should be taken into account when creating your client’s plan.

New HITT research indicates that this type of exercise could be a valuable solutions for your low-risk clients. More research is needed for safe exercise prescription with a high-risk population.

Resistance training is important to your diabetic client’s health. New resistance training research shows that HRT and ERT have a similar impact on T2D. HRT or ERT should be included in your diabetic patients’ exercise program.

Your intervention should focus as much on sitting time than on physical activity and exercise.

Pierre Boulay, PhD Professeur/Professor

Faculté d’éducation physique et sports Université de sherbrooke

[email protected]

Francois Cholette, MHK, R.Kin.

Kinésiologue/Kinesiologist Santé & Performance

Hexzone Health & Performance

[email protected]

mailto:[email protected]

mailto:[email protected]

physical activity and exercise: from fads and trends to reality and research

Health & Medicine