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Niall M. Moyna

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www.travelingbynumbers.com

Genes have evolved to support a

physically active lifestyle

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Unchanged in the past 10,000 years

Genes have evolved to support a

physically active lifestyle

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Unchanged in the past 10,000 years

Genes have evolved to support a

physically active lifestyle

Physical Inactivity

Death and Disability from

Non-Communicable Diseases

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Hypertension

CVD

Metabolic syndrome

Type 2 diabetes

Depression

Osteoporosis

Weak skeletal muscles

Physical

frailty

Obesity

Cancer

Insulin resistance

Loss of functional

capacity

Dementia Reproductive

diseases

Non-alcohol

fatty liver

Physical Inactivity

Premature

mortality

0

2000

4000

6000

8000

10000

12000

No

of d

aily

ste

ps

10501

1344

7%

17%

7%

-20

-15

-10

-5

0

5

10

15

20

Pe

rce

nta

ge

ch

an

ge

CRF

Insulin sensitivity

Visceral adipose tissue

Krogh-Madsen et al. JAP, 2010

2 Weeks

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Immediately

Electrical activity in your

legs shuts off

Calorie burning drops

to 1 per minute

Enzymes that help

breakdown fat drop 90%

Good cholesterol drops 20%

Insulin effectiveness drops

24% and risk of diabetes

rises

After 2 hours

After 24 hours

2x rate of CVD

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Excessive Sedentary Behaviour

Prolonged Sitting

Dunstan et al., 2009

http://blogs.cdc.gov/

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• Reduce risk for a

variety of diseases

• Improve functional

capacity

http://upload.wikimedia.org https://media2.wnyc.org/

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Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Jeremy Morris, MD

Morris JN, et al. Lancet.265:1111-1120, 1953

Heart Disease

Incidence Rate

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Driver Conductor

30%

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0.0

0.2

0.4

0.6

0.8

1.0

0 1-59 min 1.0-1.5 h >2h

Time Spent Walking per Week

Manson JAMA, 2001, 285:1447

1.0

Rela

tive

Ris

k S

co

re

Risk for CVD Weekly Walking

72,488 Women - 40-65 yr

0.37 0.33

0.68

Relative Risk for Prostate Cancer

Physical Activity

n = 18,000

30-79 years

Lee et al, Am J Epidem 135:169-1787, 1992

90%*

0.0

0.3

0.5

0.8

1.0

<1000 >4000

0.0

0.2

0.4

0.6

0.8

1.0

Aerobic Fitness

13,000 men

20-80 years

Oliveria et al., Med Sci Sports Exerc 28 , 97-104,1996

1.0

* Adjusted for age, smoking

and BMI

0.75

0.50

0.25*

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Breast Cancer Mortality Cardiorespiratory Fitness

4.4

3.3

1.8

0.0

1.0

2.0

3.0

4.0

5.0

Nu

mb

er/

10,0

00 w

om

en

years

Fitness Category Low High

• 14,811 women

• 20-83 years

Moderate Peel JB, et al. MSSE 2009; 41:742

Adjusted for age

0

10

20

30

40

50

Control 80Min/Week

180Min/Week

11

26

41

Dunn A et al. Am J Prev Med 2005

Drug therapy and cognitive behavioral therapy produce

remission in approximately 40% of clinically depressed

individuals

Clinical Depression – Remission Brisk Walking

Pe

rce

nt

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Myostatin

IL-6 IL-10

IL-1 sTNF-R IL-15

IL-7

IL-4

IL-13

BDNF

SPARC

Iriscin

IL-8

IGF/PI3K/Akt

Follistatin

Myonectin Visfatin

SIRT1

Skeletal Muscles

Liver

Heart

Pituritary

Gland

B\rain

Endothelial

Cells

Nerve Fibres

Spinal

Cord

Adipose

Tissue

Immune

System

Health Benefits

CAD

Stroke

T2DM

Breast cancer

Colon cancer

Injurious fall

Depression

Cognitive function

Maintains functional ability in older individuals

Helps maintain weight loss

Reduces risk of hip fractures

Reduced risk of osteoporosis

Strong Evidence Moderately Strong Evidence

Acute exercise - Physiological changes

Chronic exercise - Physiological changes

Mechanisms

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Gardening

Home repair

Sweeping

Shoveling

Vacuuming

Painting

Raking

bone density

Capillary density

Coronary artery size

Endothelial function

Insulin sensitivity

Immune function

High density lipoproteins

Mitochondrial volume

Motor unit recruitment

Muscle fibre size

Neuromuscular coordination

Stroke volume

Blood coagulation

Inflammation

Breast cancer

Colon cancer

CAD

Depression

Excess body weight

Fractures

Injurious falls

Risk of death

Stroke

T2DM

Cognitive function

Physical function

Weight

management

Physiological Changes Health Outcomes

Physical Fitness Health Related

• Optimizing health

• ADL

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Aerobic Fitness

All-Cause Mortality

3.4

1.4 1.5 1.2 1.0

4.6

2.4

1.5

1.0 1.0

Low High

1 2 3 4 5

5

4

3

2

1

Women

Men

Re

lati

ve

Ris

k

Blair et al JAMA, 262:1989

Fitness Level

0

20

40

60

80

100

120

Pe

rce

nt

YesNo

25%

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A

Healt

h S

tatu

s

A

A1

B

B1

C

C1

A1 B B1 C C1

Physical Activity Level

A – Sedentary

B - Moderately active

C- Highly active

Exercise

Prescription

Exercise will be sustained

if perceived as enjoyable

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6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

RP

E

Baseline

Week 16

9

8

7

6

10

11

12

13

14

15

16

17

18

19

20

Very, very light

Very light

Fairly light

Somewhat hard

Hard

Very Hard

Very, very hard

RPE Scale

9% increase in aerobic fitness

9

8

7

6

10

11

12

13

14

15

16

17

18

19

20

Very, very light

Very light

Fairly light

Somewhat hard

Hard

Very Hard

Very, very hard

RPE Scale

20

25

30

35

40 Baseline

Week 16

33.4 32.3

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Exercise Modality

What is Best?

200

300

400

500

600

700

800

900

Tre

adm

ill

Xtra

iner

Row

er

Ste

pper

Rid

er

Cycle

Kc

al/h

ou

r

Men

Women

Caloric Expenditure

9

8

7

6

10

11

12

13

14

15

16

17

18

19

20

Very, very light

Very light

Fairly light

Somewhat hard

Hard

Very Hard

Very, very hard

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0

5

10

15

20

25

30

35

T/mill Xtrainer Stepper Rower Rider Cycle

Men

Women

Tim

e (

min

)

Time Required to Expend 200 Kcal

RPE-13

9

8

7

6

10

11

12

13

14

15

16

17

18

19

20

Very, very light

Very light

Fairly light

Somewhat hard

Hard

Very Hard

Very, very hard

Borg RPE Scale

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• Index of aerobic exercise

capacity

• Energy expenditure at rest

(RMR) = 1 MET

• 1 MET = 3.5 ml O2/kg/min

• Exercise capacity can be

expressed in multiples of the

resting metabolic rate

• Individual with a 10 MET

maximal functional capacity

has a VO2max of

35.0 ml O2/kg/min

Metabolic Equivalent (MET)

Definition

Rela

tive

Ris

k o

f D

ea

th

1.0

0.2

0.4

0.6

0.8

METS

<4 METS <10 METS

1 MET Increase in Aerobic

Exercise Capacity

-13 -15

-16

-12

-8

-4

0

4 All cause mortality

CV events

>100,000 participants

Kodama et al JAMA 2009

Perc

en

t

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http://health.drgily.com/walking-test-peak-aerobic-capacity.php

Estimating Functional Capacity

Rockport Walk Test

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Thank you!