exercised - Swiss Family Docs Conference • Home

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Workshop:
«Pyramide du sport»
PD Dr. med.
Jean-Paul Schmid
Kardiovaskuläre Prävention und Rehabilitation, Universitätsklinik (Inselspital) Bern
«Activity Pyramid»
Adapted from: “The Activity Pyramid” ©
ParkNicolletHealthSource®,
Minneapolis, U.S.A.
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pays de cocagne
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„...all parts of the body which have a function, if
used in moderation and exercised in labours in
which each is accustomed, become thereby
healthy, well-developed and age more slowly,
but if unused and left idle, they become liable to
disease, defective in growth, and age quickly.“
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«Langläufer leben länger» - Physical activity or
fitness and cardiovascular mortality
* Physical activity
* Exercise capacity
*
*
**
*
*
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Incidence of coronary artery disease (CAD) in
London bus driver teams
Morris JN et al. Lancet 1953; ii:1053-57; 1111-20
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Health benefits of physical activity in adults
Lee I-Min et al.
Lancet 2012; 380: 219–29
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Mechanism of protection
Cancer
Cardiovascular system
• decreased lifetime exposure to
estrogen or other hormones
• improvement of endothelial
function
• reduced body fat
• regression of atherosclerosis
• enhanced gut motility
• formation of collaterals
• improved anti-oxidant defenses
• promotion of vasculogenesis by
bone marrow-derived stem cells
• stimulation of anti-tumor immune
defenses
• enhancing the immune system
• decreasing insulin and insulinlike growth factor levels
• decreasing obesity
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Minimum amount of physical activity for reduced
mortality
Chi Pang Wen et al.
Lancet 2011; 378: 1244–53
Classification in 5 leisure time
physical activity considering
light (walking), moderate (brisk
walking), medium-vigorous
(jogging) & high-vigorous (running) physical activity in METh/ week
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A little amount of physical activity is good, …
… more is better!
15 min/ day or 90 min/ week
of moderate-intensity might be of
benefit
Nigam A & Juneau M.
Lancet. 2011 Oct 1;378(9798):1202-3.
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Relation between fitness and mortality
Kokkinos P. & Myers J
Circulation 2010;122;1637-1648
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Prescription of endurance exercise - what is
endurance exercise?
• Exercise of low to medium intensity carried out for a
sustained period of time
• Aerobic in nature involving large muscle groups and multiple
joints in activities like brisk walking, cycling, jogging or
running
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Exercise prescription: FITT (EE)
• Frequency: how often (e.g. 3 x weekly)?
• Intensity: how hard (e.g. 40% to 75% of max.
heart rate)
• Type: what type (endurance vs. strength
training)?
• Time: duration of session (e.g. >30 minutes)?
• Enjoyment (essential for compliance)
• Efficiency (same work for less effort)
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Effective endurance training thresholds
The aim is to prescribe exercise at a level that allows for
sustained exercise without bringing on premature fatigue
• 65 – 85% of max heart rate
• rate of perceived exertion (Borg Scale) 12 – 14
• 50 – 70% of VO2 max, or heart rate reserve (as low as
40% in class III heart failure)
• Ventilatory/ lactate threshold
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Improvement in exercise capacity and evolution of
atherosclerosis
Niebauer J et al. Circulation 1997;96:2534-2541
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Intensities of leisure time physical activity in
patients with CAD
kcal/week
3000
2500
2000
1500
1000
500
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Progression
No Change
Regression
Hambrecht R et al, J Am Coll Cardiol 1993;22:468-77
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Volume of exercise training
Energy expenditure for cardiac patients: 1500 kcal/week
Early post-hospitalization exercise:
• typically a minimum of 20–30 min.
• three to four days per week
• average of 5 kcal/min and exercising for 30 min., one
would expend 150 kcal/session
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Expenditure of kcal/ kg/ h body weight
Gym:
3,8
Aerobic:
6,0
Horseback riding: 6,4
Tennis:
6,6
Football:
7,8
Cycling (20 km):
8,0
Walking:
8,4
Schwiming:
9,6
Running (12 km): 12,6
Squash:
90kg, walking = 750
kcal/h
12,8
2500 kcal
= 3.5h walking/ week
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Circulation 2009;119;2671-2678
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“Walk often and walk far!”
• Walking is the preferred
exercise modality to maximize
caloric expenditure vs. weightsupported exercises (cycling or
rowing), which burns fewer
calories.
• High-calorie-expenditure:
exercise expenditure goal of
3000 to 3500 kcal/wk, attained
after 2 to 4 weeks of gradually
lengthening the exercise bouts.
Ades et al. Circulation 2009;119;2671-2678
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High calorie expenditure exercise
• high-calorie-expenditure exercise subjects performed 2 to
4 sessions a week in the home environment
• 1 to 3 sessions a week onsite with home exercise logs
(reviewed weekly with the exercise physiologist to estimate
caloric expenditure and to ascertain compliance)
• Exercise prescription for the high-calorie-expenditure CR
group emphasized:
– longer-duration (45 to 60 vs. 25 to 40 minutes per session)
– lower-intensity (50% to 60% vs. 65% to 70% peak VO2)
– more frequent (5 to 7 vs. 3 times a week) exercise
Ades et al. Circulation 2009;119;2671-2678
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Fear of triggering an acute coronary event - what is
the trigger?
Stone PH. NEJM 2004; 351:17
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Inflammatory status
and
Atherosclerosis
Libby P. & Crea F.
Eur Heart J 2010;31(7):777-83
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Control of inflammatory process is the most
important to avoid plaque rupture
Handschin C. Nature 2008; 454:463
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Physical activity, low-grade
inflammation and general
health
Handschin C. Nature 2008; 454:463
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RunTastic
RunKeeper
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exercised - Swiss Family Docs Conference • Home

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