Gastroenterologist
St. Joseph, MO
1. Types of Exercise 2. Safety & Risk concerns
3. Motivation
4. Intensity & Frequency of Exercise
5. Which Conditions Benefit
1. Types of Exercise
2. Safety & Risk concerns
3. Motivation
4. Intensity & Frequency of Exercise
5. Which Conditions Benefit
1. Types of Exercise
2. Safety & Risk concerns
3. Motivation
4. Intensity & Frequency of Exercise
5. Which Conditions Benefit
ACSM: Most people can exercise without seeing a physician first
Little evidence supports evaluations prior to exercise
Patients with CV, metabolic, or renal disease may need evaluation
Too much too fast
Omitting warm up and cool down
Hydration
Electronics in the Outdoors
1. Types of Exercise
2. Safety & Risk concerns
3. Motivation
4. Intensity & Frequency of Exercise
5. Which Conditions Benefit
Music can enhance performance & lower perception of fatigue and work
Plan exercise into daily calendar
Have a workout buddy for accountability
Take class or plan an activity event
Activity during TV commercials
Reward yourself with new workout gear or a massage Activity Tracker
Accurate for step count
Overestimates & occasionally underestimates calories burned
1. Types of Exercise
2. Safety & Risk concerns
3. Motivation
4. Intensity & Frequency of Exercise
5. Which Conditions Benefit
150-300 min/wk of moderate intensity
OR 75-150 min/wk of vigorous intensity
30-60 min/day
Can be short bursts
Strength training of major muscle groups 2x/wk
Balance & flexibility 2x/wk
2,600 steps improves CVD risks and early death risks
4,000 steps improves both gray and white matter function and volume 8,800 -10,000 steps may offer more benefits
Can talk but not sing / 3-6 METs / 4-5 Modified RPE (Rate of Perceived Exertion)
Walk 4 mph
Heavy Clean (wash windows, vacuum, mop)
Push Mower, electric counts
Rake Leaves
Bicycle 10-12 mph
> 6 METs/ 6-7 Modified RPE (Rate of Perceived Exertion)
Walk/Hike/Jog/Run 6mph
Aerobics Class
Shovel snow
Bicycle 14-16mph
Move More, Sit Less Do what exercise you can
Improve your technique, not volume Progression is important
Most people can walk 3mph Every workout does not have to be intense
Stand every waking hour
1. Types of Exercise
2. Safety & Risk concerns
3. Motivation
4. Intensity & Frequency of Exercise
5. Which Conditions Benefit
Women may gain greater benefits than men at equal or lower doses of activity
Mortality Risk Reduction Women vs Men 24% vs 18% for aerobic exercise
Mortality Risk Reduction Women vs Men 19% vs 11% for strength training
Greater survival benefit for women found regardless of frequency, duration and type of exercise
Both sexes get peak survival benefit with 300 min/wk of moderate/vigorous aerobic activity
*4.2 hrs/wk
Action: women randomized to 30-60 minutes of aerobic exercise
Obese women had a 31% decrease in gestational DM with exercise
Decrease:
• Ghrelin – “hunger hormone”
• Appetite
Increase:
• GLP – decrease gastric emptying , curbs appetite, decrease glucagon if glucose high
• PYY – acts to decrease hunger
Decrease:
• Fat
Increase:
• Muscle
• Resting metabolic rate
• Satiety
• Improve response to Insulin and Leptin (prevent hunger)
If persistently active (>1 hr 2/wk), less likely to report measured insomnia, diminished sleep duration, daytime sleepiness
Social Phobia
Exercise decreases anxiety but is less effective than antidepressant
Exercise + CBT gives added benefit
Unclear what type of exercise or intensity is best
Exercise offers similar benefits as psychotherapy and medications per meta analysis
Intense exercise is especially effective although light activity offers clinical benefits
• Meta analysis of 218 RCT with 14,700 patients:
• Moderate decrease in depression for walking, jogging, yoga, strength training, aerobic exercise, tai chi regardless of comorbidities
• Effect of exercise was proportional to the intensity
Physical Activity can decrease:
Risk of Dementia by 28%
Risk of Alzheimer's by 45%
Suggested exercises:
20-30 minutes of aerobic exercise
Brisk walk, cleaning, gardening
Greater Visceral & SQ fat on MRI of abdomen can predict MRI visualized brain atrophy
Worse if you are a female Impacts Alzheimer regions of brain
• Study of 2000 men x 35 years with healthy behaviors
• No smoking, moderate alcohol, healthy weight, healthy diet, regular exercise
• Of these, exercise had the greatest effect on decreasing dementia risk
• Following > 4 of above about 60% less likely to get dementia
Physical Activity (PA) is associated with Clearer thinking
Decrease in cognitive decline
Less brain shrinkage
PA x 1 yr shows a small increase in the hippocampus (memory)
29 trials with regular aerobic PA showed an improvement in memory, attention, and thinking speed vs nonaerobic PA
Practitioners had enhanced cognition and decreased rate of memory loss
Tai chi improves balance and decreases risk of falls
Dancing helps with memory, planning, organization
6.5% of men and 29.1% of women have osteoporosis
After exercise OP patients have significant improvement in QOL, pain score, and balance
High intensity exercise improves bone health and function
Exercise can improve bone mineral density
Mind Body Exercise is the most effective to increase BMD
3-5 session/wk of weight bearing exercise for 45-60 min in post menopausal women can increase BMD in hip and spine
“Moderate certainty that exercise interventions yielded a moderate benefit in fall reduction among older adults at risk”
(GradeBrecommendation)USPSTF,AMAJune2024
Data from 83 randomized trials: PA significantly associated with reduced risk of >1 falls and injurious falls
Gait training, balance training, functional training, strength/resistance training all associated with decreased falls
Obesity related Heart Failure with preserved Ejection Fraction HFpEF is a unique phenotype of HF
More symptoms
Weight loss is preventive and improves established HF
Risk of HF doubles in obese vs normal BMI
For every 1 unit increase in BMI, incidence of HF increases 5% for men and 7% for women
• Lack of PA is associated with:
• Cardiac atrophy
• Decreased cardiac output & chamber size
• Decreased cardiorespiratory fitness
• PA in younger-middle age can be preventive
• HFpEF is a subset of normal hearts that are small from under exercise
Not purely an electrical problem
Weight loss of >10% decreased AF recurrence by 6x
750K people meeting government recommendation of 2.5 hours of moderate activity had lower risk for 7 of 15 cancer types as compared to sedentary cohorts
Highly active people tend to be of higher socioeconomic status, leaner and healthier
Exercise may help inhibit tumor growth or upregulate the immune system
JournalofClinicalOncology2019
“Webelievethere'sstrongevidenceto suggestatleast8differenttypesof cancer are associated with a level of physicalactivity(PA)”
AmericanCancerSociety2020
“Wedefinitelycan’tsayexercise reduces the risk of all cancer”
Body weight is a big confounder and PA helps prevent weight gain
Still, studies show association between exercise and many cancers remains significant after adjusting for BMI
Most studies have been on aerobic exercise
Not much known about strength training, household chores, and moderate heart rate elevating exercises
Protective effect of exercise strongest for breast and colon cancer, but that might be because they are common and its easier to detect an association
DanaFarberBreastOncologyCenter Cancer Cell Feb 2024
Exercisers had a higher risk of prostate cancer 12% and melanoma 20%
There is a lack of connection between PA and colon, gastric, bladder, endometrial, and renal cancer
Over many studies, people with the highest PA had a 10-20% decreased risk of cancer. This is probably an underestimate
One study’s highest PA level may be another's midrange
• Physical Activity of all types can potentially prevent disease / limit burden of disease
• Women are more prone to develop disease from excess weight
• Women benefit more from exercise vs men
• The rise of sedentary lifestyles will have a tremendous impact on healthcare
• PA has been poorly and under investigated as a treatment option for a variety of diseases
• Current data is often contradictory, nonspecific, and limited
• A special thanks to Neil Shewell for help with the graphics!