SPORTS MEDICINE
Exercise for
Life
through education and helped by prompt diagnosis and management. Acute cardiac ischaemia and sudden cardiac death occur rarely and typically with unaccustomed vigorous exertion on a background of known or subclinical disease. Screening of individuals for signs and symptoms, past history and risk factors for cardiovascular events is recommended. Educating adults on the relevance of the onset of cardiac symptoms and signs and the appropriate steps may reduce the risk. Importantly, the risk in those with coronary artery disease will be expected to decline with increasing physical fitness.
Who should be screened before exercise? Only the minority and young high-performing athletes are screened routinely now for congenital disorders.
Professor Cathy Speed, Sports Medicine Physician, discusses the recommendations of a healthy lifestyle and talks about the benefits of undertaking exercise on top of our daily routines “All parts of the body if used in moderation and exercised in labors to which each is accustomed, become thereby healthy and well developed, and age slowly; but if unused and left idle, they become liable to disease, defective in growth, and age quickly.” [Hippocrates] Being physically active is a natural state of human existence. Modern lifestyles – technology, transport and food – promote unnatural sedentary behaviour and numerous disease states including obesity. The continued encouragement of physical activity for health-related benefits and exercise promotion have now become a remit of the practitioner and also the physician. Regular exercise delays all-cause mortality, lowers blood pressure and CHD biomarkers such as CRP and lipid profile. It decreases the risk of developing CHD, stroke, type 2 diabetes and some forms of cancer such as colon and breast cancers. Additionally, exercise helps to preserve bone mass, control and reduce weight, reduce falls, and improve anxiety/depression, well-being and enhance cognitive function. There is a no more cost-effective or efficient form of intervention for the maintenance and enhancement of health across all ages, all abilities and all diseases than regular exercise.
Exercise Recommendations In addition to activities of daily life, a strong programme of regular exercise should include: • Cardiorespiratory – the circulatory and respiratory systems’ ability to supply oxygen to skeletal muscles during sustained physical activity. • Resistance – the use of resistance to induce muscular contraction, which builds the strength, anaerobic endurance and size of skeletal muscles. • Flexibility – the development of a wide range of movement in a joint or series of joints that is attainable in a momentary effort.
• Neuromotor – exercises that focus on improving and maintaining motor skills such as balance, coordination, gait, and agility.
Current recommendations Most adults should engage in moderate to intense cardiorespiratory exercise training for at least 30 mins per day, five days a week and vigorous to intense cardiorespiratory exercise training for 20 minutes per day, three days per week. OR
Adults who should be screened by a sport and exercise medicine consultant or cardiologist before starting moderate to vigorous exercise include: asymptomatic people with diabetes mellitus, or other metabolic disease; those with known cardiac disease; or asymptomatic men over 45 years old and women over 55 years old; or those who meet the threshold for more than two risk factors. Any patient with an uncontrolled cardiovascular condition should defer from exercising until stable and should have medical clearance before beginning a programme.
An Exercise Prescription Service Where there are concerns about the safety or efficacy of an exercise programme, its design for an individual patient, or if injuries/illnesses occur, a sport and exercise medicine consultant can help.
A combination of moderate, vigorous and intense exercise to achieve a total energy expenditure of 500–1000 MET/min/week.
At the time of initial assessment, clinical risks, barriers to exercise and adherence are identified and goals are set, after which some undergo further investigation.
For two to three days a week, adults should perform resistance exercises for each of the major muscle groups and neuromotor exercises involving balance, agility and coordination.
When fully assessed, an exercise programme is written, which provides direction and enhances motivation. The patient is offered a variety of settings in which they can pursue their programme, and a choice of follow-up and support through an exercise supervisor. As a result, compliance is maintained through continued contact with the team as appropriate during the prescribed exercise programme.
Flexibility exercises for each of the major muscle/ tendon groups (a total of 60 sets per exercise) on two days a week are also recommended. The exercise programme should be modified according to the patient. Those who cannot reach these targets should still be encouraged to engage in smaller amounts, progressively building as they adapt [American College is Sports Medicine, 2011]. All should be encouraged to increase non-specific activity, i.e. move more.
What about the risks? The benefits of exercise far outweigh the risks. The most common complication is musculoskeletal injury and many of these incidences can be prevented
Summary Simple as it may seem, exercise prescription can have its challenges. Nevertheless, it is a highly effective intervention in the promotion of health for our patients, so should never be neglected. After all, “The wise, for cure, on exercise depend”. To find out more information about Professor Cathy Speed, please visit www.practicemattersmag.co.uk/website/ contributors.php
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