Fitness Exercise As Medicine Muscular Strength and Endurance The - PDF document

Fitness Exercise As Medicine • Muscular Strength and Endurance The Medical Perspective • Body Composition • Flexibility Julie Bishop, MD • Cardiovascular/Respiratory Capacity Assistant Professor of Orthopaedics Ohio State University Medical Center Fitness Objectives Cardiovascular/Respiratory Capacity • Integrity of heart and lungs • What are the components of fitness • Ability to use O2 as fuel • Benefits of fitness • VO2 max - max O2 uptake • Exercise prescription � Best measure of overall functional capacity • Anaerobic Threshold 1

Vo2 Max Fitness Benefits • Strong genetic component to Vo2 max • Physical • Intense training can increase Vo2 max 20% • Mental • Medical Fitness: Physical Fitness Benefits Cardiovascular/Respiratory Capacity • Anaerobic Threshold • Performance of same amount of work (Lactate Breaking Point) with a decrease in: � Heart Rate � Upper limits of exercise that can be sustained � Respiratory rate before accumulation of � Systolic blood pressure lactic acid causes limitations 2

Physical Benefits of Medical Benefits of Fitness Fitness • Cardiovascular health • Longevity � Effect unclear • Cardiovascular risk factors � Exercise retards aspects of aging • HTN • Age-related decline in peak performance • Obesity • Age-related decline in max aerobic capacity • Decreases muscle and bone mass loss • Osteoporosis • Decreases nl increase in fat � 50% difference fit vrs sedentary Mental Benefits of Fitness Medical Benefits of Fitness • Too numerous to list!!!!! � Stress relief • Cardiovascular Health: � Improved self image � Maintain or increase myocardial O2 supply � Less depression � Decrease myocardial work and O2 demand � Better sleep � Increase Myocardial function � Better ability to focus � Increase electrical stability of myocardium � Endorphins!! • Natural High � Etc, etc 3

Medical Benefits of Fitness Medical Benefits of Fitness • Osteoporosis • ↓ Risk Factors for CVD � 8% Bone mass loss/decade � Body weight after menopause � % body fat � Weight bearing exercise retards loss � Smoking � Athletes have up to 40% more bone � BP mass than sedentary people � Cholesterol, HDL fraction � Exercise with Calcium and � Triglycerides estrogen is most effective Medical Benefits of Fitness Medical Benefits of Fitness • Hypertension • Bone is Sensitive to Load � No load = Lose Bone � Exercise decreases HTN overall � Low Load = Maintain Bone � Thus, it decreases it as a risk � High Load = factor for CVD • Bone remodels to withstand new loads � Strengthened skeletal muscles • Bone Builds decreases • Bone gets stronger the rise in BP induced by any � Too High Load = Failure stress Fracture lifting task 4

Exercise Prescription Medical Benefits of Fitness • Weight-Bearing Exercise • Physicians must take a role! � Running, jogging � Promote exercise � Dancing � Role models themselves! � Gardening � Aerobics • Regular Exercise � Stair-stepper � Predictable Results � Not as Good, but still good � Dose-Response curve • Walking � Develop a safe and effective program • Biking • Elliptical Exercise Prescription Exercise Prescription • How much? • Current Major Causes of Death: � Heart disease • How often? � Cancer • What types of exercise? � Stroke • Based on the patients: � Goals • All have links to lifestyle � Health/fitness needs • Exercise is a form of Preventative Medicine! � Current level of conditioning • Exercise can be a form of treatment � Past or present illnesses/injuries 5

Exercise Prescription Prescribing Exercise • ACSM Guidelines • Frequency • Medical Clearance • Intensity � Risk factors • Duration � Known diseases � Intended level of activity • Type of exercise � Age of individual • Progression � Sex of individual • Modify as necessary • Musculoskeletal Conditions � AAOS has guidelines/sample programs ACSM Guidelines for Exercise Prescription Exercise Prescription • How Intense? • Aerobic/cardiovascular � ACSM: 60 – 90% Max Heart Rate • Strength Training � Max HR: 220 – your age • Flexibility Training • 50 yo male: Max HR = 170 **Health-related benefits obtained from lower • Exercise at 70% max HR = 119 levels than those recommended for fitness � May need to adjust based on various So – Just MOVE!! health issues 6

Exercise Prescription Exercise Prescription • How Long? • Age-Related Decline � ACSM Rec: 20 – 60 minutes/continuous � 15% loss of muscle/decade when > 60yo � To Start: � Reciprocal Increase in Fat • 20 – 30 minutes is great! � Change in body composition • 3 sessions of 10 minutes is good! � Have patients increase as they adapt Exercise Prescription Exercise Prescription Strength Training • How Often? • Prevent muscle loss � Depends… • Increases strength � Just starting: • Decreases fragility • Maintains bone integrity • Several short sessions/day � Stresses the bones � Moderate fitness level � Increases Bone density • 3-5 sessions/wk • Reduces risk of falls • Depends on intensity � Falls number 1 risk of hip fractures 7

Strength Training Recommendations Exercise As Medicine • Train major muscle groups The Orthopaedists’ � 8-10 separate exercises • 2-3 x/week Perspective • Lighter weights • 8 – 12 repetitions Exercise Prescription Objectives Don’t Forget the Core!! • Overuse Injuries in Exercise � Risk factors • Supports the Spine! � Preventative measures • Protects the Back � Recognize the most common • Improves Balance • Treatment options for injuries and Agility! • Returning to exercise after an injury 8

Types of Injuries Yes!!! BUT…. • Understand Injury Risk Factors • Acute • Address These Risk Factors � Easy to recognize, sudden event • Prevention is the Best Method � Sudden onset of symptoms • But, if your patient becomes injured… • Overuse � Must recognize the injury � Repetitive trauma that overwhelms the tissue’s ability to repair itself � Properly treat the injury � Most common in recreational athlete � Safely return to exercise Is it Possible to Risk Factors Start an Exercise INTRINSIC EXTRINSIC Program Without • Prior Injury • Training Errors Becoming Injured? • Muscle Imbalance • Equipment • Inflexibility • Environment Or, are overuse injuries an • Anatomic • Technique inevitable by-product of exercise Abnormalities programs???? • Nutritional abuse 9

Proper Training Plans Training Errors • Exercise prescription • Too Much: ↑ Frequency of training • Gradual progression in each element ↑ Duration of workouts • Too Far: � (frequency, duration, intensity) ↑ Intensity of Workouts • Too Hard: • Gives the body time to adapt � Too fast � And become more efficient � Switch suddenly to hard surface • Take a rest!! � Too many hills � Build rest days into plan for recovery “Too MUCH, Too SOON!!” Muscle 10% Rule Imbalance/Inflexibility � Muscle strength imbalance • ↑ Duration/Frequency/Intensity � Muscle flexibility imbalance 10%/Week � Problematic in opposing muscle groups Keep a journal to keep track!! � Muscle tightness If : You dramatically ↑ element • Cut back on another!! • Excessive pressure/stress on underlying structures • Malalignments due to unequal pull of muscles • May interfere with proper form 10

Strengthen What should be done? • Important for Muscle Balance • Increase Flexibility • Isolate and strengthen opposing muscle � Decreases Muscular Tension groups � Increases Range of Motion • Proper technique: trainer/instructor � Decreases chance of Injury • Ok to use • Individual flexibility � Free weights � Predicts injury rate! � Resistance machines • Daily stretching program, pilates/yoga • Start with low weight/high reps Stretch!!! Don’t Ignore the CORE!! • Stretching daily for 6-10 weeks � Can improve muscle flexibility • Trunk muscles • Stretch after workout • Pelvic muscles � Most flexibility gains when muscles are warm • Abdominal muscles • Static stretch best • Remember – they support the spine and � Hold stretch – steady pressure – 30 seconds connect upper and lower body � Stretch to point of tension – not pain CORE STABILITY IS KEY!! • As Muscle relaxes – increase stretch AVOID LOW BACK PAIN!! • Good Form Essential: No Bouncing 11

Risk Factor – Previous Injury Risk Factor - Technique • Injury weakens the tissue • “True” poor technique • Prior to returning to full function • OR…Due to excessively tight muscles!! � Must restore: • If your patient is new to a certain exercise: • Strength � Get help!! • Flexibility � Coach/personal trainer/class instructor,etc Proper Full Rehabilitation can help break the Injury – Reinjury Cycle Risk Factor: Risk Factor - Equipment Anatomic Abnormalities • Exercise equipment • ↑ Stress on Surrounding Structures � Proper use/technique � Sturdy/supportive • No problems in daily activities � Ergonomical setup (ie – bike) • Repetitive activity sports: • Proper footwear � Overuse Injuries!! � Based on patients anatomy � Knowledgeable sales person � Replace every 6 mo/ 300-500 miles 12