Transcript
EXERCISE IS MEDICINE
Dr. K.D.C. Upendra Wijayasiri (MBBS, Dip.Spo.Med, M.phil (trn) )
In-charge, Sports Medicine Unit,
Colombo South Teaching Hospital,
Kalubowila.
Drug statistics; CSTH- 2014 Name of the Drug
Amount of Drug Cost (Rs.)
1. Metformin2. PCM3. Diclofenac
sodium4. Glibenclamide5. Atenolol6. Verapamil7. Aspirin 8. Insulin (mixtard)9. Insulin (soluble)
106,24,000 tabs 132,60,000 tabs 21,85,000 tabs 11,60,000 tabs 15,68,140 tabs 9,69,000 tabs 4,03,000 tabs 27,000 units 3360 units
71,18,00049,60,000 8,52,150 11,600 6,89,981 4,84,000 6,35,000 85,05,000 14,54,880
U.S. Department of Health and Human Services Physical Activity Guidelines for healthy adults ages 18–65 years
Moderate-intensity aerobic activity for a minimum of 30 min on five days each week
vigorous-intensity aerobic activity for a minimum of 20 min on three days each week
combination of moderate- and vigorous-intensity activity to meet this recommendation.
dose–response relation between physical activity and health.
Why people don’t do Exercise? Lack of time
Other priorities Lack of confidence Lack of money to join a
gym, buy equipment or appropriate clothing
Don’t want to be sweaty or uncomfortable
Boredom Pain or injury “I’m too old.”
Lack of interest Prefer relaxing Perceived benefits of
remaining inactive Fear of injury Change in routine Lack of support from family
or job Don’t know what exercise
to do Adverse weather
How you can get the patient from Bed to Foot? Concept of 3 M’s:
1. Mentioning
2. Modeling
3. Motivation
“Motivation is mental process that connects a thought or a feeling with an action.”
SMART goals
SpecificMeasurableAchievableRealisticTimely
The FITT Principle
Frequency – How Often at least 3 times a week. eg; every other day to
allow recovery Intensity- How Hard
monitor heart rate keep above training
threshold Time – How Long
Minimum of 20 min. per session
Type – What Kind Training method
Risk stratification High risk Moderate risk Low risk
Graded Exercise tests available
• Typical Angina at < 5 METs
• Ventricular dysrhythmias• ST depression > 2mm in
Ex. ECG• Abnormal
hemodynamics
• Functional capacity < 5 METs
• Angina at > 7METs • ST depression <
2mm in Ex. ECG
• Functional capacity >
7METs
No exercise tests available
• Resting Ejection fraction
< 40%• Complex dysrhythmias• Congestive cardiac
failure
• Resting ejection fraction 40% - 49%
• Resting ejection fraction > 50%
Hypertension
Benefits of ex:• normal person 5-7mmHg reduction • weight control
Majority moderate intensity aerobic exercise
will be beneficial
More risk : symptom limited graded exercise test before schedule
Over weight and Obesity Physical activity has little impact on the amount of weight
lost in the first six months, compared to dieting (NIH/USA
evidence report, 1998); however, adequate physical activity is critical to maintaining weight loss (Dietary guidelines for Americans, 2008).
Individuals who have lost at least 30 kilograms and kept this weight off for at least five years maintain weekly exercise of 2800 kcal (The National Weight Control Registry at the University of Colorado).
Pregnancy Target to have less fatigue, toss better control of weight gain, and to
possibly experience shorter labor (Exercise during pregnancy, 2007)
Benefits of exercise
• Maintenance of prenatal aerobic and musculoskeletal fitness levels
• Prevention of excessive maternal weight gain
• Facilitation of labor and recovery from labor
• Promotion of good posture
• Prevention of gestational glucose intolerance
• Prevention of low back pain
• Improved psychological adjustment to the changes of pregnancy
Osteoporosis Benefits of Exercise
• Decreased osteoporotic fractures by increased peak bone mass
• Slowed rate of bone loss with aging
• Reduced fall risk due to improved muscle strength/ flexibility and balance ( Robertson et
al, 2002,; Bec & Snow, 2003)
Precautions:
• Attention on the proper balance
• Exercise surface
• not beyond the pain limit and less than maximal strength
• twisting, forward bending, compression of the spine and high impact loading should be avoided
• if severe spinal osteoporosis ─> alternative for walk
Depression Accompany many of the chronic conditions and
complicated by weight gain from many psychiatric
medications and by higher rates of smoking
Physical activity programs reduces depression symptoms in people diagnosed as depressed, in healthy adults, regardless of age, gender, race/ethnicity, or medical condition (US Physical Activity Guidelines Advisory Committee Report,
2008)
Greater initial physical fitness predicts rapid recovery from depression (Morgan
et al, 1998)
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