Exercise-How much do I really need? (v1.0)€¦ · favorite past 1.Spending times? time with family 2.Exercise/phy sical activity 3.Travel . Which Physicians Are the Most Overweight?

Exercise-How much do

I really need?

(v1.0) Robert M. Pepper, DO,

FAAFP

ACSM Recommendations

30 min moderate 5x a week

Or

20 min vigorous 3x a week

AND

Strength training 2x a week

Self reporting

(NHANES/CDC)

49% aerobic

23% aerobic +

strength

Physical activity in the United States measured by accelerometer

Troiano,RP et al

Med sci sports exercise 2008 Jan; 40(1)

Ages 18-59 and over age 60

3.5% and 2.5%

BMJ

“...whilst these

guidelines may be

effective in those

that adhere, they

remain largely

ineffective at a

societal

level….fail in key

perceived barriers,

primarily lack of

time.”

CDC 2013

•Don’t have time • Family responsibilities/kid

s

• Boring/Hate it/not enjoyable

• Too hard

• Too long

What are

physician’s

favorite past

times? 1.Spending

time with

family

2.Exercise/phy

sical

activity

3.Travel

Which Physicians Are the Most Overweight?

0% 10% 20% 30% 40% 50%

Dermatology

Cardiology

Family Medicine

Percent Overweight

METS

1 MET = energy produced

of an average

person seated

at rest

METS

•Walking 4.0

mph(15:00

min/mile)=

5 METS •Walking 5.0 mph

(12:00 min/mile)=

8 METS

1: 4.6 METS2:

7 METS3: 10 METS

Cardiovascular evaluation of middle-aged individuals engaged in high-intensity sport activities: implications for workload, yield and economic costs

Menafoglio, et al

Br J Sports Med doi:10.1136/bjsports-2014-093857

785 (age 35-65)

asymptomatic athletes

Hx/PE/ECG/SCORE

Abnormals:112 (14.3% total)

• 5.1% “pathologic” ECG

• 4.1% SCORE >5%

• 4.7% abnormal PE

• 1.6 % red flag PMH/FHx

Where did this

lead?

•22/785 (2.8%) Dx

with new CV

problem

•ZERO had an

abnormal exercise

stress test

•100 % exceeded >

10 METS

Sitting is the new smoking?

Television viewing time and reduced life expectancy: a life table analysis

Veerman et al

Br J Sports Med 2012;46:927-930

AHA SIHD Guidelines 2012

• A moderate or high dose of a statin therapy should be prescribed..

(Level of Evidence: A)

• Treatment with aspirin 75 to 162 mg daily should be continued indefinitely (Level of Evidence: A)

J Am Coll Cardiol. 2012;60(24)

5 METS=Minimum

• Walking 4.0 mph

(15:00 min/mile)=5

METS

6 METS

Brisk walking 4.5

mph

(13:20 min/mile)=6

METS

9 METS

Wogging 5.0 mph

(12:00 min/mile)=9

METS

Wogging?

Journal Human Evolution, 2009

ideal speeds:

requiring least

amount of energy

optimal speeds

for the group:

Males:8.3 mph

(7:13 min/mile)

Females:6.5 mph

(9:08 min/mile)

Wogging?

4.5 mph (13 min/mile)

• metabolic efficiency

was at its lowest

Treadmill Conversions

Mph: 5.0=12:00

Min/Mile @ 0% /speed

fixed

3%:10:32

5%:9:38

8%:8:38

Move to

And then to

V1.0 ADHERENCE

Works in the 3%

Not taken by 97%

Exercise-How much do I

really need? (v2.0)

2014-current

2014:Best Study of the Year

3 major findings:

Runners had consistently lower all cause mortality vs non-runners

low doses and low speeds had significant mortality benefits

Persistent running over time (6 years) was more strongly associated with mortality reduction

Quick Summary

•15 years

•55,000 adults ages

18-100

(24%runners)

•Reduction all

cause mortality

29%

•Reduction CV

mortality 50%

Quick Summary

cont. •3 year added

life expectancy

benefit

•Persistent

runners

reduction AC/CV

of 29%/50%

Reduction of

cardiovascular

mortality of 45-50%

Reduction of all

cause mortality of

29%

That’s way too

much work!

This is not me!

50 minutes

@

10

min/mile

pace

For less than 10K a week (7-10 min/day) x 6 years

• 29% reduction in all cause mortality

• 50% reduction in cardiovascular mortality

>50 yoa

538 runners/ 423 non-runners Matched age, sex, functional ability

39% reduction in all cause mortality

Reduced disability and mortality among aging runners: a 21-year longitudinal study. Arch Intern Med 2008;168

Copenhagen City Heart Study

• Reduction in mortality in 1,878 recreational joggers

Schnohr et al Am J Epidemiol 2013;177

AHA Scientific Sessions 2014

CV-Who cares? I’m 30, not 50

Aussie! Aussie! Aussie! Oi! Oi! Oi!

V2.0

Run.

Slow, short, often.

Last Time-How much do I

really, really need?

(v3.0-Biohack)

• maximum rate of 02 consumption

(Ml(O2)/kg∙min)

• surrogate of cardiorespiratory fitness

Calculating VO2

Max Treadmill Cooper test

-12 minute run

Norway method

-uses maximal and resting heart rates

(see handout)

Wingate

Sprints: Pitfalls High exertion • Strong motivation

• Too strenuous for sedentary

(Hawley and Gibala 2009)

Total time > 20 minutes

• 2-3 min sprints, warm-up,

recovery intervals

(Garber et al 2011)

V3.0 BIOHACK

Spare 10 minutes? Erratic?

HIIT!

Cardiac Remodeling in Response to 1 Year of Intensive Endurance Training

Arbab-Zadeh, A et al

2014 Oct 3.:CIRCULATION.AHA

Rx transforms the heart of

a slacker into one of an

elite athlete

Plan:

“doability”

• 3-4 x a week,

30-45 min low

level exercise

• After nine

months, long

runs added

• Max 7-9

hours/week

Results:

• RV mass and volume immediate ↑

• Add intense intervals eccentric hypertrophy of LV

• VO2max↑an average of 20%.

2015:

Where are we now?

Exercise as Rx

•Absence of Fitness= Smoking

•Goals: 9 METS F/10 METS M

•Small changes in fitness provide at

least as much benefit as statins, ASA, and

ACE-I

Exercise Goals: Weight

•ACSM goals

•Consistent aerobic

+strength

CV, live

longer, time,

bored •Running provides significant

benefits- even at

relatively low

levels

•HIIT is very

effective and

doesn’t have to be

100% all out

“To do something you’ve never done before, you have to do something you’ve never done before.”