Benefits/science of Exercise - ILD Collaborative€¦ · (Adapted from Albert RK, Spiro SG, JeP JR...

Benefits/scienceofExercise

KatyBlack,MDNovember3,2016

“Giveabouttwoofthem[hours]everydaytoexercise;forhealthmustnotbesacrificedtolearning.Astrongbodymakesthemindstrong.”

Whatisfitness?

BodyburnsoxygentodoworkBePerfitness=morework=moreoxygenused1.Pulmonarygasexchange(loadingbloodwithoxygen2.Cardiovascularperformance(deliveringbloodtobody)3.Skeletalmusclemetabolism(extracXngoxygen)

Peakexercisecapacityisdefinedas“themaximumabilityofthecardiovascularsystemtodeliveroxygentoexercisingskeletalmuscleandoftheexercisingmuscletoextractoxygenfromtheblood”.

Howdowemeasurefitness?

OxygenconsumpXon(VO2)=cardiacoutput*oxygenuse(arterial-venous

oxygencontent)

•  VO2(mL/kg/min) = (SV×HR)×(CaO2−CvO2)

•  VO2max = (SVmax×HRmax)×(CaO2max−CvO2max)

CardiopulmonaryexercisetesXng

•  Evaluatemaximumexercisepossible=maximumexerciseconsumpXon(VO2max)

•  IfVO2maxislow,determinewhetherheart/lungs/musclesareculprit

hPp://www.workwellfoundaXon.org/tesXng-for-disability/

Whathappenstobreathingduringexercise?

Exerciseandbreathing

•  Faster,deeperbreaths–  peakvenXlaXonincreases–  Resistancetoflowstayslow–  SmallerlungsatpeakexhalaXon;easiertotakenextbreath–  Peakinspiratorymusclesonlyabouthalfmaxstrength

•  Increasedbloodflowtolungs–  Noincreaseincapacityforbloodflowwithexercise– Morebloodperheartbeatcompensatesforfasterheartrate

–  IncreasedoxygendemandwithbePerfitness;mayoutstripcapacityforgasexchange(diffusingcapacity)

IncreasedresprateandXdalvolumewithexercise

hPps://www.umc.edu/EducaXon/Schools/Medicine/Basic_Science/Physiology_and_Biophysics/Core_FaciliXes%28Physiology%29/Physical_Exercise_-_VenXlaXon.aspx

Exerciseandbreathing:problems

•  Fasterdeeperbreaths–  Noimprovementinmusclestrengthorresistancewithexercise

–  Resistancetoflowincreasesinolderlungs-hardertoexhale

–  LungarehyperinflatedatexhalaXon•  hardertotakenextbreath

–  Peakinspiratorymusclesreachthelimitsofstrength•  Increasedbloodflowtolungs

–  Noincreaseincapacityforbloodflowwithexercise–  Limitedcapacityforgasexchange(diffusingcapacity)–  Problemforpulmonaryfibrosis

Limitsonairflow

Younghealthy Olderathlete

Reservevolumeatrest Reservevolume

inexercise

Dempsey,Johnson,Saupe,Chest,97(3Suppl.)(1990),pp.81S–87S

ReserveatrestReservevolumeinexercise

Howdoesobesityeffectbreathing?

Limitsonbreathingmuscleswithage

Younghealthyathlete Olderhealthyathlete

MaxexhalaXon

MaxinhalaXon

MaxexhalaXon

MaxinhalaXon

J.A.Dempsey,B.D.Johnson,K.W.SaupeAdapta@onsandlimita@onsinthepulmonarysystemduringexerciseChest,97(3Suppl.)(1990),pp.81S–87S

Obesitydecreaseslungvolumes

hPp://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/pulmonary-funcXon-tesXng/(AdaptedfromAlbertRK,SpiroSG,JePJR(eds):ComprehensiveRespiratoryMedicine.StLouis:Mosby,1999,p43.)

Obesitylowerslungvolumes

Vitalcapacity Totallungcapacity

BodyMassIndex BodyMassIndex

20  25304050

extremelyobeseobese

Riccardo Pellegrino et al. J Appl Physiol 2014;116:1175-1181

Obesityandbreathing

•  Increasedchestwallweight=lowerlungvolumes

•  OxygenconsumpXonbyrespiratorymusclesesXmated4xhigherthannonobese

•  WorkofbreathingesXmated70%more

•  Shipsmoreairtotopoflungs– Mismatchbetweenairandbloodflow

– Canloweroxygen

Somethingsdoimprovewithexercise

•  Exercisehelpstheheart•  Exercisehelpsthemuscles

•  Exercisehelpsthemind(wethink)

All-cause mortality by fitness groups

Annals of Epidemiology, Volume 19, Issue 4, 2009, 253–256

2603 adults 60+ years of age.

HazardRaXofordeathduringfollowup

ExerciseimprovesheartfuncXon

Stephan Gielen et al. Circulation. 2010;122:1221-1238

DatafromTheLancet,November1953

ExerciseprotectsagainstheartaPacks:possiblemechanismsfromratstudies

Shannon L. Lennon et al. J Appl Physiol 2004;96:1299-1305

HeartmuscleacXvityassessedaperischemiainrats

HeartanXoxidantlevelsandprotecXveprotein“heatshockprotein72”alsoroseaper8daysofexercise

Bedrestleadstolossofheartmass

Todd A. Dorfman et al. J Appl Physiol 2007;103:8-16

HeaddownXltbedrestmimicsweightlessness:extremeofsedentarylifestyle

Exercisepreventedbedrest-inducedheartmassloss

Todd A. Dorfman et al. J Appl Physiol 2007;103:8-16

HeaddownXltmimicsweightlessness.ExerciseincreasedheartmassmorethannutriXonalsupplement

Exercisecanhelpreverseheartchangesseeninheartfailure

Stephan Gielen et al. Circulation. 2010;122:1221-1238

Exerciseincreasesbloodsupplytomuscles

Stephan Gielen et al. Circulation. 2010;122:1221-1238

ExerciseincreasesenergyproducXonofmuscles

•  Mitochondriaprovideenergytocells

–  UseoxygentomakeATP•  Exerciseincreasesnumberandsizeofmusclemitochondria

•  Manypossiblemechanisms

Doesexercisehelpeveryone?

Exerciseimprovesfitnessinheartfailure

Systolicheartfailure(n=25-1) diastolicheartfailure(n=26-8)

Smart et al. American Heart Journal, Volume 153, Issue 4, 2007, 530–536

Improvedqualityoflife–specificallyphysicalandfuncXonalQOL

51shortofbreathpaXentswithheartfailure;16weeksofexercisebike,thenbike+resistanceexercises

VO2max

Hearttransplant:VO2oflessthan14mL/kg/minute

ExerciseimprovedwalkdistanceILD57subjectswithILD(34IPF);8weeks

Improved6MWDNochangeinVO2max

35m=114feet

hPp://m.mlb.com/glossary/rules/field-dimensions

meanincrease35m(25minIPF,43nonIPF)

RespiraXon.2014;88(5):378-88

ExerciseimprovedQOLinILDHealth related quality of life

Chronic Respiratory Disease Questionnaire.

A E Holland et al. Thorax 2008;63:549-554

PosiXveeffectsofexercise

Stephan Gielen et al. Circulation. 2010;122:1221-1238

SXllhardtoexercise

hPps://www.blf.org.uk/support-for-you/exercise/why-is-it-important

HowtomoXvate?

Strategiesforsuccess:moXvaXonandvoliXon

•  MoXvaXon:“Threatandcopingappraisal”– DoIreallyfeelworriedaboutdecondiXoning?– DoIreallybelieveexercisewillhelpme?

•  VoliXon:“goalsexng,acXonplanningandcopingplanning– “GoodintenXons”vs.“implementaXonintenXons”

GollwitzerJournalofPersonalityandSocialPsychology1997,Vol.73.No.1,186-199FrenchDP1,StevensonA,MichieS.PsycholHealthMed.2012;17(2):127-35..2011Jul11.

MoXvaXon+voliXon

•  MoXvaXon:readpamphlet–  Toldthatheartdiseasebeginnsearlyinlife,canbepreventedby20minutesofvigorousexerciseweekly

•  VoliXon:madeexerciseplan– DuringnextweekIwillpartakeinatleast20minutesofvigorousexerciseon(dayordays)_______________at_______________(Xmeofday)at/orin(place)_______________.

MilneetalBri,shJournalHealthPsychologyVolume7,Issue2May2002163–184

Results

Control MoXvaXonatXme1 QuesXonnaireXme2

MoXvatedatXme1GoalsexngXme2

Setspecificgoals,usingIf…then

•  Ifit’sMonday,Wednesday,orFriday,I’llgoforatwentyminutewalkat3:30pm

•  IfI’matthegrocerystore,I’llbuyapplesnotcookies.

Bereadyforobstacles

•  IfitrainsonMonday,thenI’llwalkatthemall•  IfImissawalkonMonday,thenI’llwalkTuesday

•  IfIbuycookies,thenIwillclosethebagandbringthemtoworktogiveaway

GollwitzerJuly1999•AmericanPsychologist

StrengthenvoliXon

Lossaversion–  Arrangetolosemoneyifyoudon’tmeetyourgoals

•  hPp://www.gym-pact.com/

Accountability–  Promisegroupyou’llbethere

Somereferences•  PostgradMedJ.2007

Nov;83(985):675–682.•  doi:

10.1136/hrt.2007.121558

•  PMCID:PMC2734442

•  Cardiopulmonaryexercisetes@nganditsapplica@on

•  KAlbouaini,MEgred,andAAlahmar,DJWright

•  hPp://www.nature.com/scitable/topicpage/mitochondria-14053590

•  J.A.Dempsey,B.D.Johnson,K.W.Saupe

•  Adapta@onsandlimita@onsinthepulmonarysystemduringexercise

•  Chest,97(3Suppl.)(1990),pp.81S–87S

Referencescont

•  JExercRehabil.2015Apr30;11(2):74-9.doi:10.12965/jer.150190.eCollecXon2015.

•  Pulmonaryrehabilita@onandexerciseinpulmonaryarterialhypertension:Anunderu@lizedinterven@on.

•  SahniS1,CapozziB2,IpikharA1,SgourasV3,OjrzanowskiM4,TalwarA5.

•  JExercRehabil.2015Apr;11(2):74–79.

•  RespiraXon.2014;88(5):378-88.doi:10.1159/000367899.Epub2014Oct23.

•  Exercisetraining-basedpulmonaryrehabilita@onprogramisclinicallybeneficialforidiopathicpulmonaryfibrosis.

•  VainshelboimB1,OliveiraJ,YehoshuaL,WeissI,FoxBD,FruchterO,KramerMR.

Improvingourhabits

THEFRAMEWORK:•  Iden@fytherou@ne•  Experimentwithrewards

•  Isolatethecue•  Haveaplan

hPp://charlesduhigg.com/how-habits-work/

Improvingourhabits

THEFRAMEWORK:•  Iden@fytherou@ne:watchingTVat3pminsteadofexercising

•  Experimentwithrewards:Canwatchcabletvatgym

•  Isolatethecue:at3pmshowcomeson

•  Haveaplan:setalarmfor2:45

hPp://charlesduhigg.com/how-habits-work/