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© 1998 - 2004 LifeLong Health®
Becoming More Physically Active
Becoming More Physically Active
Week 2 – Eight Weeks to Wellness™
Developed by Don Hall, DrPH, CHES
© 1997 - 2004 LifeLong Health® 2
• Sponsored by:Lassen Foundation2801 Williams Rd.Butte Valley, CA 95965
• Your name, Health Educator
© 1997 - 2004 LifeLong Health® 3
The Problem – InactivityThe Problem – Inactivity
• “It is estimated that
250,000 deaths per year in
the United States,
approximately 12% of the
total, are attributed to a
lack of regular physical
activity.”
• Most people are sedentary
• Nearly 3 out of every 4 adults get little or no regular exercise
• Only 23% get regular, light-moderate activity
• And only 12% get any regular, vigorous activity
CDC, Advance Data # 325, Apr 7, 2002
JAMA, Vol 273, No. 5, 402-7
© 1997 - 2004 LifeLong Health® 4
The Solution – Regular ExerciseThe Solution – Regular Exercise
• Regular physical activity reduces the risk for:
• Obesity
• High blood pressure
• Heart disease & stroke
• Diabetes
• Osteoporosis
• Many Cancers
• Anxiety & depressionJAMA, Vol 273, No. 5, 402-7
© 1997 - 2004 LifeLong Health® 5
Physical Activity Level and
Risk of Heart Attack
Physical Activity Level and
Risk of Heart Attack• Nurses Health Study,
72,488 women followed for 8 years
• The risk of heart attack decreased with increasing levels of physical activity
• Heart attack risk dropped 54% in the most active women
1.00
0.77
0.65
0.54
0.46
0.0
0.2
0.4
0.6
0.8
1.0
1st 2nd 3rd 4th 5th
Quintile ofphysicalactivity
Little activity High activity
Re
lativ
e R
isk
NEJM, p.650, Aug. 26, ‘99
© 1997 - 2004 LifeLong Health® 6
Physical Activity and Cholesterol LevelPhysical Activity and Cholesterol Level
All CauseMortalityMen
n=25,341
19 yrs offollow-up 0
10
20
30
40
50
Normal cholesterol High cholesterol
Low fitHigh fit
JAMA, Vol 276. No. 3, pp.205-210, 1996
© 1997 - 2004 LifeLong Health® 7
Physical Activity and Blood PressurePhysical Activity and Blood Pressure
0
10
20
30
40
50
Normal BP High BP
Low fit
High fitAll Cause Mortality
Men
n=25,341
19 yrs. of follow-up
Ref. JAMA, Vol 276. No. 3, pp.205-210, 1996
© 1997 - 2004 LifeLong Health® 8
Physical Activity and Smoking StatusPhysical Activity and Smoking Status
0
10
20
30
40
50
Nonsmoker Smoker
Low fit
High fitAll Cause Mortality Menn=25,341
19 yrs. of follow-up
JAMA, Vol 276. No. 3, pp.205-210, 1996
© 1997 - 2004 LifeLong Health® 9
Physical Activity and LongevityPhysical Activity and Longevity
2.01.9
1.71.5 1.3
1.6
0.0
1.0
2.0
Lowfitness
Smoker High BP
Highchol
Over-weight
Highglucose
Relative Risk of Mortality from All Causes in Men
Aerobics Center Longitudinal Study
© 1997 - 2004 LifeLong Health®
Cardiorespiratory Fitness and Cancer PreventionCardiorespiratory Fitness and Cancer Prevention
• Study 25,892 men age 30-87, followed for 10 years
• Results High fit persons had a 55% lower cancer mortality rate than low fit persons
• Controlled for smoking, age, BMI, alcohol, diabetes
Medicine & Science in Sports and Exercise, Fitness 34(5):735-739, May, 2002
1.00
0.62
0.45
0.00
0.25
0.50
0.75
1.00
Low Moderate High
Fitness Level
All
Ca
nce
r m
ort
ality
(R
R)
© 1997 - 2004 LifeLong Health® 11
Physical Activity and Risk of Hip Fracture Physical Activity and Risk of Hip Fracture
1.00
0.79
0.67
0.530.45
0.00
0.25
0.50
0.75
1.00
<3 3 to 8.9 9 to 14.9 15 to 23.9 24+
Hip
frac
ture
rat
e (R
R)
Activity Level, MET hrs/weekLow exercise High exercise
JAMA Nov. 13, 2002; 288:2300-06
n = 61,20012 year study
© 1997 - 2004 LifeLong Health® 12
Exercise and Blood Fat Levels Exercise and Blood Fat Levels
• Women who exercised by walking for 90 minutes on the previous day had lower blood fat levels than non exercisers:
• 19% lower fasting blood fat levels (next morning)
• 24% lower blood fat levels four hours after a high fat meal
0.8
1.7
1.0
2.3
0
1
2
3
Exercise No exercise
FastingPost meal
Blo
od
fat l
eve
ls, m
mo
l/L
Amer J Clinical Nutr 2000;71:465-71
© 1997 - 2004 LifeLong Health® 13
Physical Activity and Risk of DiabetesPhysical Activity and Risk of Diabetes
1.00
0.77 0.75
0.620.54
0
0.25
0.5
0.75
1
1 2 3 4 5
Physical Activity Level (by quintile)
Re
lativ
e R
isk
of D
iab
ete
sn
=70
,10
2
Sedentary Most Active
Nurses’ Health Study, JAMA, Oct. 20, 1999
© 1997 - 2004 LifeLong Health®
Physical Activity and Breast CancerPhysical Activity and Breast Cancer
Breast Cancer Study• 6,160 women free of
breast cancer, followed for 10 years.
• Women age 50+ who consistently had high recreational activity, compared to those who were inactive, had 67% less breast cancer.
0.33
1.00
0.00
0.25
0.50
0.75
1.00
Most active Inactive
Bre
ast
canc
er (
RR
)
Cancer Epidemiol Biomarkers Prev, July 2001
© 1997 - 2004 LifeLong Health® 15
Moderate Activity and HealthModerate Activity and Health
64.0
26.320.3
0.0
20.0
40.0
60.0
Unfit Moderately fit Highly fit
Mortality rate, per 10,000 person years, all causes, Men
JAMA Vol 262:2395-2401
© 1997 - 2004 LifeLong Health® 16
Moderate Activity and HealthModerate Activity and Health
39.5
16.4
7.40
15
30
Unfit Moderately fit Highly fit
Mortality rate, per 10,000 person years, all causes, Women
JAMA Vol 262:2395-2401
© 1997 - 2004 LifeLong Health® 17
Physical Activity GuidelinesPhysical Activity Guidelines
Every U.S. adult should accumulate 30 minutes or more of moderate intensity physical activity on most, preferably all, days of the week.The goal is to expend 200+ calories daily, or the equivalent of a 2-mile brisk walk.Source: Centers for Disease Control and Prevention and the American College of Sports Medicine, JAMA, Vol 273, No. 5.
© 1997 - 2004 LifeLong Health® 18
Institute of MedicineFitness GuidelinesInstitute of MedicineFitness Guidelines
• To prevent weight gain and to gain optimal health benefits from physical activity, 60 minutes of daily moderate intensity physical activity is recommended. Examples include:• Brisk walking (4 mph when possible)• Walk/jogging (5 mph)• Other activities equivalent to these activities
• Children also need 60 minutes or more of daily activity Nat. Academy of Sciences, IOM, 2002
© 1997 - 2004 LifeLong Health® 19
Physical Activityis Good MedicinePhysical Activityis Good Medicine
“All who can possibly do so ought to walk in the open air every day, summer and winter.
A walk, even in winter, would be more beneficial to the health than all the medicine the doctors may prescribe.”
Counsels on Health, 52
© 1997 - 2004 LifeLong Health® 20
Examples of Physical ActivityExamples of Physical Activity
Moderate
• Walking briskly, 3-4 mph
• Cycling for pleasure,10 mph
• Swimming, moderate level
• Conditioning exercises
• Golf, carrying/pulling clubs
• Canoeing/rowing, 2-3 mph
• Mowing lawn, rakingleaves, hoeing in garden
Hard/Vigorous
• Walking briskly uphill or climbing stairs
• Cycling fast, 12-16 mph
• Swimming, fast crawl
• Active sports:
• Tennis• Racquetball• Basketball• Jogging/Running
© 1997 - 2004 LifeLong Health® 21
Total Activity TimeTotal Activity Time
• It’s not necessary to do all of your activity at one time.
• You may want to break it up into
• Two 15-minute or
• Three 10-minute sessions
Two 15-minute sessions
• Walk 1 mile briskly
• Ride the stationary bike for 15 minutes in the evening
Three 10-minute sessions
• Walk 10 minutes to work
• Walk another 10 minutes at noon
• Mow lawn for 10 minutes in the afternoon
© 1997 - 2004 LifeLong Health® 22
Exercise IntensityExercise Intensity
• You need to maintain your activity for the full time planned (10-30+ minutes) without undue strain or fatigue.
• Your activities should feel “fairly easy” to “somewhat hard.”
• Your activity should make you breathe deeply but not make you out of breath.
• A moderate sweat is a good indicator that health benefits are occurring.
© 1997 - 2004 LifeLong Health® 23
Walking Pace and Heart HealthWalking Pace and Heart Health
100
71
52
0
20
40
60
80
100
120
Less than 2 2 to 2.9 3 or moreWalking Pace (mph)
Re
lativ
e r
isk
of H
eart
Atta
ck
New England Jour. Medicine, Aug. 1999
n=72,000 women
© 1997 - 2004 LifeLong Health® 24
ProgressionProgression
• Start with moderate activities• Activities you can do without getting out of breath, that
are ‘fairly light” to “somewhat hard”
• Gradually build up to 30+ minutes per day
• For higher levels of fitness, add vigorous activities or increase activity time to 60 minutes after you are used to regular physical activity
• If you have a heart or other serious health problem, get your doctor’s clearance first
© 1997 - 2004 LifeLong Health® 25
Medical ClearanceMedical Clearance
• Most adults do not need to see their physician before starting a moderate intensity physical activity program.• However, men older than 40 years or women older
than 50 years who plan a vigorous program,• Or, anyone with either chronic disease or risk factors
for chronic disease, should consult his or her physician to design a safe, effective program.
Source: Centers for Disease Control and Prevention and the American College of Sports Medicine, JAMA, Vol 273, No. 5.
© 1997 - 2004 LifeLong Health® 26
Strength and FlexibilityStrength and Flexibility
• Include strength and flexibility exercises two to three times per week for other important health benefits.
• Strength and flexibility training helps… • Protect against back pain and injuries
• Maintain bone mineral content and bone strength
• Prevent the loss of muscle mass
• Improve your figure/physique
• Prevent disability in older age
© 1997 - 2004 LifeLong Health® 27
Use Proper TechniqueUse Proper Technique
• Perform each exercise through a full range of motion
• Weights should be lifted and lowered in a slow, controlled manner.
• Keep muscular balance by alternating pairs of muscles (e.g. perform a pull for each push exercise)
• Breath normally, don’t hold breath and strain
• Work in a team for safety & feedback
© 1997 - 2004 LifeLong Health®
• Study 3933 men age 20-69, followed for 13 years
• Results Persons with low abdominal fitness and low grip strength had significantly higher mortality rates.
• Summary Strength training improves survival
2.77
1.00
1.67
1.00
0.00
1.00
2.00
3.00
Sit-ups Grip strength
LowHigh
Fitness Level
All
Ca
use
mo
rtal
ity (
RR
)
Medicine & Science in Sports and Exercise, Fitness 34(5):740-44, May, 2002
Musculoskeletal Fitness and MortalityMusculoskeletal Fitness and Mortality
© 1997 - 2004 LifeLong Health® 29
Strength Test Predicts Functional Limitations 25 Years LaterStrength Test Predicts Functional Limitations 25 Years Later
• A 25-year prospective, cohort study including 3218 men, ages 45-68
• Strength assessed using hand grip test
• Groups divided into tertiles (thirds) based on strength then tested for functional capacity 25 years later
0
2
4
6
8
10
12
Poor walkingability
Difficulty risingfrom chair
High strengthMiddleLow strength
% w
ith li
mita
tion
JAMA, 1999, Vol 281, No. 6, 558-60
© 1997 - 2004 LifeLong Health® 30
0
5
10
15
20
25
30
Do heavyhousework
Walk 1/2mile
Walk up 10steps
Lift 10 lbs.
High strengthMiddleLow Strength
% w
ith li
mita
tion
JAMA, 1999, Vol 281, No. 6, 558-60
Strength Predicts Limitations in Housework, Walking, and LiftingStrength Predicts Limitations in Housework, Walking, and Lifting
© 1997 - 2004 LifeLong Health® 31
0
2
4
6
8
10
Dressing Bathing Toileting Eating
High strengthMiddleLow Strength
% w
ith li
mita
tion
JAMA, 1999, Vol 281, No. 6, 558-60
Strength Predicts Limitations in Personal Care TasksStrength Predicts Limitations in Personal Care Tasks
© 1997 - 2004 LifeLong Health® 32
Low Strength and Relative Risk for DisabilityLow Strength and Relative Risk for Disability
Activity RR*Poor walking ability 2.8Unable to rise from
a chair 2.7Lift 10 pounds 1.9Do housecleaning 1.7*Relative risk (low strength compared to high strength) adjusting for age, weight, education, smoking, physical activity, and chronic health problems.
Grip Strength Rating* Kg
Low strength < 37Middle strength 37-42High strength Over 42
*One hand
Grip Strength Rating* Kg
Low strength < 37Middle strength 37-42High strength Over 42
*One hand
JAMA, 1999, Vol 281, No. 6, 558-60
© 1997 - 2004 LifeLong Health® 33
• The bottom line is . . .
• If you want to remain independent and have fewer limitations as you grow older, it is vital to build and maintain good muscle strength now!
• Do muscle strength training exercises two to three times each week. Choose eight to 10 exercises of the major muscle groups and do eight to 10 repetitions of each exercise at near maximal effort. Increase the effort as you get stronger.
• Be careful not to overstrain.
Preventing DisabilityPreventing Disability
© 1998 - 2004 LifeLong Health®
Case StudiesCase Studies
Ben Levensin, 103 year old sets new world record in shot put for men over 100 years old.
At the World Senior Olympics
Mavis Lindgren
90 year old marathoner
Mavis Lindgren
90 year old marathoner
• Mavis started running in her mid 60s because of health problems
• She holds records for her age division in 11 Portland marathons
• She has competed all over the world: New York, Los Angeles, San Francisco, San Diego, and London
© 1997 - 2004 LifeLong Health® 37
CommitmentCommitment
“I complained about bad feet, until I met the person without feet.”
Aimee Mullins
© 1997 - 2004 LifeLong Health® 38
SummarySummary
• Warm-up/Cool-down: Ease into and out of exercise.
Don’t strain. Allow your body to adjust gradually.
• Activities: Choose activities that use the large muscle
groups, that are rhythmic, and that you enjoy.
• Duration/Intensity: Exercise daily when possible.
• Intensity: Choose moderate activities to begin and
increase your activity time or vigorous activities gradually.
• Strengthening/Stretching: Do strength and stretching
exercises at least two to three times a weekCDC and the American College of Sports Medicine. JAMA, Vol . 273, No. 5
© 1997 - 2004 LifeLong Health® 39
Being Active for a LifetimeBeing Active for a Lifetime
• Choose a variety of physical activities you enjoy.
• Don’t overdo it and become discouraged. Set
realistic goals.
• Do activities with your spouse or friends.
• Keep a written record, an activity log to track
progress toward your goals.
• Think of physical activity as play. Have Fun!
© 1997 - 2004 LifeLong Health® 40
QuizQuiz
1. T/F 250,000 people die prematurely each year due to inactivity.
2. T/F Regular activity can cut the risk of heart disease in half.
3. T/F Regular activity can cut the risk of heart disease, stroke, high blood pressure, breast cancer, diabetes, and cirrhosis.
4. T/F Smokers who exercise regularly have a lower mortality rate than sedentary nonsmokers.
5. T/F Obesity is a stronger predictor of mortality than a low fitness level.
© 1997 - 2004 LifeLong Health® 41
Quiz continuedQuiz continued
6. For best health you need ___ to ___ minutes of moderate physical activity on most, preferably all, days of the week.
7. T/F Most people do not need to see their physician before starting a moderate intensity physical activity program.
8. For best health, strengthening and stretching exercises should be done at least ___ to ___ times per week.
9. T/F The “warm up” is more important than the “cool down” period of an exercise session.
10.List two key principles for encouraging physical activity to be maintained for a lifetime.
© 1998 - 2004 LifeLong Health®
www.LifeLongHealth.us
© 1997 - 2004 LifeLong Health® 43
Physical Activity and MortalityPhysical Activity and Mortality
0.60.4
0.7 0.7
1.0 1.0
0
0.25
0.5
0.75
1
2+ times/week Occasionally Seldom or never
Entire cohort
Twin pairsRelative Risk of Heart Attack
Frequency of 30-minute physical activity sessions
Finnish Twin Cohort, JAMA, Vol 279, No. 6
(n=15,902)
© 1997 - 2004 LifeLong Health® 44
Physical Activity and MortalityPhysical Activity and Mortality
1.0
0.9
0.70.7
0.6
0
0.25
0.5
0.75
1
1 2 3 4 5
Relative Risk of Heart Attack
MET Index Quintile (1=lowest intensity, 5=highest intensity)
Finnish Twin Cohort, JAMA, Vol 279, No. 6
(n=15,902)
© 1997 - 2004 LifeLong Health® 45
Physical Activity and LongevityPhysical Activity and Longevity
5.9
9.8
12.4
0
3
6
9
12
15
Active Moderate Inactive
Mortality rate in 9 years (%)Men
Good Health Practices Study
© 1997 - 2004 LifeLong Health® 46
Physical Activity and LongevityPhysical Activity and Longevity
2.9
5.2
9.0
0
3
6
9
12
Active Moderate Inactive
Mortality rate in 9 years (%)Women
Good Health Practices Study
© 1997 - 2004 LifeLong Health® 47
HDL CholesterolHDL Cholesterol
• Factors that improve HDL
• Aerobic exercise, 12-20 aerobic miles per week
• Achieve/maintain ideal body weight
• Avoid smoking• Avoid trans fatty acids
• Note: For every 1% you increase HDL levels, you decrease CHD risk by 2-3%
223
56
107
160
0
50
100
150
75+ 74-55 54-45 44-35 <35
HDL Levels mg/dL
CH
D m
ort
alit
y r
ate
, me
n
Source: Framingham Heart Study