Practice of Medicine
Lecture Series
“Physical Fitness For The
Patient”
Julie Dial, M.A.
Disease Management Coordinator/Exercise
Physiologist
UTMB Personal Health Management
Objectives
• Brief Physiology of Exercise
• Important Research Findings
Regarding Benefits of
Exercise
• Practical Application/Patient
Education
• Special Population Concerns
• Q and A
Physiology Related to
Physical Activity
• Blood Flow
• Metabolism
• Hypertrophy/Strength
Gaining
Physiology Related to
Physical Activity
• Increase Respiration Rate
• Increase Core Temperature
• Increase Blood Flow and Oxygen Rich
Blood to Working Muscles
• Increase Efficiency of the Heart as
Beats per Minute Decreases
Rated Perceived Exertion
(RPE Scale)
0
0.5
1
2
3
4
5
6
7
8
9
10
*
Nothing at All
Very, very weak
Very Weak
Weak
Moderate
Strong
Very Strong
Very, very strong
Maximal
Overload Principle
• To Gain Strength
• Place More Stress Than the Muscle is Used
to Performing
• “Use it or Lose it” Principle
• Strength vs. Toning
• Sets, Reps - Muscle Groups to Work Out
Research Finding Regarding
Benefits of Exercise
• Surgeon General’s Report on Physical
Activity and Health
• Major Findings:
– Conclusions on Physical Activity Based on Research
Findings through 1995
– Emphasizes Benefits of Regular Physical Activity, i.e.
reduce risk of dying prematurely, dying from heart
disease, and promotes psychological well-being
How To Begin
• Never too late to begin, always will get
some results
• Over 40 – Male
• Over 50 – Female
• Clearance from physician recommended,
sometimes including stress test/stress
echo
Practical Application
• Physician Checklist
If more than two of the following
exist, increase physical activity
• Physical Inactivity
• Family History of Heart
Disease
• Smoker, past smoker, live
with smoker
• Hyperlipidemia
• Obesity
Open-Ended Questions to Ask
Your Patients
• Do you feel your lifestyle habits contribute
to your health?
If yes - What habits contribute most
to health status?
If no - Explain Benefits
• If you were to begin some physical activity
what do you feel would be beneficial to
you?
• Are there unstructured activities you
might be currently doing or willing to do?
Philosophy of Stages of Change
• Behavior Change occurs more readily
when matched to individuals’
placement on the continuum
• Examples of What’s on the Continuum
Special Population Patients
Obesity:
Excess of body fat frequently resulting in
a significant impairment of health
Primary causes: diet, physical inactivity
Other factors: genetic, endocrine, and
hypothalamic disorders
Risks:
• Not only risk of disease, but severity
of disease.
• Body fat distribution may contribute
more to disease than total body fat:
upper body fat distribution
(abdominal, trunk), CAD, HTN,
hyperlipidemia, diabetes, hormone,
and menstrual dysfunction
Risks (cont’d)
• Orthopaedic problems on lower back,
hips, and knees due to excess weight
on joints.
• Excess stress on heart due to
pumping harder to get blood to
proper areas to make the heart work
(1 lb.. of fat = 1/4 mile of capillaries makes the heart work harder)
Exercises and Benefits
• Non weight-bearing aerobic activities
- water walking, water aerobics,
recumbent bike
• Walking - if tolerated, mild short
bouts (start with 5 minutes, increase
when tolerated). Proper
environment/avoid excessive heat.
Benefits (cont’d)
• Decrease fat weight, body weight,
cholesterol (hopefully)
• Decrease risk for cardiovascular and
orthopaedic problems.
• Increase metabolism, muscle mass,
energy level.
Hypertension/Heart Disease
American Heart Association
Data
• 1.5 million Americans suffer
new/recurrent heart attacks every
year - 487,000 die.
• 500,000 Americans suffer a
new/recurrent stroke every year more than 154,000 die.
Hypertension (cont’d)
• Estimated in U.S. - 50 million
individuals have elevated BP or take
meds - increases risk for nonfatal and
fatal CVD, CAD, etc.
• 90-95% of hypertension cases are
unknown (5-10% identified medical
diagnosis)
Exercise Benefits/Reduced
Risk
• Opens arteries, decreases plaque
• Increases HDL, decreases LDL
cholesterol
Exercise Benefits (cont’d)
• Endurance exercise reduces the
magnitude of rise in BP
• Key to achieving good aerobic fitness
and decreasing heart disease risk is
to successfully fill the heart with
blood
Precautions
• Resting systolic BP > 200 mmHg
• Resting diastolic BP > 115 mmHg
• Breath holding (grunts) may elevate
BP
• Keep weight light, repetitions high
(10-15 in a row)
• Circulation Journal, Feb. 1999
Exercise in Cancer Recovery
Research:
Program in Southern California using a
four component approach:
1. Aerobic training
2. Strength Training
3. ROM/flexibility
4. Mind/body fitness
ACSM Health and Fitness Journal
Jan/Feb. 2001, Vol.5, No. 1
Study cont’d:
Increased immune system in an
ongoing exercise program
Relieved discomfort and
beneficial effects on hormones
Approximately 80% of
participants were still in
program after 5 yrs.
Cancer, Exercise, Immune
System
University of Northern Colorado –
Cancer, Exercise, Immune System
Research
Flexibility, balance, endurance, strength
Up to 2 years s/p treatments, either
chemo. and/or radiation – fatigue still
number 1 complaint
Cancer Exercise and
Benefits
• Begin mild stretching and cardiovascular
(recumbent bike, walking, swimming, etc.)
conservatively - 5-15 min. (in most cases)
• Strength training - usually begin with one
set of 5-10 reps. using either light
machines, dumbbells, or thera-bands
• Ask specifically about chemo. treatment
times and best days
Cancer Exercise and
Benefits (cont’d)
• Stronger - assist with getting out of
bed, chair, car, lifting, etc.
• Able to increase endurance to assist
with immuno suppression
• Mental/stress release
Precautions
• From Chemotherapy - immuno suppressed
• Nausea
• General Fatigue
• Soreness around catheter and/or
incision if had surgery
Diabetes
• Type I - usually developed in
childhood, formally known as insulindependent diabetes mellitus (IDDM)
• Type II - most common form
influenced by environmental factors
(mainly obesity), non insulindependent diabetes mellitus
(NIDDM)
Benefits and Exercise
• Improves insulin sensitivity
• Improves muscle flexibility and
strength
• Improves blood lipid and lipoprotein
levels
• Improves overall physical fitness
• Health and Fitness Journal (ACSM)
Precautions
• Avoid exercise when blood glucose is low and times
of peak insulin action
• Before/after exercise, look for blisters,
persistent redness (>20 min.), and potential
damage to feet (proper footwear)
• Adverse effects on glucose levels if not properly
hydrated
• May be beneficial to inject insulin away from
muscle that will be exercised
Arthritis
• Osteoarthritis - Most common cause
of disability in the United States. It
is a gradual degeneration in articular
cartilage
• Most common kind of arthritis
• Occurs mainly in weight bearing joints
- hips, knees, spine
Exercises for Osteoarthritis
• Aerobic - mainly non-weight bearing
activities such as swimming, rowing, biking,
etc. (unless otherwise directed by Orthop.
Surgeon) - 3 -5 times per wk.
• Weight Training - Upper body is usually
okay unless in shoulders, lower body- light
wts., more reps. (2-3 times per wk.)
• Stretching and Flexibility exercises
Arthritis (cont’d)
• Rhumatoid - Inflammatory arthritis
starting in the synovium, lining of the
joint, tendon inflammation
• Treat as apparently healthy individual
for all areas except those affected
• Use pool exercises for arthritic areas
Osteoporosis
• “Porous Bones” or thinning of the bones
• Condition affects about 25 million
Americans (approx. 80% women)
• Responsible for 1.5 million fractures per
year
• 1/4 million hip fractures annually (15%-20%
mortality rate)
• Disability
Osteoporosis (cont’d)
• Hip Fractures - 300,000 annually
• Vertebrae - 500,000 annually
• Wrist - 200,000 annually
• Other Fractures - 300,000 annually
• Costs - $18 billion/per year
Reaction Time Studied
• Ankle/wrist wts. and/or light free wts.
• Lateral movements w/wt. vest to test hip
bone strengthening
• Found – reaction time needed to prepare if
falls occur
Journal American Medical Assoc., Mar. 2001
Exercise Benefits
• Exercise is the key strategy for preventing
and treating osteoporosis (mainly weightbearing activities and mild strength
training/stretching to build strength and
muscle mass)
• Hopefully give enough strength to prevent
falls or lessen the severity
• Physician and Sports Medicine Journal, Feb. 1998
Recipe for Success
• Encourage Any Positive Behavior
• Be Realistic About Expectations
• Give suggestions on how to be active
• Use a Team Approach when available
• Follow up on Progress