Motivation & Exercise Get Fit Series

1. Motivation & Exercise Get Fit Series David S. Edwards, M.D. Department of Family Medicine & Sports Medicine Texas Tech University Health Sciences Center, Lubbock

2. Objectives • Discuss the effects of exercise on the human body and its major organ systems. • Review common injuries and principles of treatment. • Identify “red flags” that may lead to injury or permanent disability. • Create an exercise program that is fun!

3. You are wonderfully made!(images: www.wikiality.com, www.newsin3D.com ) • “What a piece of work is a man! How noble in reason, how infinite in faculty, in form and moving how express and admirable, in action like an angel, in apprehension how like a god!” • William Shakespeare

4. Top Ten New Year’s Resolutions (about.com, Powell & Powell) • 1. spend more time with family & friends • 2. get in shape • 3. lose weight • 4. stop smoking • 5. enjoy life more • 6. quit drinking alcohol • 7. get out of debt • 8. learn something new • 9. help others • 10. get organized

5. Why exercise? • Improved bone density • Lowering of blood pressure • Improving cholesterol, LDL, and HDL • Enhanced self-image • Improve balance and coordination • Decrease anxiety and depression • Promote restful sleep

6. Reasons Boys Play Sports • To have fun • To improve skills • Excitement of competition • Self-identity tied to athletic ability

7. Reasons Girls Play Sports • To have fun • To exercise • To get in shape • Anatomic changes during adolescence can be frustrating for athletes. • Ballet, dance • Gymnastics • Figure skating

8. Exercise is not easy! • Societal developments over the past 20 years: • Sedentary lifestyle • High fat diet • High refined carbohydrate diet Image: www.stayviolation.typepad.com

9. The Obesity Epidemic • Source: CDC

10. Sequelae of obesity • High blood pressure • Impaired glucose tolerance • Diabetes mellitus II • Elevated cholesterol, atherosclerosis • Osteoarthritis of hips and knees • Non-alcoholic steatohepatitis (NASH) • Airway obstruction , sleep apnea • Certain cancers

11. Not everyone can jump into exercise. • Certain groups require preliminary cardiac stress testing. • Low risk: male<45, female <55, 1 risk factor. • Moderate risk: male>45, female >55, 2 risk factors. • High risk: signs and symptoms

12. Coronary artery disease risk factors(image: www.topnews.in ) • Family history (male<55, female<65) • Cigarette smoking • Hypertension • Elevated cholesterol • DM II, impaired fasting glucose • Obesity • Sedentary lifestyle

13. Signs/Symptoms of coronary artery disease • Dull pain: neck, chest, jaw, left arm • “indigestion” • Shortness of breath at rest or with mild exertion • Dizziness, syncope • Orthopnea, paroxysmal nocturnal dyspnea • Ankle edema • Palpitations • Claudication • Heart murmur • Recent fatigue with usual activities

14. The Aerobics Center Longitudinal Study – Sui X., et al • Prospective cohort of over 2600 adults > 60 from 1979-2001 • Fitness measured by treadmill exercise testing periodically • Fit people had a lower mortality regardless of abdominal obesity or % body fat! • Fit people who were obese had lower mortality than non-fit people with normal weight!

15. Principles of Acute Soft Tissue Injury • Protection • Rest / relative rest • Icing • Compression • Elevation • Mobility

16. Injury Treatment - Ice • Useful for acute injury • Decreases swelling and pain • Chronic injury – only after activity • Ice massage with elevation • < 20 minutes, wait at least 45 minutes before re-application

17. Injury Treatment - heat • Relaxes and loosens soft tissues • Stimulates blood flow • Useful for chronic injury / overuse beforeactivity • Contraindictions: acute injury, after activity, altered mentation or mobility • Heating pad or hot damp towel

18. Side Effects of NSAIDs • Images: www.medicalook.com & www.gamewood.net

19. Overuse Injuries Can Progress Rapidly • Type I – pain after activity • Type II – pain during activity, does not limit activity • Type III – pain during activity, limits performance • Type IV – pain at rest

20. Prevention(Image: www.ushistory.org ) • “An ounce of prevention is worth a pound of cure.” • “Exercise is medicine!” • ACSM

21. Sites of Stress Fracture Images www.eorthopod.com , www.fairview.org

22. Risk Factors for Stress Fracture • Female gender, short stature • Overuse, repetitive activity • Recent changes in training program or running surface • Mileage > 20 miles per week • Underlying disease: Osteopenia, Osteoporosis, alcoholism, kidney failure Image www.coloradorunnermag.com

23. Prevention of Stress Fracture • Adequate nutrition and calcium intake • Proper foot wear • Softer training surface • Proper training • Gradual buildup in mileage • Rest • Cross-training

24. Flexibility: Maximize performance and protect your joints • Connective tissue – tendon, ligament, joint capsule, fasciae in and around muscle • Stretch – increase connective tissue length through range of motion • Elastic • Plastic • Temperature-dependent • Jog prior to stretching

25. Flexibility • Slow movements • Stretch reflex: rapid stretching causes protective muscle contraction • Reach maximum ROM • Beware of excess • Decreased stability: joint sprain • Decreased flexibility: muscle strain • Easily lost • Greatest in the first two weeks of injury

26. Improving Flexibility • Pre-season & in-season : start early • Daily • Static stretching – safest • Stretch large muscle groups first, then smaller groups • After warm-up and after practice

27. Flexibility - precautions • Avoid ballistic stretching • Avoid stretching as a warm-up activity. • Images: www.hsc.csu.edu, www.otda.state.ny.us, www.yoga-made-ez.com.

28. Preventing Injury • Good posture, “sit tall” • Strength and flexibility • Maintain a healthy weight. • Correct imbalances in muscle strength • Stretch daily after a warm up and as a cool down • Must rehab old injuries • Appropriate equipment / footwear

29. Prevention of heat illness • Pre-hydrate before planned exercise. • Check the weather report. • Light clothing, mesh, loose-fitting, change when soaked • Adjust schedules, increased # breaks • Adequate sleep • Avoid oil or gel-based sunscreens that can hinder evaporation

30. Prevention of Heat Illness • Monitor body weight. • Nude weight before and after workout • Loss of > 2% of body weight affects performance, > 3% weight loss affects thermoregulation • Monitor urine color. • For every 1 lb drop, must drink 1 pint (about 500 ml)

31. “Opposition is a natural part of life. Just as we develop our physical muscles through overcoming opposition – such as lifting weights- we develop our character muscles by overcoming challenges and adversity.” -Stephen R. Covey

32. Resistance Exercise(image: www.medical-look.com ) • Used in combination with aerobic exercise • Tone muscle • Increases resting metabolic rate • Reduced blood pressure: affects cardiac morbidity, stroke risk, overall mortality • Total fat reduction • Elderly: increased endurance, walking speed, balance, reduces falls

33. Benefits of Exercise • Feel better • Improved energy, decrease stress & anxiety, improved mood and endurance • Improve appearance • Weight control, tone muscles, improve posture • Decrease risk of disease • Reduce blood pressure and cholesterol • Improve bone mass and strength

34. Healthy Weight Loss • Dietary changes: • Reduce fat in the diet • Reduce # meals eaten out • Set an eating schedule • Low calorie snacks • Decrease use of soft drinks • Eat breakfast

35. 2007 Physical Activity Recommendations: ACSM & AHA • Healthy adults < 65 years old • Moderate intensity cardiovascular exercise for 30 mins/day, 5 days a week OR: • Vigorous intensity cardiovascular exercise 20 mins/day, 3 days a week • AND: strength training • 8 to 10 exercises with 8-12 repetitions of each exercise. • Twice a week on non-consecutive days

36. 2007 Physical Activity Recommendations: ACSM & AHA • Healthy adults > 65 yo, chronic illness or functional limitation in adults 50-64 yo • Moderate intensity exercise 30 mins, 5x/wk OR: • Vigorous intensity exercise 20 mins, 3x/wk AND: • Weight training: use weight to allow 10-15 repetitions • Flexibility exercises – 10 mins daily, 2x/wk • Balance exercises • Have a physical activity plan.

37. Don’t Quit • “Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it.” • Plato • “Don’t let what you cannot do interfere with what you can do.” • Coach John Wooden

38. Bring a Friend(image: www.i.co.telegraph.uk , www.w2fitness.com ) • Motivation • Support • More walk, less talk! • Accountability • A.L.S.A. – 10 year study, age 70 and older, close friendships promote longevity

39. Track your progress!(image: http://us.123rf.com ) • What are your goals? • Immediate • Short term • Long term • “A journey of 1,000 miles begins with a single step.”– Lao-Tzu • Journal / Training log • Monitor growth and development

40. Quiz • All of the following are ways to reduce risk of injury except: • A. maintaining a healthy weight • B. stretching consistently • C. icing old injury before exercise and applying heat after exercise • D. weightlifting in a structured setting

41. Quiz • Your 55 yo neighbor asks you about starting an exercise program. She weighs 220 pounds and is diabetic. Your best response is: • Please join me for my daily exercise. • Maybe you should see your doctor first. • Maybe you should join a local gym. • Maybe you should lose weight first. • Can you watch the kids this weekend?

42. Additional Sources: • Blanke, D. “Preseason Conditioning : Flexibility” in Team Physician’s Handbook,3rded., Mellion, M. et al, editors, Hanley & Belfus, inc:Philadelphia, 2002. • Carbon, R., “ABC of Sports Medicine: Female Athletes” British Medical Journal 1994; 309: 254-258. • Cluett, J. “Ice or heat” About.com: Orthopaedics, http://www.orthopaedics.about.com , accessed 4/18/08. • Griffin, L.Y., et al. “The Female Athlete” in: Mair & Johnson edsClinical Sports Medicine, 1st ed. Philadelphia: Mosby; 2006: 61-78. • Herring, S.A., et al. “Female Athlete Issues for the Team Physician: A Consensus Statement” 2007. www.aafp.org, accessed 9/21/07. • Sui X. et al, “Cardiorespiratory fitness and adiposity as mortality predictors in older adults” JAMA. 2007; 298: 2507-2516

43. Image: www.4catholiceducators.com