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Exercise Prescription

運動處方

Stanley Sai-chuen HUIAssociate Professor, Dept. of SSPE, CUHK

Fellow, ACSM

Vice-chairman, HKPFA

許世全教授許世全教授香港中文大學 體育運動科學系香港中文大學 體育運動科學系香港體適能總會 副主席香港體適能總會 副主席

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Changes of Physical FitnessChanges of Physical Fitness

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Changes of Physical FitnessChanges of Physical Fitness

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Effect of 12-week Strength TrainingEffect of 12-week Strength Training

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Effect Aerobic Ex on VO2maxEffect Aerobic Ex on VO2max

Foss 1998, Fox Ex Physiology, p. 329

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Benefits of Regular Exercise

Improvements in Cardiovascular and Respiratory Function Increased maximal oxygen uptake due to both central

and peripheral adaptations

Lower minute ventilation at a given submaximal intensity

Lower myocardial oxygen cost for a given absolute submaximal intensity

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Lower heart rate and blood pressure at a given submaximal intensity

Increased capillary density in skeletal muscle

Increased exercise threshold for the accumulation of lactate in the blood

Increased exercise threshold for the onset of disease signs or symptoms (e.g., angina pectoris, ischemic ST-segment depression, claudication)

Improvements in Cardiovascular and Respiratory Function (cont’)

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Reduction in Coronary Artery Disease Risk Factors

Reduced resting systolic/diastolic pressures

Increased serum high-density lipoprotein cholesterol and decreased serum triglycerides

Reduced total body fat, reduced intra-abdominal fat

Reduced insulin needs, improved glucose tolerance

Benefits of Regular Exercise

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Decreased Mortality and Morbidity

Primary prevention (I.e.,intervention to prevent an acute cardiac event)

1. Higher activity and/or fitness levels are associated with lower death rates from coronary artery disease

2. Higher activity and/or fitness levels are associated with lower incidence rates for combined cardiovascular diseases, coronary artery disease, cancer of the colon, and type 2 diabetes

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運動 死亡率 冠心病 癌症運動 死亡率 冠心病 癌症

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24.6

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20

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40

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7039.5

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3.9

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10.8

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10

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男男 女女

美國德州有氧運動研究中心 美國德州有氧運動研究中心 (Blair et al. 1989)(Blair et al. 1989)1=unfit2 & 3 = mod. Fit4 & 5 = high fit

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Secondary prevention (i.e. interventions after a cardiac event [to prevent another])

1. Based on meta-analyses (pooled data across studies), cardiovascular and all-cause mortality are reduced in post-myocardial infarction patients who participate in cardiac rehabilitation exercise training, especially as a component of multifactorial risk factor reduction

2. Randomized controlled trials of cardiac rehabilitation exercise training involving post-myocardial infarction patients do not support a reduction in the rate of nonfatal reinfarction

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Results of Studies Investigating the Relationship Between Physical Activity and Incidences of Selected Chronic Diseases

* Few studies, probably less than 5; ** Approximately 5 to 10 studies;*** More than 10 studies.

No apparent difference in disease rates across activity or fitness categories;

Some evidence of reduced disease rates across activity or fitness categories;

Good evidence of reduced disease rates across activity or fitness categories;

Excellent evidence of reduced disease rates across activity or fitness categories, good control of potential confounders, excellent methods, extensive evidence of biological mechanisms, relationship is considered causal.

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Disease or Condition

Number of Studies

Trends Across Activity or Fitness Categories and Strength of Evidence

All-cause mortality *** Coronary Artery Disease *** Hypertension ** Obesity *** Stroke *** Peripheral vascular disease

*

Type II diabetes mellitus ** Osteoarthritis * Osteoporosis **

Results of Studies Investigating the Relationship Between Physical Activity and Incidences of Selected Chronic Diseases

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Disease orCondition

Number ofStudies

Trends Across Activity orFitness Categories andStrength of Evidence

Cancer Colon *** Rectal *** Stomach * Breast ** Prostate *** Lung * Pancreatic *

Results of Studies Investigating the Relationship Between Physical Activity and Incidences of Selected Chronic Diseases

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Other Health Benefits

Decreased anxiety and depression Enhanced feelings of well-being Enhanced performance of work,

recreational, and sport activities Increased ability to perform daily living

tasks Reduced muscle and joint injury risk

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Improved work performance Enhanced self-concept and esteem Improved socialization Increased energy Greater resistance to fatigue

Other Health Benefits

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中年少運動 　比煙民易死 港大家庭醫學林大慶教授

07/20042 萬多個死亡的中年個案，發現 20% 人死於嚴重缺乏運動

最少一半死者生前 10年完全沒有運動

懶運動額外死亡風險 25.3% 男性死亡運動嚴重不足，女性比例則為 14.4 ； 身患癌病的人，若不運動，男性死亡風險額外激增 45% ；女性

額外增加 28% ； 罹患呼吸疾病而不運動，額外死亡風險男性達 92% ，女為 75%

； 患有心血管疾病而不運動，男性額外死亡風險為 52% ，女性為

28% 。

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Agility 敏捷

Balance 平衡

Coordination 協調

Power 肌爆炸力

Reaction time 反應時間

Speed 速度

Motor skill-relatedCardiovascular endurance

心肺耐力Muscular strength and endurance

肌肉力量與耐力Muscular flexibility肌關節柔軟度Body composition身體脂肪百分比

[Neuromuscular Relaxation肌神經鬆馳程度 ]

Health-related

Physical Fitness

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Cardiovascular endurance心肺耐力

Muscular strength and endurance肌肉力量與耐力Muscular flexibility

肌關節柔軟度Body composition

身體脂肪百分比[Neuromuscular Relaxation

肌神經鬆馳程度 ]

Health-related Physical Fitness

Should be promoted for health promotion and disease prevention

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Pre-Exercise Participation Health Screening

for those inactive participants who wish to engage in an exercise program

for those ex participants who wish to change the intensity and volume of ex program, such as planning to engage in competition

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下載區 : 香港體適能總會 網頁PAR-Qhttp://www.hkpfa.org.hk/document/426/parQ2002.pdfhttp://www.hkpfa.org.hk/document/427/PARQCHINESE02.doc

PAR-Medhttp://www.hkpfa.org.hk/document/428/

PARmedX02.pdf

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Positive Risk Factors for CHD ACSM (2006) Family History Myocardial infarction, coronary revascularization (bypass

surgery) or sudden death before :• the age of 55 years in father or other male first degree relative

(i.e. brother or son)• the age of 65 years in mother or other female first degree relat

ive (i.e. sister or daughter)

Cigarette smoking Current cigarette smoker or those who have quit in the la

st six months Hypertension Client on Hypertensive medications Resting SBP > 140 mmHg and/ or DBP > 90 mm Hg Fasting Glucose Fasting blood glucose of 100 mg/dl (5.6mmol/L)

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Hypercholesterolemia Total serum cholesterol > 200 mg/dl (5.2 mmol/L) or High density lipoprotein (HDL) < 40 mg/dl (1.03 mmol/L) Low density lipoprotein (LDL) > 130mg/dL (3.4mmol/L) Client is on lipid lowering medications Obesity Body Mass Index (BMI) > 25 kg/m2 (Asian) Waist girth >= 90 cm (M); >= 80 cm (F) (Asian) Sedentary Lifestyle not meeting the US Gurgeon General’s guidelines

Positive Risk Factors for CHD ACSM (2006)

High level of HDL HDL cholesterol > 1.6 mmol/L (60 mg/dl)

Negative Risk Factors for CHD ACSM (2006)

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Initial Risk Stratification

Low risk Younger individuals who are asymptomatic and meet

no more than one risk factor threshold

Moderate risk Older individuals (men 45 years of age; women 55

years of age) or those who meet the threshold for two or more risk factors

High Risk Individuals with one or more signs/symptoms or

known cardiovascular, pulmonary, or metabolic disease

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ACSM Recommendations for:(A) Medical Examination and Exercise Testing Prior to Participation, and (B) Physician Supervision of Exercise Tests

Low Risk Moderate Risk High Risk

A.

Moderate exercise NN NN R

Vigorous exercise NN R R

B.

Submaximal test NN NN R

Maximal test NN R R

NN - Not Necessary R - Recommended

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What to DO next ?

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An individual program of exercise based on an individual’s level of fitness and health status; should consider exercise intensity, frequency per week , duration, and mode.

What is Ex. Prescription ?

Unfit Fit

Diseased Healthy & Well

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3 – 5 days per week (F) 60 – 90% of HRmax (I) 15 – 60 min per session (T) Rhythmical & aerobic, large muscle acti

vities (running, jogging, cycling …etc.) (T)

1st Exercise Prescription (ACSM, 1978)

FeaturesCV training

Sufficient Intensity & T

Fitness improvement

A Quick Review

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1990, the 1st Ex Prescription was revised

Muscular Fitness & Flexibility were added

Recognized moderate ex may have health benefits in addition to CV fitness

1995, Joint ACSM & CDC statements on revised Ex. Prescription

A Quick Review

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3 – 5 days per week (F) 55/65% – 90% of HRmax (I) , or 40/50% - 85% VO2R / HRR, or 12-14 RPE 20 – 60 min per session (T) Rhythmical & aerobic, large muscle activities (ru

nning, jogging, cycling …etc.) (T)

Revised Exercise Prescription (ACSM, 1998)

A Quick Review

CV Fitness and Body Composition

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Rate of Perceived Exertion Scale. (RPE)

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Strength-Training Guidelines.Mode: 8 to 10 dynamic strength-training exercises

involving the body’s major muscle groups.

Resistance: Enough resistance to perform 8 to 12repetitions to near fatigue. (10 to 15repetitions for older and more frail

individuals)

Sets A minimum of 1 set.

Frequency: At least 2 times per week.

Revised Exercise Prescription (ACSM, 1998)

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Frequency of Exercise:5 to 6 times a week

Intensity of Exercise:To a point of mild discomfort

Repetitions:Each exercise be done four or five times, holding the final position each time about 10-30 seconds

Types of stretching Static: Holding at the point of tension PNF: Contract / Relax - Using reflexes to your advantage

Flexibility Training Guidelines.

Revised Exercise Prescription (ACSM, 1998)

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1996 U.S. Surgeons’ General Report: 1996 U.S. Surgeons’ General Report: Physical Physical Activity and Health (USDHHS / CDC / ACSM)Activity and Health (USDHHS / CDC / ACSM)

AccumulatingAccumulating at least at least 30 minutes30 minutes of of any any kindkind of of moderate intensity physical moderate intensity physical activityactivity on on most daysmost days of the week of the week

would effectively reduce the risk of would effectively reduce the risk of coronary heart disease, type 2 diabetes, coronary heart disease, type 2 diabetes, hypertension, stroke and some kinds of hypertension, stroke and some kinds of cancercancer

Current RecommendationCurrent Recommendation

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A ComparisonPreviousRecommendation Emphasize on fitness Continuous 20 min /

session Emphasize on structured

exercise (esp. aerobic ex, strength training, stretching)

Emphasize sufficient intensity

Current Recommendation Emphasize on PA Any kind of PA At least 30 min Accumulated 30 min Moderate intensity

(150 Kcal) Most days of week

Ex Activity

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Advantages of New Guidelines

Easier for inactive individuals More effective for PA promotion Health first then fitness Good for “BUSY” people More effective to low overall health

cost

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Problems of New Guidelines Still a bit vague to many people What is “accumulate” means? 10+10+10 ? 5 x 6 ? 1+1+1+…etc? What is most days? How many days

exactly ? Give me a simple answer ? What is “moderate” means ? What is “any kind” of PA? How about home

activities or labor intensive activities during work

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2nd Revision of New Guidelines, 2006

An expert panel has been formed by CDC / USDHHS recently

Accumulate at least 10 min / interval most days? 5 days Moderate? heavy breathing yet can talk Any kind? as long as you don’t sit

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Still there is a problems !! Exercise / PA is not only a personal

factor Many external factors interact to

affect one’s PA For example: environment, public

policy, school systems… Future trends: We need guidelines for

external factors …

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More Work to Do !! PA Guidelines for environment PA Guidelines for school PA Guidelines for parents PA Guidelines for Policy makers …..

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New Technology: GPSGlobal Position SystemTracking Space of PA (i.e. environment)

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Best Exercise / PA Advice to Give to the Public? Traditional, structured program--3-5

times/week, 20-60 minutes/session, relatively vigorous

Consensus recommendation--accumulate at least 30 minutes of moderate intensity exercise each day

The important question is not whether one approach is better than the other, but do both approaches work?

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What Is the Best Exercise (Activity)?

The one you will do regularlyNo matter how excellent the exercise is

or how effective the program might be, it will not produce any benefits for you if you do not do it

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ConclusionPhysical inactivity is one of the most important public health problems and it is important to develop an action plan to address this issue

Policy makers Public health professionals Health service providers Educators Grassroots activists

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1996 U.S. Surgeons’ General Report: 1996 U.S. Surgeons’ General Report: Physical Activity and Health Physical Activity and Health (USDHHS / CDC / ACSM)(USDHHS / CDC / ACSM)

AccumulatingAccumulating at least at least 30 minutes30 minutes of of any any kindkind of of moderate intensity physical moderate intensity physical activityactivity on on most daysmost days of the week of the week

would effectively reduce the risk of would effectively reduce the risk of coronary heart disease, type 2 diabetes, coronary heart disease, type 2 diabetes, hypertension, stroke and some kinds of hypertension, stroke and some kinds of cancercancer

Current Recommendation of PA Current Recommendation of PA for Health Promotionfor Health Promotion

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The End