Exam: Oct. 30 - HC1 – Exercise in Medicine () Pandemic: “in...

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Sport and Health

Exam: Oct. 30

th ; 15:00u – 16:00u Week 1 – Exercise is medicine HC1 – Exercise in Medicine (04/09) Pandemic: “in view of the prevalence, global reach, and health effect of physical inacitivity, the issue should be appropriately described as pandemic, with far-reaching health, economic, environmental, and social consequences.

Low fitness kills more people than ‘smokadiabesity’ → ‘sitting is the new smoking’ • Short term

• Glucose and insulin levels go up
• Sitting down causes the muscles to go into “standby” mode within minutes
• Triglycerides pile up in the bloodstream
• Levels of fatmetabolizing enzyme lipoprotein lipase plunge by up to 95%

• Long term

• Increase in waist size
• Risk of diabetes
• Increased risk of back pain
• Risk of psychological stress
• Weight gain, especially among woman
• Increased risk of colon cancer
• Risk of heart disease

→ sitting: risk for heart disease!

• Research: Coronary heart disease and physical activity of work

• Results: Sedentary London bus drivers / telephonists were at a higher risk of cardiac events than were their more active conductor / postmen peers!

Moderate-intensity: heartrate and breathing will go up; you are able to have a good conversation without interruption; 5 days a week.

VO2Max: good measure for physical activity

• Low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease, all-cause mortality, and mortality rates attributable to various cancers.• ‘Cardiorespiratory Fitness is the only major risk factor for cardiovascular disease and mortality that is not assessed in clinical practice’ • ‘The addition of CRF for risk classification presents health professionals with unique opportunities to improve patient management and to encourage lifestyle-based strategies designed to reduce cardiovascular risk.’

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Long term benefits of exercise

WHO guidelines on physical activity and sedentary behaviour

Moderate intensity = heartrate rises, but it is still possible to talk

3 most common excuses for not being physically active:

• No time
• Exercise does not take a lot of time
• Makes me tired
• Makes me sweat

Exercise Snacks: A Novel Strategy to Improve Cardiometabolic Health

For example: Jumping Jacks, Lunges or Squats between lectures

Exercise is medicine Hippocrates: “if we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” → People choose for pills and surgery, rather than lifestyle change

Medication versus Exercise VB → Hypertension 2 / 4

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Research: “How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure.” • What is already known?

• Exercise interventions are effective in lowering systolic blood pressure

• What are the new findings?

• Across all populations, individuals who receive antihypertensive medications

tend to achieve greater reductions in systolic blood pressure than those who adopt structured exercise regimes.

• In populations with hypertension, different types of exercise interventions

appear to be equally effective as most antihypertensive medications

• Structured exercise has not been evaluated as extensively as antihypertensive

medications.

VB → Mortality outcomes

Bewegen minstens zo effectief als medicijnen op mortaliteitsuitkomsten voor:

• Preventie van diabetes • Secundaire preventie van hart/vaatziekten • Revalidatie na CVA • Behandeling van hartfalen

Indication • Exercise during cancer treatment: less fatigue, less fear and depression, improvement of physical function, improvement quality of life (QoL)

Exercise → less pain killers, less surgery, less ‘sickness leave’ Prehabilitation → better treatment outcome, less complications

Physical activity is an intervention with few adverse events that may improve pain severity and physical function, and consequent quality of life.

Side effects: injuries (musculoskeletal)

Even during pregnancy and with lactation: all women without contraindication should be physically active throughout pregnancy.

Warnings/precautions • Start low, go slow • 1 hour after meal • Combine with healthy food, plenty of water and enough sleep • Do not combine with smoking • Be carefully with heat Contra-indications & risk → preventive examination and personalized exercise prescription

F.I.T.T. → Frequency, Intensity, Time (duration), Type Personalized prescription of exercise based on risk factors, mental and/or physical limitations, injuries, motivation and obesity. 3 / 4

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Summarise

• Physical inactivity is pandemic
• Cardiorespiratory fitness is a vital sign
• Prescribe exercise to your patients

Also important:

• WHO Guidelines on physical activity and sedentary behaviour 2020

https://apps.who.int/iris/bitstream/handle/10665/337001/9789240014886-eng.pdf

• Exercise is Medicine – Factsheet, available via

https://www.exerciseismedicine.org/assets/page_documents/EIM%20Fact%20Sheet

%202014_update%20March%202018.pdf

o The Miracle Drug: Exercise is Medicine, available via

https://www.exerciseismedicine.org/assets/page_documents/EIM_HCP_1_Page_Sum

mary.pdf

• Physical inactivity and non-communicable disease burden in low-income, middle-

income and high-income countries Br J Sports Med. 2022 Jan;56(2):101-106. doi: 10.1136/bjsports-2020-103640. Epub 2021 Mar 29

https://pubmed.ncbi.nlm.nih.gov/33782046/

• Exercise as medicine - evidence for prescribing exercise as therapy in 26 different

chronic diseases Scand J Med Sci Sports . 2015 Dec;25 Suppl 3:1-72. doi:

10.1111/sms.12581.https://pubmed.ncbi.nlm.nih.gov/26606383/

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