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Benefits and Risks Associated with Exercise and Exercise Testing

Benefits and Risks Associated with Exercise and Exercise Testing. Is Exercise Good For You?. Physical Activity vs. Exercise. Definition of Physical Activity Body movement that increases energy expenditure Examples – walking and gardening Definition of Exercise

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Benefits and Risks Associated with Exercise and Exercise Testing

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  1. Benefits and Risks Associated with Exercise and Exercise Testing

  2. Is Exercise Good For You?

  3. Physical Activity vs. Exercise • Definition of Physical Activity • Body movement that increases energy expenditure • Examples – walking and gardening • Definition of Exercise • Specific physical tasks to elicit specific physiological responses – planned and structured • Time and tasks have goals – health or performance • Examples – jogging and strength training

  4. Physical Activity vs. Exercise • Surgeon General Says…. • Health benefits from moderate amount of physical activity to improve quality of life • 30 min. brisk walking or raking leaves • 15 min. running • 45 min. playing volleyball • Most if not all days of the week

  5. Physical Activity vs. Exercise • Surgeon General Says…. • Additional health benefits from more physical activity • Longer duration • More vigorous intensity • Likely to derive greater benefit

  6. Implications • Quantity and quality of life improve through movement (PA or EX.) • Dose response occurs - greater dose, greater response • Public Health Policy • Recommend movement

  7. Specific Health Changes Resulting From PA/EX • Improvement in cardiovascular and respiratory function (Box 1-1). • Increased maximal oxygen consumption • Lower myocardial oxygen cost per intensity • Increased capillary density in skeletal muscle • Lower HR and BP per intensity

  8. Specific Health Changes Resulting From PA/EX • Reduced Risk • Certain disease processes occur less in physically fit people – inverse dose response relationship • All-cause mortality • Cardiovascular mortality • Type II diabetes • Hypertension • Colon cancer • Osteoporosis • Obesity

  9. Specific Health Changes Resulting From PA/EX • Decreased mortality and morbidity (Box 1-1). • Primary prevention – to prevent heart attack • Fewer deaths from coronary artery disease (CAD) • Fewer diseases combined (CAD, colon cancer, Type II diabetes) • Secondary prevention – to prevent another • Conflicting results • Other benefits • Emotional, psychological, work / sport improvement

  10. Specific Health Changes Resulting From PA/EX • Reduced coronary artery disease risk factors (Box 1-1). • Lower systolic and diastolic BP • Decreased serum triglycerides • Increased serum HDL • Lower body fat • Lower insulin needs

  11. Determining Risk • Statistical Relationship • Large group studies • Nurses & medical personnel – bias: select group • Cities – Framingham, MA – bias: features of city, SES • Longitudinal studies • Single cohort – group selection bias • 5, 10, 15 year, etc. deaths and diseases • Meta-analysis studies • Pooled studies • Effect size

  12. Do You Feel Lucky? • What level of risk / chance are you willing to accept? • Winning vs. Losing • 1 in 100, 1 in 1000, 1 in 100,000

  13. Risks of Exercise • “Negative” event • Some people die during exercise • Apparently healthy vs. known disease • Risk of death during exercise • Higher than during sedentary • Highest for least frequent exercisers – least fit • Lowest for most frequent exercisers – most fit

  14. What’s Dangerous About Exercise? • Arrhythmia – ventricular ectopic activity • Acute Exercise Stress • Increased myocardial O2 consumption • Shortened diastole – less time for perfusion • Sodium/potassium change • Increased catecholemines • Immediate Post Exercise • Decreased venous return • Decreased blood pressure

  15. What’s Dangerous About Exercise? • Couple exercise with blocked coronary arteries • Even less blood flow – ischemia • Exercise is transient so ischemia is too • For some the injury is too great – not transient

  16. If Exercise is Risky, Isn’t Exercise Testing Risky? • Various studies • Risk of death during or after exercise test (XT) is < .01% • Risk of “event” during or after XT is < .04%

  17. How is Disease Detected? • Subjective symptoms • Chest pain – angina pectoris • Low exercise tolerance – fatigue & SOB • Graded Exercise Test (GXT) – stress the heart • ST segment changes (depression of 1mm or more) • Angina pectoris • Both

  18. Diagnostic Value of Exercise GXTs(Remember?) • Sensitivity: percentage of people with CAD who have a positive exercise EKG test. • 68% for ECG stress test = TP/(TP + FN) • Specificity: percentage of people without CAD who have a negative exercise EKG test. • 77% for ECG stress test = TN/(TN + FP)

  19. So Why Exercise? • Benefits outweigh risks • Feeling lucky?

  20. Questions?

  21. End

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