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Exercise as Medicine 2018
- 1. Applying the Scienceof Exercise to your Life
- 2. Exercise as Medicine StephanEsser MD Follow me @EsserHealth on Instagram and Facebook
- 3. If you areover the age of 40 or have any chronic diseases or have a personal history or strong family history of heart disease, sudden cardiac death or the like then you should NOT begin a new exercise program without first consulting your primary physician.
- 4. Goals • Where itall began • Provide basic Definitions • Dispel common myths • Discuss frequent misconceptions • Provide tools for change
- 5. “Eating alone willnot keep a man well; he must also take exercise. For food and exercise…… work together to produce health.” Hippocrates Regimen 400 BC
- 6. A brief historyof exercise
- 10. Ancient Awareness • Earlyobservations – Hippocrates (460-370 B.C.) • “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” – Cornelius Celsus (ca.10-60) • “take exercise: for whilst inaction weakens the body, work strengthens it; the former brings on premature old age, the latter prolongs youth”
- 16. Defining Exercise • Exercise: –movementof the body resulting in the enhancement of health and improvement of function
- 17. #1 Exercise is ofno real value to my health
- 18. • I don’tneed to exercise…. I just don’t • I don’t have any health problems • I’m healthy the way I am • I’m skinny, I don’t need to exercise • I’ve never exercised before why would I start now? • That’s why they make medicine • Hello “drive through” • Aren’t we supposed to “conserve energy”?
- 19.
- 20. Exercise and PhysicalHealth • Reduces risk of – Heart Disease ≈ 40% – Obesity: ≈ 30-100% – Stroke ≈ 50% – Type 2 Diabetes ≈ 50% – Hypertension ≈ 50% – Disability delayed ≈15 years – Colon Cancer ≈ 25-40% – Breast Cancer ≈ 20%-44% – Osteoporosis ≈ 20+% • As many as 250,000 deaths per year in the United States areattributable to a lack of regular physical activity
- 21. Physical Health Cont’d •Improve Balance • Reduce Fall risk • Improve Systemic Circulation • Accelerate Skin Healing • Bowel Regularity/ risk diverticulosis • Improved Energy/Resilience
- 22. Exercise and MentalHealth • Regular Exercise: – Reduces risk/severity of: • Depression • Anxiety • ADD/ADHD • Alzheimers Dementia – Improves: • Mental Clarity, test scores, focus
- 23. Exercise and EmotionalHealth • Regular Exercise: – Increases Self Confidence – Teaches skills to manage adversity – Enhances Self Esteem – Develops Discipline – Encourages Goal setting and self awareness
- 24. #2 Exercise is thefix for everything
- 25. • I caneat all the McDonald’s I want • I run 4 miles a day and hit the gym every other day……… bring on the Dairy Queen
- 26. • While exercisedoes have multi-system, multi- modal benefits there are many, many times where exercise is NOT the answer • Acute Trauma • Progressive Cancer • Progressive Neurologic Impairment • “Weird stuff” • Too soon
- 27. #3 Exercise means pinkspandex, going to a gym, sweating with a bunch of people I don’t even know or like!
- 28. Categories • Leisure timeExercise: organized sports, running, gym activities, rehabilitation etc. • Lifestyle Exercise: activity incorporated into our daily pattern of life – eg: parking in the distant portion of the parking lot rather then the first bumper, taking the stairs instead of the elevator etc.
- 29. #4 I’m too oldto exercise
- 30. • I’m justtaking it easy now • I’ve paid my dues • Now is the time to relax • Don’t want to work myself too hard • I spent my whole life go-go-going • I’m too old for “that” • Those days are past
- 33. • “A reviewof biologic changes commonly attributed to the processof aging demonstrates the close similarity of most of theseto changes subsequent to a period of enforced physical inactivity. The coincidence of these changes from the subcellular to thewhole-body level of organization, and across a wide range of body systems, prompts the suggestion that at least a portionof the changes that are commonly attributed to aging is in realitycaused by disuse and, as such, is subject to correction. Thereis no drug in current or prospective use that holds as muchpromise for sustained health as a lifetime program of physical exercise.”(JAMA 1982;248:1203-1208) Walter Bortz MD Disuse and Aging
- 34. CDC Exercise Stats •> 60% of adults are not regularly active • 25% are not active at all • By age 75 1:3 men and 1:2 women engage in NO physical exercise
- 35. Aging and Exercise •Reduces Disability • Prolongs Independence • Slows Aging • Reduces risk of multiple Co-Morbidities • Reduces All-Cause Mortality • Reduces Medication use, Hospital Admission • Etc………
- 39. • “You haveto work at living, period. You’ve got to train like you are training for an athletic event. Most older people just give up. They think, “I’m too old for that,” because they have an ache here or a pain there. Life is a pain in the butt; you’ve got to work at it.” Jack LaLanne
- 41. #5 I’m too youngto exercise
- 42. • I don’twant to stress my childs body • My child needs to rest inside more • It’s too hot/cold etc to stay active • All that running around is too much for little Johnny • He needs to save his energy • Working out will “stunt his growth” • Exercise will make Janie look like a Johnny
- 44. • 1. Alladolescents should be physically active daily, or nearly every day, as part of play, games, sports, work, transportation, recreation, physical education, or planned exercise in the context of family, school, and community activities. • 2. Adolescents should engage in three or more sessions per week of activities that last 20 minutes or more at a time and that require moderate to vigorous levels of exertion.
- 45. • 50% ofall youth ages 12-21 are not vigorously active on a regular basis • 1 in 3 children overweight or obese • Rates of Type 2 Diabetes sky-rocketing • Rates of medication use, hospitalization
- 46. #6 No Pain, noGain
- 47.
- 48. Not good pain •Chest Pain • Joint Pain • Pain that radiates • Pain associated with neurologic changes • Pain with swelling • Pain that fails to improve with appropriate measures • Pain that compromises other systems function
- 49. “Good Pain” • Muscle“pain” while exercising • Muscle soreness 1-2 days after exercise • Moderately labored breathing during activity • The opposite of the other page
- 50. #7 You have toexercise really hard or there is no benefit
- 52. Talk Test: -Easy: CanTalk and Sing -Moderate: Can Talk but not sing -Intense: Can’t talk or sing Talk Test: -Easy: Can Talk and Sing -Moderate: Can Talk but not sing -Intense: Can’t talk or sing
- 53.
- 54. “30minutes or moreof moderate exercise a day should occur on most, if not all, days of the week “
- 55. In Pregnancy • Exercise –Helps reduce backaches, constipation, bloating, and swelling – May help prevent or treat gestational diabetes – Increases your energy – Improves your mood – Improves your posture – Promotes muscle tone, strength, and endurance – Helps you sleep better – Weigh less to start, gain less weight during pregnancy and tolerate labor better than do sedentary women.
- 56. Factoids • Pregnant womenshould NOT: – Downhill ski – Contact Sports – Scuba Diving • Not the time to start new moderate to aggressive exercise programs • Is the time to continue usual regimen or begin a new gentle regular habit
- 57. • Already active….stay active • Interested in starting…check with physician • Start low…go very slow
- 58.
- 59. • I can’tafford a gym membership • I live too far from a gym • I don’t have room for gym equipment in my house • I can’t afford new shoes, clothes etc..
- 61. Places • Parks • Gyms •Country Clubs • Lakes • Oceans • Your House: – Backyard/Frontyard/Garage/Living Room etc • ANYWHERE and EVERYWHERE
- 62. #10 I have abad shoulder….I can’t exercise
- 63. “Many people havearthritis and rheumatism; they get bum knees, a bum back. A lot of guys get a little pain in the toe or knee and then they won't exercise. Well gee, you have 640 muscles in your body. There may be a few exercises you can't do, but there are hundreds you can do!” Jack Lallane
- 64. #11 I don’t havethe time to exercise
- 65. • I workdouble shifts…not gonna happen • Between my job, the kids…no way • I commute 2 hours and work 8 hour days
- 67. Response • Remember Lifestyleand Leisure time definitions • Be creative • Be proactive • Be optimistic
- 68. #11 I have adisability, I can’t exercise
- 69. #11 • Promote Health •Increase socialization and community engagement • Enhance physical activity efficacy • Reduce depression/anxiety/social isolation • Improve function • And More
- 70. “Eating alone willnot keep a man well; he must also take exercise. For food and exercise…… work together to produce health.” Hippocrates Regimen 400 BC
- 71. “Exercise is justas essential as a rational diet” Dr. William Esser N.D. DC.
- 72.
- 73. Stages of Change(Prochaska and DiClemente) 1: Pre-contemplation 2: Contemplation 3: Preparation/planning 4: Action 5: Maintenance 6: Permanent Maintenance (Termination)
- 74. My Reasons toExercise • Feel good in my skin • Increase energy, Reduce stress • Increase my confidence, discipline • Be a role model, socialize, family time • It’s fun, I love to sweat and work hard • I love challenges • Reduce disease risk • Lower disability risk • Maintain independence
- 75. What are yourreasons?
- 76. My Reasons NOTto Exercise • Time • I’m tired or lazy • Inconvenience (I forgot my clothes etc…) • Money (shoes, travel, racquets) • Other priorities • Hate Change • Don’t know what to do • I’m Injured
- 77. What are yourreasons NOT to Exercise?
- 78. “Physical fitness canneither be achieved by wishful thinking nor outright purchase.” Joseph Pilates
- 79. You are nevertoo old to set another goal or to dream a new dream C.S. Lewis
- 80. Defining Success • Whatis success for you? • Are such goals achievable, legitimate? • What will you do if you fail to “succeed”?
- 81.
- 82. Establishing Priorities • Potentialresponsibilities, limitations • Discover balance • Be dynamic, flexible
- 83. If you havedecided to start or increase your activity level…….now what?
- 84. FITT • Frequency • Intensity •Time • Type
- 85. Lasting Change • Trackyour efforts and progress • Re-visit your goals regularly • Adjust to meet your needs • Thrive!
- 86. Conclusion • Exercise isa powerful component of health • Disease Risk, Function, Pain, Disability • More wide ranging and powerful then any “medicine’s” effects • An ancient intervention with little to no cost • Should be pursued as a part of regular “healthcare” with the advice of a physician
- 87. “First say toyourself what you would be; and then do what you have to do” Epictectus Greek Stoic Philosopher AD 55–AD 135
- 88. Thank You! Stephan EsserMD, USPTA Follow me on Instagram and Facebook @esserhealth
Editor's Notes
- #7 It is of course not well delineated just exactly when “exercise” developed as an activity. But we can make guesses. And as for my best guess, the first hominid decided to try his legs pretty early on. It may have been when he ran into one of these fellows in a cold cave or perhaps when a visiting friend told him there were luscious berries two mountain over. For most of our early existence in fact, exercise was largely built in to our daily survival. After all, for much of early human civilization we “survived.” Hiking hundreds of miles collecting food or pursuing wild game, running to survive and building homes, transportation and so much more exhausted our physical resources. Most of our exercise was associated with building, harvesting…..and just regular survival. As we “civilized” our societies became more complex and in time we developed patterns of physical fitness to achieve additional goals. Think back if you will to the storied days of the Spartans and the Romans heralded for their strength and speed. It was during this time that we saw the establishment of the gladiatorial events, and then the Olympics and so on. This trend toward fragmenting life whereby some labored in the field, others in the …..etc…led to the development of physical fitness as a leisure time activity. And so this continued into present times, when we see ……………………..
- #11 Our relationship with exercise has changed over the millenia from a purely functional activity to one of leisure and entertainment. Through it all we have Arulus Cornelius Celsus (ca 25 BC—ca 50) was a Roman encyclopedist, known for his extant medical work,
- #17 Some people think only of sports teams, athletics events, lengthy workouts in expensive gyms etc….not the case Others try to say the activity must be planned, directed etc….but I disagree…..
- #20 http://www.healthierus.gov/STEPS/summit/prevportfolio/power/index.html#we
- #21 (Journal of the American Medical AssociationJAMA: 2000, Vol. 283. No. 22, pp. 2961-2967) http://www.news.harvard.edu/gazette/1999/10.21/diabetes.html http://www.reuters.com/article/healthNews/idUSTRE53E71N20090415?feedType=RSS&feedName=healthNews http://www.nature.com/bjc/index.html http://www.ncbi.nlm.nih.gov/pubmed/18599492?ordinalpos=18&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
- #22 http://www.projectsmart.co.uk/smart-goals.html http://www.goal-setting-guide.com/smart-goals.html
- #23 In fact in studies regular exercise has been proven as effective as antidepressants and anxiolytics in controlling mild-moderate depression
- #27 Weird stuff= adrenal, endocrine problems, strange genetic disorders such us Neurofibromatosis…or epilepsy..etc….
- #32 http://www.countryliving.com/cm/countryliving/images/rocking-chairs-de.jpg mcleancountyil.gov
- #33 Dysfunction, weakness, immobility and disability are NOT the normal consequence of aging…………….Let me explain
- #34 Seminal paper published by Walter Bortz in JAMA 1982 http://www.walterbortz.com/ http://www.phasesofwomanhood.org/media/Image/elderly%20woman.jpg Disuse and AgingWalter M. Bortz II, MD JAMA. 1982;248(10):1203-1208. Abstract
- #35 ----http://www.cdc.gov/nccdphp/dnpa/physical/health_professionals/index.htm over half of US adults do not engage in physical activity at levels consistent with public health --http://books.nap.edu/openbook.php?record_id=1627&page=118 IOM: Greater then 1/2 of all US children do not get enough exercise to develop a healthy heart and lungs --http://www.cdc.gov/nccdphp/sgr/intro.htm Daily enrollment in physical education classes has declined among high school students from 42 percent in 1991 to 25 percent in 1995. --Only 19 percent of all high school students are physically active for 20 minutes or more, five days a week, in physical education classes. high school students are physically active for 20 minutes or more, five days a week, in physical education classes.
- #38 http://www.plosone.org/article/fetchArticle.action?articleURI=info:doi/10.1371/journal.pone.0000465
- #39 http://www.safesport.co.uk/images/451.jpg
- #45 http://www.aap.org/family/physicalactivity/physicalactivity.htm
- #52 http://www.cretafarms.com/retail/products/images/bologna.jpg
- #53 http://www.mehn.org.au/images/stories/mehn/Ex_RPE_Scale.jpg http://lh4.ggpht.com/_hbZ_aIisSu8/Sj4dT9_2kPI/AAAAAAAAAbo/r-Hmqox_oJs/Table_thumb.jpg http://www.cvtoolbox.com/cvtoolbox1/exercise/supports/Exercise_METS.gif
- #56 http://www.acog.org/publications/patient_education/bp119.cfm
- #61 bayareafitnessgym.com
- #81 Example…if you take up running for the first time…success should not be running a marathon in 2 hours……rather 15 minutes without running may be a legitimate goal etc
- #82 SpecificWell definedClear to anyone that has a basic knowledge of the project MeasurableKnow if the goal is obtainable and how far away completion is Know when it has been achievedAgreed UponAgreement with all the stakeholders what the goals should be RealisticWithin the availability of resources, knowledge and time Time BasedEnough time to achieve the goalNot too much time, which can affect project performance
- #84 I hope you moved one step down the path of change…from thinking to doing, or from doing to embracing….
- #85 Frequqncy: How often? Intensity……..start slowly…build up gradually…….
- #87 Imagine if a doctor came to you and said if you take this pill you will have a longer, healthier life with less disability, fewer health concerns, more energy, greater vitality and it only costs a few drops of sweat and a little bit of you time……….would you buy in……well this is the message today….you and I have the capacity to transform our lives, remake our bodies, from the nucleus up to each hair on our head……..what a profoundly simple and beautiful message……………that statement is of course nothing new………