1

Exercise for Health

2

Exercise for HealthBenefit of Regular Exercise

Improve mood

Combat chronic disease: HT, Dyslipid, DM, Osteoporosis

Help managed weight

Strengthen heart and lung

Promote better sleep

Improve sex life

3

Types of exercise

Aerobic Exercise (Isotonic or dynamic) Low to moderate intensity with long duration

( > 20 minutes) and uses large muscle groups Relies mainly on oxygen from the lung Use carbohydrate and fat as fuel Essential for weight loss, cardiovascular fitness,

body-shaping

Anaerobic Exercise (Isometric or static) Short-intensive activities lasting ≤ 1-2 minutes and

uses selective muscle groups Relies on anaerobic pathway in muscles Use carbohydrate as fuel Essential for strength building and muscle gain

4

Types of Aerobic Exercise Type of Anaerobic Exercise

* Aerobic dance * Strength training* Bicycling * Weight training* Running * Football, baseball* Jumping rope * Wrestling* Fitness walking * Sprinting * Stair climbing* Swimming* Skating and skiing

5

Hemodynamic Response to Exercise Aerobic exercise

Decrease systemic vascular resistance and increase venous return Increase HR, stroke volume, cardiac output Increase systolic BP but diastolic BP remain unchange or

slightly decrease Significant increase blood flow to the muscles (30 folds) and

coronary A (4 folds) Chronic adaptation occur if sustained dynamic exercise is

performed ≥ 1 hour, ≥ 5 times/week at least 4-6 weeks: increase oxygen extraction by muscles and increase cardiacdimension (Athlete’s heart)

Anaerobic exercise Increase systemic vascular resistance, may decrease venous return,

decrease stroke volume and exaggerated increase HR and mean arterial pressure.

6

Athlete’s Heart

A spectrum of abnormalities that reflect physiologicadaptation to training

It must be distinguished from real cardiac disease,such as sick sinus syndrome or cardiomyopathy

7

Cardiovascular manifestation in Athlete’s Heart

Physical Examination:

Resting bradycardia, generally between 30-60/min with exaggerated respiratory variation

Left ventricular enlargement

1st and 2nd heart sound are normal, but S3, S4 are heard in up to 50 %

Short, midsystolic murmur at precordial are quite common

8

ECG Sinus bradycardia and sinus arrhythmia with sinus pause up to

2.5 sec with frequent junctional escape beats

1st degree AV block (20%) ,Mobitz I AV block may be observed and disappear with exercise

Increase P wave voltage suggested LAE, RAE are common

Increase QRS voltage suggesting LVH (50%) and oftenassociated with T wave inversion in inferior lead

Early repolarization and juvenile T wave pattern are common

ST-T change indicating strain pattern are unusual, but may occur particularly in person who perform predominantly isometric exercise.

9

Chest x-ray

Cardiomegaly, globular in shape

Cardiothoracic ratio between 0.5-0.6

Echocardiogram

Slight increase wall thickness (usually ≤ 14 mm)and usually symmetry

Slight increase diastolic dimension

Normal or slight decrease systolic dimension

10

Exercise and Sudden Death

Annual incidence of sudden death:

Under age 30 : 2-7 / 100,000, 8 % are exercise-related

Over age 30 : 50-60 / 100,000, 2-3 % are exercise-related

11

Causes of Exercise-Related Death

85-97 % structural cardiac disease was identifiedYoung age (< 35 yrs) Older age (> 35 yrs)*Congenital anomalies of *CAD (up to two-thirds)

coronary A. (35 %)

*Hypertrophic cardiomyopathy *Other: cardiomyopathies,

22 % valvular HD, aortic disease,

*Other: CAD (5%), MVP (4%) primary arrhythmia dissection aorta(3%), dilated cardiomyopathy and myocarditis (1%), arrhythmogenic RV dysplasia

Pre-exercise evaluation: Pre-exercise evaluation: PE,CXR, ECG PE,CXR,ECG, EST

12

Whether exercise conditioning protects against cardiovascular death ?

The product of HR x BP for submaximal work load islower decrease myocardial oxygen demand

Coronary capillary and capacitance may increase

Enhance myocardial oxygen extraction

Diminish platelet aggregation, increase HDL

Relative risk for symptomatic CAD decrease 50 %

13

EST (Bruce protocol)

Resting HR 48 Max. HR 151 Max SBP 274 Max DBP 47 HR x BP 39456 Total Exercise time 12:13 MET 12.8 Observation

The patient can reach exercise stress test at Bruce’sstep 5 . Total duration is 12.13 minute. Maximum HRis 142/min. Target HR is 139/min. Max. predicted HR 164/min 92% max HR. The patient has no chest pain and stop exercise due to dyspnea. There is no significant STdepression in all leed. But there are sinus arrest during recovery period and there are occasionally PVC.

14