What’s the best exercise?

Exercise Benefits

•No. 1: Weight control•No. 2: Decreases incidence of cancer

•No. 3: Lowers risk of CV disease•No. 4: Improves mood•No. 5: Live longer•No. 6: Promotes better sleep•No 7: Improves QOL

30-60 min moderate x 5 days ~or~

20 min vigorous x 3 days

AND Strength training x 2 days

CDC 2013 •Don’t have time•Family responsibilities/kids•Boring/Hate it/not enjoyable

•Too hard•Too long

Exercise-How much do I really need? (v1.0)Robert M. Pepper, DO, FAAFP

METS

1 MET = energy produced of an average person seated at rest

METS•Walking 4.0 mph(15:00 min/mile)=

5 METS•Walking 5.0 mph (12:00 min/mile)=

8 METS

1: 5 METS2: 7 METS3: 10 METS

Cardiovascular evaluation of middle-aged individuals engaged in high-intensity sport activities: implications for workload, yield and economic costs

Menafoglio, et al Br J Sports Med doi:10.1136/bjsports-2014-093857

785 (age 35-65) asymptomatic athletes

Hx/PE/ECG/SCOREAbnormals:112 (14.3% total)•5.1% “pathologic” ECG•4.1% SCORE >5%•4.7% abnormal PE•1.6 % red flag PMH/FHx

Where did this lead?

•22/785 (2.8%) Dx with new CV problem

•ZERO had an abnormal exercise stress test

•100 % exceeded > 10 METS

Sitting is the new smoking?

Television viewing time and reduced life expectancy: a life table analysis

Veerman et alBr J Sports Med 2012;46:927-930

AHA SIHD Guidelines 2012

•A moderate or high dose of a statin therapy should be prescribed..

(Level of Evidence: A)•Treatment with aspirin 75 to 162 mg daily should be continued indefinitely (Level of Evidence: A)

J Am Coll Cardiol. 2012;60(24)

5 METS=Minimum

•Walking 4.0 mph (15:00 min/mile)=5 METS

6 METSBrisk walking 4.5 mph (13:20 min/mile)=6 METS

9 METSWogging 5.0 mph (12:00 min/mile)=9 METS

ideal speeds: requiring least amount of energy

Wogging? 4.5 mph (13 min/mile), metabolic efficiency was at its lowest

Fast not so fast

Treadmill Conversions

Mph: 5.0=12:00 Min/Mile @ 0% /speed fixed

3%:10:32

5%:9:38 8%:8:38

Move to And then to

Exercise-How much do I

really need? (v2.0) 2014-current

2014:Best Study of the Year

3 major findings:

Runners had consistently lower all cause mortality vs non-runners

low doses and low speeds had significant mortality benefits

Persistent running over time (6 years) was more strongly associated with mortality reduction

Quick Summary

•15 years•55,000 adults ages 18-100 (24%runners)

•Reduction all cause mortality 29%

•Reduction CV mortality 50%

Quick Summary cont.•3 year added life expectancy benefit•Persistent runners reduction AC/CV of 29%/50%

That’s way too much work!

This is not me!

Time (min)Distance (miles)

Frequency (times)Speed (miles/h)

Total amount (METS/week)

For less than 10K a week (7-10 min/day) x 6 years

•29% reduction in all cause mortality

•50% reduction in cardiovascular mortality

>50 yoa538 runners/ 423 non-runnersMatched age, sex, functional ability

39% reduction in all cause mortality

Reduced disability and mortality among aging runners: a 21-year longitudinal study.Arch Intern Med 2008;168

pleiotropy

Exercise Rx?

Last Time-How much do I really, really need? (v3.0-Biohack)

VO2 Max

• maximum rate of 02 consumption(Ml(O2)/kg∙min)•surrogate of cardiorespiratory fitness

Wingate Sprints: Pitfalls

High exertion•Strong motivation•Too strenuous for sedentary(Hawley and Gibala 2009)

Total time > 20 minutes•2-3 min sprints, warm-up, recovery intervals(Garber et al 2011)

Cardiac Remodeling in Response to 1 Year of Intensive Endurance Training

Arbab-Zadeh, A et al2014 Oct 3.:CIRCULATION.AHA

Would you invest in this Rx?

Rx transforms the heart of a slacker into one of an elite athlete

Plan:

“doability”• 3-4 x a week,

30-45 min low level exercise

• After nine months, long runs added

• Max 7-9 hours/week

Results:•RV mass and volume immediate ↑

•Add intense intervals eccentric hypertrophy of LV

• VO2max↑an average of 20%.

2015:

Where are we now?

Exercise as Rx•Absence of Fitness= Smoking•Goals: 9 METS F/10 METS M•Small changes in fitness provide at least as much benefit as statins, ASA, and ACE-I

CV, live longer, time, bored•Running provides significant benefits- even at relatively low levels

•HIIT is very effective and doesn’t have to be 100% all out

handouts

•Assessing CRP/VO2 max•Calculate daily energy expenditure

•METS calculator•VO2 max tables•Treadmill conversion