The Miracle of Exercise

J. Kelly Smith, M.D., F.A.C.P.

Benefits

• Decreases all cause mortality• Cardiovascular disease• Cancer

• Helps prevent overweight, obesity• Lowers risk of type 2 diabetes mellitus• Lowers lipid levels• Lowers blood pressure• Lowers myocardial oxygen demands• Lowers risk of osteoporosis• Improves general health• Improves physical working capacity• Improves skin health• Improves mental outlook and acuity

Exercise target

Age 20 30 40 50 60 70 80 90 100bpm 140-

170133-162

126-153

119-145

112-136

105-128

98-119

91-111

85-103

• Calculate maximum heart rate (MHR = 220 – age)• Start @ 40-50% of MHR• Target = 70-85% of MHR• Target ≥ 30 minutes/day 5 days/week

Atherogenesis

Atherogenesis

Atherogenesis

Exercise & mononuclear cell function

Six months of moderate intensity exercise• Decreased atherogenic cytokine production by

peripheral blood mononuclear cells by 58.3% (P<0.001)

• Increased atheroprotective cytokine production by peripheral blood mononuclear cells by 35.9% (P<0.001)

• Decreased CRP levels by 35%Smith JK, Dykes R, Douglas JE, Krishnaswamy G, Berk S.JAMA 1999:281;1722-1727

Exercise & atherogenesis

Exercise & atherogenesis

Exercise & VEC function

• Augments endothelial nitric oxide-dependent vasodilatation• Aids in normalizing shear stress effects on VEC function and on

arterial remodeling • Reduces risk factors that adversely effect VEC function• Reduces proinflammatory effects of white adipose tissue on VEC

function

Habitual moderate intensity aerobic exercise stimulates an an atheroprotective VEC phenotype

A Quid Pro Quo Relationship

Exercise & atherogenesis

Exercise & HIV

Exercise & HIV

Exercise & HIV

Exercise & HIV

Exercise & HIV

Exercise & HIV

Exercise & HIV

Exercise & HIV

Exercise & Obesity

Exercise & Obesity

Exercise & Obesity

Adaptive thermogenesis

Exercise target

Age 20 30 40 50 60 70 80 90 100bpm 140-

170133-162

126-153

119-145

112-136

105-128

98-119

91-111

85-103

• Calculate maximum heart rate (MHR = 220 – age)• Start @ 40-50% of MHR• Target = 70-85% of MHR• Target ≥ 30 minutes/day 5 days/week