Clinical exercise physiology
Week 1 – Concepts of exercise testing and prescription in a clinical population
Lecture 1 – Introduction Clinical exercise physiology
Increasing lifespan of man in modern social cultures
- However, increasing ‘modern’ diseases (cancer, Alzheimer, diabetes, obesity, etc…)
o Many caused by mismatch between genes and lifestyle
o Lack of physical activity is considered to be one of the key risk factors for many
clinical conditions.
o Our life style is relatively modern: reduced levels of physical activity. But our genes
are relatively old (~50.000 to 100.000 yrs) → Mismatch
- In the same population, fitness of children and teenagers is reduced
Hippocrates
- Father of Western medicine (born in 460 A.D.)
- The first to introduce the revolutionary notion that both food and exercise are important
factors in the occurrence and treatment of disease.
- “Eating healthily by itself will not keep a man well; he must also have physical exercise. Food
and exercise, while possessing opposite properties, nevertheless mutually contribute to
maintaining health.”
- “Let the food be thy medicine. Thy medicine shall be thy food.”
Physical activity & coronary heart disease (CHD) – Type 2 diabetes (Wannamethee et al., 2000)
- Age-adjusted CHD and type 2 diabetes event rate per 1000 person/years, in 5159 men aged
40 to 59 years during an average follow-up of 16.8 years. The numbers above each bar
represent number of events.
- Individuals at risk for disease related to physical activity
Exercise capacity and mortality among men referred for exercise testing (Myers et al., 2002)
- Exercise capacity → how fit you are
- 6213 (clinically referred) men graded exercise testing (X-ECG)
- Subjects both with and without documented cardio-vascular disease
- Individuals clustered by risk factors
- MET = metabolic equivalent of task (resting oxygen consumption = 3,5 ml/min/kg)
- Conclusion
o The fitter you are, the lower the risk for death
o Independent whether you have risk factors or not!
,- Prognosis (risk-stratification)
COPD: VO2peak was better predictor of survival in patients with chronic obstructive
pulmonary disease (COPD) than the FEV1 measurement! (Oga et al., 2003)
o You would expect any pulmonary outcome measure to be predictive for survival
o But… The fitness level was best predictor of survival, rather than pulmonary outcome
measurement
- Main findings and conclusion
o Exercise capacity is a strong predictor of the risk of death in patients referred for
exercise testing for clinical reasons.
o Exercise capacity was a stronger predictor of an increased risk of death than clinical
variables or established risk factors
o Although not necessarily a causal relation patients should be encouraged to increase
their exercise capacity.
o In terms of reducing mortality from any cause, improving exercise tolerance warrants
at least as much attention as other major risk factors from physicians who treat
patients with or at high risk for cardiovascular disease.
,Advantages of exercise
- Lowering blood pressure
- Better blood sugar control
- Higher immune response
- Better lipid profile
- Reduced dyspnea
- Reduced fatigue
- Better concentration
- Better weight control
- Better sleep
- Fewer falls in elderly
- Less dementia
- …
Physical activity = Any bodily movement produced by skeletal muscle that results in caloric
expenditure
Exercise = a physical (/mental) activity to improve/increase ones fitness, health or mental ability
➢ Needs to be sufficient intense
Health
• WHO (1986) stated that health is a state of complete physical, mental and social well-being.
• It is the behaviour of everyday life that is projective of daily living as a positive concept,
emphasising personal and social resources as well as physical capacities.
Relationship between health & physical activity/fitness
Health related components of physical fitness
, US guidelines for physical activity
- Adults: 150 min moderate-intensity aerobic or 75 min vigorous-intensity aerobic per week.
- PA can be accumulated in bouts of 10 min or more.
- Update: bouts of any length contribute to the health benefits associated with the
accumulated volume of physical activity
Dutch physical activity guidelines (Dutch Health Counsel, 2017)
Promoting physical activity
- Telling people what to (not) do is usually unsuccessful
- Help people how to change their behavior!
- 5 stages of behaviour change;
1. Knowledge
2. Approval
3. Intention
4. Practice
5. Advocacy
- 4 conditions for success in changing a personal behaviour;
o Defining a clear and simple goal
o Gathering sufficient and accurate knowledge to make a clear plan
o Having lots of personal motivation to follow through
o Having and relying on a supportive environment
Determinants of physical activity behaviour
- Physical environment
o Facilities
o Transport
o Bicycle trails
o Weather
- Social environment
o Support
- Biological/psychological
o ‘Talent’
o Self-efficacy
o Motivation
- Government/policies
o Education
o Health insurance
Week 1 – Concepts of exercise testing and prescription in a clinical population
Lecture 1 – Introduction Clinical exercise physiology
Increasing lifespan of man in modern social cultures
- However, increasing ‘modern’ diseases (cancer, Alzheimer, diabetes, obesity, etc…)
o Many caused by mismatch between genes and lifestyle
o Lack of physical activity is considered to be one of the key risk factors for many
clinical conditions.
o Our life style is relatively modern: reduced levels of physical activity. But our genes
are relatively old (~50.000 to 100.000 yrs) → Mismatch
- In the same population, fitness of children and teenagers is reduced
Hippocrates
- Father of Western medicine (born in 460 A.D.)
- The first to introduce the revolutionary notion that both food and exercise are important
factors in the occurrence and treatment of disease.
- “Eating healthily by itself will not keep a man well; he must also have physical exercise. Food
and exercise, while possessing opposite properties, nevertheless mutually contribute to
maintaining health.”
- “Let the food be thy medicine. Thy medicine shall be thy food.”
Physical activity & coronary heart disease (CHD) – Type 2 diabetes (Wannamethee et al., 2000)
- Age-adjusted CHD and type 2 diabetes event rate per 1000 person/years, in 5159 men aged
40 to 59 years during an average follow-up of 16.8 years. The numbers above each bar
represent number of events.
- Individuals at risk for disease related to physical activity
Exercise capacity and mortality among men referred for exercise testing (Myers et al., 2002)
- Exercise capacity → how fit you are
- 6213 (clinically referred) men graded exercise testing (X-ECG)
- Subjects both with and without documented cardio-vascular disease
- Individuals clustered by risk factors
- MET = metabolic equivalent of task (resting oxygen consumption = 3,5 ml/min/kg)
- Conclusion
o The fitter you are, the lower the risk for death
o Independent whether you have risk factors or not!
,- Prognosis (risk-stratification)
COPD: VO2peak was better predictor of survival in patients with chronic obstructive
pulmonary disease (COPD) than the FEV1 measurement! (Oga et al., 2003)
o You would expect any pulmonary outcome measure to be predictive for survival
o But… The fitness level was best predictor of survival, rather than pulmonary outcome
measurement
- Main findings and conclusion
o Exercise capacity is a strong predictor of the risk of death in patients referred for
exercise testing for clinical reasons.
o Exercise capacity was a stronger predictor of an increased risk of death than clinical
variables or established risk factors
o Although not necessarily a causal relation patients should be encouraged to increase
their exercise capacity.
o In terms of reducing mortality from any cause, improving exercise tolerance warrants
at least as much attention as other major risk factors from physicians who treat
patients with or at high risk for cardiovascular disease.
,Advantages of exercise
- Lowering blood pressure
- Better blood sugar control
- Higher immune response
- Better lipid profile
- Reduced dyspnea
- Reduced fatigue
- Better concentration
- Better weight control
- Better sleep
- Fewer falls in elderly
- Less dementia
- …
Physical activity = Any bodily movement produced by skeletal muscle that results in caloric
expenditure
Exercise = a physical (/mental) activity to improve/increase ones fitness, health or mental ability
➢ Needs to be sufficient intense
Health
• WHO (1986) stated that health is a state of complete physical, mental and social well-being.
• It is the behaviour of everyday life that is projective of daily living as a positive concept,
emphasising personal and social resources as well as physical capacities.
Relationship between health & physical activity/fitness
Health related components of physical fitness
, US guidelines for physical activity
- Adults: 150 min moderate-intensity aerobic or 75 min vigorous-intensity aerobic per week.
- PA can be accumulated in bouts of 10 min or more.
- Update: bouts of any length contribute to the health benefits associated with the
accumulated volume of physical activity
Dutch physical activity guidelines (Dutch Health Counsel, 2017)
Promoting physical activity
- Telling people what to (not) do is usually unsuccessful
- Help people how to change their behavior!
- 5 stages of behaviour change;
1. Knowledge
2. Approval
3. Intention
4. Practice
5. Advocacy
- 4 conditions for success in changing a personal behaviour;
o Defining a clear and simple goal
o Gathering sufficient and accurate knowledge to make a clear plan
o Having lots of personal motivation to follow through
o Having and relying on a supportive environment
Determinants of physical activity behaviour
- Physical environment
o Facilities
o Transport
o Bicycle trails
o Weather
- Social environment
o Support
- Biological/psychological
o ‘Talent’
o Self-efficacy
o Motivation
- Government/policies
o Education
o Health insurance
