Hoorcolleges + BOEK Clinical exercise physiology
Hoorcollege 1
life expectancy is increasing, we grow older.
there is an increase in modern diseases → cancer, alzheimer, cardiovascular,
obesitys, stroke
we see that the fitness level of the youngers is reduced → increase in diseases at
that age.
mismatch genes (quite old genes we have) and lifestyle (has changed, 20 years ago we
started a very inactive lifestyle = post industrial revolution)
lack of PA is a key factor.
food, exercise are important to maintain health
relation between coronary heart disease → most inactive have the highest risk
type II diabetes → the most inactive the highest risk
you do not have to be very active, a little active does reduce the risk.
the risk reduced by the level of activity (the more active the lower the risk)
fitness and mortality:
relative risk of death: x as
diseases/risk factors: y as
the higher fitness level (> 8 MET) is a lower risk of death (independent if you have risk
factors or not)
1 MET: metabolic equivalent: resting oxygen consumption (3.5 ml/min/kg)
a person with 10 MET and 20 MET → person with 20 MET has a higher
exercise capacity
fitness level (VO2 peak) was the best predictor of survival of COPD, rather than the
ventilatory/pulmonary measurements (FEV)
all kinds of diseases → the higher the fitness level, VO2peak is the best predictor
for survival
MAIN FINDINGS AND CONCLUSION
- exercise capacity is a strong predictor of the risk of death in patients referred for
exercise testing for clinical reasons.
- exercise capacity was a stronger predictor of an increased risk of death than clinical
variables or established risk factors
- Although not necessarily a causal relation patients should be encouraged to increase
their exercise capacity.
- 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.
medicine exercise for diseases!
- lower blood pressure
- better concentration
- better weight control
- better lipid profile
, - less dementia
- sleep better etc..
PA = any bodily movement produced by skeletal muscle that results in caloric expenditure
(just lifting up your arm is already PA)
exercise = physical activity to improve fitness, health or mental ability or to increase ones. it
needs to be sufficiently intense.
health = complete physical, mental and social well-being
blood flow in brain increase = lower risk of stroke
What are the fitness levels? → cardiorespiratory fitness divided in:
- metabolic capacity (VO2max)
- balance/proprioception
- aerobic endurance (running long time at a certain % vo2max)
- muscle strength
- muscle endurance
- flexibility
guidelines:
- minimum 150 min of moderate intensity exercise PA per week
- or vigorous of 75 min PA per week
- PA can be accumulated in bouts of 10 min of more
- update: bouts of any length contribute to health benefits
- more active than you already are → risk of health conditions will decrease
help to change behavior → 5 stages of change give knowledge, approval,
intention, practice, advocacy
1. determine a clear simple goal
2. gathering sufficient and accurate knowledge to make a clear plan
3. having lots of personal motivation to follow through
4. having and relying on a supportive environment
determinants of PA:
social environment/ family support
physical environment: transport, facilities
government/ policies: education, health insurance
,biological/ psychological: talent, self efficacy and motivation
risk associated with (high intensity) exercise
musculoskeletal injury
type and intensity of activity seem important determinants, but also poor muscle strength
cardiac events
vigorous activity can acutely and transiently increase the risk of sudden cardiac death and
acute myocardial infarction (AMI)
PA can also prevent cardiac events = paradoxically
risk of AMI is very high with low frequency vigorous PA, the risk is lower with higher
frequency
the risk of exercise is very low! even with patients with CHD or CVD
benefits of PA is much higher, but you should be aware of the risks of course
screening: To identify individuals at risk for serious exercise-related CV events including
acute myocardial infarction (AMI) and sudden cardiac death (SCD)
model:
★ medical history, known disease, sign for risk factors → Y/N
★ known CV, pulmonary, metabolic disease → Y/N
YES = high risk
NO = ask more about symptoms and signs
- symptom: experience by person itself
- sign: for the specialist
- number of CVD risk factors: (See slide 40)
- no known disease and no symptoms → still ask about risk factors
like: high BMI, risk lipid profile (see slide 41)
- > 2 = moderate risk
- < 2 = low risk
syncope = drop CO: HR and SV does not meet
orthopnea or paroxysmal nocturnal dyspnea = dyspnea in lying position, but goes away in
vertical position
known heart murmur = hypertrophic cardiomyopathy, aortic stenosis
see slide 39:
- low risk: no medical examination, exercise test or doctor supervision
- moderate risk: for vigorous exercise you need medical examination
- high risk: you need medical examination, exercise test (diagnosis cardiovascular or
cardiopulmonary problems) and doctor supervision
new guidelines (2015): screening no longer involves CVD risk factor assessment
the big change: points to consider before starting to exercise or increasing intensity
1. current activity level
2. signs/symptoms of certain diseases
3. known CV or metabolic or renal diseases
4. planned exercise intensity
, other flowchart:
- for participants in regular exercise (See slide 44)
- not participants in regular exercise (See slide 45) → need medical clearance
when you have symptoms and known CV, metabolic or renal diseases!
What can an exercise physiologist do?
He/she applies knowledge of exercise physiology to prevent and treat (chronic) disease.
Tasks:
- Screening for exercise
- Evaluation of treatment/ rehabilitation
- Design training programs/ advise PA
- Monitor safe and effective exercise
CASE: does he need medical clearance and determine the number of CVD risk factors
HIGH risk because of diabetes! so he needs medical clearance for both moderate or
vigorous (2014)
1. age > 45 y
2. sedentary lifestyle (walking is a very light activity, but for some it is very intense, so
see which person you have)
3. BMI >30
4. lipid profile: taking medication
5. he has diabetes (metabolic disease) (ask karin if it is a risk factor or sign)
so higher > 2 risk factors
no regular exercise → known metabolic disease and asymptomatic (middle one
(2015))
study risk factor uit je hoofd!
tentamen we use the new model (2015)!
Hoorcollege bespreking 1
signs and symptoms vs risk factors:
risk factor: high cholesterol might lead to an increased number of plaques. is related to the
disease. predictive of development of a condition
symptoms: feature of the disease
exercise capacity is a stronger predictor of an increased risk of death than clinical
variables or established risk factors
Hoorcollege 1
life expectancy is increasing, we grow older.
there is an increase in modern diseases → cancer, alzheimer, cardiovascular,
obesitys, stroke
we see that the fitness level of the youngers is reduced → increase in diseases at
that age.
mismatch genes (quite old genes we have) and lifestyle (has changed, 20 years ago we
started a very inactive lifestyle = post industrial revolution)
lack of PA is a key factor.
food, exercise are important to maintain health
relation between coronary heart disease → most inactive have the highest risk
type II diabetes → the most inactive the highest risk
you do not have to be very active, a little active does reduce the risk.
the risk reduced by the level of activity (the more active the lower the risk)
fitness and mortality:
relative risk of death: x as
diseases/risk factors: y as
the higher fitness level (> 8 MET) is a lower risk of death (independent if you have risk
factors or not)
1 MET: metabolic equivalent: resting oxygen consumption (3.5 ml/min/kg)
a person with 10 MET and 20 MET → person with 20 MET has a higher
exercise capacity
fitness level (VO2 peak) was the best predictor of survival of COPD, rather than the
ventilatory/pulmonary measurements (FEV)
all kinds of diseases → the higher the fitness level, VO2peak is the best predictor
for survival
MAIN FINDINGS AND CONCLUSION
- exercise capacity is a strong predictor of the risk of death in patients referred for
exercise testing for clinical reasons.
- exercise capacity was a stronger predictor of an increased risk of death than clinical
variables or established risk factors
- Although not necessarily a causal relation patients should be encouraged to increase
their exercise capacity.
- 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.
medicine exercise for diseases!
- lower blood pressure
- better concentration
- better weight control
- better lipid profile
, - less dementia
- sleep better etc..
PA = any bodily movement produced by skeletal muscle that results in caloric expenditure
(just lifting up your arm is already PA)
exercise = physical activity to improve fitness, health or mental ability or to increase ones. it
needs to be sufficiently intense.
health = complete physical, mental and social well-being
blood flow in brain increase = lower risk of stroke
What are the fitness levels? → cardiorespiratory fitness divided in:
- metabolic capacity (VO2max)
- balance/proprioception
- aerobic endurance (running long time at a certain % vo2max)
- muscle strength
- muscle endurance
- flexibility
guidelines:
- minimum 150 min of moderate intensity exercise PA per week
- or vigorous of 75 min PA per week
- PA can be accumulated in bouts of 10 min of more
- update: bouts of any length contribute to health benefits
- more active than you already are → risk of health conditions will decrease
help to change behavior → 5 stages of change give knowledge, approval,
intention, practice, advocacy
1. determine a clear simple goal
2. gathering sufficient and accurate knowledge to make a clear plan
3. having lots of personal motivation to follow through
4. having and relying on a supportive environment
determinants of PA:
social environment/ family support
physical environment: transport, facilities
government/ policies: education, health insurance
,biological/ psychological: talent, self efficacy and motivation
risk associated with (high intensity) exercise
musculoskeletal injury
type and intensity of activity seem important determinants, but also poor muscle strength
cardiac events
vigorous activity can acutely and transiently increase the risk of sudden cardiac death and
acute myocardial infarction (AMI)
PA can also prevent cardiac events = paradoxically
risk of AMI is very high with low frequency vigorous PA, the risk is lower with higher
frequency
the risk of exercise is very low! even with patients with CHD or CVD
benefits of PA is much higher, but you should be aware of the risks of course
screening: To identify individuals at risk for serious exercise-related CV events including
acute myocardial infarction (AMI) and sudden cardiac death (SCD)
model:
★ medical history, known disease, sign for risk factors → Y/N
★ known CV, pulmonary, metabolic disease → Y/N
YES = high risk
NO = ask more about symptoms and signs
- symptom: experience by person itself
- sign: for the specialist
- number of CVD risk factors: (See slide 40)
- no known disease and no symptoms → still ask about risk factors
like: high BMI, risk lipid profile (see slide 41)
- > 2 = moderate risk
- < 2 = low risk
syncope = drop CO: HR and SV does not meet
orthopnea or paroxysmal nocturnal dyspnea = dyspnea in lying position, but goes away in
vertical position
known heart murmur = hypertrophic cardiomyopathy, aortic stenosis
see slide 39:
- low risk: no medical examination, exercise test or doctor supervision
- moderate risk: for vigorous exercise you need medical examination
- high risk: you need medical examination, exercise test (diagnosis cardiovascular or
cardiopulmonary problems) and doctor supervision
new guidelines (2015): screening no longer involves CVD risk factor assessment
the big change: points to consider before starting to exercise or increasing intensity
1. current activity level
2. signs/symptoms of certain diseases
3. known CV or metabolic or renal diseases
4. planned exercise intensity
, other flowchart:
- for participants in regular exercise (See slide 44)
- not participants in regular exercise (See slide 45) → need medical clearance
when you have symptoms and known CV, metabolic or renal diseases!
What can an exercise physiologist do?
He/she applies knowledge of exercise physiology to prevent and treat (chronic) disease.
Tasks:
- Screening for exercise
- Evaluation of treatment/ rehabilitation
- Design training programs/ advise PA
- Monitor safe and effective exercise
CASE: does he need medical clearance and determine the number of CVD risk factors
HIGH risk because of diabetes! so he needs medical clearance for both moderate or
vigorous (2014)
1. age > 45 y
2. sedentary lifestyle (walking is a very light activity, but for some it is very intense, so
see which person you have)
3. BMI >30
4. lipid profile: taking medication
5. he has diabetes (metabolic disease) (ask karin if it is a risk factor or sign)
so higher > 2 risk factors
no regular exercise → known metabolic disease and asymptomatic (middle one
(2015))
study risk factor uit je hoofd!
tentamen we use the new model (2015)!
Hoorcollege bespreking 1
signs and symptoms vs risk factors:
risk factor: high cholesterol might lead to an increased number of plaques. is related to the
disease. predictive of development of a condition
symptoms: feature of the disease
exercise capacity is a stronger predictor of an increased risk of death than clinical
variables or established risk factors
