Exercise is Medicine
Lecture 1 / Zwerver
current pandemic: physical inactivity with far-reaching health, economic, environmental, and social
consequences
→ sitting is the new smoking [low fitness kills more people than ‘smokadiabesity’]
- VO2 max is very low
physical inactivity: risk for heart disease
coronary heart disease and physical activity of work
→ sedentary London transport authority bus drivers and telephonists were at a higher risk of cardiac
events than that their more active conductor and postmen peers were
Dallas bed rest study: experiment 3 weeks in bed
Then, already a decrease of fitness was shown after 3 weeks of bed rest
– 40 yrs follow-up shows the effect of age on the cardiovascular response to exercise in men
- the bed rest group had 40 years later an equally worse VO2 max
physical activity in the hospital problem:
- 90% of the time patients are in the room, bed has central position
- 60% lying in bed, 35% sitting only 5% active
- 67% can move around independently
VO2max
= max amount of oxygen you can breath in and use [endurance capacity]
- low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular
disease, all-cause mortality, and mortality rates attributable to various cancers
- increase 3.5 ml O2/kg = 14-20% survival benefit
- 17.5 ml VO2max minimum required [threshold]
- important predictor in the medical world as well (not only in sports)
WHO – dosage
at least 150 to 300 min moderate-intensity aerobic physical activity
at least 75 to 150 min vigorous-intensity aerobic physical activity
- for additional health benefits: at least 2 days a week muscle-strengthening activities at
moderate or greater intensity that involve all major muscle groups
three most common excuses for not being physically active = no time (1), makes me tired (2) and
makes me sweat (3) [7 minute workout/exercise snacks]
,Hippocrates knew already that exercise is important
“If we could give every individual the right amount of nourishment and exercise, not too little and
not too much, we would have found the safest way to health”
exercise in chronic disease
e.g. psychiatric and neurologic disease, metabolic disease, heart disease, lung disease,
musculoskeletal disease
preDiabetes
1. lifestyle → 58% reduction DM2
2. metformin [glucose lowering drug] → 31% reduction DM2
“in populations with hypertension, different types of exercise interventions appear to be as equally
effective as most antihypertensive medication” – Naci et al. 2019
several indicationsthat exercise is effective as medication
I. cancer
- less fatigue
- less fear and depression
- improvement of physical function
- improvement quality of life
II. chronic obstructive pulmonary disease (COPD)
- pulmonary rehabilitation programs using minimal equipment elicit clinically
significant improvements in 6MWD [6 minute walk daily] and HRQoL [health related
quality of life] and are comparable with exercise equipment-based programs for
improving 6MWD and strength
III. pain → physical activity is an intervention with few adverse events that may improve pain
severity and physical function, and consequent quality of life
IV. depression
V. osteoarthritis
- less pain
- improved function
- more active
- better QOL
- less painkillers, surgery and ‘sickness leave’
interactions with other treatments → better treatment outcome with less complications
– diagnosis – prehabilitation – surgery – recovery – survivorship
prehabilitation = after diagnosis before surgery, need to perform strength and endurance exercises to
induce strength
, physical activity: positive effect of the immune system + blood vessels + prevent clot formation
1. up vascular endothelium function
2. down inflammation marker
3. down thrombosis, coagulation and improved lipid profile
4. down insulin resistance
5. down vascular resistance
6. down activity of sympathetic activity/negative energy balance
side effects exercise:
- injuries to musculoskeletal system
- rare: sudden cardiac death
it is safe during pregnancy and lactation to exercise
→ all women without contra-indication should be physically active throughout pregnancy
(relative) contra-indication
risk factors: diabetes, obesity, hypertension etc
preventive examination/spiroergometry
exercise test → medical physiology
VO2max = cardiorespiratory fitness
functional capacity: metabolic equivalent of task (MET)
VO2max (ml/kg/min) : 3.5 = METs
- light intensity < 3 METs
- average intensity 3-6 METs
- heavy intensity > 6 METs
personalized prescription of exercise
FITT: frequency, intensity, time & type
there are many stakeholders involved: exercise journey after hospital visit
ex patients need to keep exercising at home
→ health care professionals, sport and exercise professionals, government, patients etc.
Lecture 1 / Zwerver
current pandemic: physical inactivity with far-reaching health, economic, environmental, and social
consequences
→ sitting is the new smoking [low fitness kills more people than ‘smokadiabesity’]
- VO2 max is very low
physical inactivity: risk for heart disease
coronary heart disease and physical activity of work
→ sedentary London transport authority bus drivers and telephonists were at a higher risk of cardiac
events than that their more active conductor and postmen peers were
Dallas bed rest study: experiment 3 weeks in bed
Then, already a decrease of fitness was shown after 3 weeks of bed rest
– 40 yrs follow-up shows the effect of age on the cardiovascular response to exercise in men
- the bed rest group had 40 years later an equally worse VO2 max
physical activity in the hospital problem:
- 90% of the time patients are in the room, bed has central position
- 60% lying in bed, 35% sitting only 5% active
- 67% can move around independently
VO2max
= max amount of oxygen you can breath in and use [endurance capacity]
- low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular
disease, all-cause mortality, and mortality rates attributable to various cancers
- increase 3.5 ml O2/kg = 14-20% survival benefit
- 17.5 ml VO2max minimum required [threshold]
- important predictor in the medical world as well (not only in sports)
WHO – dosage
at least 150 to 300 min moderate-intensity aerobic physical activity
at least 75 to 150 min vigorous-intensity aerobic physical activity
- for additional health benefits: at least 2 days a week muscle-strengthening activities at
moderate or greater intensity that involve all major muscle groups
three most common excuses for not being physically active = no time (1), makes me tired (2) and
makes me sweat (3) [7 minute workout/exercise snacks]
,Hippocrates knew already that exercise is important
“If we could give every individual the right amount of nourishment and exercise, not too little and
not too much, we would have found the safest way to health”
exercise in chronic disease
e.g. psychiatric and neurologic disease, metabolic disease, heart disease, lung disease,
musculoskeletal disease
preDiabetes
1. lifestyle → 58% reduction DM2
2. metformin [glucose lowering drug] → 31% reduction DM2
“in populations with hypertension, different types of exercise interventions appear to be as equally
effective as most antihypertensive medication” – Naci et al. 2019
several indicationsthat exercise is effective as medication
I. cancer
- less fatigue
- less fear and depression
- improvement of physical function
- improvement quality of life
II. chronic obstructive pulmonary disease (COPD)
- pulmonary rehabilitation programs using minimal equipment elicit clinically
significant improvements in 6MWD [6 minute walk daily] and HRQoL [health related
quality of life] and are comparable with exercise equipment-based programs for
improving 6MWD and strength
III. pain → physical activity is an intervention with few adverse events that may improve pain
severity and physical function, and consequent quality of life
IV. depression
V. osteoarthritis
- less pain
- improved function
- more active
- better QOL
- less painkillers, surgery and ‘sickness leave’
interactions with other treatments → better treatment outcome with less complications
– diagnosis – prehabilitation – surgery – recovery – survivorship
prehabilitation = after diagnosis before surgery, need to perform strength and endurance exercises to
induce strength
, physical activity: positive effect of the immune system + blood vessels + prevent clot formation
1. up vascular endothelium function
2. down inflammation marker
3. down thrombosis, coagulation and improved lipid profile
4. down insulin resistance
5. down vascular resistance
6. down activity of sympathetic activity/negative energy balance
side effects exercise:
- injuries to musculoskeletal system
- rare: sudden cardiac death
it is safe during pregnancy and lactation to exercise
→ all women without contra-indication should be physically active throughout pregnancy
(relative) contra-indication
risk factors: diabetes, obesity, hypertension etc
preventive examination/spiroergometry
exercise test → medical physiology
VO2max = cardiorespiratory fitness
functional capacity: metabolic equivalent of task (MET)
VO2max (ml/kg/min) : 3.5 = METs
- light intensity < 3 METs
- average intensity 3-6 METs
- heavy intensity > 6 METs
personalized prescription of exercise
FITT: frequency, intensity, time & type
there are many stakeholders involved: exercise journey after hospital visit
ex patients need to keep exercising at home
→ health care professionals, sport and exercise professionals, government, patients etc.
