Exercise Is Medicine: The Health Benefits of Physical Activity

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Exercise Is MedicineThe Health Benefits of
Physical Activity

• Robert Sallis, MD
• Department of Family Medicine
• Kaiser Permanente Medical Center
• Fontana, California
• President American College of Sports Medicine
• Chair Advisory Committee
• California Governors Council for Physical
  Fitness and Sports

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Exercise and Health

• Physical inactivity has an astonishing breadth of
  harmful health implications.
• Exercise has a powerful effect on both treatment
  and prevention of chronic disease and obesity, as
  well as premature death.
• There appears to be a linear relationship between
  physical activity and health status.
• The association between disease and an inactive
  and unfit way of life persists in virtually every
  subgroup of the population.
• Physical inactivity is THE major public health
  problem of our time.

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Lecture Overview

• Review a sampling of the proven health benefits
  from exercise.
• Suggest that Exercise Is Medicine and you should
  take it.
• Describe a typical prescription for exercise.
• Consider a Sports Medicine approach to your
  health care.

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3 Factors Determine Our Health and Longevity
Behavior
Heredity
Environment
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Leading Causes of Death in 1900

• Pneumonia/Influenza
• Tuberculosis
• Infectious Diarrhea

All 3 mainly related to environmental factors
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10 Greatest Public Health Achievements U.S.
1900-1999

• Vaccination
• Control of infections
• Safer/Healthier foods
• Healthier mothers and babies
• Safer workplaces
• Motor vehicle safety
• Decline in deaths from CAD and stroke
• Family planning
• Fluoridation of drinking water
• Recognition of tobacco as a health hazard

1st mass inoculation of Salk vaccine 1954
Source CDC, MMWR, April 2, 1999, 48(12) 241-243
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Average Lifespan U.S. population

• 1900 47 years
• Teddy Roosevelt died 1919
• Age 60
• 2000 78 years
• Ronald Reagan died 2004
• Age 93
• Became President in 1981 at age 70

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Leading Causes of Death USA 1990
Cause Number Heart Disease 720,000 Cancer
505,000 Cerebrovascular Disease 144,000 Acci
dents 92,000 COPD 87,000 Pneumonia/Flu
80,000 Diabetes 48,000 Suicide
31,000 Liver Disease 26,000 HIV 25,000
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Actual Causes of Death
Leading Causes of Death, U.S. 1. Tobacco,
18.1 2. Poor diet and Physical inactivity,
16.6
JAMA March 10, 2004
Deaths per Year in U.S. (1,000s)
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Irrefutable Evidence for Exercise in the 1o and
2o Prevention of

• Diabetes mellitus
• Cancer (breast and colon)
• Hypertension
• Depression
• Osteoporosis
• Dementia
• All-cause and cardiovascular-related death

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Exercise and Chronic Disease Mortality
Meyers NEJM 2002
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Death Rates/1000 by Fitness Level 2135 Men Aged
Grouped Men
Blair Wei. Am J Health Prom 2000 151-8
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Nurses Health Study 2987 Women with Breast
Cancer Physical Activity and Survival
Relative mortality risk
54 reduced mortality risk with 30min 5x/wk
Similar reduction in breast cancer recurrence
Physical Activity in MET-hours/Week
4-8 yr f/u
Holmes MD et al. JAMA 2005 2932479
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Physical Activity and Dementia in Women and Men,
65 Years (6yr f/u)
Age- and sex-adjusted Hazard ratio for incident
dementia
Age-specific incidence of dementia/1000
person-years
Exercise Habits
Short physical performance battery scores and
dementia in 2288 women and men
Exercise and incident dementia In 1740 women and
men
Wang L et al. Arch Int Med 2006 1661115
Larsen EB et al. Ann Int Med 2006 14473-81
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Exercise Is As Good As Other Treatments for
Clinical Depression
of Patients with Remission of Depression
40 Better Remission Rate
Amount of Brisk Walking
Drug therapy and cognitive behavioral therapy
produce remission in approximately 40 of
clinically depressed individuals
Dunn A et al. Am J Prev Med 2005
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Stanford Achievement Test 9th Edition(SAT-9)
and Fitnessgram Results

• Fitnessgram test
• 1. Aerobic Capacity
• 2. Body Composition ( of body fat)
• 3. Abdominal Strength and Endurance
• 4. Trunk Strength and Flexibility
• 5. Upper Body Strength and Endurance
• 6. Overall Flexibility

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Grade 5 SAT 9 and Physical Fitness
353,000 Students
SAT 9 Percentile
Number of Fitness Standards Achieved
Source California Dept. of Education Study,
December 10, 2002
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Grade 7 SAT 9 and Physical Fitness
322,000 Students
SAT 9 Percentile
Number of Fitness Standards Achieved
Source California Dept. of Education Study,
December 10, 2002
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Grade 9 SAT 9 and Physical Fitness
279,000 Students
SAT 9 Percentile
Number of Fitness Standards Achieved
Source California Dept. of Education Study,
December 10, 2002
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The Cost of Inactivity

• Estimated 250,000 premature deaths annually in
  U.S. attributable to inactivity.
• Medical costs attributed to inactivity in
  California were estimated at 29 billion yearly
  in 2005 (32 increase over 5 years).
• Physical activity and obesity are second only to
  tobacco use as the leading cause of preventable
  death in the U.S.
• It follows that the big 3 (exercise, smoking,
  BMI) should be assessed at every visit.

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Activity Level and Health Claims

• Health claims increase as activity levels
  decrease.
• Compared to active persons
• Inactive persons cost 1,543 per year more than
  active ones.

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Physical Activity and Health BenefitsDose-Respons
e Curve
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Exercise Is MedicineAnd Everyone Should Take
It!

• If we had a pill that conferred all the proven
  health benefits of exercise, physicians would
  prescribe it to every patient and our healthcare
  system would find a way to make sure every
  patient had access to this wonder drug.

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The Exercise Prescription Think FITT

• F Frequency
• Most days of the week 5 or more.
• I Intensity
• Moderate 50-70 of max HR or use sing-talk
  test.
• T Type
• Use large muscle groups something patients like.
• T Time
• 30 minutes.

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Patients deserve to know the facts
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Governors Council Challenge to Physicians

• The Governors Council is challenging all CA
  physicians to prescribe exercise to every patient
  seen.
• Physicians can pledge support on the Governors
  Council web-site.
• www.CalGovCouncil.org
• Receive free Exercise Rx pad.

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Sports Medicine Approach

• Every patient is an athlete.
• Every physical exam should be looked on as a
  pre-participation exam.
• Assess readiness for exercise.
• Conclude with exercise prescription.
• Virtually every patient encounter should review
  and incorporate exercise as part of the treatment
  plan whether in primary care or with a
  specialist.

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Summary

• Evidence is overwhelming on the cost and health
  burden of inactivity.
• Benefits of exercise in treatment and prevention
  of chronic disease irrefutable.
• Our healthcare system cannot continue to ignore
  this evidence.
• The Big 3 (exercise, smoking, BMI) should be
  addressed at every visit.
• Physicians should be prescribing exercise to
  every patient and they in turn need to take it.
• Exercise is a proven wonder drug, and its free!