Exercise Therapy for Chronic Diseases

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Exercise Therapy for Chronic Diseases

• Instructor Michael C. Riddell, Ph.D.
• 347 Bethune College (office)

AS/SC KINE 4900 3.0
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Why Do We Care?
Canadian Fitness and Lifestyle Research
Institute's Physical Activity Monitor
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Physical Activity Statistics 19862002 No
Leisure-Time Physical Activity Trend Chart
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Why Do we Care?
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Relative Risks and Population Attributable Risks
for Physical Inactivity

• Disease RR PAR ()
• CHD 1.9 36
• Stroke 1.4 20
• Hypertension 1.4 20
• Colon Cancer 1.4 20
• Breast Cancer 1.2 11
• Type 2 Diabetes 1.4 20
• Osteoporosis 1.6 27

Katzmarzyk et al. CMAJ 200063435-1440
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Economic Costs of Physical Inactivity
Cost Due To Disease Cost
Inactivity CHD 2.5 0.9 Stroke
1.7 0.3 Hypertension 1.6 0.3 Colon
Cancer 0.3 0.07 Breast Cancer
0.3 0.03 Type 2 Diabetes 0.6 0.1 Osteoporosi
s 1.3 0.4 TOTAL 2.1 Figures are
billions.
Katzmarzyk et al. CMAJ 200063435-1440
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Physical Inactivity-Related Mortality

• N Deaths
• Disease N Deaths Due to Inactivity
• CHD 44 061 15 774
• Stroke 15 517 3 088
• Colon Cancer 4 237 843
• Breast Cancer 4 923 542
• Diabetes 5 492 1 093
• All Causes 207 408 21 340 (10.3)

Katzmarzyk et al. CMAJ 200063435-1440
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• The cost estimates are direct costs
• hospital services
• physician care
• drugs
• health research
• The indirect costs are larger
• time off work
• loss of productivity

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10 Change in Inactivity

• Reducing levels of physical inactivity from 62
  to 56 would result in 150 million a year in
  savings

Katzmarzyk et al. CMAJ 200063435-1440
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What Can Exercise Do?

• Regular physical activity can improve health and
  reduce the risk of premature death in the
  following ways 
• Reduces the risk of developing coronary heart
  disease (CHD) and the risk of dying from CHD
• Reduces the risk of stroke
• Reduces the risk of having a second heart attack
  in people who have already had one heart attack
• Lowers both total blood cholesterol and
  triglycerides and increases high-density
  lipoproteins (HDL or the "good" cholesterol)
• Lowers the risk of developing high blood pressure
  
• Helps reduce blood pressure in people who already
  have hypertension
• Lowers the risk of developing non-insulin-dependen
  t (type 2) diabetes mellitus
• Reduces the risk of developing colon cancer
• Helps people achieve and maintain a healthy body
  weight
• Reduces feelings of depression and anxiety
• Promotes psychological well-being and reduces
  feelings of stress
• Helps build and maintain healthy bones, muscles,
  and joints
• Helps older adults become stronger and better
  able to move about without falling or becoming
  excessively fatigued

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So, You Should Get More Exercise

• Like saying you should take some pills.
• What is it about your condition that makes
  exercise valuable?
• What kind of exercise?
• What type of apparatus?
• For how long?
• At what intensity?
• What are the risks?
• What are the expected benefits?

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Why This Course?

• There is a growing interest in the use of
  exercise for individuals with chronic disease
• This course provides the basic principles for
  exercise testing and exercise training (or
  programming) for these unique individuals.
• Advanced clinical exercise physiology jobs?

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Ground rules

• Class participation is encouraged
• The only dumb questions are the ones you dont
  ask
• From time to time you may be called upon to
  comment on
• What is the most important thing you learned in
  this lecture?
• What portion of the lecture was most
  confusing?
• What question remains uppermost in your mind?
• It would be nice if you got involved by
• Bringing in newspaper clippings or journal
  articles to generate discussion in class
• Visiting a cardiac rehab clinic and report back
• Performing the in class group work

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Can you explain this figure by using an example?
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Core Components

• We will attempt to
• Find and discuss clinical conditions that tend to
  have altered physiological responses to exercise
• Provide strategies for exercise testing
• Evaluate the typical exercise response
• Develop and illustrate rationales for exercise
  programming
• functional capacity
• reduce disease severity

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Why Exercise Testing?Sample Case Study

• 58-year old man had been exposed to asbestos,
  sandblasting, and 35 years of cigarettes. He was
  not overweight and had no apparent disease.
• On questioning, he admitted to grinding chest
  pain, originating in the midback and radiating
  around the left chest into the substernal area.
• The pain, brought on when walking especially on
  cold days and was relieved in a few minutes by
  rest.
• He denied shortness of breath. He had no abnormal
  heart sounds and resting ECG was normal

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Sample Case Study

• Does this man have a disease that may be related
  to physical activity?
• Can exercise testing be useful to help determine
  the disease or the severity of the disease?
• Does physical inactivity contribute to the
  disease?
• Is exercise training (programming) useful as a
  form of treatment for this disease?

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Historical Perspective

• A. Lavoissier (1784)- determined the energy cost
  of one legged exercise (respiratory exchange).
• Medically supervised exercise regimes introduced
  in the 1940s and 50s for war injuries and polio
  patients
• Now expanded to stroke, cardiac, pulmonary and
  metabolic patients.

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Historical Perspective Cont

• Approximately 99 of all exercise physiology
  research has been published since 1960.
• Today- large number of medical rehabilitation
  facilities, health clubs, fitness centers, as
  well as sports medicine disciplines.
• Toronto Rehab
• Rouge Valley Health System
• The Cardiac Prevention and Rehabilitation
  CentreSt. Michael's Hospital
• Cardiac Wellness and Rehabilitation Centre
  Trillium Health Centre

• http//www.cardiacrehabilitation.ca/rehab_centres.
  php

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Link Between Research and Practice

• Objective data are available on the therapeutic
  role of exercise
• research vs practice
• The link is between the two is sometimes weak
• A number of clubs claim to be experts

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Exercise Rehab Definition

• Definition of rehabilitation (DeLisa et al.,
  1998) - Development of a person to the fullest
  physical, psychological, social, vocational, and
  educational potential, within his/her
  physiological or anatomic impairments and
  environmental limitations.
• Cardiac rehabilitation is the sum of activities
  required to ensure cardiac patients the best
  possible physical, mental, and social conditions
  so that they may, by their own efforts, regain a
  normal place in the community and lead an active,
  productive life (WHO Expert Committee 1964)

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• Cardiac Rehabilitaiton

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Rehabilitation Programs

• Do they cure individuals of disease?
• What do you think?
• Exercise programming should be carefully
  assessed, medically approved, and regularly
  updated and tailored to the individuals clinical
  state

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Clinical Exercise Therapist Jobs

• Exercise Therapist and Personal Fitness and
  Lifestyle Consultant
• Health Fitness Certified Exercise Physiologist
  
• Canadian Society of Exercise Physiologists
  (www.csep.ca/)
• Registered Clinical Exercise Physiologist/Speciali
  st
• American College of Sports Medicine
  (www.acsm.org)
• is an allied health professional who works in
  the application of exercise and physical activity
  for those clinical and pathological situations
  where it has been shown to provide therapeutic or
  functional benefit

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Other Professions That May Benefit From
Information In the Course

• physicians
• researchers
• physical therapists
• occupational therapists
• recreational/sports therapists
• nurses
• exercise physiologists interested in clinical
  applications of exercise

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Course Content

• Emphasis is placed on the physiological
  assessment during, and adaptations to, exercise
  in clinical populations
• Assessment techniques and Exercise Programming
• Clinical sections
• Cardiovascular
• Pulmonary
• Metabolic
• Immunological
• Neuromuscular

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Course Objectives Cont.

• I want you to
• 1) Understand the nature of adaptations to
  exercise and training
• 2) Develop a basic understanding of the
  pathophysiology of various clinical conditions
• 3) Develop a working knowledge of testing devices
  and procedures/protocols to evaluate functional
  capacity
• 4) Rationalize the matching of an exercise
  rehabilitative program to a clinical condition
• 5) Develop a knowledge of expected (realistic)
  outcomes