Take Heart: How to Start Exercising Safely

Naomi L. Albertson, M.D. Family Medicine/Sports Medicine

Outline • Quick review: the benefits of exercise for your heart and overall health • Specific exercise recommendations • Stretching and nutritional guidelines for preventing injuries

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The Benefits of Regular Exercise • Weight loss/Weight management • Reduce high blood pressure • Reduce blood fat levels – Reduce bad cholesterol and raise good cholesterol • Improve blood sugar • Reduce Stress (and feel great about yourself) • Less wear and tear on knees and hips

(More) Benefits of Exercise – Decreased mortality from coronary artery disease in more fit individuals – Decreased death rate in more fit individuals – Decreased breast cancer in individuals who exercise 5/week for 30 minutes

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And more… • Physical activity prevents disease – Coronary artery disease – Hypertension – Type II diabetes – Hip fractures – Dementia and Alzheimer's – Depression (increase remission rate by 40%) – Kids: fewer disciplinary problems, better memory, better sleep patterns, better response speed and cognitive processing speed

Let’s get Started… 1) Choosing the BEST type of exercise: - few data demonstrate superiority of one activity over another - choose activities or sports that you enjoy to maximize likelihood of continued physical activity. - resistance (strength) training adds to the benefits of aerobic (endurance) training for cardiovascular fitness

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Intensity of Exercise • Start with: – short duration of low- or moderate-intensity activity – gradually increase the duration and intensity until the goal is reached.

• Adequate intensity can be measured by the following symptoms: Breathlessness, Fatigue, and Sweating *(reaching a goal heart rate is NOT required)

Duration of exercise • 500 to 1000 MET-minutes per week is the necessary amount of physical activity to provide health benefits • As an example, 150 minutes of walking (3.3 METs) per week is equal to 500 MET-minutes per week and meets the weekly recommendations for exercise in most individuals

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Summary of exercise recommendations

• Set aside time each day to exercise • Choose cardiovascular activities you enjoy and add in weight training for the extra benefits • Start with 10 to 15 minutes of cardiovascular exercise daily and increase until you reach your goal

Injury prevention •

Stretching — conflicting results about whether stretching prior to exercise is helpful for preventing injuries. Additionally, stretching does not decrease muscle soreness after exercise.

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We still believe it is helpful to warm-up muscle before exertion. A warm up should be a slow dynamic movement followed by static stretch for at least 30 seconds. Do NOT bounce while stretching.

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Water and other nutritional supplements

How much? 1) sweat rate (cups/hour) = (pre workout weight (in lbs) - post workout weight)) x 2

+ the number of cups of water/fluids ingested during your workout Example: pre weight = 148 post weight = 146 drank 2 cups during workout Sweat rate = 6 cups/hour sweat rate

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What about salt? • Sodium helps maintain your thirst, delays urine production and delays dehydration. * Decreases risk of hyponatremia and sequellae.

How much salt do you need? 2) Sodium loss per hour = chosen level of sodium loss rate x sweat rate •

The concentration of sodium in sweat varies from 15 to 65meq/Liter (or 345mg/L to 1495 mg/L).

Example: If you assume that you sweat somewhere in the middle 920 mg/L x 6 cups/hour x 0.23 L/cup = 1269 mg sodium

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CARBOHYDRATES Most adults require 80 kcals every 20 minutes of aerobic exercise to MAINTAIN performance and MINIMIZE injuries (240kcal/hr) PRE: come fully fueled. Start nutrition early and don’t get behind During: Stay on top of your carbs, eat frequently POST: Recharge your carb stores (within 30 minutes they are stored in MUSCLE, not FAT)

We understand… Healthy eating and exercise is a personal matter We want you to succeed and we are here to help!

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For KP Members

Personalized Plans Weight Program Nutrition Program Stop Smoking Health Coach

Thank you! Live well, be well, and THRIVE!

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references • • • • • • • • • • • • • • •

Carlson SA, Fulton JE, Schoenborn CA, Loustalot F. Trend and prevalence estimates based on the 2008 Physical Activity Guidelines for Americans. Am J Prev Med 2010; 39:305. Centers for Disease Control and Prevention (CDC). Contribution of occupational physical activity toward meeting recommended physical activity guidelines: United States, 2007. MMWR Morb Mortal Wkly Rep 2011; 60:656. Gupta S, Rohatgi A, Ayers CR, et al. Cardiorespiratory fitness and classification of risk of cardiovascular disease mortality. Circulation 2011; 123:1377. Paffenbarger RS Jr, Hyde RT, Wing AL, et al. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med 1993; 328:538. Leitzmann MF, Park Y, Blair A, et al. Physical activity recommendations and decreased risk of mortality. Arch Intern Med 2007; 167:2453. Franco OH, de Laet C, Peeters A, et al. Effects of physical activity on life expectancy with cardiovascular disease. Arch Intern Med 2005; 165:2355. Manini TM, Everhart JE, Patel KV, et al. Daily activity energy expenditure and mortality among older adults. JAMA 2006; 296:171. Wen CP, Wai JP, Tsai MK, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet 2011; 378:1244. Strasser B, Siebert U, Schobersberger W. Resistance training in the treatment of the metabolic syndrome: a systematic review and metaanalysis of the effect of resistance training on metabolic clustering in patients with abnormal glucose metabolism. Sports Med 2010; 40:397. Herring MP, O'Connor PJ, Dishman RK. The effect of exercise training on anxiety symptoms among patients: a systematic review. Arch Intern Med 2010; 170:321. Nemoto K, Gen-no H, Masuki S, et al. Effects of high-intensity interval walking training on physical fitness and blood pressure in middleaged and older people. Mayo Clin Proc 2007; 82:803. Woods K, Bishop P, Jones E. Warm-up and stretching in the prevention of muscular injury. Sports Med 2007; 37:1089. Small K, Mc Naughton L, Matthews M. A systematic review into the efficacy of static stretching as part of a warm-up for the prevention of exercise-related injury. Res Sports Med 2008; 16:213. Herbert RD, de Noronha M. Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database Syst Rev 2007; :CD004577. Henschke N, Lin CC. Stretching before or after exercise does not reduce delayed-onset muscle soreness. Br J Sports Med 2011; 45:1249.

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