Benefits and Risks Associated with Regular Physical Activity

Go over definitions: Physical activity vs. Exercise.

Physical Activity-any bodily movement produced by the contraction of skeletal muscle that increases
energy expenditures above a basal level.

PA definition by CDC-a set of attributes that people have or achieve that relates to the ability to perform
physical activity

Exercise-subcategory of physical activity that is planned, structured, repetitive bodily movement done to
improve/maintain health as one or more components of physical fitness

Be able to explain the rationale for changing focus of fitness from skill/motor-related to health-
related fitness.

Early 1950s AAHPER came up with test battery that was very heavy on motor/skill related fitness (pull-
ups, sit ups, shuttle run) but modified by AAHPER in 1980 to focus more on health-related fitness
because skill-related fitness had little significance for general health in Americans

What are the components for skill-related fitness and health-related fitness?

Skill/motor related-specialized components such as agility, speed, power, balance, coordination, and
reaction time

Health-related-specific components of physical fitness that have a relationship good to health

Cardiorespiratory fitness, body composition, musculoskeletal fitness (muscular strength, muscular

endurance, flexibility)

Physical guidelines were developed by professional organizations in the 1970s. Go over the
Harvard Alumni study and how this study changed the focus of physical activity guidelines
developed later in the 1990s.

Over 2,00 kcal expended through leisure time physical activity it yielded a 36% decrease in the risk of
developing a heart attack

Focus of PA shifted from higher intensity fitness to:

health outcomes rather than cardiorespiratory fitness

volume of activity rather than intensity

leisure time PA rather than structured programs

What is the ACSM/AHA 2007 physical activity guideline for promotion and maintenance of
health?

All healthy adults ages 18-65 need moderate-intensity aerobic physical activity for a minimum of 30 min
5d/wk or vigorous-intensity for a minimum of 20 min 3d/wk, or combination of the two
Not current recommendation but most popular, no scientific evidence that you have to do 30 min a day

Included resistance training, minimum of 2 days per week

Be able to describe the first national physical activity guidelines established in 2008.

Released to provide science-based guidance to help American aged 6 and older improve their health
through PA

All adults should avoid inactivity; the health benefits of physical activity far outweigh the risks

For substantial health benefits adults 18-65 should do a minimum of 150 min of moderate activity per
week or 75 minutes vigorous activity per week, or equal combination (lowers risk of premature death,
heart disease, stroke, hypertension, Type 2 diabetes, and depression)

1 min vigorous=2 min moderate

aerobic activity can be done in multiple intermittent bouts to meet goal. 1 bout at least 10 minutes

Not all health benefits of physical activity occur at 150 min, 300 min mod more benefits (lower risk of heart
disease, colon and breast cancer and prevention of weight gain)

Should do muscle-strengthening activities that are moderate-high and involve all muscle groups 2 or more
days a week

Encouraged to stretch to increase flexibility

What are the differences among 1995, 2007 and 2008 guidelines for adults? Why were changes
made to these guidelines?

1995-at least 30 min moderate activity on most, preferably all days of week

2007-mod activity at least 30 min 5 days each week or 20 minutes vigorous 3 days a week

2008-150 min mod activity per week or 75 min vigorous

The 1995 recommendation that adults "should accumulate 30 minutes or more of moderate-intensity
physical activity on most, preferably all, days of the week" was misinterpreted by some who believed that
the daily activities of living were sufficient for health and fitness.The PA Guidelines also describes the
CDC/ACSM guidelines as too specific. For example, scientific evidence does not support that the health
benefits of 30 minutes on 5 days a week are any different from the health benefits of 50 minutes on 3
days a week.As a result, the new PA Guidelines allow a person to accumulate 150 min/wk in various
ways, with the provision that the bouts be spread throughout the week and last longer than 10 minutes
each.

Define METs. Go over the range of METs for light, moderate and vigorous intensity of activity.

METs-index of energy expenditure, simple energy equivalents that can be used by the general public to
gauge exercise intensity

1 MET=3.5 mL/kg/min (at rest)

Light 1.1-2.9 METs Moderate 3.0-5.9 METs Vigorous 6.0 or more METs

Define and be able to calculate exercise volume. What is the recommendation for gaining
substantial health benefits based on exercise volume?

Exercise Volume-total amount of energy expended or work accomplished in an activity

Volume=intensity x duration x frequency

4-MET activity for 30 min=4x30=120 MET-minute

To gain substantial health benefits depend on total weekly energy expenditure (500-1000 MET-min per
week) such as big gap between 500-1000 because the amount of physical activity necessary to produce
health benefits varies by the health benefit, for example 500 MET-min/wk lowers the risk of premature
death but activity of more than 500-MET/min/wk is necessary to reduce risk of breast cancer

What is the Exercise is Medicine initiative about?

Exercise is Medicine is a global initiative to establish physical activity as a standard in all of health care
and not just one medical office at a time

Exercise IS medicine: And Everyone Should Take It!

Physical inactivity is THE major public health problem of our time.

Exercise has a big impact on treatment and prevention of chronic disease and obesity.

There is a linear relationship between physical activity and health status.

Health claims increase and activity levels decrease.

Goal is transformational change to:

institutionalize physical activity assessment and prescription into Global Healthcare systems

What is the relationship between the quantity of PA / fitness and relative risk of all-cause
mortality?

30 minutes to 90 minutes biggest drop, 90 min per week very beneficial

People who are physically active for ~7 hours a week have a 40% lower risk of dying early than those that
are active for less than 30 minutes a week

What is the effect of age, gender, race/ethnicities, body weight on the health benefits of PA?

All physically active adults have lower rates of dying prematurely; age, gender, race, and body weight do
not matter
 What is the relationship between physical fitness and CVD incidence/mortality? What is the
advantage of using cardiorespiratory fitness (compared to measurement of the amount of
physical activity) and linking the CRF index to various health outcomes?

The higher the level of physical fitness, the lower risk of CVD

The higher your cardiorespiratory fitness level, the lower the risk of dying early

Low CRF is a major player in death and disorders

Which is more important in terms of health status, having a higher level of physical activity or
having a lower body fatness? Should we focus more on getting people to be physically active or
achieving a normal body weight? Refer to the study as discussed in class (fitness vs. fatness).
Which is a better predictor of future health outcomes? Change in fitness or change in fatness?

Higher level of physical activity is better because the risk ratio is lower

Better to be fat and fit than skinny and unfit

Change in fitness is better

A normal weight person with a low level of fitness has just about the same risk as an obese person with a
low level of fitness.

The study looked at the risk ratio for dying early from type 2 diabetes at normal, overweight and obese
bodyweight

Doesnt matter what body weight group, the fitness levels were the biggest determinants of risk
factors

Moderate/high fitness levels in obese people actually had a lower risk than low or moderate in
normal individuals

Low fitness level had drastically high risk ratios than moderate or high for all weight levels

Essay question: Be able to know all of the health benefits based on scientific evidence as
presented in lecture. There are a total of 23 health benefits (supported by moderate to strong
scientific evidence) and you might be asked to list all of them.

STRONG: MODERATE-STRONG:

Lower risk of early death Better functional health

Lower risk of coronary heart disease Reduced abdominal obesity

Lower risk of stroke MODERATE:

Lower risk of high blood pressure Lower risk of hip fracture

Lower risk of adverse blood lipid profile Lower risk of lung cancer

Lower risk of type 2 diabetes Lower risk of endometrial cancer

Lower risk of metabolic syndrome Weight maintenance after weight loss

Lower risk of colon cancer Increased bone density

Lower risk of breast cancer Improved sleep quality

Prevention of weight gain

Weight loss when combined with reduced calorie intake

Improved cardiorespiratory and muscular fitness

Prevention of fall

Better cognitive function

Reduced depression

What is the risk of sudden cardiac death in asymptomatic adults during vigorous intensity of
exercise?

1 per year for every 15,000-18,000 previously asymptomatic individuals

What is the risk of cardiac events in adults during exercise testing?

6 per 10,000 symptom-limited maximum tests

********Health Screening and Risk Classification******** 50% of exam

Know the purposes of preparticipation health screening

To identify and exclude individuals with medical conditions to exercise testing or from exercise programs
until those conditions have been abated or controlled

To identify clients at increase risk for disease should undergo a medical evaluation and exercise testing
before starting an exercise program and increasing the frequency and intensity of their current program

To identify persons with clinically significant disease or condition who should participate in medically
supervised exercise programs

To identify those with significant but nonlimiting health/medical concerns

To provide benchmark data as an effective motivation tool for client goal setting and to determine
meaningful fitness assessment choices

What are the essential elements of informed consent form? Go over the example on the
handout.
Purpose

Procedures

Risks and discomforts

Benefits

Alternative

Responsibilities of the participant

Encouragement of questions

Explanation of data handling

Ability to withdraw consent and stop the assessment at any time

What are the instruments used for self-guided screening prior to physical activity?

Physical Activity Readiness Questionnaire (PAR-Q) or the modified AHA/ACSM Health/Fitness Facility
Preparticipation Screening Questionnaire

Go over the details regarding the PAR-Q and AHA/ACSM Health Fitness Facility Preparticipation
Screening Questionnaire.

PAR-Q-brief, concise and effective tool for initial screening and for individuals to gauge their own
medical readiness to participate in PA assessments and programs

7 YES NO questions

focuses on symptoms of heart disease, while also identifying musculoskeletal problems that should be
evaluated

good at identifying clients at high risk but not necessarily reliable in identifying those at low or moderate

AHA/ACSM Health/Fitness Facility Preparticipation Screening Questionnaire-more comprehensive than

PAR-Q

Surveys recognized signs and symptoms suggestive of CVD and other ACSM risk factors

Useful for clients to gauge their own readiness and suggested as a self-guided screening tool

Practice examples given to you in class for the ACSM risk classification process

Which conditions are considered as cardiovascular, pulmonary, and metabolic disease?

Cardiovascular disease-cardiac disease, peripheral artery disease, or cerebrovascular disease

Pulmonary Disease-chronic obstructive pulmonary disease, asthma, interstitial lung disease, or cystic
fibrosis

Metabolic disease-diabetes mellitus, thyroid disorder, a renal or liver disease

Know the signs and symptoms suggestive of cardiovascular, pulmonary, and metabolic disease

Pain or discomfort in the chest, neck, jaw, arms, or other areas that may be due to ischemia or lack of
oxygenated blood flow

Dyspnea or SOB at rest or at mild exertion may be an indication of underlying cardiac/pulmonary disease

Dizziness or syncope indicate poor blood flow to the brain due to inadequate cardiac output

Orthopnea or trouble breathing while lying down and paroxysma nocturnal dyspnea or difficulty breathing
while asleep, indicative of poor ventricular function

Ankle edema suggestive of heart failure, blood clot, insufficiency of veins, or a lymph system blockage

Palpitations or tachycardia, forceful or rapid beating of the heart

Intermittent claudication, reproducible with increasing exercise intensity and indicates a lack of
oxygenated blood flow to the working muscles

Known heart murmur, may indicate valvular or other CVD

Unusual fatigue or SOB with usual activities

Know all of the criteria for positive and negative CVD risk factors

Positive:

Age: men 45 and older and women 55 and older

Family History of CV events: MI, bypass surgery, sudden death of male before 55, female before 65

Cigarette smoking: current smoker, within 6th months, regular 2nd hand smoke

Hypertension: greater than or equal to 140/90 on 2 separate occasions or taking antihypertensive

medicine

Dyslipidemia: LDL greater than or equal to 130, cholesterol greater than or equal to 200, HDL less than
40, currently taking lipid lowering medication

Pre-diabetes: glucose 100-125 on two separate occasions

Obesity: greater than or equal to 30, or male waist circumference greater than 102, female greater than
88

Sedentary lifestyle: must do at least 30 minute of exercise 3 d/wk for 3 months

Negative:

HDL: greater than or equal to 60

Be able to determine the number of CVD risk factors, and the number of signs and symptoms
suggestive of cardiovascular, pulmonary, or metabolic disease or the present of the diseases
listed above.

CVD risk factors: positive=8 (Age, family history, smoking, hypertension, dyslipidemia, pre-diabetes,
obesity, sedentary lifestyle) negative=1 (HDL)

# of signs and symptoms of disease=9

Be able to determine whether client is at low, moderate or high risk based on the
preparticipation screening logic model.

Low: asymptomatic <2 CVD risk factors

Moderate: asymptomatic greater than or equal to 2 CVD risk factors

High: Individuals who have any signs or symptoms or a known disease

Be able to determine whether a client should have a medical examination prior to exercise
testing or training.

Low Risk: Mod-no Vig-no

Moderate Risk: Mod-no Vig-yes

High Risk: Mod-yes Vig-yes

Be able to determine whether a client should perform a diagnostic exercise test prior to an
exercise program.

Low Risk: Mod-no Vig-no

Moderate Risk: Mod-no Vig-no

High Risk: Mod-yes Vig-yes

Be able to determine when a physician or competent nonphysician health care professional

needs to supervise the exercise test.

Low Risk: Sub-no Max-no

Moderate Risk: dependent on

Local policies and circumstance

Health status of patient

 Training and experience of lab staff

High Risk: Sub-yes Max-yes

What do you do with missing information regarding risk factors? Criteria for pre-diabetes?

When information regarding a risk factor is not available, safe to assume it is a positive CVD risk factor
except pre-diabetes

If pre-diabetes is missing, counted as risk factor

Those greater than or equal to 45 and BMI greater than or equal to 25

Those less than 45 with BMI of 25 and additional CVD risk factors such as hypertension,
sedentary lifestyle, family history of diabetes

III. Health-Related Fitness AssessmentBody Composition

What is the minimal amount of fat essential for bodily function in men and women?

Women: 8-12%

Men: 3-5%

Review the rationale for body composition assessment

Provides information concerning health and fitness for children, adolescents, teenagers, adults, and
elderly populations

Excess body fat is related to poor health and risk of diseases/conditions including:

Type 2 diabetes

Hypertension

Dyslipidemia

CVD

Certain types of cancer

Functional impairments

Premature death

Assessments of bone structure and muscle mass are related to several potentially serious conditions in
aging including:

Osteoporosis
 Risk of falls, broken bones or compression fractures of the spine

Sarcopenia

Loss of muscle mass, major predictor of disability

Low body fat can be detrimental to health

Function of fats/lipids

Malnutrition

Eating disorders

Be able to describe the principles behind each of the indirect methods for body composition
assessment:

Anthropometric methods: a set of quantitative techniques to measure the size and proportion of the
human body which includes height, weight, body circumference, and skinfolds. Some are invasive and
some are noninvasive

BMI: used to assess weight relative to height and is calculated by dividing body weight in kg by height
in meters squared

Underweight: Less than 18.5

Normal weight: 18.5-24.9

Overweight: 25.0-29.9

Obese: greater than or equal to 30

BMI not a perfect number but has a lot of correlation to health risks and physical activity status

BMI linked to increase risk of type 2 diabetes, dyslipidemia, hypertension, and certain cancers

Waist circumference: girths measure changes in the size of a body part, determines body fat
distribution, a cloth tape measure with a spring-loaded handle reduces skin compression and
improves consistency of measurement

Duplicate measurements are recommended at each site and should be obtained in a rotational
instead of consecutive order (take all measurements at different sites then repeat sequence)

The average of the two measures is used provided they do not differ by more than 5mm

Waist to Hip Ratio (WHR): circumference of the waist divided by the circumference of the hips

Health risk increase as WHR increases & the standards for risk vary with age & sex
 Health risk very high in young men WHR > .95 young women WHR > .86

Waist circumference=35in Hip circumference=42 in WHR 35/42=.83 (close to 1, more

fat stored in waist as opposed to hip?)

Gynoid obesity: fat is stored in hips and thighs (pear shape) typical in females

Android obesity (worse): more fat is store in trunk and abdomen (Apple shape) typical in
males, associated with increased risk for hypertension, stroke, metabolic syndrome, type
2 diabetes, dyslipidemia, CVD, and premature death compared to gynoid

Metabolic syndrome: hypertension, waist circumference (high), adverse lipid profile,

impaired glucose tolerance (high blood sugar)

Evidence indicates reliable and effective in identifying individuals at increased health risk

High risk: >88 cm for women >102 cm for men

Skinfold measurement: body fat estimation based on the thickness of subcutaneous adipose tissue
using skinfold caliper

The principle behind this technique:

The total amount of subcutaneous fat is proportional to the total amount of body fat

Approximately 1/3 of total body fat is located subcutaneously

Accuracy is +- 3.5%

Relatively quick and inexpensive method for BF estimation

Relationship between subcutaneous fat and total body fat varies with race, age, and sex

Densitometry Methods: body volume is estimated before calculation of body density

Hydrodensitometry (underwater weighing): valid, reliable, and widely used laboratory method in
research settings, often used as the criterion method for assessing % BF

Concept based on Archimedes principle:

An object submerged in water is buoyed by a counter force that is equal to the volume of
the water that is displaces

Bone and muscle tissue are denser than water whereas fat tissue is less dense, therefore
a person with more FFM for the same total body mass weights more in water and has a
higher body density and lower percentage of body fat compared to another person with
same body mass

Estimating instead of measuring residual lung volume decrease accuracy

(BM-UWBM)/DH20 RV-GV
 A person with more lean mass will weigh more underwater; this raises body density

Person should not eat within 4 hours of test, urinate before testing, wear tight clothing,
exhale while fully submerged, remain motionless, and perform several trials to obtain
consistent measurements

Percent error +-2.5% when RV (amount of air remaining in lungs) is measure and
technique is performed flawlessly, +-2.8-3.7% when RV is estimated

Plethysmography (bod pod): uses concept of density as the ratio of body mass to body volume,
measured by air displacement rather than water displacement

Bod Pod: commercially available air displacement plethysmograph

Uses dual chamber that measures body volume by changes in pressure in a closed chamber
using Boyle law

Pressure changes in the chamber related to the size of the person being measured

Requires only tight clothing and stillness

Advantages: less time consuming, eliminate the performance requirements, less anxiety inducing

Stand error between 2.2-3.7%

Other Techniques:

Bioelectrical impedance analysis: quick and non-invasive method of body composition

assessment

Harmless, low-level electrical current is applied to the subject and tissue opposition (impedance)
to the low level current is measured

Measures current going through different tissues

Indirectly estimates total body water (TBW) and subsequently FFM with BIA

Extent of hydration or dehydration determines resistance of tissues to flow of electrical current,

which will affect prediction of %BF

When water reduces resistance and current moves easily, it means tissue is leaner

When dehydration or adipose tissue slows current it means tissue is fatter

Ask clients to avoid any substances that alters the bodys hydrate state, such as alcohol or
diuretics

Inform clients not to eat or drink caffeinated beverages 4 hrs before assessment, should drink
enough water to maintain normal hydration state
 Ask clients to avoid exercise 12 hrs before BIA

Urinate completely within 30 minutes of test

Advantages: doesnt require a high degree of skill, more comfortable, less invasion of privacy, can
be used to estimate body composition of obese individuals

Error: +-3.5-5%

DEXA: 3-component model (fat, bone and lean tissue), cost more than $70,000

Developed for bone density measurement using low-dosage energy beams to pass through the
subject

Based upon the idea that attenuation of X-rays with high and low photon energies is measureable
and dependent on the thickness. Density and chemical composition of the underlying tissues

Uses 2 photon energies, low energy beam=soft tissue high energy=bone

Advantages: safe, rapid (15-20 min), minimal client cooperation, provides regional and segmental
body composition assessment

Reliable and accurate measures of body composition but not popular for general health fitness
testing because of cost and need for highly trained personnel

Error +- 1.8%

Experts reviewing DXA studies have called for more standardization among manufacturers

No consensus exists that DXA is better than HW

What are the advantages and disadvantages using each of the techniques?

BMI: not perfect # but has a lot of correlation to health risks and physical activity status, linked to high
risks of type 2, dyslipidemia, hypertensions and certain cancers

Circumferences: inexpensive, quick, can be used with extremely obese individuals,

Skinfold: relatively quick and inexpensive method for BF estimation requires skill and training

Hydrostatic (underwater): valid, reliable, bad if hydrophobic, expensive

Bod Pod: expensive, less time consuming, eliminate performance requirements of hydrostatic, less
anxiety inducing

BIA: quick and non-invasive, relative inexpensive to hydrostatic or DEXA, does not require high
degree of technician skill, more comfortable, less invasion of privacy, can be used to estimate
composition of obese individuals

DEXA: expensive, safe, rapid, requires minimal client cooperation, provides regional and segmental
body composition assessment, need highly trained personnel
 Factors that may contribute to measurement error for each of the techniques

Skinfold: inexperienced evaluator (poor technique, measurement at wrong sit, use of incorrect
equations), subject (dehydration, exercising immediately before extremely obese or lean), equipment
(improperly calibrated caliper, poor accuracy/quality)

Accuracy of predicting percent body fat from each of the techniques.

DEXA: +-1.8%

Bod Pod: +- 2.2-3.7%

Underwater: +- 2.5%

Skinfold: +-3.5%

BIA: +-3.5-5%

Review Table 4.1 Classification of disease risk based on body mass index and waist
circumference.

Disease Risk (type 2, hypertension, CVD) to

Normal Weight and Waist Circumference

BMI Men 102cm Men >102cm

Women 88 cm Women >88cm

Underweight <18.5 - -

Normal 18.5-24.9 - -

Overweight 25-29.9 Increased High

Obesity 1 30-34.9 High Very High

2 35-39.9 Very High Very High

3 40 Extremely High Extremely High

What is the difference between two and multi-compartments?

Two-compartment: divides body into fat and fat-free mass

assumes a constant density for fat and fat-free tissues among individuals

more commonly used in fitness assessments (skinfolds and underwater weighing)

Multi-compartment: divides body into 3 or more components (FM, FFM, others)

used more commonly in research or clinical settings

Hydrostatic weighing: Go over the equation for calculating body volume, body density and
body fat%

BD=BM/BV

BD-if we find this we can use equations to determine %BF

BM-we know this

BV-we can calculate this via hydrostatic weighing

A person with more lean mass will weigh more underwater; this raises the bodys density

All of equations associated with underwater weighing will be provided to you.

Be able to list several guidelines in order to achieve higher accuracy of body composition
assessment using underwater weighing.

Do not eat within 4 hours of test

Urinate and defecate before testing

Tight-fitting bathing suit that traps little air

Exhale while fully submerged

Perform several (5-10) trials, 3 trials within +-100g

Be able to list several guidelines in order to achieve higher accuracy of body composition
assessment using bioelectrical impedance analysis.

Remove oil and lotions from skin with alcohol before placing electrodes

Place electrodes precisely as directed by manufacturer

Ask clients to avoid any substances that alters the bodys hydrate state, alcohol or diuretics for as
least 48 hours before measurement

4 hours before test client should not eat or drink caffeinated drinks, should drink enough water to
maintain normal hydration

avoid exercise 12 hours before BIA

Note phase of menstrual cycle because it can alter hydration levels

Void bladder completely within 30 minutes of test

What are the % body fat categorized as obese for men and women?
25% men 38% women

Calculation of target body weight.

Target body weight=FFM/1-(desired %BF/100)

A 40 year old women weighs 200 lb and has a BF% of 25%. Her goal is to reach 15% of BG. What is
her target body weight?

200X.75=150 150/1-(.15)=176.5 lb