EXERCISE AS A PRESCRIPTION

Noel M. Laxamana, MD, FPAFP, DPCOM

Family Medicine & Community Health 1
Learning objectives
• Briefly discuss the burden of disease of NCDs

• Discuss the role of physical activity and exercise in the prevention of

NCDs

• Discuss the role of physical activity and exercise in the treatment of

NCDs

• Discuss recommended levels of physical activity and exercise that are

needed for health benefits
Physical Inactivity
An insufficiently physically active person is someone who does not
meet any of the following criteria:

1) three or more days of vigorous-intensity activity for at least 20

minutes per day; or

2) five or more days of moderate-intensity activity or walking for at

least 30 minutes per day

(World Health Organization, 2008a).

 Prevalence of Overweight/Obese Adults 20 yrs old and above: Philippines, 2015

3 out of 10 Filipino adults are

overweight/obese (31.1%)

There are more Filipina who are

overweight/obese (35.2%) than males
(26.8%), with BMI > 25 kg/m2
Metabolic Syndrome
OBESITY (BMI > 30kg/m2)
Abdominal Obesity
Men > 102 cm (>40 in) waist circumference
Women > 88 cm (35 in) waist circumference
DYSLIPIDEMIA
Triglycerides >150mg/dL
HDL cholesterol
Men < 40mg/dL
Women < 50mg/dL
HYPERTENSION
BP >130/85mmHg

DIABETES MELLITUS
FBS > 110mg/dL
Mental health benefits of exercise

• Better concentration and mental performance

• Better sleep, stamina, energy, self esteem
• Less anxiety and tension
• Improved neurocognitive function
 Comparative effectiveness of
exercise and drug interventions
on mortality outcomes:
metaepidemiological study

No statistically detectable differences

were evident between exercise and drug
interventions in the secondary prevention
of coronary heart disease and pre-
diabetes. Physical activity interventions
were more effective than drug treatment
among patients with stroke.
Existing randomised trial evidence on exercise
interventions suggests that exercise and many
drug interventions are often potentially similar
in terms of their mortality benefits in the
secondary prevention of coronary heart
disease, rehabilitation after stroke, treatment of
heart failure, and prevention of diabetes.
Benefits of Exercise and ADLs
• Increases energy expenditure
• Protects and builds lean body mass
• Raises metabolism: pound of muscle burns 5kcal more than pound of fat
everyday
• Improves psychological factors
• Reduces morbidity and mortality
• Enhances cardiorespiratory fitness
• Improves lipid profile
• Reduces BP
• Increases insulin sensitivity
• Improves blood glucose control
Physical activity
• Any body movement produced by muscular
contraction that leads to a substantial increase in
person’s energy expenditure.
 Calories burned during physical activities
Activity Calories burned per hour
Men Women
Light activity:
Cleaning house
Office work 300 240
Playing baseball
Playing golf

Moderate activity:
Walking briskly (3-5mph)
Gardening 460 370
Cycling (5mph)
Dancing
Playing basketball
Exercise

• A prescribed work task,

which generally includes
intensity, duration and
frequency of the work
bout.
Vigorous Intensity Exercise

• 20 minutes per day, 3 days a week or a total of 1 hour and 15 minutes

per week
• At least 10 minutes at a time
• You are breathing rapidly and only able to speak in short phrases.
Heart rate is substantially increased and likely to be sweating.
• Race-walking, hiking uphill, jogging or running, cycling more than 10
miles per hour, swimming fast or lap swimming, aerobic dancing, fast
dancing, heavy gardening, martial arts, playing sports with lots of
running, single tennis
 Approximate calories/hour
Vigorous Physical Activity
for a 154 pound person
Running/jogging (5mph) 590
Bicycling (>10 mph) 590
Swimming (slow freestyle laps) 510
Aerobics 480
Walking (4-5 mph) 460
Heavy yard work (chopping wood) 440
Weightlifting (vigorous effort) 440
Basketball (vigorous) 440
Moderate Intensity Exercise

• Noticeably increases heart rate and breathing rate

• May sweat but able to carry on a conversation
• Able to talk but cannot sing
• At least 10 minutes of continuous physical activity; brisk
walking, easy jogging, treadmill, elliptical trainer, bike
riding, swimming, water aerobics, ballroom dancing, line
dancing, softball and baseball, volleyball, doubles tennis,
gardening
Examples of Moderate Physical Activity – Common Chores

• Washing and waxing a car for 45-60 min

• Washing windows or floors for 45-60 min
• Gardening for 30-45 min
• Wheeling self in wheelchair 30-40 min
• Pushing a stroller 1 ½ miles in 30 min
• Raking leaves for 30 min
• Walking 2 miles in 30 min (15 min/mile)
• Shovelling snow for 15 min
• Stair walking for 15 min
Examples of Moderate Physical Activity – Sporting Activities

• Volleyball for 45-60 min

• Touch football for 45-60 min
• Walking 1 ½ miles in 35 min (20 mile/min)
• Shooting baskets for 30 min
• Bicycling 5 miles in 30 min
• Water aerobics for 30 min
• Swimming laps for 20 min
• Basketball for 15-20 min
• Bicycling 4 miles in 15 min
• Jumping rope for 15 min
• Running 1 ½ miles in 15 min (10 min/mile)
• Dancing fast (social) for 30 min
 Approximate calories/hour
Moderate Physical Activity
for a 154 pound person
Hiking 370
Light gardening/yard work 330
Dancing 330
Golf (walking and carrying clubs) 330
Bicycling (<10mph) 290
Walking (3-5mph) 280
Weightlifting (general light workout) 220
Stretching 180
Non-exercise Activity Thermogenesis (NEAT)
• All energy expenditure except that used during sleeping, eating and
formal exercise
• Reduced by 500-1000 kcal/d over last 100 years
• Tips for increasing NEAT
• Walking while speaking on the phone
• Using the stairs rather than the elevator
• Parking farther from the entrance in parking lots
• Walking while watching television or reading
• Pedometer: 10,000 steps/day
 EXERCISE DOSE CONTINUUM

• Dose response to exercise by which benefits are delivered

• Significant health benefits are achieved by going from
sedentary state  minimal level of physical activity
• Program of higher intensities/greater frequency and
duration provide additional benefits
• Lower levels of physical activity (intensity) may decrease
risk for certain chronic degenerative disease and increase
metabolic fitness
 Essential Components of Exercise Prescription: FITT Pro

• Exercise Frequency (how often)

• Exercise Intensity (how hard)
• Exercise Type (type of activity)
• Exercise Time (how long)
Cardiovascular Exercise Prescription
 Exercise Frequency

• 3 to 5 days/week for moderate to vigorous

intensity
• Deconditioned clients – lower intensity, shorter
duration at higher frequencies
• For lower intensity, more than 3 days/week is
required
 Exercise Intensity
• Relative difficulty of the exercise (i.e. how hard the exertion feels)
• Different ways to measure exercise intensity

Subjective Measure

Relative Measure

Absolute Measure
 Subjective Measure: The Talk Test

• Low intensity – talk and sing

• Moderate intensity – able to talk but not
sing
• Vigorous intensity – neither singing nor
prolonged talking is possible
 Rating of Perceived Exertion
Rating Perception Level of Intensity
0 Nothing at all No intensity
1 Very weak
2 Weak Light
3 Moderate
4 Somewhat strong
5 Strong Heavy
6
7 Very strong
10 Extremely strong Strongest intensity
 Relative Measure on Intensity
• Percentage of maximal oxygen consumption (VO2 max)
• Percentage of Hrmax
• Percentage of HRR
• Heart rate max is determined by the formula 220 minus
patient’s age
• More accurate estimate of HRmax
• HRmax = 206.9 – (0.67 x age)
 Relative Measure on Intensity
Percentage of maximum heart rate

Intensity Percentage of HR max

Low <64%

Moderate 64-76%

Vigorous >76%
 Example Intensity using HR max

• Data: 51 year-old patient to exercise at moderate intensity

• Moderate intensity exercise = 64%-76% of HR max
• Using HR max = 220 – 51 (age) = 169 bpm
• Target Lower Range = 0.64 x 169 = 108 bpm
• Target Upper Range = 0.76 x 169 = 128
 Absolute Measure of Intensity

• Metabolic equivalents (METS)

• One metabolic equivalent is the measure of the amount of
oxygen/energy used by body when rest (resting metabolic
rate)
• 1 MET = 3-5 mL/kg/min O2 consumption
• Useful way to describe the intensity of a variety of physical
activities and work in relation to the individual’s ability
 Exercise Duration
• Cumulative physical activity 30-60 minutes per day
• Continuous or intermittent (at least 10 minutes each bout)
 Exercise Prescription
• Aerobic Activities
• Select modality based on co-morbidity and preference

Non-Weight
Weight Bearing Weight Bearing Bearing
Impact Low-Impact Non-Impact
Running Stair master Cycling
Step aerobics Elliptical trainer Rowing
Skipping Low-impact Swimming
Stair climbing aerobics Water based
Jumping jacks Dance training
Arm cranking
 Exercise Frequency
• At least 2 training sessions per week on consecutive days
 Exercise Intensity
• Weights that are heavy enough to be lifted for 8 to 12
repetitions
• 2-3 sets with short (1-4 minutes) breaks between sets
 Exercise Type
• Machine weights, free weights, elastic cords or body
weight
• Gym or at home
 Exercise Time
• 8 to 10 exercises for major muscle groups per session
• 30 minutes per session
 RT: Progression
• To avoid injury and muscle soreness, start at a lower
intensity (RPE of 5-6) or 15 repetitions to fatigue
 Key Principles for Successful Exercise Program
• Set SMART goals
• Focus first on regular exercise
• Gradual change leads to permanent change
• More exercise is better than less, but something is better
than nothing
 Warm Up
• Involves low intensity activity specific to the
exercise performed
• Prepares body for more strenuous exercise
• Improve blood circulation
• Increases the heart rate
• Reduce risk of musculoskeletal injury
 Stretching
• At least 10 minutes, 2-3 times per week
• Stretch after warm-up or at the end of exercise session
• Hold each muscle stretch for 20-30 seconds
• Stretch the muscle to within limits of comfort/to the point
of feeling tight, without discomfort or pain
 Cool down
• Gradual recovery from the endurance phase:
• Adjust the circulatory response (e.g. HR and BP)
• Improve venous return
• Reduce risk of post-exercise hypotension and dizziness