II. Epidemiology

  1. Majority of United States is physically inactive
    1. American adults
      1. Completely sedentary: 25%
      2. Activity <30 minutes/day: 60%
    2. Americans age 12 to 21
      1. No recent Exercise: 14%
      2. Not vigorously active: 50%
    3. Americans over age 65 years
      1. Sedentary: 75%
  2. References
    1. (1996) USDHHS Surgeon General Report on Activity [PubMed]
    2. Jones (1998) Arch Fam Med 7:285-9 [PubMed]

III. Efficacy: Benefits of Aerobic Exercise

  1. Reduces Cardiovascular Risks
    1. Coronary Artery Disease twice as likely in sedentary
    2. Improves Lipid profile
      1. Increases High Density Lipoprotein (HDL)
      2. Decreases Low Density Lipoprotein (LDL)
      3. Decreases Total Cholesterol
      4. Decreases Triglycerides
      5. Improves VLDL Cholesterol
    3. Enhances Fibrinolysis and alters platelet function
    4. Lowers Blood Pressure
      1. Decreases Systolic Blood Pressure
      2. Decreases Diastolic Blood Pressure
    5. Significantly lowers mortality in older men with CHD
      1. Required only light activity (walking, gardening)
      2. Wannamethee (2000) Circulation 102:1358-63 [PubMed]
  2. Benefits Diabetes Mellitus
    1. See Exercise in Diabetes Mellitus
    2. Improves Glucose Tolerance and Insulin Sensitivity
      1. Improves for 16 hours after each Exercise session
    3. Significantly decreases Disability and improves mobility in obese patients with Diabetes Mellitus
      1. Rejeski (2012) N Engl J Med 366(13): 1209-17 [PubMed]
  3. Reduces Mortality in Postmenopausal Women
    1. Studied 42,000 women ages 55 to 69 years over 7 years
      1. Moderate Physical Activity (golf or long walks)
        1. Exercise once weekly: Mortality reduced 23%
        2. Exercise 2-4 times weekly: Mortality reduced 30%
        3. Exercise >4 times weekly: Mortality reduced 38%
      2. Vigorous Physical Activity: Mortality Reduced 43%
    2. References
      1. Kushi (1997) JAMA 277:1287-92 [PubMed]
  4. Benefits Mental Health
    1. Decreases Major Depression in chronic illness (patients with most significant depression have the greatest benefit)
      1. Herring (2012) Arch Intern Med172(2): 101-111 [PubMed]
  5. Reduces Cancer risk
    1. Colon Cancer and Prostate Cancer reduced
    2. Breast Cancer risk reduced
      1. Study 25,624 Norwegian women ages 35-49 in 14 years
      2. Breast Cancer reduced 37% if 5-7 days Exercise/week
      3. Thune (1997) 336:1269-75 [PubMed]
  6. Osteoporosis benefits
    1. Decreases postmenopausal Bone Mineral Density loss
    2. Decreases hip and Vertebral fracture Incidence
  7. Other Benefits
    1. Reduces Obesity
    2. Improves immune function
    3. Improves Anxiety and Major Depression
    4. Improves Insomnia
    5. Improves self-esteem and socialization
    6. Improves cognitive function and Short Term Memory
    7. Improves Chronic Pain
    8. Improves Myofascial Pain
      1. Fibromyalgia
      2. Myofascial Pain Syndrome

IV. Type: Low to moderate level aerobic activity

  1. Frequency: Daily
  2. Duration: 30 minutes or more of cumulative activity
    1. May split into three ten minute activities daily
  3. Mild to moderate intensity
    1. Metabolic Energy Equivalents: 3-6 mets
    2. Heart Rate <55% of maximum Heart Rate
    3. Borg rating of exertion <11
    4. Caloric expenditure: 150 to 500 kcals per day
  4. Examples
    1. See Walking Program
    2. See practical tips below
    3. Walk the dog
    4. Yard work (use a push mower instead of a riding mower)
    5. Golf without a cart
    6. Three ten minute fast walks per day
    7. Walk instead of ride
    8. Park car at a distance from mall or office
    9. Take stairs instead of elevator: Up and Down
    10. Coordinate activities with family and children
      1. Family biking
      2. Soccer with kids
      3. Swim as a family

V. Type: Moderate to vigorous aerobic activity

  1. Frequency: 3-5 times per week
  2. Duration: >20-30 minutes moderate intensity
  3. Goal Heart Rate: 60-80% of maximum Heart Rate
  4. Examples
    1. Biking (faster than 12 MPH)
    2. Hiking
    3. Dance
    4. Inline Skating
    5. Eliptical trainer
    6. Tennis
    7. Cross Country Skiing
    8. Soccer
    9. Running or Jogging
    10. Swimming or water aerobics
    11. Brisk walking for 60 minutes per day

VI. Management: Toning and Stretching

  1. Frequency: 1-3 times per week
  2. Stretching
    1. Yoga
    2. Tai Chi
  3. Toning
    1. Weight lifting
    2. Tension bands

VII. Management: Exercise Prescription

  1. Type of Exercise
    1. Choose sustainable activities
      1. Many will not keep up a structured program at the gym
      2. Social activities (e.g. walk with friends or family) or chores are more often maintained
      3. Tie Exercise to rewards (e.g. watching a movie on the treadmill)
      4. Mix-up activities (cross train) by alternating different Exercises (e.g. Swimming, Running)
    2. Take underlying comorbidity into account
      1. Examples: Arthritis or Peripheral Vascular Disease
      2. Avoid high intensity sport that injure Shoulder, knee
  2. Amount: Duration and Frequency are more important than intensity
    1. Duration: >30 minutes/day
      1. Can be divided into 2-3 ten-minute activities/day
      2. While starting, commit to sustainable duration (e.g. 5 minutes everyday without fail)
        1. Advance by sustainable increase each week (e.g. 1-2 minutes/day added each week)
    2. Frequency
      1. Low to Moderate Aerobic Activity: "Move daily"
      2. Moderate to vigorous aerobic activity: 5 times per week
        1. Avoid burn-out by taking 1-2 days off per week
  3. Intensity
    1. Start with low to Moderate Aerobic Activity (e.g. fast walking, yard work)
      1. See Practical tips below
      2. Start at 55% of maximum Heart Rate and slowly increase over months
    2. Increase frequency and duration before intensity
      1. Do not increase intensity more than 10% per week
      2. Consider more vigorous aerobic activities later (e.g. biking, Inline Skating)
  4. Example of an optimal program to build towards
    1. Low to Moderate Aerobic Activity daily for a cummulative total of 30 minutes/day and
    2. Moderate to vigorous aerobic activity 3-5 days weekly for >20 minutes/day and
    3. Toning and Stretching 1-3 times per week
  5. Overall goals (2008 U.S. Physical Activity Guidelines)
    1. Moderate aerobic Exercise (e.g. swim, bike, garden, walk>3 mph) >150 min/week (ideally >300) OR
      1. Vigorous aerobic Exercise (e.g. bike >10 mph, jog, hike uphill with pack) >75 min/week (ideally >150)
    2. Combine with Muscle Strengthening of all major muscle groups at least twice weekly
    3. US HHS Physical Activity Guidelines for All Americans
      1. http://health.gov/paguidelines/pdf/paguide.pdf

VIII. Management: Practical Tips

  1. Exercise while reading or watching Television
    1. Americans watch television average of 30 hours/week
    2. Hide the remote control
    3. Rent movies and watch them only when exercising
  2. Treadmill most effective indoor Exercise (n=13)
    1. Highest energy use at maximal exertion
    2. Compared 6 types of Exercise equipment
      1. Treadmill
      2. StairMaster
      3. Rower
      4. Exercise bike
      5. Nordic track
      6. Air-Dyne (bike with rower)
    3. References
      1. Zeni (1996) JAMA 275:1424-7 [PubMed]

IX. Prevention: Sports related injury

  1. Stretching does not reduce injuries in healthy athletes
    1. Herbert (2002) BMJ 325:468-70 [PubMed]
  2. Warm-ups reduce injury rate by 50%
    1. Study of 1800 teen athletes in organized sports
    2. Sample program
      1. Jogging
      2. Specific movements (e.g. Cutting, jumping)
      3. Balance (e.g. wobble boards)
      4. Strength Exercises (e.g. hamstring, quadriceps)
    3. References
      1. Olsen (2005) BMJ 330:449-52 [PubMed]

X. Resources

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Ontology: Exercise (C0015259)

Definition (MSH) Physical activity which is usually regular and done with the intention of improving or maintaining PHYSICAL FITNESS or HEALTH. Contrast with PHYSICAL EXERTION which is concerned largely with the physiologic and metabolic response to energy expenditure.
Definition (NCI) Activity that requires physical or mental exertion, especially when performed to develop or maintain fitness.
Definition (CSP) physical activity as practiced in recreation, amateur and professional sports, or planned activity to improve physical condition or health.
Concepts Daily or Recreational Activity (T056)
MSH D015444
SnomedCT 151535007, 151525001, 183309009, 256235009, 183301007, 61686008
LNC LP61581-2
English Exercise, Exercise, Physical, Exercises, Exercises, Physical, Physical Exercises, Physical exercise NOS, exercises, physical exercises, physical conditioning, exercise, physical exercise, Physical exercise NOS (procedure), Physical exercises (procedure), Physical exercise NOS (regime/therapy), Physical exercises, Physical exercises (regime/therapy), Physical exercise, Physical exercise, NOS, Physical Exercise, Exercise (observable entity), Physical exercise (observable entity), Exercise (qualifier value), Physical exercise (qualifier value)
Swedish Motion
Spanish ejercicio (calificador), ejercicio físico (calificador), Physical exercise NOS, ejercicio físico, SAI, ejercicio físico, SAI (procedimiento), ejercicio físico, SAI (régimen/tratamiento), ejercicio físico, ejercicios físicos (procedimiento), ejercicios físicos (régimen/tratamiento), ejercicios físicos, ejercicio, ejercicio (entidad observable), ejercicio físico (entidad observable), Ejercicio, Ejercicio Físico
Czech cvičení, Cvičení
Finnish Liikunta
French Exercice, Activité physique, Exercice physique
Russian AEROBNOE UPRAZHNENIE, UPRAZHNENIE AEROBNOE, UPRAZHNENIE FIZICHESKOE, UPRAZHNENIE IZOMETRICHESKOE, FIZICHESKAIA NAGRUZKA, IZOMETRICHESKOE UPRAZHNENIE, АЭРОБНОЕ УПРАЖНЕНИЕ, ИЗОМЕТРИЧЕСКОЕ УПРАЖНЕНИЕ, УПРАЖНЕНИЕ АЭРОБНОЕ, УПРАЖНЕНИЕ ИЗОМЕТРИЧЕСКОЕ, УПРАЖНЕНИЕ ФИЗИЧЕСКОЕ, ФИЗИЧЕСКАЯ НАГРУЗКА
Japanese 運動(身体の), エアロビクス, エアロビクス体操, 身体の運動, 有酸素性運動, 運動-アイソメトリック, 運動-等尺性, 有酸素性持久力, 運動-有酸素性, 等尺性運動, エクササイズ, アイソメトリック運動, 身体運動, ウンドウ, 運動
Italian Esercizio fisico, Esercizio
Croatian VJEŽBANJE
Polish Ćwiczenia fizyczne, Uprawianie aerobiku, Ćwiczenie izometryczne
Norwegian Trim, Mosjon, Trening, Not Translated[Exercise]
Dutch lichaamsbeweging, Inspanning
German Sport, Physisches Training, Training, physisches, Körperliches Training, Training, körperliches
Hungarian Testgyakorlás
Portuguese Exercício Físico, Exercício

Ontology: Physical therapy exercises (C0452240)

Definition (MSH) A regimen or plan of physical activities designed and prescribed for specific therapeutic goals. Its purpose is to restore normal musculoskeletal function or to reduce pain caused by diseases or injuries.
Definition (OMS) Therapeutic physical activities such as active/passive range of motion, isometrics, stretching, and weight lifting.
Definition (CCC) Activities to promote physical functioning
Definition (MSHCZE) Režim nebo plán fyzických aktivit navržených a předepsaných tak, aby splnil specifické terapeutické cíle. Účelem těchto aktivit je nastolit normální funkce pohybového aparátu nebo zmírnit bolest způsobenou nemocí či zraněním.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D005081
ICD9 93.1
SnomedCT 229065009, 151526000, 226029000, 51998003
English Exercise Therapies, Exercise Therapy, Therapies, Exercise, Therapy, Exercise, Physical therapy exercises, Therapeutic exercises, THER EXERCISE, EXERCISE THER, physical therapy exercises (treatment), PT exercises, physical therapy exercises, exercises, CAM Exercise Therapy, rnrx rehabilitation exercise (treatment), rnrx rehabilitation exercise, exercise rehabilitation, exercise therapy, exercise physical therapy, therapeutic exercise, rehabilitation exercise, therapy exercise, exercises rehabilitation, exercises therapy, Rehabilitation Exercise, exercise therapy (treatment), Exercises, Therapeutic exercise, Exercise therapy, Exercise therapy (regime/therapy), Exercises (regime/therapy), Exercises treatments and procedures, Therapeutic exercise (regime/therapy), Therapeutic exercise, NOS, Exercise therapy (procedure), Exercises (procedure), Therapeutic exercise (regime/therapy)(procedure), therapeutic exercises
Dutch inspanningstherapie, Bewegingstherapie, Therapie, bewegings-
Italian Terapia con esercizio fisico, Terapia dell'esercizio fisico
Portuguese Terapia de exercício, Terapia por Exercício
Spanish Terapia por ejercicio, ejercicio terapéutico (procedimiento), ejercicio terapéutico (régimen/tratamiento), ejercicio terapéutico, ejercicios (procedimiento), ejercicios (régimen/tratamiento), ejercicios, terapia de ejercicio (procedimiento), terapia de ejercicio (régimen/tratamiento), terapia de ejercicio, Terapia por Ejercicio
Swedish Motionsterapi
French Thérapie d'exercice physique, Traitement par les exercices physiques, Traitement par l'exercice physique, Traitement par l'exercice, Thérapie par les exercices physiques, Gymnastique médicale
Japanese ウンドウリョウホウ, 運動療法, 機能療法, 機能訓練
Czech terapie cvičením, tělocvik léčebný, Léčení pohybem
Finnish Liikuntaterapia
Russian KINEZOTERAPIIA, FIZICHESKAIA TRENIROVKA CHELOVEKA, LECHEBNAIA, FIZICHESKAIA KUL'TURA LECHEBNAIA, ФИЗИЧЕСКАЯ КУЛЬТУРА ЛЕЧЕБНАЯ, ФИЗИЧЕСКАЯ ТРЕНИРОВКА ЧЕЛОВЕКА, ЛЕЧЕБНАЯ, КИНЕЗОТЕРАПИЯ
Croatian KINEZITERAPIJA
Polish Terapia ruchem, Gimnastyka lecznicza, Kinezyterapia
Hungarian Gyógytorna
Norwegian Treningsterapi, Øvelsesterapi
German Bewegungstherapie

Ontology: Exercise on prescription (C0588464)

Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 151260006, 182982001, 310882002
English exercise prescription, exercise on prescription, exercises prescription, Exercise on prescription (procedure), Exercise on prescription, Exercise on prescription (regime/therapy)
Spanish ejercicio en la prescripción (régimen/tratamiento), ejercicio en la prescripción