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Chapter 6 Physical Fitness Flashcards | Quizlet

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Benefits of Exercise

Exercise training results in decreased myocardial oxygen demands for the same level of external work performed, as demonstrated by a decrease in the product of heart rate × systolic arterial blood pressure (an index of myocardial oxygen demand). These changes are also beneficial in persons with coronary artery disease, who after exercise training may attain a higher level of physical work before reaching the level of myocardial oxygen requirement that results in myocardial ischemia.³⁴

Many activities of daily living require more arm work than leg work. Therefore, persons with coronary artery disease are advised to use their arms as well as their legs in exercise training. The arms respond like the legs to exercise training both quantitatively and qualitatively, although ventilatory oxygen uptake is less with arm ergometry. Although peak heart rates are similar with arm and leg exercise, heart rate and blood pressure response during arm exercise is higher than leg exercise at any submaximal work rate. Therefore, target heart rates are designated 10 beats per minute lower for arm training than for leg training.⁵⁷ ⁵⁸ ⁵⁹ Dynamic arm ergometry is usually well tolerated by persons with coronary artery disease; however, there may be an increase in blood pressure that may be of concern in certain persons.

Maximum ventilatory oxygen uptake drops 5% to 15% per decade between the ages of 20 and 80,⁶⁰ ⁶¹ ⁶² and a lifetime of dynamic exercise maintains an individual's ventilatory oxygen uptake at a level higher than that expected for any given age. The rate of decline in oxygen uptake is directly related to maintenance of physical activity level, emphasizing the importance of physical activity.⁶³

Middle-aged men and women who work in physically demanding jobs or perform moderate to strenuous recreational activities have fewer manifestations of coronary artery disease than their less active peers.¹¹ ¹² Meta-analysis studies of clinical trials reveal that medically prescribed and supervised exercise can reduce mortality rates of persons with coronary artery disease.¹⁸ ¹⁹ ⁶⁴

In addition to the physical benefits of exercise, both short-term exercise and long-term aerobic exercise training are associated with improvements in various indexes of psychological functioning. Cross-sectional studies reveal that, compared with sedentary individuals, active persons are more likely to be better adjusted,⁶⁵ to perform better on tests of cognitive functioning,⁶⁶ to exhibit reduced cardiovascular responses to stress,⁶⁷ and to report fewer symptoms of anxiety and depression.⁶⁸ In one report ⁶⁹ persons who increased their activity levels between 1965 and 1974 were at no greater risk for depression than those individuals who were active all along; however, persons who were active and became inactive were 1.5 times as likely to become depressed by 1983 compared with those who maintained an active lifestyle.

Despite the positive physical and mental health benefits of exercise, long-term adherence to exercise programs remains problematic. It is estimated that only 50% of all persons who initiate an exercise program will continue the habit for more than 6 months.⁷⁸ The issue of nonadherence is particularly important because exercise is only beneficial if it is maintained for extended periods of time. Thus, it is important to develop strategies to improve exercise initiation and adherence, especially for persons who are among the least active-some African-American women, the less educated, the obese, and the elderly.⁷⁹

Implementation of Exercise Programs

Persons of all ages should include physical activity in a comprehensive program of health promotion and disease prevention and should increase their habitual physical activity to a level appropriate to their capacities, needs, and interest.

Physical activity may have risks as well as benefits, although risks are relatively infrequent. Estimates of sudden cardiac death rates per 100 000 hours of exercise range from 0 to 2 per 100 000 in general populations and from 0.13 per 100 000 to 0.61 per 100 000 in cardiac rehabilitation programs.⁸⁵ ⁸⁶ ⁸⁷ Studies have also demonstrated the cardiovascular safety of maximum strength testing and training in healthy adults and low-risk cardiac patients.⁸⁸ Falls and joint injuries are additional risks associated with physical activity (especially in older women), but most of these injuries do not require medical treatment. The incidence of such complications is less in those participating in low-impact activities such as walking.⁸⁹ ⁹⁰

Additional Research and Future Issues

There is a large body of knowledge on exercise, but data on exercise and its effects on the cardiovascular system and long-term survival are still limited. The responsibility for conducting research lies with government, private health agencies, the insurance industry, employers, universities, and medical schools.

Basic knowledge of the anatomic, biochemical, and physiological changes that result from various patterns of physical activity (short and long term, sustained and intermittent, isotonic and isometric, low and high intensity) in persons of different ages is needed, as is a determination of whether a certain minimum-intensity threshold of physical activity is required for benefit. The biomedical and economic impact of participation in exercise programs on coronary artery disease, cerebrovascular and peripheral vascular disease, heart failure, and hypertension should also be evaluated. The psychosocial functioning of persons with coronary artery disease and the potential value of exercise in enhancing the quality of life of cardiac and other patients warrants further study. Future studies should include adequate numbers of women, ethnic groups, and the elderly to better meet research objectives.

Furthermore, the presence and extent of coronary risk factors in the disabled and disadvantaged and in minority groups must be better identified and defined. Consequently, the effect of modifications such as increases in physical activity on members of these groups should be explored, and large studies should also include a significant number of these persons.

Research should be continued to establish the cost-effectiveness of physical activity programs for the enhancement of cardiovascular health,¹⁰⁷ with a focus on the type of promotional strategies required for initiating and maintaining physical activity (eg, insurance incentives, health personnel, public policy, and media materials) as well as the social context of such activity (eg, industry and business, rural and urban settings, schools, churches, and families). Research should also involve issues such as how physical activity can prevent (or decrease the duration of) hospitalization of patients with cardiovascular disease.

Societal, cultural, ethnic, and personal factors that affect development or maintenance of lifelong patterns of physical activity should be identified and incorporated into strategies of exercise promotion.

Research on better and more effective physical activity interventions that improve long-term compliance to a physically active lifestyle is urgently needed. Innovative, nontraditional methods of increasing physical activity in the population must be developed, implemented, and evaluated.

In summary, future developments and study should focus not only on the benefits of physical activity but also the methods used to facilitate dissemination of present and future knowledge to all members of society.

Footnotes

Requests for reprints should be sent to the Office of Scientific Affairs, American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231-4596. (Circulation. 1996;94:857-862.)

"Statement on Exercise: Benefits and Recommendations for Physical Activity Programs for All Americans" was approved by the American Heart Association Science Advisory and Coordinating Committee on June 20, 1996.

View Abstract

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Statement on Exercise: Benefits and Recommendations for Physical Activity Programs for All Americans

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Physical inactivity is recognized as a risk factor for coronary artery disease. Regular aerobic physical activity increases exercise capacity and plays a role in both primary and secondary prevention of cardiovascular disease.1 2 3 4 5 The known benefits of regular aerobic exercise and current recommendations for implementation of exercise programs are described in this revised report.6 Exercise training increases cardiovascular functional capacity and decreases myocardial oxygen demand at any level of physical activity in apparently healthy persons as well as in most subjects with cardiovascular disease.

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Chase D'Antonio prepares to return to his first-grade classroom at Sewickley Academy after an energetic gym class, where he and his peers threw and chased colorful balls in a game called Island Ball.

How does he feel after all that exercise?

"Good," says Chase, a 6-year-old Sewickley resident, with a thumbs up. "I feel really good. I love school."

Exercise - whether from gym class, recess games or out-of-school exercise - not only makes kids feel good and improves their health, but that activity boosts their brainpower and school performance, research suggests.

A study recently published in the journal Frontiers in Human Neuroscience suggests that kids who are more physically active and fit perform better academically in school. Laura Chaddock-Heyman - a research associate and post-doctoral research scientist at the University of Illinois Beckman Institute for Advanced Science and Technology, in Urbana - and some colleagues hypothesized that highly physically fit children would show greater brain white-matter microstructure than their less-fit peers. Researchers used a technique called diffusion tensor imagine to measure the structure of the white matter and see how structurally sound they are.

The results fit the theory, she says.

"Aerobic fitness has been found to play a positive role in brain and cognitive health of children," Chaddock-Heyman says.

The differences in brain health often come with performance differences, such as cognitive control and memory, and test scores, she says.

Dr. Dana Rofey, a psychologist and researcher in pediatric obesity and assistant professor at the University of Pittsburgh School of Medicine, has collaborated with other professionals in doing similar research about the effects of fitness in children, and she sees the same correlation between physical fitness and brain benefits. The reasons may be both physiological and psychological: Perhaps children who are physically active also show greater discipline in academics, she says.

"For years and decades, we've known that physical activity can help our weight and help our heart," Rofey says. "Now, it's moving upward, and physical activity can help our brain."

Rofey has noticed how her daughter - Ella, 5 - seems sharper when she's active, and does dance and soccer.

But parents shouldn't view this issue too simplistically, Rofey says. Physical fitness or the lack of it can't be credited or blamed for all academic successes and challenges. A fit child may be struggling in school because of a learning disability or other reasons, she says.

"We can't make any blanket statements that if you're physically active, it will fix anything going on academically," she says. "Certainly, you want to rule out other things."

Cheryl Ann Lassen - the health-and-physical-education chairwoman for Sewickley Academy, a pre-K-12 prep school in Sewickley - says kids may initially be more hyper after gym class or recess, but when they settle down, they show better attention, concentration and the ability to retain things.

"We feel it's very important here," she says about fitness.

It's not just kids who benefit mentally from exercise. Adults, too, can boost concentration when, say, they take a break at work for a walk.

"It does carry over into every aspect of your life," Lassen says about exercise benefits. "It really is for everyone."

Jeff Kapusta, a physical-education teacher for Metzgar and Nicely elementary schools in the Greensburg-Salem School District, agrees that movement helps kids all around.

"Even in the summertime, if kids are more active, I think their brains are working more. They're thinking more," he says. "I'm a big fan of getting the kids out" to do active play and exercise.

"I definitely think that any activity that the kids do - whether physical education, or recess, in general - is going to have a great effect on how they do in the classroom," Kapusta says.

Rofey suggests that parents set a good fitness example for their kids by doing regular exercise. And people shouldn't discount small workouts: Even a quick walk helps.

"From a parental standpoint, I always say some movement is better than no movement at all," Rofey says.

Kellie B. Gormly is a staff writer for Trib Total Media. She can be reached at kgormly@tribweb.com or 412-320-7824.

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Research validates theory physical activity can mean improved brain power

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Chase D'Antonio prepares to return to his first-grade classroom at Sewickley Academy after an energetic gym class, where he and his peers threw and chased colorful balls in a game called Island Ball. How does he feel after all that exercise? "Good," says Chase, a 6-year-old Sewickley resident, with a thumbs up.