Aerobic Exercise

From Anvita Health Wiki

Contents 1 Introduction 2 More General Terms 3 Additional Terms 4 References

Introduction

• Benefits:
• cardiovascular

• myocardium

• increased stroke volume & cardiac output
• decreased myocardial oxygen demand at rest
• increased tolerance for a given workload
• maximum heart rate is unresponsive
• age-related early diastolic dysfunction is unresponsive

• peripheral vasculature

• increased capillary blood flow
• decreased peripheral vascular resistance
• decreased resting blood pressure
• slower progression of atherosclerosis

• benefit may not be apparent in patients on statin
• see DNASCO study

• increased telomerase activity in endothelial cells; a presumptive benefit [5]

• oxygen-carrying capacity

• increased blood volume & hemoglobin
• enhanced muscular uptake of oxygen

• musculoskeletal

• muscle/ tendon

• increased blood flow to muscle
• increased muscle strength
• increased tolerance for a given workload

• bones & joints

• increased bone mass with weight-bearing exercise
• increased blood flow to synovium

• metabolic & endocrine

• glucose metabolism

• increased muscle utilization of glucose (non insulin- dependent transport)
• decreased blood glucose levels

• lipid metabolism

• increased utilization of triglycerides
• increased levels of HDL cholesterol
• decreased levels of total cholesterol
• improved overall lipid profile

• obstetric & gynecologic

• labor & delivery

• improved tolerance of labor
• shortened 1st & 2nd stages of labor

• attenuation of dysmenorrhea

• neurologic

• increases size of hippocampus
• improves memory in elderly [6]

• more vigorous activity associated with lower risk [3]
• Risks:
• cardiovascular

• patients with ischemic heart disease

• angina
• ischemia
• arrhythmia
• long-term endurance exercise increases risk of atrial fibrillation (2-10 fold) [4]

• patients with structural heart disease

• hypertrophic cardiomyopathy

• sudden death due to arrhythmia

• aortic dissection - Marfan's syndrome

• musculoskeletal

• muscle soreness
• traumatic injury

• strains
• contusions

• overuse injuries

• metabolic & endocrine

• increased autonomic activity with exercise in patients with diabetes & thyroid disease

• obstetric

• decreased exercise tolerance near term of pregnancy
• decreased uterine blood flow during exercise
• thermal stress on fetal development
• uterine contraction after exercise may increase risk of premature labor
• risk to fetus with high-intensity exercise

• gynecologic - amenorrhea

• occurs only with combination of intense exercise & weight loss (< 10% body fat)
• may increase risk of osteoporosis & stress fractures

• psychologic

• obsessive-compulsive disorder
• anorexia equivalent

• Modified programs for particular health conditions:
• cardiovascular disease

• stable angina

• exercise 5-10 beats/min below ischemic threshold
• use nitroglycerin
• supervised exercise program

• hypertension

• avoid isometric exercise
• low resistance exercise

• valvular disease

• mild to moderate exercise after valve repair
• anticoagulants
• no contact sports

• peripheral vascular disease

• claudication may limit exercise
• walk until onset of pain, rest, resume
• exercise increases functional capacity

• cardiac medications

• beta blockers blunt heart rate
• diuretics my increase risk of dehydration
• loop diuretics may increase risk of hypokalemia & muscle cramps

• pulmonary disease

• COPD: exercise improves functional capacity
• exercise-induced asthma

• worse in cold weather
• worse in dry air
• pre-exercise cromolyn or beta-adrenergic agonist inhaler (Albuterol MDI) may be indicated

• musculoskeletal disability

• arthritis

• swimming & exercise may be preferred
• stretching & range of motion exercises

• spinal cord injury

• wheel chair sports
• arm exercises have higher oxygen consumption & lower muscular efficiency than leg exercises

• metabolic & endocrine disorders

• diabetes

• type I: adjust insulin, exercise to avoid hypoglycemia
• type II

• proper foot care
• no ballistic exercises with retinopathy

• obesity: start with lower intensity to minimize musculo- skeletal injury

• pregnancy

• avoid exercise in patients with:

• vaginal bleeding
• history of premature delivery
• incompetent cervix

• avoid exercise in supine position after 20th week of pregnancy
• avoid core temperature > 102 F (39 C)

More General Terms

• exercise

Additional Terms

• age-related physiological changes
• exercise prescribing (counseling)
• exercise tolerance testing (ETT)
• physical conditioning (training)

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 224-26
2. Journal Watch 22(17):137, 2002 US Preventive Services Task Force, Ann Intern Med 137:205, 2002 Eden KB et al, Ann Intern Med 137:208, 2002
3. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
4. Mont L et al Endurance sport practice as a risk factor for atrial fibrillation and atrial flutter Europace 2009 11(1):11-17 PMID: &dopt=Abstract doi:10.1093/europace/eun289
5. Werner C et al Physical exercise prevents cellular senescence in circulating leukocytes and in the vessel wall. Circulation 2009 Dec 15; 120:2438 <PubMed> PMID: [1] <Internet> [2]
6. Erickson KI et al. Exercise training increases size of hippocampus and improves memory. Proc Natl Acad Sci U S A 2011 Feb 15; 108:3017. PMID: [3]
7. Physical Activity and Cardiovascular Health: Consensus Statement [4]

aerobic exercise (endurance exercise)