Cont ent s
Cont ent s
1.
Benefit s of physical act ivit y
Th bl
2.
The pr oblem
3.
How t o incr ease physical act ivit y?
3
o
t o
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t y
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T
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Physical Act ivit y ( PA)
“ Any bodily m ovem ent associat ed w it h
m uscular cont r act ion t hat incr eases
m uscular cont r act ion t hat incr eases
ener gy expendit ur e above r est ing levels”
Æ
Leisur e t im e PA
Æ
Leisur e- t im e PA
Æ
Occupat ional PA
Æ
PA at or near t he hom e
PA t d
it h
t
t
Æ
PA connect ed w it h t r anspor t
BENEFITS OF PHYSICAL ACTIVITY
BENEFITS OF PHYSICAL ACTIVITY
Management of the disease Management of the disease
Secondary Prevention
Secondary Prevention
Advantages of Physical Activity
Advantages of Physical Activity
Prevents Prevents and heals
¾ Diabetes Helmrich SP et al, NEJM 1991
¾ Colon cancer Thune I et al, NEJM 1997
¾ Breast cancer Thune I et al NEJM 1997
¾ Hypertension
¾ Coronary disease ¾ Stroke
¾ Breast cancer Thune I et al, NEJM 1997
¾ Osteoporosis Price RL et al, NEJM 1991
¾ Falls and fractures Brukner PD et al, MJA 2005
¾ Cognitive decay Brukner PD et al, MJA 2005
¾ Obesity
Brukner PD et al, MJA 2005
Loss of functional capacity with ageing
Loss of functional capacity with ageing
Muscle resistance
Muscle resistance 1
1--2%
2%
per annoper annoMuscle force
Muscle force
3
3--4%
4%
Muscle force
Muscle force
3
3--4%
4%
Aerobic capacity
Aerobic capacity
3
3--4%
4%
per annoper annoBone density male
Bone density male
1%1%Bone density female
Bone density female
2
2--3%
3%
Flexibility and balance
Flexibility and balance
Proprioception and coordination
Proprioception and coordination
Proprioception and coordination
Proprioception and coordination
Kinesthetic Perception
Kinesthetic Perception
I m p o em ent of q alit of life
I m pr ovem ent of qualit y of life
Physically Activey y
Physically Inactive
Physical
i
‘Minimum necessary to
exer cise
capacit y
perform activities of daily living
+
T
h
e
P
r
o
b
le
Physical activity
O
f th
t i
t
t h
One of the most important human
functions
Civilization reduces the need for
¾ H man force
¾ Human force
¾ Movement
Agriculture Buildingsg Transport
Physical activity
One of the most important human
One of the most important human
functions
Today
11
¾
In great measure eliminated
The Pr oblem
40 – 60 % of t he EU adult populat ion leads a sedent ar y
lifest yle
23 5 % is com plet ely sedent ar y
23.5 % is com plet ely sedent ar y
No Physical Activity No Physical Activity
Poor muscle tone
Poor muscle tone
Risk of fractures Risk of fractures
Obesity Obesity
Diabetes Diabetes
cooking
2.0 METs
sleeping
0.9 METs
Energy Cost
1 MET = 3.5 mL • kg-1 • min-1 V02
Slow walking on a flat surface
3.0 METs
Running quickly on a flat surface
Relationship PA and mortality
MET =
Energy cost
McAuley P et al. Am Hearth J McAuley P et al. Am Hearth J 2006
2006
McAuley P et al. Am Hearth J McAuley P et al. Am Hearth J 2006
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IN
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S
IN
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IVIT
Guidelines ( 1)
Wor ld Healt h Or ganisat ion
Th e obj e ct iv e
Goal is t o achieve a m inim um of 30 m inut es of
Goal is t o achieve a m inim um of 30 m inut es of
m oder at e- int ensit y physical act ivit y 5 days a
w eek or at least 20 m inut es of vigor
ous-h
l
d
k
int ensit y physical act ivit y 3 days a w eek
Guidelines ( 2)
Guidelines ( 2)
30 m inut es a day
Æ
pr event ion of chr onic
diseases
60 m inut es a day
Æ
w eight m anagem ent
How t o incr ease physical
t i it ?
act ivit y?
Co nselling m et hods
Counselling m et hods:
-
I ndividually or in gr oups
-
I n per son, by t elephone or via int er net
-
Br ief or int ensive
-
Br ief or int ensive
-
Physical act ivit y only or m ult iple behaviour
Pr oblem Solving Tr eat m ent
Goal set t ing:
S
pecific: incr ease physical act ivit y
M
easur able: 3 t im es a w eek for 30 m inut es, 2 w eekdays and
one w eekend day
one w eekend day
A
chieveable: w alking alone
R
elevant : w alking
R
elevant : w alking
T
im et able: in t he next w eek
Opt im al is not achieveable
Æ
Opt im um
Æ
Opt im um
3- 4 t im es a w eek, 30- 60 m inut es a day
High int ensit y
Æ
Not achieveable so:
“ Som et hing” is bet t er t han “ not hing”
Moder at e int ensit y for a long per iod is bet t er
y
g p
t han high int ensit y for shor t
Find som et hing you can achieve eg. Walking,
cycling
cycling
I ncor por at e PA int o your daily life, eg. Walk t o
t he shop inst ead of going by car
22
p
g
g
y
How t o incr ease physical act ivit y?
Type of PA: choose an act ivit y you enj oy
Æ
gr eat er effect
PA in daily life: use t he st air s inst ead of
t he lift
All t ypes of PA ar e effect ive: cycling,
w alking, t ennis, golf et c
Tr y t o keep a balance: 2- 3 t im es a w eek,
ever y w eek
Over all im pr ovem ent in healt h
Over all im pr ovem ent in healt h
I ncr ease physcal act ivit y
Decr ease diet ar y int ake
Decr ease diet ar y int ake
I nvolve fam ily and fr iends in your
b h
i
h
Æ
t h
h
t h
behaviour change
Æ
t hey have t o change
t oo
H OW TO CH AN GE PH YSI CAL
ACTI V I TY?
ACTI V I TY?
1 .
I n it ia l e v a lu a t ion of possible r isk s a n d
con t r o- in dica t ion s
( PAR- Q Qu e st ion n a ir e Apt it u de for
Ph y sica l Act v it y )
Ph y sica l Act v it y )
2 .
D e fin e a n im pr ov e m e n t pla n w it h
FACTORS TO TAKE I N TO
CON SI D ERATI ON
TYPES OF EX ERCI SE
CON SI D ERATI ON
Ca r diov a scu la r r e sist a n ce
St r e n gt h
Ba la n ce
Fle x ibilit y
FREQUEN CY AN D TI M E: se e r e com m e n da t ion s
W H O ( W or ld H e a lt h Or ga n isa t ion )
ACSM ( Am e r ica n Colle ge of Spor t s M e dicin e )
I N TEN SI TY: Bor g Sca le
M OD ERATE PH YSI CAL EX ERCI SE
Swimming
Cycling
Ping Pong
Rowing
Cycling
Race cycling
Rowing
Dancing
Gardening
Housework
M ORE I N TEN SE ACTI V I TY
Going upstairs, going for an
uphill walk or in the
Going
for
a
trip
to
the
mountains
uphill walk or in the
hills/mountains
Swimming lengths of a pool
mountains
Skiing
Going trekking in the
mountains
Tennis
Examples of resistance activities
Examples of resistance activities with moderate effort for the average elderly
Resistance activities with more intense effort.
person
Moderate:
• Swimming
Vigorous:
• Climb the stairs or a slope
• Going for a bike ride • Exercise bike
• Gardening (digging,raking) • Quick walking on a flat
f
• Shovel snow • Cycle up a hill • Tennis (singles) • Cross country skiing surface
• Sweep or wash the floor • Tennis (in doubles)
• Volleyball R
• Slope skiing • Running
STRENGTH AND
BALANCE
F
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FREQUEN CY AN D D URATI ON
OBJECTI V E
3 0 M I N UTES of m ode r a t e ph y sica l a ct iv it y
5 da y s pe r w e e k
2 0 M I N UTES of in t e n se ph y sica l a ct iv it y
3 da y s pe r w e e k
PROGRESSI ON
BORG SCALE
INTENSITY
Least effort
6
7 Very very easy
7 Very very easy
8
9 Very easy
10
Resistance11 Easy
12
13 More or less difficult
Resistance activity
14
15 Difficult
16
17 V
diffi
lt
Strength activity
17 Very difficult
18
19 Very very difficult
20
20
B
S
l
INTENSITY
E t l diffi lt 19
Most effor t 20
Borg Scale
GENERAL INSTRUCTIONS FOR USE OF THE SCALE (Rating of perceived exertion)
16
Ver y difficult 17
18
Ex t r em ely difficult 19
• While perfoming these exercises, we would like you to measure your percieved effort – how difficult the exrcise seems to you overall, not for any particular part of your body.
A lit t le difficult 13
14
Difficult 15
16 • While doing a physicla activity, look at the scale
which gos from 6 “no effort” to 20 “maximum
effort”.
• Choose the number which best describes the intensity level of your effort. This will give you a
d id f th i t it f ff t th t
10
Light 11
12 good idea of the intensity of effort that you are
carrying out, and you can use this scale to raise or lower the intensity of exercise so as to gain the required intensity.
• Try to evalutae your level of effort as honestly as possible without thinking about the physical
Ver y lit t le effor t 7
8
Lit t le effor t 9
possible without thinking about the physical effort – it is your feeling of effort that counts, not how you compare to others.
• Look at the scale and the numbers which
correspond to the levels of inensity, then choose a number.
No effor t 6
Go t o your doct or if...
Go t o your doct or if...
You have chest pain
You feel dizzy
p
Excessive breathlessness
Irregular heartbeat
I N TEN SI TY
According to the levels of physical activity, we can divide people into three groups. A different intensity level is recommended for each group.
Sedentary (at the moment does not do physical activity)
Sedentary (at the moment does not do physical activity)
from 7 to 9 on the Borg Scale
Partially Active (some physical activity but not that recommended by thePartially Active (some physical activity but not that recommended by the
WHO/ASCM)
from 10 to 13 on the Borg Scale
Active (follow WHO/ASCM recommendations)
from 13 on the Borg Scale
Borg
Borg
Scale
d
d
advanced
partially active
intermediate
sedentary
b
i
(Example of Sedentary Profile)
BEGI N N ER
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
R i t R i t R i t Resistance
20 min. Walk From 7 to 9
Borg
Resistance
20 min. Walk
From 7 to 9 Borg
Resistance
20 min. Walk From 7 to 9
(Example of Partially Active Profile)
I N TERM ED I ATE
Sunday Monday Tuesday Wednesday Thusday Friday Saturday
Resistance Resistance Resistance
30 min. Cycle 10 to13 Borg
30 min. Swim 10 to13 Borg
30 min. Cycle 10 to13 Borg
Strength/ Balance
15 min.
Strength/ Balance
15 min.
(Example of Active Profile)
AD V AN CED
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
R i t R i t R i t R i t R i t Resistance 30 min Resistance 30 min Resistance 30 min Resistance 30 min Resistance 30 min
St th/ St th/ Stength/
Balance
From 15 – 20 min
Stength/ Balance
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Pr act ical Par t ( 1)
Pr act ical Par t ( 1)
Act iv it y in m u lt idisciplin a r y gr ou ps:
Gr oups of appr ox 10 people Gr oups of appr ox . 10 people Thr ee sessions of 10 m inut es
One gr oup leader for each gr oup ( a doct or , nur se, phar m acist or ot her exper t )
ot her exper t )
I n gr oups, t he par t icipant s discuss a ca se fr om r e a l life .
An exam ple is pr ovided for every gr oup ( beginner , int er m ediat e, p p y g p ( g , ,
advanced) . They ar e asked t o decide w het her t he subj ect of t he
case st udy is a beginner , int er m ediat e or advanced level. Dist inguishing any r isk fact or s t hey m ust t hen pr epar e an Dist inguishing any r isk fact or s t hey m ust t hen pr epar e an
w e e k ly pr ogr a m m e a da pt e d t o t heir needs, w it h obj ect ives,
st ages exer cised t o do and so on.
See Handbook for addit ional det ails and solut ions for Cases A, B See Handbook for addit ional det ails and solut ions for Cases A, B
Case- st udy
Case st udy
C
St d
A A
f 65 Sh i i
d h
lt h
d
Ca se St u dy A: A w om an of 65. She is in good healt h and
t akes no m edicine. She played volleyball r egular ly unt il t he
age of 25 and t hen gr adually r educed her exer cise. For t he
last 20 year s she has har dly exer cised Her m ot ivat ion t o
last 20 year s she has har dly exer cised. Her m ot ivat ion t o
st ar t exer cising again is t hat she has not iced a gr adual
w eight gain over t he last five year s.
Ca se St u dy B: A m an aged 72. Slight ly high blood pr essur e
w hich is t r eat ed w it h m edicines. He has alw ays played
spor t and t r ained for it and has exer cised ir r egular ly for t he
last 20 year s. He has decided t o t ake up a r egular
Case St udy
Case St udy
Ca se St u dy C: A m an aged 66. He is in good healt h and
t akes only or al hypoglycem ic agent for a light . He has
alw ays played com pet it ive spor t in t he past and st ill t r ains
y
p
y
p
p
p
r egular ly, going t o t he sw im m ing pool ( t w ice a w eek) and t o
t he gym ( t w ice a w eek) . He is m ot ivat ed t o follow a
per sonalised exer cise pr ogr am m e t o im pr ove t he r esult s
b
d
S
f l
Successful
Ageing
A physically and mentally active life
A physically and mentally active life
