Chronic Disease Management
and Exercise
MISS VICTORIA HYLAND & MR DAVID WEBB
COLEG LLANDRILLO CYMRU
Overview and Aims
 Outline common Illnesses & Chronic Disease
 Management of Illnesses & Chronic Disease through the
prescription and life style changes
 Pros and cons of Exercise prescription for these illnesses
and health conditions
 To be able to manipulate exercise to fit in with specific
populations and life styles
 Exercise Myths
Determinants of Health
 Living and working conditions and access to facilities
and services
 Support and influence within communities which
can sustain or damage health
 Economic, cultural and environmental conditions
such as standards of living
 Personal behaviour and lifestyle
Lifestyle Factors
 Lifestyle factors are responsible for most of the
illness and deaths
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Smoking
Stress
Alcohol
Improper diet
Overeating
Lack of exercise
Obesity
What is obesity?
 Excessive development of body fat. (Bailliere’s 2002)
 BMI – Body Mass Index
BMI – Weight (Kg)
Height 2 (m2)
 Densitometry - Provides measurements of body density
-body pod
-Hydrostatic weighing
 Duel energy x-ray absorptiometry
-DXA scan
 Bioelectrical impedance
 Skin fold measurements
Obesity & Physical activity facts
 Average person gains 1lb (0.45kg) of fat/year after age 25 and loses 0.5
kg lean body weight/year resulting in a net gain of 0.7kg (1.5lb) of fat
per year
 Inactivity is a major cause of obesity, probably more important than
overeating
 Physical activity increases energy expenditure during the activity and
for some time after when the metabolic rate remains high
 Physical activity can cause a loss in fat weight/maintenance or a gain in
fat free mass
ACSM (2010)
Weight Loss / Fat Reduction
 To lose weight you have to create a calorie deficit.
You can do this by decreasing your calorie intake
and increasing your exercise work output.
Coronary Artery Disease (CAD)
CAD
Coronary arteries are the
vessels that supply oxygen rich
blood to the heart.
Plaque builds up in these
arteries and cause restricted
blood flow to the heart.
This build up can cause plaque
reduces the oxygen to the
working heart muscle
•Angina
•Increased BP
•Arrhythmias
•Myocardial Infraction (MI)
•Heart Failure
Reduce Risk of CAD. How?
 Reduced blood pressure (Duncan et al, 1985,
ACSM 2010 )
 Increases HDL (Goldberg & Elliot; 1987, ACSM
2010)
 Decreases LDL (Sady et al 1986; Work; 1987,
ACSM 2010 )
 Reduces obesity ( Bray; 1986, ACSM 2010)
WHAT ARE THE BENEFITS OF EXERCISE?
 Regular aerobic exercise protects against CAD;
possibly with increasing benefits as the amount of
exercise increases (ACSM 2010)
 Even after an MI regular exercise reduces the risk of
a subsequent MI by 25% (Dargie & Grant; 1991)
 Decreased risk of diabetic complications (Boule et al;
2001)
GP referral to exercise!
DIABETES
DIABETES
WHAT IS DIABETES?
 Insulin Dependant Diabetes Mellitus (IDDM) or
Type I Diabetes
 Non-Insulin Dependant Diabetes Mellitus (NIDDM)
or Type II Diabetes
IDDM
 Characterised by a lack or absence of endogenous insulin
production
 Regular subcutaneous injections of insulin are required to prevent
hyperglycaemia
Fact:
Prior to the discovery of insulin Type I patients usually died within 2
years, from ketoacidosis. (high blood glucose; often caused by
illness or taking too little insulin, ketones accumulate in the blood
ACSM(2010)
NIDDM
 Impairment of the pancreatic beta cells to secrete
insulin in response to elevated plasma glucose
concentrations
 A reduced sensitivity to insulin in target organs (such
as muscle, liver and adipose tissue)
 Often goes undiagnosed!
PHYSIOLOGICAL IMPLICATIONS
 HYPERGLYCAEMIA - elevated concentration of
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glucose in the blood
CAN BE CONTROLLED WITH EXERCISE
Occurs if the liver releases glycogen (glucose) into the
blood stream without the presence of insulin
HYPOGLYCAEMIA - Low blood sugar levels, often
causing confusion, light headedness and irritability
CAN BE MADE WORSE BY EXERCISE
Occurs if the individual has used too much insulin or not
consumed enough CHO
RISKS ASSOCIATED WITH EXERCISE
 Hypoglycaemia
 Cardiac implications
 Retinal bleeding
 Protein excreted in the urine
 Changes to BP
 Increased risk of foot ulcers
 Possible problems with thermo-regulation
 GP referral to exercise!
BENEFITS OF EXERCISE
 Increase insulin sensitivity
 Decreased triglyceride
 Improved functional
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capacity
Enhanced sense of wellbeing
Reduced risk of CAD
Reduced risk of MI
Decreased ‘stickiness’ of
blood platelets
Reduced risk of High BP
Can reduce high BP
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levels
Increased HDL levels
Decreased LDL levels
Improved HDL / LDL ratio
Decreased Body Fat
Decreased risk of
Osteoporosis
Decreased risk of Diabetic
associated complications
Older Population
What do you think is meant by the term “older adult” ?
ACMS (2010)
The term “Older Adult” is defined as a person >65
years and people 50-64 years with clinically
significant conditions or physical limitations that
affect movement, physical fitness, or physical
activity.
Benefits of physical activity
 Slow physiologic changes of ageing that impair
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exercise capacity
Optimizing age related changes in body composition
Promoting psychological & cognitive well-being
Managing chronic diseases
Reducing the risk of physical disability
Increasing longevity
(ACSM 2010)
However…………………
 Older adults are the least physically active of all age
groups.
 Exception……..
 http://www.youtube.com/watch?v=iUvjXQHt6QQ&
feature=fvw
Exercise Recommendations
WHAT ARE THE BENEFITS OF EXERCISE?
 Reduce the risk of Health Complications
 Reduces risk of osteoporosis
 Reduced Body Fat
 Increase cross sectional muscle
 Decreases risk of injury
 Improves confidence and self esteem
 Improves body image
ACSM (2010)
Exercise Prescription
 Recommended by the ACSM (2010):
 Frequency: at least 3-4 days a week / preferably daily.
 Intensity: Moderate (physical activity that noticeably increase
breathing, sweating, and HR) to vigorous (physical activity that
substantially increase breathing sweating, and HR) intensity.
 Time: 30 minutes a day of moderate exercise build to an hour.
 Type: A variety of actives that are enjoyable and developmentally
appropriate for the INDIVIDEAL.
Strength
 Recommended by the ACSM (2010):
 Frequency = at least 2 days a week
 Intensity = Moderate and vigorous
 Type = Progressive weight training - Major Muscles
groups
Flexibility
Recommended by the
ACSM (2010):
 Min 2 days a weeks
 Intensity = 5-6 intensity scale
 Type: Any activities
that maintains or
increases flexibility
 Major muscle groups
 Hold for minimum 15-30 sec
SMART Goals Applied to Exercise
 S - specific, significant, stretching
 M - measurable, meaningful, motivational
 A - attainable, agreed upon, achievable, acceptable,
action-oriented
 R - realistic, relevant, reasonable, rewarding,
results-oriented
 T - time-based, timely, tangible, trackable
What exercise do you do in a day?
 In small group discuss your daily activities.
 Make a list of activities.
 Make a note of these activities duration.
 Do they fit in with the recommendations?
Exercise Myths
 Performing exercise for a specific area in an attempt
reduce body fat in that area alone.
 But does this work? What do you think?
 Resistance training is any type of exercise using
additional resistance
 The main aim is to improve muscle strength and
endurance, usually by weight training
 Will it make females look masculine?
FACTS on RT
 Resistance training increases Basal Metabolic rate
(Mc Cartney 1993)
 Alexander (2002) RT/circuits – improve body
composition and weight loss. Also has a higher
energy expenditure post exercise then walking and
jogging.
Summary
 Life style factors contribute to illness and chronic disease.
 Manipulation of life style can help to maintain a health life
style and prevent/manage illness and chronic disease.
 Exercise provides benefits to reduce and prevention of
illness and chronic disease.
 Make exercise enjoyable and specific i.e. SMART Goal
setting
Be happy!
 Video Clip
 Be Happy with What You
Have.WMV
Any Questions