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CARDIOLOGIST AND CARDIOVASCULAR SURGEON
PAIN MANAGEMENT PHYSICIAN
FOR THE PRIMARY CARE PHYSICIAN
FAMILY PRACTICE PHYSICIAN
Exercise improves functional fitness (flexibility, coordination, agility, strength and endurance, and cardiorespiratory endurance) and overall psychological well-being.
FOR THE ONCOLOGIST
Exercise and Conditions Related to Cancer and Cancer Treatment
Fatigue remains the most frequently reported symptom of individuals with cancer, and is experienced by the majority of individuals receiving treatment for cancer. Fatigue has been described as
being unable to concentrate
feelings of sleepiness, depression, and weakness
Cancer patient exercisers also reported a significantly improved quality of lifecompared to non-exercisers. The women who walked regularly adapted better to physical symptoms of chemotherapy, physical functioning, and psychosocial changes. They experienced consistent and progressive improvement during the course of chemotherapy, while the women who did not exercise got progressively weaker.
Women with breast cancer often gain as much as 5.5-13.6 pounds during adjuvant chemotherapy. Researchers have found that exercise can assist women with breast cancer in
maintaining body weight
reducing body fat mass while receiving adjuvant therapy
Disease and cancer treatment-related side effects such as decreased energy level, muscle weakness, and declines in functional status and body mass have been well documented. Additionally, there is evidence that regular physical activity or exercise can
decrease emotional stress
decrease blood pressure
decrease the duration of neutropenia and thrombocytopenia
increase quality of life and
improve the maximal oxygen uptake during exertion, sleep patterns, and cognition
Therefore, education concerning activity and exercise should be included as part of routine health care for cancer patients.
FOR THE CARDIOLOGIST AND CARDIOVASCULAR SURGEON
The cardiovascular and pulmonary systems respond to an acute bout of aerobic exercise by augmenting oxygen delivery to active skeletal muscle in an attempt to meet the energy requirements for a given level of physical stress. The capacity to increase oxygen delivery and utilization in response to aerobic exercise is dependent on several factors, including age, gender, fitness level, genetic variability, and disease status.
Benefits Associated With Chronic Aerobic Exercise
For individuals in the high-risk or cardiovascular disease populations, moderate aerobic activity of any type has numerous health- related benefits.
Physical activity and health guidelines state that, for healthy adults (18-65 years of age),
the minimum aerobic exercise training goal is 30 minutes of continuous activity at a moderate intensity (i.e., brisk walking or similar activity corresponding to an intensity of approximately 3-6 METs)
5 days per week or 20 minutes of continuous activity at a vigorous intensity (i.e., jogging or approximately >6 METs) 3 days per week.
Achievement of the 30-minute minimum duration goal may also be attained by accumulating bouts of aerobic exercise lasting at least 10 minutes throughout the day.
Duration and intensity goals are similar for older healthy adults (>65 years of age),although
the threshold distinguishing between moderate- and vigorous- intensity exercise is likely to be lower than 6 METs for most individuals older than 65
recommended duration goal for moderate-intensity exercise is also the same for patients diagnosed with cardiovascular disease and heart failure
significant health benefits have been observed in individuals transitioning from a sedentary lifestyle to some level of physical activity that does not reach minimal goals (i.e., 45-150 minutes of brisk walking per week)
Surpassing the minimal recommendations (i.e., 30-60 minutes of aerobic exercise on most if not all days of the week and/or increasing the time spent performing vigorous aerobic exercise) produces greater health-related benefits.
FOR THE GERIATRIC PHYSICIAN
Frail elders often have chronic illnesses,
peripheral vascular disease
Exercise is a proven means of achieving nonpharmacologic benefits, even at an advanced age. Exercise has been shown to enhance the quality of life for these elders.
The outcomes for studies of exercise in community-based frail elders include notably improved sleep derived from a modest aerobic exercise routine. Many exercise studies reporting effectiveness have centered on disease states. Osteoarthritis is a major morbidity factor for frail elders for which exercise is a specific therapeutic intervention. Exercise intervention trials for knee osteoarthritis have shown significant reductions in disability using resistance training that focused on increasing muscle strength and modest aerobic exercise that centered on motion. The positive effects of either exercise modality speaks to the positive effects that any form of exercise can have if sustained even for a relatively short time. Specifically, for underlying conditions such as osteoarthritis, increased mobilization of the affected joints, when done in a safe manner, has resulted in pain reduction and enhanced mobility.
The many physiologic advantages of
preventing cardiovascular disease
reducing insulin resistance
reducing blood pressure
in the general population can also benefit frail elders. Most medical conditions, however, are treated with pharmacotherapy for maximal improvement. Interventions directed toward improving functional capabilities, such as
increasing upper extremity range of motion (which enhances dressing and bathing)
would have a more direct impact on the daily well-being of frail elders.
Regular exercise has been shown to provide such psychological benefits as
preserving cognitive function
improving a sense of personal control and self-efficacy
Strength training has been shown to improve mood significantly and reduce symptoms of anxiety.
Physicians can effectively promote exercise as a therapeutic intervention for their frail elderly patients. It is essential that physicians enthusiastically discuss exercise on a regular basis. Exercise continues to be an underused therapeutic intervention. Theincreased vitality, strength, flexibility, balance, and general sense of well-beingthat can be achieved through this intervention will reward patient and physician alike.
FOR THE PAIN MANAGEMENT PHYSICIAN
Modest Exercise Helps Chronic Pain Patients
A frequent comorbid condition of chronic pain is profound physical deconditioning, which results from inactivity. Exercise produces significant immediate antidepressant and anxiolytic effects. The research suggests that relatively modest exercise leads to improved mood and physical capacity, which has further implications for mortality risk. Exercise is a safe, cost-free, nonpharmacologic strategy for immediately reducing depression and anxiety
FOR THE PRIMARY CARE PHYSICIAN, INTERNIST, FAMILY PRACTICE PHYSICIAN, GYNECOLOGIST
Mortality, longevity, and quality of life are the most critical issues facing America’s aging population. Aging is also usually associated with musculoskeletal degeneration. The degeneration of aging is associated with loss of muscle mass, decrease in proprioception, and strength. Proprioception is the ability to
the extrinsic and intrinsic forces affecting one’s body. The most significant forms of musculoskeletal degeneration include
Osteoporosis: The decrease in bone mass density leads to 1.5 million fractures annually. Only 20% of these patients ever return to normal functional status. The combination of exercise which can increase bone mass density and training which stresses prevention of falls are best.
Osteoarthritis: Research demonstrates that osteoarthritis leads to decrease in strength and proprioception. Patients with osteoarthritis exhibit increased inhibition of knee extensor musculature which is critical to ambulation. Patients with moderate inhibition after a four week training regimen which included proprioception demonstrated a decrease in inhibition and increase in muscle strength.
Low back pain: Patients with low back pain have a decrease in ability to balance on one foot which is crucial to efficient ambulation. These patients also have been shown to have ineffective coupling of pelvic musculature or core which leads to altered gait patterns. Strengthening of core musculature has been shown to increase strength and decrease low back pain.
Obesity: 50% of Americans are over weight. For patients not involved in exercise there is a
15% decrease in fat free mass after age 30
Loss of 5 pounds of muscle per decade and simultaneous addition of 15 pounds of fat
This sarcopenia leads to age related decrease in strength, energy levels and basal metabolic rate. Research has shown a correlation between the weight of an individual and functional gait capacity.
Osteoporosis, osteoarthritis, low back pain and obesity lead to a decrease in functional capacity. The most critical component of functional capacity is the ability to walk. Many patients who have restrictions on the ability to walk resort to assistive devices including wheel chairs and motorized scooter. This often accelerates degenerative processes leading to an increased risk of falling. Many of these degenerative processes can either be slowed or reversed with proprioceptive, strength, resistance, and cardiovascular exercise and training.
Camille Williams MD is a retired Emeritus Facial Plastic and Reconstructive Surgeon. She is board certified in Head and Neck Surgery. Dr Williams is a graduate of the University of California San Francisco Medical School. Before attending Medical School, Dr Camille Williams was a Nutritionist at St Luke’s Hospital and taught Home Economics at the college level. She is a certified personal trainer with the National Academy of Sports Medicine. Dr Camille Williams is currently the CEO of the Orinda Health and Fitness Center, a full service online health and fitness center with exercise training, diet advice, meal planning, grocery shopping assistance, and with access to an extensive health and fitness library. She also serves as a medical consultant to social security administration on disability. Camille Williams MD also has an MBA from St Mary’s College.
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