Assessment and Plan: Aerobic Exercise for Disease Prevention and Treatment
- Individuals of all ages capable of aerobic exercise should do so most days of the week for the following benefits: Heart and lung conditioning, improved pumping efficiency of the heart, improved circulatory system (2), reduce incidence of cancers (3,4), weight control and obesity (5), cholesterol reduction (5,6), triglyceride lowering (5), lowering of blood pressure (7), lower rate of smoking (8), improvement of bone mass (13), control of diabetes (15,16), enhanced cognitive performance (17,18,19), reduction of cancer mortality (3), lower cardiac mortality (8), and reduced all-cause mortality (8). Patients also report less depression, improved sleep and better quality of life with aerobic exercise.
- Starting exercise in apparently healthy adults: According to the American College of Sports Medicine (ACSM) and the American Heart Association (AHA), older adults need moderate-intensity (between 5-6 on a 10-point scale) aerobic endurance activity for a minimum of 30 min which can be achieved in short 10 minute sessions on five days each week or vigorous-intensity aerobic, (rated a 7-8 on a 10-point scale) activity for a minimum of 20 min on 3 days each week.
- Exercise cardiac stress testing should be conducted prior to exercising in individuals who have suspected or known coronary artery disease, typical and atypical angina or have had prior heart attack. In healthy people, without symptoms, those with multiple heart risk factors (high cholesterol, high blood pressure, family history, obese, diabetes mellitus) or concurrent chronic diseases or those in a high-risk occupation for example pilots, firefighters, law enforcement officers, and transit operators should undergo exercise stress testing. Stress testing is also recommend for men over age 40 and women over age 50 who have been inactive but plan to start vigorous exercise. Evaluation of exercise capacity in patients with heart disease involving one or more of the valves of the heart (patient\’s whose heart valve does not open fully), those with heart rhythm disorders, and those with pacemakers is also necessary. (27)
- Formal clinical cardiopulmonary exercise testing using a treadmill or cycle ergometer and the more basic 6 minute walk test to determine baseline exercise capacity before and after medications, surgery, and pulmonary or cardiac rehab programs.
- Consider a pulmonary or cardiac rehab program for related diseases with functional impairment due to these diseases.
- Medications influences exercise in a number of ways and patients should be counseled regarding these effects.
References:
1.Walter R. Thompson, American College of Sports Medicine, Neil F. Gordon, Linda S. Pescatello. ACSM\’s Guidelines for Exercise Testing and Prescription. Lippincott Williams & Wilkins, Feb 1, 2009.