March 4,

2015
FEU-NRMF

PHYSICAL ACTIVITY
LECTURED BY: BARBARA AMITY N. FLORES, MD, DFM, FPSHPM

COMMON RISK FACTORS FOR MAJOR

NON-COMMUNICABLE DISEASES
Unhealthy diet
Physical inactivity
Tobacco use
-WHO
Non-Communicable Diseases
Cardiovascular diseases (CVDs)
Diabetes
Obesity
Cancer
Chronic Obstructive Pulmonary Disease
(COPD)
Death from NCDs
60% of 58 million deaths annually
80% of deaths occur in low and middle
income countries
o 23% WHO African Region
o 78% Americas
o 52% Eastern Mediterranean
o 86% European Region
o 54% Southeast Asian Region
o 78% Western Pacific Region
-WHO, 2008
PHYSICAL INACTIVITY
(lack of physical activity)
4th leading risk factor for global mortality
Estimated to be the main cause for
approximately
o 21-25% of breast and colon cancers
o 27% of diabetes and
o ~30% of ischemic heart disease
burden

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Figure 1. Prevalance of insufficient physical

activity
PHYSICAL ACTIVITY AND HEALTH
(+) Protective effects between
physical activity and risk for several
chronic diseases
Low levels of habitual physical
activity and low levels of physical
fitness are associated with markedly
increased all-cause mortality rates.
HEALTH BURDENS THAT COULD BE
REDUCED THROUGH PHYSICAL
ACTIVITY
13.5 million people have coronary
heart disease
1.5 million people suffer from a heart
attack in a given year
8 million people have adult-onset
diabetes
95, 000 people are newly diagnosed
with colon cancer each year
250, 000 people suffer from a hip
fractures each year
50 million people have high blood
pressure
Over 60 million people are
overweight

Physicians, their Patients & Exercise

47% of primary care physicians
include an exercise history as part of
their initial examination
Only 13% of patients report
physicians giving advice about
exercise
Physically active physicians are
more likely to discuss exercise with
their patients
DETERMINANTS OF PARTICIPATION IN
PHYSICAL ACTIVITY
Lack of time is the most commonly cited
barrier to participation in physical
activity
Injury is a common reason for stopping
regular activity
Smokers are more likely than non-smokers
to drop out of exercise programs
DETERMINANTS OF PARTICIPATION IN
PHYSICAL ACTIVITY
Body composition (percentage of body fat)
is not a powerful predictor of physical
activity habits;
o However, persons who are obese
are usually inactive.
Strongly related:
o Confidence in the ability to be
physically active
o Perceived barriers to activity
o Enjoyment of activity
Weakly related:
o Intention to exercise
o Awareness of the benefits of
exercise
Family and friends
o Role models
o Provide encouragement
o Companions during physical activity

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BARRIERS:
o Environment/ Urbanization
Fear of violence and crime in
outdoor areas
High-density traffic
Low air quality, pollution
Lack of parks, sidewalks and
sports/recreation facilities
o Technology-reduces the energy
needed for activities of daily living
Excessive television viewing/
social media/ gadgets

PHYSICAL ACTIVITY
o any bodily movement produced by
skeletal muscles that requires
energy expenditure
o includes activities undertaken while
working, playing, carrying out
household chores, traveling, and
engaging in recreational pursuits.
-WHO
Health Benefits Associated With Regular
Physical Activity
Children and Adolescents
o Strong evidence
Improved cardiorespiratory
and muscular fitness
Improved bone health
Improved cardiovascular and
metabolic health biomarkers
Favorable body composition
o Moderate evidence
Reduced symptoms of
depression
Adults and Older Adults
o Strong evidence
Lower risk of early death
Lower risk of coronary heart
disease
Lower risk of stroke
Lower risk of high blood
pressure

Lower risk of adverse blood

lipid profile
Lower risk of type 2 diabetes
Lower risk of metabolic
syndrome
Lower risk of colon cancer
Lower risk of breast cancer
Prevention of weight gain
Weight loss, particularly
when combined with reduced
calorie intake
Improved cardiorespiratory
and muscular fitness
Prevention of falls
Reduced depression
Better cognitive function (for
older adults)
Moderate to Strong evidence
Better functional health (for
older adults)
Reduced abdominal obesity
Moderate evidence
Lower risk of hip fracture
Lower risk of lung cancer
Lower risk of endometrial
cancer
Weight maintenance after
weight loss
Increased bone density
Improved sleep quality

FITT PRINCIPLE

Basic information to maximize the potential of

physical activity and exercise

Frequency
Intensity
Time
Type of Physical Activity

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FREQUENCY
How often?
Number of times per week you engage in
physical activities
INTENSITY
Difficulty or exertion level of your physical
activity
Depends on how hard you have to work to
do the activity
Determined by:
o Target Heart Rate
o Talk Test
Formula for TARGET HEART RATE
Maximum Heart Rate (MHR)
MHR = 220-age
Target Heart Rate: 50-70% of the MHR
more advanced individualstarget heart rate
70-85% of MHR
Example: 40 year old PT
Maximum heart rate:
220 - 40 = 180
Multiply 180 by 50% and 70%
Target Heart Rate:
90bpm 126bpm
TALK TEST
ability to carry on a conversation while
doing a physical activity
a person doing
o moderate intensity activity can
talk but not sing
o vigorous intensity activity cant
say more than a few words without
stopping for a breath

LIGHT
INTENSITY
Common
daily
activities that
dont require
much effort

MODERATE
INTENSITY
Make the
heart, lungs,
and muscles
work harder
than lightintensity
activities
Scale of 010; activity is
a 5 or 6

VIGOROUS
INTENSITY
Make the
heart, lungs,
and muscles
work very
hard.

Time depends on intensity

o Light-intensity activities >
moderate-intensity activities >
high-intensity activities
o Lighter activity the more time
required

Time needed Depends on Effort

Scale of 010; activity is
a 7 or 8

MODERATE INTENSITY ACTIVITIES

Walking briskly (3 miles/hr or faster,
but not race-walking)
Water aerobics
Bicycling slower than 10 miles per
hour
Tennis (doubles)
Ballroom dancing
General gardening
VIGOROUS INTENSITY ACTIVITIES
Race walking, jogging, or running
Swimming laps
Tennis (singles)
Aerobic dancing
Bicycling 10 miles.hr or faster
Jumping rope
Heavy gardening (continuous
digging or hoeing)
Hiking uphill or with a heavy
backpack
TIME
How long should you exercise?
Accumulated and continuous bouts of
moderate-intensity physical activity can
provide health benefits
o 30 minutes daily moderateintensity activities can be done in:
Five 6-minute intervals
Three 10-minute intervals
Two 15-minute intervals

Light Effort
(60 minutes)

-Light walking
-Volleyball
-Easy
gardening
-Stretching

Moderate effort
(30-60 minutes)

-Brisk walking
-Biking
-Raking leaves
-Swimming
-Dancing
-Water aerobics

Vigorous
effort
(20-30
minutes)
-Aerobics
-Jogging
-Hockey
-Basketball
-Fast
swimming
-Fast
dancing

Physical activities do not have to be

strenuous to provide health promoting
benefits
Moving from sedentary to moderately
active provides greatest improvement
in health benefits

4 TYPES OF PHYSICAL ACTIVITY

Aerobic
Muscle-strengthening
Bone-strengthening
Stretching
Aerobic Activity
o moves large musclesarms and
legs
o Examples: running, swimming,
walking, bicycling, dancing and
doing jumping jacks
o also called endurance activity
Muscle-strengthening activities
o improve the strength, power, and
endurance of muscles

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examples: pushups and sit-ups,

lifting weights, climbing stairs, and
digging in the garden

Bone-strengthening activities
o feet, legs, or arms support the
bodys weight
o muscles push against the bones
o examples: running, walking, jumping
rope, and lifting weights
Stretching
o helps improve flexibility and ability to
fully move joints
o examples: touching your toes, doing
side stretches, yoga exercises
How much of physical activity is
recommended?
Children and adolescents aged 5-17
years
o Should do at least 60
minutes of moderate to
vigorous-intensity physical
activity daily
o Physical activity of amounts
>60 minutes daily will provide
additional health benefits
o Should include activities that
strengthen muscle and bone,
at least 3 times per week
Figure 2. Physical Activity Pyramid For
Children

Type of
Physical
Activity
Moderateintensity
aerobic

Vigorousintensity
aerobic

Age Group
Children

Age Group
Adults

-active
recreation
such as
hiking
-bicycle
riding
-brisk
walking
-active
games
including
running and
chasing
-bicycle
riding
-jumping
rope
-martial arts
such as
karate
-sports such
as soccer,
ice or field
hockey ,
basketball,
swimming,
tennis
-crosscountry
skiing

-active
recreation
such as
hiking
-bicycle
riding
-brisk
walking
-active
games
including
running and
chasing
-bicycle
riding
-jumping
rope
-martial arts
such as
karate
-sports such
as soccer,
ice or field
hockey ,
basketball,
swimming,
tennis
-vigorous
dancing
-crosscountry
skiing

Table 1. Example of Moderate-intensity and

Vigorous-intensity aerobic
FITT Prescription: Child and Adolescent

Frequency: Daily

Intensity: moderate to vigorous

Time: 60 minutes

Type: Aerobic activity and Muscle and

bone strengthening (at least 3x a
week)

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How much of physical activity is

recommended?
Adults aged 18-64 years
o At least 150 minutes (2 hours and
30 minutes) of moderate-intensity
physical activity throughout the
week, or
o At least 75 minutes (1 hour and 15
minutes) of vigorous-intensity
physical activity throughout the
week, or
o An equivalent combination of
moderate- and vigorous intensity
activity
o Additional health benefits:
Increase moderateintensity physical activity to
300 minutes (5 hours) per
week, or equivalent.
o Muscle-strengthening activities
should be done involving major
muscle groups on 2 or more days
a week
FITT Prescription: Adults 18-64 years

Frequency: 1 week

Intensity: moderate intensity

Time: 150 minutes (2 hours and 30

minutes)

Type: Aerobic activity and Muscle and

bone strengthening
How much of physical activity is
recommended?
Adults aged 65 years and above
o Additional health benefits, increase
moderate intensity physical
activity to 300 minutes per week,
or equivalent
o Those with poor mobility: enhance
balance and prevent falls, 3 or
more days per week
o Muscle-strengthening activities
should be done involving major

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muscle groups, 2 or more days a

week.
FITT Prescription: Adults 65 years and
above

Frequency: 1 week

Intensity: moderate

Time: 150 minutes (2 hours and 30

minutes)

Type: Aerobic activity and Muscle and

bone strengthening; enhance
balance
OLDER ADULTS
Additional health benefits
o Greater amounts of physical
activity
o Increasing the duration, intensity,
or frequency
Care should be taken not to engage in
excessive amounts of activity risk of
injury
SEDENTARY OLDER ADULTS AND THE
OBESE
Should start with short-intervals of
moderate physical activity (5-10
minutes) and gradually build up to the
desired amount
OLDER PEOPLE
Loss of strength and stamina attributed
to aging is in part caused by reduced
physical activity
Inactivity increases with age
o By age 75, about one in three men
and one in two women engage in
no physical activity
Social support (family and friends)
o Consistently and positively related
to regular physical activity

BENEFITS OF EXERCISE IN OLDER

PEOPLE
Helps maintain the ability to live
independently
Reduces the risk of falling and fracturing
bones
Reduces the risk of dying from coronary
heart disease and of developing high
blood pressure, colon cancer, and
diabetes
Helps those with chronic, disabling
conditions improve their stamina and
muscle strength
Reduces symptoms of anxiety and
depression
Fosters improvements in mood and
feelings of well-being
Helps maintain health bones, muscles,
and joints
Helps control joint swelling and pain
associated with arthritis

SAMPLE CASES
FITT Prescription: 8-year old James
Walks to and from school (20
minutes)
Plays actively with family (20
minutes)
Jumps rope (10 minutes)
Does gymnastics in PE class (10
minutes)
FITT Prescription: 16-year old Maria
Walks dog (10 minutes)
Plays tennis (30 minutes)
Does sit-ups and push-ups (5
minutes),
Walks briskly with friends (15
minutes)

FITT Prescription: 44-year old Helen

30 minutes of brisk walking on 2
days
60 minutes (1 hour) of social
dancing (moderate intensity) on 1
evening
30 minutes of mowing the lawn
(moderate intensity) on 1 afternoon
Heavy gardening (muscle
strengthenings on 2 days
Target Heart Rate
MHR: 220 44 = 176
THR: 176 x 50% & 70%
Target Heart Rate: 88 bpm 123 bpm
FITT Prescription: 68-year old Marvin
30 minutes of brisk walking; 5x per
week
20 minutes jogging; 2x per week
8-10 reps calf raises, sideways leg
lift; 2x/wk
Sideways walking, heel to toe walk;
3x/week
10 minutes sideways stretch, upper
body twist; hip twist; daily
10-30 seconds stretch; daily

The world breaks every one

and afterwards many
are strong at the
broken places.
-Ernest Hemingway

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