Orthopedics, An Issue of Primary Care Clinics in Office Practice (eBook)

George G.A. Pujalte (Autor)

eBook Download: PDF | EPUB

2013 | 1. Auflage
100 Seiten
Elsevier Health Sciences (Verlag)
978-0-323-26123-4 (ISBN)

Infos

This issue of Primary Care: Clinics in Office Practice features expert clinical reviews on Orthopedics which includes current information on . The Preparticipation Physical Examination, Exercise Prescription, Diagnosis and Treatment of Osteoarthritis, Evaluation and Treatment of Cervical Radiculopathy, Choosing the Right Diagnostic Imaging Modality in Musculoskeletal Diagnosis, Evaluation and Treatment of Musculoskeletal Chest Pain, Evaluation and Treatment of Rotator Cuff Pathology, Evaluation and Treatment of Sternoclavicular, Clavicular, and Acromioclavicular Injuries, Evaluation and Treatment of Upper Extremity Nerve Entrapment Syndromes, Complementary and Alternative Treatments in Musculoskeletal Medicine, Evaluation and Treatment of Biking and Running Injuries, Common Injections in Musculoskeletal Medicine, and Considerations in Footwear and Orthotics.

Textauszug

A Guide to Exercise Prescription

Jason Crookham, DO, [e-mail],     Fortius Sport and Health, 3713 Kensington Avenue, Burnaby, British of Columbia, V5B 0A7, Canada

Exercise is a fundamental component of good health. The American College of Sports Medicine and “Exercise is Medicine” recommend treating exercise as a vital sign, and assessing and prescribing physical activity at every medical visit. Meeting the recommended goals of physical activity results in a significant reduction in all-cause mortality. Physicians can improve health by prescribing exercise.

Keywords

Physical activity • Physical inactivity • Cardiorespiratory fitness • Metabolic equivalents

Key points

• Exercise is a foundational component of good health. The American College of Sports Medicine and “Exercise is Medicine” recommend treating exercise as a vital sign, and assessing and prescribing physical activity at every medical visit.

• Meeting the recommended physical activity goals results in a significant reduction in all-cause mortality.

• Physicians can improve health by prescribing exercise.

Strength-of-Recommendation Taxonomy: Key recommendations for practice

Clinical Recommendation

Evidence RatingRefs.

Getting 150 min of moderate-intensity exercise reduces all-cause mortality

B1,2,3

Physicians can improve health by prescribing exercise

C4,5,6,7,8,9

Prescribe exercise with FITT (Frequency, Intensity, Type, and Time) to improve compliance

C3,10

Recommend a plan that the patient is at least 70% confident he can accomplish to improve adherence

C11,12

The problem of low cardiorespiratory fitness, sedentary time, and physical inactivity

Exercise counseling by primary care physicians has been shown to increase participation in physical activity by patients.4,5,11,13,14 Furthermore, when surveyed, patients state that they would like their physician to prescribe exercise, and report that they would be more interested in exercise if advised by their physician.4

Physical inactivity, low cardiorespiratory fitness (CRF), and prolonged sedentary time are growing public health problems. In one study, the attributable mortality risk of low cardiorespiratory fitness was greater than the risks incurred from smoking, diabetes, and obesity combined.1 To highlight the epidemic of inactivity, exercise advocate and sports medicine physician, Karim Khan, coined the term “Smokadiabesity”.

According to the World Health Organization, physical inactivity constitutes the fourth leading cause of death globally.15 When measured directly rather than by surveys, physical inactivity is the leading cause of death in the United States.15 Low CRF also infers significant mortality risk. Although mortality risk factors such as diabetes and obesity track together, Blair1 has shown that people can be fit and fat. Fig. 1 illustrates that it is the least fit people in the population who have the highest risk of mortality.1

Fig. 1 Attributable risk of all-cause mortality. (Data from Blair SN. Physical inactivity: the biggest public health problem of the 21st century. Br J Sports Med 2009;43(1):1–2.)

More than half of adults and 80% of adolescents do not meet the Centers for Disease Control and Prevention (CDC) and American College of Sports Medicine Physical Activity Guidelines.2 Most adolescents and adults in the United States also spend over 8 hours of sedentary time daily.2 Sedentary time alone is an independent risk factor for mortality, regardless of the level of fitness or physical activity.16

Short-term and long-term benefits of exercise

The benefits of exercise have been well documented by many research studies.1,4,5,15,16,17 The US Federal Physical Activity Guidelines,2 American College of Sports Medicine (ACSM),3 American Heart Association (AHA),18 and American Diabetes Association (ADA) all recommend 150 minutes per week of moderate-intensity exercise to achieve health benefits. Exercising more than 150 minutes per week will continue to reduce health risks, but the benefits are not as great (Fig. 2).

Fig. 2 “Median” shape of the exercise dose-response curve. (From US Department of Health and Human Services. Physical activity guidelines for Americans. Available at: http://www.health.gov/paguidelines/Report/G1_allcause.aspx#figureg12. Accessed March 16, 2013.)

When counseling patients about exercise, it may be helpful to promote the immediate benefits of exercise as well as long-term benefits. Immediate benefits of physical activity are improved cognitive ability, reduced anxiety, and positive sense of well-being.19 Exercise in school improves concentration and academic outcomes.20 In one study, improved SAT scores were observed to correlate strongly with time spent doing physical activity.15

Long-term benefits of exercise are numerous. Exercise lowers stroke risk by 27%,6 reduces the incidence of diabetes by approximately 50%,21 can lower the incidence of colon cancer by more than 60%,22 and reduce the risk of developing Alzheimer dementia by 40%.23 Exercise can also reduce mortality and risk of recurrent breast cancer by approximately 50%.24 Care providers should inform patients of the serious risk of low CRF and physical inactivity. Comparing the risk of low CRF with smokadiabesity may be easy to remember, and motivating.1

Summary of published guidelines on exercise

The Cochrane Collaboration, the United States Preventative Services Task Force (USPSTF), the ACSM, and the AHA have published recommendations on exercise prescription and physical activity.

Cochrane Database Recommendations on Physical Activity

Cochrane reviews have established that professional advice and continued support encourages people to increase physical activity in the short and medium term.25 Interventions aimed to increase exercise combined with diet are able to decrease the incidence of type 2 diabetes in people with impaired glucose tolerance and metabolic syndrome.26 A later Cochrane meta-analysis showed that exercise significantly improves glycemic control in people with type 2 diabetes even without weight loss.27 Along with improving diabetes outcomes, Cochrane reviews found evidence that exercise-based cardiac rehabilitation is effective in reducing cardiovascular mortality and hospital admissions in men and women who have had myocardial infarction and revascularization.28 Furthermore, when compared with either waiting or placebo, exercise improved the symptoms of depression in a Cochrane review of 28 randomized trials.29 As treatment for depression, exercise also had a similar strength of effect when compared head-to-head with cognitive therapy.7 As suspected by many educators and coaches, exercise improved self-esteem in the short term. This finding suggests that exercise may be an important intervention to improve children’s self-esteem and reduce behavioral problems in school.8 A review of 43 randomized controlled trials investigating exercise in postmenopausal women showed that exercise will improve bone mineral density and reduce the risk of fractures. Women who engaged in a combination of exercises had 3.2% less bone loss and fewer fractures.30 Cochrane reviews also elucidated the positive health effects of exercise among cancer survivors,9 and adults living with human immunodeficiency virus/AIDS.31 A review on weight reduction after childbirth32 and exercise interventions to help people quit smoking33 also revealed positive effects. However, both reviews recommended further study. Finally, low back pain (LBP) is a common disorder that tends to recur. Cochrane reviews found moderate evidence that posttreatment exercise programs can prevent recurrences of LBP up to 24 months from the first episode of pain (Box 1).34

Box 1   Summary of Cochrane Collaboration recommendations on exercise

Professional advice encourages people to increase physical activity in the short and long term25,35

Exercise along with diet interventions is able to decrease the incidence of T2D in people with IFG and metabolic syndrome26

Exercise improves glycemic control even without weight loss in...

Produkt-Details

• Erscheint lt. Verlag: 28.12.2013
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Gesundheitswesen
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Allgemeinmedizin
• Themenwelt: Medizinische Fachgebiete ► Chirurgie ► Unfallchirurgie / Orthopädie
• ISBN-10: 0-323-26123-X / 032326123X
• ISBN-13: 978-0-323-26123-4 / 9780323261234