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Exam Code: 040-444 Practice exam 2022 by Killexams.com team
ACSM Registered Clinical Exercise Physiologist
ACSM Physiologist questions
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Abstract and Introduction

Abstract

The promotion of physical activity is at the top of our national public health agenda. Although regular exercise reduces subsequent cardiovascular morbidity and mortality, the incidence of a cardiovascular event during exercise in patients with cardiac disease is estimated to be 10 times that of otherwise healthy persons. Adequate screening and evaluation are important to identify and counsel persons with underlying cardiovascular disease before they begin exercising at moderate to vigorous levels. This statement provides recommendations for cardiovascular screening of all persons (children, adolescents, and adults) before enrollment or participation in activities at health/fitness facilities. Staff qualifications and emergency policies related to cardiovascular safety are also discussed.

Introduction

The message from the nation's scientists is clear, unequivocal, and unified: physical inactivity is a risk factor for cardiovascular disease,[7,18] and its prevalence is an important public health issue. New scientific knowledge based on epidemiological observational studies, cohort studies, controlled trials, and basic research has led to an unprecedented focus on physical activity and exercise. The promotion of physical activity is at the top of our national public health agenda, as seen in the publication of the 1996 report of the U.S. Surgeon General on physical activity and health.[20]

The attention now being given to physical activity supports the goals of Healthy People 2000[10] and should lead to increased levels of regular physical activity throughout the U.S. population, including the nearly one fourth of adult Americans who have some form of cardiovascular disease.[3] Although regular exercise reduces subsequent cardiovascular morbidity and mortality,[7,17,18] the incidence of a cardiovascular event during exercise in patients with cardiac disease is estimated to be 10 times that of otherwise healthy persons.[8] Adequate screening and evaluation are important to identify and counsel persons with underlying cardiovascular disease before they begin exercising at moderate to vigorous levels.

Moderate (or higher) levels of physical activity and exercise are achieved in a number of settings, including more than 15,000 health/fitness facilities across the country. A accurate survey of 110 health/fitness facilities in Massachusetts found that efforts to screen new members at enrollment were limited and inconsistent.[14] Nearly 40% of responding facilities stated that they do not routinely use a screening interview or questionnaire to evaluate new members for symptoms or history of cardiovascular disease, and 10% stated that they conducted no initial cardiovascular health history screening at all.

This statement provides recommendations for cardiovascular screening of all persons (children, adolescents, and adults) before enrollment or participation in activities at health/fitness facilities. Staff qualifications and emergency policies related to cardiovascular safety are also discussed. Health/fitness facilities are defined here as organizations that offer health and fitness programs as their primary or secondary service or that promote high-intensity recreational physical activity (e.g., basketball, tennis, racquetball, and swim clubs). Ideally such facilities have a professional staff, but those that provide space and equipment only (e.g., unsupervised hotel exercise rooms) are also included. A health/fitness facility user is defined as a dues-paying member or a guest paying a regular daily fee to use the facility specifically to exercise. These recommendations are intended to assist health/fitness facility staff, healthcare providers, and consumers in the promotion and performance of safe and effective physical activity/exercise.

The writing group based these recommendations on a review of the literature and the consensus of the group. Earlier statements from the American Heart Association (AHA) and the American College of Sports Medicine (ACSM) are highlighted and supplemented. These recommendations were peer reviewed by selected authorities in the field representing the AHA, the ACSM, the American College of Cardiology, the International Health Racquet and Sports Clubs Association (IHRSA), and the Young Men's Christian Association. The recommendations are not mandatory or all-encompassing, nor do they limit provision of individualized care by practitioners exercising independent judgment. With this statement the AHA and the ACSM assume no responsibility toward any individual for whom this statement may be applied in the provision of individualized care. Specific details about exercise testing and training of persons with and without cardiovascular disease and those with other health problems are provided elsewhere.[2,6,8,21] The ACSM has published comprehensive guidelines for operating health/fitness facilities.[19] Although issues in competitive sports are beyond the scope of this statement, the 26th Bethesda Conference[28] on sudden cardiac death in competitive athletes and the AHA[12] provide specific recommendations for the screening and evaluation of athletes for congenital heart disease, systemic hypertension, and other cardiovascular diseases before participation in competitive sports.

Cardiovascular Screening

Rationale. Regular exercise results in increased exercise capacity and physical fitness, which can lead to many health benefits. Persons who are physically active appear to have lower rates of all-cause mortality, probably because of a decrease in occurrence of chronic illnesses, including coronary heart disease. This benefit may be the result of an improvement in cardiovascular risk factors in addition to enhanced fibrinolysis, improved endothelial function, decreased sympathetic tone, and other as yet undetermined factors.[7] Regular endurance exercise leads to favorable alterations in the cardiovascular, musculoskeletal, and neurohumoral systems. The result is a training effect, which allows an individual to do increasing amounts of work while lowering the heart rate and blood pressure response to submaximal exercise. Such an effect is particularly desirable in patients with coronary artery disease because it allows increased activity with less ischemia.[7]

The Centers for Disease Control and Prevention,[18] the ACSM,[18] and the AHA[6] recommend that every American participate in at least moderate-intensity physical activity for ≥ 30 min on most, if not all, days of the week. Unfortunately, many Americans are sedentary or perform too little physical activity; only 22% of adult Americans engage in regular exercise ≥ 5 times a week.[20] The prevalence of physical inactivity is higher among culturally diverse segments of the U.S. population, low-income groups, the elderly, and women.[20] It is important for healthcare providers to educate the public about the benefits of physical activity and to encourage more leisure-time exercise, particularly for those who are underactive. Consumers should seek information about safe and effective ways to increase physical activity and initiate and maintain a regular program of exercise.

Efforts to promote physical activity will result in an increasing number of persons with and without heart disease joining the more than 20 million persons who already exercise at health/fitness facilities.[16] Current market research indicates that 50% of health/fitness facility members are older than 35 yr, and the fastest-growing segments of users are those older than 55 yr and those aged 35-54 yr.[16] With increased physical activity, more people with symptoms of or known cardiovascular disease will face the cardiovascular stress of physical activity and possible risk of a cardiac event. More than one fourth of all Americans have some form of cardiovascular disease.[3] The prevalence of coronary heart disease for American adults aged 20 yr and older is 7.2% in the general population, 7.5% for non-Hispanic whites, 6.9% for non-Hispanic blacks, and 5.6% for Mexican Americans.[3] The prevalence of myocardial infarction in older Americans aged 65-69 yr is 18.0% and 9.7% for men and women, respectively.[3]

Moderately strenuous physical exertion may trigger ischemic cardiac events, particularly among persons not accustomed to regular physical activity and exercise. Siscovick et al.[23] examined the incidence of primary cardiac arrest in men aged 25-75 yr after excluding those with a history of clinically recognized heart disease. Although the risk was significantly increased during high-intensity exercise, the likelihood for primary cardiac arrest during such activity in a clinically healthy population was estimated at 0.55 events/10,000 men per year. Maron et al.[13] studied causes of sudden death in competitive athletes. In persons younger than 35 yr, 48% of deaths were due to hypertrophic cardiomyopathy. Coronary artery anomalies, idiopathic left ventricular hypertrophy, and coronary heart disease each accounted for 10-20% of deaths. In those over 35, coronary artery disease accounted for approximately 80% of all deaths. Overall, the absolute incidence of death during exercise in the general population is low.[25,26,29]Each year approximately 0.75 and 0.13/100,000 young male and female athletes[29]and 6/100,000 middle-aged men die during exertion.[25] No estimates are available for middleaged women or the elderly.

Cardiovascular events other than death during exercise have also been studied. Data from the Framingham heart study indicate that the baseline risk of myocardial infarction in a 50-yr-old man who is a nonsmoker and does not have diabetes is approximately 1% per year, or approximately 1 chance per million per hour.[4] Heavy exertion [≥ 6 METs (metabolic equivalents)] within 1 h of symptomatic onset of acute myocardial infarction has been reported in 4.4-7.1% of patients.[15,31] The adjusted relative risk is significantly greater in persons who do not participate in regular physical activity, with an approximate threefold increase in risk during the morning hours. The relation of physical activity to acute myocardial infarction in the thrombolytic era was examined among 3339 patients in the TIMI II trial,[27] in which moderate or marked physical activity preceded myocardial infarction in 18.7% of patients.

Van Camp et al.[30] reported the incidence of major cardiovascular complications in 167 randomly selected cardiac rehabilitation programs that provided supervised exercise training to 51,000 patients with known cardiovascular disease. The incidence of myocardial infarction was 1 per 294,000 person-hours; the incidence of death was 1 per 784,000 person-hours.

Screening Prospective Members/Users.All facilities offering exercise equipment or services should conduct cardiovascular screening of all new members and/or prospective users. The primary purpose of preparticipation screening is to identify both those not known to be at risk and those known to be at risk for a cardiovascular event during exercise. accurate evidence suggests that screening by health/fitness facilities is done only sporadically.[14] In Canada, evidence from the Canadian Home Fitness test and its screening instrument, the Physical Activity Readiness Questionnaire (PAR-Q), suggests that even simple screening questionnaires can effectively identify many persons at high risk and increase the safety of nonsupervised exercise.[22] Current knowledge of the relation between identifiable risk factors, the incidence of cardiovascular disease, and the triggering factors for acute myocardial infarction suggests that screening is both reasonable and prudent.

The cost-effectiveness of preparticipation screening is an important consideration. Exercise testing is comparatively expensive. The incidence of false-positive findings when testing asymptomatic persons[9] and the need to follow up abnormal results can lead to subsequent and more costly procedures. A thorough and mandatory screening process that might prove optimally sensitive in detecting occult cardiovascular disease might be so prohibitive to participation that fewer persons would engage in a fitness program. Such a result would be counterproductive to the goal of maximizing physical activity. Because most of the health benefits of exercise accrue at moderate levels of intensity,[18] in which the risks are probably low, recommendations that would inhibit large numbers of persons from participating in exercise programs are not justified. Preparticipation screening should identify persons at high risk and should be simple and easy to perform. Public health efforts should focus on increasing the use of preparticipation screening.

Two practical tools for preparticipation screening are likely to have an effect on identifying high-risk individuals without inhibiting their participation in exercise programs. The PAR-Q[24] (Table 1) is a self-administered questionnaire that focuses primarily on symptoms that might suggest angina pectoris. Participants are directed to contact their personal physician if they answer "yes" to ≥ 1 questions. The PAR-Q also identifies musculoskeletal problems that should be evaluated before participation because these might involve modification of the exercise program. The questionnaire is designed to be completed when the participant registers at a health/fitness facility. In unsupervised fitness facilities (e.g., hotel fitness centers), the PAR-Q can be self-administered by means of signs prominently displayed at the main entry into the facility. Although less satisfactory than documenting the results of screening, use of signs and similar visual methods are a minimal recommendation for encouraging prospective users to assess their health risks while exercising at any facility.

Another simple, self-administered device that aims to identify high-risk individuals without negatively impacting participation is a questionnaire patterned after one developed by the Wisconsin Affiliate of the American Heart Association[11] (Table 2). The one-page form is slightly more complex than the PAR-Q and uses history, symptoms, and risk factors (including age) to direct prospective members to either participate in an exercise program or contact their physician (or appropriate healthcare provider) before participation. Persons at higher risk are directed to seek facilities providing appropriate levels of staff supervision. The questionnaire can be administered within a few minutes on the same form participants use to join or register at the facility. It identifies potentially high-risk participants, documents the results of screening, educates the consumer, and encourages and fosters appropriate use of the healthcare system. In addition, it can guide staff qualifications and requirements. This instrument is also simple enough to be adapted for use as self-screening signs posted in nonstaffed facilities.

Health appraisal questionnaires should preferably be interpreted by qualified staff (see next section for criteria) who can limit the number of unnecessary referrals for preparticipation medical evaluation, avoiding undue expense and barriers to participation.

In view of the potential legal risk assumed by operators of health/fitness facilities, it is recommended that all facilities providing staff supervision document the results of screening. Screening, particularly for participants for whom a medical evaluation is recommended, requires time, personnel, and financial resources. Individual facilities can determine the most cost-effective way to conduct and document preparticipation screening.

Every effort should be made to educate all prospective new members about the importance of obtaining a health appraisal and-if indicated-medical evaluation/recommendation before beginning exercise testing/training. The potential risks inherent in not obtaining an appraisal should also be emphasized. Without an appraisal, it is impossible to determine whether a person may be at significant risk of severe bodily harm or death by participating in an exercise program. The same is true of persons who undergo a health appraisal, are identified as having symptoms of or known cardiovascular disease, and refuse or neglect to obtain the recommended medical evaluation yet seek admission to a health/fitness facility program. Due to safety concerns, persons with known cardiovascular disease who do not obtain recommended medical evaluations and those who fail to complete the health appraisal questionnaire upon request may be excluded from participation in a health/fitness facility exercise program to the extent permitted by law.

Persons without symptoms or a known history of cardiovascular disease who do not obtain the recommended medical evaluation after completing a health appraisal should be required to sign an assumption of risk or release/waiver. Both of these forms may be legally recognized in the jurisdiction where the facility is located. When appropriate guidelines are followed, it is likely that the potential benefits of physical activity will outweigh the risks. Persons without symptoms or a known history of cardiovascular disease who do not obtain recommended medical evaluations or sign a release/waiver upon request may be excluded from participation in a health/fitness facility exercise program to the extent permitted by law. Persons who do not obtain an evaluation but who sign a release/waiver may be permitted to participate. However, they should be encouraged to participate in only moderate- or lower-intensity physical activities and counseled about warning symptoms and signs of an impending cardiovascular event.

The major objectives of preparticipation cardiovascular screening are to identify persons with known cardiovascular disease, symptoms of cardiovascular disease, and/or risk factors for disease development who should receive a medical evaluation/recommendation before starting an exercise program or undergoing exercise testing. Screening also identifies persons with known cardiovascular disease who should not participate in an exercise program or who should participate at least initially in a medically supervised program, as well as persons with other special needs.[8,19]

Screening also serves another purpose. One of the trends in cardiac rehabilitation is to "mainstream" low-risk, clinically stable patients to community facilities rather than specialized, often costly cardiac programs. Facility directors should expect that an increasing percentage of their participants will have health histories that warrant supervision of exercise programs by professional staff.

When a medical evaluation/recommendation is advised or required, written and active communication with the individual's personal physician (or healthcare provider) is strongly recommended. The sample letter and medical release form in Table 3A and B, can be used or modified for such purposes.

Characteristics of Participants. Intensity of physical activity is measured through endurance- or strength-type exercise as defined in Table 4. Health appraisal questionnaires should be used before exercise testing and/or training to initially classify participants by risk for triage and preliminary decision making (Table 5), namely, apparently healthy persons (Class A-1), persons at increased risk (Classes A-2 and A-3), and persons with known cardiovascular disease (Classes B, C, and D). Apparently healthy persons of all ages and asymptomatic persons at increased risk (Classes A-1 through A-3) may participate in moderateintensity exercise without first undergoing a medical examination or a medically supervised, symptom-limited exercise test. Apparently healthy younger persons (Class A-1) may also participate in vigorous exercise without first undergoing a medical examination and a medically supervised exercise test. It is suggested that persons classified as Class A-2 and particularly Class A-3 undergo a medical examination and possibly a maximal exercise test before engaging in vigorous exercise. All other persons (Classes B and C) should undergo a medical examination and perform a maximal exercise test before participation in moderate or vigorous exercise unless exercise is contraindicated (i.e., Class D). Data from a medical evaluation performed within 1 yr are acceptable unless clinical status has changed. Medically supervised exercise tests should be conducted in accordance with previously published guidelines.[8]

Using Screening Results for Risk Stratification. With completion of the initial health appraisal and, if indicated, medical consultation and supervised exercise test, participants can be further classified for exercise training on the basis of individual characteristics detailed below. The following classifications have been modified using existing AHA[8] and ACSM[2] guidelines and are recommended (Table 5):

Class A: Apparently Healthy. There is no evidence of increased cardiovascular risk for exercise. This classification includes 1) "apparently healthy" younger persons (Class A-1) and 2) irrespective of age, persons who are "apparently healthy" or at "increased risk" (Classes A-2 and A-3) and who have a normal diagnostic maximal exercise test. Submaximal exercise tests are sometimes performed at health/fitness facilities where permitted by law for nondiagnostic purposes, including physical fitness assessment, exercise prescription, and monitoring of progress.[2] Such testing is also useful for educating participants about exercise and for motivating them. Nondiagnostic exercise testing should be conducted only for persons in Class A and only by appropriately qualified, well-trained personnel (see section on staffing below) who are knowledgeable about indications and contraindications for exercise testing, indications for test termination, and test interpretation. All health/fitness facilities, including those where exercise testing is performed, should have an emergency plan (see section on emergency policies and procedures below) to ensure that emergencies are handled safely, efficiently, and effectively. No restrictions other than provision of basic guidelines are required for exercise training. No special supervision is required during exercise training.

Class B: Presence of known, Stable Cardiovascular Disease with Low Risk for Vigorous Exercise but Slightly Greater than for Apparently Healthy Persons. This classification includes clinically stable persons with 1) coronary artery disease (myocardial infarction, coronary artery bypass surgery, percutaneous transluminal coronary angioplasty, angina pectoris, abnormal exercise test, or abnormal coronary angiogram); 2) valvular heart disease; 3) congenital heart disease (risk stratification for patients with congenital heart disease should be guided by the 26th Bethesda Conference recommendations[28]); 4) cardiomyopathy (includes stable patients with heart failure with characteristics as outlined below but not accurate myocarditis or hypertrophic cardiomyopathy); and 5) exercise test abnormalities that do not meet the criteria outlined in Class C below. The clinical characteristics of such persons are 1) New York Heart Association (NYHA) Class I or II (Table 6); 2) exercise capacity > 6 METs; 3) no evidence of heart failure; 4) free of ischemia or angina at rest or on the exercise test ≤ 6 METs; 5) appropriate rise in systolic blood pressure during exercise; 6) absence of nonsustained or sustained ventricular tachycardia; and 7) ability to satisfactorily self-monitor intensity of activity. For these persons, activity should be individualized with exercise prescription by qualified personnel. Medical supervision is recommended during prescription sessions and nonmedical supervision by appropriately qualified staff for other exercise sessions until the participant understands how to monitor his or her own activity. Subsequent exercise training may be performed without special supervision.

Class C: Those at Moderate to High Risk for Cardiac Complications during Exercise and/or who are Unable to Self-regulate Activity or Understand the Recommended Activity Level. This classification includes persons with 1) coronary artery disease with the clinical characteristics outlined below; 2) acquired valvular heart disease; 3) congenital heart disease (risk stratification for patients with congenital heart disease should be guided by the 26th Bethesda Conference recommendations[28]); 4) cardiomyopathy (includes stable patients with heart failure with characteristics as outlined below but not accurate myocarditis or hypertrophic cardiomyopathy); 5) exercise test abnormalities not directly related to ischemia; 6) a previous episode of ventricular fibrillation or cardiac arrest that did not occur in the presence of an acute ischemic event or cardiac procedure; 7) complex ventricular arrhythmias that are uncontrolled at mild to moderate work intensity with medication; 8) threevessel or left main coronary artery disease; and 9) ejection fraction < 30%. One or more of the following clinical characteristics are also present: 1) two or more previous myocardial infarctions; 2) NYHA Class III or greater; 3) exercise capacity < 6 METs; 4) ischemic horizontal or down-sloping ST depression ≥ 1 mm or angina at a workload ≤ 6 METs; 5) a fall in systolic blood pressure with exercise; 6) a medical problem that the physician believes may be potentially life-threatening; 7) a previous episode of primary cardiac arrest; and 8) ventricular tachycardia at a workload < 6 METs. Physical activity should be individualized, and exercise should be prescribed by appropriately qualified medical personnel. Medical supervision, monitoring for adverse signs and symptoms, electrocardiographic monitoring of heart rate and rhythm, and blood pressure monitoring are recommended during exercise sessions until safety is established. Subsequent exercise training should be supervised by appropriately qualified personnel.

Class D: Unstable Conditions with Activity Restriction. This classification includes those with 1) unstable ischemia; 2) heart failure that is not compensated; 3) uncontrolled arrhythmias; 4) severe and symptomatic aortic stenosis; 5) hypertrophic cardiomyopathy or cardiomyopathy from accurate myocarditis; 6) severe pulmonary hypertension; or 7) other conditions that could be aggravated by exercise (for example, resting systolic blood pressure > 200 mm Hg or resting diastolic blood pressure > 110 mm Hg; active or suspected myocarditis or pericarditis; suspected or known dissecting aneurysm; thrombophlebitis and accurate systemic or pulmonary embolus). In this population no physical activity is recommended for conditioning purposes. Risk stratification for patients with congenital heart disease should be guided by the 26th Bethesda Conference recommendations.[28]

These classifications are presented as a means of beginning exercise with the lowest possible risk. They do not consider accompanying morbidities (for example, insulindependent diabetes mellitus, morbid obesity, severe pulmonary disease, complicated pregnancy, or debilitating neurological or orthopedic conditions) that may constitute a contraindication to exercise or necessitate closer supervision during exercise training.

Using Screening Results for Exercise Prescription. For individuals considered to be in Class A, exercise training intensity (Table 4) may be prescribed using the rating of perceived exertion alone and/or specific target heart rates. A suggested rating of perceived exertion for such persons is 12-16 (moderate to hard) on the Borg scale of 6-20 and/or an intensity level that corresponds to 50-90% of maximum heart rate or 45-85% of maximum oxygen uptake or heart rate reserve. Heart rate reserve is defined as maximum heart rate minus resting heart rate. For persons taking medications that affect heart rate (e.g., β-adrenergic blockers), these heart rate methods do not apply unless guided by an exercise tolerance test.

In the absence of atrial fibrillation, frequent atrial or ventricular ectopy, a fixed-rate pacemaker, or similar conditions, exercise intensity should be prescribed for persons with cardiovascular disease (Class B or C) using target heart rates and perceived exertion ratings in accordance with previously published guidelines.[2,8] For these persons, target heart rates should be prescribed using data obtained during exercise testing performed while the participant is taking his or her usual cardioactive medications. In the absence of myocardial ischemia or other significant exercise test abnormalities, a target range of 50-90% of peak heart rate or 45-85% of peak measured oxygen uptake or heart rate reserve is recommended. This intensity level corresponds to 12-16 (moderate to hard) on the Borg scale. In the presence of myocardial ischemia (i.e., ischemic ST-segment depression > 1 mm, chest discomfort believed to be angina pectoris, or other symptoms believed to be an anginal equivalent), significant arrhythmia, or other significant exercise test abnormalities (e.g., a fall in systolic blood pressure from baseline, systolic blood pressure > 240 mm Hg, or diastolic blood pressure > 110 mm Hg), the target training intensity is derived from the heart rate associated with the abnormality. If this occurs at a high level of exercise, the above target heart rate recommendations are applicable, provided that the upper limit of the range is at least 10 beats per minute (bpm) below the level at which the abnormality appears. Other-wise, the recommended upper limit of training heart rate is 10 bpm less than that associated with the abnormality.

Staffing

Health/fitness facility personnel involved in management or delivery of exercise programs must meet academic and professional standards and have the required experience as established by the ACSM.[2,19] Such personnel include the general manager/executive director, medical liaison, fitness director, and exercise leader. In general, health/fitness facility personnel should have the formal training and experience needed to ensure that clients are provided with safe, effective programs and services. The levels of education and experience needed to ensure effectiveness and safety vary with the health status of the client population. The kinds of personnel who should be employed at health/fitness faciliies serving various types of clients are summarized in Table 5.

The general manager/executive director is responsible for the overall management of the facility and should have competencies in business as well as design and delivery of exercise programs.

The medical liaison reviews medical emergency plans, witnesses and critiques medical emergency drills, and reviews medical incident reports. In level 2 and 3 facilities (Table 5), the medical liaison may be a licensed physician, a registered nurse trained in advanced cardiac life support, or an emergency medical technician. In level 4 and 5 facilities (Table 5), the medical liaison must be a licensed physician.

The fitness director manages the facility's exercise and activity programs and is responsible for program design and the training and supervision of staff. He or she must have a degree in exercise science, another health-related field, or equivalent experience, and knowledge of exercise physiology, exercise programming, and operation of exercise facilities. The fitness director must hold professional certification at an advanced level by a nationally recognized health/fitness organization. In level 3 facilities this certification should be comparable to ACSM health fitness instructor certification. In level 4 and 5 facilities the fitness director should be certified at a level that correlates with ACSM exercise specialist certification. The exercise specialist typically holds a master's degree in exercise science or a related field and has extensive experience in exercise testing and leadership in clinical populations. He or she must be trained in cardiopulmonary resuscitation (CPR) and should have at least 1 yr of supervisory experience in the fitness industry.

The exercise leader works directly with program participants and provides instruction and leadership in specific modes of exercise. He or she also helps program participants master the behavioral skills needed to adhere to exercise programs. In level 1, 2, and 3 facilities the exercise leader as a minimum must have a high school diploma or equivalent and entry-level or higher professional certification from a nationally recognized health/fitness organization (comparable to ACSM exercise leader certification). In level 4 facilities, the exercise leader should have education and experience corresponding to that required by ACSM health fitness instructor certification. In level 5 facilities, the exercise leader should be either an exercise specialist or a health fitness instructor directly supervised by an exercise specialist. In all cases the exercise leader must be trained in CPR and should have prior supervised internship or work experience in the health/fitness industry.

Some health/fitness facilities provide services in allied health fields such as nutrition, stress management, and physical therapy. Personnel providing such services should meet current accepted professional standards in those fields and should be certified as recommended by relevant professional organizations and licensed by or registered with the state as required by law.

Emergency Policies and Procedures

All health/fitness facilities must have written emergency policies and procedures that are reviewed and practiced regularly. Such plans will correspond to the type of facility and risk level of its membership outlined in Table 5. All fitness center staff who directly supervise program participants should be trained in basic life support. Health/fitness facilities must develop appropriate emergency response plans and must train their staff in appropriate procedures to provide during a life-threatening emergency. When an incident occurs, each staff member must perform the necessary emergency support steps in accordance with established procedures. It is important for everyone to know the emergency plan. Emergency drills should be practiced once every 3 months or more often with changes in staff; retraining and rehearsal are especially important. When new staff are hired, new team arrangements may be necessary. Because life-threatening cardiovascular emergencies are rare, constant vigilance by staff and familiarity with the plan and how to follow it are important.

It is essential to acknowledge that emergency equipment alone does not save lives. Equipment alone may offer a false sense of security if it is not backed up with appropriate staffing. The training and preparedness of an astute professional staff who can readily handle emergencies is paramount. This issue is particularly important if persons with certain medical conditions are recruited and encouraged to exercise in a specific health/fitness facility. Such a facility has the responsibility to offer appropriate coverage by personnel as outlined above and in Table 5. Acquisition of equipment for evaluation and resuscitation will depend on the risk level of participants, personnel, and medical coverage. All facilities must have a telephone that is readily accessible and available when emergency assistance is needed. It would be useful for all supervised facilities to have a sphygmomanometer and stethoscope readily available. Level 4 and 5 facilities that recruit members with known cardiovascular disease must have such equipment available, and level 5 (supervised cardiac rehabilitation) facilities should be fully equipped according to the recommendations of the AHA[21] and the American Association of Cardiovascular and Pulmonary Rehabilitation.[1] Such equipment includes a defibrillator, oxygen, and fully stocked crash cart. Delineation of specific equipment standards in such facilities is beyond the scope of these guidelines; such information is detailed in the documents above.[1,21] Appropriately trained staff who are medically and legally empowered must be available to operate such devices during a facility's operational hours.

The emergency plan must address transportation of victims to a hospital emergency room and must include telephone access to 911 or the local emergency unit access system. Health/fitness facility personnel should be familiar with emergency transport teams in the area so that access and location of the center are clearly identified. Staff should greet the emergency response team at the entrance of the facility so that they can be promptly guided to the site of the emergency. A staff member should remain with the victim at all times. Prompt emergency transport is optimized by free and ready access to the victim within the health/fitness facility and assistance by designated staff.

General Considerations in Selecting a Health/Fitness Facility

In selecting a health/fitness facility, an individual should first consider his or her health status. Persons with a history of cardiovascular disease should seek facilities that provide or require a thorough medical evaluation of prospective members/users. Personnel should include nurses, exercise specialists, health/fitness instructors, and/or exercise leaders licensed or certified by the appropriate agencies, organizations, or authorities. They should be trained to recommend and supervise exercise in patients with cardiovascular and other chronic diseases. Persons at high risk for development of cardiovascular disease should seek facilities that require appropriate medical evaluation of clients and employ exercise leaders who are certified as competent to design and deliver exercise programs for high-risk persons. Table 5 summarizes personnel and safety recommendations for health/fitness facilities (levels 1 through 5) serving clients in various health categories (Classes A through C).

Persons seeking health/fitness facilities should select one that meets professional and industry standards. Facilities should be clean, well-maintained, and spacious enough to ensure the comfort and safety of program participants. Indoor facilities should be climate controlled, and changing rooms and showers should be provided. Flooring in areas where exercise is to be carried out should be designed to minimize risk of injury. Exercise equipment should be well-maintained. The variety, amount, and availability of exercise equipment should match individual needs and preferences, including time of day and preferred mode of exercise. For example, if aerobic dance is the preferred mode of exercise, individuals should seek a fitness center that offers this program at a convenient time and that provides an exercise leader who is competent in this activity and able to teach men and women of various age and fitness levels.

The programs and services of a health/fitness center should optimize participation. The location of the center should minimize time spent traveling to it. The social environment should be attractive and the staff competent in helping members/users master the behavioral skills needed to adopt and maintain a physically active lifestyle.

Sat, 19 Mar 2022 20:25:00 -0500 en text/html https://www.medscape.com/viewarticle/716398
Killexams : What Is Functional Strength Training? No result found, try new keyword!Functional fitness consistently lands among the top 20 worldwide fitness trends in the yearly survey of health professionals conducted by ACSM's Health ... an exercise physiologist and an ... Fri, 15 Jul 2022 03:21:00 -0500 text/html https://health.usnews.com/wellness/fitness/articles/what-is-functional-strength-training Killexams : Lyn Leddy

Lyn Leddy is the president of  Evolving Fitness, which provides life stage-specific conditioning for women.  Leddy creates fitness programs that not only lessen the impact of change, but also provide women with an exercise "toolbox" so they can work out on their own. Leddy got the special training she needed to create safe exercise routines while earning a Bachelor of Science in cardiovascular health and exercise physiology from Northeastern University in Massachusetts. Leddy also has certification from the American College of Sports Medicine (ACSM) and the Aerobic and Fitness Association of America (AFAA), as well as a prenatal exercise certificate from the AFAA.

Fri, 06 Oct 2017 11:11:00 -0500 en text/html https://www.webmd.com/lynn-leddy
Killexams : Does cardio kill gains? Here’s what the science says No result found, try new keyword!an ACSM-certified exercise physiologist, RRCA-certified running coach, and co-owner of Hart Strength and Endurance Coaching. So, whether you like running, cycling, or using one of the best rowing ... Fri, 22 Jul 2022 13:21:00 -0500 en-gb text/html https://www.msn.com/en-gb/health/fitness/does-cardio-kill-gains-here-e2-80-99s-what-the-science-says/ar-AAZKJec Killexams : Sport and Exercise Medicine

Overview

Providing clinicians with the requisite skills to excel in sports medicine.

The University regularly ‘refreshes’ courses to make sure they are as up-to-date as possible.

In addition it undertakes formal periodic review of courses in a process called 'revalidation’ to ensure that they continue to meet standards and are current and relevant.

This course will be revalidated in the near future and it is possible that there will be some changes to the course as described in this prospectus.

Summary

People are increasingly encouraged to undertake sport and exercise as part of a healthier lifestyle. Although this has a number of global health benefits, a related caveat is an increased risk of injury. Currently, sporting injuries commonly present to the health professional; these injuries present a unique challenge in terms of their aetiology, management and potential for recurrence.

Sport and Exercise medicine is now recognised as a specialist area and there are growing numbers of physicians and allied health professionals seeking to work in this diverse and exciting area. The teaching faculty comprises a balance of respected academics and clinical specialists in relevant fields of Sports Medicine, Physical Activity and Sports Biomechanics.


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About this course

About

This Masters programme has been developed in collaboration with various professional bodies. In particular, consultation with members of: the Association of Chartered Physiotherapists in Sports Medicine, the International Federation of Sports Physiotherapists, the Faculty of Sport and Exercise Medicine and the British Association of Sport and Exercise Medicine has informed our learning outcomes, module content and delivery. We have ensured that these are mapped directly to masters’ competencies as defined by the International Federation of Sports Physiotherapists.

The course is tailored towards clinical professionals working as medical doctors, or other health professionals including physiotherapists and podiatrists. It will provide the knowledge, critical awareness and transferable skills for physicians and allied health professionals aspiring to engage in the field of Sports Medicine. The primary focus will be to develop practitioners who understand the importance of evidence based and specialist reflective practice, who will enhance the health care of people who are involved in sport and exercise within the UK and Ireland and beyond.

Many members of the teaching staff hold a PGCE, PGCHEP, PGCHET, PGCUT or other teaching qualifications and are members of the Higher Education Academy. Several of the staff are engaged with the Sport and Exercise Sciences Research Institute (SESRI; CB, GD, CMcC, MM). Teaching staff have considerable research and practical experience that informs their teaching. In addition, many staff are qualified members of health-related professional bodies such as the British Association of Sport and Exercise Sciences (BASES) and the American College of Sports Medicine (ACSM).

The teaching faculty includes a range of academics and professionals across the following specialist areas: orthopaedic surgery, sports podiatry, sports physiotherapy, consultant sports physicians, exercise and health, strength and conditioning, sports psychology, biochemistry and sports medicine research.

Attendance

Full time or part time options are available. Students can enrol on the programme on a Full time (over 1 year; 3 semesters), or Part time basis (over 3 years; 6 semesters).

Start dates

Teaching, Learning and Assessment

Teaching and Learning Methods include: lectures, case studies, tutorials, seminars, on line material; videos; access to graphical and anatomical models; problem based cases and scenarios, workshops, on line and face to face discussion groups, analysis of clinical data; practical exercises, demonstrations, literature searching and observation.

The learning outcomes of the course will be assessed through a combination of essay, examination, case studies, reflective practice, group and individual presentations and extended research project. These assessment methods will measure students’ knowledge and understanding of the subject as well as their intellectual and transferable skills.

The content for each course is summarised on the relevant course page, along with an overview of the modules that make up the course.

Each course is approved by the University and meets the expectations of:

Attendance and Independent Study

As part of your course induction, you will be provided with details of the organisation and management of the course, including attendance and assessment requirements - usually in the form of a timetable. For full-time courses, the precise timetable for each semester is not confirmed until near the start date and may be subject to change in the early weeks as all courses settle into their planned patterns. For part-time courses which require attendance on particular days and times, an expectation of the days of attendance will often be included in the letter of offer. A course handbook is also made available.

Courses comprise modules for which the notional effort involved is indicated by its credit rating. Each credit point represents 10 hours of student effort. Undergraduate courses typically contain 10- or 20-credit modules and postgraduate course typically 15- or 30-credit modules.

The normal study load expectation for an undergraduate full-time course of study in the standard academic year is 120 credit points. This amounts to around 36-42 hours of expected teaching and learning per week, inclusive of attendance requirements for lectures, seminars, tutorials, practical work, fieldwork or other scheduled classes, private study, and assessment. Part-time study load is the same as full-time pro-rata, with each credit point representing 10 hours of student effort.

Postgraduate Masters courses typically comprise 180 credits, taken in three semesters when studied full-time. A Postgraduate Certificate (PGCert) comprises 60 credits and can usually be completed on a part-time basis in one year. A 120-credit Postgraduate Diploma (PGDip) can usually be completed on a part-time basis in two years.

Class contact times vary by course and type of module. Typically, for a module predominantly delivered through lectures you can expect at least 3 contact hours per week (lectures/seminars/tutorials). Laboratory classes often require a greater intensity of attendance in blocks. Some modules may combine lecture and laboratory. The precise model will depend on the course you apply for and may be subject to change from year to year for quality or enhancement reasons. Prospective students will be consulted about any significant changes.

Assessment

Assessment methods vary and are defined explicitly in each module. Assessment can be via one method or a combination e.g. examination and coursework . Assessment is designed to assess your achievement of the module’s stated learning outcomes. You can expect to receive timely feedback on all coursework assessment. The precise assessment will depend on the module and may be subject to change from year to year for quality or enhancement reasons. You will be consulted about any significant changes.

Coursework can take many forms, for example: essay, report, seminar paper, test, presentation, dissertation, design, artefacts, portfolio, journal, group work. The precise form and combination of assessment will depend on the course you apply for and the module. Details will be made available in advance through induction, the course handbook, the module specification and the assessment timetable. The details are subject to change from year to year for quality or enhancement reasons. You will be consulted about any significant changes.

Normally, a module will have four learning outcomes, and no more than two items of assessment. An item of assessment can comprise more than one task. The notional workload and the equivalence across types of assessment is standardised.

Calculation of the Final Award

The class of Honours awarded in Bachelor’s degrees is usually determined by calculation of an aggregate mark based on performance across the modules at Levels 5 and 6 (which correspond to the second and third year of full-time attendance).

Level 6 modules contribute 70% of the aggregate mark and Level 5 contributes 30% to the calculation of the class of the award. Classification of integrated Masters degrees with Honours include a Level 7 component. The calculation in this case is: 50% Level 7, 30% Level 6, 20% Level 5. At least half the Level 5 modules must be studied at the University for Level 5 to be included in the calculation of the class.

All other qualifications have an overall grade determined by results in modules from the final level of study. In Masters degrees of more than 200 credit points the final 120 points usually determine the overall grading.

Figures correct for academic year 2019-2020.

Academic profile

The University employs over 1,000 suitably qualified and experienced academic staff - 59% have PhDs in their subject field and many have professional body recognition.

Courses are taught by staff who are Professors (25%), Readers, Senior Lecturers (20%) or Lecturers (55%).

We require most academic staff to be qualified to teach in higher education: 82% hold either Postgraduate Certificates in Higher Education Practice or higher. Most academic staff (81%) are accredited fellows of the Higher Education Academy (HEA) by Advanced HE - the university sector professional body for teaching and learning. Many academic and technical staff hold other professional body designations related to their subject or scholarly practice.

The profiles of many academic staff can be found on the University’s departmental websites and supply a detailed insight into the range of staffing and expertise.  The precise staffing for a course will depend on the department(s) involved and the availability and management of staff.  This is subject to change annually and is confirmed in the timetable issued at the start of the course.

Occasionally, teaching may be supplemented by suitably qualified part-time staff (usually qualified researchers) and specialist guest lecturers. In these cases, all staff are inducted, mostly through our staff development programme ‘First Steps to Teaching’. In some cases, usually for provision in one of our out-centres, Recognised University Teachers are involved, supported by the University in suitable professional development for teaching.

Figures correct for academic year 2021-2022.

Modules

Here is a guide to the subjects studied on this course.

Courses are continually reviewed to take advantage of new teaching approaches and developments in research, industry and the professions. Please be aware that modules may change for your year of entry. The exact modules available and their order may vary depending on course updates, staff availability, timetabling and student demand. Please contact the course team for the most up to date module list.

Year one

Optimising Exercise and Load: Effective monitoring and management

Year: 1

In order to optimise the performance of an athlete, it is essential to understand the key scientific and practical concepts of biomechanics, athlete monitoring and load considerations to prevent injuries, or optimise rehabilitation of an athlete's return to play. This module will advance the students' ability to observe and collect athlete data, analyse, interpret, act upon and communicate with the athlete and within, or across, multidisciplinary settings. This module draws upon the student's previous knowledge and skills to ensure a multifaceted approach to the development of professional practice in sports and exercise medicine.

Research Methods for Sports and Performance

Year: 1

This module is designed to enhance the knowledge and competencies of students to prepare them to undertake research in Physical Activity and Public Health; Psychology and Sports Nutrition. It focuses on the application of advanced elements in experimental design, conducting quantitative analysis, research synthesis and the presentation of data and findings. It equips students to review, conduct and commission research.

Research Project in Sports and Performance

Year: 1

Carrying out an original, independent piece of research from the formulation of a research question through to reporting findings in accordance with the conventions of the academic area is an important part of the research training provided by Masters level study. This module provides students with an opportunity for students to carry out an original independent piece of research within the area of their own profession, or special interest in sports and performance, and present findings in the form of a journal manuscript and a conference presentation.

Sports Injury Management: Maximising Clinical Effectiveness

Year: 1

In order to provide an optimal outcome for the sports person, it is essential to understand the physiological and psychological response to injury. Assessment skills, clinical reasoning and a range of treatment strategies are also essential for successful sports injury management and outcome. This module draws upon the student's previous knowledge and skills to ensure a holistic approach to the management of the injured athlete.

Sports Rehabilitation: Critical Thinking and Dynamic Practice

Year: 1

In order to provide optimal care to the injured athlete it is essential that health professionals working in the area of sport and exercise medicine are proficient in a wide range of assessment and monitoring skills, enabling successful rehabilitation planning and outcome. During this module the student will develop an advanced knowledge of the physiology of injury and repair at key points in the rehabilitation process allowing for tailored rehabilitation programmes to be developed across a range of sporting injuries.

Standard entry conditions

We recognise a range of qualifications for admission to our courses. In addition to the specific entry conditions for this course you must also meet the University’s General Entrance Requirements.

Entry Requirements

Applicants must have gained

(1) An Honours or non-Honours degree from a University of the United Kingdom or the Republic of Ireland, from the Council for National Academic Awards, the National Council for Educational Awards, or the Higher Education and Training Awards Council or from an institution of another country which is recognised as being of an equivalent standard; OR an equivalent standard in a Postgraduate Certificate, Graduate Certificate or Graduate Diploma or an approved alternative qualification; AND
(2) Provide evidence of competence in written English (GCSE grade C or equivalent); AND

(3) Be registered as a health professional with the relevant regulatory body or equivalent (ie UK - Health and Care Professions Council, IRL - CORU, or equlivalent)

In exceptional circumstances, where an individual has substantial and significant experiential learning, a portfolio of written evidence demonstrating the meeting of graduate qualities (including subject-specific outcomes, as determined by the Course Committee) may be considered as an alternative entrance route. Evidence used to demonstrate graduate qualities may not be used for exemption against modules within the programme.

English Language Requirements

English language requirements for international applicants
The minimum requirement for this course is Academic IELTS 6.0 with no band score less than 5.5. Trinity ISE: Pass at level III also meets this requirement for Tier 4 visa purposes.

Ulster recognises a number of other English language tests and comparable IELTS equivalent scores.

Careers & opportunities

Career options

All students enrolling on this course will already possess a relevant professional qualification (eg. medical doctor, physiotherapist, podiatry). It is anticipated that most students on this programme will be employed or will be seeking employment within the National Health Service, Social, voluntary sectors, or in independent practice. The programme therefore has significant clinical and vocational relevance. The specialist knowledge and postgraduate level skills gained will enhance students’ opportunities to progress in their careers.

We have also ensured that the content of the programme meets the postgraduate education requirements and levels of competencies for accreditation, set out by key professional bodies: 1). Association of Chartered Physiotherapists in Sport and Exercise Medicine (Physios in Sport UK) and 2). International Federation of Sports Physiotherapists.

Destination of Leavers from Higher Education (DLHE) statistics provided by the University Careers Service for the last three years show that a significant cohort of students graduating from Ulster with sport and exercise related undergraduate awards go on to full-time employment (statistics are available on request). It is anticipated that this programme will allow the Faculty and the USA to continue its excellent track record of producing multi-skilled graduates who are attractive to a range of employers. This will be achieved in conjunction with the Career Development Centre at the University, with all students encouraged to avail of the relevant employability training and support.

Fees and funding

Important notice - fees information

Fees illustrated are based on academic year 22/23 entry and are subject to an annual increase.

If your study continues into future academic years your fees are subject to an annual increase. Please take this into consideration when you estimate your total fees for a degree.

Additional mandatory costs are highlighted where they are known in advance. There are other costs associated with university study.

Visit our Fees pages for full details of fees.

Correct at the time of publishing. Terms and conditions apply.

Fees (total cost)

Northern Ireland, Republic of Ireland and EU Settlement Status Fees

£6,410.00

International Fees

£15,360.00

Where the postgraduate course selected offers multiple awards (e.g. PG Cert, PG Dip, Masters), please note that the price displayed is for the complete Masters programme.

Postgraduate certificates and diplomas are charged at a pro-rata basis.

Find out more about postgraduate fees

Additional mandatory costs

It is important to remember that costs associated with accommodation, travel (including car parking charges) and normal living will need to be covered in addition to tuition fees.

Where a course has additional mandatory expenses (in addition to tuition fees) we make every effort to highlight them above. We aim to provide students with the learning materials needed to support their studies. Our libraries are a valuable resource with an extensive collection of books and journals, as well as first-class facilities and IT equipment. Computer suites and free Wi-Fi are also available on each of the campuses.

There are additional fees for graduation ceremonies, examination resits and library fines.

Students choosing a period of paid work placement or study abroad as a part of their course should be aware that there may be additional travel and living costs, as well as tuition fees.

See the tuition fees on our student guide for most up to date costs.

Disclaimer

  1. The University endeavours to deliver courses and programmes of study in accordance with the description set out in this prospectus. The University’s prospectus is produced at the earliest possible date in order to provide maximum assistance to individuals considering applying for a course of study offered by the University. The University makes every effort to ensure that the information contained in the prospectus is accurate but it is possible that some changes will occur between the date of printing and the start of the academic year to which it relates. Please note that the University’s website is the most up-to-date source of information regarding courses and facilities and we strongly recommend that you always visit the website before making any commitments.
  2. Although reasonable steps are taken to provide the programmes and services described, the University cannot guarantee the provision of any course or facility and the University may make variations to the contents or methods of delivery of courses, discontinue, merge or combine courses and introduce new courses if such action is reasonably considered to be necessary by the University. Such circumstances include (but are not limited to) industrial action, lack of demand, departure of key staff, changes in legislation or government policy including changes, if any, resulting from the UK departing the European Union, withdrawal or reduction of funding or other circumstances beyond the University’s reasonable control.
  3. If the University discontinues any courses, it will use its best endeavours to provide a suitable alternative course. In addition, courses may change during the course of study and in such circumstances the University will normally undertake a consultation process prior to any such changes being introduced and seek to ensure that no student is unreasonably prejudiced as a consequence of any such change.
  4. The University does not accept responsibility (other than through the negligence of the University, its staff or agents), for the consequences of any modification or cancellation of any course, or part of a course, offered by the University but will take into consideration the effects on individual students and seek to minimise the impact of such effects where reasonably practicable.
  5. The University cannot accept any liability for disruption to its provision of educational or other services caused by circumstances beyond its control, but the University will take all reasonable steps to minimise the resultant disruption to such services.
Thu, 24 Sep 2020 01:12:00 -0500 en-GB text/html https://www.ulster.ac.uk/courses/202223/sport-and-exercise-medicine-28125
Killexams : What are the best nuts to lower cholesterol?

Nuts are a kind of fruit with a hard outer shell, with the exception of peanuts, which are legumes. Nuts are a popular food worldwide, and there is evidence that they may benefit a person’s health.

A variety of nuts may lower low-density lipoproteins (LDL), or “bad” cholesterol, while raising high-density lipoproteins (HDL), or “good” cholesterol. However, not all nuts have the same effect on a person’s cholesterol levels.

This article discusses cholesterol and how it affects a person’s health. It also explores the effects that several types of nuts have on cholesterol levels and their nutritional content. Finally, it answers some common questions about some of the most suitable nuts for lowering cholesterol.

Cholesterol is a fatty molecule that plays a number of vital roles within the body. For example, the substance is essential to the structural integrity of cell membranes and their fluidity. Cell membrane fluidity refers to how proteins and lipids, or fats, move within the cell membrane.

There are two types of cholesterol: LDL cholesterol and HDL cholesterol. A person with higher LDL cholesterol levels may be at risk of developing:

Conversely, someone with higher HDL levels may be at a decreased risk of developing these conditions.

According to a 2016 review, peanuts are rich in chemicals called phytosterols. These chemicals may stop the body from absorbing as much cholesterol, as they are similar in structure to cholesterol and compete with it in absorption.

The review’s authors noted that eating peanuts can lower a person’s total cholesterol and LDL cholesterol levels without making significant changes to their HDL cholesterol levels.

The Department of Agriculture (USDA) provides the following nutritional data for 100 grams (g) of raw peanuts:

A 2018 meta-analysis stated that walnuts are also high in phytosterols, which people may also call plant sterols.

After reviewing 26 studies, the authors concluded that a person may lower LDL cholesterol levels by eating walnuts. However, this effect was more pronounced when walnuts contributed between 10% and 25% of a person’s daily energy intake. There was less of an effect when that figure was less than 10%.

The USDA supplies the following nutritional data for 100 g of unroasted walnuts:

According to a 2017 study, incorporating cashew nuts into a typical American diet can help a person decrease their total and LDL cholesterol levels.

However, the researchers of a 2020 meta-analysis investigated the effects of cashews on cholesterol levels. They found that cashew consumption had no significant effect on total, LDL, or HDL cholesterol.

Therefore, further research into cashews and cholesterol may be necessary.

The USDA provides the following nutritional data for 100 g of raw cashew nuts.

The authors of a 2018 review noted that supplementing the diet with almonds can lower LDL cholesterol while maintaining or even increasing HDL cholesterol.

The authors suggested that people may lower their risk of developing dyslipidemia — blood lipid levels that are too high or low — by eating 45 g of almonds daily. Dyslipidemia is a risk factor for cardiovascular disease.

The USDA supplies the following nutritional data for 100 g of unsalted dry roasted almonds.

The authors of a 2016 review and meta-analysis compared the results of nine studies on hazelnuts and cholesterol. They found people who incorporated hazelnuts into their diet had lower levels of total and LDL cholesterol, with no effect on their HDL cholesterol.

The study authors hypothesized that the high dietary fiber content of hazelnuts might contribute to this effect. According to the USDA, 100 g of unroasted hazelnuts contain 9.7 g of fiber.

The USDA provides the following nutritional data for 100 g of unroasted hazelnuts.

There is limited accurate research into the effects of macadamia nuts on cholesterol.

However, a small 2003 study indicated that macadamia nut consumption could lower LDL levels by around 5.3% while increasing HDL levels by 7.9% among men with elevated cholesterol levels.

The USDA supplies the following nutritional data for 100 g of raw macadamia nuts.

A small 2013 study indicated that a single Brazil nut serving of 20–50 g lowered LDL cholesterol levels and raised HDL cholesterol levels after 9 hours in 10 healthy study participants.

Conversely, the authors of a 2022 meta-analysis reported no significant changes in cholesterol levels after Brazil nut consumption. Therefore, further research into Brazil nuts and cholesterol may be necessary.

The USDA provides the following nutritional data for 100 g of dried, unblanched Brazil nuts.

A 2018 study indicated that people may lower their LDL cholesterol levels by consuming a high pecan diet. However, the authors concluded that further research is necessary.

The USDA supplies the following nutritional data for 100 g of unsalted dry roasted pecans.

A 2016 review investigated the results of nine different studies into the relationship between blood cholesterol and pistachio nut consumption. In six of those studies, LDL cholesterol levels dropped while HDL cholesterol levels rose in people who replaced part of their usual diet with pistachio nuts.

The USDA provides the following nutritional data for 100 g of raw pistachios.

Below are some of the most common Questions and Answers about nuts to lower cholesterol.

Can eating too many nuts raise cholesterol?

Yes, it is possible that eating nuts in excess may increase LDL cholesterol levels due to their saturated fat content. Eating nuts in excess may also exceed a person’s daily calorie needs, leading to increased LDL cholesterol levels.

However, saturated fat content varies between different types of nuts, and eating certain nuts in moderation as part of a balanced diet may increase HDL cholesterol levels.

Are cashews bad for cholesterol?

Research indicates that cashew nuts may improve or have little effect on a person’s cholesterol levels. However, an individual should eat cashews in moderation as part of a balanced diet.

Do pistachios lower cholesterol?

Yes, pistachios may reduce levels of LDL cholesterol. They may also increase levels of HDL cholesterol.

If a person has excess LDL cholesterol and insufficient HDL cholesterol, they may develop serious health conditions later in life.

However, people may Excellerate their cholesterol levels by adding certain types of nuts to a balanced diet. A healthcare professional can offer further advice and help an individual manage their diet to reduce LDL cholesterol levels.

Mon, 18 Jul 2022 12:00:00 -0500 en text/html https://www.medicalnewstoday.com/articles/best-nuts-to-lower-cholesterol
Killexams : Exercise is medicine and physicians need to prescribe it!

The three major factors that influence our health and longevity are genetics, the environment and behaviour. Because we have very little control over genetic factors, it is critical that we focus on the environmental and behavioural factors we can control to Excellerate health. Whereas great strides have been made in reducing the environmental factors influencing disease, such as through vaccinations, hygiene and safety regulations, little has been done to target behavioural factors such as physical inactivity. It is tragic that so little has been done to address the one major factor affecting our health and longevity that is almost entirely under our control. At this point in time, I believe physical inactivity has become the greatest public health problem of our time and finding a way to get patients more active is absolutely critical to improving health and longevity in the 21st century.

The beneficial relationship between exercise and health has been well known dating back to the 5th century BC, when Hippocrates said that “Eating alone will not keep a man well; he must also take exercise. For food and exercise… work together to produce health”.1 This relationship has been further defined by years of scientific research that shows a clear correlation between physical activity and health status. That is, those individuals who maintain an active and fit way of life live longer and healthier lives than those who do not. This association between physical activity and health persists in virtually every subgroup of the population, regardless of age, sex, race or environmental condition.2

THE SCIENCE BEHIND PHYSICAL ACTIVITY AND HEALTH

There is clear scientific evidence proving the benefit of regular physical activity on both the primary and secondary prevention of diabetes, hypertension, cancer (particularly breast and colon cancer), depression, osteoporosis and dementia. Furthermore, regular physical activity has been shown to be essential in achieving and maintaining weight control. Finally, there is a clear correlation between physical activity and all-cause mortality.3 Without a doubt, exercise really is medicine and, in fact, it can be seen as the much needed vaccine to prevent chronic disease and premature death.

So armed with all this knowledge, why has organised medicine not declared an all-out war against physical inactivity? If we had a pill that conferred all the confirmed health benefits of exercise, would we not do everything humanly possible to see to it that everyone had access to this wonder drug? Would it not be the most prescribed pill in the history of mankind? I think we all know the answer to these questions. We know that the immensely powerful pharmaceutical machine that exists in the world at present would see to it that everyone knew about this pill and that the healthcare systems of the world would pay for it, no matter what the cost.

ECONOMIC FACTORS

Beyond the effects of physical activity on morbidity and mortality, there are clear economic reasons to try and increase physical activity among our patients. We know that compared with active patients, sedentary patients cost over US$1500 more per year to care for.4 In California alone, the medical costs attributed to inactivity were estimated at US$29 billion in the year 2005. This figure represented a 32% increase from the same cost estimate in 2000.5 At Kaiser Permanente in southern California (USA), we spend US$1 out of every US$10 on caring for patients with diabetes, the vast majority of whom have type 2 diabetes—a condition that can be cured or markedly improved by a regimen of regular physical activity and proper diet. It is clear that the spiraling cost of inactivity is going to break the bank for healthcare spending if dramatic changes are not made.

For this reason, our leadership at Kaiser Permanente in southern California has made a major commitment to getting our patients more active. We record physical activity as a vital sign and believe that there is no greater indicator of an individual’s health and longevity than how many minutes per week he or she exercises. For this reason, at every visit patients are asked two questions during their intake while vital signs are measured: “on average, how many days per week do you engage in at least moderate (brisk walk or greater) exercise” and “on average, how many minutes per session”? These two numbers are then multiplied to supply us a patient’s minutes per week of moderate or greater exercise. In keeping with recommendations from the American College of Sports Medicine (ACSM) and the American Heart Association, we aim for a goal of at least 150 minutes per week of moderate exercise for our adult patients.

Because we have an electronic medical record at Kaiser Permanente, we are able to identify patients who are sedentary and thus at risk of chronic disease and premature death. This risk factor is particularly important in patients who have other concurrent risk factors such as diabetes or smoking. Knowing the activity level of our patients allows us to target those most at risk with interventions designed to increase physical activity, such as our physical activity telephone help-line. This help-line is manned by a counsellor who reviews a patient’s current activity level and then mails out a pedometer with clear instructions on how to use it and appropriate goals for daily step counts. They then make three more follow-up calls over the next few months to monitor compliance and provide encouragement.

The commitment to getting patients at Kaiser Permanente more active fits well with our national advertising campaign called “Thrive”. The tag line for this campaign is “at Kaiser Permanente we want you to live well, be well and thrive!” A central theme of this campaign all along has been the importance of getting patients more active and interested in taking care of themselves. It is clear this message has resonated with patients and the “Thrive” campaign has become one of the most successful advertising campaigns ever launched in the healthcare industry.

EXERCISE IS MEDICINE

As a practising family physician for the past 20 years and a long-time member of the ACSM, I have become very sensitive to the fact that mainstream medicine has mostly ignored research on the exercise pill. Instead, the healthcare system as it exists currently is completely enamoured with procedures and pharmaceuticals, while paying little more than lip service to prevention. It was against this backdrop that my major focus as ACSM president last year was to advocate for making physical activity assessment and prescription a standard part of the disease prevention and treatment paradigm. Certainly, current evidence calls for nothing less than a global initiative to make this happen.

What is already known on this topic

  • There is clear evidence proving the benefits of regular physical activity in the prevention of chronic disease and lowering of mortality rates.

  • Inactivity-related diseases account for a significant and growing cost for healthcare systems.

  • Little is being done by organised medicine to try and increase physical activity among patients.

What this paper adds

  • This paper suggests that healthcare systems must begin to think of exercise as a medication that should be prescribed to patients.

  • There should be a merging of the fitness industry with the healthcare industry, so that patients can be better helped to find an appropriate fitness regimen.

  • “Exercise is Medicine” is a new initiative jointly sponsored by the American College of Sports Medicine and the American Medical Association, which aims to make activity assessment and prescription a standard part of the disease treatment and prevention paradigm.

As luck would have it, last year’s president of the American Medical Association was Dr Ron Davis. Ron is a preventive medicine physician and head of the Center for Health Promotion and Disease Prevention of the Henry Ford Health System in Detroit, Michigan, USA. The idea that exercise prescription should become a standard of practice for organised medicine was shared by Ron and he convinced the American Medical Association to partner with ACSM on an initiative called Exercise Is Medicine (see www.exerciseismedicine.org). A national launch for this initiative was held on 5 November 2007 at the National Press Club in Washington, DC, USA. Also attending the launch was the acting US Surgeon General, Dr Steven Galson, who is also a strong advocate for promoting physical activity to influence health, along with Melissa Johnson (Executive Director of the President’s Council on Physical Fitness and Sports) and Jake Steinfeld (Chairman of the California Governor’s Council for Physical Fitness and Sports).

CHANGING PARADIGMS

It is clear to me that we must begin to merge the fitness industry with the healthcare industry if we are going to Excellerate world health. No one can argue that there are many individuals and organisations out there in the fitness world who know how to get people more active and make a living doing it. Why does this fitness world seldom intersect with the healthcare world? Why can I, as a family physician in America, refer my patient to a bariatric surgeon and have insurance cover the cost of stomach stapling, yet the same insurance plan will not pay for an appointment with a fitness professional? This simply makes no sense and has to change.

I believe that sports medicine physicians around the world are the best advocates for Exercise Is Medicine. We must collectively urge all patients to become more active and stay active throughout their lives. It is imperative that all patients understand the risks of being sedentary and the importance of exercise in treating and preventing chronic disease. We must also insist that the healthcare systems of the world make as big (or bigger) a commitment to getting patients active as they make to getting them to take medications or submit to various procedures that have less scientific evidence supporting their benefit.

For these reasons, I was very excited to hear that the British Journal of Sports Medicine has dedicated a special issue to the theme of “Exercise Is Medicine”. Dr Steve Blair, the guest editor of this special issue, has dedicated his amazing career to proving scientifically that exercise is medicine and is responsible for much of the evidence base behind it. With a wealth of evidence in hand, it is time for organised medicine to join with fitness professionals to ensure that patients around the world take their exercise pill. There is no better way to Excellerate health and longevity.

REFERENCES

  1. Hippocrates. Cambridge: Harvard University Press, 1952.

  2. US Department of Health and Human Services. Physical activity and health: a report from the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996.

  3. Chenoweth and Associates Inc. The economic costs of physical inactivity, obesity, and overweight in California adults. Sacramento, CA: Cancer Prevention and Nutrition Section, California Center for Physical Activity, California Department of Health Services, 2005.

Tue, 29 May 2012 18:54:00 -0500 en text/html https://bjsm.bmj.com/content/43/1/3
Killexams : Knowing This Number Is So Much More Useful Than Tracking Calories Burned

Photo credit: Hinterhaus Productions - Getty Images

Understanding the inner workings of your bod can be overwhelming. I get it. But whether you're trying to boost your metabolism, track your fitness progress, or focus on a weight management plan, it’s important to understand one number: your basal metabolic rate.

Simply put, basal metabolic rate (BMR) is the amount of calories your body burns while performing basic life-sustaining functions like breathing, growing hair, digesting food, and keeping your heart beating, says Alyssa Lombardi, exercise physiologist, running coach, and founder of Alyssa RunFit Coaching. “BMR is the minimum amount of calories that your body needs to sustain your current weight.”

Meet the experts: Alyssa Lombardi is an ACSM certified clinical exercise physiologist, certified personal trainer, certified running coach, and founder of Alyssa RunFit Coaching. Cara Carmichael, CPT, is a NASM certified personal trainer, OrangeTheory coach, and certified PN nutrition coach.

It's also important to know what it's not. BMR is not based on your activity levels or how much you exercise. It is the rate at which your body burns calories to perform essential bodily functions only.

And, don't confuse your basal metabolic rate with your resting metabolic rate (RMR). “RMR is your BMR plus a very small level of daily activity such as walking to the bathroom, getting out of bed, and eating, but essentially being at rest,” notes Lombardi.

There's no one-size-fits-all BMR. The number is based on height, weight, gender, age, muscle mass, and body fat. Knowing your BMR can help you stay in tune with weight management and how your body responds to life activities. “As your level of activity, exercise, and age changes, your BMR will change,” says Lombardi. “Checking it every so often can be helpful to know, so you can adjust your lifestyle to maintain a healthy weight.”

That's just a sneak peek at all that BMR can do. Read on for the complete details of calculating your basal metabolic rate, why knowing your BMR matters, and more from experts.

How To Figure Out Your BMR

There are a few different ways to calculate BMR. Getting an exact and totally accurate BMR requires a DEXA scan, says Lombardi. “This is essentially a picture of your body that will tell you the make-up of your body’s fat, muscle, and bone density,” she says. However, DEXA scans use a low dose X-ray, are performed in a hospital, and require an in-person visit with your physician.

Because DEXA scans are not exactly accessible, Lombardi recommends an online calculator like Omni Calculator for an easier (and free!) measurement right at home. While less exact, studies show online calculators using the Harris-Benedict equation take into account your height, weight, age, and gender to supply you a rough assessment of your BMR.

Since the Harris-Benedict equation does not factor in muscle mass or body fat there are limitations to its accuracy. You can estimate it yourself with the equation for women below.

Calculate your BMR: 655 + (9.6 x weight in kg) + (1.8 x height in cm) - (4.7 x age in years)

It’s also important to note that men typically have a higher BMR than women. Generally speaking, men are taller and have more muscle mass than women, resulting in a higher BMR, explains Lombardi. The more muscle you have, the higher your BMR will be.

You may be wondering... does my smartwatch supply an accurate BMR? The short answer is no. Smartwatch trackers use movement, heart rate, and your height and weight to provide some calorie intel, but do not factor in muscle mass or body fat, both of which contribute to your BMR, says Cara Carmichael, CPT. “The number the watch is creating isn’t necessarily based on the individual,” she says. “It’s a more basic formula and there’s a lot of room for error.”

Even though smartwatches are not 100% accurate, they can supply you a good starting point, adds Lombardi. But remember not to dwell on the numbers. Instead, take this information to understand your body and its necessary caloric intake.

Why BMR Is A Useful Piece Of Health Data

Beyond upping your knowledge (and appreciation!) for how your body works, knowing your BMR can help you reach your health and fitness goals. Here are a few benefits of your BMR:

  • Understanding caloric needs. Knowing your BMR can help you determine a nutrition plan and recognize your daily caloric needs, explains Carmichael. “A lot of us don’t truly know how much food we need to consume to get through the day without crashing, but your BMR can serve as a baseline,” she says. By knowing how many calories your body naturally burns, you can gauge how much you need to eat in order to gain (eat more calories than you burn), lose (eat fewer calories than you burn), or sustain weight (eat the same number of calories that you burn).

  • Weight management. Whether you are looking to lose or gain weight, understanding your BMR can help speed up the process by giving you necessary information to help set a diet that aligns with your goals, says Lombardi. Once you know your BMR - aka how many calories your body burns for basic functioning - you can use it to base the number of calories needed for the day. The higher your BMR, the more calories you can consume without gaining weight, she explains.

  • Tracking fitness progress. If your BMR increases, that generally means you are gaining more muscle and getting stronger, says Lombardi. Since gaining muscle is the most effective way to change your BMR, consistent strength training and tracking your BMR over time can be a great way to measure your progress and #gains.

  • Improving metabolism. A high BMR is often associated with a fast metabolism and greater muscle mass, while a low BMR can hint to a slower metabolism, lower muscle mass, and higher percent of body fat, says Carmichael. “A lot of people want to increase their metabolism, but you have to understand that in order to do that, you need to build more muscle and increase your BMR,” she says.

How To Excellerate Your BMR

Take a peek at the stats in the BMR equation above, and you'll get a rough idea of how you can move the BMR needle. Incorporating strength training into your workout and gaining muscle mass is the most effective way to change and increase your BMR, says Carmichael. “Muscle uses a lot more energy than fat while at rest, so at any given weight, the more muscle on your body, the higher your BMR.”

Carmichael suggests incorporating strength training at least twice a week to build muscle and raise your BMR. But remember, consistency is key and change does not happen overnight. “So many people look for quick fixes, but in reality, it's about sustainability and sustainable habits.”

Changing your BMR can help boost your metabolism, lose weight, gain strength, or set an optimal meal plan, but there is not one magic number. “Each individual has a different BMR and cannot be compared to one another,” says Carmichael. What is considered to be “healthy” varies depending on the person and their goals. The average BMR for women is around 1400 kcal and about 1700 kcal for men, she says.

Bottom line: BMR is a personalized statistic that cannot be compared to anyone else, but measuring yours and learning how your body functions can help you achieve your health and fitness goals.

You Might Also Like

Tue, 02 Aug 2022 02:15:00 -0500 en-US text/html https://www.aol.com/lifestyle/knowing-number-much-more-useful-130000196.html
Killexams : A top trainer says this number is much more useful than calories burned

Photo credit: Hinterhaus Productions - Getty Images

Understanding the inner workings of your bod can be overwhelming. I get it. But whether you're trying to boost your metabolism, track your fitness progress, or focus on a weight management plan, it’s important to understand one number: your basal metabolic rate.

Simply put, basal metabolic rate (BMR) is the amount of calories your body burns while performing basic life-sustaining functions like breathing, growing hair, digesting food, and keeping your heart beating, says Alyssa Lombardi, exercise physiologist, running coach, and founder of Alyssa RunFit Coaching. 'BMR is the minimum amount of calories that your body needs to sustain your current weight.'

Meet the experts: Alyssa Lombardi is an ACSM certified clinical exercise physiologist, certified personal trainer, certified running coach, and founder of Alyssa RunFit Coaching. Cara Carmichael, CPT, is a NASM certified personal trainer, OrangeTheory coach, and certified PN nutrition coach.

It's also important to know what it's not. BMR is not based on your activity levels or how much you exercise. It is the rate at which your body burns calories to perform essential bodily functions only.

And, don't confuse your basal metabolic rate with your resting metabolic rate (RMR). 'RMR is your BMR plus a very small level of daily activity such as walking to the bathroom, getting out of bed, and eating, but essentially being at rest,' notes Lombardi.

There's no one-size-fits-all BMR. The number is based on height, weight, gender, age, muscle mass, and body fat. Knowing your BMR can help you stay in tune with weight management and how your body responds to life activities. 'As your level of activity, exercise, and age changes, your BMR will change,' says Lombardi. 'Checking it every so often can be helpful to know, so you can adjust your lifestyle to maintain a healthy weight.'

That's just a sneak peek at all that BMR can do. Read on for the complete details of calculating your basal metabolic rate, why knowing your BMR matters, and more from experts.

How to figure out your BMR

There are a few different ways to calculate BMR. Getting an exact and totally accurate BMR requires a DEXA scan, says Lombardi. 'This is essentially a picture of your body that will tell you the make-up of your body’s fat, muscle, and bone density,' she says. However, DEXA scans use a low dose X-ray, are performed in a hospital, and require an in-person visit with your physician.

Because DEXA scans are not exactly accessible, Lombardi recommends an online calculator like Omni Calculator for an easier (and free!) measurement right at home. While less exact, studies show online calculators using the Harris-Benedict equation take into account your height, weight, age, and gender to supply you a rough assessment of your BMR.

Since the Harris-Benedict equation does not factor in muscle mass or body fat there are limitations to its accuracy. You can estimate it yourself with the equation for women below.

Calculate your BMR: 655 + (9.6 x weight in kg) + (1.8 x height in cm) - (4.7 x age in years)

It’s also important to note that men typically have a higher BMR than women. Generally speaking, men are taller and have more muscle mass than women, resulting in a higher BMR, explains Lombardi. The more muscle you have, the higher your BMR will be.

You may be wondering... does my smartwatch supply an accurate BMR? The short answer is no. Fitness trackers use movement, heart rate, and your height and weight to provide some calorie intel, but do not factor in muscle mass or body fat, both of which contribute to your BMR, says Cara Carmichael, CPT. 'The number the watch is creating isn’t necessarily based on the individual,' she says. 'It’s a more basic formula and there’s a lot of room for error.'

Even though smartwatches are not 100% accurate, they can supply you a good starting point, adds Lombardi. But remember not to dwell on the numbers. Instead, take this information to understand your body and its necessary caloric intake.

Why BMR is a useful piece of health data

Beyond upping your knowledge (and appreciation!) for how your body works, knowing your BMR can help you reach your health and fitness goals. Here are a few benefits of your BMR:

  • Understanding caloric needs. Knowing your BMR can help you determine a nutrition plan and recognise your daily caloric needs, explains Carmichael. 'A lot of us don’t truly know how much food we need to consume to get through the day without crashing, but your BMR can serve as a baseline,' she says. By knowing how many calories your body naturally burns, you can gauge how much you need to eat in order to gain (eat more calories than you burn), lose (eat fewer calories than you burn), or sustain weight (eat the same number of calories that you burn).

  • Weight management. Whether you are looking to lose or gain weight, understanding your BMR can help speed up the process by giving you necessary information to help set a diet that aligns with your goals, says Lombardi. Once you know your BMR - aka how many calories your body burns for basic functioning - you can use it to base the number of calories needed for the day. The higher your BMR, the more calories you can consume without gaining weight, she explains.

  • Tracking fitness progress. If your BMR increases, that generally means you are gaining more muscle and getting stronger, says Lombardi. Since gaining muscle is the most effective way to change your BMR, consistent strength training and tracking your BMR over time can be a great way to measure your progress and #gains.

  • Improving metabolism. A high BMR is often associated with a fast metabolism and greater muscle mass, while a low BMR can hint to a slower metabolism, lower muscle mass, and higher percent of body fat, says Carmichael. 'A lot of people want to increase their metabolism, but you have to understand that in order to do that, you need to build more muscle and increase your BMR,' she says.

How to Excellerate your BMR

Take a peek at the stats in the BMR equation above, and you'll get a rough idea of how you can move the BMR needle. Incorporating strength training into your workout and gaining muscle mass is the most effective way to change and increase your BMR, says Carmichael. 'Muscle uses a lot more energy than fat while at rest, so at any given weight, the more muscle on your body, the higher your BMR.'

Carmichael suggests incorporating strength training at least twice a week to build muscle and raise your BMR. But remember, consistency is key and change does not happen overnight. 'So many people look for quick fixes, but in reality, it's about sustainability and sustainable habits.'

Changing your BMR can help boost your metabolism, lose weight, gain strength, or set an optimal meal plan, but there is not one magic number. 'Each individual has a different BMR and cannot be compared to one another,' says Carmichael. What is considered to be 'healthy' varies depending on the person and their goals. The average BMR for women is around 1400 kcal and about 1700 kcal for men, she says.

Bottom line: BMR is a personalised statistic that cannot be compared to anyone else, but measuring yours and learning how your body functions can help you achieve your health and fitness goals.

You Might Also Like

Wed, 03 Aug 2022 23:16:00 -0500 en-GB text/html https://uk.news.yahoo.com/top-trainer-says-number-much-102800789.html
Killexams : Exercise and Ovarian Cancer: How Moving Can Help You

It’s no mystery why people might find it difficult to begin or keep up an exercise routine after a diagnosis of ovarian cancer.

Cancer treatment in general can lead to less physical activity because of nausea and discomfort, poor appetite, and fatigue. With ovarian cancer, there often are added challenges. These include dealing with the sudden onset of menopause for some people. There can be limits on physical activity after abdominal procedures known as primary cytoreductive surgery and debulking. Both of these operations involve removing as much cancerous tissue as possible.

Energy Levels Can Drop, but Exercise Is Still Important

Research has proven what many people know from personal experience about how activity levels can slip during ovarian cancer treatment.

A 2022 Danish study of women with ovarian cancer who were having chemotherapy, for example, found the percentage of participants who regularly exercised for 3 or more hours a week dropped from 65% before diagnosis to 41% after diagnosis. And the percentage of people in the study who were sedentary (no exercise) grew from 4% to 18%.

Many studies also have shown that overcoming these challenges to start or keep up your exercise plan can pay off in better quality of life, improved mental health, and even less fatigue.

Prue Cormie, PhD, a physiologist who is the founder of the Australian nonprofit EX-MED Cancer, says in a webinar called “Exercise and Cancer” that exercise should be included in treatment plans for people with cancer. “If the effects of exercise could be encapsulated into a pill, it would be demanded by every single cancer patient. It would be prescribed by every single cancer doctor,” Cormie says.

The hitch, though, is that finding time and motivation for activities like walking and yoga – especially when facing fatigue and other complications of cancer treatment – is not as easy as popping a pill. “The sad fact is that we can’t just ‘take’ exercise,” Cormie says. “We have to do exercise.”

Of course, you need to check with your doctor about choosing exercises and the intensity of your workout plans.

Some studies have shown exercise can boost the activity of parts of the immune system that target cancer. Previous research on this question had mixed results.

Exercise Should Fit Your Needs

A study in South Korea looked at results of a small supervised exercise program for women after surgery for ovarian cancer. Some women attended the exercise program at the hospital, doing aerobics as well as walking, and even eventually doing light jogging. Others did not exercise. Researchers found that the body weight and fat mass of the exercise group dropped by more than 5%, while it rose 4.6% for the group that didn’t exercise. They also said they found evidence that exercise could boost parts of the immune system linked to fight the survival and spread of tumors. This is a small study, but the finding is consistent with other research that has linked exercise to better immune response in people who have cancer.

The exercise program in this study was adapted for each person’s needs. For instance, women whose cancer had spread to bones were told to avoid resistance training with heavy weights.

Heather Leach, PhD, a Colorado State University researcher who runs the Fitness Therapy for Cancer Program (FIT Cancer), also emphasizes the need to tailor exercise to people’s needs. In a recorded session from the 2021 Ovarian Cancer Research Alliance national meeting, she says it’s OK to ease back a bit on exercise temporarily if your fatigue increases.

Jocelyn Chapman, MD, a gynecologic cancer surgeon and assistant professor of gynecologic oncology at the University of California, San Francisco, says exercises that target abdominal muscles should be avoided as you’re recovering from surgery. But Chapman says she encourages women fighting ovarian cancer to continue to be active because exercise can help them manage the stresses involved with a cancer diagnosis. “Exercise is an important part of healing and although patients might feel weakened, I do encourage them to start back slowly into an exercise routine,” Chapman says.

The American College of Sports Medicine (ACSM) says people with cancer should take realistic steps toward boosting their physical activity. Start with simple steps, such as a few laps around the kitchen table, walking your dog, or walking to the mailbox. The group gives the advice: “Start where you are. Use what you have. Do what you can.”

ACSM recommends asking your doctor about limitations you may face because of your treatments, medications, and complications.

In addition, the ACSM says you have to take into account side effects from cancer treatment and how they might affect your ability to exercise. If you have an increased risk for infections, for example, you may want to avoid swimming pools. If you have peripheral neuropathy you should be careful walking on treadmills and use handrails.

The ACSM also recommends finding a buddy to make exercise more fun.

Walking Is Just One Helpful Exercise

Walking is a go-to component of most exercise programs. There are other options, too, after an ovarian cancer diagnosis:

  • Tai chi. This offers a combination of benefits for the mind and body. It involves many slow deliberate movements. These movements can provide a gentle way to tone muscles, focus on breathing and posture, and reduce stress. Tai chi evolved from an ancient Chinese martial art. It uses a focal point for meditation just below the navel. The idea is that from that focal point “chi” – a vital energy or life force – flows throughout the body.
  • Yoga. There are many different kinds of yoga, but they share basic features: physical movement, breathing exercises, and meditation to make a connection between the mind, body, and spirit. An average yoga session may last between 20 minutes and 1 hour. You can practice yoga at home without an instructor. But if you’re new to it, you can start with classes at a yoga center, community center, or health club.
  • Water activities. Swimming and water exercise classes are gentle, low-impact exercises you can do as you’re recovering. Just make sure you don’t have any kind of skin irritation or sores when you get in the pool. And to be on the safe side, rinse off when you get out.

For most women, walking and simple aerobics are enough. Dmitriy Zamarin, MD, PhD, a medical oncologist at Memorial Sloan Kettering Cancer Center, says he will recommend weight-bearing exercises that can reduce the risk of osteoporosis. But he cautions, "Before initiation of weight-bearing exercises I typically recommend for the patients to discuss with their surgeons to ensure that their wounds have healed and that weight-bearing exercises would not predispose them to development of hernia."

Zamarian also says jogging, running, and biking are excellent options. Plus, these exercises can have a positive impact on cardiovascular health.

Sun, 24 Jul 2022 12:00:00 -0500 en text/html https://www.webmd.com/ovarian-cancer/ovarian-cancer-and-exercise
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