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Heart Disease

  • If you can't get patients to exercise, they have little hope of a functional life
    • Legs are the main source of insulin sensitivity
  • We're eating highly processed food that takes not very much energy to metabolise. It also lacks nutrients e.g. antioxidants
  • 40% of people don't do enough exercise
    • People who don't exercise have far more problems than obesity
    • You need to sweat
  • 50% less diabetes, heart disease, colon cancer etc due to being a consistent runner
  • Visceral fat driving heart disease + diabetes (that's the main driver)
  • BMI cutoff for
    • Asians: 23
    • European: 25
  • Average salary of a cardiologist in Sydney is $1.5 million (???)

Epidemiology

  • 40% of deaths
  • 22% coronary artery disease
  • 80% adults have at least one RF (inactivity, smoking, BP, overweight)
  • 12% of health budget 12% of health budget
  • less than 1% on prevention
  • 90% HD thought preventable 90% HD thought preventable
  • one third die within one year

CAD Risk Factors

Prevalence of CAD risk factors

  • Smoking 23%
  • Hypertension 25%
  • Hypercholesterolemia 33%
  • Obesity 20%
  • Physical inactivity 60% (= doing nothing at all)
    • But walking the dog isn't enough
    • We need to do really vigorous exercise
  • Interval sprinting is one of the best
    • Visceral obesity is not benign; but other obesity is benign
  • Visceral fat = that you cannot feel
  • People who are obese are largely because of the fat cells being
  • Runner: RBC lasts only 2 months. Liver cells last a month.
    • Fat cell lasts 8-10 years; they produce over 30 cytokines and chemicals (including leptin). Fat cells produce leptin to tell you that you're full. Fat people are leptin resistant
    • Gastric banding is the best way to lose fat.
  • 80% of overweight children go on to be obese.
  • Visceral fat is inside muscle and liver, epicardium in heart, skeletal muscle. Get rid of that fat = glycogen depleting exercise
  • People who do enough regular physical exercise have 1/2 the chance of everything basically
  • Obese people who exercise have 50% of the risk of death as obese non fit person
  • Also fit people have much better prognosis after stenting
    • Being fit is greatly beneficial to your health - don't know the mechanisms

Exericise & CAD

  • coronary arteries
  • catecholamines
  • cardiac efficiency
  • inflammatory proteins
  • HDL, trigs
  • hypertension
  • weight loss
  • coronary collaterals
  • visceral fat

Exercise affects all of these

Summary

  • healthy exercisers have reduced risk of CHD
  • those with disease, who exercise, have reduced CHD risk
  • exercise is as important as any other risk factor (far more important than all the others)
  • mechanisms undetermined

Hypertension

  • Very difficult to cure blood pressure problems - they don't get rid of it

Epidemiology

  • 28.6% of Australians over 25 yrs have hypertension
  • by old age 2/3 have hypertension
  • about 65% of diabetics have hypertension
  • about 65% of obese have hypertension
  • expensive drug therapies

You never cure obesity/diabetes once they've had it for a long time - once they've aged, they get stuck in their routine (better to get it early)

  • They add a lot of fructose to Australian chocolate - extremely dangerous

Risk Factors

  • Diets high in salt and alcohol
  • Low potassium in diet (fruits, vegetables)
  • Obesity
  • Being elderly
  • Being a Black American, or Japanese
  • Being sedentary
  • Best way to treat the hypertension is to lose the visceral fat
  • There are both acute and chronic effects causing reduced MAP after exercise
    • MAP = Diastolic + PP/3 = Diastolic + (Systolic-Diastolic)/3
      • Systole is only 1/3 of the diastolic pressure
  • During the exercise, systolic increases linearly, then over time it
  • Weights is not good for fat loss
  • When you do weights, you have to rest, so you only do 10 minutes in 60 minutes -- pressure loads the heart
    • In running, you do 60 minutes of exercise in 60 minutes -- volume loads the heart
  • Running, you feel better after it because your BP goes down
  • Hypertension - BP zooms up high (dangerous), but acutely, it lowers the BP (as good as any drug)
  • Pulse pressure shouldn't be >60
    • High diastolic with high systolic is a lot safer than low diastolic with high systolic
  • Pulse pressure high = the failing heart (it's weaker)

Exercise and Hypertension

  • blood vessels relaxation
  • exercise chemicals (lactate, NO)
  • decreased SNS outflow
  • change in hormones
  • change in receptor sensitivity

Same with blood pressure - homeostatic mechanisms (still unknown; certainly the vasodilatory actions of NO and sympathetic NS)

Summary

  • chronic aerobic exercise reduces 4-6 mmHg for SBP and DBP
  • chronic resistance exercise reduces 2-3mmHg for SBP and DBP
  • acute exercise lowers BP in hypertensives
  • Mechanisms undetermined

Diabetes

  • Don't know how many it's killing - people usually write cause of death as "heart attack" etc

Epidemiology

  • 8% adults have diabetes
  • leading cause of: blindness, kidney disease
  • neuropathy, amputations
  • 6th cause of death
  • over 1,000,000 in Australia
  • 50% may be unaware
  • >15 mmol/L hyperglycaemic
  • 4-5 mmol/L normal
  • <3 mmol/L hypoglycaemic
  • world's fastest growing disease

Risk Factors

90% of DM is T2DM, the other is T1DM (could be lean)

  • heredity
  • viruses
  • obesity
  • inactivity
  • diet
  • ageing
  • endocrine disorders
  • drugs
  • pancreatic disease
  • stress

The only two things that get glucose out of the blood: insulin and glucose

  • Snacking = high insulin levels = pancreatic exhaustion
  • HbA1c shouldn't be >7% - tells you how the patient has controlled their glucose for 3 months (lifecycle = 120 days for red blood cell)
    • Reducing from 7% to 6.2% = huge
      • Need moderately hard weight training, 3 times a week
  • Strong person = better function in all areas
    • Sarcopenia = you lose muscle cells over time. 30% of weight loss in dieting is muscle, then when you put the weight back on (90% do), you replace the muscle with fat.
  • Sprinting is far more impactful on T2DM and visceral obesity than aerobic exercise is.
  • Visceral fat = omental and mesenteric
    • Sprinting = lose subcutaneous fat by 5%; visceral fat decreases by 17%. This visceral fat has 10x more catecholamine receptors
      • This fat is used up only when you have glycogen depleting
  • Dieting does not impact the visceral fat; exercise carries on reducing it
    • You need to eat properly as well, because there are nutrients that will negate fat burning
  • Look up abdominal sagittal diameter
    • You do a skin fold, a waist diameter and an abdominal-sagittal diameter to see the change in fat over time.
  • Waist circumference = 0.8-0.9 correlation with fat scans.
    • Can also use DEXA

Exercise and Diabetes

  • increased insulin sensitivity
  • decreased amines, glucagon
  • improved blood glucose control
  • controls weight and appetite

Summary

  • exercisers have less type 2 diabetes
  • aerobic exercise reduces insulin resistance
  • resistance exercise reduces insulin resistance
  • LifeSprints exercise reduces insulin resistance
  • HbA1c is reduced by about .8%
  • mechanisms undetermined

Cancer

Epidemiology

  • 1 in 3 men have cancer 1 in 3 men have cancer
  • 1 in 4 women have cancer
  • 80 000 new cases each year 80,000 new cases each year
  • 28% of deaths in men
  • 24% deaths in women
  • men: lung, prostate, bowel
  • women: breast, cervical, lung

Risk Factors: Colon Cancer

  • family history
  • high fat, low fibre diet
  • inactivity
  • sitting for long periods

Risk Factors: Breast Cancer

  • never had children
  • late age of first birth
  • high education
  • early age of menarche
  • being lean
    • Only applies to premenopausal women
    • People before menopause = lean increases risk of cancer

Overweight women who are young produce far less E than skinny young women ==> E is anabolic. After menopause, you get far less E from ovaries, so overweight doesn't help them (it harms them)

Exercise and cancer

  • Increased peristalsis (colon cancer) - less likely to have carcinogens sitting in your system for a long time
  • reduced reproductive hormones (breast cancer)
    • runners become amennorrhoeic
      • but increases risk of osteoporosis (e.g. 19 year old women who have never menstruated, in the olympics)

Summary

  • those who aerobically exercise have less those who aerobically exercise have less incidence of colon and breast cancer
  • some support for reduction in lung and prostate
  • mechanisms undetermined
    • peristalsis
    • reproductive hormones

remember 50% reduction