Test, Predict & Prevent Heart Disease, Type II Diabetes & Life Expectancy

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In May, 2011 the Journal of the American College of Cardiology reported on two separate studies conducted by UT Southwestern Medical School Researchers that how fast a patient could complete the One-Mile Walk/Jog/Run Test is the most accurate predictor of dying from heart disease. Also CIRCULATION reported on a study of over 66, 000 people, fitness level lowered lifetime risk, even in people with other risk factors. Researchers analyzed the Heart Disease risk at various age groups: 45, 55 and 65 years old. Fitness level was found to be the most accurate predictor of premature death from Heart Disease…far more accurate than “traditional” risk factors such as age, systolic BP, diabetes, total cholesterol, smoking, etc. 55 year old men who could walk a mile at 15 minutes had a 30% lifetime risk of HD while 55 year olds who could jog a mile in 8 minutes had a 10% risk! In a completely separate study, smokers who exercised had a 30% decrease in mortality compared to smokers who did not. Heart Disease is the #1 Killer Worldwide. EBM to Prevent and Treat Type II Diabetes A study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM) found that the greater an individual’s total muscle mass, the lower the person’s risk of having insulin resistance, the major precursor of type II diabetes. With recent dramatic increases in obesity worldwide, the prevalence of diabetes, a major source of cardiovascular morbidity, is expected to accelerate. Insulin resistance, which can raise blood glucose levels above the normal range, is a major factor that contributes to the development of diabetes. Previous studies have shown that very low muscle mass is a risk factor for insulin resistance, but until now, no study has examined whether increasing muscle mass to average and above average levels, independent of obesity levels, would lead to improved blood glucose regulation. “Our findings represent a departure from the usual focus of clinicians, and their patients, on just losing weight to improve metabolic health,” said the study’s senior author, Preethi Srikanthan, MD, of the University of California, Los Angeles (UCLA). “Instead, this research suggests a role for maintaining fitness and building muscle. This is a welcome message for many overweight patients who experience difficulty in achieving weight loss, as any effort to get moving and keep fit should be seen as laudable and contributing to metabolic change.” In this study, researchers examined the association of skeletal muscle mass with insulin resistance and blood glucose metabolism disorders in a nationally representative sample of 13,644 individuals. Participants were older than 20 years, non-pregnant and weighed more than 35 kg. The study demonstrated that higher muscle mass (relative to body size) is associated with better insulin sensitivity and lower risk of pre- or overt diabetes. “Our research shows that beyond monitoring changes in waist circumference or BMI, we should also be monitoring muscle mass,” Srikanthan concluded. “Further research is needed to determine the nature and duration of exercise interventions required to improve insulin sensitivity and glucose metabolism in at-risk individuals.” Also working on the study was Arun Karlamangla, PhD, MD, of the David Geffen School of Medicine at UCLA. The article, “Relative muscle mass is inversely associated with insulin resistance and pre-diabetes. Findings from The Third National Health and Nutrition Examination Survey,” appears in the September 2011 issue of JCEM. The Journal of the American Medical Assoc. (JAMA) reported on the role of GAIT SPPED in the Assessment of Older Patients (JAMA, 2011: 305(1): 93-94). “Their findings from a pooled analysis of 9 major cohort studies confirm gait speed as a predictor of mortality in older persons and also provide the statistical foundations to estimate expected survival at different ages based only on gait speed.” This is HUGE! The charts below not only provide evidenced based medicine of the efficacy of fitness training, but also present high hope that improving GAIT SPEED should also significantly improve longevity! GaitSpeed1 Gaitspeed2   There is more and more EBM coming out daily on the superiority of exercise and nutrition prescriptions over all other medical protocols for the treatment of chronic diseases. Even psychiatrists, who you would suspect would be the last doctors to give up drug therapies are providing EBM on the superiority of exercise prescriptions over drug therapies in treating Psychological diseases such as anxiety, depression, moodiness and stress management. From the Cardiovascular Diseases such as: Congestive Heart Failure, Hypertension, Atherosclerosis, Hypercholesterolemia, Cardiomyopathy and Coronary Heart Disease; to the Musculoskeletal disorders such as chronic back pain, Osteoarthritis, Bone Fractures and connective tissue tears; to the Pulmonary Diseases such as: Asthma, Chronic Bronchitis and Emphysema; to Cancers such as: Breast, Colon, Lung and Prostate; to the Metabolic Disorders such as: Overweight, Over-fat, Metabolic Syndrome, Diabetes and Obesity more and more doctors are realizing that drug therapies are woefully inadequate as effective protocols.  How do you write an exercise prescription? Exercise prescriptions are based on 4 factors:

  1. Frequency – Number of Sessions/week or day.
  2. Intensity – Based on a percent of effort on the targeted Component of Fitness. For example: % of Maximal Heart Rate: If the patients MHR is 200bpm, and the prescription for their condition*[1] requires 60% of MHR, then their HR during training would be 120bpm.
  3. Time – The amount of time spent in active training
  4. Type – Type of modality, program, prescription, etc.

Exercise Prescription to Prevent Cardiovascular Disease (Aerobic Endurance Component)

  1. Frequency – 6 or 7 days/week
  2. Intensity – 60-70% MHR or 12-13 RPE (RPE 6-20 Scale)
  3. Time – 20-60mins
  4. Type – Recumbent Bike

Depending on the patients’ disorder, multiple Components of Fitness may be required. For example: Diabetes requires exercise prescriptions for the Primary 5 Components of Fitness, very specific nutrition prescriptions and potential use of various non-invasive sports medicine protocols. [1] FIISM Protocols set intensity criteria based on the patient’s disorder and seriousness/critical nature of their condition. Often RPE (Rate of Perceived Exertion) is recommended instead of HR.

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