A joint Faculty of the Royal College of Physicians of Ireland (RCPI) and the Royal College of Surgeons in Ireland (RCSI)

Exercise as part of a Healthy Lifestyle Dr Laurence J Conway Sports and Exercise Medicine Specialist.

FSEM RCSI &RCPI

Humans • Hunter gatherer • Brain development required energy • Hunter survived because of endurance

Where has evolution led us?

Where has evolution led us?

• Lessons from the aboriginal people of Australia • Less Hunting/more gathering due supply

Where are we today?

• What is Best indicator risk of death in next 10 years?

Where are we today?

• What is Best predictor of mortality risk in next 10 years?

• Exercise Capacity = Aerobic capacity

Exercise is the best medicine

Relative Risk of CVD

1 0.8

1.0

0.6

0.4

0.68

0.37

0.33

0.2

0

0 1-59 min 1.0-1.5 h >2h Time Spent Walking per Week

Mansoon JAMA, 2001, 285:1447

First 15 minutes of Exercise per day • 3 year increase in Life expectancy • First 15min/day: there is 14% reduction all causes

mortality

• Every extra 15 min/day there is a further extra 4% reduction mortality

Exercise = Treatment and Prevention • • • • Dose = Intensity + Duration Frequency = Frequency Treatment is life long Risk Benefit ratio • Side effects

How do we Reduce risk?

• • • • • • • • • Start at realistic level Build up slowly Exercise should be FUN As a group or on own Warm up Cool Down Stretch No intense exercise after meals Medical assessment?

Disease Prevention • • • • • • • • • Cardiovascular disease Diabetes Mellitus Cancers Obesity Bone Health Mood/stress Immune function Cognitive function Mobility / risk falls

Treatment • • • • • • • • • • • • Heart or Vascular Disease.

High Blood Pressure Cholesterol Obesity Diabetes Mellitus Cancers Osteoarthritis Osteoporosis Respiratory illness Mood Cognitive Function Neurological Disorders

Exercise; the Cost Benefit ratio • • • • • • Effective Low Cost Effects multiple related problems Prevention other disease Quality of Life benefit Socialisation of isolated • Dose tailored to individual

No Physical Exercise During a 7-Day Period

40

Men Women

33 37 30 20 27 21 26 27 21 21 18 17 10 14 11 0 1988

18-34

2002 1988 2002

35-54

1988

55+

2002

Slan Survey 1999

Why are people inactive?

Why are people inactive?

• • • • • • • No Time – – Work Family Cost Lost the Habit Poor motivation/mood due inactivity Health issues Social isolation Hard first few sessions so stop

How do we get message to those that need it the most • How do we change lifestyle • Those that need change are not here

Psychological states of change • • • • Pre contemplation Contemplation.

Preparation Action • Maintenance

Lifestyle • • • • • • • Diet Quantity Quality Timing Hydration Risks Tobacco Leisure drugs Healthy BMI Positive Mental Attitude Rewards in life

7 areas of Investment • • • • • • • Schools Transport Urban Design Health Care Public Education Community Sports for all

• • • • Greater opportunity National Schools Ways to keep girls active through out secondary Insurance issue Develop physical Literacy Curriculum Schools

Transport • • • Walking & Public Transport Cycling Drive children to school

Urban Design • • • New Housing Estates Safe Friendly environment Urban Plan; Green areas Sports Facilities Cycle tracks Local facilities

Health Care • • 47% Primary Care Doctor say they ask about exercise 13% Patients report getting advice about exercise • What can Medical Profession do?

What Can Medical Profession do?

• Ask people about exercise • Give green prescriptions • • Do not tell people to stop exercise Modify where possible

What Can Medical Profession do?

• • • • Educate doctors & student in exercise prescription Increase medical profession awareness Role Models Help remove barriers; – Cost – Time – Educate

Public Education • Media need to have consistent clear message • Irish innovation

National Physical Activity Guidelines ‘Get Ireland Active’ www.getirelandactive.ie

• • • • School Public Private sector Fitness Industry Community

Activity for ALL

Balance life • • • • • Work Life balance We need find place all parts of our life Look Positive Beware of negative thoughts Goal setting

Work Life Balance • Stressors Recovery _____________________________________ Financial Work related Social Health Exercise Sleep Food Social life Rewards Exercise

Health and Quality of life