10. Exercise Is Medicine (2nd half) Flashcards Preview

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4th leading risk factor for global mortality?
- # of deaths per year

physical inactivity
~ 3.2 million


Benefits of regular moderate physical activity (according to WHO)?

control body weight and reduce risk of:
- cardiovascular disease
- diabetes
- colon and breast cancer
- depression
- bone fractures


WHO exercise recommendation?
- how many people reach this

moderate-to-vigorous physical activity
- 150 mins in 10 mins bouts
- only 15% of adults meet this


Exercise pill?
- how it works

- activates AMPK
- artificially tells body there is a demand


Exercise pill - sedentary mouse study (AICAR)
- good + bad

- induced metabolic genes (carb/fat metabolism through AMPK)
- enhanced running endurance

- expensive ($1000 per 10g)
- enlarged liver (weight)


Typical causes / diseases associated with enlarged liver (6)

- excessive alcohol use
- congestive heart failure
- glycogen storage disease
- viral hepatits
- liver cancer
- steatosis (fatty liver)


Effects of exercise
- can drugs do this?

Contracting skeletal muscles elicit a host of metabolic and mechanical signals that contribute to muscle adaptations
- enhanced performance, fibre type conversion, more oxidative phenotype, multiorgan health benefits
- drugs can mimic only some of the benefits

- no single pill will show same benefits of regular exercise


what is Metformin

antidiabetic drug (preventative)
- works through AMPK


AMPK levels in obese/diabetic muscle

- not a problem in obese/diabetic
- viable pharmacological target (improve gluc uptake and FA oxidation)


Study: metformin vs lifestyle modification (diabetes)

- over 4 years
- exercise and follow food pyramid

Improved blood glucose in both lifestyle and metformin
- fasting and glycosylated hemoglobin

Reduced incidence of diabetes
- metformin: 31%
- exercise: 58% (better)


why measure glycosylated hemoglobin?

red blood cells lifespan ~120days
- good "chonic marker"
- blood glucose changes rapidly, not as good chronic marker


Meta-analysis: exercise vs drugs (mortality risk)

No statistical diff b/w drugs and exercvise in CHD and prediabetes

Exercise more effective in stroke

Diuretics more effective than exercise in heart failure


Problems with drug vs exercise studies

evidence on health benefits of exercise smaller than drugs

consider requiring pharmaceutical sponsors of new drugs to "include exercise" in clinical trials
- have control group exercise


Benefits of a single bout of exercise

improve insulin sensitivity and response to high fat meal
- up to 48 hours**

- improve fasting and postprandial (after meal) plasma TAG (markers of CVD risk)
- better response on postprandial than calorie deficit alone
- exercise PRIOR to high fat meal improves response (timing key)
- walking (real-world recommendations)


benefits of regular exercise without weight loss

reduce "visceral" fat
- obese active/fit LOWER risk of heart disease than lean adults sedentary/unfit


Study: obesity vs cardiovascular fitness

- CVD and all cause mortality
- assesed CVD risk factors
- blood cholesterol and glucose, blood pressure, presence of disease (heart disease and diabetes)

normal, overweight and obese
- high cardio fitness, low risk for all
- low cardiovascular fitness, strong and INDEPENDENT predictor of CVD and all cause mortality