PHTH 652: Integrated Clinical Exercise Rehabilitation

Definitions, benefits of exercise and physical activity,

impact of physical inactivity, burden of chronic conditions,
barrier to PA

Aug. 31st, 2023

Tania Janaudis-Ferreira, BSc(PT), MSc, PhD

Information Sources: ACSM Guidelines + Exercise Literature

 Today’s Outline

• Definition of terms related to exercise and

physical activity

• Benefits of exercise and risks of physical

inactivity

• Burden of chronic diseases

• Barriers to PA
 Sort the following terms into categories

•Rolling in bed • Bowling

•Running in the park for 30 min • 2 sets of Bicep curls
•Playing a game of tag • Taking the stairs
•Wheeling to bus stop in a • Walking with crutches
wheelchair • Swimming laps
•Walking to work • Swimming with kids in a
•Gardening backyard pool
•Yoga class • Transfer from chair to
•Playing active video game standing
• Playing ultimate Frisbee
 Three category labels
•movement/mobility

•physical activity Adjust your

groupings

•exercise
 Definitions related to Physical Activity

Movement/mobility/functional mobility
• change in the position of the body and its components; for
the purpose of changing location of the body.
Physical activity:
• Any form of body movement generated by skeletal muscle
contraction that results in a significant metabolic demand
and energy expenditure. Includes occupational, leisure,
sports, fitness, household, or other activities.
Exercise:
• Planned and purposeful physical activity with repetitive
bodily movement done for health and fitness pursuits.
 Sort the following terms into categories

Movement/Mobility: Physical Activity:

• Rolling in bed • Bowling
• Transfer from chair to standing • Playing a game of tag
• Wheeling to bus stop in a • Taking the stairs
wheelchair • Swimming with kids in a
• Walking with crutches backyard pool
Exercise • Playing ultimate Frisbee
• Running in the park for 30 min • Walking to work
• 2 sets of Bicep curls
• Gardening
• Swimming laps
• Playing active video game
• Yoga class
 Definitions related to Physical Activity

Physical fitness:
• A set of attributes or characteristics that individuals have or
achieve that relates to their ability to perform physical
activity

• These characteristics are usually separated into health-

related and skill-related components of physical fitness
 Components of Physical Fitness

HEALTH-RELATED SKILL-RELATED

http://i.ytimg.com/vi/AMTz87LckUA/hq
https://www.csustan.edu/stan-recreation/ default.jpg
fitness
 Components of Physical Fitness
Definitions: HEALTH-RELATED PHYSICAL FITNESS COMPONENTS

• Cardiorespiratory endurance: The ability of the circulatory and respiratory

system to supply oxygen during sustained physical activity.
• Muscular strength: The ability of muscle to exert force.
• Muscular endurance: The ability of muscle to continue to perform without
fatigue.
• Flexibility: The range of motion available at a joint.
• Body composition: The relative amounts of muscle, fat, bone, and other
vital parts of the body.
These components are addressed by aerobic, strength and flexibility
exercises
 Components of Physical Fitness
Definitions: SKILL-RELATED PHYSICAL FITNESS COMPONENTS

• Agility: The ability to change the position of the body in space with speed
and accuracy
• Coordination: The ability to use the senses, such as sight and hearing
together with body parts in performing tasks smoothly and accurately
• Balance: The maintenance of equilibrium while stationary or moving
• Power: The ability or rate at which one can perform work
• Reaction time: The time elapsed between stimulation and the beginning
of the reaction to it
• Speed: The ability to perform a movement within a short period of time
Physical Activity Guidelines
 Canadian 24-hour Movement Guidelines

Get the guidelines: www.csep.ca 12

 Canadian 24-Hour Movement Guidelines : An
Integration of Physical Activity, Sedentary Behaviour,
and Sleep (CSEP)
• These guidelines are unique because they don’t just focus on
a single movement behaviour, but instead look at how all
these integrate together

• There are three core recommendations to keep in mind:

 Move More – including moderate to vigorous physical activity, but for
the first time the guidelines call out that light physical activity,
including standing, matter too
 Reduce Sedentary Time
 Sleep Well
 
 Adults aged 18-64 years

https://csepguidelines.ca/guidelines/adults-18-64/
 Aged 65 years and older

https://csepguidelines.ca/guidelines/adults-65/
 Recommendations
• Replacing sedentary behaviour with additional physical
activity and trading light physical activity for more moderate
to vigorous physical activity, while preserving sufficient sleep,
can provide greater health benefits

• These Guidelines may not be appropriate for adults aged 18

and older who are pregnant or persons living with a disability
or a medical condition; these individuals should consider
consulting the Get Active Questionnaire, disability/condition-
specific recommendations, or a health professional for
guidance.
How active are Canadians?
 Physical Activity among Canadians
•~ 15% of Canadian adults meet physical activity guidelines for MVPA
(moderate to vigorous physical activity)
– majority spend most of their waking hours in sedentary activities (avg
9.5 hrs per day, 69% of waking hrs)
– Women slightly less active than men (14% vs 17% meet guidelines,
respectively)
•7% of children and youth meet physical activity guidelines
– 8 hrs per day (62%) in sedentary activity

Source: Canadian Health Measures Survey 2007-

2009; Colley et al. 2011a; 2011b 18
 Dose-response relationship
between physical activity and health

Type and amount of activity

http://www.humankinetics.com/excerpts/excerpts/physical-activity-guidelines

The more the better!

Increasing benefits from increasing amounts (expressed in
frequency, duration and intensity) of activity

Watch for risks and harms – to minimize harm, PA can be performed in

bouts!
 Dose-response relationship
between physical activity and health
!
urse!
is co
I n th

Type and amount of activity

http://www.humankinetics.com/excerpts/excerpts/physical-activity-guidelines

The more the better!

Increasing benefits from increasing amounts (expressed in
frequency, duration and intensity) of activity

Watch for risks and harms – to minimize harm, PA can be performed in

bouts!
Any physical activity Less time spent sedentary
regardless of intensity is associated is reduced
is associated with lower risk of mortality
risk of mortality
 What are the health benefits of regular PA
and/or Exercise?
Physical activity is associated with
 Improved diabetic control
 Improved hypertension control
 Improved lipid profile
 Improved musculoskeletal health
 Improved psychological well-being
 Improved health-related quality of life
 Weight reduction
 Reduction of all cause mortality
 Reduction of cardiovascular events
 Reduced health care utilization

Box 1.4 , Page 10; ACSM guidelines

Effects of Physical Inactivity
 Estimate of the intensity of physical
inactivity per unit of time
Sitting:
High intensity of inactivity -low intensity of inactivity
-Health decrements appear within days!! -Not clinically apparent within days
-Unhealthy when appearing after
many years

Booth et al. 2017

Understanding the link between physical inactivity
and chronic diseases

Parents provide genes and

lifestyle/environment (also provided by public
health)

Physical inactivity interacts with genes to

produce pathophysiology

Pathophysiology interacts with risk factors

(smoking, unhealthy diet, physical inactivity)
and establish the probability for chronic disease
and mortality

Booth et al. 2017

 What can we change??

Booth et al. 2017

Physical Inactivity as a major
cause of chronic diseases
Interactions of
physical inactivity with
different systems in
the body

Populations we will study in the course!!

Booth et al. 2017

 The burden of chronic diseases
• Chronic disease management has been identified as a key health system
concern among developed countries given the rising prevalence and
burden of chronic illness

• According to the World Health Organization, chronic diseases have

reached epidemic proportions and constitute the leading causes of death
in the world

• In Canada, 74% of individuals aged 65+ reported having one or more of 11

chronic conditions in 2008

• Statistics Canada. Tables by subject: Diseases and health conditions. http:// www.statcan.gc.ca/tables-tableaux/sum-som/l01/ind01/l3_2966_1887- eng.htm?hili_health03. Accessed July
2nd 2014.
• The Chief Public Health Officer. Annual Report on the State of Public Health in Canada, 2010. Ottawa: Public Health Agency of Canada; 2010.
• World Health Organization. Global status report on noncommunicable diseases. Geneva: WHO; 2010.
• Canadian Institute for Health Information. Seniors and the health care system: what is the impact of multiple Chronic Conditions? Toronto: CIHI; 2011.
• Koné Pefoyo et al. BMC Public Health (2015) 15:415 . The increasing burden and complexity of multimorbidity
 The burden of chronic diseases
• Improvements in survival and an aging population are two
key reasons that the prevalence of chronic disease is rising

• The likelihood of living with more than one condition are

expected to continue to rise in the future

• Several lifestyle factors, including tobacco use, physical

inactivity, harmful use of alcohol and unhealthy diet have
been identified as important contributors to the incidence of
chronic diseases and multimorbidity
 OP
T2DM
T2DM
OP
T2DM
COPD
COPD
HT

HT OA
OA Multimorbidity
 co-existence of > 2 chronic
Comorbidity
 > 1 additional disorders co-occurring conditions in the same
individual
with a primary disorder, which in
 without reference to a
this case is COPD
 pre-supposes that one condition is primary condition
‘primary’ and remains so over time
Slide created by Dr. Dina Brooks
 Canadian Study (Ontario)
• The prevalence of multimorbidity among Ontarians rose
from 17.4% in 2003 to 24.3% in 2009, a 40% increase.

• This increase over time was evident across all age groups.
Within individual chronic conditions, multimorbidity rates
ranged from 44% to 99%.

• There were no dominant patterns of co-occurring conditions.

• Koné Pefoyo et al. BMC Public Health (2015) 15:415 . The increasing burden and complexity of
multimorbidity
Barriers to PA/Exercise
 Barriers to PA/Exercise
• Given the health benefits of regular physical activity, we
might ask why 85% of the adult Canadians are not active at
recommended levels

• There are barriers that keep Canadians from being, or

becoming, physically active regularly

• Understanding common barriers to PA and creating

strategies to overcome them may help make PA part of daily
life
 Barriers to PA/Exercise
• People/Patients encounter many personal
and environmental barriers to PA
• What are some common personal barriers?
• What are some common environmental
barriers?
 Some common personal barriers
• Insufficient time to exercise
• Inconvenience of exercise
• Lack of self-motivation
• Non-enjoyment of exercise
• Boredom with exercise
• Lack of confidence in their ability to be physically active (low self-efficacy)
• Fear of being injured or having been injured recently
• Lack of self-management skills, such as the ability to set personal goals,
monitor progress, or reward progress toward such goals
• Lack of encouragement, support, or companionship from family and
friends
 Environmental factors
• Non-availability of parks, sidewalks, bicycle trails, or
safe and pleasant walking paths close to home or
the workplace
• Traffic, availability of public transportation, crime,
pollution
• Cost
• Unsuitable programs
 In-class activity
• Overcoming barriers
23 ½ HOURS A DAY: THE SINGLE BEST
THING WE CAN DO FOR OUR HEALTH

http://www.youtube.com/watch?v=aUaInS6HIGo

38
Questions?