Contents

Search

aerobic exercise (endurance exercise)

Benefits: 1) cardiovascular a) myocardium - increased stroke volume & cardiac output - decreased myocardial oxygen demand at rest - increased tolerance for a given workload - maximum heart rate is unresponsive - age-related early diastolic dysfunction is unresponsive b) peripheral vasculature - increased capillary blood flow - decreased peripheral vascular resistance - decreased resting blood pressure - slower progression of atherosclerosis - benefit may not be apparent in patients on statin - see DNASCO study - increased telomerase activity in endothelial cells; a presumptive benefit [5] c) oxygen-carrying capacity - increased blood volume & hemoglobin - enhanced muscular uptake of oxygen d) improves cerebrovascular outcomes [11] 2) musculoskeletal a) muscle/tendon - increased blood flow to muscle - increased muscle strength - increased tolerance for a given workload b) bones & joints - increased bone mass with weight-bearing exercise - increased blood flow to synovium 3) metabolic & endocrine a) glucose metabolism - increased muscle utilization of glucose (non insulin-dependent transport) - decreased blood glucose levels b) lipid metabolism - increased utilization of triglycerides - increased levels of HDL cholesterol - decreased levels of total cholesterol - improved overall lipid profile 4) obstetric & gynecologic a) labor & delivery - improved tolerance of labor - shortened 1st & 2nd stages of labor b) attenuation of dysmenorrhea 5) neurologic - increases size of hippocampus - improves memory in elderly [6] - aerobic exercise improves executive function in adults (20-67 years), with older adults seeing greater improvements [10] 6) more vigorous activity associated with lower risk [3] Adverse effects: 1) cardiovascular a) patients with ischemic heart disease - angina - ischemia - arrhythmia - long-term endurance exercise may increase risk of atrial fibrillation (2-10 fold risk) due to left ventricular hypertrophy -> left atrial enlargement [4,9] - long-term endurance exercise may increase risk of coronary atherosclerosis [12] b) patients with structural heart disease - hypertrophic cardiomyopathy - sudden death due to arrhythmia - aortic dissection - Marfan's syndrome 2) musculoskeletal a) muscle soreness b) traumatic injury - strains - contusions 3) overuse injuries 3) metabolic & endocrine - increased autonomic activity with exercise in patients with diabetes & thyroid disease 4) obstetric - decreased exercise tolerance near term of pregnancy - decreased uterine blood flow during exercise - thermal stress on fetal development - uterine contraction after exercise may increase risk of,premature labor - risk to fetus with high-intensity exercise 5) gynecologic - amenorrhea - occurs only with combination of intense exercise & weight loss (< 10% body fat) - may increase risk of osteoporosis & stress fractures 6) psychologic - obsessive-compulsive disorder - anorexia equivalent Management: Modified programs for particular health conditions: 1) cardiovascular disease a) stable angina - exercise 5-10 beats/min below ischemic threshold - use nitroglycerin - supervised exercise program b) hypertension - avoid isometric exercise - low resistance exercise c) valvular disease - mild to moderate exercise after valve repair - anticoagulants - no contact sports d) peripheral vascular disease - claudication may limit exercise - walk until onset of pain, rest, resume - exercise increases functional capacity e) cardiac medications - beta blockers blunt heart rate - diuretics may increase risk of dehydration -loop diuretics may increase risk of hypokalemia & muscle cramps 2) pulmonary disease a) COPD: exercise improves functional capacity b) exercise-induced asthma - worse in cold weather - worse in dry air - pre-exercise cromolyn or beta-adrenergic agonist inhaler (Albuterol MDI) may be indicated 3) musculoskeletal disability a) arthritis - swimming & non weight-bearing exercise may be preferred - stretching & range of motion exercises b) spinal cord injury - wheel chair sports - arm exercises have higher oxygen consumption & lower muscular efficiency than leg exercises 4) metabolic & endocrine disorders a) diabetes - type I: adjust insulin, exercise to avoid hypoglycemia - type II - proper foot care - no ballistic exercises with retinopathy b) obesity: start with lower intensity to minimize musculo-skeletal injury 5) pregnancy a) avoid exercise in patients with: - vaginal bleeding - history of premature delivery - incompetent cervix b) avoid exercise in supine position after 20th week of pregnancy c) avoid core temperature > 102 F (39 C) Comparative biology: - neurogenesis of dentate granule cells in adult Sprague Dawley rats is increased by sustained aerobic exercise [8]

Related

age-related physiological changes exercise prescribing (counseling) exercise stress testing physical conditioning (training)

General

exercise

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 224-26
  2. Journal Watch 22(17):137, 2002 US Preventive Services Task Force, Ann Intern Med 137:205, 2002 Eden KB et al, Ann Intern Med 137:208, 2002
  3. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
  4. Mont L et al Endurance sport practice as a risk factor for atrial fibrillation and atrial flutter Europace 2009 11(1):11-17 PMID: 18988654 doi:10.1093/europace/eun289
  5. Werner C et al Physical exercise prevents cellular senescence in circulating leukocytes and in the vessel wall. Circulation 2009 Dec 15; 120:2438 PMID: 19948976 http://dx.doi.org/10.1161/CIRCULATIONAHA.109.861005
  6. Erickson KI et al. Exercise training increases size of hippocampus and improves memory. Proc Natl Acad Sci U S A 2011 Feb 15; 108:3017. PMID: 21282661
  7. Physical Activity and Cardiovascular Health: Consensus Statement http://consensus.nih.gov/cons/101/101_intro.htm
  8. Nokia MS et al. Physical exercise increases adult hippocampal neurogenesis in male rats provided it is aerobic and sustained. J Physiol 2016 Feb 4; PMID: 26844666 Free Article
  9. Mohanty S, Mohanty P, Tamaki M et al Differential Association of Exercise Intensity With Risk of Atrial Fibrillation in Men and Women: Evidence from a Meta- Analysis. J Cardiovasc Electrophysiol. 2016 Sep;27(9):1021-9. PMID: 27245609
  10. George J Aerobic Exercise Boosts Cognition in Younger Adults. Benefits seen in people as young as 20. MedPage Today. Jan 31, 2019 https://www.medpagetoday.com/neurology/generalneurology/77752 - Stern Y, MacKay-Brandt A, Lee S et al. Effect of aerobic exercise on cognition in younger adults: A randomized clinical trial. Neurology 2019 Jan 30; 92:e905 PMID: 30700591 https://n.neurology.org/content/92/9/e905
  11. Guadagni V, Drogos LL, Tyndall AV et al. Aerobic exercise improves cognition and cerebrovascular regulation in older adults. Neurology 2020 May 26; 94:e2245 PMID: 32404355 https://n.neurology.org/content/94/21/e2245
  12. Hughes S Endurance Exercise Tied to More Coronary Atherosclerosis. Medscape. March 10, 2022 ttps://www.medscape.com/viewarticle/989475 - De Bosscher R, Dausin C, Claus P et al Lifelong endurance exercise and its relation with coronary atherosclerosis. Eur Heart J. 2023 Mar 6:ehad152 PMID: 36881712 https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehad152/7069916