I. EXERCISE AND HEALTH A. General 1. 46 % of all deaths are the result of heart or blood vessels 2. 20 years ago it was > 50% B. Terms 1. Arterioschlorosis a. broad generic term b. any condition that results in a thickening or hardening of the walls of the arteries c. this is the underlying facter in about 85% of all CVD deaths d. mechanism is not well agreed upon, except: (1) Injury theory has many followers (a) something (high blood pressure or turbulant flow) causes injury to the intema (b) media adventissia cells travel into the intema and cause i) roughening ii) larger ? (c) the cells responsible for blood clotting bind to this site (d) may cause the production of more smooth muscle cells (e) also collects more triglycerides and cholesterol e. begins early in life (1) need to be concerned with a childs exercise f. can occur in arteries throughout the body (1) in the Heart, called CAD (artery) or CHD (heart) (a) manifests itself as a heart attack (2) if in the brain, => stroke (3) if in other areas of the body, it is refferred to as periferal vascular disease (a) happens often in the lower extremities (b) happens in the carotid arteries g. If in the Heart (1) General (a) just beyond the aortic semilunar valve is the coronaries (R & L) (b) the right main goes to the right atrium and ventricle along the atrioventricular septum (c) the left main is short and it branches into the anterior descending and the circumflex (d) the ant. des. supplies the right and left ventricles and travels down the ventricular septum (e) the circumflex goes around the back following the art-vent septum, supplying the left vent. and atrium (2) Bypass (a) the aorta, which leaves the left ventricle, has a hole made in it into which a vein is sewed in and connected to one of the arteries to bypass a clogged area (3) Angina Pectorlis (a) pain in the pectorial region (b) due to a compromised circulation of the heart (c) result of ischemia i) lack of O2 ii) not enough blod flow (d) occurs when there is 65-70% arterial closure 2. Blod Clots a. made of broken platelets b. is a result of the wall getting rough c. this may cause a blod clot to grow (1) can grow tremendously in hours or minutes d. it may block the whole artery (1) if in the heart, called "Coronary Thrombosis" e. it may break off and float back toward the heart, then go throught the right atrium and ventricles, and then get lodged in the arteries of the lung f. if it is moving in the bloodstream, it is called an "Embolism" C. Detection of CVD 1. EKG a. use a 12 lead EKG to get 12 different pictures of 12 different areas b. may have CVD and still have a normal resting EKG c. for this reason stress EKG's are done (1) or to see the extent of resting EKG abnormalities d. if it is suspected that a subject will be at risk a cardiologist will be present, else just a technician will do it. (1) cardiologist will (a) monitor test (b) terminate the test e. clues to risk (1) ST segment of EKG (a) depression of the ST segment i) the cause is ischemic myocardium a) from plaque in the arteries (b) an upward sloping ST segment is not as bad (2) If the ST segment shows problems, then a coronary angiogram is done (a) a catheter goes up the illiac artery (near the groin-where the aorta divides into the L & R illiac arteries) (b) the catheter is run all the way up to the coronary artery (c) dye is then released into the coronary artery (timed to the pulses of the heart) and then it's flow is watched to see where the constrictions are (3) Angioplasty (a) done instead of bypass surgery (b) the catheter is fed up to the coronary artery again, then a litle balloon on the end of the catheter is blown up for about 60-90 seconds and forces the plaque bach against the artery (like styrofoam being squished- it stays squished for a while) D. Diseases 1. Hypertension (high BP) a. classifications Desireable Mild Moderate Severe SBP < 125 140-149 150-159 160 + DBP < 85 90-104 105-114 115 + b. facts (1) 60,000,000 classified as hypertensive (2) most prevelant CVD (3) 40% of blacks are HT (4) 33% of white males (5) 25% of white females 2. Strokes a. related to high BP, but the arteries are in the brain b. results from (1) atheroschlorosis (2) blod clot (3) aneurism (a) blow out of an artery i) does not have to burst to cause a stroke (b) frequently occurs at the bottom of the aorta just before the split to the illiac arteries II. Risk Factors A. Predetermined (no control over) 1. heredity 2. Age 3. gender a. prior to menopause, females have lower risk (1) 35-44 age group, males are 6 times as likely, due to female hormones b. during the 60's, it equals out c. females (1) smoking is a main causal agent (2) the "pill" is also (a) they both increase tryglycerides and total cholesterol in the blood. (b) they also decrease the HDLC (3) they also work together to cause more damage than each seperately 4. race a. blacks have more chance than whites B. Modifyable risk factors 1. ************** primary risk factors *********** a. smoking (1) 1 pack a day = 70 % greater chance than non smokers (2) 2 packs = 200 % (3) How does smoking do this? (a) Nicotine i) it is a stimulant ii) it increases the amounts of lipids in the blood iii) causes vasoconstriction a) increases BP b) more fats enter the artery walls iv) it increases the irritability of the heart v) more subject to a) ventricular defibulation b) vent. Arrythmeas (b) CO i) makes blood vessel walls more permeable to fats ii) decreases the O2 supply to the heart muscle * if there is lots of blockage, and lots of CO in the blood, there is a serious shortage of O2 to the heart iii) effects of low HDLC levels iv) low tar v) increased amounts of CVD and cancer is higher if married to a smoker than a non-smoker b. hypertension (1) females with a SBP > 150 have a 2 times greater risk than those with less than 120 (2) How? (a) the heart has to work harder every beat i) demands more over the long run (b) vascular system is under greater stress i) loses elasticity ii) becomes more rigid a) increases BP iii) become more susceptable fot the deposit of fats iv) also more suseptable to an anuerism (3) How to reduce? (a) Body fat seems related, so lose it! i) mech. for this is uncertain, but it may be releated to the increased insulin released, this increases the retention of Na++, which causes bliid volume and BP to increase (b) Reduce Na++ intake i) need min of 200 mg/day ii) avg. intake is 3900-4700 /day iii) dietary recs. are 1100-3300 /day iv) two thirds of all the sodium comes from the product itself (c) Na++ - K+ ratio i) should be one to one or less ii) K decreases BP by excreting the extra Na++ iii) helpful: fresh fruits, fruit juices, vegtables, and unsalted nuts - eat more fresh and less canned (d) Exercise i) decreases vasoconstriction ii) metabolizes the catacholomines iii) produces general relaxation a) reduces muscle tension iv) regulates insulin secretion (4) General reducers of hypertension (a) reduce caffeine intake (b) reduce stress levels (c) anti-hypertensive drugs i) diueretics a) produce more urine b) decrease blood volume ii) beta-blockers a) used for various CVD's b) blunt the sympathetic nervous systems response iii) vasodilators iv) side effects a) diueretics b) disruption of Na++ / K balance c) increased risk of CVD by other methods d) increased blood glucose e) increased triglycerides and cholesterol f) decreased HDLC g) impotence c. hyperlipidemia (1) Serum cholesterol (2) serum triglycerides (3gly) (a) both are found in the blood (b) can be controlled primarily by diet and exercise (3) Choles level (desireable) (a) adults < 200 mg% (b) children < 165 mg% * if have a choles of >250, ave a 3 times greater chance of CVD (4) 3gly level (desireable) (a) < 150 mg% (b) they are synthesised from various foods (c) needed by i) formation of biosalts - digestion ii) production of hormones iii) all membranes iv) absorbtion of nutrients (5) Lipoproteins (a) this is when they are circ. in the blood and combine with the proteins i) they are then soluble in the blood, and it makes all other fats in the blood soluble (b) choles is distributed among the different types of lipoproteins (6) Chylomicrons (a) formed in the cells of the intestional wall from fats (b) contains i) small amounts of proteins ii) large amounts of 3gly iii) small " of choles (c) they are present in the blood following meals with lots of fats i) depending on a) when the meal was b) what the meal was (d) they don't pose a health problem as they are metabolized rapidly (7) VLDL's (a) Primary concern is that they turn into LDL's (b) are larger density than chy's (c) contain i) large amounts of 3gly ii) small " " prot & chol (d) are synthesised primarily in the liver, but also in the small intestine (e) it transports 3gly from the liver to the fat cells for deposit (f) when it deposits the 3gly, it turns into a LDL (8) LDL's (the bad guys) (a) have sig. amounts of choles (b) have a higher # of protein than VLDL's and 3gly (c) primary job is the transport of choles to storage and to the liver (d) thejproblem lies in that it gets sidetracked and imbeds itself in the walls of the arteries i) this is the major contributor to plaque build-up (9) HDL's (garbage men) (a) smallest in size (b) highest in density i) more proteins and less fat (c) contains about 25% of all the serun cholesterol (d) acts as a scavenger i) picks up the lose choles and takes it to the liver to be disposed of (e) remains suspended in the plasma i) is less likely to be deposited (10) CV risk (a) Total Chol / HDL-C ratio i) should be about 4-4.5 (b) if total chol is very high (300+) then no matter what there is danger (11) Fats (a) total fats < or = to 30 % of total cals (b) 10 / 10 / 10 (c) the body is able to convert more saturated fat to chol (d) most saturated fats are animal fats i) these fats also contain choles (e) plant fats don't have choles i) except palm and coconut oils (f) poly / sat ratio should be = or > 1.0 (g) monounsat fats are now of concern also i) used to not be ii) found in fish, olive oil, nuts, avacadoes (h) fish oils decrease CVD (12) Factors that affect blood lipid levels (a) Exercise i) increases HDL-C ii) decreases LDL-C (b) How much is necessary i) 1000 kcal / week of aerobic exercise for the high benefit ii) less will still produce favorable changes (13) How does this work (a) burns more 3gly as fuel (b) greater expend of total cal's i) fewer cal's left to turn into 3gly's (c) How long i) effects last 48 hours, so exercising every 48 hours will keep them low (14) General (a) children have higher HDL-C than adults (b) women " " " " men i) due to hormone differences (c) steroids lower HDL-C's and increase LDL-C's (d) smoking decreases HDLC's and increase LDL-C's (e) the pill does this also, and the two in combination do this even moreso (15) Alcohol (in moderate quan) (a) has been shown to increase the HDL- C's i) but, there are two types of HDL's ii) one is very beneficial, and the other alcohol increases (b) increases 3gly's (c) excessive amounts is addicting (16) Obesity vs lean (a) lean have lower LDL's (17) Diabetics have ? LDL's (18) Diets (a) water soluble fiber absorbs more cholesterol, and therefore causes less to be absorbed by the digestive tract (19) Medications (a) can reduce choles i) beta blockers ii) diueretics (b) have side effects d. Diabetics (1) Two times the chance of CVD (2) cause of low HDL-C's (3) because of the way the body metab's food e. Obese (1) leads to hypertension (2) and hyperlipidemia (3) are usually more sedentary (4) leads to extra fat and a increased load on the heart f. Stress (1) effects the sympathetic nerv. sys. (2) causes the release of more adrenalin (3) and the release of more FA's and glucose (4) increased vasoconstriction (a) incr. BP (5) incr. HR and F (6) type A behavior g. exercise helps by (1) cleans the adrenalin out (2) prod. vasodilation (3) metabs glucose and FA's (4) produces relaxation h. Inactivity (1) Activity (a) strengthens heart (b) " vascular system i) more elasticity in the blood (c) reduces the amounts of fat deposits (d) " the other causation factors i) obesity ii) stress (e) hypertension (f) hyperlipidemia (g) increased HDL-C's 2. Other Health risks a. Osteoporosis (1) exercise helps reduce (2) is age related (3) decreases in bone mass increase the chances of bone fracture (4) complications of this disease are the 12th leading cause of death (5) Who is more susceptable (a) caucasions and asians (b) females = 8x's more than males (c) light skinned and fair complected (d) females with a slight build (e) females with inadequate Ca++ i) RDA's a) till age 11, 800 b) 11 - 24 , 1200 c) 25 + , 800 d) preg or lact., 1200 ii) avg female gets 4-500 iii) if low on Ca++, the body metabolizes from the bones and teeth iv) may be esp. low during preg or lactation (6) Significant after menopause (a) estrogen production drops off sig (b) Ca++ depletes rapidly (c) after age 50, Ca++ loss is 4-5 times greater than males (7) if overies are removed before menopause, then this increases the risk (8) also if exercises hard, then may cause ammenhorea because of decreased estrogen (9) weight bearing activity will lessen risk (a) causes increased Ca++ to be absorbed (10) Dietary factors that affect Ca++ absorbtion (a) excess alcohol, caffeine, excess protein and phosphorus, smoking, and excess Na (b) all either cause less Ca++ absorbtion or more Ca++ loss (11) Symptoms (hard to notice) i) may take 20-30 years to notice ii) x-rays don't show till 25% gone (a) Back pain i) demineralization of the spinal column (b) loss of height i) loss of bone ii) compression of disks (c) toothe loss (d) bone fractures i) most common in the intratrabicular (network) bone a) rigid outside and spider web like inside ii) upper end of femur (hip) iii) vertebra bodies iv) distal end of the radius (12) Prevention (a) Avoid the causes i) increase Ca to adequate levels a) milk and dairy b) fish with small bones c) green leafy veg's d) cale, turnips, mustard and collard greens, coliflower, brocholli, cabbage, and okra e) spinich and chard have high Ca++, but also are high in oxalic acid, this combines with Ca++ to not let it be absorbed f) Ca++ suppliments g) may be less effective h) may contain other substances i) heavy metals j) stay away from bone meal and dolomite k) good sources = Ca gluconate, carbonate,and lactate l) too much Ca++ may interfere with the absorbtion of other minerals, prim Fe. (b) Vitamin D status i) allows the absorbtion and metabolism of Ca ii) we get Vit D from the sunlight and the fortification of milk iii) excess is toxic, but those levels cannot be reached by the sun alone (c) Role of exercise i) weight bearing activity a) keeps mineral content in the bone ii) lack of activity a) lose min. from the bone (d) Estrogen suppliments i) problem is the increased risk of endometrial cancer ii) if include progesterone, then the chances diminish (e) AVOID i) smoking, stress, caffeine, excess salt, excess high prot diets,