aerobic exercise (endurance exercise)
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Introduction
Benefits:
- cardiovascular
- 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
- 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]
- oxygen-carrying capacity
- increased blood volume & hemoglobin
- enhanced muscular uptake of oxygen
- improves cerebrovascular outcomes[11]
- myocardium
- musculoskeletal
- muscle/tendon
- increased blood flow to muscle
- increased muscle strength
- increased tolerance for a given workload
- bones & joints
- increased bone mass with weight-bearing exercise
- increased blood flow to synovium
- muscle/tendon
- metabolic & endocrine
- glucose metabolism
- increased muscle utilization of glucose (non insulin-dependent transport)
- decreased blood glucose levels
- lipid metabolism
- increased utilization of triglycerides
- increased levels of HDL cholesterol
- decreased levels of total cholesterol
- improved overall lipid profile
- glucose metabolism
- obstetric & gynecologic
- 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]
- more vigorous activity associated with lower risk[3]
Adverse effects
- cardiovascular
- 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]
- patients with structural heart disease
- patients with ischemic heart disease
- musculoskeletal
- muscle soreness
- traumatic injury
- strains
- contusions
- overuse injuries
- metabolic & endocrine
- increased autonomic activity with exercise in patients with diabetes & thyroid disease
- 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
- gynecologic - amenorrhea
- occurs only with combination of intense exercise & weight loss (< 10% body fat)
- may increase risk of osteoporosis & stress fractures
- psychologic
- obsessive-compulsive disorder
- anorexia equivalent
Management
Modified programs for particular health conditions:
- cardiovascular disease
- stable angina
- exercise 5-10 beats/min below ischemic threshold
- use nitroglycerin
- supervised exercise program
- hypertension
- avoid isometric exercise
- low resistance exercise
- valvular disease
- mild to moderate exercise after valve repair
- anticoagulants
- no contact sports
- peripheral vascular disease
- claudication may limit exercise
- walk until onset of pain, rest, resume
- exercise increases functional capacity
- cardiac medications
- beta blockers blunt heart rate
- diuretics may increase risk of dehydration -loop diuretics may increase risk of hypokalemia & muscle cramps
- stable angina
- pulmonary disease
- musculoskeletal disability
- arthritis
- swimming & non weight-bearing exercise may be preferred
- stretching & range of motion exercises
- spinal cord injury
- wheel chair sports
- arm exercises have higher oxygen consumption & lower muscular efficiency than leg exercises
- arthritis
- metabolic & endocrine disorders
- diabetes
- type I: adjust insulin, exercise to avoid hypoglycemia
- type II
- proper foot care
- no ballistic exercises with retinopathy
- obesity: start with lower intensity to minimize musculo-skeletal injury
- diabetes
- pregnancy
- avoid exercise in patients with:
- vaginal bleeding
- history of premature delivery
- incompetent cervix
- avoid exercise in supine position after 20th week of pregnancy
- avoid core temperature > 102 F (39 C)
- avoid exercise in patients with:
Comparative biology
- neurogenesis of dentate granule cells in adult Sprague Dawley rats is increased by sustained aerobic exercise[8]
More general terms
Additional terms
- age-related physiological changes
- exercise prescribing (counseling)
- exercise stress testing
- physical conditioning (training)
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 224-26
- ↑ 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
- ↑ 3.0 3.1 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
- ↑ 4.0 4.1 Mont L et al Endurance sport practice as a risk factor for atrial fibrillation and atrial flutter Europace 2009 11(1):11-17 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18988654 doi:10.1093/europace/eun289
- ↑ 5.0 5.1 Werner C et al Physical exercise prevents cellular senescence in circulating leukocytes and in the vessel wall. Circulation 2009 Dec 15; 120:2438 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19948976 <Internet> http://dx.doi.org/10.1161/CIRCULATIONAHA.109.861005
- ↑ 6.0 6.1 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: https://www.ncbi.nlm.nih.gov/pubmed/21282661
- ↑ Physical Activity and Cardiovascular Health: Consensus Statement http://consensus.nih.gov/cons/101/101_intro.htm
- ↑ 8.0 8.1 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: https://www.ncbi.nlm.nih.gov/pubmed/26844666 Free Article
- ↑ 9.0 9.1 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: https://www.ncbi.nlm.nih.gov/pubmed/27245609
- ↑ 10.0 10.1 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: https://www.ncbi.nlm.nih.gov/pubmed/30700591 https://n.neurology.org/content/92/9/e905 - ↑ 11.0 11.1 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: https://www.ncbi.nlm.nih.gov/pubmed/32404355 https://n.neurology.org/content/94/21/e2245
- ↑ 12.0 12.1 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: https://www.ncbi.nlm.nih.gov/pubmed/36881712 https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehad152/7069916