Fitness Techniques & Programs Final

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Regular stretching exercises promote flexibility—

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a component of fitness—that permits freedom of movement, contributes to ease and economy of muscular effort, allows for successful performance in certain activities, and provides less susceptibility to some types of injuries or musculoskeletal problems.

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Flexibility Activity:

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-Flexibility is an important, but often neglected part of an exercise program.
-The importance of flexibility for health and well-being becomes more important with age.

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Flexibility Fundamentals:

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-Not the same as stretching.
-The range of motion in a joint or joints is used to reflect flexibility at that joint.
-ROM= the extent and direction of movement that is possible.
-Joint specific
-Specific vocabulary is used to describe the movement of joints.
-Flexion/extension, abduction/adduction, internal and external rotation, etc.

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Common Movements

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Flexion
Extension
Abduction
Adduction
Rotation
Circumduction: moving in a circular motion.

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Flexibility Fundamentals:

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The unique nature of the different joints causes some to allow for greater mobility than others.
Ball-and-socket joint
Hinge joint
ROM at a joint depends on how it is being assessed
Static = without movement
Dynamic = active functional activity

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Factors Influencing Flexibility:

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Anatomy
Long “muscle-tendon units” (MTUs)
Properties of connective tissue and muscle
Type of joint
Gender
Runners have poor flexibility due to shortening of muscles due to stride.
Females more flexible
Possibly related to:
bone structure (e.g., wider hips)
hormonal influences
physical activity choices (e.g., dance, gymnastics, swimming) that require good flexibility
Genetics (loose joints)
Lack of use or misuse
Lack of physical activity / muscle imbalances
Race
Age

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Influence of Age on Flexibility

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Front 8

Health Benefits of Flexibility:

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No ideal standard for flexibility exists.
Necessary for optimal posture.
Extremes of inflexibility and hyperflexibility increase the likelihood of injury.
May help prevent muscle strain and such orthopedic problems as back pain.
Stretching may help to relieve muscle cramps, stiffness, and some local or referred pain.

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Flexibility & Back Pain

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Short and tight muscles cause poor posture which leads to back pain.

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Flexibility & Back Pain

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Long and strong muscles keep the body in good alignment and reduce risk of back pain.

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Health Benefits of Flexibility

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Stretching is probably ineffective in preventing muscle soreness & muscle injury.
Overstretching may make a person susceptible to injury or hamper performance.
Freedom of movement
Improved athletic performance
Questionable benefits prior to competition, will compromise explosive, power & strength & is more beneficial after workout.

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Stretching Methods

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Static (no movement & hold to joint tension): good when intramuscular temp. is elevated, i.e. after workout.
Active assistance
Passive assistance
Dynamic (stretch in motion): increase temp of muscle, increase profusion.
Ballistic (greater chance of injury & over stretching. Bouncing stretch).
PNF - most effective. Proprioception, neuromuscular facilitation: muscle spindle is excited to trigger muscle contraction.
Golgi inhibitory: prevents muscles from contracting, called golgi tendon organs.

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Flexibility:

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-ability to move fluidly through full ROM
-is joint specific

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Methods of Stretching-Dynamic Warm-Up:

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Dynamic stretching
UW Lacrosse S & C page

http://www.uwlax.edu/strengthcenter/videos/yaw/Yaw's%20video%20page.htm

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Methods of Stretching-Dynamic Warm-Up:

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Dynamic stretching

James Madison U. S & C page
http://orgs.jmu.edu/strength/Videos/Ally_Videos/dynamic_warmup_AB.htm

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Static Stretching

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Safer and less likely to cause injury
Stretch slowly until tension
Hold stretch for 15 - 60 sec.
Relax the muscle
Increase stretch a bit more(developmental stretch)
Active stretching
Passive stretching

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Stretching

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Ballistic Stretching:

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Dynamic movement
Specificity of movement

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Proprioceptive Neuromuscular Facilitation (PNF):

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Combines (active and passive) methods
Most effective method forimproving flexibility
Promotes increase in strength

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PNF Stretching Technique(C.R.A.C. Method):

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Contract agonist isometrically
Relax muscle for a few seconds
Contract the antagonist for 15 seconds
Relax

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How Much Flexibility is Enough?
How Much Stretching is Enough?

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Stretching exercises should be done regularly to achieve optimal benefits.
For flexibility to be increased, you must stretch and hold muscles beyond normal length for an adequate amount of time.(see the stretch reflex on the next slide)
Performing warm-up exercises is not the same as doing a stretching workout for flexibility development.
The best time for stretching is when the muscles are warm.

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Maintaining stretch for 15- 60 secondswill allow the stretch reflex to subside andpermit gains.

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FIT Formula (Static Stretching)

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F 3 - 7 times per week
I 10% beyond normal length of muscle
T 15-60 seconds, 3-5 reps  (rest 30 sec between reps)
ExRx= Exercise prescription, individual vs. mass

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Flexibility-Based Activities:

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Yoga
Tai Chi
Pilates

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Stretching Aids / Technology:

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Stretching ropes can make it easier to execute and hold stretches properly.
Foam rollers can improve strength, balance, and flexibility.

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Guidelines for Safe & Effective Stretching Exercise:

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Do not force the stretch to the point of pain.
Choose safe exercises.
Avoid overstretching weak muscles.
Use good technique.

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Hamstring Stretches

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Shin & Quadriceps Stretches

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Flexibility Summary:

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Flexibility is often neglected
Joint specific
Many influencing factors
Many health benefits
Static stretching is the most widely recommended.
3-7 days per week target
15-60 seconds
3-5 reps.

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Lab 9a InformationEvaluating Flexibility:

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Make sure that you are warmed up prior to testing.
Follow the instructions as close as possible since the best use of the results is to compare scores over time.
Perform each of the stretches in the lab(Be sure to check left and right separately).
Complete ratings and then evaluate your personal flexibility needs according to your results.

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Areas Needing Stretching:

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Hamstrings
Inner thigh
Calf
Hip flexors
Lower back
Chest / shoulders

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Lab9b InformationPlanning and Logging Stretching Activity:

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Set goals for doing specific stretches during the week.
Monitor progress using logging charts.

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Static Stretching:

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Stretch slowly until tension
Hold stretch for 15 - 60 sec.
Relax the muscle
Increase stretch a bit more(developmental stretch)

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Stretching Precautions:

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Don't force stretch to the point of pain
Choose safe exercises
Avoid overstretching weak muscles
Use good technique

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Methods of Stretching-Dynamic Warm-Up:

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Both types of stretching (static and ballistic) can be further classified into active or passive dimensions. An active stretch implies that the stretch is imposed by the active contraction of the opposing (antagonist) muscle group. A passive stretch implies that the stretch is opposed by an an outside force (partner, gravity etc..) PNF is an advanced stretching technique that involves the manipulation of several stretch reflexes to enhance the overall stretch.

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Tips for leading flexibility improvement exercises:

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Warm up first! Increase intramuscular temperature prior to stretching!
Stretch all major muscle groups.
Emphasize muscles most involved in the target activity.
Be systematic: top to bottom – bottom to top

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Good posture:

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is important for neck & back health

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Good body mechanics:

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is important for neck & back health

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Microtrauma: "a silent injury" is an injury that results from repetitive motion such as calisthenics & some sports.

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Some exercises & movements can produce microtrauma, which can lead to neck & back pain.
Microtrauma: a.k.a. repetitive motion syndrome, repetitive strain injury (RSI), cumulative trauma disorder (CTD), & overuse syndrome. Later in life microtrauma results in: tendonitis, bursitis, arthritis, or nerve compression.

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Safe exercises is defined as:

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those performed with normal body posture, mechanics and movement in mind.

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The risks associated with physical activity:

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can be reduced by modifying the variables or conditions under which the activity is performed.

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Strengthening core muscles:

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involved in providing core stability can reduce the risk for back problems.

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Resistance exercise:

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can often correct muscle imbalance, the underlying cause of many postural and back problems.

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General Nutrition Concepts:

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Influences of Nutrition
Health
Appearance
Behavior
Mood
Role of Nutrients in Diet
Growth and development
Provide energy
Regulate metabolism

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MyPyramid.gov:

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Personalized, behavioral approach to nutrition
Web-based assessment tool called MyPyramid Tracker was also released to help consumers monitor their diet and activity behaviors
Also emphasizes the importance of physical activity

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Guidelines for Healthy Eating:

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Make half your grains whole
Vary your veggies
Focus on fruits
Know your fats
Get your calcium-rich foods
Go lean with protein

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Healthy Eating Pyramid

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Target Zone for Healthy Eating

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Dietary Reference Intake (DRI) Values

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Classes of Nutrients:

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Carbohydrates
Fats
Proteins
Vitamins
Minerals
Water

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Carbohydrates (2 types):

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Simple
Soda, candy, sweets, fruit
Individual glucose, sucrose, or fructose molecules
Increase blood sugar
Promote fat deposition
Complex
Pasta, rice, breads, potatoes
Contribute nutrients and fiber
Chains of glucose molecules

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Low Carb Mania(What is the basis?)

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Proponents of low carb diets blame carbohydrates on the obesity epidemic, but this is not well supported by research.
The quality of carbohydrates is the real issue and it is still wise to consume quality whole grains with adequate fiber.

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Carbohydrate Recommendations:

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Choose fiber-rich fruits, vegetables, and whole grains often.
Choose and prepare foods and beverages with little added sugars or caloric sweeteners.
Eat a variety of fruits—whether fresh, frozen, canned, or dried—rather than fruit juice for most of your fruit choices.

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Fats:

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Saturated
Animal sources
Solid at room temperature
Unsaturated (poly- or mono-)
Vegetable sources
Liquid at room temperature

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Types of Fats continued:

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The hydrogenation process used to convert oils into solids produce trans fat, which is just as harmful as saturated fats, if not more so.
Trans fats are known to cause increases in LDL cholesterol and have been shown to contribute to the buildup of atherosclerotic plaque.

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Fat Substitutes:

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Olestra
Simplesse
Benecol
Take Control

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Recommendations for Fat Consumption:

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Dietary Fat Recommendations
<10% of calories in diet from saturated fat
Total dietary fat: 20-35% of calories
Ways to Decrease Intake of Fat
Substitute lean meat, fish, poultry, nonfat milk, and other low-fat dairy products for high-fat foods
Reduce fried foods & foods high in cholesterol

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Protein:

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Sources of Protein
Animal (complete)
meats, dairy
Vegetable (incomplete)
beans, nuts, legumes, grains
Types of Amino Acids
Nonessential (11) - can be made by body
Essential (9) - must be obtained from diet
Complete proteins contain all of the essential amino acids

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Protein Requirements:

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RDA average = .8 g/kg/day
RDA athlete = 1.2-1.6 g/kg/day
High levels of protein intake above 2 g/kg/day can be harmful to the body

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Protein Guidelines:

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At least 2 servings/day of lean meat, fish, poultry, and dairy products or adequate combination of foods, such as beans, nuts, grains, and rice
Dietary supplements of protein (e.g., tablets and powders) are NOT recommended

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Dietary Recommendations (2 different sets)

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Vitamins:

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Do not contain calories
Organic substances that regulate numerous physiological processes
Antioxidant “All-stars”
Broccoli, cantaloupe, carrots, strawberries, red bell peppers, sweet potatoes, spinach
Two types
Fat soluble (A, D, E, K)
Water soluble

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Vitamin Guidelines

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A balanced diet containing recommended servings of carbohydrates, fats and proteins will meet the RDA standards
Extra servings of green and yellow vegetables may be beneficial
Extra consumption of citrus and other fruits may be beneficial

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Vitamin Supplementation?

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Not necessary if diet is healthy
Multivitamins are safe (100% RDA)
Not all vitamins are “pure”
Can be toxic at high doses

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Minerals:

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No calories/provide no energy
Inorganic elements found in food that are essential to life processes
Calcium - bone, muscle, nerve, blood development
Iron - necessary for blood to carry oxygen
Others - phosphorus, sodium, zinc, potassium (& more)

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Mineral Guidelines

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A diet containing recommended servings of carbohydrates, fats and proteins will meet the RDA standards
Extra servings of green and yellow vegetables may be beneficial
Dietary supplementation of Calcium is beneficial for post-menopausal women
Salt should be limited in the diet

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Populations Who May Benefit from Supplementation

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Pregnant/lactating women
Alcoholics
Elderly
Women with severe menstrual losses
Individuals on VLCDs
Strict vegetarians
Individuals taking medications or with diseases which inhibit nutrient absorption

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Water

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Vital to life
Drink at least 8 glasses a day
Coffee, tea, & soft drinks should not be substituted for sources of key nutrients, such as low-fat milk, fruit juices, or foods rich in calcium
≤3 caffeinated beverages/day
Limit sugared soft drinks
If you drink alcohol, do so in moderation

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Sound Eating Practices

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Consistency (with variety) is a good general rule of nutrition
Moderation & mindfulness
Minimize reliance on fast foods
Minimize consumption of overly processed foods and foods high in saturated fat or hydrogenated fats
Healthy snacks

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Nutrition & Physical Performance

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Complex carbohydrates should constitute as much as 70% of total caloric intake
Active individuals may need higher amounts of protein (1.2 g/kg of body weight)
Some protein is used as an energy source during exercise
Protein levels >15% of the diet are typically NOT necessary
Carbohydrate loading and carbohydrate replacement during exercise can enhance sustained aerobic performance

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Nutrition Quackery

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Ergogenic aids
Dietary Supplements Health & Education Act (1994)
Responsible for an explosion in the sales of products that have not been proven to be effective

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Nutrition: Summary

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Nutrition is important to health and wellness
6 classes of nutrients
Moderation and variety
Fruits and veggies are critical!!
Beware of nutrition quackery
Some individuals may have additional nutritional needs based on activity level, pregnancy, etc.

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Fiber

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Soluble - decreases cholesterol levels
found in oat bran, fruits and veggies
Insoluble - reduces risk of colon cancer
found in wheat bran and grains
Recommendation: 25-40g per day

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Ways to Get More Fiber

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Eat more fruits and vegetables
Eat whole grain foods

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Composition of Oils (%)

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Fat Soluble Vitamins

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Consist of Vitamins A, D, E, and K
Absorbed at the small intestine in the presence of bile (a fatty substance)
Overdoses can be toxic (A and D)

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Water Soluble Vitamins

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Consist of B complex and vitamin C
Excesses will be excreted in the urine, however, B-6 and Niacin can be toxic when ingested in unusually large amounts

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Water Soluble Vitamins

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B-1 (thiamine)
B-2 (riboflavin)
B-6 (pyridoxine)
B-12 (cobalamin)
Niacin (nicotinic acid)
Pantothenic Acid
Folic Acid (folacin)
Biotin
C

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Antioxidant All-Stars

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Broccoli
Cantaloupe
Carrot
Kale
Mango
Pumpkin
Red Pepper
Spinach
Strawberries
Sweet potato

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Minerals with established RDA guidelines

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Calcium
Phosphorus
Iodine
Iron
Magnesium
Zinc
Selenium

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Calcium

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Important for preventing osteoporosis
RDA = 800-1000 mg/day
Found in dairy products and vegetablesHigh protein diets leach calcium from bones and promote osteoporosis

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Iron

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Important component of hemoglobin
Iron deficiency is known as anemia(Symptoms: shortness of breath, fatigue)

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Functions of Water

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Comprises about 60% of body weight
Chief component of blood plasma
Aids in temperature regulation
Lubricates joints
Shock absorber in eyes, spinal cord, and amniotic sac (during pregnancy)
Active participant in many chemical reactions

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Caloric Content of Foods

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Carbohydrates 4 cal/g
Protein 4 cal/g
Fats 9 cal/g
Alcohol 7 cal/g

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Calorie Calculation (Example)

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Heather consumes 2000 calories per day and wishes to obtain 20% of her calories from fat:2000 calories x 20% = 400 calories from fat per day400 calories from fat = 44 grams of fat/day

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What is Baloney?

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80% "fat free”
52 calories / slice
4 grams fat / slice
Calories from fat: = 4 g/slice X 9 cal/g = 36 calories
Percent of calories from fat: = 36 cal / 52 cal total = 69%

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What is Sliced Turkey?

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98% "fat free", 30 calories / slice, 1 gram fat / slice
Calories from fat = 1 g/slice X 9 cal/g = 9 calories
Percent of calories from fat = 9 cal / 30 cal total = 30%

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Body Composition

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Possessing an optimal amount of body fat contributes to health and wellness.
1/3 of body fat is stored subcutaneously.
Non athlete, average college male has 15% body fat. Average college female has 25% body fat.

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The Origin of Fatness:

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Obesity is a multifactorial disease that is influenced by both genetics and the environment.
Body weight is regulated and maintained through complex regulatory processes.
Set-point
Fatness early in life leads to adult fatness.
Changes in basal metabolic rate can be the cause of obesity.
“Creeping Obesity”

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Understanding & Interpreting Body Composition Measures

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Component of health-related fitness & a component of metabolic fitness.
Standards have been established for healthy levels of body fatness
Health standards have been established for the Body Mass Index.
Assessing body weight too frequently can result in making false assumptions about body composition changes.

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Health-Related Body Fatness Standards

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Somatotypes

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Methods Used to Assess Body Composition

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DXA
Underwater Weighing
Bod Pod
Skinfold technique
Other

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Dual-Energy Absorptiometry (DXA or DEXA)

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“Gold Standard” - highly accurate
Criterion measure that has been used to validate other, more practical measures of body composition.
Provides whole body measurements as well as in different parts of the body.

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Underwater Weighing

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A person is weighed in air and under water.
The difference in weight is used to assess body fatness.
Body fat provides more buoyancy, so a fatter person weighs less (on a relative basis) than a lean person.

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Bod Pod

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Uses the same principles as underwater weighing, but relies on air displacement to assess body composition.
Evidence suggests that it provides an acceptable alternative to underwater weighing and is particularly useful for special populations (obese older people and the physically challenged).

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Benefits of Skinfold Technique

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Skinfold measurements are the preferred, practical method of assessing body fatness.
Fairly accurate
Easy to perform
Inexpensive

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Common Skinfold Sites

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7 site procedure
Chest
Axilla
Tricep
Subscapular
Abdomen
Supraillium
Thigh
Jackson and Pollack
Males Female
Chest Triceps
Abdomen Supraillium
Thigh Thigh
Alternative Sites
(Males & Females)
Tricep
Abdomen
Calf
Validation statistics on 3 site test: - r = .97 with 7 site procedure
- R2 = .80 with underwater weighing

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Other Body Composition Assessments

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Bioelectrical Impedance
Infra-Red Spectroscopy
Ultrasound
Imaging Techniques

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Anthropometric Measurements

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Body Mass Index (BMI)
Waist to Hip Ratio (WHR)
Circumference measures
Over > 25 BMI is over weight
Over >30 BMI is obese

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Body Composition Assessment

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Values are estimates (+/- 2-3% at best)
Values are personal and confidential

Proper uses of results:
- Serve as baseline data for repeated testing
- Provide motivation for goal setting
- Provide awareness about health risks

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Health Risks Associated with Being Overweight

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Coronary heart disease
Hypertension
Hypercholesterolemia
Diabetes
Premature death
Physical fitness provides protection from the health risks of obesity.
There are also health risks associated with being too thin!

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Regional Fat Deposition

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Abdominal body fat poses greater health risks than fat stored in other areas
Males store more fat centrally and have increased health risks associated with body fatness
Male - Apple shape (Android) > 39"= higher health risk.
Female - Pear shape (Gynoid) > 35" = lower health risk.

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Health Risks Associated withExcessively Low Body Fatness

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Anorexia Nervosa
Bulimia
Anorexia Athletica
Female Athlete Triad
Muscle Dysmorphia (males)
Fear of Obesity

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Relationship Between PA & Body Composition

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Combination of regular PA and dietary modification is the most effective means of losing body fat.
PA that can be sustained for relatively long periods is considered the most effective for losing body fat.
Strength training can be effective in maintaining a desirable body composition.
Regular PA is critical for building and maintaining bone health.

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Target Zone - Body Fat Reduction

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Physical Activity

F = Daily moderate PA; 3-6 days/wk vigorous PA

I = Slow, low-intensity that results in ≤1-2 lbs/wk of fat loss

T = 30-60 minutes
Diet

F = Consistently & daily

I = Modest caloric restriction

T = Moderate meals

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Body Composition Summary

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Obesity is prevalent in society.
Need to find ways to maintain optimal body composition.
Use assessments to determine body composition and make the necessary healthy changes to physical activity and diet.

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BMI Measurement Technique

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Convert weight to kilograms (2.2 kg/lb.)
Convert height to meters (.0254 m/in)
Square the height in meters
Divide the squared height value into the weight value
BMI = Wt (kg) / Ht2 (m)

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WHR Measurement Technique

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Waist: Measure at the "natural waist" (smallest circumference) or at the level of the umbilicus
Hip: Measure at the maximum circumference of the buttocks
Divide the hip measurement into the waist measurement to obtain the WHR

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Definitions of Overweight (Based on BMI values)

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BMI accounts for differences in frame size better than height weight tables. BMI = Wt (kg) / Ht2 (m)
Standards:
Overweight: > 25
Obesity: > 30
Severe obesity > 40

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Determining Your Daily Energy Expenditure

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Estimate your basal metabolism.
First determine the number of minutes you sleep.
Monitor your activity expenditure for 1 day. Record the number of 5-, 15-, and 30-minute blocks of time you perform each of the different types of physical activities (e.g., if an activity lasted 20 minutes, you would use one 15-minute block and one 5-minute block). Be sure to distinguish between moderate (Mod) and vigorous (Vig) intensity in your logging.
Discuss your daily caloric expenditure. In addition, comment on whether you think you should modify your daily caloric expenditure for any reason.

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Regional Fat DepositionVisceral Fat

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Visceral body fat poses greater health risks because this fat is more labile and has greater access to the circulation.
The accumulation of visceral body fat is typical of the android (male) fat pattern
males: visceral accounts for 10-35% of total fat
females: visceral accounts for 8-13%of total fat

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Abdominal Body FatRelationships with CHD Risks

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Abdominal obesity predicts CHD risk independent of BMI, smoking, cholesterol and hypertension.(Kannel et al., J. Clin Epid., 44, 183-190, 1991).
Abdominal obesity predicts CHD risk independent of total body fatness. (Larsson et al. ,Appetite, 13, 37-44, 1989).
Abdominal obesity statisticallly accounts for difference in CHD rates between men and women. (Larsson et al., Am. J. Epi., 135: 266-273, 1992).

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Abdominal Body FatRelationships with other risk factors

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Abdominal obesity is strongly influenced by genetics - similar gain among twins (r=.72). (Bouchard, NEJM, 322, 1477-1482, 1990).
Abdominal obesity is greater in smokers than non-smokers due to the presence of androgens (Barrett-Conner, Ann. Int. Med. 111, 783-787, 1989).
Abdominal body fat is preferentially lost during a physical activity program(Kohrt, J. Gerontology, 47: M99-M105, 1992)

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Waist to Hip Ratio (WHR)

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Waist to Hip Ratio is an effective way to examine regional fat distribution.
Health Risk Men Women
High Risk >1.0 >.85
Moderate Risk .90-1.0 .80-.85
Low Risk <.90 <.80

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Underwater WeighingMeasurement issues

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Based on body density calculations
Density of lean tissue = 1.1 g/cc
Density of fat tissue = .9 g/cc
Sources of error
Residual lung volume
Bone density varies by age, ethnicity and activity level
General conclusions
Gold standard measure (1-2% error)
Impractical for most applications

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Bioelectric Impedance(Measurement Issues)

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Based on resistance to current flow
Lean tissue has more water - less resistance
Fat tissue has less water - more resistance
Sources of error
Temperature
Hydration status
General conclusions
Overestimates lean / underestimates obese
Practical, but expensive, measure for general population

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Infrared Spectroscopy(Measurement Issues)

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Based on differential absorbance rates
Lean tissue has a different energy absorption and reflectance pattern than fat tissue
Sources of error
Validity of absorbance readings is questionable!
General findings
NOT a valid measure!

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Ultrasound(Measurement Issues)

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Based on reflection of sound
Fat content increases the time is required for sound to reflect off of bone and muscle.
Sources of error
Representative sites for measurement
Measurement error
General conclusions
Highly accurate measure of body fat - especially for obese
Expensive and not practical for most applications

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Imaging Techniques(Measurement Issues)

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Based on imaging of body tissues
Based on cross sectional area measures calculated at different levels of the body
Sources of error
Representative sites for measurement
Measurement error
General conclusions
Very precise measure of body composition
Expensive and not practical measure for most uses

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Circumferences (Measurement Technique)

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Based on circumference measures
sample prediction equation:% fat = - 47.372 + (.579 x abdomen) + (.252 x hip) + (.214 x iliac) + (.356 x BW)
Sources of error
Location of sites
Inability to distinguish fat and muscle
General conclusions
Provides reasonable estimate of body fat
Not as accurate as skinfold and takes same time

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Ideal (goal) BW Formula
Calculating Desired Body Weight:

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Desired Weight =
Current LBW/(1 - desired %Fat)

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Calculating Desired Body Weight (Example)

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DesiredWeight =
200 - (200 x .20)/(1 - .15)

DesiredWeight =
200 - 40/(.85) = 160/.85 = 188

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Managing Diet and Activity for Healthy Body Fatness

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Various management strategies for eating and performing physical activity are useful in achieving and maintaining optimal body composition.

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“We’re raising our children the way we raise calves for veal - keep them in boxes, feed them too much, and allow them no exercise.”

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Rich Killingsworth
Center for Disease Control and Prevention

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Creeping Obesity

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Physical activitydecreases and leads to a decrease
In metabolic rate. If energy expendituredrops more than energy intake, weight gain will occur.
The primary factors associated with an increase in body fat with age is a progressive decrease in the metabolism. Basal metabolic rate is highly dependent on the amount of lean body mass an individual has. With age a person's LBM decreases and, therefore, so does the BMR. Exercise is one way of maintaining LBM and keeping BMR elevated.

Physical Activity is also known to decrease with age. This decrease is another reason for creeping obesity.

To maintain body weight it is necessary for people to either maintain a habit of regular exercise or to progressively decrease their caloric intake as they get older.

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Factors Influencing Weight & Fat Control

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Heredity / Genetics
Lifestyles
Consumption of excess calories
Lack of regular physical activity
Environment
Easy access to high calorie food makes it harder to eat properly
Modern “conveniences” make activity less likely

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ENERGY EXPENDITURE

Back 128

Resting metabolic rate is the greatest energy need per 24 hours

Front 129

Weight Loss:

Back 129

Method: Effects:
BW Fat FFM
Diet Only low low low
Exercise Only equal low high
Diet & Exercise low low high

Front 130

Prevalence of Dieting

Back 130

40% of all women
25% of all men
Diet products are a 33 billion dollar industry.

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Almost All Diets are Unsuccessful

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50% regain all weight within 2 years because they don't make a lifestyle change
5-10% keep weight off permanently with lifestyle change.
Why do diets fail?
Temporary weight loss creates thought that they can return to old habits.
Don't change their resting metabolic rate.

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Cycle of Dieting

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Front 133

Diet

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People begin a diet and have good initial motivation. They may see some initial positive results but eventually they will have trouble with compliance (party, eating out, stress). They may give up and blow diet and gain the weight back. Eventually, people regain inspiration and decide to try again.

Because of the initial positive results, most people blame themselves and believe that dieting works. They keep trying new diets to try to find one that they can live with. Because most “diets” are inherently short term they will all fail when people come off of the diet. Only long term lifestyle changes will be effective in keeping the weight off.

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Yo-Yo Dieting

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Increased resistance to weight loss
Increased efficiency of weight gain
The concept of weight cycling or Yo-Yo dieting has recently received a lot of attention in the literature. Some evidence suggests that with repeated cycles of dieting there is increased resistance to weight loss and increased efficiency of weight gain (Essentially the body adapts to fewer calories and becomes more efficient).
Yo-yo dieting changes metabolic rate.

Some studies have suggested that repeated cycles of weight loss can increase a person's risk for CHD (usually attributed to tendency to store fat in the abdominal region. A recent review in JAMA (1994) suggests that this risk is unfounded and that individuals should persist in their efforts at weight loss. Essentially, they argued that the health risks of obesity far outweigh the potential health risks associated with weight cycling.

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Problems with Fad Diets

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Weight loss is often water loss
Supplements may be dangerous
Diet may lack essential nutrients
Metabolism may slow down if caloric intake is very low.
Most (if not all) simply do not work for people long term!

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Dangers of the Atkins Diet

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Low carb diets are not a panacea as is typically claimed but the extreme aspects of the Atkins diet are even more problematic. The diet may yield modest weight loss in the short term but long term studies show negative consequences.

The Physicians Committee for Responsible Medicine has been working to counter the pro-Atkins media and slow the hype about the Atkins diet.

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Problems with Appetite Suppressants

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Many people use non prescription appetite suppressants to control eating.
Ephedrine related products have been found to be dangerous and have been banned by the FDA
Herbal equivalents (e.g. Ma Huang are not safe).

Front 138

Problems with Prescription Weight Control Pills

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Fenfluramine/phentermine (fen/phen)
Used in medicines such as Redux and Pondimin
Contributes to a form of valvular heart disease.
Currently banned by the FDA
Sibutramine
Used in a product called Meridia.
Has been approved by the FDA but may raise blood pressure and lead to irregular heart beats.
A drug combination called fenfluramine/phentermine (fen/phen) was found to lead to a form of valvular heart disease. Products containing these drugs – Redux and Pondimin have been taken off the market.
A new drug called Sibutramine is used in a product called Meridia. It alters a person's appetite by making a person feel full. It is approved by the FDA but reports have indicated that it can raise blood pressure and lead some people to have irregular heart beats.

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Principles of Weight Control

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(A balance between intake and expenditure)
IN > EX - Gain Weight
IN = EX - Maintain Weight
IN < EX - Lose WeightWeight Control is simply a balance between energy intake and energy expenditure. If you take in more calories than you expend you will gain weight. If you take in less calories than you expend you will lose weight. To maintain weight intake must be balanced by expenditure.

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Guidelines for Losing Body Fat

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Need to create a caloric deficit (2 ways to do it!)
Eat less!
Exercise more!

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Weight Loss:

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Attempts to lose weight are most successful and long-standing if you lose no more than 0.45 to 0.9 kg (1 to 2 lb) per week and combine dietary restriction (300 to 500 kcal per day) with moderate aerobic and resistance exercise.

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Exercise for Weight Loss: Common Assumptions

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P.A. must exceed 20 min.
Fat not primary fuel during initial 15-20 minutes
Must be low intensity or CHO used as fuel
Fat burning intensity: 40-70% of VO2 max
Low intensity, long duration recommended

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Exercise for Weight Loss: Recent Research

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2/3 of U.S. is overweight or obese.
No more than 2lbs. per week is safe
Ppl. have 10-50% loss of deliberate physical activity on the day they exercise.

Obese subjects: 2 groups
Group 1: 80-90% VO2 max
Group 2: 40-50% VO2 max

Duration: calculated to ensure equal calorie deficit for both groups

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Exercise for Weight Loss: Recent Research

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Results: 1.5 lb. Loss per week in both groups!

Replicated in other studies

Conclusion: fat loss benefits similar with High and Low intensity ex.
To lose 2lbs. per week would require 1,000 kcal to produce a negative energy balance, 7 days per week.
100 kcal average burned per mile either by walking or running.
10 miles per day, 7 days per week = 70 miles run or walk & will result in not losing a full 2 lbs due to 10-50% loss of deliberate physical activity decrease on days of work outs.

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Physical Activity Rx for Weight Loss

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Glycogen is the only energy source the CNS uses. When carbs are burned, it has to be replenished, which is done via fat oxidation.

Relatively large reductions in intensity result in modest reductions in caloric expenditure

Example: 123 lb. female
7 vs. 8 min/mile running pace
7 min/mi: 21 min x 13.3 kcal /min = 279 kcal
8 min/mi: 32 min x 11.9 kcal /min = 360 kcal
Calorie deficit determines fat loss, not high or low intensity.

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Physical Activity Rx for Weight Loss continued

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Recommend lower (moderate) intensity and long duration
Can promote greater kcal deficit
Decrease risk for m-s injury

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Physical Activity Rx for Weight Loss continued

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Don’t discourage those who enjoy high intensity activity or those with time constraints
Caloric Expenditure Goal: 300-500 calories per session → 1000-2000 kcal/week
Incorporate resistance training too!

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Physical Activity Rx for Weight Loss using calorie expenditure

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ACSM Recommend: Caloric Expenditure Goal: 300-500 calories per session → 1000-2000 kcal/week
Use computer programs or calorie charts (p. 285) to determine duration of exercise

Target HR Zone needs to be determined to improve VO2 max.

Front 149

Calorie cost comparison

Back 149

Front 150

Calorie cost-intensity comparison:150 lb. subject:

Back 150

Walking pace (4 mph):
300 kcal ÷ 5.55 kcal/min = 54 minutes

Running pace (7 mph):
300 kcal ÷ 13.8 kcal/min = 22 minutes

Different pace – same kcal deficit!
E.P.O.C. = Excess Post Exercise Oxygen Consumption
1LO2 = 5 kcal energy used.

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Physical Activity Rx for Weight Loss continued

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Emphasize compliance factors:
Exercise with partner
Schedule workouts
Use activity logs
Convenience
Inclement weather alternatives
Morning workouts?
Calorie restriction over time leads to decrease resting metabolic rate being lowered & fat loss will fail.

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Lifestyle Approach!

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Healthy eating patterns
Regular activity patterns
A simple AND effective method for long-term weight control.
A lifestyle approach may take longer than the fad diets claim but the weight loss will be real and it will be allow you to take in enough calories for good health. It will also be easier to live with than an extreme fad diet.
Nutritious diet
Regular Exercise

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Healthy Eating Patterns

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Eating a variety of foods
Eating smaller, more frequent meals
Avoiding bingeing
Reducing fat intake
Fat is calorically dense (high in calories)
Fat is more easily stored than carbohydrates or protein

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Healthy Eating Patterns continued

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Low “glycemic load” diets may be a more sensible alternative to low-carbohydrate diets.
Artificial sweeteners and fat substitutes may help but cannot be considered a “sure cure” for body fat problems.
Avoid anything with ephedra.
Restrict “empty” calories.
Learn the difference between craving and hunger.

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Regular Activity Patterns

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Benefits of Exercise for Weight Control
Burns calories
Maintains LBM
Increases metabolism
Promotes greater fat loss
Suppresses appetite
What type of exercise is best?
Aerobic exercise
Strength or muscle endurance exercise

Front 156

Weight Loss Calculations

Back 156

1 pound of fat = 3500 calories

Maximum weight loss should be
no more than 1-2 pounds per week:

500 calories/day x 7 days/week = 3500 calories/week (1 pound)

1000 calories/day x 7 days/week = 7000 calories/week (2 pounds)

23 carb calories needed to convert kcal to fat stores. ex. 100kcal/ 23= 77 kcals stored as fat.
3 fat calories needed to convert kcal to fat stores. ex. 100kcal/3 = 97 kcals stored as fat.

Front 157

Weight Loss Calculations

Back 157

1 pound of fat = 3500 calories

Maximum weight loss should be
no more than 1-2 pounds per week:

500 calories/day x 7 days/week = 3500 calories/week (1 pound)

1000 calories/day x 7 days/week = 7000 calories/week (2 pounds)

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Guidelines for Gaining Muscle Mass

Back 158

Young people often have difficulty in gaining weight or muscle mass.
Changes in the frequency and composition of meals are important to gain muscle mass.
Physical activity is important in gaining muscle mass.

Front 159

Behavior Change Principles for Weight Control

Back 159

Set realistic behavioral goals
Moderation in behavior
Consistency in behavior
Social support

Front 160

Benefits of Low Fat Diets for Long Term Weight Control

Back 160

Dietary fat is stored more efficiently - 3% of ingested energy (Tucker, 1991).
Energy intake is lower when consuming low fat foods (Lissner, 1987; Kendall, 1991).
Body can increase metabolism of carbohydrates but will store excess fat (Thomas, 1992).

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Effects of Exercise and Caloric Restriction

Back 161

Front 162

What is a “Lifestyle”?

Back 162

A "lifestyle" is more than the way we spend our time!
“Lifestyles” are the behaviors that we adopt based on the context of our life circumstances.

Lifestyle behaviors have a major impact on our health

Front 163

Factors that Influence Our Lifestyles

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Biological
Psychological
Personal
Societal
Environmental

Front 164

Biological Influences

Back 164

Satisfaction of basic needs is a pre-requisite for personal growthMaslow’s Hierarchy of Needs

Front 165

Psychological Influences

Back 165

The Iceburg Model:
Only the top 10% of an
iceburg’s mass is above the water. The causes of lifestyle behaviors are similarly obscured.

Values / beliefs
Attitudes
Psychological

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Personal Influences

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School and work responsibilities
Family responsibilities

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Societal Influences

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Power of media
Power of group identity
Relative acceptance of negative behaviors

Front 168

Environmental Influences

Back 168

Access to many unhealthy options (e.g. fast food)
Lack of healthy options (e.g. walking paths)
Season / time of day

Front 169

Models of Behavior Change

Back 169

Transtheoretical Model
Health Belief Model
Social Cognitive Theory
Theory of Reasoned Action
Theory of Planned Behavior
Self-Determination Theory

Front 170

Stages of Change

Back 170

Research shows that people advance through a series of stages as they attempt to change behaviors

Front 171

Factors in Behavior Change

Back 171

Front 172

Exercise Adherence & Motivation: variables predicting the exercise dropout

Back 172

Personal Factors
Smoking: if they do work-out they are likely to quit.
Blue collar worker: incidental or occupational activity HELPS!
Type A personality: Always busy
Poor self-concept
Depression: Exercise helps depression improve
Poor credit rating
Exercises alone

Front 173

Exercise Adherence & Motivation: variables predicting the exercise dropout

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Program Factors
Inconvenient time or location
Excessive cost
Intensity of exercise (too high)
Lack of variety
Lack of positive feedback
Inflexible exercise goals

Front 174

Exercise Adherence & Motivation: variables predicting the exercise dropout

Back 174

Other Factors
Inclement weather: mall walking
Excessive job travel
Injury: prevent by recommending low intensity.
Medical problems
Job change
Relocation/moving

Front 175

Strategies to Improve Compliance

Back 175

Avoid falling into the “yea, but…” trap!
Ask the client to:
Select an activity(ies) that s/he enjoys!
Backup plan – inclement weather, travel
Schedule their exercise session
Self-Monitoring: Keep a log of activities: sign a contract and they are more likely to reach goals.
Find an exercise partner/group

Front 176

Issues affecting drop-out:

Back 176

Difficulty -> Intensity
Complexity
Realistic Goals
Personal Issues
Busy -> Family
Results
Motivating Factors
Social Support
Access
Time
Weather
Illness
Job Demands
Exercise Partner
Supportive Trainer: needs to give positive feedback.

Front 177

Strategies to Improve Compliance:

Back 177

Provide positive feedback
Add variety to the routine
Set realistic/attainable goals
Provide rewards/reinforcement
Teach safety (routines, equipment)
Increase intensity gradually – start slowly, progress gradually!

Front 178

Strategies for Changing Health Behaviors

Back 178

Start w/ fitness assessment
Monitor baseline information
Make goals
Develop plans
Monitor progress
Conduct post fitness assessment.
People who write down events on a calendar/schedule are more likely to accomplish & succeed @ what they have scheduled.
Smoking cessation programs success is only 20% w/ the BEST programs.
Research: Adopting healthy behaviors was dependent on: Perceived Severity & Susceptibility.

Front 179

Hints for Successful Behavior Change

Back 179

Make small changes
Reward your progress
Don't give up
Fitness is a process. If a person skips some exercise, it's OK! They can pick it back up!

Front 180

Predisposing Factors

Back 180

Is it Worth it?
Self-motivation
Enjoyment
Balance of attitudes
Beliefs
Knowledge
Am I able?
Self-confidence
Self-efficacy
Safe environment
Access

Front 181

Enabling Factors

Back 181

Goal setting skills
Self-assessment
Self-planning
Self-monitoring
Performance skills
Coping skills
Consumer skills
Time management

Front 182

Reinforcing Factors

Back 182

Family
Peers
Health professionals
Societal norms

Front 183

Factors that Influence Behavior Change

Back 183

Front 184

Self-Management Skills

Back 184

A major goal of the class is to help you develop self management skills so that you can maintain an active and healthy lifestyle
Different self management skills are needed for predisposing, enabling and reinforcing factors.
Changing Predisposing Factors
Overcoming barriers
Building self confidence
Balancing Attitudes
Building knowledge and changing beliefs

Front 185

Self-Management Skills

Back 185

Changing Enabling Factors
Goal setting skills
Self-assessment skills
Self-monitoring skills
Self-planning skills
Performance skills
Adopting coping skills
Learning consumer skills
Managing time
Changing Reinforcing Factors
Finding social support
Preventing relapse

Front 186

Desired Weight Formula:

Back 186

Current LBW/ (1-desired %Fat) =

Front 187

Total Body Weight Formula:

Back 187

TBW = LBW + FW
EX. 200 = 160 + 40 = .20 OR 20%

Front 188

Health Belief Model

Back 188

History and Orientation

The Health Belief Model (HBM) is a psychological model that attempts to explain and predict health behaviors. This is done by focusing on the attitudes and beliefs of individuals. The HBM was first developed in the 1950s by social psychologists Hochbaum, Rosenstock and Kegels working in the U.S. Public Health Services. The model was developed in response to the failure of a free tuberculosis (TB) health screening program. Since then, the HBM has been adapted to explore a variety of long- and short-term health behaviors, including sexual risk behaviors and the transmission of HIV/AIDS.

Core Assumptions and Statements

The HBM is based on the understanding that a person will take a health-related action (i.e., use condoms) if that person:

1.feels that a negative health condition (i.e., HIV) can be avoided,

2.has a positive expectation that by taking a recommended action, he/she will avoid a negative health condition (i.e., using condoms will be effective at preventing HIV), and

3.believes that he/she can successfully take a recommended health action (i.e., he/she can use condoms comfortably and with confidence).

The HBM was spelled out in terms of four constructs representing the perceived threat and net benefits: perceived susceptibility, perceived severity, perceived benefits, and perceived barriers. These concepts were proposed as accounting for people's "readiness to act." An added concept, cues to action, would activate that readiness and stimulate overt behavior. A recent addition to the HBM is the concept of self-efficacy, or one's confidence in the ability to successfully perform an action. This concept was added by Rosenstock and others in 1988 to help the HBM better fit the challenges of changing habitual unhealthy behaviors, such as being sedentary, smoking, or overeating.

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Health Belief Model:

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Health Belief Model

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