Who is the guy ?

CEO Sports Medicine Specialist

Team Physician

Olympic
2012

Youth
Olympic

PIT PDUI 2015

CLINICAL MENTORING

Andi Kurniawan
The rits Carlton HOTEL

18 APRIL 2015

OUTLINE PRESENTATION
Physical Inactivity ?
Exercise Benefits
Exercise Prescriptions
Individualizing
Ex Rx

WHO Global health Risks report, 2004.

WHO Global health Risks report, 2004.

Physical inactivity
(sedentarism): a fastgrowing public health
problem that contributes to
a variety of chronic
diseases and health
complications, including
obesity, diabetes and
cancer

SEDENTARY LIFESTYLE

Physical Activity
Evolution

Designed to Sit?

Medical Hazards of Prolonged Sitting Bassett et al. Exerc Sport Sci Rev

Human Evolution

SMOKING vs INACTIVITY

Wen and Wu. Lancet 2012; 380 (9838), pp. 192-193. S0140-

What if there was

one prescription
that could
prevent and treat
dozens of diseases,
such as diabetes,
hypertension and obesity?
Would you prescribe it to
your patients?
Certainly.

- Robert E. Sallis, M.D., FACSM

Exercise is Medicine Task Force Chairman

Lower risk of Early death

Lower risk of CHD
Lower risk of Stroke
Lower risk of High blood
pressure
Lower risk of adverse Blood
lipid profile
Lower risk of T 2 DM
Lower risk of Metab.
syndrome
Lower risk of Colon cancer
Lower risk of Breast cancer
Prevention of Weight gain
Weight loss
Improved Cardiorespiratory
and muscular fitness
Prevention of falls
Reduced Depression

Better functional health

(for older adults)
Reduced abdominal
obesity
Weight maintenance
after weight loss
Better Cognitive
function (for older
adults)

Lower risk of hip fracture

Lower risk of lung cancer
Lower risk of
endometrial cancer
Increased bone density
Improved sleep quality

Compared to drivers,
conductors had :
A lower rate of heart attacks
compared to drivers

One-third the rate of sudden

death from coronary heart disease,
for those under the age of 50

Two-thirds the rate of sudden

death from coronary heart disease,
for those above the age of 50
Had a smaller waist circumference
compared to drivers

J. A. Heady, J. N. Morris, And A. Kagan, P. A. B. Raffle. Coronary Heart Disease in London

Busmen: A Progress Report with Particular Reference to Physique. Brit. J. Prev. Soc. Med.

Whats the difference

between the drivers and
conductors?

PHYSICAL
ACTIVITY
J. A. Heady, J. N. Morris, And A. Kagan, P. A. B. Raffle. Coronary Heart Disease in London
Busmen: A Progress Report with Particular Reference to Physique. Brit. J. Prev. Soc. Med.

Attributable fractions (%) for all-cause deaths in 40 842 (3333

deaths) men and 12 943 (491 deaths) women in the Aerobics
Center Longitudinal Study.

Blair SN. Physical inactivity: the biggest public health problem of the 21st century. BJSM 2009;
43:1-2.

CRF and All-Cause Mortality,

4060 Women and Men 60 Years of Age,
989 Deaths
All-cause deaths/10,000 person-years

ates are age adjusted

Sui X et al. J Am Geriatrics Soc 2007; 55:194

ACSM Survey
25% of patients look to
their doctor first for
advice on exercise and
physical activity
24% of patients turn next
to fitness and health web
sites

65%

Nearly two-thirds of patients (65%) would

be more interested in exercising to stay
healthy if advised by their doctor and given
additional resources.

Four out of 10 physicians

(41%) talk to their patients about
the importance of exercise, but dont
always offer suggestions on the best
ways to be physically active.

PHYSICAL ACTIVITY AS A VITAL SIGN

General Principles of

Exercise
Prescription

What are the definitions of

basic exercise terms?

Physical activity
Active Lifestye
Exercise
Sports
Physical Fitness

PHYSICAL ACTIVITY ?
Any bodily movement
produced by the
contraction of skeletal
muscle that increases
energy expenditure
above a basal level.

ACSMs Guidelines for Exercise Testing and Prescription, Seventh Edition,

Lippincott, Williams and Wilkins, Philadelphia, 2006. page 3.

ACTIVE LIFESTYLE ?
Physical activity that you
do while performing your
routine activities at
work, at home or in your
travels throughout the
day.

ACSMs Guidelines for Exercise Testing and Prescription, Seventh Edition,

Lippincott, Williams and Wilkins, Philadelphia, 2006. page 3.

ACTIVE LIFESTYLE TIPS ?

-

taking the stairs

parking in a space furthest from the door
bicycling to work
walking during your lunch break
walking your dog
walking to the train or bus stop
raking the leaves
vacuuming the house

EXERCISE ?
1. A subset of physical
activity
2. Planned, structured and
repetitive bodily
movement
3. Performed with the goal of
improving or maintaining
physical fitness
ACSMs Guidelines for Exercise Testing and Prescription, Seventh Edition,
Lippincott, Williams and Wilkins, Philadelphia, 2006. page 3.

PHYSICAL FITNESS ?

is the ability of your body systems

to work efficiently.
A fit person is able to carry out the
typical activities of living, such as
work, and still have enough
energy and vigor to respond to
emergency situations and to
enjoy leisure time activities

ACSMs Guidelines for Exercise Testing and Prescription, Seventh Edition,

Lippincott, Williams and Wilkins, Philadelphia, 2006. page 3.

SPORTS ?
Sport covers a range of
physical activities
performed within a set
of rules and
undertaken as part of
leisure or competition.

ACSMs Guidelines for Exercise Testing and Prescription, Seventh Edition,

Lippincott, Williams and Wilkins, Philadelphia, 2006. page 3.

DOSE / DOSAGE

TYPE OF ACTIVITY
FREQUENCY
DURATION
INTENSITY

TYPE OF
ACTIVITY

Aerobic Exercise : (LOW IMPACT/LOW INTENSIT

Walking with dog

Aerobic Exercise : (MEDIUM IMPACT/INTENSITY

BRISK
WALKING

Aerobic Exercise : (HIGH IMPACT/INTENSITY)

Intensity Using Heart Rate

Very light = <50 % of maximal
heart rate
Light
= 50-63 % of maximal
heart rate
Moderate = 64-76 % of maximal
heart rate
Vigorous = 77-93 % of maximal
heart rate
Very Hard = >94 % of maximal
heart rate

Intensity Using Heart Rate

The Borg Rating of Perceived
Exertion Scale

9 = Very Light
11 = Light
13 = Somewhat hard Sing Test
- Moderate
15 = Hard
intensity : You
17 = Very hard
can talk while
exercising but
19 = Extremely hard
20 = Maximal exertion not sing.

Strengthening Exercise :

Exercise to build muscle tone

Increase general muscle strength
By using weight.

Body

Dumble

Machine

Flexibility Exercise :

Exercise to increase range of motion

and joint movement.
Prevent Injury
Good Posture

Static

Dynamic

COMPONENT OF EXERCISE

RISK OF EXERCISE
Musculoskeletal

Sudden Cardiac
Death

OR SIGN AND SYMPTOMS SUGGESTIVE of CARDIOVASCULAR DISEASE,

LONARY DISEASE AND METABOLIC DISEASE