Moments
Implications of Physical Exercise on the Patient
Physical, play or maintenance activity and practicing sports of a non-competitive nature are beneficial in the prevention and therapy of some illnesses. Because its benefits have been demonstrated in some studies, even without scientific evidence in some of their mechanisms, many medical specialties encourage light to moderate physical activity.
In practice its benefit has been proven in diabetes, in heart disease, in mild to moderate high blood pressure, in dyslipidemia and in osteoporosis.
In neoplasias of the colon, in some depressive syndromes and in immune-depressed patients, exercise may have very positive effects as a therapeutic complement. However, the dose/effect relationship of exercise for the beneficial effect to be achieved remains to be determined.
The hemodynamic effects responsible for modifications in the organs and systems depend on the type, intensity and length of the exercise, and whether it is predominantly dynamic, static, mixed or continuous-intermittent predomination. The physical profile of each exercise and knowledge of the metabolic actions induced by them form the true problem.
What is the exercise best suited for increasing bone density in osteoporosis? Continuous dynamic exercise or static exercise with intervals? And for a heart patient, before and after angioplasty? And in the patient with moderate and serious high blood pressure? Low intensity and continuous or short, moderately intense and alternated?
These questions should have answers, advice and clinical accompaniment case-by-case, which does not always take place. But as in general there are more benefits than risks in prescribing exercise, it is common for doctors to recommend 30 minutes of light to moderate exercise on a daily or every second day basis with case-by-case control of heart rate. Most of the above-mentioned illnesses produce a great impact on the economy of many nations as a consequence of late dealing with the many risk factors, as well as a reduction in productivity due to these illnesses.
Sedentarism, diet, lifestyle and illiteracy that exist in today’s consumer societies produce these illnesses, which do not spare young people, a phenomenon that should receive special attention from public entities.
More developed societies, recognising the serious social and economic consequences that these illnesses will provoke in the near future, particularly obesity and diabetes, have already invested in primary prevention, implementing compulsory programmes of physical activity and sport for children and adolescents.
The aim of this is for healthy habits to be acquired at school and in each family and for them to carry on to higher education, so that physical exercise becomes a need and a pleasure and is maintained for as long as possible throughout life. Current knowledge about some mechanisms that show the benefit of practising moderate and regular physical activity on the population in general may be summarised as:
1. Effects on the endothelial function, stimulating, besides other factors, the releasing of nitric oxide, a potential vasodilator;
2.Anti-atherogenic action on risk factors, such as the reducing of triglycerides, increase in HDL, reduction in light to moderate high blood pressure, increase in fibrinolytic activity and sensitivity to insulin;
3. Anti–ischemics through coronary vasodilation – improvement in collateral circulation and reduction of heart rate, giving greater reception of oxygen to the cardiomyocyte;
4. Regulating effect on the autonomic nervous system, reducing sympathetic activity and possibly stimulating vagal tonus;
5. It favours anti-inflammatory activity in the endothelium, reducing adherence of plaquettes to the vascular wall, and systematically temporarily increases the circulating leucocytes;
6. Anti-arhythmic effect on patients with sympathetic hypersensitivity.
J. Fonseca Esteves
President of the Portuguese Society of Sports Medicine
fonsecasteves@gmail.com
Bibliography:
Endothelial dysfuntion in patients with chronic heart failure: systemic effects of lower-limb exercise training; Linke A et al; J Am Coll Cardiol ; 2001 Feb ;37 (2) ;392 - 7
Effect of different intensities of exercise on endothelium- dependent vasodilation in humans ; role of endothelium – dependent nitric oxide and oxidative stress ; Goto C et al ; Circulation,2003 Aug 5;108 (5):530 - 5
Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure; a randomized study; Wisloff U et al; Circulation 2007 Jun 19 115 (24): 3086-94
In practice its benefit has been proven in diabetes, in heart disease, in mild to moderate high blood pressure, in dyslipidemia and in osteoporosis.
In neoplasias of the colon, in some depressive syndromes and in immune-depressed patients, exercise may have very positive effects as a therapeutic complement. However, the dose/effect relationship of exercise for the beneficial effect to be achieved remains to be determined.
The hemodynamic effects responsible for modifications in the organs and systems depend on the type, intensity and length of the exercise, and whether it is predominantly dynamic, static, mixed or continuous-intermittent predomination. The physical profile of each exercise and knowledge of the metabolic actions induced by them form the true problem.
What is the exercise best suited for increasing bone density in osteoporosis? Continuous dynamic exercise or static exercise with intervals? And for a heart patient, before and after angioplasty? And in the patient with moderate and serious high blood pressure? Low intensity and continuous or short, moderately intense and alternated?
These questions should have answers, advice and clinical accompaniment case-by-case, which does not always take place. But as in general there are more benefits than risks in prescribing exercise, it is common for doctors to recommend 30 minutes of light to moderate exercise on a daily or every second day basis with case-by-case control of heart rate. Most of the above-mentioned illnesses produce a great impact on the economy of many nations as a consequence of late dealing with the many risk factors, as well as a reduction in productivity due to these illnesses.
Sedentarism, diet, lifestyle and illiteracy that exist in today’s consumer societies produce these illnesses, which do not spare young people, a phenomenon that should receive special attention from public entities.
More developed societies, recognising the serious social and economic consequences that these illnesses will provoke in the near future, particularly obesity and diabetes, have already invested in primary prevention, implementing compulsory programmes of physical activity and sport for children and adolescents.
The aim of this is for healthy habits to be acquired at school and in each family and for them to carry on to higher education, so that physical exercise becomes a need and a pleasure and is maintained for as long as possible throughout life. Current knowledge about some mechanisms that show the benefit of practising moderate and regular physical activity on the population in general may be summarised as:
1. Effects on the endothelial function, stimulating, besides other factors, the releasing of nitric oxide, a potential vasodilator;
2.Anti-atherogenic action on risk factors, such as the reducing of triglycerides, increase in HDL, reduction in light to moderate high blood pressure, increase in fibrinolytic activity and sensitivity to insulin;
3. Anti–ischemics through coronary vasodilation – improvement in collateral circulation and reduction of heart rate, giving greater reception of oxygen to the cardiomyocyte;
4. Regulating effect on the autonomic nervous system, reducing sympathetic activity and possibly stimulating vagal tonus;
5. It favours anti-inflammatory activity in the endothelium, reducing adherence of plaquettes to the vascular wall, and systematically temporarily increases the circulating leucocytes;
6. Anti-arhythmic effect on patients with sympathetic hypersensitivity.
J. Fonseca Esteves
President of the Portuguese Society of Sports Medicine
fonsecasteves@gmail.com
Bibliography:
Endothelial dysfuntion in patients with chronic heart failure: systemic effects of lower-limb exercise training; Linke A et al; J Am Coll Cardiol ; 2001 Feb ;37 (2) ;392 - 7
Effect of different intensities of exercise on endothelium- dependent vasodilation in humans ; role of endothelium – dependent nitric oxide and oxidative stress ; Goto C et al ; Circulation,2003 Aug 5;108 (5):530 - 5
Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure; a randomized study; Wisloff U et al; Circulation 2007 Jun 19 115 (24): 3086-94
