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CASE TWO ANSWER\/NOTES<\/p>\n
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What are the health benefits of exercise?<\/span><\/strong><\/p>\n 1. Reduced overall mortality – The best study, the Harvard alumni study shows that the relative risk for dying during the followup period (10-15 years) was 0.47 for most active compared with least active.\u00a0 <\/span>Other huge studies show similar risk reductions (RRs of .47 to .7 for most active compared with least) .\u00a0 <\/span>Further evidence for the association comes from good studies that show that people who were initially inactive and later became active have reduced mortality compared with ongoing sloths.\u00a0 <\/span>In these studies the risk reduction from taking up exercise and becoming physically fit is of the same magnitude as quitting smoking.<\/p>\n \n 2. Reduced Cardiovascular Mortality, CHD, and HTN – details in question 1 & 3.<\/p>\n \n 3. Reduced risk of colon cancer – data insufficient to assess effect on other cancers or no association detected.<\/p>\n \n 4.\u00a0Reduced risk of Diabetes<\/p>\n \n 5. Relieves symptoms of Depression and anxiety.\u00a0 <\/span>May also reduce risk of developing depression.<\/span><\/p>\n <\/p>\n \n \n How would you assess her current level of physical activity?<\/span><\/strong><\/p>\n \n This is a bit of a problem. The studies documenting the above associations use many different methods for quantifying physical activity.\u00a0 <\/span>While some assess only leisure-time activities, others include all daily activities.\u00a0 <\/span>The problems in assessment are a bit akin to brief physician assessment of diet.\u00a0 <\/span>Usually, it\u2019<\/span>s more revealing to ask people what they had for breakfast, lunch, dinner, and snacks, then it is to ask them what their diet consists of.\u00a0 <\/span>Similarly, a daily recounting of occupational, housework, and leisure activities will give a ballpark idea of whether the patient is sedentary, minimally active, moderately active, or very active.\u00a0 <\/span>(Anyone who goes to the gym three times a week is very active.)\u00a0 <\/span>Also, keep in mind the general rules that every little bit helps and more is better (except at the extreme – marathoners and such).\u00a0 <\/span>These general rules have solid data behind them.\u00a0 <\/span>The aforementioned studies of all-cause mortality document graded relationships with moderate activities conveying some benefit.\u00a0 <\/span>For example, walking 15 km per week reduced risk of dying during followup period to 0.67.\u00a0 <\/span>That\u2019<\/span>s about 9 miles – if you walk half a mile to and from the subway station at both ends of the commute, you\u2019<\/span>re there.\u00a0\u00a0 <\/span>Another example, apropos of this and the previous question, is that men who climbed 55 flights of stairs per week had RR of death of 0.75.\u00a0 <\/span><\/p>\n \n \n \n Given her current situation, how might she go about getting more exercise?<\/p>\n<\/div>\n \u00a0<\/span><\/p>\n Practical suggestions would be getting off the subway or bus one stop earlier and walking.\u00a0 <\/span>Taking the stairs in her apartment building.\u00a0 <\/span>Walking for short errands rather than riding the bus.\u00a0 <\/span>Suggestions for leisure time activities should be conditioned\u00a0 <\/span>by the very mixed results that \u201c<\/span>coercive\u201d<\/span> attempts at intervention have had and the knowledge that the measurable fitness benefits of exercise diminish significantly within 2 weeks of cessation and disappear completely within 8 months.\u00a0 <\/span>If she\u2019<\/span>s going to take up something in her leisure time, it should be something she enjoys, that involves acceptable expense, that she can fit into her schedule, etc.<\/p>\n \n \n