Review the basics of exercise as medicine and how to develop and incorporate exercise into your life.

1. Applying the Science of Exercise
to your Life

2. Exercise as Medicine
Stephan Esser MD
Follow me @EsserHealth on Instagram and
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3. If you are over the age of 40 or have
any chronic diseases or have a
personal history or strong family
history of heart disease, sudden
cardiac death or the like then you
should NOT begin a new exercise
program without first consulting your
primary physician.

4. Goals
• Where it all began
• Provide basic Definitions
• Dispel common myths
• Discuss frequent misconceptions
• Provide tools for change

5. “Eating alone will not keep a man well; he must
also take exercise. For food and exercise……
work together to produce health.”
Hippocrates
Regimen 400 BC

6. A brief history of exercise

10. Ancient Awareness
• Early observations
– Hippocrates (460-370 B.C.)
• “if we could give every individual the right amount of
nourishment and exercise, not too little and not too
much, we would have found the safest way to health”
– Cornelius Celsus (ca.10-60)
• “take exercise: for whilst inaction weakens the body,
work strengthens it; the former brings on premature
old age, the latter prolongs youth”

16. Defining Exercise
• Exercise:
–movement of the body resulting in the
enhancement of health and improvement
of function

17. #1
Exercise is of no real value to
my health

18. • I don’t need to exercise…. I just don’t
• I don’t have any health problems
• I’m healthy the way I am
• I’m skinny, I don’t need to exercise
• I’ve never exercised before why would I start
now?
• That’s why they make medicine
• Hello “drive through”
• Aren’t we supposed to “conserve energy”?

19. Actual causes again

20. Exercise and Physical Health
• Reduces risk of
– Heart Disease ≈ 40%
– Obesity: ≈ 30-100%
– Stroke ≈ 50%
– Type 2 Diabetes ≈ 50%
– Hypertension ≈ 50%
– Disability delayed ≈15 years
– Colon Cancer ≈ 25-40%
– Breast Cancer ≈ 20%-44%
– Osteoporosis ≈ 20+%
• As many as 250,000 deaths per year in the United
States areattributable to a lack of regular
physical activity

21. Physical Health Cont’d
• Improve Balance
• Reduce Fall risk
• Improve Systemic Circulation
• Accelerate Skin Healing
• Bowel Regularity/  risk diverticulosis
• Improved Energy/Resilience

22. Exercise and Mental Health
• Regular Exercise:
– Reduces risk/severity of:
• Depression
• Anxiety
• ADD/ADHD
• Alzheimers Dementia
– Improves:
• Mental Clarity, test scores, focus

23. Exercise and Emotional Health
• Regular Exercise:
– Increases Self Confidence
– Teaches skills to manage adversity
– Enhances Self Esteem
– Develops Discipline
– Encourages Goal setting and self awareness

24. #2
Exercise is the fix for everything

25. • I can eat all the McDonald’s I want
• I run 4 miles a day and hit the gym every other
day……… bring on the Dairy Queen

26. • While exercise does have multi-system, multi-
modal benefits there are many, many times
where exercise is NOT the answer
• Acute Trauma
• Progressive Cancer
• Progressive Neurologic Impairment
• “Weird stuff”
• Too soon

27. #3
Exercise means pink spandex, going to a
gym, sweating with a bunch of people I
don’t even know or like!

28. Categories
• Leisure time Exercise: organized sports,
running, gym activities, rehabilitation etc.
• Lifestyle Exercise: activity incorporated into our
daily pattern of life
– eg: parking in the distant portion of the parking lot rather then the first
bumper, taking the stairs instead of the elevator etc.

29. #4
I’m too old to exercise

30. • I’m just taking it easy now
• I’ve paid my dues
• Now is the time to relax
• Don’t want to work myself too hard
• I spent my whole life go-go-going
• I’m too old for “that”
• Those days are past

33. • “A review of biologic changes commonly
attributed to the processof aging
demonstrates the close similarity of
most of theseto changes subsequent to
a period of enforced physical inactivity.
The coincidence of these changes from
the subcellular to thewhole-body level of
organization, and across a wide range of
body systems, prompts the suggestion
that at least a portionof the changes that
are commonly attributed to aging is in
realitycaused by disuse and, as such, is
subject to correction. Thereis no drug in
current or prospective use that holds as
muchpromise for sustained health as a
lifetime program of physical
exercise.”(JAMA 1982;248:1203-1208)
Walter Bortz MD
Disuse and Aging

34. CDC Exercise Stats
• > 60% of adults are not regularly active
• 25% are not active at all
• By age 75 1:3 men and 1:2 women engage in NO
physical exercise

35. Aging and Exercise
• Reduces Disability
• Prolongs Independence
• Slows Aging
• Reduces risk of multiple Co-Morbidities
• Reduces All-Cause Mortality
• Reduces Medication use, Hospital Admission
• Etc………

39. • “You have to work at living, period. You’ve got
to train like you are training for an athletic
event. Most older people just give up. They
think, “I’m too old for that,” because they
have an ache here or a pain there. Life is a
pain in the butt; you’ve got to work at it.”
Jack LaLanne

41. #5
I’m too young to exercise

42. • I don’t want to stress my childs body
• My child needs to rest inside more
• It’s too hot/cold etc to stay active
• All that running around is too much for little
Johnny
• He needs to save his energy
• Working out will “stunt his growth”
• Exercise will make Janie look like a Johnny

44. • 1. All adolescents should be physically active daily, or
nearly every day, as part of play, games, sports,
work, transportation, recreation, physical education,
or planned exercise in the context of family, school,
and community activities.
• 2. Adolescents should engage in three or more
sessions per week of activities that last 20 minutes
or more at a time and that require moderate to
vigorous levels of exertion.

45. • 50% of all youth ages 12-21 are not vigorously
active on a regular basis
• 1 in 3 children overweight or obese
• Rates of Type 2 Diabetes sky-rocketing
• Rates of medication use, hospitalization

46. #6
No Pain, no Gain

47. Depends

48. Not good pain
• Chest Pain
• Joint Pain
• Pain that radiates
• Pain associated with neurologic changes
• Pain with swelling
• Pain that fails to improve with appropriate
measures
• Pain that compromises other systems function

49. “Good Pain”
• Muscle “pain” while exercising
• Muscle soreness 1-2 days after exercise
• Moderately labored breathing during activity
• The opposite of the other page

50. #7
You have to exercise really hard or
there is no benefit

52. Talk Test:
-Easy: Can Talk and Sing
-Moderate: Can Talk but not sing
-Intense: Can’t talk or sing
Talk Test:
-Easy: Can Talk and Sing
-Moderate: Can Talk but not sing
-Intense: Can’t talk or sing

53. #8
Pregnant Women Shouldn’t
Exercise

54. “30minutes or more of moderate exercise a
day should occur on most, if not all, days of
the week “

55. In Pregnancy
• Exercise
– Helps reduce backaches, constipation, bloating, and
swelling
– May help prevent or treat gestational diabetes
– Increases your energy
– Improves your mood
– Improves your posture
– Promotes muscle tone, strength, and endurance
– Helps you sleep better
– Weigh less to start, gain less weight during pregnancy
and tolerate labor better than do sedentary women.

56. Factoids
• Pregnant women should NOT:
– Downhill ski
– Contact Sports
– Scuba Diving
• Not the time to start new moderate to
aggressive exercise programs
• Is the time to continue usual regimen or begin
a new gentle regular habit

57. • Already active ….stay active
• Interested in starting…check with
physician
• Start low…go very slow

58. #9
Exercise costs too much

59. • I can’t afford a gym membership
• I live too far from a gym
• I don’t have room for gym equipment in my
house
• I can’t afford new shoes, clothes etc..

61. Places
• Parks
• Gyms
• Country Clubs
• Lakes
• Oceans
• Your House:
– Backyard/Frontyard/Garage/Living Room etc
• ANYWHERE and EVERYWHERE

62. #10
I have a bad shoulder….I can’t
exercise

63. “Many people have arthritis and
rheumatism; they get bum knees, a bum
back. A lot of guys get a little pain in the
toe or knee and then they won't exercise.
Well gee, you have 640 muscles in your
body. There may be a few exercises you
can't do, but there are hundreds you can
do!”
Jack Lallane

64. #11
I don’t have the time to exercise

65. • I work double shifts…not gonna happen
• Between my job, the kids…no way
• I commute 2 hours and work 8 hour days

67. Response
• Remember Lifestyle and Leisure time
definitions
• Be creative
• Be proactive
• Be optimistic

68. #11
I have a disability, I can’t exercise

69. #11
• Promote Health
• Increase socialization and community
engagement
• Enhance physical activity efficacy
• Reduce depression/anxiety/social isolation
• Improve function
• And More

70. “Eating alone will not keep a man well; he must
also take exercise. For food and exercise……
work together to produce health.”
Hippocrates
Regimen 400 BC

71. “Exercise is just as essential as a rational diet”
Dr. William Esser N.D. DC.

72. Transition

73. Stages of Change (Prochaska and DiClemente)
1: Pre-contemplation
2: Contemplation
3: Preparation/planning
4: Action
5: Maintenance
6: Permanent Maintenance
(Termination)

74. My Reasons to Exercise
• Feel good in my skin
• Increase energy, Reduce stress
• Increase my confidence, discipline
• Be a role model, socialize, family time
• It’s fun, I love to sweat and work hard
• I love challenges
• Reduce disease risk
• Lower disability risk
• Maintain independence

75. What are your reasons?

76. My Reasons NOT to Exercise
• Time
• I’m tired or lazy
• Inconvenience (I forgot my clothes etc…)
• Money (shoes, travel, racquets)
• Other priorities
• Hate Change
• Don’t know what to do
• I’m Injured

77. What are your reasons
NOT
to Exercise?

78. “Physical fitness can neither be
achieved by wishful thinking nor
outright
purchase.”
Joseph Pilates

79. You are never too old to set another goal or
to dream a new dream
C.S. Lewis

80. Defining Success
• What is success for you?
• Are such goals achievable, legitimate?
• What will you do if you fail to “succeed”?

81. Setting Goals
•Specific
•Measureable
•Achievable
•Realistic
•Timely

82. Establishing Priorities
• Potential responsibilities, limitations
• Discover balance
• Be dynamic, flexible

83. If you have decided
to start or increase
your activity level…….now what?

84. FITT
• Frequency
• Intensity
• Time
• Type

85. Lasting Change
• Track your efforts and progress
• Re-visit your goals regularly
• Adjust to meet your needs
• Thrive!

86. Conclusion
• Exercise is a powerful component of health
• Disease Risk, Function, Pain, Disability
• More wide ranging and powerful then any
“medicine’s” effects
• An ancient intervention with little to no cost
• Should be pursued as a part of regular
“healthcare” with the advice of a physician

87. “First say to yourself what you would be; and
then do what you have to do”
Epictectus
Greek Stoic Philosopher AD 55–AD 135

88. Thank You!
Stephan Esser MD, USPTA
Follow me on Instagram and Facebook
@esserhealth