CH 1

Chapter 1
Benefits and Risks Associated

with Physical Activity
Physical Activity and Fitness Terminology
• Physical Activity (PA)
– Any bodily movement produced by the contraction of skeletal
muscles that results in a substantial increase in caloric
requirements over resting energy expenditure
• Exercise
– A type of PA consisting of planned, structured, and repetitive
bodily movement done to improve and/or maintain one or
more components of physical fitness
Copyright © 2018 American College of Sports Medicine

Physical Activity and Fitness Terminology
(cont.)
• Physical fitness
– The ability to carry out daily tasks with vigor and alertness,
without undue fatigue, and with ample energy to enjoy
leisure-time pursuits and meet unforeseen emergencies

Public Health Perspective for
Current Recommendations
• Over 20 yr ago, the American College of Sports Medicine (ACSM) in
conjunction with the Centers for Disease Control and Prevention (CDC),
the U.S. Surgeon General, and the National Institutes of Health (NIH)
issued landmark publications on PA and health.
– What are the amount and intensity of PA needed to improve health,
lower susceptibility to disease(morbidity), and decrease premature
mortality.
– Documented the dose-response relationship between PA and
health (i.e., some activity is better than none, and more activity, up
to a point, is better than less).

• Two important conclusions from the Physical Activity
Guidelines Advisory Committee Report that influenced
the development of the PA recommendations are the
following:
– Important health benefits can be obtained by performing a
moderate amount of PA on most, if not all, days of the week.
– Additional health benefits result from greater amounts of PA.
Individuals who maintain a regular program of PA that is
longer in duration, of greater intensity, or both are likely to
derive greater benefit than those who engage in lesser
amounts.
• Several large-scale epidemiology studies have been performed
that document the dose-response relationship between PA and
cardiovascular disease (CVD) and premature mortality
– Dose response relationship
• A meta-analysis of 23 sex-specific cohorts of PA or
cardiorespiratory fitness (CRF) representing 1,325,004
individual-years of follow-up showed a dose-response
relationship between PA or CRF and the risks of coronary
artery disease (CAD) and cardiovascular disease (CVD).
• Figure 1.1

FIGURE 1.1. Estimated dose-response curve for the relative risk of atherosclerotic cardiovascular disease
(CVD) by sample percentages of fitness and physical activity. Studies weighted by individual-years of
experience. Used with permission from (104).
104. Williams PT. Physical fitness and activity as separate heart disease risk factors: a meta–analysis. Med
Sci Sports Exerc. 2001;33(5):754–61.

Current Recommendations (cont.)
• Physical inactivity
– Global pandemic that has been identified as one of the four
leading contributors to premature mortality
• Globally, 31.1% of adults are physically inactive
• In the US:
• 51.6% of adults meet aerobic activity guidelines
• 29.3% meet muscle strengthening guidelines
• 20.6% meet both the aerobic and muscle strengthening
guidelines

Sedentary Behavior and Health
• Prolonged periods of sitting or sedentary behavior are associated
with deleterious health consequences independent of PA levels
– 50% of an average person’s waking day involves activities
associated with prolonged sitting such as television viewing
and computer
– However, sedentary time was associated with a 30% lower
relative risk for all-cause mortality among those with high
levels of PA as compared with those with low levels PA

Health Benefits of Regular Physical Activity and
Exercise
• Evidence to support the inverse relationship between regular PA
and/or exercise and premature mortality, CVD/CAD,
hypertension, stroke, osteoporosis, T2DM, metabolic syndrome
(Metsyn), obesity, 13 cancers, depression, functional health, falls
and cognitive function
– Box 1.4

Health Benefits of Improving Muscular Fitness
• The health benefits of enhancing muscular fitness (i.e., the
functional parameters of muscle strength, endurance, and power)
are well established
– Higher levels of muscular strength are associated with a
significantly better cardiometabolic risk factor profile, lower
risk of all-cause mortality, fewer CVD events, lower risk of
developing physical function limitations, and lower risk for
nonfatal disease

Importance of Exercise
& Nutrition for Optimal
Osteogenesis
Figure 4.
Mechanical loading influences MSC
differentiation. The ability of mechanical
signals to increase bone formation while
inhibiting fat formation centers on the
mechanical sensitivity of the common
progenitor stem cell from which osteoblasts
and adipocytes differentiate. Shown in
reconstructed microcomputed images, low-
magnitude mechanical signals bias the
bone marrow stem-cell population towards
osteoblastogenesis, resulting in greater bone
density in the proximal tibia (upper right) and
reduced visceral adiposity across the
abdomen (red in the lower right image).
These images are compared with those from
placebo control animals who ate the same
amount of food, yet over the same time
period had significantly less trabecular bone
(lower left) and more fat (upper left;
reproduced at same scale). The phenotypic
outcomes are mirrored by transcriptional
changes, as reflected by increased Runx2
expression and reduced PPARγ expression
in the marrow of the LMMS animals.
Abbreviations: LMMS, low- magnitude
mechanical signal; MSC, mesenchymal stem
cell; PPARγ, peroxisome proliferator-
activated receptor. Permission obtained from
J. Bone Miner. Res.24, 50–61 © (2009)

Figure 1.
Bone is subjected to a range of mechanical strains. a | A 2-minute
recording from a strain gauge attached to a sheep tibia while the animal
is standing (top panel) shows peak strains in the order of 200
microstrain. A 20-second section of that strain record (middle panel)
shows peak strain events as large as 40 microstrain, occurring at a high
frequency. Closer inspection of a 3-second period of the strain
recording (bottom panel) illustrates events in the order of 5 microstrain
occurring through the entire recording period. when the strain activity
of a bone is recorded over a 12-hour period, it is clear that there are
very few large strain events (>2,000 microstrain) and tens of thousands
of small strain events (<10 microstrain). b | Strain recordings from the
tibia of a diverse range of animals over a 12-hour period are remarkably
similar. Reprinted from Journal of Biomechanics 33, Fritton, S. P.,
McLeod, K. J. and Rubin, C. T. Quantifying the strain history of bone:
spatial uniformity and self-similarity of low-magnitude strains, 317–
325 © (2000), with permission from Elsevier.

Figure 2.
Interrelationship between loading cycles and bone adaptation. Using the turkey ulna model to determine the nonlinear interrelationship of cycle
number and strain magnitude, bone mass can be maintained through a number of distinct strategies (line); bone is preserved with either four
cycles per day of 2,000 microstrain, 100 cycles per day of 1,000 microstrain, or hundreds of thousands of cycles of signals of well below 10
microstrain (each represented as a star).34 These data indicate that falling below this ‘preferred strain history’ would stimulate bone loss, while
exceeding this interrelationship would stimulate bone gain. Nat Rev Rheumatol . 2010 January ; 6(1): 50–59

Risks Associated with Physical Activity and
Exercise
• Participation in exercise is associated with an increased risk for
musculoskeletal injury (MSI) and cardiovascular complications such
as sudden cardiac death (SCD) and acute myocardial infarction
(AMI)
– MSI is the most common exercise-related complication and is
often associated with exercise intensity, the nature of the
activity, preexisting conditions, and musculoskeletal anomalies
– SCD and AMI are associated with vigorous intensity are much
less common than MSI but may lead to long-term morbidity and
mortality

Sudden Cardiac Death among Young
Individuals
• Absolute annual risk of exercise-related death among high school
and college athletes:
– One per 133,000 men
– One per 769,000 women
• It should be noted that these rates, although low, include all
sports-related nontraumatic deaths. Of the 136 total identifiable
causes of death, 100 were caused by CVD.

4. American College of Sports Medicine, American Heart Association. Exercise and acute cardiovascular
events: placing the risks into perspective. Med Sci Sports Exerc. 2007;39(5):886–97.

Exercise-Related Cardiac Events in Adults
• In general, exercise does not provoke cardiovascular events in
healthy individuals with normal cardiovascular systems.
– Risk is related to the absence or presence of occult CVD,
exercise intensity, age and PA.
– The Onset Study showed that the risk of AMI during or
immediately following vigorous intensity exercise was 50
times higher for the habitually sedentary compared to
individuals who exercised vigorously for 1-h sessions > 5 d 
wk -1
– Figure 1.2

Exercise Testing and the Risk of Cardiac
Events
• As with vigorous intensity exercise, the risk of cardiac events
during exercise testing varies directly with the prevalence of
diagnosed or occult CVD in the study population.
• These data indicate that in a mixed population the risk of exercise
testing is low, with approximately six cardiac events per 10,000
symptom-limited maximum tests.

Risks of Cardiac Events during
Cardiac Rehabilitation
• In one survey, there was one nonfatal complication per 34,673 h
and one fatal cardiovascular complication per 116,402 h of
cardiac rehabilitation.
• More recent studies have found a lower rate, one cardiac arrest
per 116,906 patient-hours, one MI per 219,970 patient-hours, one
fatality per 752,365 patient-hours, and one major complication per
81,670 patient-hours.
• The mortality rate appears to be six times higher when patients
exercised in facilities without the ability to successfully manage
cardiac arrest.

4. American College of Sports Medicine, American Heart Association. Exercise and acute cardiovascular events: placing the
risks into perspective. Med Sci Sports Exerc. 2007;39(5):886–97.

Prevention of Exercise-Related Cardiac
Events
• Health care professionals should know the pathologic conditions
associated with exercise-related events so that physically active
children and adults can be appropriately evaluated.
• Physically active individuals should know the nature of cardiac
prodromal symptoms and seek prompt medical care if such
symptoms develop (see Table 2.1).

Events (cont.)
• High school and college athletes should undergo preparticipation
screening by qualified professionals.
• Athletes with known cardiac conditions or a family history should
be evaluated prior to competition using established guidelines.

Events (cont.)
• Health care facilities should ensure that their staffs are trained in
managing cardiac emergencies, have a specified plan, and have
appropriate resuscitation equipment (see Appendix B).
• Physically active individuals should modify their exercise program
in response to variations in their exercise capacity, habitual
activity level, and the environment (Chapters 6 and 8).

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Chapter 1

Benefits and Risks Associated

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

Copyright © 2018 American College of Sports Medicine

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