LESSON 2:

NON-COMMUNICABLE DISEASES
AND PHYSICAL INACTIVITY
OBJECTIVES:
 Assess your risk for cardiovascular disease.

 Discriminate among risk factors for CVDs that can be

controlled by lifestyle changes.

 Explain how exercise can decrease major risk factors for

CVDs.
Non-Communicable Diseases
 A non-communicable disease (NCD) is a medical condition or disease that
is noninfectious and non-transmissible among people.
 It is estimated that 6 out of 10 deaths in the world are attributed to NCDs
—cardiovascular disease (CVD), diabetes, cancer, and risk factors which
include elevated blood pressure, elevated blood sugar, and overweight.
 In 2010, the World Health Organization reported that the main causes of
NCDs are known: unhealthy diet, physical inactivity, and tobacco use.
 Elimination of these modifiable risk factors would prevent 80% of
premature heart disease, 80% Of premature stroke, 80% of type 2
diabetes, and 40% of cancer. Furthermore, physical inactivity is the fourth
leading risk factor for global mortality.
 To reduce the burden of NCDs on global health, current public health
actions stress the importance of preventing, detecting, and correcting
modifiable risk factors.

 In particular, participation in regular physical activity has been shown

to reduce the risk of coronary heart disease and stroke, diabetes,
hypertension, colon and breast cancer‘ and depression.

 It also largely determines energy expenditure, which is crucial to

energy balance and weight management (WHO, 2010).
Cardiovascular Disease

 Cardiovascular disease (CVD) is a group of degenerative conditions

that affects the heart and the vessels.

 It includes coronary heart disease (CHD), stroke, hypertension or high

blood pressure, and heart failure.

 The Department of Health (2009) identified heart disease as the

number one leading cause of mortality in the Philippines, followed by
diseases of the vascular system, malignant neoplasm (cancer), and
pneumonia.
 There is considerable evidence to show that CVD has its origins in
childhood and that obesity in childhood is associated with traditional
risk factors such as hypertension and hypercholesterolemia or
hyperlipidemia (British Medical Association, 2005).

 In adults, there is substantial evidence that high levels of physical

activity or physical fitness protect against CVDs (Hardman and
Stensel, 2003).

 Sedentary behavior also appears to be a risk factor for CVD in young

people (Hancox et al., 2004; Wong, et al., 1992). Remember,
sedentary behaviors usually involve prolonged sitting while using a
variety of media: watching television and videos; computer use, such
as video games and internet surfing; as well as travelling to and from
places (e.g. by car).
 A 15-year study (Carnethon et al., 2003) have demonstrated the
association between poor fitness in young adulthood and the risk for
developing diabetes, hypertension, and the metabolic syndrome in
middle age.

 Moreover, interventions to improve fitness through exercise, nutrition

education, and behavior therapy are effective in improving CVD risk
factors particularly among obese children (Reinehr et al., 2006).
Coronary Heart Disease
 Coronary heart diseases (CHDs) are caused by a lack of blood supply to the heart
muscle resulting from a progressive, degenerative disorder known as
atherosclerosis.

 Atherosclerosis involves a build-up and deposition of fat and fibrous plaques in

the inner lining of the arterial wall thereby narrowing it (see Figure 2.2). This
results in a reduction of blood supply to the heart (ischemia) that causes severe
chest pain (angina pectoris), which may be a warning sign for a pending heart
attack.

 This typical symptom of angina, however, does not set in until 75% of the arteries
are already blocked. When a portion of the heart muscle dies from the lack of
blood supply and causes permanent damage, we say that a myocardial infraction
or heart attack has occurred (see Figure 2.3).
Atherosclerosis
 From the Greek words athero meaning 'paste' and sclerosis meaning
'hardness' which describes the hardening of this paste (plaque) that
clogs the arteries of the heart. It is a slow, progressive disease that
typically starts in early adulthood.
Plaque
 The hardening of fatty deposits on the inner
lining of the wall of an artery.
Ischemia
 Reduced blood flow to the heart
muscle usually resulting from
atherosclerosis.
Angina pectoris
 Chest pain usually felt on the left side of the
chest or sometimes in the left arm or shoulder
and is the main symptom of CHD.
Myocardial Infraction
 Death of, and damage to the portion of a
heart muscle resulting from insufficient
blood supply. Also known as heart attack.
Heart Attack Warning Signs

 Chest discomfort that can feel like uncomfortable pressure, squeezing

or pain that lasts for more than a few minutes, or that goes away and
returns later;
 Pain or discomfort in the shoulders, neck, jaw, between the shoulder
blades, in one or both arms;
 Shortness of breath that accompanies the chest discomfort; and
 Light-headedness, cold sweats, nausea, and/or vomiting.
High Blood Pressure or Hypertension

 Hypertension refers to a chronic, persistent elevation of blood

pressure. Pressure is created when the heart contracts, pumps blood
into the arteries, and blood is forced against the walls of the arteries
as it circulates throughout the body.
 Blood pressure, which is measured in mmHg, is expressed in two
numbers: systolic and diastolic blood pressure. The blood exerts
systolic pressure against the walls of the arteries when the heart is in
a contracted state while the blood exerts diastolic pressure when the
heart is in a relaxed state. With high blood pressure, the heart is
working harder, resulting in an increased risk for heart attack, stroke,
heart failure, kidney and eye problems, and peripheral vascular
disease.
 An acceptable systolic blood pressure for adults (18 years old and
above), is below 120/80 mmHg. An individual with systolic pressure
between 120 and 139 mmHg and diastolic pressure between 80 and 89
mmHg is prehypertensive.
 This means that the blood pressure is elevated above normal but not
to the level considered hypertensive. If blood pressure is greater than
140 systolic or 90 diastolic, one is classified as a hypertensive.
 Having high blood pressure usually has no obvious symptoms, but
having extreme hypertension has symptoms like severe headache,
fatigue or confusion, vision problems, chest pain, shortness of breath,
irregular heartbeat, blood in urine, nosebleeds, and pounding in the
chest, neck, or ears.
 TABLE 2.1
CATEGORIES FOR BLOOD PRESSURE LEVELS IN ADULTS

Blood Pressure Level (mmHg)

CATEGORY SYSTOLIC DIASTOLIC
Normal Below 120 Below 80
Prehypertension 120-139 80-89
High blood pressure Stage 1 140-159 90-99
High blood pressure Stage 2 160 or above 100 or above
STROKE
 A stroke or cerebrovascular accident (CVA) is damage to part of the
brain that is caused by an interruption of blood supply to the brain
due to either rupture and leakage (hemorrhage) or blockage
(ischemic) of blood vessels. The term 'stroke' indicates the sudden
onset.
ISCHEMIC STROKE

 An ischemic stroke, which is responsible for 80% of all strokes, is

caused by a blood clot (or thrombus) that blocks the flow of blood to
the brain; while a hemorrhagic stroke occurs when blood leaks from a
ruptured artery (Figure 2.4).

 A stroke is sudden in its onset, can cause paralysis and affect sight,
touch, movement, and cognitive abilities. Since it is a medical
emergency, it is important for you to recognize its symptoms and act
immediately to reduce disability and save life.
HEMORRHAGIC STROKE

 A category of stroke caused by blood leak from a damaged artery.

 There are two types: cerebral, when a defective artery in the brain
ruptures flooding the surrounding tissues; and subarachnoid, when a
blood vessel on the brain surface ruptures and bleeds into the space
between the brain and the skull.
HEART FAILURE

 A life-threatening condition in which the heart's function as a pump to

deliver oxygen rich blood to the body is inadequate to meet the
body's needs. It can be caused by diseases that
 (1) weaken the heart muscle,
 (2) cause stiffening of the heart muscles, or
 (3) increase oxygen demand by the body tissue beyond the capability
of the heart to deliver adequate oxygen-rich blood.
 Congestive heart failure can affect the functioning of the kidneys, lungs,
liver, and intestines. weakened heart muscles may not be able to supply
enough blood to the kidneys, which then begin to lose their normal ability
to excrete salt (sodium) and water. This diminished kidney function can
cause the body to retain more fluid.

 In the same manner, the lungs fill with fluid (pulmonary edema) that
result in a decreased ability to exercise. Fluid may likewise accumulate in
the liver, thereby impairing its ability to rid the body of toxins and
produce essential proteins. The intestines become less efficient in
absorbing nutrients and medicines. Fluid may also accumulate in the
extremities, resulting in swelling (edema) of the ankles and feet

 (http://www.onhealth.com/congestive_heart_failure/
article.htm#what_is_congestive_ heart_failure).
Risk Stratification
 A risk factor refers to a lifestyle behavior, an environmental exposure, or a
hereditary characteristic that is associated with an increase in the occurrence
of a particular disease, injury, or other health condition.
 Most risk factors for cardiovascular disease can be controlled or changed and,
therefore, prevention is the key.
These modifiable risk factors are:
(1) physical inactivity,
(2) cigarette smoking,
(3) hyperlipidemia or hypercholesterolemia (elevated levels of blood
fats/cholesterol),
(4) hypertension,
(5) being overweight or obese, and
(6) diabetes.
 Although yet to be scientifically established, contributing risk factors which
are associated with an increased risk for CVD include stress and alcohol use.
 Unmodifiable risk factors, on the other hand, are those that cannot be
changed and include one's age, sex, and family history.
 Prior to participating in physical activity, it is important to determine your
readiness through pre-participation screening.
 Aside from the Physical Activity Readiness Questionnaire or PAR-Q (Activity
2.1), verifying the extent of your risk for diseases can help determine how
much of an impact this has on your plan to be active.
 To determine the level of your risk, follow the Step-by-step Process in Risk
Stratification (Activity 2.2)
 In classifying risk for diseases, there are three disease types
commonly considered: cardiovascular, pulmonary, and metabolic.
 If you have one of these diseases
 (a 'yes' answer in Step 1) or have any major signs or symptoms
suggestive of these diseases
 (a 'yes' in Step 2), you are considered to be high risk. Since the
cardiovascular system is important in the exercise and physical
activity performance, it must be further assessed in Step 3.
 Remember, cardiorespiratory endurance as an indicator of fitness
refers to the ability of the heart, blood, vessels, and the lungs to
deliver blood to the working cells to meet the demands of prolonged
activity.
 Now, carefully evaluate your CHD risk in Step 3 by completing the Risk
Factor Scoring Checklist (Activity 2.3).

 Read through this checklist of eight factors which are modifiable and,
therefore, preventable such as sedentary lifestyle, cigarette smoking; and
those that you have no control of, such as your age and family history.

 You are at 'low risk' if you score no more than 1, at 'moderate risk' if you
score 2 or greater, and at 'high risk' if you answered yes in Step 2.
RISK FACTOR

 A lifestyle behavior, an environmental exposure, or a hereditary

characteristic that is associated with an increase in the occurrence of
a particular disease, injury, or other health condition.
UNMODIFIABLE RISK FACTOR

 Factors that cannot be changed, such as age, sex, and

family history or genetic predisposition to prevent the
occurrence of disease and/or reduce deaths.
Age

 Our CVD risk increases as we grow older because our hearts

are no longer as efficient; its walls may thicken, arteries
may be plagued by atherosclerosis, which in turn make the
heart less able to pump blood throughout the body.
Sex
 Overall, men are more likely than women to develop CVD. is
attributed to male hormones (androgens) which increase the risk,
whereas female hormones (estrogen) protect against atherosclerosis.

 When a woman reaches menopause, low-density lipoprotein (LDL)

appears to increase, while high-density lipoprotein (HDL) appears to
decrease as a result of estrogen deficiency.

 This makes her susceptible to atherosclerosis. After the age of 65, the
risk of heart disease between men and women evens out.
Family History

 Our genetics predispose us to CVD, such that if your parents or

siblings had a heart or circulatory problem before age 55, then you
are at greater risk than someone with a different family history.

 Although these risk factors are beyond your control, most of the risk
factors for CVD are modifiable and, therefore, preventable. You can
significantly reduce your hereditary risk for CVD by choosing a healthy
lifestyle.
MODIFIABLE RISK FACTOR

 Factors that are within one's control and can be changed to

prevent disease and/or reduce deaths.
Hypertension
 Hypertension increases the workload of the heart, resulting in weakening over
time. When this is accompanied by other risk factors such as obesity,
smoking, high blood cholesterol or diabetes, the risk of heart attack or stroke
increases several times.
 Hypertension is directly associated with sodium intake (He et al., 1999) such
that the more sodium you consume, the higher your blood pressure. This is
particularly true for individuals who are overweight (body mass index greater
than 25). While reducing sodium intake will be beneficial, it is more
important to have a good understanding of healthy eating to improve or
maintain good health.
 Obesity on the other hand, affects the sympathetic nervous system and other
metabolic pathways that enhance sodium reabsorption and retention in the
kidneys. This helps explain why an obese individual is at greater risk for
hypertension.
Obesity
 Obesity is a medical condition characterized by storage of excess body fat (or
triglyceride). A body fat content of 18% (for males) and 22% (for females) of
one's body weight is considered normal for adults. Anything over that is
defined as obesity. This condition frequently results in hypertension, coronary
artery disease, and diabetes mellitus.
 Obesity results when the size or number of fat cells in a person's body
increases. A normal-sized person has between 30 and 35 billion fat cells.
When a person gains weight, these fat cells first increase in size and later in
number.
 Each fat cell weighs a very small amount (about 0.4 to 0.6 micrograms). In
other words, it would take about five million fat cells to get just one ounce of
fat. However, the weight of billions and billions of fat cells does add-up.
Obviously, it is not practical to count the number of fat cells in a person's
body, so science has come up with easier methods to determine if a person is
overweight or obese.
 A method that was developed which more closely correlates with body
fat and the metabolic complications of obesity is the Body Mass Index
(BMI).
 It is more accurate than weight alone because it takes into account that
short people tend to weigh less than tall people. It is calculated as
follows:

BMI = Weight (in kg)

Height (im)2
CONTRIBUTING RISK FACTORS

 Associated with an increased risk for CVD but have yet to be

scientifically established.

 These factors include stress and alcohol use.

NON-COMMUNICABLE DISEASE

 A medical condition or disease that is non-infectious and

non-transmissible among people.
MORTALITY

 Number of deaths in a given time and place in terms of the

proportion in a given population.
The risk of metabolic complications, such as hypertension and diabetes, is
related to both the BMI and the waist circumference as shown on Table 2.2
 As you can see in the table, overweight and obesity are both labels
for weight ranges that are greater than what is generally considered
healthy for a given height.

 An adult who has a BMI between 25 and 29.9 is considered

overweight; while one with BMI of 30 or higher is considered obese. It
is important to remember that although BMI correlates with the
amount of body fat, BMI does not directly measure body fat.

 As a result, some people, such as athletes, may have a BMI that

identifies them as overweight even though they do not have excess
body fat (http://www.cdc.gov/obesity/adult/ defining.html).
 Children's body composition varies as they age and differs between
boys and girls. Instead of using the BMI categories for adults, their
weight status is determined using an age- and sex-specific percentile
for BMI.

 For children and adolescents (age 2 to 19 years), overweight is

defined as a BMI at or above the 85th percentile and lower than the
95th percentile for children of the same age and sex.

 Obesity is defined as a BMI at or above the 95th percentile for

children of the same age and sex (Barlow, 2007)
 In order to achieve and maintain a healthy weight, regularly
participate in physical activities and eat healthily.

 You can objectively assess your average energy expenditure (from

physical activities) and daily energy intake (from food and beverage
consumption) by carefully recording these information in a food diary
and physical activity log.

 At the end of the week, you now have a baseline information which
you could use to develop an effective strategy to achieve a negative
energy balance.
Hypercholesterolemia
 This condition is characterized by elevated cholesterol levels, and the
term is interchangeable with hyperlipidemia or elevated lipid levels.
 Lipids are organic compounds that contain carbon, hydrogen, and
oxygen. They are insoluble in water. are grouped into fats (solid in
form), or oils (if in liquid form), phospholipids steroids, and others.
 Fats are the body's most concentrated source of usable energy fuel
and yield large amounts of energy when oxidized (nine calories per
gram of fat compared to four calories per gram of carbohydrate or
protein).
 They are found primarily beneath the skin to insulate deeper body
tissues and protect them from mechanical trauma.
 Fat is formed from a 3:1 fatty acid to glycerol ratio (three fatty acid chains to one
glycerol, a sugar alcohol), or what is called a triglyceride (see Figure 2.6).
 Fatty acid chains can be saturated or unsaturated.
 Saturated fats are common in animal fats and are solid at room temperature.
 Unsaturated fats are typical of plant lipids such as oils used for cooking and are
liquid at room temperature.

Figure 2.6
Chemical Structure of Saturated and Unsaturated Fats
 Steroids are another group of lipids. The most important steroid is
Cholesterol.
 Cholesterol is a fatty substance that occurs naturally in the body as it
performs several vital functions: provide the raw material for Vitamin D
(aid in absorption of calcium for bone and tooth formation) and sex
hormones (which make reproduction possible); and bile acids for fat
digestion.
 We ingest cholesterol in animal products such as meat, eggs, and
cheese. liver also produces a certain amount.
 The fat (lipid) and cholesterol that we eat are absorbed in the intestine,
transported to our liver which in turn converts the fat into cholesterol,
and then released into the bloodstream. It travels through the blood
attached to a protein, thus, a lipoprotein
 Since triglycerides and cholesterol are insoluble in water, they are
transported to and from tissue cells in the form of lipoprotein.

A lipoprotein is a lipid bound to a protein carrier:

1. Low-density lipoproteins (more lipids than protein),

2. High-density lipoproteins (more protein than lipids) and
3. Very low-density lipoproteins (or chylomicrons)
 About 15% of blood cholesterol comes from diet while the remaining
85% is produced by the liver.
 LDLs transport cholesterol from the liver to the peripheral tissues for
the use of cells, for hormone synthesis, and for storage (as energy
fuel).
 Excess LDLs are also known as the 'bad cholesterol' because they
potentially lay down cholesterol deposits on arterial walls
(development of arteriosclerosis).
 The more LDL there is in the blood, the higher the risk.
 HDLs are in collapsed form, like deflated balloons, and are also known as
the 'good cholesterol.' As they circulate, they pick up the cholesterol from
the tissue cells or pull it from the arterial walls and transport it to the
liver where they are broken down and secreted into bile salts which are
eventually excreted in feces. Bile is the major vehicle for cholesterol
excretion from the body. If your HDL level is low, your risk goes up.

 VLDLs transport the triglycerides made or processed in the liver mostly to

adipose tissues. Triglycerides or free fatty acids combined with cholesterol
hasten the formation of plaque in the arteries (atherosclerosis).
Triglycerides are mainly manufactured in the liver from refined sugars,
starches, and alcohol. A high intake of alcohol and sugars will, therefore,
significantly raise the triglyceride levels. It can, however, be lowered by
cutting down on foods that are sources of triglycerides along with reducing
weight (if overweight) and regular exercise that develops
cardiorespiratory endurance.
 See Figure 2.7 to have an idea how the liver regulates the production of
cholesterol. While genetics and other factors beyond your control may
affect cholesterol levels, there are also ways for you to contribute to
maintaining healthy LDL, HDL, and VLDL levels. Risk factors such as
smoking, obesity, poor diet, lack of exercise, and diabetes put you at risk
for high cholesterol that may lead to heart disease. However, by avoiding
these risk factors, you can keep your cholesterol levels in check.

 Examples of foods that help lower bad cholesterol, according to the

Harvard Health Publication, are oats, barley and other whole grains,
beans, eggplant and tofu, nuts, vegetable oils, apples, grapes,
strawberries and citrus fruits, foods fortified with sterols and stanols, soy,
fatty fish, and finer supplements.
• Meanwhile, foods
high in trans fats
(such as processed
and fast food)
directly boost LDL,
and must be
avoided.
Diabetes
 Diabetes mellitus is a group of diseases characterized by high levels of
blood glucose because the body does not produce or properly use
insulin.
 Insulin is a hormone secreted by the pancreas and is essential for the
proper metabolism of glucose and the maintenance of glucose level in
the blood. It is, therefore, needed to convert sugar, starches, and
other food into energy needed for daily life. People whose blood
sugar levels are chronically elevated may have problems in
metabolizing fats which make them more susceptible to CVDs.
 Type 1 diabetes, previously called insulin-dependent diabetes
mellitus or juvenile-onset diabetes, results from the body's failure to
produce insulin. This develops when the body's immune system
destroys pancreatic beta cells, the only cells in the body that make
the hormone insulin that regulates blood glucose. This form of
diabetes usually strikes children and young adults, although disease
onset can occur at any age.
 Type 2 diabetes, once called non-insulin-dependent diabetes mellitus
or adult-onset diabetes, may account for about 90% to 95% of all
diagnosed diabetes cases.

 It usually begins as insulin resistance, where cells do not use insulin

properly. As the need for insulin rises, the pancreas gradually loses its
ability to produce insulin.

 Type 2 diabetes is associated with older age, obesity, family history

of diabetes, history of gestational diabetes, and physical inactivity,
among others.
 In 2006, the American Diabetes Association issued a consensus statement
on physical activity/exercise and type 2 diabetes. Essentially, they
acknowledged the firm and consistent evidence on the role of physical
activity (150 minutes per week) and modest weight loss in reducing the
incidence of type 2 diabetes among individuals with impaired glucose
tolerance (p. 1433).
 Type 2 diabetic individuals who are already exercising at moderate
intensity may increase exercise intensity to obtain additional benefits in
both aerobic fitness and glycemic control (p. 1433). No more than two
consecutive days without aerobic physical activity is recommended since
the effect of a single bout of aerobic exercise on insulin sensitivity lasts
24 to 72 hours depending on the duration and intensity of the activity
(Wallberg-Henriksson, 1998).
 Finally, it underscored the importance of resistance training exercises in
improving insulin sensitivity to about the same extent as aerobic exercise
(Ivy, 1997). Resistance training is crucial in arresting the loss of muscle
mass leading to sarcopenia, or decreased functional capacity, decreased
resting metabolic rate, increased adiposity, and increased insulin
resistance as one grows older.
METABOLIC SYNDROME

 A cluster of specific disorders that when they occur

together, may significantly increase a person's risk of
developing CVD or type 2 diabetes.

 This is not a disease but a term used to describe a cluster

of specific disorders that when they occur together, may
significantly increase a person's risk of developing CVD or
type 2 diabetes.
You have metabolic syndrome if you have at least three of the following:

 Waist circumference (abdominal/visceral adiposity): >40 inches for

men, and >35 inches for women
 Triglycerides: 150 mg/dL for men and women, or taking medication
for elevated triglycerides .
 Low HDL cholesterol: < 40 mg/dL for men, and < 50 mg/dL for women
Hypertension, or taking medications for hypertension: > 130/65
mmHg for men and women.
 Elevated fasting glucose (signifying insulin resistance): 100 mg/dL for
men and women, or taking medication for elevated blood glucose
levels.
 Insulin resistance is a generalized metabolic disorder in which the
body's cells no longer respond to insulin as they should, so the body
compensates by releasing more insulin.

 Insulin is a hormone that helps move blood sugar into muscle and fat
cells where it is used.

 Glucose builds up in the bloodstream which gradually leads to type 2

diabetes, and increases your risk for cardiovascular diseases.
VO2max
 The maximal amount of oxygen the body is able to utilize per minute
of physical activity.

 It is commonly expressed in milliliters of oxygen per kilogram of body

weight per minute, or ml/kg/min.

 A measure of how efficiently the heart, lungs and muscles can

operate during aerobic exercise.
MET

 Amount of oxygen the body uses when it is at rest, which is

approximately 3.5 milliliters of oxygen per kilogram of body weight
each minute. A measure of aerobic fitness.
ACTIVITY STATUS

Variable to be considered when starting an exercise program and is the

basis for aerobic and resistance training frequency, intensity, and time.

 Beginner— those who are inactive with no or minimal physical activity

and, thus, are deconditioned;
 Intermediate—those who are sporadically active but do not have an
optimal exercise plan and, thus, are moderately deconditioned;
 Established—those who are regularly engaging in moderate to vigorous
exercise.
CIGARETTE SMOKING
 Tobacco contains nicotine. Nicotine is a drug. Therefore, when you smoke or
chew tobacco, you are using a drug. Long-term use of this drug results in
addiction and dependence.
 The nicotine contained in cigarette smoke produces an increase in heart rate
that leads to an increase in blood pressure. This causes an increase in one's
alertness but also strains the heart and the blood vessels.
 Aside from nicotine, there are other chemicals (4,000 more; at least
43 of these chemicals are known carcinogens) that are released as
tobacco burns and which cause many of the diseases that are
associated with smoking.
 Carbon monoxide (the same gas that comes out of car exhausts) is the
main gas in cigarette smoke that is formed when the cigarette is lit. It
binds with the platelets in the blood, thus, inhibiting the anti-clotting
mechanism of the blood.
 Substance also robs the muscles, brain, and body tissues of oxygen.
When oxygen is cut off to the feet and hands, limb amputation may
result. In tobacco smoke, nicotine 'rides' on small particles of tar.
Once inhaled, the smoke condenses and 70% of the tar in the smoke
coats the lungs like soot in a chimney. Lung cancer from smoking is
caused by the tar
 The World Health Organization declared tobacco use as responsible for 1
in 10 adult deaths. It is the single most preventable cause of death: 11%
of deaths from ischaemic. If current patterns continue, tobacco use will
kill more than 8 million people per year by 2030.
 Medical research suggests that those who start smoking in their teens (as
90% of smokers do) or continue for two decades or more will die 20 to 25
years earlier than those who never light up. When an individual quits
smoking, the risk of CHD declines rapidly, regardless of how long or how
much they have smoked.
PHYSICAL INACTIVITY
 Physical activity is a behavior that can be conceived as a continuum from
minimal to maximal movements with its corresponding energy expenditure.
Physical inactivity can be described as falling short of the minimum criterion
for physical activity or energy expenditure deemed to be necessary for health
benefits.
 For example, the global recommendations on physical activity for health
(WHO, 2010) is to accumulate at least 60 minutes of moderate-to-vigorous-
intensity physical activity for people aged 5-17 years Old. Moderate intensity
usually refers to movements that make you breathe hard, requiring at least as
much effort as brisk walking. You are classified as insufficiently active if you
fail to meet this recommendation.
 It is equally important to recognize the need to limit sedentary behaviors or
reduce time spent on non-active pursuits (computer games, internet, and
television). It is recommended that children and young people spend no more
than two hours a day (or decrease time incrementally to 30 to 90 minutes a
day over several months) on non active pursuits (Health Canada, 2002).

 Studies (Williams, 2001) indicate that having a high cardiorespiratory or

aerobic fitness reduces the risk of heart disease, and this reduction is greater
than that obtained merely by being physically active. In addition,
musculoskeletal fitness enables you to engage both in necessary (work and
play) and recreational activities. Musculoskeletal fitness is linked to
flexibility, an equally important but frequently neglected fitness component.
A complete exercise program, therefore, includes aerobic, resistance, and
flexibility exercises.
 Regular aerobic exercise results in a lower heart rate and blood pressure at
rest and during submaximal work. This is an indication of a more efficient
heart, wherein there is an increased ability to take in and use oxygen
(referred to as maximal oxygen consumption or V02max).
 One measure of aerobic fitness is the metabolic equivalent MET. One MET
equals the amount of oxygen the body uses when it is at rest, which is
approximately 3.5 milliliters of oxygen per kilogram of body weight each
minute (I MET = resting level = 3.5 ml. of oxygen per kg body weight per
minute).
 Walking at 3.5 miles per hour is equal to 4 METs, which means you are
working four times harder when walking at this pace than when you are
seated. Activities are classified in terms of intensity based on the following
MET values: Light (1.5-3 METs), moderate (3-6 METs), and vigorous (>6 METs).
 Average, healthy, young to middle-age adults have an aerobic
capacity of S-12 METs. means that they can consume 8-12 times the
amount of oxygen used at rest (ACSM, 2010, p.868).
 Cardiac patients, those who are elderly and morbidly obese. have an
aerobic capacity as low as 2-4 METs. Elite endurance athletes have a
range of 20-25 METs!
 This explains why those who are unfit need to work at the high end of
their aerobic capacity when performing a task, while those who are
fit use the same amount of oxygen but perform the task at a lower
percentage of their aerobic capacity.
 It is important, though, to begin any exercise program gradually and
progressively. It must meet the following criteria:
1. Absence of symptoms. There are no untoward symptoms such as chest
pain or pressure.
2. Appropriate heart rate. Work within a target heart range given your
ace, resting heart rate, and exercise intensity that is in accordance with
your activity status or fitness level (e.g., beginner/deconditioned'
intermediate/sporadically active, regular moderate-to vigorous
exerciser).
3. Appropriate intensity. Work within the range Of lower and upper
limits of your exercise heart rate.
 Most of all, be sure to complete the PAR-Q and the risk stratification
before starting an exercise program.
FYI: Chemicals in Tobacco
 In 1561, Jean Nicot, who was the French ambassador to Portugal, sent seeds of
the tobacco plant to the royal family in France. The plant was subsequently
named Nicotiana tabacum in his honor. Tobacco contains nicotine, as well as
4,000 more chemicals, at least 43 of which are known carcinogens.
Examples are:
 Benzene (petrol additive), obtained from coal and petroleum. It is used as a
solvent in fuel.
 Formaldehyde (embalming fluid) is used to preserve dead bodies.
 Ammonia (toilet cleaner) is found in dry cleaning fluids.
 Acetone is a nail polish remover.
 Arsenic is used as a rat poison.
 Hydrogen cyanide is the poison used in gas chambers.
FYI: MET Capacity

 Researchers have reported that men and women with and without
heart disease and are the least fit with an aerobic capacity less than
or equal to 4 METs have the highest mortality rate (Dutcher, Kahn,
Grines, & Franklin, 2007).
 In contrast, those with aerobic capacity higher than 8 METs have the
most favorable health outcomes (Kodama et al., 2009). Thus, each 1
MET increase in aerobic fitness confers a reduction in cardiovascular
events by 15%. If you increase your MET capacity from 5 to 7, then
you could theoretically reduce your cardiovascular risk by 30%!
 Most of the major risk factors for cardiovascular diseases are
modifiable: hypertension, obesity, hypercholesterolemia, diabetes,
cigarette smoking and most of all, physical inactivity.

 This means that they are reversible and preventable or can be

controlled by lifestyle changes.

 Physical activity and exercise, which are our focus, are important not
only for disease prevention but for achieving cardiovascular efficiency.

 To reduce your risk for cardiovascular disease and achieve aerobic

fitness, be active—this is something which you can do and have
extensive control of.