1 1 2 1 2 30 20 [1,2] [3] 65 74 20 31% 75 23% 1997 18 20 15% Healthy People 2010 30% [4] 2004 1 [5] 65 69 20 24.7% 80 11.8% 1999-2000 Elderly Nutrition and Health Survey in Taiwan [6] 54.8% walking for pleasure Chinese exercise 68.7% 21.7% 2001 Taiwan National Health Interview Survey [7] 56.9% leisure time physical activity disuse [8] Tw Fam Med Res 2007 Vol.5 No.1 1
1. 2004 60 150 * ** *** 65 69 24.7 58.1 38.2 70 74 19.4 52.1 38.3 75 79 10.2 61.4 34.7 80 11.8 51.4 43.3 * 20 ** 10 30 *** proprioception balance exercise capacity increased perception of effort associated with submaximal work [9] [10-12] [8] [13] 2 2007
[14] [15] inverse, linear dose-response relationship1,000 30% 2,000 50% [9] 1,000 50% 2,000 57% [7] [16] disability [3,14-16] Physical activity Exercise Physical fitness Sportr e l a t e d fi t n e s s Health-related fitness Tw Fam Med Res 2007 Vol.5 No.1 3
Dose Intensity Absolute intensity metabolic equivalents, METs 1MET metabolic rate 3.53.5mL O 2 kg -1 min -1 Relative intensity maximal heart rate maximum oxygen consumption, VO 2MAX Aerobic activity Balance exercise stability static dynamic F l ex i b i l i t y o r stretching activity muscle strengthening activity Lifestyle modification sedentary active [8,17] self-guide physical activity professionally-guided exercise testing/prescription [17] PAR-Q 4 2007
Physical Activity Readiness Questionnaire 2 [7] 30 2. 15 69 15 69 69 15 69 1. 2. 3. 4. 5. 6. 7. 1 2 144/94 Canadian Society for Exercise Physiology: physical activity Readiness Questionnaire (PAR-Q), Revised 1994. Tw Fam Med Res 2007 Vol.5 No.1 5
American College of Sports Medicine, ACSM ACSM risk stratification categories 35 [17] maximal exercise testing 3. ACSM Risk Stratification Categories 4555 4 45554 5* ** *** * ** *** 4. Coronary Artery Disease Risk Factor Thresholds for Use With ACSM Risk Stratification Criteria positive * 55 65 ** negative 14090 130 mg/dl 40 mg/dl 200 mg/dl 100 mg/dl body mass index 2790 80 U.S. Surgeon General s Report 60 mg/dl * ** 6 2007
5. dizziness syncope orthopnea paroxysmal nocturnal dyspnea hypertrophic cardiomyopathy aortic stenosis 45 55 physical fitness cardiorespiratory endurance muscle power and strengthflexibility balance aerobic exercise muscle strengthening training flexibility exercise [14,15,17] frequency intensity type time progressionfitt- PRO A B 1. 1MET 2 Tw Fam Med Res 2007 Vol.5 No.1 7
a percent of maximal heart rate 220 55% 90% b heart rate reserve method40% 85% 40% 85% + c oxygen uptake reserve method 40% 85% 40% 85% + 3 rating of perceived exertion [18] 2007 0 10 all-out effort 5-6 7-8 2. repetition maximum, RM 0 105-6 7-8 C D 10 general exercise 30 10 30 2 3 E 8 2007
warm up 5 10 endurance phase cool down 65 50-64 20 60 10 30 20 65% 75% 55% 64% 5-6 progressive resistance training circuit training pilates 2 48 10-15 Tw Fam Med Res 2007 Vol.5 No.1 9
40% 41% 60%60% 5-6 7-8 15 5 10 proprioceptive neuromuscular facilitation 2 3 4 10 30 30 60 10 no sweat exercise leisure time physical activity [19] gardening66% walking 73% [20] Dr. Simen cardiometabolic exercise 6 7 8 [19] 150 1,000 [17,18] 10 2007
6. cardiometaoblic points for walking on the level [20] 30CME 100 45.4 2 53/90 / 60 3 80/130 / 80 4 106/160 / 105 120 54.5 2 70 3 95 4 130 140 63.5 2 85 3 110 4 150 160 72.6 2 95 3 125 4 170 180 81.7 2 105 3 140 4 195 200 90.8 2 120 3 155 4 210 210 95.3 2 125 3 165 4 225 220 100 2 130 3 175 4 235 1. 60 2.CME cardiometabolic exercise 10 5 30 Tw Fam Med Res 2007 Vol.5 No.1 11
7. cardiometaoblic points for recreational activities [20] CME 30 200 30 100 30 150 30 170 30 280 30 130 30 250 30 400 30 65 30 100 30 130 30 230 30 150 30 150 30 200 30 100 30 145 30 165 12/ 134.11/ 30 200 30 135 30 60 30 100 30 230 15 200 30 250 10/ 160.93/ 30 300 8/ 201.17/ 30 400 6/ 268.22/ 30 500 30 230 30 150 30 400 30 200 30 230 30 280 30 135 30 130 30 160 30 200 30 100 30 160 30 75 30 130 12 2007
8. cardiometaoblic points for daily activities [20] CME 30 100 30 100 30 100 30 150 30 160 30 190 30 75 / 30 150 30 130 30 115 30 70 30 70 30 135 30 115 30 180 30 130 30 85 30 185 / 15 25 30 115 / 10 100 / 10 30 30 90 15 50 30 160 30 100 30 60 15 45 30 115 A B Tw Fam Med Res 2007 Vol.5 No.1 13
2007 14 C 1 1,000 2,000 exercise capacity 5 745 60 4 6 METs 5 7.5 METs chair stand
[21] 5 6 [9] 5A assess, advice, agree, assist, arrange 1. Haskell WL, Lee IM, Pate RR, et al: Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Health Association. Circulation 2007; 116: 1081-93. 2. Nelson ME, Rejeski WJ, Blair SN, et al: Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation 2007; 116: 1094-105. 3. Agency for Healthcare Research and Quality. Centers for Disease Control and Prevention. Physical activity and older Americans: benefits and strategies. June 2002. http://www.ahrq. gov/ppip/activity.htm Accessed on November 25, 2006. 4. Smolinski MS, NTI and Global Health and Security Initiative: Achieving health for all developing a conceptual framework by defining foals and setting priority. Conference on Health 21, Department of Helath, Executive Yuan, Taipei. Accessed on Dec 6, 2006. 5. http://www.bhp.doh.gov.tw Accessed on January 22, 2007. 6. Pan WH, Hung YT, Shaw NS, et al: Elderly Nutrition and Helath Survey in Taiwan 1999-2000 : research design, methodology Tw Fam Med Res 2007 Vol.5 No.1 15
and content. Asia Pac J Clin Nutr 2005; 14: 203-10. 7. Lan TY, Chang HY, Tai TY: Relationship between components of leisure physical activity and mortality in Taiwanese Older adults. Prev Med 2006; 43: 36-41. 8. Singh MA: Exercise and aging. Clin Geriatr Med 2004; 20: 201-21. 9. Singh MAF: Physical Fitness and Exercise. In: Pathy MSJ, Sinclair AJ, Morley JE, eds. Principles and Practice of Geriatric Medicine. 4th ed. UK: John Wiley & Sons Ltd., 2006: 123-40. 10. Gregg EW, Cauley JA, Stone K, et al: for the Study of Osteoporotic Fractures Research Group. Relationship of changes in physical activity and mortality among older women. JAMA 2003; 289: 2379-86. 11. Blair SN, Kohl HW III, Paffenbarger RS Jr, et al: Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA 1989; 262: 2395-401. 12. Paffenbarger RS Jr, Hyde RT, Wing AL, et al: The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med 1993; 328: 538-45. 13. Poulin MJ, Paterson DH, Govindasamy D, et al: Endurance training of older men: responses to submaximal exercise. J Appl Physiol 1992; 73: 452-7. 14. McAuley E, Rudolph D: Physical activity, aging, and psychological well-being. J Aging Phys Activity 1995; 3: 67-96. 15. Blumenthal JA, Babyak MA, Moore KA, et al: Effects of exercise training on older patients with major depression. Arch Intern Med 1999; 159: 2349-56. 16. Campbell A, Robertson M, Gardner M, et al: Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ 1997; 315: 1065-9. 17. Whaley MH, Brubaker PH, Otto RM, et al, for the American College of Sports Medicine: ACSM's Guidelines for Exercise Testing and Prescription. 7th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins, 2006. 18. McDermott AY, Mernitz H. Exercise and older patients: prescribing guidelines. Am Fam Physician 2006; 74: 437-44. 19. Simon H: The No Sweat Exercise Plan: Lose Weight, Get Healthy, and Live Longer. 1st ed. USA: McGraw Hill, 2005. 20. Lemaitre RN, Siscovick DS, Raghunathan TE, et al: Leisure-time physical activity and the risk of primary cardiac arrest. Arch Intern Med 1999; 159: 686-90. 21. Hirvensalo M, Heikkinen E, Lintunen T, et al: The effect of advice by health care professionals on increasing physical activity of older people. Scand J Med Sci Sports 2003; 13: 231-6. 16 2007