|
Items in cart [1] |
Questions? Call 888-624-8373 |
| Copyright © 2009. National Academy of Sciences. All rights reserved. Terms of Use and Privacy Statement |
Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 141
8
Closing Session
Dr. Haskell moderated the closing session of the workshop. Modera-
tors of the earlier sessions (Drs. Morrow, Dishman, Brubaker, Macera,
Freedson, Nelson, and Heath) provided summaries of the information
presented, focusing on the nature, level, and strength of the evidence. A
group discussion followed, and then Dr. Haskell provided an overall
summary. This chapter integrates presentations made during the closing
session. It covers risk reduction for a broad range of health conditions
and selected populations, risk–benefit considerations of physical activity,
and issues raised during the meeting. It also provides a summary of the
final group discussion. The chapter concludes with closing remarks made
by Dr. Haskell and RADM Penelope Slade Royall.
SUMMARY OF PLENARY SESSIONS
Physical Activity and Risk Reduction
Adults
Much evidence was presented that physical activity reduces the risk
of developing many health conditions. Dr. Morrow illustrated this point
with a graph such as that shown in Figure 8-1—a graph in which the spe-
cific risk could be any one of many adverse health conditions, including
cardiovascular disease, type 2 diabetes, osteoporosis, and many other
conditions. This prototype graph is characterized by a large decrease in
risk when the physical activity level increases from sedentary to moder-
ate, and a further but smaller decrease in risk when the physical activity
141
OCR for page 142
142 PHYSICAL ACTIVITY WORKSHOP
“Risk”
40
Higher
35
30
25
20
15
10
5
Lower
0
Low Moderate High
Fitness level
FIGURE 8-1 A representation of the typical relationship between physical ac-
tivity or fitness level and risk.
NOTE: This general relationship appears to be applicable to the risk of mortality, cardio-
vascular disease, hypertension, stroke, metabolic disorders, type 2 diabetes mellitus, im-
paired bone health, impaired mental health status, impaired cognitive ability, some types
of cancer, and impaired joint health. The general relationship appears to hold for males,
females, persons in different age groups, persons with disabilities, and persons of differ-
ent racial/ethnic groups.
SOURCE: Morrow (2006).
level increases from moderate to active. Regardless of the morbidity,
mortality, or population group (with few exceptions), the evidence shows
that those who are more physically active, get more exercise, or are more
fit have lower risk. All types of physical activity seem to reduce health
risks, and the greater the amount of physical activity—the more fit a per-
son is—the lower the health risks, and one’s quality of life is better.
Dr. Haskell summarized the amount and strength of the evidence re-
lating physical activity to selected outcomes for unspecified demographic
groups as shown in Table 8-1. Strength refers to both quality of data and
the magnitude of the association observed. For example, a large effect
adds to the strength of the data from an observational study, which ordi-
narily is viewed as of lower quality than a randomized controlled trial.
OCR for page 143
143
CLOSING SESSION
TABLE 8-1 Summary of the Amount and Strength of Available Data
Relating Physical Activity to Selected Outcomes, Unspecified
Demographic Groups
Amounta Strengthb
Outcome
All-cause mortality 1 1
Major Diseases
Coronary heart disease 1 1
Cardiovascular disease 1 1
Type 2 diabetes mellitus 1 1
Cancer: colon and breast 1 2
Other cancer sites 2 3
Musculoskeletal
Muscle qualityc 1 1
Muscle mass/sarcopeniad 1 1
Bone health (osteoporosis) 2 1
Osteoarthritis of knee and hip 2 3
Mental and Neurological Conditions
Depression 1 1
Anxiety 1 2
Sleep quality 2 1
Alzheimer’s disease 2 2
Chronic fatigue syndrome 2 2
Parkinson’s disease 3 3
Weight-Related Conditions
Prevention of weight regain 2 1
Contribution to long-term weight loss 1 2
Metabolic syndrome 2 1
Prevention of unhealthy weight gain 2 2
NOTE: Ratings are approximate; they are not based on a systematic review of the evi-
dence and do not represent a conclusion or consensus reached at this Institute of Medi-
cine workshop.
a
1 = considerable data; 2 = some data; 3 = limited data.
b
1 = high; 2 = moderate; 3 = low.
c
Applies to aerobic and resistance activity.
d
Applies to resistance activity.
OCR for page 144
144 PHYSICAL ACTIVITY WORKSHOP
Dr. Haskell commented that, simply in terms of cardiovascular dis-
ease and type 2 diabetes, the evidence on benefit from physical activity
could be considered sufficient to justify new guidelines and that the evi-
dence of benefit for a number of other conditions also is strong. Com-
ments from other moderators highlighted type 2 diabetes, selected mental
and neurological diseases, and weight-related conditions as conditions
for which there is sufficient evidence of benefit.
Type 2 diabetes Dr. Dishman noted that strong evidence from observa-
tional studies and randomized controlled trials indicates that moderate to
vigorous physical activity is associated with a reduced risk of developing
type 2 diabetes, even among persons with impaired glucose tolerance,
and that the effects usually are independent of weight loss. Moreover,
some evidence indicates that physical activity and/or cardiorespiratory
fitness favorably modifies cardiovascular events and mortality among
persons with type 2 diabetes. Regular physical activity also favorably
affects key features of the metabolic syndrome. Chronic effects of exer-
cise include increased insulin sensitivity and responsiveness; improve-
ments in other factors related to glucose use and storage, body fat,
skeletal muscle, and lipemic control; and the reduction of comorbidities
such as hypertension and systemic inflammation.
Mental and neurological diseases Dr. Dishman summarized that there
clearly is a sufficient amount and strength of evidence to justify a sys-
tematic review of major depression, some anxiety and sleep disorders,
self-esteem, selected features of cognitive function, and chronic pain
(data not presented earlier due to lack of time). Evidence to judge dose–
response is quite limited and mixed and will require systematic review.
Dr. Dishman supplemented earlier presentations by pointing out the
availability of a large body of evidence on mechanisms for cognitive and
emotional responses to physical activity. Examples include the summary
on the neurobiology of exercise by Dishman et al. (2006), studies of ex-
ercise and neural plasticity (Anderson et al., 1996; Ang et al., 2003;
Black et al., 1990; Carro et al., 2001; Cotman and Berchtold, 2002;
Stummer et al., 1994; van Praag et al., 1999, 2005), and studies on the
brain–behavior effects of physical activity (Chambliss et al., 2004;
Dishman, 1997, Dishman et al., 1997; Greenwood et al., 2003; Russo-
Neustadt et al., 2001; van Hoomissen et al., 2003; 2004; Yoo et al.,
2000). However, the evidence is almost entirely from animal studies.
This is a highly promising emerging area of study.
OCR for page 145
145
CLOSING SESSION
Weight-related conditions Dr. Brubaker noted that the increase in obe-
sity rates has been accompanied by an increase in so-called unsuccessful
attempts at weight loss. Nonetheless, evidence appears to be sufficient to
support roles of physical activity for weight loss, the maintenance of
weight loss, and the prevention of weight gain. Notably, a clinically sig-
nificant weight loss of approximately 5 percent of body weight generally
represents less weight loss than would be calculated based on energy
balance models and much less than the client expects. Dr. Brubaker ad-
dressed the difference in the amount of extra energy an individual may
need to expend for different purposes: 700 to 1,000 kcal per week to pre-
vent inappropriate weight gain versus 500 or 700 kcal per day (more than
2,000 kcal per week) to achieve weight loss and/or maintenance of
weight loss. He pointed out that these estimates of energy expenditure
may need careful consideration in the development of realistic guide-
lines. Men appear to respond to physical activity interventions with more
weight loss than do women. The mechanisms underlying this gender dif-
ference are unclear and warrant further investigation. Although not all
people respond to physical activity with weight loss, physical activity
produces a variety of other health benefits (see above) independent of
weight loss.
Children and Youth
Table 8-2 summarizes the information about evidence relating physi-
cal activity to outcomes for youth. Very little evidence is available about
dose–response. A summary of comments from Dr. Freesdon follows.
Children and youth are basically healthy. Regular physical activity
results in some improvements in the aerobic fitness and strength of
healthy children and adolescents, but improvements in blood pressure
and metabolic indicators are observed only in children with compro-
mised health. Weight-bearing exercise has beneficial effects on bone,
especially in prepubertal children. The need for different types of physi-
cal activity varies with age. Physical inactivity and sedentary behaviors
are highly prevalent and merit further attention.
OCR for page 146
146 PHYSICAL ACTIVITY WORKSHOP
TABLE 8-2 Summary of the Amount and Strength of the Available Data
Relating Physical Activity to Selected Outcomes for Children and Youth
Amounta Strengthb
Outcome
Fitness: strength and endurance 1 1
Skeletal health 2 2
Blood pressure in hypertensive youth 2 2
Weight loss in overweight/obesity 2 2
Metabolic syndrome factors 3 2
High-density lipoprotein cholesterol 2 3
Behavioral outcomes 2 3
Academic performance 2 3
Type 2 diabetes 4 NA
NOTE: Ratings are approximate. They are not based on a comprehensive review of the
evidence and do not represent a conclusion or consensus reached at this Institute of
Medicine workshop.
a
1 = considerable data; 2 = some data; 3 = limited data; 4 = very limited data.
b
1 = high; 2 = moderate; 3 = low.
NA = not applicable.
Pregnant Women
Physical activity appears to benefit women both during pregnancy
and the postpartum period. Regular physical activity may lower one’s
risk for gestational diabetes.
Older Persons
Considerable evidence points to the benefits of physical activity
among persons ages 65 years and older, as shown in Table 8-3. High-
lights of the comments made by Dr. Nelson appear below.
Chronic illness Most chronic illnesses and other conditions place the
greatest burden on older adults. The most notable of these are heart dis-
ease, type 2 diabetes, osteoporosis, specific cancers, cognitive impair-
ment, depression, and sleep problems. Evidence indicates that physical
activity reduces the risk of developing many of these conditions and
helps control signs and symptoms once a condition is established.
OCR for page 147
147
CLOSING SESSION
TABLE 8-3 Summary of the Amount and Strength of the Available Data
Relating Physical Activity to Selected Outcomes, Persons Age 65 Years
and Older
Amounta Strengthb
Outcome
Coronary heart disease and cardiovascular disease 1 1
Diabetes mellitus 1 1
Osteoporosis 1 1
Sarcopenia (muscle wasting) 1 1
Fitness: endurance, strength, balance 1 1
Activities of daily living 1 1
Sleep quality 2 1
Cognitive function 1 2
Fall prevention 2 2
2 3
Disability
NOTE: Ratings are approximate. They are not based on a comprehensive review of the
evidence and do not represent a conclusion or consensus reached at this Institute of
Medicine workshop. Wide variations in older persons’ ability to perform and in their
response to activity call for caution in developing physical activity recommendations.
a
1 = considerable data; 2 = some data; 3 = limited data; 4 = very limited data.
b
1 = high; 2 = moderate; 3 = low.
Physiological markers A large body of literature addresses physiologi-
cal markers. It includes strong evidence both from observational and in-
tervention studies that physical activity improves muscle mass and
strength, bone, balance, and functional performance. Aerobic capacity
declines in older adults; however, physically active older adults have
higher oxygen capacity (VO2) than sedentary peers and some have higher
VO2 than sedentary younger persons. A wide variety of physical activi-
ties improve muscle mass and strength, bone, balance, and functional
performance.
Falls prevention A moderate amount of moderate to strong evidence
addresses physical activity and the prevention of falls. Targeted physical
activity interventions—especially those with a balance component—
reduce falls in community-dwelling frail elders.
Disability Physical activity influences all segments of the path to disabil-
ity among older persons. High body fat content and poor quality of mus-
cle increase the risk of disability. Well-designed randomized controlled
trials are needed to better establish how various exercise regimens affect
OCR for page 148
148 PHYSICAL ACTIVITY WORKSHOP
the incidence of disability and hospitalization in older persons at high
risk of becoming frail.
Special considerations Consideration of the evidence relating to physi-
cal activity in older adults merits attention to their great heterogeneity
(many are in good health), body weight that is in flux, effects of intercur-
rent illness, and specific medical conditions.
Persons with Disabilities or Selected Chronic Conditions
According to Dr. Heath, strong evidence documents that individuals
with disabilities have the capacity to adapt to increased levels of physical
activity and that increased levels of physical activity can produce the fol-
lowing effects:
• Improved cardiorespiratory fitness
• Increases in muscular strength and endurance
• Improved metabolic health (particularly carbohydrate and lipid
metabolism)
• Improved psychosocial status
• Improved health-related quality of life
Among persons with coronary heart disease, physical activity-based car-
diac rehabilitation reduces all-cause mortality and cardiac mortality. A
moderate amount of evidence documents that increases in physical activ-
ity lead to beneficial changes in body composition, improved physical
functioning, decreased fatigue, improved cardiovascular disease risk pro-
file, and improved ventilation and decreased dyspnea (shortness of
breath) among persons with heart failure and chronic obstructive pulmo-
nary disease.
Insufficient evidence is available to determine whether or not in-
creases in physical activity influence treatment decisions, improve se-
lected biomarkers, lead to lower recurrence rates and longer survival
among cancer survivors, prevent and/or reduce the occurrence of secon-
dary conditions, alter underlying disease processes, decrease disability,
or improve function.
OCR for page 149
149
CLOSING SESSION
Physical Activity and Risk—Maximizing Benefits
According to Dr. Macera, a large body of literature documents the
risk of physical activity-related injuries. Strong evidence indicates that it
is possible to reduce injury risks that otherwise may deter individuals
from being active. A suggested approach in developing guidelines is to
consider evidence of how to maximize the benefits of physical activity
while minimizing the risks.
Strong evidence is available to support the following points regard-
ing physical activity and risk:
Injury Risk
• Any movement increases the risk for injury.
• Activities such as running or vigorous sports are associated with
more injuries than are such activities as walking.
• Recreational and competitive runners have a high prevalence of
injury (average about 45 percent per year).
• Higher amounts of past physical activity protect against current
injury.
• Higher levels of physical fitness protect against injury.
• Active individuals may have lower occurrence of overall injury.
• A sedentary lifestyle is associated with an elevated risk of injury
when actually engaging in physical activity.
• In military settings with a standard exercise training protocol,
women have higher injury rates than men; this effect diminishes
when adjusted for fitness.
• Extremes of flexibility (too loose or too tight) are associated with
injury risk among military subjects.
Cardiovascular Risk
• Sudden cardiac arrest is more common during exercise than dur-
ing sedentary activities.
• The risk of cardiovascular adverse effects goes down with habit-
ual activity.
OCR for page 150
150 PHYSICAL ACTIVITY WORKSHOP
• The relative risk of sudden death during vigorous exercise is
lowest among people who exercise regularly (e.g., ≥ 5 times per
week).
Weaker evidence suggests that smoking may be associated with an
elevated risk of injury and that very high or low body mass index (BMI)
may be associated with increased risk.
In general, the database of studies of physical activity and risk is
rich, including many diverse settings and populations. Much of the evi-
dence comes from military studies with prescribed training schedules and
standard injury assessment procedures. Among the weaknesses of the
evidence are a lack of a common injury definition, small sample sizes,
and a limited range of ages of subjects. More information is needed on
specific injury risks associated with special populations, long-term ef-
fects of acute as well as overuse injuries, and effects of excessive physi-
cal activity on eating disorders and joint problems
In summary, a strong body of evidence about physical activity-
related injuries and sudden cardiac events can be evaluated as a compo-
nent of a process to develop physical activity guidelines. Most modifi-
able risk factors for injury are related to frequency, intensity, duration,
and type of activity. The injury experience of youth, older adults, and
those with disabilities merits special attention.
Issues Raised During the Workshop
Over the course of the workshop, several issues were raised that war-
rant further attention. Among these issues were those relating to improv-
ing measurement (including the use of more objective measures of
physical activity), consideration of both acute and chronic effects of
physical activity, the scope and role of biomarkers in assessing benefit,
exercise as medicine, message confusion, validity, and dose–response.
According to Dr. Morrow, it can be useful to view physical activity
as a medicine—one that has preventive, therapeutic, and treatment char-
acteristics. Physical activity can help people stay healthy, and it can help
people with many types of health problems become healthier.
With regard to message confusion, the following words may have
different meanings to different people: light, moderate, brisk, heavy, vig-
orous, exercise, physical activity, typical, most, and average.
OCR for page 151
151
CLOSING SESSION
Dr. Morrow pointed out that the evidence on benefits of physical ac-
tivity appears to have external validity because it generalizes to mortality
and to a wide variety of morbidities, different populations, and activity
styles. Internal validity is strongly suggested by the convergence of find-
ings from different types of studies.
When examining dose–response data, consideration may be given to
the duration of the physical activity bout, the intensity and frequency of
the bouts, the number of kilocalories used, and/or the total volume of
exercise. Several participants suggested giving consideration to the least
amount of physical activity that will produce benefit.
DISCUSSION
Before closing the session, moderator William Haskell invited atten-
dees to share new information about outcomes already discussed as well
as new outcomes that they wanted to place on the record. The statements
made should not be interpreted as representing recommendations or the
consensus of the workshop.
Physical Activity in Diverse Racial and Ethnic Groups
Several examples were given of comparable results in studies that
involved two or more racial/ethnic groups. Such studies include the Dia-
betes Prevention Program (DPP Research Group, 2002), and the re-
sponse of bone to an exercise intervention (MacKelvie et al., 2002).
Health Benefits of Physical Activity for
Children and Adolescents
Preschool children, in particular, are an understudied group. The
terms physical activity and fitness are not interchangeable in children and
youth in the way they may be used for adults. Work by Dr. Catrine
Tudor-Locke et al. (2006) and colleagues (Flohr et al., 2006) address the
correspondence of a recommended number of steps per day for children
and adolescents with the guideline to obtain 60 minutes of physical activ-
ity daily.
OCR for page 152
152 PHYSICAL ACTIVITY WORKSHOP
Evidence Related to Additional Health Conditions
A large bibliography that includes references on physical activity and
pain soon will be available through the American Pain Society. The oc-
currence of fibromyalgia appears to be increasing and merits attention.
Benefits of Specific Types of Physical Activity
Considerable discussion occurred in response to a question about
evidence to support the development of guidelines that address specific
types of physical activity. For example, what health-related conditions
are likely to be most affected by resistance training, and what is the
strength of the evidence? Useful sources of information include work by
the following:
• Cussler et al. (2003, 2005) and Lohman et al. (1995) regarding
strength training and bone
• Sigal (2004) regarding a trial of aerobic and resistance exercise
related to diabetes
• FitzGerald (2004) regarding strength training and all-cause mor-
tality
• Meyer (2006) regarding strength training in patients with chronic
congestive heart failure
• Singh et al. (2005) regarding strength training and depression in
older persons
• Castaneda et al. (2002) regarding strength training in Hispanics
with diabetes
• Faigenbaum et al. (2001) and colleagues (Hoffman et al., 2005)
regarding children and youth
Balance training and multimodal interventions—not just resistance train-
ing—should be considered. However, relatively little evidence appears to
be available that compares effects of different types of exercise.
Interrelationships of Physical Activity and Nutrition
Emphasis was placed on considering diet as well as physical activity
with regard to weight-related benefits. A meta-analysis conducted by
OCR for page 153
153
CLOSING SESSION
Miller and colleagues (1997) and the report by Saris et al. (2003) from
the International Obesity Taskforce provide pertinent information on the
effects of physical activity on weight management. Physical activity and
nutrition interact in many other conditions as well. Examples include the
acquisition of lean body mass, diabetes mellitus, bone health, and meta-
bolic syndrome.
Strategy for Interpreting the Scientific Evidence
Dr. Pate advised the application of a conservative strategy in inter-
preting the literature, and the value of this approach was reinforced by
Dr. Haskell. There is great variability in the strength of the evidence on
physical activity in relation to benefit and risk. The strong evidence that
has accumulated since prior efforts at guidelines development for three
or four of the major chronic disease conditions in adults can serve as a
basis for further development of such evidence-informed guidelines.
Several persons pointed out the importance of developing clear evidence-
based messages.
CONCLUDING REMARKS
Overall Summary
Presenter: William Haskell
With the substantial decrease in the amount of daily activity required
for living among the U.S. population, physical inactivity has become a
major public health problem. The problem continues to grow. Nonethe-
less, the United States currently lacks up-to-date, comprehensive physi-
cal activity guidelines for promoting health. Lack of such guidelines is a
deterrent to the implementation of an effective national physical activity
plan. Scientific data collected over the past five or six decades strongly
support numerous health benefits of a physically active lifestyle through-
out the life span. The nature of the evidence that can be accumulated re-
garding behaviors—in this case, physical activity behaviors—makes it
essential to take into account the strength of a variety of types of evi-
dence (see Figure 1-1 in Chapter 1). The dose–response data that were
presented indicate that the development of new or comprehensive guide-
OCR for page 154
154 PHYSICAL ACTIVITY WORKSHOP
lines based on such new evidence would be feasible. The evidence pre-
sented at the workshop clearly indicates that the large volume of high-
quality data—much of it recent—could inform new physical activity
guidelines.
Next Steps
Presenter: RADM Penelope Slade-Royall
On behalf of the U.S. Department of Health and Human Services
(DHHS), RADM Royall expressed thanks to all who took part in the
workshop and provided outstanding information for the department’s
consideration. She and her colleagues would consider the evidence pre-
sented at this workshop and make recommendations to the Secretary of
DHHS. Collaborators include Melissa Johnson from the President's
Council on Physical Fitness and Sports, CAPT Richard Troiano from the
Office of Disease Prevention and Health Promotion of the Office of Pub-
lic Health and Science, and Harold W. (Bill) Kohl III from the Centers
for Disease Control and Prevention. A decision about initiating the proc-
ess of developing physical activities guidelines is expected to be released
soon.
REFERENCES
Anderson BJ, Alcantara AA, Greenough WT. 1996. Motor-skill learning:
Changes in synaptic organization of the rat cerebellar cortex. Neurobiol Learn
Mem 66(2):221–229.
Ang ET, Wong PT, Moochhala S, Ng YK. 2003. Neuroprotection associated
with running: Is it a result of increased endogenous neurotrophic factors?
Neuroscience 118(2):335–345.
Black JE, Isaacs KR, Anderson BJ, Alcantara AA, Greenough WT. 1990. Learn-
ing causes synaptogenesis, whereas motor activity causes angiogenesis, in
cerebellar cortex of adult rats. Proc Natl Acad Sci USA 87(14):5568–5572.
Carro E, Trejo JL, Busiguina S, Torres-Aleman I. 2001. Circulating insulin-like
growth factor I mediates the protective effects of physical exercise against
brain insults of different etiology and anatomy. J Neurosci 21(15):5678–5684.
Castaneda C, Layne J, Munoz-Orians L, Gordon P, Walsmith J, Foldvari M,
Roubenoff R, Tucker K, Nelson M. 2002. High-intensity progressive resis-
tance exercise training in Hispanic older adults with type 2 diabetes: A ran-
domized controlled trial. Diabetes Care 25(12):2335–2341.
OCR for page 155
155
CLOSING SESSION
Chambliss HO, Van Hoomissen JD, Holmes PV, Bunnell BN, Dishman RK.
2004. Effects of chronic activity wheel running and imipramine on masculine
copulatory behavior after olfactory bulbectomy. Physiol Behav 82(4):
593–600.
Cotman CW, Berchtold NC. 2002. Exercise: A behavioral intervention to en-
hance brain health and plasticity. Trends Neurosci 25(6):295–301.
Cussler EC, Lohman TG, Going SB, Houtkooper LB, Metcalfe LL, Flint-
Wagner HG, Harris RB, Teixeira PJ. 2003. Weight lifted in strength training
predicts bone change in postmenopausal women. Med Sci Sports Exerc
35(1):10–17.
Cussler EC, Going SB, Houtkooper LB, Stanford VA, Blew RM, Flint-Wagner
HG, Metcalfe LL, Choi JE, Lohman TG. 2005. Exercise frequency and cal-
cium intake predict 4-year bone changes in postmenopausal women. Osteopo-
ros Int 16(12):2129–2141
Dishman RK. 1997. Brain monoamines, exercise, and behavioral stress: Animal
models. Med Sci Sports Exerc 29(1):63–74.
Dishman RK, Renner KJ, Youngstedt SD, Reigle TG, Bunnell BN, Burke KA,
Yoo HS, Mougey EH, Meyerhoff JL. 1997. Activity wheel running reduces
escape latency and alters brain monoamine levels after footshock. Brain Res
Bull 42(5):399–406.
Dishman RK, Berthoud HR, Booth FW, Cotman CW, Edgerton VR, Fleshner
MR, Gandevia SC, Gomez-Pinilla F, Greenwood BN, Hillman CH, Kramer
AF, Levin BE, Moran TH, Russo-Neustadt AA, Salamone JD, Van Hoomis-
sen JD, Wade CE, York DA, Zigmond MJ. 2006. Neurobiology of exercise.
Obesity (Silver Spring) 14(3):345–356.
DPP (Diabetes Prevention Program) Research Group. 2002. The Diabetes Pre-
vention Program (DPP): Description of lifestyle intervention. Diabetes Care
25(12):2165–2171.
Faigenbaum AD, Loud RL, O'Connell J, Glover S, O'Connell J, Westcott WL.
2001. Effects of different resistance training protocols on upper-body strength
and endurance development in children. J Strength Cond Res 15(4):459–465.
FitzGerald SJ, Barlow CE, Kampert JB, Morrow JR Jr, Jackson AW, Blair SN.
2004. Muscular fitness and all-cause mortality: Prospective observations. J
Phys Activ Health 1:7–18.
Flohr JA, Todd MK, Tudor-Locke C. 2006. Pedometer-assessed physical activ-
ity in young adolescents. Res Q Exerc Sport 77(3):309–315.
Greenwood BN, Foley TE, Day HE, Campisi J, Hammack SH, Campeau S,
Maier SF, Fleshner M. 2003. Freewheel running prevents learned helpless-
ness/behavioral depression: Role of dorsal raphe serotonergic neurons. J Neu-
rosci 23(7):2889–2898.
Hoffman JR, Kang J, Faigenbaum AD, Ratamess NA. 2005. Recreational sports
participation is associated with enhanced physical fitness in children. Res
Sports Med 13(2):149–161.
OCR for page 156
156 PHYSICAL ACTIVITY WORKSHOP
Lohman T, Going S, Pamenter R, Hall M, Boyden T, Houtkooper L, Ritenbaugh
C, Bare L, Hill A, Aickin M. 1995. Effects of resistance training on regional
and total bone mineral density in premenopausal women: A randomized pro-
spective study. J Bone Miner Res 10(7):1015–1024.
MacKelvie KJ, McKay HA, Petit MA, Moran O, Khan KM. 2002. Bone mineral
response to a 7-month randomized controlled, school-based jumping interven-
tion in 121 prepubertal boys: Associations with ethnicity and body mass in-
dex. J Bone Miner Res 17(5):834–844.
Meyer K. 2006. Resistance exercise in chronic heart failure—Landmark studies
and implications for practice. Clin Invest Med 29(3):166–169.
Miller WC, Koceja DM, Hamilton EJ. 1997. A meta-analysis of the past 25
years of weight loss research using diet, exercise or diet plus exercise inter-
vention. Int J Obes Relat Metab Disord 21(10):941–947.
Morrow J. 2006. Physical activity, health promotion, and chronic disease pre-
vention. Presentation at the Institute of Medicine Workshop on the Adequacy
of Evidence for Physical Activity Guidelines Development. Washington, DC.
October 23.
Russo-Neustadt A, Ha T, Ramirez R, Kesslak JP. 2001. Physical activity-
antidepressant treatment combination: Impact on brain-derived neurotrophic
factor and behavior in an animal model. Behav Brain Res 120(1):87–95.
Saris WH, Blair SN, van Baak MA, Eaton SB, Davies PS, Di Pietro L, Fogel-
holm M, Rissanen A, Schoeller D, Swinburn B, Tremblay A, Westerterp KR,
Wyatt H. 2003. How much physical activity is enough to prevent unhealthy
weight gain? Outcome of the IASO 1st Stock Conference and consensus
statement. Obes Res 4(2):101–114.
Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C. 2004. Physical ac-
tivity/exercise and type 2 diabetes. Diabetes Care 27(10):2518–2539.
Singh NA, Stavrinos TM, Scarbek Y, Galambos G, Liber C, Fiatarone-Singh
MA. 2005. A randomized controlled trial of high versus low intensity weight
training versus general practitioner care for clinical depression in older adults.
J Gerontol A Biol Sci Med Sci 60(6):768–776.
Stummer W, Weber K, Tranmer B, Baethmann A, Kempski O. 1994. Reduced
mortality and brain damage after locomotor activity in gerbil forebrain ische-
mia. Stroke 25(9):1862–1869.
Tudor-Locke C, Lee SM, Morgan CF, Beighle A, Pangrazi RP. 2006. Children's
pedometer-determined physical activity during the segmented school day.
Med Sci Sports Exerc 38(10):1732–1738.
Van Hoomissen JD, Chambliss HO, Holmes PV, Dishman RK. 2003. Effects of
chronic exercise and imipramine on mRNA for BDNF after olfactory bulbec-
tomy in rat. Brain Res 974(1-2):228–235.
Van Hoomissen JD, Holmes PV, Zellner AS, Poudevigne A, Dishman RK.
2004. Effects of beta-adrenoreceptor blockade during chronic exercise on con-
textual fear conditioning and mRNA for galanin and brain-derived neurotro-
phic factor. Behav Neurosci 118(6):1378–1390.
OCR for page 157
157
CLOSING SESSION
van Praag H, Christie BR, Sejnowski TJ, Gage FH. 1999. Running enhances
neurogenesis, learning, and long-term potentiation in mice. Proc Natl Acad
Sci USA 96(23):13427–13431.
van Praag H, Shubert T, Zhao C, Gage FH. 2005. Exercise enhances learning
and hippocampal neurogenesis in aged mice. J Neurosci 25(38):8680–8685.
Yoo HS, Tackett RL, Bunnell BN, Crabbe JB, Dishman RK. 2000. Antidepres-
sant-like effects of physical activity vs. imipramine: Neonatal clomipramine
model. Psychobiology 28(4):540–549.
OCR for page 158
Representative terms from entire chapter:
uncorrected proofs
