What is exercise physiology?

Exercise physiology is all about your body’s short-term responses to physical stress, and how your body adapts to repeated exposure to physical activity – over time.

And it’s all based on your individual needs – putting you at the centre of your own care – and pro-active collaboration with treating health professionals to achieve the best results for you.

Some of the chronic health conditions and injuries that exercise physiologists help treat include:

• cardiovascular disease (CVD)

• diabetes

• obesity

• stroke

• multiple sclerosis

• osteoporosis

• mental health problems

• chronic musculoskeletal injuries

Popular Services

• Metabolic responses, aerobic power (VO2max), anaerobic threshold, heart rate, power output, blood lactate responses during sub-maximal and maximal exercise.

• Running & cycling economy evaluation

• DEXA body composition - lean & fat mass; fat %; visceral adipose tissue; fat mass index

• Exercise biochemistry – monitor training or nutritional adaptations; identifying incomplete or altered recovery status; muscle damage; overtraining syndrome; stress responses

• Endurance sports

• Young & older athlete training and competition loads

Metabolic testing can help people who have developed, are at risk of developing, or who want to prevent injuries and chronic medical health conditions.

Some of the more common conditions include:

• Metabolic (obesity, diabetes, high lipids)

• Musculoskeletal (arthritis, injuries, osteoporosis, pre/post surgery)

• Cardiovascular (high blood pressure, arterial disease, heart failure, post-heart attack)

• Cancers

• Women’s Health (PCOS, endometriosis, hormonal issues)

• Mental Illness

• Sports performance and fitness/strength goals (technique for gym-based movements)

More information and reports

If you would like more information on the function and value of exercise physiology, please refer to three reports submitted below:

For more information relating directly to our clinic, please read VO2 and DEXA evaluations at Inner West Allied Health Centre.
This provides a brief overview on:

• Necessity of VO2max evaluation

• What is involved in the evaluation

• Necessity of DEXA evaluation

• Safety as it relates to DEXA

• Expected outcomes

• Preparations for both evaluations

For more information on the importance of assessing VO2max, please read this scientific statement from the American Heart Association.
It asserts:

• That low levels of cardiorespiratory fitness (CRF) are associated with higher risks of cardiovascular disease; all-cause mortality; and cancer-attributable mortality rates

• That CRF can be a strong predictor of mortality, as effective as established risk factors of smoking; hypertension; cholesterol levels; and type 2 diabetes mellitus

For more information on the importance of assessing VO2max in healthy individuals, please read this report on exercise capacity and mortality among men referred for exercise testing

It finds:

• Men with higher maximal heart rate; lower maximal systolic and diastolic blood pressure; and higher exercise capacity were more likely to live longer

• Peak exercise capacity was the strongest predictor of risk of death

Do you know your VO2 Max?

Your VO2 max refers to the maximum rate at which your muscles can extract oxygen from your blood and put it to metabolic use to generate energy.

VO2 max is often used as an indicator of overall cardiorespiratory fitness and can serve as a metric for tracking progress.

How does VO2 max correlate with longevity? Below is a link to a paper published in 2018: Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing.

Mandsager et al 2018

You can read a summary of this paper written by Peter Attia MD below:

Figure 1. Patient survival by performance group. (Mandsager et al., 2018)

Overview of the experiment:

• A group of people that were 53 years old on average

• Ran them through a VO2 max test and then it ranked them

• Low were people who scored in the bottom 25th percentile

• Below average was the 25th to 50 percentile

• 50 to 75th percentile was above average

• High was 75th to maybe 95th

• Elite was just that top 5%.

• NOTE: Each of these levels do NOT represents 20% of the population

• A total of 122,000 patients

• The low, below average, above average, and high have about 30,000 participants in each one of those groups

• And then the elite group had around 3,500 participants

Results:

• Looking at all-cause mortality there’s a pretty clear trend

• The two things that stand out are,

  • i) there’s a monotonic relationship between fitness and mortality

  • ii) By far the biggest gap is between the people in the bottom 25%. Which are categorized as low fitness, and basically everyone above them.

Figure 2. Risk-adjusted all-cause mortality. (Mandsager et al., 2018).

When you group everyone together, male and female, if you have low fitness and then comparing it to everybody else, what’s the risk reduction?

If you go from low to below average, to above average, to high to elite, you can see what is the hazard ratio

Important stats

• Going from just being low to being below average is a 50% reduction in mortality over a decade

• If you then go from low to above average, it’s about a 60% or 70% reduction in mortality

• Then it just continues monotonically to increase

• The lowest improvement is going from high to elite—marginal gains nonetheless

• To see that you have to look at Table C

• remember, the hazard ratio for mortality is the reciprocal of the hazard ratio of risk reduction

• Tables A and C are basically showing you similar things in the group comparison

Here’s what’s interesting…

• If you compare someone of low fitness to elite, it is a five fold difference in mortality over a decade

• They put this in the context of other things that we commonly understand as being problematic for mortality… Namely, smoking, coronary artery disease, Type 2 diabetes, hypertension, and end-stage renal disease

  • That’s a 41% increase in mortality over the decade

  • Coronary artery disease, 29%.

  • Diabetes, 40%.

  • High blood pressure, 21%.

  • End-stage renal disease, about 180% increase in mortality

• But now when you compare that to the differences in these fitness levels, it gives you a greater appreciation for how much improvement in mortality comes from improving your fitness

• If you look at the biggest driver of mortality, which would be end-stage renal disease in this cohort, it’s the same as going from low cardiorespiratory fitness to above average cardiorespiratory fitness

• So going from the bottom 25th percentile to being in the 50th to 75th percentile… “which is a totally achievable feat”
  
  Looking at VO2 max in relation to all-cause mortality, we see a very clear trend. Simply bringing your VO2 max from 'low' (bottom 25th percentile) to 'below average' (25th to 50th percentile) is associated with a 50% reduction in all-cause mortality. When you go from 'low' to 'above average' (50th to 75th percentile) the risk reduction is closer to 70%!