Körperliche Aktivität in der Prävention chronischer

GYN ALLROUND 2014
Winterfortbildung unter südlicher Sonne
22.02. bis 01.03.2014, Teneriffa
Univ.-Prof. Dr. Norbert Bachl
Abteilung Sport- und
Leistungsphysiologie
Zentrum für Sportwissenschaft
und Universitätssport
Universität Wien
Körperliche Aktivität
in der Prävention
chronischer Erkrankungen
Gesund sterben
“To die young as late in life as possible”
Ein langes Leben
und
einen schönen Tod.
WHO: 70 % of all deaths are lifestyle related in 2020
•
Physical Inactivity
•
•
•
Smoking
Alcohol
Nutrition, Overweight, Obesity
< 50 000 years……………………………………………… 50 years
3
Conditions that are caused or worsened by sedentary lifestyle
Sedentary living increases these conditions
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Angina, heart attack, coronary artery disease
Congestive heart failure
Hypertension
Peripheral vascular disease
Stroke
Type II diabetes
High blood triglyceride
High blood cholesterol
Low blood HDL
Obesity
Gallstone disease
Breast cancer
Colon cancer
F.W. Booth et al, 2002
1.
2.
16.
17.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Pancreatic cancer
Prostate cancer
Osteoporosis
Low Back pain
Stiff joints
Sarcopenia
Hip fractures
Physical frailty
Less cognitive function
Depression
Sleep apnea
Lower quality of life
Premature mortality
Therefore, given these facts, F.W. Booth et al, 2002 coined the phrase:
Sedentary Death Syndrome
(SeDS)
Weak skeletal muscles, low bone density, hyperglycemia, glucosuria, low
serum, HDL, obesity, low physical endurance, and resting tachycardia are a
set or group of symptoms that together characterize SeDS.
DISUSE
W.Spirduso, 1995
GOALS:
Healthy life years
Austria
Women
Men
LE(y)
82,3
76,7
HLY(y)
59,6
57,8
%
72,4
75,4

Mobility and life quality
during ageing

Prevention of chronic
diseases (CHD Stroke,
Diabetes II, tumors)

Prevention of muscle athropy
and sarkopenia

Prevention of low backpain

Prevention osteoporosis

Reduction of hip fractures
due to falling
 Regular Physical Activity
 Nutrition
 Non Smoking
 Normal Body Weight
Regular physical activity and sports
• Reduces the risk of dying prematurely from heart disease and
other conditions
• Reduces the risk of developing diabetes
• Reduces the risk of developing high blood pressure
• Reduces blood pressure in people who already have high blood
pressure
• Reduces the risk of developing colon and breast cancer
• Helps to maintain a healthy weight
• Helps build and maintain healthy bones, muscles, and joints
• Helps older adults to become stronger and better able to
move about without falling
• Reduces feelings of depression and anxiety, and
10
• Promotes psychological well-being
11
New records in aerobic power
among octogenarian lifelong
endurance athletes
Scott Trappe, Erik Hayes, Andrew Galpin, Leonard
Kaminsky, Bozena Jemiolo, William Fink, Todd Trappe,
Anna Jansson, Thomas Gustafsson, and Per Tesch
Journal of Applied Physiology January 1, 2013 vol. 114 no. 1
3-10
Trappe et al, 2013
Trappe et al, 2013
400
Mortalitätsrisiko [%]
All cause
mortality
300
200
100
0
0
20
30
6
40
VO2 max.[ml/kg/min]
8
10
50
12
60
14
16 MET
Saltin et al, 2001
Study on drivers of Londons double decker buses
Morris et al.
nach Morris et al. : Lancet , (2) 1053-1111, 1953
16
Post-mortem Study on 206 Institutes of Pathology in GB
Morris et al.
Relative Mortality risk of CHD in relation to group „light“
Data of all groups: A+B+C (n = 5000)
1,0
0,84
0,43
"light"
"activ"
“heavy"
Job
nach Morris et al. : Brit. Med. J., (2) 1485-1496, 1958
17
„The Harvard Study“ (1993)
Paffenbarger et al. :N.Engl.J.Med.(328), 538, 545, 1993
16936 Harvard-graduates
Duration: since 1962-1964 till today (current study till 1977)
Activity Score: Questionnaire: walking („city blocks“), stair
climbing („flight of stairs“),
Sports activity: type of Sport, Volume, Intensity (5, 7.5, 10
kcal/min)
18
„The Harvard Study“ (1993)
Paffenbarger et al. :N.Engl.J.Med.(Vol314,No.10), 605-613, 1993
Period: 1962-1977
"Relative risk of all cause mortality"
(according to physical activity)
under 500
501-999
1000-1499
1500-1999
2000-2499
2500-2999
3000-3500
over 3500
kJ/week (kcal/week)
19
From Scand J Med Sci Sports 2006: 16 (Suppl. 2006)
B.K. Pedersen, B. Saltin
The relation between amount of exercise (expressed by energy expenditure) and changes in
coronary lesions. Higher levels of exercise training/physical activity were associated with a
half of progression, or even regression, of coronary lesions. (Constructed according to data in
Suaya et al.)
G. Schuler et al., 2013
Type II Diabetes
WHO: 2000 159 Millions with type II D
2025: 280 Millions with type II D
15 % under twenty
American Diabetes Association, 1996
O.Pinhas-Hamiel et al, 1996
Some (few) examples for long-term studies,
which prove the reduction of diabetes-risk by E-Training
Study/Country
Participants
Treatment
Duration of
the study
Duration and
intensity of
Exercises
Results
Helmrich et al., 1991,
United States
5990 Males
Endurance
training
14 years
Min. 500 kcal per
week
↓ Incidence of.DM
because of endurance
training
Tuomilehto et al.,
2001, Finland
522 Individuals
Endurance
training
2 years
Min.30 min. a day
↓ Incidence of.DM
because of endurance
training
Eriksson et al., 1998,
Sweden
Intervention-group:
181 Males
Control-group: 79
Males
Endurance
training and
nutritional
adaption
12 years
60 Min. units per
week
↓ Incidence of.DM
because of endurance
training
Schrauwen et
al.,2002, Holland
6 Males
Endurance
training
12 years
3 x week with 40 %
VO2 max
↓ Incidence of.DM
because of endurance
training
From Scand J Med Sci Sports 2006: 16 (Suppl. 2006)
B.K. Pedersen, B. Saltin
ATTENTION – BIG IS GETTING BIGGER
WHO:
Attention – big is
2008:
1.6
billion
adults
getting bigger
overweight,
2015: 2.3 billion adults
overweight!
2008: 400 million obese,
2015: 800 million obese!
25
Obesity Trends* Among U.S. Adults
BRFSS, 1990, 2000, 2010
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2000
1990
2010
No Data
No Data
<10%
<10%
10%–14%
10%–14%
15%–19%
15%–19%
20%–24%
20%–24%
25%–29%
25%–29%
≥30%
≥30%
European kids grow more and more fat!
Prevalence of overweight in 7 to 11 children in different European
27
Countries.
Ernährungszustand – Erwachsene (18-64) Österreich
Fehlerbalken: CI 95 %, BMI-Kategorien nach WHO [WHO, 2000]
BMI (kg/m²) wurde aus gemessenen Daten zu Körpergröße und Körpergewicht berechnet.
n=313, Frauen n=192, Männer n=121; jeweils 100 %
Abb. 2.44: Prävalenz von Untergewicht, Normalgewicht, Übergewicht und Adipositas
bei Erwachsenen (18–64 Jahre), gesamt und nach Geschlecht
Elmadfa I et al. Österreichischer Ernährungsbericht 2012.
Bewegung/Sport/körperliche Aktivität
bei Übergewicht und Adipositas
• Körperliche Aktivität in mäßiger Intensität mehr als 30 Minuten Dauer an
3 – 5 Tagen in der Woche.
–
–
–
–
Bei mäßiger Anwendung, mindestens 5 Tage pro Woche (körperliche Aktivität)
Bei intensiver Anwendung, mindestens 3 Tage pro Woche (Sport)
Bei abwechselnd mäßiger und intensiver Anwendung, 3-5 Tage pro Woche.
Ein Minimum von 1,000 kcal/wk ; 2,000 to 4,000 kcal/wk wäre optimal.
• Auf lange Sicht sollte angestrebt werden, wenn möglich, täglich über eine Zeit
von 45 Minuten, besser 60 Minuten mäßig aktiv zu sein.
• Wenn die Motivation trägt, ist ein noch längeres Programm günstiger und die
Intensität kann gesteigert werden.
• Eine deutliche Verminderung vorwiegend sitzender Lebensweise – gemeint
sind insbesondere Fernsehen und Computerspiele – und
• die Verstärkung der Alltagsaktivität kann diese Zeitangaben reduzieren.
Quelle: DGSP)
From Scand J Med Sci Sports 2006: 16 (Suppl. 2006)
B.K. Pedersen, B. Saltin
Volkskrankheit Übergewicht
Sport – was er bewirkt!
• Die gute Nachricht: Sport kann zur
Gewichtsreduktion bzw. zum Gewichtserhalt
beitragen.
• Die schlechte Nachricht: Wunder gibt es keine!
– 250 kcal/Tag: bei Nahrungsaufnahme einsparen,
– 250 kcal/Tag: motorischer Verbrauch
ca. – 0,5 kg Gewichtsverlust pro Woche
• Die positive Konsequenz: nur
Lebensstiländerungen sind nachhaltig!
The evidence for a causal association between
physical activity and colon and breast cancer is
found to be ‚convincing‘, for prostate cancer to
be ‚probable‘, for lung and endometrial cancers
to be ‚possible‘, and for testicular and ovarian
cancers to be currently ‚insufficient‘ to make
any definitive conclusions.
CM Friedenreich et al, 2002
Exercise benefits in non-communicable diseases
Cardiac disease
40 % risk reduction
Lambert R. et al.
Stable coronary
Artery disease
88 % survival at 12
months
ThÄ,gersen-Ntoumani C.
et al.
Type 2 diabetes
58 % incidence reduction
Wilson PM et al.
Hip fracture
55 % incidence reduction
Wilson PM et al.
Breast cancer
40 % risk reduction
Hagger MS et al.
Recurrent breast cancer
54 % reduction in mortality Silva MN et al.
Major depression
Exercise as effective as
sertraline
(60,4% reduced rate)
with a relapse rate of 30%
Haase AM. Et al.
Source: www.the lancet.com Vol 380 July 7, 2012
Review: Advancing the future of physical activity guidelines in Canada:
an independent expert panel interpretation of the evidence
The Consensus Panel makes three Recommendations for adults aged 19-65 years
 Recommendation 1
Adults aged 19-65 years should
accumulate 150 minutes/week of
moderate-intensity PA and
or 90
minutes/week of vigorous-intensity PA in
periods of at least 10 minutes each.
Greater amounts of activity and more
vigorous activity provide additional benefits
(evidence: level 2, grade A*).
*Grade A: Strong recommendation
Kesäniemi et al., 2010
Review: Advancing the future of physical activity guidelines in Canada:
an independent expert panel interpretation of the evidence
The Consensus Panel makes three Recommendations for adults aged 19-65 years


Recommendation 2

Engage in resistance activities on 2-4 days/week

Resistence exercise should involve the major muscle groups
of the body, and should consist of 8-12 repetitions at >60% of
1 repitition maximum (RM).

Daily activities that involve lifting, carrying, and pushing tasks
should be maintained because they can also benefit muscular
and bone health
(evidence: level 2, grade A*)
Recommendation 3

Engage in flexibility activities on 4-7 days/week

Streching exercises should be done regularly to maintain
good flexibility
(evidence: level 3, grade A*).

*Grade A: Strong recommendation
Kesäniemi et al., 2010
relative risk
relative risk
Men
Activity-/Fitness-Quantile
Women
Activity-/Fitness-Quantile
Comparison of the combined RRs for All Cause Mortality in men
and women.
G.Samitz, 2003
Relative Risk of Mortality according to Joint Categories
of Physical Activity Recommendations
Full multivariate RR (95% CI)
1,2
1
0,8
Mortality from any cause
0,6
Mortality from cardiovasular disease
Mortality from cancer
0,4
0,2
0
Inactive
Neither
Recommendation
Recommendation
for MPA only
Recommendation
for VPA only
Joint Categories of PA Recommendations
M.F. Leitzmann et al., 2007
Recommendation
for both MPA and
VPA
“Systematic application of epidemiologic
method and approaches to assess the
impact of human genetic variation on
health and disease”
Khoury, Little and Burke, HuGE 2004
• Genotype prevalence
• Gene - disease association
• Gene - gene interactions
• Gene - environment interactions
• Epigenetic influence – heritable?
Mapping the
Diseasome
Phenotype (disease) = mix of totally different entities
Health outcome = diseasome instead of disease
Epigenomic effects = environmental factors can
modify and trigger health outcomes by changing
the genome
„There is no black and white! Not everything is just
bad and not everything is just good! Best caseworst case-scenario, individual suscibilities
• Genomic variant = risk factor and protective factor
at the same time
ROLE OF INDIVIDUAL
PRESCRIBED EXERCISE
Diseasome of Physical Inactivity
activity
Individual
Suscibilities
Individual
Prescribed
Exercise
Pedersen (2009) J Physiol. Dec 1;587:5559-68.
The Myokine Concept
 Regular exercise induces an anti-inflammatory
response.
 During exercise, skeletal muscle releases IL-6.
 IL-6 has anti-inflammatory actions and
modulates glucose and lipid metabolsm.
 Muscle-dereived cytokines, termed myokines,
are likely to mediate the health benefits
against chronic diseases.
B. K. Pedersen, The Biochemical Society, 2006
FUTURE INDIVIDUAL EXERCISE
PRESCRIPTIONS
Individual
Coordinatio
n,
Flexibility
Individual
Matheson GO et al., 2014
„Ausreden“
1) Ich habe
keine Zeit
Alltagsaktivitäten, Planung, 30 Minuten
körperliche Aktivität pro Tag möglich
2) Ich kann mir das
nicht leisten
Fitnesscenter sind nicht notwendig, Ausdauer und
Kraft (mit Einsatz des eigenen Körpergewichts)
sind jederzeit und kostengünstig möglich
3) Ich mag Anstrengung
nicht
Vielleicht schlechte Vorerfahrungen; aber
für jeden gibt es angenehme und
motivierende körperliche Aktivität
4) Ich bin zu alt
Sogar weit über das achzigste Lebensjahr gibt
es noch positive Effekte körperlicher Aktivität
5) Ich könnte mich
verletzen
Wenn richtige Trainingssteuerung – geringe
Verletzungsgefahr,
Auf jeden Fall vorher sportmedizinische
Untersuchung
6) Ich bin zu dick
Dieser „Circulus Vitiosus“ muss einmal
durchbrochen werden – anfangen mit
moderater körperlicher Intensität, welche nicht
überbelastet
7) Ich kenne
niemanden, der
regelmäßig
Sport betreibt
Einer muss immer der Erste sein, gehen
Sie mit gutem Beispiel voran!
8) Ich mag nicht
schwitzen
Das ist auch nicht notwendig, es gibt viele
Aktivitäten, bei denen kaum eine
Schweissentwicklung eintritt; überdies:
Duschen oder Sauna sind angenehme
Erholungsmaßnahmen (Regeneration).