Exercise is Medicine? Efficacy vs. effectiveness

Transcription

1 Exercise is Medicine? Efficacy vs. effectiveness Matthias Wilhelm Department of Cardiology, Interdisciplinary Center for Sports Medicine

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4 EUROASPIRE: A European Society of Cardiology survey of secondary prevention of coronary heart disease (78 centeres, 24 countries)

5 EUROASPIRE: A European Society of Cardiology survey of secondary prevention of coronary heart disease (78 centeres, 24 countries)

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7 Efficacy (ˈɛfɪkəsi) The ability to produce a desired or intended result. Effectiveness (ɪˈfɛktɪvnəs) The degree to which something is successful in producing a desired result.

8 Landmark clinical trials have shown that lifestyle modification programs focused on weight loss can delay the onset of type 2 diabetes in subjects at high risk of developing the disease. Unfortunately, no study has shown that diabetes can be delayed or prevented in a community setting, and efforts to replicate the weight loss achieved in the trials have been mostly disappointing. Furthermore, both the clinical trials and the community-based prevention studies have not shown a beneficial effect on any diabetes-related clinical outcome.

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14 Exercise adherence decreased from a median of 95 minutes per week during months 4 through 6 of follow-up to 74 minutes per week during months 10 through 12 It is not easy for participants in an exercise training program, particularly for patients such as those in this study who have chronic symptomatic heart failure and multiple comorbid conditions, to continue exercise training during long-term follow-up. Although the study invested substantial effort and resources into optimizing adherence, we understand that lack of compliance is likely due to many factors, including a limitation of the disease state and concomitant comorbid conditions, diminishing motivation, or other factors, some of which are not easily modifiable.

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16 Exercise intensity and all-cause mortality association vs. causality ~ 8.5 MET (VPA>6 MET) 50*7/60*8.5=50 MET-h/wk? Recommendation: 75 VPA/week or 150 min MVPA/week ~ 4.5 MET (MVPA 3-6 MET) 100*7/60*4.5=53 MET-h/wk 1 metabolic equivalent (MET) = 1 kcal per h per kg

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18 Previous observational follow-up studies in humans suggest that increasing fitness through physical activity levels could prolong life; however, our controlled interventional study with laboratory rats bred for low and high intrinsic fitness contrast with these findings. Also, we find no evidence for the suggested association using pairwise analysis among monozygotic twin pairs who are discordant in their physical activity levels. Based on both our animal and human findings, we propose that genetic pleiotropy might partly explain the frequently observed associations between high baseline physical activity and later reduced mortality in humans.

19 Nothing in biology makes sense except in the light of evolution. Theodosius Dobzhansky Natural selection derives from the following three uncontroversial phenomena: 1) all organisms vary, 2) some of these variations are genetically heritable, 3) organisms compete for resources, leading to differential reproductive success. Natural selection favors the evolution of adaptations and selects against features that are maladaptive.

20 endurance running is a derived capability of the genus Homo, originating about 2 million years ago, and may have been instrumental in the evolution of the human body form.

21 «Dysevolution» or getting sick from mismatch Living in the 21 st century with genes of hunters and collectors Regular, moderate amounts of endurance physical activity mismatch Avoidance of unnecessary exertion, favoring inactivity (!!) Storage of energy from available food resources

22 Play is an ancient adaptation make physical activity more enjoyable in schools, workplaces, and other environments. Inactivity is a preferred behavior restructure our environments to require more physical activity

23 Promoting active living and mobility.

24 Do we really want this?

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27 Mobile telemonitoring guided cardiac rehabilitation (mcr) Part of an EU Horizon 2020 project in 7 countries

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