Sedentary Death Syndrome (SeDS)

Transcription

1 Norbert Bachl MD Prof. EFSMA President FIMS EC-Member Department Sports- and Exercise Physiology University Vienna Kraków Teplice Belgrade September 24 WHO: 7 % of all deaths are lifestyle related in 22 Physical Inactivity Smoking Alcohol Nutrition, Overweight, Obesity Conditions that are caused or worsened by sedentary lifestyle Sedentary living increases these conditions 1. Angina, heart attack, coronary artery disease 2. Congestive heart failure 3. Hypertension 4. Peripheral vascular disease 5. Stroke 6. Type II diabetes 7. High blood triglyceride 8. High blood cholesterol 9. Low blood HDL 1. Obesity 11. Gallstone disease 12. Breast cancer 13. Colon cancer 14. Pancreatic cancer 15. Prostate cancer 16. Osteoporosis 17. Low Back pain 18. Stiff joints 19. Sarcopenia 2. Physical frailty 21. Less cognitive function 22. Depression 23. Sleep apnea 24. Lower quality of life 25. Premature mortality F.W. Booth et al, 22 Therefore, given these facts, F.W. Booth et al, 22 coined the phrase: Sedentary Death Syndrome (SeDS) to categorize the emerging entity of sedentary lifestyle-mediated disorders that ultimately result in increased mortality. 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. Our society is at war against a common enemy: MODERN CHRONIC DISEASE CHRONIC HEALTH CONDITION This is a condition that is slow in its progress and long in its continuance (Dorland s, 1974). For the individual: reduced well-being, life quality and mobility For the public: increased health care costs F.W. Booth et al, 22 1

2 21: The evidence-based consensus statement from the Dose-Response Issues Concerning Physical Health: Regular physical activity is associated with a reduction in all-cause mortality, fatal and nonfatal total cardiovascular disease, and coronary heart disease. It is also associated with a reduction in the incidence of obesity and type II diabetes mellitus, and improvement in the metabolic control of individuals with established type II diabetes. Furthermore, physical activity is associated with a reduction in the incidence of colon cancer and osteoporosis. Further benefits of regular physical activity include improved physical function and independent living in the elderly. Individuals with high levels of physical activity are less likely than those with lower levels to develop depressive illness. (Kesaniemi et al, 21). Thus, it is clear from multiple consensus statements that sedentary lifestyle increases the risk of chronic health conditions. F.W. Booth et al, 22 F.W. Booth et al, 22 Heart disease remains the number one cause of death in a lot of countries. Study on drivers of Londons double decker buses Morris et al. nach Morris et al. : Lancet, (2) , 1953 Post-mortem Study on 26 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 = 5) The Harvard Study (1993) Paffenbarger et al. :N.Engl.J.Med.(328), 538, 545, , "light",84,43 "activ" heavy" Job nach Morris et al. : Brit. Med. J., (2) , Harvard-graduates Duration: since 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, 1 kcal/min) 2

3 1 Period: "Relative risk of all cause mortality" (according to physical activity),78 The Harvard Study (1993) Paffenbarger et al. :N.Engl.J.Med.(Vol314,No.1), , 1993,73,63,62,52,46, , 1, 1, 1, 1,,72,63,86,97,51,53,64,79 Age under over 35 kj/week (kcal/week) <5 5-1,999 2, +.. Waneen W.Spirduso, 1995Physical activity (kcal/week)) ADIPOSITAS/OBESITY % Obese 16 Men 14 Women UK - A.R.Carmichael, 1998 LIKE A NATURAL LAW? Percentage of patients with overweight/obesity classified by physicians in their offices Changes in adipose cellularity with weight reduction in obese subjects. G.H. Stollerman, 1971 Survival Curves for All-Cause Mortality by BMI Categories 1 Survival Rate % BMI Category kg/m 2 18,5-24,9 25,-29,9 > Follow-up Years Data are from men with 125 all-cause deaths and 439 cardiovascular disease deaths during man-years of observation. Ming Wei et al,

4 Distribution of Baseline Variables in According to Physical Activity Level on a Cohort of US Male Physicians 4 to 84 Years of Age Vigorous Exercise * No.of Mean (SD) Mean (SD) Body Times/wk Participants Age, y Mass Index ,7 (9,5) 25,3 (3,3) ,5 (9,) 25,2 (2,9) ,6 (9,3) 24,8 (2,9) > ,3 (1,1) 24,2 (2,7) Total ,1 (9,4) 24,9 (3,) * Physical activity long enough to work up a sweat. Weight in kilograms divided by the square of height an meters. E.Manson et al, 1992 Age-adjusted incidence rates of non-insulin-dependent diabetes mellitus (NIDDM) according to frequency of vigorous exercise (x 2.trend (1 df) = 13.1, P=,1) E.Manson et al, Incidence of NIDDM, per 1 Person-Years < Frequency of Vigouros Exercise, Times per Week Cohort Studies Case-control Studies I.Thune et al, 21 I.Thune et al, 21 I.Thune et al, 21 Gender differences in muscle strength at different decades Back extensor strength (N) men women Grip strength (N) men women Strength CSA -16 % -24 % +16 % +11 % Strength CSA 12 years of aging 12 weeks of training Isokinetic device 6 o /sec. Knee-Extension - W.Frontera, 22 Sinaki M et al.: Am J Phys Med Rehab 8:5 (21),

5 Depression Morbidity ALAMEDA COUNTY STUDY (CAMACHO / ROBERTS / LAZARUS et al. 1991) Physical Activity low vigorous RR,76,62 AMERICAN COLLEGE MEN (PAFFENBARGER / LEE / LEUNG 1994) W.Spirduso, 1995 Physical Activity moderate vigorous ( ) (> 2.5) kcal/week kcal/week RR,83,72 All Cause Mortality and Physical Activity Total Mortality (%) Ranges of distance walked miles/day 2,1-8, 1,-2,,-, Year of Follow-up Cumulative Mortality According to Year of Follow-up and Distance Walked per Day. To Convert distances to kilometers, multiply by AA.Hakim et al, The New England Journal of Medicine, 1998 DO GENES OR ENVIRONMENT CAUSE CHRONIC HEALTH CONDITIONS? Environmental Change Underlying the Increased Incidence of CHS s Most diseases, and in particular chronic diseases, are determined by the dynamic interaction of multiple genes with the environment. M.V.Chakravarthy, et al, 22 The modern human genome has a highly conserved ability to adapt to extreme amounts of energy expenditure Our genes expect the body to be in a physically active state if they are to function normally chronic inactivity is physiologically abnormal In evolutionary terms, inactivity elicits an abnormal phenotypic expression of our genes Evidence for this believe comes from observations that most chronic diseases are not as prevalent in society where physical work is a large part of daily life. F.Booth et al 2 5

6 Normal functioning of of animals genes is within an environment of physical activity; caging produces abnormal gene expression, which predisposes animals to modern chronic diseases. Strategies against Sedentary Death Syndrom Look at Physical Activity during all the day Increase Physical Activity during the daily life Physical Activity/Sport individual variable depending on situation must make fun life-time Sport during Leisure Time moment I ll do it goal N.Bachl METAANALYSIS Guidelines of Metaanalysis of Observational Studies in Epidemiology Group Review: Corresponding to Cochrane Collaboration Corresponding to Oxford Centre of Evidence Based Medicine relative risk Men relative risk Women 19 Studies 8 Physical Fitness Cohorts (PF) 62 Studies 4 Physical Activity Cohorts (PA) Activity-/Fitness-Quantile Activity-/Fitness-Quantile N=481468, since 1985 G.Samitz, 23 Comparison of the combined RRs for All Cause Mortality in men and women. G.Samitz, 23 6

7 STRATEGY AGAINST SDS Effectiveness +++ Physical Activity Sport Economicalness Life Quality PREVENTION REHABILITATION SAVINGS FROM PHYSICAL ACTIVITY: HEALTH CARE COSTS CAUSED BY PHYSICAL ACTIVITY: NET SAVING: AUSTRIA Mio EUR 31 Mio EUR 264 Mio EUR O.Weiss 2 TAKE HOME MESSAGE?! Physical activity decreases your risk of premature death! 7