New evidence for the positive relationship between sports, health and ageing

Transcription

1 1 10 januari 2011 New evidence for the positive relationship between sports, health and ageing Prof.dr. Marijke Hopman-Rock dr. Nico van Meeteren TNO, Leiden and BodyatWork research center TNO - VU university medical center, Amsterdam The Netherlands

2 Topics The effects of Physical Activity (PA) and Exercise in older persons: scientific evidence Physical INactivity HEPA guidelines and actual levels of PA Level of evidence for behavioural change strategies PA and exercise/sports motivation Discussion 2

3 APA Sydney 3 Chodzko-Zajko et al, 2009, MSSE Paper summarizes levels of evidence of PA and exercise 5 October 2009

4 Levels of evidence for PA and exercise on health Level of Evidence A,B,C A (overhelming from RCT s and observational studies) Positive effects on Health parameters Body weight (BMI) Body fat Blood pressure HDL/LDL cholesterol Glucose intolerance Sleep pattern Disability (review Tak et al) Muscle strength Disease Prevention (primary) CHD Diabetes mellitus II Osteoporosis Tertiary prevention CHD Diabetes mellitus II B (strong evidence) Cognitive decline Bone mass Sarcopenia Self esteem Stroke Depression Colon cancer Breast cancer Dementia COPD Osteoporosis (osteopenia) Stroke Anxiety, depression Reumatoïd arthritis Epilepsy Cystic fibrosis C (generally positive or suggestive evidence) Co-ordination Reaction time Quality of life (? C/D) Independent living Falls In hospital mortality (Dronkers et al) Osteoarthritis Kidney disease Low back pain Parkinson disease American College of Sports Medicine. Med Sci Sports Exerc 1998;30: Mosterd et al, 1996; Chodzko-Zajko et al, 2009

5 Citations from Chodzko-Zajko et al, 2009 Thus, age is considered a primary risk factor for the development and progression of most chronic degenerative disease states. However, regular physical activity substantially modifies these risks. The largest increment in mortality benefit is seen when comparing sedentary adults with those in the next highest physical activity level (pg 4) Multimodal exercise, usually including strength and balance exercises, and tai chi have been shown to be effective in reducing the risk of noninjurious and sometimes injurious falls in populations who are at an elevated risk of falling (pg 10) the outcome of treatment of some established diseases and geriatric syndromes is more effective with higher-intensity exercise (e.g., type 2 diabetes, clinical depression, osteopenia, sarcopenia, muscle weakness). (pg 13)

6 Prof. Archie Young (1986): Not only can exercise reverse the effects of immobilization, it can readily produce a further 10 to 20% improvement in strength and aerobic power, effectively postponing functionally important thresholds for some 10 to 20 years. Acta Med Scand Suppl. 1986; 711, Message: exercise and physical activity makes you feel younger! 6 The fountain of youth by Lucas Cranach de Oude

7 Special issue on Physical Inactivity (July 2012) 7

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10 Nelson et al, MSSE, 2007 Integration of preventive and therapeutic recommendations: aerobic + strength 30 minutes a day PA 10

11 Percentage of Dutch people meeting HEPA standards (30 minutes PA a day or sports > 3x pw) according to age group In Dutch nursing homes PA mean 5,3 minutes a day! (De Ligny et al, 2010) Source: Hildebrandt et al, 2013, TNO report

12 Biddle et al. position stand ECSS Ecss 2013

13 Effective strategies Best Practice Statement ACSM (Cress et al, 2004): Principles of behaviour change (in older persons): Social support Self-efficacy Active choices Health contracts Assurance of safety Positive reinforcement FUN!! Picture Katharine Devereux, Perth Australia UK National institute for health and clinical Excellence (NICE, Cavell et al, 2006, chapter older adults) a.o.: Exercise counselling and instruction 13

14 Systematic review on methods of promoting PA (Swedish Council, Advice and counselling of patients in everyday clinical practice increases physical activity by 12 50% for at least six months after the counselling session (strong scientific evidence, that means that it is supported by at least two studies with high study quality). 14

15 Why should we promote behavioural change in older persons? condition Example: Better in is Better out= Peri operative physiotherapy Critical zone 15 Event (fall, operation, etc) time Topp et al, 2002, Van der Sluis et al, 2007 Slide from dr. Nico van Meeteren APA ECSS Sydney October 2009

16 Dronkers PhD thesis (May 2013): Young Old Frail 1

17 Tak E, Kuiper R, Chorus A, Hopman-Rock M. Prevention of onset and progression of basic ADL disability by physical activity in community Erwin Tak et al dwelling Physical Activity & Disability older adults: a meta-analysis. Ageing Res Rev Jan;12(1): Physical activity and Disability: the evidence Risk of incident B-ADL disability Wu (1999) Van den Brink (2005) Stessman(2009) Ostbye(2002) Leveille(1999) Jenkins (1999) Ishizaki(2000) Haveman-Nies(2003) Avlund(2002) Summary Statistical heterogeneity No publication bias Age, FU-period and confounders did not significantly alter relationship Quality of study not linearly related to the association PA-disability Pooled OR medium/high vs. low Physical Activity: 0.51 (95% CI: ; p<.001)

18 Tak E, Kuiper R, Chorus A, Hopman-Rock M. Prevention of onset and progression of basic ADL disability by physical activity in community dwelling Erwin Tak older adults: a Physical Activity & Disability meta-analysis. Ageing Res Rev Jan;12(1): Results: Risk of progressive B-ADL disability Young (1995) Stessman(2002) Puts (2005) Miller (2000) No statistical heterogeneity significant publication bias No subgroup analysis Summary Pooled OR medium/high vs. low Physical Activity: 0.55 (95% CI: ; p<.001)

19 Competition Motivations for older persons to start exercise 6 Competition Cure and care MBvO HiB FysioSport Walking 2 Recreation Weight reduction Social contacts 1 Sports FysioSport Walking Health HiB 0 Self esteem Fitness Quality trainer -1 Advice GP MBvO Pleasure -2 Sports Health Advice GP Fitness Weight reduction Quality trainer Recreation Competition Self esteem Relaxation Relax and Enjoy Stiggelbout e.a., JAPA, Pleasure Relaxation Social contacts 19

20 Take Home messages / discussion Physical activity/ exercise is very important to prevent diseases and disability in older people Physical inactivity is a global burden Older people have relatively low levels of PA Advice + Counseling is effective Adjust to motivational groups INTROSPECTION: WHAT IS YOUR BARRIER TO PRESCRIBE OR ADVICE PHYSICAL ACTIVITY AND EXERCISE TO OLDER PEOPLE??? 20

21 Thanks for your attention! Prof. dr. Marijke Hopman-Rock