Norbert Bachl MD Prof.
EFSMA President
FIMS EC-Member
Department Sports- and Exercise Physiology
University Vienna
Kraków – Teplice – Belgrade
September 2004
WHO: 70 % of all deaths are lifestyle
related in 2020
•
Physical Inactivity
•
•
•
Smoking
Alcohol
Nutrition, Overweight, Obesity
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.
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
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Colon cancer
Pancreatic cancer
Prostate cancer
Osteoporosis
Low Back pain
Stiff joints
Sarcopenia
Physical frailty
Less cognitive function
Depression
Sleep apnea
Lower quality of life
Premature mortality
F.W. Booth et al, 2002
Therefore, given these facts, F.W. Booth et al, 2002 coined the
phrase:
Our society is at war against a common enemy:
Sedentary Death Syndrome (SeDS)
MODERN CHRONIC DISEASE
CHRONIC HEALTH CONDITION
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.
This is a condition that is slow in its progress and
long in its continuance (Dorland´s, 1974).
Æ For the individual: reduced well-being, life quality
and mobility
Æ For the public: increased health care costs
F.W. Booth et al, 2002
1
2001: 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, 2001).
Thus, it is clear from multiple consensus statements that
sedentary lifestyle increases the risk of chronic health conditions.
F.W. Booth et al, 2002
Heart disease remains the number one
cause of death in a lot of countries.
F.W. Booth et al, 2002
Study on drivers of Londons double decker buses
Morris et al.
nach Morris et al. : Lancet , (2) 1053-1111, 1953
Post-mortem Study on 206 Institutes of Pathology in GB
Morris et al.
„The Harvard Study“ (1993)
Relative Mortality risk of CHD in relation to group „light“
Paffenbarger et al. :N.Engl.J.Med.(328), 538, 545, 1993
Data of all groups: A+B+C (n = 5000)
16936 Harvard-graduates
Duration: since 1962-1964 till today (current study till 1977)
1,0
Activity Score: Questionnaire: walking („city blocks“), stair
0,84
0,43
"light"
"activ"
“heavy"
climbing („flight of stairs“),
Sports activity: type of Sport, Volume, Intensity (5, 7.5, 10
kcal/min)
Job
nach Morris et al. : Brit. Med. J., (2) 1485-1496, 1958
2
„The Harvard Study“ (1993)
Paffenbarger et al. :N.Engl.J.Med.(Vol314,No.10), 605-613, 1993
1,0
Age
300
Period: 1962-1977
1,0
"Relative risk of all cause mortality"
200
(according to physical activity)
1
500 1,0
400
0,72
0,51
0,63
0,7
60-69
8
0,7
80
3
0,6
3
0,6
2
0,5
2
0,6
2
6
0,4
1,0
60
0,86
0,64
40
1,0
501-999
1000-1499
1500-1999
2000-2499
2500-2999
3000-3500
over 3500
kJ/week (kcal/week)
% Obese
ADIPOSITAS/OBESITY
16
14
12
10
0,79
35-49
<500
500-1,999
2,000 +
..
Waneen W.Spirduso, 1995Physical activity (kcal/week))
LIKE A NATURAL LAW?
Percentage of patients with overweight/obesity classified by
physicians in their offices
Men
Women
8
6
4
2
0
1980
50-59
0,97
20
under 500
70-84
0,53
100
1986
1991
1993
UK - A.R.Carmichael, 1998
Changes in adipose cellularity with weight
reduction in obese subjects. G.H. Stollerman, 1971
Survival Curves for All-Cause Mortality by BMI Categories
Survival Rate %
100
95
90
BMI Category kg/m2
18,5-24,9
25,0-29,9
> 30
85
80
2
4
6
8
10 12
14
16
18
20
Follow-up Years
Data are from 25714 men with 1025 all-cause deaths and 439 cardiovascular disease
deaths during 258781 man-years of observation. – Ming Wei et al, 1999
3
Distribution of Baseline Variables in 1982. According to Physical Activity
Level on a Cohort of US Male Physicians 40 to 84 Years of Age
Age-adjusted incidence rates of non-insulin-dependent diabetes mellitus
(NIDDM) according to frequency of vigorous exercise
(x2.trend (1 df) = 13.1, P=0,001)
E.Manson et al, 1992
Vigorous Exercise *
No.of
Mean (SD) Mean (SD) Body
Times/wk
Participants
Age, y
Mass Index
0
1
2-4
>5
5826
3931
8035
3479
53,7 (9,5)
52,5 (9,0)
52,6 (9,3)
53,3 (10,1)
25,3 (3,3)
25,2 (2,9)
24,8 (2,9)
24,2 (2,7)
Total
21271
53,1 (9,4)
24,9 (3,0)
Incidence of NIDDM,
per 100000 Person-Years
400
369
300
279
225
214
200
100
* Physical activity long enough to work up a sweat.
† Weight in kilograms divided by the square of height an meters.
0
<1
E.Manson et al, 1992
2-4
1
Frequency of Vigouros Exercise,
Times per Week
Cohort Studies
5
Case-control Studies
I.Thune et al, 2001
I.Thune et al, 2001
I.Thune et al, 2001
Gender differences in muscle strength at different decades
20
15
600
10
5
Grip strength (N)
Back extensor strength (N)
0
-5
-10
600
500
500
400
400
300
300
200
200
100
100
0
0
20-29 30-39 40-49 50-59 60-69 70-79 80-89
men
women
+16 %
Strength CSA
-16 %
+11 %
Strength CSA
-24 %
-15
-20
-25
-30
12 years of aging
12 weeks of training
20-29 30-39 40-49 50-59 60-69 70-79 80-89
men
women
Isokinetic device 60o/sec. Knee-Extension - W.Frontera, 2002
Sinaki M et al.: Am J Phys Med Rehab 80:5 (2001), 330-338
4
Depression Morbidity
ALAMEDA COUNTY STUDY
(CAMACHO / ROBERTS / LAZARUS et al. 1991)
Physical Activity
low
vigorous
RR
0,76
0,62
AMERICAN COLLEGE MEN
(PAFFENBARGER / LEE / LEUNG 1994)
Physical Activity
moderate
(1.000-2499)
kcal/week
vigorous
(> 2.500)
kcal/week
RR
0,83
0,72
W.Spirduso, 1995
All Cause Mortality and Physical Activity
45
40
35
30
25
20
15
10
5
0
Total Mortality (%)
Ranges of distance walked
miles/day
2,1-8,0 1,0-2,0
0,0-0,8
0
2
4
6
8
10
Year of Follow-up
12
14
Cumulative Mortality According to Year of Follow-up and
Distance Walked per Day. To Convert distances to kilometers,
multiply by 1.609. 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, 2002
¾ The modern human genome has a highly conserved
ability to adapt to extreme amounts of energy
expenditure
¾ Our genes expect the body to be in a physically
active state if they are to function normally
¾ chronic inactivity is physiologically abnormal
¾ In evolutionary terms, inactivity elicits an abnormal
phenotypic expression of our genes
¾ 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 2000
5
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.
Physical Activity/Sport
Strategies against
Sedentary Death Syndrom
• individual
• variable
• depending on situation
• must make fun
• life-time
• Look at Physical Activity during all the day
• Increase Physical Activity during the daily life
• Sport during Leisure Time
moment
goal
„I´ll do it“
© N.Bachl
METAANALYSIS
Corresponding to „Oxford Centre of Evidence Based
Medicine“
19 Studies
62 Studies
8 Physical Fitness – Cohorts (PF)
40 Physical Activity – Cohorts (PA)
Men
Activity-/Fitness-Quantile
relative risk
Review: Corresponding to Cochrane Collaboration
relative risk
Guidelines of „Metaanalysis of Observational Studies in
Epidemiology Group”
Women
Activity-/Fitness-Quantile
Comparison of the combined RRs for All Cause Mortality in men
and women.
N=481468, since 1985
G.Samitz, 2003
G.Samitz, 2003
6
STRATEGY AGAINST SDS
AUSTRIA 1998
Effectiveness
+++
Physical Activity
Sport
Economicalness
+++
PREVENTION
Life Quality
+++
REHABILITATION
SAVINGS FROM PHYSICAL ACTIVITY:
566 Mio EUR
HEALTH CARE COSTS CAUSED BY
PHYSICAL ACTIVITY:
301 Mio EUR
NET SAVING:
264 Mio EUR
O.Weiss 2000
„TAKE HOME MESSAGE ?!“
Physical activity decreases your risk of
premature death!
7