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Exercise and Physical Activity in Prevention & Treatment of Civilization Diseases Dr. Rainer Wieching MSc & PhD in Exercise Physiology. Prevention Exercise Training provides lifelong prevention for the most important „Civilization Diseases“. - PowerPoint PPT Presentation
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Exercise and Physical Activity in Prevention & Treatment
of Civilization Diseases
Dr. Rainer Wieching MSc & PhD in Exercise Physiology
Background
• Prevention Exercise Training provides lifelong prevention for the most important „Civilization Diseases“
• Treatment Evidence Based Medicine proofs a Relative Risk Reduction even better than Drug Treatment
• DrugsDrugs are expensive togetherwith negative Adverse Events
• Exercise Exercise as Medicine (!) with many positive Side Effects
• Drugs -22%Relative Risk Reduction(CV Events) due to Statins…
Treating to New Targets (TNT) Investigators. Intensive Lipid Lowering with Atorvastatin in Patients with Stable Coronary Disease. N Engl J Med 2005; 352:1425-1435.
• Exercise -35%Relative Risk Reduction (CV Events) due to Exercise…
AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update. Circulation 2006;113;2363-2372.
Elevated triglycerides, Low HDL-C concentrations, High LDL-C concentrations,= independent risk factors for CAD
Dyslipidemia
Obesity
• Drugs -24%Relative Risk Reduction (CV Death) due to Rimonabant…
Rimonabant, for Management of Obesity.Circulation 2006;114;974-984.
• Exercise -22%Relative Risk Reduction(Death) due to Exercise…
Trends in 10-Year Predicted Risk of Cardiovascular Disease in the United States, 1976 to 2004. Circ Cardiovasc Qual Outcomes 2009;2;443-450.
• Elevated BMI and Waist Circumference,
• Independent Predictor of CAD disease,
• Increased Incidence of Metabolic Syndrome
Diabetes
• Drugs -36%Relative Risk Reduction(Mortality) due to Metformin…
UK Prospective Diabetes Study Group. (UKPDS 34). Lancet 1998;352:854-65.
• Exercise -58%Relative Risk Reduction(Incidence) due to Exercise…
Diabetes Prevention Program Research Group.N Engl J Med 2002;346:393–403.
Directly Associated with CAD,Severe End Organ Damages,Bad Prognosis & High Death Rates,Strongly Growing Incidence Worldwide.
Hypertension
• Drugs -66%Relative Risk Reduction(Incidence) due to Candesartan…
Trial of Preventing Hypertension (TROPHY) Study Investigators. N Engl J Med 2006; 354 (16) 1685-97.
• Exercise -50%Relative Risk Reduction(Incidence) due to Exercise…
Exercise and hypertension. Journal of Human Hypertension 2005; 19, 585–587.
Independent Risk Factor, of Coronary Artery Disease,Severe End Organ Damages, Globally Important Epidemic,Silent Disease (no pain).
CAD (incl. MI)
High Incidence in Western Countries,Angina, Myocardial Infarction,High Mortality Rates,Worldwide.
• Drugs -15%Relative Risk Reduction(Mortality) due to Eplerenone…
Eplerenone … in Patients with LV Dysfunction after Myocardial Infarction. N Engl J Med 2003; 348:1309-1321.
• Exercise -27%Relative Risk Reduction(Mortality) due to Exercise…
Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2001;(1):CD001800.
Heart Failure
Bad Prognosis,High Mortality Rates,High Hospitalizations Rates,Disease of the Elderly.
• Drugs -34%Relative Risk Reduction (Mortality) due to ConcorCOR…
CIBIS II Investigators and Comittees.Lancet 1999;353:9-13.
• Exercise -35%Relative Risk Reduction (Mortality) due to Exercise…
Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH).BMJ 2004;328: 189-92.
PAOD
Peripheral Claudication, Arterial Occlusive Disease, High Amputation Rates,Associated with CAD, Low Quality of Life.
• Drugs +30%Pain Free Walking Distance due to Pentoxiphylline…
A comparison of cilostazol and pentoxifylline for treating intermittent claudication.Am J Med. 2000 Nov;109(7):523-30.
• Exercise +179%Pain Free Walking Distance due to Exercise…
Exercise rehabilitation programs for the treatment of claudication pain: a meta-analysis. JAMA. 1995;274:975–980.
Breast Cancer
Very Serious Disease,High Mortality Rates,Psychological Involving, Genetic Predisposition, Bad Prognosis.
• Drugs -34%Relative Risk Reduction(OS) due to Herceptin…
The Herceptin Adjuvant (HERA) Trial. N Engl J Med 2005;353:1659-72.
• Exercise -40%Relative Risk Reduction(Death) due to Exercise…
Physical Activity and Survival after Breast Cancer Diagnosis. JAMA. 2005;293:2479-2486.
Colon Cancer
Very Serious Disease,High Mortality Rates,High Incidence, Bad Prognosis.
• Drugs -15%Relative Risk Reduction(PFS) due to Erbitux…
The CRYSTAL Trial. N Engl J Med 2009;360:1408-17.
• Exercise -50%Relative Risk Reduction(Death) due to Exercise…
Physical Activity and Survival after Colorectal Cancer Diagnosis. J Cli Onc 2006;24(22):3527-3534.
Lung Cancer
Very Serious Disease,High Mortality Rates,High Incidence, Bad Prognosis.
• Drugs -13%Relative Risk Reduction(OS) due to Erbitux…
The FLEX Trial. Lancet 2009;373:1525-31.
• Exercise -39%Relative Risk Reduction(Incidence) due to Exercise…
Physical Activity and Risk of Lung Cancer. Int J Epidemiol 1999;28:620-625.
Stroke (TIA)
Growing Incidence Worldwide, High Rates of Disabilities,High Mortality Rates,Families Involved.
• Drugs -30%Relative Risk Reduction (of Stroke) due to Antiplatelet Drugs…
Antithrombotic Trialists' Collaboration.BMJ 2002; 324: 71-86.
• Exercise -27%Relative Risk Reduction(of Stroke) due to Exercise…
Physical activity and stroke risk: a meta-analysis. Stroke. 2003;34(10):2475-81.
AlzheimerGrowing Incidence Worldwide,Families Seriously Involved,Bad Prognosis, Low Mortality.
• Drugs -24%Risk Reduction due to NSAID Treatment…
Protective effects of NSAIDs on the development of Alzheimer disease. Neurology 2008;70(19):1672–1677.
• Exercise -62%Risk Reduction (of Alzheimer‘s Disease) due to Exercise…
Physical activity and the risk of Alzheimer’s disease. Lancet Neurol 2005; 4: 705–11.
Depression
Strongly Growing IncidenceFamilies Seriously InvolvedVery High Mortality RatesSuicides & Death
• Drugs -33%Relative Risk Reductiondue to Trevilor…
Venlafaxine for Major Depression. BMJ 2007;334:215-6.
• Exercise -45%Prevalence of Symptoms Reduction due to Exercise…
Exercise … in the Treatment of Major Depressive Disorder. Psychosomatic Medicine 2007;69:587–596.
COPD
• Drugs -12%Relative Risk Reduction (Mortality) due to Drug Treatment…
Salmeterol and Fluticasone Propionate and Survival in COPD. N Engl J Med 2007;356:775-89.
• Exercise -55%Relative Risk Reduction(Mortality) due to Exercise…
Respiratory rehabilitation after … COPD … – a systematic review. Respiratory Research 2005, 6:54.
Stable IncidenceIntermediate Mortality RatesExercise Capacity Important Bad Prognosis
Summary
Conclusion
• Drugs
Serious Adverse Events
Very High Costs
=> Depression & Fatigue
• Exercise
Positive Side Effects
Low Costs
=> Active & Well Being…
