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LIPIDS (mg/dl) Total Cholesterol > 200 LDL-Cholesterol > 130 HDL-Cholesterol < 40 TG >150. NONLIPID RISK FACTORS Modifiable Non modifiable. CVD Risk Factors. A.T.P. III. Modifiable Risk Factors Hypertension Obesity Diabetes Thrombogenic/ Haemostatic State Cigarette Smoking - PowerPoint PPT Presentation
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CVD Risk Factors
LIPIDS (mg/dl) Total Cholesterol > 200 LDL-Cholesterol > 130 HDL-Cholesterol < 40 TG >150
NONLIPID RISK FACTORS
Modifiable Non modifiable
A.T.P. III
Non-lipid Risk Factors
Modifiable Risk Factors
Hypertension Obesity Diabetes Thrombogenic/
Haemostatic State Cigarette Smoking Physical InactivityPhysical Inactivity Atherogenic Diet
Non modifiable Risk Factors
Age Male Sex Family History of
Premature CHD
A.T.P. III
Life-style factorsLife-style factors
Reduction of CVD Risk Factors
Physical activity both prevents and helps treat many established atherosclerotic risk factors;- Low HDL-Cholesterol concentrations- Elevated Triglyceride concentrations -Insulin Resistance and Glucose Intolerance-Elevated Blood Pressure- Obesity
A meta-analysis of 52 exercise training trials of > 12 weeks’ duration including 4700 subjects demonstrated:
[HDL-C] 4.6% [TG] 3.7% [LDL-C] 5%
Physical Activity and Blood Lipids
Leon A.S. et al Circulation 2001
“Heritage” Study
Subjects: 200 men, age < 65 years, with sedentary attitudes
Training: 60 sessions of aerobic training, 21 weeks (1-4 sessions/week)
Exercise effect on blood lipids
Couillard, ATVB 2001
Physical Activity and Blood Pressure
• 44 randomized control trials (2674 particpants) have studied the effect of training exercise on resting blood pressure
Normoitensive subjects
Hypertensive Subjects
SBP 2,6 mmHg
SBP 7,4 mmHg
DBP 1,8 mmHg
DBP 5,8 mmHgExercise may serve as the only therapy in middle hypertensive subjects
Fagard RH. Med Sci Sports Exerc. 2001
•Sedentary patients should be advised to take up modest levels of aerobic exercise on a regular basis (walking, jogging or swimming for 30–45 min for 3-4 times/week) • Isometric exercise such as heavy weight-lifting can have a pressure effect and should be avoided. • If hypertension is poorly controlled in severe hypertension, heavy physical exercise should be discouraged or postponed until appropriate drug treatment is effective.
Physical Activity and Blood Pressure
EHS-ECS Guide-Lines for the management of Hypertension. J. Hypertens. 2003
Physical Activity and Obesity
•Increases Cardiorespiratoty Fitness indipendent of weight loss
(A)
•Indepentendly reduces CVD risk factors (A)
•Improves insuline action and reduces insulin resistance (A)
•Increased aerobic activity reduses blood pressure
independently of weight loss (A)
•If accompanied by weight loss affects favorably blood lipids (A)
NHI and ACSM Evidence Statements
G.A Bray, C. Bouchard. Hand Book of Obesity, 2004
Physical Activity and Endothelial function
Physical Activity may also (some hypothesis):1. Enhance endothelial function by increasing the production
of nitric oxide and prostacyclin2. Reduce LDL oxidation3. Decrease the atherogenic activity of Mononuclear Cells by
affecting the production of cytokines4. Decrease the number of atherosclerotic lesions by reducing
heart rate and pulsatile stress5. Decrease the accumulation of collagen in the artery wall
A. Cherubini et al. Aging Clin. Exp. Res. 1998
The Nurse’s Health Study (72.488 subjects) data have demonstrate that:
1. Physical Activity is associated with reduced Risk of Total and Ischemic Stroke in a dose-respond manner.
2. Physical Activity level had no significant relationship with Subaracnoid or Intracerebral Haemorrhage.
3. Similar energy expenditure from walking and vigorous exercise confer similar reduction in stroke risk.
Physical Activity and Stroke
Frank B. et al. JAMA. 2000
Physical Activity and Stroke
Relative risk of Stroke, according to usual walking pace (Nurse’s study)
0
0,2
0,4
0,6
0,8
1
1,2
Total strokes Ischemic strokes Hemorr. Strokes
Easy < 3,2 km/hModerate 3,2 - 4,8 km/hBrisk >4,8 km/h
Hu et al, JAMA 2000
Hu et al, Ann Int Med 2001
The age-adjusted RR of new cases of CVD, according toAverage hours of vigorous activity per week were:
<1 1-1.9 2-3.9 4-6.9 >7
1.00 0.93 0.82 0.54 0.52Phys. act, hrs/week
CVD, Rel. Risk:
Relative risk of cardiovascular events in diabetic women of the Nurse’s Study according to physical activity level
Physical Activity and CHD
Physical Activity and Claudicatio
Physical Activity is an effective treatment for improving walking distanceAccording to a meta-analysis of 21 exercise programs:
•average distance to pain onset increased 179% or 225m•average distance to maximal tolerated pain increased 122% or 397m
Exercise and Physical Activity in the Prevention and treatment of Atheroslerotic Cardiovascular Disease. AHA. Circulation 2003
• People > 65 years constitute a growing portion of word population population .• Age represents an independent, non modifiable CVD risk factor.• Age is no contraindication to being more active.• In elderly physical activity could prevent CVDprevent CVD and morbidity morbidity and disabilitydisability.• Aerobic activities with low impact in Aerobic activities with low impact in muscoskeletal system and jointsmuscoskeletal system and joints (brisk walking, swimming, cycling…)
Physical Activity in Elderly
Cherubini A. et al. Aging Clin Exp Res. 1998
Walking Compared with Vigorous Exercise for the Prevention of Cardiovascular Events in Women
JoAnn E. Manson N Engl J Med 2002
Aerobic exercise training reduces plasma endothelin-1 concentration in older women Seiji Maeda J Appl Physiol 2003
Prevalenza della sedentarietà in anziani americani
05
10152025303540
45-64 65-74 > 75
UominiDonne
%
BRFSS, 2001
CDC, 2001Età
Percentuale di soggetti non istituzionalizzati con regolare attivita` di resistenza 3 volte o piu` alla settimana, secondo dati
del NHIS
18-29 30-44 45-64 > 65
0
20
30% soggetti
attivi
Gruppi di eta`Caspersen et al., 1988
10
10% 8%5%
7.8%
Percentuale di soggetti ultra-sessantacinquenni che seguono le raccomandazioni
dell’ NHIS per l’attività fisica in relazione a diversecaratteristiche della popolazione (n=5537)
CDC, 2001
20,56,6
206,1
6,9
13,39,5
12,6
0 3 6 9 12 15 18 21 24
Sesso
percentuale
DonneUomini
BMI > 30< 25
SaluteScadente
EccellenteScolarità
ElementareUniversitaria
peso corporeo altezza grasso corporeo con ridistribuzione centrale dell‘adipe massa muscolare
Modificazioni della composizione corporea associateall` invecchiamento
Modificazioni della composizione corporea e della distribuzione del grasso corporeo
dopo esercizio di resistenza
%grasso corporeo totale e della massa grassa
WHR e del tessuto adiposo viscerale
valutato con TAC
FFM a livello della coscia
W. M. Kohrt et al.,1992
Modificazioni muscolari legate all`invecchiamento
forza muscolare massa muscolare totale numero e dimensione fibre tipo II unita` motorie processi neuropatici numero e dimensione mitocondri attivita` enzimi ossidativi
Fiatarone M. A. et al.,1993
Aging and sarcopenia Timothy J. Doherty J Appl Physiol 2003
Relazione tra livello di attività fisica e markers infiammatori The MacArthur Studies of Successfull Aging
TerzileSuperiore
IL-6*
TerzileSuperiore
PCR†
OR (95% IC)Livello di attività fisica
Alto livello attività fisicadi svago 0.65 (0.48-0.87) 0.70(0.51-0.95)
Alto livello di attività fisicain casa/giardino 0.90(0.67-1.20) 0.70(0.51-0.96)
Alto livello di attività fisicaDurante il lavoro 1.02(0.76-1.38) 0.99(0.68-1.30)
* dopo aggiustamento per BMI, scolarità, storia di cardiopatia ischemica
† dopo aggiustamento per BMI, scolarità, razza, fumo, storia di cardiopatia ischemica
Reuben DB, 2003
Adulto Sarcopenicosano
0
40
10
20
VO2 m
ax (m
l/Kg-
1 /min
-1)
80% of VO2 max: occurrence of dyspnea
Sarcopenicomalato
Camminareper qualche
isolato
Camminarein casa
Relazione tra modificazioni della VO2 max con l‘invecchiamento e stato funzionale
Roubenoff, 1999
Modificazioni della VO2 max legate all`età e all`attività fisica
Buskirk et al., 1987
20 40 60 80Eta´
VO2 max(ml/Kg-1/min -1)
interventodell`attività fisica
10
30
50
70
AttiviSedentari
Variazioni di peso e composizione corporea dopo 20 settimane di esercizio di resistenza
80
40
20
0
60
PESO %FATFATMASS
FFM
*
**
*
*P<0.05
pre - training post - training
J. H. Wilmore et al., 1999
Kg80
40
20
0
60
%
Variazioni del tessuto adiposo e della sua distribuzione dopo 20 settimane
di esercizio di resistenza
J. H. Wilmore et al., 1999
sottocutaneo
300
200
0
100
cm2 *
*
*
50
1
100
cm
Circ.fianchi
Circ.vita WHR
**
*
visceraleGrasso addominale
totale
*P<0.05
pre - training post - training
Esercizio di resistenza e dispendio energetico basale
8 maschi 4 femmine56-80 anniBMI 26+0.6
12 settimane di esercizio di resistenza
MASSA MAGRA MASSA GRASSA RMR (6.8%)
DOPO PAREGGIAMENTO PER FFM = RMR
W. W. Campbell et al., 1994
Can physical activity attenuate aging-related weight loss in older people? The Yale Health and Aging Study, 1982-1994.
Dziura, Am J Epidemiol 2004
Modificazioni della forza muscolare dopo esercizio di potenza
Exercise Pre-training Post-training
Knee flexion 0.22 + 0.02 0.40 + 0.04*
Right knee extension 0.27 + 0.03 0.42 + 0.03*
Left knee extension 0.26 + 0.03 0.41 + 0.03*
Campbell et al., 1994
*p<0.001
kg/kg FFM
Relazione tra intensita` dell`esercizio e risposta fisiologica nell`anziano
Variazioniforzaquadricipite(%)
175
100
50
0
150
Low Moderate HighTraining intensity
M. A. Fiatarone et al., 1993 (mod)
Aniasson, 1981 Uomini sani(69-74 anni)
No modificazioni area Trasversale muscolare Forza muscolare
Pratley, 1994 4-mesiAltaintensità
FFM, FM 40% forza muscolare
Frontera, 1988 11% area trasversalemetà coscia Forza muscolare
Effetti dell’esercizio su forza muscolare e composizione corporea
3-mesiBassaintensità
Pyka, 1994 Uomini sani(68 anni)
area trasversalefibre muscolari forza muscolare
Fiatarone, 1990
6-mesiAltaintensità
Uomini sani(50-65 anni)
7 mesiAltaintesità
Uomini e donne fragiliistituzionalizzati
2 mesiAltaintensità
2.7% area trasversale metà coscia 113% forza muscolare
Uomini sani(64 anni)
Fiatarone, 1994 (età media 90 anni) 9% area trasversale metà coscia 174% forza muscolare
(72-98 anni)
Mod from Bross, 1999
Probabilità di morire in età avanzata, senza disabilità nell’anno antecedente la morte in relazione al livello di attività fisica
EPESE Study
UominiLow exerciseMedium exerciseHigh exercise
DonneLow exerciseMedium exerciseHigh exercise
% di 65 ennisopravvissutifino a 80 anni(uomini) o 85anni (donne)
% di anzianideceduti in età
avanzatasenza disabilità
% of 65 ennisopravvissutifino a 80 e 85
anni senzadisabilità
344863
475770
434558
223441
152237
101929
Leveille et al. Am J Epidemiol 1999;149:654-664.
0
10
20
30
40
50
60
% d
isab
ility
1st 2nd 3rd
BMI < 25 (n=22)
BMI >= 25 (n=63)
tertiles of physical exercise
(min/week)
(0-420) (421-728) (729-2300)
a
b
Di Francesco, Aging in press
Leisure time physical activity obesity and disability in the Elderly
Bull World Health Organ vol.81 no.11 Genebra Nov. 2003POLICY AND PRATICE
Exercise interventions: defusing the world's osteoporosis time bombKai Ming ChanI, 1; Mary AndersonII; Edith M.C. LauIII
... Walking, aerobic exercise, and t'ai chi are the best forms of exercise to stimulate bone formation and strengthen the muscles that help support bones.
... Encouraging physical activity at all ages is therefore a top priority to prevent osteoporosis
It is clear that exercise late in life, even beyond 90 years It is clear that exercise late in life, even beyond 90 years of age, can increase muscle mass and strength twofold or of age, can increase muscle mass and strength twofold or more in frail individualsmore in frail individuals
...there is convincing evidence that exercise in elderly ...there is convincing evidence that exercise in elderly persons also improves function and delays loss of persons also improves function and delays loss of independence and thus contributes to quality of life...independence and thus contributes to quality of life...
... randomized clinical trials of exercise have been shown ... randomized clinical trials of exercise have been shown to reduce the risk of falls by approximately 25 percentto reduce the risk of falls by approximately 25 percent
Fitness cardio-vascolare Performance cardiaca Picco di riempimento diastolico Contrattilità cardiaca Contrazioni ventricolari premature Capacità aerobicaPA sistolica e diastolicaMiglioramento profilo lipidico ematicoMiglioramento resistenza Benefici legati
all’attività fisica
PesoCorporeo
Tessuto adiposo viscerale Grasso corporeo percentuale Massa muscolare
Osteoporosi declino densità ossea densità ossea
Diabete tipo 2
Tolleranza glucidica HDL LDL e VLDL Trigliceridi
Benesserepsico-fisico
livelli catecolamine, norepinefrina e serotonina Depressione
SistemaMuscolo-
scheletrico Forza, flessibilità Disabilità muscoloscheletrica Rischio cadute Rischio fratture Tempi di reazione
National Blueprint, 2001The RobertWood Johnson Foundation