Transcript Exercise and Physical Activity in the Prevention and Treatment of

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