Fysisk aktivitet, FaR
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Fysisk aktivitet, FaR
120208Mats Börjesson.
professor, överläkare,GIH & Karolinska Univ Sjukhuset, Stockholm
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MONICA studien (1985) jmft INTERGENE (2002):
-medelvikt ökat 3.3 kg för kvinnor/5 kg för män
-Största ökningen av andelen överviktiga/feta bland 25-34 åringar
-2002: Övervikt: kvinnor: 38%; män:58%
Fetma: kvinnor:11%; män 15%
-BMI ökade mest hos män, bukfetma hos kv.
Ref: Berg C, Int J Obes 2005;29:916-24
Då Nu
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Ref: Prentice, Jebb BMJ, 1995
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Ref: Prentice & Jebb, BMJ 1995
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Fysisk inaktivitet VANLIGT!
• SoS anger 35% som otillräckligt fysiskt aktiva (jmfr sve/internat rekomm 30 min/d)
• Men….
-Östergötland (Leijon -99): 23% regelb aktiva
-Eurobarometer study (IPAQ): 23% tillräcklig FA
-KART-studien (VGR, n=2694 kv, n=400 män): 32% kategoriseras som ”moderate to vigorous PA” motsv Grimby/Saltin 3-4/4 (moderate PA such as doing aerobics, dancing, swimming, playing football or heavy gardening) at least two hours a week (group 3)
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Nyhetsverket - 23 jan 11 kl. 09:31
Ungdomar har allt sämre kondition
Ungdomars kondition blir allt sämre, visar en undersökning från Gymnastik- och idrottsidrottshögskolan i Stockholm. Enligt studien hade 16-åringar tio procent bättre kondition 1987 än 2007 när den nya mätningen gjordes. - Den som har dålig kondis har nästan fördubblad risk att dö i förtid som vuxen, säger forskaren Örjan Ekblom till DN. Han efterlyser en mer hälsoinriktad skolidrott.
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”Den moderna hyperlipidemin”
• bild
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Figur
Efter förlaga: Med Sci Sports Exerc 1998;30:899.
Ris
kfakt
or.
Relativ risk för hjärt-kärlsjukdom.
Fitness som prediktor för hjärtkärlsjukdom
BMI >27
Högt blodtryck
Högt kolesterol
Rökning
”Dålig kondition” (fysisk inaktivitet)
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Fysisk aktivitet el fitness?
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Inaktivitet predikterar mental ohälsa
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Nat rekomm fys aktivitet
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”The translation of health promotion research to practice
remains the big challenge” (Glasgow 2007)
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Sjukvården har unik roll
1 Reaches a large part of the population-65-70% meet a doctor in last year (Fin) (ittasalo 2008)
-US figures even higher (Cherry 2007)
2 Considered the most credible source of health info (Lobelo 2009)
3 Ethical obligation to ”act in the best interest of the patient”
i.e. activity counselling (Chakrawarty 2002)
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”If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health”
(Hippocrates 400 BC)
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FYSS
• Indication
• Mode of action
• Dosage (type of activity, intensity, frequency)
• Side-effects
• Contra-indications
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Internationellt…
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Efficacy of exercise referral (UK)
• Williams NH, systematic review, Br J Gen Pract 2007
• Williams NH, phys act intervention in primary care in Wales, BJSM 2009
Significant increase in the proportion of sedentary people becoming moderately active
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SBU-rapporten 2007
* General advice-increase PA 12-50% in 6m
* More intense counselling over months- more effect
* Advice with additional support (pedometers, written advice, follow-ups)-increase PA 15-50% in 6m
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Fysisk aktivitet på recept
*Counselling by the health care professional
*Resulting in an individualised prescription
*The extent of the intervention varies greatly
-who gives advice?
-written prescriptions?
-the PA prescribed
-use of additional supportIn Sweden, Australia, N Zealand, Finland etc
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FaR-initiativ i Sverige
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Ökar FaR den fysiska aktiviteten?Kallings LV, Sc J Med Sci Sports 2008
Total physical activity (frombaseline to 6-month follow-up)
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53%
12%
19%
16%Self-reportedadherence toPrescription:65% at 6 months
Figure 4.10. Adherence to prescribed physical activity on prescription (Paper II) after 6-month (n=240): 53% adhered fully ( ), 12% adhered but altered type of physical activity ( ), partial adherence ( ) was reported by 19%, and 16% reported total non-adherence ( ).
Compliance?(Kallings LV, J Phys Act Health 2009)
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RCT Eur J Cardiov Prev Rehab 2009: Kallings et al.Effekt av FaR på kardiovask riskfaktorer mm
Variable Intervention group (n=41) Control group (n=50) p-value§ Mean (SD) 95% CI Mean (SD) 95% CI Weight (kg) -1.8 (0.5) -2.8 to -0.8 -0.5 (0.3) -1.1 to 0.1 0.023 BMI (weight/height2) -0.6 (0.2) -0.9 to -0.3 -0.2 (0.1) -0. 4 to 0.0 0.023 Waist circumference (cm) -2.3 (0.6) -3.5 to -1.1 -1.4 (0.4) -2.2 to -0.6 0.20 SAD (cm) -1.5 (0.3) -2.1 to -0.9 -0.9 (0.3) -1.5 to -0.3 0.16 Neck circumference (cm) -1.2 (0.2) -1.6 to -0.8 -0.6 (0.2) -1.0 to -0.2 0.019 Body fat (%) -1.2 (0.4) -2.0 to -0.5 -0.5 (0.2) -1.0 to -0.0 0.09 Fat mass (kg) -1.7 (0.4) -2.5 to -0.9 -0.6 (0.3) -1.2 to -0.1 0.032 Fat free mass (kg) -0.2 (0.3) -0.8 to 0.4 0.2 (0.2) -0.3 to 0.7 0.29 Body fat in trunk (%) -1.2 (0.5) -2.1 to -0.3 -0.4 (0.3) -1.1 to 0.2 0.18 Fat mass in trunk (kg) -0.9 (0.3) -1.4 to -0.3 -0.3 (0.2) -0.7 to 0.1 0.11 Fat free mass in trunk (kg) -0.1 (0.2) -0.4 to 0.3 0.1 (0.2) -0.2 to 0.4 0.42 Systolic blood pressure (mmHg) 0.2 (2.2) -4.3 to 4.7 -4.1 (1.7) -7.5 to -0.6 0.12 Diastolic blood pressure (mmHg) -1.0 (1.3) -3.5 to 1.6 -1.7 (1.3) -4.4 to 0.9 0.68 Glucose (mmol/l) -0.2 (0.1) -0.3 to -0.1 -0.1 (0.1) -0.2 to -0.0 0.48 HbA1c (% of totHb) -0.1 (0.1) -0.2 to 0.0 0.2 (0.0) 0.1 to 0.3 0.001 Cholesterol (mmol/l) -0.3 (0.2) -0.6 to 0.0 0.1 (0.1) -0.1 to 0.1 0.042 Triglycerides (mmol/l) -0.2 (0.1) -0.3 to -0.0 -0.0 (0.1) -0.1 to 0.1 0.08 HDL (mmol/l) 0.0 (0-0) -0.1 to 0.1 -0.0 (0.0) -0.1 to 0.1 0.75 LDL (mmol/l) -0.1 (0.1) -0.2 to 0.1 0.1 (0.1) -0.1 to 0.3 0.13 LDL/HDL -0.1 (0.1) -0.2 to 0.1 0.1 (0.1) -0.0 to 0.2 0.07 ApoA1 (g/l) 0.01 (0.02) -0.04 to 0.05 0.01 (0.02) -0.04 to 0.06 0.89 ApoB (g/l) -0.11 (0.03) -0.18 to -0.05 -0.07 (0.02) -0.11 to -0.04 0.25 ApoB/ApoA1 -0.09 (0.03) -0.14 to -0.04 -0.06 (0.02) -0.09 to -0.03 0.31
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Long-term effects of FaR
*Does a physical activity referral scheme improve the physical activity among routine primary health care patients?
-12 month follow-up – YES!
(Leijon M, Scand J Med Sci Sports 2009)
*Thesis-project (Lars Rödjer, Sahlgrenska Akademin)
24 month effect of FaR on:- Physical activity level- Quality-of-life- Stages-of-change- Health economy
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SoS riktlinjer
Levnadsvana Kort rådgivning
Rådgivning Kvalificerad rådgivning
tillägg uppföljning
Rökning x
Riskbruk av alkohol
x
Otillräcklig fysisk aktivitet
x x
Ohälsosamma matvanor
x
25
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Initiativ regionalt
• Läkemedelskommitten i VGR: specifik terapigrupp för fysisk aktivitet:
-Org ansvar för FaR-REK-listan-Medicinska riktlinjer 2011-FaR på sjukhus
110
940
1767
5195
0
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4000
5000
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1
År 2004 År 2005 År 2006 År 2007