從身體活動角度談代謝症候群的治療

台北醫學大學．雙和醫院 復健醫學部 劉燦宏

1995

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1995, 2005

(*BMI 30, or about 30 lbs overweight for 5’4” person)

2005

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Stumvoll M. et al. Lancet. 2005;365:333-346

2001

造成肥胖日益嚴重的原因

活動量降低肥胖基因飲食習慣

肥胖的併發症肥胖的併發症 憂鬱症

下背痛

退化性關節炎

痛風

睡眠呼吸中止腦中風

糖尿病 、脂肪肝

末梢血管病變

高血壓

心肌梗塞 黑色棘皮症

Treatment of Metabolic Syndrome

Treatment of Central Obesity

MRI 腹部縱剖面圖說明

臟器脂肪

皮下脂肪

體脂率

42.4％

MRI 腹部縱剖面圖說明

臟器脂肪

皮下脂肪

體脂率

27.5％

Obesity Is Caused by Long-Term Positive Energy Balance

Fatstores

Energyintake

Energyexpenditure

Treatment Pyramid

Surgery

Pharmacotherapy

Lifestyle Modification

Diet Physical Activity

Human Evolution

～五百萬年 ～五十年

Sedentary Behaviors and Metabolic Syndrome Bertrais et al. Obes Res 2005;13:936

Obesity 2007;15:2495-2503

-25

-20

-15

-10

-5

0

Effect of Decreasing Sedentary Activities vs Increasing Physical Activities on Body Weight in Children 6-12 Years Old

0Time (months)

Decreased Sedentary Activity

Cha

nge

in P

erce

nt O

verw

eigh

t

Increased Physical Activity

Epstein et al. Health Psychol 1995;14:109.

4 8 12

MetS Risk Factors (RF) Vs. METs

05

101520253035404550

體能差 體能中 體能好

No RF

1-2 RF

>=3RF

Rana et al. Int J Cardiol. 2006;110:224

Mean WBC Vs. METs & MetS Risk Factors

5.6

5.7

5.8

5.9

6

6.1

6.2

6.3

6.4

6.5W

BC

(x10

9 c

ell

s/L

)

體能差 體能中 體能好

METs

Rana et al. Int J Cardiol. 2006;110:224

5.2

5.4

5.6

5.8

6

6.2

6.4

6.6

6.8

7

WB

C (

x10

9 c

ell

s/L

)

No RF 1-2 RF >=3 RF

RF

Association of Muscular Strength with Incidence of Metabolic Syndrome in Men

00.10.20.30.40.50.60.70.80.9

1M

etS

OR

Q1 (low)

Q2 Q3 Q4

Jurca et al. Med Sci Sports Exerc 2005;37:1849

Public Health Nutr 2007;10:1194-9

Exercise Recommendations for Weight Loss

1. 減少慢性病發生的建議量 --每天至少 30分鐘的中等強度運動2. 減肥或維持體重的建議量 --每天 60分鐘的中等到激烈強度的運動3. 減肥後的體重維持或要繼續減肥 --每天 60 ～ 90分鐘的中等到激烈強度

的運動Saris WH et al. Obes Rev. 2003;4:101-114.

-16-14-12-10

-8-6-4-20

Considerable Physical Activity is Necessary for Weight Loss Maintenance

Jakicic et al. JAMA 1999;282:1554.

Cha

nge

in W

eigh

t (kg

)

Time (months)0 6 12 18

Weekly Biweekly Monthly

Concomitant Behavior Therapy

*P<0.05

<150 min/wk<150 min/wk

>150 min/wk>150 min/wk

>200 min/wk>200 min/wk

Definition

Physical activity, is any bodily movement produced by the contraction of skeletal muscles resulting in caloric expenditure, includes LTPA and OPA.

Exercise, is a sub-category of physical activity and is activity which is planned, structured and repetitive.

Metabolic Calculations

BMR=BM × 24 × 1.05 kcal/day (H-B equation or indirect measure maybe needed for specific individuals)

TEE = BMR × activity factor activity factor = 1.2 for sedentary activity factor = 1.4 for moderately active

Based on energy deficit of 1,000 kcal/day Diet control = TEE – 600 kcal/day Exercise prescription = 400 kcal/day or 2,800 kcal/wk

Losing Weight through Structured Exercise

Pre-test screen (PAR-Q) Chronic condition Build up gradually for sedentary individuals Cross train to reduce overuse injuries

Exercise prescription for weight loss Primary cardiovascular (aerobic) activities 200-300 min per week or >2000 kcal/wk 55-70% of maximal heart rate

Exercise Prescription

Wt bearing

High impact

Wt bearing

Low-impact

Non-wt bearing

Non-impact

Running (Brisk) walking Cycling

Step aerobics Low-impact aerobics

Rowing

Skipping Dance Swimming

Stair climbing Stair-master Water-based training

Kick boxing Arm-cranking

SafetyBurn energy

Exercise Prescription

What intensity? Too low

Takes too long to achieve energy expenditure target Inadequate stimulus for aerobic fitness

Too high Premature cessation of exercise

55-70% of HRmax

How frequent? At least 5 days/wk 7 days/wk for diabetics

0

20

40

60

80

100

Relationship Between Physical Activity and Maintenance of Weight Loss

Not Maintained

Sub

ject

s E

xerc

isin

g (%

)

P<0.001

Weight Loss PatternMaintained

Improving Long-term Adherence to Physical Activity (NWCR)

Short bouts Home exercise equipment Small incentives Pedometers Group and supporter

Behavioral Strategy in Weight Maintenance (NWCR)

Extended contact Clinical visit Phone call Internet Social support Problem solving and Relapse prevention

Monitoring the Calories

Energy expenditure table (manual/PDA/ websites)

Cardio machines (RFID) HR monitors 2D or 3D accelerometer Pedometers

Exercise Recommendations for Increase of Physical Activity

Assessment1) Medical and psychological readiness (PAR-Q)

2) Physical limitations (eg. knee OA, poor fitness etc.)

3) Current activities

4) Barriers to activity

Develop physical activity plan, LTPA or OPA Start activity slowly and gradually increase planned

aerobic activity to 300 min/wk Enhance compliance

Programmed vs lifestyle activity At-home vs onsite activity Multiple short bouts vs single long bout of activity

Thanks for Your Attention

台北醫學大學．雙和醫院 復健醫學部 劉燦宏