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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
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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%
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Stumvoll M. et al. Lancet. 2005;365:333-346
2001
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造成肥胖日益嚴重的原因
活動量降低肥胖基因飲食習慣
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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
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Treatment of Metabolic Syndrome
Treatment of Central Obesity
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MRI 腹部縱剖面圖說明
臟器脂肪
皮下脂肪
體脂率
42.4%
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MRI 腹部縱剖面圖說明
臟器脂肪
皮下脂肪
體脂率
27.5%
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Obesity Is Caused by Long-Term Positive Energy Balance
Fatstores
Energyintake
Energyexpenditure
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Treatment Pyramid
Surgery
Pharmacotherapy
Lifestyle Modification
Diet Physical Activity
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Human Evolution
~五百萬年 ~五十年
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Sedentary Behaviors and Metabolic Syndrome Bertrais et al. Obes Res 2005;13:936
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Obesity 2007;15:2495-2503
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-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
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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
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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
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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
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Public Health Nutr 2007;10:1194-9
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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.
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-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
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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.
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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
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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
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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
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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
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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
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Improving Long-term Adherence to Physical Activity (NWCR)
Short bouts Home exercise equipment Small incentives Pedometers Group and supporter
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Behavioral Strategy in Weight Maintenance (NWCR)
Extended contact Clinical visit Phone call Internet Social support Problem solving and Relapse prevention
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Monitoring the Calories
Energy expenditure table (manual/PDA/ websites)
Cardio machines (RFID) HR monitors 2D or 3D accelerometer Pedometers
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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
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Thanks for Your Attention
台北醫學大學.雙和醫院 復健醫學部 劉燦宏