1 / 34

從身體活動角度 談代謝症候群的治療

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. Obesity Trends* Among U.S. Adults BRFSS, 1990, 1995, 2005. (*BMI  30, or about 30 lbs overweight for 5’4” person). 1995. 1990. 2005. No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%.

aolani
Download Presentation

從身體活動角度 談代謝症候群的治療

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 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

  2. Obesity Trends* Among U.S. AdultsBRFSS,1990, 1995, 2005 (*BMI 30, or about 30 lbs overweight for 5’4” person) 1995 1990 2005 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

  3. 2001 Stumvoll M. et al. Lancet. 2005;365:333-346

  4. 造成肥胖日益嚴重的原因 • 活動量降低 • 肥胖基因 • 飲食習慣

  5. 黑色棘皮症 憂鬱症 腦中風 睡眠呼吸中止 心肌梗塞 高血壓 下背痛 糖尿病 、脂肪肝 退化性關節炎 末梢血管病變 痛風 肥胖的併發症

  6. Treatment of Metabolic SyndromeTreatment of Central Obesity

  7. MRI 腹部縱剖面圖說明 體脂率 42.4％ 臟器脂肪 皮下脂肪

  8. MRI 腹部縱剖面圖說明 體脂率 27.5％ 臟器脂肪 皮下脂肪

  9. Fat stores Obesity Is Caused by Long-Term Positive Energy Balance Energy expenditure Energy intake

  10. Treatment Pyramid Surgery Pharmacotherapy Lifestyle Modification Diet Physical Activity

  11. ～五百萬年 ～五十年 Human Evolution

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

  13. Obesity 2007;15:2495-2503

  14. Effect of Decreasing Sedentary Activities vs Increasing Physical Activities on Body Weight in Children 6-12 Years Old Increased Physical Activity Change in Percent Overweight Decreased Sedentary Activity 0 4 8 12 Time (months) Epstein et al. Health Psychol 1995;14:109.

  15. MetS Risk Factors (RF) Vs. METs Rana et al. Int J Cardiol. 2006;110:224

  16. Mean WBC Vs. METs & MetS Risk Factors Rana et al. Int J Cardiol. 2006;110:224

  17. Association of Muscular Strength with Incidence of Metabolic Syndrome in Men • Jurca et al. Med Sci Sports Exerc 2005;37:1849

  18. Public Health Nutr 2007;10:1194-9

  19. 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.

  20. Considerable Physical Activity is Necessary for Weight Loss Maintenance Concomitant Behavior Therapy Weekly Biweekly Monthly <150 min/wk Change in Weight (kg) >150 min/wk *P<0.05 >200 min/wk 0 6 12 18 Time (months) Jakicic et al. JAMA 1999;282:1554.

  21. 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.

  22. 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

  23. 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

  24. Exercise Prescription Safety Burn energy

  25. 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

  26. Relationship Between Physical Activity and Maintenance of Weight Loss P<0.001 Subjects Exercising (%) Not Maintained Maintained Weight Loss Pattern

  27. Improving Long-term Adherence to Physical Activity (NWCR) • Short bouts • Home exercise equipment • Small incentives • Pedometers • Group and supporter

  28. Behavioral Strategy in Weight Maintenance (NWCR) • Extended contact • Clinical visit • Phone call • Internet • Social support • Problem solving and Relapse prevention

  29. Monitoring the Calories • Energy expenditure table (manual/PDA/ websites) • Cardio machines (RFID) • HR monitors • 2D or 3D accelerometer • Pedometers

  30. Exercise Recommendations for Increase of Physical Activity • Assessment 1) 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

  31. Thanks for Your Attention 台北醫學大學．雙和醫院 復健醫學部 劉燦宏

More Related