Fysisk aktivitet, FaR

120208Mats Börjesson.

professor, överläkare,GIH & Karolinska Univ Sjukhuset, Stockholm

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

Ref: Prentice, Jebb BMJ, 1995

Ref: Prentice & Jebb, BMJ 1995

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)

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.

”Den moderna hyperlipidemin”

• bild

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)

Fysisk aktivitet el fitness?

Inaktivitet predikterar mental ohälsa

Nat rekomm fys aktivitet

”The translation of health promotion research to practice

remains the big challenge” (Glasgow 2007)

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)

”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)

FYSS

• Indication

• Mode of action

• Dosage (type of activity, intensity, frequency)

• Side-effects

• Contra-indications

Internationellt…

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

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

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

FaR-initiativ i Sverige

Ökar FaR den fysiska aktiviteten?Kallings LV, Sc J Med Sci Sports 2008

Total physical activity (frombaseline to 6-month follow-up)

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)

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

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

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

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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3000

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År 2004 År 2005 År 2006 År 2007