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Unformatted text preview: Content: Thirty-three chapters address the effects of and recommendations of physical activity in diseases and conditions within cardiovascular and metabolic medicine, psychiatry, orthopaedics, neurology, gastro-intestinal medicine, nephrology, rheumatology, pulmonary medicine and more. Also, fourteen general chapters deal with: • General effects of physical activity • General recommendations regarding physical activity • Promoting physical activity • Becoming physically active • Motivational interviewing about physical activity • Assessing and controlling physical activity • Various types of physical activity and exercise • Health aspects of strength training • Infections and sports • Sports and sudden death • Children and young people • Pregnancy • Menopause • Elderly The handbook is especially tailored to be a tool for licensed healthcare staff when prescribing physical activity and the method is currently used by all county councils in Sweden as well as Norway. The book is also useful for physical activity organisers working with physical activity on prescription and for educational institutions, such as colleges and universities that focus on health sciences and public health. Physical Activity in the Prevention and Treatment of Disease Physical activity in the prevention and treatment of disease summarizes the up-todate scientific knowledge on how to prevent and treat various diseases and conditions using physical activity. The book covers most areas of disease where physical activity has a documented effect. By combining recommendations on suitable exercise activities with a description of the potential risks of physical activity for various patient groups, this handbook can comprehensively be used by anyone working with physical activity and health. This book was prepared by Professional Associations for Physical Activity in cooperation with the Swedish National Institute of Public Health (SNIPH). Professional Associations for Physical Activity (see ) constitute an independent sub-association of the Swedish Society of Sports Medicine (Svensk Idrottsmedicinsk Förening – SIMF) which in turn is a section within the Swedish Society of Medicine. professional associations for physical activity (sweden) 2010 : 14 Swedish National Institute of Public Health Distribution SE-120 88 Stockholm Fax 08-449 88 11 [email protected] Rapport R 2010:14 ISSN 1651-8624 ISBN 978-91-7257-715-2 Physical Activity in the Prevention and Treatment of Disease Physical Activity in the Prevention and Treatment of Disease professional associations for physical activity (sweden) © professional associations for physical activity, sweden (yrkesföreningar för fysisk aktivitet, yfa), 2010 This is a translated and updated version of the second edition of the book in Swedish. swedish national institute of public health r 2010:14 issn: 1651-8624 isbn: 978-91-7257-715-2 editorial committee: professional associations for physical activity – carl johan sundberg, chair for sniph: anna jansson and carina edling – public health planning officers, mia wadman – production manager translation: semantix ab layout and graphic production: ab typoform cover photography: leif r jansson/scanpix printing: elanders, 2010 swedish title: fyss, fysisk aktivitet i sjukdomsprevention och sjukdomsbehandling all rights reserved. copying the contents of this book, in part or in whole, is prohibited under the copyright act without written consent from professional associations for physical activity, sweden (yrkesföreningar för fysisk aktivitet, yfa). this prohibition also applies to educational use and includes every type of copying through printing, copying, audible recording etc. Contents Preface_ ______________________________________________________________ 5 Background____________________________________________________________ 7 PART I________________________________________________________________ 9 1. General effects of physical activity_____________________________________ 11 2. General recommendations regarding physical activity_____________________ 41 3. Promoting physical activity___________________________________________ 50 4. Becoming physically active___________________________________________ 68 5. Motivational interviewing about physical activity_ ________________________ 83 6. Assessing and controlling physical activity_ _____________________________ 97 7. Various types of physical activity and exercise___________________________ 116 8. Health aspects of strength training_ __________________________________ 122 9. Infections and sports_______________________________________________ 134 10. Sports and sudden death_ __________________________________________ 150 11. Children and young people__________________________________________ 157 12. Pregnancy________________________________________________________ 176 13. Menopause ______________________________________________________ 185 14. Elderly___________________________________________________________ 200 PART II_ ____________________________________________________________ 209 15. Alcohol dependence/abuse__________________________________________ 211 16. Anxiety__________________________________________________________ 221 17. Asthma _________________________________________________________ 232 18. Back problems (chronic)____________________________________________ 242 19. Cancer_ _________________________________________________________ 256 20. Chronic obstructive pulmonary disease (COPD) ________________________ 271 21. Coronary artery disease_____________________________________________ 283 22. Cystic fibrosis_____________________________________________________ 300 23. Dementia________________________________________________________ 316 24. Depression_______________________________________________________ 325 25. Diabetes mellitus – type 1 diabetes_ __________________________________ 336 26. Diabetes mellitus – type 2 diabetes___________________________________ 345 27. Dizziness and balance disorders_ ____________________________________ 356 28. Gastrointestinal diseases ___________________________________________ 367 29. Heart failure______________________________________________________ 379 30. Heart rhythm disturbances__________________________________________ 397 31. Hypertension _ ___________________________________________________ 410 32. Kidney disease (chronic) and kidney transplant_ ________________________ 426 33. Lipids___________________________________________________________ 439 34. Metabolic syndrome_______________________________________________ 447 35. Multiple sclerosis_ ________________________________________________ 464 36. Obesity__________________________________________________________ 481 37. Osteoarthritis_____________________________________________________ 498 38. Osteoporosis _ ___________________________________________________ 510 39. Pain ____________________________________________________________ 523 40. Parkinson’s disease________________________________________________ 541 41. Peripheral arterial disease _ _________________________________________ 548 42. Post-polio________________________________________________________ 554 43. Rheumatoid arthritis_______________________________________________ 567 44. Schizophrenia_ ___________________________________________________ 579 45. Spinal cord injury__________________________________________________ 589 46. Stress___________________________________________________________ 602 47. Stroke___________________________________________________________ 611 Preface Östersund, November 2010 Physical activity has both health promoting and disease prevention properties. An increase in physical activity is one of the measures that would have the greatest positive impact on the health of the population. If everyone followed the recommendation of being physically active on a daily basis, the health of the population would improve considerably and healthcare costs would drop dramatically. Regular exercise has well-documented preventative and/or curative effects on a number of different diseases, such as diabetes, cardiovascular disease, colon cancer and depression. The burden of illness and disease related to physical inactivity costs society a great deal in terms of increased healthcare costs and production losses. The European Union Public Health Information System (EUPhix) estimates that physical inactivity might cost a country about EUR 150–300 per citizen and year, and the medical cost of physical inactivity in the US alone was estimated at USD 75 billion in 2000. According to the World Health Report 2000, physical inactivity was estimated to cause 1.9 million deaths worldwide every year. The healthcare system is in a strong position to work on increasing physical activity in the population. On one hand, people often come into contact with the healthcare system on a regular basis. On the other, people often trust their health and medical care providers in matters regarding their health. Healthcare providers also reach the groups in society that are the most sedentary, such as the elderly and the ill. One advantage of physical activity as a treatment compared to medication is that physical activity makes patients feel actively involved in their own treatment and encourages them to take personal responsibility for their own health. Physical activity on prescription (FaR®) is a method used in Swedish healthcare to increase physical activity in the population. With this method, the patient receives an individualized prescription for physical activity in a group or individual setting. Use of this method has grown in recent years and was applied by all county councils in Sweden in 2008. The English version of this text has been partly updated with additional beneficial correlations between physical activity and metabolic syndrome, stress, dementia, schizophrenia and other conditions. In some cases, physical activity can also replace pharmaceuticals and, in others, can reduce the need for medication. Prescribing physical activity should be just as natural as other proven treatments and methods. This text aims to provide the knowledge necessary to do so. We would like to express our gratitude to all of the authors for their excellent work. I would especially like to thank Professor Jon Karlsson and Associate Professor Carl J Sundberg and the other members of YFA – Yrkesföreningar för Fysisk Aktivitet (Professional Associations for Physical Activity) for the strong collaboration that made this publication possible. Sarah Wamala director-general swedish national institute of public health Background This first version in English is a translation based on the second edition of Physical Activity in the Prevention and Treatment of Disease (FYSS). The first edition of FYSS was published 2003, and a great deal has happened since then concerning the knowledge of physical activity in disease prevention and disease treatment. The first edition felt mostly like an inciter of interest in the area, but those of us who worked with the second Swedish and now the first English edition still feel that the area is just as current and exciting as then, while at the same time noting that the handbook is now perceived as an established concept in Swedish healthcare. The book includes no less than 47 chapters. A great deal has happened in the field over the past eight years, and new facts from several well-done studies have now completed the knowledge base. The objective of the book is to increase the knowledge of the value of promoting physical activity in the population. This can be done in a number of different ways and through different actors such as healthcare services, NGOs, municipalities and county councils. The book is intended to be a knowledge base, easily available and practical, for all who work with promoting physical activity, but also to function as a textbook for various educational programmes. As before, the project was run by Professional Associations for Physical Activity (Yrkesföreningar för Fysisk Aktivitet – YFA), which is an independent sub-association of the Swedish Society of Sports Medicine (Svensk Idrottsmedicinsk Förening – SIMF) which in turn is a section within the Swedish Society of Medicine. YFA comprises various professional categories, all of which have the objective of promoting physical activity in the prevention and treatment of disease. Since the work with the first Swedish edition, YFA has cooperated with the Swedish National Institute of Public Health (SNIPH), a cooperation that made the publication of this handbook possible. We would hereby like to express a huge debt of gratitude to the Swedish National Institute of Public Health and especially former Director General Gunnar Ågren and current Director General Sarah Wamala and their co-workers for their whole-hearted cooperation and support. To further deepen the knowledge in this book, we have chosen to cooperate with the Norwegian Directorate of Health and the National Council for Physical Activity in Norway. Accordingly, both Swedish and Norwegian authors have contributed to a broader knowledge base and more in-depth analysis of the evidence. We would like to direct a major thanks to all of the Norwegian co-authors and editors, especially Anita Andaas Aadland, Department of Physical Activity, Norwegian Directorate of Health, and Professor Roald Bahr, Norwegian School of Sports Sciences and National Council for Physical Activity, for a smooth and well-functioning cooperation. This cooperation has made it possible to publish a Norwegian edition of FYSS. Compiling a book of this extent has proven to be a gigantic project, which with the help of many, particularly the members of YFA’s Board, has now become a reality. Many thanks to YFA administrator Peter Lamming for his dedicated work. Finally, we would like to thank the Board of the Swedish Society for Sports Medicine for fruitful interaction and the society’s chancery officer Ann-Kristin Andersson for continuing support. It is our hope that FYSS will contribute to increased physical activity in patients and in society at large, and thereby contribute to improving the health of the entire population. The editorial committee, Stockholm, September 2010 mats börjesson mai-lis hellenius eva jansson jon karlsson, previous chair, yfa matti leijon agneta ståhle, deputy chair, yfa and editor of fyss 2008 (swedish edition) carl johan sundberg, chair, yfa jill taube background PART I 9 1. General effects of physical activity Authors Jan Henriksson, MD, PhD, Professor, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden Carl Johan Sundberg, MD, PhD, Associate Professor, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden Introduction All of the body’s tissues and our genetic material generally look like they did in our ancestors 10,000 years ago. The human body is built for movement. Body and mind benefit from physical activity. Most organs and tissues are affected by physical activity and adapt to regular exercise. Regular physical activity significantly reduces the risk of premature death. This chapter focuses on the immediate effects of physical exertion and the long-term effects of regular physical activity/fitness training (aerobic training). Physical activity refers to all bodily movement that results from the contraction of the skeletal muscles and results in increased energy expenditure (1). For greater detail and references, we refer to textbooks and overview articles in the exercise physiology literature (2–6) or the more focused references provided in each section. Aspects of strength training are discussed in a separate chapter. Physical activity can be carried out at different levels of intensity. The more intense, the greater the immediate impact on various bodily functions. Oxygen consumption, which is directly linked to energy expenditure, increases from 0.25 litres per minute at rest to slightly more than 1 litre per minute during a relaxed walk. During maximum exertion, it increases to 2–7 litres per minute, i.e. up to 10–25 times the resting rate. During physical exertion, the pulse rises and cardiac output increases. Ventilation multiplies, blood pressure increases, body temperature rises, perfusion in the heart and muscles increases, more lactic acid is formed and the secretion of hormones such as adrenaline, growth hormone and cortisol increases. Maximum oxygen uptake capacity depends on body size, gender, age, fitness level, genetics and more. The factors that limit performance capacity in full-body exertion differ depending on the length of the session. The durations stated in the following text shall only be viewed as approximate for an “average”, middle-aged person – major differences 12 physical activity in the prevention and treatment of disease exist. In maximal exertion that lasts 5–15 minutes, central circulation (the heart) is generally considered to comprise the most important limitation of the performance capacity (by limiting the maximum oxygen uptake capacity). The longer the exertion continues, the more performance capacity is limited by properties of the engaged skeletal muscles (mitochondria, capillaries, some transport molecules, buffer capacity, etc.), which affect the so-called anaerobic threshold (see below for definition). In terms of long-term endurance (more than 30–60 minutes), the muscles’ carbohydrate deposits (glycogen) also comprise a limitation. What determines the response to exercise training? Several factors determine how much a person improves if the degree of physical activity increases. One important factor is the fitness/performance level when the period of exercise training begins. A person who is inactive and in poor shape improves more in relative terms than a person who is well trained. The effects of exercise are specific to the organs and tissues that are exercised – only the muscles that are used adapt and only the parts of the skeleton that are loaded are strengthened. The length of the period of exercise training also plays a major role. Although some effects from exercise can be seen after a surprisingly short time of one to a few weeks, the effects are considerably greater if training continues for several months to years. Of course, the effect of exercise gradually “levels off” and eventually a considerable amount of training is required just to maintain the prevailing level of fitness. Three other important factors are frequency (how often the person exercises), duration (how long a session is) and intensity (how hard/intense the session is). These three factors determine the combined “exercise dose”. In other words, the higher the dose, the greater the effect. It should be pointed out that low doses also have an effect, although to a more limited extent. Frequency For physical activity to have the maximum performance and health effects, it must be pursued often and regularly. The effect that an exercise session has can affect the body for several days, and then subside. Consequently, for low-intensity physical activity, a daily “dose” is recommended. Duration As a rule, the longer the activity continues, the greater the effect it has. In many cases, the daily activity session can be divided up into several separate 10–15 minute periods, as long as the total time is sufficient. One common recommendation with regard to time is 30 minutes of physical activity per day. Intensity The harder an exercise session is, the greater its performance and health effects usually are, although excessively intense exercise can lead to deteriorations. Good health-related effects 1. general effects of physical activity 13 often seem to be achieved at a lower intensity, although a higher intensity is important to be able to improve fitness and to maintain an improvement in condition. Moreover, there are of course a...
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