Potenzial körperlicher Aktivität in Prävention und Therapie chronischer Erkrankungen

Zusammenfassung

Systematische körperliche Aktivität stellt eines der potentesten „Medikamente“ für die Prävention und Behandlung chronischer Erkrankungen dar. Metaanalysen beobachtender Studien zeigen, dass die Inzidenz von Herz-Kreislauf-, Stoffwechsel-, Krebs- und psychischen Erkrankungen invers mit dem körperlichen Aktivitäts- oder Fitnessniveau assoziiert ist. Diese Beziehung konnte auch bei der allgemeinen Sterblichkeit als auch für spezifische Mortalität in Krankheitsbildern wie koronare Herzkrankheit, Herzinfarkt, Herzinsuffizienz, Diabetes mellitus, Brust-, Darm- und Prostatakrebs nachgewiesen werden. Darüber hinaus belegen viele klinische Studien die sehr große Bedeutung von körperlichem Training beim Management von krankheits- und therapiebedingten Nebenwirkungen. Die klinisch relevante Reduktion der arteriellen Hypertonie, der krebsbedingten Fatigue, von HbA_1c-Werten (HbA_1c: Glykohämoglobin), Schmerzen und des Sturzrisikos stellen nur eine Auswahl dar. Zudem führt ein körperliches Training zu einer verbesserten Stimmungslage und steigert die Lebensqualität.

Abstract

Structured physical activity is one of the most potent “drugs” in the prevention and treatment of chronic diseases. Meta-analyses of observational studies show that the incidence of cardiovascular as well as metabolic and cancer diseases is inversely associated to physical activity respectively fitness. This association could also be proven for general and disease-related mortality regarding coronary heart disease, cardiac infarction, heart insufficiency, diabetes mellitus as well as breast, colon and prostate cancer.

Moreover, many clinical trials show the importance of physical training with regard to the management of disease and therapy related side effects. Clinical relevant reduction of arterial hypertension, cancer-related fatigue, HbA_1c, pain and risk for falling are only a selection of beneficial impacts. Furthermore physical training leads to an improved mood and ameliorates the quality of life.

Schlüsselwörter

Bewegung - Training - Fitness - kardiovaskuläre Erkrankungen - Stoffwechselerkrankungen - Onkologie - psychiatrische Erkrankungen

Keywords

physical activity - exercise - fitness - cardiovascular diseases - metabolic diseases - oncology - psychiatric diseases

• Literatur

• 1 Ainsworth BE, Haskell WL, Herrmann SD et al. Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc 2011; 43: 1575-1581
• 2 Ainsworth BE, Haskell WL, Whitt MC et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000; 32: S498-504
• 3 Scharhag-Rosenberger F, Schommer K. Die Spiroergometrie in der Sportmedizin. Dtsch Z Sportmed 2013; 64: 362-366
• 4 Ratamess NA, Alvar BA, Evetoch TK et al. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc 2009; 41: 687-708
• 5 Gabrys L, Thiel C, Tallner A et al. Akzelerometrie zur Erfassung körperlicher Aktivität. Sportwissenschaft 2015; 45: 1-9
• 6 Woodcock J, Franco OH, Orsini N et al. Non-vigorous physical activity and all-cause mortality: systematic review and meta-analysis of cohort studies. Int J Epidemiol 2011; 40: 121-138
• 7 Samitz G, Egger M, Zwahlen M. Domains of physical activity and all-cause mortality: systematic review and dose-response meta-analysis of cohort studies. Int J Epidemiol 2011; 40: 1382-1400
• 8 US Department of Health and Human Services. Physical Activity Guidelines for Americans (2008). Im Internet: www.health.gov/paguidelines (Stand: 22.01.2015)
• 9 Graham I, Atar D, Borch-Johnsen K et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts). Eur Heart J 2007; 28: 2375-2414
• 10 Rütten A, Abu-Omar K, Lampert T et al. Körperliche Aktivität. Berlin: Robert Koch-Institut in Zusammenarbeit mit dem Statistischen Bundesamt; 2005
• 11 Laskowski ER. The role of exercise in the treatment of obesity. Pm R 2012; 4: 840-844; quiz 844
• 12 Lee IM, Djousse L, Sesso HD et al. Physical activity and weight gain prevention. JAMA 2010; 303: 1173-1179
• 13 Li J, Siegrist J. Physical activity and risk of cardiovascular disease – a meta-analysis of prospective cohort studies. Int J Environ Res Public Health 2012; 9: 391-407
• 14 Li J, Loerbroks A, Angerer P. Physical activity and risk of cardiovascular disease: what does the new epidemiological evidence show?. Curr Opin Cardiol 2013; 28: 575-583
• 15 Heran BS, Chen JM, Ebrahim S et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2011; CD001800
• 16 Haskell WL, Lee IM, Pate RR et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007; 39: 1423-1434
• 17 Shipe M. Exercising with Coronary Heart Disease. Amercian College of Sports Medicine; (19.01.2012). Im Internet: https://www.acsm.org/access-public-information/articles/2012/01/19/exercising-with-coronary-heart-disease (Stand: 18.01.2015)
• 18 Marsden DL, Dunn A, Callister R et al. Characteristics of exercise training interventions to improve cardiorespiratory fitness after stroke: a systematic review with meta-analysis. Neurorehabil Neural Repair 2013; 27: 775-788
• 19 Saunders DH, Greig CA, Mead GE. Physical activity and exercise after stroke: review of multiple meaningful benefits. Stroke 2014; 45: 3742-3747
• 20 Chen MD, Rimmer JH. Effects of exercise on quality of life in stroke survivors: a meta-analysis. Stroke 2011; 42: 832-837
• 21 Lawler PR, Filion KB, Eisenberg MJ. Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Am Heart J 2011; 162: 571-584 e572
• 22 Gordon NF, Gulanick M, Costa F et al. Physical activity and exercise recommendations for stroke survivors: an American Heart Association scientific statement from the Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention; the Council on Cardiovascular Nursing; the Council on Nutrition, Physical Activity, and Metabolism; and the Stroke Council. Circulation 2004; 109: 2031-2041
• 23 Borg G. Anstrengungsempfinden und körperliche Aktivität. Dtsch Arztebl 2004; 101: A1016-A1021
• 24 Taylor RS, Sagar VA, Davies EJ et al. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev 2014; 4 CD003331
• 25 Witham MD, Fulton RL, Greig CA et al. Efficacy and cost of an exercise program for functionally impaired older patients with heart failure: a randomized controlled trial. Circ Heart Fail 2012; 5: 209-216
• 26 Haykowsky MJ, Timmons MP, Kruger C et al. Meta-analysis of aerobic interval training on exercise capacity and systolic function in patients with heart failure and reduced ejection fractions. Am J Cardiol 2013; 111: 1466-1469
• 27 Ismail H, McFarlane JR, Nojoumian AH et al. Clinical outcomes and cardiovascular responses to different exercise training intensities in patients with heart failure: a systematic review and meta-analysis. JACC Heart failure 2013; 1: 514-522
• 28 Haas TL, Lloyd PG, Yang HT et al. Exercise training and peripheral arterial disease. Compr Physiol 2012; 2: 2933-3017
• 29 Li Y, Li Z, Chang G et al. Effect of structured home-based exercise on walking ability in patients with peripheral arterial disease: a meta-analysis. Ann Vasc Surg 2014;
• 30 Milani RV, Lavie CJ. The role of exercise training in peripheral arterial disease. Vasc Med 2007; 12: 351-358
• 31 Petrella RJ. How effective is exercise training for the treatment of hypertension?. Clin J Sport Med 1998; 8: 224-231
• 32 Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc 2013; 2: e004473
• 33 Pescatello LS, Franklin BA, Fagard R et al. American College of Sports Medicine position stand. Exercise and hypertension. Med Sci Sports Exerc 2004; 36: 533-553
• 34 American Diabetes A. Standards of medical care in diabetes – 2014. Diabetes Care 2014; 37 (Suppl. 01) S14-80
• 35 Ivy JL. Role of exercise training in the prevention and treatment of insulin resistance and non-insulin-dependent diabetes mellitus. Sports Med 1997; 24: 321-336
• 36 Kodama S, Tanaka S, Heianza Y et al. Association between physical activity and risk of all-cause mortality and cardiovascular disease in patients with diabetes: a meta-analysis. Diabetes Care 2013; 36: 471-479
• 37 Avery L, Flynn D, van Wersch A et al. Changing physical activity behavior in type 2 diabetes: a systematic review and meta-analysis of behavioral interventions. Diabetes Care 2012; 35: 2681-2689
• 38 Kennedy A, Nirantharakumar K, Chimen M et al. Does exercise improve glycaemic control in type 1 diabetes? A systematic review and meta-analysis. PLoS ONE 2013; 8: e58861
• 39 van der Heijden MM, van Dooren FE, Pop VJ et al. Effects of exercise training on quality of life, symptoms of depression, symptoms of anxiety and emotional well-being in type 2 diabetes mellitus: a systematic review. Diabetologia 2013; 56: 1210-1225
• 40 Umpierre D, Ribeiro PA, Schaan BD et al. Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis. Diabetologia 2013; 56: 242-251
• 41 Yang Z, Scott CA, Mao C et al. Resistance exercise versus aerobic exercise for type 2 diabetes: a systematic review and meta-analysis. Sports Med 2014; 44: 487-499
• 42 Courneya KS, Friedenreich CM. Physical Activity and Cancer. Heidelberg: Springer; 2011
• 43 Wolin KY, Yan Y, Colditz GA et al. Physical activity and colon cancer prevention: a meta-analysis. Br J Cancer 2009; 100: 611-616
• 44 Lynch BM, Neilson HK, Friedenreich CM. Physical activity and breast cancer prevention. Recent Results Cancer Res 2011; 186: 13-42
• 45 World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a global perspective. Washington DC: AICR; 2007
• 46 Zhong S, Jiang T, Ma T et al. Association between physical activity and mortality in breast cancer: a meta-analysis of cohort studies. Eur J Epidemiol 2014; 29: 391-404
• 47 Steindorf K, Scharhag-Rosenberger F, Schmidt ME et al. Supportive Sport- und Bewegungstherapie für onkologische Patienten. Onkologie heute 2014; 12: 41-46
• 48 Holmes MD, Chen WY, Feskanich D et al. Physical activity and survival after breast cancer diagnosis. JAMA 2005; 293: 2479-2486
• 49 Courneya KS, Segal RJ, McKenzie DC et al. Effects of exercise during adjuvant chemotherapy on breast cancer outcomes. Med Sci Sports Exerc 2014; 46: 1744-1751
• 50 Je Y, Jeon JY, Giovannucci EL et al. Association between physical activity and mortality in colorectal cancer: A meta-analysis of prospective cohort studies. Int J Cancer 2013;
• 51 Jeon J, Sato K, Niedzwiecki D et al. Impact of physical activity after cancer diagnosis on survival in patients with recurrent colon cancer: Findings from CALGB 89803/Alliance. Clin Colorectal Cancer 2013; 12: 233-238
• 52 Meyerhardt JA, Giovannucci EL, Holmes MD et al. Physical activity and survival after colorectal cancer diagnosis. J Clin Oncol 2006; 24: 3527-3534
• 53 Meyerhardt JA, Heseltine D, Niedzwiecki D et al. Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. J Clin Oncol 2006; 24: 3535-3541
• 54 Kenfield SA, Stampfer MJ, Giovannucci E et al. Physical activity and survival after prostate cancer diagnosis in the health professionals follow-up study. J Clin Oncol 2011; 29: 726-732
• 55 Mishra SI, Scherer RW, Snyder C et al. Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev 2012; 8 CD008465
• 56 Mishra SI, Scherer RW, Geigle PM et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev 2012; 8 CD007566
• 57 Jones LW, Alfano CM. Exercise-oncology research: past, present, and future. Acta Oncol 2013; 52: 195-215
• 58 Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 2012; 11 CD006145
• 59 Brown JC, Huedo-Medina TB, Pescatello LS et al. Efficacy of exercise interventions in modulating cancer-related fatigue among adult cancer survivors: a meta-analysis. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 2011; 20: 123-133
• 60 Schmitz KH, Courneya KS, Matthews C et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 2010; 42: 1409-1426
• 61 Winters-Stone KM, Dobek J, Nail L et al. Strength training stops bone loss and builds muscle in postmenopausal breast cancer survivors: a randomized, controlled trial. Breast Cancer Res Treat 2011; 127: 447-456
• 62 Streckmann F, Kneis S, Leifert JA et al. Exercise program improves therapy-related side-effects and quality of life in lymphoma patients undergoing therapy. Ann Oncol 2014; 25: 493-499
• 63 Wiskemann J, Hedrich C, Bannasch M. Krafttraining. In: Baumann FT, Bloch W, Jäger E, Hrsg. Körperliche Aktivität und Sport bei Krebs. Heidelberg, Berlin: Springer; 2012: 131-144
• 64 Heiwe S, Jacobson SH. Exercise training for adults with chronic kidney disease. Cochrane Database Syst Rev 2011; CD003236
• 65 Vogelmeier C, Buhl R, Criee CP et al. [Guidelines for the diagnosis and therapy of COPD issued by Deutsche Atemwegsliga and Deutsche Gesellschaft fur Pneumologie und Beatmungsmedizin]. Pneumologie 2007; 61: e1-40
• 66 Greulich T, Nell C, Koepke J et al. Benefits of whole body vibration training in patients hospitalised for COPD exacerbations – a randomized clinical trial. BMC Pulm Med 2014; 14: 60
• 67 Watz H, Pitta F, Rochester CL et al. An official European Respiratory Society statement on physical activity in COPD. Eur Respir J 2014; 44: 1521-1537
• 68 Garcia-Aymerich J, Lange P, Benet M et al. Regular physical activity modifies smoking-related lung function decline and reduces risk of chronic obstructive pulmonary disease: a population-based cohort study. Am J Respir Crit Care Med 2007; 175: 458-463
• 69 Rohrer V, Schmidt-Trucksass A. [Impact of exercise, sport and rehabilitation therapy in asthma and COPD]. Ther Umsch 2014; 71: 295-300
• 70 Gloeckl R, Heinzelmann I, Baeuerle S et al. Effects of whole body vibration in patients with chronic obstructive pulmonary disease – a randomized controlled trial. Respir Med 2012; 106: 75-83
• 71 Carson KV, Chandratilleke MG, Picot J et al. Physical training for asthma. Cochrane Database Syst Rev 2013; 9 CD001116
• 72 Eichenberger PA, Diener SN, Kofmehl R et al. Effects of exercise training on airway hyperreactivity in asthma: a systematic review and meta-analysis. Sports Med 2013; 43: 1157-1170
• 73 Heikkinen SA, Quansah R, Jaakkola JJ et al. Effects of regular exercise on adult asthma. Eur J Epidemiol 2012; 27: 397-407
• 74 Dowman L, Hill CJ, Holland AE. Pulmonary rehabilitation for interstitial lung disease. Cochrane Database Syst Rev 2014; 10 CD006322
• 75 Zschucke E, Gaudlitz K, Strohle A. Exercise and physical activity in mental disorders: clinical and experimental evidence. J Prev Med Public Health 2013; 46 (Suppl. 01) S12-21
• 76 Aarsland D, Sardahaee FS, Anderssen S et al. Is physical activity a potential preventive factor for vascular dementia? A systematic review. Aging Ment Health 2010; 14: 386-395
• 77 Ten Have M, de Graaf R, Monshouwer K. Physical exercise in adults and mental health status findings from the Netherlands mental health survey and incidence study (NEMESIS). J Psychosom Res 2011; 71: 342-348
• 78 Cooney GM, Dwan K, Greig CA et al. Exercise for depression. Cochrane Database Syst Rev 2013; 9 CD004366
• 79 Forbes D, Thiessen EJ, Blake CM et al. Exercise programs for people with dementia. Cochrane Database Syst Rev 2013; 12 CD006489
• 80 Vreugdenhil A, Cannell J, Davies A et al. A community-based exercise programme to improve functional ability in people with Alzheimer's disease: a randomized controlled trial. Scand J Caring Sci 2012; 26: 12-19
• 81 Wipfli BM, Rethorst CD, Landers DM. The anxiolytic effects of exercise: a meta-analysis of randomized trials and dose-response analysis. J Sport Exerc Psychol 2008; 30: 392-410
• 82 Knochel C, Oertel-Knochel V, OʼDwyer L et al. Cognitive and behavioural effects of physical exercise in psychiatric patients. Prog Neurobiol 2012; 96: 46-68
• 83 Ussher MH, Taylor A, Faulkner G. Exercise interventions for smoking cessation. Cochrane Database Syst Rev 2008; CD002295
• 84 Howe TE, Shea B, Dawson LJ et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev 2011; CD000333
• 85 El-Khoury F, Cassou B, Charles MA et al. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMJ 2013; 347: f6234
• 86 Martin Ginis KA, Jorgensen S, Stapleton J. Exercise and sport for persons with spinal cord injury. Pm R 2012; 4: 894-900
• 87 Hicks AL, Martin Ginis KA, Pelletier CA et al. The effects of exercise training on physical capacity, strength, body composition and functional performance among adults with spinal cord injury: a systematic review. Spinal cord 2011; 49: 1103-1127