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

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

Stumvoll M. et al. Lancet. 2005;365:

造成肥胖日益嚴重的原因 活動量降低 肥胖基因 飲食習慣

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

Treatment of Metabolic Syndrome Treatment of Central Obesity

MRI 腹部縱剖面圖說明 臟器脂肪 皮下脂肪 體脂率 42.4 ％

MRI 腹部縱剖面圖說明 臟器脂肪 皮下脂肪 體脂率 27.5 ％

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

Treatment Pyramid Surgery Pharmacotherapy Lifestyle Modification DietPhysical Activity

Human Evolution ～五百萬年 ～五十年

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

Obesity 2007;15:

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

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

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

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

Public Health Nutr 2007;10:1194-9

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:

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

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.

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

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  min per week or >2000 kcal/wk  55-70% of maximal heart rate

Exercise Prescription Wt bearing High impact Wt bearing Low-impact Non-wt bearing Non-impact Running(Brisk) walkingCycling Step aerobicsLow-impact aerobics Rowing SkippingDanceSwimming Stair climbingStair-masterWater-based training Kick boxingArm-cranking Safety Burn energy

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 HR max How frequent?  At least 5 days/wk  7 days/wk for diabetics

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

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

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

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

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

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