Fysisk aktivitet, FaR
120208
Mats Börjesson.
professor,
överläkare,
GIH & Karolinska
Univ Sjukhuset,
Stockholm
Då

Nu
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
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
Fitness som prediktor för
hjärtkärlsjukdom
Riskfaktor.
BMI >27
Högt blodtryck
Högt kolesterol
Rökning
”Dålig kondition”
(fysisk inaktivitet)
Relativ risk för hjärtkärlsjukdom.
Figur
Efter förlaga:
Med Sci
Sports Exerc
1998;30:899.
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 support
In 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)
% 100
75
50
25
51
34
23
6
58
19
10
22
0
Hardly any phys ic al Some phys ic al
acti vity
acti vity
Could be more
phys ic al ac ti ve
>=30 mi n/day
Compliance?
(Kallings LV, J Phys Act Health 2009)
Self-reported
adherence to
Prescription:
65% at 6 months
16%
19%
53%
12%
Figure 4.10. Adherence to prescribed physical activity on prescription (P aper 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 ( ).
RCT Eur J Cardiov Prev Rehab 2009: Kallings et al.
Effekt av FaR på kardiovask riskfaktorer mm
Variable
W eight (kg)
BMI (weight/height2)
W aist circumference (cm)
SAD (cm)
Neck circumfe rence (cm)
Body fat (%)
Fat mass (kg)
Fat fre e mass (kg)
Body fat in trunk(%)
Fat mass in trunk(kg)
Fat fre e mass in trunk(kg)
Systolic bloodpressure (mmHg)
Diastolic bloodpressure(mmHg)
Glucose (mmo l/l)
HbA1c (% of totHb)
Cholesterol (mmol/l)
Triglycerides (mmol/l)
HDL (mmo l/l)
LDL (mmo l/l)
LDL/HDL
ApoA1 (g/l)
ApoB (g/l)
ApoB/ApoA1
Intervention group (n=41)
Mean (SD)
95% CI
-1.8 (0.5)
-2.8 to -0.8
-0.6 (0.2)
-0.9 to -0.3
-2.3 (0.6)
-3.5 to -1.1
-1.5 (0.3)
-2.1 to -0.9
-1.2 (0.2)
-1.6 to -0.8
-1.2 (0.4)
-2.0 to -0.5
-1.7 (0.4)
-2.5 to -0.9
-0.2 (0.3)
-0.8 to 0.4
-1.2 (0.5)
-2.1 to -0.3
-0.9 (0.3)
-1.4 to -0.3
-0.1 (0.2)
-0.4 to 0.3
0.2 (2.2)
-4.3 to 4.7
-1.0 (1.3)
-3.5 to 1.6
-0.2 (0.1)
-0.3 to -0.1
-0.1 (0.1)
-0.2 to 0.0
-0.3 (0.2)
-0.6 to 0.0
-0.2 (0.1)
-0.3 to -0.0
0.0 (0-0)
-0.1 to 0.1
-0.1 (0.1)
-0.2 to 0.1
-0.1 (0.1)
-0.2 to 0.1
0.01 (0.02)
-0.04 to 0.05
-0.11 (0.03) -0.18 to-0.05
-0.09 (0.03) -0.14 to-0.04
Controlgroup (n=50)
Mean (SD)
95% CI
-0.5 (0.3)
-1.1 to 0.1
-0.2 (0.1)
-0. 4 to 0.0
-1.4 (0.4)
-2.2 to -0.6
-0.9 (0.3)
-1.5 to -0.3
-0.6 (0.2)
-1.0 to -0.2
-0.5 (0.2)
-1.0 to -0.0
-0.6 (0.3)
-1.2 to -0.1
0.2 (0.2)
-0.3 to 0.7
-0.4 (0.3)
-1.1 to 0.2
-0.3 (0.2)
-0.7 to 0.1
0.1 (0.2)
-0.2 to 0.4
-4.1 (1.7)
-7.5 to -0.6
-1.7 (1.3)
-4.4 to 0.9
-0.1 (0.1)
-0.2 to -0.0
0.2 (0.0)
0.1 to 0.3
0.1 (0.1)
-0.1 to 0.1
-0.0 (0.1)
-0.1 to 0.1
-0.0 (0.0)
-0.1 to 0.1
0.1 (0.1)
-0.1 to 0.3
0.1 (0.1)
-0.0 to 0.2
0.01 (0.02)
-0.04 to 0.06
-0.07 (0.02) -0.11 to-0.04
-0.06 (0.02) -0.09 to-0.03
p-value¤
0.023
0.023
0.20
0.16
0.019
0.09
0.032
0.29
0.18
0.11
0.42
0.12
0.68
0.48
0.001
0.042
0.08
0.75
0.13
0.07
0.89
0.25
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
tillägg
uppföljning
Rökning
Riskbruk av
alkohol
Otillräcklig
fysisk aktivitet
Ohälsosamma
matvanor
Kvalificerad
rådgivning
x
x
x
x
x
25
Initiativ regionalt
• Läkemedelskommitten i
VGR: specifik
terapigrupp för fysisk
aktivitet:
-Org ansvar för FaR
-REK-listan
-Medicinska riktlinjer
2011
-FaR på sjukhus
5195
6000
5000
4000
3000
1767
2000
1000
940
110
0
1
År 2004
År 2005
År 2006
År 2007