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La Actividad Física para las Enfermedades Crónico Degenerativas

Conferencia dictada en el Municipio de Allende, Nuevo León, para sensibilizar sobre estrategias contra el sedentarismo.
by

Jair García-Guerrero

on 19 July 2013

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Transcript of La Actividad Física para las Enfermedades Crónico Degenerativas

Beneficios de la Actividad Física
Actividad Física y las Enfermedades Crónicodegenerativas
1. El origen de las ECD
Conceptos Básicos
Actividad física, ejercicio y deporte
Dr. Jair García-Guerrero
Sedentarismo
Abordaje terapéutico
Actividad física:
Es cualquier movimiento del cuerpo. Incluye actividades de la rutina diaria, como las tareas del hogar, ir a la compra, trabajar.
Ejercicio:
Movimientos planificados y diseñados específicamente para estar en forma y gozar de buena salud.
Deporte:
Actividad física ejercida bajo reglamentación y competición.
Sedentario:
Actividad en estado de vigilia caracterizada por gasto de energía <= 1.5MET´s* sentado o en posición reclinado. (Sedentary Behaviour Research Network)

*MET: (Unidad Metabólica) Unidad de medida del nivel del metabolismo por calorimetría, que refleja un consumo de oxígeno. El MET normal oscila entre 2.5 a 4.0 ml/kg/min.
2. Beneficios del Ejercicio
1. El origen de las ECD
Sedentarismo
Sobrepeso y Obesidad
Bajo gasto calórico
Medio Ambiente Sedentario
+
Alta ingesta calórica
Dieta T
Alimentos adquiridos
Promoción de alimentos con alto índice calórico
Enfermedades Crónico Degenerativas
Television Viewing and Long-Term Weight Maintenance: Results from the National Weight Control Registry.
Raynor, D. A., Phelan, S., Hill, J. O. and Wing, R. R. Obesity 2006, 14: 1816–1824.
N=1422

36.1% of participants reported watching <5 hours of TV per week
62.3% of participants reported watching 10 or fewer hours of TV per week
12.4% of participants reported watched > or =21 hours of TV per week

National average of 28 hours of TV viewing per week reported by American adults.
Ambos indicadores:
horas de TV “de base”
(p < 0.02) y el
incremento en las horas de TV
(p < 0.001)
en comparación con el grupo control, fueron estadísticamente significativos en la predisposición de aumento de peso a un año,
independientemente de que la persona haga o no ejercicio o de hábitos alimenticios
.
Too Little Exercise and Too Much Sitting: Inactivity Physiology and the Need for New Recommendations on Sedentary Behavior
Marc T. Hamilton, PhD, Genevieve N. Healy, PhD, [...], and Neville Owen, PhD
Curr Cardiovasc Risk Rep. 2008 July; 2(4): 292–298.
Factors associated with physical inactivity in adolescents in Ho Chi Minh City, Vietnam.

Trang NH, Hong TK, Dibley MJ, Sibbritt DW.
Med Sci Sports Exerc. 2009 Jul;41(7):1374-83.
Physical inactivity
was positively associated with:
- child's overweight status,
- passive transportation,
- not having recess exercises,
- availability of a nearby game shop,
- more time spent playing video games, watching television, and studying after class.
The following factors
decreased the odds of inactivity
:
- schools having one to two sport meetings per year,
- availability of a play yard,
- older age group, and
- male gender.
In
boys
:
- transportation,
- availability of game shop near by,
- family's economic status,
- parental body mass index status, and
- time spent watching television
were
strongly associated with physical inactivity.
In
girls
, time spent for study after class was one of the most important factors related to students' physical inactivity.
(No Transmisibles)
Alfabetización alimentaria
Agua potable
Dieta
Disponibilidad de alimentos
Acceso a los alimentos
Conocimiento de alimentos
Opciones personales
Prácticas familiares
Necesidades y gustos
Apoyo a Agricultura
Planeación y transporte
Precio de alimentos y comercio
Empleo
Seguridad Social
Regulación
Educación
Medios masivos de comunicación
POLÍTICAS PÚBLICAS
Modificado de:

Branca F, et al. WHO: The challenge of obesity in the WHO European Region and strategies for response. WHO, 2007.
Diabetes
HAS
Cáncer
Dislipidemias
EVC
AIT
Pie diabético
Nefropatía diabética
Retinopatía diabética
IAM
Paresias y Plejías
Fracturas patológicas
Osteoporosis
Artrosis
Intervenciones contra la inactividad
Subir escaleras
Estacionar el coche lejos
Caminar a dar un mensaje
Pararse en su lugar de trabajo
"Pausa por tu salud"
Beneficios para la Presión Arterial
Disminución de la resistencia arterial periférica
Disminución de la fracción de eyección
Cambios nerviosos y vasculares
2. Beneficios del Ejercicio
SNC
RCV
SME
DM
Sistema Inmune
Hematopoyético
"Orgánicos"
"Inorgánicos"
(Psicológicos)
Semantic Memory Functional MRI and Cognitive Function after Exercise Intervention in Mild Cognitive Impairment.
J Alzheimers Dis. 2013 Jun 26. [Epub ahead of print]
Smith JC, Nielson KA, Antuono P, Lyons JA, Hanson RJ, Butts AM, Hantke NC, Verber MD.
Both MCI and control participants significantly
increased their cardiorespiratory fitness
by approximately 10% on a treadmill exercise test.

Before and after the exercise intervention, participants completed an fMRI famous name discrimination task and a neuropsychological battery.

Performance on Trial 1 of a list-learning task significantly improved in the MCI participants.

11 brain regions
activated during the semantic memory task showed a significant decrease in activation intensity following the intervention that was similar between groups (p-values ranged 0.048 to 0.0001).

These findings suggest
exercise may improve neural efficiency
during semantic memory retrieval in MCI and cognitively intact older adults, and may lead to improvement in cognitive function.
Propósito:
Examinar the effects of exercise training on semantic memory activation during functional magnetic resonance imaging (fMRI).
N= 17 con "MCI", 18 controles sanos
12 week exercise: walking supervised
Low- and High-Volume of Intensive Endurance Training Significantly Improves Maximal Oxygen Uptake after 10-Weeks of Training in Healthy Men
Arnt Erik Tjønna,1,* Ingeborg Megaard Leinan,2 Anette Thoresen Bartnes,2 Bjørn M. Jenssen,2 Martin J. Gibala,3 Richard A. Winett,4 and Ulrik Wisløff1.
PLoS One. 2013; 8(5): e65382. Published online 2013 May 29.
N= 26
Twenty-six inactive but otherwise healthy overweight men (BMI: 25–30, age: 35–45 y) were randomized to either 1-AIT (n=11) or 4-AIT (n=13).
Our data suggest that
a single bout of AIT
performed
three times per week
may be a
time-efficient strategy
to improve VO2max and reduce blood pressure and fasting glucose in previously inactive but otherwise healthy middle-aged individuals.
One group followed a protocol which consisted of
4x4 min
at 90% of maximal heart rate (HRmax) interspersed with
3 min
active recovery at 70% HRmax (4-AIT), the other group performed a single bout protocol that consisted of
1x4 min
at 90% HRmax (1-AIT).
In the present study, we measured changes in VO2max and traditional cardiovascular risk factors after a 10 wk. training protocol that involved three weekly high-intensity interval sessions.
After training, VO2max increased by 10% (~5.0 mLkg−1min−1) and 13% (~6.5 mLkg−1min−1) after 1-AIT and 4-AIT, respectively (group difference, p=0.08).
Body fat, total cholesterol, LDL-cholesterol, and ox-LDL cholesterol only were significantly reduced after 4-AIT.
El sedentarismo
Modulación de la fibrinólisis.
Reducción de niveles plasmáticos de fibrinógeno.
Aumento del activador del plasminógeno tisular.
Agregación plaquetaria disminuida (aumentada en sedentarios):
- Liberación de ON
- Regulación del tono arterial
Expansión del plasma a largo plazo
Reducción de la rigidez eritrocitaria
Reducción en la viscosidad
Reducción en:
- Fibrinógeno, Factor VIIIC, Factor Von Willebrand, Factor VIIC
- Trombina
- AT III
Prolonga:
- TTP
El ejercicio mejora la entrega de oxígeno al miocardio con una reducción del tono simpático.
La disminución de las catecolaminas reduce el riesgo de FA, FARV o FV.
En HAS “moderadamente controlada”, la AF de mediana intensidad por al menos 30 minutos reduce la TA por 8 a 12 hrs. post ejercicio.
El ejercicio reduce la:
- presión sistólica 10.5 mmHg y la
- presión diastólica 7.5 mmHg
- La AF mejora la sensibilidad y afinidad a la insulina a nivel del músculo;
- Los miocitos usan más glucosa que los adipocitos;
- El ejercicio intenso de corta duración incrementa el glucógeno muscular;
- DM1: menos lesiones macrovasculares, menos nefropatía y neuropatía.
- Períodos cortos e intensos de carga sobre el hueso;
- Ejercicios excéntricos dan mayor estímulo osteogénico que los concéntricos;
- Mínimo 10 meses;
- Trabéculas mejor medidas con DXA scan que con US SOS de tibia y radio;
- Ejercicio excesivo en niñez y adolescencia también disminuye la DMO en etapas tardías de la vida.
- “Leucocitosis violenta” en maratonistas;
- Mejoramiento de inmunidad humoral y celular;
- LPMN más que linfocitos;
- Dependiente del IMC.
"...despite the ubiquitous nature of prolonged sitting in modern society,
it is possible that we have not yet reached our full sitting potential
nor realized the potential for dire future consequences".*
*Hamilton MT, Hamilton DG, Zderic TW. Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes and cardiovascular disease. Diabetes. 2007;56:2655-67.
Hamilton MT, Hamilton DG, Zderic TW.
Exercise physiology versus inactivity physiology: an essential concept for understanding
lipoprotein lipase
regulation.
Exerc Sport Sci Rev. 2004;32(4):161-6.
Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and
mortality
from all causes, cardiovascular disease, and cancer.
Med Sci Sports Exerc. 2009 May; 41(5):998-1005
Impact of inactivity and exercise on the
vasculature
in humans.
Thijssen DH; Maiorana AJ; O'Driscoll G; Cable NT; Hopman MT; Green DJ.
Eur J Appl Physiol] 2010 Mar; Vol. 108 (5), pp. 845-75.
The effects of inactivity and exercise training on
established
cardiovascular risk factors are relatively
modest
and do not account for the impact of inactivity and exercise on vascular risk.

Physical deconditioning
is associated with enhanced vasoconstrictor tone and has profound and
rapid effects on arterial remodelling
in both large and smaller arteries.

A)
Change in the carotid artery (black) and
superficial femoral artery diameter (grey);


B)
intima-media thickness (IMT);

C)
IMT-to-lumen ratio after bed rest in controls (CTR), resistive exercise (RE), and resistive vibration exercise (RVE).
Diámetro
Pared
Relación
Lifetime sedentary living accelerates some aspects of
secondary aging
.
J Appl Physiol. 2011 Nov;111(5):1497-504.
Booth FW, Laye MJ, Roberts MD.
V̇O2max·kg−1·min−1 is shown as a function age for hypothesized interactions between inherited genes and lifetime aerobic activity.
V̇O2max is shown to rise from 10 to 20 yr of age, rising less rapidly in sedentary (SED) than aerobically active (ACT).
Negative slopes of lines after the age of 20 yr indicate the primary aging for those maintaining an unchanged level of physical activity throughout their life span.
The influence of inherited genes is schematically drawn for extreme examples for the human with the lowest inherited V̇O2max genetic potential (Low CRF) and from the human who inherited the highest V̇O2max genetic potential (High CRF).
Arrows A and B
show secondary aging effects, where V̇O2max·kg−1·min−1 changes to a lower or higher family of declining V̇O2max slopes, depending on whether physical activity is chronically decreased (A) or increased (B).
Both functional and structural remodelling
adaptations
occur and that the magnitude and time-course of these changes
depends
upon training duration and intensity and the vessel beds involved.

Inactivity and exercise have direct
"vascular deconditioning and conditioning"
effects which likely modify cardiovascular risk.
SICA
Remodelación y reperfusión
Buena
Mala
Ejercicio previo
Sedentarismo previo
Previo al establecimiento del RCV
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