Άσκηση και Παχυσαρκία Συνταγογράφηση Άσκησης σε Υπέρβαρους και Παχύσαρκους Σακκάς Γεώργιος PhD Τμήμα Επιστήμης Φυσικής Αγωγής και Αθλητισμού ΠΑΝΕΠΙΣΤΗΜΙΟ.

Παρουσίαση με θέμα: "Άσκηση και Παχυσαρκία Συνταγογράφηση Άσκησης σε Υπέρβαρους και Παχύσαρκους Σακκάς Γεώργιος PhD Τμήμα Επιστήμης Φυσικής Αγωγής και Αθλητισμού ΠΑΝΕΠΙΣΤΗΜΙΟ."— Μεταγράφημα παρουσίασης:

1 Άσκηση και Παχυσαρκία Συνταγογράφηση Άσκησης σε Υπέρβαρους και Παχύσαρκους Σακκάς Γεώργιος PhD Τμήμα Επιστήμης Φυσικής Αγωγής και Αθλητισμού ΠΑΝΕΠΙΣΤΗΜΙΟ ΘΕΣΣΑΛΙΑΣ

2 Άδειες Χρήσης Το παρόν εκπαιδευτικό υλικό υπόκειται σε άδειες χρήσης Creative Commons. Για εκπαιδευτικό υλικό, όπως εικόνες, που υπόκειται σε άλλου τύπου άδειας χρήσης, η άδεια χρήσης αναφέρεται ρητώς. 2

3 Χρηματοδότηση Το παρόν εκπαιδευτικό υλικό έχει αναπτυχθεί στα πλαίσια του εκπαιδευτικού έργου του διδάσκοντα. Το έργο «Ανοικτά Ακαδημαϊκά Μαθήματα Πανεπιστημίου Θεσσαλίας» έχει χρηματοδοτήσει μόνο τη αναδιαμόρφωση του εκπαιδευτικού υλικού. Το έργο υλοποιείται στο πλαίσιο του Επιχειρησιακού Προγράμματος «Εκπαίδευση και Δια Βίου Μάθηση» και συγχρηματοδοτείται από την Ευρωπαϊκή Ένωση (Ευρωπαϊκό Κοινωνικό Ταμείο) και από εθνικούς πόρους. 3

4 Σκοποί ενότητας Ο σκοπός της παρούσας ενότητας είναι η αναγνώριση της σημαντικότητας της συστηματικής άσκησης σε συνδυασμό με την σωστή διατροφή στην γενική υγεία αλλά και στην διατήρηση του σωματικού βάρους 4

5 Περιεχόμενα ενότητας The importance of exercise and diet on health Differences between overweight and obese Exercise prescription “Healthy at every size” Long-term weight control 5

6 the war on chronic diseases Clearly, there is overwhelming evidence linking most chronic diseases seen in the world today to physical inactivity and inappropriate diet consumption Roberts & Barnard J Appl Physiol 98: 3–30, 2005; Σαφώς, υπάρχουν συντριπτικά στοιχεία που συνδέουν τις περισσότερες χρόνιες παθήσεις με τη σωματική αδράνεια αλλά και την αλόγιστη κατανάλωση κακής ποιότητας τροφής 6

7 Exercise & Diet on Health Physical activity and diet can prevent or even reverse most of the chronic diseases such as: Cardiovascular Diseases 82% of CVD events could be prevented by a combination of physical activity and diet Hypertension regular physical activity and vegetarian diet decreases blood pressure by an average of 10 mmHg both aerobic and resistance exercise training have the ability to lower blood pressure 7

8 Exercise & Diet on Health Diabetes Mellitus 2 – physical inactivity and poor diet explain the 91% of type II diabetes – 500 kcal/wk of physical activity was associated with a decrease in risk of 6% Metabolic Syndrome (insulin resistance- hyperinsulinemia-hypertension-hypertriglyceridemia- visceral obesity) – If you exercise less than 1 hour/wk you have 4.26-fold risk of death over an 11-yr – 3 times/wk exercise and diet rich in fish and vegetables corrects the 30% of the MetaS Cancer – Exercise and quality diet offers antioxidant effect and protects our body from various types of Cancer 8

9 Exercise & Diet on Health 9 Risk of several other chronic diseases may be ameliorated by physical activity and diet, including: – Sarcopenia (loss of muscle mass) – Osteoporosis (loss of bone density) – Arthritis (degeneration of the joints) – Stroke (endothelium properties) – Congestive heart failure (cardiovascular diseases) – Chronic renal failure (control of blood pressure and diabetes) – Alzheimer’s disease (neurodegenerative diseases) – Erectile dysfunction (blood vessels)

10 Gene-Environment Interaction 100% of the increase in the prevalence of Type 2 diabetes and obesity in the United States during the latter half of the 20th century must be attributed to a changing environment interacting with genes, because 0% of the human genome has changed during this time period Studies from Tarahumara Indians, the Pima Indians and from the Mormon cohort have shown: – Low mortality rate compared to westernized counterparts – 50% less incidence of diabetes – Eat more than the average American but they weight half – If they expose to western habits, they develop the same chronic disease like the westernized counterparts 10

11 Potential Mechanism 11 Roberts & Barnard J Appl Physiol 98: 3–30, 2005 This figure summarizes various potential mechanisms by which physical activity and diet may ameliorate cardiovascular-associated chronic disease risk

12 Humans evolved to be active and vegetarians in 2002, the WHO and the Institute of Medicine recommended 1 h of moderate physical activity daily “to accrue additional, weight-independent health benefits” include both aerobic and resistance exercise a diet rich in fruits, vegetables, and low-fat dairy products, reduced in saturated and total fat, fish, poultry, and whole grains reduce the risk for chronic diseases 12 World Health Organization (WHO)

13 13 Overweight vs Obese looking beyond BMI

14 Overweight vs Obese 14 OverweightObese BMI 25-29.9BMI 25-29.9 Years Overweight: ? Diabetes: possible No Hypertension: possible No CVD: No High Cholesterol and Lipids: possible Yes MetS: possible No Sleep apnea: possible Yes Knee and Back pain: possible No Arthritis: possible No Exercise Intolerance: Yes Dyspnea – Asthma: possible No BMI 30-35BMI 30-35 Years Obese: 2x? Diabetes: possible Yes Hypertension: Yes CVD: possible Yes High Cholesterol and Lipids: possible Yes MetS: Yes Sleep apnea: Yes Knee and Back pain: Yes Arthritis: Yes Exercise Intolerance: Yes Dyspnea – Asthma: Yes

15 Overweight vs Obese 15 In terms of exercise training the differences are: Overweight Don’t need to loose weight before the exercise training More capacity for exercise Less dyspnea and respiratory defects Less body pain during exercise due to excess weight Less cardiovascular defects Better self image More motivated Low drop out rate Obese Probably need to loose weight before the exercise training Less capacity for exercise More dyspnea and respiratory defects More body pain during exercise due to excess weight More cardiovascular defects No or little self-respect Less motivated High drop out rate

16 Exercise Prescription How we can develop a successful exercise training! 16

17 Exercise Prescription Define the goals Examine the population Design the training program Supervise the training session Assess the effectiveness Adjust the training to the new level of progress Set long-term goals 17

18 Define the Goals What would you like to achieve with the exercise training ? – Weight loss? – Increase muscle mass? – Reduce risk factors – improve health determinants ? – Increase endurance? – Increase bone density? – Reduce body pain? At what level? How soon? What is the success rate in this population? 18

19 Examine the Population Who do you have to work with? – Individual or a group? Do they belong to the same patient group? Are you alone or do you have a team? – Do they know you? What is the mortality rate of your population? – What is the worst case scenario ? Have they tried a training session before? – Was it successful? Do they start from ZERO or have they achieved already some level of fitness? Are they going to pay or the session is FREE? 19

20 Design the Training Program What type of exercise? – Aerobic (endurance)? – Anaerobic (resistance)? Where are you going to do the training? – At the Gym? – At the field? – At home? What is the intensity of the training? What is the duration of the session? How many times per week? For how many weeks? 20

21 Design the Training Program Example of Aerobic training (walking – Jogging) – Start with 20-30 min walk in a closed area (in a square or stadium or park) – for 2-3 weeks – Progress to 30-45 min walk in semi-closed area (from home to the park and back) – for 3 weeks – Up to 60 min continue walking (everywhere) If the patients are capable of more then – 15 min walking – 5 min fast walking for 60 min – 10 min walking – 10 min fast walking for 60 min – 5 min walking – 5 min jogging for 60min – 5 min fast walking – 10 min jogging for 60 min – 5 min fast walking – 15 min jogging for 60 min 21

22 Design the Training Program Example of Resistance Training (light weights) – Exercises with body weight Sit to stand Push ups Chin ups Abdominal crunches – Going up and down stairs – External weights (1-3 kilos) Various exercises with external weights Start with 3 sets of 5 repetitions for large muscle groups Progress to 3 sets of 8 reps and close to 3 sets of 12 reps Start with body weight and light portable weight and move up to 5 kilos for the upper body 22

23 Supervise the Training Session During the training watch out for: – Everything – Ask if anybody had something to declare for yesterday – Very red or very pale face color – A lot of sweat – Extreme pain – especially in the chest – Listen the participants – it is better to believe them than to ignore them – Abnormal high Heart Rate – Don’t let them go far away from you – you can not read the signs….of failure Stay with them until “full recovery” Be the last at the site of exercise – leave no man behind 23

24 Assess the Effectiveness Every 4-6 weeks or 15 training sessions assess the level of progress Test the major variable (time of walking, HR after 20 min walk, numbers of sit to stand) and re-set the goals Every 12 weeks ask for a blood test and ECG (for the first 6 months) Ask them to take a record of their blood pressure every day – in diabetics, the sugar levels Some people will progress slowly than others, do not let them follow the rest of the group – put them together and make a new sub-group – will drop out if they don’t get the appropriate attention 24

25 Adjust the Training Never stay still – adjust the training to the new level of progress Make baby steps – big steps hide big holes Never hesitate to step back if you have overdone it 50% of the time you will have to step back a little bit in order to go forward later…. 25

26 Set long-term goals The first 6 months are the most crucial After that…your group has the potential to continue exercise almost for ever Set “Health Goals” – Keep cholesterol below 220 – Keep BP below 120/140 – Lower glucose levels to 90 mg/dL – Keep morning HR to 60 – Keep body weight to ideal or BMI = 25 Set “Special Goals” – Run or walk a marathon – Hike the Olympus mountain – Do something crazy…? 26

27 “Healthy at Every Size” – «Υγεία σε όλα τα μεγέθη» Τhe Association for Size Diversity and Health has a mission to promote education, research, and the provision of services which enhance health and well-being, and which are free from weight-based assumptions and weight discrimination. The HAES approach supports a "holistic" view of health that promotes feeling good about oneself; eating well in a natural, relaxed way; and being comfortably active 27

28 Υγεία σε Όλα τα Μεγέθη Είναι εντελώς φυσικό το να υπάρχει ποικιλοµορφία στη σωµατική διάπλαση και στο σωµατικό βάρος Το χάσιµο βάρους µέσω δίαιτας είναι ανεπαρκές και συχνά επικίνδυνο Με το να τρώµε άνετα, χαλαρά χωρίς τύψεις για την σωστή θρέψη και ικανοποίηση του οργανισµού µας υπακούουµε καλύτερα τις ανάγκες του σώµατος µας Η άσκηση και οποιαδήποτε φυσική δραστηριότητα πρέπει να γίνεται για διασκέδαση και υγεία και όχι για τιµωρία του σώµατος (δηλαδή να χάσουµε βάρος) Η υγεία και η ευζωία είναι µια πολυδιάστατη κατάσταση που επηρεάζεται από την ισορροπία µεταξύ της σωµατικής, κοινωνικής, ψυχικής, επαγγελµατικής, συναισθηµατικής και διανοητικής µας κατάστασης. 28

29 “Healthy at Every Size” Self-acceptance (αυτοαποδοχή): affirmation and reinforcement of human beauty and worth, regardless of differences in weight, physical size, and shape; Physical activity: support for increasing social, pleasure- based movement for enjoyment and enhanced quality of life; and Normalized eating: support for discarding externally imposed rules and regimens for eating and attaining a more peaceful relationship with food by relearning to eat in response to physiologic hunger and fullness cues. 29

30 “Healthy at Every Size” 30 Traditional Weight-Loss Paradigm Health At Every Size Thin is not intrinsically healthy and beautiful, nor is fat intrinsically unhealthy and unappealing. People who are not thin are "overweight" because they have no willpower, eat too much, and don't move enough. People naturally have different body shapes and sizes and different preferences for physical activity. Everyone can be thin, happy, and healthy by dieting. Dieting often ultimately leads to further weight gain, decreased self-esteem, and increased risk for disordered eating. Health and happiness involve a dynamic interaction among mental, social, spiritual, and physical considerations. Everyone needs to be thin for good health and happiness,

31 An example…. When heavy persons present with medical problems, HAES suggests that health professionals offer the same approaches that they would for a thin person presenting with similar problems – In the case of a thin person with essential hypertension, for example, conventional wisdom suggests dietary changes, increases in aerobic physical activity, and stress management followed by medication if necessary. – Yet a heavy person presenting with the same diagnosis is told to lose weight, regardless of all that is known about the most likely consequences of this recommendation. 31

32 Long-Term Weight Control Yo-Yo Syndrome Increasing and Reducing your body weight many times in small period of time (10 years) 32

33 Predictor of Successful Weight Loss Maintenance 20% of overweight individuals are successful at long-term weight loss – defined as losing at least 10% of initial body weight and maintaining the loss for at least 1 yr Individuals who had kept their weight off for 2 y or more had markedly increased odds of continuing to maintain their weight over the following year – this finding is encouraging because it suggests that, if individuals can succeed at maintaining their weight loss for 2 y, they can reduce their risk of subsequent regain by nearly 50% Lower level of dietary disinhibition (άρση των αναστολών) - participants who had fewer problems with disinhibition were 60% more likely to maintain their weight over 1 y Lower levels of depression related to greater odds of success These findings point to the importance of both emotional regulation skills and control over eating in long-term successful weight loss 33

34 Long-term weight control Findings from the current literature suggest six key strategies for long- term success at weight loss: 1) engaging in high levels of physical activity 2) eating a diet that is low in calories and fat 3) eating breakfast 4) self-monitoring weight on a regular basis 5) maintaining a consistent eating pattern 6) catching “slips” before they turn into larger regains Initiating weight loss after a medical event may also help facilitate long- term weight control 34

35 Summary Physical activity and diet can prevent or even reverse most of the chronic diseases There are differences between Overweight and Obese and we should take them into account when design an exercise training program Designing a exercise training session meaning that you have to follow certain rules – will guaranty your success Healthy at every size means we live for a better and healthier tomorrow without predisposition about weight and appearances Long term goals: regular exercise and quality food at the majority of time 35

36 Τέλος Ενότητας ΠΑΝΕΠΙΣΤΗΜΙΟ ΘΕΣΣΑΛΙΑΣ