Fysieke fitheid, fysieke activitiet in relatie tot gezondheid
Wat is fysieke activiteit? • “Een door skeletspieren geproduceerde beweging (dynamisch) en/of houding (statisch) die gepaard gaat met een toename van het energieverbruik” (Caspersen 1985) • Op verschillende niveau’s: – In werksituatie – Verband houden met vervoer – Huishoudelijk werk – Sport, ontspanning, vrije tijd
Fysieke training • “Het regelmatig uitvoeren van geplande fysieke activiteiten met de bedoeling fysieke fitheid en/of gezondheid gunstig te beinvloeden binnen een bepaalde tijdsperiode” (Caspersen 1985) – Acute effecten (vb. insulinegevoeligheid) – Chronische effecten (vb. toename spiervolume)
Meten van fysieke activiteit • Vragenlijsten: – IPAQ – Baecke
• Dagboekmethode • Meten van verplaatsing: – Stappenteller – Accelerometrie
• Meten van energieverbruik – Draagbare spirometrie
Pro-contra’s • Hanteerbare methode versus betrouwbare methode – Vragenlijsten vs spirometrie
• Graad van fitheid – deel genetisch bepaald – Effecten van training ook deels genetisch bepaald • Zijn fitte personen actieve en omgekeerd? – (Bouchard 1994)
Fysieke fitheid • WHO (1968): het vermogen om op een bevredigende manier spierarbeid te verrichten • Clarke (1979): Physical fitness is the ability to carry out daily tasks with vigor and alertness, without undue fatigue and with ample energy to engage in leisure time pursuits and to meet the above average physical stress encountered in emergency situations”
Fysieke fitheid • Algemene fitheid: – Energetische mogelijkheden • Aeroob • Anaeroob
– Kracht • • • •
Maximaal statisch Maximaal dynamisch Krachtuithouding Explosieve kracht
Fysieke fitheid – Evenwicht – Coordinatie • Testing via Eurofittestbatterij
• Prestatiegerelateerde fitheid • Gezondheidsgerelateerde fitheid
Exercise training in chronic internal disease: casus diabetes mellitus Prof. Dr. Patrick Calders Rehabilitation Sciences and Physiotherapy Ghent Arteveldehogeschool/University of Ghent
Which training modus is the most optimal? Endurance
Strength
? Combined exercise
Endurance training • • • •
volume: 8w - 12m frequency: 2-3 times/week duration per session: 30-90min intensity: • 70-85% max HR • 60-75% peakVO2
Endurance training in DM
BMI = Total cholesterol ↓?
Exercise capacity ↑
Fat Mass ↓
Endurance training
Triglycerides ↓ QOL↑?
HbA1c ↓ Lean Body Mass = of ↓
Strength training ?
Fysieke training in DM: effecten Krachttraining: • grote spiergroepen van OL, BL en romp Strength training • • large muscle groups of LL, UL, trunk • volume: 6 weeks – 6 months
• time per session: 30-60 min • intensity: 50-75% 1RM • frequency: 2-3/week
Strength training in DM BMI = Exercise capacity ↑
HbA1c ↓
Total cholesterol ↓?
Strength training
Fat Mass = of ↓
Triglycerides = Muscle strength ↑
Lean Body Mass ↑
Pro and contra van both exercise modes Endurance training
Strength training
Positive: Aerobe capacity ↑ Strength UL= / LL = Hba1c/Glycemia: ↓ Fat mass: ↓
Positive: Aerobe capacity ↑ Strength ↑ Hba1c/Glycemia: ↓ Lean Body Mass: ↑
Negative: Lean Body Mass : ↓
Negative: Fat mass : =
Essential question Can a combined endurance and strength training modus increase the positive effects and
deminish the negative effects ?
DiaCoTra Purpose To investigate the effect of combined endurance and strength training on indices of obesity, physical and metabolic fitness in type-II diabetes patiënts (n=17) compared to endurance training (n=16) and no training (n=11).
Inclusion and exclusion criteria BMI : 25 - 35 HbA1c: 6,5 – 9
age: 30 – 65y Excluded: angiopathy, neuropathy, retinopathy, and other metabolic problems
DiaCoTra Combined exercise training Frequency: 3x/week Total volume: 3 months Intensity: 60-85% HRR 60-85% 1RM
cycling
Strength LL
running
Strength UL
stepping
Warming up 10min
Endurance training
Cooling down 10min
10min
10min
running
cycling
stepping
10min
running
10min
cycling
Warming up 10min
No training
10min
Cooling down 10min
10min
10min
10min
Daily activities – no supervised training
10min
10min
DiaCoTra Antropometry Strength, 6MWT, STS, CPX HbA1c and glycemia
inclusion
0m
End of training period
3m
DiaCoTra Antropometry BW (kg)
BMI (kg/m2)
100
32 31
95 30 pre post
90
pre post
29 28
85 27 80
26 combined
endurance
control
combined
endurance
Waist (cm) 112 110 108 106 104
pre post
102 100 98 96 94 combined
endurance
control
control
DiaCoTra Indices of exercise capacity peakVO2 (L/min) 3 2,8 2,6 2,4 2,2 2 1,8 1,6 1,4 1,2 1
* pre post
combined
endurance
control
STS (number/30s)
6MWT (meter) 18 16
600 580 560
*
*
14
*
12 pre post
540 520
10
pre post
8 6 4
500
2
480
0 combinad
endurance
control
combined
endurance
control
DiaCoTra Indices of muscle strength
LL (kg)
UL (kg)
75
65
70
60
65
55
60
*
*
pre post
55
50
40
45
35
40
30 endurance
*
control
*
pre post
45
50
combined
*
combined
endurance
*
control
DiaCoTra Indices of diabetes
HbA1c (%)
Glycemia (mmol/L) 8,5
7,8
8
7,5 7,2
*
7,5
*
*
*
6,9
pre post
7
6
6,3
5,5
6
5
*
endurance
control
pre post
6,5
6,6
combined
*
combined
endurance
*
control
Cardio Vascular Risk groep
1,30
*
1,275
1,25
1,225
1,20
1,175
1,15 1
2
hdl
* = COM vs. C
1 2 3
Conclusion
Exercise training in patients with type II diabetes mellitus Endurance and combined exercise training have a positive effect on physical and metabolic fitness. The effects of combined exercise training are stronger compared to endurance training.
