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Körperliche Aktivität, Sport und Bewegungstherapie bei (morbider) Adipositas

Physical activity, sports, and exercise therapy in (morbid) obesity

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Der Diabetologe Aims and scope

Zusammenfassung

Hintergrund und Ziel

Weltweit ist die Zahl der übergewichtigen und adipösen Personen erheblich angestiegen und damit verbunden auch die der sog. nichtübertragbaren Erkrankungen, speziell des Diabetes mellitus Typ 2. In der Prävention und Therapie spielt die körperliche Aktivität eine wichtige Rolle. Als Ziel werden in der Prävention meist 150 min moderater Ausübung/Woche bzw. 10.000 Schritte/Tag angegeben; in der Therapie beläuft sich dies auf mindestens 300 min/Woche bzw. 13.000 Schritte/Tag. Allerdings sind die Barrieren von Betroffenen hoch, zusätzlich mangelt es an strukturierten Angeboten für diese. So werden in den meisten herkömmlichen Bewegungsprogrammen schwer adipöse Patienten aufgrund möglicher Überlastungsschäden am Bewegungsapparat und/oder kardiovaskulärer Begleiterkrankungen ausgeschlossen. Aus diesem Grund ist wenig Verlässliches über die Möglichkeiten, Machbarkeit und Risiken in dieser Klientel bekannt. Grundsätzlich kann man davon ausgehen, dass körperlich Aktive von der Steigerung des Energieverbrauchs, den metabolischen Effekten, den Änderungen und der günstigen Beeinflussung der Körperkomposition, dem Gewichtsverlust und der damit verbundenen Senkung der Belastungen des muskuloskelettalen Systems sowie einer Steigerung der Lebensqualität profitieren. Die Bedeutung körperlicher Aktivität wird noch deutlicher, wenn neuere Forschungen im Kontext Adipozytokine/Myokine als Marker der Fett- bzw. Muskelmasse sowie der epigenetischen Regulation berücksichtigt werden. So gilt der übergewichtige Fitte und, damit verbunden, metabolisch Gesunde nicht als Risikopatient.

Diskussion

Im vorliegenden Beitrag werden neben Empfehlungen und einem möglichen Transfer in die Praxis insbesondere auch die oben genannten Effekte zusammengestellt.

Abstract

Background and aim

Worldwide, the number of overweight and obese people has increased significantly and thus also so-called noncommunicable diseases, especially of the type 2 diabetes mellitus. In the prevention and treatment of obesity, physical activity plays an important role. As a target in prevention, 10,000 steps/day are recommended or 150 min of moderate exercise/week; in patients undergoing therapy, at least 300 min/week or 13,000 steps/day are indicated. However, the number of barriers for obese patients is high, and there is also a lack of structured offers. Thus, morbidly obese patients are excluded in most “conventional” exercise therapy programs because of the possible impact on the musculoskeletal system and/or cardiovascular comorbidities. For this reason, few reliable data exist in terms of possibilities, feasibility, and risks for this clientele. Basically, the health benefits of physical activity is undoubted: increased energy consumption, metabolic effects, changes in body composition, favorable influence on body composition, weight loss, reduced impact on the musculoskeletal system, and an enhanced quality of life. The importance is even more evident when recent research in the context of adipocytokines/myokines as a marker of fat and muscle mass as well as epigenetic regulation are considered. Thus, the obese fit and thus metabolically healthy person is not considered a risk patient.

Discussion

In this article, recommendations and a possible transfer into practice especially of the above-mentioned effects are discussed.

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Literatur

  1. Balakumar P, Rose M, Ganti SS, Krishan P, Singh M (2007) PPAR dual agonists: are they opening pandora’s box? Pharmacol Res 56:91–98

    Article  CAS  PubMed  Google Scholar 

  2. Barry VW, Baruth M, Beets MW, Durstine JL, Liu J, Blair SN (2014) Fitness vs. fatness on all-cause mortality: a meta-analysis. Prog Cardiovasc Dis 56:382–390

    Article  PubMed  Google Scholar 

  3. Bassett DR Jr, Wyatt HR, Thompson H, Peters JC, Hill JO (2010) Pedometer-measured physical activity and health behaviors in U.S. adults. Med Sci Sports Exerc 42:1819–1825

    Article  PubMed Central  PubMed  Google Scholar 

  4. Bygren LO, Kaati G, Edvinsson S (2001) Longevity determined by paternal ancestors’ nutrition during their slow growth period. Acta Biotheor 49:53–59

    Article  CAS  PubMed  Google Scholar 

  5. Caspersen CJ, Powell KE, Christenson GM (1985) Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep 100:126–131

    PubMed Central  CAS  PubMed  Google Scholar 

  6. Febbraio MA, Pedersen BK (2002) Muscle-derived interleukin-6: mechanisms for activation and possible biological roles. FASEB J 16:1335–1347

    Article  CAS  PubMed  Google Scholar 

  7. Fletcher G, Trejo JF (2005) Why and how to prescribe exercise: overcoming the barriers. Clevel Clin J Med 72:645–656

    Article  Google Scholar 

  8. Foss ML, Lampman RM, Watt E, Schteingart DE (1975) Initial work tolerance of extremely obese patients. Arch Phys Med Rehabil 56:63–67

    CAS  PubMed  Google Scholar 

  9. Gallagher MJ, Franklin BA, Ehrman JK, Keteyian SJ, Brawner CA, deJong AT, McCullough PA (2005) Comparative impact of morbid obesity vs heart failure on cardiorespiratory fitness. Chest 127:2197–2203

    Article  PubMed  Google Scholar 

  10. Graf C (2011) Adipositas – Fit oder fett. Kardiologe 5:51–60

    Article  Google Scholar 

  11. Graf C, Halle M (2015) Aktuelle Aspekte im Herzsport – von der Historie zum Status quo. Kardiologe 1(9):68–80

    Google Scholar 

  12. Grøntved A, Hu FB (2011) Television viewing and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality: a meta-analysis. JAMA 305:2448–2455

    Article  PubMed Central  PubMed  Google Scholar 

  13. Hayashino Y, Jackson JL, Hirata T, Fukumori N, Nakamura F, Fukuhara S, Tsujii S, Ishii H (2014) Effects of exercise on C-reactive protein, inflammatory cytokine and adipokine in patients with type 2 diabetes: a meta-analysis of randomized controlled trials. Metabolism 63:431–440

    Article  CAS  PubMed  Google Scholar 

  14. Hodge FS, Cantrell BG, Kim S (2011) Health status and sociodemographic characteristics of the morbidly obese American Indians. Ethn Dis 21:52–57

    PubMed Central  PubMed  Google Scholar 

  15. Hulens M, Vansant G, Lysens R, Claessens AL, Muls E (2001) Exercise capacity in lean versus obese women. Scand J Med Sci Sports 11:305–309

    Article  CAS  PubMed  Google Scholar 

  16. Hulens M, Vansant G, Claessens AL, Lysens R, Muls E (2003) Predictors of 6-minute walk test results in lean, obese and morbidly obese women. Scand J Med Sci Sports 13:98–105

    Article  CAS  PubMed  Google Scholar 

  17. Kaati G, Bygren LO, Edvinsson S (2002) Cardiovascular and diabetes mortality determined by nutrition during parents’ and grandparents’ slow growth period. Eur J Hum Genet 10:682–688

    Article  CAS  PubMed  Google Scholar 

  18. Katzmarzyk PT (2014) Standing and mortality in a prospective cohort of Canadian adults. Med Sci Sports Exerc 46:940–946

    Article  PubMed  Google Scholar 

  19. Knight E, Stuckey MI, Prapavessis H, Petrella RJ (2015) Public health guidelines for physical activity: is there an app for that? A review of android and apple app stores. Jmir Mhealth Uhealth 3:e43

    Article  PubMed Central  PubMed  Google Scholar 

  20. Kolotkin RL, LaMonte MJ, Litwin S, Crosby RD, Gress RE, Yanowitz FG, Hunt SC, Adams TD (2011) Cardiorespiratory fitness and health-related quality of life in bariatric surgery patients. Obes Surg 21:457–464

    Article  PubMed Central  PubMed  Google Scholar 

  21. Krug S, Jordan S, Mensink GB, Müters S, Finger J, Lampert T (2013) Körperliche Aktivität – Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsblatt Gesundheitsforsch Gesundheitsschutz 56:765–771

    Article  CAS  Google Scholar 

  22. Lehr S, Hartwig S, Sell H (2012) Adipokines: a treasure trove for the discovery of biomarkers for metabolic disorders. Proteomics Clin Appl 6:91–101

    Article  CAS  PubMed  Google Scholar 

  23. Levine JA (2015) Sick of sitting. Diabetologica 58(8):1751–1758

    Article  PubMed  Google Scholar 

  24. Maud P, Ebbeling C, Alquist L (1995) Physiological Assessment of Human Kinetics. Human Kinetics.

    Google Scholar 

  25. Mensink GBM, Schienkiewitz A, Haftenberger M, Lampert T, Ziese T, Scheidt-Nave C (2013) Übergewicht und Adipositas in Deutschland. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsbl 56:786–794

    Article  CAS  Google Scholar 

  26. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE (2002) Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 346:793–801

    Article  PubMed  Google Scholar 

  27. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, Abraham JP, Abu-Rmeileh NM, Achoki T, AlBuhairan FS, Alemu ZA, Alfonso R, Ali MK, Ali R, Guzman NA, Ammar W, Anwari P, Banerjee A, Barquera S, Basu S, Bennett DA, Bhutta Z, Blore J, Cabral N, Nonato IC, Chang JC, Chowdhury R, Courville KJ, Criqui MH, Cundiff DK, Dabhadkar KC, Dandona L, Davis A, Dayama A, Dharmaratne SD, Ding EL, Durrani AM, Esteghamati A, Farzadfar F, Fay DF, Feigin VL, Flaxman A, Forouzanfar MH, Goto A, Green MA, Gupta R, Hafezi-Nejad N, Hankey GJ, Harewood HC, Havmoeller R, Hay S, Hernandez L, Husseini A, Idrisov BT, Ikeda N, Islami F, Jahangir E, Jassal SK, Jee SH, Jeffreys M, Jonas JB, Kabagambe EK, Khalifa SE, Kengne AP, Khader YS, Khang YH, Kim D, Kimokoti RW, Kinge JM, Kokubo Y, Kosen S, Kwan G, Lai T, Leinsalu M, Li Y, Liang X, Liu S, Logroscino G, Lotufo PA, Lu Y, Ma J, Mainoo NK, Mensah GA, Merriman TR, Mokdad AH, Moschandreas J, Naghavi M, Naheed A, Nand D, Narayan KM, Nelson EL, Neuhouser ML, Nisar MI, Ohkubo T, Oti SO, Pedroza A, Prabhakaran D, Roy N, Sampson U, Seo H, Sepanlou SG, Shibuya K, Shiri R, Shiue I, Singh GM, Singh JA, Skirbekk V, Stapelberg NJ, Sturua L, Sykes BL, Tobias M, Tran BX, Trasande L, Toyoshima H, van de Vijver S, Vasankari TJ, Veerman JL, Velasquez-Melendez G, Vlassov VV, Vollset SE, Vos T, Wang C, Wang X, Weiderpass E, Werdecker A, Wright JL, Yang YC, Yatsuya H, Yoon J, Yoon SJ, Zhao Y, Zhou M, Zhu S, Lopez AD, Murray CJ, Gakidou E (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384:766–781

    Article  PubMed  Google Scholar 

  28. Ortega FB, Cadenas-Sánchez C, Sui X, Blair SN, Lavie CJ (2015) Role of fitness in the metabolically healthy but obese phenotype: a review and update. Prog Cardiovasc Dis 58(1):76–86

    Article  PubMed  Google Scholar 

  29. Pate R, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, Buchner D, Ettinger W, Heath GW, King AC, Kriska A, Leon AS, Marcus BH, Morris J, Paffenbarger RS Jr., Patrick K, Pollock ML, Rippe JM, Sallis J, Wilmore JH (1995) Physical activity and public health. A recommendation from the centers for disease control and prevention and the American College of Sports Medicine. JAMA 273:402–407

    Article  CAS  PubMed  Google Scholar 

  30. Pedersen BK, Hoffman-Goetz L (2000) Exercise and the immune system: regulation, integration and adaptation. Physiol Rev 80:1055–1081

    CAS  PubMed  Google Scholar 

  31. Pedersen BK, Steensberg A, Schjerling P (2001) Muscle-derived interleukin-6: possible biological effects. J Physiol 536:329–337

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  32. Pembrey M, Saffery R, Bygren LO, Network in Epigenetiv Epidemiology (2014) Human transgenerational responses to early-life experience: potential impact on development, health and biomedical research. Med Genet 51:563–572

    Article  Google Scholar 

  33. Poirier P, Cornier MA, Mazzone T, Stiles S, Cummings S, Klein S, McCullough P, Ren Fielding C, Franklin BA (2011) Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association. Circulation 123:1683–1701

    Article  PubMed  Google Scholar 

  34. Redberg RF, Benjamin EJ, Bittner V, Braun LT, Goff DC Jr, Havas S, Labarthe DR, Limacher MC, Lloyd-Jones DM, Mora S, Pearson TA, Radford MJ, Smetana GW, Spertus JA, Swegler EW (2009) AHA/ACCF 2009 performance measures for primary prevention of cardiovascular disease in adults. Circulation 120:1296–1336 (a report of the American College of Cardiology Foundation/American Heart Association task force on performance measures (writing committee to develop performance measures for primary prevention of cardiovascular disease): developed in collaboration with the American Academy of Family Physicians; American Association of Cardiovascular and Pulmonary Rehabilitation; and Preventive Cardiovascular Nurses Association: endorsed by the American College of Preventive Medicine, American College of Sports Medicine, and Society for Women’s Health Research.)

    Article  PubMed  Google Scholar 

  35. Santos JM, Tewari S, Benite-Ribeiro SA (2014) The effect of exercise on epigenetic modifications of PGC1: The impact on type 2 diabetes. Med Hypotheses 82:748–753

    Article  CAS  PubMed  Google Scholar 

  36. Saris WH, Blair SN, van Baak MA, Eaton SB, Davies PS, Di Pietro L, Fogelholm M, Rissanen A, Schoeller D, Swinburn B, Tremblay A, Westerterp KR, Wyatt H (2003) How much physical activity is enough to prevent unhealthy weight gain? outcome of the IASO 1st stock conference and consensus statement. Obes Rev 4:101–114

    Article  CAS  PubMed  Google Scholar 

  37. Sedentary Behaviour Research Network (2012) Letter to the editor: standardized use of the terms “sedentary” and “sedentary behaviours”. Appl Physiol Nutr Metab 37:540–542

    Article  CAS  PubMed  Google Scholar 

  38. Serés L, Lopez-Ayerbe J, Coll R, Rodriguez O, Vila J, Formiguera X, Alastrue A, Rull M, Valle V (2006) Increased exercise capacity after surgically induced weight loss in morbid obesity. Obesity 14:273–279 (Silver Spring)

    Article  PubMed  Google Scholar 

  39. Sjögren P, Fisher R, Kallings L, Svenson U, Roos G, Hellénius ML (2014) Stand up for health-avoiding sedentary behaviour might lengthen your telomeres: secondary outcomes from a physical activity RCT in older people. Br J Sports Med 48:1407–1409

    Article  PubMed  Google Scholar 

  40. Soares FH, de Sousa MB (2013) Different types of physical activity on inflammatory biomarkers in women with or without metabolic disorders: a systematic review. Women Health 53:298–316

    Article  PubMed  Google Scholar 

  41. Suzuki K, Nakaji S, Yamada M, Totsuka M, Sato K, Sugawara K (2002) Systemic inflammatory response to exhaustive exercise. Cytokine kinetics. Exerc Immunol Rev 8:6–48

    PubMed  Google Scholar 

  42. Swift DL, Lavie CJ, Johannsen NM, Arena R, Earnest CP, O’Keefe JH, Milani RV, Blair SN, Church TS (2013) Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention. Circ J 77:281–292

    Article  PubMed  Google Scholar 

  43. Vanhecke TE, Franklin BA, Miller WM, deJong AT, Coleman CJ, McCullough PA (2009) Cardiorespiratory fitness and sedentary lifestyle in the morbidly obese. Clin Cardiol 32:121–124

    Article  PubMed  Google Scholar 

  44. Zimmer P, Bloch W (2015) Sport und epigenetische Anpassungen des Herz-Kreislaufsystems. Herz 40:353–360

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institut für Bewegungs- und Neurowissenschaft, Abteilung für Bewegungs- und Gesundheitsförderung, Deutsche Sporthochschule Köln, Am Sportpark Müngersdorf 6, 50933, Köln, Deutschland

    C. Graf & N. Ferrari

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Correspondence to C. Graf.

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Graf, C., Ferrari, N. Körperliche Aktivität, Sport und Bewegungstherapie bei (morbider) Adipositas. Diabetologe 11, 457–463 (2015). https://doi.org/10.1007/s11428-015-0001-5

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