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運動與代謝症候群 台大北護分院 社區及家醫部 張皓翔醫師
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什麼是運動？
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這是運動?
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這是運動?
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這是運動?
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這些都是表演
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什麼是運動？ 運動會田徑賽？ 球類競賽？ 陶侃搬磚？ 水泥工搬水泥？
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運動(Physical Activity)
Exercise: structured, planned and repetitive physical activity with the intent of improving physical fitness Leisure time physical activity:非工作的運動
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對大多數人而言，運動是…
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走路(Walking)
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慢跑(jogging)
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騎自行車
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運動用語(Exercise Terminology)
項目 定義 有氧運動 包含反覆動作，使用大肌肉群，在長時間增加心率， 提高核心體溫(如：走路，跳舞，游泳) 平衡感訓練 在每日活動及其他運動中，幫助保持身穩定性，預防跌倒。 它可以是靜態(如：單腳站立)，或是動態(如：走鋼索)， 也需用手支撐。 運動 能改善體適能的結構性、計畫性、反覆性健身。 柔軟度或 伸展操運動 關節在正常最大活動範圍內能夠流暢地作全幅度的活動。 伸展操可以是靜態(如：採取持續伸展，然後放鬆的姿勢)、動態(流暢動作【如：太極】) 、主動性(伸展時保持平衡，然後移動【如：瑜珈】) 、或合併(本體感覺神經肌肉誘導術)。 生活型態調整 使用機會在人們的日常生活就能增加消耗熱量(如：手動開門、 提貨物、使用樓梯)及運動取代久坐的閒暇時間。 體適能 包含四大要素：心肺耐力、肌肉力量、柔軟度、身體組成。 肌力 產生最大肌肉收縮速度(如：快速舉起對緩慢提起貨物袋) 漸進性阻力訓練 需要肌肉對抗遭遇的阻力重量，當體適能改善肌耐力就愈佳。 (如：伸展訓練)
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代謝症候群(Metabolic Syndrome)
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Cardiometabolic Risk Factors
The concept of cardiometabolic risk includes a number of classic risk factors/markers that contribute to cardiovascular disease and type 2 diabetes, [click once to animate “classic” factors/markers], as well as a number of emerging risk factors/markers [click again to animate “emerging” factors/markers]. Note that the concept of cardiometabolic risk takes a broader approach to multiple cardiovascular and metabolic risk factors, as compared with the NCEP/ATP III definition of metabolic syndrome, which identifies five risk factors/markers [click again to animate the “metabolic syndrome” factors/markers].
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Disease outcomes inversely related to regular physical activity
Cardiovascular disease(心血管病) Thromboembolic stroke(腦中風) Hypertension(高血壓) Diabetes mellitus, type 2(糖尿病) Osteoporosis(骨質疏鬆) Obesity(肥胖) Colon cancer(大腸癌) Breast cancer(乳癌) Anxiety(焦慮) Depression(憂鬱)
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維持正常體重與控制血壓是降低代謝症候群的兩條主要道路
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Life Style Intervention的實證
Finnish Diabetes Prevention Study(FDPS): reduce 58% DM development Diabetes Prevention Program (DPP): life style (58%), metformin(31%) reduce DM development Life style intervention = dietary + exercise intervention
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Finnish Diabetes Prevention Study
Community setting 可行 Multi-center study Members:physician, study nurse, exercise instructor/PT
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Study Design of FDPS(芬蘭)
40~64 year-old BMI>25 Mean of 2 OGTT impaired (140~199) Randomization stratified by sex, center, glucose level
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介入 of FDPS(芬蘭) Goal:weight reduction 5%, PA>30/min
Exercise: exercise >=30min/day, resistance training (free) Diet: moderate fat(<30E%), low saturated fat(<10E%), fiber >15g/1000kcal
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Finnish Diabetes Prevention Study
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Study Design of DPP
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發生代謝性症候群in DPP
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代謝性症候群消失in DPP
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Met Syndrome in DPP 50% of DPP participant have MS
Both life style intervention and metformin reduces the development of MS
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Moderate life style intervention
RCT; 335 participants; aged 45~64; metabolic abnormality cohort Intervention: life style intervention by trained professionals VS structured information given by family physician
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運動的代謝與內分泌反應 Acute effect:運動時或運動後產生的反應 Training effect：長時間的訓練才產生的效果
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Acute effect 1.運動時肌肉能量的來源不是glucose就是free fatty acids配合飲食限制當然對代謝症有幫助
2.High intensity exercise會導致碳水化合物代謝異常加劇(glucagon & catecholamine)，因此，血糖很高的患者不宜劇烈運動。
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運動與能量來源 Moderate intensity exercise能量的來源是glucose＆free fatty acids
當運動強度超過Lactate threshold時，碳水化合物的使用便增加 Maximal exercise則幾乎都是走glycolytic pathway
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運動強度與能量來源
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運動強度與能量來源
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運動強度與脂肪消耗
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運動時間與能量來源
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運動時間與能量來源
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有無訓練對乳酸移除能力的差異
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運動改善胰島素阻抗 Diabetes Research and Clinical Practice 77S (2007) S87–S91
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配合運動比起單獨飲食控制更改善胰島素阻抗
Diabetes Research and Clinical Practice 77S (2007) S87–S91
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運動改善胰島素阻抗的原因 1. Muscular factors: 2. Adipose tissue factors:
Glycolytic pathway Increase enzyme activity in TCA cycle Increase in glucose signal transduction 2. Adipose tissue factors: Decrease body fat Decreased plasma TNF-α Increase adiponectin 3. Modify the SNPs in SL2A2(Glut2) and ABCC8(SUR1) ……genes
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Increase in glucose signal transduction
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Physical inactivity Prevalence of no reported leisure-time physical activity among U.S. men and women,
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運動的好處 降低血壓 減少糖尿病 改善血脂狀況 改善脂肪肝 減重 想當然而運動可以改善代謝症候群？
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Exercise Prescription-FITT PRO
Frequency: 每天 Intensity: Moderate intensity(中度) Type: aerobic + resistance(有氧、重量) Time: at least 30min/ time(30分鐘) Progression: depends(進度)
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Commercial Programs
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Integrated commercial program—Golf
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運動去_走路
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運動去_運動
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結束！謝謝聆聽
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