Bedeutung und Evidenz der körperlichen Aktivität zur Prävention und Therapie von Erkrankungen

Zusammenfassung

Zahlreiche Studien haben negative Folgen von Bewegungsmangel und sitzender Tätigkeit auf Morbidität und Mortalität ergeben. Regelmäßige körperliche Aktivität hat dagegen eindeutig positive Auswirkungen. Inzwischen hat körperliches Training Eingang in die klinische Medizin gefunden und wird heute in vielen Disziplinen als Therapie und Therapieergänzung eingesetzt.

Der vorliegende Beitrag basiert auf einer Literaturrecherche, Meta-Analysen und aktuellen Übersichtsarbeiten. Beschrieben wird die Bedeutung und Evidenz des körperlichen Trainings bei Herz-, Gefäß- und Lungenerkrankungen, bei Diabetes mellitus, Nierenkrankheiten und Tumorleiden. Körperliche Aktivität spielt für die Primärprävention und Therapie eine bedeutende Rolle. Die Evidenz wird in den meisten klinische Fächern und Krankheiten als hochgradig eingestuft. Körperliches Training wird in der Therapie, im Verlauf und in der Rehabilitation verschiedener Krankheiten mittlerweile wie ein hochwirksames Medikament eingesetzt. Es besteht eine nicht-lineare Dosis-Wirkungsbeziehung, psychologische Aspekte spielen eine Rolle, Nebenwirkungen sind zu beachten. Für das körperliche Training bieten sich detaillierte, allgemeine und krankheitsbezogene Trainingsempfehlungen an. Diese beinhalten die Trainingsart, -dauer, -häufigkeit, -intensität und -steigerung.

Abstract

A sedentary lifestyle has been shown to have negative effects on morbidity and mortality. In contrast, a large number of prospective cohort studies on the effects of regular physical activity demonstrated positive effects. Therefore, physical training is today an essential part of prevention and therapy in internal medicine. This review is based on literature research in meta-analysis and review papers. Regular physical exercise or training is a significant and evidence-based part of prevention and therapy of diseases such as heart, cardiovascular and lung diseases, diabetes mellitus, renal disease and cancer. Evidence of training effects is mostly high grade. Physical activity or exercise training is indicated in many diseases as medicine – similar as a drug. It is applied after acute treatment as a component of the standard drug therapy. There is a non-linear dose-response effect, psychological aspects and some side-effects need to be considered.

In conclusion, physical exercise acts as a highly efficient drug, and should be used in many diseases. Training recommendations refer to the kind, the duration, the intensity, the frequency and the increase of training.

Schlüsselwörter

Bewegung - Training als Therapie - Krankheiten - Prävention

Keywords

physical activity - exercise as treatment - diseases - prevention

• Literatur

• 1 Adamsen L, Quist M, Andersen C et al. Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomized controlled trial. BMJ 2013; 339: b3410
• 2 Belardinelli R, Georgiou D, Cianci G et al. 10-year exercise training in chronic heart failure: a randomized controlled trial. J Am Coll Cardiol 2012; 60: 1521-5128
• 3 Blair SN, Kampert JB, Kohl 3rd HW et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA 1996; 276: 205-210
• 4 Bock C, Schmidt ME, Vrieling A et al. Walking, bicycling, and sports in postmenopausal breast cancer survivors – results from a German patient cohort study. Psychooncology 2013; 22: 1291-1298
• 5 Boyle T, Keegel T, Bull F et al. Physical activity and risks of proximal and distal colon cancers: a systematic review and meta-analysis. J Natl Cancer Inst 2012; 104: 1548-1561
• 6 Brazelli M, Saunders DH, Greig CA et al. Physical fitness training for stroke patients. . Cochrane Database Syst Rev 2011; CD 003316
• 7 Carlsson S, Andersson T, Lichtenstein P et al. Physical activity and mortality: Is the association by genetic selection?. Am J Epidem 2007; 166: 255-259
• 8 Carvalho VO, Mezzani A. Aerobic exercise training intensity in patients with chronic heart failure: principles of assessment and prescription. Europ J Cardiovasc Prev Rehab 2011; 18: 5-9
• 9 Chandratilleke MG, Carson KV, Picot J et al. Physical training and asthma. . Cochrane Database Syst Rev 2012; CD001116
• 10 Chao A, Connell CJ, Jacobs E et al. Amount type, and timing of recreational physical activity in relation to colon and rectal cancer in older adults: The cancer prevention study II Nutrition Cohort. Cancer Epidemiol Biomarkers Prev 2004; 13: 2187-2195
• 11 Clark AM, Hartling L, Vandermeer B et al. Meta-Analysis: Secondary prevention programs for patients with coronary artery disease. Ann Intern Med 2005; 143: 669-672
• 12 Cornelissen VA, Fagaard RH, Coeckelberghs E et al. Impact of resistance training on blood pressure and other cardiovascular risk factors: a meta-analysis of randomized, controlled trials. Hypertension 2011; 58: 950-958
• 13 Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. . Cochrane Database Sys Rev 2012; CD006145
• 14 Cindy Ng LW, Mackney J, Jenkins S et al. Does exercise training change physical activity in people with COPD? A systematic review and meta-analysis. Chron Respir Dis 2012; 9: 17-26
• 15 Davies EJ, Moxham T, Rees K et al. Exercise training for systolic heart failure: Cochrane systematic review and metaanalysis. Eur J Heart Fail 2010; 12: 706-715
• 16 Edelmann F, Gelbrich G, Düngen HD et al. Exercise training improves exercise capacity and diastolic function in patients with heart failure and preserved ejection fraction: results of the Ex-DHF pilot study. J Am Coll Cardiol 2011; 58: 1780-1791
• 17 Esteban C, Quintana JM, Aburto M et al. Impact of changes in physical activity on health-related quality of life among patients with COPD. Eur Resp J 2010; 36: 292-300
• 18 Ford ES, Caspersen CJ. Sedentary behaviour and cardiovascular disease: a review of prospective studies. Int J Epidem 2012; 41: 1338-1353
• 19 Gregg EW, Chen H, Wagenknecht LE et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. J Am Med Ass 2012; 308: 2489-2496
• 20 Halle M, Schoenberg MH. Körperliche Aktivität in der Prävention und Therapie des kolorektalen Karzinoms. Dtsch Aerztebl int 2009; 106: 722-727
• 21 Hambrecht R, Walther C, Moebius-Winkler A et al. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Circulation 2004; 1209: 1371-1378
• 22 Haskell WL, Lee I-M, Pate RR et al. Physical activity and public health. Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 2007; 116: 1081-1093
• 23 Hayes SC, Spence RR, Galvao DA et al. Australian association for exercise and sport sciences position stand: Optimising cancer outcomes through exercise. J Sci Med Sport 2009; 12: 428-434
• 24 Haykowski MJ, Liang Y, Pechter D et al. A metaanalysis of the effect of exercise training on left ventricular remodelling in heart failure. J Am Coll Cardiol 2007; 49: 2329-2336
• 25 Heiwe S, Jacobson S. Exercise training for adults with chronic kidney disease. . Cochrane Database Syst Rev 2011; CD003236
• 26 Holland AE, Hill C. Physical training for interstitial lung disease. . Cochrane Database Syst Rev 2012; CD006322
• 27 Joliffe JA, Rees K, Taylor RS et al. Exercise based rehabilitation for coronary artery disease. . Cochrane Database Syst Rev 2011; CD001800
• 28 Kenn K, Heinzelmann I. Rehabilitation in der Pneumologie. Dtsch med Wochenschr 2012; 137: 1575-1578
• 29 Kitzmann DW, Brubaker PH, Morgan TM et al. Exercise training in older patients with heart failure and preserved ejection fraction: a randomized, controlled single-blind trial. Circ Heart Fail 2010; 3, 657-667
• 30 Lawler PR, Filion KB, Eisenberg MJ. Efficacy of exercised–based cardiac rehabilitation post-myocardial infarction: A systematic review and meta-analysis of randomized controlled trials. Am Heart J 2011; 162: 571-584
• 31 Lavall H, Diehm C, Pitrow D. . Deutsche Gesellschaft für Angiologie. Leitlinie zur Diagnostik und Therapie der peripheren arteriellen Verschlusskrankheit (PAVK). 2009
• 32 Lee I-M. Dose response relation between physical activity and fitness. JAMA 2007; 297: 2137-2138
• 33 Lei P, Yan J, Guo Y et al. Effects of Tai Chi training on exercise capacity and quality of life in patients with heart failure. Eur J Heart Fail 2013; 15: 316-323
• 34 Löllgen H, Böckenhoff A, Knapp G. Primary prevention by physical activity: An updated meta-analysis with different intensity categories. Int J Sports Med 2009; 30: 213-224
• 35 Löllgen H, Leyk D, Löllgen D. Evidenzbasierte Empfehlungen für die Trainingsberatung im Breitensport. Münch med Wschr 2011; 153: 29-33
• 36 Haydon AM, Macinnis RJ, English DR, Giles GG et al. Effect of physical activity and body size on survival after diagnosis with colorectal cancer. Gut 2006; 55: 62-67
• 37 Markes M, Brockow T, Resch KL. Exercise for women receiving adjuvant therapy for breast cancer. . Cochrane Database Syst Rev 2009; CD005001
• 38 Martin BJ, Hauer T, Arena R et al. Cardiac rehabilitation attendance and outcome in coronary artery disease. Circulation 2012; 126: 677-678
• 39 McGuire DK, Levine BD, Williamson JW et al. 30-year follow-up of the Dallas bed rest and training study II. Circulation 2001; 104: 1358-1366
• 40 Mertz KJ, Lee D-C, Sui X et al. Falls among adults. The association of cardiorespiratory fitness and physical activity with walking-related falls. Am J Prev Med 2012; 39: 15-24
• 41 Mishra SI, Scherer RW, Geigle PM et al. Exercise interventions on health related quality of life for cancer survivors. . Cochrane Database Syst Rev 2012; CDD007566
• 42 Murphy T, Cutlip DE, Regensteiner JG et al. Supervised exercise versus primary stenting for claudication resulting from aortoiliac peripheral artery disease. Circulation 2012; 125: 130-139
• 43 Piepoli MF. Exercise training in heart failure: from theory to practice. A consensus document of the heart failure association and the European association for cardiovascular prevention and rehabilitation. Europ J Heart Failure 2011; 13: 347-357
• 44 Puhan MA, Gimeno-Santos E, Troosters T et al. Pulmonary rehabilitation following exacerbations of chronic pulmonary disease. . Cochrane Database Syst Rev 2011; CD005305
• 45 Rasmussen-Torvik LJ, Shay CM et al. Ideal cardiovascular health is inversely associated with incident cancer. Circ 2013; 127: 1270-1275
• 46 Reimers CD, Knapp G, Reimers AK. Bewegung zur Prophylaxe von Schlaganfällen. Dtsch Arztbl int 2009; 106: 715-721
• 47 Rejeski WJ, Ip EH, Bertoni AG et al. Lifestyle change and mobility in obese adults with type 2 diabetes. N Engl J Med 2012; 366: 1209-1217
• 48 Rossi AM, Dikareva A, Bacon SL et al. The impact of physical activity on mortality in patients with high blood pressure: a systematic review. J Hypertens 2012; 30: 1277-1288
• 49 Scott JM, Khakoo A, Mackey JR et al. Modulation of anthracycline-induced cardiotoxicity by aerobic exercise in breast cancer. Circulation 2011; 124: 642-650
• 50 Sluik D, Buijsse B, Muckelbauer R et al. Pyhsical activity and mortality in individuals with diabetes mellitus: A prospective study and meta-analysis. Arch Int Med 2012; 172: 1285-1295
• 51 Smart N. Exercise training for heart failure patients with and without systolic dysfunction: An evidence–based analysis how patients benefit. Cardiol Res Pract 2010; doi: 10.4061/2011/837238
• 52 Steindorf K, Schmidt M, Ulrich C. Welche Effekte hat körperliche Bewegung auf das Krebsrisiko und den Krankheitsverlauf nach einer Krebsdiagnose?. Bundesgesundheitsbl 2012; 55: 10-16
• 53 Steindorf K, Ritte R, Eomois PP et al. Physical activity and risk of breast cancer overall and by hormone receptor status: The European Prospective Investigation into Cancer and Nutrition. Int J Cancer 2013; 132: 1667-1678
• 54 Stoller O, de Brun ED, Knols RH et al. Effects of cardiovascular exercise early after stroke: systematic review and metaanalysis. BMC Neurol 2012; 12: 45-61
• 55 Vina J, Sanchis-Gomar F, Maretinez-Bello V et al. Exercise acts as a drug; the pharmacological benefits of exercise. Br J Pharmacol 2012; 167: 1-12