Exercise and Physical Activity in Prevention Treatment of

Exercise and Physical Activity in Prevention & Treatment of Civilization Diseases Dr. Rainer Wieching MSc & Ph. D in Exercise Physiology

Background • Drugs are expensive together with negative Adverse Events • Prevention Exercise Training provides lifelong prevention for the most important „Civilization Diseases“ • Exercise as Medicine (!) with many positive Side Effects • Treatment Evidence Based Medicine proofs a Relative Risk Reduction even better than Drug Treatment

Dyslipidemia Elevated triglycerides, Low HDL-C concentrations, High LDL-C concentrations, = independent risk factors for CAD • Drugs -22% • Exercise -35% Relative Risk Reduction (CV Events) due to Statins… Relative Risk Reduction (CV Events) due to Exercise… Treating to New Targets (TNT) Investigators. Intensive Lipid Lowering with Atorvastatin in Patients with Stable Coronary Disease. N Engl J Med 2005; 352: 1425 -1435. AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update. Circulation 2006; 113; 2363 -2372.

Obesity • Elevated BMI and Waist Circumference, • Independent Predictor of CAD disease, • Increased Incidence of Metabolic Syndrome • Drugs -24% • Exercise -22% Relative Risk Reduction (CV Death) due to Rimonabant… Relative Risk Reduction (Death) due to Exercise… Rimonabant, for Management of Obesity. Circulation 2006; 114; 974 -984. Trends in 10 -Year Predicted Risk of Cardiovascular Disease in the United States, 1976 to 2004. Circ Cardiovasc Qual Outcomes 2009; 2; 443 -450.

Diabetes Directly Associated with CAD, Severe End Organ Damages, Bad Prognosis & High Death Rates, Strongly Growing Incidence Worldwide. • Drugs -36% • Exercise -58% Relative Risk Reduction (Mortality) due to Metformin… Relative Risk Reduction (Incidence) due to Exercise… UK Prospective Diabetes Study Group. (UKPDS 34). Lancet 1998; 352: 854 -65. Diabetes Prevention Program Research Group. N Engl J Med 2002; 346: 393– 403.

Hypertension Independent Risk Factor, of Coronary Artery Disease, Severe End Organ Damages, Globally Important Epidemic, Silent Disease (no pain). • Drugs -66% • Exercise -50% Relative Risk Reduction (Incidence) due to Candesartan… Relative Risk Reduction (Incidence) due to Exercise… Trial of Preventing Hypertension (TROPHY) Study Investigators. N Engl J Med 2006; 354 (16) 1685 -97. Exercise and hypertension. Journal of Human Hypertension 2005; 19, 585– 587.

CAD (incl. MI) High Incidence in Western Countries, Angina, Myocardial Infarction, High Mortality Rates, Worldwide. • Drugs -15% • Exercise -27% Relative Risk Reduction (Mortality) due to Eplerenone… Relative Risk Reduction (Mortality) due to Exercise… Eplerenone … in Patients with LV Dysfunction after Myocardial Infarction. N Engl J Med 2003; 348: 1309 -1321. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2001; (1): CD 001800.

Heart Failure Bad Prognosis, High Mortality Rates, High Hospitalizations Rates, Disease of the Elderly. • Drugs -34% • Exercise -35% Relative Risk Reduction (Mortality) due to Concor. COR… Relative Risk Reduction (Mortality) due to Exercise… CIBIS II Investigators and Comittees. Lancet 1999; 353: 9 -13. Exercise training meta-analysis of trials in patients with chronic heart failure (Ex. Tra. MATCH). BMJ 2004; 328: 189 -92.

PAOD Peripheral Claudication, Arterial Occlusive Disease, High Amputation Rates, Associated with CAD, Low Quality of Life. • Drugs +30% • Exercise +179% Pain Free Walking Distance due to Pentoxiphylline… Pain Free Walking Distance due to Exercise… A comparison of cilostazol and pentoxifylline for treating intermittent claudication. Am J Med. 2000 Nov; 109(7): 523 -30. Exercise rehabilitation programs for the treatment of claudication pain: a meta-analysis. JAMA. 1995; 274: 975– 980.

Breast Cancer Very Serious Disease, High Mortality Rates, Psychological Involving, Genetic Predisposition, Bad Prognosis. • Drugs -34% • Exercise -40% Relative Risk Reduction (OS) due to Herceptin… Relative Risk Reduction (Death) due to Exercise… The Herceptin Adjuvant (HERA) Trial. N Engl J Med 2005; 353: 1659 -72. Physical Activity and Survival after Breast Cancer Diagnosis. JAMA. 2005; 293: 2479 -2486.

Colon Cancer Very Serious Disease, High Mortality Rates, High Incidence, Bad Prognosis. • Drugs -15% • Exercise -50% Relative Risk Reduction (PFS) due to Erbitux… Relative Risk Reduction (Death) due to Exercise… The CRYSTAL Trial. N Engl J Med 2009; 360: 1408 -17. Physical Activity and Survival after Colorectal Cancer Diagnosis. J Cli Onc 2006; 24(22): 3527 -3534.

Lung Cancer Very Serious Disease, High Mortality Rates, High Incidence, Bad Prognosis. • Drugs -13% • Exercise -39% Relative Risk Reduction (OS) due to Erbitux… Relative Risk Reduction (Incidence) due to Exercise… The FLEX Trial. Lancet 2009; 373: 1525 -31. Physical Activity and Risk of Lung Cancer. Int J Epidemiol 1999; 28: 620 -625.

Stroke (TIA) Growing Incidence Worldwide, High Rates of Disabilities, High Mortality Rates, Families Involved. • Drugs -30% • Exercise -27% Relative Risk Reduction (of Stroke) due to Antiplatelet Drugs… Relative Risk Reduction (of Stroke) due to Exercise… Antithrombotic Trialists' Collaboration. BMJ 2002; 324: 71 -86. Physical activity and stroke risk: a meta-analysis. Stroke. 2003; 34(10): 2475 -81.

Alzheimer Growing Incidence Worldwide, Families Seriously Involved, Bad Prognosis, Low Mortality. • Drugs -24% • Exercise -62% Risk Reduction due to NSAID Treatment… Risk Reduction (of Alzheimer‘s Disease) due to Exercise… Protective effects of NSAIDs on the development of Alzheimer disease. Neurology 2008; 70(19): 1672– 1677. Physical activity and the risk of Alzheimer’s disease. Lancet Neurol 2005; 4: 705– 11.

Depression Strongly Growing Incidence Families Seriously Involved Very High Mortality Rates Suicides & Death • Drugs -33% • Exercise -45% Relative Risk Reduction due to Trevilor… Prevalence of Symptoms Reduction due to Exercise… Venlafaxine for Major Depression. BMJ 2007; 334: 215 -6. Exercise … in the Treatment of Major Depressive Disorder. Psychosomatic Medicine 2007; 69: 587– 596.

COPD Stable Incidence Intermediate Mortality Rates Exercise Capacity Important Bad Prognosis • Drugs -12% • Exercise -55% Relative Risk Reduction (Mortality) due to Drug Treatment… Relative Risk Reduction (Mortality) due to Exercise… Salmeterol and Fluticasone Propionate and Survival in COPD. N Engl J Med 2007; 356: 775 -89. Respiratory rehabilitation after … COPD … – a systematic review. Respiratory Research 2005, 6: 54.

Summary

Conclusion • Drugs • Exercise Serious Adverse Events Positive Side Effects Very High Costs Low Costs => Depression & Fatigue => Active & Well Being…