Aktiv Sundhed. 14 years younger as a result of a healthy lifestyle. Yearly number of deaths related to different risk factors

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1 Aktiv Sundhed Basis Science Molecule Cell Animal Yearly number of deaths related to different risk factors Public Health Education Media Change of Praxis Inactivity Cancer Patient Other Diabetes Diseases Cardiopulmonary diseases Field Activities Municipality Hospital Human Integrative Physiology Smoking Short education Physical inactivity Alcohol High blood pressure Too little fruit and veg. Too much saturated fat Work-related diseases Passive smoking Home & leisure time Seldom meets family Psychosocial workload Overweight Drug abuse No help from others Traffic accidents Unsafe sex Occupational accidents years younger as a result of a healthy lifestyle Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC Norfolk Prospective Population Study PLOS Med 2008; Jan 8; 5(1) 1

2 3 2,5 2 1,5 1 0,5 Higher mortality among drivers compared to conductors Drivers Conductors A reverse J shaperrelationship betweenamount of exercise and mortality risk 0 IHS IHD Death Død Morris, J.N., Heady, J.A., Raffle, P.A.B., Roberts, C.G., and Parks, J.W., Coronary heart disease and physical activity of work. Lancet 265, JAMA Intern Med Jun;175(6): doi: /jamainternmed Leisure time physical activity and mortality: a detailed pooled analysis of the dose response relationship. Arem H 1, Moore SC 1, Patel A 2, Hartge P 1, Berrington de Gonzalez A 1, Visvanathan K 3, Campbell PT 2, Freedman M 1, Weiderpass E 4, Adami HO 5, Linet MS 1, Lee IM 6, Matthews CE 1 Physically inactive people have a life span which is 5 years shorter than physically active (Juel et al, 2006). Diseasome of Physical Inactivity Breast cancer Colon cancer Type 2 diabetes Cardiovascular Diseases Depression Pedersen BK. J.Physiology 2009 Dementia 2

3 Fysisk Træning og Sygdom More capillaries Untrained Trained More mitochondria Fat burning capacity 3

4 h 6h 9h 24h More than genes are regulated by exercise in the muscle 1,004 unique exercise regulated phosphosites on 562 proteins in muscle Upregulation Down-regulation Cell Metabolism 22, ; November 3, 2015 TNF Benatti F & Pedersen BK. Nature Rev Rheum 2015 Feb;11(2):

5 Pedersen BK and Febbrario MA, Nature Rev Endocrinol Apr 3;8(8): TNF Pedersen BK, Febbraio M, Physiol Reviews 2008 Benatti F & Pedersen BK. Nature Rev Rheum 2015 Feb;11(2):

6 Is irisin an exercise pill Boström P1, Wu J, Jedrychowski MP, Korde A, Ye L, Lo JC, Rasbach KA, Boström EA, Choi JH, Long JZ, Kajimura S, Zingaretti MC, Vind BF, Tu H, Cinti S, Højlund K, Gygi SP, Spiegelman BMA PGC1 α dependent myokine that drives brown fat like development of white fat and thermogenesis. Nature Jan 11;481(7382): Anticancer Effects of Myokines. Lucia A, Ramírez M. N Engl J Med 2016;375: Basis Science Molecule Cell Animal Inactivity Cancer Public Health Education Media Change of Praxis Other Diseases Patient Diabetes Human Integrative Physiology Cardiopulmonary diseases Field Activities Municipality Hospital 6

7 Healthy young males declined number of daily steps from to1.500 for 14 days. Man bliver 30 år ældre, hvis man ligger 3 uger i sengen Olsen et al JAMA 2008 Fitness Fitness 25,8 25,7 25,6 25,5 25,4 25,3 25,2 7% Before After Body Weight weight 25, ,9 Vo2max 70,4 70, ,8 1.2 kg 69,6 69,4 Before After 69, ,8 68,6 Body Weight Total Total Fat free Muscle Mass Total Fat Mass Total Fat Mass 55 54,8 54,6 54,4 54, ,8 53,6 53,4 53,2 53 Total Muscle Mass 1.2 kg Before After Total Fat mass Before After 7

8 HO OH HO O OH OH Oral Fat Tolerance Test Oral Glucose Tolerance Test OFTT - p-tag Plasma Insulin Konc. [m icrom ol/l] 2500, , , ,00 500,00 0, Preinactivity time [hours] Postinactivity pmol/l 600,00 500,00 400,00 300,00 200,00 100,00 0, Tim e (m in) OGTT before OGTT after Euglycemic Insulin clamp (GIR) Physical inactivity reduces insulin stimulated peripheral glucose uptake Before Basal glucose uptake Basal Insulin stimulated glucose uptake AUC min mg/kg/min After µmol/kg/min µmol/kg * pre post min 5 0 Pre Post Ra Rd Pre Post ptyir 0h 1h 4h 0h 1h 4h Ins Ins Ins Ins Pre Post IRS-1 tyr P P tyr pakt AKT P Total Akt i Glucose AS160 0h 1h 4h 0h 1h 4h AS160 P Visceral Total Fat Fat Mass 7 7% % GLUT4 Decrease Increase Before After Pre Post 550 pas160 0h 1h 4h 0h 1h 4h 500 Abdominal fat 8

9 MR scanning demonstrating visceral fat mass before and after 14 days of reduced daily stepping and 1.2 kg of weight loss Before After Impaired glucose uptake Impaired insulin signalling Hyperlipidemia Loss of muscle mass and fitness Increased visceral fat mass Sedentary behavour is associated with cognitive impairment Physical activity decreases the risk of dementia Br J Sports Med May 6. pii: bjsports doi: /bjsports [Epub ahead of print] What is the association between sedentary behaviour and cognitive function A systematic review. Falck RS 1, Davis JC 1, Liu Ambrose T 2. Aarsland D, Sardahaee FS, Anderssen S, Ballard C; Alzheimer's Society Systematic Review group. Aging Ment Health May;14(4): Review. 54 9

10 Regular physical exercise, including sport activities Andel R et al 1: J Gerontol A Biol Sci Med Sci Jan;63(1):62 6 Regular physical exercise, including sport activities Andel R et al 1: J Gerontol A Biol Sci Med Sci Jan;63(1): ,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0 None Light 1 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0 None Regular Positive correlation between fitness and cognitive function in the elderly My grandmother started walking five miles a day when she was sixty. She's ninety three today and we don't know where the hell she is. Rember to walk, while you can still remember to walk 10

11 Swedish men born in 1950 through 1976 who were enlisted for military service at age 18 (N = 1,221,727). Of these, 268,496 were full sibling pairs, 3,147 twin pairs, and 1,432 monozygotic twin pairs. Betaendorfin Noradrenalin Serotonin Dopamin BDNF BDNF is a growh factor for hippocampus BDNF is a growh factor for hippocampus CERE HIPPO BRAIN/CORTEX 200 BDNF mrna Pre 0h 2h 6h 24h 11

12 Hippocampus volume increases with exercise Pajonk FG, Wobrock T, Gruber O, Scherk H, Berner D, Kaizl I, et al. Hippocampal plasticity in response to exercise in schizophrenia. Arch Gen Psychiatry 2010 Feb;67(2): jeg husker den første dag, hvor jeg får udgangstilladelse. Det er en meget, meget varm dag. Jeg går op ad Nordre Fasanvej, og så er det, at jeg hører musik. På denne stillestående varme sommersøndag eftermiddag, hører jeg pludselig, at nogen spiller Rock Around The Clock Tonight: One, two three o`clock, four o`clock rock.. Jeg går efter musikken. Gennem et vindue ser jeg så dette hold af kvinder, der danser til musikken. Klædt i pink, gul, koboltblå i virkeligheden meget stærkere farver end jeg kunne tåle. Men jeg var draget. Det var kvinder på min alder eller yngre eller ældre, som dyrkede aerobics for fuld udblæsning. Og så var det, jeg vidste, at det var det, jeg skulle. Så du begynder at gå i fitness center 12

13 Ja, jeg dyrker hård konditionstræning i form af aerobics. Ikke 1 time ad gangen, men to timer i træk. Hver dag. Og ofte både formiddag og eftermiddag. Og hvad sker der forsvinder depressionen og tvangstankerne, mens du laver aerobics Joggers high Nej, slet ikke. Jeg kan have de forfærdeligste tanker, mens jeg hopper rundt. Det er bagefter det sker. Når jeg rigtigt har svedt og bagefter står under bruseren og senere smører min krop ind i lotion, så er det, at jeg får denne utrolige følelse af velvære. Desværre varer denne følelse ikke ved særlig længe. Men det er dette kick af velvære og nydelse, som jeg stræber efter. Betaendorfin Noradrenalin Serotonin Dopamin BDNF 13

14 Betaendorfin Noradrenalin Serotonin Dopamin BDNF Betaendorfin Noradrenalin Serotonin Dopamin BDNF 3 weeks of bed rest had a more profound impact on physical work capacity than did 3 decades of aging 14

15 The vicious cycle of chronic inflammation TNF Benatti, F. B. & Pedersen, B. K. (2014) Exercise as an anti-inflammatory therapy for rheumatic diseases myokine regulation Nat. Rev. Rheumatol. doi: /nrrheum Benatti F & Pedersen BK. Nature Rev Rheum 2015 Feb;11(2):86 97 Breast cancer Type 2 diabetes Cardiovascular Diseases Basis Science Molecule Cell Animal Inactivity Cancer Public Health Education Media Change of Praxis Other Diseases Patient Diabetes Human Integrative Physiology Colon cancer Depression Cardiopulmonary diseases Field Activities Municipality Hospital Dementia 15

16 5 sessions across 12-months blinded target-driven therapy + 6 x 60 min/week Partially supervised Initital adjustment 6-12 weeks 64 T2D 3 individual sessions with dietician 24 group sessions with dietician sessions across 12-months blinded target-driven therapy Glycemic control by time Intensificaton of hypoglycemic therapy Hemoglobin A1c (mmol/mol) Intention-to-treat (Primary outcome) StC U-TURN Months No. of patients U-TURN Standard care Proportions (%) Months 11 % in U-TURN And 44 % in Stc StC U- TURN Total Reductions in hypoglycemic medications Discontinuation hypoglycemic medications Reductions in Anti-diabetec medications (Key Secondary outcome) 74 % in U-TURN and 27 % in StC 56 % in U-TURN and 14 % in StC Proportion (%) Numbers-needed-to-treat = 2.1 U- TURN StC Proportion (%) Numbers-needed-to-treat = 2.5 U- TURN StC Months No. of patients U-TURN Months Standard care Total

17 Is there a cure for Type 2 diabetes What would it take to determine if lifestyle is a cure 98 What would it take to determine if lifestyle is a cure Development of a less ressourcedemanding intervention Volume Intensity Supervision Hard end-point such as micro- and macrovascular composites Mortality 99 Cykling til arbejde frem for passiv transport hænger sammen med mindre risiko for kræft, hjertesygdom og tidlig død. 40 procent mindre risiko for at dø 45 procent mindre risiko for at udvikle kræft 46 procent mindre risiko for at få hjertekar-sygdomme Cykling giver gode vaner Halvdelen svarer, at de er begyndt at spise sundere. En tredjedel drikker mindre alkohol En femtedel ryger mindre end før Halvdelen føler sig mindre stressede, mindre syge og i bedre humør Association between active commuting and incident cardiovascular disease, cancer, and mortality: prospective cohort study BMJ 2017; 357 doi: bmj.j1456 (Published 19 April 2017)Cite this as: BMJ 2017;357:j

18 Tætbefolket gangbar 18

19 Restauranter Interessant 19

20 COMFORTABLE Tilgængelighed Synlighed Variation er vigtige eksterne faktorer, når det gælder vores fysiske aktivitets niveau i dagligdagen. 20

21 Hvad kendetegner de kulturer, hvor man bliver meget gammel Livslang fysisk aktivitet At man har en mening med livet At man arbejder, også i høj alder, At man spiser en grøn kost, der ikke er industriforarbejdet, 21

22 At man ikke spiser for meget At man hører til i et fællesskab. KRAM faktorerne går igen, men der er meget mere TRYGFONDENS CENTER FOR AKTIV SUNDHED (CENTRE FOR PHYSICAL ACTIVITY RESEARCH) CORE FACILITIES ADVISORY BOARD Allan Vaag, DK Frank Booth, US Fredrik Karpe, UK Julie Gehl, DK Mark Febbraio, AUS Mike Joyner, US Rudi Westendorp, NL/DK STEERING GROUP Bente Klarlund Pedersen Camilla Scheele Carsten Lundby Inge Holm Kristian Karstoft Mathias Ried-Larsen Pernille Højman Rikke Krogh-Madsen MANAGEMENT Bente Klarlund Pedersen Inge Holm ADMINISTRATION Inge Holm Emil Holm Toft Lene Winum Juul Marie Kvistgaard LABORATORY ANALYSES, TEST & TRAINING Stine Lundby Emilia Lüders Ida Holm Katja Kofoed Lene Foged Louise Seier Hansen Ninna Schiøler Hansen FIELD HUMAN BASIC ACTIVITIES INTEGRATIVE SCIENCE PHYSIOLOGY CANCER Pernille Højman Adrian Vaaben Anette Blom Nielsen Anita Herrstedt Anna Banck-Petersen Casper Simonsen Emi Adachi Fernandez Irene Cantarero-Villanueva Jesper F. Christensen Katrine S. Pedersen Marie Lund Bay Nicole Unterrrainer Nynne Nørgaard-Christensen Sabrina Wielsøe Sarah Thorsen Sine Rossen Sissal Sigmundsdóttir Djurhuus DIABETES Pathophysiology Helga Ellingsgaard Grit Elster Legård Julie Ballisager Louise Lehrskov-Schmidt Marie Henneberg Monika Korsager Larsen Natja Launbo Regitse Højgaard Christensen Sabrina Fagerlind Sarah Heywood Sidsel Seide METABOLIC FIELD RESEARCH Mathias Ried-Larsen Cecilie Fau Brinkløv Ida Kær Thorsen Kim Blond Laura Valentiner Louise Seier Hansen Mette Yun Johansen DIABETES Clinical/Applied Kristian Karstoft Christina Petersen-Bønding Ida Elkjær Katja Hansen Katrine Bagge Hansen Nanna Skytt Pilmark CARDIOPULMONARY DISEASES Carsten Lundby Anders R. Rinnov Camilla Ryrsø Christoph Siebenmann Laura Oberholzer Ulrik W. Iepsen PHYSICAL INACTIVITY AND OTHER DISEASES Rikke Krogh-Madsen Anne-Sophie Wedell-Neergaard Peter Plomgaard CELL MODELS Søren Nielsen Camilla Scheele Birgitte Lindegaard Cecilie Nandrup-Bus Elaf Al-Saoudi Julie Abildgaard Lone Peijs Mai Charlotte Krogh Maren Schrölkamp Michal Jensen Naja Zenius Ricardo Ribeiro Soares Susanna Søberg Therese Juhlin Larsen Tora Henriksen Verena Hirschberg Jensen PUBLIC HEALTH, EDUCATION, MEDIA, CHANGE OF PRAXIS Updated Sept 26, 2017 By September 1st