Baustein Bewegung: Welche Empfehlungen sind sinnvoll im Rahmen eines Rauchstopp-Programmes?

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1 Baustein Bewegung: Welche Empfehlungen sind sinnvoll im Rahmen eines Rauchstopp-Programmes? Christine Graf Institut für Bewegungs- und Neurowissenschaft

2 Das kommt postprandial auf Sie zu... Nutzen von Bewegung Allgemeine Empfehlungen Spezielle Aspekte im Kontext Rauchen

3 ... Allgemein Bewegung... Prävention kardiovaskulärer Risikofaktoren bzw. sonstiger Erkrankungen (und Reha) Verbesserung der motorischen Leistungsfähigkeit/Fitness Verbesserung der kognitiven Leistungsfähigkeit Unfallprävention Steigerung des Selbstwertgefühls*/der sozialen Kompetenz etc. Suchtprävention** Tremblay et al. Appl Physiol Nutr Metab. 2011;36:36-46; Graf et al. Obesity facts 2014;7(3): * Ekeland et al. Cochrane Database 2004 (3 20J. N=1821) ** Rodriguez Garcia et al. Arch Argent Pediatr. 2014;112:12-8 (n=344; 14 bis 17 Jahre)

4 Schutzfaktor Fitness Biomarker der Sportmedizin Myers J et al. N Engl. J Med. 2002;345:

5 Naci & Ioannidis - BMJ 2013;347:f5577 Institut für Bewegungs- und Neurowissenschaft Metaepidemiologische Studie

6 SPORT/BEWEGUNG ZUR UNTERSTÜTZUNG?

7 Haasova et al. Addiction 2013 Jan;108:26ff. Institut für Bewegungs- und Neurowissenschaft Reduziert das Verlangen zu Rauchen (19 Studien) Study ID Ussher et al.2001 Daniel et al.2004 Taylor et al.2005 Daniel et al.2006 Katomeri & Taylor 2006 Ussher et al.2006 Taylor et al.2007 Janse Van Rensburg et al.2008 Janse Van Rensburg et al.2009a Janse Van Rensburg et al.2009b Thompson 2009 Faulkner et al.2010 Scerbo et al.2010 Haasova et al.2011 Oh & Taylor 2011 Janse Van Rensburg et al Janse Van Rensburg (in preparation) Overall (I-squared = 92.0%, p = 0.000) ES (95% CI) % Weight (-4.76, -3.79) (-2.10, -0.84) (-4.60, -2.84) (-3.43, -1.96) (-3.90, -2.71) (-0.82, 0.27) (-3.46, -1.84) (-1.74, -0.56) (-2.75, -0.79) (-2.91, -1.06) (-2.52, -0.81) (-2.14, -0.67) (-2.49, -1.34) (-1.30, -0.31) (-2.10, -1.18) (-3.15, -1.49) (-2.68, -0.54) (-2.60, -1.46) Punkt-Likert-Skala Sportarten (vor, nach, nach 5min) Moderates Walking Laufen Radfahren (alle Int.) Isometrisches KT Intensität gesteuert über BORG oder HF NOTE: Weights are from random effects analysis

8 Haasova et al. Addiction 2013 Jan;108:26ff. Institut für Bewegungs- und Neurowissenschaft Reduziert die Stärke des Verlangens Study ID % ES (95% CI) Weight Ussher et al.2001 Daniel et al.2004 Taylor et al.2005 Daniel et al.2006 Katomeri & Taylor 2006 Ussher et al.2006 Taylor et al.2007 Everson et al.2008 Thompson 2009 Ussher et al.2009 Faulkner et al.2010 Scerbo et al.2010 Haasova et al.2011 Oh & Taylor 2011 Janse Van Rensburg et al Overall (I-squared = 94.2%, p = 0.000) (-5.00, -4.09) (-1.63, -0.24) (-4.45, -2.85) (-3.33, -1.81) (-3.79, -2.73) (-1.13, 0.02) (-2.99, -1.37) (-2.42, -0.42) (-2.39, -1.08) (-1.03, 0.58) (-1.83, -0.38) (-2.61, -1.27) (-1.41, -0.47) (-2.13, -1.18) (-2.65, -0.91) (-2.59, -1.22) NOTE: Weights are from random effects analysis

9 Bewegung und Gewicht nach Rauchstopp Interventions for preventing weight gain after smoking cessation (Review) Farley AC, Hajek P, Lycett D, Aveyard P Comparison 8. Exercise interventions versus no exercise for smoking cessation: weight change Outcome or subgroup title No. of studies No. of participants Statistical method Effect size 1 Mean weight change (kg) at end of treatment 1.1 Exercise + SC versus SC only 2 Mean weight change (kg) at 12 months 2.1 Exercise + SC versus SC only Mean Difference (IV, Fixed, 95% CI) [-0.78, 0.29] Mean Difference (IV, Fixed, 95% CI) [-0.78, 0.29] Mean Difference (IV, Fixed, 95% CI) [-3.78, -0.36] Mean Difference (IV, Fixed, 95% CI) [-3.78, -0.36] -2 kg Cochrane Database Syst Rev Jan 18;1:CD006219

10 Exercise interventions for smoking cessation (Review) Ussher MH, Taylor AH, Faulkner GEJ Exercise interventions for smoking cessation Population: People who smoke or people who have recently quit smoking Intervention: Exercise programmes alone or as adjuncts to smoking cessation programmes Comparison: Smoking cessation programmes without exercise components Outcomes Effects of exercise interventions for smoking cessation No of Participants (studies) Quality of the evidence (GRADE) Smoking cessation at longest follow-up (6+ months) At longest follow-up, one study detected a difference of borderline significance in favour of the intervention group. Another study reported significantly higher abstinence rates at six month follow-up for a combined exercise and smoking cessation programme compared with brief smoking cessation advice, but not when compared to the full smoking cessation programme. No other studies detected a significant difference between intervention and comparison groups at longest follow-up 5870 (20 studies) very low 1 Cochrane Database Syst Rev Aug 29;8:CD002295

11 Postulierte Zusammenhänge Gesundheitlicher Nutzen (z.b. weniger Lungen-CA bei aktiven Ex-Rauchern) Reduziertes Verlangen Stärke des Verlangens nimmt ab... auch das Verlangen nach Süßigkeiten Möglicherweise Gewichtsstabilisierung Reduziert auch die Angst vor Gewichtszunahme Psychosoziale Aspekte (Steigerung des Selbstwertgefühls...) Neurobiologische Effekte, u.a. Endorphinspiegel Mod. aus Farley et al. Cochrane Database Syst Rev Jan 18;1:CD006219

12 Topical Review Article Between Inhale and Exhale: Yoga as an Intervention in Smoking Cessation Journal of Evidence-Based Complementary & Alternative Medicine 2014, Vol. 19(2) ª The Author(s) 2014 Reprints and permission: sagepub.com/journalspermissions.nav DOI: / cam.sagepub.com Chia-Liang Dai, MS 1 and Manoj Sharma, MBBS, MCHES, PhD, FAAHB 1 Abstract The current study provided a review of evidence-based yoga interventions impact on smoking cessation. The researchers reviewed articles obtained from MEDLINE (PubMed), EBSCOHOST, PROQUEST, MEDINDIA, CINAHL, Alt HealthWatch, and AMED databases. Inclusion criteria were as follows: (a) studypublishedbetween2004and2013,(b) studypublishedinenglish language, (c) study used yoga-based interventions, (d) study involved smokers with varying level of smoking, (e) study used any quantitative design,and (f) study had physiological and/or psychological outcomes. A total of 10 studies met the inclusion criteria. Designs were 2 pre post tests and 8 randomized controlled trials. Majority of the interventions were able to enhance quitting smoking rates in the participants under study. Yoga-based interventions hold promise for smoking cessation. Some of the limitations include short follow-up measurements and short duration of intervention.

13 Therapeutischer Start - FITT Prinzip Frequency à Ausdauer- & Krafttraining; aktiver Alltag!! Intensity à langsam beginnen knackig enden Time à plus 1 min; 1000 Schritte... u.a. in min Einheiten Type à Spaß! Mod. McInnis et al. Am Fam Physician 2003;67:1249ff. Jakicic et al. Med. Sci Sports Exerc 2001; 33:2145ff. Donnelly et al. Med. Sci Sports Exerc 2009; 41:459ff.; Fletcher et al. Circulation 2013; 128:873ff. Sharman et al. Am J Hypertens Feb;28(2):

14 Bravata et al. JAMA 2007; 298: 2298 ff. Institut für Bewegungs- und Neurowissenschaft Kleiner Helfer - Schrittzähler 26 Studien à + 26,9% Steigerung der Aktivität 2767 Beteiligte; mittlere Interventionsdauer 18 Wochen 85% Frauen 49 (9) Jahre alt 8 RCTs Outcome à BMI -0,38kg/m 2 ; BDsys 3,8 mmhg Ziel 10000/Tag

15 Gesundheitlicher Nutzen von Walking Table 3 Summary meta-analysis results table: difference between baseline and end of intervention Outcome measure n Effect 95% CIs Heterogeneity Test for overall effect Systolic BP (mm Hg) ( 5.28 to 2.17) χ 2 =12.02, df=12 (p=0.44); I²=0% z=4.70 (p<0.001) Diastolic BP (mm Hg) ( 4.15 to 2.13) χ 2 =23.16, df=12 (p=0.03); I²=48% z=6.09 (p<0.001) Resting HR (bpm) ( 4.13 to 1.64) χ 2 =2.96, df=7 (p=0.89); I²=0% z=4.53 (p<0.001) Body fat (%) ( 2.10 to 0.52) χ 2 =4.00, df=6 (p=0.68); I²=0% z=3.25 (p=0.001) Body mass index (kg/m 2 ) ( 1.19 to 0.23) χ 2 =5.52, df=11 (p=0.90); I²=0% z=2.92 (p=0.003) Total cholesterol (mmol/l) ( 0.22 to 0.01) χ 2 =12.58, df=9 (p=0.18); I²=28% z=2.13 (p=0.03) VO 2max (ml/kg/min) (1.67 to 3.65) χ 2 =9.67, df=6 (p=0.14); I²=38% z=5.28 (p<0.001) SF-36 score (physical functioning) (points) (0.51 to 11.53) χ 2 =0.26, df=1 (p=0.61); I²=0% z=2.14 (p=0.03) 6 min walk time (m) (53.37 to ) χ 2 =0.71, df=1 (p=0.40); I²=0%, z=5.95 (p 0.001) Depression score*(effect size) ( 0.97 to 0.38) χ 2 =24.14, df=4 (P 0.001); I²=83% z=4.44 (p 0.001) Waist circumference (cm) ( 8.08 to 0.98) χ 2 =0.52, df=1 (p=0.47); I²=0% z=1.54 (p=0.12) HbA1c (%) ( 0.25 to 0.03) χ 2 =1.17, df=3 (p=0.76); I²=0% z=1.53 (p=0.13) Fasting glucose (mmol/l) ( 0.28 to 0.11) χ 2 =3.33, df=4 (p=0.50); I²=0% z=0.87 (p=0.38) Low-density lipids (mmol/l) ( 0.16 to 0.06) χ 2 =8.83, df=9 (p=0.45); I²=0%, z=0.93 (p=0.35) High-density lipids (mmol/l) ( 0.04 to 0.07) χ 2 =8.04, df=8 (p=0.43); I²=0% z=0.45 (p=0.65) Triglycerides (mmol/l) ( 0.12 to 0.03) χ 2 =13.39, df=9 (p=0.15); I²=33% z=1.25 (p=0.21) SF-36 score (mental health index) (points) ( 2.09 to 7.48) χ 2 =0.18, df=1 (p=0.67); I²=0% z=1.10 (p=0.27) *All analyses fixed effects model and mean difference except depression score (effect is standardised mean difference). BP, blood pressure; HbA1c, glycated haemoglobin; HR, heart rate. 42 Studien; n = 1843 Hanson und Jones. Br J Sports Med Jan 19

16 Therapeutisches Ziel - FITT Prinzip Frequency à Ausdauer: 3 bis 5 Tage pro Woche 30 bis 60 min ; Krafttraining 2 bis 3 Tage pro Woche 30 bis 45 min Intensity à AT: 55 70% der HFmax oder 3 5 auf einer Skala von 0-10 à KT: 8 bis 10 verschiedene Übungen; 8 bis 12 Wiederholungen Time à Ziel 150 min!!! (bzw. 1000kcal/Woche Schritte/Tag) Type... immer noch Spaß! Mod. McInnis et al. Am Fam Physician 2003;67:1249ff. Jakicic et al. Med. Sci Sports Exerc 2001; 33:2145ff. Donnelly et al. Med. Sci Sports Exerc 2009; 41:459ff.; Fletcher et al. Circulation 2013; 128:873ff. Sharman et al. Am J Hypertens Feb;28(2):