Präsentation - Swiss Family Docs Conference • Home

Sportpyramidewie viel Sport für wen?
Matthias Wilhelm
Kardiovaskuläre Prävention,
Rehabilitation & Sportmedizin
Schweizer Herz- und Gefässzentrum
“Striding bipedalism is a key derived
behaviour of hominids that possibly
originated soon after the divergence
of the chimpanzee and human
lineages.
The fossil evidence of these features
suggests that endurance running is
a derived capability of the genus
Homo, originating about 2 million
years ago, and may have been
instrumental in the evolution of the
human body form.”
Evolution
Hippokrates 460-370 v. Chr.
«Wenn wir jedem
Individuum
das richtige Mass an
Nahrung und Bewegung
zukommen lassen
könnten, hätten wir den
sichersten Weg zur
Gesundheit gefunden.»
Studie mit dem Personal von
Doppeldeckerbussen in London:
Die Mortalität von Kontrolleuren
war 50% niedriger im Vergleich zu
Chauffeuren.
Morris, Lancet 1953
6213 Männer,
59±11 Jahre
klinische Indikation zum
Belastungstest
6.2±3.7 Jahre Follow-Up
Wer fit ist lebt länger.
n=2534
n=3679
Grundlage Training und Leistungssteigerung
Leistungsfähigkeit
Trainingsreiz
Trainingsreiz
Trainingsreiz
zu früh
Trainingsreiz
zu spät
Superkompensation
FITT
F – Frequency (how often?)
Ermüdung
Wiederherstellung
I – Intensity (how hard?)
T – Time (how long?)
T – Type (what type?)
ACSM Guidelines for Exercise Testing and Prescription, 2010
Zeit
“Activity pyramid”
different views
Muskelanspannungsarten
Statisch
isometrisch
Dynamisch
isotonisch
Konzentrisch (Verkürzung)
Exzentrisch
(Verlängerung)
Aerob/anaerob
(>20-30% MVC)
Aerob/anaerob
Differences between resistance and endurance activities
and impact on the cardiovascular response
Dynamic
Static
VO2
CO
HR
SV
Definition of training zones
Heart rate and rate of perceived exertion
Zone I
«light PA»
Aerobic threshold
65-75 (80)% HRmax
Zone II
«moderate PA»
Anaerobic threshold
Zone III
«vigorous PA»
85-95% HRmax
Med. Sci. Sports Exerc. 2001;33:S484–S492
Med. Sci. Sports Exerc., Vol. 40, No. 11, pp. 1863–1872, 2008.
Control Low intensity High intensity
training
training
Control Low intensity High intensity
training
training
Vorteile des Krafttrainings
• Belastung der Gelenke 
• Verletzungsgefahr  (diabetischer Fuß)
• Trainingsmöglichkeiten 
bei reduziertem VO2max
• erforderliche koordinative Fähigkeiten 
(diabetische Polyneuropathie)
• supportiv bei der Gewichtsreduktion
(abdominales Fett , Muskelmasse ,
Grundumsatz )
Spezielle Risiken von Krafttraining
• Übermässiger Blutdruckanstieg
Vermeidung Valsalva
Nephropathie
(max RR<180 mmHg)
Retinopathie
(RR Anstieg max 30 mmHg)
• Muskeltrauma
Korrekte Durchführung
der Übungen
Trainingsmaschinen
Formen des Krafttrainings
InnervationHypertrophie
130-150%
110%
100%
85%
Intramuskuläre Koordination
Fmax
Training des Muskelquerschnitts
70%
Pmax
Training der Schnellkraft
30%
Training der Schnelligkeit
Vmax
0%
Exzentrisch
100%
Konzentrisch
Implementation of resistance training
Chest press
Endurance
Hypertrophy
Innervation
Quadriceps ext.
1 set, 8 to 12 (10 to 15) repetitions,
8 to 10 exercises, 2 times a week
1+2
6
3
7
8
4
5
9
10
Exercise capacity in heart failure patients
Anemia
LV Dysfunction
Muscular deconditioning
Wassermann, Principles of Exercise Testing, 2005
Fletcher, Circulation 2001;104:1694-1740
Exercise test mandatory:
• Determination of exercise
capacity
• Peak heart rate response
• Exercise induced arrhythmias
• Training recommendations
• Patient reassurance
Low (I)
Low (I)
Moderate (II)
Cardiopulmonary
Exercise Test
definition of training zones in
heart failure patients
VO2
VCO2
HR
Watt
aerobic threshold
anaerobic threshold
Zone I
Aerobic
capacity
Zone II
Lactate
metabolism
Zone III
Anaerobic
capacity
High Intensity Interval Training in CHF Patients
Interval
Watt
>AnS
Zone III
(4’)
Watt
>AnS
Zone III
(4’)
Watt
>AnS
Zone III
(4’)
Watt
>AnS
Zone III
(4’)
Cool-down
Watt<AeS
Zone I (5’)
Interval
Active pause
Watt<AeS
Zone I (3’)
Interval
Active pause
Watt<AeS
Zone I (3’)
Interval
Active pause
Watt<AeS
Zone I (3’)
Warm-up
Watt<AeS
Zone I (10’)
modified from Wisloff et al. Circulation 2007
CW, male, 65 years
STEMI, EF 20%->40%, NYHA II
AeT: 57 Watt (HR 82/min)
AnT: 117 Watt (HR100/min)
AnT
AeT
27 patients with CAD post MI
Mean age 76 years,
EF 29%, VO2peak 13 ml/min/kg
Frequency:
3x/week
Intensity:
90-95%/50-70% HRmax vs.
70-75% HRmax, isocaloric
Circulation 2007; 115:3086
Concepts for long-term physical activity in CHF patients
Lessons to learn from athletes
Home-based training
low-to-moderate intensity
exercise sessions (2+/week)
Supervised training
high intensity exercise
session (1/week)
Case report: female marathon runner (51 y)
with CAD (PCI RCA) and Type 1 diabetes
VO2peak 44.5 ml/min/kg
(197% of pred.)
Case report: female marathon runner (51 y)
with CAD (PCI RCA) and Type 1 diabetes
Sudden cardiac arrest 10 min. after exercise
AED
1st shock
2nd shock
Stable sinus rhythm after 4 minutes
Intervention:
• Weight loss
• goal -10% (mean -7%)
• Meal replacement products
• Pyhsical activity increase
• 175 min/week moderate intensity
• 10,000 steps per day
• Lifestyle councelling sessions
• Month 1-6: 4/week
• Month 7-12: 3/month
• Year 2+: individual 1/month
2-3 yearly group classes
Medication adjustments by the
patients’ health care provider
Primary end point:
composite outcome
including death from
cardiovascular
causes, nonfatal
myocardial infarction,
nonfatal stroke, and
hospitalization for
angina.
Fitness =
adherence to PA goals
Statin use = Potent CV
mortality reduction
Wichtiges Ziel «Motivation aufrechterhalten»
Take home message
150-300 min moderat (Zone II) oder
60-150 min intensiv (Zone II/III),
mindestens 10 min Dauer
(Herzpatient ≥3x30 min moderat)
1 Satz, 8-12 Wiederholungen,
10 Übungen Beine-Rumpf-Arme
(Herzpatienten 10-15 Wiederh.)