AMSE
“VALUTAZIONE FUNZIONALE E PRESCRIZIONE DELL’ESERCIZIO
FISICO IN SOGGETTI PORTATORI DI PATOLOGIE CRONICHE”
Montecatini 10 Dicembre 2012
Prescrizione dell’esercizio fisico
nei soggetti affetti da patologie croniche:
una nuova frontiera per la Medicina dello Sport
GIORGIO GALANTI LAURA STEFANI
SCUOLA DI SPECIALIZZAZIONE DI MEDICINA DELLO SPORT
AGENZIA DI MEDICINA DELLO SPORT E DELL’ESERCIZIO
PERCHÉ L’ESERCIZIO?
PIRAMIDE DELLE ETÀ NEL 2050
60-85 anni
Europa
60-85 anni
Italia
THEORETICAL
RELATION BETWEEN
MUSCULOSKELETAL FITNESS AND INDEPENDENT
LIVING ACROSS A PERSON’S LIFESPAN
THE NORMAL AGE-ASSOCIATED
DECLINE IN
CARDIOVASCULAR PERFORMANCE
CMAJ • March 14, 2006; 174(6)
Ath
NAth
J Appl Physiol 82:1508-1516, 1997
 Necessario per lo stato di salute
 Riduce i rischi per molte malattie
 Favorisce la salute ed una buona
indipendenza nell’età avanzata
 Componente chiave nella gestione di
malattie croniche
RELATIONSHIP BETWEEN EXERCISE CAPACITY, EXPRESSED AS
METS, AND 1-YR TOTAL HEALTH CARE COSTS IN THE YEAR
FOLLOWING THE TREADMILL TEST.
WHO
DEFINITIONS
OF CONCEPTS USED IN THE
RECOMMENDED LEVELS OF PHYSICAL ACTIVITY
• TYPE
(WHAT TYPE). THE MODE OF
PARTICIPATION IN PHYSICAL ACTIVITY. THE TYPE OF PHYSICAL
ACTIVITY CAN TAKE MANY FORMS: AEROBIC, STRENGTH, FLEXIBILITY,
BALANCE.
• DURATION (FOR HOW LONG). THE LENGTH OF TIME IN WHICH AN
ACTIVITY OR EXERCISE IS PERFORMED. DURATION IS GENERALLY
EXPRESSED IN MINUTES.
• FREQUENCY (HOW OFTEN). THE NUMBER OF TIMES AN EXERCISE OR
ACTIVITY IS PERFORMED. FREQUENCY IS GENERALLY EXPRESSED IN
SESSIONS, EPISODES, OR BOUTS PER WEEK.
• INTENSITY (HOW HARD A PERSON WORKS TO DO THE ACTIVITY).
INTENSITY REFERS TO THE RATE AT WHICH THE ACTIVITY IS BEING
OF PHYSICAL ACTIVITY
PERFORMED OR THE MAGNITUDE OF THE EFFORT REQUIRED TO
PERFORM AN ACTIVITY OR EXERCISE.
VOLUME (HOW MUCH IN TOTAL). AEROBIC EXERCISE EXPOSURES CAN BE
CHARACTERIZED BY AN INTERACTION BETWEEN BOUT INTENSITY, FREQUENCY,
DURATION, AND LONGEVITY OF THE PROGRAMME. THE PRODUCT OF THESE
CHARACTERISTICS CAN BE THOUGHT OF AS VOLUME.
• MODERATE-INTENSITY PHYSICAL ACTIVITY. ON AN ABSOLUTE SCALE,
MODERATE
INTENSITY
PHYSICAL
ACTIVITY
. ON AN AT 3.0–5.9
MODERATE-INTENSITY
REFERS
TO ACTIVITY
THAT IS PERFORMED
TIMES THESCALE
INTENSITY
OF REST. ONINTENSITY
A SCALE RELATIVE
TO ANTO
INDIVIDUAL
’S
ABSOLUTE
, MODERATE
REFERS
ACTIVITY
PERSONAL CAPACITY, MODERATE-INTENSITY PHYSICAL ACTIVITY IS USUALLY A
THAT
IS6PERFORMED
AT 3.0–5.9 TIMES THE INTENSITY OF
5 OR
ON A SCALE OF 0–10.
REST
. ON A-INTENSITY
SCALE RELATIVE
TO AN .INDIVIDUAL
’SPERSONAL
• VIGOROUS
PHYSICAL ACTIVITY
ON AN ABSOLUTE
SCALE,
VIGOROUS
INTENSITY REFERS
TO ACTIVITY
THAT IS PERFORMED
AT 6.0
CAPACITY
, MODERATE
-INTENSITY
PHYSICAL
ACTIVITY
IS OR
MORE TIMES THE INTENSITY OF REST FOR ADULTS AND TYPICALLY 7.0 OR
USUALLY
A 5 OR 6 ON A SCALE OF 0–10.
MORE TIMES FOR CHILDREN AND YOUTH. ON A SCALE RELATIVE TO AN
INDIVIDUAL’S PERSONAL CAPACITY, VIGOROUSI NTENSITY PHYSICAL ACTIVITY
IS USUALLY A 7 OR 8 ON A SCALE OF 0–10.
• AEROBIC ACTIVITY. AEROBIC ACTIVITY, ALSO CALLED ENDURANCE ACTIVITY,
IMPROVES CARDIORESPIRATORY FITNESS. EXAMPLES OF AEROBIC ACTIVITY
INCLUDE: BRISK WALKING, RUNNING, BICYCLING, JUMPING ROPE, AND
SWIMMING.
•
SCALA DI PERCEZIONE DELLA FATICA
PUBLIC HEALTH SIGNIFICANCE
OF PHYSICAL ACTIVITY
 IT IS ESTIMATED CURRENTLY THAT OF EVERY 10
DEATHS, 6 ARE ATTRIBUTABLE TO NCDS
 PHYSICAL INACTIVITY IS ESTIMATED AS BEING THE
PRINCIPAL CAUSE FOR APPROXIMATELY 21–25% OF
BREAST AND COLON CANCER BURDEN, 27% OF
DIABETES AND APPROXIMATELY 30% OF ISCHAEMIC
HEART DISEASE BURDEN IN ADDITION, NCDS NOW
ACCOUNT FOR NEARLY HALF OF THE OVERALL GLOBAL
BURDEN OF DISEASE.
LEADING RISK FACTOR
FOR GLOBAL MORTALITY (%)
14
12
10
HBP
8
Tobacco
HBG
6
Obesity
4
Inactivity
2
0
HBP
Tobacco
HBG
Obesity Inactivity
GLOBAL RECOMMENDATIONS ON
PHYSICAL ACTIVITY FOR HEALTH
 CARDIORESPIRATORY HEALTH (CORONARY
HEART DISEASE, CARDIOVASCULAR , STROKE
AND HYPERTENSION)
 METABOLIC HEALTH (DIABETES AND OBESITY)
 MUSCULOSKELETAL HEALTH (BONE HEALTH,
OSTEOPOROSIS)
 CANCER (BREAST AND COLON CANCER)
 FUNCTIONAL HEALTH AND PREVENTION OF
FALLS
 DEPRESSION
 THESE GUIDELINES ARE RELEVANT TO ALL
HEALTHY ADULTS AGED 18–64 YEARS UNLESS
SPECIFIC MEDICAL CONDITIONS INDICATE TO THE
CONTRARY.
 PREGNANT, POSTPARTUM WOMEN AND PERSONS
WITH CARDIAC EVENTS MAY NEED TO TAKE EXTRA
PRECAUTIONS AND SEEK MEDICAL ADVICE BEFORE
STRIVING TO ACHIEVE THE RECOMMENDED LEVELS
OF PHYSICAL ACTIVITY FOR THIS AGE GROUP.
 INACTIVE ADULTS OR ADULTS WITH DISEASE
LIMITATIONS WILL HAVE ADDED HEALTH BENEFITS
IF MOVING FROM THE CATEGORY OF “NO
ACTIVITY” TO “SOME LEVELS” OF ACTIVITY.
 ADULTS AGED 65 YEARS AND ABOVE SHOULD DO AT LEAST 150 MINUTES OF
MODERATE-INTENSITY AEROBIC PHYSICAL ACTIVITY THROUGHOUT THE WEEK
OR DO AT LEAST 75 MINUTES OF VIGOROUS-INTENSITY AEROBIC PHYSICAL
ACTIVITY THROUGHOUT THE WEEK OR AN EQUIVALENT COMBINATION OF
MODERATE- AND VIGOROUSINTENSITY ACTIVITY.
 AEROBIC ACTIVITY SHOULD BE PERFORMED IN BOUTS OF AT LEAST 10
MINUTES DURATION.
 FOR ADDITIONAL HEALTH BENEFITS, ADULTS AGED 65 YEARS AND ABOVE
SHOULD INCREASE THEIR MODERATE INTENSITY AEROBIC PHYSICAL ACTIVITY
TO 300 MINUTES PER WEEK, OR ENGAGE IN 150 MINUTES OF VIGOROUS
INTENSITY AEROBIC PHYSICAL ACTIVITY PER WEEK, OR AN EQUIVALENT
COMBINATION OF MODERATE-AND VIGOROUS-INTENSITY ACTIVITY.
 ADULTS OF THIS AGE GROUP, WITH POOR MOBILITY, SHOULD PERFORM
PHYSICAL ACTIVITY TO ENHANCE BALANCE AND PREVENT FALLS ON 3 OR MORE
DAYS PER WEEK.
 MUSCLE-STRENGTHENING ACTIVITIES SHOULD BE DONE INVOLVING MAJOR
MUSCLE GROUPS, ON 2 OR MORE DAYS A WEEK.
 WHEN ADULTS OF THIS AGE GROUP CANNOT DO THE RECOMMENDED AMOUNTS
OF PHYSICAL ACTIVITY DUE TO HEALTH CONDITIONS, THEY SHOULD BE AS
PHYSICALLY ACTIVE AS THEIR ABILITIES AND CONDITIONS ALLOW.
 FOR ADULTS OF THIS AGE GROUP, PHYSICAL ACTIVITY INCLUDES
RECREATIONAL OR LEISURE-TIME PHYSICAL ACTIVITY, TRANSPORTATION (E.G
WALKING OR CYCLING), OCCUPATIONAL (I.E. WORK), HOUSEHOLD CHORES,
PLAY, GAMES, SPORTS OR PLANNED EXERCISE, IN THE CONTEXT OF DAILY,
FAMILY, AND COMMUNITY ACTIVITIES. IN ORDER TO IMPROVE
CARDIORESPIRATORY AND MUSCULAR FITNESS, BONE HEALTH AND REDUCE
THE RISK OF NCDS AND DEPRESSION THE FOLLOWING ARE RECOMMENDED:
1. ADULTS AGED 18–64 SHOULD DO AT LEAST 150 MINUTES OF MODERATEINTENSITY AEROBIC PHYSICAL ACTIVITY THROUGHOUT THE WEEK OR DO AT
LEAST 75 MINUTES OF VIGOROUS-INTENSITY AEROBIC PHYSICAL ACTIVITY
THROUGHOUT THE WEEK OR AN EQUIVALENT COMBINATION OF MODERATEAND VIGOROUS-INTENSITY ACTIVITY.
2. AEROBIC ACTIVITY SHOULD BE PERFORMED IN BOUTS OF AT LEAST 10
MINUTES DURATION.
3. FOR ADDITIONAL HEALTH BENEFITS, ADULTS SHOULD INCREASE THEIR
MODERATE-INTENSITY AEROBIC PHYSICAL ACTIVITY TO 300 MINUTES PER
WEEK, OR ENGAGE IN 150 MINUTES OF VIGOROUS-INTENSITY AEROBIC
PHYSICAL ACTIVITY PER WEEK, OR AN EQUIVALENT COMBINATION OF
MODERATE- AND VIGOROUS-INTENSITY ACTIVITY.
4. MUSCLE-STRENGTHENING ACTIVITIES SHOULD BE DONE INVOLVING MAJOR
MUSCLE GROUPS ON 2 OR MORE DAYS A WEEK.
 OVERALL, ACROSS ALL THE AGE GROUPS, THE


BENEFITS OF IMPLEMENTING THE ABOVE
RECOMMENDATIONS, AND OF BEING PHYSICALLY
ACTIVE, OUTWEIGH THE HARMS.
AT THE RECOMMENDED LEVEL OF 150 MINUTES PER
WEEK OF MODERATEINTENSITY ACTIVITY,
MUSCULOSKELETAL INJURY RATES APPEAR TO BE
UNCOMMON.
IN A POPULATION-BASED APPROACH, IN ORDER TO
DECREASE THE RISKS OF MUSCULOSKELETAL INJURIES,
IT WOULD BE APPROPRIATE TO ENCOURAGE A
MODERATE START WITH GRADUAL PROGRESS TO
HIGHER LEVELS OF PHYSICAL ACTIVITY.
AMSE
 NO STRATEGIES HAVE BEEN ADEQUATELY STUDIED TO
EVALUATE THEIR ABILITY TO REDUCE EXERCISE-RELATED
ACUTE CARDIOVASCULAR EVENTS.
 MAINTAINING PHYSICAL FITNESS THROUGH REGULAR
PHYSICAL ACTIVITY MAY HELP TO REDUCE EVENTS BECAUSE
A DISPROPORTIONATE NUMBER OF EVENTS OCCUR IN LEAST
PHYSICALLY ACTIVE SUBJECTS PERFORMING
UNACCUSTOMED PHYSICAL ACTIVITY.
 OTHER STRATEGIES, SUCH AS SCREENING PATIENTS BEFORE
PARTICIPATION IN EXERCISE, EXCLUDING HIGH-RISK
PATIENTS FROM CERTAIN ACTIVITIES, PROMPTLY
EVALUATING POSSIBLE PRODROMAL SYMPTOMS, TRAINING
FITNESS PERSONNEL FOR EMERGENCIES, AND ENCOURAGING
PATIENTS TO AVOID HIGH-RISK ACTIVITIES, APPEAR
PRUDENT BUT HAVE NOT BEEN SYSTEMATICALLY EVALUATED.
Physiological alterations accompanying acute
exercise and recovery and their possible sequelae.
THE FOCUS OF THE GLOBAL
RECOMMENDATIONS ON PHYSICAL
ACTIVITY FOR HEALTH IS PRIMARY
PREVENTION OF NCDS THROUGH
PHYSICAL ACTIVITY AT POPULATION
LEVEL
THE PRIMARY TARGET AUDIENCE
FOR THESE RECOMMENDATIONS ARE
POLICY-MAKERS AT NATIONAL
LEVEL.
GLOBAL RECOMMENDATIONS ON
PHYSICAL ACTIVITY FOR HEALTH
 CARDIORESPIRATORY HEALTH (CORONARY
HEART DISEASE, CARDIOVASCULAR , STROKE
AND HYPERTENSION)
 METABOLIC HEALTH (DIABETES AND OBESITY)
 MUSCULOSKELETAL HEALTH (BONE HEALTH,
OSTEOPOROSIS)
 CANCER (BREAST AND COLON CANCER)
 FUNCTIONAL HEALTH AND PREVENTION OF
FALLS
 DEPRESSION
But,exercise…..
HABITUAL PHYSICAL ACTIVITY REDUCES
CORONARY HEART DISEASE EVENTS, BUT
VIGOROUS ACTIVITY CAN ALSO ACUTELY
AND TRANSIENTLY INCREASE THE RISK
OF SUDDEN CARDIAC DEATH AND ACUTE
MYOCARDIAL INFARCTION IN
SUSCEPTIBLE PERSONS.
Relative risk of MI associated with vigorous exertion (>6
METs) according to habitual frequency of vigorous exertion.
"The paradox of physical
exercise"
 HABITUAL PHYSICAL ACTIVITY REDUCES CORONARY
HEART DISEASE EVENTS, BUT VIGOROUS ACTIVITY CAN

ALSO ACUTELY AND TRANSIENTLY INCREASE THE RISK OF
SUDDEN CARDIAC DEATH AND ACUTE MYOCARDIAL
INFARCTION IN SUSCEPTIBLE PERSONS.
EXERCISE-ASSOCIATED ACUTE CARDIAC EVENTS
GENERALLY OCCUR IN INDIVIDUALS WITH STRUCTURAL
CARDIAC DISEASE. HEREDITARY OR CONGENITAL
CARDIOVASCULAR ABNORMALITIES ARE PREDOMINANTLY
RESPONSIBLE FOR CARDIAC EVENTS AMONG YOUNG
INDIVIDUALS, WHEREAS ATHEROSCLEROTIC DISEASE IS
PRIMARILY RESPONSIBLE FOR THESE EVENTS IN ADULTS.
Herz 2006;31:553-8
RISPOSTA CARDIOVASCOLARE
ALL’ESECIZIO ACUTO
25% Radius
63% Area
Vasoconstriction
(Acute Exercise)
AMSE
No Ischemia
25% Radius
63% Area
Vasoconstriction
(Acute Exercise)
No Ischemia
17% Radius
96% Area
Ischemia
Distribution of Flow at rest and
during Acute Exercise
20%
22%
4%
6%
14%
27%
Muscle
Heart
Skin
Brain
Other
Liver
Kidneys
4%
5%
4%
1%
Muscle
84%
7%
Rest
3-5 Lmin
Exercise
25-30 Lmin
Exercise and Blood Pressure in
normal and hypertensive subjects
P.A.
260
240
220
200
180
160
140
120
100
80
60
Normot
Hypert
normot
Peak
hyp
0
100
150
230
Watts
rec
rec
Chronic Cardiac
Adaptation to Exercise
Morphological
Functional
•Myocardial
•Neural
•Vascular
AMSE
Dynamic and static exertion
Dynamic or isotonic activity: physical
exertion characterized by
rhytmic,repetitive movements of
large muscle groups
Isometric or static activity: physical
exertion characterized by sustained
muscle contraction against a fixed
load or resistance with non change
in length of the involved muscle
group or joint motion
EVIDENCE
REGULAR PHYSICAL ACTIVITY CONTRIBUTES TO THE
PRIMARY AND SECONDARY PREVENTION OF SEVERAL
CHRONIC DISEASES AND IS ASSOCIATED WITH A
REDUCED RISK OF PREMATURE DEATH.
THERE APPEARS TO BE A GRADED LINEAR RELATION
BETWEEN THE VOLUME OF PHYSICAL ACTIVITY AND
HEALTH STATUS, SUCH THAT THE MOST PHYSICALLY
ACTIVE PEOPLE ARE AT THE LOWEST RISK.
HOWEVER, THE GREATEST IMPROVEMENTS IN HEALTH
STATUS ARE SEEN WHEN PEOPLE WHO ARE LEAST
FIT BECOME PHYSICALLY ACTIVE.
Evidence Based Sport Medicine D.MacAuley,T.B Best 2006
GLOBAL RECOMMENDATIONS ON PHYSICAL
ACTIVITY FOR HEALTH RECOVERY
 CARDIORESPIRATORY HEALTH (CORONARY
HEART DISEASE, CARDIOVASCULAR , STROKE
AND HYPERTENSION)
 METABOLIC HEALTH (DIABETES AND OBESITY)
 MUSCULOSKELETAL HEALTH (BONE HEALTH,
OSTEOPOROSIS)
 CANCER (BREAST AND COLON CANCER)
 FUNCTIONAL HEALTH AND PREVENTION OF
FALLS
 DEPRESSION
L’ESERCIZIO NELLA PREVENZIONE
DELLE MALATTIE
MALATTIE CORONARICHE / ICTUS
OBESITÀ E DIABETE DI TIPO 2
DEMENZA
DEPRESSIONE
ALCUNI TUMORI
OSTEOPOROSI
KUJALA UM
EVIDENCE
OF THE EFFECTS OF
EXERCISE THERAPY IN THE
TREATMENT OF CHRONIC
DISEASE.
BR J SPORTS MED 2009; 43:
550-555.
Sponsored by:
EXERCISE IS MEDICINE
‘THE BENEFITS OF REGULAR
PHYSICAL ACTIVITY ON
HEALTH, LONGEVITY AND
WELLBEING EASILY SURPASS
THE EFFECTIVENESS OF ANY
DRUGS OR OTHER MEDICAL
TREATMENT.’
SIR LIAM DONALDSON
‘‘In a word, all parts of the body which were made for
active use, if moderately used and exercised at the labor to which they
are habituated, become healthy, increase in bulk, and bear their age
well, but when not used, and when left without exercise, they become
diseased, their growth is arrested, and they soon become old.’’
Hyppocrates Medicine’s view of exercise did not progress much in the
subsequent two millenia, and exercise was primarily viewed as an activity for
healthy people, but not for the chronically ill.
The use of exercise as a medical treatment is an old concept, but
one that did not start gaining acceptance until the 20th century.
Today, exercise scientists are exploring the limits of exercise as a therapy—of
exercise as a medicine.
Br J Sports Med 2004;38:6–7.
The first recorded anecdote of exercise as a treatment for heart disease is
thought to be from William Heberden,who wrote of a man with angina
pectoris in 1772: ‘‘I knew of one who set himself the task of sawing
wood forhalf an hour every day, and was nearly cured’’.Ironically,
Heberden did not know that angina pectoris is a cardiac disorder.‘‘
Physicians of the 1800s were interested in the role of exercise in
maintenance of health, but the modern notion of exercise as a medical
treatmentis thought to have originated with R Tait McKenzie. McKenzie
perceived exercise as a technique to rehabilitate people with disabling
injuries’’
William Osler, in the 1909 edition of The principles and practice of
medicine, wrote that bed rest and baths at spas like Bad Nauheim
were the optimal treatment for heart disease.
In 1939, Paul Dudley White, the first cardiology professor at Harvard
Medical School, co-authored a manuscript showing cardiac dilatation
through aneurysm formation after myocardial infarction, and this was
used as an argument against exercise after myocardial infarction.
By 1958, Dr White had changed his views and coauthored a textbook on
cardiac rehabilitation in which low level exercise was promoted.Then in
1968, the concept of bed rest was finally put to rest by the landmark
paper of Bengt Saltin et al. In 60 years, physicians had learned that
exercise was useful in rehabilitation of people with both
musculoskeletal injuries and cardiovascular disease.
‘‘Our current understanding of exercise prescription is limited for most
chronic diseases’’
 Il concetto di “esercizio fisico come terapia”,
nato in America già dal secolo scorso, si
identifica con la pratica regolare e costante di
questo, opportunamente stabilito e dosato come
“intensità, frequenza e durata”, all’interno di un
atto medico diagnostico – terapeutico complesso
del quale la Medicina dello Sport, come disciplina
internistica, ha la piena ed esclusiva
competenza.
 La prescrizione dell’esercizio quindi ha effetti
positivi sulla salute attraverso azioni specifiche
sui meccanismi della malattia stessa , che
rappresenta, a differenza dell’Attività Fisica
Adattata, un atto sanitario con finalità
terapeutiche.
L’ESERCIZIO NELLA CURA
DELLE MALATTIE
 OSTEOARTRITE
 OBESITÀ & DIABETE DI
TIPO 2
 ARTRITE REUMATOIDE
 ASMA
 SPONDILITE
ANCHILOPOIETICA
 BPCO
 FIBROMIALGIA
 MALATTIA DI PARKINSON
 MALATTIA
 SCLEROSI MULTIPLA
CORONARICA
 CANCRO DEL SENO E
 IPERTENSIONE
DELL’INTESTINO
 ICTUS
 DEPRESSIONE
Physical activity/exercise as theraphy:Mechanisms of Action
Physical fitness
(aerobic fitness and
muscular strength)
Body fat
Visceral fat
Liver fat
Posittive changes in skeletal
muscle structure function
and metabolism
Insulin sensityvity
Parasympathetic tone
Peripheral resistance
Heart structure
And function
Inflammation
Electrical stability of the heart
Blood pressure
Glicemic control in
insulin resistance
HDL2 Cholest
Risks of type 2 of Diabete Mell
Risk of life threatening
arithmias
Neurotropic
effects
Platelet agggregation
Atherosclerosis
Risks of ischemic stroke
Risks of
Dementia
Brith Med Sport J 43 2009
Risks of myocardial infarction
EXERCISE
COMPARED WITH DRUGS OR SURGERY IN IN
NCD
EXERCISE BENEFIT
DRUGS OR SURGERY BEN
CARDIAC DISEASE
40% RISK REDUCTION
24% RISK RED WITH
STATINS
STABLE CORONARY ARTERIES
DISEASE
80% SURVIVAL AT 12
MONTHS
70% AT 12 MONTHS WITH
PTCA
TYPE 2 DIABETE
58% REDUCTION
38% RED WITH METPHORM
HIP FRACTURE
55% INCIDENCE REDUCTION
38% RISK REDUCTION WITH
RISEDRONSTE
BREAST CANCER
40% RISK REDUCTION
38% INCIDENCE AND RISK
REDUCTION WITH TAMOXIF
RECURRENT BREAST CANCER
MAJOR DEPRESSION
54% REDUCTION OF
59% REDUCTION OF
MORTALITY
MORTALITY WITH TAMOXF
EXERCISE EFFECTIVE AS
SERTRALINE(60,4%
REMISSION)BUT WITH
REDUCED RELAPSE OF 30%
SERTRALINE EFFECTIVE AS
EXERCISE(65,4%
REMISSION)BUT WITH
INCREASED RELAPSE OF 50%
Lancet vol 280 Jul 2012
Exercise interventions on health-related quality of life for
cancer survivors (Review)
Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, Snyder C
Cocrhane lib 2012 n 8
Exercise or exercise and diet for preventing type 2 diabetes
mellitus (Review)
Orozco LJ, Buchleitner AM, Gimenez-Perez G, Roqué i Figuls M, Richter B, Mauricio D
The Cochrane Library 2008, Issue 3
Exercise interventions on health-related quality of life for
cancer survivors (Review)
Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, Snyder C
Cocrhane lib 2012 n 8
Exercise for the management of cancer-related fatigue in
adults (Review)
Cramp F, Byron-Daniel J
Cocrhane library 2012 n 11
EXERCISE/DRUG
GENERICALLY
SPEAKING, ANY EXERCISE PRESCRIPTION
RESEMBLES A DRUG PRESCRIPTION:EXERCISE A, TAKEN N
TIMES DAILY, FOR X DURATION OF WEEKS/MONTHS/YEARS.
THE EXERCISE
TYPE AND DOSE ARE CHOSEN BY THE PERSON’S
INDIVIDUAL NEEDS, GOALS, AND ABILITY LEVEL;THE
FREQUENCY AND INTENSITY OF EACH SESSION ARE CHOSEN
BY THE PERSON’S INTRINSIC ENDURANCE AND ABILITY TO
RECOVER; THE PROGRESSION AND DURATION OF THE
PROGRAMME IS DETERMINED BY THE PERSON’S
INTERMEDIATE AND LONG TERM GOALS.
ADVERSE
EFFECTS ARE RELATED TO THE TYPE OF EXERCISE-FOR
EXAMPLE, DELAYED ONSET MUSCLE SORENESS-AND THE
SPECIFIC CHRONIC DISEASE-FOR EXAMPLE, CHEST PAIN IN
ANGINA PECTORIS, JOINT PAIN IN ARTHRITIS, FATIGUE IN
FIBROMYALGIA.
La medicina dello sport è ad
una svolta: dalla valutazione
dei soggetti che possono far
sport,gli idonei;
alla
valutazione dei soggetti che
devono fare sport all’interno di
un piano terapeutico,i pazienti.
AMS