Liikunnan vaikuttavuus ja kuntoutus

Transkriptio

1 Liikunnan vaikuttavuus ja kuntoutus Urho Kujala Liikuntalääketieteen erikoislääkäri Liikuntalääketieteen professori Terveystieteiden yksikkö, Liikuntatieteellinen tiedekunta Jyväskylän yliopisto

2 Tärkeitä lähteitä: käypä hoito suositus Johdantoartikkeli liikuntaan ja kroonisiin sairauksiin: Kujala U. Liikunta kroonisten sairauksien hoidossa. Suomen Lääkärilehti 2014;69: Kujala U, Kukkonen-Harjula K, Tikkanen H. Liikunta pitkäaikaissairauksien hoidossa ja kuntoutuksessa. Duodecim 2015;131:

3 Fyysinen aktiivisuus ja krooniset sairaudet Vähäinen fyysinen aktiivisuus on useiden kroonisten sairauksien riskitekijä. Viime vuosikymmeninä on lisääntyvästi tutkittu liikuntahoitojen vaikuttavuutta sairauksien hoidossa. Satunnaistettuihin kontrolloituihin tutkimuksiin perustuvat metaanalyysit osoittavat että liikunta on positiivisesti vaikuttava osatekijä monien kroonisten sairauksien hoidossa. Meta-analyysitulosten mukaan liikuntahoitojen vaikutuksia ovat kroonisesti sairaiden potilaiden fyysisen kunnon paraneminen, kipujen väheneminen erityisesti useissa tuki- ja liikuntaelinsairauksissa, sairauksien etenemisen hidastuminen erityisesti kardio-metabolisissa sairauksissa, masennuksen väheneminen, yleisen hyvinvoinnin paraneminen ja joissain sairauksissa eliniän piteneminen. Lähde: Kujala U. Liikunta kroonisten sairauksien hoidossa. Suomen Lääkärilehti 2014;69:

4 Exercise therapy for functional capacity in chronic diseases: an overview of meta-analyses of randomized controlled trials Pasanen TT, Tolvanen S, Heinonen A, Kujala UM BJSM, e-pub ahead of print: Data sources: We systematically searched the CENTRAL, CINAHL, DARE, Medline, OTSeeker, PEDro, SPORTDiscus, ProQuest Nursing & Allied Health Database, Web of Science, Scopus, OpenGrey and BMC Proceedings from their inception to 1 st of September Eligibility criteria for selecting studies: We included meta-analyses that compared the effects of exercise therapy with no treatment or usual care in adults with chronic diseases and included outcomes related to functional capacity.

5 Flow diagram of the study selection process. 2 Copyright BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.

6 Effect of aerobic exercise on functional capacity in chronic diseases. Copyright BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.

7 Effect of resistance training on functional capacity in chronic diseases. Copyright BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.

8 Effect of mixed exercise (aerobic and resistance) on functional capacity in chronic diseases. Copyright BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.

9 Effect of other condition-specific exercise-based rehabilitation modes (than those included in figures 2 4) on functional capacity in chronic diseases. Copyright BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.

10 Exercise therapy for physical function in chronic diseases: a systematic review of meta-analyses of randomized controlled trials: Results I 85 meta-analyses with 22 different chronic diseases were included. The exercise interventions resulted in statistically significant (p<0.05) improvements for 126 of 146 (86%) functional capacity outcomes, compared with the control group. The SMDs were small in 64 (44%), moderate in 54 (37%) and large in 28 (19%) of the 146 functional capacity outcomes. The exercise effects were similar for aerobic, resistance, and mixed exercises.

11 Exercise therapy for physical function in chronic diseases: a systematic review of meta-analyses of randomized controlled trials: Results II In some severe conditions (Parkinson s disease, preoperative osteoarthritis) and in case the control treatment included active rehabilitation (stroke) the results were variable. The results were similar for objective and selfreported measures of function. There were no significant differences in serious adverse effects between the intervention and control groups.

12 Exercise therapy for physical function in chronic diseases: a systematic review of meta-analyses of randomized controlled trials: Conclusions Exercise therapy significantly improves physical function and performance, and reduces disability in chronic diseases. This is important for the mobility, independent living, and care needs of the patients. Exercise therapy interventions should be designed to address the functional impairments caused by the specific chronic disease.

13 Lähde: Leskinen T, Kujala UM. Twin Res Human Genetics 2015;18:

14 Hospital care in twin pairs discordant for sedentariness Physically inactive behaviour is associated with increased need for hospital treatments, even after genetic and other confounding factors are taken into account Sedentary Active 0 DZ MZ (Kujala et al. Am J Public Health 1999;89: )