Atatürk Üniversitesi Tıp Fakültesi

... konulu sunumlar: "Atatürk Üniversitesi Tıp Fakültesi"— Sunum transkripti:

1 Atatürk Üniversitesi Tıp Fakültesi
Beslenme ve Egzersiz Danışmanlığı Atatürk Üniversitesi Tıp Fakültesi Doç. Dr. Zekeriya Aktürk Eylül 2009

2 Hedefler Egzersiz ve sağlıklı beslenmenin faydalarını belirtebilmek
Sağlıklı beslenme piramidini açıklayabilmek Sağlıklı beslenme danışmanlığının komponentlerini açıklayabilmek Çeşitli fiziksel aktivitelerde harcanan kalorileri hesaplayabilmek Egzersiz danışmanlığındaki bileşenleri (SŞTZİ akronimi) açıklayabilmek Hamilelik ve aterosklerotik kalp hastalığı için egzersiz kurallarını açıklayabilmek

3 Şişmanlığın Sağlığa Etkileri
21/07/1438 Şişmanlığın Sağlığa Etkileri VKİ’ye göre erkeklerde tıbbi durumların yaygınlığı Hastalık VKİ 18.5 to 24.9 25 to 29.9 30 to 34.9 > 40 Prevalans (%) Tip 2 Diyabet 2.03 4.93 10.10 10.65 Koroner kalp hastalığı 8.84 9.60 16.01 13.97 Yüksek tansiyon 23.47 34.16 48.95 64.53 Osteoartrit 2.59 4.55 4.66 10.04 American Obesity Association .AOA Fact Sheets. Health effects of obesity. DR. ABDULAZIZ AL- JOHANI

4 100 kg Olan Hasta 10kg Zayıflarsa
Mortalite %20-25 düşer Diyabetle ilişkili ölüm ihtimali %30-40 düşer Şişmanlığa bağlı kanser ölümleri %40-50 düşer Sistolik ve diyastolik kan basıncı yaklaşık10mm/Hg düşer Diyabet gelişme riski %50’den fazla düşer Açlık kan şekeri %30-50 düşer HbA1C %15 düşer Yağlar: Kolesterol %10 LDL %15 Trigliseritler %30 düşer HDL %8 artar 1Hubert HB et al. Circulation 1996; 93: 1372–9, 2Colditz GA et al. Am J Epidemiol 1990; 132: 501–13, 3Chan JM et al. Diabetes Care 1994; 17: 961–9, 4Soloman CG, Manson JE. Am J Clin Nutr 1997; 66 (Suppl. 4): 1055S–50S, 5Schapira DV et al. Cancer 1994; 74: 632–9

5 NIH/NHLBI/NAASO; October 2000. NIH Publication No. 00-4084.
Şişmanlık Tedavisi VKİ Sınıfı Tedavi 25– – – –39.9 40 Diyet, egzersiz Ek hastalık Ek hastalık EVET EVET EVET davranış, varsa EVET varsa EVET tedavisi Ek hastalık EVET EVET EVET Farmakoterapi varsa EVET Ek hastalık EVET Cerrahi varsa EVET NIH/NHLBI/NAASO; October NIH Publication No

6 Sağlıklı Yaşam Piramidi
Europrev healthy diet, 2005 (modified)

7 Sağlıklı Belenme Danışmanlığı
Organizasyon Randevu verin Hastanın sağlık ekibine güvenini sağlayın Gerektiğinde bir diyetisyene danışın Sağlıklı yaşamı popüler göstermeye çalışın Grup tartışmaları düzenleyin Arrange for an appointment (individual or group) to have enough time and to take place in a quiet environment. 2. Remember that the patient’s confidence in the GP and nurses, and a close relationship between them, are essential for success. Primary care is therefore the right place for providing counselling on a healthy diet. 3. If the support of the dietician is needed, use it! Be careful that both messages are the same. 4. It is very important that a healthy lifestyle is made popular. Spread the message using publicity pamphlets, web pages,TV / radio / press campaigns, and speeches in the media. Trial recipes must accompany healthy diet messages. On a regular basis, provide different recipes, messages and posters to the public in waiting rooms in health centres. 5. Arrange meetings where patients discuss healthy food with medical teams and with other patients who can share their experiences of the change towards a healthy diet, and where they can be shown healthy recipes.

8 Sağlıklı Belenme Danışmanlığı
Yöntem Kişinin anlama kapasitesini dikkate alın Uygun kelimeler kullanın Sakin konuşun, yargılamayın, nasihat etmeyin Kişinin bilgi düzeyini saptayın Beslenme alışkanlıklarını araştırın Zaman sınırlaması koymayın Sorulara cevap verin Olumlu davranışları teşvik edin Method 1. Assess the person’s capacity for understanding the message correctly. Use words appropriate to the person’s educational level. 2. Talk to the person quietly. Do not judge or preach. Ask the person about his/her doubts, troubles and fears. 3. Explore the person’s knowledge about a healthy diet. 4. Explore the person’s eating behaviours and traditional food habits. 5. Do not make a person feel anxious or threatened by setting a time limit for observing results. 6. When closing the counselling session, answer questions and clarify any mistaken concepts about the topic. 7. Do reinforce positive behaviour in successive visits, in order to achieve: . An increase in the person’s self-esteem. . Maintenance of the changed behaviour. . Credibility in the eyes of the person. . The proposed objective.

9 Sağlıklı Belenme Danışmanlığı
Kavramlar Daha iyi hissedecekler Kişinin hastalık algısını değiştirmeye çalışın Sağlıklı beslenme sağlığı ve iyilik halini artırır “Diyet” yerine “beslenme” kelimesini kullanın Katı yasaklar ve kurallar koymayın Gönüllü ve isteğe bağlı olmalıdır “olumlu” yönleri görmeyi teşvik edin Ergenlerde “ne kadar zayıf, o kadar iyi” mesajının algılanmasından kaçının Concepts 1. Communicate to persons the concept that, when they have changed their dietary habits, they are going to feel better both physically and mentally and enjoy a healthy way of life. 2. Try to convert persons to the concept of a healthy diet so that they feel rewarded. 3. Try to convey the idea that a healthy diet is not an obligation but a way to increase health and well-being. 4. Use the word ‘food’ instead of ‘diet’. The word ‘diet’ may convey the impression of a ban on food. 5. An inflexible ban on some foods can lead to frustration and result in a person not keeping a healthy diet. 6. The regular consumption of healthy food must be voluntary and done willingly. 7. In order to obtain a change in lifestyle, encourage people to think about its “pros” rather than “cons”, like: healthy food is inexpensive, easy to find and to prepare. 8. In adolescents, do not convey the simple message: “the thinner the better”, because there are a lot of problems with anorexia. Young people need more caution with counselling and special care

10 Sağlıklı Belenme Danışmanlığı
Teknikler Günde birkaç kez beslenin Öğün atlamayın Yavaş yiyin Tuzdan kaçının Alınan toplam kaloriyi hesaplayın Techniques of a healthy diet 1. Eat several meals a day. If you are overweight or obese, reduce the quantity of food in each meal. 2. Don’t skip meals. Breakfast is the cornerstone of a healthy diet. 3. Eat slowly, to digest your food properly! (over 20 minutes to reach satiety) 4. Avoid cooking with a lot of salt. 5. Modify the total number of calories consumed during the day according to your energy consumption needs in order to prevent subsequent weight gain leading to obesity. Usually it is easier to control energy intake by means of one well-balanced main course including fruit.

11 Sağlıklı Belenme Danışmanlığı
Besin içeriği Lif miktarını artırın Rafine besinlerin miktarını azaltın Geleneksel tam tahıllardan yapılan ekmek yinin Günde iki kezden fazla meyve ve sebze yiyin Kırmızı et tüketimini azaltın Balık tüketimini artırın Haftada birkaç kez yumurta yiyin Yağsız süt ve yoğurt tüketin Bol sıvı, özellikle de su tüketin The composition of meals 1. Increase the amount of fibre (vegetables and wholegrain cereals) and decrease the amount of refined foods (such as sugar). 2. Eat traditional wholegrain bread (in moderation) and cereals. 3. Eat fruit and vegetables more than twice a day ( grams per day)! 4. Reduce the consumption of red meat. 5. Increase the consumption of fish, preferably ‘blue’ fish. 6. Eat few eggs a week. 7. Consume skimmed milk and yoghurt or other forms of acidified dairy products. 8. Drink a lot of liquids, especially water.

12 Sağlıklı Belenme Danışmanlığı
Pişirme Hazır gıdalardan, fast fooddan, tuzlu besinlerden, fabrikasyon tatlı ve keklerden uzak durun Yağda kızartmak yerine fırında, haşlama veya mangalı tercih edin Çok tuzlu pişirmeyin Zeytin yağı kullanın Cooking 1. Avoid pre-cooked food, fast food, salted meals, manufactured sweets and cakes. 2. Roast, boil or grill food (avoiding the charred and burnt parts) instead of frying it! 3. Avoid cooking with a lot of salt. 4. Use olive oil. If that’s not possible, use small amounts of vegetable seed oil.

13 Fiziksel Aktivite Danışmanlığı

14 Hastanız hazır mı? This questionnaire serves to recognise patients who would need additional cardiovascular investigation if their answer to any of the questions is “YES” or “DON’T KNOW” (80% specific, 100% sensitive). You can also perform the 2 km walking test (UKK 2 km) This is very useful in population preventive programs, testing both subjective and objective health status and cardiovascular fitness during 2 km of brisk walking. The patient’s individual fitness is calculated by using a computer system to measure blood pressure and heart rate before and after exercise.

15 Fiziksel Aktivite Danışmanlığı
Kalori eşiği Sağlıklı bir erişkin için ideal kalorik eşik haftada 2000 kaloridir. Fizik aktivitede harcanan kalori miktarı: American College of Sport Medicine

16 Fiziksel Aktivite Danışmanlığı

17 Fiziksel Aktivite Danışmanlığı
S - Sıklık (haftada kaç gün egzersiz yapacak?) Ş - Şiddet (hafif, orta, şiddetli) T - Egzersiz Tipi (aerobik, anaerobik…) Z - Zaman (günde ne kadar egzersiz yapacak?) İ - İlerleme EUROPREV Guide on Promoting Health through Physical Activity A Guide to Physical Activity Counselling in Daily Practice, 2007

18 Fiziksel Aktivite Danışmanlığı
S- Sıklık Hangi egzersiz yapılırsa yapılsın her gün yapılması önerilir. Fiziksel aktivite sürekli yapıldığında faydalı olur. En az haftada 3-5 gün 30 dakika yapılmalıdır

19 Fiziksel Aktivite Danışmanlığı
Ş – Şiddet Hafif: Gezi, yavaş yürüme, orta yoğunlukta ev işi, Hafif egzersizde nabız azami kalp hızının %50’sinden azdır Orta: Hızlı yürüyüş, çim biçme... Nabız azami kalp hızının %50-70’i arasındadır. Şiddetli: Koşma, ağır işte çalışma... Nabız azami kalp hızının %70’inden fazladır. According to physiological parameters, 3 levels of intensity exist: (a) Mild: This refers to any activity that burns less than 3.5 calories per minute (kcal/ min). These levels are equal to what a healthy individual might burn while strolling, walking slowly, doing moderate housekeeping, etc. The heart rate (pulse) in mild exercise is less than 50% of the maximal pulse (see sub-section A below for more details). (b) Moderate: Moderate-intensity physical activity refers to any activity that burns 3.5 to 7 calories per minute (kcal/min). These levels are equal to what a healthy individual might burn while walking briskly, mowing the lawn, dancing, swimming for recreation, bicycling, walking for pleasure, gardening and working in the yard, housekeeping, dancing and performing recreational activities such as tennis, racquetball, soccer, basketball and touch football. In moderate physical activity our heart rate (pulse) is 50-70% of the maximal pulse. Moderate-intensity activities, if performed daily, have many long-term health benefits. They help lower the risk of cardiovascular diseases. (c) Intensive: Such physical activity refers to any activity that burns more than 7 calories per minute (kcal/min). These levels are equal to what a healthy individual might burn while jogging, engaging in heavy yard work, participating in high-impact aerobic dancing, swimming continuous laps, or bicycling uphill. In very intensive exercise one’s heart rate (pulse) is more than 70% of the maximal pulse.

20 Fiziksel Aktivite Danışmanlığı
Şiddetin değerlendirilmesi Kişi kendi kalp hızını sayabilir veya egzersizde nasıl hissettiğine bakabilir. Intensity assessment There are several ways to assess the intensity of physical activity. One can count his/her heart beats or observe his/her reaction to exercise. A. Pulse (heart rate) measurement By measuring the heart rate (beats per minute) we can tell how hard the heart is working. One can check his/her heart rate by counting the pulse for 15 seconds and multiplying the beats by 4. Maximal, recommended and target pulses can be calculated using the following equations:

21 Fiziksel Aktivite Danışmanlığı

22 Egzersiz Şiddetinin Değerlendirilmesi

23 Fiziksel Aktivite Danışmanlığı
T- Tipi Anaerobik Oksijen olmadığında vücuttaki enerji üretimi oksijensiz gerçekleşir Kısa, kuvvete dayalı egzersizler: vücut geliştirme, ağırlık kaldırma, kısa mesafe koşma, yüksek atlama... T- Type Some activities improve flexibility, some build muscular strength and some increase endurance. Anaerobic exercise comprises brief, strength-based activities such as sprinting or bodybuilding, whereas aerobic exercise is centred on endurance activities such as marathon running or long-distance cycling. However, the early stage of all exercise is anaerobic. A. Aerobic exercise This is generally an activity performed over a long period of time, typically 20 minutes or more. It is used to tone the body, make it leaner, and improve endurance by keeping the cardiovascular system healthy. Technically, aerobic exercise is exercise that mainly uses energy from the body’s muscle cells doing aerobic respiration. Aerobic respiration of a cell is when the cell uses oxygen to burn energy (aerobic means “requiring air/oxygen”). This is unlike anaerobic respiration where the cell does not use oxygen when it burns energy. Cellular aerobic respiration can potentially be 18 times more efficient than anaerobic respiration, and aerobic respiration produces fewer toxins in the cell. Because of this, the cell will try to do aerobic respiration whenever it can, but it will do anaerobic respiration to get energy when it lacks oxygen. Exercise that is less intense but lasts longer allows the body to give the muscles oxygen as they are using it up, and keep them doing aerobic respiration. More intense exercise uses up the oxygen in the cells faster than it can be replaced, so the cells divert to anaerobic respiration to get the energy they need. Continuous activities, which involve using the large muscles in the arms or legs, are called endurance or aerobic exercise. They help the heart by making it work more efficiently during exercise and at rest. Types of aerobic exercise are: swimming, dancing, walking, running, climbing stairs (sustained for 20 minutes or more), rowing, chopping wood (sustained for 20 minutes or more), cross country skiing, hiking, jogging, cycling, etc. B. Anaerobic exercise Anaerobic means “without air”, and refers to the energy exchange in living tissue that is independent of oxygen. Anaerobic exercise is brief, high intensity activity where anaerobic metabolism is taking place in muscles. Any exercise that consists of short exertion, high-intensity movement is an anaerobic exercise. Anaerobic exercise is typically used by athletes in non-endurance sports to build power and by body-builders to build muscle mass. Muscles that are trained under anaerobic conditions develop biologically differently giving them greater performance in short duration-high intensity activities. Examples of anaerobic exercise include: weight lifting, sprinting, jumping, etc. In primary prevention the rule of balanced physical activity should be followed: 50% = 4-7 days a week: endurance exercise - aerobic activity 25% = 2-4 days a week: anaerobic activity for muscular strength 25% = 4-7 days a week: exercise for flexibility (stretching plus relaxation) Preferably one should start the exercise session with a gradual warm-up period. During this time (about 5 to 10 minutes), one should slowly stretch muscles first, and then gradually increase the level of activity. For example, one should begin walking slowly and then pick up the pace. When the exercise is finished, one should cool down for about 5 to 10 minutes, stretch the muscles and let the heart rate slow down gradually. The same stretches as in the warmup period can be used.

24 Fiziksel Aktivite Danışmanlığı
T- Tip Aerobik Oksijen gerektirir Uzun zaman içerisinde, tipik olarak 20 dakika veya daha fazla yapılan egzersizlerdir Maraton koşusu gibi dayanıklılık sporları, uzun mesafe biziklet binme, yüzme, dans, yurume, koşma, merdiven çıkma... T- Type Some activities improve flexibility, some build muscular strength and some increase endurance. Anaerobic exercise comprises brief, strength-based activities such as sprinting or bodybuilding, whereas aerobic exercise is centred on endurance activities such as marathon running or long-distance cycling. However, the early stage of all exercise is anaerobic. A. Aerobic exercise This is generally an activity performed over a long period of time, typically 20 minutes or more. It is used to tone the body, make it leaner, and improve endurance by keeping the cardiovascular system healthy. Technically, aerobic exercise is exercise that mainly uses energy from the body’s muscle cells doing aerobic respiration. Aerobic respiration of a cell is when the cell uses oxygen to burn energy (aerobic means “requiring air/oxygen”). This is unlike anaerobic respiration where the cell does not use oxygen when it burns energy. Cellular aerobic respiration can potentially be 18 times more efficient than anaerobic respiration, and aerobic respiration produces fewer toxins in the cell. Because of this, the cell will try to do aerobic respiration whenever it can, but it will do anaerobic respiration to get energy when it lacks oxygen. Exercise that is less intense but lasts longer allows the body to give the muscles oxygen as they are using it up, and keep them doing aerobic respiration. More intense exercise uses up the oxygen in the cells faster than it can be replaced, so the cells divert to anaerobic respiration to get the energy they need. Continuous activities, which involve using the large muscles in the arms or legs, are called endurance or aerobic exercise. They help the heart by making it work more efficiently during exercise and at rest. Types of aerobic exercise are: swimming, dancing, walking, running, climbing stairs (sustained for 20 minutes or more), rowing, chopping wood (sustained for 20 minutes or more), cross country skiing, hiking, jogging, cycling, etc. B. Anaerobic exercise Anaerobic means “without air”, and refers to the energy exchange in living tissue that is independent of oxygen. Anaerobic exercise is brief, high intensity activity where anaerobic metabolism is taking place in muscles. Any exercise that consists of short exertion, high-intensity movement is an anaerobic exercise. Anaerobic exercise is typically used by athletes in non-endurance sports to build power and by body-builders to build muscle mass. Muscles that are trained under anaerobic conditions develop biologically differently giving them greater performance in short duration-high intensity activities. Examples of anaerobic exercise include: weight lifting, sprinting, jumping, etc. In primary prevention the rule of balanced physical activity should be followed: 50% = 4-7 days a week: endurance exercise - aerobic activity 25% = 2-4 days a week: anaerobic activity for muscular strength 25% = 4-7 days a week: exercise for flexibility (stretching plus relaxation) Preferably one should start the exercise session with a gradual warm-up period. During this time (about 5 to 10 minutes), one should slowly stretch muscles first, and then gradually increase the level of activity. For example, one should begin walking slowly and then pick up the pace. When the exercise is finished, one should cool down for about 5 to 10 minutes, stretch the muscles and let the heart rate slow down gradually. The same stretches as in the warmup period can be used.

25 Tipik Bir Aerobik Egzersiz
ACSM (2006) p.137

26 Fiziksel Aktivite Danışmanlığı
Egzersize tedrici bir ısınmayla başlanmalı Bu sırada (yaklaşık dakika), önce kaslar esnetilmeli, sonra giderek egzersiz artırılmalıdır. Örn. önce yürüyüş, sonra hızlnarak koşma yapılabilir. Egzersiz bittiğinde 5-5 dakika soğuma egzersizi yapılmalı, yine kaslar esnetilerek kalp hızı yavaş yavaş normale döndürülmelidir.

27 Fiziksel Aktivite Danışmanlığı
Z- Zaman

28 Fiziksel Aktivite Danışmanlığı
İ- İlerleme

29 Egzersiz Önerileri Hekim danışmanlığında yapılmalı Yavaş başlanmalı
Sevilen bir spor yapılmalı Bir arkadaşla birkilte yapmak daha iyi Günlük rutin değiştirilmeli Günün uygun saatleri seçilmeli Moralini bozmamalı Here are some tips that will help you start and stick with an exercise program: g Start by talking with your doctor. This is especially important if you haven’t been active, if you have any health problems, or if you’re pregnant or elderly. Start out slowly. If you’ve been inactive for years, begin with a 10-minute period of light exercise or a brisk walk every day and gradually increase how hard you exercise and for how long. g Enjoy it! Choose the activity you like to do. Make sure it suits you physically, too. For instance, swimming is easier on arthritic joints. g Get a partner. Exercising with someone else can make it more fun. g Vary your routine. You may be less likely to get bored or injured if you change your routine. Walk one day. Bicycle the next. Consider activities like dancing and racquet sports, and even chores like chopping wood. g Choose a comfortable time of day. Don’t work out too soon after eating or when it’s too hot or cold outside. Wait until later in the day if you’re too stiff in the morning. g Don't get discouraged. It can take weeks or months before you notice some of the changes from exercise Forget "no pain, no gain". While a little soreness is normal after you first start exercising, pain isn’t. Stop if you hurt. g Make exercise fun. For example, read, listen to music or watch TV while riding a stationary bicycle. Find fun things to do, like taking a walk through the zoo. Go dancing. Learn how to play tennis. g Use appropriate clothes and footwear. g Drink plenty of fluids. g Warm up before starting, start slowly and increase frequency and time gradually! Do not forget to cool down and stretch at the end of your exercise!

30 Egzersiz Önerileri “ağrı yoksa fayda da yok” yaklaşımı yanlış
Egzersiz eğlenceli hale getirilmeli Uygun giysiler ve ayakkabılar giyilmeli Bol su içilmeli Isınma yapılmalı Soğuma ihmal edilmemeli Takip yapılmalı Günlük besin alımı Haftada birden daha az sıklıkla tartılma

31 Özel Durumlar Gebelikte – hedef nabız < 140 olmalı
(azami kalp hızının %60-70’i) Süre dakika Emzirme – aşırı egzersiz yapan annelerde süt kesilebilir

32 ASKH Egzersiz için risk sınıfları
Class A — Sağlıklı bireyler ve kardiyovasküler riski bulunmayanlar. Class B — Klinik olarak stabil kalp hastalığı olanlar. Bu kişilerde kardiyovasküler komplikasyon riski düşüktür. Class C — Egzersizle orta derecede veya yüksek kardiyovasküler riski bulunan bireyler. Örn. kalp krizi geçirmiş veya hafif egzersizle göğüs ağrısı olanlar. Class D — Stabil olmayan hastalığı olan ve egzersiz yapması sakıncalı olan bireyler.

33 ASKH Class A – Ön inceleme gerekmez
Class B – İlk 6 seansta EKG takibi gerekir Class C – İlk 8-12 hafta boyunca gözlem altında olmalıdır. Class D – egzersiz yapamaz * B ve C grubunda ısınma ve soğuma sırasında da gözlem gerekir.