standard italiani per la cura del diabete mellito - Changing Diabetes ...
standard italiani per la cura del diabete mellito - Changing Diabetes ...
standard italiani per la cura del diabete mellito - Changing Diabetes ...
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42 Standard <strong>italiani</strong> <strong>per</strong> <strong>la</strong> <strong>cura</strong> <strong>del</strong> <strong>diabete</strong> <strong>mellito</strong> 2009-2010<br />
mancanza di tempo, <strong>la</strong> pigrizia e <strong>la</strong> presenza di problemi respiratori.<br />
La maggior parte dei pazienti (77%), tuttavia, ritiene utile <strong>la</strong><br />
figura <strong>del</strong>l’o<strong>per</strong>atore di fitness metabolica nell’ambito dei Servizi<br />
di Diabetologia mentre il 94% userebbe strumenti <strong>per</strong> praticare<br />
l’attività fisica se il servizio ne fosse provvisto.<br />
I documenti principali di riferimento <strong>per</strong> <strong>la</strong> frequenza <strong>del</strong>l’attività<br />
fisica si riferiscono al<strong>la</strong> popo<strong>la</strong>zione generale e sono stati<br />
prodotti <strong>del</strong>l’American College of Sports e <strong>del</strong>l’US Department<br />
of Health and Human Services (16,17) e più recentemente<br />
dall’American Heart Association (18).<br />
Attività fisica: definizioni<br />
Le definizioni si basano sul rapporto <strong>del</strong><strong>la</strong> Surgeon General<br />
“Attività fisica e salute” <strong>del</strong> 1996 (16).<br />
attività<br />
fisica<br />
esercizio<br />
fisico<br />
esercizio<br />
aerobico<br />
esercizio<br />
contro<br />
resistenza<br />
Movimento corporeo prodotto dal<strong>la</strong><br />
contrazione di muscoli scheletrici<br />
che richieda una spesa energetica<br />
in eccesso rispetto al<strong>la</strong> spesa<br />
energetica a riposo<br />
Movimento corporeo programmato,<br />
strutturato e ripetuto, eseguito allo<br />
scopo di migliorare o mantenere<br />
una o più componenti in buona<br />
forma fisica<br />
Movimenti ritmici, ripetuti e continui<br />
degli stessi grandi gruppi musco<strong>la</strong>ri<br />
<strong>per</strong> almeno 10 minuti ciascuno. Gli<br />
esempi comprendono camminare,<br />
andare in bicicletta, corsa lenta,<br />
nuoto, esercizi aerobici acquatici<br />
e molti sport<br />
Attività che utilizzano <strong>la</strong> forza<br />
musco<strong>la</strong>re <strong>per</strong> muovere un peso o<br />
<strong>la</strong>vorare contro un carico che offre<br />
resistenza<br />
Bibliografia<br />
1. Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects<br />
of exercise on glycemic control and body mass in type 2 <strong>diabete</strong>s<br />
mellitus: a metanalysis of controlled clinical trial. JAMA<br />
2001;286:1218-227.<br />
2. Boulé NG, Kenny GP, Haddad E, Wells GA, Sigal RJ. Metanalysis of<br />
the effect of structured exercise training on cardiorespiratory fitness<br />
in type 2 <strong>diabete</strong>s mellitus. Diabetologia 2003;46:1071-1081.<br />
3. Church TS, Cheng YJ, Earnest CP, Barlow CE, Gibbons LW,<br />
Priest EL, B<strong>la</strong>ir SN. Exercise capacity and body composition<br />
as predictors of mortality among men with <strong>diabete</strong>s. <strong>Diabetes</strong><br />
Care 2004;27:83-88.<br />
4. Wei M, Gibbons LW, Kam<strong>per</strong>t JB, Nichaman MZ, B<strong>la</strong>ir SN.<br />
Low cardiorespiratory fitness and physical inactivity as predictors<br />
of mortality in men with type 2 <strong>diabete</strong>s. Ann Intern Med<br />
2000;132:605-611.<br />
5. Hu FB, Stampfer MJ, Solomon C, Liu S, Colditz GA, Speizer FE,<br />
Willett WC, Manson JE. Physical activity and risk for cardiovascu<strong>la</strong>r<br />
events in diabetic women. Ann Intern Med 2001;134:96-105.<br />
6. Di Loreto C, Fanelli C, Lucidi P, Murdolo G, De Cicco A, Par<strong>la</strong>nti<br />
N, Ranchelli A, Fatone C, Taglioni C, Santeusanio F, De Feo P.<br />
Make your diabetic patients walk: long-term impact of different<br />
amounts of physical activity on type 2 <strong>diabete</strong>s. <strong>Diabetes</strong> Care<br />
2005;28:1295-1302.<br />
7. Ivy JL. Role of exercise training in the prevention and treatment<br />
of insulin resistance and non-insulin-dependent <strong>diabete</strong>s mellitus.<br />
Sports Med 1997;24:321-336.<br />
8. Dunstan DW, Daly RM, Owen N, Jolley D, de Courten M,<br />
Shaw J, Zimmet P. High-intensity resistance training improves<br />
glycemic control in older patients with type 2 <strong>diabete</strong>s. <strong>Diabetes</strong><br />
Care 2002;25:1729-1736.<br />
9. Castaneda C, Layne JE, Munoz-Orians L, Gordon PL, Walsmith<br />
J, Foldvari M, Roubenoff R, Tucker KL, Nelson ME. A randomized<br />
controlled trial of resistance exercise training to improve<br />
glycemic control in older adults with type 2 <strong>diabete</strong>s. <strong>Diabetes</strong><br />
Care 2002;25:2335-2341.<br />
10. Snowling NJ, Hopkins WG. Effects of different modes of exercise<br />
training on glucose control and risk factors for complications<br />
in type 2 diabetic patients: a meta-analysis. <strong>Diabetes</strong> Care<br />
2006;29:2518-2527.<br />
11. Zanuso S, Jimenez A, Pugliese G, Corigliano G, Balducci S.<br />
Exercise for the management of type 2 <strong>diabete</strong>s: a review of the<br />
evidence. Acta Diabetol 2009;Jun 3. Pubblicato online.<br />
12. Sigal RJ, Kenny GP, Boule NG, Wells GA, Prud’homme D,<br />
Fortier M, Reid RD, Tulloch H, Coyle D, Phillips P, Jennings<br />
A, Jaffey J: Effects of aerobic training, resistance training, or both<br />
on glycemic control in type 2 <strong>diabete</strong>s: a randomized trial. Ann<br />
Intern Med 2007;147:357-369.<br />
13. Hays LM, C<strong>la</strong>rk DO. Corre<strong>la</strong>tes of physical activity in a<br />
sample of older adults with type 2 <strong>diabete</strong>s. <strong>Diabetes</strong> Care<br />
1999;22:706-712.<br />
14. Zinman B, Ruderman N, Campaigne BN, Devlin JT, Schneider<br />
SH. American <strong>Diabetes</strong> Association. Physical activity/exercise and<br />
<strong>diabete</strong>s. <strong>Diabetes</strong> Care 2004;27(Suppl 1):S58-S62.<br />
15. Gruppo di Studio Attività Fisica, Indagine conoscitiva sulle cause<br />
di ridotta attività fisica in NIDDM in Italia. 3° Convegno Centro<br />
studi e ricerche AMD, Ancona 2006. Accessibile al: http://www.<br />
info<strong>diabete</strong>s.it/congressi_nazionali/2006/ancona/pdf/14/attivita_motoria/corigliano.pdf<br />
(visitato il 07/12/2009).<br />
16. US Department of Health and Human Services: Physical Activity<br />
and Health. A Report of the Surgeon General. At<strong>la</strong>nta, GA, U.S.<br />
Department of Health and Human Services, Centers for Disease<br />
Control and Prevention, National Center for Chronic Disease<br />
Prevention and Health Promotion, 1996.<br />
17. Albright A, Franz M, Hornsby G, Kriska A, Marrero D, Ullrich<br />
I, Verity LS. American College of Sports Medicine position<br />
stand: exercise and type 2 <strong>diabete</strong>s. Med Sci Sports Exerc 2000;<br />
32:1345-360.<br />
18. Marwich TH, Horden MD, Miller T, et al. On behalf of the<br />
American Heart Association Exercise, Cardiac Rehabilitation, and<br />
Prevention Committee of the Council on Clinical Cardiology;<br />
Council on Cardiovascu<strong>la</strong>r Disease in the Young; Council<br />
on Cardiovascu<strong>la</strong>r Nursing; Council on Nutrition, Physical,<br />
Circu<strong>la</strong>tion 2009;119:3244-3262.<br />
e. terapia medica nutrizionale<br />
raccomandazioni<br />
Le <strong>per</strong>sone affette da alterazioni glicemiche o <strong>diabete</strong><br />
devono ricevere, preferibilmente da un dietologo<br />
o da un dietista, es<strong>per</strong>ti in terapia medica<br />
nutrizionale (MNT) <strong>del</strong> <strong>diabete</strong> e quindi inseriti nel