L`esport (encara que sigui extrem) és salut?

L’esport (encara que sigui extrem) és salut?
Jonatan R Ruiz, PhD (ruizj@ugr.es)
Investigador Ramón y Cajal
Facultad de Ciencias del Deporte
Universidad de Granada
Manresa 12 Noviembre 2011
Daily physical activity energy expenditure in
contemporary Western societies is only ~38% of
that of our Palaeolithic ancestors
physical activity
(Cordain et al 1998)
Daily physical activity energy expenditure in
contemporary Western societies is only ~38% of
that of our Palaeolithic ancestors
physical activity
(Cordain et al 1998)
Physical inactivity has become one of the major
public health problems of the 21st century
(Blair 2009)
¿Somos ciudadanos del Paleolitico viviendo en el
siglo 21?
¿Serán aquellos que tienen un estilo de vida más
parecido al de nuestros antepasados los que tendrán un
menor riesgo de desarrollar enfermedades crónicas y
por tanto una mayor esperanza de vida?
Salud
Riesgo para la salud
Actividad Física y Salud: Modelo teórico
Actividad Física
Soldier Pheidippides (530-490 BC)
Marathon to Athens (~40 km)
Hipócrates
(~ 450 años a.c.)
“...nadie pone en juego su salud
tanto como los atletas”
Galeno
(~ 150 años a.c.)
“Los atletas viven una vida contraria a los
preceptos de la higiene…Cuando los atletas
dejan su profesión entran en una situación
peligrosa: algunos mueren enseguida, otros
viven algunos años pero no llegan a viejos”
1700
Bernardino Ramazzini
(1633 –1714)
Padre de la medicina del trabajo
estudió más de 52 ocupaciones de su
época y los efectos en sus trabajadores
Sastres vs mensajeros profesionales
Ramazzini, B. Disease of Workers (in Latin) (translated by W.C. Wright). New York: Hafner. (1700/1964)
1873
J. E. Morgan, 1873
“El ejercicio intenso
es malo para la salud”.
Morgan, J. University Oars, Being a critical Enquiry into the After Health of Men Who Rowed in the Oxford and Cambridge BoatRace from the Year 1829-1869, Based on the Personal Experiences of the Rowers Themselves. London: MacMillan. (1873).
Introduction of professional running in the U.S.
1909
Introduction of professional running in the U.S.
New York Times, 1909
“...Sólo los superdotados
pueden acabar la
maratón, y aún a riesgo
de dañar su corazón y de
acortar su vida”.
1909
1939
The longevity of endurance athletes
1939
( longevity)
A study of those who
rowed in the Oxford
and Cambridge boat
race from 1829-1928.
BMJ 1:657:662, 1939
Hartley PHS & Llewellyn GF
The Lancet
Morris et al. Lancet 2: 1207-10, 1980.
1953
1953
1953
31 000 London Transport Workers
Morris et al. Lancet 1953
1953
1953
Former athletes
(Cases)
834, sprint and endurance runners, cricketers
and rugby players
Non-athletes (Controls)
761 ‘Intellectuals’ (academically
distinguished) and random controls, both
from Cambridge
1953
1956
JAMA
Life expectancy of 629 athletes vs 583 controls
All deaths included
Athletes
Non-athletes
Excluding accidental deaths
Athletes
Non-athletes
Mean Life
Mean age at
Expectancy, yr Death, yr
65.96
73.86
65.97
74.24
65.96
65.99
74.43
74.59
1956
JAMA
Life expectancy of 629 athletes vs 583 controls
All deaths included
Athletes
Non-athletes
Excluding accidental deaths
Athletes
Non-athletes
Mean Life
Mean age at
Expectancy, yr Death, yr
65.96
73.86
65.97
74.24
65.96
65.99
74.43
74.59
SOS!
Moorstein
All members of the 1948 Harvard
rowing crew had died by 1968 from
“various cardiac diseases”
Moorstein, B. Life expectancy of Ivy League rowing crews. JAMA 205, 106 (1968).
1968
1971
Former athletes
(Cases)
Danish athletic champions in 19
different sports (n=297, born
between 1880- 1910)
Non-athletes (Controls)
General Danish male population
1971
~39% lower risk of death
1972
JAMA
Harvard and Yale
University oarsmen
(n=172) matriculating
during 1882-1902
Prout C. Life expectancy of college oarsmen. JAMA 1972 Jun 26;220(13):1709-1711
1972
Average life span of crew member and controls
+6 years
Prout C. Life expectancy of college oarsmen. JAMA 1972 Jun 26;220(13):1709-1711
1974
396 Finish champions skiers (born from 1845 to 1910)
Median life expectancy: 73
1974
2.8 y longer life expectancy
↓Blood pressure
↓Smoke
↑Physical activity
1983
822 rugby players (blacks) from New Zealand since 1884
1983
No differences of life expectancy with normal population
Non-Maory all black live 10 years than Maori all Blacks
1988
NEJM
U.S. white baseball players (n=985;
started playing between 1911-1915)
1988
Life expectancy ↑6%
Relative Risk of Mortality
Capacidad aeróbica y riesgo de mortalidad
1989
5
4
3
2
1
0
<5
Very Low
Adults
6
7
Low
8
9
Medium
10
11
High
12
>13
METS
Very high
Cardiorespiratory Fitness
Blair et al. JAMA351989
1990
Non-professional Dutch
male ice skaters
(n=2,259) able to finish
ultra-endurance
(200km) races
van Saase JL, et al . BMJ 1990 Dec 22-29;301(6766):1409-1411
All cause mortality
1990
24% lower than expected during the entire 32 year follow up period.
47% lower was found during the first 10 years after the race
Increased life expectancy of world
class male athletes
1993
Cases
Controls
2613 Finnish team members in the Olympic
1712 men selected from the
games, World or European championships or
Finnish Defence Forces
intercountry competitions during 1920-1965 in
track and field athletics, cross-country skiing,
soccer, ice hockey, basketball, boxing,
wrestling, weight lifting, and shooting
Sarna S, Sahi T, Koskenvuo M, et al. Increased life expectancy of world class male athletes. Med Sci Sports
Exerc 1993 Feb;25(2):237-244
1993
Increased life expectancy of world
class male athletes
77
76
75
years
74
Endurance
73
Team games
72
Power athletes
71
Controls
70
69
68
67
1
Sarna S, Sahi T, Koskenvuo M, et al. Increased life expectancy of world class male athletes. Med Sci Sports Exerc 1993 Feb;25(2):237-244
1996
39 sujetos (13 mujeres) que completaron el Ironman de Hawai 1994
(3.9 km nadando; 180.2 km en bici; 42.2 km corriendo)
1996
1996
2006
Int J Sports Med 2006 Jul;27(7):587-9
2006
METODOLOGÍA
Sierra Nevada Límite
2400 m
95km
2006
METODOLOGÍA
justo al término
1 día antes
Perfil lipídico (TC, HDL, LDL, TG)
Susceptibilidad oxidativa
11 ciclistas
Perfil lipídico (TC, HDL, LDL, TG)
Susceptibilidad oxidativa
RESULTADOS
COLESTEROL TOTAL
TRIGLICÉRIDOS
190
80
185
70
180
60
175
50
170
40
165
30
160
pre
post
20
pre
LOW DENSITY LIPOPROTEIN Chol
post
HIGH DENSITY LIPOPROTEIN Chol
80
120
115
70
110
60
105
100
50
95
40
90
30
85
20
80
pre
post
2006
pre
post
2006
Susceptibilidad a la peroxidación lipídica
Susceptibility to Lipid Peroxidation (µm/L)
RESULTADOS
16
14
P<0.001
12
10
8
6
4
2
0
Pre-race
Post-race
2006
16
14
P<0.001
12
10
8
6
4
2
Susceptibility to Lipid Peroxidation (µm/L)
16
Susceptibility to Lipid Peroxidation (µm/L)
RESULTADOS Y DISCUSIÓN
Susceptibilidad a la peroxidación lipídica
14
P<0.001
12
10
8
6
4
2
0
0
Pre
Post
Ruiz et al., 2004
Pre
Post
Ginsburg et al.,1996; 2001
1. Nivel de Condición Física de los sujetos
2. Hipoxia
Davies et al., Biochem Biophys Res Commun 1982; Ginsbrug et al., JAMA 1996; Ginsburg et al., Clin Chem Acta 2001
2006
CONCLUSIONES
1. El perfil lipídico plasmático no se mejora tras un ejercicio de resistencia
realizado en hipoxia moderada en sujetos no entrenados
2. La susceptibilidad a la peroxidación lipídica incrementa tras un ejercicio
de resistencia realizado en hipoxia moderada
2001
Cohort of athletes (n=2,009) including endurance sports,
team games, track&field jumpers and sprinters, and power
athletes
2001
43%
22%
10%
2001
44%
40%
5%
2001
27%
66%
+2.63%
2001
0%
73%
42%
2001
86%
63%
54%
2008
Annual self-administered questionnaires were sent to 538 members of a
nationwide running club and 423 healthy controls from Northern California
aged 50 years and older beginning in 1984
Participants: 284 runners and 156 controls completed 21-years of follow-up (up
to 2003)
Runners’ Club members versus
Community Control subjects
2008
Mean disability by year
Disability in Ever-Runners versus
Never-Runners
2008
Mortality estimates
2008
15% of runners died
34% of controls died
2008
Conclusion
Vigorous exercise (running) at middle and older
ages is associated with reduced disability in
later life and a notable survival advantage
Tour de France
Tour de France
6000
Total km per race
5500
World War I
World War II
5000
4500
4000
3500
3000
2500
2000
1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
Years
Lucia et al 2003
Maurice Garin,
primer vencedor del Tour (1903)
25 kg
Tour de France
Primer español: Vicence Blanco
2011
834 cyclists from Tour de France (1930 and 1964)
Países participantes
2011
Life expectancy Tour de France
2011
11% ↑
The age at which 50 % of the general population died was 73.5 vs. 81.5 years in
TdF participants
Conclusiones
 El ejercicio de resistencia mejora la esperaza de vida
Está en nuestros genes?
Study 1: Endurance athletes vs controls
N=100 CASES: male elite endurance athletes (Europe/World
Champions, Tour de France finishers/winners)
N=100 CONTROLS: male sedentary controls
OUTCOME: N=33 disease risk-related genetic variants
Gomez-Gallego et al 2010
Study 1: Endurance athletes vs controls
CONCLUSION: no evidence that male elite endurance
athletes are genetically predisposed to have lower disease
risk than matched nonathletic control subjects
Gomez-Gallego et al 2010
Study 2: centenarians vs controls
N=54 CASES: Centenarians 100-108 years, 48 women
N=87 CONTROLS: ethnically matched healthy controls (19–43
years) 47 women)
OUTCOME: N=62 disease risk-related genetic variants
Ruiz et al 2011
Study 2: centenarians vs controls
Disease category/subcategory
Health-related (global)
Cardiometabolic risk (global)
Cardiovascular disease
Hypertension
Thrombosis/ischemic stroke
Dyslipidemia
Insulin resistance
Cancer (global)
Lung cancer
Breast cancer*
Other types
Exceptional longevity
No. of
variants
62
36
13
5
6
8
3
24
4
8
14
7
Centenarians
31.0
24.9
37.8
32.6
25.9
6.2
46.6
37.8
27.1
28.0
43.0
51.8
±
±
±
±
±
±
±
±
±
±
±
±
0.6
0.7
1.2
2.2
1.8
1.0
2.4
1.1
2.7
2.1
1.6
2.1
Controls
subjects
32.0 ± 0.5
25.3 ± 0.5
38.2 ± 1.0
38.9 ± 1.7
24.2 ± 1.4
5.4 ± 0.7
43.5 ± 1.9
40.6 ± 0.8
26.4 ± 2.0
28.2 ± 2.2
47.7 ± 1.2
53.8 ± 1.6
P**
0.263
0.664
0.790
0.026
0.445
0.531
0.306
0.048
0.830
0.963
0.020
0.457
Ruiz et al 2011
Conclusiones
 El ejercicio de resistencia mejora la esperaza de vida
 La genética no es determinante
L’esport (encara que sigui extrem) és salut?
Jonatan R Ruiz, PhD (ruizj@ugr.es)
Investigador Ramón y Cajal
Facultad de Ciencias del Deporte
Universidad de Granada
Manresa 12 Noviembre 2011
Ruiz JR, Morán M, Arenas J, Lucia A. Br J Sports Med. 2011 Mar;45(3):159-61.
Moltes gràcies per la seva atenció
Jonatan R Ruiz, PhD (ruizj@ugr.es)
Investigador Ramón y Cajal
Facultad de Ciencias del Deporte
Universidad de Granada