Sport und Bewegung bei asthmakranken Kindern

Children and young people today tend to be considerably less active than they used to be. Together with the greater amount of time they spend watching TV and playing video games, this development is leading to generally shallower breathing and an increase in bronchial hyperreactivity. Links between decreasing activity and a higher prevalence of childhood asthma cannot be ignored. Sport and exercise programs are part of modern asthma management in patients who already have bronchial asthma and are core components of effective behavior training. Sport programs not only improve general performance parameters; they also reduce exercise-induced asthma and the bronchial hyperreactivity itself. In addition, indirect positive effects have been demonstrated in other areas of child development. However, effective sport and exercise programs are attached to general conditions, primarily ensuring that there is a sufficiently long warm-up phase before exertion and selecting types of sport and main forms of exertion that are suitable for patients of that age. Sufficient drug treatment methods are available both for prevention and for acute cases.     

Bewegung und Sport bei Typ-2-Diabetes

In addition to diet and medical therapy, physical activity and exercise play a pivotal role in the prevention and therapy of type 2 diabetes mellitus. There are clear guidelines and recommendations for exercise in type 2 diabetes. The positive effect on metabolism is well documented but to date there are few data indicating a reduction in mortality. Further research is also needed to improve the implementation of exercise programs into clinical practice. The frequency of physically active patients is still significantly lower compared with the age-matched general population.     

Begutachtung bei Osteoporose

There are about 8 million people in German-speaking countries who suffer from osteoporosis, making it the most common bone disease. Osteoporotic fractures can significantly impair quality of life and working ability in those affected, and they also give rise to huge expenditures in the healthcare system. Expert assessments should be based on estimated risk of fracture, risk of falling, pain, fitness for work, degree of disability, need for rehabilitation, and causality.     

Physiotherapeutische Interventionen bei Osteoporose

Osteoporosis is an increasing public health problem which ultimately causes fractures and a significant reduction in patient's health-related quality of life. In this context, physiotherapists are involved in a wide range of therapies related both to prevention and treatment of osteoporosis. The reduction of the risk of falling by elderly patients with osteoporosis is a very important goal for physiotherapists because it is known to significantly decrease fracture incidence. Indeed, exercise programs including elements of muscle strengthening and better body balance control have a positive effect on the risk of falling, hence reducing the incidence of fractures and increasing the health-related quality of life of osteoporotic patients. As a further consequence, the decreased fracture incidence has a key roll in reducing health care costs. Once a patient presents with an osteoporotic fracture, he may be assisted with various forms of passive, active-assisted and active therapies. This treatment will help reduce pain, increase patient's mobility and prevent the occurrence of additional fractures. In addition, a good and well-balanced education process regarding secondary osteoporosis prevention may also help to modify the behavior of patients and help to improve skeletal health in the longer term. The physiotherapist has definitively a major role to play in the interdisciplinary team aimed at preventing osteoporotic fractures in both primary and secondary prevention levels.     

Folgeerkrankungen und Komplikationen der Adipositas

In the industrial countries the prevalence of adipositas has risen to approximately 20% during the last decades. In addition, a further rise in adipositas-related comorbidities is to be expected. Adipositas is an important risk factor for nonalcoholic fatty liver diseases, reflux, cholelithiasis, and tumour diseases. Adipose patients have a significantly higher risk of developing colon carcinoma, gallbladder carcinoma, oesophageal adenocarcinoma, and hepatocellular carcinoma. Visceral fat measured as waist circumference or waist:hip ratio correlates more with the comorbidity risk than body mass index. Apart from insulin resistance and oxidative stress, secretion of adipokins such as leptin and proinflammatory cytokines of visceral fatty tissue play an important pathogenic role. Still not completely clarified, these pathomechanisms represent the link between visceral adipositas and many organ systems and tumourigenesis. Regarding preventive aspects, adipositas is increasingly relevant concerning the determination of risk profiles and therapy.     

Diabetesclusters: Diabetessubgruppen und Folgeerkrankungen

Die Diabetologie - Diabetes mellitus ist eine heterogene Krankheit mit Unterschieden in der Klinik und dem Risiko für Komorbiditäten und Komplikationen. Bisherige Klassifikationen...     

Alter und Osteoporose

Background

Osteoporosis is an age-associated disease, which is influenced by genetic, epigenetic and environmental factors.

Aim

This article examines the evidence for specific aspects in osteoporosis diagnosis and management in higher age groups.

Material and methods

The study was based on extraction of data from literature databases and from the guidelines of the “Dachverband Osteologie” (DVO, Governing Body for Osteology).

Results

Age is a high risk factor for osteoporosis. Vitamin D insufficiency and reduced calcium absorption are common in the elderly. Loss of bone and muscle develop in a vicious circle of immobilization caused by underlying diseases. In addition deficits in cognition and coordination promote falls and fragility fractures. Clinical risk assessment including geriatric test batteries is recommended in all women >?70 and men >?80 years of age. Specific medication is indicated if the 10-year fracture risk exceeds 30?%, where in women >?75 and in men >?85 years of age bone density measurement can be relinquished. There is good evidence for the efficacy of antiosteoporotic medication even for the elderly. Prevention of falls requires multimodal management to enhance muscle power and coordination. It is essential to improve underlying cardiovascular, pulmonary and neurological diseases while critically evaluating the necessity of medication that boosts the risk of falls and fractures. There is good evidence for age and disease-adapted exercise programs such as Tai-Chi. Treating osteoporosis reduces the fracture risk, improves the quality of life, maintains independence and decreases mortality.

Conclusion

Treating osteoporosis in the elderly is strongly recommended. Multimodal management and medication according to guidelines can be very successful, given that interdisciplinary and geriatric concepts consider the specific needs of the elderly population.     

Osteoporose und Osteomalazie

Ohne Zusammenfassung     

Diabetes und Osteoporose

Osteoporosis is an age-associated disease, resulting in impaired bone quality and increased risk for bone fractures. Patients with type 2 diabetes mellitus have—despite a normal or even increased bone mineral density—an increased risk for fractures, which is related to an imbalance between osteoblastic bone formation and osteoclastic resorption. Complex pathophysiological mechanisms associated with insulin resistance and hyperglycemia are involved in the deleterious effects on osteoblast function and bone formation. The quality and regimen of antidiabetic therapy are discussed as modulators of bone metabolism. Of great clinical importance is an assessment of the fall risk especially for diabetic patients, because late complications, such as neuropathy, but also side effects of medication can result in a significantly increased risk for falls. Lifestyle intervention is of advantage with respect to diabetes and osteoporosis prevention and therapy. Vitamin D supplementation results in favorable effects with a reduced risk for falls and also improvements of insulin sensitivity. According to published data, the safety and efficacy of specific medication for the treatment of osteoporosis (bisphosphonates, denosumab, selective estrogen receptor modulators) reveal no difference between patients with and without diabetes mellitus.     

Diagnose, Prophylaxe und Therapie der Osteoporose bei juveniler idiopathischer Arthritis

In all subgroups of juvenile idiopathic arthritis (JIA), a pathologic loss of bone or the lack of increase in bone mass has been described in a high percentage of cases, even with new therapeutic approaches. The decrease in bone mass is correlated with the duration of active disease and the number of affected joints (cytokines, inactivity). In several studies, muscle mass was the strongest predictor of bone mass. A standardized diagnostic approach to the musculoskeletal system including measures of prophylaxis and therapy therefore seems to be mandatory for all children with JIA who do not achieve rapid remission. In this review, the diagnostic and therapeutic options are described and summarized in an algorithm.     

COPD und Osteoporose

The prevalence of osteoporosis increases in humans above the age of 50 years. In otherwise healthy people, 5% of men and 10% of women have significant osteoporosis, and these percentages increase to 15% and 35%, respectively, at the age of 80. Chronic diseases affecting many organ systems of the body are frequently accompanied by osteoporosis. This is of particular interest in patients with chronic obstructive pulmonary disease (COPD), since 35–70% of such patients have some degree of bone demineralisation. This might also affect COPD patients younger than 50 years, due to the numerous impacts of COPD upon other organ systems. Treatment with systemic steroids might further aggravate this problem. Measurement of bone mineral density is the only way to assess the diagnosis. Supplementation with calcium and vitamin D is the basis of treatment. In addition, therapy with bisphosphonates may be necessary.     

Physiotherapie bei der juvenilen idiopathischen Arthritis

Control of disease activity and recovery of function are major issues in the treatment of children and adolescents suffering from juvenile idiopathic arthritis (JIA). Functional therapies including physiotherapy are important components in the multidisciplinary teamwork and each phase of the disease requires different strategies. While in the active phase of the disease pain alleviation is the main focus, the inactive phase requires strategies for improving motility and function. During remission the aim is to regain general fitness by sports activities. These phase adapted strategies must be individually designed and usually require a combination of different measures including physiotherapy, occupational therapy, massage as well as other physical procedures and sport therapy. There are only few controlled studies investigating the effectiveness of physical therapies in JIA and many strategies are derived from long-standing experience. New results from physiology and sport sciences have contributed to the development in recent years. This report summarizes the basics and main strategies of physical therapy in JIA.     

Genderaspekte der Malnutrition und assoziierte Folgeerkrankungen

Malnutrition is related to a range of secondary complications. The prevalence of many of these sequelae is higher in elderly women than in men, thus resulting in a higher level of impairment and reduced quality of life. Multiple factors lead to the development of malnutrition and socioeconomic causes, such as poverty among the elderly and isolation, are more common in elderly women. The age-associated loss of muscle mass is more pronounced in women than in men and the risk of developing sarcopenia and frailty is increased. The prevalence of sarcopenic obesity is higher in women than in men. Malnutrition increases the risk of osteoporosis and about 80?% of all osteoporosis patients are women. Furthermore, low serum levels of vitamin D correlate more closely to a poorer cognitive outcome in elderly women than they do in men. The prevention, early diagnosis and therapy of malnutrition is of great clinical importance, particularly to preserve physical functional capacity and thus quality of life in elderly women.     

Folgeerkrankungen und Komplikationen der Adipositas

Overweight and obesity are associated with a high number of complications and co-morbidities. Obesity can affect almost all tissues and organs of the body. Obesity is associated with the components of the metabolic syndrome and is the leading cause of type 2 diabetes. Either obesity itself or co-morbidities of obesity are responsible for the increased cardiovascular risk. The increased overall mortality risk is due to cardiovascular and other complications like the higher prevalence and incidence of malignant tumors. Other complications of obesity like the polycystic ovary syndrome or the obstructive sleep apnea syndrome are relatively unknown but important and frequent. Medical care of people with obesity should focus not only on weight loss but also on complications and co-morbidities.     

Postmenopausale und kortikoidinduzierte Osteoporose

Prevention of osteoporosis and osteoporotic fractures consists of non-drug and drug therapy. Components of non-drug therapy include improvement of muscle strength and coordination, treatment of modifiable causes of falls, a diet rich in calcium and sufficient in calories, adequate supply of vitamin D and a careful approach towards drugs known to increase falls or osteoporosis. Assessment of clinical risk factors in combination with bone mineral density measurements can identify persons at high risk of fracture who benefit most from pharmacological treatment. Particular attention should be paid to patients with previous fragility fractures and long-term oral glucocorticoid therapy.