Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 196

There are many ways to conceptualise the integration of exercise into the treatment of established disease. For example, traditional medical interventions do not typically address disuse syndromes accompanying chronic disease, which may be responsible for much of their associated disability. Exercise is particularly good at targeting syndromes of disuse and may thus significantly impact disability without altering the underlying disease itself in any primary way. Examples include Parkinson’s disease, chronic obstructive pulmonary disease, and chronic renal failure. Exercise may also lower the risk of recurrence of a disease, such as secondary events in patients with cardiovascular disease or preventing recurrent injurious falls in an individual after a hip fracture. Some pathophysiological aberrations central to a disease are specifically addressed by exercise, which may therefore serve as an adjunct to standard care. For example, losses of visceral fat achieved through resistive or aerobic training improve insulin resistance and complement dietary and pharmacological management of type 2 diabetes in the older adult with central obesity.²²

Exercises designed to stimulate skeletal muscle hypertrophy in congestive heart failure provide benefits that counteract the catabolic effects of circulating cytokines in this disease and are not achievable with cardiac medications alone. Indeed, regular exercise induces antiatherogenic adaptations in vascular function and structure, irrespective of traditional cardiovascular disease (CVD) risk factors. Muscle‐derived myokines are responsible for many of the beneficial effects of exercise, particularly by promoting a healthy anti‐inflammatory milieu.²¹

Functional improvements in individuals with arthritis who are given lower‐extremity exercises include improved joint stability and may thus add to the benefits of anti‐inflammatory and analgesic medications. It is not possible in this chapter to review every disease in which exercise has beneficial effects, and therefore we will use type 2 diabetes as one example of the diseases outlined in Table 7.7.