• Kobal Sangaji

• Physical Medicine and Rehabilitation

• Awalbros Pekanbaru Hospital
 NON COMUNICABLE DISEASE

The leading cause of death in the world 63% of all annual deaths
38 million people are killed /year

1. Cardiovascular diseases (17.5 million)

Complications of hypertension (9.4 million)
2. Cancers (8.2 million)
3. Respiratory diseases (4 million)
4. Diabetes (1.5 million )
These 4 diseases account for 80 % of all
NCDs deaths (> 38 million)
•Stress depression
•Diet
•Sleep-awake
•Lack of exercise
•Sun avoidance
•Wireless wifi devices
•Leaky gut syndrome (increased intestinal permeability)
•Other pollutans
 Physical inactivity pandemic

Obesity Do we think we have a chance

Coronary artery without exercise?
disease The answer is no!
Diabetes
Hypertension
Cancer Why no ?
Depression and
Exercise Treat the Root Cause Of Chronic
anxiety diseases Cancer & Aging
Arthritis
1- A state of chronic low grade inflammation
Osteoporosis Dr. Richard K. Bernstein

Etc, etc, etc… 2- Mitochondrial dysfunction

Dr. Ron Rosedale
Obesity and Type 2 Diabetes
are high rocketed and reached an
epidemic after 1980

Since the low fat guidelines

1979
Obesity epidemic
Type 2 diabetes epidemic
(Insulin resistance 92%) Increasing prevalence of type 2 diabetes (vertical bars) in the
United States between 1933 and 1997 with increasing per capita
percentage of carbohydrate intake from corn syrup (•) (14, 17)
BLOOD SUGAR AND INFLAMMATION - THE VICIOUS CYCLE

Obesity
Hyperglycemia
Free fatty acids (NEFA)
Triglycerides

Lipogenesis
Hyperinsulinemia
Systemic Insulin
resistance
Adipose tissue
Macrophages Liver
Local insulin
resistance Systemic Insulin
resistance
Kidney
Musculoskeletal
Phagocytosis + Pro inflammatory Vessels
mediators
Triggering adipose
DM 2
tissue inflammation
Adipokines Metabolic disorders
1- Leptin (pro-inflammatory)
Local insulin
Metabolic syndrome
2- Adiponectin (anti-inflammatory). resistance

Diabetes & Inflammation—the Vicious Cycle

Anatomy of the Vicious Cycle Dr. Richard K. Bernstein
Chronic low-grade inflammation plays a role in all major diseases including musculoskeletal manifestations
 INSULIN RESISTANCE SYNDROME
Hyper insulinemia - Insulin toxicity
Sedentary Lifestyle
Caloric overload, High Carb-Sugar, Inactivity, Stress, Sleep, Obesity, Drugs, etc

1- Direct damage blood vessels 6- Obesity (abdominal),

Lipogenesis - Dyslipidemia
Intima –neoangiogenesis –plaque -

7- Insulin-Leptin-Ghrelin
2- Coagulation & fibrinolysis INSULIN (Hunger pain)
disorders RESISTANCE
3- High blood pressure 8- Certain types of cancer
Mg loss in urine –> spasm of blood (Toxicity) as colon, breast & prostate
vessels – salt water retention
Sympathetic nervous system
4- Heart disease & failure 9- Osteoporosis
Endothelial dysfunction, coagulopathy,
Hypertension , coronary heart disease. 10- polycystic Ovary
Syndrome
(PCOS)
5- 83% Type 2 diabetes
12- Ch. Inflammation 11- Higher risk of Alz.D,
Glucose - NEFA -Triglycerides Nephropathy, etc
Insulin, Not Cholesterol, Is the True Culprit in Heart Disease
February 18, 2017 | 6,928 views - Dr. JosephMercola
Reaven GM. Physiol Rev.1995;75:473-486
Clauser, et al. Horm Res. 1992;38:5-12.
 MUSCULOSKELETAL MANIFESTATION
OF SYSTEMIC DISORDERS
Systemic disorders and musculoskeletal
manifestations are interrelated
Diagnosed systemic disorders
We expect musculoskeletal manifestations

Musculoskeletal manifestations
will guide us to the hidden systemic disorder
Countless sources of information
Plain X-rays can tell a lot
Even the lifestyle and food selection can help
in future expectations
 Role of Regular Physical Exercise
A. Burn of fat
(Same as MMT & Ketogenic diet)
B. Improve insulin sensitivity
(Depleting glycogen &
fat stores Replenish
by glucose in blood)
C. Peak rise of hormones
Exercise intensity - Human growth
hormone(HGH-GH) Endorphins,
Dopamine, Serotonin,
Norepinephrine
D. Mitochondrial Biogenesis
 EXERCISE
AND
MITOCHONDRIAL
BIOGENESIS
MITOCHONDRIAL BIOGENESIS
MITOCHONDRIA REPRODUCTION AND MULTIPLICATION

Exercise one of the most powerful signals for

PPARGC1A
PGC 1-alpha
(protein encoded by PPARGC1A gene)

PGC 1-alpha is the primary signal for

Mitochondrial Biogenesis
Mitochondria Reproduction and Multiplication
(PGC-1α) is a protein encoded by the PPARGC1A gene. known as human accelerated region 20 (HAR20).
PGC-1α is a transcriptional co activator that regulates the genes involved in energy metabolism. It is
the master regulator of mitochondrial biogenesis.
 MITOCHONDRIAL BIOGENESIS
Peroxisome proliferator-activated receptor gamma coactivator 1-
alpha (PGC-1α)
PGC-1α activating host factors PPARGC1A
1 Free Radicals
Reactive oxygen species (ROS) and reactive nitrogen species (RNS),
both formed intracellularly as by-products of metabolism but
upregulated during times of cellular stress.

2 Cold Exposure
adaptive thermogenesis

3 Endurance Exercise
PGC-1α determines lactate metabolism, preventing high lactate levels in
endurance athletes & making lactate as an energy source

plays a central role in the regulation of cellular energy metabolism. It stimulates 1- mitochondrial biogenesis 2- promotes the
remodeling of muscle tissue to a fiber-type that is metabolically more oxidative and less glycolytic in nature
It participates in the regulation of both carbohydrate & lipid metabolism.
It is involved in obesity, diabetes, & cardiomyopathy.
 Exercise
(Mitochondrial Biogenesis)
for Cutting Cancer
Risk
 EXERCISE FOR CUTTING CANCER RISK
The research involved a mega-pool of
Exercise slashed the risk of cancer 1.44 million men and women from a
dozen large European and U.S.
in 13 out of the 26 cancers
prospective cohort studies (groups of
participants who’d been followed for
for example several years).

Kidney cancer by (23 %) Participant age, body mass index, gender,

self-reported data on exercise, smoking
status and, if applicable, any cancer
Lung cancer by (26 %) diagnoses, were analyzed to determine
the effect exercise had on various cancers.
Liver cancer by (27 %)
A total of 186,932 primary cancers were
diagnosed during the follow-up period,
Esophageal adenocarcinoma by (42 %) which had a median length of 11 years.

LARGE STUDY 2016 UNDERSCORES VALUE OF EXERCISE FOR CUTTING CANCER RISK Regardless of the person’s weight or
JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION INTERNAL MEDICINE 2016; 176(6): smoking history, the data suggested
816-825
physical activity cut their risk of cancer.
ROLE OF EXERCISE IN OSTEOPOROSIS
1- Simulate Osteoblasts

like small doses parathyroid

Bone Mass and Activity
hormone (Ratio of OPG >
RANKL) - (Teriparatide –
Forteo) 115

110

% S eden tary C ontrol

105

100

95
2- Anabolic effect 90
stop or reverse
85
osteoporosis
80
3- 60% reduction in Row Volleyball Basketball Swim Run Weights

fracture incidence Sports

 Insulin is a Hormone

Responsible for several anabolic effects,

primarily glucose intake

A. Type 1 Diabetes
Auto immunity Low insulin level

B. Type 2 Diabetes
1. 83 % insulin resistance pre-diabetes –
metabolic
syndrome – hyperinsulinemia – insulin
toxicity
2. 17 % Adult onset diabetes like Type 1
diabetes Low insulin level
 DIABETES CAUSED BY
1. Low insulin level, or
2. Insulin resistance
1 Low insulin level
(type 1 diabetes + 17% type 2 diabetes)
Sunlight & Vitamin D
Stimulate insulin production

2 Insulin resistance
(83% type 2 diabetes)
Exercise & Calcium
Improve insulin sensitivity

Sunlight + Vitamin D + Exercise + Calcium

= Drugs for diabetes – its side effects
 INSULIN RESISTANCE SYNDROME
Reduced response to circulating insulin

Hyperinsulinemia
Hyperglycemia Insulin resistance

Liver Adipose
Muscle tissue

 Glucose output  Glucose uptake  Glucose uptake

Hyperinsulinemia
Insulin resistance

Hyperglycemia
Exercise improve Insulin
sensitivity
Exercise, Diet and Intermittent fasting
Can improve Insulin sensitivity
Exercise & Human
Growth Hormone
HGH-GH
Exercise & Human Growth Hormone
HGH-GH
 Exercise
Stress, Depression
and the Brain
 EXERCISE, DEPRESSION, AND THE
BRAIN
Written by Ryan Collins
Medically Reviewed by Timothy J. Legg, PMHNP-BC, GNP-BC, CARN-AP, MCHES
on Mar 29, 2016
“Runner’s high”. Endorphins
->> Relieve pain and stress.

Dopamine, Norepinephrine, Serotonin

->> Mood, Appetite, Sleep cycles
(Opposite effect of Depression)

Stress hormones,adrenaline,cortisone
(fight-or-flight response)
->> Relieve fatigue
But too much of it can damage health.

Exercise and Brain chemistry

Endorphins and other neurotransmitters Dopamine, Norepinephrine, Serotonin
 ROLE OF REGULAR PHYSICAL EXERCISE
SUMMARY
1. Mitochondrial Biogenesis
Cutting Risk of cancer, aging & chronic diseases

2. Protect against osteoporosis

3. Improve insulin sensitivity

4. Stimulate secretion of human growth hormone

(HGH-GH)

5. Big rule in stress, depression and brain function

(Neurotransmitters, endorphins dopamine, norepinephrine, serotonin, adrenaline
& cortisone)
Walking vs Running
Calorie Burning
Comparisons
 WALKING VS. RUNNING
Calorie Burning Comparisons
By Wendy Bumgardner Updated March 29, 2017

Adding running intervals to your

walking workouts
Raise calorie burn per mile as well as per minute.

Higher-intensity workouts
require faster energy, so you'll
use a greater proportion of
carbs for fuel. Lower-intensity
exercise doesn't need as much
"fast" energy, so you'll burn a
greater proportion of fatty
acids while you work out.
 Walking & Running Vs Sustained
Resistance Exercise
Top 10 Exercises to Lose Weight
1. The Squat
2. The Lunge
3. The Push Up
4. The Pull Up
5. The Plank
6. The Spider Crawl
7. The Get Up
8. The Burpee 10 Minutes of This Exercise Can Burn
9. The Skater
10. Jumping Rope More Calories Than 30 Minutes of
Jogging

if you want to be just a smaller version of your former fat self, ‘cardio’ is your answer. But, if
improved strength and endurance and looking better naked is your goal, then resistance
training
 How to control Diabetes Mellitus
Lifestyle diseases can be reversed and cured

Therapeutic lifestyle change Rather than

treating risk factors by drugs for life
Prevent rather than treating Risk factors
How to control Diabetes Mellitus
Therapeutic lifestyle change

Stimulate insulin production :

1- Sunlight ->> circadian rhythm (Melatonin- Insulin)
2- Vitamin D ->> immunosuppressive (B cells)
(type 1 diabetes + 17% type 2 diabetes)
3- Drugs ->> Insulin

Improve insulin sensitivity :

1- Calcium ->> VGCC (Voltage gated calcium channel)
2- Exercise ->> Depletion of stores
3- Diet ->> LCHF vs. IF (Intermittent fasting)
(83% type 2 diabetes)
4- Drugs ->> Glucobay – Glucophage

Sunlight +Vitamin D + Calcium + Exercise + Diet

= Drugs for diabetes - its side effects
Rule of diet - LCHF vs. Intermittent fasting