Ako dobehnúť cholesterol a utiecť infarktu

Napísal MUDr. Vladimír Tuka, Ph.D. 06. máj 2019

Vzťah k pohybu si vytvárame už od detstva, a pokiaľ nás rodičia k pohybu neviedli, môže byť v dospelosti utrpe- ním. Navyše máme genetickú výbavu, ktorá nás čiastoč- ne predurčuje, k akému typu pohybu budeme mať väčšie sklony, čo nám pôjde lepšie.

doktorka fonendoskop 17

Búranie mýtov o pohybe

Všeobecné odporúčania pre pohybovú aktivitu v rámci kardiovaskulárnej prevencie: Pre zdravé dospelé osoby (napr. len so zvýšenými koncentráciami lipidov, s vysokým krvným tlakom) sa odporúča venovať minimálne 150 minút týždenne pohybovej aktivite vytrvalostného typu o strednej intenzite alebo 75 minút týždenne aktivite o vysokej intenzite alebo kombinácii oboch. Zvýšením objemu pohybovej aktivity na 300 minút pohybovej aktivity vytrvalostného typu o strednej intenzite týždenne alebo na 150 minút pohybovej aktivity o vysokej intenzite týždenne sa dosiahnu ďalšie zdravotné prínosy. Pohybová aktivita sa dá nakumulovať po desaťminútových časových úsekoch a odporúča sa jej venovať väčšinu dní v týždni. Zdá sa vám to zložité? Nebojte sa, nie je. Nižšie nájdete niekoľko praktických odporúčaní, ktoré by vám mali pomôcť začať a pritom sa vyvarovať najčastejších omylov a chýb. Možno ste si všimli, že v odporúčaniach sa nehovorí o cvičení, ale o pohybovej aktivite. Cvičenie je len jednou, a to relatívne malou podskupinou pohybovej aktivity.

Medzi pohybovú aktivitu sa počíta aj cesta do/z práce (chôdza, jazda na bicykli), domáce práce (pri vysávaní sa človek niekedy pekne zapotí), práce na zá‐ hrade atď. Turistika je tiež veľkou pohybovou aktivitou s tradíciou v Slovenskej republike, do pohybu sa počítajú aj také aktivity ako tanec.

Čo treba odporúčať:
▶ Nájdite si takú pohybovú aktivitu, ktorá vás bude baviť (alebo vás aspoň nebude veľmi obťažovať).
▶ Povedzte si, prečo sa pohybu venujete (ak je cieľom zdravie, potom nemusíte zabehnúť maratón).
▶ Neporovnávajte sa s ostatnými (možno nebudete výkonnostnými športovcami, ale prečo by ste nemohli na konci roku prejsť o 1 000 krokov denne viac ako teraz).

Mám denne cvičiť 30 minút, ale dnes môžem len 5 minút, tak to nemá cenu a vykašlem sa na to

Často sa stane, že sa naplánovanej pohybovej aktivite nemôžeme venovať celých 30 minút. V takom prípade by bola škoda sa na pohyb „vykašlať“. Naše telo si „pamätá“ akúkoľvek pohybovú aktivitu, ale aj akékoľvek zanedbanie pohybu. Rovnako ako keď si dohovoríte hodinu posedenia s priateľom/priateľkou v kaviarni a nestíhate, tak iste aj on/ona ocení, keď s ním/s ňou prehodíte aspoň pár slov alebo s ním/s ňou strávite aspoň 10 minút. Existuje tajná čarovná formulka pre pohyb: KPsP – každý pohyb sa počíta. Keď budete mať málo času a do pohybu sa vám nebude chcieť, skúste si povedať KPsP a budú sa diať divy.

Je jedno, čo cvičím, hlavne keď cvičím

Rôzne typy pohybovej aktivity sa nedajú zamieňať: chô- dza, beh, korčule, pilates, posilňovanie, joga a pod. Pre svaly platí pravidlo špecificity, t. j. ak budem trénovať vy- trvalosť, bude sa mi zlepšovať vytrvalosť, a ak budem posilňovať, budú sa mi zväčšovať svaly a ich sila.

Existujú nasledujúce hlavné typy pohybu, ktoré by sa mali kombinovať:
▶ dynamický pohyb (vytrvalostný) – chôdza, bicykel, beh, plávanie, in‐line korčuľovanie;
▶ kontinuálny pohyb (stále rovnaká intenzita);
▶ intervalový pohyb (napr. moderný HITT – high inten-
sity interval training, ale aj mnoho domácich prác);
▶ odporový typ pohybu – posilňovanie;
▶ preťahovanie – rôzne formy strečingu alebo pilates,
joga.

Najviac údajov o prospešnom pôsobení na kardiovasku- lárny systém máme u aktivít vytrvalostného typu, ktorým by sme sa mali venovať po väčšinu dní. Odporovému tréningu (posilňovaniu) by mali byť venované optimálne 2–3 dni v týždni a preťahovaniu by sme sa mali venovať najmenej obdeň.

Ako poznám strednú intenzitu pohybovej aktivity?

Stredná intenzita pohybovej aktivity je definovaná ako pohyb, kedy srdcová frekvencia dosahuje 64–76 % maximálnej srdcovej frekvencie. Pokiaľ sa vám to zdá krkolomné a neviete, ako si merať srdcovú frekvenciu, tak si môžete orientačne pomôcť jednoduchým „testom hovorenej reči“:
▶ nízka intenzita: môžem spievať a baviť sa s partnerom v súvetiach;
▶ stredná intenzita: môžem sa baviť v krátkych vetách;
▶ vysoká intenzita: môžem... povedať... jedno až...dve... slová... medzi nadýchnutím.
Pokiaľ sa rozhodnete cvičiť podľa pulzovej frekvencie, tak pozor na stanovenie maximálnej pulzovej frekvencie. Treba ju priamo zmerať testom do maxima (najlepšie spiroergometriou), pretože všetky rovnice pre jej výpočet na základe veku platia len pre celú populáciu, a nie pre jednotlivcov. Pre jednotlivcov môže byť maximálna pulzová frekvencia až o 12 tepov pod či nad vypočítanou hodnotou.

Keď cvičím, nemusím už užívať lieky

Pohybová aktivita je súčasťou zdravého životného štýlu a ľudia, ktorí ho dodržiavajú, menej často užívajú lieky. Aj keď však pravidelná pohybová aktivita významne znižuje celkové kardiovaskulárne riziko a dokáže čiastočne ovplyvniť aj jednotlivé rizikové faktory (vysoká koncentrácia cholesterolu, vysoký krvný tlak, diabetes), tak v mnohých prípadoch sa bez špeciálnych liekov nezaobídeme. Na druhej strane pravidelná pohybová aktivita dokáže znížiť počet užívaných liekov, napr. u hypertenzie o 1–2 tablety. Pri zvýšenej koncentrácii cholesterolu je vplyv na koncentráciu cholesterolu menší. Ale aj v prípade, že sa nepodarí lieky „odbúrať“, riziko infarktu či cievnej moz- govej príhody sa pohybom podstatne zníži vždy.

Keď ma bolia svaly po cvičení a užívam statín, tak je to nežiaduci účinok lieku

Po cvičení, najmä intenzívnom, dochádza vo svaloch k obnove. Svalová bolesť je ochranným mechanizmom, aby neboli svaly preťažované. Pokiaľ zároveň užívate statíny (znižujú koncentráciu cholesterolu v krvi), môže byť u niektorých ľudí svalová slabosť o niečo intenzívnejšia. Stáva sa to však menej často, ako sa pôvodne uvádzalo.

Zdroj: MUDr. Vladimír Tuka, Ph.D.,3. interná klinika VFN a 1. LF UK

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