Physical Inactivity and Sedentariness

Physical Inactivity and
Sedentariness
Prof. Brian Oldenburg
DIET, NUTRITION and
OBESITY…..
PHYSICAL INACTIVITY AND
SEDENTARINESS………..
Learning Objectives
• Extent of the problem? – To describe
• Causes? – To understand
• What to do about it? – To identify
solutions and knowledge exchange
• What is the problem and extent of
the problem? - DESCRIBE
Summary of Benefits of Physical Activity
Through the public health lens…..
• Increasing levels of physical activity is a
problem for the whole society not just
individuals
• Requires a population-based, multisectoral, multi-disciplinary, and culturally
relevant approaches
WHO facts and figures
• Globally, around 31% of adults aged 15 and
over were insufficiently active in 2008 (men
28% and women 34%).
• Approximately 3.2 million deaths each year
are attributable to insufficient physical
activity.
ASCEND RESEARCH NETWORK
Reminder…….
• 80% of deaths from common NCDs occur in
low-and middle-income countries.
• Therefore, NCDs associated with physical
inactivity are a significant public health
problem in most countries around the world.
ASCEND RESEARCH NETWORK
Increase in inactivity
• Physical inactivity is increasing in most
countries and has major implications for NCDs
such as cardiovascular diseases, diabetes and
cancer.
• Physical inactivity is associated with:
– 3.2 million deaths per year, including 2.6 million in
low- and middle-income countries;
– over 670 000 premature deaths (people aged
under 60 years);
– Significant % of diabetes and ischaemic heart
disease burden.
ASCEND RESEARCH NETWORK
• "Physical activity has a strong role to play in
reducing the incidence of certain cancers,"
says Dr Ala Alwan, WHO's Assistant DirectorGeneral for NCDs and Mental Health. "Physical
inactivity is the fourth leading risk factor for all
global deaths, with 31% of the world's
population not physically active."
ASCEND RESEARCH NETWORK
Deaths attributed to 19 leading factors,
by country income level, 2004
19
Percentage of disability-adjusted life years (DALYs)
attributed to 19 leading risk factors, by country income
level, 2004
20
Leading causes of attributable global mortality and burden
of disease, 2004
Attributable Mortality
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
%
12.8
High blood pressure
Tobacco use 8.7
High blood glucose
5.8
Physical inactivity
5.5
Overweight and obesity
4.8
High cholesterol
4.5
Unsafe sex
4.0
Alcohol use
3.8
Childhood underweight
3.8
Indoor smoke from solid fuels 3.3
59 million total global deaths in 2004
Attributable DALYs
%
1. Childhood underweight
5.9
2. Unsafe sex
4.6
3. Alcohol use
4.5
4. Unsafe water, sanitation, hygiene4.2
5. High blood pressure
3.7
6. Tobacco use
3.7
7. Suboptimal breastfeeding
2.9
8. High blood glucose
2.7
9. Indoor smoke from solid fuels
2.7
10. Overweight and obesity
2.3
1.5 billion total global DALYs in 2004
21
How to measure physical (in)actvity?
PA Measurement options
可选的测量方法
Global self-assessmentss 自我评价
Recalls
回顾
Pedometerso 计步器
Accelerometerso 加速
Increasing
practicality
可行性
器
Heart rateo 心
率
PA logss
Diariess
日记
Direct observationo 直接
观察
客观S
Subjective 主观
DLWo
Indirect
calorimetryo 间
O Objective
接能量仪
Increasing accuracy 准确性
Acknowledgment: Fiona Bull; Stewart Trost
What about sedentariness/sitting
time as a risk factor?
What is the best ‘proxy’
measure of sitting time?
28
27
Mean BMI
26
25
24
<1 hr/day
1-2.5 hrs/day
2.5-4 hrs/day
>4 hrs/day
23
22
21
*High
*Mod
#Low
Inactive
Activity Level
Salmon J, Bauman A, Crawford D, Timperio A, Owen N. (2000) The association between
television viewing and overweight among Australian adults participating in varying levels of
leisure-time physical activity. International Journal of Obesity, 24, 600 - 606
TV-watching a heart, diabetes, death risk
A REVIEW of published studies in the past 40 years has shown a
higher risk of diabetes, heart problems and early death among people
who watch lots of television, US researchers said today.
The results of the meta-analysis performed by scientists at the Harvard
School of Public Health are published in the June 15 issue of the
Journal of the American Medical Association.
More than two hours per day of TV-watching boosted risk of type two
diabetes and heart disease, while more than three hours a day
increased a person's risk of dying prematurely.
Each two-hour increment in viewing per day was linked to a 20 per
cent higher risk for type two diabetes; a 15 per cent increased risk for
fatal or nonfatal cardiovascular disease; and a 13 per cent higher risk
for all-cause mortality.
"We should not only promote increasing physical activity levels but
also reduce sedentary behaviours, especially prolonged TV watching.“
2. What are the causes and
the causes of the causes?
Social and behavioural
epidemiology…….
Socio-Ecological Model
(Stokols, Best, Fisher et al)
PUBLIC POLICY: national,
state, local laws
HEALTHY
POLICY!
COMMUNITY: relationships among organizations
ORGANIZATIONAL: organizations, social
institutions
INTERPERSONAL: family,
friends, social networks
INDIVIDUAL:
Knowledge,
attitudes, skills
Reasons for increase physical
inactivity and sedentariness
• Why ???
– Different levels?
Sexual
behavior
Genetic
factors
Age
Exercise
Sex
Soil
quality
Vibration
Water
quality
Environment
Smell
Civic
design
Hazards
Public
Safety
measure
Waste
Disposal
Alcohol
Diet
Housing
tenure
Housing
conditions
Employment
status
Working
conditions
Income
Air
quality
Land use
Green
space
Natural
resources
Availability of
employment
Social
contact
Discrimination
Distribution
Of incomes
Availability
Of training
Quality of
employment
Health
care
Respite
care
Social
services
Childcare
Access
Public
transport
Housing
Advice
Skills
level
Social
support
Social
influences
Fear of
discrimination
Shops
Banking
services
Education
Means of
transport
HEALTH&
WELLBEING
Economic
conditions
Business
activity
Substance
misuse
Family
relationships
Personal
circumstances
Job
creation
Technological
Development
Prescription
drugs
Lifestyle
Recreation
Biological
factors
Noise
Smoking
& passive
smoking
Crime &
Anti-social
behavior
Community
facilities
Leisure
facilities
Education
& training
Workplaces, employment
Opportunities & services
Community
participation
Pear
pressure
Fear of
Crime &
Anti-social
behavior
Environmental Influences on
Behaviour
‘…... behavior, cognitive and other personal factors, and
environmental influences all operate interactively
the relative influence exerted by the three sets of
interacting factors will vary for different activities,
different individuals, and different circumstances
when environmental conditions exercise powerful
constraints on behavior, they emerge as the overriding
determinants …...’
Bandura A (1986) Social foundations of thought and action Prentice-Hall
3. What to do about it? - Solutions
What are the ‘take home’ messages for
policy makers/program implementers?
•
Regular moderate physical activity is one of
the easiest ways to improve and maintain
health.
•
Contributes to prevention and control of
many different diseases
3. Regular active play promotes healthy growth
and development in children and young people
4.
Healthy ageing, improving and maintaining
quality of life and independence
5. Daily physical activity helps people with
disabilities by improving mobility and
increasing energy levels
Ottawa Charter for Promoting
Health (WHO)
•
•
•
•
•
Build healthy public policy
Create supportive environments
Strengthen community action
Develop personal skills
Reorient (health) services
World Health Organization
What is the Public Health message?
• "Physical activity
includes all
movement in
everyday life,
including work,
recreation, exercise,
and sporting
activities..." WHO,
1997
• World Health Day Move for Health Day
2004 - "Active Youth"
©copyright World Health
Organization 2002
Various Levels of Physical Activity and their Benefits
National Physical Activity Guidelines for
Australians
• Think of movement as an
opportunity, not an
inconvenience
• Be active every day in as many
ways as you can
• Put together at least 30
minutes of moderate-intensity
physical activity on most,
preferably all, days
• If you can, also enjoy some
regular, vigorous exercise for
extra health and fitness
Do these messages incorporate
latest evidence related to sitting
time?
What might be suitable interventions for reducing
sitting time?
10,000 Steps Project
The 10,000 Steps community-wide prevention project in
Rockhampton, Australia, aims to increase daily activity by
encouraging "incidental" physical activity as part of everyday
living. People experience significant health and well-being
benefits simply by physically moving as part of normal daily
activities. For this reason, the project is
recommending using pedometers to count daily activity. For
more information about the project, visit the 10,000 Steps
web site at www.10000steps.cqu.edu.au.
Just Walk It
A community-based walking program that aims to
increase the community's participation in regular
and enjoyable physical activity. The program uses
volunteer walk organizers to establish small groups
of people who will walk in their local area. Just
Walk It is a Heart Foundation program funded by
the Queensland Government through Sport and
Recreation Queensland. For more information
about the program, visit the Heart Foundation web
site at www.justwalkit.com.au.
www.activelivingresearch.org
An Active Living Program supported by The Robert Wood Johnson Foundation
and administered by San Diego State University.
Active Living Research:
A Program of
The Robert Wood
Johnson Foundation
www.activelivingresearch.org
Elements of An Active Living
Community
Community Design
Destinations
Home
Transportation System
School & Worksite
Park & Rec
Policies that affect Physical Activity
• Zoning laws to encourage mixed use
• Transport policies
–
–
–
–
Change goal to balanced transport system
Complete streets
More funding for bike/ped enhancements
Safe Routes to Schools
• Ensure parks & recreation programs in low
income neighborhoods
• Ensure active PE & recess in schools
• Joint use agreements between schools and
parks departments
Why Environment & Physical Activity?
• Broad societal & technological developments are
believed to be reducing PA in work, transport, &
household settings
• These developments are happening in all
countries
• Ecological models of behavior teach that policy &
environmental factors have the broadest &
longest-lasting impacts
• Research on environment & policy aspects of PA
is limited in all countries and absent in most
30
60
25
50
20
40
15
30
10
20
5
10
0
0
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Obesity
Credit: John Pucher
Walk, Bike, Transit
Percent Walk, Bike,Transit
Percent of Obesity
Does car dependence make us fat? Obesity falls sharply
with increased walking, cycling, and transit use!
How to develop culturally
appropriate and tailored
intervention for specific
population groups?