Transcript Physical Activity in the Prevention and Treatment of
World-Wide Physical Inactivity: Scope of the Problem and What to Do about It
Moscow, Russia Russia-U.S.A. Scientific Forum November 17, 2011 Steven N. Blair Departments of Exercise Science & Epidemiology/Biostatistics University of South Carolina
Non-Communicable Diseases (NCDs) Changing patterns in leisure and work have led to a health crisis NCDs cause 65% of all deaths worldwide 36.1 million deaths from CVD, Stroke, Diabetes, Cancer & Respiratory diseases. Physical inactivity causes 3.2 million deaths/year WHO. Mortality and burden of disease estimates for WHO Member States in 2008. Geneva: World Health Organization, 2010.
NCDs: Key Risk Factors
Beaglehole et al., Lancet 2011; 377: 1438
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Direct Causal Factors
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Tobacco use Physical Inactivity Poor Nutrition
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Intermediate Risk Factors Obesity Hypertension Hyperglycemia Hypercholesterolemia
Leading risk factors for mortality by income group (estimates from 2004) High blood pressure Tobacco use High blood glucose Physical Inactivity Overweight & obesity High Income Middle Income Low Income High cholesterol 0 1 2 3 4 5 6 7 8 Mortality in millions (total 58.8 million) © World Health Organization 2009 (http://www.who.int/healthinfo/global_burden_disease/global_health_risks/en/index.html)
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Self-reported Physical Activity Underestimates the True Effect 1,2 31,818 men and 10,555 Low women 1 Moderate 1492 deaths in men 0,8 High during average follow 0,6 up of 14.6 years, and 230 deaths in women 0,4 during average follow up of 12.8 years 0,2 PA mortality trends not significant after adj for CRF 0 CRF trends significant after adj for PA Phys Act CRF Lee DC, et al. BJSM 2011; 45:504-10
Aerobics Center Longitudinal Study
Design of the ACLS
1970 More than 80,000 patients 2005 Cooper Clinic examinations--including history and physical exam, clinical tests, body composition, EBT, and CRF Mortality surveillance to 2003 More than 4000 deaths 1982 ‘86 ‘90 ‘95 ’99 ‘04 Mail-back surveys for case finding and monitoring habits and other characteristics
60 50 40 30 20 10 0 All-Cause Death Rates by CRF Categories —3120 Women and 10 224 Men —ACLS 70 Women Men Low Moderate High Blair SN. JAMA 1989
Does Changing Cardiorespiratory Fitness Reduce Mortality Risk?
Fitness Change Categories
Unfit was defined as the least fit 20% of men in each age group
Men were classified as fit or unfit at both examinations
Change categories
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unfit at both examinations = never fit unfit at first, fit at second = improvers fit at both examinations = always fit Blair SN et al. JAMA 1995; 273:1093-8
Age-Adjusted Death Rates by Fitness Change Groups, Men, ACLS Fitness Groups Never fit
Age-adjusted Death Rates/10,000 Man-years
CVD All-cause 65 122 Improvers 31 68 Always fit 14 40 Blair SN et al. JAMA 1995; 273:1093-8
CRF and Other Health Outcomes
CRF and Risk of Incident Hypertension, ACLS Women
4,884 healthy women examined at the Cooper Clinic, 1970-1998 157 women developed hypertension during average follow-up of 5 years Risk of Developing Hypertension 1 0,9 0,8 0,7 0,6 0,5 0,4 P for trend <0.01
Low Moderate High Risk adjusted for age, exam year, alcohol intake, smoking, BP, family history of hypertension, waist girth, glucose, & 0,3 0,2 0,1 0 Fitness Groups triglycerides Barlow CE et al. Am J Epidemiol 2006; 163:142-50
CRF and Breast Cancer Mortality
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14,551 women, ages 20-83 years
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Completed exam 1970-2001
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Followed for breast cancer mortality to 12/31/2003
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68 breast cancer deaths in average follow-up of 16 years
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Odds ration adjusted for age, BMI, smoking, alcohol intake, abnormal ECT, health status, family history, & hormone use 1 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0 Odds Ratio p for trend=0.04
Low Moderate High Sui X et al. MSSE 2009; 41:742
Activity, Fitness, and Mortality in Older Adults
Cardiorespiratory Fitness and All-Cause Mortality, Women and Men ≥60 Years of Age
4060 women and men ≤60 years 45 989 died during ~14 40 years of follow-up 35 All-Cause death rates/1,000 PY Low 30 Moderate ~25% were women 25 High Death rates adjusted for age, sex, and exam year 20 15 10 5 0 60-69 70-79 80+ Age Groups Sui M et al. JAGS 2007.
Cardiorespiratory Fitness and Health Outcomes in Various Population Subgroups
Such as People Who Are Overweight or Obese or Those with Chronic Disease
Cardiorespiratory Fitness, Risk Factors and All-Cause Mortality, Men, ACLS 60 50 40 30 20 10 0 0 Low Mod High Cardiorespiratory Fitness Groups 1 *Adjusted for age, exam year, and other risk factors # of risk factors 2 or 3 Risk Factors current smoking SBP >140 mmHg Chol >240 mg/dl Blair SN et al. JAMA 1996; 276:205-10
CVD Mortality Risk* by Fitness and BMI Categories, 2316 Men with Diabetes, 179 CVD Deaths 10 9 4 3 2 1 8 7 6 5 p for trend <0.0001
p for trend <0.0001
p for trend <0.002
0 Low M od er at e H ig h Low M od er at e H ig h Low M od /H ig h 18.5 < BMI <25.0 25.0 ≤ BMI <30.0 30.0 ≤ BMI < 35.0
*Adj for age and examination year
Church TS et al. 2005; 165:2114 Arch Int Med
Age and exam year adjusted rates of total CVD events by levels of CRF and severity of HTN in 8147 hypertensive men CVD incidence/1000 man-years 18 P <.001 P <.001 P =.048
16 14 12 CRF: Low Moderate High 10 8 6 4 2 0 Controlled HTN Stage 1 HTN Stage 2 HTN Severity of HTN Sui X et al. Am J Hyptertension. 2007
Summary
18 16 14 12 10 8 6 4 2 0 Attributable Fractions (%) for All-Cause Deaths 40,842 Men & 12,943 Women, ACLS Men Women Low C RF Ob ese Sm ok er Hy per ten Hi sion gh C hol Dia bet es Blair SN. Br J Sports Med 2009; 43:1-2.
Getting People to Be Physically Active
Behavioral Approaches to
Physical Activity Interventions Theoretical foundations
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Social Learning Theory
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Stages of Change Model Environmental/Ecological Model Methods
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Problem solving
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Self-monitoring Goal setting Social support Cognitive restructuring Incremental changes Manipulating the environment Marcus & Forsyth. Motivating People to Be Physically Active,
2 nd
edition. 2009. Human Kinetics (www.hkusa.com
Track Record of Lifestyle PA Interventions
Successfully implemented in many different populations and settings
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Men and women of all ages African-American men and women, Hispanic women
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Prostate cancer survivors Worksites, YMCA’s, public heath departments, recreation facilities, senior centers, churches
We can get a substantial proportion of inactive people to become active
Using Modern Technology to Promote Healthful Lifestyles
Promoting PA via PDA
37 healthy, inactive adults, ≥50 years of age
8-week RCT
PDA intervention (93% had not used PDAs)
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Questions about amount and type of PA Alerted at 2 PM and 9 PM to complete PA assessment
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Gave motivational and behavioral tips Controls —standard written materials King AC et al. Am J Prev Med 2007; 34:138-42
Promoting PA via PDA
Intervention participants completed 68% of the 112 PDA entries available
After adjusting for baseline differences
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PDA group reported 310.6 minutes of moderate to vigorous PA/week
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Control group reported 125.5 minutes/week p=0.048 for group comparison
78.6% of PDA group reported enjoying using the device King AC et al. Am J Prev Med 2007; 34:138-42
The SenseWear Armband (SWA)
The SenseWear TM Armband (BodyMedia, Pittsburgh, PA)
Lightweight monitor worn on the upper left arm
Four sensors (skin temp, galvanic skin response, heat flux, tri-axial accelerometer)
Estimates energy expenditure
Physical activity – duration & intensity
Effects across time for weight. Estimates adjust for age, gender, race, education, and wave. 104 102 100 Standard Care GWL 98 96 94 92 SWA GWL + SWA Baseline Month 4 Month 9 GWL=Group Weight Loss SWA=SenseWear Armband Shuger S et al. 2011 IJBNPA
Where Do We Go from Here?
All countries should develop a national physical activity plan
What is a Physical Activity Plan?
A comprehensive set of strategies including policies, practices, and initiatives aimed at increasing physical activity in all segments of the population.
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Mass Media
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Public Health
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Education
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Healthcare
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Volunteer and Non-Profit Organizations
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Transportation, Urban Design, Community Planning
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Business and Industry
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Parks, Recreation, Fitness, and Sports
Prevention of NCDs
Prevention is essential to reduce immediate burden and protect future generations NCDs threaten health and social systems and hinder economic performance A 2% reduction in NCD death rates will achieve an increase in economic growth of 1% per year within a decade Cecchini et al. The Lancet 2010; 376:1775-84