Chapter 1: The Health Benefits of Physical Activity

Copyright © 2018 Wolters Kluwer • All Rights Reserved Introduction It is recommended that everyone engage in regular physical activity throughout their lifespans. Physical activity Bodily movements that result in energy expenditure Exercise Subset of physical activity Physical fitness Set of attributes relating to physical activity performance Copyright © 2018 Wolters Kluwer • All Rights Reserved

Copyright © 2018 Wolters Kluwer • All Rights Reserved Introduction—(cont.) Physical activity and exercise are behaviors, whereas physical fitness is an outcome of behaviors. Components of physical fitness can be measured with exercise testing protocols. Time-consuming but reliable and valid Physical activity can be measured with large-scale surveys or objective monitoring devices. More feasible and cost-effective but less accurate Copyright © 2018 Wolters Kluwer • All Rights Reserved

Copyright © 2018 Wolters Kluwer • All Rights Reserved Introduction—(cont.) Sedentary behavior Sitting or reclined while engaging in ≤1.5 METs Physical inactivity Not meeting the following activity recommendations 30 minutes of moderate-intensity activity on at least 5 days per week 20 minutes of vigorous-intensity activity on at least 3 days per week Equivalent combination achieving 600 MET-minutes per week Copyright © 2018 Wolters Kluwer • All Rights Reserved

Copyright © 2018 Wolters Kluwer • All Rights Reserved Introduction—(cont.) Intensity of physical activity defined: Light-intensity physical activity is <3.0 METs. Example: walking Moderate-intensity physical activity is 3.0–5.9 METs. Example: jogging Vigorous-intensity physical activity is ≥6.0 METs Example: running Copyright © 2018 Wolters Kluwer • All Rights Reserved

Domains of Physical Activity Four physical activity domains Recreation Exercise and recreation activities Transport Occupation Household Physical activity interventions and policies are most effective when they operate on multiple levels. Copyright © 2018 Wolters Kluwer • All Rights Reserved

Physical Activity Recommendations 2008 Physical Activity Guidelines for Americans Adults should avoid inactivity. Adults should engage in at least 150 minutes per week of moderate-intensity or 75 minutes per week of vigorous-intensity activity. For more extensive benefits, this recommendation should be extended to 300 minutes per week of moderate-intensity or 150 minutes per week of vigorous-intensity Adults should engage in muscle-strengthening activities on at least 2 or more days per week. Copyright © 2018 Wolters Kluwer • All Rights Reserved

Physical Activity Recommendations—(cont.) Healthy People 2020 (Box 1.1) The nation’s health agenda sets a goal to improve health, fitness, and quality of life. Includes 36 delineated objectives related to the promotion of physical activity across the lifespan Objectives are categorized based upon the target population. Adults and/or children Copyright © 2018 Wolters Kluwer • All Rights Reserved

Physical Activity Recommendations—(cont.) American Heart Association (AHA) and ACSM’s Recommendations All adults (18–65 yr) need moderate-intensity aerobic activity for 30 minutes on at least 5 days per week or 20 minutes of vigorous activity on at least 3 days per week Combinations of moderate and vigorous activity can be used to meet this goal. Exceeding the minimum recommendation may help to: Further improve fitness Reduce risk of chronic disease Prevent unhealthy weight gain Copyright © 2018 Wolters Kluwer • All Rights Reserved

Prevalence of Physical Activity Physical inactivity is considered a global pandemic. One in 4 adults are insufficiently physically active. Health equity Every individual has the opportunity to “attain his or her full health potential.” Health disparities National physical activity data reveals health disparities exist due to all of the following: Sex, race/ethnicity, age, educational attainment, family income, family type, country of birth, disability status, geographic location, health insurance status, sexual orientation, and marital status Copyright © 2018 Wolters Kluwer • All Rights Reserved

Copyright © 2018 Wolters Kluwer • All Rights Reserved Prevalence of Physical Activity—(cont.) Copyright © 2018 Wolters Kluwer • All Rights Reserved

Benefits of Physical Activity and Chronic Disease Regular physical activity can attenuate the prevalence, mortality, or morbidity of many leading causes of death. Physical activity and all-cause mortality Numerous studies underscore the relationship between physical activity and reduced all-cause mortality. Example: Harvard Alumni Health Study Physical activity and chronic diseases Chronic diseases Diseases that develop overtime and are not infectious The World Health Organization (WHO) promotes physical activity for the improvement or maintenance of chronic diseases. Copyright © 2018 Wolters Kluwer • All Rights Reserved

Benefits of Physical Activity and Chronic Disease—(cont.) Physical activity and cardiovascular disease (CVD) The positive relationship between physical activity and cardiovascular health has been well established. Physical activity and stroke Meta-analysis data displays an 11% reduction in the risk of stroke with moderate-intensity exercise and a 19% reduction with vigorous-intensity exercise. Physical activity and cancer Exercise has been shown to benefit individuals with several types of cancer, including lung, breast, colon, and pancreatic. Copyright © 2018 Wolters Kluwer • All Rights Reserved

Benefits of Physical Activity and Chronic Disease—(cont.) Physical activity and diabetes Regular physical activity promotes glycemic control and insulin action. This improves blood glucose, lipids, blood pressure control abnormalities, and weight loss/maintenance. Physical activity and obesity Physical activity is associated with weight loss and/or the prevention of weight gain. Physical activity and disabilities/aging Physical activity is recommended to all persons, including the aging population and to those with disabilities. Copyright © 2018 Wolters Kluwer • All Rights Reserved

Copyright © 2018 Wolters Kluwer • All Rights Reserved Summary Physical activity is a behavior associated with many benefits. There are many federal initiatives to promote physical activity and it’s associated benefits, including: Exercise is MedicineTM “Step it Up!” initiative “Let’s Move!” campaign It is important to address health disparities and focus on delivering a variety of interventions. Consider social determinants that may have a positive or negative impact on a patient’s ability to engage in activity. Copyright © 2018 Wolters Kluwer • All Rights Reserved