Scientific evidence for the benefits of walking and physical activity – and how to take the “next steps”

CHD mood, anxiety, QOL, depression, social benefits,mental health Physical Activity Other possible health benefits ?prostate Ca. ?lung disease ?breast cancer arthritis diabetes colon cancer osteoporosis BMI BP Cholesterol Health benefits of physical activity Stroke, CVD

CVD Mortality, Relative Risk Level of Physical Fitness or Activity Overall summary

Relative Risks (RR) of Total Mortality According to Level of Physical Activity Among Post-menopausal Women in Iowa,

Nurses health study n=72,488 [>10 year f/up] Walking and risk of CHD Manson J, NEJM 1999;341:650-8

Honolulu Heart health : walking & CVD risk Elderly males N=2678 Followed for 4 yrs Hakim AA, Circulation 1999:100:9-13

Walking and CHD (Hakim 1999)

Effects on other risk factors Hypertension Lipid levels, HDL:total chol ratio Overweight and obesity – need 1 hour /day walking

Physiological benefits of walking Moderate to Brisk walking May help cardiovascular training strength, flexibility energy/expenditure lower injury incidence than most other physical activity (Powell 1998)

Metabolic effects of walking Bone density? Muscle strength influences HDL cholesterol improves glucose metabolism reduces risk of acute thrombosis ?immuno-potentiation

Social and Psychological benefits Social activity Sense of well being, positive mental health, reduces anxiety Sense of community

National Recommendations for physical activity every adult should accumulate at least 30 mins + of moderate intensity Physical activity on most days can be accumulated in short bouts, intermittently use opportunities in everyday life

Burden of disease and injury in AUSTRALIA AIHW November 1999 Building on Global BOD study Alan Lopez et al (WHO 1993) Uses DALYs as a metric Comparable across countries Useful for assessing health burden

What is the contribution of PA? Compared to other risk factors Overall to the “burden of disease” What conclusions can we draw from this about PA and its positioning among risk factors ?

Percent of total burden attributed to risk factors BoD study, AIHW 1999

The health costs of physical inactivity

Introduction direct costs (of health care) indirect costs (cost productivity) intangible costs (QOL) economic sector factors beyond the scope of costing studies

Australian adults : physical activity levels, November 1997

Mortality attributable to physical inactivity, Australia, 1996.

DIRECT Costs of six major diseases attributable to physical inactivity ($ million)

Effect of increasing physical activity on health costs avoided from Coronary Heart Disease

Potential Savings of Direct Health Care Costs from increased P.A., 1993/94 ($m)

Recent trends in Australia

TRENDS in PA in Australia: % meeting recommended levels

Completely sedentary (Nat PA surveys, Australia, November 1997, 99, 2000

Relevance of walking to physical activity promotion Accessible to all (equity) few age, gender seasonal restrictions initial activity most easily adopted

The ‘share’ of walking and other activities from Australian adults aged over 40

Physical Activity Interventions more likely to succeed if: Not “facilities” or “program attendance” based – adherence wanes over time increased routine or incidental physical activity include environmental change - “making walking an easier choice”

Risks of Activity - [i] Cardiac and [ii] Injury cardiac events and injury increased slightly in vigorous activity Injuries when running - up to 35-65% p.a. very low risk - walking, gardening <1% p.a

The evidence is very good for health benefits of walking and physical activity

“Walk a mile per day” (1.6 km) Achievable strategy for most people expend about 2 mega joules/week without any extra energy intake, would consume enough energy for 3 kg weight loss/year

Walking project in Rockhampton Queensland Govt, Investment $ 800,000

Other [beyond health] issues in promoting walking ecological impact of reduced car use increased DOT/ public transport usage Social well being / social capital strategy community growth – shops, restaurants urban planning – fits into designs for sustainable urban growth increased recreation / leisure sector walk to schools - PA among children

What to do next ?

NEW SOUTH WALES, Australia, The NSW Premier’s Physical Activity Taskforce

NSW Physical Activity Task Force An intersectoral [inter agency] and whole of Government strategic approach to the promotion of physical activity in NSW Partners : NSW Health, Sport and Recreation, Education, Local Government, Fitness Industry, Heart Foundation,, DUAP, DOT, RTA

NSW PATF achievements International model for strategic planning for PA Achieved major goals in PA when focused programs prevented national decline in PA – ONLY in NSW

NSW PATF : future Existing PATF infrastructure and network will continue for future programs After 5 years, undergoing a strategic review March- April 2002 current review will suggest clear need for future integrated program directions Needs program resources – never had any to date [a remarkable model, but not sustainable in the climate of PA decline]

Conclusions physical inactivity, and especially walking is an issue for all in NSW infrastructure exists in NSW – PATF – to assist with PA interventions needs the commitment and political will to move (forwards)