1. Physical activity and public health Dose-response of pa and health (hand-out) Pekka Oja MPH course Schlosshofen, 12 January 2008

2. Intensity Frequency Duration Mode >60 % VO max 3-5/week 15-60 min aerobic, continuous 50-75 % VO max every day > 30 min varied, intermittent Health-enhancingFitness-related Physical activity.. 22 Otherresistance trainingtotal amount

3. Lifestyle activity for health M.Murphy: (2004) Increasing evidence shows that lifestyle physical activities improve fitness and health of previously inactive people. Encourageing, if not yet convinsing, evidence that lifestyle activities are better than traditional exercises in supporting sustained activity behaviour.

4. Fitness/health dose response Health Activity/Fitness A B C

5. Nonexercise physical activity and mortality in Chinese women Matthews et al. Am J Epidemiol 165,2007 67143 Chinese women 40-70 y free of heart disease, stroke, cancer 5,7 y follow-up all-cause, CVD, cancer, other cause mortality physical activity at baseline –exercise –nonexercise housework walking cycling stairclimbing

6. Copyright restrictions may apply. Matthews, C. E. et al. Am. J. Epidemiol. 2007 165:1343-1350; doi:10.1093/aje/kwm088 Risk for all-cause mortality, by exercise and nonexercise physical activity, the Shanghai Women's Health Study, 1997-2004

7. Effects of walking on coronary heart disease Manson et al 1999: 72 488 female nurses, 40-65 years old in 1986 8-year follow-up incidence of new coronary events –non-fatal Myocardial Infarction –death from coronary causes

8. 0 0,1 0,2 0,3 0,4 0,5 0,6 0,7 0,8 0,9 1 <3.2 (easy or casual) 3.2-4.6 (average) >4.7 (brisk or very brisk) Age-adjusted Multivariate Risk of coronary events Relative Risk Walking Pace Manson et al. 1999

9. Walking and cardiovascular risk factors A meta-analysis Murphy et al. Prev Med 44, 2007 24 studies –RCT’s –Walking the only interventio –Min of 4 weeks intervention –CV risk factors measured pre and post –Subjects sedentary but healthy at baseline –Subjects 18- y CV risk factors –VO 2 max –Body weight –Body fat –BMI –SBP –DBP

10. Walking and cardiovascular risk factors A meta-analysis Murphy et al. Prev Med 44, 2007 variablenWighted mean TEp VO 2 max242.73<0.001 Body weight27-0.95<0.001 Body fat18-0.630.035 BMI16-0.280.015 SBP14-1.060.316 DPB12-1.540.026

11. 0 2 4 6 8 10 Stairclimbing at work 25 flights per day effective Treatment Upper 50% Treatment VO max 2. % (l/min) 30 men 12 weeks Control using lifts Treatment using stairs Control Source: Fardy & Ilmarinen 1975 NS *

12. Nordic walking and fitness Kukkonen-Harjula et al. Scand J Med Sci Sports 17,2007 Randomised study 121 non-obese sedentary women, 50-60 y 2 groups: walking with or without poles Intervention –13 weeks –4 times/week –40 min/session –52-54 % HRR Outcomes –Cardiorespiratory fitness –Neuromuscular fitness

13. Nordic walking and fitness Kukkonen-Harjula et al. Scand J Med Sci Sports 17,2007 HR and lactate at submaximal work decreased equally in both groups Both groups improved VO 2 max similarly Leg strength improved more in regular walking group

14. ”Back to the dogs” Tatschl et al. Am J Prev Med 30, 2006 68-year-old Caucasian woman suffered –hypertension –hypercholesterolemia –depression –tinnitus status –gained 12 kg in 13 years –BMI 28 physical activity –walked 2-3 times/week got a golden retriever as gift status –lost 7 kg ->BMI 25,5 –cholesterol down –in good mood –tinnitus remains physical activity –3 hours daily with dog what can a dog do? ”Most probably, the woman’s reduction in weight and cholesterol and regression of the depression were consequences of dog ownership…”

15. +30 min 4 km 5000 steps 7 km 9000 steps 10 km 13000 steps. +30 min Daily walking steps for health Insufficient daily steps Sufficient daily steps Optimal daily steps Note: about 5000 steps needed for necessary daily chores

16. Cycling and all-cause mortality Andersen et al. Arch Intern Med 160, 2000 Prospective cohort study 13 375 women, 17 265 men, 20-93 y Mean follow-up 14,5 y All-cause mortality Cycling –All cycling –Cycling to work –Changes in cycling

17. Relative risk of cycling (yes/no) N=8,466 men, 2,389 deaths, p<0.001 6,510 women, 1,398 deaths, p<0.01 Both adjusted for LTPA (data from CCPPS) Cycling RR of mortality

18. Changes in cycling over 5 years and subsequent mortality: Copenhagen City Heart Study Changes in cycling habits among 3291 men and women 618 death

19. Commuting activity and health Hamer & Chida, PrevMed 2007 Meta analysis Prospective epidemiological studies 8 studies, 173146 participants Health end points –Mortality –Incident CHD, stroke, hypertension, diabetes Overall RR 0.89 (0.81-0.98) Women RR 0.87 (0.77-0.98) Men RR 0.91 (0.80- 1.04)

20. Is housework good for health? Lawlor et al. JECH 56, 2002 Brittish Women’s Heart and Health Study 2341 women, 60-79 y national cross-sectional survey health –subjective –CHD –hypertensio –cancer –falls –depression physical activity –vigorous exercise –brisk walking –heavy house work

21. Is housework good for health? Lawlor et al. JECH 56, 2002 Adj OR (95% CL) nbrisk walkingheavy housework exercise subjective health, poor 7300.3 (0.2-0.4)0.5 (0.4-0.6)0.3 (0.2-0.4) CHD297o.4 (0.2-0.7)0.7 (0.5-0.9)0.6 (0.4-0.9) hypertensio n 5230.8 (0.5-1.1)1.1 (0.9-1.3)0.9 (0.6-1.1) cancer2131.3 (0.8-1.9)0.7 (0.5-0.9)1.0 (0.7-1.6) falls3860.6 (0.4-0.9)0.7 (0.6-0.9)0.9 (0.6-1.2) depression4000.9 (0.7-1.3)0.8 (0.6-1.0)0.9 (0.7-1.2)

22. How effective are lifestyle physical activities for function and health? moderate-intensity pa concept = HEPA daily life-activities: all-cause mortality, hypertension ↓ walking –brisk walking: CHD and risk factors ↓, function ↑ –stair climbing: function ↑ –nordic walking ~ brisk walking –10 000 steps: promising –dog walking ? cycling: all-cause mortality ↓, function ↑, accidents ↓ commuting pa: MI, stroke, type 2 diabetes, colon cancer, CV risk factors ↓, function ↑ domestic work: need more studies

23. Fitness and risk factors Duncan et al. Arch Int Med 2005;165: 2362-2369  Randomised trial  492 sedentary adults  5 groups Control, physician advice Moderate intensity/low frequency Moderate intensity/high frequency Hard intensity/low frequency Hard intensity/high frequency All ex. Groups walking 30 min/session  6 and 24 months intervention  Outcomes: VO2max, HDL-C, TotC/HDL-C

24. Copyright restrictions may apply. Duncan, G. E. et al. Arch Intern Med 2005;165:2362-2369. Mean {+/-} SEM change in maximum oxygen consumption (IMGf1.gif" BORDER="0">O2max) (measured in liters per minute) from baseline to 6 months (A) and from baseline to 24 months (B) according to treatment condition

25. Obesity Slentz et al. Arch Intern Med 2004;164:31-39  RCT  120 men and women, 40-65 years, sedentary overweight with mild to moderate dyslipidemia  4 groups Control High amount/vigorous (~32 km jogging/week) Low amount/vigorous (~19 km jogging/week Low amount/moderate (~19 km walking/week  8 months intervention  Outcomes: body weight, body composition, waist circumference

26. Copyright restrictions may apply. Slentz, C. A. et al. Arch Intern Med 2004;164:31-39. Effects of exercise amount and intensity on mean changes in body weight (A), fat mass (B), percent lean body mass (C), and lean body mass (D)

27. Life expectancy Franco et al. Arch Intern Med 2005; 165: 2355-2360  Prospective cohort study  2336 men 2873 women, 28-62 years  Follow-up 12 years  Physical acitivity Low daily METs Moderate daily METs High daily MEDTs  outcome: life ecpectancy at 50 years of age

28. Copyright restrictions may apply. Franco, O. H. et al. Arch Intern Med 2005;165:2355-2360. Effect of physical activity level on life expectancy (LE) at age 50 years

29. Conclusions Vigorous pa > moderate intensity pa –Fitness –CHD risk factors –Obesity –Life expectancy –Type 2 diabetes New evidence invites exercise & sport as HEPA