1. Health Disparities in Physical Activity: Patterns and Implications
Ross C. Brownson
Prevention Research Center
Saint Louis University School of Public Health

2. Learning Objectives
1. To understand the importance of physical activity as a public health issue
2. To understand the descriptive patterns in physical activity, related health conditions, and macro factors (e.g., demographics)
3. To review the gaps and implications for health disparities research and practice.

3. Definitions: Behaviors
Physical Activity: “any bodily movement produced by skeletal muscles that results in energy expenditure.”
Occupational, household, exercise, sports, play
Exercise: “planned, structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness.”
Running, aerobic dance, bicycling, calisthenics
Caspersen C, et al, Public Health Reports 1985; 100(2)

4. The Benefits of Physical Activity
Health Benefits
Fitness Benefits
Lowers risk for heart disease
Reduces risk for certain cancers
Lowers blood pressure
Improves lipid profile
Prevents obesity
Prevents diabetes
Builds healthy bones
Enhances immune function
Relieves stress and improves mood
Promotes self-esteem
Increases aerobic capacity
Increases strength
Increases flexibility
Improves balance and coordination
Increases functional Health:
Allows us to do the things we need to do and want to do with ease and enjoyment!

5. Physical Activity and Health (Dose-Response)
Prevention of Weight Gain
Diabetes Mellitus
Risk of “Disease”
CHD
Stroke
Musculoskeletal Injury
Functional Health Status
Physical Activity

7. The Obesity Epidemic

8. Fit or fat evidence? Puzzle is not so simple…
Britton et al 1998
Concato et al, 2000
Benson and Hartz, 2000
Ioannidis et al, 2001

9. Fit or Fat? CVD Mortality, % Body Fat, and Fitness
Better to have two F’s than two S’s.
*adj for age,
exam year,
smoking,
alcohol, &
fam history
25%
<16%
16-<25%
Lee CD et al. Am J Clin Nutr 1999.

10. The Chronic Disease Epidemic: Changing Environment
Acting upon Pre-existing Genes
Phenotype = Genotype x Environment
Unhealthy
Gene
Expression
No Change
in past 100 Years
Large Change
in past 100 Years
*Physical Inactivity
Diet
Pollution, etc.

11. CDC/ACSM recommendations on the types and amounts of physical activity needed for health promotion and disease prevention:
Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week.
Moderate-intensity - Activity performed at 3 to 6 times the resting metabolic rate.
Equivalent to brisk walking 2 miles at 3 to 4 mph (15 to 20 minutes/mile) for healthy adults

12. Accumulating Physical Activity?
Guidelines allow for the accumulation of moderate-intensity physical activity over the course of a day
Five recent studies compared the traditional 30 minutes of continuous activity vs. shorter (5- to 15-minute) bouts of activity spread throughout the day
Shorter bouts resulted in comparable improvements in cardiorespiratory fitness and health
Multiple short bouts of physical activity also appear to increase participation and adherence

13. The Lifestyle Approach
Noon-time jog 10 8
Sedentary
Structured Exercise
Lifestyle Activity 6
Energy Expenditure (METS)
After-dinner walk
Walk to bus stop 4 2 2 4 6 8 10 12 14 16 18 20 22 24
Blair et al. Med Exerc Nutri Hlth 1:54, 1992
Time (hours)

14. Physical Activity Levels Survey Measures
Recommended level
Moderate-intensity activity 5 times per week for 30 minutes each time,
Vigorous-intensity 3 times per week for 20 minutes each time, or
Both
Insufficient
Some activity but not enough to be classified as moderate or vigorous
Inactive
No leisure-time physical activity during the preceding month

15. Possible Domains of Physical Activity
Leisure/recreational
Occupational
Transportation
Household chores
Gardening/yardwork
Completely sedentary activities (e.g., watching television)

16. Descriptive Epidemiology
1. Person
2. Place
3. Time

17. Physical Activity, U.S. Adults (2003 BRFSS, Age-Adjusted)

18. Classify PERSON age race sex ses family occupational blood type
marital status personality traits
migrants

19. Physical Activity by Race/Ethnicity (2003 BRFSS, Age-Adjusted)

20. Physical Activity by Income Group (2003 BRFSS, Age-Adjusted)

21. Physical Activity by Income Group (2003 BRFSS, Age-Adjusted)

22. Moderate Physical Activity for Adults by Disability and Arthritis Status
Age-adjusted percent
1997
2002*
2010 Target
No significant differences over time, although trend is in the right direction for people with disabilities and/or arthritis.
With
Without
With
Without
Disabilities
Arthritis

23. Physical Activity in Ethnically Diverse Women 40 and older
Brownson RC et al. Am J Public Health 1999.

24. Vigorous Physical Activity for Adolescents by Grade Level: 2001
Percent
Statistically significant drops in vigorous physical activity as grade level increases.
10th
12th
9th
11th

25. Classify PLACE natural boundaries political subdivisions
urban-rural differences
weather variations

26. Prevalence of No Leisure-Time Activity, 2000

27. Age-adjusted percent (Quartiles)
No Physical Activity for Adults by State, 2003
Age-adjusted percent (Quartiles)

28. Age-adjusted heart disease mortality, Missouri, 1992-98
168.3 to 280.1
150.8 to 168.1
137.1 to 150.6
99.6 to 137.4

29. Classify TIME secular trends declining rates cyclicity-seasonality
periodicity
clusters in time or place

30. Age-adjusted colon cancer incidence by gender and race
Rate per 100,000 (from 0 to 90)
Years of diagnosis (from 1973 to 2001)
White/Male
White/Female
Black/Male
Black/Female

31. Age-adjusted breast cancer incidence by race
Rate per 100,000 (from 0 to 160)
Years of diagnosis (from 1973 to 2001)
All races
White
Black

32. Other important macro patterns & trends in the United States that are likely to affect health disparities and the burden of physical inactivity

33. Population Trends Aging of the Population
65+ the most rapidly growing US segment
Projected increases 65+:
1990, 31 million
2010, 40 million
2030, 70 million
Large impacts on public health and health care systems

34. Population Trends Changing Racial/Ethnic Makeup Non-Hispanic Whites
1992, 191 million to 202 million in 2050
African American
1992, 32 million to 62 million in 2050
Asian/Pacific Islander
1992, 9 million to 41 million in 2050
Distinguish counts from percentages
Large potential effects on disease burden
Issues of cultural competence

35. Car ownership, walking & biking
Percent by Walking or Biking

36. Vehicle miles traveled by automobile
Miles per person per day

37. Ave. daily television viewing
Hours per household per day

38. Knowledge Gaps
Do correlates differ between majority and minority populations?
What data are lacking (for both descriptive and analytic epidemiology)?
How generalizable are various, tested interventions?
How do we do a better job in assessing context for intervention among population subgroups?

39. Acknowledgments
Certain slides were provided by Dr. Greg Heath (Centers for Disease Control and Prevention) and Dr. Steve Blair (Cooper Institute)