Opportunities and Challenges to Healthy, Active Living in the Modern World

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1 Opportunities and Challenges to Healthy, Active Living in the Modern World Bradley J. Cardinal, Ph.D. Professor, Nutrition and Exercise Sciences Oregon State University From Where Do I Come? A Little Bit About Me and My Research I have a background in sports and athletics, having played American football in college I have taught and coached at both the high school and college levels Prior to joining the faculty at Oregon State University in 1997, I served on the faculties of Eastern Washington University and Wayne State University I have been professionally involved in the field for 23 years, including two previous trips to Mainland China. This is my first trip to Hong Kong. I study health and physical activity behavior change, promotion, and retention issues from a psycho-social and socio-cultural perspective Contributing Factors to Premature Mortality: The Importance of Behavior Source: McGinnis et al. (2002), Health Affairs The Problem of Physical Inactivity Increased Risk of Hypokinetic Diseases Diseases associated with disuse and inactivity. Increased Risk of Sedentary Death Syndrome sedentary-lifestyle-mediated disorders that ultimately result in increased mortality (Booth & Chakravarthy, 2002, p. 2). Physical inactivity and poor eating habits account for 300, ,000 deaths per year in the U.S. 2nd leading preventable cause of death in the U.S. At present rate, it may very well be the leading cause of death by Leading Causes of Death in the U.S and 2000 * * Trend: 2000 > 1990 * * Number of Deaths (in Thousands) Source: McGinnis & Foege (1993) and Mokdad et al (2004), JAMA. 1

2 Medical Costs in OECD* Nations 2002 Medical Cost/Employee and Percent Change Among Large Employers % % % + 7.0%+ 6.6% + 5.7% + 6.1% + 6.1% + 6.1%* + 9.0% *Organization for Economic Cooperation and Development Source: OECD Health Data, 2004 Source: Mercer s 2007 National Survey of Employer Sponsored Health Plans Physical Activity: A Key Part of the Solution! Unfortunately Prevalence At least* 70% of U.S. adults are insufficiently active and of those 25% are totally sedentary Relapse 50% of the people who start an exercise program stop within the first 6 months How Much Physical Activity? Health Benefits 60 min. 7 d/wk 60 min. 5 d/wk 30 min. 7 d/wk Sedentarism Moderate intensity 30 min. 5 d/wk First Ever U.S. Federal Guidelines for Physical Activity for Americans (10/7/08) Adults should exercise for a minimum of two and a half hours - or 150 minutes - per week at a moderate intensity. This breaks down into 30 minutes of exercise five days per week. Children should exercise for a minimum of five hours (300 minutes) per week. Troiano et al. (2008). Physical activity in the United States measured by accelerometer. Medicine and Science in Sports and Exercise, 40,

3 The Vast Majority of Americans Do Not Obtain Sufficient Physical Activity on a Regular Basis This may relate to Americaʼs so called obesity epidemic - Troiano et al. (2008). Physical activity in the United States measured by accelerometer. Medicine and Science in Sports and Exercise, 40, The Obesity Epidemic in America Adult obesity rates climbed even higher last year in 31 states Mississippi was the heaviest state with an adult obesity rate of 29.5 percent. Colorado was the least heavy state with an obesity rate of 16.9 percent. Letʼs take a closer look Obesity Trends* Among U.S. Adults BRFSS, 1990, 1995, 2005 (*BMI 30, or about 30 lbs overweight for 5 4 person) Source: Fitness Business Pro (September, 2006). No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) Obesity and the World: Percent of People > 15 yrs old with BMIs > 30 from OECD Countries United States 30.6%! No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% 3

4 Overweight Trends in Youth Enough! Mechanisms for Getting and Keeping People Physically Active Remain Elusive Historically, people assumed that schoolbased physical education programs fostered the requisite attitudes, knowledge, and skills needed to be active for life However, this assumption has been questioned Increasingly, efforts are focusing on new social institutions, partnerships, and exploring other potential influences Is Physical Activity No Longer Necessary for Life? They claim that the ordinary duties and employments of life will give one all of the physical training that he needs. This may have been true in primitive times when it was necessary for a man to do his own ploughing [sic] and planting, reaping and mowing, to chop his own wood, hunt his own game, catch his own fish, make his own tools, build his own house, and do the hundred and one things necessary to maintain a comfortable existence. But times have changed. (p. 4). - Dr. Dudley Allen Sargent (1900). The place for physical education in the school and college curriculum. American Physical Education Review, 5(1), Increased Availability and Use of Labor Saving Devices Lifestyles of yesteryear and today 100 Years Ago Today Outhouse toilet (walk) Horse and plow Bike, ride horse, walk Stairs, ladder, pulley Hammer Pump and haul water Manual can opener Indoor toilet Tractor Drive or ride in car Elevator or escalator Nail gun Indoor faucet Electric can opener 4

5 Lifestyle and Energy Expenditure Sedentary Way Using TV remote control Electric garage door opener Leaf blower Take elevator Shop on internet kcal <1 <1 100 (30 min.) 0.3 (3 flights) 30 (1 hour) Active Way Manually change channels Open garage manually Rake leaves Walk stairs Shop in mall kcal (30 min.) 15 (3 flights) 165 (1 hour) Lifestyle and Energy Expenditure Assume a personʼs caloric intake remained the same Completing all of the tasks reviewed daily or as listed for the Active way=148,190 kcal/year Sedentary way=58,874 kcal/year Difference of 89,316 kcal/year is the energy equivalent of 25.5 pounds (11.9 kilograms)/year Sit and listen to lecture 30 (1 hour) Stand and give lecture 70 (1 hour) Physical Activity. A Multidimensional Construct Not just exercise All Physical Activity Contributes to Health: The Theoretical Model of Physical Activity Bicycling Conditioning Exercises Dancing Walking Fishing & Hunting Gardening Physical Activity House Work Running Self-care Sports Recreational Pursuits Etc. An Historical Perspective: U.S. News and World Report 1957 Todayʼs children ride in the car too much and walk too little, spend too much time at TV sets instead of playing vigorous games - or doing chores. An Historical Perspective: A lifetime of physical inactivity? Do not persuade yourself that your child will grow out of it. If he/she is conditioned to laziness at 5 or 6, he/she will still be lazy at 15. And at 50. Prudden, B. (1956). Is your child really fit? Harper 5

6 Percentage Percentage Screen Time By Age: Child Reports By Mean Hours and Minutes Spent Yesterday. Physical Activity Patterns in Adolescents and Young Adults 3:57 hrs 5:52 hrs 6:18 hrs 5:29 hrs Source: Hersey & Jordan (2007). Reducing childrenʼs TV time to reduce the risk of childhood overweight. The childrenʼs media use study. Highlights report Age Physical Activity Levels of Adolescents and Young Adults, by Age and Sex Males Females Lower Activity Levels Result in Lower Cardiovascular Endurance Levels Among Adolescents (Especially Girls) One-Mile Run Passing Rates Fitnessgram Standards Physical Activity Promotion Efforts Must Move Beyond the Individually-Based Efforts of the Past Males Age Females Physical Education in America Societiesʼ major social institution responsible for promoting physical activity and health among youth. Does it stand a chance? Physical Education in America Consider Elementary Physical Education is offered 2x/wk for 20-30/min/d (or 1 hr/wk) School year is about 36 wks/yr So, Physical Education = 36 hr/yr (or the equivalent of about 1 1/2 d/yr out of 365 d/yr). Thatʼs not much time! Obviously there is a need for more physical activity than can be obtained in Physical Education. 6

7 Public Support is Improving: Obesity Epidemic, Findings that Student Achievement Test (SAT) Scores and Youth Fitness Levels Are Related! Beyond School-Based Physical Education We Need to Consider Other social institutions and partnerships that have a chance to reach everybody Worksite settings Health care settings Community settings Changing the view that the pursuit of an active lifestyle is a solitary, individually-driven act Other models that have the potential to change the cultural norm of sedentary living Social Ecological Model Worksite Settings Have the potential to reach the majority of working adults. Healthy People 2010 (USDHHS, 2000) Goal = 75% of worksites by 2010 Currently <50%, with large companies more likely than small ones Economic Viability of Worksite Health Promotion Programs Absenteeism reduced by ~ 30% (average from 20 independent studies) Health Care costs reduced by ~ 22% (average from 21 independent studies) Cost:Benefit Analysis for every $1.00 spent, the company realizes a ~ $5.64 benefit (average from 16 independent studies) Source: Cardinal (2004), American Fitness Who Potentially Benefits from Worksite Health Promotion? Employer Health Care System Employee Health Care Settings Primary Care Physicians Most people visit their primary care physician at least once per year. Patients are receptive and responsive to their physicianʼs advice, encouragement, and counsel. The Healthy People 2010 Goal is to have 50% of primary care physicians counseling their patients in the area of physical activity. 9,299 patients surveyed 34% reported being counseled by their physician during their last office visit. Source: Cardinal et al. (2002). American Journal of Medicine and Sports 7

8 Project PACE: Physician-based Assessment and Counseling for Exercise Community Settings Active Community Environments (ACE) Healthy People Healthy Streets Healthy Communities Population Growth: U.S. Population Growth Urban Sprawl * Urban Sprawl Continued Is Urban Sprawl (i.e., the Built Environment) Partly to Blame for the Inactivity and Obesity Epidemic? 200 years of growth in Baltimore, Maryland 8

9 They will drive! Aerial View of Sub-Division Housing Project in Development How will people get to and from here? Americans Drive Almost Everywhere and Do Almost Everything by Car How Much Do Americans Walk or Bike? Only 6.4% of all trips are on foot or by bicycle 89% of all trips are made by auto On average we drive 73 minutes/day What is the potential for more walking and bicycling? 75% of trips under one mile are by auto Many of these short trips could be made on foot or by bicycle Traditional vs. Newer Style Development Comparison of Travel Choices by Adults in the Netherlands, Germany, and USA 100% 80% Private Car Public Transport Bicycle Walk 60% 40% 20% 0% The Netherlands Germany USA 9

10 Active Living and the Built Environment Percent Source: Aytur et al. (2007), American Journal of Health Promotion Social Ecological Model Behavior is affected by and affecting multiple levels of influence. Reciprocal causation between individual and Intrapersonal environment. Personal Interpersonal Institutional Community Societal Public Policy Social Ecological Model Examples Level of Influence Intrapersonal Interpersonal Institutional/ Organizational Community Public/Social Policy Characteristics Knowledge, attitudes, behavior, health status, self-esteem, skills Family, friends, neighbors, co-workers Schools, universities, workplaces, places of worship Infrastructure, neighborhoods Government agencies, laws Healthy Lifestyles In Todayʼs World: Challenges and Opportunities Physical activity may be a key ingredient for solving many of todayʼs most pressing health challenges. The pursuit of a healthy, active lifestyle should not simply be an individual effort. Relying on compulsory Physical Education in the schools to teach the requisite knowledge and skills necessary to be active for life is likely not enough. Other social institutions must be involved. The Social Ecological Model provides a general framework from which to pursue creative and innovative solutions to the physical inactivity epidemic. All of you!! 10