An overwhelming body of observational and experimental evidence accumulated over the last 60 years shows that exercise and physical activity have huge benefitial impact on pretty much each and every human system and organ and is a superb tool not only for preventing and managing chronic disease but for optimal wellbeing and quality of life. Physical activity is linked to the prevention or treatment of no fewer than 40-50 medical conditions. Yet, about half of waking times on average are spent sitting and physical activity and exercise participation is low across all age groups with some >50 % of adult population never exercising and not meeting the very modest public health physical activity recommendations (the equivalent of only 2.5 hours of brisk walking A WEEK). Physical activity is largely ignored by conventional "healthcare" and on the whole is a very small component of public health that is often consumed by targeting the surrogate sequences of physical inactivity (diabetes, obesity, dislipedimia, etc) but not the cause itself. The neglect of physical activity is one of the most obvious gaps between current knowledge and practice in modern medicine, public health, and education. What do you think would be the best investment/set on investments/solution/action that should be made/taken by healthcare, education, and public health to make physical activity an integral part of people's everyday life across the age spectrum and/or an integral part of preventative and therapeutic healthcare in developed western countries?
I think that exercises has huge benefitial impact on pretty much each and every human health. It is known that regular exercises can help protect you from many diseases, such as heart disease and high blood pressure. We need to encourage people to go exercise.
People have watches to continuously track time. Perhaps people also need watches to track and guide physical activity (still X km to go this week to be healthy). Perhaps too stressful? Do people that apply YOGA (mental activity combined with slow physical activity) walk or run a lot?
Dear Emmanuel,
this is indeed the holy graile of behavioral research. However, it is so complex that an easy answer for this does not suffice. I believe that education does not really help. A number of trials have shown that pure educational interventions do not change much. People know already that exercise (or its unspecific brother "physical activity") is good for them. For me a good strategy is too improve their self-regulatory skills. And one of the major components (as outlined by numerous papers) is self-efficacy. People need to understand that they can do it. Once we have encouraged them we can move them towards action (intention to action). This is probably the most difficult part and there are a few promising theories and behavioral strategies out there that can be used. The HAPA model (Schwarzer et al., see attached) has been shown to move people from no intention to intention and from intention to action (to also maintenance). It integrates self efficacy and planning (to bridge the intention-behaviour gap).
However, now we need to think how can we best implement a model (whatever it might be) on a larger scale. This is crucial because we know that most intervention get people in who are already inclined to exercise or PA. Or we get people that are an "easy catch" (those who are more wealthy and are easy to reach). How to effectively reach many people for low cost (resources and time). I think it is time to go for more non-face-to face interventions. Almost 100% in the developed world owns a mobile phone and we should use this channel to get people moving. Have just recently looked at this in older adults (http://www.ijbnpa.org/content/11/1/35). And now I am implementing an intervention in Malaysia (not a developed country, but same issue).
Well, another issue is surely infrastructure. There are studies out there that urge policy makers to increase the availability of green space, adequate facilities and so forth: http://www.sciencedirect.com/science/article/pii/S0091743511003975
To sum it all up. Public Health and policy makers (also city developers) need to look at the infrastructure. Institutions can develop and implement non-face-to-face intervention that work for large proportions of the public. And finally, alternatives for people who do not prefer/have the opportunity or infrastructure to go out for activity need to be developed. This could be accomplished with home-based programs that are successful: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004017.pub2/pdf/standard.
@Emmanuel et al. I also observe among my students that only those who are active in some kind of sports (hockey, football, netball...) keep up being active in college, when physical education may not be part of curriculum. All the students I meet on the track were active in school, as I was, although I'm not among the top athletes.
Besides that I took care of old folks and accompanied them to hospitals, and have the opportunities to see for myself that growing old and frail isn't for those who lack courage and determination. By exercising we can have a healthier, more graceful way of growing older without depending too much on others.
So to answer your Q, I suggest education and exposure.
yes, I agree that exercise and physical activity play a major role in elevating and increasing daily activity. On the other hand protect human from chronic and fatal diseases like high cholesterol, high blood pressure, diabetics, stroke, heart failure and back pain. furthermore, sport help you to be away from stomach pain, bad digestion, obesity, depression, and emotionally you will be comfortable. Thanks
Let me make a few more comments. We know very well (many studies show) that a history of activity is a strong predictor of current activity/exercise levels. This is also observed in the population of older adults. Hence, if we want to really "grow" a population of active people we need to start in early years. I would call it "prevention" against a couch potato lifestyle. However, when we encounter a population that is not active in later age, we need to go for "intervention" that can be done in ways I have highlighted before. I would stress again that I do not see education as a major driver of these processes, but exposure (as mentioned earlier) has certainly a role.
Friends, we get a bonus from exercise. Exercise isn't just for health. It contributes much to our happiness, releasing endorphins (the neurotransmitters responsible for that famous "runner's high." :))
So please choose to be happy and healthy!
I agree Miranda. But it's not always a matter of "choice". "Choice" implies that there is knowledge, oppurtunities, and a mindset that is geared towards health and wellbeing. For most of the population all three are lacking
Declare the business / city centres, where people work, as pedestrian zones. People will have to at least walk to and from the bus/train station or car parkade.
Ahhh it's such a difficult topic! We have a mountain of evidence to say that exercise is the best medicine for preventing many chronic diseases and also for maximising quality of life in general throughout the lifespan. I wonder if perhaps we need greater education aimed at general practitioners who are the main source of health information for a lot of people. How can we encourage general practitioners to talk to their patients about the need for physical activity to maximise health? Or, perhaps we need tax incentives for people who maintain an active lifestyle? Perhaps we need drastic measures if we are to see a change in the rising proportion of inactive people across all age groups...
Yeah. Indeed difficult. That's why there is probably no golden way. The practitioners things works very (esp. for older adults) but then the docs are often not aware or do not have the time available to encourage people sufficiently. There are a few countries that use prescriptions for PA. And in Germany (my home country) there are programs where health insurance companies give incentives for a healthy lifestyle. This is all fine, but you still not reach a big chunk of the population. Choice..yeah. The "problem" with PA is that the choice of being more active is related to an effort (something that might exhaust you). It is not like eating an apple a day, it is a complex behaviour.
I think any sort of change does depend mainly on the personal perspective on (the need to change!). People stay healthy and active depending on different reasons which work as motives along the way. Exploring motivation throughout physical activity counselling might be an effective method for the public. Also encourage, follow up and teach exercise goal settings are essential to this process and should be studies effectively.
We need to direct effort at both ends of the physical activity continuum - firstly to encourage individuals to be less sedentary - replacing sedentary behaviour such as sitting down with light activity where possible, to 'move around more' and to value 'micro-exercise' - short bouts of activity - even household tasks qualify as such. Being generally more active is important as prolonged sedentary behaviour is an health risk, independent of levels of moderate/vigorous exercise.
Secondly, we need to encourage activity at the other end of the physical activity continuum - targeting more exercise of at least moderate intensity as this too exerts unique benefits for health.
So, it is likely we need a dual strategy to targets both ends of the activity spectrum - which isn't an easy challenge!
Dear all, i agree with all your answers. If we look back on the history of physical fitness, the globalization/ urbanization has played major role in deteriorating physical as well as general health. Here I am not suggesting to go back to the stone age but we can take the good points from ancient lifestyles and habits. Everyone of us need to create time partition between the professional/ job time and personal time to take care of ourself. We all spend more of time in professional/ job which need to balance with personal times which is quite difficult due to demand of life....
Regards
Hi Julie,
very much true. There is the phenomenon of the sedentary exercisers. And this is something we need to look at as well. I know that there are companies that provide training on how to keep moving even during work time (walk to the printer that is not near to you or use the stairs..). I think that is very common in Japan. But, we also need to be more specific when it comes to exercise (specific strength training for certain body parts. etc.). So, reducing sedentary time is probably doable when we look at habit formation. But, the exercise might work differently, since we need to do a lot more things to get started (go to the place, change, do the work out....). I am not a friend of all the motivational approaches. I think we know quite well, that motivation does not necessarily lead to action (esp. on the longer run). But, well sub sets of motivation have shown to explain a lot of variance (self-efficacy in particular).
I do clearly also see that development leads sort of to an inactive lifestyle. We are now soo lazy to even use the stairs when we do not have to. I do indeed believe that city planners should think about giving less opportunities to move (however, people with special needs need to be considered as well).
Another angle is to practice Muay Thai. Even though the 'type' that is typically allowed in the U.S. is watered down (rarely allow elbows and knees; if so, no knees to face; etc.), you can find real fighters, world champions to train with. It is a Buddhist sport and when it comes to learning to control attentional processes, to keep your heart rate around 65 even in the ring, thereby regulating neurotransmitters, developing mindfulness--not flow, as you need to be in touch completely with your surroundings, and hopefully with all your wits about you--2 hours/night (6:30-8:30, 1 hour warm up then technique and depending on the teacher's mood, sparring) leaves you in shape, sharp, able to sleep, completely aware of the dangers of drinking, drugs or anything your liver processes as one good hit to your liver and you wake up in the hospital. Yet, the bulk of training is about coming to know your body and yourself...you. Why fight if its a Buddhist sport? A few reasons. 1- it was a version of prayer forever, but with Thailand's financial difficulties and the fact that they typically are the world's best Thai fighters, people pay to watch. Money talks. But spiritually, your opponent is your mirror, and allows you to 'see' where you need work. So you are grateful for anyone who'll go a few rounds with you. We don't wear much, but mouthpiece, 12 oz gloves, male protection, and shin guards (imported from Thailand at $100) if the teacher allows shin guards. For 12 years my teacher (4 black belts and former Cuban Karate National Leader), his students (two are Eric Castanos and Raul Llopis, both world champs several times over, plus a handful of others all rushed to the no A/C gym and watched time disappear. Practicing real muay thai has the ability to prevent osteoporosis, to regulate appetite, lifestyle, social problems, shyness, and doesn't promote aggression. The links below are to some compilations, some short training vidoes (see how everyone smiles?) and to our foundation. Bruce Leeroy (real name, Alex Caceres) was one of our first foundation members, and since muay thai fights aren't very popular in the U.S., if you want to make a living, you usually go to MMA, which is very different. Anyway, Bruce made it, and cleared $100k his last fight, which is so strange as all of us have trained in the ratiest, hottest gym for years, barely able to pay rent... and yes, with the right teacher you can train at any age. Manuel Lopez trained all of the fighters and he's in his 60s, and can still beat each one of them.
https://www.youtube.com/watch?v=ehKDjYRbxp0
https://www.youtube.com/watch?v=zA-mK70JIrI
https://www.youtube.com/watch?v=KV2KInsI-Fw
https://www.youtube.com/watch?v=ZPPpTVZepjk
https://sportsmatter.com/the-rising-of-young-tigers
Oh, you also learn new languages FAST. When I started, I only spoke English, unfortunately, and they spoke Spanish and Russian. Here in Miami we often speak Spanglish, which saved me.
A timely question Emmanuel.
As most readers are well aware there is now an extensive literature supporting physical activity as one of the most important health promoting behaviours. There are also numerous research reports showing the wide range of actions that will promote physical activity participation.
It is clear that a comprehensive health promotion approach involving educational, economic, policy and environmental supports is likely to be most effective. We can look to the comprehensive approach used so effectively to control tobacco use in countries like Australia and the USA. ( Refer to the recently released 2014 update to the Centers for Disease Control and Prevention’s “Best Practices for Comprehensive Tobacco Control Programs” (The Community Preventive Services Task Force recommends smoke-free policies to reduce secondhand smoke exposure and tobacco use on the basis of strong evidence of effectiveness.)
One of the areas we need to be serious about is better physical activity opportunities in all our schools especially primary schools. My wife is a teacher - and she like some of her colleagues is passionate about the health of her children. Despite the school system increasingly reducing physical activity requirements, she ensures her class has daily involvement in physical activities. The contributions of these people are so important in reducing the physical inactivity (and obesity) problem.
We need to convince our school authorities that regular school physical activity is just as important as any ‘academic subject’ is, and that it needs to be treated with as much respect.
We need to work had to make physical activity a norm once again.
Very much Peter. I remember reading a number of studies showing that higher PA and exercise is strongly (and significantly) associated with higher academic achievements. This is probably a great rational to get the authorities in. Well, in an ideal world (that we are not living in, but might work to create) we would instill a drive to move in early age. This will likely prevent many health conditions in later life.
Peter, thank you. A great insight. That's exactly what is happening
In line with the above comments, martial arts, including muay thai (which is often confused with kickboxing. Kickboxing is American, and a mix; Muay Thai is seamless and was designed to use the whole body, but as mentioned, we don't allow the practice of it here in its entirety, so it is safe with the right teacher and equipment) are able to be learned beginning around age 5, and most kids, boys and girls, are interested, laugh, learn their physical limits, reap the benefits of a social group as well as being alone when it matters, and parents don't need to worry about bullies, kidnappings, molestations, or any of the really 'bad' stuff that invariably comes up at PTA talks. All without the American mantra of 'no pain, no gain,' no screaming coach (most of the teaching is silent, and you are positioned so that you can't help but improve the technique you are working on), no derogatory comments, and no sleep overs/weekends away with the coaches!
A recent report paints a disturbing picture of physical activity for young people in Australia. This shocking “inactivity epidemic,” is probably typical for many countries around the globe. (Results from Australia’s 2014 Report Card on Physical Activity for Children and Youth. Journal of Physical Activity and Health, 2014, 11(Sup 1), S21-S25)
Overall Physical Activity Levels were assigned a grade of D-.; Other physical activity behaviors were graded D to D-; Organized Sport and Physical Activity Participation was assigned a grade of B-; Strategies and Investments (A- to a C). Four incompletes were assigned due to a lack of quality data.
The report concluded: “Everyone needs to be held accountable and work together with the goal of providing children and youth with endless opportunities to be active and to ensure they are aware of the physical activity guidelines and why being physically active is important for their health and well-being….”
We have certainly come a long way in 30 years ( backwards !), with enormous challenges for the future.
Shocking info Peter, but probably a general picture. When we look again at our kids what can be done to avoid increased sedentary behaviour? Kids today do not go out and play very much...they stay home and play computer games, enjoy their tablets or smartphones (or are busy with academic work). The technology industries have become so powerful (as the fast food industry while we are trying to promote healthy food) that we might want to explore ways to use the devices to make kids (and people) move. There are some studies out there looking at that, but on the Public Health level we need to work more holistically. In the end of the day these devices do what we want and if we do not want to move then technology cannot do anything.
Collaborations with the respective industries can be the way forward.
"Exericse is medicine" is the current Technogym slogan and whilst in some sense that is corporate hype, I think the message is applicable.
For example what if a local health commissioning groups were legally required to ensure that children recieved their recommended daily amount of physical activity whilst at school (30 mins a day i think)? This would see the very large number of sport science graduates and industry experts in the UK employed to provide exericse as a prevantative medicince to school children.
I realise this would be expensive but western governments can find money for all sorts of things (e.g. HS2 in the UK - projected cost £50bn) so the cost of improving the health and education of all young people should be a good high profile project to spend money on.
Totally agree Graham. Society as a whole and governments specifically need to realise that physical activity is the best investment in health. It should be viewed as a necessary part of school life just as learning to read and write are.
Yeah Graham. That's something to think about. Instead of putting graduates in gyms better use the expertise to intervene in schools. I also think that PE teachers should play a major role in this. They have the expertise and if we give them a bit more power they could possibly push for more compulsory PE. Well, before that we need to probably work more on the recognition of PE teachers.
Costs should not be an issue (rationally) because the the benefits will be great. We probably need some bright people to sell it well, so that governments jump on the exercise/PA idea.
A great proposal is to change the habit of the population early. Here in Brazil the projects to meet the elderly population over 40 years to try to avoid these problems, encourage the regular practice of exercises in adulthood aprece be a good strategy
There is probably nothing new here, but it does reinforce the growing evidence that it is beneficial to sit less.
A new study in the Mayo Clinic Proceedings claims that sitting too much is as detrimental to cardiovascular health as lack of exercise. The researchers analysed data from 2,223 participants in the National Health and Nutrition Examination Survey (NHANES). They examined the association between fitness levels, daily exercise, and sedentary behavior.
To stay active and combat sedentary behavior, the researchers recommend, “taking short walks during lunch and throughout the day, using a pedometer to track daily steps, taking the stairs instead of the elevator, hosting walking meetings at work, and replacing a standard desk chair with a fitness ball or even a treadmill desk, if possible”.
They suggest that if desk bound, shift positions frequently, stand up while taking phone calls, and stand up from the desk and stretch at intervals.