exercise - not enough worldwide

With the approach of the Olympics the British medical journal The Lancet has published a series of papers on the worldwide lack of exercise. (you need to register to read the articles, but it is free)  A pr note picked up by newspapers around the world summarized some of the findings ..  here is what appeared in the LA Times.

The abstract for one of the papers dramatically makes the point:

 

Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy

Dr I-Min Lee ScD a , Eric J Shiroma MSc b, Felipe Lobelo MD c, Pekka Puska MD d, Steven N Blair PED e, Peter T KatzmarzykPhD f, for the Lancet Physical Activity Series Working Group†

Summary

Background

Strong evidence shows that physical inactivity increases the risk of many adverse health conditions, including major non-communicable diseases such as coronary heart disease, type 2 diabetes, and breast and colon cancers, and shortens life expectancy. Because much of the world's population is inactive, this link presents a major public health issue. We aimed to quantify the effect of physical inactivity on these major non-communicable diseases by estimating how much disease could be averted if inactive people were to become active and to estimate gain in life expectancy at the population level.

Methods

For our analysis of burden of disease, we calculated population attributable fractions (PAFs) associated with physical inactivity using conservative assumptions for each of the major non-communicable diseases, by country, to estimate how much disease could be averted if physical inactivity were eliminated. We used life-table analysis to estimate gains in life expectancy of the population.

Findings

Worldwide, we estimate that physical inactivity causes 6% (ranging from 3·2% in southeast Asia to 7·8% in the eastern Mediterranean region) of the burden of disease from coronary heart disease, 7% (3·9—9·6) of type 2 diabetes, 10% (5·6—14·1) of breast cancer, and 10% (5·7—13·8) of colon cancer. Inactivity causes 9% (range 5·1—12·5) of premature mortality, or more than 5·3 million of the 57 million deaths that occurred worldwide in 2008. If inactivity were not eliminated, but decreased instead by 10% or 25%, more than 533 000 and more than 1·3 million deaths, respectively, could be averted every year. We estimated that elimination of physical inactivity would increase the life expectancy of the world's population by 0·68 (range 0·41—0·95) years.

Interpretation

Physical inactivity has a major health effect worldwide. Decrease in or removal of this unhealthy behaviour could improve health substantially.

 

The opening piece provides some sets the tone.

This Series on physical activity is not about sport and it is about more than just exercise. It is about the relationship between human beings and their environment, and about improving human wellbeing by strengthening that relationship. It is not about running on a treadmill, whilst staring at a mirror and listening to your iPod. It is about using the body that we have in the way it was designed, which is to walk often, run sometimes, and move in ways where we physically exert ourselves regularly whether that is at work, at home, in transport to and from places, or during leisure time in our daily lives.

There is substantial evidence to show that physical inactivity is a major contributor to death and disability from non-communicable diseases (NCDs) worldwide. Since 2005, The Lancet has been part of a worldwide effort to implement action on NCDs. Increasing levels of physical activity is one such priority.1 However, unlike other NCD risk factors, such as tobacco, diet, and alcohol, the importance of physical activity has been slow to be recognised, and the emphasis to tackle it at a population level has not been forthcoming.

Physical activity is a neglected dimension of prevention and intervention worldwide, especially in low-income and middle-income countries. One problem is that physical activity is often perceived only in the context of controlling obesity, and therefore physical inactivity is regarded as a minor or secondary risk factor for NCDs. But an Article in this Series by I-Min Lee and colleagues2 should cause us to rethink. The authors quantify the ill-effects of inactivity in the first study of its kind with detailed data for each country, where available. They estimate that physical inactivity causes 6–10% of all deaths from the major NCDs (coronary heart disease, type 2 diabetes, and breast and colon cancers). Furthermore, they show that inactivity causes 9% of premature mortality, or more than 5·3 of the 57 million deaths that occurred worldwide in 2008.3 This figure equates to as many deaths as tobacco causes globally, which is uniformly regarded as a major NCD risk factor.4

But it is a mistake to view physical activity only in terms of its disease-specific associations. The benefits of physical activity are far-reaching and extend beyond health alone. Being physically active is a major contributor to one’s overall physical and mental wellbeing. Positive outcomes include a sense of purpose and value, a better quality of life, improved sleep, and reduced stress, as well as stronger relationships and social connectedness. Additionally, promoting active modes of travel, such as walking and cycling, are good for the environment, which in turn also has a positive impact on health.

But how do we encourage a behaviour that should be part of everyday life? For too long the focus has been on advising individuals to take an active approach to life. There has been far too little consideration of the social and physical environments that enable such activity to be taken. Regular activity must, of course, be done by the individual but, as this Series shows, efforts beyond the health sector through social and environmental change will be necessary if we are to see greater uptake of this healthier behaviour in people’s lives.

There are many ways around this, but in the US physical education seems to be shrinking.  Much could be done to make it more relevant and perhaps begin to contribute to better habits and health outcomes, but that seems unlikely at this point.  

Some talk about teaching physical literacy.  A meaningful and sustainable physical literacy makes a lot of sense - just like teaching kids that learning is fun and teaching them how to learn. Unfortunately, just as teaching kids how to learn stumbles, phys ed programs tend to be a farm program to sort out those who can be good high school athletes.  A lot of progress could probably be made with modest changes and phys ed teachers could probably be motivated as their ranks are thinning these days with decreasing school budgets.

Our GP labeled me an "athletic male" during my last physical.  I'm something of a maladroit so I had to ask.  He noted that for my age group I would be considered in excellent physical health - at the level of an active athlete my age - and that I would be considered in good shape for someone 20 years younger.

When I was a kid I walked or biked quite a bit and had gym class every other day during the school year.  I hated gym, and it did little to encourage physical activity the way it was taught, but it did provide added activity.  In college I used my feet and bike even more.  This probably set me on a path towards general good health now.  After asking about my historical activity he asked for tips he might use himself.  

Some of the burden falls on parents and many seem afraid to allow their kids to walk and bike.  My sister and brother-in-law did a great job. One of my nieces regularly does half marathons and the other, even though she is extremely challenged for time, runs nearly every day and runs marathons and is a nationally ranked ultra-marathoner (those start at about 50 miles).

Cracking the low level of physical activity is one of those societal issues that is easy in theory, but extremely difficult in practice.  It was a sad commentary watching the firestorm of opposition around the First Lady's efforts to promote healthy eating and more physical activity...