The Second Fifty Years Promoting Health and Preventing Disability (1992) / Chapter Skim
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Physical Inactivity
Physical Inactivity
Pages 224-242
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From page 224... ...
A workshop conducted by the Centers for Disease Control in 1984 on the epidemiology and public health aspects of physical activity and exercise underscored the importance of physical activity and pointed out the difficulties involved in its measurement.28 The term physical activity, defined as "any bodily movement produces] by skeletal muscles that results in energy expenditure," has been used interchangeably with exercise and physical fitness.9 However, exercise is a subcategory of physical activity in that exercise is planned, structured, repetitive, ant]
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From page 225... ...
Rather, what is known of the benefits of physical activity in general and how such activity can be encouraged and maintained during the "second 50" will guide the discussion that follows. BURDEN Prevalence One measure of physical inactivity is sedentariness, which is defined as either no physical activity or physical activity less than three times per week and/or physical activity of less than 20 minutes per occasion.27 The Centers for Disease Control reported the prevalence of a sedentary lifestyle in selected states using data from its Behavioral Risk Factor Surveillance System.
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From page 226... ...
. < I I I 18-34 35-~ 55+ ME GROUP ~ -~an Pavane tar -~ FICURE 13-1 Box-plot summaries of the age-speciOc distribution of sedentary lifestyle prevalence from 22 states participating in the 1985 Beb~viora1 Risk Pactor Su~cUlance System.
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From page 227... ...
Activity limitations owing to chronic health problems were reported in the 1982 National Health Interview Survey. The data indicate that the number of reported activity limitations begins to increase markedly some time after age 44.
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From page 228... ...
4. Numerous reports from the Alameda County Study24 show allcause mortality to be significantly and positively associated with smoking, poor steep habits, physical inactivity, relative overweight, immoderate alcohol intake, not eating breakfast, and regular snacking.
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From page 229... ...
With advanced age and senescence, further reductions have been observed. Cross-sectionalL research using muscle biopsies of healthy older aclults indicates that impairments can be attributed to reduced muscle mass as a result, primarily, of a Toss of muscle fiber.
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From page 230... ...
.4° Determinants of the VO2max are the cardiac output (itself determined by heart rate, which decreases with age, and stroke volume, which may or may not decrease with agel, which is a central adjustment of the body to exercise; arteriovenous oxygen difference, which is a peripheral adjustment to exercise; and pulmonary function, which is measured by the maximum ventilation in the lungs. The prevention of disability and handicaps through physical fitness can be crucial in the elderly.
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From page 231... ...
PREVENTABILITY OF BURDEN: AVAILABILITY AND EFFECTIVENESS OF INTERVENTIONS If physical inactivity in aging can be termed the "problem" or diagnosis with which this chapter is concerned, then "activation" must become the goal of "treatment." Rather than focusing on the prevention of specific diseases or clisabilities, the "prescription" is aimed at increasing active life expectancy and the maintenance of independence.25 To achieve this goal the means of initiating and maintaining physical activities for the elderly must be explored. There is great potential for increased physical activity among the elderly.
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From page 232... ...
Writing for the American College of Sports Medicine, Heath recommends that individuals who participate in supervised exercise programs complete a brief medical history and risk factor questionnaire.22 Diagnostic tolerance testing is recommended for participants with diabetes mellitus or coronary heart disease and for individuals known to be at risk for these diseases. For vigorous programs, the college advises exercise leaders to ensure that program applicants have had a physical examination by a physician within the two years previous to program initiation.22 Adaptations of exercise programs may vary considerably.
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From page 233... ...
In addition, because intense stretching exercises and calisthenics may present difficulties for patients with knee and hip mobility problems or for those with degenerative joint changes,22 these activities should not be part of an exercise program for patients with such problems. Finally, because women and individuals from Tower socioeconomic classes and minorities are less inclined to adopt rigorous exercise programs,2 physicians and policymakers should take steps to encourage their participation.
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From page 234... ...
* Note: ++ = repeatedly documented increased probability; + = weak or mixed documentation of increased probability; 00 = repeatedly documented that there is no change in probability, 0 = weak or mixed documentation of no change in probability; ~ = weak or mixed documentation of decreased probability; = repeatedly documented decreased probability.
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From page 235... ...
One program that follows the community health model, Johnson and lohnson's Live for Life project, demonstrated striking changes in population physical activity. Blair reports that, by the end of two years, 20 percent of the initially sedentary women and 30 percent of the initially sedentary men were exercising regularly at or above the optimal level.2 Economic analyses of the Live for Life program show reduced hospitalization costs.4 Other benefits of employee participation in a worksite exercise program include decreasecl absenteeism, turnover, and medical care costs.38
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From page 236... ...
Many have wondered if the benefits of physical fitness would have significant implications for the reduction of dependency; others have seen increased physical fitness as a way to reduce health care costs. Shephard has suggested that participation by the elderly in three onehour exercise classes per week may reduce health care costs from acute and chronic treatment, mental health treatment, and extended residential care by more than $600 for each senior citizen per year.38
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From page 237... ...
. - - r - -- ~ J ~ ~ ~ ~~ ~ ~~x ~~ ~11~11 Exercise programs should accommodate the participants.
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From page 238... ...
5. The use of methodological ground rules could greatly assist research efforts.
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From page 239... ...
Policymakers General recommendations for policy regarding exercise programs for the overall population have already been developed.30 Although these recommendations are not specifically aimed at exercise for the "second 50," several are applicable.
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From page 240... ...
A Status of the 1990 physical fitness and exercise objectives evidence from NHIS 1985.
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From page 241... ...
Sex-, age-, and region-specific prevalence of sedentary lifestyle in selected states in 1985 the behavioral risk factor surveillance system. Journal of the American Medical Association 1987; 257:2270-2272.
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From page 242... ...
Current Estimates from the National Health Interview Survey; United States, 1981. National Center for Health Statistics, Public Health Service.
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