Bupa Steps to a Healthy Heart

CARDIOVASCULAR DISEASE

STEPS TO AHEALTHY HEART

A global partnership to promote walking

bupa.com/heart world-heart-federation.org

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CONTENTS

2

Acknowledgements 2

Foreword 3

TheglobalburdenofCVD 4

Theimportanceofphysicalactivity 5

Physicalactivityrecommendations 6

Thebenefitsofwalking 8

Theneedforcollaborativeaction 10

AbouttheWorldHeartFederation 11

AboutBupa 13

References 14

ACKNOWLEDGEMENTS

BupaandtheWorldHeartFederationwouldliketothankKatyCooperfromC3Collaboratingfor

Health,andtheWorldHeartFederation’sChiefScienceOfficer,ProfessorKathrynTaubert,fortheir

valuableassistanceandfeedbackinthepreparationofthisreport.

3

Cardiovasculardisease(CVD),whichincludesheartdiseaseandstroke,isoneofthetoughestchallengesinhealthcare.Globally,morepeoplediefromCVDthanfromanyothercause.In2008,CVDclaimed17.3millionlivesand,by2030,itisexpectedthatnumberwillincreasetoover23million.

YetalargeproportionofillnessanddeathfromCVDcouldbepreventedifpeoplearoundtheworldwereabletobettermanagesimplelifestyleriskfactorsby,forexample,notsmoking,eatingwelland,importantly,doingmorephysicalactivity.

BupaandtheWorldHeartFederationarecommittedtogettingpeoplearoundtheworldtodomorephysicalactivitytolowertheirriskofCVD,sothatpeoplecanlivelonger,healthier,happierlives.

TheWorldHealthOrganization(WHO)estimatesthatmorethan60%ofpeoplearoundtheworldare

notsufficientlyactive,andphysicalinactivityisthefourthleadingriskfactorforglobalmortality.

That’swhyBupaandtheWorldHeartFederationarelaunchinganewpartnershiptogettheworldwalking.Walkingisthemostaccessibleformofphysicalactivity:it’sfree,mostpeoplecandoit,itcanbeeasilyincorporatedintoadailyroutineandit’sclinicallyproventhatitcanimproveaperson’shearthealth.

InordertosignificantlyreducethenumberofpreventabledeathsfromCVD,weallneedtoworktogethertosupportandmotivatepeopleacrosstheworldtotakestepstolowertheirrisk.

Wehaveasharedvisionandpurposetoimprovetheworld’shealthandweareproudtobeworkingtogethertomotivatepeopletotakestepstoahealthyheart.Wehopethattheworldjoinsusonourjourney.

FOREWORD

Stuart Fletcher Chief Executive Officer Bupa

Johanna RalstonChief Executive OfficerWorld Heart Federation

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Cardiovasculardisease(CVD)isoneofthetoughestchallengesinhealthcare.Globally,morepeopledieeachyearfromCVDthanfromanyothercause.1

In2008,CVDclaimed17.3millionlives,accountingforonethirdofalldeathsfromallcauses,globally2andnearlyhalfoftheglobalnon-communicablediseaseburden,takingaterribletollonindividuals,familiesandsociety.3

By2030,itisexpectedthatthenumberofpeoplewhowilldiefromCVD(mainlyfromheartdiseaseandstroke)willincreaseto23.3million.4Yet,alargeproportionofdeathsfromCVDareavoidableandthereareanumberofwaysthatpeoplecanreducetheirrisk.5

AlthoughsomeCVDriskfactors,suchasfamilyhistoryorage,cannotbe

modified,80%ofallheartdiseaseandstrokewouldbepreventedifthemainriskfactorswereeliminated:ifweallstoppedsmoking,ateahealthydietanddidenoughphysicalactivity.6

TheprevalenceofCVDriskfactors(suchasphysicalinactivity)isincreasinginmostcountriesaroundtheworld7andthemoreriskfactorsapersonhas,thegreatertheirchanceofdevelopingthedisease.CVDriskfactorsthatcanbemodifiedortreatedincluderaisedbloodpressure(hypertension),raisedbloodglucose(diabetes),raisedbloodcholesterol,tobaccouse,physicalinactivity,andoverweightandobesity.8

Thegoodnewsisthat,formostCVDriskfactors,therearestepsyoucantaketoreducethem.

THE GLOBAL BURDEN OF CVD

What is CVD?

CVDiscausedbydisordersoftheheartandbloodvessels,andincludescoronaryheartdisease(heartattacks),cerebrovasculardisease(stroke),raisedbloodpressure(hypertension),peripheralarterydisease,rheumaticheartdisease,congenitalheartdiseaseandheartfailure.

CVDcanleadtoacuteeventssuchasheartattackorstroke,ormaycauselong-termhealthcomplicationsthatcanaffectmanypartsofaperson’slife,fromtheirabilitytoworkandhaverelationships,tohousingandeducationopportunities.

Heartattacksandstrokesareusuallyacuteeventsandaremainlycausedbyablockagethatpreventsbloodfromflowingtotheheartorbrain.Themostcommonreasonforthisisabuild-upofcholesterolandotherfattydeposits(calledplaque)ontheinnerwallsofthearteriesthatsupplytheheartorbrain.Thisbuild-updevelopsoveryears.Atsomepoint,aplaquecansuddenlyrupture,whichcausesabloodclottoformintheartery,cuttingoffbloodflowtoapartoftheheartorbrainandcausingaheartattackorastroke.Whilethemajorityofstrokesarecausedbybloodclots(ischemicstroke),somecanalsobecausedbyaburstbloodvesselinthebrain(hemorrhagicstroke).

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Physicalinactivityisthefourthleadingriskfactorforglobalmortality(behindhighbloodpressure,tobaccouseandhighbloodglucose),andisakeyriskfactorforCVD9-beingphysicallyinactiveincreasesaperson’sriskofhavingaheartattackorstroke.10

Theimportanceofphysicalinactivityasariskfactorwasparticularlyrecognisedin2013whentheWorldHealthAssembly-theannualgatheringoftheworld’shealthministers-madeaglobalcommitmenttoreducetheprevalenceofinsufficientphysicalactivityby10%,asapartofasuiteoftargetsthataimtoreduceprematuremortalityfromnon-communicablediseases(NCDs)by25%by2025.

Despitetheknownhealthbenefitsofphysicalactivity,peopleinmanycountriesarebecominglessactive.Insomecases,thisisbecausetheenvironmentmakesithardertobuildexerciseintodailyroutines(forexample,ifitiseasiertotakethecarthantowalk),orbecausepeople’sjobsandlifestylesarebecominglessphysicallydemanding.ThiscanhavemajorimplicationsfortheprevalenceofNCDsandthegeneralhealthofpeoplearoundtheworld.11

AccordingtotheWHO,morethan60%oftheglobalpopulationarenotsufficientlyactive.12In2008,around31%ofadults(28%ofmenand34%ofwomen),aged15orolder,wereinsufficientlyactive.13

PrevalenceofinsufficientphysicalactivitywashighestintheWHORegionoftheAmericasandtheEasternMediterraneanRegion.Inboththeseregions,almost50%ofwomenwereinsufficientlyactive,whiletheprevalenceformenwas40%intheAmericasand36%inEasternMediterranean.TheSouthEastAsianRegionshowedthelowestpercentages(15%formenand19%forwomen).14

High-incomecountrieshavemorethandoubletheratesofinsufficientphysicalactivitycomparedtolow-incomecountriesforbothmenandwomen,with41%ofmenand48%ofwomenbeinginsufficientlyphysicallyactiveinhigh-incomecountriescomparedto18%ofmenand21%ofwomeninlow-incomecountries.15Inaddition,peopleindifferentsocioeconomicgroupshavedifferentpatternsofphysicalactivity–inEngland,forexample,peopleinhighersocioeconomicgroupsaremorelikelytoreachtherecommendedphysicalactivitylevels.16

THE IMPORTANCE OF PHYSICAL ACTIVITY

More than 60% of the

global population are

not sufficiently active

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PHYSICAL ACTIVITY RECOMMENDATIONS

Differentagegroupshavedifferentphysicalactivityrequirements.17

Itisrecommendedthatchildrenandyoungpeopleshouldaccumulateatleast60minutesofmoderatetovigorous-intensityphysicalactivitydaily.Mostofthedailyphysicalactivityshouldbeaerobicactivities;andactivitiesthatstrengthenmuscleandboneshouldbeincluded,atleastthreetimesperweek.

Forchildrenandyoungpeopleaged5-17yearsold,physicalactivityincludesplay,games,sports,transportation,recreation,physicaleducationorplannedexercise,inthecontextoffamily,school,andcommunityactivities.

Adultsshoulddoatleast150minutesofmoderate-intensity(oratleast75minutesofvigorous-intensity)aerobicphysicalactivitythroughouttheweek,oranequivalentcombinationofmoderateandvigorous-intensityactivity.Aerobicactivityshouldbeperformedinboutsofatleast10minutesinduration,andmuscle-

strengtheningactivitiesthatinvolvemajormusclegroupsshouldbedoneontwoormoredayseachweek.

Whenadultsover65yearsoldcannotdotherecommendedamountsofphysicalactivityduetohealthconditions,theyshouldbeasphysicallyactiveastheirmobilityandhealthallow.

Physicalactivityforadultsincludesrecreationalorleisure-timephysicalactivity,transportation(e.g.walkingorcycling),occupational(i.e.work),householdchores,games,sportsorplannedexercise,inthecontextofdaily,family,andcommunityactivities.

DoingsomephysicalactivityisbetterthandoingnoneandevensmallincreasesinphysicalfitnessareassociatedwithasignificantreductioninCVDrisk.Inactiveadults,olderadultsandthosewithdiseaselimitationsreceiveaddedhealthbenefitswhentheybecomemoreactive.19

Adults should do at least 150

minutes of moderate physical

activity per week

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Ifyou’renotusedtophysicalactivity,even30minutesmightsoundlikealot-butyoudonotneedtodoyour30minutesinonesession,20inactivepeopleshouldstartwithsmallamountsofphysicalactivityandgraduallyincreaseduration,frequencyandintensityovertime.

Youcanstartbymakingasmallchangesuchasensuringyougetupandmovearoundmorethroughouttheday,asevidenceshowssittingforlongperiodsoftimecanincreaseyourriskofchronicdiseasessuchascancer,diabetesandCVD.21

The difference between ‘moderate’ and ‘vigorous-intensity’ physical activity

Thetalktestisaneasywaytodeterminewhetheryourphysicalactivitycanbeconsidered‘moderate’,or‘vigorous’.Ifyou’redoingmoderate-intensityactivityyoucantalk,butnotsing,duringtheactivity.Ifyou’redoingvigorous-intensityactivity,youwillnotbeabletosaymorethanafewwordswithoutpausingforabreath’.18

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THE BENEFITS OF WALKING

Walkingisagreatwaytoincreasephysicalactivitylevels.Itisoneofthemostaccessibleformsofphysicalactivity:mostpeoplecandoit,itisfree,canbeeasilyincorporatedintoadailyroutine,andevidencehasshownthatitcanimproveyourhearthealth.22

Importantly,walkingbriskly(atapaceofatleast3mphor5kph)countstowardtheWHO’srecommendationthatadultsdoatleast150minutesaweekofmoderatephysicalactivity.

TheimpactofwalkingonreducingtheriskofCVD(includingheartdiseaseandstroke)hasbeenexaminedinseveralstudies,whichhavedemonstratedthatwalkingcan:

• reducetheriskofCVDbyover10%23

• decreasebodyweight,bodymassindex(BMI),bodyfatpercentageandwaistcircumference

• lowerbloodpressure,andincreaseaerobiccapacity(thecapacityofanindividual’sbodytotransportanduseoxygenduringexercise)byuptoaboutafifth

• lowerlevelsofthefatthatcancausehardeningandnarrowingofthearteries(triglycerides)24

• increase‘good’(HDL)cholesterol.25

OnestudyshowedthatwalkingatleasttwohoursaweekreducedtheincidenceofprematuredeathfromCVDbyabout50%.26

InadditiontoloweringtheriskofCVD,walkinghasbeenshowntoprovideotherhealthbenefits,including:

• reducingtheriskofothernon-communicablediseases,suchastype2diabetes,27andhavebenefitsforpeoplerecoveringfromcancer28

• improvesleeppatterns,boostenergylevels29

• increasemuscleendurance30

• mentalhealthbenefitsthroughthereleaseofhormones(chemicalsproducednaturallybyyourbody)calledendorphinsthatimprovemood-buildingself-esteemaswellasreducingfeelingsofstressandanxiety31

• decreasetheriskofdementia32

• reduceandalleviatejointandbackpainbyincreasingmusclestrengthandhelpingtokeepbonesstrong(whichmayalsohelpprotectagainstosteoporosis)33

• peoplewithchronicobstructivepulmonarydisease(COPD),whoundertakemorewalking,halvetheirriskofbeingadmittedasanemergencyadmission.34

Arecentstudyof400,000peoplefoundthat,just15minutesadayofbriskwalkingcanhavesignificanthealthbenefits,addinguptothreeyearstolifeexpectancy-andeveryadditional15minutesofdailyexercisereducedall-causedeathratesbyafurther4%.35

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10

THE NEED FOR COLLABORATIVE ACTION

Heartdiseaseisoneofthemostcriticalhealthcarechallengesofourtime.However,thereisahugeopportunitytomakeadramaticdifferencetolivesofmillionsofpeople.Together,BupaandtheWorldHeartFederationarecommittedtohelpingpeoplereducetheirriskofCVD,bymotivatingandencouragingpeopletobemorephysicallyactive-bywalkingmore.

Alongwiththeheartspecific,andwiderhealthbenefitsofwalking,studieshavealsoshownthatwalkinghashigherlevelsof‘stickability’thanotherformsofphysicalactivity36-itisconvenientandovercomesmanyofthecommonlyperceivedbarrierstophysicalactivity:lackoftime,lackoffitnessorlackofskill.

Walking rates have

declined steadily over

several decades

Unfortunately,however,walkingrateshavedeclinedsteadilyoverseveraldecades.37Theproportionofchildrenwalkingorcyclingtoschoolfellfrom48%to13%between1969and2009intheUS,andfrom62%to50%between1989and2004amongprimaryschoolchildrenintheUK38-thisdeclineiscontinuingaroundtheworld.Forexample,inIndiarisingcarownershipisdiscouragingwalkingand,inChina,reducedwalkinghascontributedtoanincreaseinobesitylevels.

Together,Bupa,aleadinginternationalhealthcaregroupthatexiststohelppeoplelivehealthier,happier,longerlives,andtheWorldHeartFederation,thegloballeaderinthefightagainstCVD,arecommittedtoreversingtheincreasingprevalenceofCVD,aswellasthesedecliningwalkingrates.Inordertodoso,weallneedtoworktogethertosupportandmotivatepeopletogetwalkingandstaywalking.

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TheWorldHeartFederationisdedicatedtoleadingtheglobalfightagainstCVDviaaunitedcommunityofmorethan200memberorganisations.

Withitsmembers,theWorldHeartFederationworkstobuildglobalcommitmenttoaddresscardiovascularhealthatthepolicylevel;generatesandexchangesideas;sharesbestpractice;advancesscientificknowledge;andpromotesknowledgetransfertotackleCVD-thenumberonekillerworldwide.

TheWorldHeartFederationisagrowingmembershiporganisationthatbringstogetherthestrengthofcardiacsocietiesandheartfoundationsfrommorethan100countries.

AlongsidetheWorldHealthOrganization,theWorldHeartFederationiscommittedtodrivinga25%reductioninprematuredeathsfromCVDby2025.

Formoreinformationvisit:www.world-heart-federation.org

ABOUT WORLD HEART FEDERATION

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17.3 millionpeople around the world died from CVD in 2008

60%of people around the world are not doing enough physical activity

in 2008

30%of all deaths were due to CVD

23.3 millionpeople are expected to die from CVD (mainly from heart attack and stroke) by 2030

80%of all heart disease and stroke would be prevented if the major risk factors were eliminated - if we stopped smoking, ate a healthy diet and did enough physical activity.

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Bupa’spurposeislonger,healthier,happierlives.

Aleadinginternationalhealthcaregroup,weserveover14millioncustomersinmorethan190countries.Weofferpersonalandcompany-financedhealthinsuranceandmedicalsubscriptionproducts,runhospitals,provideworkplacehealthservices,homehealthcare,healthassessmentsandchronicdiseasemanagementservices.Wearealsoamajorinternationalproviderofnursingandresidentialcareforelderlypeople.

Withnoshareholders,weinvestourprofitstoprovidemoreandbetterhealthcareandfulfilourpurpose.

Bupaemploysmorethan62,000people,principallyintheUK,Australia,Spain,Poland,NewZealandandtheUSA,aswellasSaudiArabia,HongKong,India,Thailand,ChinaandacrossLatinAmerica.

Formoreinformationvisit:www.bupa.com

ABOUT BUPA

14

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