Physical Activity for Americans

Physical Activity forPhysical Activity forAmericansAmericans

Fuzhong Li, Ph.D.Fuzhong Li, Ph.D.

Oregon Research InstituteOregon Research Institute

FocusFocus

To understand To understand What is physical activity (PA)? What is physical activity (PA)? Current PA statusCurrent PA status Health risks of being sedentaryHealth risks of being sedentary Research – Scientific EvidenceResearch – Scientific Evidence

Terminology and DefinitionsTerminology and DefinitionsPhysical ActivityPhysical Activity

““Bodily movement produced by the Bodily movement produced by the contraction of skeletal muscle that contraction of skeletal muscle that increases energy expenditure above increases energy expenditure above the basal level”the basal level”

Source: USDHHS (1996)Source: USDHHS (1996)

1988-2007 No Leisure Time 1988-2007 No Leisure Time Physical Activity NationwidePhysical Activity Nationwide

Source: www.cdc.gov/nccdphp/dnpa/physical/stats/leisure_time.htm

Levels of Physical ActivityLevels of Physical Activity

Source: apps.nccd.cdc.gov/PASurveillance/StateSumV.asp

Source: http://apps.nccd.cdc.gov/PASurveillance/StateSumResultV.asp

ThailandThailand

Source: Thailand Health Profile – 2004-2006

Prevalence (%) of Physical Inactivity In Prevalence (%) of Physical Inactivity In University Students from 23 CountriesUniversity Students from 23 Countries

Black bar = maleShaded bar = female

Prevalence (%) of Recommended Prevalence (%) of Recommended Frequency (6 times in the past 2 weeks) Frequency (6 times in the past 2 weeks)

Leisure-time PA in University Students from Leisure-time PA in University Students from 23 Countries23 Countries



Proportion of Students Who knew of Proportion of Students Who knew of Association Between PA and Heart DiseaseAssociation Between PA and Heart Disease

Health Risks of Physical InactivityHealth Risks of Physical Inactivity

Risk of coronary heart diseaseRisk of coronary heart disease People with inactive and unfit almost twice People with inactive and unfit almost twice

as likely to die from heart disease as more as likely to die from heart disease as more active and fit peopleactive and fit people

Risk of being overweigh or obese, Risk of being overweigh or obese, Which in turn, associated with certain Which in turn, associated with certain

cancers, osteoarthritis, and back problemscancers, osteoarthritis, and back problems

Risk of developing type 2 diabetesRisk of developing type 2 diabetes

Risk of lowering bone density - osteoporosisRisk of lowering bone density - osteoporosis

Certain CancerCertain Cancer

State of HealthState of Health

13.5 million people have coronary artery disease13.5 million people have coronary artery disease

1.5 million people have a heart attack per year1.5 million people have a heart attack per year

8 million people have type 2 diabetes8 million people have type 2 diabetes

95,000 people are diagnosed with colon cancer 95,000 people are diagnosed with colon cancer each yeareach year

250,000 people suffer a hip fracture per year250,000 people suffer a hip fracture per year

50 million people have high blood pressure50 million people have high blood pressure

More than 60 million people are overweightMore than 60 million people are overweight

Fat AmericanFat AmericanPercentage of people who are overweight or Percentage of people who are overweight or

obeseobese

0

10

20

30

40

50

60

70

Per

cen

tag

e (%

)

1976-1980

1988-1994

1999-2000

2001-2002

2003-2004

Men and FitnessMen and FitnessThe risk of death in unfit and fit menThe risk of death in unfit and fit men

Unfit

Fit

Unfit

Fit

Unfit

Fit

0

0.5

1

1.5

2

2.5

Rel

ativ

e R

isk

< 17 17-25 > 25

% Body Fat

Weighty WomenWeighty WomenRelative risk of death in unfit and fit womenRelative risk of death in unfit and fit women

Unfit

Fit

Unfit

Fit

Unfit

Fit

0

1

2

3

4

Rel

ativ

e R

isk

Normal Over Obese

Weight

Age and ActivityAge and ActivityRelative risk of death in people 60 and olderRelative risk of death in people 60 and older

Low

Moderate

High

Low

Moderate

High

0

0.25

0.5

0.75

1

Rel

ativ

e R

isk

Women Men

Fitness Level

Percentage of Disease Attributable Percentage of Disease Attributable to Physical Inactivityto Physical Inactivity

0

5

10

15

20

25

Per

cen

tag

e (%

)

Stroke Osteoporosis Type 2Diabetes

CAD Colon Cancer Hpertenion breast cancer

DiabetesDiabetesTotal Prevalence of Diabetes Among People Total Prevalence of Diabetes Among People

aged 20 Years or Older (2005)aged 20 Years or Older (2005)

3

12

21

0

5

10

15

20

25

Per

cen

tag

e (%

)

20-39 40-59 60+

Age Group

Estimated Total % of diabetes in people age 20 years or older, by age group

• Age 20 years or older: 20.6 million; 9.6%• Age 60 years or older: 10.3 million; 20.9%• Men: 10.9 million; 10.5%• Women: 9.7 million: 8.8%

Who Exercise?Who Exercise?Leisure-time Physical Activity among Adults (2005)Leisure-time Physical Activity among Adults (2005)

No activityNo activity No activity

No activity

Some activity

Some activitySome activity

Some activity

Regular activityRegular activity Regular activity

Regular activity

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

18 to 24 25 to 44 45 to 64 65 +

Per

cen

tag

e (%

)

Who Exercise?Who Exercise?Overall Physical Activity among Adults (2005)Overall Physical Activity among Adults (2005)

No No No

NoLow LowLow

LowMedium

Medium Medium

Medium

Medium-Hi

Medium-Hi Medium-Hi

Medium-Hi

High High High High

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

18 to 24 25 to 44 45 to 64 65 +

Per

cen

tag

e (%

)

Recommended Physical Recommended Physical Activity Levels - AdultsActivity Levels - Adults

Moderate-intensity aerobic (endurance) Moderate-intensity aerobic (endurance) physical activities (i.e., brisk walking, physical activities (i.e., brisk walking, bicycling, vacuuming, gardening, or bicycling, vacuuming, gardening, or anything else that causes small anything else that causes small increases in breath or heart rate) for a increases in breath or heart rate) for a minimum of 30 min on five days each minimum of 30 min on five days each week week

OROR

Source: Haskell et al. (2007), Medicine & Science in Sports & Exercise

Recommended Physical Recommended Physical Activity LevelsActivity Levels

Vigorous-intensity aerobic Vigorous-intensity aerobic physical activities (i.e., running, physical activities (i.e., running, aerobics, heavy yard work, or aerobics, heavy yard work, or anything else that causes large anything else that causes large increases in breathing or heart increases in breathing or heart rate) for a minimum of 20 min on rate) for a minimum of 20 min on three days each weekthree days each week

Source: Haskell et al. (2007), Medicine & Science in Sports & Exercise

Insufficient Physical ActivityInsufficient Physical Activity

Doing more than 10 minutes Doing more than 10 minutes total per week of moderate or total per week of moderate or vigorous-intensity lifestyle vigorous-intensity lifestyle activities (i.e., household, activities (i.e., household, transportation, or leisure-time transportation, or leisure-time activity), but less than the activity), but less than the recommended level of activityrecommended level of activity

Source: http://www.cdc.gov/nccdphp/dnpa/physical/stats/definitions.htm

InactivityInactivity

Less than 10 minutes total per week of Less than 10 minutes total per week of moderate or vigorous-intensity lifestyle moderate or vigorous-intensity lifestyle activities (i.e., household, transportation, activities (i.e., household, transportation, or leisure-time activity).or leisure-time activity).


Understand PA IntensityUnderstand PA Intensity

METs and MET-minutesMETs and MET-minutes MET – Metabolic equivalent MET – Metabolic equivalent A ratio of the rate of energy expended during an A ratio of the rate of energy expended during an

inactivity to the rate of energy expended at restinactivity to the rate of energy expended at rest A 1 MET = rate of energy expenditure while at restA 1 MET = rate of energy expenditure while at rest A 4 MET activity expends 4 times the energy used A 4 MET activity expends 4 times the energy used

by the body at restby the body at rest If a person does a 4 MET activity for 30 min., this If a person does a 4 MET activity for 30 min., this

person has done 4 MET x 30 min = 120 MET-min person has done 4 MET x 30 min = 120 MET-min (or 2.0 MET-hours) of PA(or 2.0 MET-hours) of PA

Understand PA IntensityUnderstand PA Intensity

Test Question – Test Question – If I did a 8 MET activity in 15 minutes, how If I did a 8 MET activity in 15 minutes, how

many MET-minutes?many MET-minutes?

Understand PA IntensityUnderstand PA IntensityMET-Minutes and Health BenefitsMET-Minutes and Health Benefits Health benefits of PA depend on total weekly energy expenditure due to PA.Health benefits of PA depend on total weekly energy expenditure due to PA. In scientific terms, this range is In scientific terms, this range is 500 to 1,000 500 to 1,000 MET-minutes per weekMET-minutes per week

3.3 METS for 150 min per week ≈ 500 MET-min per week3.3 METS for 150 min per week ≈ 500 MET-min per week

13.4 MET for 75 min. per week ≈ 1000 MET-min per week13.4 MET for 75 min. per week ≈ 1000 MET-min per week Activity of 500 MET-min. a week results in a substantial reduction in the risk of premature death, but Activity of 500 MET-min. a week results in a substantial reduction in the risk of premature death, but

activity of activity of MOREMORE than 500 MET-minutes a week is necessary to achieve a substantial reduction in the risk than 500 MET-minutes a week is necessary to achieve a substantial reduction in the risk of breast cancerof breast cancer

Understand PA IntensityUnderstand PA IntensityAbsolute IntensityAbsolute Intensity

Light-intensity: 1.1 MET to 2.9 METsLight-intensity: 1.1 MET to 2.9 METs

Moderate-intensity: 3.0 – 5.9 METsModerate-intensity: 3.0 – 5.9 METs Waling at 3 miles per house requires 3.3 METs of energy expenditureWaling at 3 miles per house requires 3.3 METs of energy expenditure

Vigorous-intensity: 6.0 METs activity or moreVigorous-intensity: 6.0 METs activity or more Running at 10 minutes per mile (6 mph) is a 10 MET activityRunning at 10 minutes per mile (6 mph) is a 10 MET activity

Understand PA IntensityUnderstand PA IntensityRelative IntensityRelative Intensity

Relative to fitness, with the intensity expressed in terms of a percent of a Relative to fitness, with the intensity expressed in terms of a percent of a person’s (1) maximal heart rate, (2) heart rate reserve, or (3) aerobic person’s (1) maximal heart rate, (2) heart rate reserve, or (3) aerobic capacity reserve. capacity reserve.

ModerateModerate: 40 and 59% of aerobic capacity reserve (or 5 or 6 effort on a : 40 and 59% of aerobic capacity reserve (or 5 or 6 effort on a scale of 0-10)scale of 0-10)

VigorousVigorous: 60 to 84% of reserve (or 7 or 8 of the scale): 60 to 84% of reserve (or 7 or 8 of the scale)

PA Guidelines for AmericansPA Guidelines for AmericansChildren and Adolescents Children and Adolescents (aged 6-17)(aged 6-17)

Children and adolescents should do 1 hour (60 minutes) or more of Children and adolescents should do 1 hour (60 minutes) or more of PA every day. PA every day.

Most of the 1 hour or more a day should be either moderate- or Most of the 1 hour or more a day should be either moderate- or vigorous-intensity aerobic PA. vigorous-intensity aerobic PA.

As part of their daily physical activity, children and adolescents As part of their daily physical activity, children and adolescents should do vigorous-intensity activity on at least 3 days per week. They should do vigorous-intensity activity on at least 3 days per week. They also should do muscle-strengthening and bone-strengthening activity on also should do muscle-strengthening and bone-strengthening activity on at least 3 days per week. at least 3 days per week.


PA Guidelines for AmericansPA Guidelines for AmericansAdults Adults (aged 18-64)(aged 18-64)

Adults should do 2 hours and 30 minutes a week of Adults should do 2 hours and 30 minutes a week of moderate-intensity, or 1 hour and 15 minutes (75 moderate-intensity, or 1 hour and 15 minutes (75 minutes) a week of vigorous-intensity aerobic physical minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and activity, or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity. Aerobic vigorous-intensity aerobic physical activity. Aerobic activity should be performed in episodes of at least 10 activity should be performed in episodes of at least 10 minutes, preferably spread throughout the week. minutes, preferably spread throughout the week.


PA Guidelines for AmericansPA Guidelines for AmericansAdults Adults (aged 18-64)(aged 18-64)

Additional health benefits are provided by increasing to 5 hours Additional health benefits are provided by increasing to 5 hours (300 minutes) a week of moderate-intensity aerobic physical (300 minutes) a week of moderate-intensity aerobic physical activity, or 2 hours and 30 minutes a week of vigorous-intensity activity, or 2 hours and 30 minutes a week of vigorous-intensity physical activity, or an equivalent combination of both. physical activity, or an equivalent combination of both.

Adults should also do muscle-strengthening Adults should also do muscle-strengthening activities that activities that involve all major muscle groups involve all major muscle groups performed on 2 or more days performed on 2 or more days per week. per week.


PA Guidelines for AmericansPA Guidelines for AmericansOlder Adults Older Adults (aged 65+)(aged 65+)

Older adults should follow the adult guidelines. Older adults should follow the adult guidelines. If this is not possible due to limiting chronic If this is not possible due to limiting chronic conditions, older adults should be as physically conditions, older adults should be as physically active as their abilities allow. They should avoid active as their abilities allow. They should avoid inactivity. Older adults should do exercises that inactivity. Older adults should do exercises that maintain or improve balance if they are at risk of maintain or improve balance if they are at risk of falling.falling.


PA Guidelines for AmericansPA Guidelines for AmericansAdults With DisabilitiesAdults With Disabilities

Follow the adult guidelines. If this is not Follow the adult guidelines. If this is not possible, these persons should be as physically possible, these persons should be as physically active as their abilities allow. They should avoid active as their abilities allow. They should avoid inactivity.inactivity.


PA Guidelines for AmericansPA Guidelines for AmericansChildren and Adolescents with Children and Adolescents with

Disabilities Disabilities

Work with the child's health care provider to Work with the child's health care provider to identify the types and amounts of physical identify the types and amounts of physical activity appropriate for them. When possible, activity appropriate for them. When possible, these children should meet the guidelines for these children should meet the guidelines for children and adolescents—or as much activity children and adolescents—or as much activity as their condition allows. Children and as their condition allows. Children and adolescents should avoid being inactive.adolescents should avoid being inactive.


PA Guidelines for AmericansPA Guidelines for AmericansPregnant and Postpartum WomenPregnant and Postpartum Women

Healthy women who are not already doing vigorous-intensity Healthy women who are not already doing vigorous-intensity physical activity should get at least 2 hours and 30 minutes (150 physical activity should get at least 2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity a week. minutes) of moderate-intensity aerobic activity a week. Preferably, this activity should be spread throughout the week. Preferably, this activity should be spread throughout the week. Women who regularly engage in vigorous-intensity aerobic Women who regularly engage in vigorous-intensity aerobic activity or high amounts of activity can continue their activity activity or high amounts of activity can continue their activity provided that their condition remains unchanged and they talk to provided that their condition remains unchanged and they talk to their health care provider about their activity level throughout their health care provider about their activity level throughout their pregnancy.their pregnancy.


Health Benefits of Physical ActivityHealth Benefits of Physical ActivityStrong Evidence Strong Evidence

for Adults and Older Adultsfor Adults and Older Adults

Lower risk of: early death, heart disease, stroke, Lower risk of: early death, heart disease, stroke, Type 2 diabetes, high blood pressure, adverse Type 2 diabetes, high blood pressure, adverse blood lipid profile, metabolic syndrome, colon and blood lipid profile, metabolic syndrome, colon and breast cancersbreast cancers

Prevention of weight gainPrevention of weight gain

Weight loss when combined with dietWeight loss when combined with diet

Improved cardiorespiratory and muscular fitnessImproved cardiorespiratory and muscular fitness

Prevention of fallsPrevention of falls

Reduced depressionReduced depression

Better cognitive function (older adults)Better cognitive function (older adults)

Health Benefits of Physical ActivityHealth Benefits of Physical ActivityModerate to Strong EvidenceModerate to Strong Evidencefor Adults and Older Adultsfor Adults and Older Adults

Better functional health (older adults)Better functional health (older adults)

Reduced abdominal obesityReduced abdominal obesity

Health Benefits of Physical ActivityHealth Benefits of Physical ActivityStrong Evidence for Adults and Older Strong Evidence for Adults and Older

AdultsAdults

Weight maintenance after weight loss Weight maintenance after weight loss

Lower risk of hip fracture Lower risk of hip fracture

Increased bone density Increased bone density

Improved sleep quality Improved sleep quality

Lower risk of lung and endometrial Lower risk of lung and endometrial cancers cancers

Health Benefits of Physical ActivityHealth Benefits of Physical ActivityStrong Evidence for Children and Strong Evidence for Children and

AdolescentsAdolescents

Improved cardiorespiratory endurance and Improved cardiorespiratory endurance and muscular fitness muscular fitness

Favorable body composition Favorable body composition

Improved bone health Improved bone health

Improved cardiovascular and metabolic Improved cardiovascular and metabolic health biomarkers health biomarkers

Health Benefits of Physical ActivityHealth Benefits of Physical ActivityModerate Evidence for Children and Moderate Evidence for Children and

AdolescentsAdolescents

Muscle strengtheningMuscle strengthening

Bone strengtheningBone strengthening

Reduced symptoms of anxiety and Reduced symptoms of anxiety and depression depression

Boosting energyBoosting energy

Keep healthy weightKeep healthy weight

Enhanced school performanceEnhanced school performance

Better friendship with peer friendsBetter friendship with peer friends

MessagesMessages

Whatever your age physical activity Whatever your age physical activity plays an important part in your health plays an important part in your health and well-beingand well-being

Your bones, joints, and muscles – Your bones, joints, and muscles – especially your heat – will stay especially your heat – will stay younger if you keep them busyyounger if you keep them busy

Going From Fat to FitGoing From Fat to Fit

DoDo: Yielding boons from stronger muscles : Yielding boons from stronger muscles to a healthier heart to enhanced brain to a healthier heart to enhanced brain functionfunction

Don’tDon’t: carrying serious health risks, e.g.,: carrying serious health risks, e.g., Coronary artery disease Coronary artery disease StrokesStrokes High blood pressureHigh blood pressure OsteoporosisOsteoporosis OverweightOverweight

Fit and Health – Some FactsFit and Health – Some Facts

Colon cancer is about 40% more likely to Colon cancer is about 40% more likely to occur in a person who does not exercise occur in a person who does not exercise than in someone who is activethan in someone who is activePeople who don't exercise have an almost People who don't exercise have an almost 60% greater risk of developing 60% greater risk of developing osteoporosis than those who are activeosteoporosis than those who are activePhysically inactive people have a 45% Physically inactive people have a 45% greater chance of developing coronary greater chance of developing coronary artery disease than active peopleartery disease than active people


Only 31.1% of people 18 and older in the united Only 31.1% of people 18 and older in the united States engage in any regular leisure-time States engage in any regular leisure-time physical activityphysical activity

Physical activity, which increases bone size and Physical activity, which increases bone size and density, helps to prevent osteoporosis and bone density, helps to prevent osteoporosis and bone loss associated with agingloss associated with aging

Muscle coordination, reaction time and strength, Muscle coordination, reaction time and strength, all of which are necessary for balance and all of which are necessary for balance and stability, improve with exercisestability, improve with exercise


High Density Lipoprotein (good cholesterol) that High Density Lipoprotein (good cholesterol) that reduces CAD risk, increases an average of 4.6% reduces CAD risk, increases an average of 4.6% with exercisewith exercise

Working out increases the heart’s endurance Working out increases the heart’s endurance and the volume of blood it can pump, drastically and the volume of blood it can pump, drastically improving overall heart function improving overall heart function

Exercise can decrease falls resulting in injury by Exercise can decrease falls resulting in injury by 30% in the elderly, and can reduce the risk of 30% in the elderly, and can reduce the risk of hip fracture 20 to 40%hip fracture 20 to 40%


Adults can gain as many as two hours of life Adults can gain as many as two hours of life expectancy for every hour of regular, vigorous expectancy for every hour of regular, vigorous exerciseexercise

By keeping the arteries flexible and free of By keeping the arteries flexible and free of plaque, exercise lowers blood pressure and plaque, exercise lowers blood pressure and helps prevent dangerous blood clotshelps prevent dangerous blood clots

Poor diet / physical inactivity is second only to Poor diet / physical inactivity is second only to smoking in lifestyle factors contributing to the smoking in lifestyle factors contributing to the national’s top killers, including CADnational’s top killers, including CAD


Aerobic exercise prompts the release of Aerobic exercise prompts the release of mood-lifting hormones that promote a mood-lifting hormones that promote a sense of well-being and reduce stresssense of well-being and reduce stress

In studies of women already being treated In studies of women already being treated for breast cancer, moderate activity cut for breast cancer, moderate activity cut rates of recurrence and death in halfrates of recurrence and death in half

So, Do Something About itSo, Do Something About itAn Activity PyramidAn Activity Pyramid

Cut down on sedentary activitiesCut down on sedentary activities Sitting, watching TV, working or playing at the Sitting, watching TV, working or playing at the

computercomputer

Exercise 3+ times a week to stretch and Exercise 3+ times a week to stretch and strengthen your musclesstrengthen your muscles Take stretch breaks, TOGA/Tai Chi, weight lifting, Take stretch breaks, TOGA/Tai Chi, weight lifting,

tension bands, push ups/curl upstension bands, push ups/curl ups

3-5 times a week to give your heart and lungs a 3-5 times a week to give your heart and lungs a workoutworkout Biking/hiking, running/jogging, brisk walking, Biking/hiking, running/jogging, brisk walking,

basketballbasketball

Make it a daily routineMake it a daily routine Walk to work or walk whenever you can, take the Walk to work or walk whenever you can, take the

stairsstairs

An “Exercise Snack” PlanAn “Exercise Snack” PlanThree StepsThree Steps

Step 1: Find the time, with “exercise Step 1: Find the time, with “exercise snacks”snacks” Find times that last as little as 10 minutes. Find times that last as little as 10 minutes.

Pacing in your office while on the phonePacing in your office while on the phone

Taking the stairs instead of the elevatorTaking the stairs instead of the elevator

Breaking up the day with 5-10 minutes walks – to Breaking up the day with 5-10 minutes walks – to the mailbox, in a loop around your corridorthe mailbox, in a loop around your corridor


Step 2: Ramp it UpStep 2: Ramp it Up It begins to kick in when you burn about 100 It begins to kick in when you burn about 100

calories a day. calories a day. Moving on: 30 minutes of moderate activity, Moving on: 30 minutes of moderate activity,

which burns about 210 calories, on most days which burns about 210 calories, on most days of the week (Surgeon General; CDC)of the week (Surgeon General; CDC)


Step 3: Keep it UpStep 3: Keep it Up Find times that last as little as 10 minutes. Find times that last as little as 10 minutes.

Pacing in your office while on the phonePacing in your office while on the phone

Taking the stairs instead of the elevatorTaking the stairs instead of the elevator

Breaking up the day with 5-10 minutes walks – to Breaking up the day with 5-10 minutes walks – to the mailbox, in a loop around your corridorthe mailbox, in a loop around your corridor

Thank you!Thank you! Contact Information:Contact Information: [email protected]@ori.org 541-484-2123541-484-2123

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Physical Activity for Americans