Titledrpauthor: WTBKLast, A SubdrpJob

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Physical Activity, ObesityandCommunity Health
Randal J. Thomas, MD Mayo Clinic and Foundation
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Disclosures

• Research grants
• Omron
• Mayo Clinic

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CardiovascularHealth Clinic

• Cardiovascular Prevention andRehabilitation for
  a HealthierHeart, Mind and Body

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Overview

• Why is physical activity an issue today?
• The cost of obesity
• How can a community promote physical activity?
• Changing the future next steps

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Case Examples

• 65 year old male, recent heart attack
• 55 year old female, osteoporosis
• 35 year old female, family history of stroke
• 25 year old city employee, obese, diabetes

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Why is Physical Activity Such an Issue?
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Lawn Care Circa 1950

• Drag cast iron push mower up from cellar
• Oil mower
• Cut grass
• Stop for drink of water from garden hose
• Rake grass and bag
• Carry across street to vacant lot and dump
• Time 3 hours
• Calories burned 900
• Calories consumed 0

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Lawn Care 2007

• Open refrigerator and take out a soft drink
• Strap on MP3 player
• Press garage door opener
• Turn key, start riding mower with mulching option
• Cut grass while sipping soft drink
• Time 30 minutes
• Calories burned 40
• Calories consumed 150

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Trends in Physical Activity
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Were On a Sinking Ship
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Why is Physical Activity an Issue?

• Among US adults
• 25 are physically active
• 45 are moderately active
• 30 are sedentary
• Among children
• 40 girls, 60 of boys have 60 minutes/day
• Sedentary lifestyle increases
• Obesity, diabetes, heart disease, stroke, and
• cancer

MMWR Weekly March 09, 2001 / 50(09)166-9
MMWR Weekly March 09, 2001 / 50(09)166-9 http//
www.dhs.ca.gov/cdic/cpns/research/download/calchee
ps_2001/Physical-Activity-and-Inactivity-2001203.
pdf
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Why is Physical Activity an Issue?

• Challenges for an office employee
• Time concerns
• Competing demands
• Money concerns
• Sedentary habits at work
• Lack of positive role models

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The Cost of Physical Inactivity and Obesity
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The Cost of Physical Inactivity and Obesity

• 75 billion in healthcare costs each year
• Same amount in lost productivity
• Increasing at double rate of inflation

www.dhs.ca.gov/cdic/cpns/press/downloads/CostofObe
sityToplineReport.pdf -
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The Cost of Physical Inactivity

• 250,000 deaths per year in the United States
• Twelve Jumbo Jets crashing each week

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Obesity Trends Among U.S. AdultsBRFSS, 1985
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
http//www.cdc.gov/nccdphp/dnpa/obesity/trend/maps
/
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Obesity Trends Among U.S. AdultsBRFSS, 1990
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
http//www.cdc.gov/nccdphp/dnpa/obesity/trend/maps
/
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Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519
http//www.cdc.gov/nccdphp/dnpa/obesity/trend/maps
/
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Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 20
http//www.cdc.gov/nccdphp/dnpa/obesity/trend/maps
/
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Obesity Trends Among U.S. AdultsBRFSS, 2005
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 2529
30
http//www.cdc.gov/nccdphp/dnpa/obesity/trend/maps
/
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Obesity Trends Among U.S. AdultsBRFSS, 1990,
1998, 2006
(BMI ?30, or about 30 lbs. overweight for 54
person)
1998
1990
2006
No Data lt10 1014
1519 2024 2529
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http//www.cdc.gov/nccdphp/dnpa/obesity/trend/maps
/
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• Advertisement Campaigns
• USA 2001
• 635 million (McDonalds)
• 298 million (Burger King)
• 224 million (Coca Cola)

CM862659-22
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Benefits of Physical Activity
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Benefits of Physical Activity
Study by Morris and co-workers, age-adjusted
relative incidence of acute myocardial infarction
in London busmen, 19491958
International Journal of Epidemiology
2001301184-1192
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Benefits of Physical Activity

• Physical activity is associated with
• Improved quantity of life
• Inproved quality of life
• Lower healthcare costs
• States with highest physical activity
• Lowest risk of heart disease
• Lowest risk of diabetes

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Benefits of Physical Activity
Habitual physical activity helps every body
system work better
W Roberts, Am J Cardiol. 1984 Jan 153(1)261-2.
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Benefits of Physical Activity

• Physiologic effects
• Cardiopulmonary
• Neurologic
• Musculoskeletal
• Endocrine
• Immunologic

• Outcomes effects
• BP, Fitness, CVD
• Mood, Memory
• Muscle, Bone
• Diabetes, Lipids
• Anti-inflammatory

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Benefits of Physical Activity
Age-adjusted coronary heart disease (CHD) and
type 2 diabetes event rate/1,000 person-years in
5,159 men aged 40-59 years during an average F-U
of 16.8 years
CHD
Type 2 Diabetes
80
29
170
186
115
65
52
Event rate/1,000 person-yr
65
24
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Inactive(n465)
Occasional(n1,498)
Light(n1,279)
Moderately vigorous/vigorous(n1,075)
Moderate(n842)
Inactive(n465)
Occasional(n1,498)
Light(n1,279)
Moderately vigorous/vigorous(n1,075)
Moderate(n842)
Physical activity
Physical activity
Wannamethee SG et al Arch Intern Med 1602108,
2000
CP1282228-1
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Benefits of Physical Activity

• Group Health, Seattle
• N 1740
• gt65 years old, free of dementia
• 6.2 years follow-up
• Biennial evaluations

Larson, E. B. et. al. Ann Intern Med
200614473-81
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How much physical activity is needed?
The association physical activity and
cardiovascular disease mortality in 5 large
prospective studies
Am J Clin Nutr, 79913S-920S, May 2004
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How much physical activity is needed?
The association physical activity and
cardiovascular disease mortality in 5 large
prospective studies
Am J Clin Nutr, 79913S-920S, May 2004
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What type of physical activity is best?

• General Health
• Fitness
• Muscular Strength
• Bone Strength
• Fall Prevention

• All types
• Endurance Exercise
• Strength Activities
• Weight Bearing
• Flexibility/Balance

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How to Promote Physical Activity?
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Does the Built Environment Influence Physical
Activity? Examining the Evidence -- Special
Report 282 (2005)
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How to Promote Physical Activity?

• Factors associated with Physical Activity
• Social support
• Family, friend, social group, work group
• Point of decision prompts
• Physical education in schools
• Individually adapted physical activity programs
• Access to places for physical activity
• Walking/Bike Trails (awareness, proximity)
• Community campaigns

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How to Promote Physical Activity?

• Factors NOT associated with Activity
• Weather

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How to Promote Physical Activity?

• States with highest percentage of trips to work
  by bicycle or foot
• Alaska (7), Montana, New York, Vermont, Wyoming,
  Oregon, North Dakota, South Dakota, Idaho,
  Massachusetts
• Highest meeting physical activity goals
• Lowest rates of obesity generally

www.thunderheadalliance.org/benchmarking.htm
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Examples of Cities that Promote Physical Activity

• New York City
• Chicago
• Minneapolis
• Rochester

www.thunderheadalliance.org/benchmarking.htm
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Why do Walking/Bike Trails Help?

• Can be used for various activities
• Commuting to work
• Traveling to school
• Leisure time
• Fitness training

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Are Walking/Bike Trails Cost Effective?

• Guide to Community Preventive Services
• Cost-benefit ratios 12-3

http//www.thecommunityguide.org/pa/pa-econ.pdf
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Community PreventionNext Steps
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Community Prevention Model
How?
Where?
What?
Circulation. 2003107645
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Community PreventionExamples

• North Karelia (Finland)
• NHLBI Studies
• Community Projects
• CDC Projects
• Internet-based Resources

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Changing the Future Next Steps

• Environmental changes
• Exercise options access and awareness
• Social support for active lifestyles
• Interventions and incentives
• Focus on least active sub-populations
• Community partnerships
• Track progress and report

http//www.cdc.gov/nccdphp/dnpa/physical/recommend
ations.htm
Scand J Med Sci Sports. 2005 Oct15(5)304-12,
Br J Sports Med. 1998 Sep32(3)236-41,
Circulation 2004110666-673
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Summary

• Modern lifestyles are sedentary
• The cost of obesity is enormous
• Many ways to improve trends
• Small, continuous steps in multiple dimensions

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Walk more, Eat less, Sleep more. Paul Dudley
White
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(No Transcript)
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Looking to lose weight? Burn an extra 100
calories a day and drop 10 pounds in a year Walk
an additional 3000 steps a day Walk the dog for
30 minutes Stand while talking on the
phone Take 3 flights of stairs a day Walk in,
dont drive through
http//www.prevention.com/cda/article/lose-35-poun
ds-without-working-out/963868f271903110VgnVCM10000
013281eac____/weight.loss/strategies.for.success/e
xercise/
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Physical Activity
2001
2005
http//apps.nccd.cdc.gov/PASurveillance/StateSumV.
asp?Year2005
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How Much Physical Activity is Needed?
Adjusted for age and walking time
Multivariate
P for trend lt0.001
P for trend 0.002
Relative risk of cardiovascular disease
Rarely or never walk(n10,896)
lt2 mph(easy, casual)(n10,690)
2-3 mph(average)(n30,523)
3-4 mph(brisk)(n17,555)
gt4 mph(very brisk)(n990)
Walking pace (mph) among walkers
N Engl J Med 347(10)716, 2002
CP1282228-2