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Health%20Disparities%20in%20Physical%20Activity:%20Patterns%20and%20Implications

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Patterns and Implications Ross C. Brownson Prevention Research Center Saint Louis University School of Public Health http://prc.slu.edu – PowerPoint PPT presentation

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Title: Health%20Disparities%20in%20Physical%20Activity:%20Patterns%20and%20Implications


1
Health Disparities in Physical Activity
Patterns and Implications
  • Ross C. Brownson
  • Prevention Research Center
  • Saint Louis University School of Public Health
  • http//prc.slu.edu

2
Learning Objectives
  • 1. To understand the importance of physical
    activity as a public health issue
  • 2. To understand the descriptive patterns in
    physical activity, related health conditions, and
    macro factors (e.g., demographics)
  • 3. To review the gaps and implications for health
    disparities research and practice.

3
Definitions Behaviors
  • Physical Activity any bodily movement produced
    by skeletal muscles that results in energy
    expenditure.
  • Occupational, household, exercise, sports, play
  • Exercise planned, structured, and repetitive
    bodily movement done to improve or maintain one
    or more components of physical fitness.
  • Running, aerobic dance, bicycling, calisthenics

Caspersen C, et al, Public Health Reports 1985
100(2)126-131.
4
The Benefits of Physical Activity
Health Benefits
Fitness Benefits
  • Lowers risk for heart disease
  • Reduces risk for certain cancers
  • Lowers blood pressure
  • Improves lipid profile
  • Prevents obesity
  • Prevents diabetes
  • Builds healthy bones
  • Enhances immune function
  • Relieves stress and improves mood
  • Promotes self-esteem
  • Increases aerobic capacity
  • Increases strength
  • Increases flexibility
  • Improves balance and coordination
  • Increases functional Health
  • Allows us to do the things we need to do and want
    to do with ease and enjoyment!

5
Physical Activity and Health (Dose-Response)
Prevention of Weight Gain
Diabetes Mellitus
Risk of Disease
CHD
Stroke
Musculoskeletal Injury
Functional Health Status
Physical Activity
6
(No Transcript)
7
The Obesity Epidemic
8
Fit or fat evidence? Puzzle is not so simple
9
Fit or Fat? CVD Mortality, Body Fat, and
Fitness
adj for age, exam year, smoking, alcohol,
fam history
??25
lt16
16-lt25
Lee CD et al. Am J Clin Nutr 1999.
10
The Chronic Disease Epidemic Changing
Environment Acting upon Pre-existing Genes
Phenotype Genotype x Environment
Unhealthy Gene Expression
No Change in past 100 Years
Large Change in past 100 Years
Physical Inactivity Diet Pollution, etc.
11
CDC/ACSM recommendations on the types and amounts
of physical activity needed for health promotion
and disease prevention
  • Every US adult should accumulate 30 minutes or
    more of moderate-intensity physical activity on
    most, preferably all, days of the week.
  • Moderate-intensity - Activity performed at 3 to 6
    times the resting metabolic rate.
  • Equivalent to brisk walking 2 miles at 3 to 4 mph
    (15 to 20 minutes/mile) for healthy adults

12
Accumulating Physical Activity?
  • Guidelines allow for the accumulation of
    moderate-intensity physical activity over the
    course of a day
  • Five recent studies compared the traditional 30
    minutes of continuous activity vs. shorter (5- to
    15-minute) bouts of activity spread throughout
    the day
  • Shorter bouts resulted in comparable improvements
    in cardiorespiratory fitness and health
  • Multiple short bouts of physical activity also
    appear to increase participation and adherence

13
The Lifestyle Approach
Noon-time jog
10
Sedentary
8
Structured Exercise
Lifestyle Activity
6
Energy Expenditure (METS)
After-dinner walk
Walk to bus stop
4
2
0
Blair et al. Med Exerc Nutri Hlth 154, 1992
Time (hours)
14
Physical Activity Levels Survey Measures
  • Recommended level
  • Moderate-intensity activity ?5 times per week for
    ?30 minutes each time,
  • Vigorous-intensity ?3 times per week for ?20
    minutes each time, or
  • Both
  • Insufficient
  • Some activity but not enough to be classified as
    moderate or vigorous
  • Inactive
  • No leisure-time physical activity during the
    preceding month

15
Possible Domains of Physical Activity
  • Leisure/recreational
  • Occupational
  • Transportation
  • Household chores
  • Gardening/yardwork
  • Completely sedentary activities (e.g., watching
    television)

16
Descriptive Epidemiology
  • 1. Person
  • 2. Place
  • 3. Time

17
Physical Activity, U.S. Adults (2003 BRFSS,
Age-Adjusted)
18
Classify
  • PERSON
  • age
  • race
  • sex
  • ses family
  • occupational blood type
  • marital status personality traits
  • migrants

19
Physical Activity by Race/Ethnicity (2003 BRFSS,
Age-Adjusted)
20
Physical Activity by Income Group (2003 BRFSS,
Age-Adjusted)
21
Physical Activity by Income Group (2003 BRFSS,
Age-Adjusted)
22
Moderate Physical Activity for Adults by
Disability and Arthritis Status
Age-adjusted percent
1997
2002
2010 Target
With
Without
With
Without
Disabilities
Arthritis
23
Physical Activity in Ethnically Diverse Women 40
and older
Brownson RC et al. Am J Public Health 1999.
24
Vigorous Physical Activity for Adolescents by
Grade Level 2001
Percent
10th
12th
11th
9th
25
Classify
  • PLACE
  • natural boundaries
  • political subdivisions
  • urban-rural differences
  • weather variations

26
Prevalence of No Leisure-Time Activity, 2000
27
No Physical Activity for Adults by State, 2003
28
Age-adjusted heart disease mortality, Missouri,
1992-98
29
Classify
  • TIME
  • secular trends
  • declining rates
  • cyclicity-seasonality
  • periodicity
  • clusters in time or place

30
Age-adjusted colon cancer incidence by gender and
race
31
Age-adjusted breast cancer incidence by race
32
Other important macro patterns trends in the
United States that are likely to affect health
disparities and the burden of physical inactivity
33
Population Trends
  • Aging of the Population
  • 65 the most rapidly growing US segment
  • Projected increases 65
  • 1990, 31 million
  • 2010, 40 million
  • 2030, 70 million
  • Large impacts on public health and health care
    systems

34
Population Trends
  • Changing Racial/Ethnic Makeup
  • Non-Hispanic Whites
  • 1992, 191 million to 202 million in 2050
  • African American
  • 1992, 32 million to 62 million in 2050
  • Asian/Pacific Islander
  • 1992, 9 million to 41 million in 2050
  • Distinguish counts from percentages
  • Large potential effects on disease burden
  • Issues of cultural competence

35
Car ownership, walking biking
Percent by Walking or Biking
36
Vehicle miles traveled by automobile
Miles per person per day
37
Ave. daily television viewing
Hours per household per day
38
Knowledge Gaps
  • Do correlates differ between majority and
    minority populations?
  • What data are lacking (for both descriptive and
    analytic epidemiology)?
  • How generalizable are various, tested
    interventions?
  • How do we do a better job in assessing context
    for intervention among population subgroups?

39
Acknowledgments
  • Certain slides were provided by Dr. Greg Heath
    (Centers for Disease Control and Prevention) and
    Dr. Steve Blair (Cooper Institute)
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