Physical Inactivity UBC Students for Science Based Medicine

THEN

http://www.drdavidgeier.com/wp-content/uploads/2011/03/Kids-playing-outside.jpg

NOW…

http://evidencebasedliving.human.cornell.edu/wp-content/uploads/2011/01/children-video-game.jpg

How much exercise is enough?

http://ocnutrition.files.wordpress.com/2010/06/istock_workout1.jpg

Let’s look at the evidence relating physical activity with health…

Outline

• Defining terms• Physical activity vs. exercise

• Canadian recommendations for physical activity • How can we achieve these guidelines

• Consequences of inactivity – the evidence • The future of prescribed exercise

http://amyfreundbodytalk.com/yahoo_site_admin/assets/images/physical_body.326120151_std.jpg

Question – fact or fiction:Does physical activity provide benefits to only the physical body?

http://www.kaiserquotes.com/blog/wp-content/uploads/2012/01/Mental-Health-Insurance_XL.jpg

The Mayo clinic suggests that mechanistically speaking physical activity is able to improve mental health three ways: 1. brain chemicals

(endorphins & neurotransmitters)

2. immune system markers3. body temperature

FICTION!Physical activity does not just promote physical fitness but mental wellness as well.

Outline

• Defining terms• Physical activity & exercise vs. inactivity

• Canadian recommendations for physical activity • How can we achieve these guidelines

• Consequences of inactivity – the evidence • The future of prescribed exercise

Physical Activity

“Any bodily movement produced by the contraction of skeletal muscles that results in

a substantial increase over resting energy expenditure.”

- ACSM

What does that mean?

http://fitnessbodybuilding.co.uk/images/1musclesatside.jpg

Skeletal Muscle – attaches to and moves your bones

Resting Energy Expenditure - estimated value of how much energy your body requires in a day at rest

http://img.ehowcdn.com/article-new/ds-photo/getty/article/78/104/86500437_XS.jpg

Our definition of Physical Activity Becomes…

• Any movement you make using your muscles that requires more energy than your body would need to lie on a couch

http://tsh.to/img/Raking.jpg http://www.thedogtrainingsecret.com/s/g1PTdejmiUmyW1ip-Afz6A/walking-the-dog.jpg

What comes to mind when you hear exercise?

http://www.macrichmond.com/wp-content/uploads/2011/12/exercise-heart.gif

Exercise

“A type of physical activity consisting of planned, structured, and repetitive bodily movement done to improve or maintain one or more

components of physical fitness.”- ASCM

Our Definition of Exercise Becomes…

• A planned or organized workout you do in order improve aspects of fitness such as flexibility or cardiovascular endurance

http://www.faqs.org/photos/physical-fitness-2476.jpg

http://www.downtownvancouver.com/images/gallery/2006-Sun-Run-finish-line-image.jpg

Physical Inactivity

“A lack of physical activity…currently the 4th leading risk factor for mortality worldwide.”

- WHO

Outline

• Defining terms• Physical activity & exercise vs. inactivity

• Canadian recommendations for physical activity • How can we achieve these guidelines

• Consequences of inactivity – the evidence • The future of prescribed exercise

Canadian Recommendations “All healthy adults aged 18-65 need moderate intensity physical activity for a minimum of 30

minutes five days per week”*Or a total of 150 minutes/week

http://media.coreperformance.com/images/411*308/people-who-take-the-stairs-are-fitter-and-more-productive.jpg

Intensity

• Moderate intensity exercise for 150 minutes a week

Intensity Example Activity Affect on breathing Affect on body temperature

Sitting Watching TV Normal Normal

Very light Effort Dusting Normal Normal

Light Effort Light Gardening Slight Increase Start to Feel Warm

Moderate Effort Brisk Walking Greater Increase Warmer

Vigorous Effort Jogging More out of breath Quite Warm

Very Hard Effort Fast Run Greater Increase Hot/Sweating

Maximal Effort All-Out Sprint Completely Out of Breath

Sweating/Very Hot

*Table adapted from Prescribing exercise as preventative therapy. Warburton, D., Nicol, C., & Bredin S

The Dose-Response CurveD

eath

Rat

e

http://ars.els-cdn.com/content/image/1-s2.0-S0140673697123558-gr1.gif

(The Lancet, 1998)

Doing something is better than doing

nothing!

http://www.triradar.com/files/2010/09/RulesOfRunning.jpg

Question - Fact or fiction? Is aerobic training – the classic running, walking, or biking the only way to achieve health benefits from exercise?

http://armstrongpodnsportshealth.files.wordpress.com/2010/12/evelyn_musclepose1.jpg

FICTION! Resistance also known as strength training has recently been proven to show important health benefits that are not gained from aerobic training.A study conducted by researchers from the Centre for Hip Health and Mobility (Vancouver), recently found that women that did strength training showed lasting improved cognitive function and functional brain plasticity, while the women doing other forms of exercise did not.

Outline

• Defining terms• Physical activity & exercise vs. inactivity

• Canadian recommendations for physical activity • How can we achieve these guidelines

• Consequences of inactivity – the evidence • The future of prescribed exercise

http://summertomato.com/wp-content/uploads/2009/12/jump1.jpg

5 Ways to Increase Daily Physical Activity

#1 Choose the parking space farthest away

http://farm1.static.flickr.com/202/490057821_c43bda0d79.jpg

#2 Take the stairs instead of the elevator

http://www.summitsofcanada.ca/canatrek/graphics/pix/banner-TakeTheStairs.jpg

#3 Grocery shop with a basket instead of a buggy

http://watermarked.cutcaster.com/cutcaster-photo-100810270-Grocery-store-shopping-Basket-with-food.jpg

#4 Go for a walk – with friends, colleagues, or a pet!

http://blog.northernhealth.ca/nhblog/wp-content/uploads/2012/09/walkingmeeting500x350.jpg

http://www.chicagonow.com/katalin-fitness-health-driven/files/2011/07/948c6_exercise-ball-in-office.jpg

#5 Sit on an exercise ball instead of a chair

http://www.modernmom.com/sites/default/files/featured/article/03/blood_type-exercise_article.jpg

Question - Fact or fiction? Do you have to engage in organized exercise for 150 minutes a week to be considered physically active?

American CDC, 2011

FICTION! Remember, physical activity DOES NOT have to be organized exercise

Outline

• Defining terms• Physical activity & exercise vs. inactivity

• Canadian recommendations for physical activity • How can we achieve these guidelines

• Consequences of inactivity – the evidence • The future of prescribed exercise

http://www.caresearch.com.au/Caresearch/Portals/0/Nurses%20Hub/Evidence%20Based%20Practice.jpg

Let’s look at some facts from the evidence

#1 About one-third to one-half of the world’s adult population is insufficiently physically active(WHO)

http://media.onsugar.com/files/ed2/192/1922729/46_2009/3f52b5f0448c5aa0_dv2014006.preview.jpg

http://www.bellenews.com/wp-content/uploads/2012/07/About-a-third-of-adults-are-not-doing-enough-physical-activity-causing-5.3-million-deaths-a-year.jpg

#2 Physical inactivity is a major contributor to death and disability from non-communicable diseases (NCDs) worldwide

Warburton, Health benefits of PA: the evidence. CMAJ 2006

#3 Many Canadian deaths are attributed to physical inactivity

(CMAJ, 2000)

The Economic Burden of Physical Inactivity, Peter T. Katzmarzyk,* Norman Gledhill,* Roy J. Shephard, 2000

#4 Musculoskeletal fitness is shown to reduce the risk of falling

Shaw & Snow, 1998; Campbell et al., 1999; Buchner et al., 1997

#5 Physical activity has been proven to slow the early memory decline in Alzheimer’s Disease

http://www.alz.org/braintour/images/alzheimer_brain.jpg

Are There Risks?

• More is not always better• Overuse injuries • Most gains are in the first bout of exercise

• Acute risks of exercise• Risk of training:

•Men 1 SD per 1.51 million episodes of exertion

• Always consult your doctor before beginning an exercise program

Question - fact or fiction:Does getting enough physical activity automatically mean you will get the body of your dreams?

http://jesscw.files.wordpress.com/2012/05/body-types.jpg

FICTION! Of course not. Our bodies depend on how we treat them – things like what we eat, how much we exercise and how much we sleep – and our genetics. Every person is coded to have a different body type.

Outline

• Defining terms• Physical activity & exercise vs. inactivity

• Canadian recommendations for physical activity • How can we achieve these guidelines

• Consequences of inactivity – the evidence • The future of prescribed exercise

Physical Activity – A Prescription?

• Pedometer based study• Showed a decrease in blood pressure & increase

in walking time

• Exercise…• If your doctor says so

• Physical activity is preventative medicine

Take Away Messages

• This presentation is not intended to promote or discredit a specific mode of exercise

• Activity doesn’t have to been organized exercise programs

• In terms of activity something is better than nothing

• Inactivity is associated with a higher rate of mortality & morbidity

“Lack of activity destroys the good condition of every human being while movement and

methodical physical exercise save it and preserve it”

- Plato

http://www.departments.bucknell.edu/history/carnegie/plato/plato_bust.jpg

References1. American College of Sports Medicine, Guide to Personal Training

2. British Journal of Cancer, 2009

3. Journal of Alzheimer’s Disease, 2013

4. Katzmazyk, P.T., Gledhill, N., & Shephard, R.J. (2000). The economic burden of physical inactivity in Canada, CMAJ, 163(11):1435-40

5. Kolt GS. Schofield GM. Kerse N. Garrett N. Ashton T. Patel A., Annals of Family Medicine. 10(3):206-12, 2012 May-Jun.

6. Mayo Clinic, Website

7. Myers J, Kaykha A, George S, et al. Fitness versus physical activity patterns in predicting mortality in men. Am J Med 2004;117:912-8.

8. Pronk NP, Katz AS, Lowry M, Payfer JR. Reducing Occupational Sitting Time and Improving Worker Health: The Take-a-Stand Project, 2011. Prev Chronic Dis 2012;9:110323

9. The Lancet, Physical Activity Series Working Group (5 papers), 2012

10. Wannamethee, G.S., Shaper, G.A., & Walker, M. Changes in physical activity, mortality, and incidence of coronary heart disease in older men. The Lancet, Volume 351, Issue 9116, Pages 1603-1608

11. Warburton, Health benefits of PA: the evidence. CMAJ 2006

12. World Health Organisation, website

13. *URLs of all photo references are pasted on specific slides

THEN

http://www.drdavidgeier.com/wp-content/uploads/2011/03/Kids-playing-outside.jpg

NOW…

http://evidencebasedliving.human.cornell.edu/wp-content/uploads/2011/01/children-video-game.jpg

How much exercise is enough?

http://ocnutrition.files.wordpress.com/2010/06/istock_workout1.jpg

Let’s look at the evidence relating physical activity with health…

Outline

• Defining terms• Physical activity vs. exercise

• Canadian recommendations for physical activity • How can we achieve these guidelines

• Consequences of inactivity – the evidence • The future of prescribed exercise

http://amyfreundbodytalk.com/yahoo_site_admin/assets/images/physical_body.326120151_std.jpg

Question – fact or fiction:Does physical activity provide benefits to only the physical body?

http://www.kaiserquotes.com/blog/wp-content/uploads/2012/01/Mental-Health-Insurance_XL.jpg

The Mayo clinic suggests that mechanistically speaking physical activity is able to improve mental health three ways: 1. brain chemicals

(endorphins & neurotransmitters)

2. immune system markers3. body temperature

FICTION!Physical activity does not just promote physical fitness but mental wellness as well.

Outline

• Defining terms• Physical activity & exercise vs. inactivity

• Canadian recommendations for physical activity • How can we achieve these guidelines

• Consequences of inactivity – the evidence • The future of prescribed exercise

Physical Activity

“Any bodily movement produced by the contraction of skeletal muscles that results in

a substantial increase over resting energy expenditure.”

- ACSM

What does that mean?

http://fitnessbodybuilding.co.uk/images/1musclesatside.jpg

Skeletal Muscle – attaches to and moves your bones

Resting Energy Expenditure - estimated value of how much energy your body requires in a day at rest

http://img.ehowcdn.com/article-new/ds-photo/getty/article/78/104/86500437_XS.jpg

Our definition of Physical Activity Becomes…

• Any movement you make using your muscles that requires more energy than your body would need to lie on a couch

http://tsh.to/img/Raking.jpg http://www.thedogtrainingsecret.com/s/g1PTdejmiUmyW1ip-Afz6A/walking-the-dog.jpg

What comes to mind when you hear exercise?

http://www.macrichmond.com/wp-content/uploads/2011/12/exercise-heart.gif

Exercise

“A type of physical activity consisting of planned, structured, and repetitive bodily movement done to improve or maintain one or more

components of physical fitness.”- ASCM

Our Definition of Exercise Becomes…

• A planned or organized workout you do in order improve aspects of fitness such as flexibility or cardiovascular endurance

http://www.faqs.org/photos/physical-fitness-2476.jpg

http://www.downtownvancouver.com/images/gallery/2006-Sun-Run-finish-line-image.jpg

Physical Inactivity

“A lack of physical activity…currently the 4th leading risk factor for mortality worldwide.”

- WHO

Outline

• Defining terms• Physical activity & exercise vs. inactivity

• Canadian recommendations for physical activity • How can we achieve these guidelines

• Consequences of inactivity – the evidence • The future of prescribed exercise

Canadian Recommendations “All healthy adults aged 18-65 need moderate intensity physical activity for a minimum of 30

minutes five days per week”*Or a total of 150 minutes/week

http://media.coreperformance.com/images/411*308/people-who-take-the-stairs-are-fitter-and-more-productive.jpg

Intensity

• Moderate intensity exercise for 150 minutes a week

Intensity Example Activity Affect on breathing Affect on body temperature

Sitting Watching TV Normal Normal

Very light Effort Dusting Normal Normal

Light Effort Light Gardening Slight Increase Start to Feel Warm

Moderate Effort Brisk Walking Greater Increase Warmer

Vigorous Effort Jogging More out of breath Quite Warm

Very Hard Effort Fast Run Greater Increase Hot/Sweating

Maximal Effort All-Out Sprint Completely Out of Breath

Sweating/Very Hot

*Table adapted from Prescribing exercise as preventative therapy. Warburton, D., Nicol, C., & Bredin S

The Dose-Response CurveD

eath

Rat

e

http://ars.els-cdn.com/content/image/1-s2.0-S0140673697123558-gr1.gif

(The Lancet, 1998)

Doing something is better than doing

nothing!

http://www.triradar.com/files/2010/09/RulesOfRunning.jpg

Question - Fact or fiction? Is aerobic training – the classic running, walking, or biking the only way to achieve health benefits from exercise?

http://armstrongpodnsportshealth.files.wordpress.com/2010/12/evelyn_musclepose1.jpg

FICTION! Resistance also known as strength training has recently been proven to show important health benefits that are not gained from aerobic training.A study conducted by researchers from the Centre for Hip Health and Mobility (Vancouver), recently found that women that did strength training showed lasting improved cognitive function and functional brain plasticity, while the women doing other forms of exercise did not.

Outline

• Defining terms• Physical activity & exercise vs. inactivity

• Canadian recommendations for physical activity • How can we achieve these guidelines

• Consequences of inactivity – the evidence • The future of prescribed exercise

http://summertomato.com/wp-content/uploads/2009/12/jump1.jpg

5 Ways to Increase Daily Physical Activity

#1 Choose the parking space farthest away

http://farm1.static.flickr.com/202/490057821_c43bda0d79.jpg

#2 Take the stairs instead of the elevator

http://www.summitsofcanada.ca/canatrek/graphics/pix/banner-TakeTheStairs.jpg

#3 Grocery shop with a basket instead of a buggy

http://watermarked.cutcaster.com/cutcaster-photo-100810270-Grocery-store-shopping-Basket-with-food.jpg

#4 Go for a walk – with friends, colleagues, or a pet!

http://blog.northernhealth.ca/nhblog/wp-content/uploads/2012/09/walkingmeeting500x350.jpg

http://www.chicagonow.com/katalin-fitness-health-driven/files/2011/07/948c6_exercise-ball-in-office.jpg

#5 Sit on an exercise ball instead of a chair

http://www.modernmom.com/sites/default/files/featured/article/03/blood_type-exercise_article.jpg

Question - Fact or fiction? Do you have to engage in organized exercise for 150 minutes a week to be considered physically active?

American CDC, 2011

FICTION! Remember, physical activity DOES NOT have to be organized exercise

Outline

• Defining terms• Physical activity & exercise vs. inactivity

• Canadian recommendations for physical activity • How can we achieve these guidelines

• Consequences of inactivity – the evidence • The future of prescribed exercise

http://www.caresearch.com.au/Caresearch/Portals/0/Nurses%20Hub/Evidence%20Based%20Practice.jpg

Let’s look at some facts from the evidence

#1 About one-third to one-half of the world’s adult population is insufficiently physically active(WHO)

http://media.onsugar.com/files/ed2/192/1922729/46_2009/3f52b5f0448c5aa0_dv2014006.preview.jpg

http://www.bellenews.com/wp-content/uploads/2012/07/About-a-third-of-adults-are-not-doing-enough-physical-activity-causing-5.3-million-deaths-a-year.jpg

#2 Physical inactivity is a major contributor to death and disability from non-communicable diseases (NCDs) worldwide

Warburton, Health benefits of PA: the evidence. CMAJ 2006

#3 Many Canadian deaths are attributed to physical inactivity

(CMAJ, 2000)

The Economic Burden of Physical Inactivity, Peter T. Katzmarzyk,* Norman Gledhill,* Roy J. Shephard, 2000

#4 Musculoskeletal fitness is shown to reduce the risk of falling

Shaw & Snow, 1998; Campbell et al., 1999; Buchner et al., 1997

#5 Physical activity has been proven to slow the early memory decline in Alzheimer’s Disease

http://www.alz.org/braintour/images/alzheimer_brain.jpg

Are There Risks?

• More is not always better• Overuse injuries • Most gains are in the first bout of exercise

• Acute risks of exercise• Risk of training:

•Men 1 SD per 1.51 million episodes of exertion

• Always consult your doctor before beginning an exercise program

Question - fact or fiction:Does getting enough physical activity automatically mean you will get the body of your dreams?

http://jesscw.files.wordpress.com/2012/05/body-types.jpg

FICTION! Of course not. Our bodies depend on how we treat them – things like what we eat, how much we exercise and how much we sleep – and our genetics. Every person is coded to have a different body type.

Outline

• Defining terms• Physical activity & exercise vs. inactivity

• Canadian recommendations for physical activity • How can we achieve these guidelines

• Consequences of inactivity – the evidence • The future of prescribed exercise

Physical Activity – A Prescription?

• Pedometer based study• Showed a decrease in blood pressure & increase

in walking time

• Exercise…• If your doctor says so

• Physical activity is preventative medicine

Take Away Messages

• This presentation is not intended to promote or discredit a specific mode of exercise

• Activity doesn’t have to been organized exercise programs

• In terms of activity something is better than nothing

• Inactivity is associated with a higher rate of mortality & morbidity

“Lack of activity destroys the good condition of every human being while movement and

methodical physical exercise save it and preserve it”

- Plato

http://www.departments.bucknell.edu/history/carnegie/plato/plato_bust.jpg

References1. American College of Sports Medicine, Guide to Personal Training

2. British Journal of Cancer, 2009

3. Journal of Alzheimer’s Disease, 2013

4. Katzmazyk, P.T., Gledhill, N., & Shephard, R.J. (2000). The economic burden of physical inactivity in Canada, CMAJ, 163(11):1435-40

5. Kolt GS. Schofield GM. Kerse N. Garrett N. Ashton T. Patel A., Annals of Family Medicine. 10(3):206-12, 2012 May-Jun.

6. Mayo Clinic, Website

7. Myers J, Kaykha A, George S, et al. Fitness versus physical activity patterns in predicting mortality in men. Am J Med 2004;117:912-8.

8. Pronk NP, Katz AS, Lowry M, Payfer JR. Reducing Occupational Sitting Time and Improving Worker Health: The Take-a-Stand Project, 2011. Prev Chronic Dis 2012;9:110323

9. The Lancet, Physical Activity Series Working Group (5 papers), 2012

10. Wannamethee, G.S., Shaper, G.A., & Walker, M. Changes in physical activity, mortality, and incidence of coronary heart disease in older men. The Lancet, Volume 351, Issue 9116, Pages 1603-1608

11. Warburton, Health benefits of PA: the evidence. CMAJ 2006

12. World Health Organisation, website

13. *URLs of all photo references are pasted on specific slides