Running Ahead: The Impact of Physical Inactivity

Running Ahead: The Impact of Physical Inactivity
Gina Yoryet Román with the contribution of Tamar Roman-Jorgensen
Research done for California State University of Sacramento
Original investigation and written date: March 29, 2011


The Impact of Physical Inactivity
Introduction
The miraculous anatomy of the human body unlike any other species is designed for complex daily physical activities. The multiple and often simultaneous physiological responses that take place in response to physical activity affect virtually all the body’s systems in a favorable way. In fact, many research studies have found conclusive evidence that being physically active has substantial physical as well as psychological benefits (U.S Department of Health and Human Services [USDHHS], 2008, Healthy People 2010 [HP 2010]).

However, despite public awareness it has been found that the general population does not engage in any type of physical activity to accrue its benefits. A recent report announced that “Physical inactivity is now identified as the fourth leading risk factor for global mortality. Levels of physical inactivity are rising in many countries with major implications for the general health of people worldwide and for the prevalence of non-communicable diseases (NCDs)” (World Health Organization, 2010, p. 7). This alarming news had already gained attention in the United States (U.S.) during the past few decades, but even with ample alertness, physical inactivity has become the norm for many adults.

The health and economic benefits that physical activity offers for the prevention and mitigation of NCDs have become a key role in the planning of interventions to reduce the mounting cost of physical inactivity to public health. Moreover, when indirect cost such as days lost to physical and mental illness are taken into consideration, the economic burden of physical inactivity becomes significantly larger. For this reason, various organizations including Healthy People 2010, the U. S. Department of Health and Human Services, the American College of Sports Medicine, the Center of Disease Control and Prevention, and the World Health Organization, in collaboration with health professionals including nurses and other concerned individuals, have joined efforts in order to tackle this emerging public health issue. In the U.S., increasing physical activity is a multifaceted task that requires shrewdness and ingenuity in order to successfully apply culture specific interventions in diverse populations.

There are many key elements that could play an active role in increasing physical activity among at-risk populations. Several of these key elements include: understanding how physical inactivity has reached a critical point in today’s society, being familiar with affiliated organizations that promote physical activity, clearly defining physical activity and other related terms, knowing the scientific basis for increasing physical activity, identifying the current recommended physical activity guidelines for adults, recognizing the multiple health and socioeconomic benefits of physical activity, knowing the importance of becoming culturally competent, being familiar with current census and other relevant population data, considering informational, behavioral, social, environmental and policy approaches to increase activity levels and making pertinent recommendations to promote physical activity among identified at risk populations.

How Physical Inactivity has reached a Critical Point in Today’s Society
In the past, greater physical efforts were required to obtain daily provisions because they were less readily available than today. However, industrialization and the technology revolution that have been taken place since the 1980s have dramatically changed how people go about their daily lives.

The increasing use of household appliances and other labor-saving devices, the availability of a wide variety of television programs, and the daily use of internet as well as other technology innovations have contributed to a peak in physical inactivity. In contrast, the current and worsening economy issues of society have caused many people to work additional and longer hours often leading to a lack of time and exhaustion. The reality is that due to the economic boom physical activity is not a top priority for many adults who are at risk for NCDs. These current societal facts have created a challenging situation for individuals and organizations working diligently on decreasing physical inactivity levels.

Affiliated Organizations that Promote Physical Activity
The Unites States Department of Health and Human Services (USDHHS) is a department of the U.S. government with the mission of protecting the health of all Americans. The USDHHS collaborates with state and local entities to perform various tasks and services, including food and drug safety, research, health insurance, public health and many others.

Healthy People (HP) is a USDHHS nationwide plan that for the past three decades has provided national objectives for improving the health of Americans every ten years. One of the goals of HP 2010 was to increase physical fitness in order to prevent NCDs and improve quality of life. Because the rates of physical inactivity did not substantially change, the USDHHS assembled the Physical Activity Guidelines Advisory Committee (PAGAC) to generate a consensus report that scientifically demonstrated that physical inactivity presents health risks throughout the lifespan. Based on recommendations from the PAGAC report the Physical Activity Guidelines for Americans were developed.

These guidelines focus on encouraging American people to be physically active in order to reap the confirmed benefits of physical and mental health. The Center for Disease Control and Prevention (CDC) is yet another integral constituent of the USDHHS that collaborates with state health departments and other organizations to combat emerging and chronic diseases as well as other health risks, including physical inactivity.

The American College of Sports Medicine (ACSM) is the largest world leader organization devoted to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine. The ACSM partnered with the American Heart Association (AHA) to develop guidelines that outline exercise recommendations for healthy adults and older adults.
The World Health Organization (WHO) is a specialized agency of the United Nations that develops and promotes the worldwide use of evidence-based tools, norms and standards to combat diseases spread worlwide. These stakeholders have the common goal of improving health, and quality of life through daily physical activity in order to reduce a considerable fraction of the unnecessary global financial burden.

Definition of Physical Activity and Other Related Terms
The USDHHS states that “physical activity is any bodily movement produced by the contraction of skeletal muscle that increases energy expenditure above a basal level while physical inactivity is minimal bodily movement in which the energy expenditure approximates resting metabolic rate” (USDHHS, 2008, p. 2).

Energy expenditure refers to the amount of external and internal energy the human body uses to carry out daily activities Just as energy intake, it is also measured in calories. Energy expenditure is highly dependent on energy intake which refers to food and beverage consumption. Resting metabolic rate is the minimal required amount of energy by the body at rest to maintain vital activities such as heart rate, respiration, temperature regulation, digestion, and nerve communication. Energy intake, energy expenditure and Body Mass Index (BMI) are important elements associated with weight monitoring for a healthy life. BMI is a reliable tool for measuring body fat that could lead to health problems and is based on height and weight. It is one of the most used methods for assessment of whether a person is overweight or obese because it is economic, easy to use, and generates accurate information for most people. BMI is calculated by dividing an individual’s body weight in pounds by their height in inches, then dividing by their height in inches again and then multiplying the result by 703.

According to the 2008 Physical Activity Guidelines for Americans, physical activity is a complex and multi-dimensional behavior, yet there are three main kinds of physical activity that significantly contribute to energy expenditure and health benefits: aerobic, muscle–strengthening, and bone-strengthening activities. Aerobic activities which are also known as endurance activities or cardio activities cause the heart to beat faster and more vigorously than usual.

Movement of large muscles is required minimally at moderate intensity levels in a rhythmic manner for a sustained period of time. Indoor examples of aerobic activities include stair climbing and the use of a treadmill, elliptical trainer, or stationary bicycle. Outdoor examples include swimming, bicycling, running, walking, jumping rope, soccer, and football. Muscle-strengthening activities make muscles do more than the usual work and include lifting weights, doing push-ups, pull-ups, and sit-ups as well as the use of elastic bands.

These types of activities require muscles to work against an applied force and may include the body weight for resistance. Bone-strengthening activities increase bone density by stimulating tissue growth when engaging in activities that put increased stress on the bones. Another term for bone strengthening activities is weight-bearing exercises and it includes walking, jogging, hiking, playing tennis, and other activities that reduce risk for fractures. Balance and stretching activities such as gentle stretching, yoga, and martial arts enhance physical stability and flexibility which also reduce the risk for fractures and other injuries.

Assessing physical activity patterns such as frequency, duration, and intensity is particularly important for maintaining or improving goals safely and for personal satisfaction. Frequency refers to how often a physical activity is performed. Duration is determined by how long an individual spends performing a physical activity. Intensity has to do with the effort that is required to perform a physical activity. Moderate-intensity activity refers to being physically active but not pushing or exerting oneself and may include brisk walking, hiking, and riding a bike on level grounds. Vigorous-intensity physical activities include, bicycling uphill, running, and other activities that produce large increases in breathing and/or heart rate and sweating.

It is important to keep in mind that exercise is any type of physical activity that is “planned, structured, repetitive, and performed with the goal of improving health and fitness” (American College of Sports Medicine [ACSM], 2007, p. 7). Fitness is a measure of the body’s ability to efficiently perform physical activity particularly the type that requires considerable amounts of energy expenditure. A person’s fitness will determine the intensity felt during a specific physical activity. Many people do not realize that only performing activities of daily living such as getting dressed, cooking, eating, and showering without engaging in any type of exercise is considered to be physically inactive. These activities are important in life but do not spawn the necessary physiological responses that ultimately reduce the risk of NCDs.

Current Recommended Physical Activity Guidelines for Adults
Leading organizations such as the USDHHS 2008, the CDC 2010, the WHO 2010, and the ACSM 2007, concur on specific physical activity guidelines for improvement of health in the general public. Currently, it is recommended that adults ages 18 to 65 years of age gradually engage in at least 150 minutes a week of moderate-intensity, or 75 minutes a week of vigorous-intensity physical activity or an equivalent combination of both in periods of at least 10 minutes preferably spread throughout the week. This level of activity should at least be maintained throughout adulthood and preferably be increased as long as capabilities allow.

To attain additional health benefits, the recommended levels of activity include 300 minutes a week of moderate-intensity activities or 150 minutes a week of vigorous-intensity activities or an equivalent combination of both in periods of at least 10 minutes preferably spread throughout the week. The guidelines emphasize the importance of selecting appropriate physical activities that match individual fitness levels, health goals, and abilities. Other fundamental advice included in the recommendations is using proper gear and equipment as necessary to prevent and reduce injuries. In addition, it is advised to select safe environments and to always make sensible choices such as following rules and policies of facilities used.

Scientific Basis for Increasing Physical Activity
For several decades public health organizations have been making tremendous efforts to control infectious diseases. This grand stride has resulted in people living longer lives, but unfortunately, many of those individuals have become afflicted with devastating chronic conditions which cost billions of dollars annually. According to stakeholders, habitual physical activity has consistently been found to reduce the risk of several of the leading NCDs that cause disability and/or death. Congruent information derived from the 2008 PAGAC report demonstrates that physical inactivity presents health risks throughout the lifespan. This report also provides the scientific basis for the conclusion that the amount and intensity of physical activity required for improving health is within a safe capacity for most Americans regardless of age, gender, ethnicity, socioeconomic status, or physical/mental limitations.

Moreover, this review documents very strong scientific evidence “that physically active people have higher levels of health-related fitness, a lower risk of developing a number of disabling medical conditions, and lower rates of various chronic diseases than people who are inactive.” (USDHHS, 2008, p. A-2).

In addition, data has increasingly been documented from a growing number of reliable observational and experimental research studies supporting the central role physical activity plays in the improvement of health and well being. Yet, amid the consensus that concrete and coordinated steps must be taken to decrease sedentary life, progress has been disproportionate to the rising cost and delivery demands of NCDs. Due to the proven fact that maintenance of health and ultimately cost control can be achieved simply through incorporation of physical activity, focus on this approach has been made.

Because the percentage of individuals who achieve the recommended amount of physical activity remains low and the prevalence of NCDs continues to grow, aggressive measures to decrease physical inactivity are desperately needed. New strategies must be formulated, implemented, and continually evaluated to ensure and advance progress in the battle for health across the nation.

Health Benefits of Physical Activity
As mentioned before, the 2008 PAGAC report confirmed that physical inactivity is one of the modifiable risks factors of the most prevalent NCDs in the United States. Conditions such as obesity, hypercholesterolemia, hypertension, cardiovascular disease, type 2 diabetes, cancer, depression, and anxiety have proven to reduce quality of life and life expectancy.

Individuals with a BMI between 25 and 29 are considered to be overweight and are advised to maintain a balanced diet and to engage in physical activity to reduce their risk of obesity. Obesity is a term that is used to refer to a body weight that is much greater than what is considered to be healthy or a BMI greater than 30. Over the last 30 years, obesity rates have dramatically increased becoming an epidemic in the United States. This is a concern because excessive body fat increases the risk of atherosclerosis, a trigger of strokes and heart attacks.

Atherosclerosis occurs when fat accumulates in the blood vessels, then undergoes a process resulting in thickening of the wall vessels. As the diameter of the vessels shrinks over time, blood flow is significantly reduced jeopardizing health. Being physically active regularly prevents atherosclerosis by improving circulation and reducing hypercholesterolemia (high blood cholesterol). Over time, hypercholesterolemia can also contribute to the accumulation of atherosclerotic plaque, diminishing blood supply to body tissues and organs.

There is substantial evidence that shows that aerobic physical activity produces favorable changes in plasma lipoproteins, particularly an increase of high density lipoprotein (HDL) cholesterol. HDL cholesterol is also referred to as “good cholesterol” because it binds to excess low density lipoprotein (LDL) or “bad cholesterol”, adding to the preventive measures of heart disease.

Hypertension is the clinical term for high blood pressure, which also affects circulation adversely. Blood pressure is the force of blood pushing against the walls of arteries and is essential for proper blood distribution but can get out of range. Hypertension is known as the silent killer because it rarely causes symptoms yet can lead to serious complications such as stroke, heart attack, and kidney failure. Active living is highly associated with a decrease in blood pressure and loss of excessive body weight. Obesity, hypercholesterolemia, and hypertension are serious conditions that can increase the risk for and/or aggravate cardiovascular disease.

Cardiovascular disease is a term that refers to a group of conditions of the heart and blood vessels including coronary heart disease, cerebrovascular disease, and peripheral arterial disease, among others. Each of these conditions limit blood flow and consequently adequate oxygenation of the body which is essential for proper function of all body cells. Exercising large muscles of the body regularly results in more efficient cardiac output caused by the dilation of blood vessels and a decrease of peripheral resistance. These mechanisms are important for appropriate distribution of blood and oxygen in the body which are crucial for cardiac health, including the regulation of blood pressure.

Diabetes is a chronic disease marked by high levels of sugar in the blood and can lead to serious complications such as blindness, nerve damage, amputations, kidney and heart failure, and pregnancy complications. Levels of sugar in the blood are regulated by a hormone known as insulin. There are different types of diabetes but approximately 90% to 95% of diagnosed cases are Type 2 diabetes which can be prevented and managed with diet and exercise.

In Type 2 diabetes, either the body does not make enough insulin to keep normal sugar levels or insulin resistance occurs, leading to hyperglycemia (high blood sugar). Insulin resistance occurs when cells cannot absorb enough sugar from the blood to use for energy expenditure and is highly associated with excessive body fat. Hyperglycemia is a threat to health because it can cause dehydration, weakness, fatigue, blurry vision, susceptibility to infections, and other detrimental complications. It is clear that physical activity can prevent or hinder the effects and complications of Type 2 diabetes by reducing a moderate amount of body fat and thus reversing insulin resistance.

Cancer is an uncontrolled growth of abnormal cells that can happen anywhere in the body and is one of the top deadly diseases worldwide. Colorectal cancer starts in the colon (large intestine) or the rectum (end of colon) and can cause extreme elimination pattern changes among other unpleasant symptoms. Breast cancer is a malignant tumor that grows in the breast of both females and males and also causes thousands of deaths each year.

As in other NCDs, physical activity may play an important role in the prevention of colon and breast cancer. Exercise may protect against colon cancer through its role in altering various immune and inflammatory responses, energy balance regulation and by decreasing the time the colon is exposed to potential carcinogens (cancer causing agents). Prevention of breast cancer through physical activity involves lowering hormone levels, particularly in premenopausal women, improving the immune response, and reducing excess body fat.

Depression is a state of persistent feelings of worthlessness, sadness, loss of energy, loss of pleasure or interest in activities among others disruptive symptoms, and it is becoming prevalent worldwide. Anxiety involves excessive feelings of apprehension, fear, and worry that disrupt daily living. Physical activity is not only central to the reduction of depression and anxiety, but according to recent research, sedentary behavior is a potential risk factor for such mental health issues.

A reliable study concluded that “Depressive and anxiety disorders are highly prevalent worldwide and reducing sedentary behaviors might be an important intervention in treatment and prevention of depressive and anxiety disorders.” (Cuijpers, p., Dewit, L., Lamers, F., Penninx, B., & Straten, A.V., 2010, p. 239). An association between physical activity and reduced symptoms of depression and anxiety among adults has been generally supported by the CDC, USDHHS and other stakeholders that promote physical activity for well-being.

Other reported benefits of physical activity include, reduced stress, relief of constipation, immunity to minor illness, increased energy, better balance, reduced risk of falls, suppleness and mobility, improved coordination, improved sleep, improved sense of achievement, and more independence in later life. The aging physiological changes that the body undergoes specifically put individuals at risk for NCDs. Structural deterioration occurs in most of the body systems, virtually affecting every aspect of life. For example, the slowing down of metabolism and the loss of body mass contribute to gradual accumulation of body fat and a reduction in functional capacity. Fortunately, the 2008 PAGAC reported that engaging in recommended levels of activity regularly may help counteract age-related physiological changes in most adults.

Socioeconomic Benefits of Physical Activity
The aforementioned chronic conditions and diseases along with their costly consequences have created a substantial economic burden for society over the past several decades. Disease prevention and health promotion have become of critical importance in our uncertain economy.

In California alone, physical inactivity has led to “nearly $13 billion annually in direct and indirect medical care, lost employee productivity, and worker’s compensation costs. Unfortunately, these costs will continue to rise due to increases in California’s aging population, growth in the general population, monetary inflation and the continued high prevalence of physical inactivity” (Hooker & Carman, 2006, p. 2).

Promoting regular physical activity has become a public health priority because it is expected to reduce morbidity, mortality, and ultimately health care costs. While physical activity has shown to directly improve the health and well-being of engaged individuals, it may also indirectly improve the quality of life of their family and friends as they become more pleasant to socialize with, which in turn could help reduce the increasing cost of depression and anxiety.

Therefore, promoting physical activity could be a relatively inexpensive and simple way to manage, reduce, and prevent NCDs in the general population.
The importance of Being Culturally Competent.

The increasing growth of diverse communities in the U.S. population mandates healthcare and other public workers to become culturally competent in order to efficiently assist and advocate for individuals. According to the USDHHS, cultural competency refers to “having the capacity to function effectively as an individual and/or as an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.”

USDHHS, 2008, p. A-2). Programs designed with the goal of increasing physical activity must determine which populations are at greatest risk and aim at implementing cultural and other specific interventions that target those populations. In order for interventions to be effective, they must adequately address barriers that lead to physical inactivity. Understanding what motivates specific populations to be physically active is essential to avoid wasting valuable resources. Since California has one of the most diverse populations in the U.S.,

“out of the box thinking” is necessary to generate strategies that not only can be conserved but also passed on with ease to other individuals and generations. Identifying personal, physical, social, environmental, and cultural barriers can help decrease the evident health disparities that are prevalent among minorities.

Raising health awareness, increasing levels of engagement and adherence to a physical activity regimen requires time, diligence and much patience. Most importantly, it is essential that leaders and researchers establish a trusting working relationship with the population of study in order to facilitate assessment and obtain accurate information or feedback for implementation. As Marquez & McAuley state “Many researchers get caught in a ‘one size fits all’ process of dissemination, failing to tailor to the content, timing, setting and format of dissemination to unique groups” (Marquez & McAuley, 2006, p. 186).

According to the USDHHS 2008, providers can get broader and more accurate perspectives about cultures by learning about people’s beliefs and preferences. Having a broader perspective helps ensure the deliverance of respectful, understandable, and effective interventions to diverse groups in order to elicit desired results.

Current Census and Other Relevant Population Data
The information generated by the Census is a great source that tells leaders about communities and their needs for proper interventions. It is used by the federal government to distribute billions of dollars each year for community services and programs. Census 2000 figures indicated that the Latino population is the fastest growing and largest minority in the United States, and “according to recent projection it will grow by 180% between 2000 and 2050” in California (Farrel et al., 2009, p. 374).

This is relevant information because according to HP 2010, more Latinos reported having no leisure time physical activity (LTPA) compared to other ethnic groups. In addition, “Latinos have been reported to have higher blood pressure, higher BMI, more central adiposity, a greater prevalence of diabetes and obesity compared with Non-Hispanic Whites” (Marquez, McAuley, & Overman, 2004, p. 196). Furthermore, various studies have concluded that Latino women or ‘Latinas’ have the highest rates of physical inactivity.

According to Marquez and McAuley (2006) for many Latinas the concept of “leisure time”, a time without responsibility ties to anyone or anything, simply does not exist. Multiple care-giving responsibilities for grandchildren, children, and other family members often lead to lack of time and energy in this population. Additional reported common deterrents to physical activity among Latinas include concern for safety, inadequate street lightning, lack of self-esteem, lack of social support, lack of childcare, lack of transportation, and lack of accessible facilities or programs.

Given that the Latino population has significantly grown and has been identified as having health disparities, it would be prudent to focus attention on this salient population. However, to date there has been limited research focusing on minorities, particularly in women, making it challenging to develop and implement adequate interventions to decrease physical inactivity among Latinas.

The 2008 PAGAC recognized this issue, which became evident during the review of literature, as “the lack of data on selected subpopulations, especially various race/ethnic groups, persons of low socioeconomic status (SES), individuals with specific cognitive and physical disabilities, and obese persons” (USDHHS, 2008, p. G11-2).

It is lamentable that despite the indisputable need for immediate interventions, policy and environmental support is either insufficient or lacking. Therefore, this information needs to be considered by policy makers and other community leaders when allocating funds for wellness programs that increase physical activity levels. It does not take a rocket scientist to figure out that prevention is much less costly and more convenient than treatment of disease. Contrary to common belief, targeting Latinas as well as other underserved communities can ultimately improve the health and financial instability of the United States.


Informational Approaches to Increase Physical Activity
Informational approaches to promote and increase physical activity include population specific interventions to raise and spread awareness about the variety of benefits it offers, as well as ways to overcome actual and/or perceived barriers for engaging regularly in physical activity.

Continual and well-presented information about specific ways of increasing physical activity levels that is individually meaningful can encourage people to become physically active. Because people are notorious for choosing not to do what is good for them, it is important to present solid, repeated, and readily accessible information to make the healthy choice the easy choice.


Behavioral and Social Approaches Increase Physical Activity
Behavioral and social approaches to promote and increase physical activity include interventions that are designed to produce individual behavior changes and building a social environment in communities that promote social support to help individuals increase their physical activity levels. Individuals along with family, friends and other supportive community members can work as a team and encourage each other. Desired actions can be made more attractive to consumers by using a strategic known as social marketing. Through education and persuasion, social marketing is all about getting individuals or communities to change a behavior leading to a healthier life.

Environmental and Policy Approaches to Increase Physical Activity
Environmental and policy approaches to promote and increase physical activity comprise strategies aimed at entire communities rather than at individuals. Population specific interventions are designed to create and provide access to places for people to exercise in convenient and safe environments. These commonly require the commitment and effort of various entities and organizations to ensure success.

Recommendations for Promoting Physical Activity among Latinas
As previously mentioned, Latino women are part of the fastest growing U.S. population. They have the highest physical inactivity and NCDs ratings, requiring immediate intervention. In order to avoid failure, it is highly recommended by the CDC, USDHHS, and other influential organizations to take time to assess specific cultural learning preferences and to identify successful promotion methods of physical activity prior to intervention. Evidence-based interventions to increase physical activity among Latinas include distributing culturally sensitive, easy to understand materials that emphasize the importance of regular physical activity and targeting sources of self-efficacy such as social support within families and communities.

These research studies concurred that Latinos are most likely to respond to community-wide education and promotion programs that are imparted by leaders of the same ethnic background and at convenient and frequently visited locations and/or through Spanish television channels. These culture-tailored findings are similar to the recommendations from the CDC and USDHHS for the general population.

Therefore, one recommendation is to distribute information through programs that are implemented in schools, churches, and other familiar and convenient places where Latinos gather and/or via Spanish television channels. Becoming aware of the various NCDs that can be prevented and controlled with exercise may lead to favorable behavioral changes in Latinas, such as commitment to physical activity. Another recommendation is to provide opportunities for Latinas to get involved in exercise programs with friends and/or families.

As Marquez & McAuley state “Latino culture is collectivist in nature, meaning that emphasis is placed on the group rather that the individual” (Marquez & McAuley, 2006 p. 282). Social support can raise self-efficacy in the Latino community through the vicarious experiences provided by social models. According to the CDC and USDHHS, social persuasion has proven to be a powerful and effective tool in bringing desired changes in populations. Encouraging and developing family and community support through community programs is likely to increase success rates of Latinas becoming and remaining physically active.









References
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