health disparities in physical activity: patterns and implications ross c. brownson prevention...
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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
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.
Caspersen C, et al, Public Health Reports 1985; 100(2)126-131.
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
The Benefits of Physical Activity
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
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!
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!
Health Benefits Fitness Benefits
Physical Activity and Health (Dose-Response)
Physical Activity
Ris
k o
f “D
i sea
se”
Prevention of Weight Gain
Diabetes Mellitus
Musculoskeletal Injury Functional Health Status
CHDStroke
The Obesity
Epidemic
Fit or fat evidence?
Puzzle is not so simple…
Fit or Fat? CVD Mortality, % Body Fat, and Fitness
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Adj RR*
Lean Normal Obese
Body Fat
FitUnfit
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Adj RR*
Lean Normal Obese
Body Fat
FitUnfit
Lee CD et al. Am J Clin Nutr 1999.
<16% 16-<25% 25%
*adj for age, exam year,smoking, alcohol, &fam history
Phenotype = Genotype x Environment
The Chronic Disease Epidemic: Changing Environment
Acting upon Pre-existing Genes
UnhealthyGeneExpression
No Changein past 100 Years
Large Changein past 100 Years
*Physical InactivityDiet
Pollution, etc.
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
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
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
0
2
4
6
8
10
0 2 4 6 8 10 12 14 16 18 20 22 24
Noon-time jog
Walk to bus stop
After-dinner walk
En
erg
y E
xpen
dit
ure
(M
ET
S)
Time (hours)
SedentaryStructured Exercise
The Lifestyle Approach
Blair et al. Med Exerc Nutri Hlth 1:54, 1992
Lifestyle Activity
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
Possible Domains of Physical Activity
Leisure/recreational Occupational Transportation Household chores Gardening/yardwork
Completely sedentary activities (e.g., watching television)
Descriptive Epidemiology
1. Person
2. Place
3. Time
Physical Activity, U.S. Adults (2003 BRFSS, Age-Adjusted)
Classify
PERSONage
race
sex
ses family
occupational blood type
marital status personality traits
migrants
Physical Activity by Race/Ethnicity
(2003 BRFSS, Age-Adjusted)
0
10
20
30
40
50
60
70
80
Recommended Insufficient
White Black Latino
Physical Activity by Income Group (2003 BRFSS, Age-Adjusted)
0
10
20
30
40
50
60
Recommended, moderateLess than $15K $15K - <$25K$25K - < $50K $50K+
Physical Activity by Income Group (2003 BRFSS, Age-Adjusted)
0
10
20
30
40
50
60
Recommended, vigorousLess than $15K $15K - <$25K$25K - <$35K $35K - < $$50K$50K+
0
10
20
30
40
50
60
With
Age-adjusted percent
2010 Target
Moderate Physical Activity for Adults by Disability and Arthritis Status
WithoutDisabilities
With WithoutArthritis
1997 2002*
Physical Activity in Ethnically Diverse Women 40 and older
0
10
20
30
40
50
60
70
80
Regular Occupational Housework Composite
Caucasian Black Am. Indian Hispanic
Brownson RC et al. Am J Public Health 1999.
0
20
40
60
80
100
Vigorous Physical Activity for Adolescents by Grade Level:
2001
11th10th9th
Percent
12th
Classify
PLACEnatural boundaries
political subdivisions
urban-rural differences
weather variations
0
5
10
15
20
25
30
35
40
45
Alabama Colorado Indiana Kentucky SouthCarolina
Utah
Men
Women
Prevalence of No Leisure-Time Activity, 2000
No Physical Activity for Adults by State, 2003
15.0 - 20.0
20.5 - 22.4
23.0 - 26.2
26.4 - 30.2
Age-adjusted percent
(Quartiles)
Age-adjusted heart disease mortality, Missouri, 1992-98
Classify
TIMEsecular trends
declining rates
cyclicity-seasonality
periodicity
clusters in time or place
Age-adjusted colon cancer incidence by gender and race
Age-adjusted breast cancer incidence by race
Other important macro patterns & trends in the United States that are likely to affect
health disparities and the burden of physical inactivity
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
Population TrendsChanging 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
Car ownership, walking & biking
0
5
10
15
20
25
30
35
40
No Car 1 Car 2 Cars 3 Cars
Highest Income
Lowest Income
Per
cent
by
Wal
king
or
Bik
ing
Vehicle miles traveled by automobile
0
5
10
15
20
25
30
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000
Mile
s pe
r pe
rson
per
day
Ave. daily television viewing
2
3
4
5
6
7
8
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000
Hou
rs p
er h
ouse
hold
per
day
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?
Acknowledgments
Certain slides were provided by Dr. Greg Heath (Centers for Disease Control and Prevention) and Dr. Steve Blair (Cooper Institute)