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A New View of Physical Activity By- Ragini Chaturvedi Ragini Chaturvedi has been living in New Jersey , USA for the last 3 years. Before that she was in New Delhi and Bombay. Ragini has a 12 years of experience in Print Media in the capacity of transcriber, translator, copy-editor and editor with various reputed publishing houses.

It is widely accepted that young people benefit from regular physical activity, but until recently there was debate over the amount of exercise needed to benefit health. In 1997 the HEA drew together scientific evidence and international opinion on young people and health-enhancing physical activity, which led to the following recommendations:

All young people should participate in one hour per day of moderate physical activity.

Young people who currently do little activity should participate in physical activity of at least moderate intensity for at least half an hour per day. At least twice a week, some of these activities should help to enhance and maintain muscular strength and flexibility and bone health.

How times and things have changed

Thirty years ago, American children grew up in a world consisting of four television channels, friendly sports that required no more than a glove and a bat, and a secure environment that allowed for endless exploration of the neighborhood. The changing times have lead to bad health habits, making the family physician's role more critical than ever.

Today, more than 100 stations are available for TVs with cable and the bat and glove have been replaced by Game Boys and action-figure software. For many parents -- single and otherwise -- especially those who work outside the home, the greatest sense of security is when a child is safely rooted on the family sofa rather than outside, running around, unsupervised. Inactivity may provide relief for some parents -- but it comes with a price.

The authors of a new report assert, with ample verification, that today's lifestyle is crippling the health of this and future generations and they urge the primary care physicians take advantage of their contact with the patient to intervene. Experts from the fields of medicine and physiology have joined together to summarize an avalanche of epidemiological and biochemical evidence that supports the benefits derived from moderate physical activity. Their findings have led a call to family physicians to include physical activity (and inactivity) counseling into patient care.

An Alarming Profile of American In-Activity

The activity profile for America is alarming:

• Approximately 70 percent of American adults do not understand physical activity or are under active, and nearly half of this country's youth (12-21 years) are not vigorously active on a regular basis.
• A documented decline in physical activity has been correlated with a sharp rise in television viewing hours. Such sedentary behavior in children is believed to translate into an identical lifestyle as an adult.
• The sedentary lifestyle among young people has led to a doubling of childhood obesity rates in the last 20 years.
• A sedentary adult is at greater risk for chronic heart disease, Type 2 diabetes, colon cancer, and hypertension. Although many of these chronic heath conditions do not begin until middle age, the biochemical or cardiovascular risk factors can be found in 60 percent of obese children.
• Aging Americans who settle for a life of bed rest may be signing on to an early death warrant. A recent study found that three weeks of continuous bed rest by healthy volunteers was associated with muscle wasting, bone loss, insulin resistance, a reduction in cardiac output, and decreased immune function.

The Causes

Avoidance of activity may be linked to a negative connotation of the word "exercise," which many associate with pain and discomfort.

While the US gene pool has not significantly changed in the last ten years, rates for obesity have soared. The main cause associated with the changes in rates is environmental change. A documented decline in physical activity has been correlated with a sharp rise in television viewing hours.

Unfortunately, obesity is only the beginning of the body's problems. Genes that evolved to be used by physically active humans cannot easily adapt to the sedentary lifestyle. The sedentary individual cannot oxidize enough food to keep their genes from expressing enough

Why Is Physical Activity So Important?

• Physical activity improves quality of life.
• Physical activity extends longevity, protects against the development of CHD, stroke, hypertension, obesity, non-insulin-dependent diabetes mellitus, osteoporosis, colon cancer, and depression.
• Physical activity helps maintain full functioning and independence among the elderly.
• Relationships between physical activity and improved health include:

Regular physical activity that is performed on most days of the week reduces the risk of developing or dying from some of the leading causes of illness and death in the United States. Regular physical activity improves health in the following ways:

• Reduces the risk of dying prematurely.
• Reduces the risk of dying from heart disease.
• Reduces the risk of developing diabetes.
• Reduces the risk of developing high blood pressure.
• Helps reduce blood pressure in people who already have high blood pressure.
• Reduces the risk of developing colon cancer.
• Reduces feelings of depression and anxiety.
• Helps control weight.
• Helps build and maintain healthy bones, muscles, and joints.
• Helps older adults become stronger and better able to move about without falling.
• Promotes psychological well being.

An important public health goal is to achieve more physically active lifestyles among US's elderly residents. Achieving this goal will improve the health status and quality of life for this growing population, increasing the period of time individuals can remain contributing members of society. Additionally, more active senior citizens will have fewer needs for health care and human welfare resources. The policies developed to attain this goal must address both the behavioral and environmental barriers that interfere with or prevent elderly residents from adopting more active lifestyles.

The Front Line Defense: Primary Care Physicians

The opportunity for the family physician to intervene already exists. Each year, the nation's 100,000 primary care doctors see millions of Americans seeking treatment for a wide range of medical disorders. The range of motivations for seeing the doctor range from general physicals and check-ups to specific types of complains, many of which do not require specialty treatment.

Despite the evidence of the problems associated with sedentary lifestyles, less than half of patients now receive advice from their primary care provider to get moving and increase their level of physical activity.

If the sedentary individual engaged in three hours of moderate physical activity (such as walking) a week he or she would have a 30 percent reduction in the risk for four of the nation's leading killers: coronary artery disease, stroke, type 2 diabetes, and colon cancer. If not addressed, these risk factors can become overt later in life, leading to disease. Thus, prevention strategies are essential for diminishing morbidity and mortality rates associated with chronic disease. (Note: The researchers' summary of common chronic health conditions where physical activity has a direct role in positive outcomes is available.)

Rx

The prescription to a healthier lifestyle is doable and practical. Recommended activities that all patients should receive include "prescriptions" calling for:

• Walking and bicycling 15 minutes twice a day, in lieu of driving that short distance.
• Parking on the far side of the shopping mall instead of circling the lot, looking for a space nearest the entrance.
• Climbing stairs, doing yard work, or playing with grandchildren.
• Always turning off the television.

The authors contend that the medical community should lead the way in pulling Americans away from their televisions and computers. They cite studies that prove that aggressive counseling on physical activity leads to an increased exercise regimen by patients. Moreover, the family doctor is almost always the most trusted and authoritative source for health recommendations.

Conclusion

The authors acknowledge the barriers physicians have to such an effort, which include a reduced amounts of time to work with patients, inadequate information for counseling about physical activity/inactivity, and the lack of reimbursement for such services. Nonetheless, the authors urge every primary care physician to make the effort.

Intervention and prevention strategies are essential for diminishing morbidity and mortality rates associated with chronic disease spawned from a sedentary lifestyle. Reversing or preventing these conditions is the rationale for incorporating physical activity counseling into the routine practice of primary care.

The authors of the article, "An Obligation for Primary Care to Prescribe Physical Activity to Sedentary Patients to Reduce the Risk of Chronic Health Conditions" are Manu V. Chakravarthy, MD, PhD, from the University of Pennsylvania, Philadelphia, PA; Michael J. Joyner, MD, from the Mayo Clinic, Rochester, MN; and Frank W. Booth, PhD, from the University of Missouri, Columbia, MO. Their findings appeared in the February 2002 edition of the Mayo Clinic Proceedings. Dr. Booth is also Associate Editor of the Journal of Applied Physiology, a publication of the American Physiological Society (APS).

All Americans should engage in regular physical activity at a level appropriate to their capacity, needs, and interest. Children and adults alike should set a goal of accumulating at least 30 minutes of moderate-intensity physical activity on most, and preferably all, days of the week. Most Americans have little or no physical activity in their daily lives, and accumulating evidence indicates that physical inactivity is a major risk factor for cardiovascular disease. However, moderate levels of physical activity confer significant health benefits. Even those who currently meet these daily standards may derive additional health and fitness benefits by becoming more physically active or including more vigorous activity. For those with known cardiovascular disease, cardiac rehabilitation programs that combine physical activity with reduction in other risk factors should be more widely used.

Just the Facts

• More than 60% of US adults do not engage in the recommended amount of activity.
• Approximately 25% of US adults are not active at all.
• A 1993 study concerning causes of death in the US: #1 Tobacco, #2 Lack of exercise/poor diet, #3 Alcohol.
• Chronic disease costs the US $655 Billion in healthcare costs.
• In this year, 1.5 million people will have a heart attack in the US and 500,000 will die.

Given the numerous health benefits of physical activity, the hazards of being inactive are clear. Physical inactivity is a serious, nationwide problem. Its scope poses a public health challenge for reducing the national burden of unnecessary illness and premature death.

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