Physical Activity Promotion:

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• Physical Activity Promotion
• Population Health Approaches Challenges
• PARC Conference, 2006
• Ron Plotnikoff, PhD
• Professor
• University of Alberta
• Alberta Heritage Foundation for Medical Research
  
• Canadian Institutes for Health Research

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Health Benefits of Regular PA

• High blood pressure, stroke coronary
  heart disease
• Risk of developing type II diabetes
• Overweight/Obesity
• Risk of colon cancer Protection
  against breast cancer

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Health Benefits of Regular PA

• Risk of developing osteoporosis
• Functioning symptom relief from
  osteoarthritis rheumatoid arthritis
• Anxiety, depression stress

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• Despite the importance of PA,
• why is the majority of our population inactive
  ?

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Prevalence

• Nearly two-thirds of Canadian adults are risking
  their health quality of life because of
  inactive lifestyles.

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Percentage Meeting PA Guidelines (Plotnikoff, Can
J of Diabetes, in press, March 2006)
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Of Great Significance

• Physical inactivity/heart disease
• Population attributable risk
• Increasing type II diabetes
• Increasing obesity (esp. child)

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Obesity Trends Among Canadian AdultsHPS, 1985
(BMI ? 30, or 30 lbs overweight for 54 woman)
Source Katzmarzyk PT. Can Med Assoc J
20021661039-1040.
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Obesity Trends Among Canadian AdultsCCHS, 2000
(BMI ? 30, or 30 lbs overweight for 54 woman)
Source Statistics Canada. Health Indicators,
May, 2002.
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Of Great Significance

• Increasing Mortality/Morbidity Economic Costs

So, what do we do?
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INDIVIDUAL
POPULATION
Energy Expenditure
I
T
Y
OBESE OR UNDERWT
O
P
R
E
V
Food intake Nutrient density
A
L
E
Source see Kumanyika Ann Rev Pub Health 2001
22293-308
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McKinlays (1995) Population Model of Prevention

• Downstream - individually oriented treatments
• Midstream - interventions aimed at worksites
  organizations, health care settings
  entire communities
• Upstream - macro-level programs healthy
  public policies

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Population Health Approach
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Ecological Levels (Ind. Env.)
Population Health Approach
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Ecological Approach for PA(McLeroy et al., 1988
Richard et al., 1996 Sallis Owen, 1997)

• Individual
• Social
• Organizational
• Community
• Public Policy
• Physical Environment

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• Every drop of water in the entire river is
  important!

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(No Transcript)
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The interaction between the individual
environmental levels.
19
Age-adjusted mortality rates of coronary heart
disease in North Karelia the whole of Finland
among males aged 35-64 years from 1969 to 1995.
Mortality per 100, 000 population
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However

• As yet, we do not have enough evidence for
  recommended
• sequencing
• proportionate emphasis
• (limited research on the env. levels)

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Ecological Levels (Ind. Env.)
Target populations
Population Health Approach
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Target Populations

• Children Youth
• Adult (general)
• Women
• Older adults
• First Nations
• Visible minority groups

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Ecological Levels (Ind. Env.)
Target populations
Population Health Approach
Settings (i.e., clinics, schools, workplaces,
communities)
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Ecological Levels (Ind. Env.)
Target populations
Population Health Approach
Settings (i.e., schools, clinics, workplaces,
communities)
Inter-disciplinary Inter-sectoral

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How Successful are PA Programs?

• Participation rate is 20-30 with only half of
  these participating on a regular basis
• Of the most rigorously designed intervention
  studies -at best small to modest effects on
  program impact
• However, even small effects at the
  population-level can be meaningful
• Long-term assessments very limited
• Long-term adherence is poor (e.g.,10 PA
  participation rates in a behav. mod. program at
  12 months - Schneider et al., 1992)
• .We need programs and better ones where ones
  exit.

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Importance of Behaviour Change Theory

• Explains 40-60 of PA Intentions
• Explains 10-35 of PA Behaviour
• Theory-based interventions are more successful

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• However limited use of theory in our programs
  research
• Only 12 of diabetes education behaviour
  research employs a theoretical base (Anderson,
  1999)

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Individual LevelSocial-Cognitive Theories

• Social Learning/Cognitive Theory
• Theory of Reasoned Action/Planned Behavior
• Protection Motivation Theory
• Health Belief Model
• Transtheoretical Model

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Transtheoretical Model

• Applied to over 30 health related behaviours and
  growing (e.g.)
• Most health practitioners love it.Why?
• easy to use widgets staging concept
• Researchers skepticism

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Stages of Behaviour Change Model
Maintenance Action Preparation Contemplation P
re-Contemplation
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Summary of Predictions for PA Plotnikoff et al.
(Prev Med 2001)
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Percentage Meeting Guidelines (Plotnikoff et al.,
under review)
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Key PA Social-Cognitive Determinants

• Self-efficacy
• Perceived confidence in ones ability to take
  action
• Application
• Provide training, guidance, in performing action
• Use progressive goal setting
• Give verbal reinforcement
• Demonstrate desired behaviours
• Reduce anxiety

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Other Important Constructs to Target

• Benefits Barriers / Pros Cons
• .What is the most common cited PA barrier?...

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No time??
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Other Important Constructsto Target

• Attitudes (e.g., PA is enjoyable)
• Social Support (e.g., PA with friends/family)
• Physical Environments
• Threat messages have limited effect

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• When is the theory ripe for practitioners?

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• Never

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Example Strategies/Modes of Delivery at the
Individual Level

• Individual counseling
• Behaviour modification
• Incentives
• Telephone prompting/counseling
• Monitoring
• Goal setting
• Print materials/staged-matched
• Information technology/ computer mediated
• Publicly displayed attendance charts

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Tailoring Considerations

• Demographical / Health Factors
• Age
• Sex
• Overweight/obese
• SES
• Ethnicity/migrants
• Stage of Readiness

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Measure of Success

• PA change takes time relapse is very common
• Dont be discouraged or short-change the results
  of your efforts

Changing confidence, attitudes intentions
towards PA can be a success within its own right.
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• Recent Canadian Initiatives Examples

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• PA Report Card Children Youth
• Tremblay et al., (2005)

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• PA Worksite Study (PAWS)
• Plotnikoff, Courneya, Spence, Birkett Marcus
• Am J of Health Promotion (under review)
• Funded by the Canadian Institutes of Health
  Research
• Alberta Heritage Foundation for Medical Research

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PA Recommendations

• 1 hour of any (light) intensity PA every day
• 30-60 minutes of moderate-intensity PA at least 4
  days a week

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Step Series Plotnikoff et al., based on cohort
data
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
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Women

Stage
1200
Guide
1100
Control
1000
Group
Physical Activity Means
control
900
standard
800
stage
3
2
1
Time
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• Workplace PA
• Healthy Eating -
• Electronic Messaging Study
• Plotnikoff, McCargar, Wilson Loucaides
• Am J of Health Promotion (2005)

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Men
Exp.
960
940
Control
920
900
880
Estimated Marginal Means
860
GROUP
840
experimental group
820
800
control group
3
2
1
TIME
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Program Standard Audit Tool for Workplace PA
Download the Program Standard Audit Tool
free of charge from The Alberta Centre for
Active Living website www.centre4activeliving.ca/
research/reresources.html Plotnikoff et al,
(2005) Health Promotion Practice
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• Canada on the Move - Step One
• Can J Health Prom (in press, 2006)
• A web-based, research platform to collect data on
  pedometer usage.
• Large natural PA experiment

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Pedometer Distribution

• 800,000 cereal boxes (Dec 2003 - Jan/March 2004)
  
• 1.5 Million (June 2004)

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CFLRI PA Monitor
Nov 03
vs Jan 04
Have you heard of a pedometer or step counter?
Do you currently own a pedometer or step counter?
Yes
Yes
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Website
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Regional Provincial Campaigns

• Active Edmonton www.activedmonton.ca
• Healthy U www.healthyalberta.com
• Healthy Alberta Communities (Chronic Disease
  Prevention) Raine Plotnikoff

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Summary, Challenges Future Directions

• Surveillance
• Theoretically-based, multi-level interventions (
  best practices)
• Measurement (valid, reliable standard
  measures)

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Summary, Challenges Future Directions cont

• Aerobic resistance training activities

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Physical Activities Plotnikoff, CJD, 2006
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Summary, Challenges Future Directions cont

• Feasibility sustainable/practical, economical
• Forums frameworks to plan, share evaluate
  best-practices research study results
• Inter-disciplinary / Inter-sectoral
• Knowledge transfer

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Summary, Challenges Future Directions cont

• Advocacy
• Pushing boundaries

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• Every tear drop of sweat in all parts of the
  river is important for promoting change!

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Thank you for your attention

• References attached
• Website www.chps.ualberta.ca

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References

• This text by Glanz et al (2003) is an excellent
  resource which reviews key theories and
  frameworks.
• The chapter by Sallis Owen on PA/Ecological
  Models within the text is also very relevant.

• Sallis JF, Owen N. Ecological models. In Glanz
  F, Rimer BK, Marcus-Lewis F, eds. Health Behavior
  and Health Education Theory, research and
  practice, 3rd edition. San Franciso Jossey-Bass,
  2002.