Health%20Disparities%20in%20Physical%20Activity:%20Patterns%20and%20Implications

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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

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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.

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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

Caspersen C, et al, Public Health Reports 1985
100(2)126-131.
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The Benefits of Physical Activity
Health Benefits
Fitness Benefits

• 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!

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Physical Activity and Health (Dose-Response)
Prevention of Weight Gain
Diabetes Mellitus
Risk of Disease
CHD
Stroke
Musculoskeletal Injury
Functional Health Status
Physical Activity
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(No Transcript)
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The Obesity Epidemic
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Fit or fat evidence?Puzzle is not so simple
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Fit or Fat? CVD Mortality, Body Fat, and
Fitness
adj for age, exam year, smoking, alcohol,
fam history
??25
lt16
16-lt25
Lee CD et al. Am J Clin Nutr 1999.
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The Chronic Disease Epidemic Changing
Environment Acting upon Pre-existing Genes
Phenotype Genotype x Environment
Unhealthy Gene Expression
No Change in past 100 Years
Large Change in past 100 Years
Physical Inactivity Diet Pollution, etc.
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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

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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

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The Lifestyle Approach
Noon-time jog
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Sedentary
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Structured Exercise
Lifestyle Activity
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Energy Expenditure (METS)
After-dinner walk
Walk to bus stop
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2
0
Blair et al. Med Exerc Nutri Hlth 154, 1992
Time (hours)
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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

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Possible Domains of Physical Activity

• Leisure/recreational
• Occupational
• Transportation
• Household chores
• Gardening/yardwork
• Completely sedentary activities (e.g., watching
  television)

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Descriptive Epidemiology

• 1. Person
• 2. Place
• 3. Time

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Physical Activity, U.S. Adults (2003 BRFSS,
Age-Adjusted)
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Classify

• PERSON
• age
• race
• sex
• ses family
• occupational blood type
• marital status personality traits
• migrants

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Physical Activity by Race/Ethnicity (2003 BRFSS,
Age-Adjusted)
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Physical Activity by Income Group (2003 BRFSS,
Age-Adjusted)
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Physical Activity by Income Group (2003 BRFSS,
Age-Adjusted)
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Moderate Physical Activity for Adults by
Disability and Arthritis Status
Age-adjusted percent
1997
2002
2010 Target
With
Without
With
Without
Disabilities
Arthritis
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Physical Activity in Ethnically Diverse Women 40
and older
Brownson RC et al. Am J Public Health 1999.
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Vigorous Physical Activity for Adolescents by
Grade Level 2001
Percent
10th
12th
11th
9th
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Classify

• PLACE
• natural boundaries
• political subdivisions
• urban-rural differences
• weather variations

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Prevalence of No Leisure-Time Activity, 2000
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No Physical Activity for Adults by State, 2003
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Age-adjusted heart disease mortality, Missouri,
1992-98
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Classify

• TIME
• secular trends
• declining rates
• cyclicity-seasonality
• periodicity
• clusters in time or place

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Age-adjusted colon cancer incidence by gender and
race
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Age-adjusted breast cancer incidence by race
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Other important macro patterns trends in the
United States that are likely to affect health
disparities and the burden of physical inactivity
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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

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Population Trends

• Changing 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

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Car ownership, walking biking
Percent by Walking or Biking
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Vehicle miles traveled by automobile
Miles per person per day
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Ave. daily television viewing
Hours per household per day
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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?

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Acknowledgments

• Certain slides were provided by Dr. Greg Heath
  (Centers for Disease Control and Prevention) and
  Dr. Steve Blair (Cooper Institute)