Chapter Three - Physical Activity and Health: “What is Old is New Again”

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Abstract

Much recent interest has focused on the relationship between physical activity and health and supported with an abundance of scientific evidence. However, the concept of Exercise is Medicine™ copromoted by the American College of Sports Medicine and American Medical Association and similar august bodies worldwide is far from new—the importance of exercise for health has been reported for centuries. Participation in regular physical activity and exercise provides numerous benefits for health with such benefits typically varying according to the volume completed as reflected by intensity, duration, and frequency. Evidence suggests a dose–response relationship such that being active, even to a modest level, is preferable to being inactive or sedentary. Greatest benefits are commonly associated with the previously sedentary individual assuming a more active lifestyle. There is an apparent linear relationship between physical activity and health status and as a general rule, increases in physical activity and fitness result in additional improvements in health status. This narrative review provides a selective appraisal of the evidence for the importance of physical activity for health, commencing with a baseline historical perspective followed by a summary of key health benefits associated with an active lifestyle.

Introduction

An increasing body of evidence demonstrates that engagement in regular physical activity results in numerous health benefits (Blair and Morris, 2009, NIH Consensus Development Panel on Physical Activity and Cardiovascular Health, 1996, Paffenbarger et al., 2001, Pate et al., 1995, Powell et al., 2011). This evidence has been generated over many recent decades and compiled in a number of landmark documents such as the U.S. Department of Health and Human Services Surgeon General's Report (1996) and the more recent U.S. Department of Health and Human Services Physical Activity Guidelines for Americans (2008). Many other countries, along with UN agencies such as the World Health Organization (WHO), have also periodically published evidence-based documents in support of the importance of physical activity and exercise to the health of all individuals (WHO, 2010).

Typically, the activity–health relationship has been illustrated by referencing the amount, type, and intensity of physical activity needed to achieve a particular benefit(s). It is important to note that the relationship between physical activity and health, particularly in the prevention of disease, is not a new concept but has been understood and appreciated for millennia (Booth and Hargreaves, 2011, Tipton, 2014), most notably through the contributions of Hippocrates (460–370 B.C.) and Galen (129–210 A.D.) (Berryman, 2010a).

More recent interest in the importance of physical activity to health has been predicated on the significant and progressive lifestyle changes experienced in the developed world over recent centuries and the developing world in recent decades. Population estimates of physical activity participation have consistently referenced a progressive decrease (Brownson et al., 2005, Church et al., 2011, Hallal et al., 2012, Ng and Popkin, 2012), certainly massively different from early hunter–gatherer populations (Booth, Chakravarthy, & Spangenburg, 2002). In short, physical activity has been engineered out of the daily agenda of many populations globally and consequently inextricably linked to increased risk of hypokinetic diseases or diseases of inactivity (Booth et al., 2002). These trends are not limited to the developed world as low- and middle-income countries (LMICs) in the developing world are also exposed to a rapid and often fateful nutrition and physical activity transition (Ng & Popkin, 2012) “associated with rapid acculturation to sedentary living” (Katzmarzyk & Mason, 2009).

One of the major consequences of population decreases in physical activity and the more recently documented increase in physical inactivity and sedentary behaviors and associated impact, has been a concomitant increase in noncommunicable diseases (NCDs) (Bauer et al., 2014, Blair, 2009, Lee et al., 2012, Murray et al., 2012, Thyfault and Krogh-Madsen, 2011, World Health Organization, 2011). NCDs account for an estimated 60% of all deaths and 44% of premature deaths and are thought to be the greatest cause of morbidity and mortality, even in the developing world (Daar et al., 2007, World Health Organization, 2011). Levels of physical inactivity globally are so dire that the situation has been described as a pandemic (Kohl et al., 2012) and the greatest public health challenge of the twenty-first century (Blair, 2009). Recent Canadian surveillance data based on objective measures indicate that an estimated 85% of adults do not meet the modest physical activity guidelines of 150 min/week of moderate-to-vigorous physical activity (Colley et al., 2011). Sadly, similar figures are commonplace in many other industrialized nations.

Of particular note is that physical inactivity is a major modifiable risk factor for cardiovascular disease and a range of other chronic diseases, including type 2 diabetes, some cancers, obesity, hypertension, bone, and joint diseases including osteoporosis and osteoarthritis, and depression (Blair et al., 2001, Blair et al., 2001, Blair, 2009, Dunn et al., 2001, Lee et al., 2012, Murray et al., 2012, Warburton et al., 2001; Warburton, Nicol, & Bredin, 2006).

In summary, profound changes in lifestyle practices (low levels of habitual physical activity plus poor diet) and an environment supportive of decreased daily energy expenditure are in large part responsible for the escalation in population ill health (Booth and Hargreaves, 2011, Chakravarthy and Booth, 2004). Therefore, a major public health challenge is associated with encouraging a sedentary population to adopt a more active lifestyle and thereby improve health status (Global Advocacy for Physical Activity (GAPA) the Advocacy Council of the International Society for Physical Activity and Health (ISPAH), 2012, Murphy et al., 2010). Despite the focus of this paper being on physical activity and health, we endorse the statements of Brooks, Butte, Rand, Flatt, and Caballero (2004) that diet and physical activity recommendations for health are inextricably intertwined and that “adequate physical activity provides protection against chronic diseases and helps to balance energy expenditure and intake.”

In view of the enormity of the public health challenge, the scientific community would likely gain significantly more traction and translation to improved health outcomes if petty biases regarding terminology and the relative importance of physical activity versus exercise versus sedentary behaviors and/or diet versus physical activity were eliminated in favor of collaborative messaging. For example, Tudor-Locke and Schuna (2012) recently presented the simple but useful notion of “walk more, sit less, and exercise.”

The aim of this narrative review is to provide an overview of current knowledge and understanding in relation to physical activity and health. The review commences with a brief historical perspective followed by a summary of the evidence for the key health benefits of an active lifestyle. The review is not designed to be a treatise on physical activity promotion or exercise prescription.

Section snippets

Physical Activity and Health—A Brief Historical Perspective

Physical activity and health has been a topic of interest for an extended period, indeed some would contend millennia (Booth and Hargreaves, 2011, MacAuley, 1994, Tipton, 2014). Therefore, perhaps not surprisingly, the Exercise is Medicine™ initiative launched by the American College of Sports Medicine (ACSM) and American Medical Association (AMA) (ACSM, 2007; 2011) and progressively gaining global traction (Berryman, 2010a, Sallis, 2009), resonates with the original adage espoused by

Physical Activity and Nutrition Transitions in the Developed and Developing Settings

The epidemiological shifts in population mortality rates are tied to economic and demographic changes and referred to as the epidemiological transition (Olshansky and Ault, 1986, Omran, 1971). The epidemiological transition in turn encompasses the theory of nutrition transition used to explain the parallel changes in lifestyle and the increasing prevalence of obesity and chronic disease (Katzmarzyk & Mason, 2009). Popkin (1993) is generally credited with the development of the concept of

The Importance of Sound Comparisons—Quantification of Terminology

Inconsistent use of terminology is commonplace; therefore, it is important from the outset to provide an overview of key terms (Hills, Mokhtar, & Byrne, 2014). Physical activity is traditionally defined as bodily movement resulting from contraction of skeletal muscle that contributes to an increase in energy expenditure above resting levels (Caspersen, Powell, & Christenson, 1985). In contrast, exercise is commonly defined as planned, structured, and repetitive movement with the intention of

Physiological and Psychosocial Benefits of Physical Activity and Exercise

There is significant evidence that lack of exercise is a major cause of chronic diseases (Booth and Hargreaves, 2011, Booth et al., 2012). Similarly, Voss, Nagamatsu, Liu-Ambrose, and Kramer (2011) contend that based on available research evidence, aerobic and resistance exercise are the most effective approaches to improve both mental and physical health. The numerous physiological and psychosocial benefits of activity (Powell et al., 2011) are briefly summarized below. In contrast, the

Optimal Volume of Physical Activity: How Much Is Sufficient, How Much Is Too Much?

Despite the essential role of physical activity in the prevention of chronic disease (Booth et al., 2012, Green et al., 2008, Joyner and Green, 2009, Lee and Skerrett, 2001) substantial gaps in knowledge abound (Garber et al., 2011), including contention regarding the optimal volume of physical activity as defined by the components of volume: intensity, duration, and frequency (Kesaniemi et al., 2001). At the individual level, optimal adaptation (or “trainability”) and likelihood of deriving

Conclusions

A significant body of evidence supports the numerous physical and mental health benefits associated with regular involvement in physical activity and exercise. An increasing body of evidence relates to the independent role of physical inactivity in relation to health risk. Lifestyle practices of many societies are characterized by low levels of habitual physical activity in combination with poor diet, a recipe for NCDs, and this scenario is widespread in both developed and LMIC’s. Physical

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