Physical activity

Health and Social Behaviour: The Effects on Health of Physical Activity and Combating Inactivity

Definition

Physical activity is ‘any force exerted by skeletal muscle that results in energy expenditure above resting level’. It includes a full range of activities, for example, competitive sport and exercise, hobbies, walking, cycling, or activities
of daily living.

Epidemiology

• Physical activity levels in England are low in adults and there is increasing concern regarding groups of children, such as teenage girls.
• In England in 2004, only 35 per cent of men and 24 per cent of women reported achieving the physical activity recommendations for adults.
• In 2002, only 70 per cent of boys and 61 per cent of girls met current physical activity guidelines for children.
• Over the last 20-30 years there has been a decrease in physical activity as part of daily routines but an increase in the proportion of people taking physical activity for leisure.

Effects on Health of Physical Activity

The health benefits for physical activity are seen throughout the lifecourse as long as moderate, frequent levels of exercise are maintained throughout the lifetime.

Adults:

Cardiovascular Disease

Physical inactivity is a major independent risk factor for coronary heart disease in both men and women, at a similar level to that of smoking cigarettes. Physical activity also has beneficial effects on preventing stroke and treating peripheral
vascular disease, and a beneficial impact on high blood pressure and adverse lipid profiles.

The health benefits can be achieved through meeting the current government recommendation of 30 minutes 5 days a week but greater benefits are achieved through increasing levels of activity. The benefits, however, are lost if physical activity is
not maintained. Exercise-based cardiac rehabilitation programmes for patients with coronary heart disease are generally effective in reducing the risk of premature mortality.

Overweight and Obesity

Prevention of obesity and overweight is achieved in part by maintaining adequate physical activity levels. Physical activity is also important for managing overweight and obesity by achieving weight loss. The most effective means of losing weight
involves a combination of physical activity and healthy eating where energy expenditure is increased through activity and energy input is reduced by adopting a healthy, balanced diet.

Type 2 Diabetes

Physical inactivity is a major risk factor for type 2 diabetes and the risk of developing type 2 diabetes is reduced when people engage in moderate intensity physical activity. 

Cancer

The overall risk of cancer is reduced by adopting adequate levels of moderate physical activity. For example, colon cancer, breast cancer in post menopausal women and possibly lung cancer are all associated with lower risks with increased levels
of physical activity. In addition, physical activity indirectly reduces the risk of all-cause cancer via the indirect role it has in preventing obesity. Obesity is associated with increased risk of all-cause cancer.

Musculo-skeletal health

Physical activity increases bone mineral density in adolescents, maintains it in young adults, and slows its decline in old age.  For example, in adults, moderate activity reduces the progression of osteoporosis and decreases the rate at
which bone mineral density declines. There is some evidence to suggest that physical activity reduces the progression of osteoarthritis and the onset of low back pain. Exercise such as jogging, jumping and tennis, which is high impact and places
physical stress on bones, is required to increase peak bone mass in adolescence and decrease the rate of bone loss after adolescence. Bone mineral density is not increased by low impact activity, for example, swimming.

Mental health

Physical activity is associated with the treatment of mild, moderate and severe depression and other mental illnesses. Moderate intensity and frequent activity improves mood, reduces anxiety and enhances self-perceptions. The psychological impact
of exercise will vary with every individual and will depend of the type of exercise taken up, for example, group recreational activities may bring social and mood benefits whereas rhythmic, aerobic forms of exercise (e.g. brisk walking) may also
improve mood.

There are also additional benefits of physical activity for older adults, for example, maintaining mobility, reducing the risk of falls, and sustaining cognitive function.

Children and Adolescence:

Overweight and Obesity

The high and escalating levels of overweight and obesity among children are recognised; the national average shows that 9.9% of reception year and 17.5% of year 6 children are obese. Children who are obese are more likely to have certain
cardiovascular risk factors, a higher incidence of insulin resistance, and experience long-term social and economic discrimination. The degree to which inactivity is responsible for the current obesity rates has not been established but there is some
evidence to suggest that children who are less active and participate in more sedentary behaviours are more likely to have excess fat.

Cardiovascular Disease

This is not a disease of childhood but some children do have certain risk factors for cardiovascular disease (e.g. high blood pressure and high cholesterol levels). There is some evidence to suggest that children with lower physical activity
levels are more likely to have risk factors for cardiovascular disease in part because children who do regular physical activity are more likely to have a higher HDL cholesterol level. No consistent evidence currently exists on the relationship
between physical activity and blood pressure in children.

Type 2 Diabetes

The prevalence of type 2 diabetes is increasing in children and adolescents in the UK; it is likely that this is due to the increasing rates of childhood obesity, poor lipid balance, insulin resistance, and elevated blood pressure. In adults,
evidence shows that physical inactivity and obesity are risk factors for type 2 diabetes. It is likely, therefore, that the increasing rates of type 2 diabetes in children are associated with the increase in obesity and decrease in physical activity
observed in children.

Musculo-skeletal/bone health

During childhood and adolescence, both boys and girls gain bone mineral density especially during their growth spurts and early puberty. Increased bone mineral density reduces the chances of age-related loss of bone mass and the likelihood of
osteoporosis in later life.  Physical activity and particularly exercise that stresses the bone (e.g. running, jumping, skipping, aerobics, gymnastics, football, rugby but not swimming) is important for bone health.

Mental health

A positive relationship has been established between physical activity and children’s psychological well-being.  Overall, physical activity, sport and exercise can have a positive impact on self-esteem and body-image. In addition, higher
physical activity levels have been associated with better cognitive function.

Combating Physical Inactivity Using a Wide Range of Approaches

(including health service interventions and broader cultural interventions)

Government Policy and Recommendations

The current DH recommendations for physical activity levels are outlined below:

The activity can be continuous activity or intermittent throughout the day for both of the targets.

In September 2008, the physical activity target for schools increased from a minimum of 2 hours to 5 hours per week of structured physical activity.

Sport England is the government agency responsible for developing a world-class community sports system. In June 2008, Sport England published a new radical strategy which aims to get more people playing and enjoying sport and help those
with talent succeed. The strategy outlines a series of targets to be delivered by Sport England by 2012/13:

• one million more people doing more sport  
• a 25% reduction in the number of 16 year olds who drop out of five key sports   
• improved talent development systems in at least 25 sports
• a measurable increase in people’s satisfaction with their experience of sport – the first time the organisation has set such a qualitative measure
• a major contribution to the delivery of the five hour sports offer for children and young people.

The strategy is capitalising on the forthcoming London 2012 Olympic and Paralympic games.

Interventions

The list below is not complete but provides a selection of interventions that have been initiated to increase levels of physical activity:

• Sport England ‘Everyday Sport Campaign’
• Brief interventions in primary care – opportunistic advice, discussion and encouragement. Vary from basic to individually focused advice.
• Exercise referral schemes – a service offering an assessment, tailored physical activity programme, monitoring and follow-up.
• Pedometers – used as a method of increasing the amount of physical activity undertaken by monitoring the number of steps taken per day or week to try to achieve a set target.
• Community-based exercise programmes for walking and cycling
• Initiatives promoting and creating environments that encourage support and physical activity – e.g. planning and providing a comprehensive network of routes for walking and cycling, reallocate road space to support physically active
  modes of transport, ensure public open spaces and public paths can be reached on foot, bicycle or other modes of physically active transport, ensure public open spaces and paths are maintained to a high standard, building designs to encourage the
  use of staircases.
• Workplace initiatives – health checks by qualified practitioner, policies to encourage employees to walk or cycle (e.g. bike loan schemes).
• General Practitioner Physical Activity Questionnaire (GPPAQ) – questionnaire intended for use in adults (16-74 yrs) in routine general practice to provide a 4-level Physical Activity Index reflecting an individual’s current physical
  activity.
• Physical activity care pathway – launched in October 2008 and being piloted by DH. It enables front line health professionals to help sedentary adults and those at risk of adverse health outcomes associated with low activity levels to
  become more physically active.

References

• Department of Health (2004). At least five a week: evidence on the impact of physical activity and its relationship to health. A report from the Chief Medical Officer.
• The Information Centre for Health and Social Care (2006) Statistics on obesity, physical activity and diet, England 2006.
  http://www.ic.nhs.uk/statistics-and-data-collections
• National Institute for Health and Clinical Excellence (2006). Four commonly used methods to increase physical activity: brief interventions in primary care, exercise referral schemes, pedometers and community-based exercise programmes fro
  walking and cycling.
• National Institute for Health and Clinical Excellence (2008). Physical activity and the environment.
• National Institute for Health and Clinical Excellence (2008). Physical activity in the workplace.
• Sport England (2008) Sport England Strategy 2008-2011.
  http://www.sportengland.org

© Hannah Pheasant 2008