Physical Activity: the best route to population health Ashley Cooper ashley.cooper@bristol.ac.uk

Outline What is physical activity? A brief history of physical activity and health Two possible approaches to improving health

Physical inactivity is the fourth leading cause of death worldwide The pandemic of physical inactivity should be a public health priority

What is Physical Activity?

Physical activity is….. Exercise is….. Fitness is….. Any bodily movement produced by skeletal muscles that results in energy expenditure Exercise is….. Planned, structured and repetitive bodily movement done to improve or maintain physical fitness Fitness is….. The ability of circulation and respiration to supply oxygen during sustained physical activity

A Brief History of Physical Activity and Health

Occupational physical activity and heart attacks Jerry Morris – compared heart attack incidence in drivers vs conductors Morris et al (1953) "Coronary heart-disease and physical activity of work". Lancet 265 (6795): 1053–7

The Harvard Alumni Study 16,936 men who entered Harvard University between 1916-1950 Questionnaires: specific physician diagnosed disease; socio-demographic characteristics including physical activity 1962/66 Baseline 1977 Follow-up 1 1985 Follow-up 2

Physical activity measures Flights of stairs climbed (1 flight = 70 stairs = 28 kcal) City blocks walked (6 blocks = 0.5 miles = 50 kcal) Type and amount of sport (light 5 kcal/min; vigorous 10 kcal/min; mixed 7.5 kcal/min) Physical activity index computed as an indicator of energy expenditure

Harvard alumni: physical activity and all-cause mortality A relatively small increase in energy expenditure (equivalent to approx 30 minutes of walking per day) is associated with ~30% reduced risk of early death Paffenbarger et al (1986, 1993)

MVPA and prevention of chronic disease

UK activity guidelines (2011)

Physical activity in the UK Inactive population 35% of men and 45% of women do not meet physical activity guidelines Only 21% of boys and 16% of girls aged 5-15 meet guidelines for youth People in the least prosperous areas are twice as likely to be inactive than those in the most prosperous Disabled people are half as likely to be active compared to non-disabled people

Health impact of physical inactivity in the UK (BHF 2013) 10.5% of CHD cases 18.7% of colon cancer cases 17.9% of breast cancer cases 13.0% of type 2 diabetes cases 16.9%of premature all-cause mortality

Cost of physical inactivity in the UK 2009/10 estimated cost to PCTs in England >£940 million Reducing physical inactivity by just one per cent a year over a five-year period would save the UK economy just under £1.2bn (UK Active 2014) “If every local authority was able to reduce inactivity levels by 1% each year over five-years, they would save local taxpayers £44 per household” (UK Active 2014) (£17,000 a minute)

Possible Approaches to Improving Health: Reducing Sedentary Behaviour

The new science of sedentary behaviour Research over the past 30 years has focussed on establishing the association between MVPA and health Sedentary behaviours (e.g. sitting in a car, watching TV, using the computer) are ubiquitous Up to 60% of adult waking time is spent in sedentary behaviours

Sitting time and all-cause mortality 17,013 Canadians, 18-90yrs; 12 year follow up; 1,823 deaths Daily sitting time (5 categories) and leisure time physical activity assessed at baseline Higher risk of mortality across higher levels of sitting time from all-causes and CVD Katzmarzyk (2009) MSSE 41: 998-1005

Possible Approaches to Improving Health: Increasing Walking by Active Travel

Contribution of walking to work to daily physical activity Measure Car Walk p MVPA (mins/day) 50 (25) 79 (24) <0.001 Sed (mins/day) 599 (61) 580 (76) 0.206 Audrey et al (2014). IJBNPA 11:37

Physical activity and the school journey Children who walk to school are more active than car travellers Walking to school contributes about one-third of adolescent MVPA Adoption of car travel to school reduces daily MVPA

Summary There is a huge amount of evidence showing the health impacts of physical activity/inactivity There are major health and societal gains from increasing population levels of physical activity, even by a small amount There is strong evidence to support active travel for all, and outdoors play for children, as important approaches to increasing physical activity

Thank you! Outdoors & Active: Delivering public health outcomes by increasing Children’s outdoor play and active travel Thank you!