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"Heath, Gregory"
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Progress in physical activity over the Olympic quadrennium
On the eve of the 2012 summer Olympic Games, the first Lancet Series on physical activity established that physical inactivity was a global pandemic, and global public health action was urgently needed. The present paper summarises progress on the topics covered in the first Series. In the past 4 years, more countries have been monitoring the prevalence of physical inactivity, although evidence of any improvements in prevalence is still scarce. According to emerging evidence on brain health, physical inactivity accounts for about 3·8% of cases of dementia worldwide. An increase in research on the correlates of physical activity in low-income and middle-income countries (LMICs) is providing a better evidence base for development of context-relevant interventions. A finding specific to LMICs was that physical inactivity was higher in urban (vs rural) residents, which is a cause for concern because of the global trends toward urbanisation. A small but increasing number of intervention studies from LMICs provide initial evidence that community-based interventions can be effective. Although about 80% of countries reported having national physical activity policies or plans, such policies were operational in only about 56% of countries. There are important barriers to policy implementation that must be overcome before progress in increasing physical activity can be expected. Despite signs of progress, efforts to improve physical activity surveillance, research, capacity for intervention, and policy implementation are needed, especially among LMICs.
Journal Article
Evidence-based intervention in physical activity: lessons from around the world
Promotion of physical activity is a priority for health agencies. We searched for reviews of physical activity interventions, published between 2000 and 2011, and identified effective, promising, or emerging interventions from around the world. The informational approaches of community-wide and mass media campaigns, and short physical activity messages targeting key community sites are recommended. Behavioural and social approaches are effective, introducing social support for physical activity within communities and worksites, and school-based strategies that encompass physical education, classroom activities, after-school sports, and active transport. Recommended environmental and policy approaches include creation and improvement of access to places for physical activity with informational outreach activities, community-scale and street-scale urban design and land use, active transport policy and practices, and community-wide policies and planning. Thus, many approaches lead to acceptable increases in physical activity among people of various ages, and from different social groups, countries, and communities.
Journal Article
Participation of people living with disabilities in physical activity: a global perspective
Approximately 1·5 billion people worldwide live with a physical, mental, sensory, or intellectual disability, about 80% of which are in low-income and middle-income countries. This Series paper provides a global overview of the prevalence, benefits, and promotion policies for physical activity for people living with disabilities (PLWD). PLWD are 16–62% less likely to meet physical activity guidelines and are at higher risk of serious health problems related to inactivity than people without disabilities. Meta-analyses have shown that physical activity has beneficial effects on cardiovascular fitness (average standardised mean difference [SMD] 0·69 [95% CI 0·31–1·01]), musculoskeletal fitness (0·59 [0·31–0·87]), cardiometabolic risk factors (0·39 [0·04–0·75]), and brain and mental health outcomes (0·47 [0·21–0·73]). These meta-analyses also show that health benefits can be achieved even with less than 150 min of physical activity per week, and suggest that some physical activity is better than none. Meta-analyses of interventions to increase physical activity for PLWD have reported effect sizes ranging from SMD 0·29 (95% CI 0·17–0·41, k=10) to 1·00 (0·46–1·53, k=10). There is increasing awareness among policy makers of the needs of PLWD for full participation in physical activity. Physical activity action plans worldwide must be adequately resourced, monitored, and enforced to truly advance the fundamental rights of PLWD to fully participate in physical activity.
Journal Article
Physical Activity and Public Health among People with Disabilities: Research Gaps and Recommendations
Physical activity has become an integral component of public health systems modeling the public health core functions of assessment, policy development, and assurance. However, people with disabilities have often not been included in public health efforts to assess, develop policies, or evaluate the impact of physical activity interventions to promote health and prevent disease among people with disabilities. Addressing the core function of assessment, current physical activity epidemiology, and surveillance among people with disabilities across the globe highlights the paucity of surveillance systems that include physical activity estimates among people with disabilities. The status of valid and reliable physical activity measures among people with condition-specific disabilities is explored, including self-report measures along with wearable devices, and deficiencies in measurement of physical activity. The core functions of policy development and assurance are described in the context of community-based intervention strategies to promote physical activity among people with disabilities. The identification of research gaps in health behavior change, policy, and environmental approaches to promoting physical activity among people with disabilities is explored, along with recommendations based on the principles of inclusive and engaged research partnerships between investigators and the members of the disability community.
Journal Article
Towards better evidence-informed global action: lessons learnt from the Lancet series and recent developments in physical activity and public health
In the past few decades, the field of physical activity has grown and evolved in scope, depth, visibility and impact around the world. Global progress has been observed in research and practice in physical activity regarding surveillance, health outcomes, correlates/determinants, interventions, translation and policy. The 2012 and 2016 Lancet series on physical activity provide some of the most comprehensive global analysis on various topics within physical activity. Based on the Lancet series and other key developments in the field, literature searches, and expert group meetings and consultation, we provide a global summary on the progress of, gaps in and future directions for physical activity research in the following areas: (1) surveillance and trends, (2) correlates and determinants, (3) health outcomes and (4) interventions, programmes and policies. Besides lessons learnt within each specific area, several recommendations are shared across areas of research, including improvement in measurement, applying a global perspective with a growing emphasis on low-income and middle-income countries, improving inclusiveness and equity in research, making translation an integral part of research for real-world impact, taking an ‘upstream’ public health approach, and working across disciplines and sectors to co-design research and co-create solutions. We have summarised lessons learnt and recommendations for future research as ‘roadmaps’ in progress to encourage moving the field of physical activity towards achieving population-level impact globally.
Journal Article
Metabolically Guided Walking and Plant-Based Nutrition Enhance Body Composition and Weight Loss
Sedentary behavior contributes to obesity and metabolic dysfunction, yet few interventions individualize exercise intensity using fuel-based metrics such as the respiratory exchange ratio (RER; VCO2/VO2). This study investigated the effects of metabolically guided walking combined with whole-food, plant-based nutrition on body composition and metabolic outcomes in sedentary overweight and obese women. Forty-four women mean age 43 years; BMI 30.1 kg·m−2) were randomized to low-intensity continuous training (LICT; RER ≈ 0.75), moderate-intensity intermittent training (MIIT; RER ≈ 0.85), or high-intensity continuous training (HICT; RER ≈ 0.95). Following a 2-week dietary lead-in with an individualized ~200 kcal·day−1 energy deficit, participants completed an 8-week RER-guided walking program (5 sessions·week−1; 15–50 min·session−1). Assessments included air-displacement plethysmography (BodPod) body composition, resting metabolic rate and substrate utilization, and oxygen uptake at the first ventilatory threshold (VT1). Data were analyzed using ANCOVA, mixed-factorial ANOVA, and Pearson correlations. Percent body fat decreased significantly across participants (p < 0.0001, η2 = 0.827), with MIIT demonstrating the most favorable integrated outcomes. MIIT elicited the largest reductions in total body mass (−11.2%), fat mass (−25.9%), and percent body fat (−17.1%), alongside improvements in VT1 VO2 (Δ = 1.487 ± 0.895 L·min−1; p = 0.038). Resting respiratory quotient (RQ) declined in LICT and MIIT but increased in HICT, corresponding with increased fat oxidation in LICT and MIIT and reduced fat oxidation in HICT. Changes in RQ were significantly associated with changes in percent body fat (r = 0.316, p = 0.039). Metabolically guided moderate-intensity intermittent walking combined with whole-food, plant-based nutrition produced the most consistent improvements in adiposity, substrate utilization, and submaximal fitness, supporting the public-health feasibility of a community-deliverable, substrate-informed walking prescription.
Journal Article
Physical activity: more of the same is not enough
Men and women of all ages, socioeconomic groups, and ethnicities are healthier if they achieve the public health recommendation of at least 150 min per week of moderate-intensity aerobic physical activity, such as brisk walking.3 Immediate and future health benefits are also clearly described for children and adolescents, for whom at least 60 min per day of vigorous or moderateintensity physical activity is recommended.4,5 Muscular strengthening physical activities are also recommended for health improvement.3 In 2008, 63% of deaths worldwide were due to noncommunicable diseases, mainly diseases of the heart and vascular system, diabetes mellitus, cancers, and obstructive pulmonary disease.
Journal Article