To Preventing Disease
activity, fitness, and exercise are critically important for the
health and well being of people of all ages. Research has demonstrated
that virtually all individuals can benefit from regular physical
activity, whether they participate in vigorous exercise or some
type of moderate health-enhancing physical activity. Even among
frail and very old adults, mobility and functioning can be improved
through physical activity.1 Therefore,
physical fitness should be a priority for people of all ages.
activity has been shown to reduce the morbidity and mortality
from many chronic diseases. Millions suffer from chronic illnesses
that can be prevented or improved through regular physical activity:
- 12.6 million
people have coronary heart disease2;
- 1.1 million
people suffer from a heart attack in a given year2;
- 17 million
people have diabetes; about 90% to 95% of cases are type 2 diabetes,
which is associated with obesity and physical inactivity3;
approximately 16 million people have pre diabetes;
people are newly diagnosed with colon cancer each year4,5;
people suffer from hip fractures each year6;
- 50 million
people have high blood pressure2;
50 million adults (between the ages of 20 and 74), or 27% of
the adult population, are obese; overall more than 108 million
adults, or 61% of the adult population are either obese or overweight.7,8
In a 1993
study, 14 percent of all deaths in the United States were attributed
to activity patterns and diet.9 Another study linked sedentary lifestyles to 23 percent of deaths
from major chronic diseases.10 For example, physical activity has been shown to reduce the risk
of developing or dying from heart disease, diabetes, colon cancer,
and high blood pressure. On average, people who are physically
active outlive those who are inactive.11-16
well-known benefits of physical activity, most adults and many
children lead a relatively sedentary lifestyle and are not active
enough to achieve these health benefits. A sedentary lifestyle
is defined as engaging in no leisure-time physical activity (exercises,
sports, physically active hobbies) in a two-week period. Data
from the National Health Interview Survey shows that in 1997-98
nearly four in 10 (38.3 percent) adults reported no participation
in leisure- time physical activity.17
1: Physically inactive
1997-98 National Health Interview Survey
one-third of persons age 65 or older lead a sedentary lifestyle.
Older women are generally less physically active than older men.
Fifty-four percent of men and 66 percent of women age 75 and older
engage in no leisure-time physical activity.17 In general, African American older adults are less active
than white older adults. In the mid 1990's, 37 percent of white
men age 75 and older reported no leisure-time physical activity,
compared to 59 percent of African American men age 75 and older;
47 percent of white women age 75 and older reported no leisure-time
physical activity, compared to 60 percent of African American
women age 75 and older.18
one-third of young people in grades 9-12 do not regularly engage
in vigorous physical activity. Furthermore, 43 percent of students
in grades 9-12 watch television more than two hours per day.19 Physical activity declines dramatically over the course
of adolescence, and girls are significantly less likely than boys
to participate regularly in vigorous physical activity.
2: Vigorous Physical Activity of Adolescents
by Grade Level, 1999
physical activity is defined as exercise that made the respondent
sweat and breathe hard for at least 20 minutes on 3 or more
of the 7 days preceding the survey.
SOURCE: Youth Risk Behavior Surveillance System (YRBSS), CDC,
Consequences of Inactivity
and its associated health problems have substantial economic consequences
for the U.S. health care system. In the long run, physical inactivity
threatens to reverse the decades-long progress that has been made
in reducing the morbidity and mortality associated with many chronic
conditions such as cardiovascular disease. A physically inactive
population is at both medical and financial risk for many chronic
diseases and conditions including heart disease, stroke, colon
cancer, diabetes, obesity, and osteoporosis.
prevalence of chronic medical conditions and diseases related
to physical inactivity are associated with two types of costs.
First, there are health care costs for preventative, diagnostic,
and treatment services related to these chronic conditions. These
costs may include expenditures for physician visits, pharmaceuticals,
ambulance services, rehabilitation services and hospital and nursing
home care. In addition, there are other costs associated with
the value of lost wages by people unable to work because of illness
and disability, as well as the value of future earnings lost by
premature death. In 2000, the total cost of overweight and obesity
was estimated to be $117 billion.7 In addition, the total estimated cost from chronic diseases is
| Table 1: National Cost of Illness
for Selected Diseases
| Heart Diseases
National Institutes of Health, 2000
suffering from chronic diseases bear a substantial portion of
these medical costs. A recent study demonstrated that obese individuals
spend approximately 36 percent more than the general population
on health services and 77 percent more on medications.20 Furthermore, the study found that the effects of obesity on health
spending were significantly larger than effects of current or
and Medicaid programs currently spend $84 billion annually on
five major chronic conditions that could be significantly improved
by increased physical activity, specifically diabetes, heart disease,
depression, cancer, and arthritis. Medicare spent $10.4 billion
on diabetes treatment and services in 2000 and is estimated to
spend $12.7 billion in 2004.
Medicare spending on heart disease treatment and services has
grown from $21.1 billion in 1992 to $34.9 billion in 2000 and
is expected to reach $42.8 billion in 2004.
on depression treatment and services has grown from $1.3 billion
in 1992 to $2.1 billion in 2000 and is estimated to increase to
$2.5 billion in 2004.
on cancer treatment and services has grown from $10.3 billion
in 1992 to $15.2 billion in 2000 and is expected to increase to
$18.5 billion in 2004.
on arthritis treatment and services has grown from $3.4 billion
in 1992 to $5.8 billion in 2000 and is estimated to be $7.1 billion
physical activity helps prevent disease and promote health, it
may actually decrease health care costs. A study performed by
researchers at the Centers for Disease Control and Prevention
found that physically active people had, on average, lower annual
direct medical costs than did inactive people. The same study
estimated that increasing regular moderate physical activity among
the more than 88 million inactive Americans over the age of 15
years might reduce the annual national direct medical costs by
as much as $76.6 billion in 2000 dollars.21 Further, it found that physically active people had fewer hospital
stays and physician visits and used less medication than physically
inactive people. The cost savings were consistent for men and
women, for those with and without physical limitations, and even
for smokers and nonsmokers. In this study, the biggest difference
in direct medical costs was among women 55 and older, supporting
the belief that the potential gain associated with physical activity
is especially high for older women. The researchers concluded
that adoption of a population-wide physical activity strategy
might produce health care cost savings among most adult age groups.
can benefit too. Workplace physical activity programs can reduce
short-term sick leave by six to 32 percent, reduce health care
costs by 20 to 55 percent, and increase productivity by 2 to 52
percent. 22 In 1998, 93 percent of employers had programs
that fostered employee health, up from 76 percent in 1992, according
to Hewitt Associates. Such wellness programs typically
offer help in smoking cessation, managing stress, prenatal care,
nutrition, and fitness.23
Activity and Good Physical Health
in regular physical activity at least 30 minutes of moderate
activity on at least five days per week, or 20 minutes of vigorous
physical activity at least three times per weekis critical
to sustaining good health. Youth should strive for at least one
hour of exercise a day. Regular physical activity has beneficial
effects on most (if not all) organ systems, and consequently it
helps to prevent a broad range of health problems and diseases.
People of all ages, both male and female, derive substantial health
benefits from physical activity.
activity reduces the risk of developing or dying from some of
the leading causes of illness in the United States. Regular physical
activity improves health in the following ways22:
the risk of dying prematurely from heart disease and other conditions;
the risk of developing diabetes;
the risk of developing high blood pressure;
blood pressure in people who already have high blood pressure;
the risk of developing colon and breast cancer5;
- Helps to
maintain a healthy weight;
- Helps build
and maintain healthy bones, muscles, and joints;
- Helps older
adults to become stronger and better able to move about without
feelings of depression and anxiety; and
activity is associated with lower mortality rates for both older
and younger adults.22 Even those
who are moderately active on a regular basis have lower mortality
rates than those who are least active. Regular physical activity
leads to cardiovascular fitness, which decreases the risk of cardiovascular
disease mortality in general and coronary artery disease mortality
in particular. High blood pressure is a major underlying cause
of cardiovascular complications and mortality. Regular physical
activity can prevent or delay the development of high blood pressure,
and reduces blood pressure in persons with hypertension.
activity is also important for maintaining muscle strength, joint
structure, joint functioning, and bone health.22 Weight-bearing physical activity is essential for normal skeletal
development during childhood and adolescence and for achieving
and maintaining peak bone mass in young adults. Among post-menopausal
women, exercise, especially muscle strengthening (resistance)
activity, may protect against the rapid decline in bone mass.
However, data on the effects of exercise on post-menopausal bone
loss are not clear-cut and the timing of the intervention (e.g.,
stage of menopausal transition) can influence the response. Regardless,
physical activity including muscle-strengthening exercise appears
to protect against falling and fractures among the elderly, probably
by increasing muscle strength and balance.22 In addition, physical activity may be beneficial for many
people with arthritis.
activity can help improve the lives of young people beyond its
effects on physical health. Although research has not been conducted
to conclusively demonstrate a direct link between physical activity
and improved academic performance, such a link might be expected.
Studies have found participation in physical activity increases
adolescents self-esteem and reduces anxiety and stress.22 Through its effects on mental health, physical activity may help
increase students capacity for learning. One study found
that spending more time in physical education did not have harmful
effects on the standardized academic achievement test scores of
elementary school students; in fact, there was some evidence that
participation in a two-year health-related physical education
program had several significant favorable effects on academic
in physical activity and sports can promote social well-being,
as well as good physical and mental health, among young people.
Research has shown that students who participate in interscholastic
sports are less likely to be regular and heavy smokers or use
drugs25, and are more likely
to stay in school and have good conduct and high academic achievement.26 Sports and physical activity programs can introduce young people
to skills such as teamwork, self-discipline, sportsmanship, leadership,
and socialization. Lack of recreational activity, on the other
hand, may contribute to making young people more vulnerable to
gangs, drugs, or violence.
Activity and Good Mental Health
activity reduces morbidity and mortality from mental health disorders.27 Mental health disorders pose a significant public health burden
in the United States and they are a major cause of hospitalization
and disability. Mental health disorders cost approximately $148
billion per year.22 Potentially,
increasing physical activity levels in Americans could substantially
reduce medical expenditures for mental health conditions.
with affective disorders, physical activity has a beneficial effect
on symptoms of depression and anxiety.27 Animal research suggests that exercise may stimulate the
growth of new brain cells that enhance memory and learningtwo
functions hampered by depression. Clinical studies have demonstrated
the feasibility and efficacy of exercise as a treatment for depression
in older men and women. Currently, National Institute of Mental
Health (NIMH) investigators are conducting research comparing
the effectiveness of home-based and supervised aerobic exercise
to the use of antidepressants in relieving depression in these
groups, and reducing relapse rates. Other NIMH researchers are
studying whether greater exercise levels result in more symptom
improvement. Regular physical activity also appears to enhance
effects of physical activity on mental disorders are less well
studied. Some studies suggest physical activity prevents depressive
illness. Future research will clarify the extent to which physical
activity may actually protect against the development of depression.
activity may also reduce risk of cognitive decline in older adults,
though more research is needed to clarify the mechanism of this
possible effect. Among people who suffer from mental illness,
physical activity appears to improve the ability to perform activities
of daily living.27
Activity (Along with a Nutritious Diet) is Key to Maintaining
Energy Balance and a Healthy Weight
activity along with a nutritious diet is key to maintaining a
healthy weight. In order to maintain a healthy weight, there must
be a balance between calories consumed and calories expended through
metabolic and physical activity. Although overweight and obesity
are caused by many factors, in most individuals, weight gain results
from a combination of excess calorie consumption and inadequate
a large portion of a persons total caloric requirement is
used for basal metabolism and processing food, an individuals
various physical activities may account for as much as 15 to 40
percent of the calories he or she burns each day. While vigorous
exercise uses calories at a higher rate, any physical activity
will burn calories. For example, a 140-pound person can burn 175
calories in 30 minutes of moderate bicycling, and 322 calories
in 30 minutes of moderate jogging. The same person can also burn
105 calories by vacuuming or raking leaves for the same amount
of Overweight and Obesity
As a result
of lifestyle and dietary changes, overweight and obesity have
reached epidemic proportions in the United States. The Body Mass
Index (BMI) is the most commonly used measure to define overweight
and obesity. BMI is a measure of weight in relation to height.
BMI is calculated as weight in pounds divided by the square of
the height in inches, multiplied by 703.
to the National Institutes of Health Clinical Guidelines, overweight
in adults is defined as a BMI between 25 lbs/in2 to
29.9 lbs/in2; and obesity in adults is identified by
a BMI of 30 lbs/in2 or greater.28 These definitions are based on evidence that suggests that health
risks are greater at or above a BMI of 25 lbs/in2 compared
to those at a BMI below that level. The risk of premature death
increases with an increasing BMI. This increase in mortality tends
to be modest until a BMI of 30 lbs/in2 is reached.
3: BMI Weight Chart
Surgeon Generals Call to Action to Prevent and Decrease
Overweight and Obesity, 2001
and obesity are increasing in both genders and among all population
groups. In 1999, an estimated 61 percent of adults in the U.S.
were overweight or obese; this contrasts with the late 1970s,
when an estimated 47 percent of adults were overweight or obese.7
the prevalence of overweight and obesity generally is higher in
women who are members of racial and ethnic minority populations
than in non-Hispanic white women.7 Among men, Mexican Americans have a higher prevalence of overweight
and obesity than non-Hispanic whites or non-Hispanic blacks. For
non-Hispanic men, the prevalence of overweight and obesity among
whites is slightly greater than among blacks.
4: Age-adjusted prevalence of overweight or obesity
in selected groups, 1988-1994
Surgeon Generals Call to Action to Prevent and Decrease
Overweight and Obesity, 2001
in prevalence of overweight and obesity also exist based on socioeconomic
status.7 For all racial and ethnic
groups combined, women of lower socioeconomic status (income <130
percent of the poverty threshold) are approximately 50 percent
more likely to be obese than those with higher socioeconomic status
(income > 130 percent of the poverty threshold). Men are about
equally likely to be obese whether they are in a low or high socioeconomic
and obesity epidemic is not limited to adults. What is particularly
alarming is that the percentage of young people who are overweight
has almost doubled in the last 20 years for children aged 6-11
and almost tripled for adolescents aged 12-19. In children and
adolescents, overweight has been defined as a sex- and age- specific
BMI at or above the 95th percentile for a reference
population, based on Centers for Disease Control and Prevention
(CDC) growth charts
5: Figure 6: Prevalence of Overweight in Children
and Adolescents ages 6-19
Excludes pregnant women starting with 1971-74. Pregnancy status
not available for 1963-65 and 1966-70. Data for 1963-65 are
for children 6-11 years of age; data for 1966-70 are for adolescents
12-17 years of age, not 12-19 years.
SOURCE: CDC/NCHS, NHES and NHANES.
Health Risks of Not Maintaining a Healthy Weight
studies show an increase in mortality associated with overweight
and obesity. Approximately 300,000 deaths a year in this country
are currently associated with overweight and obesity.29 Morbidity from obesity may be as great as from poverty, smoking,
or problem drinking.20 Overweight
and obesity are associated with an increased risk for developing
various medical conditions including cardiovascular disease, certain
cancers (endometrial, colon, postmenopausal breast, kidney, and
esophageal)5, high blood pressure,
arthritis-related disabilities and type 2 diabetes.7
| Table 2: Health risks associated with obesity
Obesity is Associated with an Increased Risk of:
(degeneration of cartilage and bone in joints)
(endometrial, colon, kidney, esophageal, and postmenopausal
(presence of excess body and facial hair)
incontinence (urine leakge caused by weak pelvic-floor
disorders such as depression
difficulties due to social stigmatization
Surgeon Generals Call to Action to Prevent and Decrease
Overweight and Obesity, 2001
It is also
important for individuals who are currently at a healthy weight
to strive to maintain it since both modest and large weight gains
are associated with significantly increased risk of disease. For
example, a weight gain of 11 to 18 pounds increases a persons
risk for developing type 2 diabetes to twice that of individuals
who have not gained weight, while those who gain 44 pounds or
more have four times the risk of type 2 diabetes.30
studies have shown that a gain of 10 to 20 pounds resulted in
an increased risk of coronary heart disease (which can result
in nonfatal heart attacks and death) of 1.25 times in women31 and 1.6 times in men.32 In these studies, weight increases of 22 pounds in men and
44 pounds in women resulted in a increased coronary heart disease
risk of 1.75 and 2.65, respectively. In one study among women
with a BMI of 34 or greater, the risk of developing endometrial
cancer was increased by more than 6 times.33 Overweight and obesity are also known to exacerbate many chronic
conditions such as hypertension and elevated cholesterol. Overweight
and obese individuals also may suffer from social stigmatization,
discrimination, and poor body image.
morbidities occur most frequently in adults, important consequences
of excess weight as well as antecedents of adult disease occur
in overweight children and adolescents. Overweight children and
adolescents are more likely to become overweight or obese adults.
As the prevalence of overweight and obesity increases in children
and adolescents, type 2 diabetes, high blood lipids, and hypertension
as well as early maturation and orthopedic problems are occurring
with increased frequency. A common consequence of childhood overweight
is psychosocialspecifically discrimination.34
inactivity is a risk factor for many diseases and conditions,
making physical activity an integral part of daily life is crucial.
Physical activity need not be strenuous to be beneficial. People
of all ages benefit from moderate physical activity, such as 30
minutes of walking five or more times a week. In addition, physical
activity does not need to be sustained for long periods of time
in order to provide health benefits. Repeated shorter bursts of
moderate-intensity activity also yield health benefits. In other
words, walking in two 15-minute segments or three 10-minute segments
makes clear the pressing need to encourage a more active lifestyle
among the American people. Clearly, the goal of a more active
population will be a challenge, requiring a commitment to change
on the part of individuals, families, work places, and communities.
Both the public and private sectors will need to band together
to promote more healthy habits for those of all ages.7 Encouraging more activity can be as simple as establishing walking
programs at schools, worksites and in the community. Some communities
have an existing infrastructure that supports physical activity,
such as sidewalks and bicycle trails, and work sites, schools,
and shopping areas in close proximity to residential areas. In
many other areas, such community amenities need to be developed
to foster walking, cycling, and other types of exercise as a regular
part of daily activity. Schools provide many opportunities to
engage children in physical activity as well as healthy eating.
For adults, worksites provide opportunities to reinforce the adoption
and maintenance of healthy lifestyle behaviors. Perhaps the most
important change, however, is at the individual and family level.
Each person must understand the value of physical activity for
his or her health and well-being and commit to a lifestyle that
is truly active.
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