Dr Paul Batman
Fitpro welcomes Dr Paul Batman to the editorial team.
Dr Batman originally contributed to our PT Network magazine in the 1990s. You can look forward to reading two pieces of research in each issue of the magazine.
Title: The descriptive epidemiology of total physical activity, muscle strengthening exercises and sedentary behaviour among Australian Adults – result from the National Nutrition and Physical Activity Survey. Authors: Bennie, J., Pedisic, Z., van Uffelen, J., Gale, J., Banting, L., Vergeer, I., Stamatakis, E., Bauman, A., Biddle, S. (2016).
Source: BMC Public Health, 16:73.
More than 65% of deaths in the world have been attributed to non-communicable diseases, of which inactivity is one of the main preventable causes. Inactivity is the fourth-ranked mortality risk factor after hypertension, high blood glucose, and smoking.
For many years, National Physical Activity Guidelines were based around the accumulation of moderate- to vigorous-intensity exercise (MVPA). Using these criteria, between 40-60% of the world’s population is insufficiently active for health benefits, so surely this is this century’s main public health challenge?
More recent epidemiological studies have reported that improvements in metabolic health, sarcopenia, osteoporosis and osteoarthritis can be effectively achieved by participation in muscle strengthening exercises.
With the emergence of sitting as a significant cause of chronic diseases such as Type 2 diabetes and cardiovascular disease, all-cause mortality is also now considered to be a comparable major risk factor.
To incorporate all these factors for optimum health benefits, the most recent guidelines now include: at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous exercise, or a combination of both per week; two days per week of muscle strengthening exercises and limiting the amount of time in sedentary activities as generally represented by sitting.
Interestingly, very few studies have examined national participation rates in muscle strengthening activities other than the US (21.9%) and the UK (31.7%), which are among the highest. Combining MVPA and muscle strengthening is even scarcer with only 18.2-20.6% reportedly meeting the combined guidelines in the US.
As no such information is available for the Australian population, the aim of this study was to determine the prevalence of adherence to MVPA, muscle strengthening guidelines and sedentary behaviour.
Data was accessed from the Australian Bureau of Statistics, National Nutritional and Physical Activity Survey 2011-2012. Data was obtained by face-to-face interviews from 14,363 households, of which 77% adequately responded, reducing the sample size to 9,510 dwellings or 12,153 participants between the ages of 18-85 years.
From the sample size, 54.1% were females, 45.9% were aged between 18-44 years, 25.7% had higher education qualifications, 51.5% reported they were in very good to excellent health, 34.3% had a normal BMI, and 48.5% reported never having smoked.
The results indicated that only 52.6% of participants met the MVPA guidelines, while 18.6% met the muscle strengthening guidelines. Only 15% met both the MVPA and muscle strengthening guidelines together, with females less likely to meet the combined guidelines. The 18 to 24-year age group were the most likely to meet the combined guidelines. The older age groups with low education levels and in poor health had the lowest levels of MVPA, muscle strengthening and the combined guidelines. This data underscores the importance of targeting this large, emerging population group with sustainable and realistic health promotion strategies to meet the combined guidelines.
The key finding of this study was that the vast majority of Australians did not meet the new combined guidelines (85%), which is a serious concern for public health. This would suggest that only using the MVPA data (52.6%) as a measure of physical activity participation could be very misleading and does not truly reveal the full extent of the inactivity problem.
Globally, these results add to the existing body of knowledge that suggests the current methods used to attract populations to improve physical activity levels across the world have been largely ineffective and are in need of some review.
Title: The importance of non-exercise physical activity (NEPA) for cardiovascular health and longevity.
Authors: Eklborn-Bak, E., Eklbom, B., Vikstrom,M., de Faire, U., Hellenius, M. (2014).
Source: British Journal of Sports Medicine, 48:233-238.
Given that the vast majority of the world’s population does not meet the current minimum physical activity recommendations for health improvements, more sustainable physical activity guidelines based on every-day activities might be a more viable option. Since 1980, there has been a significant change in our every-day activities, with sitting and sedentary behaviour dominating our lives. More than 10 hours per day are now reported as being the norm for inactivity.
Sitting is now recognised as a signi cant risk factor in all-cause mortality, irrespective of participation in moderate to vigorous structured exercise (MVPA), and is now regarded as an important independent risk factor. Sedentary behaviour refers to activities equal to or less than an energy expenditure of 1.5 METs, which is equivalent to sitting and lying down.
The most realistic approach in reducing sedentary activity and reducing sitting time is to replace it with non-exercise physical activity (NEPA) that can be performed over the day, at home, during leisure times, during personal transportation, and at work/retirement, etc. NEPA can be performed over a range of energy expenditures between 2-6 METs (low to moderate levels of intensity).
The importance of NEPA in cardiovascular and metabolic health and longevity is limited. The purpose of this study was to evaluate the association between NEPA and changes in cardiovascular and metabolic health over a 12.5-year period.
In this study, NEPA and exercise habits were assessed on 4,232 60-year-old males and females. Over 12.5 years, or up until their death, all subjects were assessed for waist circumference, systolic and diastolic blood pressure, HDL levels, LDL cholesterol, triglycerides, insulin, glucose and plasma brinogen, and self- administered questionnaires. A NEPA index was devised that assessed the subject’s involvement in activities of daily living including home repairs, mowing the lawn and car maintenance, as well as general exercise participation.
Regardless of participation in regular exercise, high NEPA levels reduced waist circumference, lowered LDL levels, and had a favourable effect on triglyceride levels, as well as insulin, glucose and brinogen levels. The occurrence of metabolic syndrome was less in those subjects with higher NEPA levels in both non-exercising and exercising groups. Higher NEPA levels reported a lower risk of a rst-time cardiovascular (CV) event.
A generally active lifestyle as measured by higher levels of NEPA, regardless of exercise habits, reduced rst-time CV events by 27% and all mortality by 36%. Greater NEPA levels produced more significant results across all health parameters measured, including metabolic syndrome, irrespective of participation in a structured exercise programme.
This finding has dramatic clinical significance as NEPA can be regarded as a sustainable alternative to a structured exercise programme for those who have difficulty in maintaining the MVPA required in the National Physical Activity Guidelines, particularly in older age groups.
It appears that the multiple intermittent activation of skeletal muscles in NEPA is more effective in activating myokines, such as lipoprotein enzymes (LPL); important for fat metabolism, IL-A; important for central anti-inflammation, GLUT 4; important in glucose transport, and IL-5; important in muscle fat crosstalk, rather than the maintenance of higher intensity structured exercise programmes.
A study examining Amish people in the US, who lead a traditional agricultural lifestyle, reported the lowest levels of heart disease and metabolic syndrome across the country. Amish people complete three times as many steps as the current average non-Amish American, with in excess of 18,000 steps reported for males, and 14,500 steps for females, per day.
For future health gains, promoting every-day NEPA could be just as important and effective as recommending regular exercise for all populations, particularly the older age groups. fp
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