steven n. blair professor departments of exercise science and epidemiology & biostatistics
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Physical Activity and Public Health around the World: The Toronto Charter and ISPAH Physical Activity and Public Health Seminar September 16, 2011 Hilton Head, SC. Steven N. Blair Professor Departments of Exercise Science and Epidemiology & Biostatistics University of South Carolina. - PowerPoint PPT PresentationTRANSCRIPT
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Physical Activity and Public Health around the World: The Toronto
Charter and ISPAHPhysical Activity and Public Health Seminar
September 16, 2011Hilton Head, SC
Steven N. BlairProfessor
Departments of Exercise Science and Epidemiology & BiostatisticsUniversity of South Carolina
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Disclosures• Medical/Scientific Advisory Boards
– Jenny Craig, Inc– Alere– Technogym– Cancer Foundation for Life– Santech– Clarity Project
• Research Funding– NIH– Body Media– Coca Cola– Department of Defense
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Acknowledgments • Adrian Bauman• Fiona Bull• Bill Kohl• Scientists who started us on this
journey–Jeremy Morris–Marti Karvonen–Ralph Paffenbarger–Per-Olaf Astrand
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Lecture Outline
• Benefits of activity for adults• Pathway to the Toronto Charter
– International Congress on Physical Activity and Public Health
– International Society for Physical Activity and Health
• Review of the Toronto Charter• Next steps
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Major Health Concerns of Adults
• The three D’s–Death–Disability–Dementia
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Cardiorespiratory Fitness and All-Cause Mortality, Women and Men ≥60 Years of Age
• 4060 women and men ≤60 years
• 989 died during ~14 years of follow-up
• ~25% were women• Death rates adjusted
for age, sex, and exam year
0
5
10
15
20
25
30
35
40
45
60-69 70-79 80+
Low
Moderate
High
All-Cause death rates/1,000 PY
Age Groups
Sui X et al. JAGS 2007.
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Prevalence of Self-reported Functional Limitations by Fitness and Age Groups
Age Groups (years)Fitness Group 40-49 50-59 60+WomenLow 18* 23 46Moderate 8 13 26High 7 3 18MenLow 7 14 24Moderate 3 5 9High 3 1 7
*Prevalence (%)Huang et al. MSSE 1998, 30:1430-5
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Cardiorespiratory Fitness and Risk of Dementia, ACLS
• 59,960 women and men• Followed for 16.9 years
after clinic exam• 4,108 individuals died
– 161 with dementia listed on the death certificate
• Hazard ratio adjusted for age, sex, exam yr, BMI, smoking, alcohol, abnormal ECG, history of hypertension, diabetes, abnormal lipids, and health status
00.10.20.3
0.40.50.6
0.70.8
0.91
Low Moderate High
Fitness Categories
Hazard Ratio
P for trend=0.002
Lui R et al. In press. MSSE
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Forestry Work
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Supervisory Work
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Is Exercise Safe?
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Physical activityN=213
Successful agingN=211
p
Death 0.9% 0.9% >0.99Life threatening event 1.4% 1.4% >0.99Hospitalization 20.7% 20.9% >0.99Significant lab exam 2.8% 3.8% 0.60Any SAE 22.5% 23.7% 0.82
LIFE-P Serious adverse events
J Gerontol Biol Sci Med Sci 2006;61:1157
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Lecture Outline
• Benefits of activity for adults• Pathway to the Toronto Charter
– International Congress on Physical Activity and Public Health
– International Society for Physical Activity and Health
• Review of the Toronto Charter• Next steps
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Jeremy Morris & Ralph Paffenbarger
Marti Karvonen with Rhonda Pollock, Linda Franklin, & Jane Blair
Per-Olaf Åstrand
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Lecture Outline
• Benefits of activity for adults• Pathway to the Toronto Charter
– International Congress on Physical Activity and Public Health
– International Society for Physical Activity and Health
• Review of the Toronto Charter• Next steps
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Slide from Bill Kohl
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Slide from Bill Kohl
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About ISPAH
The International Society for Physical Activity and Health, founded in 2009, is an international professional society of individual members who are interested in advancing the science and practice of physical activity and health.
Slide from Bill Kohl
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Mission
To advance health through scientific study and the promotion of physical activity.
Slide from Bill Kohl
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CouncilsThematic councils are organized to help ISPAH members align with specific areas of interest in the broad field of physical activity and health.
– Global Advocacy for Physical Activity (GAPA) – Advocacy Council of ISPAH
– Council on Physical Activity Assessment & Surveillance (PAAS)
– Council on Activity Interventions (PAI)– Council on Physical Activity and Obesity (PAO)– Council on Environment & Physical Activity (CEPA)
Slide from Bill Kohl
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Slide from Bill Kohl
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Lecture Outline
• Benefits of activity for adults• Pathway to the Toronto Charter
– International Congress on Physical Activity and Public Health
– International Society for Physical Activity and Health
• Review of the Toronto Charter• Next steps
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Slide from Bill Kohl
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The Writing Team The Writing Team (the « (the « ChartistsChartists ») »)
Slide from Fiona Bull
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Final Charter:6 pages / 5 key sections
Slide from Fiona Bull
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A Framework for Action
Slide from Fiona Bull
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7 Investments that work for physical activity
1. Whole-of-school’ programs2. Transport policies and systems
that prioritise walking, cycling and public transport
3. Urban design regulations and infrastructure that provides for equitable and safe access for recreational physical activity, and recreational and transport-related walking and cycling across the life course
4. Physical activity and NCD prevention integrated into primary health care systems
5. Public education, including mass media to raise awareness and change social norms on physical activity
6. Community-wide programs involving multiple settings and sectors & that mobilize and integrate community engagement and resources
7. Sports systems and programs that promote ‘sport for all’ and encourage participation across the life span
Slide from Fiona Bull
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Web based sign up of support underway
• Visit www.globalpa.org.uk• We monitor number of
supporters – By country / region– By individual / organisations
• With national and International endorsements this increases the influence and value of the Charter to all that use the Charter Sign up board at the 3rd ICPAH
Toronto 5-8 May 2010
Slide from Fiona Bull
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TranslationAvailable in: • Arabic• Catalan• Czech• Dutch• English• French• German• Italian• Japanese• Norwegian• Portuguese• Russian
• Spanish • Thai• Turkish
Others underway: • Bengali• Chinese (2)• Greek• Hindi• Korean• Polish• Solvene• Slovak
Available at www.globalpa.org.uk
Slide from Fiona Bull
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Latin American Launch: Oct 2010
AGITA MUNDO MEETING Slide from Fiona Bull
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How is the Charter being used?
• To build partnerships beyond health - with sectors interested and relevant to actions on physical activity
• To meet with politicians and decision makers to raise their knowledge and discuss actions and commitment
• To support funding requests for projects• To plan national and sub national action
plans on physical activitySlide from Fiona Bull
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Advocacy Resources• Bull FC and Bauman AE. Physical Inactivity – the
‘Cinderella’ risk factor for NCD prevention. Journal of Health Communication. In Press.
• Bull FC. (2011). Global Advocacy for Physical Activity- Development and Progress of the Toronto Charter for Physical Activity: A Global Call for Action. Research in Exercise Epidemiology, 13(1), 1-12. [link from GAPA website]
Slide from Fiona Bull
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Lecture Outline
• Benefits of activity for adults• Pathway to the Toronto Charter
– International Congress on Physical Activity and Public Health
– International Society for Physical Activity and Health
• Review of the Toronto Charter• Next steps
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All countries should develop a national physical
activity plan
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What is a Physical Activity Plan?What is a Physical Activity Plan?
• A comprehensive set of strategies including policies, practices, and initiatives aimed at increasing physical activity in all segments of the population.
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U.S. National Physical Activity PlanU.S. National Physical Activity Plan
www.physicalactivityplan.org
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American Academy of Pediatrics American Medical Assoc. American Diabetes Assoc.
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•Mass Media•Public Health•Education•Healthcare•Volunteer and Non-Profit Organizations•Transportation, Urban Design, Comm. Plan.•Business and Industry•Parks, Recreation, Fitness, and Sports
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Content of the PlanContent of the Plan
• 5 Overarching Strategies• Sector-specific Strategies & Tactics
• 52 Strategies• 215 Tactics
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Upcoming international activities related to physical activity and
public health
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The UnitedNations is interestedin non-communicablediseases
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Fogarty International Center—NIHRussian Academy of Science
Moscow, November 16-18, 2011
• Scientific forum for biomedical and behavioral research– Brain sciences– Cancer– Cardiovascular disease– Clinical/translational research training– Healthy lifestyles– Human development– Infectious diseases– Rare diseases
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Sydney Australia 201231st October – 3rd November
Slide from Adrian Bauman
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Time for the Pop Quiz
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Which causes more deaths in the U.S.—smoking or obesity?
• ~40% of U.S. adults think obesity causes at least as many deaths as does smoking
• ~20% of U.S. adults think obesity causes more deaths than smoking
• The truth– Smoking causes ~440,000 deaths/year– Obesity causes ~110,000 deaths/year
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Definitions for adultsBody mass index (BMI) – weight/height 2
• Underweight: BMI < 18.5• Normal weight: BMI 18.5-<25• Overweight*: BMI 25-<30• Obesity: BMI 30 +
BMI 18.5 BMI 25 BMI 30
162 cm (64 in)
49 kg (107 lbs)
66 kg (145 lbs)
79 kg (174 lbs)
178 cm (70 in)
59 kg (129 lbs)
79 kg (174 lbs)
95 kg (209 lbs)
* WHO defines overweight as BMI 25+
Courtesy of Katherine Flegal
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SOURCE: Harris 2008 Int J ObesityCourtesy of Katherine Flegal
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SOURCE: Harris 2008 Int J ObesityCourtesy of Katherine Flegal
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SOURCE: Harris 2008 Int J ObesityCourtesy of Katherine Flegal
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SOURCE: Harris 2008 Int J ObesityCourtesy of Katherine Flegal
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Courtesy of Katherine Flegal
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Obesity and Diabetes• We hear a great deal, in both the scientific
literature and popular press, about the epidemics of obesity and diabetes– In fact, some dummies even use the term
“diabesity”
• What is the prevalence of type 2 diabetes in U.S. individuals under 45 years of age?– 45%– 35%– 25%– 15%– 1.5%
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U.S. Prevalence of Diagnosed Type 2 Diabetes in Persons under 45 Years of
Age in 2010
• 1.4%• Of course this is higher than it was in 1980
– 0.6%
• Diagnosed diabetes in those under 20 years of age in the U.S.– 0.26%
Source: CDC website--
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Thank youQuestions?