Considering Physical Inactivity in Relation to Obesity

A Peer Reviewed Publication of the College of Allied Health & Nursing at Nova Southeastern University Dedicated to allied health professional practice and education http://ijahsp.nova.edu Vol. 2 No. 1 ISSN 1540-580X Considering Physical Inactivity in Relation to Obesity Janet C. Struber, BPthy (PT), MHS Director of Primary Health Care Cape York Health Service District Queensland Health - Weipa CITATION: Struber, J. Considering physical inactivity in relation to obesity. The Internet Journal of Allied Health Sciences and Practice. January 2004. Volume 2 Number 1. ABSTRACT Physical inactivity and obesity contribute enormously to the current burden of disease in Australia, as in all Western Countries. Although diet and exercise have been linked to health since antiquity, the connection has recently experienced a revival of interest. There is mounting evidence that the current prevalence of obesity is more closely related to decreases in energy expenditure than to the traditionally accepted imbalance between consumption and expenditure, and that physical activity is therefore crucial in maintaining weight loss. With overweight and obesity now the norm in Australia, physical inactivity is a major issue within and beyond the health sector, and should be a concern of all health practitioners. This paper provides an overview of the relationship between obesity and physical inactivity and reflects on some strategies for increasing physical activity in the obese. More research on effective strategies to promote physical activity in all its forms (eg. exercise, transportation and incidental activity) is needed. Body Mass Index (BMI) >25. (BMI = weight(kg)/height2(m)) Body Mass Index > 30. INTRODUCTION As non-communicable diseases emerge as the major cause of mortality, morbidity and disability worldwide, a relatively small number of universal and preventable risk factors have been identified, specifically: lack of physical activity, tobacco use and an unhealthy diet.1,2 Because physical activity is both an independent risk factor, and interacts positively with strategies to improve diet and discourage tobacco use,1 it has experienced a resurgence of interest and should be a concern of all health practitioners. Yet, “the exercise boom is not just a fad; it is a return to ‘natural’ activity—the kind for which our bodies are engineered.” 3 Broad prescriptions of health based on diet and physical activity long predate the classical Greek philosophy on which we base modern medicine. Yet, even when empirical observation and case studies espousing “eating alone will not keep a man well; he must also take exercise"3 were replaced by rigorous scientific investigation, the claims held true.” The classical notion that one could improve one’s health through one’s own actions, such as eating right and exercising, proved to be a powerful influence on medical theory as it developed over the centuries. However, the evolution of biomedicine resulted in a dichotomy of medical thinking that created an artificial distinction between health and disease and lifestyle issues became neglected.4 Following the revelation in 1953, that 56.6% of American children were unfit, exercise physiology flourished.3 However, the stringent exercise prescriptions of the 1970s, based on physical fitness, did little to inspire the population to become active, and it is estimated that presently over 60% of the world population is not physically active enough to gain health benefits.1,5 Obese adults are 40-45% less likely to achieve sufficient levels of physical © The Internet Journal of Allied Health Sciences and Practice, 2004 Considering Physical Inactivity in Relation to Obesity 2 activity than overweight or normal weight adults, and there is an inverse relationship between measures of physical activity and indices of obesity.6-8 HEALTH IMPLICATIONS Physical Inactivity The importance of physical inactivity as a primary and independent risk factor for all-cause mortality and for the development of certain common diseases has emerged from strong, consistent epidemiological evidence collected over the past 30 years. Physical inactivity has shown a strong, and almost certainly causal, relationship to mortality from coronary heart disease, non insulin dependent diabetes mellitus and colon cancer, and is a significant contributor to the pathology of stroke, hypertension, breast cancer, obesity, osteoporosis, falls in the elderly, and depressive disorders.1,2,7,9-15 The population attributable risks related to physical inactivity are substantial. The relative contribution of physical inactivity to disease and disability in Australia is 7%, second only to smoking (11%).6,9,16 With new studies continuing to identify consistent and stronger associations between physical inactivity and adverse health risks, it constitutes a major and increasing contribution to the burden of disease in Australia.2,10,17 If every Australian adult became moderately physically active, there would be a health care cost saving of approximately $377 million annually, and more than 13000 premature deaths could be prevented.9 Obesity As well as an overall increased risk of all cause mortality, obesity has also been linked to a variety of chronic diseases and metabolic disorders, such as coronary heart disease, type II diabetes, hypertension, dyslipidemia, stroke, gall bladder disease, respiratory diseases, sleep apnea, back pain, various cancers and osteoarthritis.16-19 Posing a major public health challenge, obesity has been recognized as a chronic disease itself, with a complex etiology which should be approached with a chronic disease treatment model, with particular emphasis placed on the maintenance of weight after the completion of weight loss therapy.18-21 Yet, losing weight is a frustrating and usually unsuccessful endeavor with failure rates of 95% at five years51 and fluctuations in weight further increase health risks with each episode of weight gain associated with a decrease in physical function and vitality.22 An American study revealed that, any given time, some 29% of men and 44% of women are attempting to lose weight.23 PREVALENCE Physical Inactivity Changes in the environment and increases in labor-saving technology have reduced work and daily living related physical activities, contributing to more sedentary lifestyle, with approximately 30% of Australians failing to engage in even one leisure time physical activity.2,6,7,17,21,24 1999 data indicates that 60% of males and 54% of females are sufficiently active, while some 43% of the Australian adult population is so inactive that they gain no health benefit, and put themselves at risk of major health problems.2,8,10,25 This number, which has not changed significantly in a decade, is higher than the rates of smoking (25%) and hypertension (15%).25,26 Physical inactivity is more prevalent among middle aged and older persons; women; those belonging to lower socioeconomic groups; pe (...truncated)