WHY DO SOME PEOPLE EXERCISE AND OTHERS DON’T? Prof. K. Srinath Reddy President, Public Health Foundation of India President, World Heart Federation Bernard Lown Professor of Cardiovascular Health, Harvard School of Public Health
GBD 2010
Risk Factors (Top Contributors to DALYs)
1.
High Blood Pressure
2.
Smoking (excluding SHS)
3.
Alcohol Use
4.
Household Air Pollution
5.
Low Fruit
6.
High Body Mass Index
7.
High Fasting Plasma Glucose
Largest Global
8.
Childhood Underweight
9.
Ambient PM Pollution
Disease Burden
10
Physical Inactivity
Diet & Physical Inactivity Cluster Responsible For
Lancet 2012
DETERMINANTS OF NCD RISK GLOBAL
NATIONAL
Development
COMMUNITY
FAMILY
(stage and speed)
Perceptions (cultural)
Distribution (equity)
Priorities (socio-economic)
Demand- Supply (trade)
Pathways (availability, access)
INDIVIDUAL
Beliefs Behaviours Biology
EFFECTS OF SOCIO-ECONOMIC TRANSITION
•Initially - Physical Activity with Economic Growth (Across Society) •Later – Reversal of Social Gradient (Rich and Educated persons LTPA)
Physical inactivity in age-groups by WHO regions
World-wide, 31.11% (95%CI 30.9-31.2) of adults are physically inactive
Halal, Pedro, et al. Lancet, 2012
LTPA IN SAUDI ADULTS 2176 Adults Attending PHCs 18-65 Years of Age Only 21% Sufficiently active ( Nearly 80% did not attain recommended LTPA) Female gender, urban residence and associated chronic diseases correlated with low LTPA
- Amin et al , 2012
PA: Young Persons in Saudi Arabia Youth from Al- Ahsa significantly less active, more sedentary and have higher obesity levels than those in Birmingham and Coventry ( Al-Nakeeb et al, 2012) Obese males and females (adolescents) significantly less active than non-obese ( Al-Hazza et al, 2012) Vitamin D deficiency common in Saudi children and adolescents ( Al- Othman el al , 2012)
WHAT ARE WE TALKING ABOUT? PHYSICAL ACTIVITY
HOME
WORK
TRANSPORT
EXERCISE
LEISURE TIME
WHO ARE WE TALKING ABOUT? INDIVIDUALS
WITH DISEASE/DISABILITY
‘HEALTHY’
GENDER
AGE
(?) ETHNICITY
LIFE COURSE PERSPECTIVE • Early Life Exposure • Childhood • Adolescent • Young Adult • Middle Aged • Older Adult (Bauman A et al, Lancet 2012)
Individual Psychological
Intrapersonal •Cognition •Beliefs •motivation
Biological
Genetic factors
Evolutionary physiology
Genetics – Epigenetics – Evolutionary Biology Heretability estimates vary from small to moderate (mostly). ‘Averse’ and ‘Rewarding’ effects vary among individuals Candidate genes: those associated with Dopaminergic and Melanocortinergic Pathways Epigenetic effects: Intra – Uterine and early childhood Influences; Trans – Generational Effects Evolutionary effect : Less energy required for foraging [ gathering of food]
PEOPLE ARE OF MANY TYPES
•Those Who Exercise •Those Who ‘Exercise Their Minds’ (only) •Those Who Exercise In Their Minds!
Interpersonal Social support from family from friends at work
Cultural norms and practices
Environment
Regional or National Policy
Global
PA IN CHILDREN AND ADOLOSCENTS
POSITIVE CORELATES
INVERSE CORELATES
•Sex (Male) •Perceived Activity Competence •Intentions •Previous Physical Activity •Healthy Diet •Direct Help From Parents •Sibling Physical Activity •Support from others •Opportunities for Exercise •Community Sports
•Age •Perceived Barriers •Depression •Sedentary After School and on Weekends
PA IN ADULTS
Enabling •Knowledge of Health Benefits •Desire for Weight Loss and Body Shape maintenance •Social Support •Structured Group Exercise •Presence of Children at Home •Easy access to Banks and Recreational Facilities
Impeding •Lack of Time •Lack of Motivation •Lack of Knowledge •Specific Health Conditions •Lack of Child Care •Family Responsibilities •Neighborhood Crime •Other Safety Concerns (e.g., Traffic)
PA IN OLDER ADULTS
Enabling •Knowledge of Health Benefits •Promotion of Healthy Sleep Patterns •Muscle Strength & Balance •PA Counseling By Physician •Group/Structured Activities •Easy access to Parks & Gyms
Impeding •Physical Health Concerns •Fatigue •Depression •Lack of Knowledge on Appropriate Exercise •Insufficient Motivation •Cost of Gyms •Unsafe Neighborhood •Lack of Public Transportation •Unfavorable Weather and Traffic Conditions
PARADOX OF MODERNITY
•Previously People were Paid For Doing Physical Work •Now They Have to Pay For Doing Physical Work!
Approaches in Public Health Individual Approach Focuses on changing behavior High risk approach
04/14/13
Population Based Approaches Structural approach, Legislation, taxation, public policy, ecological, or environmental measures
Author: Shifalika goenka
251
PRINCIPLES OF HEALTH PROMOTION Supportive Services Knowledge
I know Help is Available Perform Personally
Motivation
I want
I Act Reach & Teach (Involve Others)
Skills
I can
It is possible
Enabling Environment
Dedicated Shaded cycling paths will promote physical activity, prevent diseases, save fuel and promote safety of entire communities and populations
Shaded pedestrian paths increases physical activity, promotes health, prevents diseases and decreases accidents
Public Health through physical activity in daily living
Open green spaces promote communities and people of all ages and backgrounds to be physically active Source Goenka S, Powering India’s Growth
04/14/13
Author: Shifalika goenka
27
WHAT WE
DO NOT WISH TO SEE
WHAT WE WISH TO SEE
MORE OFTEN