SHA24/067004

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