Chapter 01

Origins of Physical Activity Epidemiology

Origins of Physical Activity Epidemiology

What is Epidemiology?

Physical activity epidemiology has emerged as a new field of study and intervention during the past 25 years as its scientific undergirding has grown.

However, the ideas that underlie the field are not new but are based in antiquity, dating to the use of structured exercise for health promotion in

China around 2500 B.C.

Origins of Physical Activity Epidemiology

Ancient History of Physical Activity and Health

• The Code of Hammurabi, king of Babylon, had laws about health practices and physicians as early as 2080 BC.

• In Greek Culture:• Panacea, goddess of healing, gave medicines

to the sick, while Hygeia, goddess of health, taught people to protect their bodies by prudent living

• In Modern Medicine “panacea” refers to a healing agent and “hygiene” refers to healthy practices.

Origins of Physical Activity Epidemiology

Ancient History of Physical Activity and Health

• Hippocrates (460-377 BC), known as the “father of medicine,” has also been described as the first epidemiologist.

• He kept records of associations between diseases and climate, living conditions, and habits such as diet and exercise. He distinguished endemic diseases that differ in prevalence between places from epidemic diseases that vary in prevalence across time

Origins of Physical Activity Epidemiology

Ancient History of Physical Activity and Health

• In Class Task… Read the quote from Hippocrates on page 4.

• What ideas from Hippocrates can be substantiated from modern research?

• What ideas, if followed in modern day lifestyle behavioral practice would reduce the health burden in The United States?

Origins of Physical Activity Epidemiology

Exercise as Medicine

Ayurveda System of Medicine, 9th Century India

• (Sanskrit for “the knowledge of living”), which recommended exercise and massage for the treatment of rheumatism

• The Indian physician Sushruta prescribed moderate daily exercise as early as 600 BC for the treatment of diabetes.

• Sushruta also recognized physical activity as preventive medicine, viewing sedentary living as a cause of obesity, diabetes, and early death

Origins of Physical Activity Epidemiology

Exercise as Medicine

Gymnastics, 5th century Greece

• Around 480 BC, the Greek physician Herodicus specialized in therapeutic gymnastics (one of three classes of medical practice at that time). He based his therapies mainly on vigorous exercise.

• Herophilus and Eristratus of Alexandria, Egypt, in the fourth century BC recommended moderate exercise, and,

• Asclepiades of Bithynia, a Greek reformer of Hippocratic therapy in the first century BC, recommended walking and running for his patients

Origins of Physical Activity Epidemiology

Exercise as Medicine

Alexander the Great in the court of Macedonia, extended those views, stating,

“The following are examples of the results of action: bodily health is the result of a fondness for gymnastics; a man falls into ill health as a result of not caring for exercise”

Origins of Physical Activity Epidemiology

Exercise as Medicine

Middle Ages

Even during the Middle Ages in Europe, when the influence of Greek writings was obscured awaiting their rediscovery in the Renaissance, the Greek medical tradition of using exercise was preserved by the Arabs and later translated from Arabic into Latin medical manualsThe Canon of Medicine, written by the Persian physician Ibn Sine (a.k.a. Avicenna) in 1025, was the most influential medical text in Europe during the 15th and 16th centuries.

Origins of Physical Activity Epidemiology

Exercise as Medicine

The work Sirr al-asrar, reportedly written by Aristotle, is believed to be the basis of the famous poem of medicine, Regimen Sanitatis Salernitanum, which was published at the medical school at Salerno, Italy, in the 12th century and which mentioned the healthful benefits of walking after a meal and the use of exercise as a purgative.

Middle Ages

Origins of Physical Activity Epidemiology

Exercise as MedicineRevival of Physical Education, Renaissance Period

• During the Renaissance, scholars in Italy renewed interest in classical Greek gymnastics and recommended it as a fundamental part of education.

• The 14th-century Italian poet laureate, Francesco Petrarca, encouraged exercise as a natural remedy to replace medicines that “poison the body” in his 1354 work, Invective Contra Medicum (Protest Against the Doctor)

Origins of Physical Activity Epidemiology

Exercise as MedicineRevival of Physical Education, Renaissance Period

• Leon Battista Alberti recommended physical exercise beginning in early infancy for strengthening the muscles, stimulating the circulation, and adapting the nervous system. He also stated that exercise for those purposes became even more important with increasing age.

Origins of Physical Activity Epidemiology

Exercise as MedicineRevival of Physical Education, Renaissance Period

• Maffeus Vegius, in his 15th-century Education of Children and Their Good Habits, distinguished between light recreational exercises and heavy exercise designed to strengthen the body, advising moderation in all physical activity.

• Although the great educators of the 15th century recommended exercise as a lifelong habit, contemporary physicians did not embrace exercise. This was changed during the Renaissance by the Italian physician Hieronymus Mercurialis. (see next slide)

Think About It…

Discuss how some of the early beliefs and observations in health and exercise are now considered science fact (review the slides)

Origins of Physical Activity Epidemiology

Origins of Physical Activity Epidemiology

His Six Books on the Art of Gymnastics, printed in 1569, laid the foundation for modern rehabilitative medicine by recommending that convalescents and weakened older people do special exercises, based on specific diagnoses, that should not worsen their infirmities.

Revival of Physical Education, Renaissance Period

Hieronymus Mercurialis

Origins of Physical Activity Epidemiology

For the purpose of health, Mercurialis replaced passive exercises, which had been recommended by early Renaissance experts, with vigorous exercise involving heavy breathing and physical effort, including mountain climbing among three types of walking. He considered running, jumping, rope climbing, and wrestling healthy forms of exercise and suggested ball games to strengthen the upper body.

Revival of Physical Education, Renaissance Period

Origins of Physical Activity Epidemiology

Exercise as MedicineRevival of Physical Education, Renaissance Period

One of the first physicians since the classical Greeks to attempt to explain the benefits of exercise was the Frenchborn Swiss pharmacologist Joseph Duchesne, who in 1648 wrote in Ars Medica Hermetica, “The essential purpose of gymnastics for the body is its deliverance from superfluous humors, the regulation of digestion, the strengthening of the heart and joints, the opening of the pores of the skin, and the stronger circulation of blood in the lungs by strenuous breathing.”

Origins of Physical Activity Epidemiology

Exercise as MedicineAge of Enlightenment to the Modern Era

In 1772, Benjamin Rush, Philadelphia physician and father of American psychiatry, delivered a “Sermon on Exercise,” in which he recommended sports and exercises for young and old alike. His “Plan of a Federal University” included exercises to improve the body’s strength and health

Sports Illustrated Article

November 19, 1979Benjamin Franklin Was An Athlete Whose Ideas Were Ahead Of His Time

Origins of Physical Activity Epidemiology

Exercise as MedicineAge of Enlightenment to the Modern Era

In 1802, the British physician William Heberden reported a case history of heart disease in which he concluded, “I know one who set himself a task of sawing wood half an hour every day, and was nearly cured”

Origins of Physical Activity Epidemiology

Exercise as MedicineAge of Enlightenment to the Modern Era

It was not until the years between the U.S. Civil War and World War I that physicians became the main proponents of exercise to promote good health. Their influence was the basis for our present-day acceptance of the relationship between exercise and a more rewarding and healthier life, and for our contemporary knowledge about the developing science of exercise as a form of preventive medicine.

Origins of Physical Activity Epidemiology

Exercise as MedicineAge of Enlightenment to the Modern Era

Edward Hitchcock Jr. (1828-1911) graduated from Harvard Medical School in 1853, then he and his father published a discussion of the relationship between exercise and health for boys and girls, which argued that gymnastics was as important to schools and colleges as were academic libraries

In 1861 He began a teaching career promoting physical activity at Amherst College

In 1885 he was elected the first president of the Association for the Advancement of Physical Education.

Origins of Physical Activity Epidemiology

Exercise as MedicineAge of Enlightenment to the Modern Era

• The role of physical fitness in preventive medicine was advocated further by Dudley Sargent, an 1878 graduate of Yale Medical School who was the first director of the Hemenway Gymnasium at Harvard in 1880.

Sargent published Health, Strength, and Power in 1904, in which he argued for the importance of regular vigorous exercise for health and presented exercises for children and men of all ages designed to increase fitness.

Origins of Physical Activity Epidemiology

1909 – R. Tait McKenzie publishes “Exercise in Education and Medicine”– Emphasizes physiology of exercise, and the use

of exercise to treat disease. This publication provides the foundation of modern physical medicine and rehabilitation.

Exercise as MedicineAge of Enlightenment to the Modern Era

Origins of Physical Activity Epidemiology

Exercise as MedicineAge of Enlightenment to the Modern Era

The impetus provided by those early physician-educators continued in the United States and Europe during the first half of the 20th century and culminated in the founding of The American College of Sports Medicine in 1954.

Note Founding Fathers in ACSM

Origins of Physical Activity Epidemiology

Exercise as Medicine – Physical Activity Epidemiology

Landmark Research–Epidemiologist Dr. Jeremy Morris

begins to study the relationships between physical activity and coronary heart disease. (late 1940’s –early 1950’s)

Morris observed what appeared to be a protective effect of occupational physical activity against CHD

Origins of Physical Activity Epidemiology

Morris hypothesized that those men with more active jobs would have a protective effect against heart disease.

1953 – Morris finds that highly active bus conductors on double-decker buses were at lower risk that the drivers

Morris later reports similar findings in postal workers who walk deliver mail when compared to office clerks and telephone operators.

Origins of Physical Activity Epidemiology

Other Supporting Studies had similar findings as Morris, including the community study of Framingham, MA.Framingham Study:– Began in 1948– 5000 + men / women– 30 to 62 yrs. of age– Study continues– Findings = physical activity reduces the risk of

heart disease, and that high blood pressure , cigarette smoking, and cholesterol increases risk.

Origins of Physical Activity Epidemiology

Other Studies– Tecumseh Community Health Study– Longshoremen and College Alumni

StudiesRecent Developments– 1980: U.S. Public Health Service

identifies physical fitness and exercise as one of 15 areas of focus for improving health

– CDC created “Behavioral Epidemiology and Evaluation Branch”. In 1990, this branch begins to monitor national goals for physical fitness.

Origins of Physical Activity Epidemiology

Recent Developments– 1988 First International Conference on

Exercise held in Toronto, Canada.– 1992 Second International Consensus

Symposium on Physical Activity, Fitness, and Health in Toronto, Canada.

Conference publication “Physical Activity, Fitness, and Health: International Proceedings and Consensus Statement”, lays the foundation for “Physical Activity and Health: A Report of the U.S. Surgeon General”, 1996.

Origins of Physical Activity Epidemiology

Recent Developments– Government Reports

1992: American Heart Association Position Statement on Physical Inactivity and Coronary Heart Disease1996: Physical Activity and Health: A Report of the Surgeon General.

– National Health GoalsHealthy People 2000Healthy People 2010Healthy People 2020 (see Physical Activity in Objectives and Topics)

Physical Activity /Health Promotion for U.S. and World

At the May 2002 World Health Assembly, member nations mandated that the World Health Organization (WHO) create a Global Strategy on Diet, Physical Activity and Health. In 2003, the WHO and the Food and Agriculture Organization of the United Nations published the technical report “Diet, Nutrition, and the Prevention of Chronic Diseases,”

Origins of Physical Activity Epidemiology

Physical Activity /Health Promotion for U.S. and World

• In 1995 the CDC and the Prevention Research Center at the University of South Carolina started offering widely renowned postgraduate training courses for physical activity and public health researchers and practitioners, which continue today.

• Largely as an outgrowth of those courses, the U.S. National Society of Physical Activity Practitioners in Public Health was formed in 2006.

Origins of Physical Activity Epidemiology

Physical Activity /Health Promotion for U.S. and World

In May 2004, the WHO adopted the Global Strategy on Diet, Physical Activity and Health, which has four main objectives:

1) Reduce risk factors for chronic diseases that stem from unhealthy diets and physical inactivity through public health actions.

2) Increase awareness and understanding of the influences of diet and physical activity on health and the positive impact of preventive interventions.

Origins of Physical Activity Epidemiology

Physical Activity /Health Promotion for U.S. and World

3) Develop, strengthen, and implement global, regional, national policies and action plans to improve diets and increase physical activity that are sustainable and comprehensive and that actively engage all sectors.

4) Monitor science and promote research on diet and physical ActivityConsistent with those goals, the International Congress on Physical Activity and Public Health met first in Atlanta in 2006 and then in Amsterdam in 2008 and Toronto in 2010.

Origins of Physical Activity Epidemiology

In Class Review

Read through the section “Health Goals for the Nation” (pp 11-13)Discuss and compare the goals verses the outcomes of the health objectivesHow does the level of activity reflect our nation’s priorities in preventing disease through physical activity?

Origins of Physical Activity Epidemiology

Origins of Physical Activity Epidemiology

END OF PRESENTATION

Additional Reading (FYI)

A history of physical activity, cardiovascular health and longevity: the scientific contributions of Jeremy N Morris, DSc, DPH, FRCP

By: Ralph S Paffenbarger Jr, Steven N Blair, and I-Min Lee.