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

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

Acknowledgments • Adrian Bauman• Fiona Bull• Bill Kohl• Scientists who started us on this

journey–Jeremy Morris–Marti Karvonen–Ralph Paffenbarger–Per-Olaf Astrand

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

Major Health Concerns of Adults

• The three D’s–Death–Disability–Dementia

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.

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

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

Forestry Work

Supervisory Work

Is Exercise Safe?

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

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

Jeremy Morris & Ralph Paffenbarger

Marti Karvonen with Rhonda Pollock, Linda Franklin, & Jane Blair

Per-Olaf Åstrand

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

Slide from Bill Kohl

Slide from Bill Kohl

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

Mission

To advance health through scientific study and the promotion of physical activity.

Slide from Bill Kohl

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

Slide from Bill Kohl

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

Slide from Bill Kohl

The Writing Team The Writing Team (the « (the « ChartistsChartists ») »)

Slide from Fiona Bull

Final Charter:6 pages / 5 key sections

Slide from Fiona Bull

A Framework for Action

Slide from Fiona Bull

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

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

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

Latin American Launch: Oct 2010

AGITA MUNDO MEETING Slide from Fiona Bull

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

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

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

All countries should develop a national physical

activity plan

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.

U.S. National Physical Activity PlanU.S. National Physical Activity Plan

www.physicalactivityplan.org

American Academy of Pediatrics American Medical Assoc. American Diabetes Assoc.

•Mass Media•Public Health•Education•Healthcare•Volunteer and Non-Profit Organizations•Transportation, Urban Design, Comm. Plan.•Business and Industry•Parks, Recreation, Fitness, and Sports

Content of the PlanContent of the Plan

• 5 Overarching Strategies• Sector-specific Strategies & Tactics

• 52 Strategies• 215 Tactics

Upcoming international activities related to physical activity and

public health

The UnitedNations is interestedin non-communicablediseases

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

Sydney Australia 201231st October – 3rd November

Slide from Adrian Bauman

Time for the Pop Quiz

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

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

SOURCE: Harris 2008 Int J ObesityCourtesy of Katherine Flegal

SOURCE: Harris 2008 Int J ObesityCourtesy of Katherine Flegal

SOURCE: Harris 2008 Int J ObesityCourtesy of Katherine Flegal

SOURCE: Harris 2008 Int J ObesityCourtesy of Katherine Flegal

Courtesy of Katherine Flegal

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%

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--

Thank youQuestions?