Facts and Feelings about Disease Prevention and Health Promotion - Physical Activity

Lack of physical exercise not only contributes to risk for heart disease but also increases the risk of colon cancer, diabetes, high blood pressure, osteoporosis, and arthritis. Regular physical activity also is linked to improved mental health, reducing mild anxiety and depression. Health professionals agree that even moderate amounts of exercise, such as walking thirty minutes per FIGURE 10.4
Age- and sex-adjusted percent of persons of all ages who assessed their own health as being excellent or very good, by race/ethnicity, January–June 2003 FIGURE 10.5
Percent of adults who reported eating fewer than five servings of fruits and vegetables per day, by sex, 2000 day, five times per week (as opposed to strenuous physical activity such as running), provides substantial health benefits. Despite the mounting evidence demonstrating the potent disease prevention and health promotion benefits FIGURE 10.6
Percentage of children ages 19 to 35 months with the 4:3:1:3 combined series of vaccinations, by poverty status, 1996–2001 of exercise, the CDC found that 60 percent of American adults do not exercise enough to reap health benefits and 25 percent do not exercise at all during their leisure time.

Physical activity is the first leading health indicator of Healthy People 2010, the source document that serves as a blueprint for improving the health status of Americans. Healthy People 2010 defines regular leisure-time physical activity as performing light to moderate physical activity for thirty minutes or longer, five or more times per week, or vigorous physical activity for twenty minutes or longer, three or more times per week. Adults responding to the NHIS surveys were given this definition of regular leisure-time activity.

Figure 10.8 shows a slow, steady increase in the percent of adults age eighteen and older who engage in regular leisure time activity, from 29.9 percent in 1998 to 32.5 percent in 2002. The percent of adults who participated in regular leisure-time physical activity declined with advancing age, and women in every age group were less likely than men to report physical activity. (See Figure 10.9.) When the survey results were adjusted for age and sex, regular leisure-time physical activity was highest among whites (35.9 percent), followed by African American (26.5 percent) and Hispanic (24.7 percent) adults. (See Figure 10.10.)

The President Makes Physical Fitness a Top Priority for the Nation

Concern about Americans' inactivity prompted President George W. Bush to announce on June 20, 2002, a federal effort to improve fitness levels among adults and children. He called it The President's Challenge. In a campaign that recalled a similar one launched by President John F. Kennedy four decades earlier, President Bush appointed a presidential council and issued an executive order along with twelve pages of recommendations on how Americans could improve their health and fitness. The president urged Americans to follow his example of running three miles per day and lifting weights to stay fit. His recommendations also included warnings about the health risks of obesity, smoking, and alcohol and drug abuse.

As part of President Bush's encouragement to get fit and healthy, the President's Council established an interactive Web site (www.presidentschallenge.org) that allows users to choose their age category, fitness level, and activity preference. An interactive activity log and award points also are featured for motivation.

Physical Activity Benefits Older Adults Too

Until recently, older adults were not advised by health professionals to exercise regularly because it was believed that the risks, such as heart attack, falls, and muscle injuries, outweighed the benefits of improved muscle tone, flexibility, circulation, and mood. Historically, an exercise stress test to detect cardiovascular disease was considered an essential part of a pre-exercise medical evaluation. During 2000 researchers from the Yale University School of Medicine Department of Epidemiology and Public Health concluded that not all older adults require an exercise stress test before beginning physical

TABLE 10.1
Annual percent of adults aged 50 years and over who had received an influenza vaccination during the past 12 months, by age group and sex, 1997–2002

Age and sex	1997	1998	1999	2000	2001	2002
	Percent
50–64 years
Total	31.9	33.1	34.1	34.6	32.2	34.0
Men	28.0	29.0	30.5	31.9	30.3	30.7
Women	35.5	37.0	37.4	37.2	34.0	37.2
65 years and over
Total, crude	63.2	63.3	65.7	64.4	63.1	65.7
Total, age-adjusted	63.1	63.3	65.1	64.6	63.2	65.9
Men	64.8	63.7	67.2	66.0	64.8	67.1
Women	62.1	63.0	64.6	63.3	61.8	64.7
Notes: Respondents were asked if they had received a flu shot during the past 12 months. Responses to this question cannot be used to determine when during the preceding 12 months the subject received the flu shot. In addition, estimates are subject to recall error, which will vary depending on when the question is asked because the receipt of an influenza vaccination is seasonal. The analyses excluded those with unknown influenza vaccination status (about 1% of respondents each year).
SOURCE: Adapted from "Table 4.1. Annual Percent of Adults Aged 50 Years and over Who Had Received an Influenza Vaccination during the Past 12 Months, by Age Group and Sex: United States, 1997–2002," in Early Release of Selected Estimates Based on Data from the January–June 2003 National Health Interview Survey, Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD, December, 2003 [Online] http://www.cdc.gov/nchs/data/nhis/earlyrelease/200312_04.pdf [accessed February 1, 2004]

activity. Dr. Thomas M. Gill and his colleagues published their findings in the July 19, 2000, issue of the Journal of the American Medical Association.

The researchers found that although vigorous exercise briefly increases risk of heart attack among older people, "regular exercise and physical activity may actually reduce the overall risk, possibly through improvements in cardiac risk factors and overall fitness." Further, the researchers believe, "In addition to being expensive and of unproven benefit, the current policy of routine exercise stress testing potentially could deter many older persons from participating in an exercise program."

Aerobic activity does not need to be strenuous to be healthful, according to the CDC. Older adults also can benefit from strength training—stronger muscles help reduce the risk of falling and improve the ability to perform routine tasks of daily life.

OLDER ADULTS SHOULD ALSO EXERCISE CAUTION.

To ensure safety the researchers advise older adults to start with low-intensity activities, such as balance exercises, tai chi, self-paced walking, and lower-extremity resistance training. They favor gradually increasing the intensity and duration of exercise. Older exercisers who fare well in low-intensity activities may progress to more intensive training, such as fast walking, swimming, or bicycling. Still, before beginning intensified exercise programs, the blood pressures and heart rates of older adult exercisers should be monitored by health care practitioners.