You Moving Towards Health?
Robert M. Otto
the World Health Organization health is defined as "a state
of complete physical, mental, and social well-being, and not merely
the absence of disease or infirmity". Since the inception of
this definition in 1948, our perspective on health has evolved to
include individual responsibility for our well being through the
practice of health-promoting lifestyle behaviors. These behaviors
are directed toward an improvement in quality of life and the reduction
in the risk of premature disease. Obviously health is far from elusive,
but it is labile. The interdependence of mental, physical and social
components of health is depicted as a continuum with positive lifestyle
habits contributing to optimal health on one end and premature death
or the absence of health on the other extreme. Premature death is
often preceded by a prolonged duration of negative lifestyle habits.
are living longer, we still rank twenty-fifth in life expectancy
around the world. The world leader in life expectancy is Japan.
Most European countries also surpass the life expectancy of people
in the United States. Longevity is merely one measure of life. More
importantly, we should be concerned with the proportion of quality
life versus unhealthy life. Currently Americans enjoy approximately
83% or 64.2 years of life in a healthy state. The remaining 17%
are spent in less than optimal health because of chronic or acute
disease and illness. It is estimated that more than 70% of all premature
deaths as well as the decline in one's own health are attributed
to individual health behaviors and environmental factors.
that one effective intervention for developing and maintaining health
is a chronic engagement in physical activity and/or exercise. Ample
data support the impact of exercise on quality of life by enhanced
glucose control, reduced blood pressure, attenuated osteopenia and
osteoporosis, enhanced body composition and a lowered risk of cardiovascular
disease. In an analysis of the relative risk of all-cause-mortality,
a low fitness level (sedentary lifestyle) is of greater risk than
cigarette smoking, high blood pressure, high cholesterol, or obesity.
One who expends less than 1000 kcalories per week in physical exertion
beyond their normal resting metabolic rate is considered sedentary.
Currently, approximately 40% of Americans engage in no leisure physical
activity and another 20% move sparingly. Hence, over 60% of the
United States population is classified as sedentary. This number
parallels the 61% prevalence of overweight and obesity in American
adults. It can be argued that Americans are the heaviest people
in the world. Over the past thirty years adults in the US have increased
their overweight/obesity prevalence almost 28%, while the youth
of America has increased more than 200%. The statistics with children
are alarming because the percentage of obese preschool, school-age,
and adolescents who become obese adults are 33%, 50%, and 80%, respectively.
The trends show no signs of abatement.
acutely aware of overweight/obesity since at any one time approximately
40% report being on a diet. Although the incidence of overweight
and obesity is often noted due to physical appearance, the danger
is far greater than expected with a high risk of hypertension, hyperlipdemia,
gallstones, ostoeathritus, diabetes, metabolic syndrome, cancer,
and premature death.
The cause of
this epidemic involves cultural, lifestyle, environmental, and genetic
factors. Despite all of these factors, experts agree that a caloric
consumption in excess of caloric expenditure is the simple equation
leading to the epidemic. The popularity of fast foods and the marketing
of "super size" portions has increased caloric intake
of a typical fast food meal by more than 150% in the past thirty
years. Additionally, convenient foods often contain portions of
high density calories. Conversely, energy expenditure has decreased
dramatically. As a mode of transportation, walking trips have decreased
from 9.3% to 5.5%, while automobile trips have increased from 84%
to 89% since 1977. Sedentary leisure activities such as computer
use and television viewing now occupy almost four hours of a typical
American's day. In children, the prevalence of obesity is 12% if
watching less than two hours of television per day, but rises to
34% for children viewing five or more hours per day. In adults,
the risk of type 2 diabetes is proportional to the amount of television
watching with a two-fold increase in risk for the individual watching
3-6 hours/day versus the individual viewing one hour or less/day.
of physical inactivity are exemplified in the application to the
overweight/obesity epidemic. However, the role of physical activity
is more far reaching than this. Physical activity is inversely associated
with the risk of all-cause and cause-specific mortality, as well
as the incidence and severity of several chronic morbidities. The
quantity and quality of the physical activity is still under investigation.
In our Human Performance Laboratory, we are directly involved with
the role of physical activity and exercise on the health continuum.
This leads to diverse research studies that over the past year include
the evaluation of bone density and body composition as related to
exercise, the energy cost of specific exercise activities (vinyasa
yoga and salsa aerobics), the training of senior citizens to enhance
balance, and a twelve week training study to compare the impact
of Pilates versus resistance exercise on conditioned females. Data
from our laboratory, in conjunction with studies from a global network
of exercise science laboratories contribute to the development of
public health recommendations for physical activity and exercise.
As associate editor of the American College of Sports Medicine's
Guidelines for Exercise Testing and Prescription, 7th edition (in
press), I can assure you that a new recommendation for adequate
physical activity will be an expenditure of 2000 kcalories/week.
Are you moving in the direction of enhancing your health?