PHYSICAL ACTIVITY AND IT’S IMPACT ON HEALTH IN DIFFERENT AGE GROUPS
(From WHO, Regional Committee for Europe 65th Session,Sept.2015),
(Physical activity strategy for WHO European Region 2016-2025)
Physical activity is one of the most basic human functions. It is an important foundation of health throughout life. Its known health benefits include a reduced risk of cardiovascular disease, hypertension, diabetes and certain forms of cancer; it also has an important role in the management of certain chronic conditions. In addition, it has positive effects on mental health by reducing stress reactions, anxiety and depression and by possibly delaying the effects of Alzheimer’s disease and other forms of dementia (A,B,C,D). Furthermore, physical activity is a key determinant of energy expenditure and is therefore fundamental to achieving energy balance and weight control. Throughout childhood and adolescence, physical activity is necessary for the development of basic motor skills, as well as musculoskeletal development. Furthermore, physical activity is also embedded in the United Nations Convention on the Rights of the Child. In adults, physical activity maintains muscle strength and increases cardiorespiratory fitness and bone health. Among older people, physical activity helps to maintain health, agility and functional independence and to enhance social participation. It may also help to prevent falls and assists in chronic disease rehabilitation, becoming a critical component of a healthy life.
There are many different forms, kinds and levels of intensity of physical activity. These include fundamental movement skills, active play, leisure activities, such as walking, dancing, hiking and biking, sports and structured exercise. Physical activity can take place in a range of domains and settings, such as in “green” or “blue” spaces (water landscapes), at school, in the workplace, during transport from place to place, at home or as part of the activities of daily living, such as gardening or household chores. Different forms of physical activity may be more or less relevant to certain social groups or genders and at different stages of life.
WHO recommends that adults, including older people, undertake at least 150 minutes of moderate-intensity aerobic physical activity each week. The existing recommendations emphasize the health benefits of moderate-intensity activities and that the recommended levels can be accumulated in relatively short bouts of activity at a time. Children and young people should accumulate at least 60 minutes of moderate- to likely to provide additional health benefits both for adults and for children. People that are currently inactive should aim to meet the recommendations. However, it is recognized that small amounts of physical activity are better than none. Groups that cannot achieve the recommended amounts of physical activity due to existing health conditions should be as physically active as their abilities and conditions allow, including low-intensity physical activity. Recent research has also suggested that people should reduce extended periods of sedentary behaviour, such as sitting at work or watching television, since these may constitute an independent risk factor for ill health regardless of other activity levels. Especially for the elderly, physical activity is important for strength training and balance, in particular to prevent falls.
Despite the known benefits of physical activity, there is a worldwide tren towards less total daily physical activity. Globally, one third of adults do not achieve the recommended levels of physical activity. In Europe, estimates indicate that more than one third of adults are insufficiently active (3). While there are some continuing challenges in terms of the validity and comparability of data on levels of physical activity across Europe, recent figures from member States of the European Union (EU) indicate that six in every 10 people above 15 years of age never or seldom exercise or play a sport and more than half never or seldom engage in other kinds of physical activity, such as cycling, dancing or gardening (4). At the same time, a high proportion of adults in Europe spend more than four hours a day sitting, which could be a contributing factor to sedentary lifestyles (3).
As a consequence, physical inactivity has become a leading risk factor for ill health:
- 1 million deaths (about 10% of the total) and
- 3 million disability-adjusted life years lost per year in the WHO European Region are attributable to physical inactivity.
- It is estimated to cause 5% of the burden of coronary heart disease,
- 7% of type 2 diabetes,
- 9% of breast cancer and 10% of colon cancer (5).
Rising rates of overweight and obesity have also been reported in many countries in the Region during the past few decades.
The statistics are disturbing: in 46 countries (accounting for 87% of the Region),
- More than 50% of adults are overweight or obese;
- In several of those countries the rate is close to 70% of the adult population.
- Overweight and obesity are also highly prevalent among children and adolescents, particularly in southern European countries.
Physical inactivity has been identified as contributing to the energy imbalance that leads to weight gain. Collectively, physical inactivity not only has substantial consequences for direct health-care costs but also causes high indirect costs due to increased periods of sick leave, work disabilities and premature deaths. For a population of 10 million people, where half the population is insufficiently active, the overall cost is estimated to be €910 million per year (6).
Different groups have diverse needs and challenges with regard to the promotion
of physical activity. This evidence needs to be taken into account by policy-makers.
The increasing rates of physical inactivity among children and adolescents are alarming.
- Only 34% of European adolescents aged 13–15 years are active enough to meet the current guidelines (E).
- This contributes to rising rates of overweight and obesity among children in Europe, particularly among children from low socioeconomic backgrounds. Data from the WHO European Childhood Obesity Surveillance Initiative (COSI) show that, in some countries, almost 50% of eight-year-old boys are overweight and more than 25% are obese (7). In most
- European countries, physical activity levels begin to decline significantly among young people aged 11–15 years,
- In particular among girls of that age group (in all WHO European Region countries that were part of the Health Behaviour in School-aged Children study more than 86% of 15-year-old girls are considered physically inactive).
Research also indicates that adults and older people from disadvantaged backgrounds, as well as some minority ethnic groups, engage in less physical activity and are harder to reach for the promotion of physical activity than others.
People with disabilities are another particularly vulnerable group, with an elevated risk of health problems associated with physical inactivity. In addition, there are significant disparities in physical activity levels among Member States of the European Region, especially between the north and south and the east and west.
Maintaining sufficient levels of physical activity is becoming more and more difficult, as most daily environments have changed significantly in recent years. The causes of physical inactivity are predominantly the result of systemic and environmental factors, which have made daily living and working environments increasingly sedentary. Greater distances between homes, workplaces, shops and places for leisure activities have increased the use of cars and led to a decline in walking and cycling.
Simultaneously, in many contexts, road safety remains a concern, whereby it is, or is perceived to be, not safe to engage in active transport.
Children and adolescents spend more time in school or day-care settings than ever before; academic demands are increasing, which can reduce the time dedicated to physical education and active play.
Other factors that are believed to have influenced levels of physical activity include the quality of neighbourhood environments, increasing sedentary forms of entertainment, such as screen-based activities, and technical aids, such as elevators (6).
In July 2013, ministers of countries of the European Region adopted the Vienna Declaration on Nutrition and Noncommunicable Diseases in the Context of Health 2020 (7), which, for the first time, called for the development of a stand-alone physical activity strategy for the European Region. This clear mandate was further strengthened by the 63rd session of the WHO Regional Committee for Europe in Çeşme Izmir, Turkey, where Member States endorsed the Vienna Declaration in resolution EUR/RC63/R4 (8).
Reducing the level of physical inactivity in Europe would lead to substantial benefits for the health of the population, as well as benefits in other areas. It is estimated that the average life expectancy could be increased by 0.63 years in the European Region if physical inactivity were to be eradicated (5). There could be improvements in the environment, the individual quality of life, community social participation and resilience. More walking and cycling could help reduce greenhouse gas emissions, air pollution, noise and congestion. In addition, increased physical activity could increase economic development in a number of sectors, including manufacturing, transport, health services, sports and tourism. As an example to illustrate the potential impact, a comparison of 56 major cities in Europe and North America suggests that more than 76 000 new jobs could be created in these cities alone if the level of cycling could be increased to that of Copenhagen, Denmark (21). It is recognized that Member States will need to tailor their own responses to their specific national context.
Inspired by Health 2020, the Regional Office’s vision is for governments in the European Region to work across sectors, levels and countries and with stakeholders to
enable all citizens to have better and longer lives owing to a lifestyle that incorporates regular physical activity.
The physical activity strategy aims to inspire governments and stakeholders to work towards increasing levels of physical activity among all citizens of the European
- promoting physical activity;
- reducing sedentary behaviours;
- ensuring an enabling environment that supports physical activity through engaging and
safe built environments, accessible public spaces and infrastructure;
- providing equal opportunities for physical activity regardless of gender, age, income,
education, ethnicity or disability; and
- removing barriers to and facilitating physical activity.
1.Global action plan for the prevention and control of noncommunicable diseases2013–2020. Geneva: World Health Organization; 2013(http://www.who.int/nmh/publications/ncd-action-plan/en/, accessed 12 June2015).
(2) World Health Assembly resolution WHA 66.10 on follow-up to the PoliticalDeclaration of the High-level Meeting of the General Assembly on the Preventionand Control of Non-communicable Diseases. Geneva: World Health Organization;2013 (http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R10-en.pdf, accessed12 June 2015).
(3) Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U. Globalphysical activity levels: surveillance progress, pitfalls, and prospects. Lancet.2012;380(9838):247–257. doi: 10.1016/S0140-6736(12)60646-1.
(4) Sport and physical activity report. Special Eurobarometer 412. Brussels: EuropeanCommission, Directorate-General for Education and Culture; 2014.doi:10.2766/73002.
(5) Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT. Effect ofphysical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380(9838):219–229. doi:10.1016/S0140-6736(12)61031-9.
(6) Steps to health: a European framework to promote physical activity for health.Copenhagen: WHO Regional Office for Europe; 2007(http://www.euro.who.int/en/health-topics/disease-prevention/physicalactivity/publications/2007/steps-to-health.-a-european-framework-to-promotephysical-activity-for-health-2007, accessed 12 June 2015).
(7) Wijnhoven TM, van Raaij JM, Spinelli A, Starc G, Hassapidou M, Spiroski I et al.WHO European Childhood Obesity Surveillance Initiative: body mass index andlevel of overweight among 6–9-year-old children from school year 2007/2008 toschool year 2009/2010. BMC Public Health. 2014;14:806. doi: 10.1186/1471-2458-14-806.
(8) Vienna Declaration on Nutrition and Noncommunicable Diseases in the Contextof Health 2020. Copenhagen: WHO Regional Office for Europe; 2013(http://www.euro.who.int/en/media-centre/events/events/2013/07/viennaconference-on-nutrition-and-noncommunicable-diseases/documentation/viennadeclaration-on-nutrition-and-noncommunicable-diseases-in-the-context-of-health-
2020, accessed 12 June 2015).
(9) WHO Regional Committee for Europe resolution EUR/RC63/R4 on the ViennaDeclaration on Nutrition and Noncommunicable Diseases in the Context ofHealth 2020. Copenhagen: WHO Regional Office for Europe; 2013(http://www.euro.who.int/en/about-us/governance/regional-committee-foreurope/past-sessions/sixty-third-session/documentation/resolutions-anddecisions/
eurrc63r4-vienna-declaration-on-nutrition-and-noncommunicablediseases-in-the-context-of-health-2020, accessed 12 June 2015).
(10) Action plan for implementation of the European strategy for the prevention andcontrol of noncommunicable diseases 2012–2016. Copenhagen: WHO RegionalOffice for Europe; 2011 (EUR/RC61/12; http://www.euro.who.int/en/aboutus/ governance/regional-committee-for-europe/past-sessions/sixty-firstsession/documentation/working-documents/wd12-action-plan-forimplementation-of-the-european-strategy-for-the-prevention-and-control-ofnoncommunicable-diseases-20122016, accessed 12 June 2015).
(11) Global strategy on diet, physical activity and health. Geneva: World HealthOrganization; 2004(http://www.who. int/dietphysicalactivity/strategy/eb11344/en/, accessed 12 June2015).
(12) Global recommendations on physical activity for health. Geneva: World HealthOrganization; 2010(http://www.who.int/dietphysicalactivity/publications/9789241599979/en/,accessed 12 June 2015).
(13) Parma Declaration on Environment and Health. Copenhagen: WHO Regional Office for Europe: 2010 (http://www.euro.who.int/en/healthtopics/noncommunicable-diseases/cancer/publications/2010/parma-declarationon-environment-and-health, accessed 12 June 2015).
(14) Paris Declaration on THE PEP. Fourth High-level Meeting on Transport, Healthand Environment, Paris, France, 14–16 April 2014. United Nations EconomicCommission for Europe, WHO Regional Office for Europe (http://www.unece.org/fileadmin/DAM/thepep/documents/Déclaration_de_Paris_EN.pdf, accessed 12 June 2015).
(15) European food and nutrition action plan 2015–2020. Copenhagen: WHO RegionalOffice for Europe; 2014 (EUR/RC64/14; http://www.euro.who.int/en/aboutus/governance/regional-committee-for europe/64thsession/documentation/ workingdocuments/ eurrc6414-european-food-andnutrition-action-plan-2015-2020, accessed 12 June 2015).
(16) A healthy city is an active city: a physical activity planning guide. Copenhagen:WHO Regional Office for Europe; 2008 (http://www.euro.who.int/en/healthtopics/disease-prevention/physical-activity/publications/2008/healthy-city-is-anactive- city-a-a-physical-activity-planning-guide, accessed 12 June 2015).
(17) Council recommendation on promoting health-enhancing physical activity across sectors. Brussels: Council of the European on; 2013(http://ec.europa.eu/sport/library/documents/hepa_en.pdf, accessed 12 June 2015).
(18) Council conclusions on nutrition and physical activity. Brussels: Council of the European Union; 2014 (http://www.consilium.europa.eu/uedocs/cms_data/docs/pressdata/en/lsa/143285. pdf, accessed 12 June 2015).
(19) EU action plan on childhood obesity 2014–2020. Brussels: European Union; 2014 (http://ec.europa.eu/health/nutrition_physical_activity/docs/childhoodobesity_acti onplan_2014_2020_en.pdf, accessed 12 June 2015).
(20) The Toronto Charter for Physical Activity: A Global Call for Action. International Society for Physical Activity and Health: Global Advocacy for Physical Activity; 2010 (http://www.ispah.org/AcuCustom/Sitename/DAM/132/Charter-ENGUS_ LOW2.pdf, accessed 12 June 2015).
(21) Unlocking new opportunities: jobs in green and healthy transport. Copenhagen: WHO Regional Office for Europe; 2014
(http://www.euro.who.int/en/publications/abstracts/unlocking-new-opportunitiesjobs- in-green-and-healthy-transport, accessed 12 June 2015).
(22) Growing older – staying well: ageing and physical activity in everyday life. Geneva: World Health Organization; 1998 (WHO/HPR/AHE/98.1;