Module 1

Week #1

Kinesiology

Incorporates: exercise physiology, movement science, sport psychology

Epidemiology

The study of the distribution of causes of health and disease.

Population observational studies: PA and health outcomes.

Exercise Physiology

Study of how the body responds to physical activity

“The study of how the body structures and functions are altered by acute bouts of exercise or physical activity, how the body adapts to the chronic stress of physical training, and how it maintains homeostasis” – Exercise is Medicine (Kohl & Murray, 2012, p20)

Physical Activity

“Bodily movement that is produced by the contraction of skeletal muscle and that substantially* increases energy expenditure”

To a metabolic equivalent of 3.5 METS and over (e.g. brisk walking pace) (where resting MET rate=1)

Physical activity intensities

Light (2.0-3.4 METs)

Moderate (3.5-5.9 METs)

Vigorous (6.0+ METs)

What is ‘incidental’ activity?

Unstructured, unplanned. Primary purpose is not to achieve gains in physical fitness. E.G. Walking to letter box to post letter, walking to a shop rather than driving.

Active, insufficiently active, inactive

Active – meeting guidelines (participating in >150 min/weekof PA)

Insufficiently active – participating in 1 – 150 minutes.

Inactive – participating in NO physical activity

Physical Activity Guidelines for Adults (age 18-64)

Accumulate 150 to 300 minutes of moderate intensity physical activity or 75 to 150 minutes of vigorous intensity physical activity, or an equivalent combination of both moderate and vigorous activities, each week.

Formally Obese Individuals Guidelines

60-90 min of PA to prevent further weight gain in formally obese individuals.

What is ‘health-enhancing physical activity’?

At least 10 min duration

At least moderate duration

150 – 300 minute over 5 days/week

What is ‘sedentary behaviour’?

Energy expenditure is very low – ≤1.5 METS

Sitting or lying is the dominant mode of posture

Previous recommendations (pre 1995) ACSM, 1978

Frequency: 3‐5 days/week

Intensity: Moderate to high (60 – 90% of HRR)

Time: 20 – 60 mins

Type: Activity that uses large muscle groups, is rhythmical and aerobic in nature.

Revised PA recommendations (Pate et al., 1995)

Moderate amount of PA provided health benefits

Short bouts of activity may be ok (e.g., 10 min)

Total amount of energy expenditure is important (200kcals per day – 1000kcals per week) which equates to approximately 30 min/day of mod PA

Module 2 + Seminar 3

Week #2 & 3

Essentially, exercising more hours per week and expending more calories trends towards decreasing the likelihood of early death.

There have not been randomised clinical trials (probably because it would be a 20-60 year study to wait until a person dies)

Cardiovascular Disease & Coronary Heart Disease

CHD is the slow build of fatty deposits (plaque) on the inner walls of the arteries that supply blood to the heart. This creates a narrowing that restricts blood flow. A heart attack usually begins when an area of plaque cracks – a clot is formed over the damaged area that blocks the flow of blood to the heart. If the artery remains blocked the lack of blood permanently damages the area the heart muscle supplied by that artery which leads to a heart attack.

CHD can also lead to heart failure. Which is when the heart muscle becomes to weak to pump blood.

Stroke is caused by bleeding or blockages of blood in the brain.

Hypertension is considered a CV disease. A systolic BP 140mmhg+ and/or a diastolic BP 90mmhg+

Longitudinal Study

Participants are followed over a long period of time – repeated observations of the same variables over long periods of time, often many decades.

Meta-Analysis

A quantitative systematic review of the scientific literature in which the results of many studies are combined. Allows for more accurate estimation of the effects.

Relative Risk (RR)

The probability that the exposed group will develop a condition/disease compared to the non-exposed group.

Below 1 = reduced risk. Above 1 = higher risk. RR of 1 = no increased risk.

Cancer

From http://www.cancer.org.au/about-cancer/what-is-cancer/facts-and-figures.html.
Accessed 24 February 2015

https://video.deakin.edu.au/media/t/0_ws11uf8f

Odds Ratio Statistic

IS a a measure of relative strength of an association.

Odds ratio is a measure of association between an exposure (physical activity) and an outcome (disease).

Examines the odds of the disease/outcome in one group compared to the odds pf disease / outcome in another group.

The odds ratio represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure.

95% Confidence Interval

Determines whether the association is SS or meaningful. It is a measure of the degree of confidence that the observed relative risk is meaningful.

“The 95% CI gives an estimate of the lowest and highest values that might be expected 95 times if the study was repeated 100x.”

“In frequentist statistics, a confidence interval (CI) is a type of interval estimate (of a population parameter) that is computed from the observed data.”

Confidence interval is statistically significant if it doesn’t cross through 1.00. E.G. 0.84-1.25 is NOT statistically significant but a figure like 0.60-.94 AND 1.2-1.45 are both data ranges that are statistically significant because they don’t cross 1.00.

95% Confidence Interval

Indicates that we’re 95% confident that the true value of the population would fall in this interval.

If repeated samples were taken and the 95% confidence interval was computed for each sample, 95% of the intervals would contain the population mean. A 95% confidence interval has a 0.95 probability of containing the population mean.

Continuous Measures

Continuous measures are on a scale and have almost any numerical value.

E.G. BMI, Height and weight. Minutes of PA per week. Blood pressure.

Categorical Measures

Breaking down into different categories of weight: e.g. average weight, overweight, obese, underweight. Active vs inactive. 18-25 26-35 etc.

Inferential Statistics

Helps determine how confident we are that what we have observed in our samples is true and accurate of the wider population.

Statistical Significance

Determines whether the behaviour observed is a ‘significant’ result (a genuine observation) or whether it is a ‘not significant’ result (observation due to chance).

How do we determine statistical significance?

Probability range 0.0-1.0 (0 = 0% probability will occur / 1.0 = 100% probability will occur)

p = probability

Significance set as 0.05

p value < 0.05 = statistically significant

> 0.05 = not statistically significant

p‐value

Probability of getting a test statistic at least as extreme as the one observed

p value < 0.05 = statistically significant

What is a correlation?

Tells us what happens to a dependent variable when we look at an independent variable and whether the associated is positive or inverse and how strong the association is.

Explains the relationship between 2 variables. Whether they be positively or negatively (inverse) correlated.

Used with continuous data.

Correlation Coefficient (r)

r = 1.0 = perfect correlation

r = 0.0 = no correlation

r = < 0.3 weak correlation

‘+’ or no sign indicates positive association (e.g. r=0.87)

‘‐’ indicates negative association (e.g. r=‐0.45)

Measured between between ‐1 and 1

Weak correlation <0.3, moderate 0.3‐0.5, strong 0.5+

Any correlation that is not significant = no correlation

Statistics

Descriptive Statistics

Statistics used to describe the population (e.g., means,
proportions)

Aim to describe, show or summarize data in a meaningful way. i.e., the mean age of participants was 56 years; i.e., 40% of the population were sufficiently active.

Inferential Statistics

Statistics used to infer information about the population from
the sample;

Used to make judgments of the probability that an observed difference between groups is a dependable one or one that might have happened by chance in this study.

Diabetes

Diabetes Mellitus –a chronic disorder characterised by a deficiency of insulin secretion or insulin action, which impairs the body’s ability to regulate the levels of blood glucose.

Type 1 Diabetes

Autoimmune disorder

Body unable to produce enough insulin

Type 2 Diabetes

Metabolic disorder

Insulin resistance (for a given amount of insulin less glucose is cleared into cells) / Insufficient insulin produced by pancreas

Burden Of Diabetes

Diabetes to be leading cause of burden of disease in the next five years

1.5 million Australians have diabetes

At least 2 million Australians have pre-diabetes and are at high risk of developing type 2 diabetes

THAT’S 3.5 MILLION!

Total annual cost of type 3 diabetes is $14.6 billion

Levels of Prevention

Primary Prevention: Prevents onset of disease in healthy populations (E.G. PA for preventing disease in healthy pops)

Secondary Prevention: Control disease progression (E.G. screening procedures)

Tertiary (treatment): Minimising the risks associated with disease and maintained QoL (E.G. promoting PA)

PA & Primary Prevention of Diabetes

Cohort studies have reported:

In men aged 45-55, for each 500kcal/week increment, the risk decreased by 6% (Helmrichet al., 1991)

In women aged 34-59, vigorous PA at least once/week showed a 16% reduction in risk (Manson et al., 1991)

In men aged 40-84, vigorous PA at least once/week showed a 29% reduction in risk (Manson et al., 1992)

Physical Activity & Weight Control

Obesity: a condition of excessive fat accumulation to the extent that health is impaired

Limitations of measuring BMI: Doesn’t distinguish the proportion of weight due to fat or muscle.

Burden of Overweight/Obesity

3 in 5 Australian adults are overweight / obese (AIHW)

Associated with increased risk of:

Premature mortality, CVD, type 2 diabetes, osteoarthritis, chronic back pain, asthma, certain cancers (Aniset al., 2010)

Globally it is thought that 937 million adults are overweight and 396 million are obese (Kelly et al., 2008)

Changes in Physical Activity

Between 1970 and 2000 energy intake remained relatively stable in American children and youth and increased slightly in American adults. Over that same time period leisure time physical activity decreased slightly in children and youth and increased slightly in adults. (Briefel & Johnson, 2004)

PA & Weight Loss Maintenance (Tertiary Prevention)

‘There is compelling evidence that the prevention of weight gain in formerly obese individual requires 60 –90 minutes (a day) of moderate intensity activity’ (Saris et al., 2003)

For prevention of weight gain, and weight loss more than 150 minutes of PA is required

Physical Activity & Mental Health

Common Mental Health Disorders Are Characterized As…

Mood disorders (depression, bipolar, manic-depressive)

Anxiety (generalised anxiety disorder, panic attacks)

A major depressive disorder is diagnosed when a person experiences at least five of the nine symptoms over the same two week period (Am Psych Ass, 2000a)

Symptoms include, depressed mood, marked loss of interest or pleasure, significant weight loss/gain, insomnia/hypersominia, psychomotor agitation or retardation, fatigue, feelings of worthlessness, diminished ability to think or concentrate, recurrent thoughts of death.

A generalised anxiety disorder is a condition categorised by persistent and generalised symptoms of anxiety, resulting from worry. It is diagnosed when symptoms are present most days for several weeks at a time and usually for several months (WHO, 1992). Symptoms include apprehension, motor tension, autonomic activity

Burden of Disease

In 2007 (4102.0 Australia Social Trends, 2009)

45% of Australians had at some point in their life experienced at least one mood disorder

Anxiety disorders affected 14% of people aged 16 –85 (2007)

Mood disorders affected 6.2% of people aged 16 -85 (2007)

Prevention of Depression

150+ observational studies show associations between PA and depression (Buckworth& Dishman, 2002)

Approx 85% of studies show adults who participate in PA have a lower risk of developing depression.

Treating Depression

Evidence from RCTs indicates that exercise reduces depression symptoms among people diagnosed with depression (Herring et al., 2012; Lawlor& Hopker, 2001)

Changes represent about 5 to 10 points on standard self-rating scales of depression

Typically studies have used walking or running BUT resistance training also appears to have a positive effect

PA appears comparable to psychotherapy and drug therapy for treating mild to moderate depression BUT its effect occur later than drug therapy

Physical Activity Vs Antidepressants

3 groups showed similar decreases in depression which were statically and clinically significant. Only difference was the medication group exhibited the fastest initial response.

A follow up of this study showed the exercise group was more likely to have fully recovered and less likely to relapse into depression 6 months after treatment.

Physical Activity & Anxiety

Prevention: Only three cohort studies have reported that PA is associated with a 25-40% reduction in the risk of anxiety disorder (Beard et al., 2007; Sanchez-Villegas et al., 2008; Jonsdottiret al., 2010)

Treatment: Generally studies show reduction in anxiety regardless of training intensity or changes in aerobic capacity (Broockset al., 1998; Herring et al., 2012; Meromet al., 2008)

Biological Mechanisms

(Raglin& Wilson, Bouchard, Blair and Haskell -Physical Activity and Health)

Biological:

Endorphins: A common held belief is that exercise can stimulate the production of endorphin’s. This has lead to the beleif of the popular but unsubstationted phenonman known as ‘runners high’. Research has not shown that endorphine levels following exercise are assocaited with mood change.

Thermogenic: The thermogenic hypothesis proposes that changes in body temp that occur during exercise are assocaited with central and peripheral neuron activity in the brain as well as decreased muscle tension, thereby enhancing mood.

Monoamine: The monoamine hypothesis proposes PA may alter mood states by positively impacting neurotransmitters including norepinerphrane, dopamine and serotonin. It is at this time not possible to accuratly measure the levels of of these hormones in the brain to confirm this.

Psychosocial:

Distraction: From anxiety provoking thoughts and provides a psychological time out.

Mastery: May also produce feelings of achievement and personal mastery resulting from the successful completion of a task.

Social support: May enhance mood.

Module 3

Week #3 & 4

Module 3.1- Understanding Physical Activity: Correlates and Theory

What Are Correlates

Why Study Correlates?

How Do We Study Correlates?

Cross-sectional or correlational studies -“correlates” to identify correlates of PA.

This gives info on the associations or correlates between PA and a particular correlate but it doesn’t give us any info on the cause and effect or the direction of the relationship because its essentially a snapshot in time.

Seen as the weakest form of evidence.

Longitudinal Cohort Ctudies

Provide a predictive value of ‘correlate’ (predictor/correlate comes before behaviour). We can see if they correlate comes before the behaviour or whether the beaviour comes before the correlate. We can see the direction of the relationship.

Experimental Studies (e.g. interventions, RCT)

Provide an intervention and observe if there’s any change in PA and behaviour.

The strongest form of evidence for the research on PA correlates.

We know reproduced results = the strongest evidence. When we see repeated studies producing very similar results with large sample sizes this provides strong evidence which correlates are most likely to influence PA.

Types Of Correlates

Demographic & biological

Psychological, cognitive, and emotional

Behavioural attributes & skills

Social & cultural factors

Physical environment

Physical activity characteristics

Theories/Models

Theory= interrelated constructs that explain& predicta behaviour

A set of principles that tell us how and why concepts are related to each other

We use theories to understand what’s going and take that info and apply an appropriate intervention.

Constructs: factors, variables, or correlates of which theories are comprised that explain& predicta behaviour

Operationalise: Creating a working practical definition of a theoretical construct

What do PA theories do?

Explain influences or correlates of PA

Explain the association between those factors (e.g., beliefs, constraints) & PA

Explain the condition sunder which the associations with PA do & don’t occur (e.g., the time, place & circumstances which lead to PA)

Module 3.2- Intrapersonal theories of behaviour change

Theory of Reasoned Action / Planned Behaviour (TRA/TPB)

Ajzen& Fishbein(1967; 1980) -TRA

Individual motivational factors:

Attitudes and social norms influence intention (intention to be PA in this context) and intention influences behaviour

TRA: Operationalisation

TRA and PA Summary

Intention has been repeatedly shown to predict behaviour

We also know that attitudes are more important than subjective norms

TPB and PA Summary

Perceived control predicts intention

Perceived control is positively associated with behaviour (direct)

Transtheoretical Model

Stages of change -> decisional balance -> self-efficacy & temptation -> processes of change

Construct 1: Stages of change

Construct 2: Decisional Balance

Pros-the benefits of changing behaviour (losing body fat / becoming more conditioned)

Cons-the costs of changing behaviour

Operationalisation: Decisional Balance

Pros-the benefits of changing behaviour

(“I would feel better about myself if I exercised more regularly”)

Cons-the costs of changing behaviour

(“I would probably be sore and uncomfortable if I exercised more regularly”)

As one moves along the stages of change, the pros begin to outweigh the cons (cross-over during contemplation or preparation)

Construct 3: Self-efficacy & temptation

Self-efficacy

Confidence in one’s ability to engage in healthy behaviours across a range of challenging situations

High self-efficacy

“I could exercise even when I’m tired”

“I could exercise even when I have no oneto exercise with”

Temptation

The intensity of urges to engage in specific behaviours when face with a challenging situation

High temptation

“I’d rather stay inside where it’s warm than go out for a walk”

As one moves through the stages of change, self-efficacy is enhanced while temptation weakens

Stages 1-5 are classified as experimental processes which are seen in the early stage transitions. 6-10 are classified as behavioural processes and they’re used for later stages of change.

Module 3.3 – Individual Level Correlates

Demographic & Biological Factors

OLD ASS DATA! NEED MORE RECENT BECAUSE PREVALENCY WOULD HAVE CHANGED IN THE LAST 20 YEARS BECAUSE OF CULTURE SHIFTS AND TRENDS CHANGING.

Psychological, Cognitive & Emotional Correlates

Enjoyment of exercise, expected benefits and intention to exercise are all strongly positively associated with PA. Whereas knowledge of health benefits has been shown to have no association with PA. So it appears people need MORE than just knowledge to change their behaviour. They need smart strategies and a multifactoral approach to behaviour change.

(Could write a post about it one day how just spurting out knowledge won’t get most people to change. They need multiple sparks to ignite behaviour change)

Module 3.4 – Interpersonal Theories of Behaviour Change

Social Cognitive Theory (SCT)

Behavior depicted as ‘dynamic’, based on the interaction of behaviour, cognitive & other personal factors, and environmental influences

The relative influence of each set of interacting factors varies for different activities, individuals & circumstances

Reciprocal determinism = the overriding principle which suggests a continuing interaction between the characteristics of a person, behaviour and environment.

SCT shows that environmental factors may influence personal factors or it may be influenced by personal factors which in turn aid in determining behaviour.

High self-efficacy people are more likely to perceive greater access to facilities to be active which may then increase engagement in PA.

Ecological Models

“Ecological models emphasize that behaviours have multiple levels of influence that include intrapersonal, interpersonal, environmental, and policy variables” (Saelens, Sallis & Frank, 2003)

Ecological Models & Defining ‘Environment’

Social: family members, friends, peers

Physical (built): buildings (architecture), urban planning, open space

Policy: laws, regulations, formal & informal rules

Guidelines Derived from Ecological Models

PA interventions should be most effective when they target changes in four domains: intrapersonal, social, physical environmental, and policy.
Interventions should be tailored to each behavior setting.

Module 3.5 – Social, Environmental & Policy Level Correlates

We see that physician influence, social support from family/friends and spouse are the strongest social/cultural correlates to PA. (Trost 2002) (15 years old though)

Limitation: We now recognise that the correlates of PA are ‘behaviour-context’specific. i.e., the correlates of walking for transport are different to the correlates of cycling for recreation

Physical Environment Characteristics

Module 4.1

Overview of Approaches Used to Promote Physical Activity

Week #5 & 6

Informational Approaches

The idea that providing info about the health benefits of PA, where to be active, barriers and opportunities increases PA.

Behavioural Approaches

Behavioural approaches –rely on theories and models to explain behaviour.

Individually tailored to the needs and motivations of an individual.

Examples of Behavioural Approaches

Interpersonal (social) Approaches

Any strategy for strengthening or developing the social environment to encourage or overcome barriers to PA.

Social support in public health refers to the degree to which people perceive that they are receiving assistance to overcome health challenges (Kohl & Murray, 2012)

3 Types of Social Support:

Perceived: The perceptions that one is adequately supported.

Received: The amount of direct support a person can count on (more direct and measurable)

Connected: The degree to which a person is socially integrated.

Environmental & Policy Approaches

Changes to the environment (built or natural) or to policy to support physical activity

Polices can relate to those that support incentives to those that relate to resources and infrastructure

E.G. Suburban, buildings, workplace, entertainment, transport

Natural Environment: • Weather -in areas with frequent or severe rain or cold, provide additional resources for indoor activity.

Built environment • Establish walking/biking trails, separate from roads, that connect homes with shopping areas. Create more parks and recreation centres.

Policy (incentives) • Subsidize health club memberships for employees. Pay mileage costs for employee transport by bicycle. Reduce insurance rates for active and fit employees.

Policy (resources and infrastructure) •Require building codes to mandate that shopping be within 10-min walk of all homes. Require greenways for person-powered transport. Require numerous parks and recreation centres.

Module 4.2

Primary Care Setting for the Promotion of Physical Activity

Barriers to PA Promotion in General Practice

Lack of time

Pessimism about potential success

Lack of training/knowledge

Patient preference for drug treatment

Lack information and resources

(Bull et al., 1995; Bauman et al., 1989) Old ass study.

Summary of Evidence

Evidence suggests that short-term increases in physical activity are possible in the primary health care setting

“Best bets” for promoting PA in primary health care

Individually tailored advice (eg health condition) results in the most effective intervention

Follow up from allied health professional may increase the effectiveness of an intervention

Opportunistic use of brief interventions with written advice

Module 4.3

Workplace Setting for the Promotion of Physical Activity

Work Place Interventions

Focus on:

promoting physical activity (incidental and structured) during the work day

promoting physical activity at the beginning and end of the day

promoting active commuting

Individual / Behavioural Level Approaches

Health risk appraisal

Use of HRA with feedback as part of a comprehensive wellness program has usefullness (Kahn et al., 2002)

Health Messaging: Booklets / emails / brochures

One-to-one counselling: Personal health coach (Proper et al., 2003)

Physically active commuting to work

Many adults commute to work on most days of the week

People who actively travel participate in more overall physical activity (Sahlvistet al., 20 12)

Social approaches

Buddy systems, walking clubs etc obvious things people hold themselves accountable and build a social support network.

Environmental Level Approaches

Physical workplace (building design and layout, surrounding environment)

Provision of facilities and equipment in the workplace: standing desk

“Research has shown sitting on a therapy ball or working at standing desk results in significantly more energy expenditure than sitting in a standard office chair.”

Organizational Policies

Discounts / subsidies for home fitness equipment / local gym memberships

Flex-time for workers to engage in physical activity

Incentives / disincentives for the specific person within the specific context of their workplace

Module 4.4

Community Based Approaches to Physical Activity Promotion

Mass-media campaigns

Can: Put physical activity on the agenda (Wake et al., 2010; Leavyet al., 2011)

Stimulate increases in help-seeking behaviours and can change beliefs and attitudes (Wake et al., 2010; Leavyet al., 2011)

Be persuasive in young people (Huhamn, et al., 2005)

Be effective IF implemented in combination with community physical activity programs and policies and environmental change (Pratt et al., 2012)

Can’t: Bring about behaviour change when used in isolation and when NOT based on a sound theory

Successful programs create consistent messages and program identification across multiple sectors of the community.

Point-of-decision prompts

Found to be effective in the community:

Shopping malls (Kerr et al., 2001) •Commuter stations (Blamey et al., 1995)

Airports (Coleman et al., 2001)

Found NOT to be effective in the workplace (Marshall et al., 2002)

Environmental Change

Community and neighbourhood design impact on walking, cycling, public transport use and recreational physical activity

Module 5.1

Risks & Injury: Musculoskeletal injuries

Week #7

Musculoskeletal Injure: Involves acute disorder in a bone, muscle, joint or connective tissue that is attributable to physical activity or exercise (Kohl & Murray, 2012).

Two categories: Chornic / Acute

Risk Factors – Type of Activity

Collision – participants purposefully hit or collide with each other or inanimate objectives

Contact – participants make contact with each other but usually with less sport

Limited contact – contact with other players or objects is infrequent or unintentional

Noncontact – contact between participants is uncommon

Proposed methods of reducing musculoskeletal sport injuries: the evidence

Module 5.2

Risks & Injury: Risks & Injury: Sudden Adverse Cardiac Event

Sudden Cardiac Arrest

Unexpected loss of heart function, breathing and consciousness due to a dysfunction of the heart, usually within one hour of the onset of symptoms (Kohl & Murray 2012)

Sudden cardiac arrest is usually caused by an abrupt loss of electrical stability of the heart causing it to beat rapidly and inefficiently or to stop beating all together. These events typically occur in those with undiagnosed structural cardiac disease.

A study 1200+ men/women who had survived myocardial infarction to determine what they were doing immediately prior to or during the cardiac event. There was a 6 fold increase in myocardial infarction in the first hour of heavy physical exertion. This indicates that participating in vigorous PA substantially increases once risk of sudden cardiac arrest (most likely predominantly with those who already have structural issues)

Though the number of sudden deaths in mod-vig PA is very small. 0.35 – 0.5% of all sudden deaths and is less than 1 death per million exercise hours in middle aged men. Though it has been argued that sudden cardiac death is 2-4 times more frequent in young athletes than aged matched persons who do not engage in sport.

Though the overall benefit of being active far outweighs the short term acute risk of avert events due to PA.

He also showed the risk was far greater for men who showed lower levels of habitual PA. For men who participated in little PA the risk was 56x higher during vigorous exercise. However men who were highly active had only a 5x higher risk. Case a point reason to ease novices into training and not beat the shit out of the physically from the start.

(USDHHS, PAGAC 2008, adapted from Siscovicket al., 1984)

Key points

Sudden cardiac arrest is a serious consequence of participation in physical activity

Risk is higher when participating in vigorous physical activity and in those who have low levels of habitual physical activity

Risks can be reduced by encouraging participation in moderate intensity physical activity and following standard principles of exercise training

Module 6.1

Physical activity amongst socioeconomically disadvantaged populations

Week #8

Socioeconomically disadvantaged = Low level of education OR income OR occupation OR area-level (neighbourhood)

Influences/Barriers of Low SEP Women’s PA

Key points

Socioeconomically disadvantaged groups are risk of lifestyle-related diseases

Disadvantaged groups more likely to be physically inactive than more advantaged groups

Such groups face many barriers to PA (complex)

They’re a hard-to-reach group…but equally important!

Module 6.2

Physical activity in Rural Australia

‘Rural’ classification

ABS (using Australian System Geographical Standard) classifies level of remoteness (‘rurality’) by proximity to services, index includes; major cities, inner, outer regional and remote (ABS 2013).

‘Rural’ commonly an umbrella term that may include; inner, outer regionaland remote.

Rural environments often heterogeneous (unique/diverse in characteristics) between countries.

Rural Health & PA

Rural populations experience poorer health outcomes than their urban counterparts;

Overweight/obesity • Type 2 diabetes • Cardiovascular disease • Mental illness (AIHW 2008)

Prevalence and trends of PA in rural Australia

When compared to major cities, remote living adults were 15% more likely to report sedentary activity. This figure increased to 24% when excluding the inner regional data suggesting a positive association between the level of remoteness in sedentary levels of PA. E.G. The more remote one lives the lower likelihood of one’s PA/

State based studies

Rural south-east (Vic/SA) 17% men and women (25–75 years) inactive and only 30% men and 21% women did >20/30 mins mod/vigPA four times week(Vaughan et al. 2009).

Regional QLD (mean age 47 years) 18% inactive and 53% did not meet PA guidelines(Brown et al. 2013).

Rural SA (Riverland) 57% (18 –65 years) did not meet PA guidelines

* SA representative state-level data indicated for the wider population this was 47% (Carroll et al. 2014).

National Secondary Students Diet and Activity Survey 2009-10

Rural students significantly more likely to meet the PA guidelines when compared to their metropolitan (urben) peers.

Barriers to PA in rural populations

Facilitators of PA in rural areas

Team sport participation = social support = social capital (Tonts2005)

Community connectedness = multi level approach (Miller et al.. 2011)

Physical environment –walking trails initiative

Important to develop interventions that are contextual to the environments in which rural populations reside enhance intervention success because areas are heterogeneous.

Farmers & PA

Recent research has found farming men and women have poorer health outcomes than rural average (Brumby et al. 2011).

Mechanization of farming practises = lowers levels of PA. e.g. broad acre cropping enterprises, GPS, Auto steer machinery and remote control augers

High production periods (sowing and harvest) may mean 12-15 hours spent sedentary (‘sitting’ in tractor).

Module 6.3

Physical activity in Underserved Populations

Culturally and Linguistically Diverse/Multicultural

Australia’s Changing Population

6.2 million people were born overseas and 20% of Australians have one parent that was born overseas

There is a net gain of 1 international migrant every 2 mins and 13 sec

Almost half (49%) of longer-standing migrants and 67% of recent arrivals speak a language other than English at home (ABS, 2011)

The Issues

People born overseas are more likely to have a sedentary or low exercise level

People from CaLD/Multicultural backgrounds have lower rates of participation in planned physical activity and sport

Women and girls from CaLD/Multicultural backgrounds have the lowest level of participation level

Things to consider

Asylum seeker:

Someone who has applied for recognition as a refugee (protection under international law –1951 UN Refugee Convention), but their case is yet to be determined.

Refugee background:

Someone who is forced to leave their country out of fear of persecution; determined to warrant protection under the 1951 UN Refugee Convention.

Migrant:

Someone who leaves voluntarily & can return if they want to.

Extra Barriers

The same barriers they may encounter: Time/$/Transport/Location/Support

Different barriers: Cultural beliefs, religion, language, discrimination

Overcoming the barriers

Engage with the community

Engage with community elders because they’re placed high in the social order

Consider and respect beliefs

Consider and respect culture

Timing of events depending on religious/cultural events

Use of images and language

Module 6.4

Indigenous Australians & Physical Activity

In Australia, the term Indigenous includes Aboriginal and Torres Strait Islander peoples.

Health Status & PA

NHS 2011-2013 suggests the health status gap continues with a exponential rise in Type 2 diabetes (T2D) –indigenous Australians 3.3times more likely to report T2D than non-indigenous.

AND 1.2x more likely to report having CVD and be overweight or obese. (Australian Indigenous HealthInfoNet2015)

AIHW 2008 report cited physical inactivity was the third leading cause of burden of disease in indigenous Australians (AIHW 2008).

Prevalence & Trends

Indigenous children aged 5-17 years living in non-remote areas reported;

48% met the PA guidelines compared to 35% of non-indigenous children

Indigenous youth did spend on average 2.6 hours on sedentary screen-based activities per day, but this was still less than non-indigenous children.

For adults (18 years and over) living in non-remote areas;

38% met the PA guidelines (on the day prior to the interview).

When compared to non-indigenous populations, indigenous adults living in non-remote areas were;

Less likely to be sufficiently active for health (rate ratio 0.8)

Less likely to be participating in any physical activity (rate ratio 0.9)

However they did spend less time in sedentary behaviours (occupation, leisure and travel).

When looking to remote areas

82% children aged 5-17 years did met the recommended PA guidelines.

55% of adults (18 years and over) did more than the recommended 30 minutes of PA (on the day prior to the interview).

The most common type of PA for adults in remote areas was walking places and cultural activities of hunting and fishing.

Influencing Indigenous PA

Interventions –What’s being done?

Sport powerful force in indigenous communities. 1/3 of indigenous Australian participate in some form of sport (though still lower than non-indigenous)

Module 7.1

Measuring Physical Activity: An Overview

Week #9

Nothing of value.

Module 7.2

Self-Report Measures

Global self-assessment

E.G. How active are you compared to other people of the same age and sex…ANSWER = multiple choice.

Recall surveys

Positives

Most useful tool for large population surveys / epidemiological studies

Self-completed or interview administered

Telephone, mail or face-to-face

Recall periods range from 1 day to lifetime

Unobtrusive, non-reactive & cost-efficient

Provide information on type of activity

Negatives

Subject to recall problems and reporting bias

Not good with young children or Older people because of memory retension issues of those demo’s = Reliability and validity issues

Physical activity diaries (time break down of day to day activities)

Positives

Detailed accounting of all PA performed

Data rich

Negatives

Intensive effort required by subject (participant burden because of time requirements)

Reactivity can be a concern = the person will change their behaviour as a result of completing the diary

Data reduction is labour intensive

Physical activity logs

Positives

A modified form of the diary

Specifies activities

Less prone to reactivity problems

Reduces subject burden

Simplifies data reduction

Negatives

Still somewhat labour intensive

Possible participant burden

Module 7.3

Objective Measures

Pedometer

Positives

Cost-effective

Practical in walking studies

Useful for detecting change overtime

Negatives

No info on intensity, duration, frequency of PA

Insensitive to many forms of PA

Step counts influenced by body size and speed of locomotion

Reactive? Results of knowing the step count changes PA behaviour.,

Accelerometer

Positives

Monitors movement in a specific plane frequency & intensity of movement

Real time data storage

Provides measure of intensity

Negatives

Insensitive to many forms of PA like carrying a load/cycling/cannot be used in water.

Difficult to equate ‘counts’ to PA intensity or EE

Direct observation

Positives

Very accurate data

Often used in studies of children

Can assess environmental and policy change

Negatives

Requires multiple observers

Extensive observation time needed

Extensive training required

Data reduction is labour intensive

Doubly labelled water

A biochemical procedure that estimates energy expenditure through biological markers that reflect the bodies metabolic rate.

Positives

Water Ingested : [2H ] [18O]

2H leaves body as water (urine, sweat etc)

18O leaves body as both water & CO2

Difference in rate of elimination – VCO2 allows for the calculation of VO2 & EE

Output: EE

Negatives

Accurate but very expensive (isotopes can cost $500-$1000 per person + $2.5k for the spectrometer that reads the samples)

No data on type, freq or intensity

Indirect Calorimetry

Positives

Collects & analyses respiratory gas exchange (E.G. VO2 max test)

Measures O2 consumption & CO2 production

Requires person to use mouthpiece, facemask back pack (short periods) or confined to a metabolic chamber (long periods)

Output: EE

Very precise, ‘gold standard’for field based assessment

Negatives

Costly, has high participant burden, no info on PA

No practical for population based research

Key Points

When considering population based research, objective measures of physical activity (i.e., accelerometers) tend to provide more accurate estimates relative to self-report

Limited in that, with the exception of direct observation, they provide no ‘contextual’ information (type, domain, location of PA)

Often a combination of self-report and objective measures are used.

Module 7.4

New Methods in Physical Activity Measurement

Wearable Cameras, Wrist accelerometers, GPS receivers.

This power point was useless.

Module 8.1

An Introduction to Sedentary Behaviour

Week #10

Sedentary Behaviour

Behaviours that require minimal amount of energy to perform (approx. 1-1.5 METs): E.G. Sitting.

Inactivity

An absence of PA – a person who does no/little PA is called inactive.

How Australian adults’ overall daily behaviour patterns are distributed between physically-active and sedentary time

National Physical Activity Recommendations for Children & Young People (2013)

Limit the use of electronic media for entertainment (e.g. television, seated electronic games, computer use) to no more than 2 hours a day

Break up long periods of sitting as often as possible

Sedentary behaviour guidelines for adults (2014)

1. Minimise the amount of time spent in prolonged sitting.

2. Break up long periods of sitting as often as possible.

Module 8.2

Sedentary Behaviour and Metabolic Health

Quartiles of Sitting Time – Dose Response Associations

Thorp et al. 2010 Diabetes Care

Q4 = Most amount of sitting time.

Metabolic Syndrome

Diabetes or impaired glucose tolerance or insulin resistance + 2 or more of:

Obesity–BMI>30kg/m2 or WHR >0.9 (m) >0.85 (f)

Dyslipidaemia–triglycerides ≥1.7 mmol/llHDL-C <0.9 (m) < 1.0 (f)

Hypertension–BP ≥ 140/90 mmHg or medication

Microalbuminuria–albumin excretion ≥ 20μg/min

All cause mortality

Key Findings (1)

Over a 6-year period, death rates were significantly higher with increased TV viewing time in adults

(NB: this is the first time TV viewing time has been linked with mortality)

Every hour spent watching TV can increase risk of dying earlier:
• by 11% for all causes of death
• by 18 % for cardiovascular death
• by 9 % for cancer death

Mental Health

Recent evidence suggests relationship between sedentary behaviour and mental health (although direction of relationships still not known)

Module 8.3

Inactivity Physiology

Sitting induces muscular inactivity

Key Physiological Responses to Sedentary Behaviour

During standing, postural muscles (predominantly those of the lower limbs) are continually contracting in order to keep the body upright and prevent loss of balance

Such contractions are predominantly absent when sedentary

Animal studies have shown this leads to changes in two key physiological responsesthat can promote poor metabolic health

Skeletal muscle lipoprotein lipase (LPL) production is suppressed (LPL enzyme is important for breaking down bloodfats/triglycerides) – Thus inhibiting LPL (through being nsedentary) can lead to elevated triglycerides

The absence of local muscle contraction is linked to blunted translocation of glucose transporters to the skeletal muscle surface which results in reduced glucose uptake thus elevating blood sugar levels.

** the decline in LPL activity seen when being sedentary does not appear to exist when we introduce light, incidental activity (including standing)
**There is a need to replicate these animal studies in humans

(Healy, G. ‘The Unique Influence of Sedentary Behaviour on Health’ in Physical activity and Public Health Practice, Eds. Ainsworth & Macera)

Module 8.4

Correlates of Sedentary Behaviour

Intrapersonal factors: race, BMI, age, PA

Social factors: single vs dual parent home, parent education, parent income, parent TV behaviour, parent TV rules, parental attitudes to children walking to school

Physical environmental factors: TV in bedroom, living in urban areas, cars in the household, distance to school)

Risks associated with watching TV for more than 2 hrs/day (n=1560 children)

Children engaging in 2+ hours of TV a day are 1.5 more likely to be overweight/obese.

Ecological model of four domains of sedentary behaviour

A review of correlates of sedentary behaviour among adult women

Module 9.1

The Aging Process

Week #9

Old-age Defined

Centenarian: 100 / Super Centenarian: 110+

Population Ageing

% of older people aged 65+ expected to increase over the decades.

Why the changing age structure?

Baby boomers, Increase in life expectancy, Small family sizes

Successful Ageing

Sarcopenia: Degenerative loss of skeletal muscle mass quality, and strength associated with aging.

Module 9.2

The role of physical activity in preventing ageing

What influences this ageing process?

Three factors play a part in ageing

1.Heredity

2.Environment

3.Lifestyle

Bone Loss

PA helps maintain bone mass density.

Lifestyle Influences

It’s estimated that 50% of age related decline is caused by: inactivity, associated with boredom & expected infirmity

PA and Cognitive Decline -Evidence

A meta-analysis showed that PA improves

Mental speed (response time)

Executive Functioning (problem solving)

Also found that…

Less than 30 minutes of PA a day has little effect and the greatest benefits come when PA is maintained for 6 months or more

Combination of aerobic and strength training has greater benefits than aerobic alone

(Colcombe & Kramer 2003)

PA & Cognitive Functioning – How Does It Work?

Biological

Cerebrovascular integrity

Neurotransmitter function

Neuro endocrine function

Brain morphology

Disease prevention

Psychological: Mental Health

PA & Falls

1 person in every 11 aged aged greater than >85yrs is admitted to hospital for falling

Module 9.3

Physical Activity Guidelines for Older Adults

Recommendation 1

Older people should do some form of physical activity, no matter what their age, weight, health problems or abilities.

Recommendation 2

Older people should be active every day in as many ways as possible, doing a range of physical activities that incorporate fitness, strength, balance and flexibility.

The evidence?

Recommendation 3

Older people should accumulate at least 30 minutes of moderate intensity physical activity on most, preferably all, days.

Recommendation 4

Older people who have stopped physical activity, or who are starting a new physical activity, should start at a level that is easily manageable and gradually build up the recommended amount, type and frequency of activity.

Recommendation 5

Older people who continue to enjoy a lifetime of vigorous physical activity should carry on doing so in a manner suited to their capability into later life, provided recommended safety procedures and guidelines are adhered to.

Module 9.4

Promoting Physical Activity in Older Adults

Correlates of physical activity among older adults

Individual level influences: age, gender, ses, BMI, self-efficacy, perceived benefits vs barriers, fear of injury (Sallis et al. 2000)

Social influences: social support, physician advice, social isolation (Ewing Garber & Blissmer 2002)

Environmental influences: living in a rural area or within walking distance of a park or trail, footpaths safe for walking, perceived good access to facilities