A method for the inclusion of physical activity-related health benefits in cost-benefit analysis of built environment initiatives

The Potential Impact of Physical Activity on the Burden of Osteoarthritis and Low Back Pain in Australia: A Systematic Review of Reviews and Life Table Analysis

OBJECTIVE

The objectives were (1) to establish the strength of the association between incident cases of osteoarthritis (OA) and low back pain (LBP), and physical activity (PA) and to assess the likelihood of the associations being causal; and (2) to quantify the impact of PA on the burden of OA and LBP in Australia.

METHODS

We conducted a systematic literature review in EMBASE and PubMed databases from January 01, 2000, to April 28, 2020. We used the Bradford Hill viewpoints to assess causality. We used a proportional multistate life table model to estimate the impact of changes in the PA levels on OA and LBP burdens for the 2019 Australian population (aged ≥ 20 y) over their remaining lifetime.

RESULTS

We found that both OA and LBP are possibly causally related to physical inactivity. Assuming causality, our model projected that if the 2025 World Health Organization global target for PA was met, the burden in 25 years' time could be reduced by 70,000 prevalent cases of OA and over 11,000 cases of LBP. Over the lifetime of the current adult population of Australia, the gains could add up to approximately 672,814 health-adjusted life years (HALYs) for OA (ie, 27 HALYs per 1000 persons) and 114,042 HALYs for LBP (ie, 5 HALYs per 1000 persons). The HALY gains would be 1.4 times bigger if the 2030 World Health Organization global target for PA was achieved and 11 times bigger if all Australians adhered to the Australian PA guidelines.

CONCLUSION

This study provides empirical support for the adoption of PA in strategies for the prevention of OA and back pain.

Physical Activity and Depression and Anxiety Disorders in Australia: A Lifetable Analysis

Introduction

Mental disorders, in particular, depressive and anxiety disorders, are a leading cause of disability in Australia and globally. Physical activity may reduce the incidence of anxiety and depression, and this supports the inclusion of physical activity in strategies for the prevention of mental ill health. Policy makers need to know the potential impact and cost savings of such strategies. We aimed to quantify the impact of changes in physical activity on the burden of anxiety and depression and healthcare costs in Australia.

Methods

We used a proportional multistate lifetable model to estimate the impact of changes in physical activity levels on anxiety and depression burdens for the 2019 Australian population (numbering 24.6 million) over their remaining lifetime. The changes in physical activity were modeled through 3 counterfactual scenarios informed by policy targets: attainment of the Australian Physical Activity Guidelines and achievement of the WHO Global Action Plan on Physical Activity targets of a 10% relative reduction in the prevalence of insufficient physical activity by 2025 and a 15% relative reduction by 2030.

Results

If all Australians adhered to the recommended minimum physical activity levels, in 25 years' time, the burden of anxiety could be reduced by up to 6.4% (95% uncertainty intervals=2.5, 10.6), and that of depression could be reduced by 4.4% (95% uncertainty intervals=2.3, 6.5). Over the lifetime of the 2019 Australian population, the gains could add up to 640,592 health-adjusted life years for anxiety (26 health-adjusted life years per 1,000 persons), 523,717 health-adjusted life years for depression (21 health-adjusted life years per 1,000 persons), and healthcare cost savings of 5.4 billion Australian dollars for anxiety (220 Australian dollars per capita) and 5.8 billion for depression (237 Australian dollars per capita).

Conclusions

Adherence to the Australian physical activity guidelines and achievement of the 2025 and 2030 global physical activity targets could lead to a substantial reduction of the burden of anxiety and depression. This study provides empirical support for the inclusion of physical activity in strategies for the prevention of mental ill health. Future studies should also assess the size and distribution of the benefits for different socioeconomic and ethnic groups.

Walkability and urban built environments-a systematic review of health impact assessments (HIA)

BACKGROUND

Urban environments are important determinants of human health. The term walkability summarizes features of the urban built environment that promote walking and other types of physical activity. While the beneficial effects of active and public transport have been well established, the health impact of other features of walkability are less well documented.

METHODS

We conducted a systematic review of health impact assessments (HIAs) of walkability. Studies were identified through PUBMED and Science Direct, from two German websites related to urban health and reference tracking. Finally, 40 studies were included in the present review. We applied qualitative thematic analysis to summarize the major results from these studies.

RESULTS

Most of the HIAs (n = 31) reported the improvement of health or health behaviour resulting from an investigated project or policy. However, three HIAs reported a lack of improvement or even a decrease of health status. In parallel, 13 HIAs reported a gain in economic value, whereas one reported a lack or loss of economic effects. Moreover, three HIAs reported on social effects and six HIAs gave additional recommendations for policies or the implementation of projects or HIAs.

CONCLUSIONS

Most HIAs investigate the impact of increasing active or public transport. Other features of walkability are less well studied. With few exceptions, HIAs document beneficial impacts of improving walkability on a variety of health outcomes, including reductions of mortality and non-communicable diseases.

Motives and Passion of Adults from Pakistan toward Physical Activity

Globally, a large proportion of people do not participate in adequate physical activity to gain health benefits. Physical inactivity is a primary risk factor for global mortality. Research suggests that motives and passion influence participation in physical activity. The main purposes of the present study were to examine the relationship between motives and passion for participation in physical activity among adults, and to examine whether motives and passion predicted physical activity. Prior to data collection, we translated and validated the Physical Activity and Leisure Motivation Scale (PALMS) and the Passion Scale (PS) into Urdu. With the research sample, both translated questionnaires showed acceptable internal consistency, test-retest reliability, and factorial validity. To address the main purposes, we then employed a quantitative, cross-sectional research design, with a sample of 572 adults between 18 and 65 years (31.51 ± 10.25), who regularly participated in moderate-to-vigorous physical activity. Participants completed the PALMS, the PS, and the International Physical Activity Questionnaire (IPAQ). Correlation coefficients showed strong relationships between motives and harmonious passion, and weaker, negative relationships between motives and obsessive passion. We used stepwise multiple regression to test whether motives and passion subscales were significant predictors of overall PA measured by the IPAQ. In step 1 of the regression model, mastery and physical condition motives were significant predictors of overall physical activity. Further, in step 2, the mastery motive and harmonious passion were significant predictors of overall physical activity, accounting for 26% of the variance, with F (5, 566) = 38.84, p < 0.01. The present study provides a basis for physical activity interventions examining whether increasing motives and passion leads to higher adherence to and lowered dropout from physical activity.

Provisional COVID-19 infrastructure induces large, rapid increases in cycling

The bicycle is a low-cost means of transport linked to low risk of transmission of infectious disease. During the COVID-19 crisis, governments have therefore incentivized cycling by provisionally redistributing street space. We evaluate the impact of this new bicycle infrastructure on cycling traffic using a generalized difference in differences design. We scrape daily bicycle counts from 736 bicycle counters in 106 European cities. We combine these with data on announced and completed pop-up bike lane road work projects. Within 4 mo, an average of 11.5 km of provisional pop-up bike lanes have been built per city and the policy has increased cycling between 11 and 48% on average. We calculate that the new infrastructure will generate between $1 and $7 billion in health benefits per year if cycling habits are sticky.

Physical activity-related health and economic benefits of building walkable neighbourhoods: a modelled comparison between brownfield and greenfield developments

BACKGROUND

A consensus is emerging in the literature that urban form can impact health by either facilitating or deterring physical activity (PA). However, there is a lack of evidence measuring population health and the economic benefits relating to alternative urban forms. We examined the issue of housing people within two distinct types of urban development forms: a medium-density brownfield development in an established area with existing amenities (e.g. daily living destinations, transit), and a low-density suburban greenfield development. We predicted the health and economic benefits of a brownfield development compared with a greenfield development through their influence on PA.

METHODS

We combined a new Walkability Planning Support System (Walkability PSS) with a quantitative health impact assessment model. We used the Walkability PSS to estimate the probability of residents' transport walking, based on their exposure to urban form in the brownfield and greenfield developments. We developed the underlying algorithms of the Walkability PSS using multi-level multivariate logistic regression analysis based on self-reported data for transport walking from the Victorian Integrated Survey of Transport and Activity 2009-10 and objectively measured urban form in the developments. We derived the difference in transport walking minutes per week based on the probability of transport walking in each of the developments and the average transport walking time per week among those who reported any transport walking. We then used the well-established method of the proportional multi-cohort multi-state life table model to translate the difference in transport walking minutes per week into health and economic benefits.

RESULTS

If adult residents living in the greenfield neighbourhood were instead exposed to the urban development form observed in a brownfield neighbourhood, the incidence and mortality of physical inactivity-related chronic diseases would decrease. Over the life course of the exposed population (21,000), we estimated 1600 health-adjusted life years gained and economic benefits of A$94 million.

DISCUSSION

Our findings indicate that planning policies that create walkable neighbourhoods with access to shops, services and public transport will lead to substantial health and economic benefits associated with reduced incidence of physical inactivity related diseases and premature death.

Relation of Moderate Physical Activity to Blood Markers of Oxidative Stress and Antioxidant Defense in the Elderly

The aim of the present study was to establish whether markers of oxidative stress and the enzymatic defense system of the blood are related to moderate physical activity in younger old and the oldest old men. They were divided into four groups according to the age and level of physical activity (groups YN and YA—inactive and active younger old men aged 65-74 years, groups ON and OA—inactive and active oldest old men aged 90-99 years). Venous blood was collected from the subjects in the morning before breakfast. MDA concentration and antioxidant enzyme activities (SOD, CAT, GPx, and GR) in erythrocyte hemolysates were assayed. The concentration of isoprostanes (8-iso-PGF2α) and carbonyl groups in protein (CP) was measured in plasma and serum. All assayed antioxidant enzyme activities and the SOD/GPx ratios were significantly higher in the active younger old males than in all the inactive ones. In the group of oldest old active participants, only the GPx activity was significantly higher compared to the inactive oldest old males. The activity of CAT and GPx in the younger old inactive men was significantly lower than that in the oldest old inactive subjects. However, SOD, CAT, and GR activities and SOD/GPx ratio were significantly higher in the younger old active men compared to the oldest old active participants. The concentrations of isoprostanes, protein carbonyls, and MDA were significantly lower in both active and inactive younger old males than in the respective groups of the oldest old men and in both groups of active men, independently of age, compared to the respective inactive subjects. The present study confirmed that oxidative stress is related to age. Physical activity caused a decrease of oxidative stress markers independently of age and resulted in an increase of GPx activity in both younger old and the oldest old active groups.

Increasing the Intensity over Time of an Electric-Assist Bike Based on the User and Route: The Bike Becomes the Gym

Nowadays, many citizens have busy days that make finding time for physical activity difficult. Thus, it is important to provide citizens with tools that allow them to introduce physical activity into their lives as part of the day's routine. This article proposes an app for an electric pedal-assist-system (PAS) bicycle that increases the pedaling intensity so the bicyclist can achieve higher and higher levels of physical activity. The app includes personalized assist levels that have been adapted to the user's strength/ability and a profile of the route, segmented according to its slopes. Additionally, a social component motivates interaction and competition between users based on a scoring system that shows the level of their performances. To test the training module, a case study in three different European countries lasted four months and included nine people who traveled 551 routes. The electric PAS bicycle with the app that increases intensity of physical activity shows promise for increasing levels of physical activity as a regular part of the day.