Development of public policy and physical activity initiatives internationally

Impact of urbanization on obesity, anthropometric profile and blood pressure in the Igbos of Nigeria

BACKGROUND

Hypertension in developing setting is often attributed to westernization of life style and stresses of urbanization, some of these increases have been noted in Nigeria.

AIM

This is a study on rural-urban differences on the blood pressure, obesity and anthropometrics among a major ethnic group in Nigeria.

PATIENTS AND METHOD

A total of 325 men and 242 women aged 20 to 80 years, of the Igbo ethnicity were selected for this study. The samples were selected from the rural and urban subgroups of the Igbo population. Systolic and diastolic blood pressure, body mass index, waist- hip ratio, waist-height ratio, waist circumference, triceps, subscapular, calf and sum of the three skin fold thicknesses and other anthropometric measurements were obtained using standard procedures.

RESULT

Blood pressure correlated with age and most of the anthropometric parameters (p< 0.05 ). All adiposity and blood pressure indicators were higher in the urban than in the rural sample. Women showed higher predisposition to both general and abdominal obesities in both samples. High blood pressure occurred more often in the urban sample than the rural. Urban men had the highest mean blood pressure (p< 0.05). High blood pressure appeared much connected with the pressures of city life. Regression formulae were derived for all the adiposity measures of Igbos in both rural and urban locations.

CONCLUSION

High rates of obesity and hypertension are noted among Igbos in both rural and urban areas. This is especially in the urban setting. The finding is indicative of a low level of attention on hypertension and obesity in the Igbos. The data reported here call for intervention programs on the risks, preventions and management of obesity and obesity related conditions.

The benefits of body weight loss on health-related quality of life

BACKGROUND

Obesity is a worldwide public health issue, and the prevalence of obesity is also increasing steadily in Taiwan. Obesity leads to several chronic diseases. Often, impaired quality of life is a consequence of obesity. The aim of this study was to determine if body weight-loss could improve health-related quality of life (HRQOL) in Taiwan.

METHODS

The cutoff for obesity is body mass index (BMI) = 27 as compared with 30 in US and Europe. We enrolled 67 participants with BMI ≥ 27 and more than one criterion of the metabolic syndrome, who underwent 3 months of body weight-loss intervention by diet control and regular exercise. We performed anthropometric measurements and blood tests, and administered the WHOQOL-BREF questionnaire Taiwanese version to assess HRQOL before and after the weight loss intervention. This is the first study using the WHOQOL-BREF to examine HRQOL in Taiwan. The questionnaire included D1 physical, D2 psychological, D3 social relationships and D4 environmental domains; each was scored from 4 to 20.

RESULTS

Obese subjects had lower D1 and D2 scores as compared with the Taiwan healthy population reference group at baseline. In this study, 38 participants completed the 3-month intervention program and 29 participants dropped out. Twenty-five participants reached the 5% of initial BMI goal. Among them, significant statistical improvements were found both in medical comorbidities and in the four domains of the HRQOL questionnaire.

CONCLUSION

Obesity can cause impaired HRQOL, which can be improved through BMI intervention. In addition to the benefits of biomedical aspect, this could be an incentive goal for keeping body weight control.

Weight loss favorably modifies anthropometrics and reverses the metabolic syndrome in premenopausal women

OBJECTIVE

To determine the effects of a weight loss program, including dietary modifications, increased physical activity and dietary supplement (L-carnitine or placebo) on anthropometrics, leptin, insulin, the metabolic syndrome (MS) and insulin resistance in overweight /obese premenopausal women.

METHODS

Participants consumed a hypocaloric diet; 30% protein, 30% fat and 40% carbohydrate in addition to increasing number of steps/day. Carnitine supplementation followed a randomized double blind protocol. Protocol lasted for 10 weeks. Seventy subjects (35 in the control and 35 in the carnitine group) completed the intervention. Anthropometrics, plasma insulin and leptin concentrations and body composition were measured. The number of subjects with the MetSyn and insulin resistance, were assessed at baseline and post-intervention.

RESULTS

Because there were no significant differences between the carnitine and the placebo groups for all measured parameters, participants were grouped together for all analysis. Subjects decreased total energy (-26.6%, p < 0.01) and energy from carbohydrate (-17.3%, p < 0.01) and increased energy from protein by 67% (p < 0.01) and number of steps/day (42.6%, p < 0.01). Body weight (-4.6%, p < 0.001), body mass index (-4.5%, p < 0.01), waist circumference (-6.5%, p < 0.01), total fat mass (-1.7%, p < 0.01), trunk fat mass (-2.0%, p < 0.01), insulin (- 17.9%, p < 0.01) and leptin (-5.9%, p < 0.05) decreased after the intervention. Ten of 19 participants with insulin resistance became insulin sensitive and 7 of 8 participants with the MetSyn no longer had the syndrome after the intervention.

CONCLUSION

Moderate increases in physical activity and a hypocaloric/high protein diet resulted in multiple beneficial effects on body anthropometrics and insulin sensitivity. Realistic dietary and physical activity goals must be the focus of intervention strategies for overweight and obese individuals.

Self-rated measures of physical activity and cardiovascular risk in a sample of Southern Italian male workers: the Olivetti heart study

BACKGROUND AND AIM

The number of people who are overweight, obese and/or lead a sedentary lifestyle is increasing, and numerous studies have shown that physical activity has beneficial cardiovascular effects.

METHODS

The aim of this study was to evaluate the relationship between physical activity and the anthropometric, cardiovascular and metabolic variables involved in coronary risk. The study population consisted of 1075 adult men aged 25-75 years, all of whom were workers in Olivetti factories. Physical activity was assessed by means of a questionnaire and the sample was divided into two groups: those practising sport and those who said they were sedentary.

RESULTS

Age-adjusted BMI was higher in the participants practising sport, whereas the values of all of the remaining variables (i.e. abdominal circumference, skinfolds, heart rate, blood pressure, serum cholesterol, triglyceride, glucose, insulin and HOMA) were lower; however, the only statistically significant differences were in heart rate and blood pressure. After the subjects were classified as being normal weight, overweight or obese on the basis of BMI, the active participants tended to have lower values for all of the parameters than their sedentary counterparts in each BMI category. In a subgroup undergoing OGTT, glucose and insulin levels at T0 and T60 were significantly lower in the active participants.

CONCLUSIONS

These findings confirm the usefulness of physical activity in preventing cardiovascular disease.

[Knowledge and perceptions of physical exercise in an adult urban population in Southern Brazil]

This study evaluates perception and knowledge of physical exercise in an urban adult population and relates knowledge level to behavioral, demographic, and socioeconomic factors, using a cross-sectional, population-based approach with 3,182 participants aged 20 or older. The questionnaire originated a score (range 0-25 points). Mean score for the sample was 17.1 (SD=4.0). After adjustment, female gender, age 30 to 40 years, higher social strata, and schooling were strongly associated (p<0.001) with the outcome (knowledge). Weaker associations (p< or =0.01) were observed between the score and higher body mass index, level of physical activity, and white skin color. Based on the results, specific benefits from exercising are still unknown to some population groups. Counseling by teachers on the advantages of an active lifestyle is still not common practice.

Reported frequency of physical activity, fitness, and fatness in Kuwait

We studied reported frequency of physical activity (PA), body composition, and fitness in Kuwaiti females (n = 84) and males (n = 72), urban office government employees, or students. A sedentary (SED) group reported no or occasional participation in self-directed PA of 30 minutes or more during the week for the last 6 months; group LOF (low frequency) participated in 1-2 sessions/week (walking, jogging, sports such as volleyball, soccer, or gym); group HIF (higher frequency) reported three or more sessions/week. Aerobic fitness was measured using Bruce's treadmill protocol. Body fat and fat-free mass (FFM) were estimated from seven skinfolds and body weight (BW). Grip strength and trunk flexibility were also measured. Maximal O(2) consumption (VO(2)max)/BW was proportional to reported frequency of PA in males and females, indicating reliability of the reported PA frequencies. SED males (%fat > 25), SED and LOF females (%fat > 30) were overweight. In males, LOF PA was associated with lower %fat and higher flexibility than SED, and in females with higher VO(2)max/FFM than SED. LOF females, in contrast to males, were resilient to or exercised at levels insufficient for fat loss but sufficient for aerobic conditioning of the FFM, likely related to the low VO(2)max of females in which PA would have the most effect. HIF PA (>/=3/week) was associated in females with significantly lower %fat and higher flexibility than SED females and no further aerobic conditioning of the FFM, and in males with no further differences in study variables compared with LOF males. Grip strength was higher in males than females but was unrelated to frequency of PA, likely reflecting lack of strength training in the activities of most participants. Thus, low-frequency PA was associated with health benefits both in males (lower %fat) and females (higher VO(2)max/FFM). Probably due to the generally low fitness level of females and, hence, the high aerobic effort (%VO(2)max) required for exercise sufficient to impinge on fat stores, this was only achieved in females participating in higher weekly frequency (>/=3) of PA.

Using different physical activity measurements in eight European countries. Results of the European Physical Activity Surveillance System (EUPASS) time series survey

OBJECTIVES

The European Physical Activity Surveillance System (EUPASS) research project compared several physical activity (PA) measures (including the International Physical Activity Questionnaire (IPAQ)) in a time series survey in eight countries of the European Union. The present paper describes first results provided by the different instruments regarding PA participation, frequency and duration, both at the European and national levels. The purpose of the present study is to explore and compare the specific quality and usefulness of different indicators rather than to provide valid and reliable prevalence data. Thus, the main focus is on discussion of the methodological implications of the results presented.

METHODS

A time series survey based on computer-aided telephone interviewing (CATI) was carried out in eight European countries over a six-month period. The study provided for about 100 realised interviews per month in each country (i.e. approximately 600 per country). Descriptive statistical analysis was used to: (1) report IPAQ results on vigorous, moderate and light PA and sitting, as well as on the overall measure of calories expenditure (MET min-1), in the different countries; (2) compare these results with national PA indicators tested in EUPASS; and (3) compare IPAQ results with other European studies.

RESULTS

First, the scores for the different PA categories as well as for the overall measure of calories expenditure provided by the IPAQ appeared rather high compared with previous studies and public health recommendations. Second, the different PA measurements used in EUPASS provided completely different results. For example, national indicators used in Germany and The Netherlands to date neither corresponded in absolute values (e.g. means of PA or sitting) nor correlated with the IPAQ in any significant way. Third, comparing EU countries, the ranking for vigorous, moderate and light activities by use of the IPAQ differed from that of other European studies. For example, in the present analysis, German respondents generally showed higher scores for PA than the Finns and the Dutch, while, in contrast, findings from other studies ranked Finland before The Netherlands and Germany.

CONCLUSIONS

The present analysis highlights some methodological implications of the IPAQ instrument. Among other things, differences in overall scores for PA as well as in the ranking of nations between the present results using IPAQ and other measures and studies may partly be due to the concepts of PA behind the measurements. Further analysis should investigate if the range of PA-related categories provided by the IPAQ is fully appropriate to measure all relevant daily activities; it may also consider the public health implications of mixing up different contexts of PA (e.g. work, leisure-time, transportation) in the IPAQ short version.

Physical activity monitoring in Europe. The European Physical Activity Surveillance System (EUPASS) approach and indicator testing

OBJECTIVES

The main objective of this paper is to describe the approach and specific findings of the European Physical Activity Surveillance System (EUPASS) research project. In particular, the analysis presented aims at testing the reliability, comparability and predictive power of different sets of physical activity (PA) indicators.

DESIGN

First, a panel study based on computer-aided telephone interview (CATI) was designed to report PA data of a representative, selected group of about 100 persons per country at three points in time. Second, a CATI time series survey was carried out with the goal of realising about 100 interviews per month over six consecutive months.

SETTING

The project was carried out in eight European countries to support the development of the European Union's (EU) Health Monitoring Programme.

SUBJECTS

Random population samples (subjects aged 18 years and older) were drawn from each participating country.

RESULTS

While many PA indicators used in EU countries to date as well as the psychosocial and environmental measures tested in the present study had acceptable to good reliability coefficients, the test-retest reliability scores of the International Physical Activity Questionnaire (IPAQ) version tested (the short (last 7 days) telephone interview IPAQ; IPAQ-S7T) were rather low. The comparability between extant national PA items and the IPAQ-S7T was low for all countries. The strongest predictors of perceived health were the psychosocial and environmental PA indicators.

CONCLUSIONS

According to the results of the present study, more research is needed to further investigate and improve the quality of the IPAQ. In addition, the specific predictive power of the tested psychosocial and environmental PA indicators on perceived health should be of particular interest for designing health surveillance activities in the future.

Comparison of peak muscle power between Brazilian and French girls

This study examined the muscle power of Brazilian circumpubertal girls and extended the analysis to a cross-cultural dimension. A total of 462 children, 123 Brazilian girls and 339 French girls, 9-18 years, participated in this investigation. Anthropometric data included body mass (BM), height, skinfold thicknesses, and estimated lean leg volume (LLV). All subjects completed a physical activity questionnaire. Cycling peak power was measured including the flywheel inertia of the device (CPPi). Brazilian girls self-assessed their maturation using pubic hair development. CPPi and optimal velocity (v(opt) = velocity at CPPi) increased with stages of puberty. A multiple stepwise regression with anthropometric variables as explanatory factors showed only LLV and age explaining the variance of CPPi (R2 = 0.40, P < 0.001). Therefore, 60% of the variance of CPPi in Brazilian girls was related to undetermined qualitative individual factors, which may be related to cycling skill. Even when normalized for anthropometric variables, the anaerobic performance (CPPi and v(opt)) of Brazilian girls was significantly lower than a cohort of French girls. The latter demonstrated a high participation in sport and training activities, while 50% of the Brazilian girls had only physical education classes in the form of regular physical activity. Moreover, most of the Brazilian girls demonstrated an ineffective sprint cycling skill. The data suggest that motor learning is an important issue in muscle power assessment and might, therefore, partially explain peak power differences in Brazilian compared with French girls.

Promotion of physical activity in a developing country: the Agita São Paulo experience

The purpose of this paper is to present key points of an intervention programme (Agita São Paulo Program) to promote physical activity in a developing country. Agita is a multi-level, community-wide intervention designed to increase knowledge about the benefits and the level of physical activity in a mega-population of 34 million inhabitants of São Paulo State, Brazil. The main message was taken from the Centers for Disease Control/American College of Sports Medicine (CDC/ACSM) recommendation that: 'everyone should accumulate at least 30 minutes of physical activity, on most days of the weeks, of moderate intensity, in one single or in multiple sessions'. Activities were encouraged in three settings: home, transport and leisure time. Focus groups were students from elementary schools through to college, white and blue collar workers, and elderly people. Innovative aspects included: (1) a research centre leading the process, (2) scientific and institutional partnerships (over 160 groups), (3) a feasible approach--the 'one-step-ahead' model, (4) empowerment, (5) inclusion, (6) non-paid media, (7) social marketing, and (8) culture-linked. Data were obtained from 645 random, home-based questionnaires over four years--stratified by sex, age, education and socio-economic level. These data show that the Agita message reached 55.7% of the population, and among these, 23.1% knew the main message. Recall of Agita and knowledge of its purpose were well distributed among different socioeconomic levels, being known by 67% of the most educated. The prevalence of people reaching the recommendation was 54.8% (men 48.7%, women 61%); and risk of being sedentary was quite smaller among those who knew the Agita message (7.1%) compared with those who did not know (13.1%). In conclusion, based upon the Agita São Paulo experience, it appears that a multi-level, community-wide intervention to promote physical activity may obtain good results if the model contains the items listed above.

Minisymposium on obesity: overview and some strategic considerations

The high and still increasing prevalence of obesity in US children, adolescents, and adults poses a major economic and health threat to our society. The three reviews in this minisymposium on obesity explore the health issues by: 1) describing the public health impact of obesity; 2) examining the multiple and complex environmental influences on eating and physical activity patterns; and 3) considering how the development of obesity during childhood and adolescence can be prevented through interventions in school, family, and primary care settings. This overview explains the importance, for effective long-term obesity prevention and control, of intersectoral policy and environmental initiatives-in addition to behavior change approaches aimed at individuals. The need for public health professionals to influence and operate within a variety of non-health sectors such as transportation, education, urban planning, and commerce may be seen as the greatest barrier but may also be the greatest opportunity.

[Health promotion by sports and physical activity: politics, behavior and infrastructures in a European comparison]

OBJECTIVES

The focus of physical activity promotion is moving from measures to increase health-enhancing physical activity on the individual level to higher-level strategies including policy and environmental approaches. Scientific evidence, traditionally related to individual-based strategies, calls for adaptation and refinement when environmental and policy changes become more relevant.

METHODS

This paper investigates differences in physical activity promotion and public policy among six European countries. Data from a European study on public health promotion policy and health behaviours (MAREPS) is analysed to study behaviour, community-based opportunities for physical activity, and populations' perception of the effectiveness of their national policies in promoting physical activity.

RESULTS

Analyses show significant differences in both involvement in and perceived opportunities for physical activity among the investigated countries. Populations in Finland, Switzerland, and The Netherlands show comparably higher participation and, at the same time, perceive better opportunities for physical activity within the residential environment than people in East Germany, Belgium, and Spain. Moreover, respondents from the former group of nations report considerably greater contribution of health policy in their country to the promotion of physical activity than respondents from the latter group.

CONCLUSIONS

In conclusion, the results provide empirical support for the significance of environmental and policy approaches with regard to physical activity. Opportunities created by implementing such approaches may enable populations to develop more active lifestyles conducive to health. Further research employing longitudinal designs could be especially helpful to explore the causalities of the relationship between policy, environment and physical activity.

Self reported physical activity, public health, and perceived environment: results from a comparative European study

STUDY OBJECTIVE

The focus of physical activity promotion is moving from methods for increasing health enhancing physical activity on the individual level to higher level strategies including environmental and policy approaches. Scientific inquiry, traditionally related to individual-based strategies, requires adaptation and refinement when environmental and policy changes become more relevant. The objective of this study is to investigate the significance for behaviour and health of community-based environments that encourage physical activity.

DESIGN AND SETTING

The article presents data and results from a cross sectional comparative survey of the general population in six European countries (Belgium, Finland, Germany (East and West), Netherlands, Spain, Switzerland). Specifically, the relation between perceived community-based opportunities for physical activity, self reported physical activity, and self rated health status is investigated.

PARTICIPANTS

Representative samples of general populations (adults 18 years or older). Overall response rate: 53.5%. Sample sizes realised: Belgium: n = 389; Finland: n = 400; Germany (East): n = 913; Germany (West): n = 489; Netherlands: n = 366; Spain: n = 380; Switzerland: n =406.

MAIN RESULTS

Analyses show that best opportunities are reported by people who are lightly to moderately physically active. People's self rated health is moderately, but significantly associated with both perceived opportunities, and physical activity itself. These predictors interact in that especially for women, the health impact of physical activity is more pronounced in case of good opportunities.

CONCLUSIONS

The paper shows the potential of opportunities within residential and community environments with regard to physical activity, both for behaviour and health. Opportunities may enable the population, especially women, to develop an active lifestyle, and thus improve their health. Future studies with objective indicators for physical activity related environments should test the findings that are based on perceptions.

Moderate-intensity exercise: for our patients, for ourselves

Even more than the general population, orthopaedic patients suffer from multiple consequences of immobility. Fortunately, most of these patients are physically able to participate in some degree of moderately intense exercise. Helping the orthopaedic patient initiate and adhere to a moderately intense exercise routine is a nursing challenge. This challenge is even more difficult because as nurses, we are often expecting our patients to make a lifestyle change that we have been unable or unwilling to make ourselves. Understanding the health-related benefits that can be derived from participation in moderately intense exercise routines and the recommended guidelines for exercise frequency and intensity is a first step toward initiating a fitness routine. Using information acquired from research, nurses can assess for specific facilitators and barriers to exercise participation. This assessment data can then be used to individualize plans for exercise that meet the fitness needs of our patients and ourselves.

Determinants of leisure time physical activity in rural compared with urban older and ethnically diverse women in the United States

STUDY OBJECTIVE

Determinants of leisure time physical activity (LTPA) in rural middle aged and older women of diverse racial and ethnic groups are not well understood. This study examined: (1) urban-rural differences in LTPA by sociodemographic factors, (2) urban-rural differences in LTPA determinants, and (3) the pattern of relations between LTPA determinants and LTPA.

DESIGN

A modified version of the sampling plan of the Behavioral Risk Factor Surveillance Survey (BRFSS) was used. Zip codes were selected with 20% or more of each of the following race/ethnic groups: African American, American Indian/Alaskan Native (AI/AN), and Hispanic. A comparison group of white women were also surveyed using standard BRFSS techniques.

PARTICIPANTS

Rural (n=1242) and urban (n=1096) women aged 40 years and older from the US Women's Determinants Study.

MAIN RESULTS

Rural women, especially Southern and less educated women, were more sedentary than urban women. Rural women reported more personal barriers to LTPA, cited caregiving duties as their top barrier (compared with lack of time for urban women), and had greater body mass indices. Rural women were less likely to report sidewalks, streetlights, high crime, access to facilities, and frequently seeing others exercise in their neighbourhood. Multivariate correlates of sedentary behaviour in rural women were AI/AN and African American race, older age, less education, lack of enjoyable scenery, not frequently seeing others exercise, greater barriers, and less social support (p<0.05); and in urban women, older age, greater barriers, less social support (p<0.05), and less education (p<0.09).

CONCLUSIONS

Rural and urban women seem to face different barriers and enablers to LTPA, and have a different pattern of determinants, thus providing useful information for designing more targeted interventions.

Walking in (affective) circles: can short walks enhance affect?

Recent physical activity recommendations call for activities that are of moderate intensity and can be performed intermittently during the day, such as walking. These proclamations were based partly on the assumption that moderate activities are generally more enjoyable than physically demanding ones, and they are, therefore, also more likely to be continued over the long haul. However, little is actually known about the affective outcomes of short bouts of walking and extant findings are equivocal. Four experimental studies examined the affective responses associated with short (10- to 15-min) bouts of walking using a dimensional conceptual model of affect, namely, the circumplex. Results consistently showed that walking was associated with shifts toward increased activation and more positive affective valence. Recovery from walking for 10-15 min was associated with a return toward calmness and relaxation. This pattern, was robust across different self-report measures of the circumplex affective dimensions, across ecological settings (field and laboratory), across time, and across samples.

Leisure-time, occupational, and household physical activity among professional, skilled, and less-skilled workers and homemakers

BACKGROUND

Adults in lower status occupations are at higher risk of premature cardiovascular disease, for which physical inactivity is a major risk factor. While lower rates of leisure-time physical activity have been found to be associated consistently with lower income and education levels, the association between occupational and home-based physical activity with membership of different occupational categories is not well understood.

METHODS

An urban-representative population data set derived from a self-completion questionnaire was used to examine both self-reported leisure-time physical activity and a combined measure of occupational/home-based physical activity of adult less-skilled, skilled, and professional workers and homemakers (3795 males; 4140 females). chi(2) analyses, ANOVA, and logistic regressions were used to examine the associations between occupational group membership and physical activity.

RESULTS

After adjustment for age, body mass index, education, country of birth, marital status, and smoking, less-skilled workers were less likely to report any form of leisure-time physical activity. However, occupational category was not a strong predictor of participation in combined vigorous occupational/home physical activity. Homemakers and those in lower status occupations were less likely to report participation in vigorous leisure-time physical activity sufficient for cardiorespiratory fitness. With the inclusion of time spent in combined vigorous occupational/home physical activity, there was no longer an association of activity with occupational status for males. However, for females the association remained.

CONCLUSIONS

The assessment of occupational and household physical activity in addition to leisure-time activity may be important for understanding associations between occupational categories, physical activity, and increased levels of health risk and for the development of physical activity promotion strategies.

Variables independently associated with self-reported obesity in the European Union

OBJECTIVE

The rapid increase in obesity rates over recent years suggest that cultural and societal influences are affecting the adjustment in the energy balance equation in addition to other physiopathological or genetic determinants. Therefore, a pan-EU study was carried out to explore the influence of sociodemographic factors as well as some attitudes (smoking and exercise) on the prevalence of obesity in the adult population of all 15 member states of the EU.

DESIGN

Overall, a sample of 15,239 individuals aged 15 years and upwards in the EU completed the questionnaire. Subject selection was quota-controlled to make the sample nationally representative following a multistage stratified cluster sampling. Self-reported height and weight were used to calculate body mass index (BMI).

RESULTS

From the EU average results, it can be seen that only about half of the EU population (48%) is within the normal weight range, while the obesity (BMI > or = 30 kg m(-2)) prevalence was about 10% in the EU and the overweight prevalence was 36.6% and 25.6% among men and women, respectively. UK subjects had the highest prevalence of obesity (12%), while Italians, French and Swedes had the lowest levels of obesity (about 7%). Concerning age and social class interactions, logistic regression analysis showed that high social class and younger individuals in all groups had a lower odds ratio for obesity prevalence. People with a higher level of education are less likely to be obese, while the interaction between educational levels and obesity was different for men and women. A low participation in various leisure-time physical activities, the lack of interest (precontemplation) in being involved in exercise/physical activity and the increasing number of hours sitting down at work appear to be predictors of obesity. Single individuals were less prone to become obese than couples or widowed/divorced people. Finally, smoking status was statistically linked to the prevalence of obesity, since non-smokers or ex-smokers for more than 1 year presented a higher tendency for a BMI > 30.

CONCLUSIONS

This survey confirms that a priority area for health intervention aimed at preventing the development of obesity should be to increase levels of physical activity, although the approach will depend on the population, especially with respect to educational and socioeconomic aspects.

Environmental and policy interventions to promote physical activity

BACKGROUND

Because most adults in industrialized countries do not meet physical activity guidelines, population-wide interventions are needed. Environmental and policy interventions are based on ecological models of behavior and have the potential to influence entire populations. Ecological models are particularly applicable to physical activity because the behavior must be done in specific physical settings. Cross-sectional data indicate that environmental and policy variables are associated with physical activity behaviors of young people and adults.

METHOD

Seven published evaluations of environmental and policy interventions to increase physical activity were reviewed.

RESULTS

Two studies showed that placing signs encouraging stair use can be effective. Quasi-experimental evaluations provided limited evidence that broad environmental changes can be effective. Large-scale policy interventions are currently being conducted in several countries. PROPOSED MODEL: A model describing the development of policy and environmental interventions is proposed, in the hope of stimulating more research in this area. Advocacy or planning groups identify and work with agencies that control policies and environments that can be altered to increase physical activity. Educational and policy/environmental interventions are seen as complementary.

CONCLUSION

Lack of conceptual models and the inherent difficulties of evaluation have hampered research on environmental and policy interventions. Further research is needed, and practitioners and researchers should work together to evaluate programs.

Physical exercise and psychological well being: a critical review

The relation between physical exercise and psychological health has increasingly come under the spotlight over recent years. While the message emanating from physiological research has extolled the general advantages of exercise in terms of physical health, the equivalent psychological literature has revealed a more complex relation. The paper outlines the research evidence, focusing on the relation between physical exercise and depression, anxiety, stress responsivity, mood state, self esteem, premenstrual syndrome, and body image. Consideration is also given to the phenomena of exercise addiction and withdrawal, and implications for exercise prescription are discussed.

Guidelines for school and community programs to promote lifelong physical activity among young people. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and prevention

Regular physical activity is linked to enhanced health and to reduced risk for all-cause mortality and the development of many chronic diseases in adults. However, many U.S. adults are either sedentary of less physically active than recommended. Children and adolescents are more physically active than adults, but participation in physical activity declines in adolescence. School and community programs have the potential to help children and adolescents establish lifelong, healthy physical activity patterns. This report summarizes recommendations for encouraging physical activity among young people so that they will continue to engage in physical activity in adulthood and obtain the benefits of physical activity throughout life. These guidelines were developed by CDC in collaboration with experts from universities and from national, federal, and voluntary agencies and organizations. They are based on an in-depth review of research, theory, and current practice in physical education, exercise science, health education, and public health. The guidelines include recommendations about 10 aspects of school and community programs to promote lifelong physical activity among young people policies that promote enjoyable physical activity and social environments that encourage and enable physical activity; physical education curricula and instruction; health education curricula and instruction; extracurricular physical activity programs that meet the needs and interests of students; involvement of parents and guardians on physical activity instruction and programs for young people; personnel training; health services for children and adolescents; developmentally appropriate community sports and recreation programs that are attractive to young people; and regular evaluation of physical activity instruction, programs, and facilities.