As lifestyles change to become more sedentary, combined with rapidly changing diets, a number of diseases are becoming more common and are striking at a younger age. According to the World Health Organisation, physical inactivity is the principal cause of approximately 27 per cent of type 2 diabetes and 30 per cent of ischemic heart disease.
Being physically active plays a crucial role in ensuring health and well-being. Physical activity is defined as any bodily movement produced by skeletal muscles that requires energy expenditure. Regular moderate physical activity, such as walking, cycling or participating in sports has significant benefits for health.
Physical activity benefits many parts of the body, including the heart, skeletal muscles, bones, blood cholesterol levels, the immune system and the nervous system. Research also shows that physical activity can reduce many of the risk factors for non-communicable diseases such as reducing blood pressure, improving blood cholesterol levels and lowering weight.
So reversing the tide of physical inactivity can have striking impacts on many of the major diseases such as hypertension, diabetes, many cancers and heart disease. Specific benefits include:
• a risk reduction for breast cancer of approximately 20-40 per cent for those who do vigorous physical activity for 30 to 60 minutes on five days each week;
• the most active people have a 30 per cent lower risk of getting colon cancer than those who are least fit;
• a 25-30 per cent reduction in stroke among active individuals;
• physically inactive people run as much as twice the risk of suffering coronary heart disease.
In addition to the benefits of physical activity on improving health and reducing risk factors for chronic disease, it has been shown to be effective in improving mental health, which is also a major cause of disability worldwide.
Physical activity is important and has benefit at all ages. Among adolescents increased leisure-time physical activity (i.e. outside structured school programmes) is significantly associated with fewer depressive symptoms over a two-year period. Some studies also show that physical activity accelerates learning by increasing cognitive processes.
Regular moderate physical activity, such as walking, cycling or participating in sports, has significant benefits for health
Among older people, physical activity can be of benefit to maintaining mental health. A study of men aged 70-81 shows that those who had the highest physical activity have a 20 per cent lower risk of cognitive decline including memory and attention.
Unfortunately, despite all of this evidence to push for physical activity, it yet remains at very low levels in many countries including Malta. There is no single intervention which can be done that will be effective. This is a complex problem which needs interventions across various categories and which are multi-component and adapted to the local context for them to be successful.
The World Health Organisation recommends interventions in areas of policy and environment; using the mass media; using various settings such as school, the workplace and the community; supported through health systems especially in primary healthcare; and targeting the whole population through a lifecourse approach in an equitable manner.
Interventions that are culturally and environmentally appropriate are more likely to be implemented and sustained. Furthermore, interventions that use the existing social structures of a community, such as schools or the regular meetings of older adults in religious settings or day centres, reduce barriers to implementation.
Increasing physical activity needs the participation of stakeholders throughout the process. For example, when planning an intervention at the workplace, the involvement of workers in the planning and implementation is essential. Listening and learning from these target groups ensures that the interventions address their needs.
Two main types of strategies used are the individual and the population approaches. For the individual-based approach, one needs to target the intervention to the specific group.
In order to have sustainable behaviour change one needs to take up small, manageable, appropriate changes, while setting personal goals to encourage behaviour change.
Population-based approaches look at changing the environment in the wider concept including the social and built environments, which together influence health choices made by individuals.
Factors in the social environments known to affect update of physical activity are socioeconomic status, cultural beliefs and opportunities to improve social cohesion in the various areas. Factors in the built environment that influence participation in physical activity are urban design, transport (traffic) and availability of open spaces.
Targeting physical activity will bring benefits to the individual and to the whole of society. Each individual can do his part.
Dr Charmaine Gauci is Superintendent of Public Health.