Carol A. Macera

Physical Activity and Public Health in Older Adults Recommendation From the American College of Sports Medicine and the American Heart Association

OBJECTIVE To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults. PARTICIPANTS A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology. EVIDENCE The expert panel reviewed existing consensus statements and relevant evidence from primary research articles and reviews of the literature. PROCESS After drafting a recommendation for the older adult population and reviewing drafts of the Updated Recommendation from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults, the panel issued a final recommendation on physical activity for older adults. SUMMARY The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adults aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management.

Levels of physical activity and inactivity in children and adults in the United States: current evidence and research issues.

PURPOSE The purpose was to describe current levels of physical activity and inactivity among adults and young people in the United States. METHODS Estimates of participation in regular physical activity were derived from three national surveys for adults (National Health Interview Survey, National Health and Nutrition Examination Survey, and the Behavioral Risk Factor Surveillance System) and from the Youth Risk Behavior Survey for high school students. RESULTS Overall, 63.8% of high school students surveyed on the 1997 YRBS reported participating in vigorous physical activity for at least 20 min on 3 or more days per week. Participation in vigorous activity was higher for boys (72.3%) than girls (53.5%), whites (66.8%) compared with blacks (53.9%) and Hispanics (60.4%), and decreased with advancing grade. Among adults, 27.7% meet recommended levels of either moderate or vigorous physical activity, whereas 29.2% report no regular physical activity outside of their work. Gender differences in participation in physical activity are less pronounced than in youth, and age-related patterns were complex. Whites are more active than blacks and Hispanics, and persons with higher family incomes and more education report being more physically active. There have been only minor changes in reported participation in leisure time physical activity over the past 15 yr. CONCLUSION National estimates of physical activity appear to be reliable and valid for adults but may be less so for adolescents and are poor measures for children. Research is needed to determine the role that objective monitoring with accelerometers may play in surveillance. Reliable and valid measures of occupational, household, and transportation-related physical activity and sedentary behaviors are needed to better characterize the range of activity that is associated with health.

Physical activity programs and behavior counseling in older adult populations

Physical activity offers one of the greatest opportunities for people to extend years of active independent life and reduce functional limitations. The purpose of this paper is to identify key practices for promoting physical activity in older adults, with a focus on older adults with chronic disease or low fitness and those with low levels of physical activity. Key practices identified in promotion activity in older adults include: 1) A multidimensional activity program that includes endurance, strength, balance, and flexibility training is optimal for health and functional benefits; 2) Principles of behavior change, including: social support, self-efficacy, active choices, health contracts, assurances of safety, and positive reinforcement enhance adherence; 3) Management of risk by beginning at low intensity but gradually increasing to moderate physical activity, which has a better risk-to-benefit ratio and should be the goal for older adults; 4) An emergency procedure plan is prudent for community based programs; and 5) Monitoring aerobic intensity is important for progression and for motivation. Selected content review of physical activity programming from major organizations and institutions are provided. Regular participation in physical activity is one of the most effective ways for older adults, including those with disabilities, to help prevent chronic disease, promote independence, and increase quality of life in old age.

Predictors of Lower Extremity Injury Among Recreationally Active Adults

ObjectiveTo identify gender-specific predictors of lower extremity injury among a sample of adults engaging in running, walking, or jogging (RWJ) for exercise. DesignProspective cohort study. SettingCooper Clinic Preventive Medicine Center, Dallas, Texas. ParticipantsParticipants were 2,481 men and 609 women who underwent a physical examination between 1970 and 1981 and returned a follow-up survey in 1986. Predictor variables measured at baseline included height, weight, and cardiorespiratory fitness. At follow-up, participants recalled information about musculoskeletal injuries, physical activity levels, and other predictors for lower extremity injury over two time periods, 5 years and 12 months. Main Outcome MeasuresAn injury was defined as any self-reported lower extremity injury that required a consultation with a physician. Cox proportional hazards regression (HR) was used to predict the probability of lower extremity injury for the 5-year recall period, and unconditional logistic regression was used for the 12-month recall period. ResultsAmong men, previous lower extremity injury was the strongest predictor of lower extremity injury (HR = 1.93–2.09), regardless of recall period. Among women, RWJ mileage >20 miles/wk was the strongest predictor for the 5-year period (HR = 2.08), and previous lower extremity injury was the strongest predictor for the 12-month period (HR = 2.81). ConclusionsFor healthy adults, walking at a brisk pace for 10–20 miles per week accumulates adequate moderate-intensity physical activity to meet national recommendations while minimizing the risk for musculoskeletal lower extremity injury. Clinicians may use this information to provide appropriate injury prevention counseling to their active patients.

Influence of physical activity-related joint stress on the risk of self-reported hip/knee osteoarthritis: a new method to quantify physical activity

BACKGROUND The relationship between physical activity (PA) and the development of hip/knee osteoarthritis (OA) has not been clearly defined. The purpose of this study was to develop a method to quantify PA-related joint stress and to assess its influence on the risk of hip/knee OA. METHODS Participants in a large longitudinal study, without knee/hip OA (n = 5284), were asked about their PA participation in 1986. PA-related joint stress was calculated using information on the frequency, intensity, and duration of individual types of PA, and incorporated a quantification of joint stress. Self-reported, physician-diagnosed hip/knee OA was ascertained by survey in 1990, 1995, and 1999 (average length of follow-up: 12.8 years). METHODS The joint stress PA score was not associated with an increased risk of hip/knee OA. Also, among walkers and runners there was no association between the frequency, pace, or weekly training mileage and hip/knee OA. Older age, previous joint injury and surgery, and higher body mass index were confirmed as independent risk factors for hip/knee OA. CONCLUSIONS Participation in PA as an adult does not increase the risk of hip/knee OA and there does not seem to be a threshold of increasing risk with increased training among walkers and runners.

Economic burden of cardiovascular disease associated with excess body weight in U.S. adults.

BACKGROUND Excess body weight (EBW), which continues to become more prevalent, is a clear contributor to cardiovascular disease (CVD), the leading cause of death and disability among U.S. adults. Information on the economic impact of CVD associated with EBW is lacking, however. OBJECTIVE To estimate the direct medical costs of CVD associated with EBW. METHODS We conducted a population-based analysis of direct medical costs by linking the 1995 National Health Interview Survey and the 1996 Medical Expenditure Panel Survey. The study subjects are adults (aged > or =25 years, excluding pregnant women) in the non-institutionalized, civilian population in 1996. RESULTS The prevalence of CVD among people in the normal weight (body mass index [BMI] > or =18.5 to <25), overweight (BMI > or =25 to <30), and obese (BMI > or =30) groups was 20%, 28%, and 39%, respectively. There were 12.95 million CVD cases among overweight people, more than 25% of which was associated with overweight. There were 9.3 million CVD cases among obese people, of which more than 45% was associated with obesity. This extra disease burden led to

Physical activity-related injuries in walkers and runners in the aerobics center longitudinal study.

22.17 billion in direct medical costs in 1996 (

Inactivity-associated Medical costs among US adults with arthritis

31 billion in 2001 dollars, 17% of the total direct medical cost of treating CVD). CONCLUSIONS The strong positive association between EBW and CVD, and the significant economic impact of EBW-associated CVD demonstrate the need to prevent EBW among U.S. adults.

The Use of Surveillance Data and Market Research to Promote Physical Activity

ObjectiveTo examine the association between physical activity-related injuries and participation in walking versus running. DesignNested case-control study. SettingCooper Clinic Preventive Medicine Center, Dallas, Texas. Participants5,327 men and women undergoing exams between 1987 and 1995 and completing follow-up health history questionnaires in 1990 or 1995. Participants were classified as those reporting regular participation in walking or jogging/running at baseline. Those reporting both or neither activity were excluded from the study (n = 1404). Cases (698 men, 169 women) were those reporting physical activity-related injuries requiring physician visits in the previous year on the follow-up questionnaire. Controls (2,358 men, 698 women) were randomly selected from the remaining population. Main Outcome MeasuresLogistic regression was used to examine the risk of injury in walkers versus runners and risk of injury by exercise dose while considering age, body mass index, previous injury, and strength training. ResultsThere was a significantly lower risk of injury for walkers compared with runners in young (<45 years old) (odds ratio [OR] = 0.75, 95% confidence interval [CI] = 0.58–0.97) and older (≥45 years) men (OR = 0.64, 95% CI = 0.49–0.82), and a nonsignificantly lower risk among young (OR = 0.73, 95% CI = 0.39–1.37) and older women (OR = 0.72, 95% CI = 0.38–1.35). There was no effect of greater amounts of walking on injuries for either gender; however, there was a higher injury risk associated with running 15–30 min/day (OR = 1.36, 95% CI = 1.07–1.73) and 30+ min/day (OR = 1.52, 95% CI = 1.14–2.04) compared with <15 min/day among men, but not among women. ConclusionsThis low risk of musculoskeletal injury suggests that participation in walking can be safely recommended as a way to improve health and fitness.

Self-Reported Smoking and Musculoskeletal Overuse Injury Among Male and Female U.S. Marine Corps Recruits

OBJECTIVE To analyze direct medical costs among US adults with arthritis and estimate the proportion associated with inactivity. METHODS In the 1987 National Medical Expenditure Survey, arthritis was defined using questions on self-reported, doctor-diagnosed arthritis or rheumatism. Physical activity was defined using a self-report question on level of activity. Inactivity-associated medical costs were derived by subtracting costs for active adults from costs for inactive adults after controlling for functional limitation. RESULTS Among 5,486 adults with arthritis, inactive persons had higher medical costs than did active persons in all demographic groups examined. In multivariate models adjusting for key covariates, the proportion of costs associated with inactivity averaged 12.4% (