Physical activity and health: adults

physical activity

Physical activity and health: adults

Introduction


There are many and indisputable benefits that a physically active life can give: moving is one of the keys to taking care of yourself, a way to improve the quality of your life right away.
Exercise is also one of the best tools for preventing and treating many diseases. In particular, the fight against chronic non-communicable diseases, which is at the center of the universal strategy that the World Health Organization (WHO) and many member countries (including Italy) have been implementing for several years, involves prevention and prevention plans and programs. health promotion through the promotion of a healthy and active life.

The benefits of physical activity

physical activity

Regular physical activity reduces all-cause and cardiovascular-related mortality by 20-30% in a dose-dependent manner in the general population, but also in people with coronary risk factors and heart patients. Being active (at or above the recommended minimum of 150 minutes of brisk walking per week) was associated with an overall life expectancy gain of 3.4-4.5 years.

Furthermore, constant physical exercise has a direct protective effect on the development of atherosclerotic lesions and a favorable indirect effect on other cardiovascular risk factors (lipid profile, insulin sensitivity, fat mass, and blood pressure), while a sedentary lifestyle acts instead with the opposite trend.
Cardiovascular protection also occurs when heart disease is established, including mild to moderate forms of heart failure. Furthermore, after an acute cardiovascular event, the practice of physical activity allows faster recovery, with the resumption of normal activities, including work.

Several studies and meta-analyses have established that a sedentary lifestyle is a risk factor for the development of type 2 diabetes mellitus, a condition that is worrying not only for the constant growth but also for the tendency towards an increasingly marked the advance of the age of onset. It is estimated that the risk of developing type 2 diabetes mellitus increases by 20% for every additional 2 hours a day that you watch TV. On the other hand, a preventive effect of moderate or vigorous but constant physical activity is proven, with a 30% reduction in the risk of the onset of diabetes for active subjects compared to sedentary ones.

There is a direct relationship between physical activity levels and predisposition to overweight and obesity. The combination of a BMI (≥25 kg / m²) with a sedentary lifestyle (≤3.5 hours of physical activity per week) is responsible for 59% of premature cardiovascular deaths. Constant physical activity, even moderate, allows you to maintain a stable weight. In subjects who are already overweight, physical activity and moderate exercise, in association with correct lifestyles and in particular with adequate nutrition, promote weight loss.
The presence of overweight/obesity also predisposes to functional impairment of mobility. A 5% increase in BMI is sufficient to cause limitations in the mobility of the lower part of the body, with repercussions on the activities of daily and working life. Participation in physical activity programs is useful for maintaining its functionality and slowing the physiological age-dependent decline of the musculoskeletal system, a process that leads to degenerative forms of arthrosis, as well as a prevalent loss of strength and elasticity.

A medium to high level of physical activity is also useful for preventing osteoporosis, especially in the elderly and in menopausal women. Simple walking alone, however, determines limited or even absent effects on the optimization of health and musculoskeletal function, while more structured physical activity programs seem to be more effective, with exercises also aimed at improving balance and mobility.
According to estimates by the World Cancer Research Fund, 20-25% of cancer cases would be attributable to a 'too' rich energy balance, in practice to excessive nutrition and a sedentary lifestyle and physical activity would therefore seem associated with a reduction in overall cancer risk.

The advantages related to physical activity translate into psychological and social benefits, such as increased self-esteem and quality of life and a better self-image, especially in women.
Psychosocial benefits are more evident when team sports are played than with individual forms of physical activity. Of particular importance seems to be the possibility of choosing the mode of practice of physical activity that is preferred as the component of fun, passion and intrinsic motivation to participate would contribute to improving health.
The psychological benefits of physical activity are observable in terms of prevention of psychic disorders, from anxiety to panic attacks, from depression to various addictions, from stress to loneliness.

What physical activity?

physical activity

The levels of physical activity useful for maintaining good health and for controlling bodyweight is defined by the WHO.

To obtain health benefits in adults (18-64 years) physical activity should be practiced during the week for at least 150 minutes overall with moderate intensity (on average 30 minutes for 5 days a week) or for at least 75 minutes overall with higher intensity (on average 15 minutes for 5 days a week) or with an equivalent combination of moderate and high-intensity activity. Aerobic activity must be performed in fractions of at least 10 continuous minutes to obtain a significant metabolic advantage. Doubling the recommended weekly time (300 minutes of moderate activity or 150 minutes of strenuous activity or an equivalent combination) achieves additional benefits.

Even if to stay healthy and prevent chronic diseases it is sufficient to regularly practice moderate-intensity activity, intense activity may be appreciated by some people and is even more effective but should be reserved for adequately trained people avoiding in particular that intense effort is practiced sporadically because it increases the risk of cardiovascular accidents. Conversely, light intensity physical activity has only a modest preventive efficacy and is not recommended except in the initial stages of "training" in sedentary, obese or very elderly subjects with a view to a very gradual increase in times and intensity.

In the adult population, as in all age groups, practicing physical activity depends on many individual and collective factors. The first includes the degree of motivation, the awareness of the benefits, the psychological disposition more or less favorable to the practice, the conviction of not having free time to devote to exercise (an idea often more perceived than real). Among the strongest social conditioning, there is the sedentary lifestyle, the result of the change in the working methods of large sections of the population, the characteristics of the urban environment. Other significant social factors are education and income. A difficult socio-economic situation generally translates into a disadvantage due to the reduced availability of free time, less access to dedicated facilities and few opportunities for physical activity, the perception of the sport as a luxury and not as a necessity. Some categories such as women, the disabled, families with serious socio-economic difficulties, migrants and ethnic minorities are particularly at risk of not reaching adequate levels of physical activity and therefore deserve greater attention in terms of intervention to promote physical activity and, more generally, a healthy lifestyle.

What do the data on physical activity and sedentary lifestyle tell us?

The surveillance system Passi (Progress of the Health Authorities for Health in Italy) promoted and financed by the Ministry of Health / Ccm and coordinated by the ISS in collaboration with the Regions, since 2008 has been collecting information on the state of health and on the behaviors connected to it of the Italian adult population (18-69 years).

Passi's physical activity questions were adapted from the Behavioral Risk Factor Surveillance System (Brfss) - physical activity module of the Centers for Disease Control and Prevention (Cdc) of Atlanta. The aspects investigated include: frequency, duration, intensity, physical activity at work, self-perception of the level of physical activity, interest, and advice from doctors and other health professionals.

The data collected allow the classification of the population by physical activity by referring to both the physical activity carried out in the workplace and that carried out in free time in the thirty days preceding the interview, according to frequency, duration and intensity. This is how in Steps are defined:
  • "physically active" people those who carry out heavy work that requires considerable physical effort (eg. manual worker, bricklayer, farmer) and/or have carried out in the 30 days prior to the interview at least 30 minutes of moderate activity for at least 5 days a week and/or intense activity for more then 20 minutes for at least 3 days a week
  • "partially active" people those who do not carry out heavy work from a physical point of view, but do physical activity in their free time, without however reaching the levels mentioned above (at least 30 minutes for at least 5 days a week of moderate activity and/or at least 20 minutes for at least 3 days a week of intense activity)
  • for "sedentary" people those who do not carry out heavy work and who, in their free time, do not carry out any moderate or intense physical activity.
Starting from these definitions, according to the 2014-2017 Passi data (out of over 135 a thousand interviews), 31.7% of adults residing in Italy can be classified as physically active, 34.7% partially active and the remaining 33, 6% sedentary. Sedentary lifestyle increases with age (it is equal to 37.9% between 50-69 years of economic status. economically most disadvantaged due to economic difficulties (44.9% among those who claim to have many economic difficulties vs 26.7% of those who declare they do not have any) or for the low level of education (48.2% among people with at most, the license elementary vs25.4% in graduates) and is higher among Italian citizens than foreigners (33.6% vs 35.6%). A sedentary lifestyle is also associated with poor mental health.

The geographical gradient of sedentary lifestyle is clear and divides Italy in two: in the central-southern regions, the prevalence of sedentary is significantly higher than that observed in the northern regions, with a range of values ​​ranging from 65.8% of Basilicata 11.6% of the Autonomous Province of Bolzano. The temporal variations over 10 years of observation describe an increasing share of sedentary people throughout the country, and in particular, in Southern Italy, contributing to widening the geographical gap.
ds), it is greater among women than men (35.4% vs 31.7%), among people with a socio-

economic status. economically most disadvantaged due to economic difficulties (44.9% among those who claim to have many economic difficulties vs 26.7% of those who declare they do not have any) or for the low level of education (48.2% among people with at most the license elementary vs25.4% in graduates) and is higher among Italian citizens than foreigners (33.6% vs 35.6%). A sedentary lifestyle is also associated with poor mental health.

The geographical gradient of sedentary lifestyle is clear and divides Italy in two: in the central-southern regions, the prevalence of sedentary is significantly higher than that observed in the northern regions, with a range of values ​​ranging from 65.8% of Basilicata 11.6% of the Autonomous Province of Bolzano. The temporal variations over 10 years of observation describe an increasing share of sedentary people throughout the country, and in particular, in Southern Italy, contributing to widening the geographical gap.
The subjective perception of the level of physical activity practiced does not always correspond to that actually performed: 1 in 2 of partially active adults and 1 in 5 sedentary adults perceive their level of physical activity as sufficient.

The attention of health workers to the problem of low physical activity appears too low (and without any sign of increase over time, indeed decreasing in the North), even towards people with excess weight or with chronic diseases: almost 3 out of 10 interviewed report having received advice from their doctor or healthcare professional to exercise regularly; among people with excess weight this share does not reach 40% and among people with chronic diseases it is just over 45%.

According to current WHO guidelines on minimum levels of physical activity, indicated for adults as useful for having health benefits (at least 150 total weekly minutes of moderate activity or at least 75 total weekly minutes of intense activity, for continuous sections of no less than 10 minutes, or an equivalent combination of moderate and high activity) the Passi data in the four-year period 2014-2017 provides an estimate of physically active people of 49%, partially active of 22.3% and sedentary of 28.1%.

Reading the Passi data in terms adhering to the definition of the minimum levels of physical activity recommended by the WHO identifies a greater share of people who can be defined as "physically active" (compared to the historical indicator used since 2008), but confirms the differences by gender, age, socio-demographic characteristics and geographical distribution that have always been highlighted.

Useful resources

  • consult the section of EpiCentro dedicated to surveillance Steps
  • consult the pages of the national program Gaining Health on physical activity
  • read the comment by Barbara De Mei, Valentina Possenti and Angela Spinelli (Iss) on the World Physical Activity Day 2018
  • read the comment by Carla Faralli, Lorenzo Fantozzi, Paola Luzi (Iss) on the card “ Physical activity and health: an ageless alliance! "(Pdf 4,3 Mb) created by the National Center for Disease Prevention and Health Promotion, with the translation of the WHO recommendations on recommended physical activity levels
read the comment by Chiara Cattaneo and Paola Nardone (Iss) " Physical activity and health: children and adolescents ".

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