This is an archive copy of a web document originally located at http://heartfoundation.isa.net.au/prof/docs/phys_policy_2001.htm published by the National Heart Foundation. All copyright remains with the creator.

National Heart Foundation of Australia Physical Activity Policy

A position paper prepared by the National Physical Activity Program Committee, National Heart Foundation of Australia, April 2001.

Chief Authors: Prof. Adrian Bauman, Ms Cheryl Wright, Prof. Wendy Brown

Other committee members: Dr Peter Abernethy, Mr Rick Atkinson, Dr Fiona Bull, Dr Geri Naughton, Prof. Brian Oldenburg, Ms Jenny Purtell, Mr Trevor Shilton.

Summary of Heart Foundation Physical Activity Recommendations for Australians

The Heart Foundation recommends and promotes enjoyable active living for all Australians. This can include incorporating physical activity into usual activities of daily living as well as participation in exercise or sport for recreation or fitness. All people should aim to participate in moderate intensity physical activity for 30 minutes or more on most or all days of the week. While this level of moderate physical activity is recommended for health benefit, more vigorous activity (for those who are able and want to do it) may confer additional benefit in terms of cardiovascular health. Physical activity should be a part of a general healthy lifestyle that also includes healthy eating and being smoke free. The Heart Foundation supports the Physical Activity Guidelines for Australians developed by the Commonwealth Department of Health and Aged Care.

Definitions

Physical activity: any movement involving large skeletal muscles e.g. walking, walking up stairs, gardening, playing sport, work-related activity etc.

Exercise: planned physical activity for recreation, leisure or fitness, with a specific objective such as improving fitness, performance, health or social interaction.1

Moderate activity: activity that is energetic, but at a level at which a conversation can be maintained.

Vigorous activity: activity at a higher intensity, which may, depending on fitness level, cause sweating and puffing.

Background and Evidence

The general health benefits of physical activity/exercise have been recognised for many centuries. However, scientific evidence documenting the clear health benefits of regular moderate intensity physical activity has only emerged over the past four decades. The best documented health gain of moderate regular physical activity is in the prevention of heart disease, and reduced risk of cardiovascular and all-cause mortality among those who are physically active, compared with those who are sedentary.2

1. The evidence that activity confers cardiovascular health benefits.

Physical activity may also favourably influence risk factors related to thrombosis, including fibrinogen and platelet function. In addition there is some evidence to suggest a benefit of activity on stroke incidence and mortality, but the amount and intensity of activity required, and the type of stroke prevented, are not yet clarified.2 More sustained levels of physical activity may be required to produce other benefits, including weight loss and increases in the HDL: total cholesterol ratio.

The US Surgeon General’s Report on Physical Activity (1996) concluded that there is a positive relationship between protection against coronary heart disease and physical activity.2 Consistently across studies, maximal cardiovascular protection is seen in moderate activity groups compared with sedentary groups, and in both men and women.2,7

The evidence is based on longitudinal population-based (cohort) studies, rather than experimental evidence (similar to that for tobacco smoking and health).7,8,9 Better-designed studies, which include improved measures of physical activity and outcomes of heart disease, show stronger associations, typically almost twice the risk of coronary heart disease in the least active people compared with those who are adequately active.5 There is evidence of a dose-response relationship, with more activity conferring additional benefit.3

There is also consistency across studies, even after statistical adjustment for the effects of other risk factors. Finally, the evidence is strengthened by demonstrations that increases in physical activity provide lasting health benefits, even after as little as two years.9 Further, increasing activity to a moderate level confers a benefit at any age, suggesting that it is never too late to start some physical activity.6

2. The amount and type of physical activity required for cardiovascular benefit.

Recent evidence suggests that there are benefits, particularly in relation to cardiovascular health, from regular, moderate intensity activity. More vigorous exercise may confer additional benefits in some groups. Moderate activity is defined as activity which uses large skeletal muscles, which involves some effort, but does not necessarily have to cause puffing, panting or breathlessness. The US Surgeon General’s report concludes that significant health benefits can be obtained by including 30 minutes of moderate intensity physical activity (e.g. brisk walking) on most or all days of the week, while additional health benefits can be gained through greater amounts of physical activity.2 Two randomised clinical trials have demonstrated that health benefits can be gained through lifestyle physical activity, as well as through structured exercise programs. Increased fitness and reduction in cardiovascular risk factors were demonstrated for both intervention groups in these studies.10,11

NB. Depending on air temperature and humidity, in many parts of Australia moderate intensity physical activity will be associated with fluid loss through sweating. To minimise the risk of significant dehydration (and associated complications) it is important that people who undertake physical activity:

3. People most likely to benefit from being more physically active

Australian population data show that women, middle-aged and older adults, non-English speaking groups, parents of young children and those with lower educational attainment are less likely to be physically active.12,13 Overall, about half of all Australian adults expend sufficient energy on physical activity for cardiovascular health gain.12,13 Adult Aboriginal people and Torres Straight Islanders are more likely to report no leisure time physical activity.14

It is recommended that physical activity be developed as a lifelong habit during the growing years. During childhood and adolescence physical activity has an important role in preventing the development of hypertension, obesity, diabetes and cardiovascular disease later in life.2 Physical activity in childhood and adolescence has been linked with improved serum lipid profiles, reduced blood pressure (in hypertensive young people), and weight maintenance (when combined with balanced nutrition).15,16 Avoiding long periods of physical inactivity may be an effective strategy for developing a more active lifestyle for young people.

Physical activity is also recommended for people with heart disease, but medical screening and assessment should precede the adoption of vigorous activity programs in this group.17 Although the risks of sudden death are transiently increased during vigorous exercise among those with heart disease, the population benefit substantially outweighs the risks.17 Adopting moderate activity carries a much lower risk for this group.

If people are to be more active, the social and physical environment in which physical activity takes place is important. Qualitative research has shown that infrastructure such as road systems, transport and open space, as well as social factors such as social support and community identity, play a role in enabling people to be active.18

4. Trends in Australia

There has been no consistent approach to the monitoring of population physical activity in Australia. Slight increases in participation in exercise for sport, recreation or fitness were reported between 1989-90 and 1995, chiefly among people aged 35-54 years. However, data from recent national surveys suggest that the proportion of the population doing sufficient activity for health benefit declined from 62% in 1997 to 57% in 1999. 19

Trend data from North America show little change over the past decade in the proportions of the population that are sedentary or engage in regular moderate activity. The only developed countries to show increases in physical activity over the last two decades are Canada and Finland.2

Several reports have indicated higher Body Mass Index values in children since the Australian Health and Fitness Survey of 1985, which included fitness and health measures of Australian children aged 7-15 years.20,21 In childhood, habitual physical activity decreases with age 22 and most studies show girls to be less active than boys, from an early age. 23 There is however a lack of longitudinal data on cardiovascular risk factors among Australian children and adolescents.

5. Research needs

There is a clear need for further research in Australia to clarify the levels of activity required for optimal health and fitness, and trends in population levels of physical activity. There is also an urgent need for development and evaluation of population interventions that encourage and enable people to be physically active.

    6.Developing interventions and programs to increase physical activity among all Australians.

There is growing recognition that a range of strategies is needed to increase physical activity levels. These might include:

Heart Foundation Position

  1. There is widespread recognition that physical inactivity is a major risk factor for cardiovascular disease, second only to the population risk attributed to smoking, and greater than the risk attributed to high cholesterol or hypertension.
  2. In addition there is good evidence that being physically active improves other cardiovascular risk factors and reduces all cause mortality. Physical activity is beneficial in terms of other conditions, including reducing the risk of diabetes, assisting in the prevention of falls and assisting in achieving and maintaining peak bone mass. It may also improve mental health.
  3. Physical activity benefits males and females of all ages. There is increasing evidence that the benefits occur relatively soon after the adoption of an active lifestyle and are likely to occur at whatever age physical activity is commenced.
  4. Physical activity should start as a lifelong habit in childhood and its benefits are maximal if maintained throughout life.
  5. Physical activity is also important for those with coronary heart disease, with the benefits far outweighing the risks. Activity is an important and effective component of cardiac rehabilitation programs following myocardial infarction, cardiac procedures or surgery.
  6. Evidence on the amount of physical activity required for health benefit has moved from the 1970's recommendations of vigorous activity three times a week towards a current consensus of 30 minutes or more of moderate intensity activity on most or all days of the week. The total amount of physical activity seems to be more important than the intensity, so that lower intensity daily activity (such as walking) may confer similar benefits to higher intensity activity on fewer days of the week.
  7. There is some evidence to suggest that there may be health benefits even when the recommended 30 minutes of activity is accumulated in multiple bouts of 10 minutes during the course of the day. More evidence is required to establish the benefits of this form of activity for the prevention and management of cardiovascular disease and diabetes.
  8. The moderate physical activity message suggests a lifestyle approach to physical activity. Strategies are required which will increase incidental physical activity, regular brisk walking and other forms of active recreation.
  9. Both moderate intensity physical activity and more vigorous physical activity appear to contribute to health benefits. Moderate intensity activity can reduce the risk of cardiovascular disease and can assist with the maintenance of healthy weight.
  10. Effective physical activity promotion also has an adjunctive role in weight control and maintenance, although more prolonged activity and dietary change will be needed to achieve sustained weight loss among the overweight and obese.
  11. There is evidence that health professionals are able to effectively counsel and advise their patients/clients to increase their physical activity levels.
  12. Physical activity should be considered in the context of the environments in which it takes place. Policy and practice related to urban planning, transport and related environmental issues must be addressed.
  13. The overall goal is to develop general population strategies and programs that will increase physical activity. However specific populations who are more likely to be sedentary or minimally active, or who have special needs deserve special efforts.
  14. The Heart Foundation recommends further research into physical activity, including monitoring levels of activity of all age groups, determining more precise levels of activity for health and fitness and determining the effectiveness of strategies that will assist population change in physical activity levels.

References

  1. 1.Bouchard C, Shepherd RJ, Stephens T. Physical activity, fitness and health: consensus statement. Champaign, IL. Human Kinetics. 1993.
  2. Department of Health and Human Services. Physical activity and health: a report of the US Surgeon General. National Centres for Disease Control, Atlanta, Georgia. 1996.
  3. Berlin J, Colditz GA. A meta -analysis of physical activity in the prevention of coronary heart disease. A J Epidemiol 1990; 132:612-628.
  4. Scheuer J, Tipton CM. Cardiovascular adaptations to physical training. Ann Rev Physiol 1977; 39: 221-251.
  5. Eriksson G, Liestel K, Bjornholt J, et al. Changes in physical fitness and changes in mortality. Lancet 1998; 352:759-762.
  6. Hakim A, Petrovich H, Burchfiel C, et al. Effects of walking on mortality among non-smoking retired men. New Eng J Med 1998; 338 (2):94-99.
  7. Blair SN, Kohl H, Baxter CE. Physical activity, physical fitness and all-cause mortality in women: Do women need to be active? American College of Nutrition 1993; 12:368-372.
  8. Paffenbarger R, Hyde RT, Wise AL, et al. The association of changes in physical activity level and other lifestyle characteristics with mortality among men. New Eng J Med 1993; 328:538-545.
  9. Blair SN, Kohl HW, Barlow CE, et al. Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA 1995; 273:1093 -1098.
  10. Dunn A, Marcus BH, Kampert J, et al. Comparison of Lifestyle and Structured Interventions to Increase Physical Activity and Cardiorespiratory Fitness, a randomised trial. JAMA 1999; 281:327–333.
  11. Andersen RE, WaddenT, Bartlett S, et al. Effects of lifestyle activity vs. structured aerobic exercise in obese women: a randomised trial, JAMA 1999; 281:327– 334.
  12. Bauman A, Bellew B, Booth M, et al. Towards best practice for physical activity in the areas of NSW, NSW Health Department, December 1996.
  13. Booth M, Owen N, Bauman A, Gore CJ. Active and inactive Australians, Department of Environment, Sport and Territories, AGPS, Canberra 1995.
  14. Australian Bureau of Statistics. 1995 National Health Survey:Aboriginal and Torres Strait Islander results. ABS Cat. No. 4806.0 Canberra: ABS. 1999.
  15. Casperson CJ, Nixon PA, DuRant RH. Physical activity epidemiology applied to children and adolescents. Exerc Sport Sci Rev, 1998; 26:341- 403.
  16. Epstein L.H, Coleman KJ, Myers MD. Exercise in treating obesity in children and adolescents. Med Sci Sports Exerc, 1996; 8:428 -435.
  17. NIH (National Institutes of health, USA) 'Consensus statement on physical activity and cardiovascular health' 18.3.96 (reproduced in US Surgeon Generals Report. pp 41-48, see reference #2).
  18. Wright C, MacDougall C, Atkinson R, Booth B. Exercise in Daily Life - Supportive Environments. Commonwealth of Australia, 1996.
  19. Armstrong T, Bauman A & Davies J. Physical activity patterns of Australian adults . AIHW Canberra. 2000.
  20. Hill M, Nowise C, Taverner M, et al. Relationship of dietary restraint and activity patterns to body mass index in Melbourne primary and secondary children: a preliminary study. Aust J Nutr Dietetics, 1997; 54:118-225.
  21. Dollman J, Olds T, Norton K, Stuart D. Trends in the health-related fitness of Australian children (Abstract) Australian Conference of Science and Medicine in Sport, Adelaide, 1998.
  22. Sallis J. Epidemiology of physical activity and fitness in children and adolescents. Crit Rev Food Sci Nutr, 1993; 33(4/5): 403-408.
  23. Goran MI, Gower BA, Nagy TR, and Johnson RK. Developmental changes in energy expenditure and physical activity in children: evidence for a decline in physical activity in girls before puberty. Paediatrics. 1998; 101(5): 887-91.

April 2001


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