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Physical Activity and Public Health around the World: The Toronto Charter and ISPAH Physical Physical Activity and Public Health around the World: The Toronto Charter and ISPAH Physical Activity and Public Health Seminar September 16, 2011 Hilton Head, SC Steven N. Blair Professor Departments of Exercise Science and Epidemiology & Biostatistics University of South Carolina

Disclosures • Medical/Scientific Advisory Boards – – – Jenny Craig, Inc Alere Technogym Cancer Disclosures • Medical/Scientific Advisory Boards – – – Jenny Craig, Inc Alere Technogym Cancer Foundation for Life Santech Clarity Project • Research Funding – – NIH Body Media Coca Cola Department of Defense

Acknowledgments • • Adrian Bauman Fiona Bull Bill Kohl Scientists who started us on Acknowledgments • • Adrian Bauman Fiona Bull Bill Kohl Scientists who started us on this journey – Jeremy Morris – Marti Karvonen – Ralph Paffenbarger – Per-Olaf Astrand

Lecture Outline • Benefits of activity for adults • Pathway to the Toronto Charter Lecture Outline • Benefits of activity for adults • Pathway to the Toronto Charter – International Congress on Physical Activity and Public Health – International Society for Physical Activity and Health • Review of the Toronto Charter • Next steps

Major Health Concerns of Adults • The three D’s –Death –Disability –Dementia Major Health Concerns of Adults • The three D’s –Death –Disability –Dementia

Cardiorespiratory Fitness and All-Cause Mortality, Women and Men ≥ 60 Years of Age • Cardiorespiratory Fitness and All-Cause Mortality, Women and Men ≥ 60 Years of Age • 4060 women and men ≤ 60 years • 989 died during ~14 years of follow-up • ~25% were women • Death rates adjusted for age, sex, and exam year All-Cause death rates/1, 000 PY Age Groups Sui X et al. JAGS 2007.

Prevalence of Self-reported Functional Limitations by Fitness and Age Groups *Prevalence (%) Huang et Prevalence of Self-reported Functional Limitations by Fitness and Age Groups *Prevalence (%) Huang et al. MSSE 1998, 30: 1430 -5

Cardiorespiratory Fitness and Risk of Dementia, ACLS • 59, 960 women and men • Cardiorespiratory Fitness and Risk of Dementia, ACLS • 59, 960 women and men • Followed for 16. 9 years after clinic exam • 4, 108 individuals died Hazard Ratio P for trend=0. 002 – 161 with dementia listed on the death certificate • Hazard ratio adjusted for age, sex, exam yr, BMI, smoking, alcohol, abnormal ECG, history of hypertension, diabetes, abnormal lipids, and health status Fitness Categories Lui R et al. In press. MSSE

Forestry Work Forestry Work

Supervisory Work Supervisory Work

Is Exercise Safe? Is Exercise Safe?

 LIFE-P Serious adverse events Physical Successful activity aging p N=213 N=211 Death 0. LIFE-P Serious adverse events Physical Successful activity aging p N=213 N=211 Death 0. 9% >0. 99 Life threatening event 1. 4% >0. 99 Hospitalization 20. 7% 20. 9% >0. 99 Significant lab exam 2. 8% 3. 8% 0. 60 Any SAE 22. 5% 23. 7% 0. 82 J Gerontol Biol Sci Med Sci 2006; 61: 1157

Lecture Outline • Benefits of activity for adults • Pathway to the Toronto Charter Lecture Outline • Benefits of activity for adults • Pathway to the Toronto Charter – International Congress on Physical Activity and Public Health – International Society for Physical Activity and Health • Review of the Toronto Charter • Next steps

Jeremy Morris & Ralph Paffenbarger Marti Karvonen with Rhonda Pollock, Linda Franklin, & Jane Jeremy Morris & Ralph Paffenbarger Marti Karvonen with Rhonda Pollock, Linda Franklin, & Jane Blair Per-Olaf Åstrand

Lecture Outline • Benefits of activity for adults • Pathway to the Toronto Charter Lecture Outline • Benefits of activity for adults • Pathway to the Toronto Charter – International Congress on Physical Activity and Public Health – International Society for Physical Activity and Health • Review of the Toronto Charter • Next steps

Slide from Bill Kohl Slide from Bill Kohl

Slide from Bill Kohl Slide from Bill Kohl

About ISPAH The International Society for Physical Activity and Health, founded in 2009, is About ISPAH The International Society for Physical Activity and Health, founded in 2009, is an international professional society of individual members who are interested in advancing the science and practice of physical activity and health. Slide from Bill Kohl

Mission To advance health through scientific study and the promotion of physical activity. Slide Mission To advance health through scientific study and the promotion of physical activity. Slide from Bill Kohl

Councils Thematic councils are organized to help ISPAH members align with specific areas of Councils Thematic councils are organized to help ISPAH members align with specific areas of interest in the broad field of physical activity and health. – Global Advocacy for Physical Activity (GAPA) – Advocacy Council of ISPAH – Council on Physical Activity Assessment & Surveillance (PAAS) – Council on Activity Interventions (PAI) – Council on Physical Activity and Obesity (PAO) – Council on Environment & Physical Activity (CEPA) Slide from Bill Kohl

Slide from Bill Kohl Slide from Bill Kohl

Lecture Outline • Benefits of activity for adults • Pathway to the Toronto Charter Lecture Outline • Benefits of activity for adults • Pathway to the Toronto Charter – International Congress on Physical Activity and Public Health – International Society for Physical Activity and Health • Review of the Toronto Charter • Next steps

Slide from Bill Kohl Slide from Bill Kohl

The Writing Team (the « Chartists » ) Slide from Fiona Bull The Writing Team (the « Chartists » ) Slide from Fiona Bull

Final Charter: 6 pages / 5 key sections Slide from Fiona Bull Final Charter: 6 pages / 5 key sections Slide from Fiona Bull

A Framework for Action Slide from Fiona Bull A Framework for Action Slide from Fiona Bull

7 Investments that work for physical activity 1. Whole-of-school’ programs 5. Public education, including 7 Investments that work for physical activity 1. Whole-of-school’ programs 5. Public education, including 2. Transport policies and systems mass media to raise awareness that prioritise walking, cycling and change social norms on and public transport physical activity 3. Urban design regulations and 6. Community-wide programs infrastructure that provides for involving multiple settings and equitable and safe access for sectors & that mobilize and recreational physical activity, integrate community and recreational and transport engagement and resources -related walking and cycling 7. Sports systems and programs across the life course that promote ‘sport for all’ and 4. Physical activity and NCD encourage participation across prevention integrated into the life span primary health care systems Slide from Fiona Bull

Web based sign up of support underway • Visit www. globalpa. org. uk • Web based sign up of support underway • Visit www. globalpa. org. uk • We monitor number of supporters – By country / region – By individual / organisations • With national and International endorsements this increases the influence and value of the Charter to all that use the Charter Sign up board at the 3 rd ICPAH Toronto 5 -8 May 2010 Slide from Fiona Bull

Translation Available in: • Arabic • Catalan • Czech • Dutch • English • Translation Available in: • Arabic • Catalan • Czech • Dutch • English • French • German • Italian • Japanese • Norwegian • Portuguese • Russian • Spanish • Thai • Turkish Others underway: • Bengali • Chinese (2) • Greek • Hindi • Korean • Polish • Solvene • Slovak Available at www. globalpa. org. uk Slide from Fiona Bull

Latin American Launch: Oct 2010 AGITA MUNDO MEETING Slide from Fiona Bull Latin American Launch: Oct 2010 AGITA MUNDO MEETING Slide from Fiona Bull

How is the Charter being used? • To build partnerships beyond health - with How is the Charter being used? • To build partnerships beyond health - with sectors interested and relevant to actions on physical activity • To meet with politicians and decision makers to raise their knowledge and discuss actions and commitment • To support funding requests for projects • To plan national and sub national action plans on physical activity Slide from Fiona Bull

Advocacy Resources • Bull FC and Bauman AE. Physical Inactivity – the ‘Cinderella’ risk Advocacy Resources • Bull FC and Bauman AE. Physical Inactivity – the ‘Cinderella’ risk factor for NCD prevention. Journal of Health Communication. In Press. • Bull FC. (2011). Global Advocacy for Physical Activity- Development and Progress of the Toronto Charter for Physical Activity: A Global Call for Action. Research in Exercise Epidemiology, 13(1), 1 -12. [link from GAPA website] Slide from Fiona Bull

Lecture Outline • Benefits of activity for adults • Pathway to the Toronto Charter Lecture Outline • Benefits of activity for adults • Pathway to the Toronto Charter – International Congress on Physical Activity and Public Health – International Society for Physical Activity and Health • Review of the Toronto Charter • Next steps

All countries should develop a national physical activity plan All countries should develop a national physical activity plan

What is a Physical Activity Plan? • A comprehensive set of strategies including policies, What is a Physical Activity Plan? • A comprehensive set of strategies including policies, practices, and initiatives aimed at increasing physical activity in all segments of the population.

U. S. National Physical Activity Plan www. physicalactivityplan. org U. S. National Physical Activity Plan www. physicalactivityplan. org

Organizational Partners American Academy of Pediatrics American Medical Assoc. American Diabetes Assoc. Organizational Partners American Academy of Pediatrics American Medical Assoc. American Diabetes Assoc.

Sectors • Mass Media • Public Health • Education • Healthcare • Volunteer and Sectors • Mass Media • Public Health • Education • Healthcare • Volunteer and Non-Profit Organizations • Transportation, Urban Design, Comm. Plan. • Business and Industry • Parks, Recreation, Fitness, and Sports

Content of the Plan • 5 Overarching Strategies • Sector-specific Strategies & Tactics • Content of the Plan • 5 Overarching Strategies • Sector-specific Strategies & Tactics • 52 Strategies • 215 Tactics

Upcoming international activities related to physical activity and public health Upcoming international activities related to physical activity and public health

The United Nations is interested in noncommunicable diseases The United Nations is interested in noncommunicable diseases

Fogarty International Center—NIH Russian Academy of Science Moscow, November 16 -18, 2011 • Scientific Fogarty International Center—NIH Russian Academy of Science Moscow, November 16 -18, 2011 • Scientific forum for biomedical and behavioral research – Brain sciences – Cancer – Cardiovascular disease – Clinical/translational research training – Healthy lifestyles – Human development – Infectious diseases – Rare diseases

Sydney Australia 2012 31 st October – 3 rd November Slide from Adrian Bauman Sydney Australia 2012 31 st October – 3 rd November Slide from Adrian Bauman

Time for the Pop Quiz Time for the Pop Quiz

Which causes more deaths in the U. S. —smoking or obesity? • ~40% of Which causes more deaths in the U. S. —smoking or obesity? • ~40% of U. S. adults think obesity causes at least as many deaths as does smoking • ~20% of U. S. adults think obesity causes more deaths than smoking • The truth – Smoking causes ~440, 000 deaths/year – Obesity causes ~110, 000 deaths/year

Definitions for adults Body mass index (BMI) – weight/height 2 • • Underweight: BMI Definitions for adults Body mass index (BMI) – weight/height 2 • • Underweight: BMI < 18. 5 Normal weight: BMI 18. 5 -<25 Overweight*: BMI 25 -<30 Obesity: BMI 30 + BMI 18. 5 BMI 25 BMI 30 162 cm (64 49 kg (107 in) lbs) 66 kg (145 lbs) 79 kg (174 lbs) 178 cm (70 59 kg (129 in) lbs) 79 kg (174 lbs) 95 kg (209 lbs) * WHO defines overweight as BMI 25+ Courtesy of Katherine Flegal

SOURCE: Harris 2008 Int J Obesity Courtesy of Katherine Flegal SOURCE: Harris 2008 Int J Obesity Courtesy of Katherine Flegal

SOURCE: Harris 2008 Int J Obesity Courtesy of Katherine Flegal SOURCE: Harris 2008 Int J Obesity Courtesy of Katherine Flegal

SOURCE: Harris 2008 Int J Obesity Courtesy of Katherine Flegal SOURCE: Harris 2008 Int J Obesity Courtesy of Katherine Flegal

SOURCE: Harris 2008 Int J Obesity Courtesy of Katherine Flegal SOURCE: Harris 2008 Int J Obesity Courtesy of Katherine Flegal

Courtesy of Katherine Flegal Courtesy of Katherine Flegal

Obesity and Diabetes • We hear a great deal, in both the scientific literature Obesity and Diabetes • We hear a great deal, in both the scientific literature and popular press, about the epidemics of obesity and diabetes – In fact, some dummies even use the term “diabesity” • What is the prevalence of type 2 diabetes in U. S. individuals under 45 years of age? – 45% – 35% – 25% – 1. 5%

U. S. Prevalence of Diagnosed Type 2 Diabetes in Persons under 45 Years of U. S. Prevalence of Diagnosed Type 2 Diabetes in Persons under 45 Years of Age in 2010 • 1. 4% • Of course this is higher than it was in 1980 – 0. 6% • Diagnosed diabetes in those under 20 years of age in the U. S. – 0. 26% Source: CDC website--

Thank you Questions? Thank you Questions?