Literature Review

Brittney Santerre

06/04/2017

HLTH 634
Introduction

Physical inactivity is problem that needs to be addressed through multiple interventions.

Many Americans are clearly not meeting the recommended guidelines for physical activity of at

least 150 minutes per week of moderate aerobic activity or 75 minutes per week of vigorous

aerobic activity and 2 days per week of muscle-strengthening activity.1 A whopping 80% of

adults do not currently meet the aerobic and muscle-strengthening recommendations.2 Physical

inactivity is among the top risk factors leading to death sitting in 4th place and is estimated by the

World Health Organization to cause death among 3.2 million people each year.3

Physical activity is essential to obtain a long, healthy life. Physical activity is associated with

a lowered risk for cardiovascular disease, stroke, type 2 diabetes, depression, and some cancers.2

Another health protective benefit of physical activity is the reduction in levels of low-grade

inflammation and insulin resistance.3 Medical costs are affected substantially by increasing

physical activity levels - an increase in physical activity can reduce medical costs.4 Those that

participate in higher levels of physical activity utilize more preventative services.4 Although

preventative service utilization increases with higher physical activity, a decrease in inpatient

and emergency room visits occur.4 Additionally, physical activity lowers home health needs and

prescription drugs.4 Kang reports, physically inactive adults incurred 11% higher health care

costs.4 Physical activity is crucial for cost-savings at a population-level.4

Activate Your Body is intended to promote physical activity through comprehendible

educational material. This coalition seeks to increase physical activity participation to achieve

the physical activity recommended guidelines to improve overall health. To meet the guidelines,

Activate Your Body brings awareness of the necessary resources and accessibility to achieve

physical activity guidelines. The literature review of governmental reports and peer-reviewed
journals ranging from cohort studies to reviews of secondary data to state-level reports, adequate

scientific evidence is proposed that explain the importance of physical activity. The selection

criteria for the references chosen followed specific standards of having been peer-reviewed

journal articles, governmental reports, and having been published within the last 8 years.

Body of Evidence

Carlson et. al. and Kang both used strictly secondary data as their methodology to conduct a

review. The two articles collected data from the Medical Expenditure Panel Survey and the

National Health Interview Survey.4,5 Physical activity levels and consequential health care

expenditures were assessed. The two articles findings agreed that inadequate physical activity

yielded 11% higher health costs.4,5 The cross-sectional studies analyzed were Physical Activity

in U.S. Adults Compliance with the Physical Activity Guidelines for Americans, Sedentary

Lifestyle and Its Relation to Cardiovascular Risk Factors, Insulin Resistance and Inflammatory

Profile, and Meeting Physical Activity Guidelines is Associated with Lower Allostatic Load

and Inflammation in Mexican Americans. The articles utilized self-reported physical activity

questionnaires and/or accelerometers to measure physical activity levels in participants.3,6,7

Similar findings within the latter two articles express physical activity as a factor that decreases

chronic implications and diseases.6,7 Reiner et. al. categorizes under the systematic review.8 The

longitudinal studies analyzed universally reported physical activity being a negative relation to

multiple chronic diseases except for one specific study that indicated a positive relation.8

Government reports and statements consisted of The Surgeon Generals Vision for a Healthy and

Fit Nation 2010, Physical Activity and Health - A Report of the Surgeon General: Executive

Summary, CDCs 2014 State Indicator Report on Physical Activity, and 2008 Physical Activity
Guidelines for Americans. All reports and statements explained the benefits of physical activity

and specific recommended physical activity guidelines.

Findings illustrated from the data collection by Carlson et. al. brings forth evidence that

physical activity reduces medical costs substantially.5 After compiling data from the National

Health Interview Survey and Medical Expenditure Panel Survey of physical activity levels and

health care expenditures, a key finding that inadequate physical activity yielded 11% higher

health costs was reported.5

Kang collected secondary data from the Medical Expenditure Panel Survey-Household.4 This

research examined physical activity levels and categories of health care.4 Higher physically

active individuals expressed an increase in preventative and office-based visits with lower costs.4

Inactive or insufficiently active individuals had more visits to the emergency room, home health,

inpatient, and utilization of prescription drugs.4 Similar to the aforementioned article, the article

found that physically inactive adults incurred 11% higher health care costs.4

To measure physical activity levels and compare means, Tucker et. al. examined self-

reported to measured physical activity levels.6 Accelerometers were used to directly measure

physical activity, and questionnaires were used to self-report physical activity.6 The study

concluded that self-reported levels of physical activity were significantly higher than the

accelerometer measured.6 The physical activity measured by the accelerometer showed the

majority of participants did not meet the recommended physical activity guidelines.6

Leon-letre et. al. examined the relation of time spent seated and levels of inflammation and

insulin resistance.3 After assessing levels of physical activity and sedentary behavior, dietary

habits, sociodemographic variables, insulin resistance and inflammatory measures, and lipid

profiles in male workers, the researchers concluded that the more sedentary individuals
expressed higher inflammation and insulin resistance.3 A unique aspect of the finding is the

independence of sedentary behavior to physical activity.3

Reiner et. al. examines the long-term relationship between physical activity and weight

gain, obesity, coronary heart disease, type 2 diabetes mellitus, Alzheimers disease, and

dementia8 Majority of results show a negative relation between physical activity and weight

gain/obesity with one article deeming physical activity led to weight gain over time.8 In regards

to coronary heart disease, results were conclusive that physical activity had a negative relation.8

Physical activity also portrayed a negative relation to type 2 diabetes mellitus, Alzheimers, and

dementia.8 This article is differentiated because of the lack of generalization due to participants

being mainly Caucasian and from western countries.8

Gay et. al. examined allostatic load with physical activity levels.7 The data derived were

blood pressure, heart rate, anthropometric measures, fasting blood glucose, glycosylated

hemoglobin, lipid panel, and C-reactive protein.7 Additionally, there was a self-reported

physical activity questionnaire.7 The findings suggested that higher levels of physical activity

were associated with lower total allostatic load.7 However, low levels of physical activity did not

portray a dose-response relationship to allostatic load.7

Government reports were also analyzed. The Surgeon Generals Vision for a Healthy and Fit

Nation 2010 reports on key physical activity material and recommendations. Physical activity

has many health benefits including the control of weight, weight loss, reduction of risk for

chronic diseases, and strengthens bones.9 The report recommends obtaining at least 150 minutes

per week of moderate aerobic activity or 75 minutes per week of vigorous aerobic activity.9

Physical activity may be accomplished in 10-minute bouts.9 Additionally, the Surgeon General
recommends reducing television and computer time to reduce sedentary behavior.9

Physical Activity and Health A Report of the Surgeon General: Executive Summary lists

the physiologic functions and physical activity.10 Physical activity showed positive effects on

musculoskeletal, cardiovascular, respiratory, and endocrine systems.10 In result, a reduced risk

of developing chronic diseases such as cardiovascular disease, type 2 diabetes, and some cancers

exists when participating in physical activity.10 Findings suggest physical activity is associated

with lower depression rates, as well.10 The report acknowledges the risks associated with

physical activity including musculoskeletal injuries and myocardial infarction.10 Those living a

sedentary lifestyle with atherosclerosis increases the risk of having myocardial infarction during

physical activity.10

The Center for Disease Control and Preventions 2014 State Indicator Report on Physical

Activity recommends guidelines for physical activity. The recommended guidelines are similar

to the Surgeon Generals report at least 150 minutes per week of moderate aerobic activity or

75 minutes per week of vigorous aerobic activity.2 Additionally, the CDC suggests avoiding

physical inactivity.2 Also similar to the other governmental reports, the CDC allows for the

activity to completed in 10-minute bouts.2 To achieve additional benefits of physical activity, it

is recommended to perform 300 minutes per week of moderate aerobic activity or 150 minutes

per week of vigorous aerobic activity combined with 2 days per week of muscle-strengthening

activity.2 State policies fundamentals to promote physical activity are listed as: increasing safety

and access for physical activity, enhancing physical education, and street and community scale

design policies.2

The 2008 Physical Activity Guidelines for Americans lists the same guidelines as
aforementioned government reports of participating in at least 150 minutes per week of moderate

aerobic activity or 75 minutes of vigorous aerobic activity.1 Additionally, benefits of physical

activity include reduced risk of chronic diseases, and a higher intensity, frequency, or duration

can yield even greater health benefits.1 Similar to previous reports, it is agreed that individuals

should avoid inactivity and activity may be completed in 10-minute bouts.1 The 2008 Physical

Activity Guidelines support the suggestion of increasing aerobic activity to 300 minutes per

week for additional benefits.1

Conclusion

Physical activity is essential in obtaining overall health by reducing risk for chronic

disease. Physical activity is associated with a lowered risk for cardiovascular disease, stroke,

type 2 diabetes, depression, and some cancers.2 Additionally, physical activity reduces medical

costs with inactive individuals having a 11% higher health expenditure.4 The findings suggested

that higher levels of physical activity were associated with lower total allostatic load.7

Individuals living a sedentary lifestyle express higher inflammation and insulin resistance

levels.3

Scientific-based research supports the need for an intervention to increase physical

activity levels. Activate Your Body intends to utilize this research and apply to intervention

strategies. This coalition seeks to increase physical activity participation to achieve the physical

activity recommended guidelines to improve overall health.

References

1. 2008 Physical Activity Guidelines for Americans. https://health.gov/paguidelines/.

Accessed June 4, 2017.

2. 2014 State Indicator Report on Physical Activity.

https://www.cdc.gov/physicalactivity/resources/reports.html. Accessed June 4, 2017.

3. Len-Latre M, Moreno-Franco B, Andrs-Esteban EM, et al. Sedentary Lifestyle and Its

Relation to Cardiovascular Risk Factors, Insulin Resistance and Inflammatory Profile.

Revista Espaola de Cardiologa (English Edition). 2014;67(6):449-455.

doi:10.1016/j.rec.2013.10.015.
4. Kang S-W, Xiang X. Physical Activity and Health Services Utilization and Costs Among

U.S. Adults. Preventive Medicine. 2017;96:101-105. doi:10.1016/j.ypmed.2016.12.043.

5. Carlson SA, Fulton JE, Pratt M, Yang Z, Adams EK. Inadequate Physical Activity and

Health Care Expenditures in the United States. Progress to Cardiovascular Diseases.

2015:315-323.

6. Tucker JM, Welk GJ, Beyer NK. Physical Activity in U.S. Adults Compliance with the

Physical Activity Guidelines for Americans. American Journal of Preventative Medicine

.2011:454-461.

7. Gay JL, Salinas JJ, Buchner DM, et al. Meeting Physical Activity Guidelines is

Associated with Lower Allostatic Load and Inflammation in Mexican Americans. Journal

of Immigrant and Minority Health. 2013;17(2):574-581. doi:10.1007/s10903-013-9950-1.

8. Reiner M, Niermann C, Jekauc D, Woll A. Long-term health benefits of physical activity

a systematic review of longitudinal studies. BMC Public Health. 2013;13(1).

doi:10.1186/1471-2458-13-813.

9. The Surgeon Generals Vision for a Healthy and Fit Nation 2010. 2010.

doi:10.1037/e511782010-001.

10. Physical Activity and Health - A Report of the Surgeon General: Executive Summary.

:114.