Physical activity and energy balance: public health priorities for the Americas

Scaling up physical activity promotion in the Americas

Michael Pratt

Emory University, Atlanta, Estados Unidos de América. Los Andes University, Bogotá, Colombia

Introduction/objectives: Since antiquity physical activity has been recognized as an important part of a healthy lifestyle. In recent decades the relationship between regular physical activity and reduced risk for chronic diseases including ischemic heart disease, stroke, diabetes, colon and breast cancer, osteoporosis, obesity, depression and anxiety has been well documented. The quantity and quality of physical activity required for health benefits has been codified in national and global recommendations. Most recently, in 2010, the World Health Organization (WHO) released recommendations for children and adolescents, adults, and older adults. One hundred and fifty minutes of moderate intensity physical activity such as brisk walking per week provides clear health benefits. Seventy five minutes of vigorous intensity activity or an equivalent combination of moderate and vigorous intensity physical activity provides comparable benefits. WHO recommends that children and adolescents participate in at least one hour per day of moderate and/or vigorous physical activity. Development: Unfortunately, about one third of adults and 80% of adolescents from around the world are not regularly physically active. In much of the Americas at least half of adults are inactive and the rate of inactivity appears to be increasing. Obesity rates in the region are now amongst the highest in the world for both children and adults. Given the importance of physical activity in chronic disease and obesity prevention and the high prevalence of physical inactivity, it is not surprising that physical inactivity imposes a large economic cost on many countries in addition to the burden of disease. Across the Americas national public health policy and programs are beginning to address physical inactivity. Colombia and Brasil have led the way with strong national legislation and public health policy, ongoing surveillance of physical activity as part of national health surveys, and national programs reaching a substantial proportion of states and municipalities. Brasil has focused much effort on implementing, evaluating, and nationally extending a program based on free physical activity classes in public settings. In Colombia, ciclovías or open streets programs are a key component of national and city physical activity promotion. Mexico and other countries in the region have also begun public health programs addressing physical activity, chronic disease prevention, and obesity, but physical activity research, policy, and intervention programs are at a much earlier stage than in Colombia and Brasil. Conclusions: Successfully increasing levels of physical activity is challenging and requires a combination of clinical and community strategies. Systematic reviews of the research literature show that physical activity counseling with referral to community programs is effective. Educational, behavior change, environmental, and policy approaches can all be effective in increasing population levels of physical activity, especially if they are carefully adapted to country, culture, and context. Experience from Canada, Finland, Colombia, and Brasil demonstrates that it is feasible to develop and implement national programs for physical activity that will increase the population prevalence of persons meeting physical activity guidelines. However, this requires a long-term commitment. In Finland and Canada large increases in population prevalence were seen over a period of approximately 20 years. National surveillance systems in Colombia and Brasil suggest increases in population prevalence of adult physical activity since 2000. Increasing physical activity across the Americas will be a challenge, but with multi-sectoral collaboration, and effective application of the growing body of evidence from Latin America it can be achieved. Key words: Physical activity, public health policy, surveillance, interventions, obesity. References: 1.Pratt M, Perez LG, Goenka S, Brownson RC, Bauman AE, Sarmiento OL, Hallal PC. Changing population levels of physical activity: global evidence and experience. Progress in Cardiovascular Diseases 2015; 57(4): 356-367. 2.Pratt M, Charvel S, Hernandez-Avila M, Reis RS, Sarmiento OL, Sallis JF. Obesity prevention lessons from Latin America. Preventive Med 2014; 69 (Supplement December): S120-S122. 3.Parra DC, Hoehner CM, Hallal PC, Reis RS, Simoes EJ, Malta DC, Pratt M, Brownson RC. Scaling up of physical activity interventions in Brazil: how partnerships and research evidence contributed to policy action. Global Health Promotion 2013; 20 (4):5-12. 4.Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U; Lancet Physical Activity Series Working Group. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. 2012 Jul 21; 380(9838):247-57.