Lunch Hour Lecture amend

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Physical Fitness: Population trends and why they matter Professor Bruce Lynn Dept of Physiology MSc School of Human Health and Performance Lunch Hour Lecture 18 Oct 2007

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Fitness and Health Many studies showing lower incidence if fit, including: CVD Type II Diabetes Cancer Mental health problems Dose dependent – the fitter the better

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Relative risk of death versus aerobic fitness Data from Kuopio Ischaemic Heart Disease Risk Factor Study. The study population is a representative sample of Finnish men who were 42–60 years of age at baseline examination between 1984 and 1989. 1294 healthy men, median follow up 13.7 yrs Jari A. Laukkanen et al. European Heart Journal (2004) 25, 1428–1437

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Fitness and Fatness Fitness is more important than fatness

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Physical activity  Fitness and good health We are designed to run!

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First studies by Jerry Morris et al, 1950, Heart disease in London Bus drivers cf conductors. Drivers 2x risk of heart attack. Only difference: degree of physical activity

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Boost your brain... use your brawn Last Updated: 12:01am BST 04/04/2007 Page 1 of 3 'If you're sporty, you must be thick' is a misguided cliché. In fact, a new study says exercise actually increases memory and learning potential. Victoria Lambert reports Nice piece last April based on Newsweek article A certain Prof Lynn is quoted: “At UCL, we have a bright bunch of students and a high proportion of them are physically active.” http://www.telegraph.co.uk/health/main.jhtml?xml=/health/2007/04/04/hbrain104.xml&page=1

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HEALTH FOR LIFE Stronger, Faster, Smarter Exercise does more than build muscles and help prevent heart disease. New science shows that it also boosts brainpower—and may offer hope in the battle against Alzheimer's. By Mary Carmichael | NEWSWEEK Mar 26, 2007 Issue http://www.newsweek.com/id/36056/page/1

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Why is fitness good for you? Glucose transport enhanced, helps reduce risk of diabetes Neurogenesis. Increased with exercise; improves brain function But we really do not know why CV disease and some cancers less likely Would be nice to know – imagine a “fitness” pill… It is all rather counter-intuitive. If you run a car more, you need to get it serviced more often and it wears out sooner.

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An active policy area for the UK government. Key documents: At least five a week Evidence on the impact of physical activity and its relationship to health A report from the Chief Medical Officer 2004 Choosing Health UK Govt White Paper, 2004 Choosing Activity: a physical activity action plan Dept of Health, 2005

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Physical activity guidelines National targets. 70% doing 5x per week 30 min moderate intensity exercise by 2020 But to make targets stick need good measures, Wanless II report (2004) to Dept of Health: “Lack of evaluation of public heath initiatives” [3.94] “Adequate resources for monitoring…should be an integral part of planning” [9.13]

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Surveys of Physical Activity Big new survey by Should become a rolling event, but only first survey data from 2005-6 available so far.

Health Survey for England has been doing questionnaires since 1995 and questions are similar to 1990 Nat Fitness Survey. For example:Proportion of the population doing at least 5 sessions of >=30 min moderate or vigorous physical activity each week, 1990-2004Sources, ADNFS 1990, Health Surveys of England 95-04: 

Health Survey for England has been doing questionnaires since 1995 and questions are similar to 1990 Nat Fitness Survey. For example: Proportion of the population doing at least 5 sessions of >=30 min moderate or vigorous physical activity each week, 1990-2004 Sources, ADNFS 1990, Health Surveys of England 95-04

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Surveys of fitness – there have been few ADNFS – England. 1990, a one off. Canadian fitness. Done twice, 1981, 1988, not since NHANES – USA. 2 year rolling since 1999. Only data up to 2002 published so far. Australian. One off Scandinavian. Various one-offs

Average aerobic fitness (measured as maximum oxygen consumption, VO2max) by age. ADNFS, England 1990, n ~ 150 per chart bar: 

Average aerobic fitness (measured as maximum oxygen consumption, VO2max) by age. ADNFS, England 1990, n ~ 150 per chart bar

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Surveys of fitness – there have been few Hard to compare surveys done in different countries as methodologies and numbers of exclusions have varied. It is interesting that the 2 most recent, Finrisk and NHANES, show less reduction with age than earlier studies.

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Need simple portable test Meeting of Experts, DoH, Jerry Morris, June 2002 DoH Steering group, 2004-5 6-8 minute submaximal step test, David Jones, Birmingham Field testing by National Centre for Social research (NatCen), completed 2005 Result – it works in the field!

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Health Survey for England will do very similar test in 2008 Also Objective PA and Questionnaire on PA Will provide best database of linked PA and Fitness data in any country Needs to be repeated every 3-5 years So in 2012, maybe we will know if trends are improving fast enough to meet the 2020 target…

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How are we to get more people exercising? We know a lot of things that do not work! Medical led, government sponsored campaigns have been inneffective Young and middle-aged people are not easily scared into getting fit

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Some ideas (none particularly original…) Encourage sport participation in younger and middle-aged people High intensity aerobic sports like 5-a-side football are very good for fitness Tour de France, Olympics, coming to UK. These will all help. The “Wimbledon effect” – always a few extra people playing tennis in the weeks of the Wimbledon Champs.

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I had set last Saturday (Oct 13 2007) aside for preparing this lecture, alas I found it necessary to watch a little TV. But there is just a possibility that a few people will be inspired to go out and emulate their heroes

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But with all respect to our football and rugby players, the greatest GB sporting result last Saturday was Chrissie Wellington winning the Iron Man World Champs in Hawaii. We have beaten France before but no Brit has come close to winning the Hawaii Ironman

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Build PA into everyday activity. Bonus: these changes also improve the environment Steps – everyone should use the stairs unless they are incapable. But in many office blocks and hotels you cannot find the stairs! So building regulations need to change.

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Heart rate response, walking out of Warren Street Station, up 2 escalators Esc 1 Esc 2

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Sedentary 18-20 year old female undergraduates. Average baseline VO2max = 28 ml/min.kg 8 weeks, stair climbing of 199 steps, total rise 32.8m at 90/min, i.e. just over 2 minutes total. Started with 2 sessions per day, 5 times/week. Then increased to 5 per day for 5 days in weeks 7 & 8. Error bars, one s.e. Colin Boreham and colleagues, Br. J. Sports Med. 2005;39;590-593 Stair climbing leads to 16% increase in fitness

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8 weeks of taking the stairs instead of the lift gave a 6% increase in average VO2max. Subjects were relatively fit to start with. Average office location 3rd floor. Asked to walk up stairs on arrival and in morning and afternoon breaks, plus encouraged to climb higher than office then descend. Unpublished data from Matthew Wyatt, MSc Adv Physiotherapy, UCL, 2007

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Brisk walking is good enough for older (>55 years) subjects. But slow cf motorised transport Cycling is great For up to 4-5 miles in Central London - as quick or quicker than motorised transport And good things are happening. London is the only UK city where cycling has increased, and what an increase! Need to remove many barriers e.g. No parking notices Enough bike racks And sweaty must become OK!

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Gr Way/TCR Lts Eus Rd/TCR Lts Parkway Prince W Rd KT Rd/Fortess Rd jn Tufnell Pk Archway Morn Cresc Bicycling from Bloomsbury to the Archway Campus Heart rate recording At or above the “training zone” for 22 min – big contribution to fitness.

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Why?

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London Travel Report 2006, TfL

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Valuing the benefits of cycling, A report to Cycling England, May 2007 Cycling becomes safer as more cyclists use roads

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Emphasise quality of life aspects of fitness Can participate fully in physical activities that are enjoyable, e.g. walks in the country, charity events etc And I think sex life is much better for the physically fit……maybe we need a proper study on this and if we get a positive effect, I see a great national advertising campaign!

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In conclusion We have evolved to exercise Not exercising makes you ill! We have targets to improve fitness and are starting the monitoring needed to check progress Need imaginative approaches to get more people active in sport and in their everyday life Most of all need a cultural shift where sedentary is bad, and active and SWEATY is GOOD!