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Guidelines for school and community programs to promote lifelong physical activity among young people. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and prevention.

Regular physical activity is linked to enhanced health and to reduced risk for all-cause mortality and the development of many chronic diseases in adults. However, many U.S. adults are either sedentary of less physically active than recommended. Children and adolescents are more physically active than adults, but participation in physical activity declines in adolescence. School and community programs have the potential to help children and adolescents establish lifelong, healthy physical activity patterns. This report summarizes recommendations for encouraging physical activity among young people so that they will continue to engage in physical activity in adulthood and obtain the benefits of physical activity throughout life. These guidelines were developed by CDC in collaboration with experts from universities and from national, federal, and voluntary agencies and organizations. They are based on an in-depth review of research, theory, and current practice in physical education, exercise science, health education, and public health. The guidelines include recommendations about 10 aspects of school and community programs to promote lifelong physical activity among young people policies that promote enjoyable physical activity and social environments that encourage and enable physical activity; physical education curricula and instruction; health education curricula and instruction; extracurricular physical activity programs that meet the needs and interests of students; involvement of parents and guardians on physical activity instruction and programs for young people; personnel training; health services for children and adolescents; developmentally appropriate community sports and recreation programs that are attractive to young people; and regular evaluation of physical activity instruction, programs, and facilities.

Adolescent↗

Adolescent physical activity and health: a systematic review.

Physical activity in adolescence may contribute to the development of healthy adult lifestyles, helping reduce chronic disease incidence. However, definition of the optimal amount of physical activity in adolescence requires addressing a number of scientific challenges. This article reviews the evidence on short- and long-term health effects of adolescent physical activity. Systematic reviews of the literature were undertaken using a reference period between 2000 and 2004, based primarily on the MEDLINE/PubMed database. Relevant studies were identified by examination of titles, abstracts and full papers, according to inclusion criteria defined a priori. A conceptual framework is proposed to outline how adolescent physical activity may contribute to adult health, including the following pathways: (i) pathway A--tracking of physical activity from adolescence to adulthood; (ii) pathway B--direct influence of adolescent physical activity on adult morbidity; (iii) pathway C--role of physical activity in treating adolescent morbidity; and (iv) pathway D - short-term benefits of physical activity in adolescence on health. The literature reviews showed consistent evidence supporting pathway 'A', although the magnitude of the association appears to be moderate. Thus, there is an indirect effect on all health benefits resulting from adult physical activity. Regarding pathway 'B', adolescent physical activity seems to provide long-term benefits on bone health, breast cancer and sedentary behaviours. In terms of pathway 'C', water physical activities in adolescence are effective in the treatment of asthma, and exercise is recommended in the treatment of cystic fibrosis. Self-esteem is also positively affected by adolescent physical activity. Regarding pathway 'D', adolescent physical activity provides short-term benefits; the strongest evidence refers to bone and mental health. Appreciation of different mechanisms through which adolescent physical activity may influence adult health is essential for drawing recommendations; however, the amount of exercise needed for achieving different benefits may vary. Physical activity promotion must start in early life; although the 'how much' remains unknown and needs further research, the lifelong benefits of adolescent physical activity on adult health are unequivocal.

Adolescent↗

Physical therapy use by community-based older people.

BACKGROUND AND PURPOSE: Little information is available on factors associated with physical therapy use. Identifying the characteristics of people who use physical therapy and some of the factors associated with its use is a useful first step in determining whether disparities exist in physical therapy use. The purpose of this study was to identify factors associated with physical therapy use by community-based older people. SUBJECTS: The subjects were community-based people 65 years of age or older who participated in the Medicare Current Beneficiary Survey and had at least one physician encounter (N=38,312 person-years across 20,227 individuals). METHODS: Logit and ordinary least squares regression analyses were conducted to identify factors associated with physical therapy use. RESULTS: Several measures of health and function were associated with physical therapy use. Several demographic, insurance, and geographic characteristics also were associated with physical therapy use. Income, education, having supplemental private insurance, participating in a managed care plan, and physical therapist supply were positively associated with physical therapy use. Age was negatively associated with physical therapy use. For people who saw a physical therapist, amount of physical therapy received was positively associated with income, having supplemental private insurance, living in a metropolitan area, physical therapist supply, and being African American. Amount of physical therapy received was negatively associated with being in a managed care plan. DISCUSSION AND CONCLUSIONS: Variation in physical therapy use, explained by factors other than need, suggests potential underuse or overuse of physical therapy by community-based older people.

Activities of Daily Living↗

Personal, social, and environmental correlates of physical activity in urban African-American women.

BACKGROUND: African-American women are at risk of chronic diseases for which regular physical activity can provide benefits. This group, however, remains predominantly sedentary. Little research has been undertaken to elucidate the multiple factors that influence their physical activity levels. This study was designed to determine associations among personal, social environmental, and physical environmental factors with physical activity level in urban African-American women. METHODS: The Women and Physical Activity Survey, an interviewer-administered survey consisting of demographic, personal, and social and physical environmental factors, was given to 234 African-American women living in Baltimore, Maryland. Physical activity level was determined from the Behavioral Risk Factor Surveillance System survey. Women were divided into three groups: meeting current recommendations for moderate or vigorous physical activity, insufficiently active, and inactive. Comparisons were made between the group of women that met recommendations versus women who did not, and women who reported any activity versus women who were inactive. RESULTS: Twenty-one percent (48) of women met recommendations for physical activity, 61% (143) were insufficiently active, and 18% (43) were inactive. Women who had a partner or who had no children were less likely to engage in some physical activity. Inactive women were more likely than women who participated in some physical activity to know people who exercised. Women who belonged to community groups were more likely to be inactive than women who met current recommendations for physical activity. Women with fewer social roles were more likely to meet current recommendations. Physical environment factors were not associated with physical activity level. CONCLUSIONS: Further exploration is needed to determine how personal and social environmental and physical environmental factors relate to physical activity in African-American women.

Adult↗

[Unhealthy lifestyles during the life course: association with physical decline in late life].

This study aimed to examine the association between unhealthy lifestyle in young age, midlife and/or old age and physical decline in old age, and to examine the association between chronic exposure to an unhealthy lifestyle throughout life and physical decline in old age. The study sample included 1297 respondents of the Longitudinal Aging Study Amsterdam (LASA). Lifestyle in old age (55-85 y) was assessed at baseline, while lifestyle in young age (around 25 y) and midlife (around 40 y) were assessed retrospectively. Lifestyle factors included physical activity, body mass index (BMI), number of alcohol drinks per week and smoking. Physical decline was calculated as change in physical performance score between baseline and six-year follow-up. Of the lifestyle factors present in old age, a BMI of 25-29 vs. BMI <25 kg/m2 (odds ratio (OR) 1.6; 95% confidence interval (CI) 1.1-2.2) and a BMI of > or =30 vs. BMI <25 kg/m2 (OR 1.8; 95% CI 1.2-2.7) were associated with physical decline in old age. Being physically inactive in old age was not significantly associated with an increased risk of physical decline, however, being physically inactive both in midlife and in old age increased the odds of physical decline in old age to 1.6 (95% CI 1.1-2.4) as compared to respondents who were physically inactive in midlife and physically active in old age. Being overweight in both age periods was associated with an OR of 1.5 (95% CI 1.1-2.2). These data suggest that overweight in old age, and chronic exposure to physical inactivity or overweight throughout life increases the risk of physical decline in old age. Therefore, physical activity and prevention of overweight at all ages should be stimulated to prevent physical decline in old age.

Adult↗

Factors associated with changes in physical activity: a cohort study of inactive adolescent girls.

OBJECTIVE: To identify factors associated with changes in physical activity in adolescent girls at risk for sedentary lifestyles and obesity. DESIGN: A cohort study was performed with 201 high school girls recruited to participate in an evaluation study of a school-based obesity prevention physical education program. Three assessments were performed during an 8-month period. MAIN OUTCOME MEASURES: Associations between physical activity and a range of personal factors (self-acceptance, self-worth, athletic competence, body image, depressive mood, perceived benefits, enjoyment of physical activity, self-efficacy, and body mass index), behavioral factors (watching television and time constraints), and socioenvironmental factors (social support and costs/resources) were assessed. RESULTS: The 2 strongest and most consistent factors associated with change in physical activity were time constraints and support for physical activity from peers, parents, and teachers. Measures assessing self-perceptions, global (ie, self-worth) and specific to physical activity (ie, self-efficacy to be physically active), were also associated with change in physical activity. For example, a decrease of 2.0 U for an adolescent's perceived time constraints (possible range, 3.0-12.0 U) would be expected to lead to an increase of 53 minutes of moderate to vigorous physical activity per week (95% confidence interval, 33-72 minutes). An increase of 2.0 U in perceived support for physical activity (possible range, 3.0-12.0 U) would be expected to lead to an increase of 35 minutes of moderate to vigorous physical activity per week (95% confidence interval, 13-56 minutes). An increase of 3.0 U on the self-worth scale (possible range, 5.0-20.0 U) might be expected to lead to an increase of 19 minutes of moderate to vigorous physical activity per week (95% confidence interval, 0-40 minutes). CONCLUSION: The effectiveness of interventions aimed at increasing physical activity among adolescent girls might be enhanced by engaging support from friends, family, and caring adults; addressing real and perceived time constraints; and helping adolescent girls feel more confident about themselves and their ability to engage in physical activity.

Adolescent↗

Physical activity epidemiology as applied to elderly populations.

Physical activity epidemiological studies provide one of many types of research evidence that are necessary to assess the importance of physical activity to health. Available epidemiological evidence, when coupled with relevant experimental and clinical research, suggests that physical activity has the potential to favourably influence the development and progression of a variety of chronic diseases and conditions that are a burden to public health. The evidence is only beginning to emerge for elderly populations, however, thereby highlighting an important void in our scientific knowledge. Attempting to increase the level of physical activity of elderly people raises three important issues. First, improving adherence to a physically active life-style requires assistance of behavioural scientists, either through direct intervention, or through research that can help the elderly identify and overcome impediments to physical activity. Second, many elderly people have diseases that can limit their physical ability, but exercise scientists can assist by prescribing exercise that is both efficacious and safe given the level of limitation. Third, the number of injuries may increase with increased physical activity in elderly persons. Epidemiologists and exercise scientists working in the area of injury control can determine which activities are safe at specific levels of physical ability and function. To quote one of the originators of exercise physiology, Per Olaf Astrand (1992), 'As a consequence of diminished exercise tolerance, a large and increasing number of elderly people will be living below, at, or just above "thresholds" of physical ability, needing only a minor intercurrent illness to render them completely dependent'. Physical activity can help to push back that 'threshold of physical ability' and thereby improve physical functioning. As physical function improves, there is a propensity to perform even greater amounts of physical activity that may be essential to the quality and perhaps quantity of life for an elderly person.

Adult↗

Validation of questionnaires to estimate physical activity and functioning in end-stage renal disease.

BACKGROUND: Patients on dialysis are less physically active than sedentary persons with normal kidney function. To assess the consequences of inactivity and the results of efforts to increase activity in the end-stage renal disease (ESRD) population, valid instruments to measure physical activity and physical functioning in this group are needed. METHODS: We performed a cross-sectional study to establish the validity in ESRD of several questionnaires designed to measure physical activity or physical functioning in the general population. Questionnaires studied included the Stanford 7-day Physical Activity Recall questionnaire (PAR), the Physical Activity Scale for the Elderly (PASE), the Human Activity Profile (HAP), and the Medical Outcomes Study Short Form 36-item questionnaire (SF-36). Physical activity was measured using three-dimensional activity monitors (accelerometers) over a seven-day period (the "gold standard"). Patients also underwent physical performance tests, including measurement of gait speed, stair climbing time, and chair rising time. Study questionnaires were administered, and questionnaire results were compared with each other and with activity monitor and physical performance test results. RESULTS: Thirty-nine maintenance hemodialysis patients participated in the study. Dialysis patients scored worse than previously published healthy norms on all tests. All questionnaires correlated with seven-day accelerometry and with at least one measure of physical performance. The HAP correlated best with accelerometry (r = 0.78, P < 0.0001). Seventy-five percent of the variability in physical activity measured by accelerometry could be explained by a model that combined information from the HAP and the PASE. The HAP and the physical functioning scale of the SF-36 were about equally well correlated with physical performance measures. CONCLUSIONS: These questionnaires are valid in patients on hemodialysis and should be used to study the physical activity and rehabilitation efforts in this population further.

Cross-Sectional Studies↗

Physical activity and cancer risk: dose-response and cancer, all sites and site-specific.

PURPOSE: The association between physical activity and overall and site-specific cancer risk is elaborated in relation to whether any observed dose-response association between physical activity and cancer can be interpreted in terms of how much physical activity (type, intensity, duration, frequency) is needed to influence site- and gender-specific cancer risk. METHODS: Observational studies were reviewed that have examined the independent effect of the volume of occupational physical activity (OPA) and/or leisure time physical activity (LPA) on overall and site-specific cancer risk. RESULTS: The evidence of cohort and case-control studies suggests that both leisure time and occupational physical activity protect against overall cancer risk, with a graded dose-response association suggested in both sexes. Confounding effects such as diet, body weight, and parity are often included as a covariate in the analyses, with little influence on the observed associations. A crude graded inverse dose-response association was observed between physical activity and colon cancer in 48 studies including 40,674 colon/colorectal cancer cases for both sexes. A dose-response effect of physical activity on colon cancer risk was especially observed, when participation in activities of at least moderate activity (>4.5 MET) and demonstrated by activities expressed as MET-hours per week. An observed inverse association with a dose-response relationship between physical activity and breast cancer was also identified in the majority of the 41 studies including 108,031 breast cancer cases. The dose-response relationship was in particular observed in case-control studies and supported by observations in cohort studies when participation in activities of at least moderate activity (>4.5 MET) and demonstrated by activities expressed by MET-hours per week. This association between physical activity and breast cancer risk is possibly dependent on age at exposure, age at diagnosis, menopausal status and other effect modifiers, e.g., body mass index. Furthermore, data concerning carcinoma of other cancers (prostate, lung, endometrium, ovary, and testicular cancers) are required. CONCLUSION: A protective effect of physical activity on site-specific cancer risk with a dose-response association between physical activity and colon and pre- and postmenopausal breast cancer supported by identified biological mechanisms has been observed. The optimal permutation of type, intensity, duration, and frequency of physical activity across the lifespan is unclear, but it is gender, age, and site specific and supports moderate activity (>4.5 MET) more than light activities (<4.5 MET). The complicated nature of the physical activity variable, combined with lack of knowledge regarding possible biological mechanisms operating between physical activity and cancer, warrants further studies including controlled clinical randomized trials.

Adult↗

Assessments of physical activity and cancer risk.

The assessment of physical activity is one of the most important methodological issues in research into physical activity and cancer risk. A sedentary Western lifestyle has been observed to influence biological mechanisms promoting development of certain types of cancer. At present the totality of evidence supports a protective effect against cancers of the colon and probably the breast, while further data concerning carcinoma of other cancers are required. Thus, physical activity represents a powerful public health measure for reducing cancer risk. Studies of the association between physical activity and cancer risk have used a great variety of methods, but have most often included work and/or leisure time activity. Questionnaires are the method most often used and various components of physical activity such as type, frequency, intensity and lifetime physical activity have been recorded. However, the measurements used when assessing physical activity have been hampered by lack of accuracy as regards validity and reliability, missing information on the various components of physical activity and sparse information of lifetime exposure, and often no repeat assessments in cohort studies. Discrepancies between studies elaborating the association between physical activity and site-specific cancer risk may be explained through real differences or lack of information on the various components of physical activity (type, intensity, duration) and incomplete information about the cancer type studied (localization, histological type). The complicated nature of the variable physical activity, combined with incomplete understanding of the pathogenesis of most cancer and lack of knowledge regarding possible biological mechanisms operating between physical activity and cancer, warrants further studies. In these studies methodological improvements in measuring physical activity, combined with inclusion of physiological markers (heart rate, energy balance, hormonal levels, etc.) reflecting the variety of physical activities performed are of particular interest. Assessing biomarkers and intermediate steps for site-specific cancer risk may give us further insight into the relation between physical activity and cancer that will be of enormous interest for public health recommendations.

Breast Neoplasms↗

Physical fitness and changes in mortality: the survival of the fittest.

Physical fitness is a term describing maximal aerobic capacity adjusted for body size and composition, and is an integrated measure of cardiorespiratory and neuromusculo-skeletal function, oxygen transport and delivery, and psychological drive. Accordingly, high physical fitness requires that all these important body functions function normally, while low physical fitness suggests malfunction of one or more of them. High levels of physical fitness--maintained through heavy daily exercise--has probably been a necessary requirement for survival in the earlier history of humans. In modern, industrialised countries the demand for physical activity to sustain life is declining, and a decline in physical fitness is observed in many populations. Epidemiological studies over the past 50 years have unanimously shown that low physical activity and physical fitness is associated with high cardiovascular and total mortality. Recent data also suggest that low physical activity and physical fitness is followed by an increased incidence of diabetes mellitus and nonfatal cardiovascular diseases. A number of unfavourable biochemical and physiological aberrations following physical inactivity probably explain these observations. However, recent studies also indicate that changes in physical activity, and especially changes that bring increases in physical fitness, can reverse this rather pessimistic scenario. The Global Burden of Disease Study initiated by the World Health Organization included physical inactivity among the most important risk factors threatening global health. A sedentary life style may be as detrimental to health as smoking. Encouragement of physical activity is an important and difficult task, as society is becoming increasingly successful in reducing our need to move.

Adult↗

Assessment of free-living physical activity in humans: an overview of currently available and proposed new measures.

The number of physical activity measures and indexes used in the human literature is large and may result in some difficulty for the average investigator to choose the most appropriate measure. Accordingly, this review is intended to provide information on the utility and limitations of the various measures. Its primary focus is the objective assessment of free-living physical activity in humans based on physiological and biomechanical methods. The physical activity measures have been classified into three categories: Measures based on energy expenditure or oxygen uptake, such as activity energy expenditure, activity-related time equivalent, physical activity level, physical activity ratio, metabolic equivalent, and a new index of potential interest, daytime physical activity level. Measures based on heart rate monitoring, such as net heart rate, physical activity ratio heart rate, physical activity level heart rate, activity-related time equivalent, and daytime physical activity level heart rate. Measures based on whole-body accelerometry (counts/U time). Quantification of the velocity and duration of displacement in outdoor conditions by satellites using the Differential Global Positioning System may constitute a surrogate for physical activity, because walking is the primary activity of man in free-living conditions. A general outline of the measures and indexes described above is presented in tabular form, along with their respective definition, usual applications, advantages, and shortcomings. A practical example is given with typical values in obese and non-obese subjects. The various factors to be considered in the selection of physical activity methods include experimental goals, sample size, budget, cultural and social/environmental factors, physical burden for the subject, and statistical factors, such as accuracy and precision. It is concluded that no single current technique is able to quantify all aspects of physical activity under free-living conditions, requiring the use of complementary methods. In the future, physical activity sensors, which are of low-cost, small-sized, and convenient for subjects, investigators, and clinicians, are needed to reliably monitor, during extended periods in free-living situations, small changes in movements and grade as well as duration and intensity of typical physical activities.

Acceleration↗

Total physical activity in relation to age, body mass, health and other factors in a cohort of Swedish men.

BACKGROUND: Despite a large public health interest in physical activity and its role in obesity and other chronic diseases, only a few reports to date have addressed total levels of physical activity in relation to age, body mass, health and other lifestyle factors. OBJECTIVE: To investigate whether levels of total physical activity among men are associated with age, body mass, self-rated health and other lifestyle factors in a cross-sectional setting. METHODS: In a population-based cohort of 33 466 men aged 45-79 y in central Sweden, we collected information about physical activity through a self-administered questionnaire. Level of total physical activity was assessed quantitatively based on six questions on different activities: work/occupation, housework, walking/bicycling, exercise, inactive leisure time and sleeping. The physical activity levels were measured as metabolic equivalents, MET-h/day. The relation between age, body mass index, smoking, education, marital status and self-rated health, and total physical activity was studied in a cross-sectional analysis, using multivariate regression. RESULTS: Total daily physical activity was decreasing systematically between age 45 and 79 (-4.1%, 95% CI -4.6, -3.6). Obese men reported -2.6% (95% CI -3.0, -2.1) lower physical activity than normal weight men. Those with high education had -7.0% (95%CI -7.3, -6.7) lower total physical activity than those with elementary school. Men with self-rated poor health had -11.3% (95%CI -12.1, -10.6) lower physical activity than those reporting very good health. The cross-sectionally observed decrease with age was greatest among obese men (-8.7%), current smokers (-7.9%), low-educated men (-5.6%) and those with poor health (-9.8%); the subgroups with very good health reported almost the same level of total physical activity (-0.6%) for age 74-79 as for age 45-49. CONCLUSIONS: The observed decreasing levels of total physical activity with age to large degree depend on health status and other factors. The characterization of subjects with low total physical activity levels is of importance for understanding observed worldwide trends in increasing prevalence of obesity. The better understanding of these phenomena might also facilitate a better planning of public health interventions with messages specifically adjusted for subgroups of population with lower physical activity.

Aged↗

Physical activity and health-related quality of life in liver transplant recipients.

The US Surgeon General's Report on Physical Activity and Health recommends that people of all ages engage in regular physical activity, and that significant health benefits can be obtained through a moderate amount of physical activity. Physical activity appears to improve health-related quality of life (HRQOL) by enhancing physical functioning in persons compromised by poor health. The Medical Outcomes Study Short Form-36 (SF-36) Health Status Questionnaire was sent to all patients who were 5 years or more post-liver transplantation at the University of California at San Francisco. Additional questions related to coexisting medical conditions and participation in regular physical activity were included. SF-36 scale scores were compared between active and inactive patients. Regression analysis was also performed to determine the contributions of coexisting medical conditions and physical activity to the physical scales of the SF-36 questionnaire. Patients who participated in regular physical activity had significantly higher scores on all physical scales and the physical component scale (PCS). The regression model, which included age, sex, time posttransplantation, retransplantation, recurrence of hepatitis C, number of comorbid conditions, and physical activity participation showed that both the number of comorbid conditions and participation in physical activity were significant independent contributors to the physical functioning scale and PCS. This study indicates that physical activity is related to HRQOL after liver transplantation independent of other coexisting medical conditions.

Adult↗

Correlates of recreational physical activity in early pregnancy.

OBJECTIVE: Despite the well-documented benefits of a physically active lifestyle, over 25% of American adults report that they never engage in regular recreational physical activity. Little is known about the determinants of physical activity among pregnant women. We investigated the predictors of physical activity in 386 normotensive pregnant women. METHODS: Participants provided information about the type, frequency and duration of each physical activity performed during the first 20 weeks of pregnancy. We calculated odd ratios (OR) for active compared with inactive women using logistic regression models. RESULTS: Approximately 61% of women reported participating in some regular physical activity during pregnancy. Walking, swimming, gardening and jogging were the most common activities. Physical activity as an adolescent (OR 4.0) and during the year before pregnancy (OR 48.9) were the strongest predictors of physical activity in pregnancy. Active women who continued to exercise during pregnancy decreased the average intensity of their exercise and the weekly duration of exercise compared with the year before pregnancy. Nulliparas were twice as likely to engage in physical activity as compared with multiparas. Education and income were positively related with physical activity. Non-White women were 40-60% less likely to engage in physical activity as compared with White women. Smokers were also less likely to engage in physical activity. High protein intake was positively associated with physical activity, while the opposite was true for high carbohydrate intake. CONCLUSIONS: The identification of determinants of physical activity in pregnancy has important implications for developing strategies aimed at promoting a physically active lifestyle among young women.

Adult↗

Individuals with low back pain: how do they view physical activity?

BACKGROUND: Recent guidelines for those with acute low back pain have advocated early resumption of normal activity and increased physical activity. Little is known about the relationship between low back pain and physical activity, and on the impact of that relationship on the promotion of increased levels of physical activity within a general practice population. OBJECTIVES: We aimed to explore associations between factors that influence changes in physical activity and the way individuals perceive and behave with their low back pain, and the impact of those perceptions and behaviour on physical activity. METHODS: Twenty-seven informants were chosen using a purposive sample from a larger group of individuals who, because of their low back trouble, had been referred by their GPs to a community-based, single-blind, randomized controlled trial (RCT) at the University of York, which is evaluating the effectiveness and cost-effectiveness of a progressive exercise programme. Fifty-four interviews were conducted with this subgroup of the RCT; four informants were interviewed once, 19 twice and four of them three times. Interviews were transcribed and analysed using manual and computer-aided approaches. RESULTS: Physical activity was perceived as (i) activities of daily living, (ii) activities causing breathlessness that they went out of the way to do and (iii) more competitive-type activity. The avoidance of physical activity and fear of pain returning were the two main factors directly associated with informants' backs and changes in physical activity. These two factors hindered increases in physical activity, even though the majority of informants believed strongly that being physically active helped ease their low back pain. CONCLUSIONS: When advocating that individuals with acute low back pain return to or increase physical activity, it is important that clinicians identify avoidance of physical activity and/or fear of pain at the earliest stage in order to tailor advice and reassurance appropriately. If avoidance of activity and fear of pain is identified and clinicians want to encourage patients to take up and sustain increased physical activity, they should explore issues of fear of pain, and avoidance of and confidence to do physical activities, in addition to other factors influencing physical activity.

Adult↗

Physical activity trends in South Carolina, 1994-2000.

OBJECTIVES: During the 1990s, physical activity recommendations and surveillance methods were developed in an attempt to increase and monitor, respectively, regular physical activity prevalence rates. For this article, Behavioral Risk Factor Surveillance System data were analyzed to determine whether regular physical activity proportions in South Carolina adults changed from 1994 to 2000. The physical activity prevalence rates for South Carolina were compared with national rates and Healthy People 2000 goals to measure progress. The rate of physical activity counseling by physicians and other health professionals was also analyzed from 1998 to 1999. METHODS: Total subjects included 10,495 adults ages 18 years and older from South Carolina and 545,445 from the remainder of the United States. Using random-digit dialing procedures in 1994, 1996, 1998 and 2000, the two most frequent types of leisure-time physical activity performed in the past month were identified. For activities listed, the frequency (days/wk) and duration (minutes/d) were obtained. Linear regressions were performed on regular physical activity and inactivity for the total population and by gender, race, age, and body mass index (BMI). Data pertaining to whether or not a physician or other health professional had provided physical activity counseling were also obtained for 1998 and 1999. RESULTS: From 1994 to 2000, the proportion of South Carolina adults participating in regular leisure time physical activity significantly increased (10.8%). Interestingly, the prevalence of regular physical activity in the rest of the nation remained unchanged during this time. Although significant increases were observed in nearly all subgroups, physical activity prevalence rates for South Carolina adults lagged behind national levels and did not meet Healthy People 2000 goals. Physical activity counseling by physicians and other health professionals increased from 1998 (24.1%) to 1999 (30.4%). CONCLUSIONS: While it is not known what factors influenced regular physical activity from 1994 to 2000, they seem to have been equally effective in South Carolina adults of both genders, both races, regular and overweight status, and nearly all age groups. Despite these positive trends, additional efforts are needed to develop and implement effective community and primary care physical activity interventions that facilitate improvements among the nearly two-thirds of South Carolina adults who do not participate in sufficient physical activity to reap significant health benefits.

Adult↗

Epidemiological study to investigate potential interaction between physical and psychosocial factors at work that may increase the risk of symptoms of musculoskeletal disorder of the neck and upper limb.

OBJECTIVES: To investigate potential interactions between physical and psychosocial risk factors in the workplace that may be associated with symptoms of musculoskeletal disorder of the neck and upper limb. METHODS: 891 of 1514 manual handlers, delivery drivers, technicians, customer services computer operators, and general office staff reported on physical and psychosocial working conditions and symptoms of neck and upper limb disorders using a self administered questionnaire (59% return rate). Of the 869 valid questionnaire respondents, 564 workers were classified in to one of four exposure groups: high physical and high psychosocial, high physical and low psychosocial, low physical and high psychosocial, and low physical and low psychosocial. Low physical and low psychosocial was used as an internal reference group. The exposure criteria were derived from the existing epidemiological literature and models for physical and psychosocial work factors. The frequency and amplitude of lifting and the duration spent sitting while experiencing vibration were used as physical exposure criteria. Ordinal values of mental demands, job control, and social support with managers and coworkers were used as psychosocial exposure criteria. RESULTS: In the multivariate analyses, the highest and significant increase in risk was found in the high physical and high psychosocial exposure group for symptoms of hand or wrist and upper limb disorders after adjusting for years at the job, age, and sex. A potential interaction effect was found for the symptoms of the hand or wrist and upper limb disorders but not for the neck symptoms. CONCLUSION: This study showed that workers highly exposed to both physical and psychosocial workplace risk factors were more likely to report symptoms of musculoskeletal disorders than workers highly exposed to one or the other. The results suggest an interaction between physical and psychosocial risk factors in the workplace that increased the risk of reporting symptoms in the upper limbs. Psychosocial risk factors at work were more important when exposure to physical risk factors at work were high than when physical exposure was low. Ergonomic intervention strategies that aim to minimise the risks of work related musculoskeletal disorders of the upper limb should not only focus on physical work factors but also psychosocial work factors.

Adult↗