Journal of Cardiovascular Nursing
Vol. 29, No. 3, pp 203Y204 x Copyright B 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Progress in Prevention Physical Activity and Cardiovascular Health Laura L. Hayman, PhD, RN, FAAN, FAHA; Cheryl Dennison Himmelfarb, PhD, RN, ANP, FAHA, FPCNA, FAAN
A
pproximately 60 years ago, the observations of Jeremy Morris and colleagues1 showed that the incidence of coronary heart disease in bus conductors who climbed the stairs of double-deck buses collecting tickets was lower than that of the relatively inactive bus drivers who were sedentary during most of their occupational time. Since then, numerous studies have confirmed the strong association between physical activity and health in diverse populations. The accumulated evidence linking physical inactivity to health prompted the American Heart Association (AHA) to include physical inactivity as a major risk factor for coronary heart disease in 1992.2 More recently, the AHA included Laura L. Hayman, PhD, RN, FAAN, FAHA Associate Vice-Provost for Research and Professor of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston.
Cheryl Dennison Himmelfarb, PhD, RN, ANP, FAHA, FPCNA, FAAN Associate Professor, School of Nursing, Department of Acute and Chronic Care, Johns Hopkins University; Associate Professor, School of Medicine, Division of Health Sciences Informatics, Johns Hopkins University and Deputy Director, Johns Hopkins Institute for Clinical and Translational Research, Boston, Massachusetts. The authors have no funding or conflicts of interest to disclose.
Correspondence Laura L. Hayman, PhD, RN, FAAN, FAHA, College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA 02125-3393 ([email protected]). DOI: 10.1097/JCN.0000000000000151
physically active lifestyles as 1 of the 7 goals for ideal cardiovascular health for children as well as for adults.3 Underscoring the importance of physical activity as a key health indicator, the Global Cardiovascular Disease Task Force, an international panel of experts in cardiovascular and noncommunicable disease, set a goal of 10% relative reduction in the prevalence of insufficient physical activity, 1 of the top 4 evidence-based global targets to reduce noncommunicable diseases.4 Despite the well-established and broadly disseminated evidence linking physically active lifestyles to cardiovascular health and the public health impact of the role of physical activity in reducing chronic disease risk, nationally representative US data continue to indicate that children and adults are insufficiently physically active.5 For example, in 2011, the proportion of students who met activity recommendations of 60 minutes or more of moderate to vigorous physical activity on 7 days of the week was 28.7% nationwide and declined from 9th (30.7%) to 12th (25.1%) grades.5 This decline in physical activity observed from the school-age years through adolescence has been documented in previous studies, nationally and globally.6 Additional observations with individual/clinical and public health implications are the gender and racial/ ethnic differences observed in patterns of physical activity behaviors. Spe-
cifically, in 2011, more high school boys (38.3%) than girls (18.5%) self-reported meeting the daily and weekly recommended levels of physical activity; self-reported rates of activity were higher in white (30.4%) than in black (26.0%) or Hispanic (26.5%) adolescents.5 Unfortunately, from a public health perspective, nationally representative recent data for adults are similar to those observed for US children and youth. For example, according to 2012 data from the National Health Interview Survey,7 29.9% do not engage in leisure-time physical activity, operationally defined as no sessions of light/moderate or vigorous physical activity of duration of 10 minutes or more. Consistent with previous reports, in the 2012 survey, nonHispanic black and Hispanic adults were more likely to be inactive (39.4% and 39.8%, respectively) than their non-Hispanic white (26.2%) counterparts.7 Taken together, accumulated evidence on the cardiovascular health benefits of physical activity, combined with the physical activity/inactivity prevalence and trend data in children, adolescents, and adults, points to the urgent need for more effective individual/clinical and public health strategies designed to promote this health behavior beginning early in life and extending across the life course. The Centers for Disease Control and Prevention (CDC),8 consistent with selected recommendations from 203
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
204 Journal of Cardiovascular Nursing x May/June 2014 AHA,9 provides nurses and other healthcare providers with strategies that can be incorporated with ease in a variety of clinical settings. These recommendations include making physical activity a patient vital sign by ensuring that all healthcare professionals assess physical activity and discuss ways to make progress toward meeting the Physical Activity Guidelines for Americans.10 Relatedly, the AHA recently issued a statement that includes guidelines for assessment of physical activity applicable for providers in a variety of settings.9 Emphasis is placed on dimensions (the mode, frequency, duration and intensity of activity) and domains (occupational, domestic, transportation, leisure time) of physical activity assessment. Available to all healthcare providers, the statement also provides a valuable decision matrix guide to selecting a physical activity measurement based on patient, provider, and contextual factors as well as the purpose(s) of the assessment.9 Additional clinically relevant physical activity promotion strategies offered by CDC include ensuring sufficient appropriate referral for services to qualified providers based on each individual patient’s needs, encouraging referral services to catalog community-based physical activity programs, and ensuring the availability of culturally salient patient education materials and counseling for physical activity.8 A healthcare system approach is also suggested enabling the evaluation and promotion of effective practices and programs that encourage physical activity in partnership with insurers as well as making low-cost, evidence-based cognitive and behavioral interventions widely available for referral by healthcare providers. Such interventions may include an array of high-tech approaches, including Webbased resources and ‘‘smart-phone’’ applications. A critically important
strategy focuses on the urgent need to include physical activity education in the training of all healthcare professionals.8 The depth and scope of such training would vary by profession but should normally include the evidence base highlighting the individual and public health benefit of physical activity, knowledge and awareness of the methods of physical activity assessment, and interventions appropriate for and tailored to the sociodemographic characteristics and environment of individuals. In addition to individual/clinical approaches to physical activity promotion, population-based/public health approaches are clearly warranted. As Rose11 defined the need for such strategies in his seminal document entitled ‘‘Strategy of prevention: lessons from cardiovascular disease,’’ these strategies are essential to shift the entire distribution of risk, particularly when risk is widely diffused throughout the whole population. Viewed in this context, nationally representative current and trend data on patterns of physical activity and inactivity underscore the importance of population-based strategies. Lessons learned point to the importance of multilevel policies designed to promote school, neighborhood, and community environments conducive to physically active lifestyles across the life course.12 Cardiovascular nurses are well positioned to implement the CDC strategies for individual/clinically based physical activity promotion and to advocate for funding and implementation of policies designed to promote the health of the public by enabling physically active lifestyles for all US children and adults.
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REFERENCES 1. Morris JN, Heady JA, Raffle PA, Roberts CG, Parks JW. Coronary heart disease and physical activity of work. Lancet. 1953;265:1111Y1120. 2. Fletcher GF, Blair SN, Blumenthal J, et al. Statement on exercise: benefits
12.
and recommendations for physical activity programs for all Americans: a statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology: American Heart Association. Circulation. 1992;86: 340Y344. Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s Strategic Impact goal through 2020 and beyond. Circulation. 2010;121:586Y613. doi:10.1161/ CIRCULATIONAHA.109.192703 Smith SC Jr, Collins A, Ferrari R, et al. Our time: a call to save preventable death from cardiovascular disease (heart disease and stroke). Circulation. 2012; 126:2769Y2775. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statisticsV2014 update: a report from the American Heart Association. Circulation. 2014;129:e28Ye292. Corder K, Sharp SJ, Atkin AJ, et al. Change in objectively measured physical activity during the transition to adolescence. Br J Sports Med. 2013. doi:1136/bjsports-2013-093190. PMID:24273308. Blackwell D, Lucas J, Clarke T. Summary health statistics for U.S. adults: National Health Interview Survey 2012. Vital Health Stat. In press. Centers for Disease Control and Prevention. National Plan for Physical Activity: Midcourse Review: 2012. Atlanta, GA: Centers for Disease Control and Prevention. Strath AJ, Kaminsky LA, Ainsworth BE, et al. Guide to the assessment of physical activity: clinical and research applications: a scientific statement from the American Heart Association. Circulation. 2013;128(20):2259Y2279. U.S. Department of Health and Human Services. Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC: US Department of Health and Human Services; 2008 http://www.health.gov/paguidelines/ report/. Accessed January 30, 2014. Rose G. Strategy of prevention: lessons learned from cardiovascular disease. Br Med J. 1981;282:1847Y1851. Mozaffarian D, Afshin A, Benowitz NL, et al. Population approaches to improve diet, physical activity and smoking habits: a scientific statement from the American Heart Association. Circulation. 2012;126:1514Y1563.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Vol. 29, No. 3, pp 203Y204 x Copyright B 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Progress in Prevention Physical Activity and Cardiovascular Health Laura L. Hayman, PhD, RN, FAAN, FAHA; Cheryl Dennison Himmelfarb, PhD, RN, ANP, FAHA, FPCNA, FAAN
A
pproximately 60 years ago, the observations of Jeremy Morris and colleagues1 showed that the incidence of coronary heart disease in bus conductors who climbed the stairs of double-deck buses collecting tickets was lower than that of the relatively inactive bus drivers who were sedentary during most of their occupational time. Since then, numerous studies have confirmed the strong association between physical activity and health in diverse populations. The accumulated evidence linking physical inactivity to health prompted the American Heart Association (AHA) to include physical inactivity as a major risk factor for coronary heart disease in 1992.2 More recently, the AHA included Laura L. Hayman, PhD, RN, FAAN, FAHA Associate Vice-Provost for Research and Professor of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston.
Cheryl Dennison Himmelfarb, PhD, RN, ANP, FAHA, FPCNA, FAAN Associate Professor, School of Nursing, Department of Acute and Chronic Care, Johns Hopkins University; Associate Professor, School of Medicine, Division of Health Sciences Informatics, Johns Hopkins University and Deputy Director, Johns Hopkins Institute for Clinical and Translational Research, Boston, Massachusetts. The authors have no funding or conflicts of interest to disclose.
Correspondence Laura L. Hayman, PhD, RN, FAAN, FAHA, College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA 02125-3393 ([email protected]). DOI: 10.1097/JCN.0000000000000151
physically active lifestyles as 1 of the 7 goals for ideal cardiovascular health for children as well as for adults.3 Underscoring the importance of physical activity as a key health indicator, the Global Cardiovascular Disease Task Force, an international panel of experts in cardiovascular and noncommunicable disease, set a goal of 10% relative reduction in the prevalence of insufficient physical activity, 1 of the top 4 evidence-based global targets to reduce noncommunicable diseases.4 Despite the well-established and broadly disseminated evidence linking physically active lifestyles to cardiovascular health and the public health impact of the role of physical activity in reducing chronic disease risk, nationally representative US data continue to indicate that children and adults are insufficiently physically active.5 For example, in 2011, the proportion of students who met activity recommendations of 60 minutes or more of moderate to vigorous physical activity on 7 days of the week was 28.7% nationwide and declined from 9th (30.7%) to 12th (25.1%) grades.5 This decline in physical activity observed from the school-age years through adolescence has been documented in previous studies, nationally and globally.6 Additional observations with individual/clinical and public health implications are the gender and racial/ ethnic differences observed in patterns of physical activity behaviors. Spe-
cifically, in 2011, more high school boys (38.3%) than girls (18.5%) self-reported meeting the daily and weekly recommended levels of physical activity; self-reported rates of activity were higher in white (30.4%) than in black (26.0%) or Hispanic (26.5%) adolescents.5 Unfortunately, from a public health perspective, nationally representative recent data for adults are similar to those observed for US children and youth. For example, according to 2012 data from the National Health Interview Survey,7 29.9% do not engage in leisure-time physical activity, operationally defined as no sessions of light/moderate or vigorous physical activity of duration of 10 minutes or more. Consistent with previous reports, in the 2012 survey, nonHispanic black and Hispanic adults were more likely to be inactive (39.4% and 39.8%, respectively) than their non-Hispanic white (26.2%) counterparts.7 Taken together, accumulated evidence on the cardiovascular health benefits of physical activity, combined with the physical activity/inactivity prevalence and trend data in children, adolescents, and adults, points to the urgent need for more effective individual/clinical and public health strategies designed to promote this health behavior beginning early in life and extending across the life course. The Centers for Disease Control and Prevention (CDC),8 consistent with selected recommendations from 203
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
204 Journal of Cardiovascular Nursing x May/June 2014 AHA,9 provides nurses and other healthcare providers with strategies that can be incorporated with ease in a variety of clinical settings. These recommendations include making physical activity a patient vital sign by ensuring that all healthcare professionals assess physical activity and discuss ways to make progress toward meeting the Physical Activity Guidelines for Americans.10 Relatedly, the AHA recently issued a statement that includes guidelines for assessment of physical activity applicable for providers in a variety of settings.9 Emphasis is placed on dimensions (the mode, frequency, duration and intensity of activity) and domains (occupational, domestic, transportation, leisure time) of physical activity assessment. Available to all healthcare providers, the statement also provides a valuable decision matrix guide to selecting a physical activity measurement based on patient, provider, and contextual factors as well as the purpose(s) of the assessment.9 Additional clinically relevant physical activity promotion strategies offered by CDC include ensuring sufficient appropriate referral for services to qualified providers based on each individual patient’s needs, encouraging referral services to catalog community-based physical activity programs, and ensuring the availability of culturally salient patient education materials and counseling for physical activity.8 A healthcare system approach is also suggested enabling the evaluation and promotion of effective practices and programs that encourage physical activity in partnership with insurers as well as making low-cost, evidence-based cognitive and behavioral interventions widely available for referral by healthcare providers. Such interventions may include an array of high-tech approaches, including Webbased resources and ‘‘smart-phone’’ applications. A critically important
strategy focuses on the urgent need to include physical activity education in the training of all healthcare professionals.8 The depth and scope of such training would vary by profession but should normally include the evidence base highlighting the individual and public health benefit of physical activity, knowledge and awareness of the methods of physical activity assessment, and interventions appropriate for and tailored to the sociodemographic characteristics and environment of individuals. In addition to individual/clinical approaches to physical activity promotion, population-based/public health approaches are clearly warranted. As Rose11 defined the need for such strategies in his seminal document entitled ‘‘Strategy of prevention: lessons from cardiovascular disease,’’ these strategies are essential to shift the entire distribution of risk, particularly when risk is widely diffused throughout the whole population. Viewed in this context, nationally representative current and trend data on patterns of physical activity and inactivity underscore the importance of population-based strategies. Lessons learned point to the importance of multilevel policies designed to promote school, neighborhood, and community environments conducive to physically active lifestyles across the life course.12 Cardiovascular nurses are well positioned to implement the CDC strategies for individual/clinically based physical activity promotion and to advocate for funding and implementation of policies designed to promote the health of the public by enabling physically active lifestyles for all US children and adults.
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REFERENCES 1. Morris JN, Heady JA, Raffle PA, Roberts CG, Parks JW. Coronary heart disease and physical activity of work. Lancet. 1953;265:1111Y1120. 2. Fletcher GF, Blair SN, Blumenthal J, et al. Statement on exercise: benefits
12.
and recommendations for physical activity programs for all Americans: a statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology: American Heart Association. Circulation. 1992;86: 340Y344. Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s Strategic Impact goal through 2020 and beyond. Circulation. 2010;121:586Y613. doi:10.1161/ CIRCULATIONAHA.109.192703 Smith SC Jr, Collins A, Ferrari R, et al. Our time: a call to save preventable death from cardiovascular disease (heart disease and stroke). Circulation. 2012; 126:2769Y2775. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statisticsV2014 update: a report from the American Heart Association. Circulation. 2014;129:e28Ye292. Corder K, Sharp SJ, Atkin AJ, et al. Change in objectively measured physical activity during the transition to adolescence. Br J Sports Med. 2013. doi:1136/bjsports-2013-093190. PMID:24273308. Blackwell D, Lucas J, Clarke T. Summary health statistics for U.S. adults: National Health Interview Survey 2012. Vital Health Stat. In press. Centers for Disease Control and Prevention. National Plan for Physical Activity: Midcourse Review: 2012. Atlanta, GA: Centers for Disease Control and Prevention. Strath AJ, Kaminsky LA, Ainsworth BE, et al. Guide to the assessment of physical activity: clinical and research applications: a scientific statement from the American Heart Association. Circulation. 2013;128(20):2259Y2279. U.S. Department of Health and Human Services. Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC: US Department of Health and Human Services; 2008 http://www.health.gov/paguidelines/ report/. Accessed January 30, 2014. Rose G. Strategy of prevention: lessons learned from cardiovascular disease. Br Med J. 1981;282:1847Y1851. Mozaffarian D, Afshin A, Benowitz NL, et al. Population approaches to improve diet, physical activity and smoking habits: a scientific statement from the American Heart Association. Circulation. 2012;126:1514Y1563.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
