Regular exercise, and physical activity in general, is an important health promotion intervention that reduces the risk of a variety of chronic diseases, including coronary heart disease (CHD), type 2 diabetes (T2D), high blood pressure (HBP) and obesity. While the evidence is quite clear on these causal links, Australian research statistics indicate that chronic diseases of this nature are steadily increasing each year. In fact, chronic diseases are the leading cause of ill health, disability and death, and have a significant impact on the health sector. Indeed, the importance and benefit of exercise in the geriatric population has also been well established. How can we, as a nation, combat these alarming trends? What are the most effective interventions to promote physical activity that are supported by the scientific literature?
Chronic disease trends in Australia
Chronic disease in Australia appears to be on the rise with cardiovascular disease (18%) and mental health conditions (18%) being the most commonly reported chronic diseases in Australia, followed by back pain and problems (16%). Among males, cardiovascular disease (18%) was followed by back pain and problems (16%) and among females, mental health conditions (19%) and cardiovascular disease (19%) were most common.
In 2014–15, more than 11 million Australians (50%) reported having at least one of the eight selected chronic diseases, which include:
- Back pain and problems
- Cancer (such as lung and colorectal cancer)
- Cardiovascular disease (e.g., CHD and stroke)
- Chronic obstructive pulmonary disease (COPD)
- Mental health conditions (e.g., depression)
Risk factors for chronic disease
A diverse range of factors influence the health and wellbeing of the Australian population. These factors are attributes, characteristics or exposures that increase the likelihood of a person developing a disease or health disorder. They are categorised as:
- Behavioural risk factors. These are the most common risk factors for many chronic conditions. As such, they are often a major focus for prevention strategies and interventions. Examples include smoking, poor diet and nutrition, harmful consumption of alcohol, physical inactivity and/or cognitive inactivity.
- Biomedical risk factors. These relate to the condition, state or function of the body that contributes to the development of chronic conditions. The effects of a single biomedical risk factor can be intensified when additional biomedical risk factors or behavioural risk factors are present. Examples include high blood pressure, high blood cholesterol, overweight or obesity, impaired glucose tolerance, stress, mental illness, trauma, or illness (communicable disease).
- Non-modifiable risk factors. These comprise individual physical and psychological components. Examples include age, sex, genetics or intergenerational influences.
- Physical environment determinates. These comprise both the natural and built environment, can impact health in a subtle or obvious manner and can occur over the short or long-term. Examples include UV exposure, air pollution, urban environment, or geographical location.
- Social and economic determinants. These can be difficult for individuals to control, however they influence the way in which people live their lives. Examples include beliefs, customs and culture, education and employment status.
There are also specific groups of the population who are at a particularly higher risk of chronic disease. These include:
- People aged 65 and over (87%) compared with people aged 0–44 (35%)
- Females (52%) compared with males (48%)
- People in the lowest socioeconomic areas (55%) compared with those in the highest socioeconomic areas (47%)
- People living in regional and remote areas (54%) compared with those in major cities (48%)
The occurrence of chronic diseases increases with age, and indeed Australia is an ageing population. Therefore we must focus on strategies to reduce preventable risk factors for chronic disease.
Evidence for physical activity in chronic disease
Physical inactivity is strongly linked to increased risk of CHD, and participating in sufficient amounts of physical activity is now recognised as one of the most important actions to prevent chronic diseases. Furthermore, scientific guidelines issued by various international bodies, national centres and institutes, and professional organisations have documented that regular physical activity protects against cardiovascular disease and stroke, T2D, HBP, some cancers and osteoporosis. There is also solid evidence of the mental health benefits of physical activity including in the prevention and management of clinical depression.
The significant health benefits of promoting physical activity for whole populations and at-risk individuals is a well established agenda for public health agencies and all types of healthcare systems around the world.
Current thoughts on effective health-promotion interventions
There are several proposed interventions aimed at promoting health and wellbeing in the literature. To address the multidimensional nature of health and disease, these interventions are mostly complex and multifaceted endeavours. Current suggestions include:
- Coordinating efforts between health agencies and organisations. Interventions to promote physical activity can are more effective when health agencies form partnerships and coordinate efforts with several other organisations, such as schools; businesses; policy, advocacy, nutrition, recreation, planning, and transport agencies; and healthcare organisations.
- Effective public communication. Effective and public communication of health-promoting physical activities by implementing community-wide campaigns, mass media campaigns, and decision prompts encouraging the use of stairs versus lifts and escalators.
- Social support for communities. Interventions to increase social support for health-promotion by means of physical activity within communities, neighbourhoods, and workplaces can promote physical activity.
- School-based health-promotion programs. Multifaceted school-based strategies including physical education, classroom activities, after-school sports, and active transport can increase physical activity in young people.
- Improving urban and environmental design and policy. Environmental and policy approaches can create or improve access to places for physical activity with outreach activities; infrastructural initiatives through urban design of land use and planning at community and street scales and active transport policy and practices are effective
- Training of workforces in physical activity and health. To properly support initiatives for the promotion of physical activity, workforces need to be trained in physical activity and health, core public health disciplines, and methods of intersectoral collaboration.