Physical Activity in Diverse Populations

Evidence and Practice

Melissa Bopp, Melissa Bopp

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781317200826
• Edition: 1
• Topic: Ciencias biológicas
• Subtopic: Ciencias del deporte y del ejercicio

The health benefits associated with regular physical activity are now widely recognized. This book examines how social determinants such as race, ethnicity, socioeconomic status, sexual orientation and disability can impact on physical activity and its associated health outcomes. It explores the social, cultural, political and environmental factors that influence engagement in physical activity in a range of diverse populations and presents evidence-based, culturally appropriate strategies for targeting and promoting physical activity participation.

Each chapter considers how the social determinants that impact on health are formed by the environments in which people live, work, learn and play. Incorporating a series of original case studies, this book analyzes physical activity behaviors in groups such as:

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• African Americans, Latinos, Asian Americans and Native Americans

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• military veterans and physically disabled populations

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• low-income populations

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• rural populations

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• LGBT populations.

It also includes a variety of useful features such as key terms, summary points and critical thinking questions, as well as a chapter on international perspectives.

Physical Activity in Diverse Populations: Evidence and Practice is vital reading for any course touching on social factors in physical activity behavior.

1
Introduction to Physical Activity and Health Disparities

Melissa Bopp

Modern medical technology combined with organized public health efforts have led to the greatest advances in human life span, health-related quality of life and an expanded understanding of factors that influence morbidity and mortality. Collectively, as a species we have never been healthier than we are today. These gains in population level health, however, are not equally distributed across the populace. Many population groups across the globe experience poorer health outcomes and experience higher rates of chronic diseases compared with the majority.

The importance of physical activity

Current recommendations for physical activity indicate that adults should engage in 150 minutes a week of moderate-intensity aerobic physical activity or 75 minutes of vigorous intensity aerobic activity (or a combination of the two). Strength training is also recommended twice a week. For youth, 60 minutes of moderate to vigorous physical activity daily is recommended. This dose of physical activity is associated with lower morbidity and mortality, most notably a decreased risk of CVD, certain forms of cancer, diabetes, obesity, mental illness and premature mortality. Regular physical activity participation has many positive health outcomes including improved cardiovascular and muscular fitness, body composition, improved psychological well-being and longevity (Physical Activity Guidelines Advisory Committee 2008). Despite these known benefits, globally, physical inactivity (a lack of physical activity) is a noted public health problem (Kohl et al. 2012). The World Health Organization (WHO) estimates that 3.2 million deaths a year are attributable to insufficient physical activity (World Health Organization 2010). Estimates of the economic burden associated with a lack of physical activity related to premature morbidity and mortality have been estimated at $53.8 billion (USD) worldwide in 2013 (Ding et al. 2016).

WHO’s Global Recommendations on Physical Activity for Health highlight the importance of scientifically informed strategies for addressing low rates of participation in physical activity. These recommendations would include population-level surveillance on the rates of participation, documenting influences on physical activity behavior and using evidence-based practices for targeting inactivity. The U.S. Department of Health and Human Service’s Healthy People Initiative, along with many other international organizations, highlight the importance of multi-level approaches to address the full breadth of the influences on physical activity participation (U.S. Department of Health and Human Services (USDHHS) 2012).

Measuring physical activity

Measuring physical activity behavior can often be challenging and complex. It is important to understand how health and wellness professionals measure this behavior to better understand how physical activity is related to health outcomes (e.g. decreased disease risk), which groups of the population are more at risk for being inactive and understanding if a program or intervention was successful at improving physical activity participation. There are four main components of physical activity that can be measured:

1. Frequency: How many times per week physical activity is performed.
2. Intensity: Refers to the level of effort associated with doing the activity. This can be relative to the individual (e.g. % of aerobic capacity) or absolute (e.g. amount of energy used by the body during the activity). This is the most difficult component to measure.
3. Time/Duration: The number of minutes of physical activity.
4. Type: This can refer to aerobic or strength/resistance training, or can also refer to the context in which the physical activity is occurring (e.g. occupational activity, leisure time, household, transportation).

For health-related outcomes, the most important components of physical activity are frequency, intensity and time, the product of which is the volume of physical activity, which is most relevant for understanding benefits. There are a number of important considerations when selecting a measurement tool for physical activity. First, it is important to reflect on the fact that physical activity is a behavior, and like most behaviors, there is a lot of variability in an individual’s physical activity participation hour-to-hour, day-to-day, week-to-week or even season-to-season. Measurement tools should do their best to capture typical behavior in a reliable, consistent manner. When deciding on measurement tools, a few considerations are necessary:

• Population: Ensure that the tool is appropriate for the group who would be using it. This could include reading level, ability to recall information or types and intensities of activities.
• Feasibility: Consider whether the tool is costly, how many individuals will be measured, or how long it will take to complete the measurement process.
• Acceptability: Determine if the tool is user-friendly and individuals would be alright with completing the measurement process. This could consider time burden, what individuals would need to do to complete the process (e.g. complete a paper survey vs. wear a measurement device).
• Reliability: The measurement tool should give reliable and consistent results each time it is used under similar measurement conditions.

There are two main categories of physical activity measurement tools: subjective and objective. Both categories have a number of different tools, all with pros and cons. Table 1.1 outlines different measurement tools.

Table 1.1 Methods of measuring physical activity

Tool	Description	Pros	Cons
Subjective
Recall Measure (e.g. retrospective survey)	Individuals are asked to remember how much physical activity they participated in over a certain time period (e.g. last month, typical week).	Low cost, can document types of activity, easy to administer, acceptable to participants.	Problems with accurately recalling information, subject to bias, may not capture all forms of activity.
Diaries/Logs (e.g. prospective methods)	Individuals are asked to write down or note all the activity they do over a period of time.	Low cost, can document types of activity, easy to administer.	May be tedious or burdensome, could cause behavior change (reactive).
Subjective
Pedometer (step counter)	Small device worn on the waistband in line with the hip. Lever arm records vertical movement and a total step count for a time period can be recorded.	Relatively low cost, easy to use with simple instructions, removes problems with recall.	Could cause behavior change (reactive), depends on individual wearing device correctly, doesn’t capture intensity of activity and can’t measure strength training, swimming, bicycling.
Accelerometers	Small device worn on the hip, wrist or ankle. Measures acceleration of the body across all planes of movement. Stores information for processing.	Not reactive (no feedback mechanisms), can accurately measure intensity, duration, frequency, limited burden to participants.	Expensive, can’t measure strength training, swimming.
Commercially available physical activity monitors	Wearable devices that assess the users’ physical activity (e.g. steps, caloric expenditure).	Easy to use, high acceptability from participants.	Expensive, reliability and accuracy varies across models, could cause behavior change (reactive), may not assess certain types of activities, depending on models.

Physical inactivity and sedentary behavior

Physical inactivity (not being active enough to meet recommendations) and sedentary behavior (any waking activity with an energy expenditure less than 1.5 METS and in a sitting or reclining posture) have increasingly been the focus of more research (Sedentary Behavior Research Network 2017, World Health Organization 2010). As noted previously, WHO (2015) has indicated that physical inactivity is the fourth leading cause of death globally, tied closely to its relationship with many chronic diseases. Although inactivity is related to physical activity, it is important to recognize that they are different things. Throughout this text we may describe physical activity or inactivity in a given population and it is important to interpret them appropriately. It is important to know what factors are related to engaging in a behavior (physical activity) as well as what is related to not engaging in a behavior (physical inactivity) as they provide an indication of what to target to make improvements. There a wide range of strategies used to combat these issues that have a strong evidence base (Kohl et al. 2012). The study of sedentary behavior has grown exponentially over the past 20 years, likely related to the increase in sitting-based leisure-time activity (television viewing, video games, computer use). The American Heart Association has reviewed the evidence in terms of the negative health impact of sedentary time on cardiovascular morbidity and mortality and has noted an increase in CVD risk associated with more sedentary time (Young et al. 2016). One of the significant challenges associated with understanding how sedentary time is related to negative health outcomes is measurement. As noted, it is difficult to measure physical activity and beyond that, measuring a behavior that takes up several hours in a day presents some significant challenges in terms of accurate recall. Objective measures (e.g. accelerometers) may be better for determining time spent in sedentary activities; however, further research is needed to establish best practices for measurement.

Although inactivity and sedentary time are not exactly the opposite of physical activity, they are a part of the larger picture of an individual’s overall health and well-being. Throughout this book, we will outline how physical activity is impacted by race, ethnicity, income, location, sexual orientation or ability level. However emerging research is also suggesting that there are differences in sedentary time based on these factors as well. For example, a study by Whitt-Glover and colleagues (2009) noted differences in the amount of sedentary time among youth by race, income and gender, though the relationship was different in children compared with adolescents. Research among adults living in New York City noted sit time was related to income and education levels (Yi et al. 2015). As the detrimental health effec...