THE IMPORTANCE OF PHYSICAL ACTIVITY & RUNNING TO HEALTHY AGING

DR DANIELLE HOPEMBBS BMedSci IOCDipSpPhys

DISCLOSURES….▪ none

OVERVIEW

1. The problem from an Australian perspective – how do measure health?

2. What are the PA guidelines?

1. Activity for health vs activity for fitness/performance

3. What is the evidence for PA in the NCD problem areas

1. Prevention

2. Treatment

4. Where relevant – is there specific evidence for running?

ASSESSING HEALTH OF AUSTRALIANS

▪ Self assessment of general health

• 56.2% of all Australians aged >15years considered themselves to be in excellent or very good health

• 14.8% rated their health as fair or poor

• 11.7% experienced high or very high levels of psychological distress

• Life ExpectancyHas increased but continue to experience 8-10years of ill health

2018

Australia’s Health 2018 Report

• Leading cause of mortality overall and in >45 are chronic conditions• Heart disease• Cancer• Dementia

• Leading cause in 15-24yo • suicide

NATIONAL HEALTH SURVEY 2014-2015

0 5 10 15 20 25 30

arthritis

asthma

cholesterolaemia

diabetes

heart disease

hypertension

mental illness

osteoporosis

obese

arthritis asthmacholesterola

emiadiabetes

heartdisease

hypertension

mentalillness

osteoporosis obese

percent % 15.3 10.8 7.1 5 5.2 11.3 4 3.5 27.9

PERCENT PREVALENCE

Data adapted from NHS survey, ABS

NATIONAL PHYSICAL ACTIVITY GUIDELINESAGE 18-64

NATIONAL HEALTH SURVEY 2014-2015

Exercise:

• 55.5% of people aged 18-64 met the Australian physical activity guidelines• 29.7% were insufficiently active• 14.8% were inactive (no activity)

MORTALITY

▪ Prospective observational cohort study

▪ 55 137 individuals Reported leisuretimerunning activity

▪ Followed 15yrs for outcomes: CVD mortality and all cause mortality

▪ Runners

▪ Reduced CVD mortality 45%

▪ Reduced all cause mortality 30%

▪ Benefits greatest for

▪ Consistent runners

▪ Low-moderate volume/intensity

1. Lee D et al. J Am Coll Crdiol 2014

EXERCISE CAPACITY, CHRONIC CONDITIONS AND MORTALITY

▪ Exercise capacity was the strongest predictor of risk of death

▪ For normal subjects

▪ And for those with CVD

▪ Exercise capacity imparted a survival benefit regardless of which other condition was present.

Meyers J et al. NEJM 2002

HOW MUCH EXERCISE?

▪ Large prospective epidemiologic study

▪ Even smaller amounts of PA are associated with reduced mortality

▪ 15min/day for 6 days per week →reduced all cause mortality 14% and improves life expectancy by 3 years

▪ Every additional 15min daily

▪ Additional 4% decrease in all cause mortality

▪ Reduced all cancer mortality by 1%

▪ Inactivity had 17% increased risk of mortality compared with low volume group

Wen CP et al. Lancet. 2011

CAN EXERCISE OFFSET THE DETRIMENTAL EFFECTS OF INCREASED SITTING?

▪ Large SR and meta-analysis showed that moderate intensity PA can reduce the risk of mortality associated with high sitting time

▪ BUT

▪ High activity level attenuates but does not eliminate the increased risk associated with high TV viewing time

HYPERTENSION, DYSLIPIDAEMIA, TYPE 2 DM & CORONARY HEART DISEASE▪ Coronary heart disease is a leading cause of mortality in Australians

▪ HTN, dyslipidaemia and T2DM are recognised RF and have independent morbidities

Hypertension (1)

Aerobic Exercise ↓ systolic BP ~ 7 mmHgResistance exercise →↓ systolic BP ~ 3mmHg

5mmHg reduction systolic BP →14% decrease stroke deaths9% decrease CHD deaths7% decrease all cause mortality

Diabetes

In patients who do not have diabetes (2)Combination of diet and PA at level consistent with current guidelines →

Decreased incidence of DM by 37%

In patients with Diabetes Exercise as treatment (3)

Improves glycaemic controlDecreases abdominal adiposityImproves blood lipid profile

1. Sharman JE, J Sci Med Sport 2009 2. Orozco et al Cochrane Review 2008 3. Fransen et al Cochrane Review 2014

HYPERTENSION, DYSLIPIDAEMIA, TYPE 2 DM & CORONARY HEART DISEASE

1. Willliams PT. 20132. Williams PT, 2008

▪ National Runners and Walkers Health Study Cohort (1)

▪ Runners (n=33 060) and walkers (n=15 945)

▪ Followed for 6yrs and monitor for HTN, dyslipidaemia, T2DM, CHD reports

Hypertension Hypercholesterolaemia

T2DM CHD

Runners - 7.2% - 7.0% -12.3% -9.3%

Walkers - 4.2% - 4.3% - 12.1% -4.5%

Adapted: Williams PT 2013

• Higher intensity and faster running associated with lower prevalences of HTN, dyslipidaemia and T2DM (2)

OBESITY

normal weight %35%

overweight %35%

obese %28%

underweight2%

2015 – ABS Data

• RF for other noncommunicable disease• T2DM, • Heart disease,• HTN, • stroke, • MSK disorders• Impaired psychosocial function• Cancer (14-20%) (1)

• shorter life span • lower QoL• >70% have another co-morbidity Data adapted from NHS survey 2014-2015, ABS

1. Callee EE NEJM 2003

OBESITY

▪ 41 RCT

▪ 3476 overweight and obese individuals

▪ Diet or PA alone can result in weight loss

▪ Combining diet and PA is more effective

▪ High intensity exercise is more effective than low intensity

▪ Most studies report as effective

▪ Intensity >60%MVO2

▪ 40-50min per session

▪ 3-5x per week

Risk of cardiovascular disease mortality by cardiorespiratory fitness and body mass index categories, 2316 men with type 2 diabetes at baseline, 179 deaths.

Steven N Blair Br J Sports Med 2009;43:1-2

Copyright © BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.

OBESITY MANAGEMENT

▪ Waist circumference is better than BMI (1)

▪ Bariatric surgery for the morbidly obese (2)

▪ Beware of co-morbidities and increased risk of MSK injuries

1. Schneider et al, J Clin Endocrin Metab 20102. Sjöström L et al. NEJM 2007

CANCER1 in 3 people will be diagnosed with cancerMost prevalent: Breast (F); Prostate (M); colon; lung

Cancer effects

• Weight loss

• Sarcopenia

• Fatigue

• Malaise

• Poor appetite

Cancer Treatments

• Surgery

• Chemotherapy

• Radiotherapy

• Hormone therapy

• Immunotherapy

• Stem cell transplant

+ Low Physical Activity

CANCER

▪ Active lifestyle decreases (1):

▪ Colon cancer

▪ Breast cancer

▪ Endometrial cancer

▪ Prostate cancer

▪ Exercise after diagnosis improves outcomes in (1):

▪ Colon cancer

▪ Breast cancer

▪ Additional benefits of exercise for cancer patients (2):

▪ Reduced fatigue

▪ Improved QoL

▪ Improved mental health

▪ Reduced depression

▪ Improved physical function

▪ Enhanced social integration

Benefits are all noted at activity levels equivalent to the current guidelines

1. Pederson et al, 20152. Fong et al 2012 BMJ

MENTAL HEALTH▪ 3 million Australians are living with depression or anxiety

▪ Depression is the leading cause of disability worldwide.

▪ 1 in 6 women; 1 in 8 men

▪ Anxiety is the most common mental health condition in Australia.

▪ 1 in 3 women; 1 in 5 men

ABS National Survey of Mental Health and Wellbeing: Summary of Results. 2008

Treatment Options:

DepressionMedication – expensive, side effects, not always effectiveTherapy – expensive, low availabilityExercise – simple, low cost, easy availability, other secondary benefits

AnxietyCognitive Behavioural TherapyMedicationExercise

DEPRESSION

Exercise Vs Psychotherapy

▪ Running as treatment for depression

▪ Subjects: moderately depressed outpatients

▪ Treatments

▪ 12 wks running

▪ Psychotherapy (time limited)

▪ Psychotherapy (time unlimited)

▪ Exercise was equally effective as one form of psychotherapy (time limited) and more effective than another (time unlimited)

Greist et al. 1979

DEPRESSION

Exercise Vs Medication

▪ Subjects: major depressive disorder

▪ Treatments

▪ Medication (Zoloft)

▪ Supervised exercise

▪ Home based exercise

▪ Placebo pill

▪ exercise prescription = 3x/wk; walk/run for 45min at 70-87% HRR

▪ Exercise was equally effective as the medication

▪ Exercise or medication were both better than placebo

▪ Effect was irrespective of the social interaction (ie supervised = home based)

Blumenthal et al 2007

DEMENTIA

Physical activity can

▪ Reduce the risk of onset of cognitive decline by about 1/3 (1)

▪ Improve cognition in those with cognitive decline (2)

1. Sofi et al, 20112. Gregory A, 2018

OSTEOARTHRITIS – BURDEN

▪ 2.1 million Australians (9% population)

▪ Low mortality, high morbidity

OSTEOARTHRITIS – CAUSES

▪ Risk factors(1)

▪ Knee OA is increased with heavy physical work involving knee bending, kneeling or squatting

▪ Increased OA in elite sports people who perform repetitive, high impact activities (weightlifters, ball sports)

▪ Trauma results in increased OA (ACL, meniscal injuries)

▪ No evidence that moderate activity in recreational athletes causes increased OA

▪ Recreational running with normal joints in many longitudinal studies is not associated with increased OA (2)

▪ May be protective (reduced weight)

▪ Recreational 3.5%; Nonrunner 10.2%; Competitive runner 13.3%

1. Blagojevic M 20102. Alentorn-Geli et al 2017

OSTEOARTHRITIS – EXERCISE AS TREATMENT

HIP

▪ Cochrane review 2014

▪ 10 RCT

▪ General land-based exercise vs no exercise

▪ Improved pain by 8%

▪ Improved function by 7%

▪ No change in QoL

▪ Similar withdrawal from trial for exercise and nonexercised group

KNEE

▪ Cochrane review 2015

▪ 54 studies, 3913 participants

▪ Mild-moderate knee OA

▪ General land-based exercise vs no exercise

▪ Improved pain by 12% (range 10-15%)

▪ Improved function by 10% (range 8-13%)

▪ Improved QoL by 4% (range 2-5%)

▪ Similar withdrawal from trial for exercise and nonexercised groups

▪ Magnitude of effect similar to NSAIDS

1. Fransen et al, Cochrane review 2014; 2. Fransen et al. Cochrane review 2015

RUNNING WITH OA

▪ No worse radiological progression

▪ No worse knee pain

Lo et al; 2018

OSTEOPOROSIS

▪ Accrual of peak bone mass in adolescents

▪ Higher with impact exercises – hopping, skipping, jumping

▪ Excess exercise can be harmful to skeletal health (RED-S in adolescents)

▪ Exercise and bone density - Can exercise minimise bone loss?

▪ Large meta-analysis; 43 RCTs; 4320 participants (1)

▪ Exercise vs control for BMD

▪ Exercise – various types including resistance, jogging, jumping, walking

▪ Most effective for BMD at femoral neck: NWB high force exercise – progressive resistance program

▪ Most effective for BMD at lumbar spine were combination/mixed exercise type programs

▪ Other benefits

▪ Reduced falls

Howe TE et al. Cochrane review, 2011.

BEST TYPE OF EXERCISE TO STIMULATE BONE

▪ For osteogenic potential

▪ High impact: ground reaction force

▪ Multidirectional force

▪ Irregular load

▪ Rapid peak force

▪ Changes are site specific

▪ Running is predominantly vertical and acceleration/deceleration.

▪ Soccer players >BMD than runners (1)

▪ Gymnasts have higher BMD than runners (2)

1. Fredericson, M et al. BJSM 20172. Robinson T et al. J Bone Miner Res. 1995

Running volumes/intensities should be modified and may not be appropriate for severe established osteoporosis

The role of exercise and PGC1α in inflammation and chronic disease

Handschin C and Spiegelman B

Nature 2008

Physical inactivity is a primary cause of most chronic disease

Physical activity is a recommended treatment in many chronic diseases

WHO DEFINITION OF HEALTH

‘a state of complete physical, mental and social well being and not merely the absence of disease or infirmity’

WHO 1946

IMPORTANCE OF RUNNING TO HEALTHY AGING:

- Reduces cardiovascular and all cause mortality

- Reduces the risk of heart disease

- Lowers the risk of stroke

- Reduces the incidence of diabetes

- Reduces the progression of diabetes

- Reduces the risk of high blood pressure

- Improves lipid profile

- Can reduce incidence, mortality and the risk of recurrent breast cancer

- Can lower the risk of colon cancer

- Can reduce the risk of developing Alzheimers

- Can decrease depression

- Improves pain and function in lower limb arthritis

- Is fun, socially engaging and aids stress management

“All we have to decide is what to do with the time that is give us.”

JRR Tolkien

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