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Canadian Health Measures Survey 2007 to 2009

Canadian Health Measures Survey 2007 to 2009. Published January 2010 40 million dollar study Provides up-to-date estimates of the fitness in Canadian adults and children. Fitness of Canadian Children and Youth: 2007 - 2009. Estimate of the fitness of Canadians aged 6 to 19 years.

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Canadian Health Measures Survey 2007 to 2009

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  1. Canadian Health Measures Survey 2007 to 2009 Published January 2010 40 million dollar study Provides up-to-date estimates of the fitness in Canadian adults and children.

  2. Fitness of Canadian Children and Youth: 2007 - 2009 • Estimate of the fitness of Canadians aged 6 to 19 years. • In the last 2 decades childhood obesity and sedentary behaviours have increased. • Fitness levels of children have declined significantly and measurably since 1981, regardless of age or sex. • This decline in fitness may result in accelerated chronic disease development, higher health care costs, and loss of future productivity.

  3. Fitness of Canadian Children and Youth: 2007 - 2009 • Overwhelming evidence demonstrates that improved fitness is associated with improved health in children and youth. • The CHMS reported a significant decline in fitness in Canadian children and youth since 1981, regardless of age and sex. • Muscular strength and flexibility have significantly decreased, and all measures of adiposity have increased.

  4. Fitness of Canadian Children and Youth: 2007 - 2009 • The CHMS studied the Canadian population aged 6 to 79 years. • This study examined 2,087 participants aged 6 to 19 years. Groups 6 to 10, 11 to 14 and 15 to 19 yrs. • Used CPAFLA measurement protocols for assessing body composition, aerobic fitness and musculoskeletal fitness. • Examiners had a Kines degree and CSEP cert.

  5. Aerobic Fitness • Measured using the modified Canadian Aerobic Fitness Test (mCAFT). • Respondents had to complete one or more 3-min “stepping” stages at predetermined speeds, based on their age and sex. • Heart rate was recorded after each stage, and the test was completed when HR reached 85% of age-predicted max. • Predicted VO2max from formula.

  6. Anthropometric Measures • The anthropometric measures collected included height, weight, waist circumference, hip circumference and skinfold measurements. • Body mass index (BMI), waist-to-hip ratio, and the sum of the five skinfolds were calculated according to standard procedures.

  7. Muscular Strength • Muscular strength was assessed by measuring grip strength with a hand-grip dynamometer and combining the maximum score for each hand (in kg).

  8. Muscular Endurance • Muscular endurance was measured with the partial curl-up test, which required respondents to perform as many partial curl-ups as possible in one minute, at a set pace, to a maximum of 25. • Flexibility was assessed with the sit-and-reach test, where respondents sat on the floor with their legs extended against a flexometer; the best of two attempts was recorded.

  9. Musculoskeletal Fitness • An overall musculoskeletal fitness health benefit rating was assessed based on the results of the grip strength, partial curl-up and sit-and-reach tests. • A back fitness health benefit rating was calculated based on waist circumference, partial curl-ups and sit-and-reach tests.

  10. Fitness of Canadian Children and Youth: 2007 - 2009 • Comparisons with the 1981 Canada Fitness Survey (CFS) were made for estimates of grip strength, sit and-reach, and all body composition measurements. • Muscular endurance comparisons could not be made because the partial curl-up test was not used in the CFS (speed sit-ups).

  11. Results • Predicted maximal aerobic power (VO2max) declined with age for both boys and girls. • At all ages, boys had higher VO2max values than did girls. • Based on the sit-and-reach test, girls were more flexible than boys. • BMI rose with age. • Average BMIs were similar for boys and girls in all three age groups.

  12. Results • Waist circumference increased with age. • Average waist circumference was similar for boys and girls aged 11 to 14 years, but in the older and younger age groups, boys’ average waist circumference was larger. • At ages 11 to 14 years, the boys avg. skinfold measurements were higher than at ages 6 to 10 or 15 to 19 years. • Among girls, avg. skinfold measurements rose with age, and in the two older age groups, girls had higher avg. skinfold measurements than boys.

  13. Portrait of typical 12-year-old boy, 1981 and 2007-2009

  14. Portrait of typical 12-year-old girl, 1981 and 2007-2009

  15. Results • Fitness scores for children and adolescents were less favourable in 2009 than in 1981. • Compared with 1981, in 2009 there were higher percentages of boys and girls aged 15 to 19 years who were in the fair/needs improvement category for flexibility and muscular strength. • The percentage classified as overweight or obese rose from 14% to 31% among boys, and from 14% to 25% among girls.

  16. Conclusions • In the past two decades there has been a remarkable rise in childhood obesity. • Fitness levels have declined significantly and meaningfully since 1981. • Sex and age-related differences reflect complex and interconnected effects of genetics, anatomy, physiology, behaviour and social and physical environments. • Increases in childhood obesity and overweight based on BMI are related to greater adiposity, not greater muscularity.

  17. Conclusions • The current decrease in aerobic fitness in children cannot be explained solely by the increase in child adiposity. • These findings suggest that a decrease in physical activity, and subsequent detraining effect, are likely at least partially responsible for the decline in aerobic fitness. • Age related declines in aerobic fitness may be due to less physical activity, increased adiposity, or changes in hemodynamic and/or metabolic functions associated with growth and development.

  18. Conclusions • Today children are taller, heavier, fatter and weaker than in 1981. • Previous research predicts that this observed population decline in fitness, may result in accelerated disease development, increased health care costs, and loss of future productivity.

  19. Fitness of Canadian Adults: Results from the 2007-2009 CHMS • Estimates based on BMI reveal that Canadian adults have become far heavier for their height over the past 30 years. • Mean scores for aerobic and musculoskeletal fitness were lower with advancing age in both sexes, while BMI, waist circumference and skinfold measurements rose at older ages.

  20. Fitness of Canadian Adults: Results from the 2007-2009 CHMS • At ages 40 to 69 years, the % of males and females whose waist circumference placed them at a high risk for health problems more than doubled between 1981 and 2009; at ages 20 to 39 years, percentages more than quadrupled. • The percentage of males and females with suboptimal health benefit ratings for muscular strength increased between 1981 and 2009.

  21. Fitness of Canadian Adults: Results from the 2007-2009 CHMS • Between 1981 and 2009, the percentage of Canadians aged 40 to 69 years categorized as fair or needing improvement according to their body composition (BMI, waist circumference and skinfold measurements) more than doubled. • Among males aged 20 to 39 years, the increase was fourfold, and among younger females, sevenfold.

  22. Results • Results are based on 3,102 examination participants aged 20 to 69 years. • Comparisons with the 1981 CFS. • Used CPAFLA protocols. • Aerobic fitness using mCAFT.

  23. Aerobic Fitness • Mean aerobic fitness levels, measured by predicted maximal aerobic power(ml•(kg•min)-1), were highest at ages 20 to 39 years and decreased with age. • Males aged 20 to 39 years had a mean aerobic fitness score of 44 ml•(kg•min)-1 • Males 60 to 69 yrs, the mean was 28 ml•(kg•min)-1. • Female decline from 38to 24ml•(kg•min)-1.

  24. Conclusions • Overall, the prevalence of suboptimal fitness levels has increased markedly since 1981. • Increases were particularly pronounced for young adults, among whom the percentage with a waist circumference that placed them at a high risk for health problems more than quadrupled.

  25. Conclusions • The percentage whose body composition was classified as “fair/needs improvement” rose fourfold among young males and sevenfold among young females. • Increases in the percentage of young adults with suboptimal health benefit ratings of muscular strength and flexibility were also substantial.

  26. Conclusions • Longitudinal data reveal that once adults are overweight or obese, further weight gain is likely, and very few return to the normal weight range. • As these young adults with suboptimal fitness levels get older, commensurate increases in health risks and the resulting public health and economic burden of non-communicable disease are inevitable.

  27. Recommended Amountsof Physical Activity

  28. Early Recommendations to Promote Fitness • The health benefits of physical activity have been recognized around the world for centuries. • Efforts to determine the precise amount of exercise required to achieve health benefits have only occurred in the past 50 years. • A Finnish (Karvonen) study in 1957, observed the effect of treadmill running on aerobic fitness in medical students. He reported that a training intensity of at least 60% of the heart rate range is required to produce significant gains in cardiovascular fitness. • This finding was the basis for ensuing fitness guidelines

  29. Dr. Kenneth Cooper, 1968 • Air Force physician. Published the book Aerobics, which had a simple point system for the amount of exercise you should do each week. Activity Points Run 1 mile in < 8min 5 Walk 3 miles in < 43min 6 Cycle 5 miles in < 20min 5 Swim 600yd in in < 15min 5 • Recommended that adults accumulate a minimum of 30 points per week. • Choose an activity they enjoy, and exercise with other people when possible.

  30. ACSM Recommendations • The American College of Sports Medicine (ACSM) published an Exercise Guidelines book in 1975 to promote health and fitness. • In 1978 the ACSM was the first organization to publish recommendations on the amount of physical activity required to improve aerobic fitness and body composition in healthy adults.

  31. ACSM 1978 Recommendations Frequency: 3 to 5 days per week Intensity: 60% to 90% of max HR 50% to 85% of max O2 uptake Duration: 15 to 60 min per session Type: aerobic activities using large muscle groups. e.g. running cycling, swimming

  32. ACSM 1978 Recommendations • Public policy around the world was influenced by these recommendations. • The public learned of these recommendations through numerous articles and TV exposure. • Benefits of recommendations: • Relatively easy to understand guidelines • Raised public awareness about the importance of being physically active. • May have helped to start the fitness boom of the 1970s. • Improved infrastructure to help people achieve their goals (cities, companies, manufacturers, schools)

  33. ACSM 1978 Recommendations Limitations to Recommendations: • Based on improving fitness in sedentary adults. • Interpreted as being the amount of exercise required to ensure good health. • Guidelines were based on exercise studies conducted on young Caucasian males. • Most adults do not enjoy the recommended exercises and find 3 to 5 times a week too much.

  34. The American Heart Association • In 1975 the AHA published guidelines on exercise prescription for patients with cardiovascular disease. Frequency: 3 to 4 days per week Intensity: 70% to 85% of max HR Duration: 20 to 60 min per session • These guidelines helped establish the importance of exercise in medicine.

  35. ACSM 1990 Recommendations • The ACSM position statement was revised in 1990 to include the benefits of muscular strength and endurance. • Minor changes to aerobic recommendations. Recognition of the importance of moderate intensity activity. • Distinguished between physical activity to improve fitness and physical activity to improve health. • The vast majority of adults do not meet the original ACSM guidelines for aerobic fitness. • Acknowledged that lower intensity exercises would have health benefits for sedentary individuals. • Greatest health improvements occur when sedentary people become moderately active.

  36. ACSM 1995 Recommendations • Exercise 3 to 5 days per week. • Warm up for 5 to 10 minutes before aerobic activity. • Maintain your exercise intensity for 30 to 45 minutes. • Gradually  the intensity of your workout, then stretch to cool down for 5 to 10 min. • If weight loss is a major goal, be active at least 30 min for 5 days a week.

  37. 30 min of Moderate Physical Activity • Supported by WHO and Int. Fed of Sports Med. • Frequency  from 3 days/wk to daily to account for drop in intensity. • Burn more kcal/week if you train 30 min daily at a mod intensity instead of a vigorous intensity. • Vigorous activity is still recommended as it has more fitness and health benefits.

  38. 30 min of Moderate Physical Activity • In 1995 a refinement to the moderate activity guideline. • Research indicates that activity can be accumulated over the course of the day. • Three 10min activity sessions produced similar health benefits as one 30 min session. • More people find this activity recommendation easier to fit into their schedule.

  39. US Surgeon General’s report • 1996 US Surgeon General’s report on “Physical Activity and Health” • Concluded that 150 kcal/day or 1,000 kcal/wk over sedentary levels will improve health. • Stated that “significant health benefits can be obtained by including a moderate amount of physical activity on most, if not all days of the week”. • Also concluded that there are additional advantages to more vigorous activity. • A person can be more flexible in their activity. • Less intense activity for a longer period of time, or vigorous activity for a shorter time.

  40. Developing Better Recommendations to Promote Health Healthy People 2000 • US health promotion and disease prevention objectives. • Objective to increase physical activity in the whole population. • Recommendations to promote physical activity. • 30 min of light to mod physical activity daily. • Vigorous activity for fit individuals. • Activities that promote muscular strength, endurance and flexibility.

  41. ACSM 2007 Recommendations Similar to 1995 with some improvements: • Moderate- and vigorous-intensity activities are complementary in the production of health benefits and that a variety of activities can be combined to meet the recommendation. • Aerobic activity needed is in addition to routine activities of daily life. • “More is better” emphasizes the important fact that physical activity above the recommended minimum amount provides even greater health benefits. • Short bouts of exercise: the minimum length of short bouts is clarified as being 10 minutes. • Muscle-strengthening recommendation now included.

  42. ACSM 2007 Activity Guidelines • Do moderately intense cardiovascular activity 30 minutes a day, five days a week or • Do vigorously intense cardio 20 minutes a day, 3 days a week and • Do 8 to 10 strength-training exercises, 8 to 12 repetitions of each exercise, twice a week.

  43. ACSM 2011 Activity Guidelines • Adults should get at least 150 minutes of moderate-intensity exercise per week. • 30 to 60 min of moderate-intensity exercise 5 days per week or • 20 to 60 min of vigorous-intensity exercise 3 days per week. • One continuous session and multiple shorter sessions of at least 10 minutes are both acceptable to accumulate daily exercise.

  44. ACSM 2011 Activity Guidelines • Resistance Exercise: Adults should train each major muscle group two or three days each week using a variety of exercises and equipment. • Very light or light intensity is best for older individuals or previously sedentary adults just starting to exercise. • 2 to 4 sets of each exercise, with anywhere between 8 and 20 repetitions, will help adults improve strength and power.

  45. ACSM 2011 Activity Guidelines • Flexibility Exercise: Adults should do flexibility exercises at least 2 or 3 days each week to improve range of motion. • Each stretch should be held for 10 to 30 seconds, to the point of tightness or slight discomfort. • Repeat each stretch 2 to 4 times, accumulating 60 seconds per stretch.

  46. ACSM Tips for meeting guidelines • Do it in short bouts.Research shows activity can be accumulated throughout the day in 10-minute bouts. • Mix it up.Combinations of moderate- and vigorous-intensity physical activity can be used to meet the guidelines. • Set your schedule.The key is to set aside specific days and times for exercise, making it just as much a regular part of your schedule as everything else. • The gym isn’t a necessity.It doesn’t take an expensive gym membership to get the daily physical activity. • Make it a family affair.Take your spouse, children, or a friend with you during exercise to add some fun.

  47. Canada’s Physical Activity Guide www.phac-aspc.gc.ca • Public Health Agency of Canada • Health promotion • Healthy Living Unit • Website and downloads • Good resource for project

  48. Canada’s Physical Activity Guide • In 2011, the Canadian Society for Exercise Physiology (CSEP) released new guidelines for physical activity and general health promotion for adults aged 18-64 • Strength-training 2 days per week • At least 10 minutes of moderate-vigorous intensity aerobic physical activity most days per week (a minimum of 150 minutes per week)

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