Inadequate Physical Activity and Health Care Expenditures in the United States

Carlson, Susan A.; Fulton, Janet E.; Pratt, Michael; Zhou, Yang; Adams, E. Kathleen

doi:10.1016/j.pcad.2014.08.002

Cited by 355 publications

(247 citation statements)

References 24 publications

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“…11,12 There is an acute awareness by governments, professional organizations and healthcare systems that being physically inactive, carrying excess body weight, and poor dietary choices are primary drivers for chronic disease…”

Section: Introductionmentioning

confidence: 99%

Public Park Spaces as a Platform to Promote Healthy Living: Introducing a HealthPark Concept

Arena

Bond

O’Neill³

et al. 2017

Progress in Cardiovascular Diseases

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The concept of Healthy Living (HL) as a primary medical intervention continues to gain traction, and rightfully so. Being physically active, consuming a nutritious diet, not smoking and maintaining an appropriate body weight constitute the HL polypill, the foundation of HL medicine (HLM). Daily use of the HL polypill, working toward optimal dosages, portends profound health benefits, substantially reducing the risk of chronic disease [i.e., cardiovascular disease (CVD), pulmonary disease, metabolic syndromes, certain cancers, etc.] and associated adverse health consequences. To be effective and proactive, our healthcare system must rethink where its primary intervention, HLM, is delivered. Waiting for individuals to come to the traditional outpatient setting is an ineffective approach as poor lifestyle habits are typically well established by the time care is initiated. Ideally, HLM should be delivered where individuals live, work and go to school, promoting immersion in a culture of health and wellness. To this end, there is a growing interest in the use of public parks as a platform to promote the adoption of HL behaviors. The current perspectives paper provides a brief literature review on the use of public parks for HL interventions and introduces a new HealthPark model being developed in Chicago.

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Section: Introductionmentioning

confidence: 99%

Public Park Spaces as a Platform to Promote Healthy Living: Introducing a HealthPark Concept

Arena

Bond

O’Neill³

et al. 2017

Progress in Cardiovascular Diseases

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“…Clearly great efforts are needed to increase CR penetration in healthcare systems across the globe, given these are highly cost-effective strategies [100][101][102][103] . The next most commonly-offered component was patient education, which was delivered particularly often in North America, as well as the Middle East and North Africa.…”

mentioning

confidence: 99%

A Review of Cardiac Rehabilitation Delivery Around the World

Pesah

Supervía

Turk-Adawi

et al. 2017

Progress in Cardiovascular Diseases

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Herein, 28 publications describing cardiac rehabilitation (CR) delivery in 50 of the 113 countries globally suspected to deliver it are reviewed, to characterize the nature of services. Government funding was the main source of CR reimbursement in most countries (73%), with private and patient funding in about ¼ of cases.Myocardial infarction patients and those having revascularization were commonly served. The main professions delivering CR were physicians, nurses, and physiotherapists. Programs offered a median of 20 sessions, although this varied. Most programs offered the core components of exercise training, patient education and nutrition counselling. Alternative models were not commonly offered. Lack of human and/or financial resources as well as space constraints were reported as the major barriers to delivery. Overall, CR delivery has been characterized in less than half of the countries where it is offered. The nature of services delivered is fairly consistent with major CR guidelines and statements.Keywords: cardiac rehabilitation, global health, secondary prevention Alphabetical List of Abbreviations: AS= administrative support CABG = coronary artery bypass graft CB = community-based A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT2 CR = cardiac rehabilitation CPR= cardiopulmonary resuscitation CVD = cardiovascular disease ECG = electrocardiogram EQ= equipment ET = exercise training FR= financial resources HB = home-based HF = heart failure HR= human resources IA = initial assessment IB = internet-based IHD = ischemic heart disease LMIC = low-and middle-income country MI = myocardial infarction NC = nutrition counseling NZ = New Zealand PAW= patient awareness PCI = percutaneous coronary intervention PE = patient education PR= patient referral RF = risk factor management SC = smoking cessation SM = stress management and/or psychosocial support/counselling TI = transportation issues UAE = United Arab Emirates VAD = ventricular assist device A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT3 By 2030, it is expected 84 million individuals will be diagnosed with cardiovascular disease (CVD) 1 .Moreover, it is among the leading causes of disability around the world, and contributes to 10% of disabilityadjusted life years lost world-wide 2 . With improved survival (in high-income countries 3 ), clearly there is a great need for secondary prevention, such as is offered in cardiac rehabilitation (CR) programs.Many meta-analyses demonstrate that participation in CR is associated with improved quality of life, as well as decreased morbidity and mortality [4][5][6][7] . CR is also cost-effective 8 . Accordingly, it is a class 1 level A recommendation in clinical practice guidelines for CVD patients 9,10 . 19 , have established guidelines to ensure consistent provision and quality of CR delivery in order to achieve the greatest population health benefits. They all outline the nature of patients indicated for services, and make recommendations regarding the composition of a multi-disciplinary...

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“…Parenthetically, research from a prominent tracking study, conducted over 21 years, that assessed physical activity from childhood through to adulthood found that high levels of continuous physical activity among youth predicted a high level of physical activity in adulthood [18]. As such, by establishing regular physical activity during the formative years of childhood appears to have downstream effects on physical activity later in life; with physical activity in adulthood not only related to improvements in psychological and physical health [19], but also reduced health care costs (recent estimates indicate that physical inactivity in adulthood accounts for 11.1 % ($117 billion) of aggregate health care expenditure per year in the USA) [20].…”

Section: Practice and Public Health Policiesmentioning

confidence: 99%

Physical activity for children in elementary schools: time for a rethink?

Beauchamp

Rhodes

Nigg

2016

Behav. Med. Pract. Policy Res.

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In spite of the well-known benefits of physical activity, the vast majority of children in North America do not meet current international guidelines for accumulating sufficient health-enhancing physical activity. Indeed, despite considerable attention to this population health crisis, the current prevalence of inactivity, along with its concomitant health consequences, shows little sign of abating. In this paper, we identify acknowledged barriers to wide scale physical activity adoption and maintenance at the population level among children and propose a viable tripartite framework (albeit one that would require political support) that we hope will provide the basis for debate and implementation. We emphasize that each of these considerations, in isolation, would be insufficient to substantively address the problem, but when combined would ensure that all elementary school children (without any medical contraindication) are sufficiently active, rather than the minority of this population. KeywordsPhysical activity, Children, Population health, PolicyIn North America, the vast majority of children do not meet current guidelines of 60 min of daily moderate to vigorous physical activity (MVPA) [1,2]. Specifically, in the USA, 42 % of children aged 6-11 are estimated to meet these recommendations, while only 8 % of adolescents are sufficiently active [1]. The picture is equally bleak in Canada, with less than 10 % of children and youth meeting these guidelines [2]. In light of compelling medical and epidemiologic evidence concerning both the physiological and psychological benefits of physical activity [3], as well as the prevalence and risks of inactivity (e.g., reduced risk of diabetes, obesity, cardiovascular disease, most cancers, depression) [3], a wide-range of behaviorchange interventions and initiatives have been developed and implemented over the past few decades to encourage children to adopt and sustain active lifestyles. These initiatives have been tested using increasingly robust research designs. Unfortunately, however, the accumulated evidence to date suggests that the effectiveness of these interventions have been limited. To illustrate, in a recent meta-analysis that examined the effects of interventions that were tested using controlled trials in relation to objective measures of physical activity among children, the overall effect of the interventions was very small and equated to an average increase of just 4 min more of walking or running per day on children's overall activity levels [4].Given the current evidence regarding (a) the small effects that the best pediatric physical activity interventions can deliver, (b) the pervasive levels of inactivity that exist among children, and (c) the considerable health-related and developmental costs associated with inactivity among this population, we propose that it is time for a substantive rethink about our

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Inadequate Physical Activity and Health Care Expenditures in the United States

Cited by 355 publications

References 24 publications

Public Park Spaces as a Platform to Promote Healthy Living: Introducing a HealthPark Concept

Public Park Spaces as a Platform to Promote Healthy Living: Introducing a HealthPark Concept

A Review of Cardiac Rehabilitation Delivery Around the World

Physical activity for children in elementary schools: time for a rethink?

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