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Personal HealthPhysical Recreation and Active Living are Essential to Personal Health - A Key Determinant of Health Status
In 1986, Paffenbarger and colleagues published the news-breaking findings that they had found a means of extending the life span of men by as much as two years. To achieve this, participants simply had to walk at a moderate pace for an hour every day. The activity did not have to be done all at one time. The benefit could be achieved by frequent short periods of different types of activity. Only the total energy expended was found to be important. Researchers reported that men in the lowest tertile of energy expenditure had increased risk of Cardiac Heart Disease (CHD), sudden cardiac death and at[-cause mortality. (Paffenbarger. 1986)
Mortality from all causes and longevity are influenced by exercise, fitness, and other lifestyle considerations. A Finnish study looked at the influence of high physical activity on incidence of premature death. from any cause among 636 Finnish men over 20 years (aged 45-64 at beginning of study). The men who had been most active lived 2.1 years Longer than men less active, mainly because of differences in coronary heart disease risk. (Pekkanen et al., 1987)
Physical activity was studied in 1986 with 11,864 Harvard alumni for 9 years. It was and found that:
Age-adjusted all-cause risk of death decreased with increasing energy expenditure up to 3,000-3,499 kilocalories per week.
In terms of physical activity index, the risk of premature death might have been reduced by 20% if every person adopted an active Lifestyle. Maintaining a routine of walking as Little as five kilometers per week, climbing three flights of stairs daily, doing sports of moderate intensity (4.5 METS) or expending 2000 kilocalories of energy weekly is sufficient to receive protection. (Paffenbarger et al., 1994)
Regular moderate sports playing adds 1.25 years to the life expectancy of a 45-54 year old man; men who were initially sedentary but who started in moderately vigorous sports had a 23% lower risk of death than men who remained inactive; also death rates in sedentary individuals are approximately twice as high as for physically active persons. (Paffenbarger et al., 1993)
Physical exercise is a normal function of the body which promotes optimal performance of all body systems - musculoskeletal, cardiovascular-respiratory, hormonal-immunologic, hematologic, neurosensory, gastrointestinal. When exercise is adequate, fitness is maintained or improved, good health is preserved, quality of life is favorable, systemic disease is avoided or deferred and length of life is maximal. Avoidance or postponement of morbidity is especially influenced by physical activity. (Paffenbarger et al., 1994)
Dietary factors and activity patterns that are too sedentary, together are accountable for at least 300,000 deaths each year in the U.S. Longevity is partially related to the balance between calories consumed and calories, expended through metabolic and physical activity. Many studies have associated dietary factors or sedentary lifestyles with:
This sums up to a range between 309,000 and 582,000 deaths in 1990 related to diet and activity patterns. (McKinnis, 1993)
Sport was most influential in leading to a decreased mortality rate in a 16 year follow-up interval of former students who had attended Harvard university from 1916-1950. This was followed closely by walking and stair climbing which were equal in importance. (Paffenbarger.et al., 1986)
A roughly 10% point increase in the number of active people in the state of Minnesota would be expected to reduce deaths by 5% in men and 6% in women. (Blackburn et al., 1993)
It is estimated that nearly 250,000 deaths per year in the United States are attributed to lack of exercise. (Hahn et al., 1990)
Reports on physical activity and mortality are consistent with one another and conclusions from nine studies demonstrate an inverse gradient for all-cause mortality across physical activity categories. (Powell et al., 1987)
In the Aerobics Centre Longitudinal Study, 9.0% of the deaths in men and 15.3% of the deaths in women were attributable to tow physical fitness. (Blair et al., 1989)
Starting an activity program reduced risk of dying by 51% in men who became physically active when compared to those who remained sedentary. Also, Blair states that beginning moderately vigorous sports is as important to risk reduction as stopping smoking. (Blair, 1993)
The greatest decrease in risk occurs when people move from fitness levels of 6 METS to 7 METS. These benefits can be achieved from a brisk walk of as little as 30 minutes a day. The Least fit men face almost 3.5 times as much risk as the most fit; unfit women, over 4.5 times as much risk as fit women. Mortality rates indicate that the most optimal fitness level is 10 METS for men and 9 METS for women. Similar risk profiles have been found in other studies including the Canada Health Survey follow-up study. (CFLRI, 1995)
A seven year follow-up study compared fitness levels of 2,174 people and found that compared to the most fit, the relative risk of all-cause mortality was 1.6 for subjects with minimally acceptable fitness levels and 2.7 for unacceptable levels. Their findings were similar for cardiovascular disease mortality. (Arraiz, 1992)
Another study tracked 8,715 men for 8.2 years; researchers found that physically fit men had lower age-adjusted all-cause death rates than unfit men at all levels of glucose tolerance. The age-adjusted death rates for unfit men were 82.5 and 45.9 for fit men per 10,000 persons years of follow-up. (Kohl et al., 1992)
Researchers concluded that the prevalence of high risk sedentary behavior in Canada is likely to be in the range of 15% to 25%. Based on three valid studies, we estimate conservatively, that 20% of the adult population in developed countries are an elevated risk for premature death and disease because of low level of physical activity. (Blair et al., 1994)
Dubbert (1992) reviewed the research on the preventive and rehabilitative applications of exercise and Literature on exercise adherence from the past 10 years. There is now substantial evidence that a Low Level of physical activity is associated with decreased life expectancy for both men and women and contributes independently to the development of many prevalent chronic diseases.
Of the 9,484 men studied between 1960 and 1985; those who practiced moderate physical activity were older and had lower death rates than those who reported tittle or no physical activity. (Linsted, 1991)
In 1993, the Heart and Stroke Foundation in Canada and the United States, identified physical inactivity as the fourth modifiable risk factor for cardiovascular disease after smoking, high blood pressure and high blood cholesterol. (Alberta Community Development, 1995)
A comprehensive literature review conducted by a research team at the University of Alberta indicated that since 1990, over 1500 scientific studies have been published that positively [ink short and long-term physical activity (CFLR1, 1995). Thirty-eight different types of positive health outcomes were identified ranging from symptom management of Alzheimer's patients to pain control in osteoarthritis. In that report, six major positive health outcomes were identified:
The slowing of many forms of physical decline by up to 50%.
Researchers have begun to develop an astonishing profile of those elderly who are physically active. The physically active older adult is likely to be one or two decades younger physiologically than their sedentary contemporaries. Moreover, they cut the effects of the age decline in half- that is, in many biological functions, the 1% decline per year is reduced to a 0.5% decline per year. Over many decades, this slower rate of aging becomes significant and it is not uncommon to find Masters athletes in their seventies who can match performances of sedentary 20 year old individuals (Vaccaro, Dummer & Clarke, 1981). Available evidence suggests that older people can acquire two types of benefits from physical activity & recreation:
Changes in physical, social, and emotional well-being; an increase in physical mobility, overcome stiffness, aches and pains plus social and psychological; new friends and a happy disposition due to participation in fun activities; support network to bolster commitment.
Regular physical activity can prevent the onset of old age; the age at which adults are not capable of performing desired exercises. If a woman remains physically active, she will enjoy the relative absence of aches and pains. She will be able to continue walking up and down stairs, and will remain some what independent. (Fournier et at., 1990)
Older adults who are physically active are more self-confident, more independent, and enjoy life more than older adults who are sedentary. (Government of Canada, 1983)
3.3 million Canadians (12% of the population) have a functional limitation or disability; 40% are 65 years of age or older and not yet institutionalized. By 2011, about 25% of the entire population will exceed 55 years of age; the implications for health care expenses and personal wellbeing warrants an active life which prolongs independent living. Currently, about 50% of Canadians reporting functional limitations are sedentary. The notion of active living as a viable promotion strategy is intuitively obvious and strongly endorsed by the scientific community. Chronic conditions which cause functional [imitations can be positively influenced by physical interventions and active living. (Sharratt et al., 1994)
Evidence shows that regular periodic energy stimulation throughout the day is increasingly important for the older adult. Unless one aspires to embrace an active lifestyle that includes a habitual dosage of leisure and physical activity, one increases the risk of impairment, frailty and morbidity along with a shorter life. Optimal active living increases the probability of a higher quality of life with a dignified death. (Orban, 1994)
Muscular strength is of importance in an aging population because age-related decline in strength can severely restrict activity. Decline in physical strength with age can be modified substantially with exercise; much of the muscle frailty in the elderly can be prevented or decreased. With designed strength training program, a sedentary adult can achieve a 50% increase in muscular strength within six months. (Wankel & Berger 1991)
The importance of resistance exercise (to increase muscle strength, such as by lifting weights) is increasingly being recognized as a means to preserve and enhance muscular strength and endurance and to prevent falls and improve mobility in the elderly. (Surgeon General Report, 1996)
Researchers took 20 active elderly male and female subjects (mean age was 66.4 years) through a 12 week weight training program to assess increases in muscular strength and body weight. Males had an average increase of 66% in total maximum weight lifted, while females had an average increase of 72.2%.
Lean body weight also increased but not to a significant degree; thus weight training did have positive effects for this group. (Dupler et al., 1993)
A group of sedentary older adults from the Duke Exercise and Aging Study participated in an exercise program for 14 months. Results showed the older adults achieved up to an 18% increase in aerobic capacity. However, one year later; 87 older adults (88% of original group) completed a questionnaire; 94% (85 people) had continued to participate in some form of physical activity, including stretching exercises, walking, stationary bicycle riding, strength training, yard work, swimming, golf, and more. The motivators for continuing exercise were: it kept them in good shape and good health plus it improved energy level and alertness. (Emery, 1992)
Ashley (1993) makes a case that dance has many benefits for older adults, including improved balance and coordination, physical fitness, weight control, creative expression, and relaxation.
Sedentary elderly women (mean age 65 years) participated in low impact aerobic dance 3 times/week. Results showed significant functional improvements with: cardiorespiratory endurance, strength/endurance, body agility, flexibility, body fat, and balance. (Hopkins et al., 1990)
Improvements in Long-term function and reduction of pain due to arthritis can. result from regular exercise. (Buchner et al., 1992)
Physical activity helps to maintain functional ability avoiding functional. loss. (Wagner et al., 1992)
The impact of daily exercise on mobility balance, and urine control was examined with 15 cognitively impaired elderly residents (70 to 97 years) in a nursing home. Results showed that daily exercise was found to improve both the mobility and bladder control of this group. (Jirovec, 1991)
Researchers found that spinal flexion, perceived health status, life satisfaction, and maximal physical exertion were significantly improved following participation in a 32 week aerobic exercise class in a group of older healthy volunteers (60 to 81 years). (McMurdo et al., 1992)
Researchers examined the impact of supervised exercise on the health status (measured by Sickness Impact Profile) and well-being (measured by the Psychological General Well-Being Index) of 23 veterans (65 to 80 years). The intervention was 90 minutes of exercise, 3 days/week at 65-75% of maximal capacity. At a 1 year follow-up, the program resulted in significantly increased psychological well-being and cardiovascular fitness in the veterans. (Cowper et at., 1991)
Choi, P. (1992) reviewed studies examining the hypothesis that physical exercise is effective in the management of menstrual cycle symptoms and thus, is beneficial to women. Choi states that because physical exercise is associated with reductions in anxiety and depression in general, and these findings are stronger for. women, exercise may help to alleviate menstrual symptoms and possibly be a preventative measure.
Twenty-five elderly patients with peripheral vascular disease and intermittent claudication were continually examined during a six month period of physical training. Results demonstrated that there was an improvement of hormonal and metabolic balance after physical training. Regular applied physical activity does improve the health status of older adults. (Rosfors et al., 1989)
A 9 to 12 month exercise program of walking and/or jogging at 80% of maximal heart rate improved fat distribution patterns in 60 to 70 year old men and women. Older adults Lost 3 to 4% of their body weight over the course of the intervention, all of the weight lost was fat weight and 'the fat Lost occurred in the truncal area indicating "a preferential Loss of fat from the central regions of the body". (Kohrt et at., 1992)
Regular physical activity for the aging can improve cardiopulmonary functioning, Lower blood pressure, increase bone mineral content, increase muscular strength and joint flexibility and improve psychological well-being. (Moore, 1989)
A water aerobics program two times a week for 16 weeks significantly reduced diastolic blood pressure, body fat and body weight in elderly community residents, (Green, 1989). These findings were replicated in a second study with 24 elderly community residents. (Keller, 1991)
Researchers assigned 43 sedentary postmenopausal women (mean age 58.9 years) to a 12 week aerobic exercise group, a 12 week passive exercise group, or a sedentary control group. Before and after the 12 week period, the women completed measures of physical fitness and psychological functioning. Improvement in aerobic power as a result of regular physical activity was shown to be significantly correlated with improvement in overall psychological distress, depression and perceived stress in the sedentary, middle-age women. (Norvell et al., 1991)
The effects of aerobic exercise and strength training on premenstrual symptoms was evaluated on 23 healthy premenopausal women (45-55 years). Premenstrual symptoms were assessed at baseline and following 3 months of exercise. They found that aerobic exercise had a positive influence on premenstrual symptoms, especially premenstrual depression. (Steege et at., 1993)
Researchers looked at the long term effects of exercise training on selected psychological processes for older non-exercising adults. Over a 1 year period, participants progressively increased their exercise intensity to sustain large improvements in cardiovascular fitness with an average increase in Vo2 max of 28% over baseline; plus a significant improvement in self reported morale in the exercise group over the control group. (Hill et al., 1993).
Studies have demonstrated that those who were physically active earlier in Life are more Likely to be physically active in the Later years. Research indicates that most older adults have the ability to participate in some type of physical activity, to some degree, which will improve their quality of life. Studies have shown that those who remain physically active at an older age may have a 20% to 30% greater performance capacity than sedentary older adults of a similar age. (McPherson, 1991)
Older adults who are physically active have more opportunities for socialization and friendship than those who are inactive. (Government of Canada, 1983)
A qualitative exploration of personal Life philosophy was undertaken to understand the cognitive make-up of competitive older men and women. The results provided evidence that sport -and physical recreation may be an important type of coping strategy for some elderly adults who find meaning and a sense of achievement in challenging themselves physically. (O’Brien et al., 1991)
Studies have revealed that no factor contributed as much to life satisfaction and social integration, of older adults as leisure participation. Also, leisure activities which have some high degree of investment (e.g..a certain skill level acquired over time) will reflect enhanced feelings of competence, worth and self-expression. (Kelly, 1987)
Between May and November 1994, a ten member research team at the University of Alberta conducted a critical evaluation of the scientific evidence demonstrating health outcomes of active living among older searchers, over 1500 scientific articles were relevant to older adults and active living outcomes.
| The following research themes had 'evidence ratings' of 3 or more (0 = inconclusive evidence and 5 = conclusive evidence) based on this research: | |
| Cardio-respiratory fitness | acceptable (4) |
| musculoskeletal adaptations | acceptable (4) |
| Joint mobility | acceptable, conclusive (4.5) |
| Body composition | acceptable (4) |
| Hypertension Reduction | acceptable (4) |
| Cognitive/Motor Performance | indicative (3) |
| Balance Promotion | acceptable (4) |
| Falls prevention | indicative (3) |
| Coronary heart disease | acceptable (4) |
| Bone health, osteoporosis | acceptable (4) |
| Arthritis | indicative (3) |
| Cancer | indicative (3) |
| Diabetes | indicative (3) |
| Mortality outcomes | indicative men (3) |
| Sudden death | acceptable (4) |
| The above themes ore supported by a good deal of research of adequate quality to warrant evidence ratings of 'acceptable or conclusive, (Cousins, 1995) | |
Recent position statements issued by the American Heart Association and the Canadian Heart and Stroke Foundation clearly identify physical inactivity as a "primary modifiable risk factor" in the development of CHD, equivalent in risk to high blood pressure, cigarette smoking and elevated cholesterol. (CFLRI, 1995)
The U.S. Surgeon General's Report (1996) which was developed collaboratively with at least 11 different National Health Institutes (Heart, Lung, Blood, Diabetes, Arthritis, etc..) involved extensive scientific research/review and came up with these conclusions:
Physical activity reduces the risk of aft-cause death as well as the number one killer, coronary heart disease. There are 4 recognized primary factors of coronary heart disease: blood pressure, high blood cholesterol, cigarette smoking and physical inactivity. According to the U.S. Center for Disease Control, inactivity is the most significant risk factor for CHD in terms of its ability to influence inactivity and have an impact on public health. (CFLRI, 1995)
Researchers reported that moderate physical activity (frequent walking or cycling, very frequent recreational activities and sports playing once a week), is -associated with Lower rates of heart disease and stroke in men both with and without pre-existing heart disease. Men who were more active had a significantly lower risk of stroke than did their Less active counterparts. (Wannamethee et al., 1992)
Physical activity and fitness are causally related to the risk of death due to CHD. Physical activity and fitness:
These are all factors that are associated with increased risk of stroke. (Kohl et al., 1994)
Existing evidence supports a causal inference for inactivity and CHD (Coronary Heart Disease) relationship. Significant studies on physical activity and mortality show a strong inverse gradient with cardiovascular disease and physical activity and fitness. (Blair, 1994)
Physical activity plays a role in rehabilitation and treatment of patients who have suffered a heart attack. Studies have found a 20% reduction of risk for total mortality and a 25% reduction of risk for fatal infarction. (O'Connor 1989)
Epidemiological studies (48 study groups) suggest an inverse relationship between physical activity or fitness and blood pressure. (Fagard et al., 1994)
Individuals climbing 36+ flights of stairs per week had a 28% lower relative risk of death from cardiovascular disease than sedentary individuals. (Paffenbarger et al., 1991)
Over a 20 year period, researchers have shown the physiological benefits of systematic physical activity:
Studies have shown that men who reported eight or more bouts of vigorous physical activity per month at baseline were much less likely to develop coronary heart disease than the men who reported no vigorous activity. Morris and colleagues found that the age-standardized death rates from CHO decreased with the frequency of vigorous activity reported in a four-week period prior to entry into the study. Vigorous denoted an exercise intensity of six METS, equivalent to jogging, swimming, playing badminton or soccer, walking at a fast pace of over four miles per hour or cycle at Least an hour per day (25 miles/week.). (Morris et al., 1990)
In studies that used satisfactory methods, more than 80% of the active individuals showed a reduced risk of coronary heart disease. Higher levels of physical activity are consistently associated with a lower incidence of CHD and vice versa. Thus, it appears if a study is carefully done, it is certain that a protective effect of physical activity on disease processes will be observed. (Blair et al., 1994)
The risk for CHD is increased nearly twofold (1.9) for those who are inactive. (Powell et at., 1987)
Sedentary living is a risk factor for hypertension, which in turn is a risk factor for heart disease and stroke;
Fagard and Tipton (1994) after a comprehensive review, concluded that depending on the efficacy of the aerobic training, significant reductions in blood pressure readings could be achieved. For example:
Physical activity is an effective treatment intervention for hypertension. The reductions achieved by exercise are similar to those resulting from drug therapy. (Hagberg, 1990)
Physical activity has an immediate effect in lowering blood pressure, observed soon after an exercise session. Blood pressure decreases with exercise and may remain at a lower level for hours. (Tipton, 1991)
It is generally accepted, that Low Levels of physical activity or fitness precede the development of CHD in healthy individuals. There is a near doubting of risk of CHD among the least active individuals compared with the most active individuals; this can increase up to eight fold among the least fit compared with the most fit individuals. (Bouchard et al., 1994)
Maintaining high levels of physical activity after a heart attack decreases the likelihood of subsequent cardiac death. (Kitajima et at., 1990)
A study of adults with physical disabilities who were involved in community and individual aerobic exercise programs had significant improvements in cardiovascular and metabolic functional capacity when compared to a non-exercising group. Improved cholesterol levels were also, reported Which represents a, potential reduction in the risk of coronary heart disease of about 35%. (Santiago et al., 1991)
Researchers completed statistical analyses on 2 surveys of British adults - the Indoor Sports Research Project (1,122 adults) and the Health and Lifestyle Survey (5,998 adults). The results showed that sports participants had significantly lower body mass index values, lower blood pressures, and tower resting pulse rates. They also possessed better self-perceived health and perceived themselves to be more active than members of the general population. (Lamb et al., 1991)
Any increase in bone mass that occurs as a result of exercise is considered an important benefit for both the individual and society; for example, if osteoporosis fractures in the population can be delayed by just a few years, this will result in fewer years of dependency and associated substantial reductions in health care costs overall, not to mention the increase in the quality of Life for older citizens. (Drinkwater, 1994)
The U.S. Surgeon General's Report (1996) which was developed collaboratively with at Least 11 different National Health Institutes (Heart, Lung, Blood, Diabetes, Arthritis, etc.); involved extensive scientific research/review and resulted in these conclusions:
In childhood and adolescence, habitual physical activity, as opposed to a sedentary lifestyle, leads to increased bone mass and bone strength. A gradual and sustained loss of bone mass begins in the third to fourth decade of life and continues unrelentingly in all subsequent decades. Physical activity, particularly weight-bearing and strength building activities, help sustain bone mass and reduce the incidence of trauma-induced fractures. Thus physical activity helps prevent osteoporosis and its consequences, and is recommended in the rehabilitation of the osteoporotic subject. (Aloia et al., 1978; Holloszy & Coyle, 1984; Smith & Raab, 1985 - in Paffenbarger et al., 1991)
Prolonged exercise has been found to increase bone density; increased bone density was found not only in athletes of highest international class, but also in ordinary athletes and exercising control subjects. (Panush, 1994)
For maximizing bone mineral density development in youth, activities that repeatedly put physical stress on the bone will help to increase peak bone density (usually achieved by late teens or early twenties) - activities that include upper as well as tower body should be included. The greater value of exercise in older persons may be to decrease the risk of falling by enhancing muscle strength and possible balance. (Haskell, 1994)
Weight bearing physical activity is regarded as essential to bone health. Osteoporosis is a serious public health problem; for example, 15 to 20% of women suffering from an osteoporotic hip fracture die within six months as a result of complications; 50% will not be able to return to independent living. In the US, health costs associated with this disease are about $10 billion per year. It is expected these costs will increase as the population ages. (Drinkwater, 1994)
Younger adults, and active men and women typically have higher bone mineral density than sedentary individuals. (Heinrich et at., 1990)
Cross-sectional studies have indicated that active men and women under 50 years of age typically have 10% and 8% higher bone mass than their sedentary peers. (Bouchard et al., 1994)
Research has found that active, premenopausal women have a higher bone mineral density than sedentary women. Some data suggests that physical activity can increase bone density over time in both men and women. (Bouchard et al., 1994)
Programs incorporating aerobics, callisthenics, stair climbing, weightlifting, and dancing have also been found to increase bone mineral density. (Drinkwater. 1994)
Several epidemiological studies have suggested that maintaining a physically active lifestyle between the ages of 15 and 45 is critical in the prevention of osteoporosis and decreases significantly the risk of osteoporotic fractures in later Life. (Astrom et al., 1987)
Research has demonstrated that physical activity is effective in counteracting and even reversing bone toss. A gradual and sustained loss of bone mass begins in, the third to fourth decade of Life and continues unrelentingly in at[ subsequent decades. Physical activity, particularly weight bearing and strength -building activities, help sustain bone mass and reduces the incidence of trauma-induced fractures. Thus, physical activity helps prevent osteoporosis and its consequences and is recommended in the rehabilitation; physical activity is considered essential in the maintenance of bone health over the life span. (Smith et al., 1988)
Women who participated in organized sport and fitness programs as children have significantly higher bone densities as adults than women who were not active as children. (McCulloch et al., 1990)
There is evidence that exercise can effectively prevent and treat osteoporosis by contributing to the building of maximum bone mass before the age of 35 and maintaining bone mass during the rest of the life cycle. (Lenskyj, 1991)
Researchers suggest that exercise programs are beneficial for noninsulin-dependent dependent diabetes melltius (NIDDM) when combined with weight loss. Long term studies (Helmrick et at., 1991) point to the efficacy of exercise training programs in preventing NIDDM diabetes in individuals who are at risk of developing this disease. (Sharratt et at, 1994)
Studies show that the beneficial effects of training on the health of a child with diabetes mellitus was decreased need for insulin with increased diabetic control. (Bar-or 1994)
Researchers followed 87,253 women for 8 years and concluded that women who performed vigorous exercise at Least once per week were 33% Less Likely to develop diabetes (NIDDM) than their counterparts. (Manson et al., 1991). Physical activity performed regularly can reduce by 50% the relative risk of non-insulin dependent diabetes (NIDDM). (Monson et al., 1992)
The U.S. Surgeon Generals Report (1996) which was developed collaboratively with at Least 11 different National Health Institutes (Heart, Lung, Blood, Diabetes, Arthritis, etc.); involved extensive scientific research/review and concluded that regular physical activity lowers the risk of developing non-insulin dependent diabetes mellitus.
Leisure-time physical activity was inversely related to the development of noninsulin-dependent diabetes mellitus in a study of University of Pennsylvania alumni. (Helmrick et al., 1991)
The Joslin Clinic reported on a group of 48 diabetic patients stating that regular Lifetime activity was one of the characteristics of the patients with unusually Long survival and few diabetic complications. Another study showed that when examined cross-sectionally, low physical activity levels were associated with the presence of all complications. In summary, increased physical activity is protective against cardiovascular disease in individuals with Type I diabetes. (Giacca et al., 1994)
Cross-sectional and longitudinal studies have demonstrated that insulin sensitivity increases with physical training. (Kovisito et at, 1986 & Rodnick et al., 1987)
Researchers found in a study of male Harvard alumni ages 35 to 74 that the relative risk among persons reporting less than 2000 kilocalories per week of physical activity compared with men engaging in more than 2000 kilocalories per week was 3.99 in diabetic subjects (including both types I and II) and 1.48 in non-diabetic subjects. (Paffenbarger et al., 1978)
Studies indicate that a lifetime of regular physical activity was characteristic of diabetics with unusually Long survival and fewer diabetic complications. (LaPorte et at, 1986)
The American Diabetes Association encourages members to exercise to improve cardiovascular fitness and psychological well-being and for social and recreational reasons. (Giacca et al., 1994)
Participation in regular physical activity appears to offer protection against the development of diabetes; this protective benefit is highest for those persons most at risk, persons with high body mass index, a history of arterial hypertension or a family history of diabetes. (CFLRI, 1995)
In addition to playing an important role in prevention, physical activity is indicated in the treatment of Type II diabetes; regular physical activity has the potential to improve glucose tolerance and reduce the insulin response. Benefits can also include lower blood glucose, and glycosylated hemoglobin levels, lower insulin levels, increased insulin sensitivity, favourable changes in plasma lipid profiles, increased cardiovascular fitness and physical work capacity, increased antithrombotic activity, improved self-esteem and improved sense of well-being. (Bouchard et al., 1994)
Researchers have concluded that increased physical activity appears to offer the greatest potential benefit in the primary prevention of Type II diabetes, particularly for those who have one or more known risk factors for the disease. Also, exercise seems to have definite potential in improving glucose tolerance in patients with impaired glucose tolerance or very early NIDDM. Recent studies indicate that increased physical activity is effective in the primary prevention of NIDDM and that the protective benefit of exercise is especially pronounced in persons with a high body mass index, a history of arterial hypertension or a parental history of diabetes. (Gudat et al., 1994)
Physical fitness is inversely associated with cancer deaths in the Aerobics Centre Longitudinal Study. Researchers assessed fitness in 10,244 men and 3,120 women aged 20 to 60+ years and followed them for more than 8 years and determined age adjusted cancer mortality rates for three categories of increasing fitness levels:
The U.S. Surgeon General's Report (1996) which was developed collaboratively with at least 11 different National Health Institutes (Heart, Lung, Blood, Diabetes, Arthritis, etc.); involved extensive scientific research/review and concluded that regular physical activity is associated with a decreased risk of colon cancer.
Several studies over the past decade show higher colon cancer rates in sedentary individuals that in more active ones. (Whittmore et al., 1990; Gerhardsson et al., 1986)
Physical activity has a protective effect for colon cancer. There is an association between physical activity and a decreased risk of colon cancer; increasing amounts of physical activity appear to confer greater degrees of protection against colonic cancers. (Bouchard et al., 1994)
Physical activity has been shown to confer protection against colon cancer and data also suggests that it may be a beneficial effect in preventing other site-specific cancers including breast and lung cancer. Lee has estimated that the most sedentary individuals have 1.2 to 3.6 times more risk of developing colon cancer than the most active individuals. In fact, physical activity can reduce by 50% the risk of developing colon cancer. (Lee et al., 1994)
With respect to colon cancer, the results are clear; findings have repeatedly demonstrated that there is an inverse relationship between physical activity and incidence of colon cancer. (Sternfeld, 1992)
Physical activity decreases the risks of colon cancer (especially in men) and breast and reproductive cancer in women. (Blair et al., 1992)
"At least a dozen studies have found a Link between exercise and reduced risk of breast cancer." The latest conducted by Dr. Inger Thune and others from the University of Tromso followed 25,624 women in the 1970s and early 1980s. After an average of 14 years, 351 of these women developed breast cancer. There Researchers found that after they took into consideration a woman's weight, pregnancy histories and other factors, those who got regular exercise (at least four hours a week) developed significantly less breast cancer. (Thune, 1997)
The single major study of physical activity and breast cancer demonstrated a higher risk of subsequent breast cancer among female nonathletes than among female athletes. (Frisch et al., 1987)
Women who were college athletes reported a lower lifetime prevalence of breast cancers and cancers of the reproductive system, and lower prevalence of diseases affecting the breast and reproductive system than women who were not college athletes. (Frisch, 1987)
Based on a prospective study of over 20,000 Harvard alumni over a 25 year period, researchers report that highly active alumni had 0.39 to 0.62 times the lung cancer risk of their inactive colleagues. (Lee et al., 1994)
Researchers completed a study of female smokers and found that with just 15 minutes of daily exercise, cigarette cravings were reduced. (Grove et al., 1993)
A review of five studies showed that the relative risk of Lung cancer for men was higher for those who were most inactive. (Sternfeld, 1992)
Back problems are the Leading cause of activity limitation (Statistics Canada, 1994) - Back problems are related to sedentary living, infection, rheumatoid disease, structural problems for youth, high psychosocial pressure, smoking and obesity. (Nachemson, 1990 & Biering-Sorensen et al., 1994)
In 1990, 164,000 claims were made for back injuries, accounting for 28% of all WCB claims. The problem is getting worse; back claims grew 33% between 1982 and 1990 - overexertion is the main cause of injury with 63% of the claims listing sprains or strain. (Statistics Canada, 1992)
From a thorough review of the literature, it is clear that back exercises play an important role in rehabilitation and treatment of back pain. Exercise can be as effective as back surgery in cases of acute herniated discs. High dose exercise programs over long periods of time provide positive results in treating individuals with chronic low back pain, particularly those with sedentary jobs. Improvements should be expected within three months, although a three-week period has been effective for daily high-dose programs. (Biering-Sorensen et al., 1994)
Trunk flexion and pelvic exercises significantly reduce the recurrence of Lower back problems, with the improvements in flexion and abdominal strength correlated to fewer occurrences. (Donchin et al., 1990)
Significant reductions in the recurrence of Low back pain were achieved by a weekly program of one hour of exercise at work and at least some weekly leisure-time physical activity. (Kellett et al., 1991)
The U.S. Surgeon General's Report (1996) which was developed collaboratively with at Least 11 different National Health Institutes (Heart, Lung, Stood, Diabetes, Arthritis, etc.); involved extensive scientific research/review and concluded that most musculoskeletal injuries related to physical activity are believed to be preventable by gradually working up to a desired level of activity and by avoiding excessive amounts of activity.
Researchers have developed PAL’s (Paragraphs About Leisure) that relate the extent to which various leisure activities can contribute to psychological needs (44 need-gratifying dimensions, 27 of which vary the most across leisure activities, often summarized as 8 psychological benefits). A study by Tinsley & Johnson (1984) considered a sample of 34 leisure activities (active and passive, individual and group, etc.), and found that all contributed in some way to the 8 psychological benefits: self-expression, companionship, power, compensation, security, service, intellectual aestheticism, and solitude.
Physical fitness is positively associated with mental health and well-being. Depression is a common symptom of failure to cope with mental stress and exercise has been associated with a decreased level of mild to moderate depression. Current clinical opinion hold that exercise has beneficial emotional effects across all ages and in both sexes. (Morgan, 1994)
Regular physical activity, physical fitness and exercise have been found to be consistently related to reduced levels of stress and anxiety in a diverse range of settings and with a variety of populations and population sub groups. A number of studies have shown:
Researchers (Landers et al., 1994) reviewed about 188 empirical studies and made the following conclusions on the 'Effectiveness of Exercise and Physical Activity in Reducing Anxiety and Reactivity to Psychosocial Stressors:
The U.S. Surgeon General’s Report (1996) which was developed collaboratively with at least 11 different National Health Institutes (Heart, Lung, Blood, Diabetes, Arthritis, etc.), involved extensive scientific research/review and concluded that:
McAuley (1994) categorized 33 different measures to assess psychological well-being and concluded that the majority of studies (69%) state that physical activity is positively associated with psychological well-being. In fact, of all the measures of both positive and negative components of emotional well-being, positive affect appeared to be the most consistently linked to physical activity.
Highly stressed individuals and members of psychiatric populations have reported decreases in both state and trait anxiety after exercising. People who are physically fit are less vulnerable to the adverse effects of life stress than those who are less fit. (Brown, 1987)
Negative behaviours displayed by institutionalized adults with a mental handicap decreased by 24% and positive behaviour increased by. 66% after one hour of continuous physical activity. (Brown et al., 1993)
Coping strategies can be two basic types: problem-focused and emotion-focused. Problem-focused strategies involve managing and solving the problem that is causing the distress, while emotion-focused strategies involve processes associated with alleviating emotional distress. While it has generally been assumed in the research that exercise services an emotion-focused function in reducing stress, physical activity may in fact act to reduce stress in a number of ways, including relaxation, acting as a time out, providing a psychological distraction, changing mood, enhancing personal resources such as self-esteem and self-efficacy providing a time and an opportunity to work through problems (eg. when running) and generally regulating emotional and physiological reactions to a stressful event. (CFLRI, 1995 - based on Devries, Edwards, Bahrke, Blumenthal)
The benefits of regular exercise may reside most in its ability to reduce anxiety on a daily basis anxiety and hence, prevent the development of chronic anxiety. (Morgan et al., 1987)
The general conclusions of the benefits from the length of time of a person's involvement in physical activity is that anxiety reductions are far greater when the physical activity program is at least 10 weeks in duration and preferably longer than 15 weeks. (CFLRI, 1995)
Researchers have suggested that it may be not be necessary to insist that people exercise longer than 20 minutes to achieve anxiety-reducing effects. (Dishman, 1986)
For 15 weeks, researchers examined the relationship between moderate exercise training (5,45-minute sessions/week of brisk walking) and psychological well-being/mood state in 35 sedentary, mildly obese women (25-45 years). 18 subjects exercised; 17 subjects were controls. Measures included a general well-being schedule, the State-Trait Anxiety Inventory and Profile of Mood States. The results showed that moderate exercise training improved psychological well-being and mood state in the mildly obese subjects. (Cramer et al., 1991)
Researchers measured motivation, enjoyment and access to various categories in both work and play of 20 young adults (20-30 years) and their relationship with psychological well-being. Various measures were used, including the General Health Questionnaire. Results found enjoyment obtained from leisure experiences to be related to overall psychological well-being. (Haworth et al., 1992)
The objective of the study was to determine the extent to which participation in a weight training program was associated with changes in body cathexis and emotional well-being, as well as the extent to which psychological factors affected these changes. An experimental group of 60 female university students participated in a 15 week weight training intervention plus they also participated in a physical exercise program 3 days/week along with a control group of 92 women. The results showed that women in the weight training group showed greater improvement in emotional well-being and body image than the exercise only group. Weight training was associated with psychological improvements. (Tucker et al., 1992)
Some research has demonstrated exercise to be more effective than a tranquilizer drug (DeVries, 1981), and a number of studies of trait anxiety have found a meaningful difference between the effectiveness of exercise and other forms of treatment on anxiety levels. (Landers et al., 1994)
The International Society of Sport Psychology (1991) has suggested, based on an accumulation of research findings, that the potential psychological benefits of being involved in regular physical activity are: reduced state anxiety; decreased Levels of mild to moderate depression; reduction in neuroticism and anxiety; an adjunct to the professional treatment of severe depression; the reduction of various stress indices; beneficial emotional effect across all ages and for both sexes, and an increase in vigor and clear mindedness.
The beneficial emotional effects of exercise appear to hold for persons of all ages of both sexes with mild to moderate depression. (CFLRI, 1995)
Physical activity is related to decreased risk of mild to moderate depression. (Bouchard et al., 1994)
A review of the psychological benefits of exercise found that exercise is an effective antidepressant; all modes of exercise are effective in decreasing depression - the longer the program the better the effects. Overall, there is an association between exercise and decreased tension, decreased anxiety, ability to cope with stress; exercise plus supportive counseling was most effective at helping students with low self-concept improve their views of themselves. (Anthony, 1991)
Researchers examined the effects of aerobic and non aerobic exercise on depression and self-concept in pre/post tests with 89 college students (18 to 42 years); engaged in swimming (aerobic), weight lifting (non aerobic), and general education (no exercise control). Individuals in swimming and weight training programs were shown to have lower depression scores than those in general education; weight training students displayed a higher concept of self than swimming group. (Stein et al., 1992)
Thirty community-dwelling, moderately depressed elderly were randomly assigned to 1 of 3 interventions: walking; social contact control situation; and a control group. Both walking and social contact were equally effective in reducing both total depression and psychological symptoms compared with no treatment. Only the walking/exercise situation resulted in a significant decrease in somatic conditions thus, showing exercise reduces a broader range of depressive symptoms. (McNeil et al., 1991)
Researchers studied 87 college students in 2 swimming classes, a yoga class and a Lecture-control class. All subjects completed the Profile of Mood States and the State-Trait Anxiety Inventory. An ANOVA indicated that both yoga participants and swimmers reported greater decreases in scores on anger, confusion, tension, and depression than did the control students. Among the men, the acute decreases in tension, fatigue, and anger after yoga were significantly greater than those after swimming; women reported fairly similar moods after both swimming and yoga. (Berger et al., 1992)
Researchers examined the relationship between regular meditation and/or physical exercise and 3 dimensions of self-actualization in 103 advanced graduate counseling students (aged 23-62), and found that a combination of exercise and meditation helped reduce their anxiety. (Brown et al, 1993)
Physical activity can have significant effect on mental health. Physically active adults have enhanced self-concepts and self-esteem, as indicated by increased confidence, assertiveness, emotional stability, independence, and self control. (Seefeldt et al., 1986)
Researchers examined the effect of a single exercise session on mood state. 72 college-age students completed the Profile of Mood States prior to land immediately after a 75 minute activity class (running, karate, or weight lifting). They found that a single exercise session can reduce reported total mood disturbance, tension, depression, anger, confusion. (McGowan et al. 1991)
Exercise is associated with improvement in mental health including mood state and self-esteem. Evidence indicates that benefits associated with exercise are comparable to gains found with standard forms of psychotherapy. For healthy individuals, the principal psychological benefit of exercise may be prevention, whereas for those suffering from mild to moderate emotional illness, exercise may function as a means of treatment. (Raglin, 1990)
Regular physical activity is of benefit to both physical and psychological health. Adults that exercise regularly have a better body image. Exercise can be used effectively as a form of psychotherapy. (Kirkcaldy et al., 1990)
Regular bouts of moderate physical activity reduce the symptoms of mild or moderate depression and anxiety neuroses by improving self-image, social skills, mental health, perhaps cognitive functions and total well-being. (Taylor et al., 1985)
Level of physical activity was shown to be positively related to general well-being, lower levels of anxiety and depression, and positive moods. The relationship is particularly strong for women and persons 40 years of age and over. (Stephens, 1988)
Substantial research evidence supports the association of psychological well-being with regular involvement in physical activity. (Berger & Hatfield, 1991; Morgan & Goldston, 1987; Sachs & Buffone, 1984; Sacks & Sachs, 1981)
Noncompetitive, aerobic, individual, rhythmic physical activity has repeatedly been associated with decreases in tension and state anxiety in normal population. These populations, which are not unusually anxious to begin with, typically report feeling better after exercising. (Wankel & Berger, 1991)
Raglin & Morgan (1987) compared the influence of exercise and quiet rest on anxiety and blood pressure of normotensive men. Subjects were assessed before and after 40 minutes of either rest or involvement in a variety of physical activities. Results indicated that state anxiety was reduced immediately after the exercise, but not after the quiet rest.
Thayer (1987) has reported tension reduction benefits that lasted for several hours after exercises in a nonclinical population. He found that. a 10 minute walk resulted in tension levels which were significant[y below pre-test levels at 30, 60, and 120 minutes post-exercise. Significant decreases in tiredness and increases in energy were reported 30 and 60 minutes after walking.
Higher stressed individuals and members of psychiatric populations have reported decreases in both state and trait anxiety after exercising. (Brown, 1987; Long, 1983 & 1985)
Long (1983) reported impressive results of exercise and stress-inoculation training for sedentary adults after participation in a jogging program for 10 weeks. The exercisers were recruited based on their interest in stress reduction and continued to report stress related benefits 3 months after completing the program.
Exercise is frequently prescribed for the treatment of anxiety. Sixty percent of 1,750 physicians polled reported that they prescribed exercise for the management of anxiety. (Ryan, 1983) The types of exercise prescribed, in order of preference, were: walking, swimming, cycling, strength training, and running.
Another study compared the psychological benefits of jogging, and the relaxation response, with participation in a discussion group, and participation in a lecture situation. 387 participants were involved over a four month period. The joggers and those in a relaxation situation reported significantly greater benefits than those in either the discussion group or lecture. (Berger et. al., 1988)
Play has a significant role in maintaining our emotional well-being. It is curative as well as preventative. Expressive dance, recreation therapy, arts and crafts, play acting, and any number of games promoting social intercourse are all used very successfully in heLping to achieve an equilibrium in those suffering emotional difficulties. (Bonacci in Colorado Parks and Recreation, 1993)
A study of benefits sought by outdoor recreationists ranked the benefit of ‘reduce tensions’ on a list of 16 recreation experience preference domains. For users of 8 designated wilderness areas, reduction of tension was ranked 2nd, 3rd, or 4th on the list of 16; for users of 4 undesignated wilderness areas, reduction of tension was ranked 1st or 2nd on the list; for users of 3 non-wilderness areas, reduction of tension was ranked 3rd, 4th, or 5th. (Driver et al., 1987)
Simply viewing a natural setting can be relaxing and stress reducing. Ulrich (1981) recorded brain wave activity when subjects viewed urban scenes as opposed to natural scenes. Alpha wave activity was higher for the natural scenes - suggesting that individuals were more wakefully relaxed when viewing nature.
Brief exposures to natural settings in the urban environment can have significant therapeutic value - Ulrich (1979, 1981) reports that such exposures to nature may be positively distracting, produce positive feelings, and block or reduce stressful thoughts.
Environmental psychology research has identified and measured the benefits people obtain from interacting with nature. One benefit of natural surroundings is their beauty or aesthetic quality, plus many individuals report that the experience of serenity or peacefulness is an important benefit. Consistent with this are physiological measurements of heart rate, blood pressure and brain waves that have shown relaxation and stress reduction occur when people are viewing natural landscapes. Hull (1992) has shown that even short visits to city parks contribute to improved moods. Kaplan (1993) believes that natural environments provide restorative experiences in which people are relieved of the need to maintain focused mental attention.
Another benefit of natural environments is the opportunity for people to experience settings that are dramatically different from the artificial environment which they usually live and work. People report that natural areas give them a sense of refuge and an escape from the pressures of urban environments and daily routines. (Above references in Schroeder, 1996)
Another study by Ulrich exposed 120 subjects to a stressful movie and then to 10 minute videos of natural and urban settings. Heart rate decelerated when the natural videos were shown, whereas acceleration occurred during the urban exposures. (Ulrich & Simons, 1986)
Research conducted in prisons suggested that cell window views of nature are associated with Lower frequencies of stress symptoms such as digestive illness and headaches, and with fewer sick calls by prisoners. (Moore, 1982; West, 1986)
Kaplan & Kaplan (1989) report on the therapeutic value of natural content and spaces that are integrated with Living and work spaces - not necessarily truly natural environments.
Bev Driver and his associates have been applying their REP scales (Recreation Experience Preference) to many outdoor activities over the past two decades. They consistently find that participants rank scales associated with stress reduction in the top 5 or 6 of 43 experiential scales. (Ulrich, Dimberg, & Driver, 1991)
Tinsley and his associates have identified 27, Leisure activity-specific needs in their 'Paragraphs about Leisure' methodology. Several of the 28 scales (e.g. compensation, catharsis, and independence) explicitly or implicitly tap Leisure motivations related to coping with stress. Results of the many studies that have used this set of scales, for different activities in different locations, show that Leisure activities are important for helping people cope with stress. (Tinsley et al., 1985)
Kaplan (1984) evaluated a wilderness program in Michigan's Upper Peninsula using questionnaires, reactions to photos, reactions to solo experiences, and ratings of moods and feelings before and after the program. She found that the program resulted in many psychological benefits to the participants.
A report from the Surgeon General stated; "We have today strong evidence to indicate that regular physical activity will provide clear and substantial health gains. ...Because physical activity is so directly related to preventing disease and premature death and to maintaining a high quality of life, we must accord it the same level of attention that we give other important public health practices that affect the entire nation. Physical activity thus joins the front ranks of essential health objectives, such as sound nutrition, the use of seat belts and the prevention of adverse health effects of tobacco... (in fact, the report states "Being inactive is as risky to one's health as smoking). Health benefits appear to be proportional to amount of activity; thus every increase in activity adds some benefit." The 3 major messages are:
The American Heart Association issued a Statement on Exercise intended for health professionals – "Persons of all ages should be part of a comprehensive exercise program for disease prevention and health promotion". (McHenry et al., 1990)
There appears to be a linear dose-response relationship between physical activity and health and functional effects; if sedentary/unfit adults walk 30 minutes per day (or the equivalent e.g., sports, household/occupational tasks); they would receive clinically significant health benefits. The key factor is total energy expenditure. (Blair et al., 1992 in ALCFW)
In a study of 219 employed males and females, it was found that leisure participation and leisure satisfaction were positively associated with perceived wellness. Specifically, family satisfaction accounted for 26% of the variance in perceived wellness, leisure satisfaction for 10% and health satisfaction for 7%. The positive association found between engaging in leisure activities and perceived wellness in this study is consistent with findings from other studies. (Ragheb et al., 1993)
In a study of 492 workers from 2 pharmaceutical firms, researchers found that perceived well-being was higher for individuals involved in regular physical activity than for those who were not involved in regular physical activity. (Rosenfeld et al., 1992)
| Statistics Canada. produced a summary of 'Recent measures taken to improve health'; the results indicate the need to increase our efforts around providing/promoting our services to reverse the negative trends and improve fitness/health. Recent measures for both sexes 15 years + are: | ||
| Category | 1985 | 1990 |
| Total in Canada | 19,611,090 | 20,643,380 |
| Do nothing | 37.12% | 49.81% |
| Increase Exercise | 29.08% | 17.81% |
| Lose weight | 3.99% | 3.45% |
| Learn to Manage Stress | 1.28% | 1.50% |
| (http://www.statcan.ca/pgdb/people/health, March, 1997) | ||
Research on psychological well-being and physical activity conducted on depressed patients, persons with coronary heart disease, and with the population in general report:
Individual Canadians concur: having one chronic condition significantly decreases the reported level of satisfaction with their health. Among Ontarians, 67% have some reduced function, 9% have some activity limitation (the average number of disability days in a two-week period is 0.55), 85% saw a doctor in the previous 12 months, 6% saw a physiotherapist, 3% saw a psychologist, only 13% have high well-being as indicated by high positive Bradburn Affect Balance scores, 47% face higher risks due to their relative weight to height, 5% consumed a minimum of 14 alcoholic drinks in the previous week, 29% smoke cigarettes and 23% are sedentary. (Statistics Canada, 1994)
65% of Ontarians report at least one chronic condition. Reported conditions include allergies (25%), arthritis or rheumatism (11%), hypertension (85%), back pain (7%), asthma (4%), and heart disease (3%). (Ontario Health Survey, 1994)
Minor (1991) examined the results of arthritis exercise research and found that regular physical activity has been shown to be effective in the management of selected forms of arthritis.
Researchers report that empirical evidence for arthritis states that; in the absence of acute inflammation, the avoidance of aerobic activity is probably the worst choice that could be made. In addition to the physi cal gains in aerobic capacity, flexibility, functional status and muscle strength are quality of Life components such as pain tolerance, mood, and social activity. (Hewett et al., 1989) One intervention that has proven successful in terms of reversing muscle weakness and atrophy is the use of exercise therapy in a heated swimming pool (Danneskiold-Samsoe et al.,1989) and another attractive exercise alternative is bicycling. This brings physical, psychological benefits plus a renewed sense of independence as a result of overcoming a limitation (Namey, 1990). (Above references in Sharratt et al., 1994)
Two in five Ontarians face possible health risks and premature death by being overweight; more men are at risk than women. This is similar to the higher rates of cardiovascular disease and shorter life expectancy among men. Over 10% of youth are obese, and as many as 85% of these youth are expected to remain obese as adults. (CFLRI, 1995)
Mayer & colleagues (1954) proved 40 years ago that although inactivity leads to obesity; obesity can be delayed and possibly even prevented through exercise.
Physical activity is a good predictor of long-term maintenance of weight reduction. Researchers concluded that regular, moderately intense exercise of prolonged duration continued over a period of years is effective in normalizing weight among overweight individuals. Also, regular low intensity exercise of prolonged duration continued over years is effective in the treatment of obesity and severe obesity. (Bouchard et al., 1994)
Sustained physical activity leads to a decrease in fat body mass and an increase in lean body mass, with resultant increased basal metabolism and tower risk of obesity. Together with recommendations concerning prudent dietary measures, a physical activity regimen is recommended for immediate and long term control of obesity. (Bray, 1989)
A study was conducted on "Dance Movement Training on the Wellness of Young Women". Researchers took 10 healthy females (19 to 31 years) and guided them through a program consisting of 30 minutes -3 days/week for 8 weeks. Control group was 10 healthy women (19 to 21 years). Following the training, body weight decreased significantly and resting systolic and resting heart rate decreased. Total mean score of stress response, depression, anxiety/fear, anger and cognitive disorganization decreased remarkably; thematic responses about the dance movement were positive following the training. (Heber, 1995)
High volumes of exercise sustained for a period of years help to produce the negative energy balance required for weight loss. In addition, physical activity leads to other important benefits for overweight individuals. These benefits include improved insulin sensitivity, reducing the risk of non-insulin-dependent diabetes; improved lipid and tipoprotein profile, improved blood pressure, reducing the risk of coronary heart disease and stroke; and reduced risk of premature death. (Bouchard et al., 1994)
Physical activity has been linked to slowing of the onset of HIV-related symptoms, including decrement of natural killer cells. (LaPerriere et al., 1990)
In a study of 314 subjects on self-assessed well-being, a well developed social network and physical exercise were the most positive determinants of well-being, white drug intake, angina pectoris, and smoking were the most negative. (Thorell, 1990)
Inactive Ontarians are more likely to smoke cigarettes; less likely to adhere to Canada's Food Guide and to report limiting fat in their diet; more likely to be overweight and have excess fat that elevates their risk of premature death. Individuals who are inactive, intend to exercise less than once a week. (CFLRI, 1995)
In a study of mate police officers, subjects undergoing aerobic training had larger changes on the self report measures of well-being and stress than those police officers who trained anaerobically. Both anaerobic and aerobic trained officers showed significant improvements when compared to controls. Evidence showed that exercise, particularly aerobic exercise, has positive effects on well-being. (Norris et at., 1990)
Chronic Obstructive Pulmonary Disease patients are aware of every breath and so avoid physical activity; this is not a wise choice. The careful integration of systematic physical activity into their lifestyle could have a positive impact on both physical and mental well-being. (Sharratt et at., 1994)
Exercise may have both acute and chronic beneficial effects on resting blood pressure in people with mild to moderate hypertension. In cross-sectional studies of the general population, more physically active and physically fit adults generally have lower blood pressure and less hypertension than inactive and low fit persons with the relationship generally existing across all levels of activity and fitness. (Reaven et al., 1991)
Chronic diseases effect several million children in the United States. Many have their physical activities restricted. Sport, can alleviate symptoms of diseases as well as improve the psychosocial development and quality of life for many children. Physicians should be prescribing exercise programs for children with cystic fibrosis, congenital heart disease, juvenile rheumatoid arthritis and asthma to allow them to reach their potential. (Goldberg, 1990)
More than 33% of the Canadian population judge regular physical activity as very important to their health, and 39% believe that regular physical exercise helps them meet important personal goats. (Stephens et al., 1990)
Canadian mates aged 15 to 19 rated regular activity (49%), a smoke-free environment (47%), and adequate sleep (44%) as the three most important contributors to their health. (Stephens et al., 1990)
Physical activity can prevent many health disorders for women. Obesity is related to under-activity and overeating, both of which predispose women to heart disease risk, hypertension, adult-onset diabetes, gall bladder disease and possibly cancer. In addition, research indicates that osteoporosis is associated with a sedentary lifestyle. It is important for all women to be provided with opportunities to be physically active. (Wells, 1990)
An exercise program for menopausal women that includes both aerobic training and resistance training may prevent or relieve problems such as cardiovascular disease, obesity, muscle weakness, osteoporosis, and depression. Increases in bone mineral content have been found at lumbar vertebral and distal radial sites in women who participate in exercise programs. (Shangold, 1990)
A sport competition motivates adults to remain physically active. A goal can be a powerful motivator. Establishing goats and achieving realistic objectives can lead to feelings of competence and personal responsibility. (Olsen, 1992; Grove, 1984)
Wilderness travel provides psychological and physical benefits by experiencing wild areas with a free of the soiling influences of modern peoples. The search is for personal redemption through challenge and sacrifice and nature is the backdrop to an intensely personal experience. (Eagles, 1995)
Researchers assigned 46 undergraduates to 1 of 4 conditions; exercise with music; exercise without music; no exercise with music and no exercise, no music (control). Subjects completed the Torrance Tests of Creative Thinking before and after treatment. Music, exercise, and exercise with music were found to positively influence fluency and creativity. (Curnow et al., 1992)
In two experiments, researchers examined the effect of moderate exercise on self-rated mood and other behaviors. Brisk 5 minute walks were taken by 16 smokers (18-44 years) before a desired cigarette and by 18 frequent snackers (18 to 52 years) before a sugar snack on multiple occasions of a 3 week period. Walks produced increased energy feelings and reduced urge to smoke or snack. Also, the walks doubled the time before smoking the next cigarette or eating the next snack in free smoking and snacking conditions. Data suggests a self-regulation of mood model in which moderate exercise may sometimes be substituted for smoking or snacking on the basis of common mood effects is effective. (Thayer et al., 1993)
Significant health benefits can be obtained by including a moderate amount of physical activity (e.g. 30 minutes of brisk walking or raking leaves, 15 minutes of running or 45 minutes of playing volleyball) on most, if not all, days of the week. Through a modest increase in daily activity, most Americans can improve their health and quality of life. People who maintain a regular regimen of activity that is of longer duration or of more vigorous intensity are likely to derive greater benefit. (Surgeon General Report, 1996)
Physical activity has numerous beneficial physiologic effects. Most widely appreciated are its effects on the cardiovascular and musculoskeletal systems, but benefits on the functioning of metabolic, endocrine and immune systems are also considerable. Many of the beneficial effects of exercise training - from both endurance and resistance activities -diminish within 2 weeks if physical activity is substantially reduced and effects disappear within 2 to 8 months if physical activity is not resumed. (Surgeon General Report, 1996)
People who are more physically active throughout life generally benefit from a higher level of health and functional capacity than their sedentary counterparts. Exercise will activate many of the body's systems and produce health related benefits. (Haskell, 1994)
In middle-age and older men and women, data demonstrates that moderate intensity (40% to 60% of aerobic capacity) exercise provides significant health related benefits at low risk. Exercise should be considered as a group of 'essential nutrients' required for optimal health -a diverse program of exercise will reap all the various health benefits. (Haskell, 1994)
Given the benefits of physical activity for reducing mild depression and increasing self-esteem and self-concept and in tight of the rote that these factors play in substance abuse, crime and suicide, physical activity could be a culturally relevant contributor to improving the health risk profile of aboriginal peoples. (CFLRI, 1995)
Researchers (Bar-Or, 1990) reported on the beneficial effects of training on the health of the Child with a Chronic Disease as follows:
A pre and post test was conducted (Huang et at., 1989) with a two month swim program with asthma patients; swim training resulted in:
A controlled study of exercise and asthma found that an exercise program involving physically active recreation (swimming and running) resulted in increased work tolerance and decreased heart rate for asthmatic children. (Rothe et al., 1990)
Several studies have examined the effects of training on fibromyalgia patients. Goldman (1991) had previously inactive fibromyalgia patients perform 15 minutes of structured activity 3 times per week. He found that approximately 80% of patients showed clinical improvements. McCain et at. (1988) had fibromyalgia patients undergo aerobic exercise 3 times per week for 20 weeks. Their exercise consisted of pedaling a cycle ergometer at intensities that produced heart rates in excess of 150 beats/minute study, 50% of the fibromyalgia patients s and improved fitness. (McCully, 1996)
Researchers evaluated the effect of yoga training owed clinical improvement in 46 young asthmatics (11 to 18 years) with a history of childhood asthma. Yoga training resulted in a significant increase in pulmonary function and exercise capacity in these young asthmatics. (Jain et al., 1991)
Szentagothai, et al., (1987), reported that long term physical exercise (1 to 2 years of regular swimming and gymnastic activities involving 121 children *between 5 and 14 years of age) were effective in reducing asthmatic symptoms, frequency of hospitalization and use of medication.
Cerny (1989) found that an exercise program was equally effective as a standard protocol of bronchial hygiene therapy in terms of the pulmonary function and exercise response of patients with cystic fibrosis.
Numerous studies have demonstrated a significant increase in both pain-free and maximum work capacity with exercise training patients with peripheral vascular disease. Some patients completely lost the symptoms of claudication. Early treatment of exercise training seems to be important for maximum results. (Barnard, 1994)
The benefits of exercise for patients with ESRD (end-stage renal disease) are very encouraging; the documented improvements in cardiovascular function, lipid and glucose metabolism, hematological and psychological status of dialysis patients with exercise training could have far reaching implications. It would be of major socioeconomic benefits if dialysis patients could maintain employment, reduce medications, and have lower medical costs due to fewer disease-related complications. (Goldberg et al., 1994)
Sport participation among individuals who are physically challenged promotes health, physical appearance, and coordination. (Brasile et al., 1991)
Santiago, Coyle & Troup (1991) found adults with physical disabilities who were involved in community and individual aerobic exercise programs had significant improvements in cardiovascular and metabolic functional capacity (as measured by peak V02) when compared to a non-exercising control group.
Wheelchair athletes adopt many of the psychological characteristics of able bodied athletes. Studies indicate that wheelchair athletes have higher self-esteem and more educational, occupational, and athletic aspirations, when compared to those who are physically disabled and non-athletic. (Hopper et al., 1985)
An exercise program was shown to facilitate job-related task performance in adults with mental disabilities. (Croce et al., 1992)
A study found that exercise can foster social interaction along with improvements in aerobic fitness and psychological state. They recommend physical exercise should be a priority item in the daily routine of a schizophrenic patient in the psychiatric rehabilitation setting. (Pelham et al., 1991)
Ulrich compared the recovery rates of patients whose hospital windows overlooked trees as opposed to others that overlooked adjacent brick watts. Therapeutic influences of the natural window views were evident in behavioural indicators, shorter length of hospital stay, Lower intake of strong pain drugs, and more favorable evaluations by nurses. (Ulrich, 1984)
Levitt (1991) reviewed over 100 research studies on mentally and emotionally disturbed individuals to identify the therapeutic benefits of participation in different typos of recreation programs and found that participation could be linked with the following outcomes:
Studies of participants in mixed recreation activities programs (e.g. arts, crafts, sports, games, music, exercise, ballet, walking) showed the following benefits:
The therapeutic benefits of physical exercise programs (mostly jogging or running) for mentally and emotionally disturbed patients include:
The benefits of therapeutic camping for mentally and emotionally disturbed individuals include the following:
For full research support for each of the above, see Levitt (1991)
An extensive amount of literature and research was reviewed on the benefits derived from involvement in therapeutic recreation during a conference that included over 80 of Canada's finest researchers, educators and practitioners. Research was shared and proceedings reported in Chapter 9 on; "A summary of Benefits Common to Therapeutic Recreation" by (Coyle et at., 1991), re: the benefits derived from involvement in therapeutic recreation are:
The proceedings include documentation showing the measured benefit and impact on the individual and their families. Examples of the scientific research proving the above statements are:
Involvement in a comprehensive recreation program significantly improved cognitive abilities as measured on the Clifton Cognitive Ability Assessment for 70% of the nursing home residents in the program. (Conroy et al., 1988)
A quasi-experimental design using matched controls showed significantly improved functioning on the Mini-Mental State exam for elderly individuals who received dance and movement activities 1 hour per week for 8 months. (Osgood et at., 1990)
A music based sensory stimulation program conducted 30 minutes per week, twice a week for 16 weeks, significantly improved reality orientation of disoriented nursing home residents who were randomly assigned to treatment or control groups. (Banziger et al., 1983)
Katz et al. (1985) found that exercise reduced depression among individuals with a physical disability; Greenwood et al. (1990) found that tennis resulted in significant reductions in depression; and a Weiss, et al. (1988) study with the same population, found that water exercise effectively reduced depression among individuals with a physical disability.
In a quasi-experimental study with adults with physical disabilities, Santiago et al. (1991) found a lessening of depressive symptoms in the exercise experimental group of 59.3% in comparison to an increase of 2.0% in the control group.
A 9-week aerobic exercise intervention contributed to a significant reduction in depressive symptomatology such as inner tension, sleep disturbance, concentration difficulties, and depressive thinking for adults hospitalized for depression. (Martinsen et al., 1984)
Ipsa et al. (1988) reported on an experimental study in which a supervised play program offered to children 5 to 10 years receiving medical treatment in an outpatient clinic resulted in less anxiety among the children and less irritability among the parents who were waiting with their children.
A thorough review of the literature indicates substantial agreement among researchers that exercise provides a tranquilizer effect and that exercise of the appropriate type, intensity, and duration appears to be equal to or more effective than medication for anxiety. (DeVries, 1987)
Hiking, camping, and adapted sports have produced significant increases in self-efficacy and self-confidence among individuals with a physical disability. (Austin, 1987, Curtis et al., 1986, Robb et al., 1987, Strucker et al., 1986)
Participating in sports and nature/wilderness activities has significantly increased acceptance of disability. (Jackson et al., 1983; McAvoy et al., 1989; Sherril et al., 1988)
Research conducted with women who were in treatment for substance abuse showed that a comprehensive leisure education program of social and recreational activities resulted in better stress management among the individuals with addictions. (Roncourt, 1991; Chien, 1986)
Therapeutic recreation interventions led to increased spontaneous initiation of activity, engagement with the environment and self-assertiveness for individuals with mental retardation. (Dattilo et al., 1985)
An experimental design with 28 randomly assigned nursing home residents in a horticulture intervention resulted in significant improvement in perceived competence. (Shory et al., 1989)
Persons in a rehabilitation hospital who received individual therapeutic recreation services reported significantly higher Levels of self-esteem at discharge when compared with individuals who did not receive any intervention. These researchers also surveyed individuals with a variety of disabilities who were involved in special recreation programs across the United States. Benefits reported from recreation participation were positive feelings about their self, and maintaining and improving social and recreational activities. (Shank et at., 1991)
Comparing hospitalized children who received structured play programs with those who did not, Gillis (1989) found that structured play resulted in significantly more positive self-esteem.
Drama, camping, and athletic activities have been documented to improve socialization in a variety of studies conducted with individuals with a physical disability. (Stensrud et al., 1987; Bodziock, 1986; Stuckey et al., 1986)
Experimental studies documented increased sociability (utilizing ratings by nursing staff) among nursing home residents using two separate therapeutic recreation interventions. (Banzier et al.; Beck, 1982)
Rancourt (1991) has documented how individuals with substance abuse who were involved in a comprehensive leisure education program showed increased knowledge and skills in self-awareness, decision-making, social skills, and social interactions.
A study investigating the contribution of activity therapies to comprehensive treatment programs involving chemical dependency, found that recreation therapy activities assisted in developing interpersonal trust and improving specific communication skills. (James et al., 1989)
Efficacy studies on adventure programs have determined this type of intervention to be effective in increasing communication skills (Roland et al., 1987), social cooperativeness and trust among adolescents and adults receiving inpatient treatment for psychiatric disorders. (Witman, 1987)
Using case study methodology, it was demonstrated that systematic recreational therapy intervention reduced hallucinatory speech (Wong, 1983; Wong et al., 1987). Similarly, Liberman et al., (1986) determined that inappropriate laughter and bizarre behaviors were significantly reduced when psychiatric patients were engaged in structured recreational activities.
Self-stimulatory behavior could be reduced in autistic children with instruction in appropriate play. (Eason et al., 1982)
Daily structured play interventions, beginning during hospitalization and continuing for 2 years after discharge were found to significantly advance the developmental levels of severely malnourished children over the control group in the areas of locomotor, hearing, speech, eye and hand coordination. (Grantham-McGregor, 1983)
Creative dance and movement activities resulted in significantly improved life satisfaction scores for the elderly individuals in the experimental group compared to the control group. (Osgood et al., 1990)
Significant health differences existed between individuals with a spinal cord injury who had a commitment to leisure involvement and those who did not. Individuals with a leisure commitment reported higher mean score for sitting tolerance; had spent fewer days in the hospital in the previous year; and were two and one-half times less likely to have a pressure sore than individuals without a commitment to leisure involvement. (Trader et al., 1991)
Clients with dementia involved in therapeutic recreation programs showed reduction in need for medication. (Schwab, 1995)
Researchers found that positive changes in leisure functioning were related to favorable outcomes on drug use and criminality. (Simpson., et al., 1981) (Above references found in Coyle et al., 1991)
Dr. Lourdes Heber (1993), conducted research with people ages 18 to 60 on the effectiveness of therapeutic dance movement therapy (DMT) in treating clients suffering from a range of mental health illnesses such as post-traumatic stress disorders (PTSD), anorexia nervosa for young adults, and anxiety and depression for older adults and children. Results showed that dance/movement therapy uses movement as a therapeutic process to improve the emotional, psychological, and physical well-being of psychiatric clients. Creative movement and dance expressions will assist psychiatric and nonpsychiatric clients to create a positive approach to lifestyle changes and maintain a good body posture and healthy practice. Also, DMT was an outlet for anger, conflict, and guilt among clients with PTSD such as sexual abuse. Conclusions stated that; DMT is beneficial and can facilitate the rehabilitation of psychiatric clients who display anxiety, tension, depression, and low self-esteem. Thematic responses and case study analyses demonstrated significant positive changes occurred in the client's attitudes towards self, affect, ability to communicate with peers, and the release of tension and apprehensiveness.
A clinical project involving over 350 patients during a five year period looked at 'the effectiveness of ethnic dance on psychiatric patients'. The evaluations indicated that Dance/Movement Therapy can intervene in the rehabilitation of psychiatric clients who display anxiety, tension and low self-esteem and dance is effective in the holistic care of patients along with other interventions. (Heber, 1993)
Ulrich's (1984) well known hospital study that showed improved recovery benefits to gallbladder surgery patients whose hospital room had a window view of nature over a control group of patients who had a view of a brown brick wall, has led to changes in hospital designs that optimize views of nature. Many hospitals, medical institutions now offer patients opportunities to view and, care for plants and gardens as part of recovery. (Montes, 1996)
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Canadian Parks/Recreaetion Association
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ISBN 0-919963-62-5
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