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Passport for health
Victor Keihan Rodrigues Matsudo
A physical activity programme in Sao Paulo, Brazil, seeks to upgrade everyone s activity by one level - so that the sedentary will be at least occasionally active, the occasionally active will be regularly so, the regularly active will be very active and the very active will maintain that level.
he idea of a relationship between physical activity and health is an ancient one, recorded in Chinese
World Health • SOth Yeor, No. 3, Moy-June 1997
culture, in the Ayurvedic medicine of India and in classical Greek and Roman writings. But only during the last 40 years or so have well-
designed epidemiological, experi- mental and clinical studies brought strong support to the hypothesis that low levels of physical activity and fitness are important factors in the development of such major degener- ative diseases as non-insulin-depen- dent diabetes mellitus, hypertension, coronary heart disease, stroke and osteoporosis. Higher death rates from all causes are seen in sedentary groups. Conversely, physical activ- ity appears to reduce the risk of developing chronic disease and, if so, could be a key factor in enhancing longevity.
Daily exercise: 30 minutes that make a difference.
Some recent findings have shown that these benefits can be felt among initially unfit or sedentary people who become more active and im- prove their fitness. The data indicate a positive influence of some exercise regimes. They can control body weight and favourably affect body fat distribution; they can help the elderly maintain their independence and reduce the risk of falling down; and they can improve mood, relieve depression and anxiety symptoms, and generally improve the quality of
Photo WHO/Poster· Centre for the Physical Fitness Research Laboratory, Saa Paula, Brazil.
life. Companies which adopted work-site programmes on wellness or active living reported a decrease in absenteeism, a decline in medical costs, an increase in work produc- tion, and better cost-benefit ratios.
For almost 25 years Dr Ralph Paffenbarger studied former students from Harvard University and analysed the relationship between such lifestyle factors as physical activity and causes of death. A total of 10 269 healthy men aged 45-84 years were surveyed from 1977 to 1985, among whom 574 died. He found that the most active men had half the death rate of the least active.
Smokers had a 75% higher risk of death than non-smokers and those with high blood pressure had a 34%
higher risk than those with normal blood pressure. The more active subjects seemed to live upwards of two years longer than those less
active, and this held true even for those who only began a more active lifestyle in their forties.
Missed opportunity
Physical inactivity is most common in developed countries, where the level of education is generally higher.
Although we have access to all the scientific data proving the benefits of exercise, our societies are not taking advantage of this knowledge.
However, some better news was reported recently. Researchers realized that the link between human mobility and health does not demand hours and hours of strenuous activity.
Only 30 minutes of exercise a day, on most days of the week, taken contin- uously or in cumulative sessions of 10 to 15 minutes, at moderate inten- sity, may be all that is needed for a
World Health • SOth Year, No. 3, May-June 1997
Daily gym in Thailand Short sessions of moderate exercise performed regularly may be your
"passport for health". Photo WHO/H Anenden
"passport for health". Accordingly, sports scientists and health authori- ties recommend that everyone should include regular physical activities in their daily life at home, at work or in the community. Such
"training sessions"might include climbing stairs, walking the dog, gardening, washing the car, or walk- ing to work. More energetic activi- ties, such as brisk walking, dancing, cycling, jogging or swimming, are also recommended.
These new recommendations are endorsed by WHO, the International Council for Sports Sciences and Physical Education, the Centers for Disease Control and Prevention, the American College of Sports Medicine, the International Federation of Sports Medicine and the American Heart College Association, among others. They have also received the support of important conferences, and have been adopted by national
programmes in different countries.
The improvement of physical activ- ity is the main focus of such national campaigns as Active Living in Canada, Health People 2000 in the United States, Active for Life in the United Kingdom and many others, and these will benefit larger seg- ments of the population in the com- ing years.
Agita Sao Paulo
Taking this scenario into account, the State Secretary for Health in Sao Paulo asked our Research Centre to develop a programme to promote health through physical activity.
After two years of preparation and in consultation with the US Centers for Disease Control and Prevention, the United Kingdom's Health Education Authority and the Institute for Aerobic Research in Dallas, Texas, the programme "Agita Sao Paulo"
was launched last December. Its two combined phases are intended to increase the population's knowledge of the benefits of physical activity and to increase the amount of posi- tive involvement in physical activity.
The purpose is to upgrade everyone's physical activity by one level, in other words: to persuade the seden- tary to be at least occasionally active, the occasionally active to be regu- larly so, the regularly active to be very active and the very active to maintain that level - thus diminish- ing risks. Building on the new recommendations mentioned above,
"Agita Sao Paulo" has three target populations: schoolchildren and students, workers (blue-collar and white-collar), and the elderly.
The programme is sustained by a Scientific Board and an Executive Board. The former comprises profes- sionals with wide experience in sports sciences from our research centre and from the most important
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universities in the country. Forty influential governmental and non- governmental organizations are represented as partners on the Executive Board, where community and individual activities are dis- cussed and the general calendar of events is prepared. Posters, flyers, manuals and slide and video presen- tations have been developed to educate the public on 23 topics relating to physical activity and health, and the media have been involved as well. Among the major events planned are the "Day for the Active Worker" (around 1 May); the
"Day for the Elderly" in the first week of October and the "Day for the Active Student" involving around seven million children and adolescents as well as schoolteach- ers and parents.
Special attention has been given to diagnosing the physical activity status of the target population. A questionnaire adapted from interna- tional models was issued before the programme started; and it will be re- issued during different phases of the campaign to determine any changes in behaviour. It has been designed to detect not only gross changes (i.e., from sedentary to active) but even the stages of change (i.e., starting to consider getting involved in exer- cise, or setting aside time for sports activity in the everyday agenda), since these are considered important signs of improvement.
One further concern relates to improving the quality of physical education - and revising the medical training curricula, as well as up- dating the attitudes of health professionals.
The programme is at present on a state level but it will serve as a kind of pilot project for a national project ("Vida Ativa") which will be launched in the near future. In both instances, the purpose is to increase physical activity as an important tool for promoting health and improving the quality of life. •
Dr Victor Matsuda works at the Research Centre of the Physical Fitness Research Laboratory (CELAFISCS), Av. Goias 1400, Sao Caetano do Sul, Sao Paulo, Brazil CEP 09521-300.
