Physical fitness and health

This page contains research and evidence on complex and wide-ranging issues relating to the impact of physical activity on various aspects of health. It includes:

  • Comprehensive reviews of general evidence.
  • Consideration of dose-response relationships.
  • Reviews of the relationship between physical activity and cardiovascular health and bone density and osteoporosis.
  • Reviews of the relationship between sports participation and more general health behaviours among young people.
  • The effects of physical activity on the health of older people.

Physical activity and bone mass development in young adults (Netherlands, 2000)

Authors Kemper, HCG; Twisk, JWR; Van Mechelen, W; Post, GB; Roos, JC and Lips, P Date 2000 Keywords Adolescents Country of research Netherlands Summary of findings In this longitudinal study, daily physical activity and fitness were monitored from age 13 to 29 years in a group of 182 males and females. At a mean age of 28 bone mineral density (BMD) was measured at three sites with dual X-ray absorptiometry in the limber region (lumber BMD), the femoral neck (hip BMD) and the distal radius (wrist BMD). Physical activity was estimated for the cross-check activity interview taking into consideration all daily physical activities during the last 3 months. Such activity was scored (i) metabolic physical activity and (ii) mechanic physical activity and physical fitness was measured with a neurometer fitness test and cardiopulmonary fitness. The overall conclusion is that daily physical activity during adolescence and in the young adult period is significantly related to the BMD at the lumbar spine and femoral neck at age 28 of males and females. Only neurometer fitness and not cardiopulmonary fitness is related to BMD of males and females at age 28. Methodology Bone mineral density measurements Source of reference Bone, 2000, 27, (6), 847-853. Web reference http://journals.elsevierhealth.com/periodicals/bon

Links between starting to drink alcohol and organised sports (Norway, 2002)

Authors

Hellansjo Bu, ET; Watten, RG; Foxcroft, DR; Ingebrigtsen, JE and Relling, G

Date

Jan-02

Keywords

Adolescents, alcohol / drug abuse, physical health, sport

Country of research

Norway

Summary of findings

This study examined the age distribution of alcohol and intoxication debut and factors associated with this for a representative sample of 3368 Norwegian 12-18 year olds. Pupils with early alcohol or intoxication debut tended to come from single-parent families, from cities, experience less family support and a more highly organised family life, reported more frequent peer and parental drinking and did not participate in sports.

It is proposed that participation in organised sports activities may delay a drinking debut. This is explained by sports clubs' rules, the important socialisation role played by clubs, sports participation taking up a lot of time and information being provided about the adverse effects of alcohol. It is concluded that sports organisations should be included in drinking prevention programmes.

Methodology

Questionnaire data

Source of reference

Alcohol and Alcoholism, 2002, 37, (1), 74-80.

Web reference

http://alcalc.oupjournals.org/

Effects of PE and school-sponsored sport on student fitness (US, 2005)

Authors

Beets, MW and Pitetti, KH

Date

2005

Keywords

Physical health; fitness; school sport; sport; physical education; adolescents; boys; girls.

Country of research

USA

Summary of findings

This study compared the health-related fitness variables of high school students (14-19 year old; 120 males, 67 females) participating in physical education (PE) and  school-sponsored sport (SSS) to students participating solely in PE.  During their regular PE lessons students were tested on measures of health-related fitness included, cardiovascular fitness (measured using the 20-Meter Shuttle Run), upper body strength (push-ups) flexibility (sit and reach), and body mass index (BMI).  Males and females participating in SSS completed significantly more shuttle runs than those participating solely in PE.

As the number of SSS increase, significant increases are observed in cardiovascular fitness.  Furthermore, males participating in SSS completed significantly more push-ups than males taking part solely in PE.  However, there was no significant increase in this measure for females.  Also there were no significant increases between groups for sit and reach and BMI.  The authors suggest that the lack of significant relationship between BMI and the number of SSS reflects the inability of BMI to differentiate between lean body and andipose tissue and that it fails to adequately represent body composition.

The authors argue that the current PE environment does not provide activities of sufficient intensity and duration to improve cardiovascular fitness.

They acknowledge limitations of the cross-sectional study: a causal relationship between participation in SSS and cardiovascular fitness is not established - it may be that pupils that exhibit high cardiovascular fitness levels are selected to take part in sport, rather than the sport developing the cardiovascular fitness.  However, PE alone may not result in improvements in cardiovascular fitness, but do promote weight management, strength development and flexibility.  T

he results suggest that elements of SSS, such as intensity and duration, may provide adolescents more opportunities to engage in moderate-to-vigorous physical activity.

Methodology

 Fitness testing

Source of reference

Journal of School Health, 75(1), 25-30

Web reference

http://www.blackwellpublishing.com/journal.asp?ref=0022-4391&site=1

Effects of physical conditioning in asthmatic children (Australia, 2005)

Authors

Welsh, L; Kemp, JG, and Roberts, RGD

Date

2005

Keywords

Physical health; asthma; exercise; fitness

Country of research

Australia

Summary of findings

This provides a systematic review of  31 studies which examined the effects of physical conditioning on asthmatic children, the majority of which were based on quantitative pre-and post-training measurement of aerobic fitness, or the on the severity and incidence of exercise-induced asthma (EIA). 

The studies are examined for the age of participants, their sex, the training method (e.g. swimming, running, cycling) and the results.  Not all selected studies produced beneficial effects in aerobic fitness, although the authors identify methodological limitations with most of these studies. 

Their overall conclusion is that the large majority of such studies demonstrate significant increases in aerobic fitness post-training or the achievement of normal levels of aerobic fitness.  Although there were few reports of a reduced severity in EIA symptoms post-training, the majority of studies demonstrate no change in the occurrence or degree of EIA.  However, a number of these studies have reported some reductions in hospitalisations, wheeze frequency, school absenteeism, doctor consultations and medication usage.

The authors recommend that children and adolescents with asthma should participate in regular physical activity.  This may improve asthma management and associated general health benefits, while minimising inactivity-related health risks.

Methodology

Systematic review

Source of reference

Sports Medicine, 35(2), 127-141

Web reference

http://sportsmedicine.adisonline.com/pt/re/spo/home.htm;jsessionid=G0XG6rylrjrn19HxTFnL5XQDGG6qSvDr2

Physical activity or cardiovascular fitness – which should take priority for older people? (Canada, 2003)

Authors

Dionne, IJ; Ades, PA and Poehlman, ET.

Date

2003

Keywords

Physical health; physical activity; older adults

Country of research

Canada

Summary of findings

This review article explores whether health recommendations should focus on improving cardiovascular fitness or physical activity energy expenditure in older persons.

Although the literature is limited, the authors examined the association between cardiovascular fitness and physical activity.

Cross-sectional studies support a positive association between cardiovascular fitness and physical activity energy expenditure, whereas intervention studies suggest that when aerobic exercise is implemented later in life, older individuals either do not change or decrease physical activity energy expenditure outside of the programme.

The authors also considered the impact of improvements in cardiovascular fitness and physical activity on some commonly measured health outcomes in older persons. Based on preliminary studies, it appears that improving cardiovascular fitness has a greater impact on various health outcomes, whereas increased physical activity is also associated with health benefits, although to a lesser extent.

Further work should be devoted at elucidating the individual benefits of increasing cardiovascular fitness or physical activity on health outcomes in older persons, to enable refinement of exercise prescription.

Methodology

Review article

Source of reference

Mechanisms of Ageing and Development, 2003, 124, 259-267.

Web reference

http://www.sciencedirect.com/science/journal/00476374

The contribution of sport to health (Scotland, 1999)

Authors

Allison, M

Date

1999

Keywords

Physical health; sport; physical activity

Country of research

Scotland

Summary of findings

This short review outlines the various physical and mental health benefits of physical activity and discusses some of the possible mechanisms involved. It also provides a brief discussion of the risks associated with certain types of physical activity. It examines the evidence and recommendations relating to the optimal amount of physical activity and looks at issues relating to people with special needs and children and young people. It illustrates current levels of sports participation and health status and outlines several implications for policy and practice in promoting the physical activty message:

Physical inactivty is an independent risk factor similar to smoking, but much more widespread among the population.
The majority of the inactive population do not regard themselves as unfit and at risk.
Physical activity does not have to be of vigorous intensity to provide health benefits.
Many sports injuries can be avoided through product design, safer behaviour and safer environments.
Multi-agency approaches will be most effective, with sport as a component of these.

Methodology

Literature review

Source of reference

Allison, M, The contribution of sport to health, Edinburgh: sportscotland; 1999, Research digest no 39, ISBN 1 85060 266 2.

Short-term effects of regular physical activity on health (US, 2002)

Authors

Rankinen, T and Bouchard, C

Date

2002

Keywords

Physical health; physical activity

Country of research

United States of America

Summary of findings

This paper, based on the contributions of 24 experts from six countries, examines evidence relating to the varying dose–response relationships between physical activity (PA) and several health-related outcomes.

The strength of evidence was ranked in four categories – rich body of evidence (A), limited body of data (B), observational studies (C) and committee consensus judgement (D).

The panel paper examines evidence relating to dose-response relationships between the volume of physical activity and all-cause mortality; cardiovascular disease; diabetes; cancer; blood pressure; weight loss; bone density; blood lipids and lipoproteins; hemostatic factors; low back pain and osteoarthritis; quality of life and independent living in the elderly, depression and anxiety.

The paper concludes that, despite strong evidence for the beneficial effects of regular PA on all reviewed health outcomes, the dose-response relationships are often less clear. This lack of clarity is explained by such factors as: absence of relevant research; lack of sensitive field-methods; small effects of PA on some health outcomes; uncontrolled confounding factors. It also stresses the need to consider the potential health risks associated with regular PA .

Methodology

Expert review panel

Source of reference

Rankinen, T and Bouchard, C, Dose-response issues concerning the relations between regular physical activity and health, Washington: President's Council on Physical Fitness and Sports; 2002, Research Digest series 3, no 18.

Review of the links between sport and adolescent health (US, 2000)

Authors

Miller, KE; Sabo, DF; Melnick, MJ; Farrell, MP and Barnes, GM

Date

2000

Keywords

Physical health; sport; adolescents

Country of research

United States of America

Summary of findings

This report attempts to provide a comprehensive evaluation of the positive and negative relationships between sports and adolescent health and how sports participation contributes to preventative health programmes.

The findings and analysis are based on the 1997 Youth Risk Behaviour Survey, a nationally representative sample of 16,626 students in grades 9 to 12. A logistic regression analysis was used to compare athletes' and non-athletes' odds of engaging in a series of health-risk behaviours (most comparisons are made within genders).

The findings include: athletes were less likely to use illicit drugs; findings on use of anabolic steroids were mixed; only highly involved athletes were more likely to binge drink; athletes were less likely to smoke cigarettes, but more likely to use chewing and dipping tobacco; athletes were less likely to be suicidal; female athletes had more positive body images, but were more likely to attempt weight loss; female athletes were more likely to wear seat belts, but more likely to drive after drinking.

 The researchers conclude that athletic participation has both positive and negative implications for adolescent health and provide the following list of policy recommendations to better use sport as a means of promoting adoescent health:

  1. Create federal, state and local policy and action agendas to protect and support school athletic programmes (especially in poor neighbourhoods). Public and private funds should be provided to promote health advocacy through sport.
  2. Use sport as a gateway to adolescent wellness and long-term health promotion Families, educators, parent-teacher associations, community organisations and health professionals must evaluate and monitor the extent to which athletic programmes protect and promote the health of teen athletes. Health-related educational materials should be developed specifically for athletes.
  3. Form new partnerships to pursue health advocacy through sport. Women's (and men's) health advocates and organisations should explore policies and programmes that seek to enhance girl's health through athletic participation.
  4. Promote gender equity in athletics.
  5. Foster working relationships between coaches, parents and health professionals. Information about the health needs and risks of adolescents should be included in coaching certification and education programmes. Education and health should become the key organising principles for developing and evaluating athletic programmes.
  6. Welcome all interested adolescents into high school and community sports. Competition should be de-emphasised and the potential of sport to promote fitness and personal development should be exploited.

The authors also provide a number of recommendations to reduce health risks in adolescent sports:

Acknowledge the existence of health risks and discuss it openly with all interested parties.

  1. Increase efforts to detect and prevent health risk behaviours. High schools should develop risk management procedures that allow school health officials, administrators and coaches to identify and deal with problem behaviours among athletes.
  2. Provide positive and healthy adult role models. Schools can also organise mentoring programmes in which 'team mentors' are used to promote the concept of healthy living through sports and offer support and encouragement to teams.
  3. Let teens help each other via peer health education and support programmes.
  4. Challenge the use of sport imagery to sell harmful substances to teens (e.g. tobacco and alcohol).
  5. Pay close attention when depressed athletes talk about suicide. Because athletes often grow close to their coaches and seek their advice on non-sport-related matters, coaches and health professionals can work together to supplement parental and school efforts along these lines.

Finally, the authors outline a research agenda:

  1. Longitudinal studies are required to develop a clearer understanding of the causal mechanisms through which athletic participation influences adolescent health.
  2. There is a need to evaluate how the quality and availability of athletic programmes influence the health behaviours of teen athletes.
  3. A better understanding of the differences and similarities between girls' and boys' experiences of sport.
  4. The extent to which some girls may be adopting health risk behaviours traditionally associated with some men's sports. The extent to which the growing involvement of girls in sport may be changing boys' health beliefs and practices.
  5. The risk-inducing and risk-reducing dimensions of various sports and the relative health consequences of participation in high school and community sports.
  6. In-depth study of the meanings and motivations that teen athletes attach to their daily decisions about risk-related health behaviours.

Methodology

Survey data

Source of reference

Miller, KE; Sabo, DF; Melnick, MJ; Farrell, MP and Barnes, GM, The Women's Sports Foundation report: health risks and the teen athlete, East Meadow, New York: Women's Sports Foundation; 2000.

Links between physical activity and bone density (US, 2003)

Authors

Greendale, GA; Huang, M; Wang, Y; Finkelstein, JS; Danielson, ME and Sternfeld

Date

2003

Keywords

Physical health; sport; physical activity; bone mineral density; women; menopause

Country of research

United States of America

Summary of findings

This article explores the relation between four domains of physical activity - sport, home, work and active living - and bone density (BMD) in a sample of 2,057 women aged between 42 and 52 years of age.

Standardised self-completion questionnaires were used to assess age, height and weight, smoking, history of hyperthyroidism, use of estrogen/progestin, menopause stage, intakes of calcium and alcohol.

The primary exposure variable was physical activity, assess via an adapted version of the Kaiser Physical Activity Survey.  Measurement of lumber spine, femoral neck and total hip BMD were made at clinical sites.  Linear regression models were used to estimate the relations between each activity domain and BMD.  Spine and femoral bone densities were positively, independently and statistically significantly associated with higher levels of sport and home physical activity (not, with sport and home activity being approximately equal predictors of greater BMD at both bone sites.

The study emphasises that excluding the home domain from physical activity  assessment will underestimate associations between physical activity and health in women.

The authors admit that the cross-sectional nature of this study and the self-reporting of physical activity constrain casual inference.  Nevertheless both sport and home physical activity appear to be more positively related to BMD than work and active life style activity.

Methodology

Survey; self-completion questionnaire; BMD measurement

Source of reference

Medicine and Science in Sport and Exercise, 35(3), 506-512

Web reference

http://www.acsm-msse.org/

Regular physical activity and rate of bone loss among women (Finland, 2001)

Authors

Puntila, E; Kroger, H; Lakka, T; Tuppurainen, M; Jurvelin, J and Honkanen, R

Date

2001

Keywords

Physical health; physical activity; menopause; osteoporosis; women

Country of research

Finland

Summary of findings

The association between continuous lesiure-time physical activity and the change in bone mineral density and bone mineral content in a population-based random sample of peri- and postmenopausal women is examined.

Since previous similar studies have tended to use small populations and relatively high physical loading, this population-based study investigates whether regular, moderate, leisure-time physical activity is associated with diminished axial bone loss among peri- and postmenopausal women.

The overall conclusion is that as little as 1-3 hours/week of leisure-time weight-bearing physical activity appears to be sufficient to diminish lumbar bone loss, but light-to-moderate physical activity seems to be ineffective in the prevention of femoral bone loss. The optimal physical activities associated appear to be brisk walking or jogging.

The implication is that regular weight-bearing physical activity may be recommended to prevent lumbar bone loss in peri- and postmenopausal women. The authors acknowledge the need for further studies of the association between weight-bearing physical activity and femoral bone loss.

Methodology

Longitudinal survey data

Source of reference

Bone, 2001, 29, (5), 442-446.

Web reference

http://journals.elsevierhealth.com/periodicals/bon

Effects of physical activity and bone health in young adults (Northern Ireland, 2002)

Authors

Neville, CE; Murray, LJ; Boreham, CAG; Gallagher, AM; Twisk, J; Robson, PJ; Savage, JM; Kemper, HCG; Ralston, SH and Davey Smith, G

Date

2002

Keywords

Physical health; physical activity; bone mass; adults; sport

Country of research

Northern Ireland

Summary of findings

The aim of this study was to determine the extent to which different components of physical activity may influence bone mineral status in a representative population.

Physical activity was assessed via a self-report questionnaire designed to measure the frequency and duration of physical activity and its components (including various aspects of sport). Potential confounding factors such as height, weight, diet and smoking habits were also assessed.

Bone mineral density and content were determined at the lumbar spine and femoral neck by dual-energy X-ray absorptiometry. The results demonstrate the importance of sports activities, especially those involving high peak strain, in determining peak bone status in young men. Failure to observe this association in women reflects their lower participation in such activities, but they may have the same capacity to benefit. Intervention studies are warranted to determine whether peak bone density in women can be improved by participating, during childhood and adolescence, in sports activities involving high peak strain.

Methodology

Medical assessments and questionnaire data

Source of reference

Bone, 2002, 30, (5), 792-798.

Web reference

http://journals.elsevierhealth.com/periodicals/bon

Comprehensive review of physical activity and health (US, 1996)

Authors

US Department of Health and Human Services

Date

1996

Keywords

Physical health; psychological well-being; physical activity; barriers

Country of research

United States of America

Summary of findings

A seminal summary of the effects of physical activity on health and disease. The report provides a review of the terminology (physical activity, physical fitness, health), the evolution of physical activity recommendations and a review of issues of measurement of physical activity, fitness and intensity.

It provides a review of physiologic responses (cardiovascular, musculoskeletal systems, metabolic, endocrine and immune systems) and long-term adaptation to exercise (many of the benefits diminish within two weeks of reducing physical activity). The effects of physical activity on health and disease are examined:

1. Overall Mortality

  • Higher levels of regular physical activity are associated with lower mortality rates for both older and younger adults.
  • Even those who are moderately active on a regular basis have lower mortality rates than those who are least active.

2. Cardiovascular Diseases

  • Regular physical activity or cardiorespiratory fitness decreases the risk of cardiovascular disease mortality in general and of coronary heart disease mortality in particular.
  • The level of decreased risk of coronary heart disease attributable to regular physical activity is similar to that of other lifestyle factors, such as not smoking.
  • Regular physical activity prevents or delays the development of high blood pressure, and exercise reduces blood pressure in people with hypertension.

3. Cancer

  • Regular physical activity is associated with a decreased risk of colon cancer.
  • There is no association between physical activity and rectal cancer. Data are too sparse to draw conclusions regarding a relationship between physical activity and endometrial, ovarian, or testicular cancers.
  • Despite numerous studies on the subject, existing data are inconsistent regarding an association between physical activity and breast or prostate cancers.

4. Non–Insulin-Dependent Diabetes Mellitus

  • Regular physical activity lowers the risk of developing non–insulin-dependent diabetes mellitus.

5. Osteoarthritis

  • Regular physical activity is necessary for maintaining normal muscle strength, joint structure, and joint function. In the range recommended for health, physical activity is not associated with joint damage or development of osteoarthritis and may be beneficial for many people with arthritis.
  • Competitive athletics may be associated with the development of osteoarthritis later in life, but sports-related injuries are the likely cause.

6. Osteoporosis

  • Weight-bearing physical activity is essential for normal skeletal development during childhood and adolescence and for achieving and maintaining peak bone mass in young adults.
  • It is unclear whether resistance or endurance type physical activity can reduce the accelerated rate of bone loss in postmenopausal women in the absence of estrogen replacement therapy.

7. Falling

  • There is promising evidence that strength training and other forms of exercise in older adults preserve the ability to maintain independent living status and reduce the risk of falling.

8. Obesity

  • Low levels of activity, resulting in fewer kilocalories used than consumed, contribute to the high prevalence of obesity in the United States.
  • Physical activity may favorably affect body fat distribution.

9. Mental Health

  • Physical activity appears to relieve symptoms of depression and anxiety and improve mood.
  • Regular physical activity may reduce the risk of developing depression, although further research is needed.

10. Health-Related Quality of Life

  • Physical activity appears to improve health-related quality of life by enhancing psychological well-being and by improving physical functioning in persons compromised by poor health.

11. Adverse Effects

  • 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.
  • Serious cardiovascular events can occur with physical exertion, but the net effect of regular physical activity is a lower risk of mortality from cardiovascular disease.

The report also reviews US participation patterns and trends for adults and adolescents. It also outlines theories and models used in behavioural and social science research on physical activity:

  • Learning Theories
  • Belief Model
  • Transtheoretical Model
  • Relapse Prevention Model
  • Theory of Reasoned Action and Theory of Planned Behaviour
  • Social Learning/Social Cognitive Theory
  • Social Support
  • Ecological Approaches

It reviews behavioural research on physical activity for adolescents and adults and a a range of interventions to promote physical activity:

  • Environmental and policy approaches
  • Community-based approaches
  • Societal barriers
  • Societal resources

It offers the following conclusions:

  • Consistent influences on physical activity patterns among adults and young people include confidence in one's ability to engage in regular physical activity (e.g. self-efficacy), enjoyment of physical activity, support from others, positive beliefs concerning the benefits of physical activity, and lack of perceived barriers to being physically active.
  • For adults, some interventions have been successful in increasing physical activity in communities, worksites, health care settings, and at home.
  • Interventions targeting physical education in elementary school can substantially increase the amount of time students spend being physically active in physical education class.

Methodology

Research review

Source of reference

US Department of Health and Human Services, Physical activity and health: a report of the Surgeon General, Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.

Web reference

http://www.cdc.gov/nccdphp/sgr/pdf/sgrfull.pdf

Physical activity as a risk factor in osteoarthritis (US, 2000)

Authors

Cheng, Y; Macera, CA; Davis, DR; Ainsworth, BE; Troped, PJ and Blair, SN

Date

2000

Keywords

Physical health; physical activity; osteoarthritis; men; women

Country of research

United States of America

Summary of findings

The association between physical activity and the incidence of self-reports of physician-diagnosed osteoarthritis, while controlling for other potential risk factors, is evaluated.

The study population consisted of individuals aged 20 years or older examined at the Cooper Clinic, Dallas, between 1970 and 1995. The definition of osteoarthritis was limited to knee and hip joints only. Walking and jogging were chosen as the basis for the physical activity index used because it was the most common activity for this population. All analyses were gender specific. Among those aged 50 years and older, osteoarthritis incidence was higher among women than among men, while among those under 50 years of age, osteoarthritis incidence was similar between men and women.

High levels of physical activity (running 20 or more miles per week) were associated with osteoarthritis among men under age 50 after controlling for other risk factors, while no relationship was suggested among women or older men. The authors offer the explanation that other unmeasured factors (such as the intensity of chosen activities) may vary by the age and gender of the subjects.

The findings support the conclusion that high levels of physical activity may be a risk factor for symptomatic osteoarthritis among men under the age of 50 years.

Methodology

Medical evaluations, clinical examinations, and questionnaire data

Source of reference

Journal of Clinical Epidemiology, 2000, 53, 315-322.

Web reference

http://www.sciencedirect.com/science/journal/08954356

Physical activity and quality of life in older women (US, 2001)

Authors

Koltyn, KF

Date

2001

Keywords

Physical activity; physical health; psychological well-being; quality of life; older adults; women

Country of research

United States of America

Summary of findings

The association between physical activity and quality of life in older women is examined based on a study with women over the age of 60 years, living independently or in assisted-care facilities.

Quality of life was measured via questions from the World Health Organisation Quality of Life instruments (WHOQOL-BREF), which includes four major domains - physical and psychological health, social relationships and environment.  Despite an unbalanced sample (70% lived independently and 30% in assisted-care facilities), results indicated that women living independently had significantly higher physical activity levels, including total time spent being physically active (hours/week), energy expenditure (kcals/week), vigorous activities, walking, and climbing stairs, than women living in assisted-care facilities.

Overall quality of life, as well as the specific domains of physical health, social relationships, and environment were found to be significantly higher in women living independently compared to women living in assisted-care facilities. There was no significant difference in the psychological domain of quality of life between the two groups of women.

The association between physical activity and quality of life, regardless of living status, is also analysed. Significant associations were found between overall quality of life and energy expenditure, and between overall quality of life and vigorous activities.

There was also a significant association between the physical health domain of quality of life and three of the physical activity categories including:

1) total time spent being physically active
2) energy expenditure,
3) vigorous activity.

The need for further research to determine what kinds of and how much physical activity is needed to influence quality of life in older adults is acknowledged.

Methodology

Survey data

Source of reference

Women's Health Issues, 2001, 11, (6), 471-480.

Web reference

http://www.sciencedirect.com/science/journal/10493867

Physical activity and reduced risk of ovarian cancer (US, 2000)

Authors

Cottreau, CM; Ness, RB and Kriska, AM

Date

2000

Keywords

Physical health; physical activity; cancer; women

Country of research

United States of America

Summary of findings

The relation between leisure-time physical activity and ovarian cancer is examined. Data is used from a population based case-control study of women in regions of Pennsylvania, New Jersey, and Delaware.

The overall conclusion is that lifetime leisure physical activity was strongly related to decreased risk of ovarian cancer. Occurrence of ovarian cancer was reduced by 27% among women in the highest category of lifetime leisure physical activity compared with those in the lowest level.

Since several previous studies found that the reliability of leisure activity measurements was lessened when walking was included, this study assessed and analysed walking as a separate variable. The relation between walking and ovarian cancer risk was not significant, although the authors acknowledge the unreliability of walking measurements.

A discussion of the various mechanisms by which physical activity might protect against ovarian cancer is offered, including reducing the number of lifetime ovulatory cycles, alterations in metabolic pathways, and alterations in prostaglandin levels.

Methodology

Survey and in-depth interview data

Source of reference

Obstetrics and Gynecology, 2000, 96, (4), 609-614.

Web reference

http://www.sciencedirect.com/science/journal/00297844

Cost of cardiovascular disease linked to inactivity (US, 2004)

Authors

Wang, G; Pratt, M; Macera, CA; Zheng, ZJ and Heath, G

Date

2004

Keywords

Physical fitness and health; physical activity, cardiovascular disease, healthcare costs; adults.

Country of research

United states of America

Summary of findings

The objective of this study was to estimate the direct medical expenditures of cardiovascular disease (CVD) associated with inactivity.

CVD is the leading cause of death and disability among US adults and physical inactivity is an established independent risk factor for CVD.

A nationally representative sample of  2,472  adults' direct medical expenditures was obtained by linking the 1996 Medical Expenditure Panel Survey and was related to  the 1995 National Health Interview Survey to obtain activity data.  The sample was stratified by age/sex/bodyweight and smoker/non-smoker.  Active was defined as those who increased their heart rate for 30 minutes or more five or more times per week, or 20 minutes or more on three or more times which substantially increased their heart rate.

For this study population, 22.5 per cent of the medical expenditures of persons with CVD in the inactive population was associated with their inactivity.  Applied to the national figure of total medical expenditure on CVD patients in the US in 2001, this implies that $23.7 billion of the total expenditure was on inactive patients.

The authors conclude that the high economic burden of inactivity associated with CVD demonstrates the need to promote physical activity among US adults.  The authors list a number of potential limitations with the study:  the use of a dichotomous scale ('active' or 'inactive') which may have affected the differences in medical expenditures between the two categories; the exclusion of persons with physical limitations means that estimates of medical expenditures associated with inactivity may be conservative; its cross-sectional and self-report approach; selection bias, based on those who have survived.

The study also excludes the indirect costs of inactivity (e.g. lost productivity) which in 2001 were estimated as $116.4 billion.

Methodology

Secondary analysis; survey data.

Source of reference

Annals of Behavioral Medicine, 28(2), 88-94

Are physical activity guidelines for children useful? (Netherlands, 2001)

Authors

Twisk, JWR

Date

2001

Keywords

Physical health; physical activity; children; adolescents; adults

Country of research

Netherlands

Summary of findings

This critical review of various physical activity guidelines for children and adolescents suggests that such guidelines are based on weak scientific evidence. It argues that there is only marginal evidence of a relationship between physical activity during youth and adult health status.

The authors quote the Harvard Alumni study in which three groups with different levels of physical activity as students had no difference in the incidence of cardio-vascular disease as adults. The relatively limited evidence regarding cardiovascular disease, osteoporosis and mental health are reviewed and, although there is some suggestive evidence about positive relationships, the author concludes that the current state of the evidence does not provide the basis for a certain dose-response relationship, or a particular threshold value from which guidelines can be obtained.

It is suggested that the aetiology of chronic diseases is highly multi-dimensional and not fully understood - ie the increased incidence of overweight children and childhood obesity and the existence of at least one modifiable cardiovascular disease factor is not per se caused by a decrease in physical activity. This, combined with the marginal nature of the evidence for the relationship between physical activity and health, may produce poor guidelines. It also acknowledges the major methodological difficulties associated with undertaking relevant experimental studies. It acknowledges the public health value of physical activity guidelines for children and adolescents purposes, but suggests that they should focus on aspects other than possible adult health benefits.

Methodology

Review article

Source of reference

Sports Medicine, 2001, 31, (8), 617-627.

Web reference

http://www.adis.com/page.asp?objectID=55

How physical activity protects against health risks of obesity (US, 2000)

Authors

Welk, GJ and Blair, SN

Date

2000

Keywords

Physical health; physical activity; obesity

Country of research

United States of America

Summary of findings

This digest reviews the relationships between physical fitness and body composition and their combined effect on obesity and health. It provides an outline of the epidemiological evidence for the protective effect of physical activity, including an on-going study of individuals at the Aerobics Centre at the Cooper Clinic in Dallas.

There is a strong protective effect for physical activity and physical fitness on the health risks associated with obesity.
Persistence in the proposed protective effect is evident in the fact that the results have been found to be similar for a number of different indicators of body composition.
The studies reviewed also illustrate that overweight or obese individuals can be fit and the data illustrate that such active or fit individuals are also protected against the health risks of obesity.

It also explores the probable mechanisms that produce this protective effect. Physical activity reduces and/or reverses the development of a progressive disease process known as insulin-resistance syndrome that is related to abdominal body fat, the production of free fatty acids and high levels of blood glucose and reduced sensitivity to insulin.

Physical activity induces beneficial metabolic changes that limit the progression of this underlying disease process. It reduces abdominal obesity and because such benefits appear to occur independently of changes in body composition it may prove more successful to promote physical activity for its own sake-without emphasising, or expecting, corresponding changes in body composition. The focus on behaviour rather than outcomes has motivational advantages for obese individuals, since it increases the likelihood that they can be successful and feel positive about their efforts. Further, benefits can be accrued via only modest amounts of physical activity.

Methodology

Literature review

Source of reference

Welk, GJ and Blair, SN, Physical activity protects against the health risks of obesity, Washington: President's Council on Physical Fitness and Sports; 2000, Research digest series 3, no 12.

Effects of sport on young people's emotional well-being (US, 2006)

Authors

Donaldson, SJ and Ronan, KR

Date

2006

Keywords

Mental health/psychological well-being, self-concept; self-esteem; sport, adolescents.

Country of research

United States of America

Summary of findings

This article reports on a study of the relationship between children's sports participation and emotional well-being, including self-reported emotional and behaviours problems and multi-dimensional aspects of self-concept.  It provides a broad review of research and literature on the positive and negative relationships found between physical activity/sport and depression/anxiety, delinquency, problem behaviours, emotional well-being.  It also reviews inconsistent research on the relationship between sport and physical and global self-esteem and concludes that perceived competence may contribute more to emotional well-being than actual competence. 

The main hypotheses of the study were:

(i) young adolescents' increased level of sports participation would be associated with fewer behavioural problems;

(ii) young adolescents who have a  higher rate of sports participation at various levels would have increased perception of athletic competence, social competence, physical competence and global self-worth;

(iii) young adolescents who have higher perceptions of athletic competence would have lower problems scores compared to those who were rated as more competent at sports by a PE teacher. 

This research is different from most previous research in that it uses a multi-dimensional approach to the measurement of self-concept and a perceived competence measurement tool. There were 203 participants, with an average age of 12 (93 males; 109 females; 1 no data) and a three self-report questionnaires were used - socio-emotional development; self-perception/competence and sports participation and attitudes – plus a teacher global rating scale (evaluation of student's overall sporting ability). 

Statistical analysis produced the following conclusions:

(i) Greater participation in sport (especially formal) was related to enhanced emotional and behavioural well-being, based on reporting of lower levels of externalising and social problems; 

(ii) There was a positive relationship between higher levels of total sports participation and perceived competence (although not necessarily fewer behaviour problems); 

(iii) Participants who perceived themselves to be competent at sport reported fewer emotional and behavioural problems; 

(iv) A positive relationship was found between sports participation and some domains of self-concept (e.g. social competence, global self-worth); 

(v) Unlike other studies, this found that global self-worth was positively related to total sports participation. 

Overall, they conclude that formal sport (with its need for commitment, conformity,rules, frequency, intensity) has the greatest positive impact on perceived athletic and behavioural competence and reducing behavioural problems (although this clearly raises the issue of self-selection).  However, the authors  admit that because of self-reporting, inability to differentiate performance in specific sports and the cross-sectional nature of this study no definitive conclusions can be drawn about causal relationships (although the covariation of relevant variables has important implications). 

The key conclusion draw is that sports educators need to become aware of the importance of self-perception and design programmes to maximise this (e.g. less emphasis on competition, more on cooperation and autonomy, positive feedback).

Methodology

Survey; self-reporting

Source of reference

Adolescence, 41(162), 369-389

Physical activity as a part of substance abuse treatment (US, 2004)

Authors

Williams, DJ and Strean, WB

Date

2004

Keywords

Physical health; mental health/psychological well-being; physical activity; alcohol/drug abuse

Country of research

Physical health; mental health/psychological well-being; physical activity; alcohol/drug abuse

Summary of findings

This review article summarises the relationship of physical activity to common addiction variables and. discusses the existing literature on physical activity and substance abuse treatment. 

The authors then outline the transtheoretical model of behaviour change to explain the somewhat inconsistent empirical findings and point to theoretical directions to guide practitioners and researchers and provide suggestions for implementing physical activity as a clinical adjunct to substance abuse treatment. 

In addition to certain neurobiological outcomes of physical activity which may assist in the recovery process, the authors also suggest that the positive psychosocial properties of physical activity may help to reduce some of the factors associated with substance abuse – low self-esteem, external locus of control, inadequate coping skills, negative affect and psychiatric morbidity. 

They also provide a brief review of the existing, limited, research on substance abuse treatment and physical activity and conclude that it indicates inconsistent evidence.

In order to promote exercise as part of such treatments the authors suggest the need to consider individual differences in exercise self-efficacy, motivation and exercise readiness and to adopt the transtheoretical model of behaviour change (precontemplation; contemplation; preparation; action; maintenance).

The authors also provide a series of recommendations for implementing such programmes as follows:

  1. Physical activity programmes should only be used with those who are well into a detoxification programme
  2. Physical activity should complement and relate directly to treatment goals (e.g. managing anxiety and stress, mastering psychomotor skills; building confidence
  3. Understand the context of drug use and any previous relations with physical activity (e.g. drinking and team games) to avoid classical-conditioned response
  4. Select physical activities that are consistent with the function of the overall treatment programme
  5. Staff administering the activity should have knowledge and training in the activity

 

Methodology

Review of literature

Source of reference

Journal of Social Work Practice in the Addictions, 4(3), 83-100

The role of physical activity in preventing cardiovascular disease (Belgium, 1999)

Authors

European Heart Network Expert Group on Physical Activity

Date

1999

Keywords

Physical health; physical activity; cardiovascular disease

Country of research

Belgium

Summary of findings

This provides evidence relating to the significance of cardiovascular disease (CVD) throughout Europe (it accounts for nearly half of all deaths) and outlines the evidence for the significant role physical activity can play in combating this. A sedantry lifestyle more than doubles the risk of CVD and it is possible to reduce the risk of coronary heart disease by making lifestyle changes even relatively late in life. Physical activity influences CVD risk in a number of ways:

(i) Lowers heart rate.

(ii) Raises insulin sensitivity.  

(iii) Lowers blood pressure.

(iv) Raises HDL/total blood cholesterol ratio.

(v) Helps with weight control.

The document provides a summary of the evidence regarding required levels and frequency of activity. These are:

(i) Daily, moderate and accumulated (30 minutes per day).

(ii) Frequency is more important than intensity (although exercise to increase cardio-respiratory fitness has to be vigorous and tends to be achieved through dedicated sports or exercise activities).

(iii) Intensity depends on existing levels of fitness. Common forms of moderate-intensity activities for the moderately fit include brisk walking at 5-6 km/h, cycling at approximately 16km/h, walking up stairs or heavy forms of gardening and housework.

(iv) Accumulated activity is also effective and activity needs to be current and continuing.

On this basis it recommends:

(i) Adults should accumulate 30 minutes of moderate-intensity physical activity most and preferably every day of the week.

(ii) All young people (5-18) should participate in physical activity of at least moderate intensity for one hour per day.

Although the potential risks of physical activity are far outweighed by its benefits, there are also some risks to consider and the diocument provides a self-administered screening questionnaire for high-risk individuals.

The document outlines policy recommendations at European Union and local levels:

(i) European Union

Develop an integrated EU policy on health-enhancing physical activity; support pan-European initiatives and stress that most health benefits are gained by moving from a sedantary life-style to one of moderate daily activity; monitor participation rates via regular surveys; research the needs of special groups; encourage information exchange.

(ii) National level

Raise awareness among key professionals of the importance of physical inactivity as a risk factor for CVD; shift policies from curative to preventative approaches; encourage cooperation between sectors and develop a physical activity strategy.

Raise public awareness of the modern health message that even low levels of physical activity are beneficial; publicise approaches to overcoming personal barriers to physical activity, skill development and the experience of fun and companionship.

(iii) Environment and transport

Encourage infrastructural and policy changes that increase opportunities for physical activity as part of daily living and transportation and develop an integrated transport strategy.

(iv) Facilities

Increase opportunities and facilities for appropriate sport and active recreation for individuals and families. Appropriate facilities include not only traditional sports halls or gyms, but also playing fields, parks, footpaths, inner-city basketball hoops and open spaces. Stage 'taster days' for non-exercisers, provide free creches and discounted access for relevant target groups.

(v) Workplace

Promote physical activity and encourage commuting to work on foot or bicycle.

(vi) Education and physical activity skills

Develop school and teacher-training programmes that emphasise enjoyable non-competitive physical activity and foster the acquisition of essential skills and a lifelong physical activity habit. Involve young people in decision-making and programme design.

(vii) For older people and those at high risk, promote appropriate physical activity.

(viii) Encourage whole-community approaches (this also can lead to greater community cohesion).

(ix) Develop clear well-structured physical activity programmes for disabled people.

(x) Reduce inequality of provision.

Various appendicies outline the health benefits of regular physical activity (with a 'surety rating'), examples of the strength of association between moderate physical activity and various health outcomes, explain the difference between physical activity and physical fitness and provides a physical activity readiness questionnaire.

Methodology

Review of evidence

Source of reference

European Heart Network Expert Group on Physical Activity, Physical activity and cardiovascular disease prevention in the European Union, Brussels: European Heart Network; 1999.

Healthcare costs and the benefits of exercise (UK, 1994)

Authors

Nicholl, JP; Coleman, P and Brazier, JE

Date

1994

Keywords

Physical health; mental health; healthcare costs; exercise

Country of research

United Kingdom

Summary of findings

Using secondary data estimates are provided of the relative risk of each of the major disease groups for individuals who do and do not exercise regularly (coronary heart disease, stroke, diabetes, hip fracture and mental illness).

These relative risks are  used to estimate the incidence of hospital admissions and mortality and associated health care costs which could be prevented by exercise. 

Literature on the incidence and costs of exercise-related morbidity and mortality was also reviewed to derive estimates of both the costs to health and also the healthcare resource implications of exercise in a total population.

Indirect costs and benefits (e.g. more productive work, less absenteeism) and also quality-of-life effects (e.g. sense of well-being) associated with exercise were not included in this assessment.

The authors admit that some of the estimates (taken from routine data sources) are crude and the current state of research evidence means that some assumptions about the precise nature of the relationship between exercise and health are unsubstantiated. However, the results for England and Wales, show that in younger adults (15 to 44) the average annual medical care costs per person that might be incurred as a result of full participation in sport and exercise (approximately £30 at 1990 prices) exceed the costs that might be avoided by the disease-prevention effects of exercise (£5 per person). However, in older adults (45 plus) the estimated costs avoided (>£30) greatly outweigh the costs that would be incurred (<£10).

The conclusion is that with regard to health and medical care costs, there are strong economic arguments in favour of exercise in adults aged (45 plus) but not in younger adults. The health costs for young people can be reduced by promoting safer sports. Similar overall results were found in a study of a Dutch population.

Methodology

Review article

Source of reference

PharmacoEconomics, 1994, 5, (2), 109-122.

Web reference

http://www.adis.com/page.asp?objectID=52

Health benefits of physical activity (Canada, 2006)

Authors

Warburton, DER; Nicol, CW and Bredin, SSD

Date

2006

Keywords

Physical health; physical activity; cardiovascular disease; diabetes; cancer; osteoporosis.

Country of research

Canada

Summary of findings

This narrative review provides a summary and evaluation of the role played by physical inactivity in the development of chronic disease and premature death. 

The authors confirm that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g. cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis). 

The authors selected individual studies from the various published and systematic reviews and meta-analyses considered them as examples of the best evidence available (they also include new findings). 

They review these various studies in depth under various headings: 

(i) All–cause and cardiovascular-related death: primary and secondary prevention

They conclude that studies provide compelling evidence that regular physical activity and a high fitness level are associated with a reduced risk of premature death among both men and women. Also a dose-response relation appears to exist, with those with the highest level of physical activity and fitness at the lowest risk of premature death. 

(ii) Diabetes mellitus

Regular physical activity contributes to the primary prevention of type 2 diabetes, although research is required to uncover the optimal methods (e.g. resistance or aerobic training) and intensity of exercise. 

(iii) Cancer

There is compelling evidence that routine physical activity is associated with reductions in the incidence of breast and colon cancer and it confers a health benefit to those with established cancer (although further research is needed). 

(iv) Osteoporosis

Routine physical activity appears to be important in preventing loss of bone mineral density and osteoporosis, particularly in postmenopausal women.  It also appears to be an effective secondary preventive strategy. 

The authors conclude that physical activity and physical fitness both appear to be similar in relation to morbidity and mortality, but fitness is more predictive of health outcomes.  In terms of musculoskeletal fitness, there is strong evidence that resistance training and flexibility exercise should be performed at least twice a week to maintain functional status, promote lifelong physical activity and enhance overall quality of life. 

The authors provide a review of the variety of perspectives on the 'optimal' volume of activity required to prevent a range of diseases.  They end by reviewing evidence relating to the processes involved in translating physical activity and firmness into improved health outcomes.  These include improved body composition, enhanced lipid lipoprotein profiles, improved glucose homeostasis and insulin sensitivity, reduced blood pressure, decreased blood coagulation, improved coronary blood flow, enhanced endothelial function, improved psychological well-being. 

The authors conclude that there appears to be a linear relationship between physical activity and health status, with the greatest improvements seen in when people who are least fit become active.

Methodology

Review of literature

Source of reference

Canadian Medical Association Journal, 174(6), 801-809

Web reference

http://www.cmaj.ca/

Health benefits of physical activity in childhood and adolescence (US, 1995)

Authors

Bar-Or, O

Date

1995

Keywords

Physical health; physical activity; children; adolescents; adults

Country of research

United States of America

Summary of findings

Current evidence that enhanced physical activity during childhood and adolescence imparts immediate health benefits, or reduces risk for adult chronic disease is examined.

The author acknowledges a lack of longitudinal studies and discusses the limitations of alternative studies. The overall conclusion is that no long-term studies exist that support or reject the notion that physical activity during childhood and adolescence is beneficial to adult health.

There is however some evidence for short-term benefits of enhanced physical activity during the early years, particularly among children and youth who are at a high risk for chronic illness in later years.

The author suggests two ways in which research may yield more positive training-induced results:

  1. using more vigorous interventions than those commonly used in research, and
  2. using longer interventions (e.g. 1-2 years) than those used in most studies.

Methodology

Review article

Source of reference

Bar-Or, O, Health benefits of physical activity during childhood and adolescence, Washington: President's Council on Physical Fitness and Sports; 1995, Research digest series 2, no 4.

Review of evidence on physical activity and health in young people (UK, 2004)

Authors

Biddle, SJH, Gorley, T and Stensel, DJ

Date

2004

Keywords

Physical health; mental health/ psychological well-being; obesity; cardiovascular disease; diabetes; physical activity; determinants; children; adolescents.

Country of research

United Kingdom

Summary of findings

This provides a wide ranging review of evidence for the link between physical activity and various markers of health in youth.  It adopts a behavioural epidemiological approach using a five phase framework. 

(i) The link between physical activity and health

This reviews evidence relating to cardiovascular disease, weight and obesity, psychological outcomes, Type 2 diabetes, and skeletal health. The conclusion is that there is lack of definitive research evidence for meaningful health gains though being an active child.  However, this is in part because of a lack of longitudinal studies and it is unlikely that some of the markers of health outcomes of inactivity will be sufficiently clear until adulthood, even though inactivity in youth may be a precursor to such effects.  The overall conclusion is that it is unlikely that physical activity will not provide some benefit to children and adolescents, with some implications for adult health and it is prudent to encourage physical activity in such groups. 

(ii)  Prevalence of physical activity and sedentary behaviours

The authors provide a review of participation data which indicates a high level of worldwide consistency relating to overall levels of participation and gender differences. They review young people's use of electronic media and reject the displacement hypothesis (media use is displacing physical activity) and emphasise the reduction in cycling and walking and increase in motorised transportation (especially to schools). 

(iii) Determinants and correlates of physical activity

This provides a review of research on the relative influences of demographic and biological, psychological, behavioural, social and physical environment variables. Although a range of objective factors are important variables the authors emphasise factors such as perceptions of enjoyment, self-efficacy, competence, control and autonomy, positive attitudes to the activity and perceptions of few barriers and many benefits. The authors also argue that we need to shift from an approach based on 'activity absence' to one of understanding the relative attraction of sedentary behaviours. The data suggest that certain sedan try pursuits (e.g. TV) appear uncorrelated with physical activity and both can coexist.

(iv) Interventions: promoting physical activity

The authors illustrate the increasing recognition of the importance of family and community level interventions (the majority of young peoples' activity occurs outside schools hours) and suggest that the key measure of effectiveness of interventions is their ability to effect both short and long-term behaviour change.  In terms of school-based interventions, the authors suggest that current research is limited, it is unrealistic to expect schools to facilitate wider changes without the support of families and communities and that there are four potentially influential school environmental factors – break periods, intramural programmes, facilities that support physical activity and psychosocial support. 

The effectiveness of family interventions seems generally poor for healthy populations, but more effective among low-fit or obese populations (although changing intentions seems easier than changing behaviour).  There are only a few studies of community interventions for young people and they produced equivocal results, although there is some evidence that the use of primary care settings can change moderate-intensity physical activity in youth. 

The authors conclude that interventions are most likely to be successful when they consistently target the same behaviour across a number of sites in which the individual engages.  Also, programmes aimed at achieving 'life long physical activity' need to focus on the development of activities and skills that promote generalisation and maintenance of physical activity and enhance the probability of carryover to adulthood. They also argue that there is a need for research to understand sedentary behaviours and not simply policies to promote physical activity. 

(v) Implications for health policy

In this section the authors adopt an ecological and multi-dimensional approach and outline a series of recommendation for schools, local government, sport and recreation organisations, health services, mass media and government departments.

Methodology

Review of literature

Source of reference

Journal of Sports Sciences, 22, 679-701

Web reference

http://www.tandf.co.uk/journals/titles/02640414.asp

Intensity of exercise and health in students (US, 2003)

Authors

Pyle, RP; McQuivey, RW; Brassington, GS and Steiner, H

Date

2003

Keywords

Physical health; mental health; sport; adolescents; boys; girls

Country of research

USA

Summary of findings

Based on a survey of 770 high school students (mean age 15.9 years; males 59%), this research explored the impact on mental and physical health and coping skills of organised, more intensive sports participation and lower intensity participation.  Intense participants were defined as those who reported exercising for twenty minutes, four or more times each week.  The Juvenile Wellness and Heath Survey-76 was used to measure five factors: General Risk Taking; Mental Health problems; Eating and Dietary Problems; General Health Problems and Sex-related Risks.  For both boys and girls competitive sports participation was associated with a lower frequency of mental health problems, eating and dietary problems and total risks compared to non-competitive peers.  However, they had a higher frequency of sports-related injuries.

The authors suggest that the strengths of their study are: completeness of the sample; the wide range of domains examined; the retention for analysis of partial completers (who might be the most problematic participants).  The limitations of the study are: the population was primarily upper-middle class; more ethnically, economically and geographically diverse populations would most likely show some differing results; results are based on self-reported measures and there is a need for this to be complemented by objective measures; the data are cross-sectional, with a need for longitudinal analyses.  The study helps to define what some of the relevant domains for study should be and lays the groundwork for such an approach.

Methodology

Self-completion survey

Source of reference

Clinical Pediatrics, October 2003, 697-701

Web reference

http://www.westminsterpublications.com

How much physical activity is needed for good health? (Canada, 1999)

Authors

Shephard, RJ

Date

1999

Keywords

Physical health; physical activity

Country of research

Canada

Summary of findings

This provides a critical review of the Harvard Alumni study examining the apparent conflict between the conclusions drawn from this research and the current consensus on the optimal patterns of physical activity for health.

The author argues that the optimal energy expenditure reported for the Harvard data set has been over-estimated because too high a cost was assumed for stair climbing and over-reporting of sport involvement. The author suggests that the format of the Paffenbarger questionnaire produced a tendency to over-estimate the duration, frequency and intensity of participation (a tendency noted in other studies).

The apparent discrepancy between the consensus positon and Paffenbarger's can be traced to confusion between gross and net costs of physical activity, disagreement over the energy cost of stepping and possible errors in reporting sports activities.

Methodology

Review article

Source of reference

International Journal of Sports Medicine, 1999, 20, (1), 23-27.

Web reference

http://www.thieme.de/sportsmed/

Out-of-school sport and physical fitness in boys (Spain, 2006)

Authors

Ara, I; Vincente-Rodriguez, G; Perez-Gomez, J; Jimenez-Ramirez, J; Serrano-Sanchez; Dorado, C and Calbet, JAL

Date

2006

Keywords

Physical health, fitness; body mass; sport

Country of research

Spain

Summary of findings

This article reports on a Spanish 3 year longitudinal research project exploring the effect of extracurricular physical activities (including sport) on fat accumulation and physical fitness during growth in 42 early pubertal males. 

A range of physical fitness, body composition and anthropometrical variables were measured at the start and 3.3 years later.  Questionnaire data were collected on personal profiles, sports record (including the number of raining hours per week) and medical history (past injuries and medication). 

The major findings were: 

(i) Early pubertal males who participate in extracurricular sport for at least 3 hours per week over a three year period increased their total fat mass to a lower extent than their non-PA matched counterparts. 

(ii)  There is a positive relationship between the increment of total and trunkal fat mass, especially in non-active children.  In contrast there is an inverse relationship between total lean mass growth and the accumulation of total and regional fat mass. 

(iii) During the prepubertal years, PA children maintain their physical fitness and their body composition, while the less active children worsen.

Methodology

Pre- and post-study physiological assessment; fitness testing.

Source of reference

International Journal of Obesity, 30, 1062-1071

Web reference

www.nature.com/ijo

Links between high-impact sports and bone health in later life (Belgium, 2003)

Authors

Van Langendonck, l; Lefevre, J; Claessens, AL; Thomis, M; Philippaerts, R; Delvaux, K; Lysens, R; Renson, R; Vanreusel, B; Eynde, BV; Dequeker, J and Beunen, G

Date

2003

Keywords

Physical health; osteoporosis; sport; adolescents; boys; adults; men

Country of research

Belgium

Summary of findings

This longitudinal study examined whether participation in high impact sports during adolescence and adulthood contributes to bone health in males aged 40 years. 

Data were analysed on 154 Belgian men aged 13 years at the study outset in 1969 and aged 40 at the end of the 27 year follow-up.  Body mass and body mass index were determined and bone mineral density (BMD) of the lumbar spine and total body were determined via radiogrammetry at 13 and dual-energy x-ray absorptiometry at 40. 

Impact scores for sports were estimated based on a ranking of jumping actions (peak strain), explosive actions such as turning and sprinting, weight-bearing activities and other (least strain).  Regression analysis revealed that body mass and impact scores during adulthood were significant predictors of total body and lumbar spine BMD. 

These results indicated that type of sports participation is more important than time spent participating.  Additional analysis was undertaken by dividing the group into three types of sports participation, based on the ground reaction forces involved. 

Sports whose ground reaction forces were higher than four times body weight were regarded as high-impact sports (eg basketball, volleyball, gymnastics); two-four times were moderate-impact (tennis, soccer); one-two times were low-impact (jogging, ballroom dancing) and less than one time bodyweight were non-impact (cycling, swimming). 

Within this, three groups were analysed:

(i) participation during adolescence and adulthood in high impact sports (n:18);

(ii) participation during adolescence in high-impact sports and during adulthood in non-impact or no sports (n:15);

(iii) participation during adolescence and adulthood in non-impact or no sports (n:14). 

Analysis of variance revealed significant differences for lumbar spine BMD between the high impact group and the other two groups.  Total body BMD was also higher in the high impact group at age 40 years, but not significantly.  Covariance analyses for total body and lumbar spine BMD, with body mass and time spent participating confirmed these results.  Continued participation in impact sports is beneficial for the skeletal health of males aged 40 years.

Methodology

Longitudinal study

Source of reference

American Journal of Epidemiology, 2003, 158, 525-533

Web reference

http://aje.oupjournals.org/

Links between school sport and risky health behaviours (US, 1998)

Authors

Page, RM, Hammermeister, J, Scanlan, A and Gilbert, G

Date

1998

Keywords

Physical health; adolescents; health behaviour; sport

Country of research

United States of America

Summary of findings

This study investigated the relationship between participation in school sport and adolescent health behaviours in a nationally representative sample of 12,272 high school students. 

Male and female students reporting participation in one or two teams and three or more teams were significantly more likely to have not engaged in cigarette smoking and illegal drug use than those not playing on any sports teams. 

Although sports participation was not significantly associated with the likelihood of not ever having sexual intercourse, females who played one or more teams were significantly more likely to have not ever had a sexually transmitted disease and to not have been pregnant. 

Among sexually active students, sports participation was significantly associated with not having four or more sexual partners, the non-use of a condom during last sexual intercourse and the non-use of a method to prevent pregnancy (males only). 

In males, sports participation significantly increased the likelihood of smokeless tobacco and steroid use.  For both males and females the likelihood of carrying a weapon in the past 30 days and attempting suicide was reduced in those who played on one or two teams, compared to those not participating in school sports. 

However, the authors admit that, because this is a cross-sectional study it is not possible to determine the temporal relationship of the variables and address the issue of self-selection and interviewing variables.  To address such issues longitudinal studies are required.

Methodology

Survey

Source of reference

Journal of Health Education, May/June 1998, 29(3), 186-192.

Physical activity and sickness absenteeism (Netherlands, 2006)

Authors

van Amelsvoort, LGPM, Swaen, GMH and Kant, I

Date

2006

Keywords

General fitness and health, sport, physical activity, musculoskeletal disorders.

Country of research

Netherlands

Summary of findings

This study from the Netherlands reports on the relationship between self-reported leisure time physical activity and sickness absenteeism from work (self-reported and company data).  It collected data for 2,079 workers in 45 companies over a period of 54 months. 

Overall, the researchers found that 'active workers' (leisure time physical activity 2 or more times per week) reported significantly less sickness absence compared to inactive workers (physical activity once or less per week) - 14.8 days per year compared to 19.5., mainly due to a decrease in sick leave because of musculoskeletal disorders. 

They also found a small, not significant, positive effect for psychological problems.  Based on the costs due to lost workdays the authors estimate that being leisure time inactive was associated with a decreased productivity of 488 euros per worker per year. 

They conclude by arguing that seeking to discourage sports participation by making workers liable for workdays lost due to sporting injuries might be counter-productive and promoting workers' sports participation might lead to reduced absenteeism.

Methodology

Employer sickness absence records

Source of reference

Occupational Medicine, 56, 210-212

Web reference

http://occmed.oxfordjournals.org/

Teenage health and sport (Netherlands, 1999)

Authors

Kemper, HCG

Date

1999

Keywords

Physical health; sport; adolescents

Country of research

Netherlands

Summary of findings

This reviews six international longitudinal studies which included repeated measurements of maximal aerobic power.

The author illustrates a consistent general trend of a decrease in maximal aerobic power (VO2 max) relative to body weight between 12 and 18 years of age. This decrease is significantly greater for girls than boys. However, the data do not support the perception of a decline in VO2 max over the last 25 years.

Comparison of boys and girls from the Amsterdam Growth and Health Longitudinal study with different activity and sport participation between 12 and 21 years showed that the relative physically active boys and girls have significantly higher VO2 max values than their inactive counterparts.

The boys' superiority in aerobic fitness and the decline over age in both sexes is mainly caused by the difference in intensity and not duration of the physical activity.

Because the significantly higher VO2 max of the relatively active does not increase over the teenage years, this suggests that the differences in VO2 max between the high and low activity groups is not caused by the activity pattern itself, but is the other way round: boys and girls are more physically active because they have higher VO2 max.

Methodology

Review article

Source of reference

Medicina Sportiva, 1999, 3, (2), 85-102.

Web reference

Summary available at http://www.awf.krakow.pl/wydaw/ms990302.htm#kem1

Physical activity and breast cancer risk (US, 2007)

Authors

Dallal, CM; Sullivan-Halley, J; Ross, RK; Wang, Y; Deapen, D; Horn-Ross, PL; Reynolds, P; Stram, DO; Clarke, CA; Anton-Culver, A; Ziogas, A; Peel, D; West, DW; Wright, W and Bernstein, L

Date

2007

Keywords

Physical health; physical activity; cancer; breast cancer.

Country of research

United States of America

Summary of findings

This article reports on a longitudinal study (1995-2002) of more than 100,000 current and retired Californian female teachers to explore the association between recreational physical activity and the risk of invasive and in situ breast cancer. 

Participants provided information about their participation in moderate and strenuous recreational physical activities between high school and their current age or age 54 years if 55 years or older as well as recent activity. 

Participants were provided with examples of moderate activities (e.g. brisk walking, golf, volleyball) and strenuous activities (e.g. swimming laps, aerobics/callisthenics, running, jogging) and reported their mean hours per week and months per year.  A summary measure of long-term activity up to the current age was constructed for each woman. 

The results indicated that both invasive and in situ breast cancer were inversely associated with long term strenuous activity.  Strenuous and moderate activities were associated with reduced risk of estrogen receptor negative (although not estorgen receptor positive). 

Although they were unable to identify ages when physical activity might have its greatest impact and the participation data are based on self-report and recall, the authors conclude that their results support a protective role of strenuous long-term exercise activity against invasive and in situ breast cancer.

Methodology

Secondary analysis; longitudinal data.

Source of reference

Archives of Internal Medicine, 167(4), 408-415

Web reference

www.archinternmed.com

Physical activity and adolescent behaviour (US, 2006)

Authors

Nelson, MC and Gordon-Larsen, P

Date

2006

Keywords

Pgysical fitness and health, health behaviour, delinquency, self-esteem, physical activity, adolescents.

Country of research

United States of America

Summary of findings

The article reports on a study in the USA of the relationships between physical activity and sedentary behaviour patterns and a range of adolescent risk behaviours (e.g. truancy, cigarette smoking, sexual intercourse, delinquency), other weekly activities (e.g. work, academic performance) and self-esteem.  Data were used from the National Longitudinal Study of Adolescent Health, a nationally representative self-report survey, 1994-1996 (n:11,957).  Cluster analyses identified seven homogeneous groups based on PA and sedentary behaviours and statistical analysis predicted the relative risk of health risk behaviours, other weekly activities and self-esteem across the seven clusters, controlling for demographics and socioeconomic status.

Relative to high television and video viewers, adolescents in clusters characterised by skating and video gaming, high overall sports and sports participation with parents, using neighbourhood recreation centre, strict parental control of TV, reporting fewer activities overall and being active in school were less likely to participate in a range of risky behaviours.  Active teens were less likely to have low self-esteem and more likely to have higher grades.

The authors conclude that participation in a range of physical activity-related behaviour, particularly those characterised by high parental sport/exercise involvement was associated with favourable adolescent risk profiles.  In addition, adolescent involved in a variety of physical activities do not report reduced rates of other activities such as working for pay, doing home work and/or sleeping.  As with any secondary analysis the authors point to a number of limitations with the study.  These include self-reporting of behavioural measures, the changing nature of adolescent culture since 1996, missing data which might reduce the representativeness of the sample, and the inability to control for external factors such as school and local environment.  Nevertheless, the authors conclude that enhancing opportunities for physical activity and sport may have a beneficial effect on leading adolescent risk behaviours.

Methodology

Longitudinal data, survey data, self reporting.

Source of reference

Pediatrics, 117(4), 1281-1290

Web reference

www.pediatrics.org

Sport and sexual behaviour among students (US, 1999)

Authors

Miller, KE; Sabo, DF; Farrell, MP; Barnes, GM and Melnick, MJ

Date

1999

Keywords

Physical health; sport; sexual behaviour; pregnancy; adolescents

Country of research

United States of America

Summary of findings

Using a nationally representative sample of 8,979 high school students, this research examined the relationships between athletic participation and sexual behaviour, contraceptive use and pregancy in male and female students.

After controlling for race, and ethnicity, age and mother's education, girls who participated in sports had lower rates of sexual experience, fewer sexual partners, later age of first intercourse, higher rates of contraceptive use and lower rates of past pregnancy than girls who did not participate. Male school athletes reported higher rates of sexual experience and more partners than non-athletes. However, they were more likely to to use birth control during their most recent intercourse.

Cultural resource theory suggests that athletic participation may reduce girls' adherence to conventional cultural scripts while providing them with additional social and personal resources on which to draw in the sexual bargaining process. Sports provide boys with similar resources while strengthening their commitment to traditional male scripts.

Methodology

Survey data

Source of reference

Sociology of Sport Journal, 1999, 16, 366-387.

Effects of physical activity on one of the risk factors for stroke (US, 2002)

Authors

Rodriguez, CJ; Sacco, RL; Sciacca, RR; Boden-Albala, B; Homma, S and Di Tullio, MR

Date

2002

Keywords

Physical health; physical activity; stroke

Country of research

United States of America

Summary of findings

A case-control study design is used to investigate in a multi-ethnic population in Manhattan whether the risk of ischemic stroke associated with increased left ventricular mass is modified by the presence of physical activity and whether this effect is related to age or gender.

Previous studies have confirmed that left ventricular mass is a risk factor for stroke, after adjustment for other stroke risk factors, however this study is the first ever to investigate the relationship of left ventricular mass and physical activity on the risk of stroke.

In conclusion patients who had increased left ventricular mass without physical activity conferred the greatest risk of ischemic stroke, whereas the presence of physical activity reduced the stroke risk among those in the highest quartile of left ventricular mass down to a level comparable to that of patients without increased left ventricular mass. This benefit was apparent for light intensity activities, such as walking, and a modest incremental benefit may be gained from increasing the duration of activity.

The study suggests that the stroke risk associated with increased left ventricular mass may be potentially modifiable by nonpharmocologic means such as physical activity.

Methodology

Interview and medical data

Source of reference

Journal of the American College of Cardiology, 2002, 39, (9), 1482-1488.

Links between playing sport and feeling healthy (England, no date)

Authors

Farrell, L and Shields, MA

Date

No date

Keywords

Physical health; sport

Country of research

England

Summary of findings

Via a secondary analysis of data from the 1996 and 1997 English Health Education Monitoring Survey (age 16-74; n: 2318) the authors attempt to quantify the value of sports participation in explaining:

(i) the differences across the population in self-reported health and

(ii) changes in individual health over time (controlling for age, gender, ethnicity, education, employment status, household income and region of residence).

Sports participation was defined by 15 categories, measured over a four week period and respondents were asked about the usual length of each activity episode. 65.5 percent of the sample had taken part in sport in the four weeks prior toi interview, with the average number of minutes being 18.1 (19.3 in 1996 and 17.0 in 1997).

They also examine the impact of major life events on self-reported health. Using a series of statistical tests to explore causality, the authors conclude that individuals who participate regularly in sporting activities report significantly higher levels of general health than non-participants.

(i) Among participants, 41.8 percent reported very good levels of health compared to 28.9 percent of non-participants.

(ii) A much smaller proportion of sporting participants reported poor levels of health than non-participants, although not all participants reported good levels of health.

(iii) The effect of intensity (average daily duration of participation) of sports activities is significantly and positively related to self-reported health.

(iv) Being ill, experiencing problems at work, financial or family problems all result in significantly lower levels of health.

(v) Changing from a sport non-participant to being a participant is positively and significantly related to reported health.

However, there is a large degree of joint causality (i.e. individuals with very bad health cannot practically and physically participate in sports) which is dificult to fully disentangle. Overall the authors conclude that their results are consistent with a large body of medical and epidemiological literature and suggest that government initiatives aimed at widening access and participation in sports would have a positive impact on the population's health.

Methodology

Survey data

Source of reference

University of Melbourne mimeograph

Physical activity in adolescents and bone mass in later life (Sweden, 2006)

Authors

Barnekow-Bergkvist, M; Hedberg, G; Pettersson, U and Lorentzon

Date

2006

Keywords

Physical health, bone mineral density, physical activity, women, adults.

Country of research

Sweden

Summary of findings

This article reports on a longitudinal investigation as to whether physical activity and physical performance in adolescence are positively related to adult bone mineral density (BMD).  In 1974 a random selection of 204 Swedish female students aged 15-17 were investigated about their physical capacity and sports participation.  In 1994 BMD measurements were performed on 36 members of this group who agreed to participate and lived close to a hospital where the tests could be conducted.  Women who were members of a sports club in adolescence had significantly higher adult BMD (between 5%-17%) compared to non-members. 

Further, women with persistent weight-bearing activity in adulthood had significantly higher BMD compared to those who had stopped or had never been active.  Stepwise regression analysis showed that membership of a sports club at baseline was a significant independent predictor of BMD in the total body, lumbar spine, legs, trochanter and femoral neck, explaining 17%-26% of the variation in BMD. 

Change in body weight was a strong predictor of BMD of the total body and arms, explaining 8% of the variation.  Running performance at baseline was an independent predictor of total body BMD, whereas the two-hand lift performance significantly predicted BMD of the total body, legs and trochanter.  The hanging leg-lift and handgrip were both significant predictors of arm BMD. 

The authors conclude that membership of a sports club and site-specific physical performance in adolescence together with the change in body weight were significantly associated with the adult BMD in premenopausal women.  The study also suggests that the activities should be maintained through adult age to maintain the increase in BMD.

Methodology

Longitudinal study, bone mineral density measurements.

Source of reference

Scandinavian Journal of Medicine and Science in Sport, 16, 447-455

Web reference

http://www.blackwellpublishing.com/journal.asp?ref=0905-7188

Research priorities on physical activity and young disabled people (US, 1999)

Authors

Cooper, RA; Quantrano, LA; Axelson, PW; Harlan, W; Stineman, M; Franklin, B; Krause, JS; Bach, J; Chambers, H; Chao, EYS; Alexander, M and Painter, P

Date

1999

Keywords

Physical health; physical activity; disabilities

Country of research

United States of America

Summary of findings

This reports the results of a consensus process using selected experts in health and exercise in order to identify research priorities for physical activity and health among people with disabilities.

The consensus focused on five areas: epidemiology, cardiovascular health, pulmonary health, nutrition, and risk factors.

Epidemological research suggests an overall active and satisfying lifestyle is related to greater longevity. Physical activity protects agains cardiovascular disease and modifies associated risk factors (high blod pressure, obesity). Exercise for those with chronic lung disease has been shown to produce significant physical and psychological benefits.

The general conclusion is that the ability to exercise and maintain health differs substantially among people with disabilities and the general population.

Five areas have been identified as focal points for future research: epidemiological studies, effects of nutrition on health and ability to exercise, cardiovascular and pulmonary health, children with disabilities, and accessibility and safety of exercise programs.

The authors express the need for addressing long-term health issues and risk for secondary disability. Further, research studies need to be expanded to include people from a broad array of disability etiologies.

As a consequence of the consensus process, specific recommendations for future research regarding the impact of exercise on the health and quality of life of persons with disabilities were defined :

(i) Develop safe and effective exercise training programs for children with disabilities

(ii) Explain the effect of acute and chronic exercise on the metabolism of medications used by people with disabilities.

(iii) Describe the physical and psychological effects of physical activity on children with disabilites.

(iv) Clarify the influence of physical activity on disability during human development.

(v) Describe the influence of growth on locomotion efficiency.

(vi) Describe the effects of physical activity on the health of people with disabilities and chronic diseases.

It also provides the following policy recommendations:

(i) Physician's recommendations should be specific and focus on the helath/fitness goals of the individual and concomitant risk factors. Because of possible transportation difficulties home exercise should be considered.

(ii)   Health professionals should evaluate joint integrity, degree and areas of paralysis or spacticity and cardiac status. These will affect the mode, frequency and duration of activities.

(iii) If an individual is unable to tolerate the optimal aerobic intensity for cardiopulmonary reconditioning, a longer duration, more frequent sessions, or both, should be recommended. Lower intensity training levels can provide health benefits and the least fit show the greatest magnitude of improvement.

(iv) Establish short-term goals, promote positive reinforcement through periodic feedback of results, document individual achievement on progress charts and compare an individual's achievements to past status, rather than to established norms. Make it fun.

(v) Develop progressive programmes that are sufficiently practical, accessible and compatible with individuals' lifestyles so that the exercise will be continued on a long-term basis. Teach people with disabilities about the importance of alternating rest and activity to minimise fatigue and maximise conditioning benefits.

Methodology

Review of evidence and consensus process

Source of reference

Journal of Rehabilitation Research and Development, 1999, 36, (2), 142-154.

Web reference

http://www.vard.org/jour/99/36/2/coope362.htm

Risk due to inactivity in older people (US, 1993)

Authors

Simonsick, EM; Lafferty, ME; Phillips, CL and Mendes de Leon, CF

Date

1993

Keywords

Physical health; older adults; physical activity; mortality; stroke; diabetes; cardiovascular disease

Country of research

United States of America

Summary of findings

Using data from three geographical areas of the Established Populations for Epidemiologic Studies of the Elderly in the United States, the research examined the association between recreational physical activity by physically capable older adults (65 plus) and functional status, the incidence of selected chronic conditions and mortality over three and six years. Physical activity and evaluation of intensity and frequency were self-assessed and included a range of activities (walking, vigorous exercise, sports, gardening, housework).

The authors admit that this highly subjective approach means that distinctions between high and moderate activity were rather arbitrary. Health status was also self-rated and data were gathered about the prevalence of diabetes, angina, stroke, myocardial infraction and respiratory symptoms. It was found that:

(i) A high level of recreational physical activity reduced the likelihood of mortality over both three and six years. This is defined as performing vigorous exercise at least weekly and frequent walking.

(ii) Moderate to high physical activity reduced the risk of physical impairment over three years, but the effect diminished after six years.

There was no relationship between activity and new myocardial infraction or stroke, or the incidence of diabetes or angina after three or six years. Findings suggest that physical activity confers some benefits to physically capable older adults, primarily in reducing the risk of functional decline and mortality. More vigorous activity offers greater protection from impairment and mortality than moderate activity. However, this does not imply that only fitness promoting levels of exercise are required to receive benefits. Highly active individuals were pursuing activities well within the scope of a moderately active lifestyle.

Methodology

Longitudinal survey data

Source of reference

American Journal of Public Health, 1993, 83, (10), 1443-1450.

Web reference

http://www.ajph.org/

How exercise affects the heart over time (US, 2008)

Authors

Baggish, AL; Wang, F; Weiner, RB; Elinoff, JM; Tournoux, F; Boland, A; Picard, MH; Hutter, AM and Wood, MJ

Date

2008

Keywords

Physical health, exercise

Country of research

United States of America

Summary of findings

This article reports on a USA short longitudinal study over 90 days to investigate how exercise affects the heart over time.  The study was undertaken on two groups of Harvard University student athletes, with one group comprised of endurance athletes – rowers  ( 20 male; 20 female) and the second group  consisting of  strength athletes (35 male football players).  The groups were studied while participating in their normal team training developed by their coaches and trainers, and weekly training activity was recorded.  The research concern was with how the heart adapts to a typical season of competitive athletics.

Echocardiography studies - ultrasound examination of the heart's structure and function - were taken at the beginning and end of the 90-day study period.  Endurance training included one to three-hour sessions of on-water practice or use of indoor rowing equipment.  The strength athletes took part in skill-focused drills, exercises designed to improve muscle strength and reaction time, and supervised weight training.  Participants also were questioned confidentially about the use of steroids, and any who reported such use were excluded from the study.

At the end of the 90-day study period, both groups had significant overall increases in the size of their hearts.  For endurance athletes, the left and right ventricles - the chambers that send blood into the aorta and to the lungs, respectively - expanded.  In contrast, the heart muscle of the strength athletes tended to thicken, a phenomenon that appeared to be confined to the left ventricle.  The most significant functional differences related to the relaxation of the heart muscle between beats - which increased in the endurance athletes but decreased in strength athletes, while still remaining within normal ranges.  The authors conclude that just as not all heart disease is equal, not all exercise prescriptions are equal and that there is a need to tailor the type of exercise patients should do to their specific type of heart disease.  The functional differences raise questions about the potential impact of long-term training, which should be followed up in future studies.

Methodology

Echocardiography

Source of reference

Journal of Applied Physiology, 104(4), 1121-1128

Web reference

http://www.jap.org

Sports injury among teenage sports club members (Finland, 2009)

Authors

Mattila, VM; Parkkari, J; Koivusilta, L; Kannus, P and Rimpela, A

Date

2009

Keywords

Sport, participation, sport clubs, injury.

Country of research

Finland

Summary of findings

This Finnish prospective cohort study reports on injuries leading to hospitalisation among adolescent (14-18 years of age) members of sports clubs over an 11 year period.  The study combined data from the biennial Adolescent Health and Lifestyle Survey with the Finnish National Hospital Discharge Register and Official Cause of Death Statistics.  The follow-up period (1979-1997) ranged from 0 to 23 years with participants' mean average age of 26.5.  From the baseline respondent cohort of 57,407 the authors identified 5,889 (10.3%) who had sustained injury leading to hospital admission, with males (16.1%) much more likely than females (5.2%) to be injured. The most common anatomical locations for injuries were the knee and shin (23.9%); head and neck (17.8%); and ankle and foot (16.7%).  Fractures (30.4%) and distortions (25.4%) accounted for more than half of the hospitalisations.

There were no relationships between guardian's occupation and urbanisation level of residence (not surprising given the relatively egalitarian nature of Finnish society).  Overweight and chronic disease or disability predicted injuries only in females.  Daily smoking increased injury risk by 1.4 per cent in males and 1.3 per cent in females.  Males who reported recurring drunkenness in adolescence had 1.6 times the risk of injury hospitalisation compared with non alcohol users.  The strongest risk factors for injuries were related to frequent participation in sports clubs in adolescence.  After adjusting for all background variables the injury risk for males was – 1.2 times higher injury risk for those participating two or three times per week and 1.9  for those participating four or more times per week.  The equivalent figures for females were 1.1 and 2.4.  The frequency of other leisure-time physical fitness activity was not associated with injury hospitalisation.  Also the effect of increased injury risk persisted into early adulthood.

However the authors admit that they did not have information to determine whether injuries treated in hospitals were sports injuries.  They have assumed, on the basis of previous studies that sports injuries represent the most common injuries in this age group and the types of injuries recorded are those associated with sports injuries.

The authors conclude that effective preventative interventions directed towards adolescents who take part in sports clubs may decrease injury occurrence.

Methodology

Longitudinal study, secondary sources, medical data, survey data.

Source of reference

Scandinavian Journal of Medicine and Science in Sports, 19(2), 267-273

Web reference

http://www.wiley.com/bw/journal.asp?ref=0905-7188

Links between sports in adolescence and drinking, smoking and drug use later (Norway, 2009)

Authors

Wichstrom, T and Wichstrom, L

Date

2009

Keywords

Sports participation, health behaviour; adolescents.

Country of research

Norway

Summary of findings

This Norwegian longitudinal study explores the relationship between adolescent participation in different types of sports and levels of competition and certain forms of drug use in early adulthood.

The authors list five features of sport that may relate to young people's use of drugs: (i) social activity and involvement in drug-related networks; (ii) age segregation and not associating with older adolescents who smoke and drink; (iii) time consuming sport; (iv) adult supervision and monitoring; (v) orientation towards success and fitness. However, they point to and illustrate inconsistent research findings and the frequent absence of controls for third variables, which may explain the varying findings (e.g. family structure, pubertal timing, friends' substance abuse, grades, socio-economic status and social acceptance).  In this study the authors explore the influence of type of sport (team and individual); predominant skills needed (endurance, power, technical) and levels of competition on early adulthood drug use.

Data for the study was derived from the Young in Norway Study of students aged 12-20 from 63 representative schools. Data were collected in 1992, 1994, 1999 and 2006.  The final sample for the study was 3,251, with a mean age of 28.5.  Data were collected on sports participation, use of cannabis, alcohol and tobacco, family structure, parental occupation, academic grades and self-assessed pubertal timing compared to their peer group, friends' drug use.

Controlling for the range of potential cofounders, sports participation at the beginning of the study predicted growth in alcohol intoxication. Initial level of sports participation also predicted reduced growth in tobacco use via lower initial level of tobacco and cannabis use and higher social acceptance.   Those initially involved in team sports had increased growth in alcohol intoxication and those involved in endurance sports had reduced growth. Both team and endurance sports were related to reduced growth in tobacco use. Team sports participation predicted reduced growth in cannabis use, which is also related to reduce cannabis use. The authors suggest that the increase in use of alcohol by team sport participants concurs with the social influence explanation. As does the reduced growth in endurance sports which are held at weekends (precluding the Friday and Saturday night drinking). The authors suggest that team sport participation fosters socialisation into normative behaviour – getting drunk, but avoiding illicit drugs.

The authors offer three possible limitations of the study: (i) attrition rate in a multiple wave study and the possibility of different associations between those remaining in the sample and those dropping out; (ii) the study concentrated on organised sports and not physical activity; (iii) Norway is different from many other countries because of the high level of participation organised sports and with less gender-based differences in participation. They emphasise that the associations between sports participation and growth in drug use were small and that the reported estimates merely indicate possible causality.

Methodology

Longitudinal survey data

Source of reference

Addiction, 104, 138-149

Web reference

http://www.addictionjournal.org/

Sport and prevention of female osteoporosis (Japan, 2009)

Authors

Iwamoto, J; Sato, Y; Takeda, T and Matsumoto, H

Date

2009

Keywords

Physical health; exercise; bone mass; young women; women; menopause

Country of research

Japan

Summary of findings

This Japanese article provides a review of research evidence relating to the contribution which sport and exercise can make across the life span to the prevention of female osteoporosis. It argues that strategies for preventing osteoporotic fractures are: maximising peak bone mass (around the age of 20); counteracting age- and menopause-related bone loss; minimising an increase in spinal kyphosis (curvature of the upper back); and preventing falls. The maximum amount of bone a person can obtain in the first two decades of life is an important determination of bone mass in later life. Both calcium intake and physical activity are important, although whether they react synergistically is unclear.

In terms of maximising peak bone mass in the young the authors suggest that high impact mechanical loading is effective. In young adults higher bone mineral content and density have been found in strength and power-trained athletes, while endurance activities (running and swimming) seem less effective. During the prepubertal stage and very early stage of puberty, bone may be particularly responsive to weight-bearing and high-impact exercise. It appears that physical activity during the most active period of maturity plays a vital role in optimising peak bone mass and that benefits extend into adulthood. The results show that calcium intake and exercise seem more beneficial before menarche than after it. Although research in relation to adolescence is limited it seems that some types of sports are good for bone health (involving impact loading, muscle stress, gravitational forces). Female children who wish to be swimmers or long distance runners might need some interventions to increase bone mass before the menarche.

In terms of premenopausal women, resistance training and the provision of the optimum type and volume of loading are required. In terms of postmenopausal women, the evidence suggests that weight bearing and resistance exercises need to be combined with adequate calcium intakes. Spinal kyphosis can be minimised via exercises which strengthen the back extensor muscle. This can reduce thoracic hyperkyphosis, the incidence of vertebral fracture, loss of height and pain in the anterior rib cage.

In the elderly population sedentary women may prevent further bone loss by becoming active, although this is not a substitute for hormone replacement therapy). The optimal programme for older women will include activities that improve strength, flexibility and coordination that may indirectly but effectively decrease the incidence of osteoporotic fractures by lessening the likelihood of falling. There should be a combination of muscle strengthening exercises of the back and lower extremities, balance exercise and walking. Improvement of muscle power rather than muscle strength is most important to prevent falls.

The authors conclude that the aim of sport and exercise differs among ages in the maintenance of bone health in females. Appropriate sport activity and exercise maximise peak bone mass, reduce age-and menopause-relate bone loss, maintain physical functions and prevent falls.

Methodology

Literature review

Source of reference

Journal of Bone and Mineral Metabolism, 27, 530-537

Web reference

http://www.springerlink.com/content/101814/

Expert recommendations for physical activity for health (UK, 2010)

Authors

O'Donovan, G; Blazevich, AJ; Boreman, C; Cooper, A, Crank, H; Giles-Corti, B; Gill, JMR; Hamer, M; McDermott, I; Murphy, M; Mutrie, N; Reilly, JJ; Saxton, JM and Stamatakis, E

Date

2010

Keywords

Physical health; psychological well-being; physical activity; children; adults;

Country of research

United Kingdom

Summary of findings

This is a consensus statement prepared on behalf of the British Association of Sport and Exercise Sciences. This was deemed to be necessary because the guidelines had not been changed since 2004.

The review enabled an update of research published since 2004; the review might clarify the dose-response relationship between physical activity and health; the review might identify various ways of meeting the physical activity goals.

The experts produced literature reviews on physical activity and the prevention of overweight and obesity; the prevention of type 2 diabetes; the prevention of cardiovascular disease; the prevention of common cancers; psychological well-being;  minimal and optimal levels of physical activity and physical fitness;  health in children and adolescents; and the prevention of musculoskeletal injury. 

The reviewers considered the dose–response relationships and produced evidence statements on minimal and optimal levels of physical activity in men, women, and any sub-populations that might be at increased risk of chronic diseases. 

The literature reviews were circulated and discussed during a public meeting and comments recorded. In phase 2, summary reviews were circulated and members of the expert panel approved the recommendations in the document. In phase 3, three independent experts reviewed the document and it was revised in light of their comments.

The statement contains tabular summaries of the nature and strength of the evidence relating to causal relationships between physical activity and reduced risk of a range of chronic diseases. It also contains a series of tables outlining the perception of effort for various physical activities for males and females in different age ranges with varying levels of aerobic fitness.

In the ABC of Physical Activity for Health, A is for All healthy adults, B is for Beginners, and C is for Conditioned individuals.  The statement provides a comprehensive set of  recommendations as follows:

All healthy adults aged 18–65 years should aim to take part in at least 150 min of moderate intensity aerobic activity each week, or at least 75 min of vigorous-intensity aerobic activity per week, or equivalent combinations of moderate- and vigorous-intensity activities.

Moderate-intensity activities are those in which heart rate and breathing are raised, but it is possible to speak comfortably. Vigorous-intensity activities are those in which heart rate is higher, breathing is heavier, and conversation is harder. Aerobic activities should be undertaken in bouts of at least 10 min and, ideally, should be performed on five or more days a week.

All healthy adults should also perform muscle-strengthening activities on two or more days a week. Weight training, circuit classes, yoga, and other muscle-strengthening activities offer additional health benefits and may help older adults to maintain physical independence.

Beginners should work steadily towards meeting the physical activity levels recommended for all healthy adults. Even small increases in activity will bring some health benefits in the early stages and it is important to set achievable goals that provide success, build confidence, and increase motivation. For example, a beginner might be asked to walk an extra 10 min every other day for several weeks to slowly reach the recommended levels of activity for all healthy adults. It is also critical that beginners find activities they enjoy and gain support in becoming more active from family and friends.

Conditioned individuals who have met the physical activity levels recommended for all healthy adults for at least 6 months may obtain additional health benefits by engaging in 300 min or more of moderate-intensity aerobic activity per week, or 150 min or more of vigorous-intensity aerobic activity each week, or equivalent combinations of moderate- and vigorous-intensity aerobic activities.

Adults who find it difficult to maintain a normal weight and adults with increased risk of cardiovascular disease or type 2 diabetes may in particular benefit from going beyond the levels of activity recommended for all healthy adults and gradually progressing towards meeting the recommendations for conditioned individuals.

Physical activity is beneficial to health with or without weight loss, but adults who find it difficult to maintain a normal weight should probably be encouraged to reduce energy intake and minimize time spent in sedentary behaviours to prevent further weight gain. Children and young people aged 5–16 years should accumulate at least 60 min of moderate-to-vigorous-intensity aerobic activity per day, including vigorous-intensity aerobic activities that improve bone density and muscle strength.

The statement also outlines a range of strategies that may help to initiate and sustain physical activity. Policies and providers should help participants to:

  • Develop realistic expectations and a sense of patience and commitment.
  • Understand that the most important factor is building and sustaining regular engagement in physical activity. This should be prioritized and rewarded and celebrated through strategies and interactions.
  • Achieve steady progression through careful setting of short-term goals that have an element of flexibility.
  • Focus on building confidence, competence, and pride in achievements through steady progression.
  • Take responsibility in decision making and experience ownership for change to encourage self-determination and confidence.
  • Understand the importance of social support and explore ways in which they can find it.
  • Identify activity opportunities in their daily lives and localities in which they live and work.

The statement also reviews research on the role of the built environment and suggests that encouraging more physical activity in adults may require not just accessibility to walkable neighbourhoods (which do encourage recreational walking), but greater attention needs to be given to designing attractive and convivial neighbourhoods and facilities.

Methodology

Expert review panel

Source of reference

Journal of Sports Sciences, 28(6), 573-591

Web reference

http://www.tandf.co.uk/journals/titles/02640414.asp

The impact on health of major sport events (UK, 2010)

Authors

McCartney, G; Thomas, S; Thomson, S; Scott, J; Hamilton, V; Hanlon, P; Morrison, DS and Bond, L

Date

2010

Keywords

Major events; economic impact; health; volunteers.

Country of research

United Kingdom

Summary of findings

This article presents the findings of a systematic review of research evidence (1978-2008) relating to the relationship between large scale sports events and health and the socioeconomic determinants of health.  All studies which sought to assess such impacts were included. 

Those excluded were those which used exclusively estimated data that investigated host population support for an event or media portrayals of host cities, or that described new physical infrastructure. Studies were selected and critically appraised by two independent reviewers. Studies dealing with health, wellbeing, quality of life, health service use, physical activity access to services and transport, environment, crime, housing, demography and cultural and economic outcomes were included.

Fifty-four studies met the review criteria (although a further 34 could not be accessed), although their quality was low and characterised by a high risk of bias. The article provides two tables summarising the studies, their reported impacts and the assessment of the level of evidence.

The decrease in traffic and pollution during the period for two major events was associated with a reduction in paediatric hospital admissions for asthma. During the Sydney Olympics there was an increase in illicit drug-related hospital attendances.

In terms of recreation impacts one study indicated a decrease in overall sports participation following a major games, whereas another illustrated an upward trend associated with an Olympic Games.

The authors argue economic impact studies often use estimated data, have a short post-event data collection period and fail to take account of the opportunity costs of hosting large events.  Some with longer data collection report negative growth, detrimental impacts on employment, inflation and in one case delayed investment in health and education.  Other studies report that being a host city for the Olympic Games was associated with higher investment and business development activity.

In relation to volunteers two studies indicated a perceived increase in skills and one no change in desire to volunteer in future.

Other impacts reported included decrease in crime, increased satisfaction with local area and, in several places, increases in house prices, with impacts on tourism being variable.

The authors conclude that the evidence addressing the impact of major multi-sport events on health comprises a relatively small number of poor quality studies They believe that they have not overlooked a large positive effect of such events on health  nor on socioeconomic determinants of health.  The evidence does not refute expectations of a positive or negative legacy, but indicates that very little is known about the impacts of previous events.  The authors suggest that the evaluation of impacts needs to improve to allow decision-makers to make more informed judgements.  Until this happens they conclude that it is unclear how the costs can be justified in terms of host population benefits.

Methodology

Systematic review

Source of reference

BMJ, 340, c2369

Web reference

http://www.bmj.com/content/340/bmj.c2369.abstract

Links between playing sport and drinking alcohol among teenagers (UK, 2011)

Authors

Davies, FM and Foxall, GR

Date

2011

Keywords

Sport; adolescents; health; alcohol.

Country of research

United Kingdom

Summary of findings

The authors claim that this is the first UK investigation of the links between sporting involvement and alcohol consumption among high school students (most previous research is from the USA).  The authors provide a review of literature emphasising the intimate relationship between alcohol and sponsoring, watching and participating in sport.  They also review literature on, mostly USA, research on the use of alcohol by young athletes, which indicated that athletes were more likely than non-athletes to binge drink because of socialisation, celebration and stress management.  There were little differences between the alcohol consumption of female athletes and non-athletes. Some studies indicate that these patterns are established in secondary school.

This study was based on the theory of reasoned action to predict the likelihood of alcohol use (in the near future, 'next weekend' and the longer term) from attitudes to alcohol consumption and subjective norms (peer and parental attitudes; athlete and non-athlete friends) and their relationship to sporting involvement.  Within this context the study explored a number of hypotheses; Young male athletes will have a more positive attitude to drinking alcohol/getting drunk/believe that their peer group will approve of getting drunk than non-athletes.

The study was undertaken in a South Wales city via a self-completion questionnaire from Year 10 students (14/15 years old) in a stratified sample of five schools (prior focus groups were used to explore many of the issues).  There were a total of 296 satisfactorily completed questionnaires (164 males, 132 females).  Involvement in and identification with sport were measured using the Athletic Identity Measurement Scale.  Using a measure of 3 days participation per week and high importance, 66 boys and 18 girls were identified as athletes.  Current consumption, attitudes to alcohol and its consumption and perceived likelihood of short and long term consumption were measured.

The findings indicate that male athletes scored higher than non-athletes on all measures of intention to drink, or get drunk and showed a more positive attitude towards getting drunk, although not all differences were statistically significant.  However, they had a less positive attitude to drinking alcohol.  Male athletes believed that their friends would be more approving of drinking and getting drunk, although they had a less positive attitude to drinking alcohol.  Because the female sample of athletes was small (n: 18) the authors emphasise caution.  Means for the likelihood of drinking and getting drunk on the weekend were higher for female athletes than non-athletes; although differences were not statistically significant.  Female athletes had a significantly more negative attitude toward drinking alcohol and had more negative attitudes to drinking alcohol.  For female athletes, friends' approval of all drinking behaviours was slightly higher for female athletes than non-athletes (although it was only significant for approval of drinking at age 18).  Girls' current behaviour appeared to be highly influenced by their peer groups while for boys parental approval/disapproval was also significant.

The authors conclude that male teenage athletes appear to have a higher level of involvement with alcohol particularly in terms of excess consumption than non-athletes, although they may be ambivalent about whether this is a good thing. The evidence suggests that male athletes believe that they will consume alcohol and get drunk more often than non-athletes. There is little evidence that female athletes have or will have more involvement with alcohol.

The authors admit a number of limitations with the study: attitudes and intentions to consume alcohol are vulnerable to a number of competing pressures to conform to social and peer expectations; young males may exaggerate consumption and young women understate it; athletes may play down their consumption of alcohol. However they state that there is evidence that intentions are good predictors of behaviour in relation to alcohol consumption.

The authors conclude that males may be socialised at a relatively young age into a masculine culture in which alcohol is accepted as a normal accompaniment to sporting activity and this may affect their expectations of both current and future behaviour (despite having more negative attitudes to alcohol).  The authors speculate that perhaps the sports played by boys are more likely to have alcohol sponsorship than girls' sports; that boys' sports are more likely to have communal post games activities organised around alcohol; that certain sports attract risk takers with a propensity for sensation-seeking.  They propose that a larger sample of females is required to explore such issues and that any future research should include an analysis of the choice of preferred sports and psychometric analyses.

Methodology

Survey

Source of reference

Journal of Applied Social Psychology, 41(9), 2284-2311

Web reference

http://onlinelibrary.wiley.com/doi/10.1111/j.1559-1816.2011.00806.x/abstract

Promoting health among young people through physical activity (international collaboration, 2011)

Authors

Mountjoy, M; Andersen, LB; Armstrong, N; Biddle, S; Boreham, C; Bedenbeck, H-PB, Ekelund, U; Engebretsen, L; Hardman, K; Hills, A; Kahlmeier, S; Kriemler, S; Lambert, E; Ljungqvist, A; Matsudo, V; McKay, H; Micheli, L; Pate, R; Riddoch,C; Schamasch, P; Sundberg, CJ; Tomkinson, G; van Sluijs, E and van Mechelen, W

Date

2011

Keywords

Physical fitness and health; psychological well-being; physical activity; bone health; obesity; mental health; determinants.

Country of research

International collaboration

Summary of findings

This was produced by an expert group after a critical evaluation of scientific evidence as a basis for decision making (including a number of systematic reviews reported in this paper).  Its key purpose is to identify potential solutions through collaboration between sport and existing programmes and to review research gaps.  The paper provides a broad introduction stating that insufficient PA has been classified by the WHO as the fourth leading risk factor for global mortality from non-communicable diseases (NCDs) after hypertension, tobacco use and high blood glucose.  Insufficient PA is responsible for 5.5% of all deaths.  In addition, evidence shows that insufficient levels of PA are adversely affecting the health and the health trajectory of young people and PA levels are declining as they move through childhood into adolescence.

The paper admits the difficulties in measuring and interpreting the levels of young people PA and the limitations of self-report.  The recent use of accelerometry has increased knowledge of PA and how it is associated with health outcomes, although significant issues of interpretation remain.  Self-reported PA suggests that 30-40% of young people satisfy current health-related PA recommendations.  However accelerometry data indicate that they are achieved by less than 25% of young people

There are no widely recognised recommendations for health-related levels of aerobic fitness in youth and no compelling evidence to suggest that young people have low levels of peak VO2 or that they are less aerobically fit than young people of the previous generations.  There has been a very small decline of about 0.1% per decade in mass-related peak VO2 between 1962 and 1994.  In contrast, there has been a substantial deterioration of about 4.0% per decade in maximal aerobic performance, since 1975.  Declines in maximal aerobic performance are likely the result of a network of social, behavioural, physical, psychological and physiological factors.  In this context the paper provides a review of the evidence on the impact of this on cardiovascular and metabolic health.  It concludes that current scientific literature suggests that low levels of PA in young people are associated with higher levels of obesity, hypertension and cardiovascular risk factors, including increased instances of metabolic syndrome.

It reviews research evidence about PA and bone health and concludes that, taken together, a wide range of extra-curricular sports, other activities and targeted school-based programmes provide a weight-bearing stimulus that promotes young people's bone health.  With regard to obesity the paper states that in recent decades active behaviours have been displaced by more sedentary pursuits, which have contributed to reductions in PA energy expenditure.  While many reports suggest that young people's participation in organised sport and PA is high or has increased, incidental PA and exercise, including active transport such as walking to and from school, has declined.  The promotion of a healthy diet and of PA and exercise are equally important factors.

In terms of mental health, review-level evidence has shown small-to moderate beneficial effects for reduced depression and anxiety from PA, but the evidence base is weak and effects are small.  Little research has specifically addressed sports participation and mental health separate from PA more broadly.  The absence of adequate fitness levels can increase the risk of sports injuries.  The paper presents a review of related research and states that an ideal system for preventing sports injuries due to lower levels of fitness would entail a pre-participation evaluation of each participant followed by a training prescription to address individual deficits in fitness levels.

The paper presents a review of research evidence relating to correlates and determinants of PA and sedentariness, categorised into biological, psychosocial, behavioural, social and environmental factors. However, on the basis of two systematic reviews undertaken for the consensus statement, the paper concludes that there is little 'true' high-quality information about the determinants of PA in youth.  In terms of sedentary behaviour research indicates that time spent in sedentary behaviour is higher in lower socioeconomic groups, in older versus younger youth, in non-white youth, in more mature youth, and in young people who live in homes that present heavy exposure to electronic forms of entertainment.

On the basis of systematic reviews of intervention studies it is suggested that family-based interventions set in the home and including self-monitoring and goal setting may be a useful strategy to pursue.  Also creating safe environments in which young people can engage in free play or that they can use for active travel may have the potential to increase population levels of PA.  School-based interventions are thought to be the most universally applicable and effective way to counteract low PA, although little is known about their effect on out-of-school PA.  While the results support the effectiveness of school-based PA interventions there is a need to look at long-term effects and implementation strategies.

The consensus statement outlines the broad context for action:

The International Olympic Committee - The IOC has developed programmes for prevention of injuries and diseases in high level and recreational sports, including Periodic Health Exam, protection of the child athlete, consensus meeting on training of the elite athlete.

International Federations - Few have programmes that address inactivity in young people and they can be instrumental in supporting National Federation programmes that address inactivity in youth.

National Olympic Committees - A few National Olympic Committees (e.g. Canada) have developed programmes to promote PA and sport in young people.

The World Health Organization - The WHO and the IOC have agreed to cooperate to promote, physical activity and sport.  In 2010, the WHO published the Global Recommendations on Physical Activity for Health, which includes recommendations for 5-17 year olds.

International PA networks - There are two global and four regional PA promotion networks. Such networks can promote the health and fitness of young people in several ways: by providing exchange platforms and access to key experts; by analysing practice-led evidence to identify good practice, develop guidance and foster monitoring and evaluation by distributing recommendations to expert communities and local implementers; and by contributing to more effective dissemination of recommendations and good practice regionally, nationally or locally.

Non-governmental organizations - Such organisations use PA and sport as platforms to develop social capital and social cohesion.  There is, however, limited central coordination to promote interagency cooperation and inadequate evaluation of programme implementation.

Governments - Reviews of actions taken by governments in many countries show mixed results in terms of operationalised plans for sports and PA promotion.  Lessons learned from one programme, the Agita Galera Program, which deals with 6000 schools, and about 6 million students, in the State of Sao Paulo, Brazil, provided an opportunity for the government to identify and promote PA and sports participation, a surveillance system, and support for building partnerships; to build  infrastructures for sports participation; to facilitate the development and implementation of an eActive-School Curriculum; to promote active transport to school; and to incentivise the practice of PA and sports inside and outside school.

Education - Health and fitness promotion via PA represents a complex issue, which can only be resolved by multisectoral interventions.  The education sector and physical education comprises a primacy setting for interventions throughout formative development, which can influence positive attitudes and behaviours of young people.  Comprehensive whole-of-school approaches represent an effective strategy to address childhood physical inactivity.

Healthcare system - Through the provision of adequate education of primary healthcare professionals on the benefits and prescription of PA, the healthcare system can play an important role in the promotion of PA and sport involvement in young people.

The consensus statement ends with a series of detailed sector-specific recommendations and a range of recommendations for further research.

Methodology

Consensus process; expert review panel.

Source of reference

British Journal of Sports Medicine, 45, 839-848

Web reference

http://bjsm.bmj.com/content/45/11/839.full.pdf

Levels of physical activity achieved in organised youth sport (US, 2011)

Authors

Leek, D; Carlson, JA; Cain, K; Henrichon, S; Rosenberg, D; Patrick, K and Sallis, JF

Date

2011

Keywords

Physical fitness; sport; physical activity; exercise; boys; girls.

Country of research

United States of America

Summary of findings

This USA study used accelerometers attached to participants' wrists to examine the level of physical activity achieved by young people (7-14 years of age) during organised sports practices in soccer and baseball/softball.  A sample of 103 soccer players (55 boys; 48 girls) and 97 baseball/softball players (50 boys; 47 girls) was selected form various teams in local community leagues.  Cut off points were decided for measurement of light, moderate and vigorous physical activity based on criteria of the US Department of Health and Human Services, but the analysis was based on a combination of moderate and vigorous in a MVPA variable.  Data were collected by age and sex for each sport on minutes of physical activity spent in each level of intensity; participants' average minutes in MVPA; participants' mean minutes and percentage of practice time for each intensity level.

The findings indicated that fewer than one fourth of participants obtained the recommended 60 minutes of MPVA during practice and that there were substantial sport, age and sex differences.  Soccer players spent about 17 more minutes per practice in vigorous physical activity than baseball/softball players.  Girls were less active than boys by 11 minutes overall.  Only 2 per cent of girls obtained 60 or more minutes MYPA in baseball/softball practice compared to about 32 per cent of boys.  Owing to the extensive running in soccer, boys' and girls' MVPA levels were very similar.  Consistent age differences were found with 11-14 year old players obtaining about 7 fewer minutes of MVPA per practice than 7-10 year olds (perhaps because of the increased emphasis on skills).

Strengths of the study included: objective assessment of physical activity; comparison across sports/age/sex; multiple teams.  Weaknesses included: non-randomisation; cross-sectional design; possible under-estimation of intensities of upper-body activities common to baseball/softball such as throwing, catching and batting.

The authors conclude that although participation in youth sports contributes to overall physical activity this study illustrates that fewer than one fourth of participants obtained the recommended 60 minutes of MPVA during sports practices.  Further, there are clear differences between different types of sports (in this case soccer and baseball/softball) sexes and ages.  Surprisingly, youth sport players were inactive about 30 minutes during the average practice.  Consequently,   there is a need to adopt policies and practices that ensure sufficient levels of physical activity during practices, emphasising participation over competition sponsoring teams for all skill levels across all ages, increase practice frequency, extend short seasons, use pedometers or accelerometers during practices and provide coaches with strategies to increase physical activity.

Methodology

Cross-sectional; accelerometers.

Source of reference

Archives of Pediatrics and Adolescent Medicine, 165(4)

Web reference

http://archpedi.ama-assn.org/cgi/content/short/archpediatrics.2010.252

Bone health in adolescent cyclists (Spain, 2011)

Authors

Olmedillas, H; González-Agüero, A; Moreno, LA; Casajús, JA and Vicente-Rodríguez, G

Date

2011

Keywords

Physical health; sport; bone mass; bone mineral density; adolescents.

Country of research

Spain

Summary of findings

This Spanish study explored the bone status and bone mass in adolescent cyclists.  Twenty-two male road cyclists who had been training for a minimum of 2 years and a maximum of 7 years were compared to age-matched controls (n:22) involved in recreational sports activities.  The subjects were divided in 2 groups based on age: adolescents under 17 years (cyclists, n: 11; controls, n:13) and over 17 years (cyclists, n:11; controls, n: 9).  Peak oxygen uptake (VO2max) was measured on a cycloergometer.  Whole body, lumbar spine, and hip bone mineral content (BMC), density (BMD) and bone area were assessed using dual x-ray absorptiometry (DXA).  Volumetric BMD (vBMD) and bone mineral apparent density (BMAD) were also estimated.

The results indicated that the BMC of the cyclists was lower for the whole body, pelvis, femoral neck and legs; BMD for the pelvis, hip, legs and whole body and legs bone area was lower but higher in the hip area after adjusting by lean mass and height.  The BMC of young cyclists was 10% lower in the leg and 8% higher in the hip area than young controls.  The BMC of cyclists over 17 years was 26.5%, 15.8% and 14.4% lower BMC at the pelvis, femoral neck and legs respectively, while the BMD was 8.9% to 24.5% lower for the whole body, pelvis, total hip, trochanter, intertrochanter, femoral neck and legs and 17.1% lower the vBMD at the femoral neck.

The authors conclude that the adolescent cyclists had lower BMC and BMD compared with healthy age-matched controls in regions of clinical interest (hip, pelvis and femoral neck).  The study also shows that differences in BMC and BMD between cyclists and controls were higher in those over 17 years old.

The authors note some limitations: it cannot be concluded that the effect observed in older adolescents is due to the longer period (years) of practice of cycling rather than internal (i.e. genetic) or external (i.e. energy imbalance) factors; there is an absence of hormone and calcium intake data and this might affect bone acquisition.

The authors conclude that cycling training, may adversely affect bone mass during adolescence.  Although they warn that caution must be used in interpreting the results, the practice of cycling during adolescence may negatively affect bone health and compromise the acquisition of peak bone mass.

Methodology

Bone mineral density testing; fitness testing.

Source of reference

PLoS One, 6(9), e24841

Bone health in teenage female athletes (France, 2012)

Authors

Ferry, B; Lespessailles, E; Rochcongar, P; Duclos, M and Courteix, D

Date

2012

Keywords

Physical fitness and health; sport; bone mineral density; female.

Country of research

France

Summary of findings

This French study investigated the changes in hip structural parameters in high level female adolescent soccer players (n: 32) and swimmers (n: 26) over an eight month period.  All had been involved in their sport for between 6-7 years and all were postmenarcheal.   A non-active matched control group (n: 15) was also recruited.  Soccer training consisted of 225 sessions of 2 hours plus about 30 matches.  Swimmers trained 260 sessions with an average distance of 1500 km per season.

Testing was conducted at start and end of the eight months and measures were taken of: body height/body composition/lower limb composition/bone mineral content for lumbar spine and dominant hip.  A hip structural analysis was undertaken and estimation was made of daily calcium intake.

The major finding was that the weight bearing soccer-based physical activity improved both bone density and bone geometry.  Bone density did not change for swimmers, but increased for soccer players.  The results also indicated a potential harmful effect of intensive swimming training on bone tissue.  The swimmers had a higher daily calcium intake than is reported to influence bone density, suggesting that in non-deficiency subjects, calcium is of minor importance compared with physical practice in improving bone mass.

The authors conclude that a training session of soccer playing induced bone geometry improvement in late adolescent females even though this period of growth is currently described as a plateau for bone maturation.  The geometric changes had significantly increased the structural properties of bone and therefore could have increased its resistance to loading.  The absence of change in buckling ratio suggests that increased structural properties were insufficient to improve fracture resistance or that soccer's values at baseline were too high to improve.  The absence of changes in mechanical parameters related to bone geometry could suggest that swimming is not in favour for bone health.  Particular attention needs to be paid when an intensive training practice in unloaded sports is performed during childhood or adolescence.

Methodology

Bone mineral density measurements

Source of reference

Joint Bone Spine, In Press, Corrected Proof, Available online 9 March 2012.

Web reference

http://www.sciencedirect.com/science/article/pii/S1297319X12000103