Physical Activity Epidemiology

Rod K. Dishman, PhD, is a professor of exercise science, adjunct professor of psychology, and the director of the Exercise Psychology Laboratory at the University of Georgia at Athens. He is also adjunct professor in the Arnold School of Public Health at the University of South Carolina at Columbia. Dr. Dishman is a reviewer for more than 50 journals, including Journal of the American Medical Association (JAMA) and American Journal of Public Health. He has served on editorial boards of numerous journals in preventive medicine and public health, such as Exercise and Sport Science Reviews, Medicine & Science in Sports & Exercise, and Health Psychology and as an exercise consultant to public health agencies in the United States, Canada, and Europe. He has published approximately 150 peer-reviewed articles and written or edited several books related to physical activity and health. Dr. Dishman is an American College of Sports Medicine fellow, where he has served as a member of the Research Advisory Committee and the Board of Trustees. He was a member of the jury for selection of the Olympic Prize in Sport Sciences awarded by the International Olympic Committee's Medical Commission and served on the scientific advisory committee for the 2008 Physical Activity Guidelines for Americans. He resides in Athens, Georgia. Gregory Heath, DHSc, MPH, has been contributing to the field of exercise science and health promotion for over 25 years. Dr. Heath is Guerry professor and head of the department of health and human performance at the University of Tennessee at Chattanooga. Previously, he worked at the Centers for Disease Control and Prevention as lead health scientist in the Physical Activity and Health Branch. He has extensive experience in conducting studies and data analyses in the areas of physical activity epidemiology and public health practice. Dr. Heath is a fellow in the Council on Epidemiology and Prevention, the American Heart Association, and the American College of Sports Medicine. He earned his doctor of health science degree in applied physiology and nutrition and his master's of public health in epidemiology from Loma Linda University. I-Min Lee, MBBS, MPH, ScD, is an associate professor of medicine at Harvard Medical School, an associate professor of epidemiology at Harvard School of Public Health, and associate epidemiologist at Brigham and Women's Hospital in Boston. Her main research interest is in the role of physical activity in promoting health and preventing chronic disease. This extends to characteristics associated with a physically active way of life, such as maintenance of ideal body weight. She also is concerned with issues relating to women's health. Lee has published more than 190 peer-reviewed articles and is a frequent invited presenter, teacher, and speaker at local, national, and international levels. A reviewer for 30 journals, including Lancet and New England Journal of Medicine, Lee also serves on the editorial board for Harvard Women’s Health Watch, Medicine & Science in Sports & Exercise, and the Brazilian Journal of Physical Activity and Health. Lee is an elected member of the American Epidemiological Society and a member of the Society for Epidemiologic Research, the American Heart Association, and the International Society for Physical Activity and Health. She is a member and fellow of the American College of Sports Medicine (ACSM) and has served on the ACSM’s Research Advisory Committee and Board of Trustees. Dr. Lee also served on the scientific advisory committee for the 2008 Physical Activity Guidelines for Americans. Lee is the recipient of numerous awards and recognitions, in particular the Young Epidemiologist Award from the Royal Society of Medicine in the United Kingdom (1999); the William G. Anderson Award from the American Alliance for Health, Physical Education, Recreation and Dance (2007); the Charles C. Shepard Award from the Centers for Disease Control and Prevention (2009); and the ACSM’s Citation Award (2011). Lee resides in Brookline, Massachusetts.

Part I. Introduction to physical Activity Epidemiology

Chapter 1. Origins of Physical Activity Epidemiology

Ancient History of Physical Activity and Health

Modern History of Physical Activity and Health

Physical Activity for Health Promotion in the United States and the World

Summary

Bibliography

Chapter 2. Concepts and Methods in Physical Activity Epidemiology

Epidemiologic Measures

Crude, Specific, and Standardized Rates

Research Design in Epidemiologic Studies

Evaluating Associations in Epidemiologic Studies

Models in Physical Activity Epidemiology

Inferring Cause in Epidemiologic Studies

Criteria for Causation

Summary

Bibliography

Chapter 3. Measurement and Surveillance of Physical Activity and Fitness

Why Is Behavioral Epidemiology Important?

What Is Physical Activity?

Measures of Physical Activity

What Is Physical Fitness?

Surveys and Surveillance of Physical Activity

Summary

Bibliography

Part II. Physical Activity and Disease Mortality

Chapter 4. All-Cause Mortality

Life Expectancy at Birth

Major Causes of Mortality

Physical Activity and All-Cause Mortality

Sedentary Behavior and All-Cause Mortality

Physical Fitness and All-Cause Mortality

Changes in Physical Activity or Fitness and All-Cause Mortality

Are the Associations Real?

Strength of the Evidence

How Much Physical Activity Is Needed to Decrease Risk of Premature Mortality?

Summary

Bibliography

Chapter 5. Coronary Heart Disease

History and Magnitude of the Problem

Coronary Heart Disease Risk Factors

Coronary Heart Disease Etiology

Physical Activity and Coronary Heart Disease

Sedentary Behavior and Coronary Heart Disease Risk

Physical Fitness and Coronary Heart Disease Risk

Individuals With Other Risk Factors or Existing Coronary Heart Disease

Physical Inactivity Compared With Other Risk Factors

Are the Associations Real?

Strength of the Evidence

How Much Physical Activity Is Needed to Decrease Coronary Heart Disease Risk?

Summary

Bibliography

Chapter 6. Cerebrovascular Disease and Stroke

Magnitude of the Problem

Risk Factors for Stroke

Etiology of Stroke

Physical Activity and Stroke Risk: The Evidence

Strength of the Evidence

Summary

Bibliography

Part III. Physical Activity and Risk Factors

Chapter 7. Physical Activity and Hypertension

Magnitude of the Problem

Treating Hypertension

Hypertension Etiology

Autonomic Nervous System

Physical Activity and Reduced Hypertension Risk: The Evidence

Physical Activity and Treatment of Hypertension: The Evidence

Strength of the Evidence

Summary

Bibliography

Chapter 8. Physical Activity and Dyslipidemia

Magnitude of the Problem

Drug Treatment

Dyslipidemia Etiology and Physical Activity

Physical Activity and Lipoprotein Levels: The Evidence

Strength of the Evidence

Summary

Bibliography

Chapter 9. Physical Activity and Obesity

Magnitude of the Problem

Treatment of Overweight and Obesity

Assessing and Defining Overweight and Obesity

Etiology of Overweight and Obesity: Set Point or Settling Point?

Physical Activity and Fitness and the Health Risks of Obesity: The Evidence

Physical Activity and Prevention of Excess Weight Gain: The Evidence

Physical Activity and Weight Loss: The Evidence

Physical Activity and Weight Maintenance: The Evidence

The Ultimate Goal: Weight Loss or Risk Reduction?

Summary

Bibliography

Part IV. Physical Activity and Chronic Diseases

Chapter 10. Physical Activity and Diabetes

Magnitude of the Problem

Demographics of Diabetes

Clinical Features

Health Burden of Diabetes

Risk Factors

Insulin and Glucose Transport

Etiology of Type 2 Diabetes

Effects of Physical Activity on Diabetes Risk: The Evidence

Strength of the Evidence

Summary

Bibliography

Chapter 11. Physical Activity and Osteoporosis

Magnitude of the Problem

Fractures and Mortality

Etiology of Osteopenia and Osteoporosis

Risk Factors and Prevention

Bone Measurement Techniques

Physical Activity and Osteoporosis: The Evidence

Strength of the Evidence

Summary

Bibliography

Part V. Physical Activity, Cancer, and Immunity

Chapter 12. Physical Activity and Cancer

Magnitude of the Problem

Etiology of Cancer

Risk Factors

Population Studies of Physical Activity: Specificity of Protection?

Colon and Rectal Cancer

Breast Cancer

Other Cancers

Physical Activity and Cancer Survivors

Summary

Bibliography

Chapter 13. Physical Activity and the Immune System

An Abridged History of Immunology

HIV and AIDS

The Immune System

Immunomodulation by the Nervous and Endocrine System

Physical Activity and Immunity: The Evidence

Mechanisms of Alterations in Monocytes, Granulocytes, and Natural Killer Cells After Acute Exercise

Exercise and Cytokines

Summary

Bibliography

Part VI. Physical Activity and Special Concerns

Chapter 14. Physical Activity and Mental Health

Depression

Magnitude of the Problem

Results From the National Comorbidity Survey

Etiology of Depression

Brain Neurobiology in Depression

Treatment of Depression

Physical Activity and Depression: The Evidence

Anxiety Disorders

Magnitude of the Problem

Etiology of Anxiety Disorders

Brain Neurobiology in Anxiety Disorders

Treatment of Anxiety Disorders

Physical Activity and Anxiety: The Evidence

Cognitive Function and Dementia

Physical Activity and Cognitive Function: The Evidence

Summary

Bibliography

Chapter 15. Physical Activity and Special Populations

Physical Activity Among Diverse Racial–Ethnic Populations

Physical Activity and Disability

Inactivity and Aging

Physical Activity and Long-Term Health Amoung People With Disabilities

Role of Physical Activity in the Prevention of Secondary Complications

Summary

Bibliography

Chapter 16. Adverse Events and Hazards of Physical Activity

Magnitude of the Problem

Evaluating Risk

Methods of Research

Myocardial Infarction and Sudden Death

Joint and Muscle Injury

Injury Features

Risk of Physical Activity Injuries: The Evidence

Other Medical Hazards

Psychological Hazards

Summary

Bibliography

Chapter 17. Adopting and Maintaining a Physically Active Lifestyle

Individual Barriers to Physical Activity

How Do People Decide to Be Active?

Environmental Barriers to Physical Activity

Genetics of Physical Activity

Environmental Intervention and Self-Regulation

Effectiveness of Physical Activity Interventions

Interventions to Increase Physical Activity

Mediators and Moderators of Physical Activity Change and Interventions

Features of Physical Activity That Promote Adoption and Maintenance

Summary

Bibliography