Physical Activity Epidemiology

Rod K. Dishman, PhD, is a professor emeritus of the University of Georgia, where he taught courses in exercise science and psychology and served as the director of the exercise psychology laboratory. Dishman is a reviewer for more than 50 journals, including Journal of the American Medical Association (JAMA), The Lancet, and American Journal of Public Health. He has served on the editorial boards of numerous journals in preventive medicine and public health, such as Exercise and Sport Sciences Reviews, Medicine & Science in Sports & Exercise, and Health Psychology. He has been an exercise consultant to public health agencies in the United States, Canada, and Europe. He has published over 200 peer-reviewed articles and written or edited several books related to physical activity and health. Dishman is an American College of Sports Medicine (ACSM) fellow and has served as a member of their research advisory committee and board of trustees. In 2016, he received ACSM’s Citation Award. He was a member of the jury for selection of the Olympic Prize in Sport Science awarded by the International Olympic Committee's Medical Commission and served on the scientific advisory committee for the 2008 Physical Activity Guidelines for Americans. Gregory Heath, DHSc, MPH, is Guerry professor emeritus of 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. In 2019, he edited Physical Activity & Public Health: A Practitioner’s Guide, published by the American Public Health Association (APHA Press). Heath is a fellow of the American College of Sports Medicine, where he has served as a vice president and on the board of trustees. He is also a fellow on the Council on Epidemiology and Prevention in the American Heart Association. 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. Heath has been contributing to the field of exercise science and health promotion for over 35 years. Michael D. Schmidt, PhD, is an associate professor and graduate program coordinator in the department of kinesiology and an adjunct assistant professor in the department of epidemiology and biostatistics at the University of Georgia. Schmidt earned a master’s degree in exercise physiology and a doctoral degree in epidemiology, each from the University of Massachusetts in Amherst. Schmidt is a productive scholar with special training in the measurement of physical activity and sedentary behavior and research foci on obesity and cardio-metabolic health outcomes. He has served as a research fellow in the cardiovascular disease and diabetes unit at the Menzies Institute for Medical Research in Hobart, Australia, where he was celebrated as an Honorary Research Associate from 2008 to 2013. In 2007, Schmidt was awarded the postdoctoral research fellowship in public health by the National Heart Foundation of Australia. I-Min Lee, MBBS, MPH, ScD, is a professor of medicine at Harvard Medical School, a professor of epidemiology at the Harvard T.H. Chan School of Public Health, and an epidemiologist at Brigham and Women's Hospital in Boston. A reviewer for over 30 journals, including The Lancet and New England Journal of Medicine, Lee has served on the editorial boards for Harvard Health Publications, Harvard Women’s Health Watch, Contemporary Clinical Trials, British Journal of Sports Medicine, Medicine & Science in Sports & Exercise, and Brazilian Journal of Physical Activity and Health. She has authored over 500 scientific publications and is a frequent invited speaker at local, national, and international levels. 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. Lee also served on the scientific advisory committee for the 2008 Physical Activity Guidelines for Americans, and in 2010 she was on the expert panel for the World Health Organization’s Global Recommendations on Physical Activity for Health. In 2013, she contributed to AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk. Lee is the recipient of numerous awards and recognitions, in particular 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).

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 Sedentary Behavior?
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
Leisure-Time Physical Activity and All-Cause Mortality: Exemplar Cohort Studies
Resistance (Strengthening) Exercise and All-Cause Mortality
Device-Measured Physical Activity
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
Treatment of Ischemic 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
Strength of 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
Bone Measurement Techniques
Risk Factors and Prevention
Pharmacotherapy for Osteoporosis
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
The Evidence for Physical Activity: Specificity of Protection?
Colon and Rectal Cancer
Breast Cancer
Lung Cancer
Endometrial Cancer
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 Systems
Immunotherapy in Cancer
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
Anxiety Disorders
Cognitive Function and Dementia
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 Among People With Disabilities
Role of Physical Activity in the Promotion of Health
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
Types of 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