Steven N. Blair Professor Departments of Exercise Science and Epidemiology & Biostatistics

1. Physical Activity and Public Health around the World: The Toronto Charter and ISPAHPhysical Activity and Public Health SeminarSeptember 16, 2011Hilton Head, SC Steven N. Blair Professor Departments of Exercise Science and Epidemiology & Biostatistics University of South Carolina

2. Disclosures • Medical/Scientific Advisory Boards • Jenny Craig, Inc • Alere • Technogym • Cancer Foundation for Life • Santech • Clarity Project • Research Funding • NIH • Body Media • Coca Cola • Department of Defense

3. Acknowledgments • Adrian Bauman • Fiona Bull • Bill Kohl • Scientists who started us on this journey • Jeremy Morris • Marti Karvonen • Ralph Paffenbarger • Per-Olaf Astrand

4. Lecture Outline • Benefits of activity for adults • Pathway to the Toronto Charter • International Congress on Physical Activity and Public Health • International Society for Physical Activity and Health • Review of the Toronto Charter • Next steps

5. Major Health Concerns of Adults • The three D’s • Death • Disability • Dementia

6. Cardiorespiratory Fitness and All-Cause Mortality, Women and Men ≥60 Years of Age • 4060 women and men ≤60 years • 989 died during ~14 years of follow-up • ~25% were women • Death rates adjusted for age, sex, and exam year All-Cause death rates/1,000 PY Age Groups Sui X et al. JAGS 2007.

7. Prevalence of Self-reported Functional Limitations by Fitness and Age Groups *Prevalence (%) Huang et al. MSSE 1998, 30:1430-5

8. Cardiorespiratory Fitness and Risk of Dementia, ACLS • 59,960 women and men • Followed for 16.9 years after clinic exam • 4,108 individuals died • 161 with dementia listed on the death certificate • Hazard ratio adjusted for age, sex, exam yr, BMI, smoking, alcohol, abnormal ECG, history of hypertension, diabetes, abnormal lipids, and health status Hazard Ratio P for trend=0.002 Fitness Categories Lui R et al. In press. MSSE

9. Forestry Work

10. Supervisory Work

11. Is Exercise Safe?

12. LIFE-P Serious adverse events J Gerontol Biol Sci Med Sci 2006;61:1157

13. Lecture Outline • Benefits of activity for adults • Pathway to the Toronto Charter • International Congress on Physical Activity and Public Health • International Society for Physical Activity and Health • Review of the Toronto Charter • Next steps

14. Jeremy Morris & Ralph Paffenbarger Per-Olaf Åstrand Marti Karvonen with Rhonda Pollock, Linda Franklin, & Jane Blair

15. Lecture Outline • Benefits of activity for adults • Pathway to the Toronto Charter • International Congress on Physical Activity and Public Health • International Society for Physical Activity and Health • Review of the Toronto Charter • Next steps

16. Slide from Bill Kohl

17. Slide from Bill Kohl

18. About ISPAH The International Society for Physical Activity and Health, founded in 2009, is an international professional society of individual members who are interested in advancing the science and practice of physical activity and health. Slide from Bill Kohl

19. Mission To advance health through scientific study and the promotion of physical activity. Slide from Bill Kohl

20. Councils Thematic councils are organized to help ISPAH members align with specific areas of interest in the broad field of physical activity and health. • Global Advocacy for Physical Activity (GAPA) – Advocacy Council of ISPAH • Council on Physical Activity Assessment & Surveillance (PAAS) • Council on Activity Interventions (PAI) • Council on Physical Activity and Obesity (PAO) • Council on Environment & Physical Activity (CEPA) Slide from Bill Kohl

21. Slide from Bill Kohl

22. Lecture Outline • Benefits of activity for adults • Pathway to the Toronto Charter • International Congress on Physical Activity and Public Health • International Society for Physical Activity and Health • Review of the Toronto Charter • Next steps

24. Slide from Bill Kohl

25. The Writing Team (the « Chartists ») Slide from Fiona Bull

26. Final Charter: 6 pages / 5 key sections Slide from Fiona Bull

27. A Framework for Action Slide from Fiona Bull

28. 7 Investments that work for physical activity Public education, including mass media to raise awareness and change social norms on physical activity Community-wide programs involving multiple settings and sectors & that mobilize and integrate community engagement and resources Sports systems and programs that promote ‘sport for all’ and encourage participation across the life span • Whole-of-school’ programs • Transport policies and systems that prioritise walking, cycling and public transport • Urban design regulations and infrastructure that provides for equitable and safe access for recreational physical activity, and recreational and transport-related walking and cycling across the life course • Physical activity and NCD prevention integrated into primary health care systems Slide from Fiona Bull

29. Web based sign up of support underway • Visit www.globalpa.org.uk • We monitor number of supporters • By country / region • By individual / organisations • With national and International endorsements this increases the influence and value of the Charter to all that use the Charter Sign up board at the 3rd ICPAH Toronto 5-8 May 2010 Slide from Fiona Bull

30. Available in: Arabic Catalan Czech Dutch English French German Italian Japanese Norwegian Portuguese Russian Spanish Thai Turkish Others underway: Bengali Chinese (2) Greek Hindi Korean Polish Solvene Slovak Translation Available at www.globalpa.org.uk Slide from Fiona Bull

31. Latin American Launch: Oct 2010 AGITA MUNDO MEETING Slide from Fiona Bull

32. How is the Charter being used? • To build partnerships beyond health - with sectors interested and relevant to actions on physical activity • To meet with politicians and decision makers to raise their knowledge and discuss actions and commitment • To support funding requests for projects • To plan national and sub national action plans on physical activity Slide from Fiona Bull

33. Advocacy Resources • Bull FC and Bauman AE. Physical Inactivity – the ‘Cinderella’ risk factor for NCD prevention. Journal of Health Communication. In Press. • Bull FC. (2011). Global Advocacy for Physical Activity- Development and Progress of the Toronto Charter for Physical Activity: A Global Call for Action. Research in Exercise Epidemiology, 13(1), 1-12. [link from GAPA website] Slide from Fiona Bull

34. Lecture Outline • Benefits of activity for adults • Pathway to the Toronto Charter • International Congress on Physical Activity and Public Health • International Society for Physical Activity and Health • Review of the Toronto Charter • Next steps

35. All countries should develop a national physical activity plan

36. What is a Physical Activity Plan? • A comprehensive set of strategies including policies, practices, and initiatives aimed at increasing physical activity in all segments of the population.

37. U.S. National Physical Activity Plan www.physicalactivityplan.org

38. Organizational Partners American Academy of Pediatrics American Medical Assoc. American Diabetes Assoc.

39. Sectors • Mass Media • Public Health • Education • Healthcare • Volunteer and Non-Profit Organizations • Transportation, Urban Design, Comm. Plan. • Business and Industry • Parks, Recreation, Fitness, and Sports

40. Content of the Plan • 5 Overarching Strategies • Sector-specific Strategies & Tactics • 52 Strategies • 215 Tactics

41. Upcoming international activities related to physical activity and public health

42. The United Nations is interested in non- communicable diseases

43. Fogarty International Center—NIHRussian Academy of ScienceMoscow, November 16-18, 2011 • Scientific forum for biomedical and behavioral research • Brain sciences • Cancer • Cardiovascular disease • Clinical/translational research training • Healthy lifestyles • Human development • Infectious diseases • Rare diseases

44. Sydney Australia 2012 31st October – 3rd November Slide from Adrian Bauman

45. Time for the Pop Quiz

46. Which causes more deaths in the U.S.—smoking or obesity? • ~40% of U.S. adults think obesity causes at least as many deaths as does smoking • ~20% of U.S. adults think obesity causes more deaths than smoking • The truth • Smoking causes ~440,000 deaths/year • Obesity causes ~110,000 deaths/year

47. Definitions for adultsBody mass index (BMI) – weight/height 2 • Underweight: BMI < 18.5 • Normal weight: BMI 18.5-<25 • Overweight*: BMI 25-<30 • Obesity: BMI 30 + * WHO defines overweight as BMI 25+ Courtesy of Katherine Flegal

48. SOURCE: Harris 2008 Int J Obesity Courtesy of Katherine Flegal

49. SOURCE: Harris 2008 Int J Obesity Courtesy of Katherine Flegal

50. SOURCE: Harris 2008 Int J Obesity Courtesy of Katherine Flegal