Microsoft PowerPoint - Tremblay M.S. (Think Tank Abbreviated Symposium).ppt MOVING FORWARD BYMOVING FORWARD BY LOOKING BACK:LOOKING BACK: lessons learned from longlessons learned from long--lost lifestyleslost lifestyles Dr. Mark Tremblay, Ph.D., FACSMDr. Mark Tremblay, Ph.D., FACSM Chair, Active Healthy Kids CanadaChair, Active Healthy Kids Canada National: 48% 48% 47% 49% 46% 43% 50% 54%48% 52% 53% Current Physical Activity Levels in Current Physical Activity Levels in Canadian Youth, 12Canadian Youth, 12--19 y (>3 KKD)19 y (>3 KKD) Source: 2002/03 CCHS YOUTH WATCHING T.V.YOUTH WATCHING T.V. ((≥≥ 4 hours per day4 hours per day)) 0 10 20 30 40 50 60 11 yr boys 13 yr boys 15 yr boys 11 yr girls 13 yr girls 15 yr girls week days weekend days % Young People’s Health in Context: HBSC. WHO, 2004 Shields. Statistics Canada, 2005 PREVALENCE OF OVERWEIGHT AND OBESITY: Effects of screen-time Canadian children (ages 2-17) 0 5 10 15 20 25 30 35 40 <1 hour 1-2 hours 2+ hours obese overweight 0 1 2 3 4 Physical Activity and Clustered Physical Activity and Clustered Cardiovascular Risk in ChildrenCardiovascular Risk in Children O dd s R at io s of C V D R is k* Andersen et al. Lancet 368:299-304, 2006. *Composite risk factor score: SBP, triglyceride, TC/HDL, insulin resistance, SO4S, aerobic fitness 1 2 3 4 5 Physical Activity Quintile ““I like to play indoors better I like to play indoors better ’’cause thatcause that’’s where all the s where all the electrical outlets are.electrical outlets are.”” A Fourth-Grader in San Diego From R. Louv. Last Child in the Woods. 2005 NATURENATURE--DEFICIT DISORDERDEFICIT DISORDER IS OUR FRAME OF REFERENCE CHANGING? IS THE CHANGE TEMPORALLY UNSTABLE I S O U R F R A M E O F R E F E R E N C E C H A N G I N G ? sedentary 0 50 100 150 200 250 0 to 2 2 to 4 4 to 6 6 to 8 8+ sedentary DISTRIBUTION OF SEDENTARY BEHAVIOUR DURATION (hours) OF CHILDREN 8-13 yrs 0 5 10 15 20 25 30 35 Self-report Direct Measure % m ee ti ng g ui de lin es Is Our Frame of Reference Changing? Direct Measure vs Self-report Physical Activity NHANES and BRFSS Trends in Households with Entertainment Trends in Households with Entertainment Equipment that Promotes Sedentary BehaviourEquipment that Promotes Sedentary Behaviour 0 10 20 30 40 50 60 70 80 90 100 1981 1986 1991 1996 1997 1998 2002 % one TV cable 2+TV computer VCR/DVD internet Statistics Canada, 2001; 2004 “Hyper-parenting” “Are we are falling prey to the fantasy that we can engineer the perfect child?” ““Ironically the childhood obesity Ironically the childhood obesity epidemic has coincided with a epidemic has coincided with a dramatic increase in childrendramatic increase in children’’s s organized sportorganized sport.. This does not mean This does not mean that organized sports contribute to that organized sports contribute to obesity, but that an overobesity, but that an over--scheduled, scheduled, overover--organized childhood mayorganized childhood may”” R. Louv. Last Child in the Woods. (p.16) 2005 ““Recreation has gone from Recreation has gone from spontaneous to organized and spontaneous to organized and regimented activity: parents exercise regimented activity: parents exercise at the gym while the young play soccer at the gym while the young play soccer and hockey in leagues with schedules and hockey in leagues with schedules rather than in the backyard or the rather than in the backyard or the street in front. More time is often spent street in front. More time is often spent preparing for and getting there rather preparing for and getting there rather than on the activity itself.than on the activity itself.”” Friedman. Room For Thought. 2005 NSNS 0.77**0.77** 0.88*0.88* NSNS 1.19**1.19** 1.15*1.15* 1.36**1.36** 1.18*1.18* 0.76**0.76** NSNS NSNS 0.58**0.58** NSNS NSNS NSNS NSNS 1.51**1.51** NSNS 0.60**0.60** 1.36**1.36** Organized SportOrganized Sport Unorganized SportUnorganized Sport Art/Music/DanceArt/Music/Dance ClubsClubs Video GamesVideo Games TV 2TV 2--3 hrs/day3 hrs/day TV 3TV 3--5 hrs/day5 hrs/day Low SESLow SES High SESHigh SES Single ParentSingle Parent ODDS OF ODDS OF OVERWEIGHTOVERWEIGHT ODDS OF ODDS OF OBESITYOBESITY VARIABLEVARIABLE Tremblay and Willms. Int J Obese, 2003 A LITTLE MEANS A LOT!A LITTLE MEANS A LOT! THE CASE OF THE TV REMOTETHE CASE OF THE TV REMOTE •• Average age 78 yearsAverage age 78 years •• 20 years x 52 wks x 25 hrs/wk = 26,000 hrs of TV20 years x 52 wks x 25 hrs/wk = 26,000 hrs of TV •• 58 years x 52 wks x 12.5 hrs/wk = 37,700 hrs of TV58 years x 52 wks x 12.5 hrs/wk = 37,700 hrs of TV •• (26,000 + 37,700) x 5 CC/hr = 318,500 CC in lifetime(26,000 + 37,700) x 5 CC/hr = 318,500 CC in lifetime •• 318,500 x 0.5 kcal / CC = 159,250 kcals318,500 x 0.5 kcal / CC = 159,250 kcals •• 159,250 / 3,500 kcal / lb of fat159,250 / 3,500 kcal / lb of fat •• 45.5 pounds of fat!!!45.5 pounds of fat!!! What aboutWhat about ““incidental movementincidental movement”” oror ““lifestyle embedded activitylifestyle embedded activity”” oror NEAT?NEAT? A LOOK AT THE PAST Traditional Contemporary LIFESTYLELIFESTYLE RESULTSRESULTS Directly Measured Physical ActivityDirectly Measured Physical Activity •• Old Order MennonitesOld Order Mennonites ––↑↑ average movement counts per dayaverage movement counts per day ––↑↑ minutes of moderate physical activity (3minutes of moderate physical activity (3--6 METS)6 METS) ––↑↑ minutes of MVPA (3+ METS)minutes of MVPA (3+ METS) ––↑↑ total daily energy expendituretotal daily energy expenditure Tremblay et al., MSSE, 2005 Despite having no physical Despite having no physical education, no institutionalized education, no institutionalized sport, and low socioeconomic sport, and low socioeconomic status, Old Order Mennonite status, Old Order Mennonite children are more active than children are more active than children living a contemporary children living a contemporary Canadian lifestyle.Canadian lifestyle. Tremblay et al., MSSE, 2005 Steps/day in children (ages 6Steps/day in children (ages 6--12); 12); average of 4 weekdaysaverage of 4 weekdays 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000 Ca na da ( Am is h) Be lg iu m Sw ed en Cy pr us Au st ra lia US A (S ou th w es t) S te ps /d ay 0 500 1000 1500 Canada 2000 Canada 1900 Kenya 2000 school / OPA domestic transport leisure Energy Expenditure (kcal)Energy Expenditure (kcal) PHYSICAL ACTIVITY GUIDELINESPHYSICAL ACTIVITY GUIDELINES ↑↑ activity 90 min beyond currentactivity 90 min beyond current ↓↓ inactivity 90 min beyond currentinactivity 90 min beyond current Health Canada, 2002Health Canada, 2002 1 hr/day mod activity (1/2 if inactive)1 hr/day mod activity (1/2 if inactive) 2x/wk strength, flexibility, bone2x/wk strength, flexibility, bone HEA, 1998HEA, 1998 60 min from 3 or more bouts daily60 min from 3 or more bouts dailyNASPE, 1994NASPE, 1994 active daily, 3x20 min MVPA/wk (Y)active daily, 3x20 min MVPA/wk (Y)Int. Consensus, 1994Int. Consensus, 1994 2020--30 min vigorous each day (C+Y)30 min vigorous each day (C+Y)ACSM, 1988ACSM, 1988 GUIDELINEGUIDELINEGROUPGROUP 0 30 60 90 120 150 180 210 240 270 300 M in o f M V P A p er d ay PROPORTION OF CHILDREN MEETING GUIDELINES 100% 96% SUBJECT ID# Tremblay. CPHI Report, 2003 USK CHILDREN MEETING USK CHILDREN MEETING GUIDELINESGUIDELINES 0 20 40 60 80 100 AV MVPA AL MVPA AV MVPAb AL MVPAb >30 min >60 min P E R C E N T M E E TI N G G U ID E LI N E CHMS 2007CHMS 2007--0808 0 5 10 15 20 25 30 35 Self-report Direct Measure % m ee ti ng g ui de lin es Direct Measure vs Self-report Physical Activity NHANES and BRFSS OUR CHALLENGE!OUR CHALLENGE! •• Reduce time reference from an hour to a minuteReduce time reference from an hour to a minute •• Reduce activity reference from 200 kcal to 2 kcalReduce activity reference from 200 kcal to 2 kcal •• Reduce exercise ref to a few muscle contractionsReduce exercise ref to a few muscle contractions •• Reduce Reduce autodependencyautodependency •• Reduce financial dependencyReduce financial dependency •• Reduce reward (food, awards, prizes) dependencyReduce reward (food, awards, prizes) dependency •• Reduce institutional approaches and dependenciesReduce institutional approaches and dependencies •• Reduce natureReduce nature--deficit disorderdeficit disorder •• Reduce screen timeReduce screen time •• Reduce chair timeReduce chair time •• Get back to the basicsGet back to the basics