Physical Activity & Health: New Knowledge in Research & Technologies
This session was sponsored by ILSI North America, ILSI Focal Point in China, and ILSI Argentina.
This session explored the latest research on health benefits of physical activity and focus on new and innovative technologies that both promote physical activity and provide better methods for collection and analysis of physical activity and dietary intake data. Two case studies were presented and the session also examined the application of combination approaches and technologies for individualized physical activity and food intake measures for better adherence to public health recommendations and to promote personalized interventions.
Introductory Remarks: State of the Science on the Biological Importance of Diet & Physical Activity in Disease Risk Reduction and Health Maintenance
Ángel Gil, PhD
University of Granada, Spain
Diet and Physical Activity: Using Contextual Data to Improve Assessment
Carol Boushey, PhD
University of Hawaii, USA
The Exercise is Medicine (EIM) in China
Wenhua Zhao, MD, PhD
ILSI Focal Point China and
Chinese Center for Disease Control & Prevention, China
Mini SALTEN Program
Irina Kovalskys, MD
ILSI Argentina, Argentina
New Combination Methods for Advancing Physical Activity and Food Intake Assessment for Better Adherence to Public Health Recommendations
Michael Pratt, MD, MPH
University of California, San Diego, USA
Introductory Remarks: State of the Science on the Biological Importance of Diet & Physical Activity in Disease Risk Reduction and Health Maintenance
Ángel Gil, PhD
University of Granada
Spain
Non-communicable chronic diseases (NCDs), also known as chronic diseases, are the main cause of disease in the world. According to the WHO, NCDs kill 40 million people each year, equivalent to 70% of all deaths globally, affecting not only developed but also developing countries. Each year, 17 million people die from a NCD before the age of 70 and 87% of these "premature" deaths occur in low- and middle-income countries. Cardiovascular (CDV) diseases account for most NCD deaths, or 17.7 million people annually, followed by cancers (8.8 million), respiratory diseases (3.9 million), and diabetes (1.6 million). These four groups of diseases account for 81% of all NCDs deaths. Tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets all increase the risk of dying from a NCD. Indeed, an important way to control NCDs is to focus on reducing the risk factors associated with these diseases. Hence, the authentic way for preventing NCDs is linked to healthy lifestyles with a multidisciplinary focus addressed to the individuals and their environments. A varied and moderate diet, with small food size portions and low-energy density, as well as generous in vegetables and fruits, and low in free added sugars, salt and trans fatty acids, have been demonstrated to have a role in the prevention of NCDs. In addition, physically active persons show a reduced risk of developing CDV diseases as well as other NCDs. Decreasing the risk of CDV diseases requires the participation of subjects in programs of regular physical activity (PA) for a number of years. However, there are significant benefits for the individuals derived of PA in only a few weeks, namely improvement of CDV response, decrease of blood pressure, increase of muscle mass, and decrease of moods and anxiety, and those effects are independent of the gender, age and race. People affected with type 2 diabetes, who usually are obese (80%), hypertensive (60-80%) and dilipidemics (40-50%), benefit from regular PA as, independently of the weight loss, it contributes to the improvement of the cardiovascular response, glucaemia control, blood pressure, and plasma lipids. In addition, numerous studies have demonstrated that there is an inverse relationship between the level of PA and insulin resistance, not only in adults but also in adolescent and children, particularly in those obese. A number of changes in lifestyle habits seem to have a key role in the starting and progression of neurodegenerative diseases. In fact, longitudinal studies followed up for periods of 5-7 years have shown that physically active persons have a lower decreased risk (20-50%) of having dementia as compared to less active persons. Based on animal studies, the reasons behind those beneficial effects of PA appear to be related to the increased cerebral plasticity that favours the regenerative and adaptive processes, which are mediated by neurotrophic factors, augmented expression of neuron growth factors, which are important for the neurogenesis and neurotransmitters production, an improvement of the immune response associated with a reduction of neurotoxic citokines, and increased elimination of β-amyloid in brain.
New Methods: Learnings from Biosurveillance
Carol Boushey, PhD
University of Hawaii
USA
Access to methods to enhance objective data collection of physical activity and dietary intake are becoming more available. Use of accelerometers have enhanced knowledge regarding the benefits of physical activity. For diet, use of images from mobile phones or video have improved objective data capture with regard to foods, time of eating, and location of eating. Associations with accelerometer data and health outcomes are stronger than those observed with self-reports. The benefits of physical activity timing have been elucidated as a result of time-stamped accelerometer data. On the other hand, mixing self-reported physical activities with an objective accelerometer can provide specific information about best activities to achieve 5 minute bouts. Examples of these advancements in physical activity assessment and its associated outcomes will be shared. For dietary intake, subjective or cultural terms (e.g., supper) for eating occasions have had mixed results with regard to overall diet quality. The use of objective time measures have revealed distinct temporal dietary patterns with significant differences in diet quality. Examples will be shared to demonstrate the improvement in dietary assessment that can accrue from objectively documenting time of eating, the environment of eating, and other contextual data. The new methods available to implement these data collection activities will be summarized.
Exercise is Medicine
Wenhua Zhao, MD, PhD
ILSI Focal Point China and Chinese Center for Disease Control & Prevention
China
Background and Objectives
A third of the world's population does not meet the recommended levels of physical activity, leading to substantial health and economic burdens. Over the past several decades, along with the changes of lifestyle in the Chinese population, the physical activity and fitness of Chinese has decreased, whereas physical inactivity becomes a major causal risk factor for the rapid increase of overweight and obesity as well as an increase in associated comorbidities. In China, 86% of deaths due to non-communicable diseases and 8.3% of deaths related to physical inactivity already occur, but a large gap in research and implementation of PA strategies exists.
Methods and Results
‘Exercise Is Medicine’ (EIM) is a global health initiative managed by the American College of Sports Medicine (ACSM) that is focused on encouraging primary care physicians and other health care providers to include physical activity when designing treatment plans for patients and referring them to EIM Credentialed Exercise Professionals.
ILSI Focal Point in China signed the Memorandum with ACSM for the Cooperation in Exercise is Medicine (EIM) in China in 2012. The main objective is working on promoting the EIM solution and physical activity in China by holding EIM training courses, setting up EIM website and other projects.
To provide advice for clinicians, to offer patients an exercise prescription, and to provide guidelines on scientific exercise and non-communicable diseases prevention, ILSI Focal Point in China has organized more than 10 training courses on EIM in collaboration with relevant organizations, and in total 1,500 clinicians have been trained by the end of May 2017.
Conclusions
Training trainers and increasing public awareness are the key to the success of EIM in China. In this presentation, Dr. Zhao describes the evolution and Chinese expansion of the EIM initiative, the implementation and future directions.
Mini Salten
Irina Kovalskys, MD
ILSI Argentina
Argentina
The World Health Organization (WHO), recommends at least 60 minutes a day in moderate to vigorous physical activity (MVPA) for ages 5-17.
Mini SALTEN is a program developed to improve eating habits and increase moderate to vigorous physical activity at home and school in first grade children. It aims to assess the effects of a technology family-based and physical activity (PA) school-based intervention.
The design of the protocol was based in a cluster-randomized controlled trial designed to run from July 2015 to November 2016 in twelve public schools of the city of Buenos Aires, matched for socio-demographic characteristics. The intervention was based on two main components: a) virtual (V): web-based presentations delivered to the mothers via a multiplatform application; b) active breaks (AB): implemented during school breaks by a PA instructor. V: Especially designed web-based contents, targeting families and children aimed at encouraging the improvement of eating habits of the whole family both at home and at school, and increasing mothers’ knowledge of the benefits of PA and consequences of sedentary behaviour, and proposing pleasurable movement entailing activities for the children. AB: included activities comprising movement during school breaks that were promoted with motivation as a backbone and devoid of a competitive strive; active play in which fun, pleasure, and sharing were emphasized. PA instructor guided activities with the goal of promoting active play for a minimum of 20-30 min/day, depending on each school. Using a computer generated random sequence participants were allocated to one of four intervention conditions resulting in 4 clusters: (AB), (V), (AB) + (V), and control (C). Outcomes are measured at baseline and 12 months post intervention, and included data collected from the dyad (child and her/his mother). The levels of PA were measured using ActiGraph wGT3X-BT accelerometers for 7 consecutive days (24 hours). Outcomes were: time in light, moderate and vigorous PA and sedentary time (minutes/day). Family socio-economic level, home environment, and school environment were also assessed. This study provides objective information regarding dietary and PA patterns of first grade children of public schools of Buenos Aires. It is a pioneer assessment of the impact of a technology-based virtual intervention, involving the parents, designed to prevent obesity, and planning public health policies.
New Combination Methods for Advancing Physical Activity and Food Intake Assessment for Better Adherence to Public Health Recommendations
Michael Pratt, MD, MPH
University of California, San Diego
USA
Measurement of dietary intake and physical activity has become increasingly important for health monitoring, and providing interventions that optimize population health. Advances in technology have been useful for reducing survey or study participant burden and have increased objectivity and accuracy for some measures. A plethora of tools, applications and systems have been developed and although significant advances have been made, several limitations at the level of the individual measure limit the ability to capture information that is accurate. In November 2016 a group of experts on diet, physical activity, and the use of technology for health purposes gathered at the University of California, San Diego to examine current experience with the use of technology for research on physical activity and diet. This unique forum investigated current and emerging challenges related to improving energy balance behavior assessment and intervention via technology, while focusing on how the research community might embrace and apply innovative new tools. The assembled experts made a number of recommendations that will be summarized in this presentation. To be able to fully take advantage of recent technological advancements for the measure of diet and physical activity:
- A consensus is needed regarding current methodology and needs with regards to each area of assessment. This will foster inter-disciplinary collaborations among experts from technology, nutrition, public health, epidemiology, and medicine to address the gaps in this direction.
- Additionally, a focus on assessing the validity and reliability of the available methods for dietary intake and physical activity assessment in adult, youth, and older adult populations ratified by expert researchers in the field will help guide investigators to obtain high quality measures.
- Increasing efforts that are directed to facilitate a plug-and-play open architecture systems that allows for modular systems to be assembled for specific assessments. Success would include smartphone links with various software applications.
- Establishing a committee or international working group to evaluate, manage or channel the huge influx of new apps and emerging technologies to measure dietary intake and physical activity, so that there is a focused and effective effort in this direction.
- Development of novel biomarkers using the technological capabilities to increase objectivity of the measures.
- Bridging between technology developed for research and consumer wearable technology will be important if research on diet and physical activity is to be optimized at the population level.
While there are still many limitations and challenges in the measurement of dietary intake and physical activity, there is much progress and even more promise for using technology to improve measuring diet, physical activity, and sedentary time. Managing the current knowledge base and facilitating a resource center for sharing measurement technology and analytic approaches are keys for success in obtaining accurate dietary intake and physical activity measures and contributing to higher quality research that can in turn improve population health.
Ángel Gil, PhD
University of Granada
Spain
Prof. Angel Gil was born in Granada, Spain. In 1996, he became Full Professor of Biochemistry and Molecular Biology at the University of Granada (UGR). He is an internationally recognised authority in the field of food and nutrition; his expertise extends from the study of food composition to the metabolism of macronutrients and bioactive compounds, and their effects on health. Since his early career he has balanced his role of researcher and professor, and conducted pioneering and innovative research, leading more than 50 projects and contracts. He has taught at the University of Granada since 1981, supervising more than 50 Ph.D. students. He has several areas of interest that include the evaluation of the role of dietary nucleotides in early life and the development of infant nutrition products. In addition, the isolation, identification and description of the mechanism of action of probiotics and the metabolic, molecular and genetic factors involved in obesity and the early onset of the metabolic syndrome (MS) in childhood; and the design, development and evaluation of enteral clinical nutrition products. What, probably describes Prof Gil best, is the variety of fields and problems he has faced during his professional career and his significant ability to combine his knowledge and expertise in food science and human biochemistry. This has allowed him to design, develop, innovate and evaluate special products for human nutrition, which are clearly demonstrated in his published articles and the impact of his patents. The multi- and interdisciplinary nature of his work is reflected in the variety of international journals in which he has published more than 430 papers. In addition, he has published about 149 book chapters. Prof. Gil has also been the Chairman of the International Union of Nutritional Sciences (IUNS) 21st International Congress of Nutrition, the most important event in nutrition every 4 years in the world and has been engaged in the organization of other renowned international congresses. He is member of important international nutrition societies and President of the Iberoamerican Nutrition Foundation (FINUT), a non-profit organization promoted by the IUNS, with the main goal to contribute to the formation of young scientists in food and nutrition in the setting of Iberoamerica.
Carol Boushey, PhD
University of Hawaii
USA
Carol Boushey specializes in evaluating dietary exposures with an emphasis on technology, diverse racial/ethnic groups, and dietary patterns. She is an Associate Professor of Epidemiology at the University of Hawaii (UH) Cancer Center and an adjunct professor at Purdue University. With engineering scientists, she created the Technology Assisted Dietary Assessment program that uses images from mobile devices for dietary assessment. She has been instrumental in describing dietary intakes of Pacific Northwest Tribal Nations and young children in remote jurisdictions in the Pacific. Dr. Boushey is involved with the dietary assessment of the five ethnic groups (Japanese, Hawaiian, non-Hispanic white, African American, Hispanic/Latino) in the Multiethnic Cohort. She has been the chief architect of methods to assess calcium consumption among Asian, Hispanic, and non-Hispanic white adolescents. Dr. Boushey received a Bachelor of Science at the University of Washington (UW), a Master of Public Health from the UH, and a PhD from the UW through the interdisciplinary nutrition and epidemiology programs.
Wenhua Zhao, MD, PhD
ILSI Focal Point China and Chinese Center for Disease Control & Prevention
China
Dr. Zhao holds a Bachelor Degree of Medicine from the Beijing Medical University and Master Degree of Nutrition from the University of Philippines, and PhD in nutrition from the Kagawa Nutrition University of Japan. She has worked in the field of public health for 33 years.
Dr. Zhao was the field director of the China National Nutrition and Health Survey in 2002 at the Institute of Nutrition and Food Safety of China CDC. She was the Director of the National Working Group of 2010, China Chronic Disease and Behavior Risk Factors Surveillance at the National Center for Chronic and Non-Communicable Disease Control and Prevention of China CDC. She is currently a professor in Nutrition and Public Health Deputy Director, National Institute for Nutrition and Health Chinese Center for Disease Control and Prevention (CDC). She has considerable experience and expertise in both dietary assessment methods and Nutrition Epidemiology in China. She has developed and validated the Chinese Food Frequency Questionnaire (CFFQ) for use in various populations in China. Moreover she has worked on the prevalence and burden of obesity, diabetes and related factors among adults. Dr. Zhao has also worked extensively on the policy making, health promotion and education on balanced diet and active lifestyle. Dr. Zhao has published more than 150 scientific articles, books and book chapters in the area of diet, nutrition, lifestyle and chronic disease control and prevention.
Irina Kovalskys, MD
ILSI Argentina
Argentina
Dr. Irina Kovalskys is a medical doctor specializing in pediatric nutrition. She is a graduate of the University of Buenos Aires, and works in clinical child nutrition and diabetes at the National Children´s Hospital J.P. Garrahan. She completed her training in enteral and parenteral nutrition at the Children´s Hospital in La Plata City, and completed a scholarship in childhood obesity at the Stanford Center for Research in Disease Prevention at Stanford University. Today, Dr. Kovalskys is a Profesor at the Nutrition and Public Health Masters of the La Plata Pediatric Research Institute (IDIP), at Rosario City (Universidad del Centro Educativo Latinoamericano)( UCEL) . She also teaches Obesity and Pediatric Nutrition at The Tucumán National University (UNT). Dr. Kovalskys is the head of the Obesity Nutrition and Physical Activity committee at ILSI Argentina and a PhD candidate at the Institute of Biomedicine at the Pontifica Universidad Catolica Argentina (UCA). She is an author and reviewer of various peer-reviewed journals and book chapters, and a speaker and chair of many national and international conferences. Her current studies and research lines are focused on chronic diseases, and population studies of food intake and energy expenditure.
Michael Pratt, MD, MPH
University of California, San Diego
USA
Michael Pratt recently moved to the University of California San Diego where he is Director of the Institute for Public Health and the Global Observatory for Physical Activity. Over the past 25 years he held leadership positions at CDC for chronic disease prevention, global health, and physical activity promotion, including serving as the first chief of the Physical Activity and Health Branch. Dr. Pratt led or co-led many large research and public health policy efforts related to global physical activity. Major projects include co-leading the 2012 and 2016 Lancet series on physical activity and global health, serving as PI for IPEN Mexico, developing the International Physical Activity Questionnaire (IPAQ), developing the first public health recommendation for physical activity, creating national and global research and practice courses for physical activity and public health and directing 50 courses in 20 countries, the GUIA Project (evidence-based physical activity interventions in Latin America), Project MOVE (cost effectiveness analysis of community-based physical activity interventions). His work in the last decade focused on a series of projects involving urban settings and physical activity in Latin America with emphasis on objective measurement of PA and the environment, and physical activity interventions in public spaces. Dr. Pratt also created and directed for 12 years the CDC World Health Organization (WHO) Collaborating Center for Physical Activity and Health, and led an initiative funded through the CDC Foundation for building applied public health research capacity for physical activity in low and middle- income countries.
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