- Email: [email protected]
Activities of Daily Living and Health
Public Health Forum 21 Heft 79 (2013) http://journals.elsevier.de/pubhef
Activities of Daily Living and Health Eszter Fu¨ze´ki and Winfried Banzer Since the 1990s the focus of public health recommendations for increased cardiorespiratory fitness and health had shifted from vigorous exercise to moderate intensity physical activity (Murphy et al., 2010; Lee and Buchner, 2008). Current scientific consensus and public health guidelines emphasize the significance of overall energy expended, regardless of the type, intensity of physical activities, and their duration, provided they are cumulated in bouts of minimum 10 minutes. To gain significant health benefits, adults and older adults should perform a total of 150 minutes of moderate intensity or 75 minutes of intensive aerobic activity per week (WHO, 2010). Though as of now not integrated in guidelines, activity bouts shorter than 10 minutes may also have beneficial effects on cardiometabolic markers (Barr-Anderson et al., 2011; Boreham et al., 2005; Meyer et al., 2010). Activities of daily living, such as household, gardening, stair climbing, walking and cycling are typically non-vigorous, non-exercise activities, often of shorter duration. These activities are now acknowledged as a major health resource, and are explicitly advocated by many health authorities. The present paper gives a succinct overview of health effects of activities of daily living, including their potentials and limitations. In line with its availability and measurability, of all activities of daily living, walking, ‘‘the nearest activity to perfect exercise’’ (Morris and Hardman, 1997), has received by far the most scientific interest both in prevention and therapy of chronic diseases. We are born to walk; walking is
our most ancient and natural way of getting around and being physically active (Morris and Hardman, 1997). Walking is a low-threshold, low risk and highly accessible aerobic activity, involving over half of the body’s total muscle mass (Morris and Hardman, 1997). Energy expended increases with pace; energy expenditure of walking at 5 km/h is approximately threefold that of resting (Morris and Hardman, 1997). Current physical activity recommendations ‘‘translate’’ into some 3.000-4.000 steps/day on top of ‘‘baseline activity’’, resulting in a total of 10.000 steps/day (Tudor-Locke et al., 2010). As to walking, Germany ranks in the middle among European countries, and way beyond Canada, Australia, and the US (Bassett et al., 2008). Germans walk an average of 18,49 minutes/day, and walking comprises 23,7% of all trips (Buehler et al., 2011). A single bout of slow or brisk walking has been shown to improve cardiometabolic markers, such as postprandial lipid levels (Miyashita et al., 2013), plasma triacyglycerol concentrations, resting blood pressure (Miyashita et al., 2008), and post-meal blood glucose response (Nygaard et al., 2009) in healthy and in metabolically compromised subjects (Lunde et al., 2012). In diabetic patients a single session of brisk walking improved affect and psychological wellbeing (Kopp et al., 2012). Most data on chronic effects of walking derive from epidemiologic studies. Walking is a powerful weapon in prevention: it provides incremental protection against cardiovascular (Boone-Heinonen et al., 2009;
Murtagh et al., 2010) and coronary heart disease (Zheng et al., 2009). In The Nurses’ Health Study, energy expenditures being equal, walking and vigorous activity resulted in commensurate magnitudes of diabetes risk reduction (Hu et al., 1999). A large case-control study found significant inverse associations between colon cancer risk and levels of commuting (walking and cycling) (Hou et al., 2004), and a current meta-analysis reported a 3% risk reduction for breast cancer for every 10 metabolic equivalent hours per week (10 MET-h/week) increment in recreational activity, including walking (Wu et al., 2013). Possible mechanisms behind these protective effects might be lower blood pressure (Lee et al., 2010), improved blood lipid profiles (Kelley et al., 2004) and decreased Body Mass Index (BMI) (Bravata et al., 2007). The rewards of walking go beyond bodily ones; ‘‘walkers’’ benefit from better cognitive function and less cognitive decline: the respective cognitive scores of women who walked ca. 150 min/week vs. 40 min/week showed a difference corresponding to 1.5 years (Weuve et al., 2004). Increased walking has been shown to be protective against depressive symptoms in elderly men (Smith et al., 2010). Also, in the Australian Longitudinal Study on Women’s Health walking was associated with both current and future mental health in elderly women (Heesch et al., 2011). Walking can play an important role also in secondary prevention; patients with diabetes who walk regularly have reduced cardiovascular mortality risk (Sluik et al., 2012), and patients with
4.e1
Public Health Forum 21 Heft 79 (2013) http://journals.elsevier.de/pubhef
cardiovascular diseases who engage in regular walking enjoy lower cardiovascular and all-cause mortality risks than their inactive counterparts (Hamer and Stamatakis, 2009). Prostate cancer patients who walk 90 or more minutes per week at a normal to very brisk pace had a 46% reduced risk of all-cause mortality compared to those who walk less or at a lower pace (Kenfield et al., 2011). Intervention studies show that increasing the number of steps taken by the recommended 3.000 steps extra or 30 minutes per day may lower body weight and body mass index, enhance aerobic fitness and subjective quality of life, and improve blood lipid profile in previously inactive but healthy people (Wallmann and Froboese, 2011; Pagels et al., 2012). Cancer survivors also benefit from walking through lower levels of fatigue and improved quality of life (Yeo et al., 2012), as well as treatment-related symptoms and mood (Yang et al., 2011). Commuting cycling at approximately 15 km/h (Møller et al., 2011; Hartog et al., 2010) has a metabolic equivalent (MET) value of 4-6.8 and is of moderate-high intensity (Ainsworth et al., 2011). Germans cycle an average of 6.41 minutes/day and do 10% of all trips by bicycle (Buehler et al., 2011). In prospective observational studies commuter cycling was found to be strongly and inversely associated with all-cause and cancer mortality, and cancer morbidity (Oja et al., 2011). Increasing commuter cycling has been shown to improve coronary heart disease risk factors and healthrelated quality of life (Geus et al., 2008), cardiorespiratory fitness and
4.e2
body composition (Møller et al., 2011) in untrained adults. Data on activities of daily living excluding walking and cycling are limited compared to active commuting (Stamatakis et al., 2009; Matthews et al., 2007). In a current metaanalysis housework, gardening, stair climbing and active travel were associated with a relative risk reduction of all-cause mortality comparable with that produced by exercise (Samitz et al., 2011). High volume of household activities seems to be protective of breast cancer (Steindorf et al., 2013) and of psychological distress (Hamer et al., 2009). The metaanalysis of Woodcock and colleagues confirms that any activity is better than none: they found a non-linear relationship between light and moderate physical activity, including active commuting and household chores and all-cause mortality, with the greatest risk reduction occurring between complete inactivity and low level of activity (Woodcock et al., 2011). Stair climbing is a high intensity activity, which is easy to integrate into daily life. The accumulation of 10-11 minutes of stair climbing per day may improve cardio-metabolic parameters and increase cardiorespiratory fitness (Boreham et al., 2005; Meyer et al., 2010). Also, integration of bouts of physical activity as short as 3-20 minutes into organizational routine in schools and work places may represent a promising avenue to increase overall physical activity and ultimately promote health (BarrAnderson et al., 2011). The public health relevance of activities of daily living lies in the fact that
they are readily available for large parts of the population, require no special skills or equipment, and are low injury-risk. These activities, however, are often of light-moderate intensity and may not represent the overload necessary to evoke physiological adaptations, which could translate into health benefits in fit individuals (Zheng et al., 2009). In physically unfit and elderly populations, on the other hand, even these intensities seem to stimulate health-enhancing responses (Zheng et al., 2009). Since the highest public health benefits would occur when the least fit individuals became at least moderately fit, activities of daily living have high potential (Mandic et al., 2009). In conclusion, activities of daily living yield health benefits without noteworthy risks in untrained and elderly populations. The combined effects of these benefits at the public health level make the promotion of these activities a promising and necessary way to improve health in populations disinclined to exercise. Die korrespondierende Autorin erkla¨rt, dass kein Interessenkonflikt vorliegt. Literatur siehe Literatur zum Schwerpunktthema. http://journals.elsevier.de/pubhef/literatur http://dx.doi.org/10.1016/j.phf.2013.03.002
Eszter Fu¨ze´ki, M.A. Goethe Universita¨t Frankfurt Institut fu¨r Sportwissenschaften Abteilung Sportmedizin Ginnheimer Landstraße 39 60487 Frankfurt [email protected]
Public Health Forum 21 Heft 79 (2013) http://journals.elsevier.de/pubhef
Summary Activities of daily living, such as household, gardening, stair climbing, walking and cycling are now acknowledged as a major health resource, and explicitly advocated by many health authorities. Of activities of daily living, walking has received by far the most scientific interest both in prevention and therapy of chronic diseases. A considerable body of scientific evidence suggests that activities of daily living yield health benefits meaningful at the public health level. Promotion of these activities might be a promising way to improve health in unfit and elderly population disinclined to exercise.
Einleitung Aktivita¨ten des ta¨glichen Lebens, wie Haushaltsaktivita¨ten, Gartenarbeit, Gehen, Fahrradfahren und Treppensteigen werden von fu¨hrenden Gesundheitsorganisationen als gesundheitsfo¨rdernd empfohlen. Am besten erforscht und dokumentiert sind die Effekte des Gehens auf unterschiedliche ko¨rperliche und mentale Gesundheitsparameter bei Gesunden und chronisch Kranken. Die Fo¨rderung von Alltagsaktivita¨ten kann die Gesundheit inaktiver, a¨lterer und sportferner Menschen stark verbessern.
Keywords: activities of daily living = Aktivita¨ten des ta¨glichen Lebens, walking = Gehen, public health = Public Health, prevention = Pra¨vention, therapy = Therapie
Literaturverzeichnis Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett Jr. DR, Tudor-Locke C, et al. 2011 Compendium of Physical Activities. Medicine & Science in Sports & Exercise 2011;43:1575–81. Barr-Anderson DJ, AuYoung M, Whitt-Glover MC, Glenn BA, Yancey AK. Integration of short bouts of physical activity into organizational routine a systematic review of the literature. Am J Prev Med 2011;40:76–93. Bassett DR, Pucher J, Buehler R, Thompson DL, Crouter SE. Walking, cycling, and obesity rates in Europe, North America, and Australia. J Phys Act Health 2008;5:795– 814. Boone-Heinonen J, Evenson KR, Taber DR, Gordon-Larsen P. Walking for prevention of cardiovascular disease in men and women: a systematic review of observational studies. Obesity Reviews 2009;10:204–17. Boreham CAG, Kennedy RA, Murphy MH, Tully M, Wallace WFM, Young I. Training effects of short bouts of stair climbing on cardiorespiratory fitness, blood lipids, and homocysteine in sedentary young women. Br J Sports Med 2005;39:590–3. Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA 2007;298:2296–304. Buehler R, Pucher J, Merom D, Bauman A. Active travel in Germany and the U.S.
Contributions of daily walking and cycling to physical activity. Am J Prev Med 2011;41:241–50. de Geus B, van Hoof E, Aerts I, Meeusen R. Cycling to work: influence on indexes of health in untrained men and women in Flanders. Coronary heart disease and quality of life. Scand J Med Sci Sports 2008;18:498– 510. Hamer M, Stamatakis E. Physical activity and mortality in men and women with diagnosed cardiovascular disease. European Journal of Cardiovascular Prevention & Rehabilitation 2009;16:156–60. Hamer M, Stamatakis E, Steptoe A. Doseresponse relationship between physical activity and mental health: the Scottish Health Survey. British Journal of Sports Medicine 2009;43:1111–4. de Hartog JJ, Boogaard H, Nijland H, Hoek G. Do the Health Benefits of Cycling Outweigh the Risks? Environ Health Perspect 2010;118:1109–16. Heesch KC, Burton NW, Brown WJ. Concurrent and prospective associations between physical activity, walking and mental health in older women. Journal of Epidemiology & Community Health 2011;65:807–13. Hou L, Ji B, Blair A, Dai Q, Gao Y, Chow W. Commuting physical activity and risk of colon cancer in Shanghai, China. Am J Epidemiol 2004;160:860–7. Hu FB, Sigal RJ, Rich-Edwards JW, Colditz GA, Solomon CG, Willett WC, et al. Walking compared with vigorous physical activity and
risk of type 2 diabetes in women: a prospective study. JAMA 1999;282:1433–9. Kelley GA, Kelley KS, Tran ZV. Walking, lipids, and lipoproteins: a meta-analysis of randomized controlled trials. Prev Med 2004;38:651– 61. Kenfield SA, Stampfer MJ, Giovannucci E, Chan JM. Physical Activity and Survival After Prostate Cancer Diagnosis in the Health Professionals Follow-Up Study. Journal of Clinical Oncology 2011;29:726–32. Kopp M, Steinlechner M, Ruedl G, Ledochowski L, Rumpold G, Taylor AH. Acute effects of brisk walking on affect and psychological well-being in individuals with type 2 diabetes. Diabetes Research and Clinical Practice 2012;95:25–9. Lee I, Buchner DM. The importance of walking to public health. Med Sci Sports Exerc 2008;40:S512–8. Lee L, Watson MC, Mulvaney CA, Tsai C, Lo S. The effect of walking intervention on blood pressure control: A systematic review. International Journal of Nursing Studies 2010;47:1545–61. Lunde MSH, Hjellset VT, Høstmark AT. Slow post meal walking reduces the blood glucose response: an exploratory study in female Pakistani immigrants. J Immigr Minor Health 2012;14:816–22. Mandic S, Myers JN, Oliveira RB, Abella JP, Froelicher VF. Characterizing Differences in Mortality at the Low End of the Fitness Spectrum. Medicine & Science in Sports & Exercise 2009;41:1573–9.
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Matthews CE, Jurj AL, Shu X, Li H, Yang G, Li Q, et al. Influence of exercise, walking, cycling, and overall nonexercise physical activity on mortality in Chinese women. Am J Epidemiol 2007;165:1343–50. Meyer P, Kayser B, Kossovsky MP, Sigaud P, Carballo D, Keller P, et al. Stairs instead of elevators at workplace: cardioprotective effects of a pragmatic intervention. European Journal of Cardiovascular Prevention & Rehabilitation 2010;17:569–75. Miyashita M, Burns SF, Stensel DJ. Accumulating short bouts of brisk walking reduces postprandial plasma triacylglycerol concentrations and resting blood pressure in healthy young men. Am J Clin Nutr 2008;88:1225–31. Miyashita M, Park J, Takahashi M, Suzuki K, Stensel D, Nakamura Y. Postprandial lipaemia: effects of sitting, standing and walking in healthy normolipidaemic humans. Int J Sports Med 2013;34:21–7. Møller NC, Østergaard L, Gade JR, Nielsen JL, Andersen LB. The effect on cardiorespiratory fitness after an 8-week period of commuter cycling–a randomized controlled study in adults. Prev Med 2011;53:172–7. Morris JN, Hardman AE. Walking to health. Sports Med 1997;23:306–32. Murphy MH, McNeilly AM, Murtagh EM. Session 1: Public health nutrition: Physical activity prescription for public health. Proc Nutr Soc 2010;69:178–84. Murtagh EM, Murphy MH, Boone-Heinonen J. Walking: the first steps in cardiovascular disease prevention. Current Opinion in Cardiology 2010;22:490–6. Nygaard H, Tomten SE, Høstmark AT. Slow postmeal walking reduces postprandial glycemia in middle-aged women. Appl Physiol Nutr Metab 2009;34:1087–92.
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Oja P, Titze S, Bauman A, de Geus B, Krenn P, Reger-Nash B, et al. Health benefits of cycling: a systematic review. Scand J Med Sci Sports 2011;21:496–509. Pagels P, Raustorp A, Archer T, Lidman U, Alricsson M. Influence of moderate, daily physical activity on body composition and blood lipid profile in Swedish adults. J Phys Act Health 2012;9:867–74. Samitz G, Egger M, Zwahlen M. Domains of physical activity and all-cause mortality: systematic review and dose-response metaanalysis of cohort studies. Int J Epidemiol 2011;40:1382–400. Sluik D, Buijsse B, Muckelbauer R, Kaaks R, Teucher B, Johnsen NF, et al. Physical Activity and Mortality in Individuals With Diabetes Mellitus. A Prospective Study and Meta-analysis Physical. Arch Intern Med 2012;172:1285–95. Smith TL, Masaki KH, Fong K, Abbott RD, Ross GW, Petrovitch H, et al. Effect of Walking Distance on 8-Year Incident Depressive Symptoms in Elderly Men with and without Chronic Disease: The Honolulu-Asia Aging Study. Journal of the American Geriatrics Society 2010;58:1447– 52. Stamatakis E, Hamer M, Lawlor DA. Physical activity, mortality, and cardiovascular disease: is domestic physical activity beneficial? The Scottish Health Survey – 1995, 1998, and 2003. Am J Epidemiol 2009;169:1191–200. Steindorf K, Ritte R, Eomois P, Lukanova A, Tjonneland A, Johnsen NF, et al. Physical activity and risk of breast cancer overall and by hormone receptor status: The European prospective investigation into cancer and nutrition. Int J Cancer 2013;132:1667–78. Tudor-Locke C, Brashear MM, Johnson WD, Katzmarzyk PT. Accelerometer profiles of
physical activity and inactivity in normal weight, overweight, and obese U.S. men and women. Int J Behav Nutr Phys Act 2010;7:60. Wallmann B, Froboese I. Interventionseffekte einer Aktivita¨tserho¨hung von 3000 Schritten mehr am Tag. Wien Klin Wochenschr 2011;123:369–77. Weuve J, Kang JH, Manson JE, Breteler MMB, Ware JH, Grodstein F. Physical activity, including walking, and cognitive function in older women. JAMA 2004;292:1454–61. Woodcock J, Franco OH, Orsini N, Roberts I. Non-vigorous physical activity and all-cause mortality: systematic review and metaanalysis of cohort studies. International Journal of Epidemiology 2011;40:121–38. World Health Organization. Global recommendations on physical activity for health 2010. Geneva, Switzerland. Wu Y, Zhang D, Kang S. Physical activity and risk of breast cancer: a meta-analysis of prospective studies. Breast Cancer Res Treat 2013;137:869–82. Yang C, Tsai J, Huang Y, Lin C. Effects of a home-based walking program on perceived symptom and mood status in postoperative breast cancer women receiving adjuvant chemotherapy. Journal of Advanced Nursing 2011;67:158–68. Yeo TP, Burrell SA, Sauter PK, Kennedy EP, Lavu H, Leiby BE, et al. A Progressive Postresection Walking Program Significantly Improves Fatigue and Health-Related Quality of Life in Pancreas and Periampullary Cancer Patients. Journal of the American College of Surgeons 2012;214:463–75. Zheng H, Orsini N, Amin J, Wolk A, Nguyen VTT, Ehrlich F. Quantifying the doseresponse of walking in reducing coronary heart disease risk: meta-analysis. Eur J Epidemiol 2009;24:181–92.
Activities of Daily Living and Health Eszter Fu¨ze´ki and Winfried Banzer Since the 1990s the focus of public health recommendations for increased cardiorespiratory fitness and health had shifted from vigorous exercise to moderate intensity physical activity (Murphy et al., 2010; Lee and Buchner, 2008). Current scientific consensus and public health guidelines emphasize the significance of overall energy expended, regardless of the type, intensity of physical activities, and their duration, provided they are cumulated in bouts of minimum 10 minutes. To gain significant health benefits, adults and older adults should perform a total of 150 minutes of moderate intensity or 75 minutes of intensive aerobic activity per week (WHO, 2010). Though as of now not integrated in guidelines, activity bouts shorter than 10 minutes may also have beneficial effects on cardiometabolic markers (Barr-Anderson et al., 2011; Boreham et al., 2005; Meyer et al., 2010). Activities of daily living, such as household, gardening, stair climbing, walking and cycling are typically non-vigorous, non-exercise activities, often of shorter duration. These activities are now acknowledged as a major health resource, and are explicitly advocated by many health authorities. The present paper gives a succinct overview of health effects of activities of daily living, including their potentials and limitations. In line with its availability and measurability, of all activities of daily living, walking, ‘‘the nearest activity to perfect exercise’’ (Morris and Hardman, 1997), has received by far the most scientific interest both in prevention and therapy of chronic diseases. We are born to walk; walking is
our most ancient and natural way of getting around and being physically active (Morris and Hardman, 1997). Walking is a low-threshold, low risk and highly accessible aerobic activity, involving over half of the body’s total muscle mass (Morris and Hardman, 1997). Energy expended increases with pace; energy expenditure of walking at 5 km/h is approximately threefold that of resting (Morris and Hardman, 1997). Current physical activity recommendations ‘‘translate’’ into some 3.000-4.000 steps/day on top of ‘‘baseline activity’’, resulting in a total of 10.000 steps/day (Tudor-Locke et al., 2010). As to walking, Germany ranks in the middle among European countries, and way beyond Canada, Australia, and the US (Bassett et al., 2008). Germans walk an average of 18,49 minutes/day, and walking comprises 23,7% of all trips (Buehler et al., 2011). A single bout of slow or brisk walking has been shown to improve cardiometabolic markers, such as postprandial lipid levels (Miyashita et al., 2013), plasma triacyglycerol concentrations, resting blood pressure (Miyashita et al., 2008), and post-meal blood glucose response (Nygaard et al., 2009) in healthy and in metabolically compromised subjects (Lunde et al., 2012). In diabetic patients a single session of brisk walking improved affect and psychological wellbeing (Kopp et al., 2012). Most data on chronic effects of walking derive from epidemiologic studies. Walking is a powerful weapon in prevention: it provides incremental protection against cardiovascular (Boone-Heinonen et al., 2009;
Murtagh et al., 2010) and coronary heart disease (Zheng et al., 2009). In The Nurses’ Health Study, energy expenditures being equal, walking and vigorous activity resulted in commensurate magnitudes of diabetes risk reduction (Hu et al., 1999). A large case-control study found significant inverse associations between colon cancer risk and levels of commuting (walking and cycling) (Hou et al., 2004), and a current meta-analysis reported a 3% risk reduction for breast cancer for every 10 metabolic equivalent hours per week (10 MET-h/week) increment in recreational activity, including walking (Wu et al., 2013). Possible mechanisms behind these protective effects might be lower blood pressure (Lee et al., 2010), improved blood lipid profiles (Kelley et al., 2004) and decreased Body Mass Index (BMI) (Bravata et al., 2007). The rewards of walking go beyond bodily ones; ‘‘walkers’’ benefit from better cognitive function and less cognitive decline: the respective cognitive scores of women who walked ca. 150 min/week vs. 40 min/week showed a difference corresponding to 1.5 years (Weuve et al., 2004). Increased walking has been shown to be protective against depressive symptoms in elderly men (Smith et al., 2010). Also, in the Australian Longitudinal Study on Women’s Health walking was associated with both current and future mental health in elderly women (Heesch et al., 2011). Walking can play an important role also in secondary prevention; patients with diabetes who walk regularly have reduced cardiovascular mortality risk (Sluik et al., 2012), and patients with
4.e1
Public Health Forum 21 Heft 79 (2013) http://journals.elsevier.de/pubhef
cardiovascular diseases who engage in regular walking enjoy lower cardiovascular and all-cause mortality risks than their inactive counterparts (Hamer and Stamatakis, 2009). Prostate cancer patients who walk 90 or more minutes per week at a normal to very brisk pace had a 46% reduced risk of all-cause mortality compared to those who walk less or at a lower pace (Kenfield et al., 2011). Intervention studies show that increasing the number of steps taken by the recommended 3.000 steps extra or 30 minutes per day may lower body weight and body mass index, enhance aerobic fitness and subjective quality of life, and improve blood lipid profile in previously inactive but healthy people (Wallmann and Froboese, 2011; Pagels et al., 2012). Cancer survivors also benefit from walking through lower levels of fatigue and improved quality of life (Yeo et al., 2012), as well as treatment-related symptoms and mood (Yang et al., 2011). Commuting cycling at approximately 15 km/h (Møller et al., 2011; Hartog et al., 2010) has a metabolic equivalent (MET) value of 4-6.8 and is of moderate-high intensity (Ainsworth et al., 2011). Germans cycle an average of 6.41 minutes/day and do 10% of all trips by bicycle (Buehler et al., 2011). In prospective observational studies commuter cycling was found to be strongly and inversely associated with all-cause and cancer mortality, and cancer morbidity (Oja et al., 2011). Increasing commuter cycling has been shown to improve coronary heart disease risk factors and healthrelated quality of life (Geus et al., 2008), cardiorespiratory fitness and
4.e2
body composition (Møller et al., 2011) in untrained adults. Data on activities of daily living excluding walking and cycling are limited compared to active commuting (Stamatakis et al., 2009; Matthews et al., 2007). In a current metaanalysis housework, gardening, stair climbing and active travel were associated with a relative risk reduction of all-cause mortality comparable with that produced by exercise (Samitz et al., 2011). High volume of household activities seems to be protective of breast cancer (Steindorf et al., 2013) and of psychological distress (Hamer et al., 2009). The metaanalysis of Woodcock and colleagues confirms that any activity is better than none: they found a non-linear relationship between light and moderate physical activity, including active commuting and household chores and all-cause mortality, with the greatest risk reduction occurring between complete inactivity and low level of activity (Woodcock et al., 2011). Stair climbing is a high intensity activity, which is easy to integrate into daily life. The accumulation of 10-11 minutes of stair climbing per day may improve cardio-metabolic parameters and increase cardiorespiratory fitness (Boreham et al., 2005; Meyer et al., 2010). Also, integration of bouts of physical activity as short as 3-20 minutes into organizational routine in schools and work places may represent a promising avenue to increase overall physical activity and ultimately promote health (BarrAnderson et al., 2011). The public health relevance of activities of daily living lies in the fact that
they are readily available for large parts of the population, require no special skills or equipment, and are low injury-risk. These activities, however, are often of light-moderate intensity and may not represent the overload necessary to evoke physiological adaptations, which could translate into health benefits in fit individuals (Zheng et al., 2009). In physically unfit and elderly populations, on the other hand, even these intensities seem to stimulate health-enhancing responses (Zheng et al., 2009). Since the highest public health benefits would occur when the least fit individuals became at least moderately fit, activities of daily living have high potential (Mandic et al., 2009). In conclusion, activities of daily living yield health benefits without noteworthy risks in untrained and elderly populations. The combined effects of these benefits at the public health level make the promotion of these activities a promising and necessary way to improve health in populations disinclined to exercise. Die korrespondierende Autorin erkla¨rt, dass kein Interessenkonflikt vorliegt. Literatur siehe Literatur zum Schwerpunktthema. http://journals.elsevier.de/pubhef/literatur http://dx.doi.org/10.1016/j.phf.2013.03.002
Eszter Fu¨ze´ki, M.A. Goethe Universita¨t Frankfurt Institut fu¨r Sportwissenschaften Abteilung Sportmedizin Ginnheimer Landstraße 39 60487 Frankfurt [email protected]
Public Health Forum 21 Heft 79 (2013) http://journals.elsevier.de/pubhef
Summary Activities of daily living, such as household, gardening, stair climbing, walking and cycling are now acknowledged as a major health resource, and explicitly advocated by many health authorities. Of activities of daily living, walking has received by far the most scientific interest both in prevention and therapy of chronic diseases. A considerable body of scientific evidence suggests that activities of daily living yield health benefits meaningful at the public health level. Promotion of these activities might be a promising way to improve health in unfit and elderly population disinclined to exercise.
Einleitung Aktivita¨ten des ta¨glichen Lebens, wie Haushaltsaktivita¨ten, Gartenarbeit, Gehen, Fahrradfahren und Treppensteigen werden von fu¨hrenden Gesundheitsorganisationen als gesundheitsfo¨rdernd empfohlen. Am besten erforscht und dokumentiert sind die Effekte des Gehens auf unterschiedliche ko¨rperliche und mentale Gesundheitsparameter bei Gesunden und chronisch Kranken. Die Fo¨rderung von Alltagsaktivita¨ten kann die Gesundheit inaktiver, a¨lterer und sportferner Menschen stark verbessern.
Keywords: activities of daily living = Aktivita¨ten des ta¨glichen Lebens, walking = Gehen, public health = Public Health, prevention = Pra¨vention, therapy = Therapie
Literaturverzeichnis Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett Jr. DR, Tudor-Locke C, et al. 2011 Compendium of Physical Activities. Medicine & Science in Sports & Exercise 2011;43:1575–81. Barr-Anderson DJ, AuYoung M, Whitt-Glover MC, Glenn BA, Yancey AK. Integration of short bouts of physical activity into organizational routine a systematic review of the literature. Am J Prev Med 2011;40:76–93. Bassett DR, Pucher J, Buehler R, Thompson DL, Crouter SE. Walking, cycling, and obesity rates in Europe, North America, and Australia. J Phys Act Health 2008;5:795– 814. Boone-Heinonen J, Evenson KR, Taber DR, Gordon-Larsen P. Walking for prevention of cardiovascular disease in men and women: a systematic review of observational studies. Obesity Reviews 2009;10:204–17. Boreham CAG, Kennedy RA, Murphy MH, Tully M, Wallace WFM, Young I. Training effects of short bouts of stair climbing on cardiorespiratory fitness, blood lipids, and homocysteine in sedentary young women. Br J Sports Med 2005;39:590–3. Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA 2007;298:2296–304. Buehler R, Pucher J, Merom D, Bauman A. Active travel in Germany and the U.S.
Contributions of daily walking and cycling to physical activity. Am J Prev Med 2011;41:241–50. de Geus B, van Hoof E, Aerts I, Meeusen R. Cycling to work: influence on indexes of health in untrained men and women in Flanders. Coronary heart disease and quality of life. Scand J Med Sci Sports 2008;18:498– 510. Hamer M, Stamatakis E. Physical activity and mortality in men and women with diagnosed cardiovascular disease. European Journal of Cardiovascular Prevention & Rehabilitation 2009;16:156–60. Hamer M, Stamatakis E, Steptoe A. Doseresponse relationship between physical activity and mental health: the Scottish Health Survey. British Journal of Sports Medicine 2009;43:1111–4. de Hartog JJ, Boogaard H, Nijland H, Hoek G. Do the Health Benefits of Cycling Outweigh the Risks? Environ Health Perspect 2010;118:1109–16. Heesch KC, Burton NW, Brown WJ. Concurrent and prospective associations between physical activity, walking and mental health in older women. Journal of Epidemiology & Community Health 2011;65:807–13. Hou L, Ji B, Blair A, Dai Q, Gao Y, Chow W. Commuting physical activity and risk of colon cancer in Shanghai, China. Am J Epidemiol 2004;160:860–7. Hu FB, Sigal RJ, Rich-Edwards JW, Colditz GA, Solomon CG, Willett WC, et al. Walking compared with vigorous physical activity and
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