Week 2 - Are Canadians Physically Healthy? Flashcards
How many risk behaviours are there?
5
what is the new risk behaviour added to the recommendations?
sedentary behaviour
what are the risk behaviours
1) smoking
2) physical inactivity
3) sedentary behaviour
4) unhealthy eating
5) harmful use of alcohol
how many risk conditions are there?
2
what are the risk conditions?
1) obesity
2) hypertension
what are the main chronic diseases?
FOUR MAIN:
1) cardiovascular diseases (HD and stroke)
2) cancer
3) chronic respiratory diseases (asthma and COPD)
4) diabetes
ALSO:
5) mood and anxiety disorders
Chronic Disease Multi morbidity
two or more of the four major chronic diseases
OR
mood and anxiety disorder co-morbid with at least one of the major four chronic diseases
Other Health Indicators
1) influenza immunization
2) neonatal and infant mortality
3) premature mortality
4) health-adjusted life expectancy and life expectancy
Regarding health, the average Canadian is HEALTHY
Chronic Disease
noncommunicable diseases (NCDs) are not passed from person to person; of long duration and generally slow progression
Four main types of Chronic Disease
1) Cancers
2) Cardiovascular Diseases
3) Diabetes
4) Chronic Respiratory Diseases
WHO definition of Physical Activity
any bodily movement produced by skeletal muscles that requires energy expenditure. PA refers to all movement including during leisure time, for transport to get to and from places, or as part of a person’s work
Physical Activity
- Significant health benefits for hearts, bodies, and minds
- Contributes to preventing and managing NCDs, ie. CVD, cancers, diabetes
- Reduces symptoms of depression and anxiety
- Enhances thinking, learning, and judgement
- Improves overall wellbeing
WHO Definition of Physical Inactivity
physical inactivity is a major, modifiable risk factor for chronic diseases
- Globally, 1 in 4 adults do NOT meet the global recommendations of PA
- Up to 5 millions deaths/year could be averted if the global population was more active
- Inactive people have 20-30% increased risk of death compared to people who are sufficiently active
- > 80% of the world’s adolescent population is insufficiently active…
“Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it”
Plato
Big Four Chronic Diseases Link
Physical Inactivity
Prevalence of IHD
Prevalence of Diabetes
10-year Prevalence of Cancer
Annual Prevalence Health Services Use for Mood & Anxiety Disorders
Prevalence of Arthritis
overall prevalence peaks ages 55-65
more women
increases with age
Prevalence of Osteoarthritis
more women
increases with age
Prevalence trends Major Chronic Diseases and Risk Conditions 2000-2012
Cancer — stayed roughly the same
Asthma — INCREASING
COPD — INCREASING
Diabetes — INCREASING
IHD — relatively the same
Stroke — relatively the same
Hypertension — INCREASING
Mood & Anxiety — relatively stable/very slight decline
Prevalence of Chronic Diseases among Canadian Adults
44% 20+ have at least 1 of 10 common chronic diseases
- 25% hypertension
- 14% osteoarthritis
- 13% mood and anxiety
- 12% osteoporosis
- 11% diabetes
- 11% asthma
- 10% COPD
- 8% IHD
- 8% cancer
- 7% dementia
Chronic Diseases in Ontario
- over 7 in 10 deaths due to a chronic disease
- 242,054 hospitalizations due to big four chronic diseases
Chronic Disease Risk Factors
- tobacco smoking
- alcohol consumption
- physical inactivity
- unhealthy eating
+ sedentary behaviour
how many adults have at least one of these risk factors
1 in 5
ontario high prevalence of tobacco smoking and alcohol consumption
13% self-report having NONE
we spend billions of dollars due to chronic disease
if major risk behaviours for chronic diseases were eliminated….
80% of IHD, stroke, and T2DM would be prevented
40% of cancer
Prevalence of Risk Factors in Canada
- MOST prevalent = physical inactivity then unhealthy eating
- smoking decreases with age
- obesity increases with age
- physical inactivity HIGHEST 12-19 year olds
Percentages of Canadians with Risk Factors
- 19.6% NONE
- 34.8% ONE
- 32.1% TWO
- 11.2% THREE
- 2.3% FOUR
BMI
ratio of body weight to height-squared
= mass (kg) / height (m squared)
ie. 75 kg individual 175 cm tall
- 75/1.75 = 24.5kg/m squared
Weight Status based on BMI
below 18.5 = underweight
18.5-24.9 = normal weight
25-29.9 = overweight
30-34.9 = obesity class I
35-39.9 = obesity class II
above 40 = obesity class III
Global Obesity Rates
Increasing across the globe (Canada, USA, Sweden, Zimbabwe)
- women more than men EXCEPT sweden
Canadian Childhood Obesity Rates
30% (1978 - 23%, increased to 35%, then decreased)
- over 90% NOT meeting PA guidelines
- 1 in 3 are overweight or obese
- 18.6% are overweight
- 12.5% are obese
Waist Circumference and Health
Equal to or less than
Men SMALL 102 inch / 40 inch
Women 88 cm / 35 inch
Large is above
Hypertension
- Definition: chronic high blood pressure
- Prevalence: 24.9% (2011/12) - 6.9 million Canadians >20 years old
>70% of Canadians aged 65+ are affected
Diagnostics:
Accurate diagnosis begins with accurate measurement
Blood Pressure Measurement Technique
Treatment Hypertension Health Behaviour Recommendations
being more physically active, weight reduction, moderation in alcohol intake, eating healthier, relaxation therapies, smoking cessation
Being More Physically Active
accumulation of 30-60 min of dynamic exercise of moderate intensity 4-7 days per week in addition to routine activities of daily living
- higher intensities of exercise are no more effective at BP lowering but may produce other cardiovascular benefits
- non-hypertensive resistance or weight training exercise does not adversely influence BP
- prescribe to both normotensive and hypertensive individuals for prevention and management of hypertension, respectively
Weight Reduction
- healthy BMI and waist circumference is recommended for non-hypertensive individuals to prevent hypertension and for hypertensive patients to reduce BP
- encourage multidisciplinary approach to weight loss, including dietary education, increased PA, and behaviour modification
Moderation in Alcohol Intake
limited consumption— 0-2 standard drinks/day
men: less than 14/week
women: less than 9/week
- prescribe to both normotensive and hypertensive individuals for prevention and management of hypertension, respectively
Eating Behaviour
diet HIGH in fresh fruits, vegetables, dietary fibre, non-animal protein, and low-fat dairy products
- low in saturated fat in cholesterol
- to decrease BP, increase dietary potassium
- prescribe to both normotensive and hypertensive individuals for prevention and management of hypertension, respectively
Relaxation Therapies
individualized CBT more likely to be effective when relaxation techniques are employed
- prescribe for selected patients in whom stress plays a role in elevating BP
Smoking Cessation
abstinence from smoking; smoke-free environment
- GLOBAL cardiovascular risk reduction strategy
3 Options for Measuring PA
1) SUBJECTIVELY
2) OBJECTIVELY — Accelerometer
3) OBJECTIVELY — Wearables
Subjective Measures
Ie, questionnaire
Guthold, Stevens, Riley, Bull (2018) — worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1-9 million participants
- Insufficient pA is a leading risk factor for noncommunicable diseases and has a negative effect on mental health and quality of life
- Levels of insufficient PA across countries and estimate global and regional trends
Objective Measurements Accelerometer
Colley et al (2018) Health Reports Vol. 29, no. 12, pp. 3- 15, December 2018
Statistics Canada
Comparison of self-reported and accelerometer-measured physical activity in Canadian adults Research Article
Physical Activity Report Card
“Better with Age, Move more today for a healthier tomorrow”
by ParticipACTION
- daily behaviours; individual characteristics; settings & sources of influence; strategies & investments
- assigns overall grade
Objective Measurement — Wearables
Althoff et al. (2017)
- Study of 700,000+ people, 111 countries, using smartphones with built-in accelerometry (Azumio Argus App) to track activity
- Canadians walked an average of 5000 steps/day.
- HALF THE RECOMMENDED
- Main finding: Physical activity levels did not predict obesity rates as much as _activity inequality_
- Walkability predicts activity inequality
More walkable city, more activity throughout the day and age
- Across age groups, gender, BMI
- Because of built environment
The Gender Gap
- Female activity is reduced in areas with high gender activity inequality
7 Facts about Physical Activity “Pulse” in Canada
- Canadians know physical inactivity is a problem. 93% said it’s a more serious health problem than tobacco and alcohol use.
- Canadians are aware people need to be more active.
- Canadians have positive feelings about being active. 74% said they enjoy being active.
- Canadians think that a more active life is within reach. 61% said they wouldn’t need to change too much to be more active.
- Canadians think everyone contributes to the physical inactivity problem. (social factors ie. gov, schools, industry, parents, etc.)
- Canadians think individuals are at the heart of the issue. 88% believe individuals are the solution.
- Canadians support public policy to encourage increased physical activity.
PA Report Card 2020 Key Findings
- 39% meet PA recommendations within 24 hour movement guidelines
- no sig changes overtime
- boys encage in more physical activity than girls and children (5-11) engage more than youth (12-17)
- 25% 10-17 year olds are meeting the PA recommendations
- 41% 5-9 year olds take 12 000 steps daily - meets guideline
- 5-19 year olds take 11 300 steps daily
PA Report Card 2020 Grades
Canadian PA Guidelines
- ONLY 16% Canadian adults are getting the recommended amount of PA (15 min moderate-vigorous PA/week)
- 84% is NOT active enough
8 in 10 Canadian adults are not active enough to reap the health benefits of a physically active lifestyle. Your neighbour, mother, brother, daughter, coworker, or maybe even you could be part of the physical inactivity crisis in Canada.
Activity Declines during COVID-19
Sebastiano, Chulak-Bozzer, Vanderloo, and Faulkner, 2020. Don’t Walk So Close to Me: Physical Distancing and Adult Physical Activity in Canada.
PA Report Card 2021
F — Active Transportation
C+ — Light Physical Activity
F — Sedentary Behaviours
The Problem?
in many ways, people have never been less healthy
- main reason is physical inactivity
BMI of 24.0 implies the person is
normal weight
which new modifiable risk factor was included in the How Healthy Are Canadians report?
Sedentary behaviour
Survey data suggests __% of Canadian adults are meeting PA guidelines
16%
Which is not on our list of top 4 chronic diseases with strong links to physical inactivity?
Arthritis
T/F
We will be using the WHO definition of health in this class
TRUE
T/F Physical Activity Reduces symptoms of depression and anxiety
TRUE
T/F Obesity is a disease
FALSE
- is a risk condition
Smoking
- Negative impacts on nearly every organ of body and reduction in overall health
Trend = significant decrease in the age-standardized rate of daily or occasional smokers
- Declined in all age groups but declined most in younger age groups
- Greater proportion of males
- Rates highest among 20-34 year olds
- Older adults significantly lower
- BC lowest; NWT nearly double rates and Nunavut more than 3X of Canadian average
Physical Inactivity
- More than 3/4 are not meeting guidelines
- PH concern — 4th leading cause for global mortality and linked to a number of chronic diseases including CVDs, cancer, and diabetes
- Trend = no significant change in proportion of children but small decrease in mean number of steps taken
- Proportion of adults not meeting had not changed sig; self-report small increase reported being active or moderately active
- Greater proportion girls do not meet levels; men and women don’t differ sig
- Adherence to guidelines diminishes with age
Sedentary Behaviour
- Half fail to meet guidelines
- Health risks — obesity and decreased fitness
- Association is independent of physical inactivity
- Limiting recreational screen time to no more than 2hr/day
- Remained stable since 2007 — 8.5 hours per day
- Younger children spend less time being sedentary than older children and youth
Unhealthy eating
- More than 1 in five eat less than recommendation
- Adult = 7-10 servings; children = 4-8 servings
- Those who do not eat fruit and veg five or more times per day as a measure of unhealthy eating
- More men do not consume
- Proportion exceeded the national average by more than 20% in Newfoundland and Labrador and Nunavut
Harmful use of alcohol
1 in 6 15+ exceeded guidelines; more than 1 in- 6 heavy drinking at least once a month
- Immediate health risks are associated with “binge” or heavy
- 4+ one night for women, 5+ men
- Long-term linked chronic liver disease, certain cancers, CVDs, and premature death
- Trend = increased
- More males exceed; diff even greater heavy drinking
- High among 25-34 year olds, low 50+
- No geographical difference regarding guidelines but greater NS, NB, NFL, Yukon, NWT for heavy drinking
Male vs Women Risk Factors
Overall rates among females statistically lower in females
Aging
Proportion of those reporting at least one risk factor increased with age
Obesity
- Strongest predictor of being obese as adult = being obese as a child
- Dramatic increase in last few decades; no sig diff since 2007
- Obesity rate for children peaked 2007-2009
- Men and women similar
- Boys higher than girls
- Highest age 35-49 and 50-64
hypertension
- Can cause heart attacks, stroke, heart failure, dementia, renal failure and blindness
- Canada has the world’s highest reported national blood pressure control rate
- Trends = PREVALENCE increased, INCIDENCE decreased
- Similar between males and females
- Increased with increasing age
- Highest prevalence NFL, lowest prevalence NWT
Ischemic Heart Disease
- Second leading cause of death after cancer and leading cause of hospitalization
- Heart muscle is damaged or works inefficiently because the absence or relative deficiency of its blood supply
- IHD is number one cause of years of life lost (YLL) due to premature mortality and the second leading cause of disability-adjusted life years (DALYs)
- Prevalence increased then has stayed stable
- Incidence has decreased
- Men more
- Prevalence increases with age; white males had higher rates than females in all age groups
- NB has highest; Nunavut lowest
Stroke (cerebrovascular disease)
- sudden loss of brain function that occurs when blood flow supplying oxygen to a part of the brain is interrupted
- Stroke is third leading cause of death
- Fourth leading cause of years of life lost due to premature mortality and the tenth largest contributor to disability adjusted life years (DALYs)
- Hospitalizations and deaths steadily declined over the past few decades but absolute number of living with the effects of strokes is increasing
- Burden is increasing among younger adults
– Mean age of stroke is decreasing; burden of stroke is likely to increase even further - Age-standardized prevalence increasing but incidence has decreased
- Males and females equally affected
- Increased with increasing age
- Highest PEI, lowest Newfoundland and Labrador
Cancer
- Not just one disease, but a large group of almost 100 diseases
- Two main characteristics:
1) Uncontrolled growth of the cells in the human body
2) Ability of cells to migrate from the original site and spread to distant sites - Cancer has been leading cause of death in Canada
- prostate, breast, colorectal cancers account for over half of all prevalent cases in Canada
- 2 in 5 Canadians are expected to be diagnosed with cancer in Canada in their lifetime, and one in four will die from cancer
- Age standardized prevalence increased but incidence rate decreased
- Higher prevalence in men, higher incidence in men
- Nearly 90% diagnosed, over the age of 50, 40% over age of 70
- Cancer incidence rates are higher in eastern Canada and lower in western Canada
Lowest = Yukon
Chronic Obstructive Pulmonary Disease (COPD)
- Chronic and progressive condition characterized by gradual airway obstruction, shortness of breath, cough and sputum production
- Cigarette smoking main cause
- 7th leading cause of years of life lost due to premature mortality and 9th leading contributor to DALY
- Age-standardized prevalence increased but incidence decreased
- Very similar males and females
- Prevalence rates steadily increase with age
- High in Nunavut, NS and the three territories all had rates more than 20% higher than national average
Asthma
- Characterized by cough, shortness of breath, chest tightness and wheezing
- Two out of three Canadians with active asthma do not have good control of their condition
- Age-standardized prevalence increased but incidence decreased
- Slightly higher among females
- Highest ages 1-19 and 20-34 declined until age 65 when began increasing again
- High in Ontario; 3 territories had rates more than 20% lower than canadian average
Diabetes
- Body is either unable to sufficiently produce or properly use insulin
- Age standardized prevalence increased
– Incidence increased then dropped - More males living with diabetes (type 1 and 2 combined)
- Prevalence increased by age group; highest = 65-79 and 80+
- Low in Nunavut, high in Yukon but did not differ by more than 20% from national average
Mood and Anxiety Disorders (health services use)
- Mood disorders = lowering or elevation of a person’s mood
- Anxiety disorders = excessive and persistent feelings of apprehension, worry and even fear
- Mood and anxiety disorders are most common types of mental illnesses
- Major depressive disorder was ranked as second leading cause of years of life lost due to disability; anxiety 8th
- Higher among females
- Rates highest between 35-64, decreased slightly with increasing age
- Highest in NS, lowest Nunavut, Newfoundland and Labrador, Quebec, NWT
Multi-morbidity
- Greater risk of adverse health outcomes and have increased health care needs
- 65+, prevalence rates have slightly increased
- Females (65+) had significantly higher rates
- Increases dramatically with age
- Highest prevalence Yukon and Alberta, lowest rates BC and Manitoba
- Rates differ by at least 20% from the Canadian rate
Mood and Anxiety Disorders Comorbidity
- Early onset of depressive and anxiety disorders has been shown to be associated with an increased risk of developing heart disease, asthma, arthritis, chronic back pain and chronic headaches in adult life
- Can lead to unhealthy behaviours that increase the risk of developing or exacerbating other chronic diseases or conditions
- May result from the burden of living with a chronic disease or condition
- Significant increase in prevalence
- Females significantly higher rates
- High prevalence in 50-64 age group
- Highest NS and NB; lowest BC, SK, MB
Influenza Immunization
- Chronic diseases are at high risk from complications and death due to influenza infection
– May trigger an exacerbation and deterioration of pre-existing conditions - Vaccine rate has fluctuated over last decade
- Females with chronic disease slightly higher
- Immunization rate among those with chronic disease generally increased with age
- NS had a rate at least 20% higher than national average
Neonatal and Infant Mortality
Infant mortality = number of deaths of live-born babies in first year (per 1000)
Neonatal mortality = first 28 days
- Infant mortality declined, neonatal stayed stable
- Infant and neonatal higher in boys — genetic and biological makeup; boys in general are more susceptible to disease and premature death
- Nunavut 3X canadian average
Premature Mortality
- Deaths that occur at a younger age than expected and, therefore, reflect the potential for avoidable deaths
- Decrease from the four main NCDs was observed
– Mainly due to decrease in mortality from cardiovascular diseases and from cancer - Probability of dying between ages 30-64 from any of the 4 main chronic diseases was higher in males
– Particularly for cardiovascular diseases which were 2.5 times more likely for males - Nunavut 2X greater than Canadian average
- Very high premature mortality for chronic respiratory diseases (8X) and cancer (2X)
- NWT, Yukon, Newfoundland risk 20% higher than Canada as a whole
Life Expectancy
LE = describes the overall health status of a population and is defined as the average number of years a person of a certain age would be expected to live given current mortality rates
Health adjusted life expectancy (HALE) = average number of years that a person is expected to live in full health
- Both LE and HALE steadily increasing (due to decrease in mortality)
- Females have higher LE and HALE
- Nunavut and NWT low, high BC for LE
- Nunavut, NWT, and Yukon lowest HALE, Quebec highest
