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Perspectives in Disease Prevention and Health Promotion Coronary Heart Disease Attributable to Sedentary Lifestyle -- Selected States, 1988
During 1987, coronary heart disease (CHD)* accounted for 27.5% of the 2.1 million deaths in the United States (1). Well-documented risk factors for CHD include sedentary lifestyle, elevated serum cholesterol, cigarette smoking, hypertension, diabetes, and obesity (2,3). This report uses data from the 1988 Behavioral Risk Factor Surveillance System (BRFSS) and the 1976-1980 Second National Health and Nutrition Examination Survey (NHANES II) (4) to estimate the number of persons at risk for CHD due to sedentary lifestyle and to compare the prevalence of this risk factor with other risk factors for CHD.
The 37 state health departments participating in the BRFSS used standard questionnaires and methods to conduct monthly random-digit-dialed telephone interviews of adults greater than or equal to 18 years of age (5). For the BRFSS, sedentary lifestyle was defined as no physical activity reported or irregular physical activity reported (i.e., fewer than three times per week and/or less than 20 minutes per session). NHANES II, a nationwide probability sample of 28,000 persons aged 6 months to 74 years, described the relationship between age and cholesterol levels for men and women aged 20-57 years; because this sample used direct serum measurement instead of self-report to record cholesterol levels, it provides the best national estimate for this CHD risk factor.
In the BRFSS survey, sedentary lifestyle was the most prevalent (58%) modifiable risk factor for CHD reported, followed by cigarette smoking, 25%; obesity, 22%; hypertension, 17%; and diabetes, 5% (Figure 1). Based on NHANES II, the estimate for serum cholesterol levels greater than or equal to 200 mg divided by L among persons 20-74 years of age was 31%.
To reduce the burden of CHD attributable to sedentary lifestyle, 13 states** are promoting physical activity as part of comprehensive cardiovascular disease prevention programs. Based on a median adjusted*** relative risk of 1.9 (2) (i.e., sedentary persons are approximately twice as likely as physically active persons to die from CHD) and the reported prevalence of sedentary lifestyle ranging from 45% (Washing-ton) to 74% (New York), the percentage of CHD deaths attributable to sedentary lifestyle for these 13 states is 29%-40% (Table 1). Based on population-attributable risk (PAR) (6), the estimated number of preventable CHD deaths (i.e., deaths that might have been prevented if this risk factor had not been present in each of the 13 states) ranged from 1130 (Rhode Island) to 22,225 (New York). Reported by: The following BRFSS coordinators: L Eldridge, Alabama; S Hoecherl, Florida; J Sheridan, Maine; J Jackson-Thompson, Missouri; C Maylahn, J Marin, New York; E Capwell, Ohio; R Cabral, Rhode Island; M Mace, South Carolina; D Ridings, Tennessee; K Tollestrup, Washington; J Criniti, West Virginia. Office of Surveillance and Analysis and Cardiovascular Health Br, Div of Chronic Disease Control and Community Intervention, Center for Chronic Disease Prevention and Health Promotion, CDC.
Editorial Note: These data underscore the high prevalence of sedentary lifestyle and suggest that CHD could be reduced considerably if the U.S. population became more physically active. The estimated number of preventable CHD deaths calculated from these data are substantial; however, the data must be interpreted with caution. The relative risk used in the PAR calculations is a median value obtained from a review of 43 published studies and is adjusted for other selected CHD risk factors, indicating a substantial independent risk for CHD for persons with sedentary lifestyle. However, the number of estimated preventable deaths attributed to each factor may not be added to estimate the total population burden of specific CHD risk factors unless the relative risk for each factor was adjusted for the presence or absence of the others. In addition, for a more precise estimate of the number of preventable deaths and years of potential life lost, age-specific data, when available, should be used to describe the prevalence of and relative risk for sedentary lifestyle and CHD death rates. Also, the apparent effects of sedentary lifestyle may be influenced by other, unmeasured risk factors that may not be modifiable by increasing physical activity.
In addition to its beneficial effect on CHD, physical activity confers other important health benefits. Regular physical activity reduces the incidence of, or is otherwise beneficial to, hyperlipidemia, obesity, noninsulin-dependent diabetes mellitus, osteo porosis, psychologic impairment (7), colon cancer (7), stroke (8), and back injury (9).
Several of the 13 state programs to reduce the risk for CHD attributable to sedentary lifestyle are in the planning phase; others already have implemented walking campaigns, worksite activity competitions, and media campaigns to increase awareness and participation. Two handbooks on the promotion of physical activity in the community have been published (10,11); both emphasize a community-based approach and may be useful to public health officials as a resource for both ongoing and new health promotion programs that target sedentary lifestyle.
The current challenge is to effectively target sedentary lifestyle and subsequently reduce the risk for CHD and other chronic diseases associated with physical inactivity. Improved coordination of existing programs, new research, and expanded demonstration projects are needed to meet this challenge. The year 2000 national health objectives will provide guidance for increasing physical activity and fitness (12).
part A. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1990; DHHS publication no. (PHS)90-1101.
2. Powell KE, Thompson PD, Caspersen CJ, Kendrick JS. Physical activity and the incidence of coronary heart disease. Ann Rev Public Health 1987;8:253-87.
3. CDC. Chronic disease reports: coronary heart disease mortality--United States, 1986. MMWR 1989;38:285-8.
4. NCHS. Total serum cholesterol levels of adults 20-74 years of age: United States, 1976-80. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1986; DHHS publication no. (PHS)86-1686. (Vital and health statistics; series 11, no. 236).
5. Remington PL, Smith MY, Williamson DF, Anda RF, Gentry EM, Hogelin GC. Design, characteristics, and usefulness of state-based behavioral risk factor surveillance: 1981-87. Public Health Rep 1988;103:366-75.
6. CDC. Chronic disease reports in the Morbidity and Mortality Weekly Report (MMWR). MMWR 1989;38(no. S-1).
7. Powell KE, Caspersen CJ, Koplan JP, Ford ES. Physical activity and chronic diseases. Am J Clin Nutr 1989;49:999-1006.
8. Salonen JT, Puska P, Tuomilehto J. Physical activity and risk of myocardial infarction, cerebral stroke and death: a longitudinal study in eastern Finland. Am J Epidemiol 1982;115:526-37.
9. Cady LD, Bischoff DP, O'Connell MS. Strength and fitness and subsequent back injuries in firefighters. J Occup Med 1979;21:269-72. 10. CDC. Promoting physical activity among adults: a CDC community intervention handbook. Atlanta: US Department of Health and Human Services, Public Health Service, 1989. 11. King AC, Haskell WL, Blair S. Promotion of physical activity in the community. Stanford, California: Stanford Center for Research in Disease Prevention, 1988.12. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives (Draft). Washington, DC: US Department of Health and Human Services, Public Health Service, 1989. *International Classification of Diseases, Ninth Revision(ICD-9), rubrics 410-414, 429.2. **Alabama, Colorado, Florida, Maine, Missouri, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Washington, and West Virginia. ***Adjusted for other selected known risk factors for CHD.
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