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Health and Avoidance of Disease

   What does being healthy mean? For some it is the simple  avoidance of disease, but it is also more than that. Health has been defined as a human condition possessing social,  psychological, and physical dimensions. Positive health is associated with a capacity to enjoy life and withstand  challenges. Negative health is associated with morbidity  (incidence of disease) and premature mortality (34). The  highest quality of life includes mental alertness and curios- ity, positive emotional feelings, meaningful relationships  with others, awareness and involvement in societal striv- ings, recognition of the broader forces of life, and the physi- cal capacity to accomplish personal goals with vigor. These  aspects of positive health are interrelated; a high level of  accomplishment in one area enhances the other areas, and,  conversely, a low level of function in any area restricts the  accomplishments possible in other areas. Although physi- cal activity plays a major role in the physical dimension,  it also contributes to learning, relationships, and a sense  of human limitations within the broader perspective. An  optimal quality of life requires individuals to strive, grow,  and develop, though they may never achieve the highest  level of positive health. What are the risks or challenges  to our health and well being? 

   Factors Affecting Health and Disease 

   The five leading causes of death in the United States in  2007 were cardiovascular diseases (CVD) (31.0%), can- cers (23.2%), chronic lower-respiratory diseases (5.3%),  accidents (5.1%), and Alzheimer’s disease (3.1%) (35).  Although infectious diseases are not in the top five, we are  warned each year to make sure that our flu shots and other  vaccinations are up to date in order to prevent a problem   from occurring. Most of the top five leading causes of  death are chronic degenerative diseases whose onset can  be delayed or prevented. Risk factors associated with  chronic diseases can be divided into three categories (see  figure 1.2) (38). 

   Inherited or Biological Factors 

   These factors include the following: 

   • Age—older adults have more chronic diseases than  younger people. 

   • Gender—men develop CVD at an earlier age than  women, but women experience more strokes than  men (6). 

   • Race—African Americans develop about 30%  more heart disease than non-Hispanic white  Americans (36). 

   • Susceptibility to disease—several diseases have a  genetic component that increases the potential for  having them. 

   People can achieve health and fitness goals up to their  genetic potential, but it is not possible to establish the  relative portion of a person’s health that is determined by  heredity. Although heredity influences physical activity,  fitness, and health (27), most people can lead healthy or  unhealthy lives regardless of their genetic makeup. Thus,  genetic background neither dooms a person to poor health  nor guarantees good health. 


   We are born not only with fixed genetic potentials but  also into environments that affect our development. An  environment includes physical factors (e.g., climate, water,  altitude, pollution), socioeconomic factors (e.g., income,  housing, education, workplace characteristics), and family  (e.g., parental values, divorce, extended family, friends)  that affect our opportunities to be active, level of fitness,  and health status. Some elements, such as our nutrition or  the air we breathe and water we drink, affect us directly.  Other elements, such as the values and behaviors of people  we admire, influence our lifestyles indirectly. We can  control certain aspects of our environments; for instance,  we choose many of the mental and physical activities we  undertake. However, our past and current environments  affect us in various ways. For example, some children  have inadequate food because of their environment and  cannot think about other aspects of health until that basic  need is fulfilled. 


   We have discussed the leading causes of death, but what are  the actual causes of death? The list of behaviors in figure  1.2 helps answer that question. That smoking is at the top  of the list should be no surprise given its connection to both  lung cancer and CVD. In fact, it is the number one actual  cause of death, accounting for 18% of all deaths (23, 24).  The existence of smoking-cessation programs and laws to  restrict areas in which one can smoke speak to the serious- ness with which our society takes that risk to health. The  number two actual cause of death is poor diet and physical  inactivity (15.2%), with alcohol consumption coming in  at number three (3.5%). The emphasis on healthy eating  at work and school and the creation of new parks and bike  trails to enhance opportunities to be physically active are  examples of responses to these actual causes of death.  Figure 1.3 shows that healthy eating and physical activity  affect a large number of factors that influence health and  disease. Clearly, your ability to help establish and reinforce  the behaviors of healthy eating and physical activity in the  people you serve during your professional life will do much  to improve their health and well-being. (See chapter 5 for  information on nutrition and chapter 23 for steps to help  clients change their behaviors.) This chapter introduces  the role that physical activity and fitness play in a healthy  lifestyle. However, before we begin, we need to review a  few terms that will be important in the following sections  of this chapter.  
   Important Definitions 

   We will introduce you to key terms as we move through  the chapters of the text; however, we need to begin here in  order to facilitate your understanding of the various parts  of an exercise prescription or physical activity recom- mendation (9, 33, 34). 

   • Physical activity is defined as any bodily move- ment produced by skeletal muscle that results in  energy expenditure (e.g., it is associated with occu- pation, leisure time, household chores, and sport). 

   • Exercise is a subset of physical activity that is  planned, structured, and repetitive and has the  objective of improving or maintaining physical  fitness. 

   • Physical fitness refers to a set of health- or skill- related attributes that can be measured by specific  tests. 

   • Health-related fitness refers to muscular strength  and endurance, CRF, flexibility, and body composi- tion (relative leanness). 

   • Skill-related (performance-related) fitness refers  to agility, balance, coordination, speed, power,  and reaction time that are linked to games, sport,  dance, and so on. 

   • Exercise intensity describes the rate of work (i.e.,  how much energy is being expended per minute)  and the degree of effort required to carry out the  task. The rate of work is the absolute intensity and  can be expressed in a number of ways: kilocalories  (kcal) of energy produced per min (kcal ∙ min−1),  milliliters of oxygen consumed per kilogram of  body weight per minute (ml ∙ kg−1 ∙ min−1), or  metabolic equivalents (METs), where one MET  is taken as resting metabolic rate and is equal to  3.5 ml ∙ kg−1 ∙ min−1. Walking at 3 mi ∙ hr−1 (4.8 km  ∙ hr−1) requires 3.3 METs (11.5 ml ∙ kg−1 ∙ min−1),  and jogging at 6 mi ∙ hr−1 (9.7 km ∙ hr−1) requires  10 METs (35 ml ∙ kg−1 ∙ min−1). You will see more  on this in chapter 6. 

   • Relative intensity describes the degree of effort  required to expend that energy and is influenced  by maximal aerobic power or cardiovascular fitness  (V.O2 max). Relative intensity can be expressed as a  percentage of V.O2 max or a percentage of maximal  heart rate (HRmax). You will see more on this in  chapter 11. 

   • Moderate intensity refers to an absolute intensity  of 3 to 5.9 METs and a relative intensity of 40% to  59% V.O2max or 64% to 76% HRmax. 

   • Vigorous intensity refers to an absolute intensity  of 6 or more METs and a relative intensity of 60%  to 84% V.O2max or 77% to 93% HRmax. 

   • Frequency refers to the number of days per week  physical activity is done. Duration refers to the amount of time a physical  activity is done. 

   • Volume refers to the total amount of energy  expended or work accomplished in an activity, and  it is equal to the product of the absolute intensity,  frequency, and time. For example, a person expend- ing 5 kcal ∙ min−1 for 20 min on 3 days ∙ wk−1 will  have an exercise volume of 300 kcal ∙ wk−1 (5 kcal ∙  min−1 × 20 min ∙ day−1 × 3 days ∙ wk−1). The volume  can also be expressed using the MET scale: A 10  MET activity done 3 days ∙ wk−1 for 20 min ∙ day−1  generates a volume of 600 MET-min ∙ wk−1 (10  METs × 3 days ∙ wk−1 × 20 min ∙ day−1).

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