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The economic burden of physical inactivity: A global analysis of major non-communicable diseases
Abstract
Background:
The pandemic of physical inactivity is associated with a range of chronic diseases and early deaths. Despite the well documented disease burden, the economic burden of physical inactivity remains unquantified at the global level. A better understanding of the economic burden could help to inform resource prioritisation and motivate efforts to increase levels of physical activity worldwide.
Methods:
Direct health-care costs, productivity losses, and disability-adjusted life-years (DALYs) attributable to physical inactivity were estimated with standardised methods and the best data available for 142 countries, representing 93·2% of the world's population. Direct health-care costs and DALYs were estimated for coronary heart disease, stroke, type 2 diabetes, breast cancer, and colon cancer attributable to physical inactivity. Productivity losses were estimated with a friction cost approach for physical inactivity related mortality. Analyses were based on national physical inactivity prevalence from available countries, and adjusted population attributable fractions (PAFs) associated with physical inactivity for each disease outcome and all-cause mortality.
Findings:
Conservatively estimated, physical inactivity cost health-care systems international (INT) 53·8 billion worldwide in 2013, of which 12·9 billion by the private sector, and 13·7 billion in productivity losses, and physical inactivity was responsible for 13·4 million DALYs worldwide. High-income countries bear a larger proportion of economic burden (80·8% of health-care costs and 60·4% of indirect costs), whereas low-income and middle-income countries have a larger proportion of the disease burden (75·0% of DALYs). Sensitivity analyses based on less conservative assumptions led to much higher estimates.
Interpretation:
In addition to morbidity and premature mortality, physical inactivity is responsible for a substantial economic burden. This paper provides further justification to prioritise promotion of regular physical activity worldwide as part of a comprehensive strategy to reduce non-communicable diseases.
Funding:
None.
... 4 Insufficient physical activity is a risk factor for a variety of physical and psychological health outcomes. 5,6 Physical inactivity's costs for the health care systems are over 50 billion worldwide, 7 and it has been liable for millions of deaths per year. 5 Due to all impairments associated with physical inactivity, a profound and precise understanding of the driving forces and contributors of the development and maintenance of a physically active lifestyle is important. ...
... It has previously been shown that adolescents' perceptions of their Tjur R 2 = coefficient of discrimination. 7 The models were adjusted for parents' and children's sex, siblings, BMI, health status, and children's living area as well as parents' educational status and income. 8 The association between parents' sports club participation at parents' age of 9 and children's age of 18 diluted after controlling for children's health status (OR = 8.61; 95% CI, 0.93-79.46). ...
Background : Physical activity has been shown to transfer across generations, but more information is needed regarding the transference of different physical activity modes. This study examined (1) whether parents’ sport club participation at the ages 9–18 was associated with their offspring’s sports club participation at the same ages and (2) whether the associations were robust against adjusting for demographic, health-related, and socioeconomic covariates. Methods : The participants (parents, G1, N = 309–539 and children, G2, N = 131–332) were from the ongoing, population-based Young Finns Study. Participants’ sports club participation was assessed through self-reports during 1980–1992 (G1) and 2018/2020 (G2). The analyses were conducted using generalized estimation equations controlling for participants’ sex, number of children’s siblings, children’s body mass index, health status, and living area as well as parents’ educational status and income. Results : Parents’ sports club participation at the age of 9 was favorably associated with their children’s participation at the age of 9 (odds ratio = 5.23; 95% CI, 1.59–17.17; Tjur R ² = .27) and 12 (odds ratio = 2.56; 95% CI, 1.06–6.18; Tjur R ² = .14) adjusting for the covariates. Conclusions : Parents’ sports club participation at the age of 9 was favorably associated with their offspring’s sports club participation at childhood and early adolescence. Childhood might be one of the most essential periods to conduct physical activity interventions or motivational programs to support children’s sports club participation.
... 10 When physical activity preferences are better understood, they will likely be utilized more effectively to optimize their impacts. Given that physical inactivity has remained a global challenge for a significant period, [11][12][13][14] there is ground to capitalize on any benefit that physical activity preferences may offer in physical activity interventions. This approach will likely aid in mitigating the negative consequences that physical inactivity poses on health and society. ...
... This approach will likely aid in mitigating the negative consequences that physical inactivity poses on health and society. [11][12][13][14] It will also likely offer support in attaining the World Health Organization's goal to reduce worldwide physical inactivity by 15% by 2030. 15 These prospects help further reveal the importance of continuing the study of physical activity preferences to facilitate their incorporation into physical activity interventions to capitalize on any benefit they may offer. ...
... A survey on the nutritional status and chronic disease status of Chinese residents revealed that in 2020, the overweight and obesity rates for children and adolescents aged 6-17 years and under 6 years in China were 19 and 10.4%, respectively; the incidence of single behavioral abnormalities in children ranged from 10 to 20%; the prevalence of hyperactivity disorders, autism, learning disabilities, and behavioral disorders among children increased; and unhealthy lifestyles were prevalent (Yu and Zou, 2023). Chronic diseases such as hypertension, diabetes mellitus, dyslipidemia, and fatty liver, which typically appear only in adulthood, now appear in overweight and obese children and adolescents and indicate a trend toward chronic diseases at a younger age (Ding et al., 2016). ...
Background: This study aimed to develop a scale to assess the physical activity (PA)-related parenting practices of Chinese parents of children aged 3-6 years based on general parenting theory. Methods: A pool of scale items (123 items) was constructed based on a literature review and in-depth personal interviews. The pretest scale (60 items) was developed using Delphi correspondence and a presurvey. After two rounds of item screening of the pretest scale using exploratory factor analysis (EFA) and analysis of variance, we deleted 30 items. We ultimately developed a formal version of the Chinese Physical Activity Parenting Practices Scale (CPAPPS) using the remaining 30 items. We examined the structure of the scale using factor analysis and evaluated its reliability, validity, and discriminant ability using data from 899 parents of children aged 3-6 years. Results: The CPAPPS includes 30 items in 6 dimensions scored on a 5-point Likert scale. The 6 dimensions are education, autonomy promotion, modeling, demands, expectations, and rewards. Both exploratory and confirmatory factor analyses confirmed the construct validity of the scale. Furthermore, the scale had adequate internal consistency, split-half reliability, test-retest reliability, and concurrent validity. Parents younger than 30 scored significantly lower on the demand dimension than parents aged 40-50 (p < 0.05). The differences in rewards and expectations between parents of different ethnicities were statistically significant (p < 0.05). Compared with married parents, parents who were currently single had lower scores for education, rewards, modeling, and autonomy promotion (p < 0.05). There was a significant difference in scores across all dimensions between parents with different places of residence (p < 0.05). Conclusion: The CPAPPS satisfies the conditions for reliability and validity in accordance with psychometric requirements. The scale can be employed to evaluate the characteristics of Chinese parents' physical activity-related parenting practices and to design family-based PA interventions.
... Moreover, engagement in physical activity (PA) is a way to socialize with peers, as well as establish other social connections (Jonsson et al., 2017;Li and Zizzi, 2018), which are important factors affecting mental and physical health per se, particularly in children and adolescents (Román et al., 2023). Also, speaking the language of economy, it is worth noting that physical inactivity causes a significant financial burden for societies (Ding et al., 2016). ...
Background
Considering the low engagement of contemporary adolescents in physical activity (PA), apparently, PA still has a low priority for adolescents, who are the only ones making decisions and performing behavior. So, analysis of more proximal factors that lay on the personal and interpersonal levels as well as psychological mechanisms forming PA behavior is important.
Methods
The population-based cross-sectional study included 4,924 5th to 12th-grade school students. Among them, 50.9% were girls. The mean age of study participants varied from 11 to 19 years [mean 14.08 (2.21)]. Moderate-to-vigorous physical activity was measured by four items out of the IPAQ-SF questionnaire. Psychological well-being was assessed using The World Health Organization Five Well-Being Index (WHO-5) 5-item questionnaire. Psychological distress has been assessed by Kessler’s six-item scale. Social support in terms of family and friends social support has been assessed by a 13-item subscale of Sallis’ Support for Exercise Survey. Body mass index (BMI) was calculated by dividing body mass (kg) by height-squared (m²).
Results
Higher motivation for MVPA was predicted by higher family (β = 0.653) but not friends‘support and both mental health indicators – higher psychological well-being (β = 0.049) and lower psychological distress (β = −0.078) were linked to higher motivation for physical activity, regardless the covariates. Higher motivation (β = 0.137), greater psychological well-being (β = 0.580) with the greatest magnitude, and lower psychological distress (β = −0.293) contributed to the greater MVPA.
Conclusion
Family but not friends’ support for physical activity, greater psychological well-being, and lower psychological distress have direct and indirect effects on greater moderate-to-vigorous physical activity in adolescents.
... Exercise, especially when voluntary, promotes cardiovascular fitness, reduces morbidity with chronic diseases, and promotes mental wellness [1][2][3]. Conversely, a sedentary lifestyle, characterized by insufficient physical activity, poses deleterious effects on health and fitness, leading to amplified chronic inflammation and increasing the risk of cardiovascular, metabolic, neoplastic, and psychiatric diseases [4,5]. Despite these benefits, participation levels and performance outcomes in humans show significant heterogeneity among different individuals [3,6]. ...
Regular exercise confers numerous physical and mental health benefits, yet individual variability in exercise participation and outcomes is still poorly understood. Uncovering the neurobiological mechanisms governing exercise behavior is essential for promoting physical activity and developing targeted interventions for related disorders. While genetic studies have provided insights, they often cannot account for protein-level alterations, such as changes in kinase activity. Here, we employ protein kinase activity profiling to delineate brain protein kinase activity and signaling networks modulated by acute voluntary exercise in rats. Focusing on the dorsal striatum, which governs voluntary exercise, as well as the hippocampus, which is susceptible to modulation by physical activity, we aim to understand the molecular basis of exercise behavior. Utilizing high throughput kinome array profiling and advanced pathway analyses, we identified protein kinase signaling pathways implicated in regulating voluntary exercise. Pathway analysis using Gene Ontology (GO) revealed significant alterations in 155 GO terms in the dorsal striatum and 206 GO terms in the hippocampus. Changes in kinase activity were observed in the striatum and hippocampus between the exercise (voluntary wheel running, VWR) and sedentary control rats. In both regions, global serine-threonine kinase (STK) activity was decreased, while global phospho-tyrosine kinase (PTK) activity was increased in VWR rats compared to control rats. We also identified specific kinases altered in VWR rats, including the IKappaB Kinase (IKK) and protein kinase delta (PKD) families. C-terminal src Kinase (CSK), epidermal growth factor (EGFR), and vascular endothelial growth factor receptor (VEGFR) tyrosine kinase were also enriched. These findings suggest regional heterogeneity of kinase activity following voluntary exercise, emphasizing potential molecular mechanisms underlying exercise behavior. This exploratory study lays the groundwork for future investigations into the causality of variations in exercise outcomes among individuals and different sexes, as well as the development of targeted interventions to promote physical activity and combat associated chronic diseases.
... However physical inactivity is a leading risk factor for mortality and morbidity worldwide [2,3], with 30% of European adults failing to meet recommended levels of PA [4]. Physical inactivity has implications beyond health, with physical inactivity related deaths contributing $13.7 billion in global productivity losses [5]. Increasing PA can also have significant environmental implications, such as a fall in vehicle use [6]. ...
Background
Physical inactivity is a leading cause of premature mortality and morbidity worldwide. Primary care settings provide an opportunity for effective lifestyle interventions, including physical activity (PA) promotion. This study aims to evaluate the impact of a rural community-based multi-component, 12-week exercise, nutrition, education and peer-support programme on participants health and wellbeing.
Methods
This retrospective service evaluation included patients referred to the programme between January 2020 and December 2022 from primary care settings. Quantitative data (including body composition measures, mental wellbeing and patient activation) were collected at the entry and exit of the 12-week program. Participants also self-reported healthcare attendance in the 3 months prior to the baseline and post-intervention data-collection.
Results
Of the 424 people who participated in the programme, 84.7% (n = 359) indicated that they had achieved their goals. Significant improvements in BMI, weight, blood pressure, wellbeing, patient activation, muscle mass, body-fat mass and reduced healthcare attendance over a 12-week intervention were identified by repeated measure ANOVA. Post-hoc tests with a Bonferroni correction found that younger participants were significantly more likely to decrease their BMI and increase their mental wellbeing (as measured by WEMWBS) over the course of the programme. Higher attendance at the programme was also associated with greater reductions in BMI and greater improvements in patient activation.
Discussion
The findings support the effectiveness of multicomponent community-based exercise, nutrition, education and peer support interventions in improving health outcomes and reducing healthcare utilisation. Further research is needed to evaluate the long-term health outcomes of the education-exercise referral programme, across settings, and its potential to contribute to a sustainable healthcare system.
... Hence, our findings emphasize the importance of a holistic approach to improving physical activity and health outcomes among bank employees, incorporating workplace interventions, leisure-time activity promotion, and support for active commuting. [43,47] ...
Background
Sedentary lifestyles and prolonged sitting among office workers, such as bank employees, are associated with a high burden of physical inactivity and chronic conditions. This study evaluates the physical activity levels and associated morbidities among bank employees in Greater Kolkata, India.
Objective
The objective of this study was to assess physical activity levels, identify the burden of chronic conditions linked to physical inactivity, and explore associations of physical activity with demographic, occupational, and behavioral characteristics, as well as morbidities.
Materials and Methods
This community-based, cross-sectional study was conducted between August 2024 and November 2024 in the Barrackpore II community development block, North 24 Parganas district, Kolkata. A total of 144 participants were selected through simple random sampling. Data were collected via inperson interviews based on World Health Organisation’s Global Physical Activity Questionairre version2.
Results
The study revealed concerning health behavior trends: 73.6% of employees consumed junk food regularly, contributing to noncommunicable diseases such as obesity, hypertension, and gastrointestinal disorders. Despite good vegetable intake, high unhealthy food consumption emerged as a significant risk factor. Surprisingly, employees with preexisting conditions such as hypertension and diabetes reported higher physical activity levels, possibly reflecting increased health awareness. An inverse relationship was noted between fruit consumption and physical activity, with regular fruit consumers reporting lower metabolic equivalent values, warranting further exploration. Factors such as working hours, addiction habits, and gender showed no significant associations with physical activity levels.
Conclusion
This study underscores the urgent need for workplace health initiatives targeting diet and physical activity to mitigate sedentary lifestyle risks among bank employees. While limitations include self-reported data and a cross-sectional design, the findings provide critical insights into health behaviors and inform strategies for promoting healthier lifestyles in this occupational group.
... Open access deaths annually. 2 To address this issue, the evaluation and widespread implementation of suitable PA interventions are urgently needed. International organisations such as the WHO and International Society for Physical Activity and Health have advocated for PA promotion to be integrated into healthcare settings, with health professionals holding a valuable opportunity to promote PA to a large group of people across the lifespan. ...
Introduction
Physical activity has important benefits for the prevention and management of chronic diseases and healthy ageing. Health professionals have valuable opportunities to promote physical activity to a large group of people across the lifespan. Promotion of Physical Activity by Health Professionals is a hybrid type 1 effectiveness-implementation cluster randomised trial designed to evaluate the impact of physical activity promotion by health professionals (n=30 clusters) on physical activity participation in their patients (n=720). To inform the future implementation of this programme, we will be conducting a within-trial and modelled economic evaluation.
Methods and analysis
We will conduct a cost-effectiveness and cost-utility analysis from the perspective of the healthcare, aged care and disability funder. The time horizon will be 6 months for the within-trial analysis and 2 years for the modelled analysis. Data on intervention costs will be collected using trial records. Data on healthcare utilisation will be collected using data linkage. Incremental cost-effectiveness ratios (ICERs) will be reported for physical activity and quality-adjusted life years outcomes. Bootstrapping will be used to explore uncertainty around the ICERs and estimate 95% CIs. Results will be presented on a cost-effectiveness plane. The probability that the intervention would be cost-effective at varying willingness-to-pay thresholds will be presented using a cost-effectiveness acceptability curve.
Ethics and dissemination
Ethics approval was obtained through Sydney Local Health District (RPAH zone) Ethics Review Committee (X23-0197). The findings of this study will be disseminated through peer-reviewed journal articles and conference presentations.
Trial registration number
Australian New Zealand Clinical Trials Registry: ACTRN12623000920695.
... PM emissions and exposure adjustment factors were updated based on a recent review (Pope et al. 2021). Cost-of-illness for stroke, which was not included in the latter, was taken from a recent systematic review of LMIC evidence (Ding et al. 2016). Other parameters-behavioral parameters, economic valuation parameters-were taken from a prior peer-reviewed cost-benefit model and database (Jeuland et al. 2018), with valuation assumptions following general guidance for global health and development applications, that is, using global prices (e.g., for fuels such as LPG) and average variable costs for additional electricity consumption, and adjusting for income and purchasing power differences where appropriate (Robinson et al. 2019). ...
Clean cooking technologies have the potential to deliver substantial health, environmental, climate, and gender equity benefits. We use the BAR‐HAP model to conduct the first global analysis of the regional and global costs and benefits of several subsidy and financing policies supporting household transitions to cleaner technologies. The analysis provides evidence‐based estimates of these interventions' impacts, while remaining conservative about factors such as stove usage, subsidy leakage, and exposure levels, for which there remains considerable uncertainty. These conservative assumptions notwithstanding, we show that policies supporting a clean cooking transition would deliver net benefits of 1.4 trillion USD from 2020 to 2050 across 120 LMICs; the promotion of improved‐efficiency biomass stoves alongside fully clean technologies yields lower net social benefits. Most monetized benefits are from health—especially mortality—improvements, followed by averted CO2e. Although considerable investment will be needed to realize these benefits, the economic case for scaling up policy action is strong. Moreover, because the effectiveness of cooking transition policies is currently low, research and innovation on incentive designs to achieve more exclusive clean fuel use is sorely needed.
... Accordingly, PA includes activity during leisure time, transport-related PA or work-associated PA [3]. Physical inactivity may have large individual consequences and considerable societal costs [1,4]. It is estimated that 499 million new cases of preventable noncommunicable diseases and mental health conditions will develop in the period from 2020 to 2030 [5]. ...
Background: Social prescribing (SP) has received increasing interest in recent years due to its potential to encourage health-promoting behaviours, such as physical activity (PA). However, to develop effective SP interventions, it is critical to enhance our understanding of the mechanisms of change associated with SP and their potential to promote PA. This review aimed to synthesise the mechanisms of change in SP interventions and to develop a logic model illustrating a theoretical framework for SPs potential to promote PA.
Methods: A narrative review was performed, including a systematic literature search in Medline, Embase and PsycINFO. The systematic literature search was finalised on 21 February 2023, and studies investigating mechanisms of change in SP interventions were included. Findings were synthesised and illustrated in a logic model illustrating how SP interventions may promote PA as an outcome.
Results: The systematic literature search identified 340 studies, of which 11 met the inclusion criteria. The SP interventions comprised three processes: referral, linking and engagement. These processes influenced various mechanisms of change, which were classified into two perspectives. From a person-centred perspective, the mechanisms with the potential to promote PA comprised self-efficacy, motivation, empowerment and ‘having a voice’. These mechanisms were associated with crucial elements of SP, such as tailoring to needs, trusted relationships, nonstigmatising activities and peer-to-peer support. From a system-based perspective, the mechanisms with the potential to promote PA included system capacity and resources together with shared understanding and knowledge. These mechanisms were related to crucial elements of SP, including reliance on established communication and network, local agency and accessibility.
Conclusion: A person-centred perspective describes SPs potential to promote PA through various mechanisms of change. However, these mechanisms appear to be intricately connected with the local context. Consequently, SP intervention research could benefit from incorporating contextual factors and, ideally, also integrating system thinking.
... Physical inactivity is associated with the onset of a wide range of chronic diseases and premature deaths, accounting for approximately 3.2 million deaths annually 1 and imposing a significant disease J o u r n a l P r e -p r o o f burden globally, particularly in low-and middle-income countries (LMICs). 2 Despite this, substantial gaps remain in understanding the full spectrum of health outcomes associated with physical activity (PA), particularly across diverse settings and populations. ...
... Adults not meeting recommended physical activity (PA) guidelines, regardless of their current health status, face potential future risk of developing ill health and are, therefore, a key target for intervention seeking long-term lifestyle change (Howlett et al. 2019). Worldwide, insufficient PA is a major modifiable risk factor for noncommunicable diseases and premature mortality, creating substantial costs to the economy (Ding et al. 2016). In Ireland, only 34% of adults aged 55-65 years reported achieving National Physical Activity Guidelines and the percentage decreased to 29% in those aged 65-74 years, and 19% among those aged > 75 years (Health Service Executive 2024). ...
To strengthen practice-based evidence, pragmatic, yet rigorous, evaluation of real-world programs is necessary. This study sought to add to the evidence for the effectiveness of physical activity programs for middle-aged and older adults offered by publicly funded local sports partnerships (LSPs) in Ireland. We analysed data from 468 individuals aged 50 + years, who took part in the Move for Life cluster randomised feasibility trial. Outcomes were accelerometer-based moderate-to-vigorous intensity physical activity (MVPA), light intensity physical activity (LiPA), standing time, and sedentary time; self-reported compliance with physical activity guidelines, body composition, physical function, and mental well-being. LSP programs included Women on Wheels/Bike for Life, Go for Life Games, Get Ireland Walking, and Men on the Move. We used a difference-in-differences approach to estimate program effects. We found evidence of positive program effects on accelerometer-derived MVPA (Women on Wheels/Bike for Life, Get Ireland Walking), LiPA (Go for Life Games), and sedentary time (Women on Wheels/Bike for Life, Go for Life Games) (p < .05), plus evidence of positive effects on self-reported physical activity for all LSP programs (p < .05). We did not find evidence of program effects on body composition. Outcomes related to physical function were mixed. Men on the Move was the only program where mental well-being scores increased significantly relative to the control group. Despite sample size limitations, the results support the effectiveness of LSP programs over a 6-month period, notably in terms of energy expenditure outcomes, while identifying areas for improvement regarding outcomes related to body composition, physical function and, particularly, mental well-being.
... The potential of LM as a preventative measure -as well as an effective treatment -makes it particularly useful as a means of reducing both the financial and mortality burdens of non-communicable disease. The global financial burden of physical inactivity alone was estimated to be $ (Int) 67.5 billion annually [6], while inadequate quality sleep is estimated to cost the United States $ (USD) 14 billion each year [7]. Effective LM delivery has the potential to reduce these costs as well as improving other factors such as worker productivity [7] and disability-adjusted life years [8]. ...
Non-communicable diseases are the greatest cause of mortality and disability globally. Lifestyle medicine (LM) can facilitate effective prevention and treatment of such diseases. However, the extent and nature of LM education has not been sufficiently mapped. This scoping review aimed to assess the pedagogies, content and structure of LM education in pre-registration health profession degrees using the JBI methodology. Fifty-two articles met the inclusion criteria. Three of the six core LM pillars were not taught in the majority of programmes studied. Universities should survey their curricula to identify such gaps and appropriate opportunities to incorporate these pillars into existing modules.
... 5 Physical inactivity contributes to the rising prevalence of non-communicable diseases (NCDs), resulting in premature mortality and economic burden. 6 Physical activity advice should be delivered as part of primary and secondary prevention of NCDs. According to the 2019 National Health Morbidity Survey, an adult person sees their primary care physician to seek treatment on an average of 3.54 visits yearly. ...
Introduction
Specific physical activity advice delivered to patients with non-communicable diseases (NCDs) improves physical activity levels and health outcomes. This study aimed to develop a physical activity advice tool and determine the physical activity level of primary care physicians, prevalence of physical activity advice delivered to patients and its associated factors.
Methods
During phase 1 of the study, a valid and reliable tool was developed to assess physical activity advice delivered by primary care physicians. Phase 2 was a cross-sectional study conducted at 12 primary care clinics using an online questionnaire assessing sociodemographic characteristics, physical activity level (Global Physical Activity Questionnaire) and physical activity advice delivered. Multiple logistic regression was used to identify the factors associated with specific physical activity advice delivered.
Results
More than half of the primary care physicians (53.7%) were physically inactive. Most (79.3%) delivered specific physical activity advice to their patients. The primary care physicians who were women (odds ratio [OR]=4.54, 95% confidence interval [CI] = 1.78, 11.56), possessed postgraduate qualifications (OR=6.72, 95% CI=1.48, 30.51), received formal training in physical activity advice (OR=2.79, 95% CI=1.01, 7.79) and were physically active (OR=2.67, 95% CI=1.17, 6.10) were more likely to deliver specific physical activity advice.
Conclusion
Primary care physicians should be encouraged to pursue postgraduate studies, be given training in how to deliver physical activity advice and be physically active to be able to deliver specific physical activity advice to patients seen in NCD clinics.
... Despite the absence of contagion, the gradual progression and prolonged duration of these diseases have a deleterious impact on human health, accounting for 74% of global mortality [1]. Furthermore, these diseases impose a considerable financial burden on healthcare systems [2], necessitating the development of new therapeutic approaches. In this context, the significance of plants to humanity is considerable, as they provide natural solutions for the prevention and treatment of numerous diseases, due to their abundance of bioactive compounds [3]. ...
A novel series of oleanolic acid (OA, 1) derivatives incorporating phenolic and coumarin moieties were synthesized. This acid was extracted from olive pomace (Olea europaea L.) using an ultrasound-assisted method. The structures of these novel derivatives of OA were characterized through the utilization of ¹H-NMR, ¹³C-NMR and ESI-HRMS analyses. An evaluation of some biological activities of the prepared derivatives was conducted. The evaluation focused principally on the capacity of these structures to inhibit 15-lipoxygenase and α-glucosidase, as well as their anticancer properties when tested against tumour cell lines (HCT-116 and LS-174T) and a non-tumour cell line (HEK-293). In terms of their cytotoxic activity, the majority of the compounds exhibited notable inhibitory effects compared to the starting molecule, OA. Derivatives 4d, 4k and 4m exhibited particularly strong inhibitory effects against the HCT-116 cell line, with IC₅₀ values of 38.5, 39.3, 40.0 µM, respectively. Derivatives 4l, 4e and 5d demonstrated the most effective inhibition against the LS-174T cell line, with IC50 values of 44.0, 44.3, 38.0 µM, respectively. However, compound 2a was the most effective, exhibiting the most potent inhibition of 15-lipoxygenase and α-glucosidase, with IC₅₀ values of 52.4 and 59.5 µM, respectively. Furthermore, molecular docking studies supported in vitro cytotoxic activity, revealing that the most potent compounds exhibited low binding energies and interacted effectively within the EGFR enzyme’s active pocket (PDB: 1M17). These findings highlight the potential of these derivatives as anticancer agents and enzymatic inhibitors, warranting further investigation.
... Worldwide, insufficient PA is a major modifiable risk factor for chronic illness and premature mortality [3]. Globally, noncommunicable diseases (NCDs) pose significant costs to population health and to the economy [4]; yet are largely preventable. Research indicates that ageing is associated with more chronic illnesses [5], and reduced participation in PA [6]. ...
The combination of an ageing population, increasing prevalence of preventable noncommunicable diseases and a decline in physical activity with age emphasizes the need for investment in physical activity programs and services for older people. This study aimed to add to the initial evidence on the effectiveness of the Move for Life (MFL) intervention by examining its effects on psychosocial health outcomes and determinants of physical activity. MFL is an intervention that aims to augment existing community-based public physical activity programs for middle-aged and older adults in Ireland with strategies derived from behavioural theory and support from peer leaders. A 3-arm cluster randomised feasibility trial compared MFL intervention, usual provision (UP) and waiting list control (CON) groups at baseline (T0), post-intervention (T1, at 8-, 10- or 12-weeks) and 6-month follow up after baseline (T2). Psychosocial health and determinants of physical activity were assessed at each occasion by validated self-report measures. Linear or generalized linear mixed models were fitted to estimate group differences over time. Of 733 recruited individuals, 601 (mean age: 63.06 ± 8.1 years, 80.4% female) met study inclusion criteria. Significant advantages were found in the MFL group relative to UP in ratings of self-efficacy to overcome barriers to physical activity participation, subjective norms for and attitudes towards participation in physical activity (ps < .05). Subsequent analyses accounting for implementation fidelity revealed additional advantages for the ‘high fidelity’ MFL group relative to other groups, notably regarding loneliness and relatedness to others, perceived behavioural control, attitudes toward and intentions to participate in physical activity (ps < .05). The pattern of results shows the potential of MFL to impact positively the psychosocial health of inactive adults aged 50 + years and change psychosocial determinants of physical activity, particularly when implemented as intended. The results suggest as well that existing physical activity programs may have unexpected psychosocial consequences.
... 13 To develop effective, evidence-based interventions, it is crucial to collect gender-stratified data for adult and youth populations in this region. 19 This data is essential for understanding LPA trends and informing resource allocation and program development. 20 Without a comprehensive assessment of the burden attributable to LPA, policymakers face challenges in formulating effective strategies to reduce its impact. ...
Background
Research on low physical activity (LPA) in the Middle East and North Africa (MENA) region remains limited.
Aims
To assess the disease burden associated with LPA using data from the Global Burden of Disease (GBD) study.
Study Design
Longitudinal epidemiological study.
Methods
GBD 2021 data were used to extract information on the burden of eight LPA-related conditions-breast cancer, chronic kidney disease, colorectal cancer, diabetes mellitus (DM), ischemic heart disease, lower extremity peripheral arterial disease, stroke, and tuberculosis-analyzed by age group, sex, country within MENA, and year (1990-2021).
Results
The age-standardized disability-adjusted life year (DALY) rate for LPA-related diseases in MENA declined by 8.62%, from 431.84 per 100,000 people in 1990 to 394.64 per 100,000 in 2021. In 2021, Sudan (846.47 per 100,000), Iraq (630.29 per 100,000), and Afghanistan (626.88 per 100,000) recorded the highest age-standardized DALY rates. Across all age groups, females had higher DALY rates than males in both 1990 and 2021.
Conclusion
Despite a recent decline, the MENA region continues to experience a greater LPA-attributable disease burden than the global average. The increasing contribution of DM and breast cancer highlights evolving trends, emphasizing the need for targeted interventions such as lifestyle promotion and improved access to health facilities.
... Physical inactivity prompts lower energy expenditure and may be associated with cardiometabolic risks, diminished insulin activity, and skeletal muscle wasting. Physical activity has a protective role against the development of non-communicable diseases including cardiovascular disease and diabetes mellitus [58,59]. Physical inactivity initiates the body to become insulin resistant and promotes muscle build-up. ...
Background
Metabolic syndrome is a cluster of metabolic risk factors, including glucose intolerance, dyslipidemia, central obesity, high triglyceride levels, and low levels of high-density lipoprotein. It is the commonest type of co-morbidity among people with psychiatric conditions particularly in low and middle-income countries due to poor health care systems and financial burden. Metabolic syndrome among people with psychiatric conditions may be due to prolonged use of psychiatric medications, diminished quality of life, and personal and behavioral-related factors. Except for single studies with fluctuating reports, there is no nationwide study conducted on the prevalence of metabolic syndrome among people with psychiatric conditions in Ethiopia. Thus, this review aims to estimate the pooled prevalence of metabolic syndrome and its association with selected factors among people with psychiatric conditions in Ethiopia.
Methods
We conducted a thorough search of PubMed, Scopus, Wiley online library, African journals online, and Google Scholar. For analysis, STATA version 14 software was used. A funnel plot and Egger's regression test statistic were used to find the potential reporting bias. A fixed effect model was used to contrast summary effects, odds ratios, and 95% confidence intervals all over research findings. The Newcastle–Ottawa Scale (NOS) was used to evaluate the quality of each included study.
Results
Eight articles were included in the final review after retrieving 9,714 articles through electronic database searching. By using the national cholesterol education adult treatment panel criteria, the pooled prevalence of metabolic syndrome among people with psychiatric conditions in Ethiopia was found to be 37.33% (95%CI: 24.52–50.14). Being female AOR = 2.66; 95% CI: 0.89, 7.92), urban residency (AOR = 2.84; 95% CI: 0.56, 14.45), physical inactivity (AOR = 3.80; 95% CI: 1.61, 8.98), alcohol consumption (AOR = 4.53; 95% CI: 1.62, 12.71) and body mass index higher than the normal range (AOR = 4.66; 95% CI: 1.22, 17.85) were the factors significantly associated with metabolic syndrome among people with psychiatric conditions. According to the review, schizophrenic-form disorder, delusional disorder, major depressive disorder, schizophrenia, bipolar disorder, and schizoaffective disorder were the frequently reported psychiatric conditions.
Conclusion
This systematic review and meta-analysis revealed that the magnitude of metabolic syndrome among people with psychiatric conditions in Ethiopia was high and female gender, physical inactivity, alcohol consumption, and body mass index higher than the normal range were the factors that determined the occurrence of metabolic syndrome. Thus, policymakers, clinicians, and other concerned stakeholders must reinforce effective strategies in the control, timely screening, prevention, and management of metabolic syndrome among people with psychiatric conditions.
Protocol registration
PROSPERO CRD42023405293.
... adults meeting the WHO recommendations on minimal PA, an estimated 5.3 million deaths could be prevented yearly 10 . Physical inactivity is reported to be one of the ten leading causes of mortality worldwide and places a significant financial burden on healthcare systems 11 . Regular PA improves motor and functional abilities, contributing to overall independence and physical wellbeing 12 . ...
The association of physical activity (PA) with the prevention and treatment of various diseases is well known. The issue of insufficient physical activity among university students has worsened due to the effects of the COVID-19 pandemic. The aim of this research is to examine the social, lifestyle, and health factors associated with moderate and high levels of PA in two cross-sectional studies conducted before and after COVID-19 involving 1,266 medical students from five universities in Serbia. Two cross-sectional studies were conducted on the population of fifth-year medical students from five different universities in Serbia before and after the COVID-19 pandemic (in 2019 and 2023). The research instrument was a questionnaire specially designed based on similar research. The mean energy expenditure in MET-minutes per week increased from 2,265.26 ± 1,930.67 in 2019 to 2,871.65 ± 2,301.99 in 2023 (p < 0.001). Multivariate logistic regression analysis with high PA as an outcome variable for the entire sample showed the association of high PA with the University of Kosovska Mitrovica and score on the Zung anxiety scale. Multivariate logistic regression analysis with high PA as an outcome variable for 2019 showed the association of high PA with the University of Kosovska Mitrovica, number of meals per day, and score on the Zung anxiety scale. Multivariate logistic regression analysis with high PA as an outcome variable for 2023 showed the association of high PA with the University of Kosovska Mitrovica, number of meals per day, and score on the Zung anxiety scale. The average energy expenditure was significantly higher in 2023. Factors such as studying in Kosovska Mitrovica, scores on the Zung Anxiety Scale, alcohol consumption, binge drinking in the past month, and the number of meals consumed per day were associated with either moderate or high levels of PA or both.
... Moreover, the economic implications of physical inactivity are profound. Globally, the estimated cost of inactivity-related NCDs is $53.8 billion annually in direct healthcare costs, with LMICs bearing a significant portion of this burden [8]. Despite these global trends, sociocultural barriers in Afghanistan, including restrictive gender norms, lack of safe recreational spaces, and inadequate public health initiatives, significantly impede women's ability to engage in regular physical activity [9]. ...
Objectives: This study aimed to assess women's knowledge, attitudes, and practices regarding physical activity in Kabul, Afghanistan, and evaluate their correlation with CVD risk factors, such as hypertension, hypercholesterolemia, and fasting blood sugar levels. Methods: A cross-sectional study was conducted from June 2023 to March 2024 at Watan Hospital, involving 425 women aged 20 years and above. Data were collected using a standardized questionnaire, including demographic and lifestyle-related sections. Physical activity awareness, attitudes, and performance were categorized into weak, moderate, and good levels. Participants' health parameters, including blood pressure, cholesterol, and glucose levels, were measured and analyzed using SPSS v.27 to explore associations between physical activity levels and CVD risk factors. Results: Good awareness of physical activity was reported by 58.8% of participants, while 32.9% demonstrated good performance. Regular exercise was significantly associated with healthier fasting blood sugar levels (86.7% ≤ 100 mg/dL) (p < 0.001), cholesterol levels (83.3% ≤ 200 mg/dL) (p < 0.001), and blood pressure (83.3% ≤ 140 mmHg) (p < 0.001). However, the frequency of exercise showed no statistically significant impact on these parameters. Conclusion: Despite moderate-to-good awareness, a considerable gap exists in women's actual physical activity performance. Regular physical activity is strongly associated with improved metabolic and cardiovascular health outcomes. Interventions targeting behavioral change, addressing sociocultural barriers, and promoting sustainable physical activity practices are critical to reducing the CVD burden among women in Afghanistan.
... In terms of the prevention and treatment of DM, the consistent relationship between obesity and DM makes the role of physical activity as a non-pharmacological tool relevant to its prevention/treatment [4,5]. Moreover, the beneficial impact of physical activity level on economic outcomes has been previously described [6,7], in which higher physical activity level has been linked to lower productivity losses, lower costs attributed to medicine use, and lower utilization of healthcare services [7][8][9][10][11]. ...
Objectives
Physical activity and costs have been consistently related each other, but mostly in cross-sectional investigations. This study aims to investigate the relationship between changes in physical activity level and changes in healthcare costs among older diabetic adults in an 8-year follow-up study.
Methods
The study followed 151 diabetic adults ≥50 years of age, for a period of 8 years, who were patients of Basic Health Care Units in the city of Bauru (Brazil). Medical records were consulted to obtain information on healthcare costs. Physical activity level was assessed through an interview. Data analysis included descriptive statistics, analysis of variance, and linear regression.
Results
Participants who increased leisure-time physical activity from 2010 to 2018 accumulated less healthcare costs from 2020 to 2018. The magnitude of the relationship was small (r = −0.233 [95% CI: −0.379 to −0.076]).
Conclusion
In summary, among diabetic patients, to increase leisure-time physical activity from 2010 to 2018 was inversely related to the amount of healthcare costs spent over the same period of 8 years.
... Engaging in regular physical activity is a simple and effective way to maintain health and prevent or reduce risks associated with chronic diseases such as diabetes, obesity, cardiovascular disease, cancer, and stroke [10][11][12]. In addition, physical activity has been shown to alleviate anxiety and depressive symptoms [13] The economic burden of physical inactivity is substantial, with global costs estimated at $67 billion in 2013, underscoring the need to prioritize continuous physical activity promotion as part of a comprehensive chronic disease prevention strategy [14,15]. ...
Background
Physical activity patterns are critical for public health and chronic disease prevention. Limited research exists on physical activity behaviors in Yemen. This study fills that gap by providing essential data to support the development of effective intervention programs targeting the Yemeni population.
Objective
The objective of this study is to investigate physical activity levels among three distinct age groups (18–23, 24–44, and 45–64 years) within a sample of Yemeni society, while also examining gender-based differences.
Methods
A descriptive survey was conducted on 1,605 Yemeni adults (men and women) across three age groups. Physical activity levels were assessed using the International Physical Activity Questionnaire (IPAQ), a validated tool recommended by the World Health Organization (WHO).
Results
Approximately, half of the participants demonstrated sufficient moderate physical activity based on metabolic equivalent per minute per week (MET-min/week). Specifically, 14.2% of the sample exhibited low physical activity levels, while 48.5% and 37.3% demonstrated moderate and high physical activity levels, respectively. Women showed a greater decline in physical activity (17.3%) compared to men (11%). Significant statistical differences (p ≤ 0.05) were observed among men in the 18–23 age group, who were more active than participants in older age groups.
Conclusions
The majority of the Yemeni population studied met the minimum recommendations for physical activity. Men were generally more active than women, and a decline in physical activity was observed with increasing age in both genders.
... The role of HRQoL in the adult population is a critical area of research, as improving health in older adults has profound implications not only for individual wellbeing, but also for reducing the economic and social costs associated with aging-related healthcare needs [85]. Physical resilience, the body's ability to withstand, recover from, and adapt to physical stressors and health challenges, is a cornerstone of healthy aging and is crucial for individuals managing chronic diseases [86]. ...
Background/Objectives: With the increasing life expectancy and, as a result, the aging of the global population, there has been a rise in the prevalence of chronic conditions, which can significantly impact individuals’ health-related quality of life, a multidimensional concept that comprises an individual’s physical, mental, and social wellbeing. While a balanced, nutrient-dense diet, such as Mediterranean diet, is widely recognized for its role in chronic disease prevention, particularly in reducing the risk of cardiovascular diseases and certain cancers, its potential benefits extend beyond these well-known effects, showing promise in improving physical and mental wellbeing, and promoting health-related quality of life. Methods: A systematic search of the scientific literature in electronic databases (Pubmed/Medline) was performed to identify potentially eligible studies reporting on the relation between adherence to the Mediterranean diet and health-related quality of life, published up to December 2024. Results: A total of 28 studies were included in this systematic review, comprising 13 studies conducted among the general population and 15 studies involving various types of patients. Overall, most studies showed a significant association between adherence to the Mediterranean diet and HRQoL, with the most significant results retrieved for physical domains of quality of life, suggesting that diet seems to play a relevant role in both the general population and people affected by chronic conditions with an inflammatory basis. Conclusions: Adherence to the Mediterranean diet provides significant benefits in preventing and managing various chronic diseases commonly associated with aging populations. Furthermore, it enhances the overall health and quality of life of aging individuals, ultimately supporting more effective and less invasive treatment approaches for chronic diseases.
... Among the main changes in the behaviour patterns of today's society, an increase in sedentary levels and hyper caloric diets can be seen (Crespo, 2001;DGS 2016). The global decline in physical activity levels has become a major 21st century public health problem (Blair, 2009;Ding et al., 2016). Insufficient physical activity is one of the leading risk factors of death worldwide and it is also a key risk factor for non-communicable diseases such as cardiovascular diseases, cancer and diabetes (WHO, 2016). ...
Carvalho, A.S.; Fernandes, A.P.; García-Gallego, A.B.; Vaz, J.A.; Sierra Vega, M. (2019). The relation of sports with sleep quality and anthropometric measures at secondary schools. RESUMEN El objetivo de este estudio es evaluar la relación de la práctica deportiva con la calidad del sueño y los hábitos nutricionales de los adolescentes y su implicación en el peso y forma corporal. Se llevó a cabo el estudio en una población de 345 estudiantes de la enseñanza Secundaria del Ayuntamiento de Bragança, Portugal. Los datos se recopilaron en mayo de 2017 a través de un cuestionario que incluía el Índice de Calidad del sueño de Pittsburgh (PSQI) y un cuestionario auto informado sobre los hábitos nutricionales y la práctica de actividad física extra-curricular, su tipología, su frecuencia y duración en adolescentes. La evaluación antropométrica y la composición se realizaron con una báscula de escala electrónica, con métodos de bioimpedancia eléctrica bipolar. Se procedió a la validación del percentil/ IMC (WHO, 2007). Se verificó que el 58% de los adolescentes en estudio practicaba deporte fuera de la actividad escolar. La mayoría de los adolescentes, el 75,1%, presentaban percentil normoponderado, el 14,5% pre-obesidad y el 5,5% obesidad, siendo que el 36,0% presentaba grasa corporal por encima de lo sano. En cuanto a la evaluación de la calidad del sueño, se llegó a la conclusión de que el 39,71% de los participantes mostró pobre calidad de sueño (PSQI > 5 puntos). Se constató que el percentil de IMC y el porcentaje de grasa corporal estaban significativamente asociados al hecho de que los adolescentes practican deporte y la calidad del sueño, verificándose que la práctica deportiva y la buena calidad del sueño son factores positivos en la obtención del percentil y de la masa grasa normoponderales. Se observó también que el número de hábitos diarios correctos es superior en los alumnos que practican actividad deportiva extra-curricular, en los alumnos con percentil sano y/o grasa corporal adecuada. Estos resultados muestran la importancia de fomentar la actividad física, las opciones nutricionales saludables y también la calidad del sueño en la niñez y adolescencia, con el objetivo de maximizar un ambiente promotor de salud y mejorar el nivel de salud actual y en la edad adulta. ABSTRACT The objective of this study is to assess the relationship between sports practice, sleep quality and eating habits of adolescents and its implication in weight and body composition. The study was carried out in a population of 345 high school students of the county of Bragança, Portugal. The data was collected in May 2017 through a questionnaire that included the Pittsburgh Sleep Quality Index (PSQI), and a self-report questionnaire about food habits and practice of extracurricular physical activity, regarding its typology, frequency and duration in adolescents. The anthropometric and composition evaluation was performed using an electronic scale and using a bipolar electric bioimpedance method (Tanita BC-545®). The equivalent percentile was validated using the percentile / IMC tables (WHO, 2007). The results showed that 58% of the adolescents were practising sports outside school activities. The majority of adolescents, 75.1%, had a normoponderal percentile, 14.5% preobesity and 5.5% obesity. 36.0% of the students showed body weight above healthy. Regarding the quality of sleep, it was concluded that 39.71% of the participants showed poor quality of sleep (PSQI >5 points). The BMI percentile and body fat percentage were significantly correlated with sports practice and quality of sleep, which shows that both factors are positive factors to obtain percentile of BMI and normoponderal fat mass. It was also observed that the number of healthy daily habits is higher in students who practice extra-curricular sports, in students with a healthy percentile and / or adequate body fat. The results showed the importance of promoting physical activity, healthy eating choices and also sleep quality in childhood and adolescence. The maintenance of a healthy environment can be crucial not only to improve their actual lifestyles but also their future adult life.
... Por esta razón, la carga económica de la inactividad física es significativa y el coste del tratamiento de nuevos casos de ECNT prevenibles alcanzará los 300 000 millones de dólares en 2030 (OMS, 2022). Por otro lado, las muertes relacionadas con la inactividad física contribuyen entre 13 000 y 7 000 millones de dólares en pérdidas de productividad (Ding, 2016). ...
El sedentarismo, definido como la práctica de actividad física por menos de 15 minutos y menos de tres veces por semana, es un factor modificable en enfermedades crónicas no transmisibles. Este estudio tuvo como objetivo analizar los estilos de vida asociados al sedentarismo en la comunidad Quebrada “La Paja” en Portoviejo. Se llevó a cabo un estudio no experimental, transversal, exploratorio y descriptivo con 103 personas de 24 familias. Los resultados indicaron que la mayoría de la población lleva un estilo de vida sedentario, con bajo consumo de frutas y vegetales. Además, el sedentarismo se relacionó con ocupaciones específicas y niveles educativos bajos; el 29,17 % de los participantes no realiza actividad física alguna. Se concluyó que la ocupación laboral, el bajo nivel educativo y los hábitos alimenticios poco saludables son factores clave en el sedentarismo.
... diseases such as heart disease and cancer are preventable by changes in lifestyle behaviours [2], with unhealthy lifestyles linked to poor health and decreased productivity at work [3,4]. Workplace health interventions, such as diet and smoking education, exercise promotion, and environmental cues, are recognised as effective strategies for chronic disease prevention [5,6]. ...
Background
Workplace health screening rarely includes measures of cardiorespiratory fitness, despite it being a greater predictor of cardiovascular disease and all-cause mortality than other routinely measured risk factors. This study aimed to determine the comparative acceptability of using a novel seismocardiography device to measure cardiorespiratory fitness via VO2 max during a workplace health check.
Methods
Participants were invited to participate in workplace health screening sessions where VO2 max was assessed by both seismocardiography at rest and sub-maximal exercise testing, in order for acceptability of both to be compared across multiple domains. Questionnaires and focus group guides for participants and practitioners were developed based on the Theoretical Framework of Acceptability. Data were analysed using t-tests and deductive thematic analysis.
Results
There was a significant difference in the acceptability domain of ‘affective attitude’ between the novel SCG device (M = 9.06 ± 1.14) and the sub-maximal exercise testing (M = 7.94 ± 1.79); t = 3.296, p = .001, d = 0.50, and in the domain of ‘burden’ between the novel SCG device (M = 9.16, ± 0.55) and the sub-maximal exercise testing (M = 7.41 ± 1.45); t = 7.033, p = < 0.001, d = 1.45. Practitioners and employees highlighted the potential of seismocardiography to create a more inclusive and accessible workplace offer, allowing those with restricted mobility or those with differing physical or emotional needs to participate in wellness testing; yet there was a lack of understanding in both groups around intervention effectiveness and coherence.
Conclusions
Seismocardiography may offer an acceptable route to cardiorespiratory fitness testing in the workplace, due to the low effort requirement and simplicity of administration. This study suggests that practitioners delivering such services have a critical role to play in acceptability of health interventions at work, as employees will be heavily influenced by practitioner beliefs around coherence and effectiveness. Comprehensive delivery training is important for the adoption of new health-related technologies such as seismocardiography into workplace health screening.
... The World Health Organization estimates that over five million deaths annually could be prevented through increased physical activity [2]. The global cost of physical inactivity is estimated at $54 billion in healthcare expenses, accounting for 1-3% of national health expenditure [3]. Despite established guidelines recommending 150-300 min of moderate-intensity activity or 75-150 min of vigorous-intensity activity per week [4], according to the European Commission's Report on Sport and Physical Activity nearly 45% of individuals in the EU aged 15 years and older report never doing any physical activity, with women less likely than men to engage in regular physical activity [5]. ...
Background
This study aimed to investigate the relationship of psychological empowerment and enjoyment of physical activity with changes in physical activity levels, sleep quality, and muscular endurance following a high-intensity interval training (HIIT) program in physically inactive young women.
Methods
A total of 61 physically inactive young women (age: 20.1 ± 2.7 y) were recruited to participate in a six-month HIIT intervention delivered via a smartphone app. Outcome measures included physical activity levels (MET-min/week), muscular endurance (plank test), and sleep quality through the Pittsburgh Sleep Quality Index (PSQI). The Healthy Lifestyle and Personal Control Questionnaire (HLPCQ) and the Physical Activity Enjoyment Scale (PACES) were used to assess psychological empowerment and enjoyment, respectively. Repeated measures ANOVA and covariate analyses were performed to evaluate the impact of the intervention and the role of psychological empowerment and enjoyment.
Results
At 6 months, significant improvements in physical activity (p < 0.001; ηp²=0.336) and muscular endurance (p = 0.005; ηp²=0.085) were observed, with large and moderate effect sizes, respectively. The PACES showed a significant interaction with time for MET-min/week (F = 11.67, p = 0.001, ηp²=0.129), suggesting that enjoyment influenced the increase in physical activity. No significant differences in sleep quality were observed (p > 0.05).
Conclusion
Enjoyment plays a crucial role in the response to HIIT programs among physically inactive young women, particularly in improving weekly physical activity levels. Psychological training showed no significant relationship with the outcomes studied.
... On the contrary, unhealthy lifestyle behaviors, including poor diet, physical inactivity, smoking and alcohol use, have been reported to be the main causes of the global burden of disease [14]. A physically inactive lifestyle behavior is one of the leading causes of chronic noncommunicable diseases [15], and a study has found that a physically inactive lifestyle behaviors is a risk factor for obesity, coronary heart disease, diabetes, cancer, and shorter life expectancy [16]. ...
Background
During the COVID-19 pandemic, the social distancing has significantly affected the healthy lifestyle behaviors of residents. China ended social distancing on January 8, 2023, and the healthy lifestyle behaviors of residents after this time are unclear. The goal of this study was to evaluate the differences in healthy lifestyle behaviors between Chinese urban and rural residency after the termination of social distancing.
Methods
From February 1, 2023, to February 8, 2023, a cross-sectional survey which include participants (≥ 18 years old) was carried out in four regions of mainland China (Changzhou in the eastern region, Zhengzhou in the central region, Xining in the western region, and Mudanjiang in the northeastern region). A healthy lifestyle behaviors scale containing 11 items was designed to calculate the healthy lifestyle behaviors scores among urban and rural residents. The healthy lifestyle behaviors scores ranged from 11 to 51. Multivariate linear regression was used to analyze the influencing factors of healthy lifestyle behaviors scores among urban and rural residents. Propensity Score Matching was used to assess the net differences in healthy lifestyle behaviors scores between urban and rural residents.
Results
A total of 5780 residents (53.04% females) were included in the study, including 3302(57.13%) urban residents. The average healthy lifestyle behavior score was 38.33(95%CI: 38.18 to 38.49). Healthy lifestyle behaviors score among males was lower than that among females in both urban (β = -1.98, 95%CI: -3.05 to -2.10) and rural residents (β = -2.57, 95%CI: -2.37 to -1.60). Higher education was associated with higher healthy lifestyle behaviors scores in both urban and rural residents. PSM analysis indicated that urban residents still had higher healthy lifestyle behaviors scores (38.72, 95% CI: 38.46 to 38.99) than rural residents (37.85, 95%CI: 37.57 to 38.13), with a net difference of 0.87 points.
Conclusions
After the termination of social distancing, the overall healthy lifestyle behaviors of Chinese residents were found to be at a medium level. Urban residents have a better healthy lifestyle behavior compared to their rural counterparts. It is essential to prioritize efforts towards enhancing the healthy lifestyle behaviors of rural residents.
Background: The Social Return on Investment (SROI) model has been applied to physical activity and sports (PAS) inconsistently in the past. In order to demonstrate that PAS creates social value for society, consistent, scientific-based tools must be developed. Methods: In 2022, a group of interdisciplinary researchers started a project to standardize the application of SROI to global PAS activities. A Delphi study, informed by a systematic review on this topic, was used and the present commentary exposes the main conclusions. Results: Six main lessons can be drawn from the process of building a global SROI applied to PAS: the methodology to measure the impact of PAS at the population level is different from the methodology applied to specific interventions; there is consensus on the impact in health; there is knowledge, but also unanswered questions on the impact of PAS in education; the impact of PAS in population well-being as a promising area; the of impact on crime and social capital requires more research; and there is controversy in the relationship between PAS, and environment, and climate change. Conclusions: A global SROI applied to PAS is a powerful tool to demonstrate how an active population can bring value to society. For this purpose, researchers and policymakers are called to action to fill in the gaps that remain open in order to build a robust model.
For centuries, regular exercise has been acknowledged as a potent stimulus to promote, maintain, and restore healthy functioning of nearly every physiological system of the human body. With advancing understanding of the complexity of human physiology, continually evolving methodological possibilities, and an increasingly dire public health situation, the study of exercise as a preventative or therapeutic treatment has never been more interdisciplinary, or more impactful. During the early stages of the NIH Common Fund Molecular Transducers of Physical Activity Consortium (MoTrPAC) Initiative, the field is well‐positioned to build substantially upon the existing understanding of the mechanisms underlying benefits associated with exercise. Thus, we present a comprehensive body of the knowledge detailing the current literature basis surrounding the molecular adaptations to exercise in humans to provide a view of the state of the field at this critical juncture, as well as a resource for scientists bringing external expertise to the field of exercise physiology. In reviewing current literature related to molecular and cellular processes underlying exercise‐induced benefits and adaptations, we also draw attention to existing knowledge gaps warranting continued research effort. © 2021 American Physiological Society. Compr Physiol 12:3193‐3279, 2022.
Background/Objectives: Neurodegenerative diseases represent a growing global health challenge with limited therapeutic options. Physical exercise has emerged as a promising non-pharmacological intervention with potential neuroprotective effects. This narrative review examines the mechanisms through which exercise induces neuroplasticity and their implications for neurodegenerative disease prevention. Methods: We synthesized evidence from molecular, animal, and human studies on exercise-induced neuroplasticity and neurodegenerative disease prevention through a comprehensive literature review. Results: Exercise enhances neuroplasticity through multiple pathways: (1) neurotrophic signaling (BDNF, IGF-1, VEGF), (2) neuroendocrine regulation, (3) epigenetic modifications, and (4) metabolic pathway optimization. These molecular changes support structural adaptations including hippocampal neurogenesis, enhanced synaptic plasticity, improved cerebrovascular function, and optimized brain network connectivity. Exercise directly impacts pathological features of neurodegenerative diseases by reducing protein aggregation, attenuating excitotoxicity and oxidative stress, and enhancing mitochondrial function. Clinical evidence consistently demonstrates associations between physical activity and reduced neurodegenerative risk, with intervention studies supporting causal benefits on cognitive function and brain structure. Conclusions: Exercise represents a multi-target intervention addressing several pathological mechanisms simultaneously across various neurodegenerative conditions. Its accessibility, minimal side effects, and multiple health benefits position it as a promising preventive strategy. Future research should focus on understanding individual response variability, developing sensitive biomarkers, and creating personalized exercise prescriptions for optimal neuroprotection.
Purpose
The aim of this study was to analyze the effect of exercise on endothelial function and other cardiovascular risk factors in patients with chronic obstructive pulmonary disease (COPD).
Methods
Forty patients were randomized to an 8-week pulmonary rehabilitation (PR) program or usual care. Symptoms, exercise capacity, and quality of life were measured at baseline and after intervention or observation. Flow-mediated brachial artery dilation (FMD), ankle-brachial index, intermittent claudication questionnaire, cardiovascular risk score, blood pressure, daily steps count, glucose, lipids, and C-reactive protein were evaluated before and after intervention.
Results
Participants had a mean age of 64.2 ± 6.7 years in the PR group and 62.2 ± 8.0 years in the usual care group. The forced expiratory volume in the first second was 45.5 ± 15.4% predicted in the PR group and 48.1 ± 24.3% predicted in the usual care group. Attending PR was associated with reduced symptoms, improved exercise capacity and quality of life in patients with COPD ( P < .005 for all). Endothelial function did not improve after PR (FMD% at baseline 9.38 ± 4.40 vs 9.67 ± 6.56 post PR; P = .87), and there was no difference between the 2 groups ( P = .61). However, exercise reduced C-reactive protein, triglycerides, and glucose and improved cardiovascular risk score, systemic blood pressure, and ankle-brachial index ( P < .005 for all).
Conclusions
Pulmonary rehabilitation elicited improvement in symptoms, exercise capacity, quality of life, and parameters related to cardiorespiratory fitness. The endothelial function measured by FMD did not change with exercise. However, other cardiovascular risk factors such as blood markers, systemic blood pressure, and lower limb blood flow improved after PR.
Objective
The aim of this meta-analysis was to examine the effect of family doctor contract service on managing non-communicable diseases (NCDs) among elderly patients.
Methods
Chinese and English articles published up to 15 July 2022 were systematically searched. Relevant randomized controlled studies (RCTs) were extracted from seven databases: PubMed, Coherence, Embase, Web of Science, CNKI, Wanfang Data, and WeiPu. All these studies have evaluated the effect of family doctor contract services on chronic disease management among the elderly. A meta-analysis was conducted using either random or fixed effects. Mean difference and risk ratio were used to analyze quantitative and qualitative data, respectively.
Results
We identified that 25 independent studies, involving 4,046 elderly patients with chronic diseases across China, were eligible for meta-analysis. The results from these RCTs indicated that family doctors could disseminate knowledge about NCDs to elderly patients, improve their disease management abilities (including drug compliance, healthy diet, regular exercise, non-smoking, and non-drinking), lower blood pressure and blood glucose levels, reduce BMI, and increase quality of life and patient satisfaction ( P < 0.05).
Conclusion
Family doctor contract services could improve health management for elderly patients with NCDs and should be promoted in China.
Background
The rising prevalence of obesity in the Kingdom of Saudi Arabia (KSA) poses a significant public health challenge. Estimates of the economic cost of obesity are crucial for prioritizing healthcare interventions, guiding policy choices, and justifying budget allocations aimed at reducing obesity prevalence. This study aimed to estimate the cost of obesity in the KSA in 2022.
Methods
A prevalence-based cost-of-illness approach was used to determine the cost of obesity. This analysis encompasses 29 diseases, namely obesity and twenty-eight diseases attributable to obesity. Both direct and indirect costs were considered. The annual cost of treatment for each obesity-attributable disease was obtained from the hospital records of one tertiary hospital in the KSA. Data on direct non-medical costs were obtained from the patient survey. The human capital approach was used to estimate the indirect costs of morbidity and mortality.
Results
The total economic burden of obesity (2022 values) was estimated at US109.67 billion from a healthcare system perspective. From a societal perspective, the total direct medical cost accounted for the largest portion of the total cost (94%). In terms of direct medical costs, the cost of treating diseases attributable to obesity was substantially greater than the cost of treating obesity itself. According to the sensitivity analysis, the total cost ranged from 3.4% of the country’s Gross domestic product (GDP) when the unit cost of treatment was reduced by 74% to 9.5% of the country’s GDP when the prevalence of obesity and its comorbidities was reduced by 5%.
Conclusion
Obesity imposes a substantial economic burden on the healthcare system and society in the KSA. Interventions aimed at promoting healthier lifestyles to reduce the prevalence and incidence of obesity and its comorbidities are highly warranted to alleviate the impact of obesity in the country.
Many countries face an unprecedented challenge in aging demographics. This has led to an exponential growth in research of aging, which, coupled to a massive financial influx of funding in the private and public sectors, has resulted in seminal insights into the underpinnings of this biological process. However, critical validation in humans have been hampered by the limited translatability of results obtained in model organisms, additionally confined by the need for extremely time-consuming clinical studies in the ostensible absence of robust biomarkers that would allow monitoring in shorter time frames. In the future, molecular parameters might hold great promise in this regard. In contrast, biomarkers centered on function, resilience and frailty are available at the present time, with proven predictive value for morbidity and mortality. In this review, the current knowledge of molecular and physiological aspects of human aging, potential anti-aging strategies, and the basis, evidence, and potential application of physiological biomarkers in human aging are discussed.
Objective
Physical activity (PA) is critical for healthy development in preschoolers, with long-lasting benefits that can affect later life. The World Health Organization (WHO) recommends that children aged 5–17 years should engage in 60 min of moderate-to-vigorous PA per day. However, physical inactivity in children is on the rise globally, with declines in PA starting at the age of 4 years. Increasing PA during early childhood is important to delay adiposity rebound, promote behavioral changes, improve physical fitness, and facilitate future PA engagement. However, limited evidence has been established on the effects of school-based PA interventions on preschoolers. This study examines the effects and sustainability of a preschool-based PA intervention on increasing PA, improving physical fitness and health in preschoolers, with the exercise dose benchmarked to the WHO PA guidelines.
Methods
This assessor-blinded, two-arm cluster randomized controlled trial will include 3300 preschoolers (aged 5–6 years) from 110 kindergartens in Hong Kong, China. Kindergartens will be randomized into intervention and control groups in a 1:1 ratio. The control kindergartens will continue their usual curriculum of ∼2.5 h PA/week, whereas preschoolers in the intervention kindergartens will engage in an additional 75-min game-based PA class twice per week (extra 2.5 h PA/week) over the preschool year. This multi-component intervention will also target parents, teachers, and the kindergarten environment to further encourage PA in preschoolers and their families. Objectively measured PA, cardiorespiratory fitness and other physical fitness components (muscle strength and power, agility, balance, flexibility, body composition), and psychological health will be examined at the start (0 month) and end (10 months) of the preschool year. Maintenance effects will be assessed after preschoolers’ transition into primary school (16 months). Generalized estimating equations or other appropriate statistical models will be used to examine the treatment effects with adjustment for baseline values.
Study impact
This study will investigate the effects of a preschool-based PA intervention with PA dose benchmarked to the WHO recommendations on promoting PA, physical fitness, and health in preschoolers, and its sustainability after preschoolers' transition into primary education. The findings will raise public awareness on the importance of PA in young children, and will inform policy making to facilitate early childhood educational reforms to incorporate adequate PA into preschool curriculums to improve children's health in the long run.
Trial registration
ClinicalTrials.gov (NCT05521490)
Background
Research indicates major risk factors including smoking, alcohol consumption, obesity and physical inactivity contribute significantly to global disease burden and healthcare costs. However, these studies have challenges, such as increased bias and uncertainty arising from use of population attributable fractions (PAF) and the issue of reverse causality in cross-sectional data. This study aims to evaluate the long-term healthcare costs associated with these behaviors using a longitudinal cohort.
Methods
This longitudinal cohort study used the Korean National Health Insurance Service—National Sample Cohort database (NHIS-NSC 2.0), covering 2002–2019. The cohort included individuals aged 40–69 years who underwent health examinations in 2002–2004 and had no pre-existing risk factor-related diseases. Cumulative healthcare costs during 2010–2019 were analyzed using a generalized linear model with log-link function and gamma distribution, adjusted for other health behaviors and sociodemographic factors.
Results
Smoking, alcohol consumption, obesity, and physical inactivity significantly increased healthcare costs for both sexes. Male current smokers incurred 13.8% higher costs than never-smokers, while female smokers spent 18.6% more. Former smokers had lower costs than current smokers, with reductions of 9.9% for males and 13.2% for females. Almost daily alcohol consumption raised costs by 21.4% for males and 31.8% for females. Costs varied by BMI categories, with severe obesity increasing expenditures by 26.9% for males and 46.5% for females compared to normal weight. Overweight status showed contrasting effects between sexes, with a 3.4% decrease in healthcare costs for males but a 7.6% increase for females. Exercising 1–4 times weekly reduced costs by 7.6% for males and 7.4% for females compared to non-exercisers.
Conclusions
The study underscores the economic impact of health risk behaviors and supports the need for targeted public health interventions. The findings highlight the importance of targeted interventions for high-risk groups for reducing healthcare costs.
Background
The physical activity of the old people is affected by many factors, and the economic situation is an important factor affecting the physical activity. However, the relationship between economic autonomy and physical activity patterns among older adult Chinese has not been fully studied.
Objective
To investigate the association between different types of economic autonomy and physical activity patterns among Chinese older adults aged 60 and above.
Methods
Cross-sectional analysis of 1,961 participants from the 2018 China Health and Retirement Longitudinal Study (CHARLS). Economic autonomy was categorized into autonomous and non-autonomous groups. Physical activity was assessed through type, frequency, duration, and purpose, using validated questionnaires.
Results
Economic autonomy showed positive associations with low and moderate-intensity physical activities (p < 0.05). However, economically non-autonomous individuals demonstrated higher participation in high-intensity physical activities, primarily due to work-related demands (78.7%). The frequency of physical activity was significantly different among economic autonomy groups (p < 0.01).
Background
Evidence of an association between physical activity (PA) and mortality has mainly focused on leisure-time physical activity (LTPA) and moderate-to-vigorous-intensity physical activity (MVPA). We aimed to assess the associations of total, domain-specific, and intensity-specific PA with all-cause and cause-specific mortality.
Methods
We used baseline PA data from the China Kadoorie Biobank, including 482,067 participants aged 30–79 years from 10 areas in China. PA via self-report was quantified as a metabolic equivalent of task hours per day. Total PA was calculated by summing occupational, commuting, household, and leisure-time PA, and domain- and intensity-specific PAs were also calculated. Cox regression was used to estimate the associations of quintiles of different types of PA with all-cause and cause-specific mortality and adjust for potential confounders. Cause-specific mortalities were also examined in a competing risk analysis.
Results
During a median follow-up of 12.1 years, 47,281 deaths occurred. Total PA was inversely associated with the risk of all-cause mortality, with a hazard ratio (HR) (95% confidence interval [95% CI]) of 0.69 (0.67–0.71) in the highest quintile as compared with the lowest quintile. Similar associations were observed for disease-specific mortality risks from cardiovascular disease, cancer, respiratory disease, diabetes, and nervous system disease, with HR (95% CI) for top vs . bottom quintile of PA of 0.68 (0.64–0.71), 0.80 (0.76–0.83), 0.39 (0.35–0.44), 0.44 (0.35–0.55), and 0.52 (0.38–0.73), respectively. In addition, the risk of all-cause mortality was lowered by 34%, 13%, 17%, and 30% for occupational PA, non-occupational PA, low-intensity PA, and MVPA, respectively, when comparing the highest quintile with the lowest quintile.
Conclusions
PA was inversely associated with the risk of all-cause and cause-specific mortality, regardless of domain and intensity. Any PA can bring long-term beneficial health effects.
This paper provides an overview of the literature on effects of physical activity on cognition for children and adolescents. Aimed as a starting point into this active research field, it guides the interested reader from core concepts, a summary of research findings to characteristics of successful programs as well as barriers and motives for participation.
Responsible for ~18 million global deaths annually, cardiovascular disease (CVD) is a prominent cause of morbidity and mortality that negatively affects population health and well-being. Despite increased knowledge and advancements in medicine, technology, and an array of global initiatives to slow the prevalence of CVD across the world in recent decades, future projections for prevalence and the wider societal and economic impacts are alarming. It is outlined in this review that little progress is being made against a series of landmark initiatives and that, in a postpandemic world, we might need to consider innovative approaches to tackle the unprecedented growth and projections in CVD prevalence. To address the sustained reductions in positive health behaviors which is coupled with an established rise in cardiovascular risk factors and events following infections with severe acute respiratory syndrome coronavirus 2, there is an urgent public health challenge that lies ahead. Accordingly, we must establish bespoke systems that can recognize and address the complexity and interactive and interdisciplinary nature of chronic diseases. Future approaches must heed learning from the many previous unsuccessful approaches that have not been appropriately monitored or evaluated. Establishing or aligning international and collaborative approaches that have a clear mandate to oversee the development and implementation of analysis of global surveillance and interventions is needed to address the spiraling growth in CVD prevalence, healthcare costs, morbidity, and mortality.
Many workplaces and insurers sponsor programs to increase employees’ physical activity, but these programs often fail to create healthy behaviors or else work only temporarily. They typically offer financial incentives without considering cognitive biases that influence whether people will join the programs and remain committed to exercising. We argue that interventions should leverage both insights from behavioral economics and the availability of remote-monitoring technologies, such as automatic step trackers, to be more effective. In this article, we summarize relevant insights from behavioral economics, highlight research findings that show the value of combining behaviorally informed program design with remote monitoring, and suggest strategies for selecting interventions and remote-monitoring devices.
Despite decades of literature on the benefits of physical activity (PA) on cardiovascular disease (CVD) and other health outcomes, rates of physical inactivity and sedentary time remain alarmingly high and are likely contributing to the global increase in CVD. Roughly one-third of the world’s population does not meet the World Health Organization (WHO) guideline recommended levels of aerobic PA, defined as ≥ 150 min of moderate-intensity PA or ≥75 min of vigorous-intensity PA, or an equivalent combination of both. This is in addition to recommending individuals perform at least 2 days of muscle-strengthening activities per week involving all major muscle groups, which provide additional CVD benefits beyond aerobic PA. Disparities by sex and between high- and low-income countries persist, with modeling studies suggesting a direct global economic cost of $5 billion dollars. To combat the global health crisis of physical inactivity, the WHO implemented a global action plan on PA in 2013, which set a target of a 15% relative reduction in physical inactivity by 2030. Barriers to attaining adequate PA levels are abundant, however, step counting represents a relatively novel metric of PA with a growing body of literature supporting their utility given mounting evidence of CVD benefits, with trends that mirror intensity-centric metrics of PA that are used in WHO guidelines. This manuscript provides an up-to-date review of the evidence on the benefits of PA, steps, and cardiovascular outcomes.
On the eve of the 2012 summer Olympic Games, the first Lancet Series on physical activity established that physical inactivity was a global pandemic, and global public health action was urgently needed. The present paper summarises progress on the topics covered in the first Series. In the past 4 years, more countries have been monitoring the prevalence of physical inactivity, although evidence of any improvements in prevalence is still scarce. According to emerging evidence on brain health, physical inactivity accounts for about 3·8% of cases of dementia worldwide. An increase in research on the correlates of physical activity in low-income and middle-income countries (LMICs) is providing a better evidence base for development of context-relevant interventions. A finding specific to LMICs was that physical inactivity was higher in urban (vs rural) residents, which is a cause for concern because of the global trends toward urbanisation. A small but increasing number of intervention studies from LMICs provide initial evidence that community-based interventions can be effective. Although about 80% of countries reported having national physical activity policies or plans, such policies were operational in only about 56% of countries. There are important barriers to policy implementation that must be overcome before progress in increasing physical activity can be expected. Despite signs of progress, efforts to improve physical activity surveillance, research, capacity for intervention, and policy implementation are needed, especially among LMICs.
Background: The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development.
Methods: We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time.
Results: Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries.
Conclusions: Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition-in which increasing sociodemographic status brings structured change in disease burden-is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.
Funding: Bill & Melinda Gates Foundation.
Background: Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013.
Methods: Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries.
Findings: Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2·4 billion and 1·6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537·6 million in 1990 to 764·8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114·87 per 1000 people to 110·31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013.
Interpretation: Ageing of the world's population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries.
This article describes major topics discussed from the 'Economics of Physical Inactivity Consensus Workshop' (EPIC), held in Vancouver, Canada, in April 2011. Specifically, we (1) detail existing evidence on effective physical inactivity prevention strategies; (2) introduce economic evaluation and its role in health policy decisions; (3) discuss key challenges in establishing and building health economic evaluation evidence (including accurate and reliable costs and clinical outcome measurement) and (4) provide insight into interpretation of economic evaluations in this critically important field. We found that most methodological challenges are related to (1) accurately and objectively valuing outcomes; (2) determining meaningful clinically important differences in objective measures of physical inactivity; (3) estimating investment and disinvestment costs and (4) addressing barriers to implementation. We propose that guidelines specific for economic evaluations of physical inactivity intervention studies are developed to ensure that related costs and effects are robustly, consistently and accurately measured. This will also facilitate comparisons among future economic evidence.
Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control.
Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75 000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights.
5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease.
International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems.
Canadian Partnership Against Cancer (Toronto, Canada), Cancer Focus Northern Ireland (Belfast, UK), Cancer Institute New South Wales (Sydney, Australia), Cancer Research UK (London, UK), Centers for Disease Control and Prevention (Atlanta, GA, USA), Swiss Re (London, UK), Swiss Cancer Research foundation (Bern, Switzerland), Swiss Cancer League (Bern, Switzerland), and University of Kentucky (Lexington, KY, USA).
Copyright © 2014 Allemani et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd. All rights reserved.
Physical inactivity is increasingly being recognised as a major problem in global health. The WHO estimates that 3.3 million people die around the world each year due to physical inactivity, making it the fourth leading underlying cause of mortality.1 Physical activity has beneficial effects on 23 diseases or health conditions.2 However, in most countries fewer than half of adults are active enough to reap most of these benefits.3 ,4 Given that inactivity increases the risk for many of the most costly medical conditions such as type 2 diabetes, stroke, ischaemic heart disease, falls and hip fractures, and depression, it is not surprising that physical inactivity has a substantial cost burden in addition to a large health burden.
Physical inactivity is the fourth leading cause of death worldwide. We summarise present global efforts to counteract this problem and point the way forward to address the pandemic of physical inactivity. Although evidence for the benefits of physical activity for health has been available since the 1950s, promotion to improve the health of populations has lagged in relation to the available evidence and has only recently developed an identifiable infrastructure, including efforts in planning, policy, leadership and advocacy, workforce training and development, and monitoring and surveillance. The reasons for this late start are myriad, multifactorial, and complex. This infrastructure should continue to be formed, intersectoral approaches are essential to advance, and advocacy remains a key pillar. Although there is a need to build global capacity based on the present foundations, a systems approach that focuses on populations and the complex interactions among the correlates of physical inactivity, rather than solely a behavioural science approach focusing on individuals, is the way forward to increase physical activity worldwide.
Estimates of the economic cost of risk factors for chronic disease to the NHS provide evidence for prioritization of resources for prevention and public health. Previous comparable estimates of the economic costs of poor diet, physical inactivity, smoking, alcohol and overweight/obesity were based on economic data from 1992-93.
Diseases associated with poor diet, physical inactivity, smoking, alcohol and overweight/obesity were identified. Risk factor-specific population attributable fractions for these diseases were applied to disease-specific estimates of the economic cost to the NHS in the UK in 2006-07.
In 2006-07, poor diet-related ill health cost the NHS in the UK £5.8 billion. The cost of physical inactivity was £0.9 billion. Smoking cost was £3.3 billion, alcohol cost £3.3 billion, overweight and obesity cost £5.1 billion.
The estimates of the economic cost of risk factors for chronic disease presented here are based on recent financial data and are directly comparable. They suggest that poor diet is a behavioural risk factor that has the highest impact on the budget of the NHS, followed by alcohol consumption, smoking and physical inactivity.
Uncertainties persist about the magnitude of associations of diabetes mellitus and fasting glucose concentration with risk of coronary heart disease and major stroke subtypes. We aimed to quantify these associations for a wide range of circumstances.
We undertook a meta-analysis of individual records of diabetes, fasting blood glucose concentration, and other risk factors in people without initial vascular disease from studies in the Emerging Risk Factors Collaboration. We combined within-study regressions that were adjusted for age, sex, smoking, systolic blood pressure, and body-mass index to calculate hazard ratios (HRs) for vascular disease.
Analyses included data for 698 782 people (52 765 non-fatal or fatal vascular outcomes; 8.49 million person-years at risk) from 102 prospective studies. Adjusted HRs with diabetes were: 2.00 (95% CI 1.83-2.19) for coronary heart disease; 2.27 (1.95-2.65) for ischaemic stroke; 1.56 (1.19-2.05) for haemorrhagic stroke; 1.84 (1.59-2.13) for unclassified stroke; and 1.73 (1.51-1.98) for the aggregate of other vascular deaths. HRs did not change appreciably after further adjustment for lipid, inflammatory, or renal markers. HRs for coronary heart disease were higher in women than in men, at 40-59 years than at 70 years and older, and with fatal than with non-fatal disease. At an adult population-wide prevalence of 10%, diabetes was estimated to account for 11% (10-12%) of vascular deaths. Fasting blood glucose concentration was non-linearly related to vascular risk, with no significant associations between 3.90 mmol/L and 5.59 mmol/L. Compared with fasting blood glucose concentrations of 3.90-5.59 mmol/L, HRs for coronary heart disease were: 1.07 (0.97-1.18) for lower than 3.90 mmol/L; 1.11 (1.04-1.18) for 5.60-6.09 mmol/L; and 1.17 (1.08-1.26) for 6.10-6.99 mmol/L. In people without a history of diabetes, information about fasting blood glucose concentration or impaired fasting glucose status did not significantly improve metrics of vascular disease prediction when added to information about several conventional risk factors.
Diabetes confers about a two-fold excess risk for a wide range of vascular diseases, independently from other conventional risk factors. In people without diabetes, fasting blood glucose concentration is modestly and non-linearly associated with risk of vascular disease.
British Heart Foundation, UK Medical Research Council, and Pfizer.
Physical inactivity is a global concern, but diverse physical activity measures in use prevent international comparisons. The International Physical Activity Questionnaire (IPAQ) was developed as an instrument for cross-national monitoring of physical activity and inactivity.
Between 1997 and 1998, an International Consensus Group developed four long and four short forms of the IPAQ instruments (administered by telephone interview or self-administration, with two alternate reference periods, either the "last 7 d" or a "usual week" of recalled physical activity). During 2000, 14 centers from 12 countries collected reliability and/or validity data on at least two of the eight IPAQ instruments. Test-retest repeatability was assessed within the same week. Concurrent (inter-method) validity was assessed at the same administration, and criterion IPAQ validity was assessed against the CSA (now MTI) accelerometer. Spearman's correlation coefficients are reported, based on the total reported physical activity.
Overall, the IPAQ questionnaires produced repeatable data (Spearman's rho clustered around 0.8), with comparable data from short and long forms. Criterion validity had a median rho of about 0.30, which was comparable to most other self-report validation studies. The "usual week" and "last 7 d" reference periods performed similarly, and the reliability of telephone administration was similar to the self-administered mode.
The IPAQ instruments have acceptable measurement properties, at least as good as other established self-reports. Considering the diverse samples in this study, IPAQ has reasonable measurement properties for monitoring population levels of physical activity among 18- to 65-yr-old adults in diverse settings. The short IPAQ form "last 7 d recall" is recommended for national monitoring and the long form for research requiring more detailed assessment.
Based on studies published so far, the protective effect of physical activity on stroke remains controversial. Specifically, there is a lack of insight into the sources of heterogeneity between studies.
Meta-analysis of observational studies was used to quantify the relationship between physical activity and stroke and to explore sources of heterogeneity. In total, 31 relevant publications were included. Risk estimates and study characteristics were extracted from original studies and converted to a standard format for use in a central database.
Moderately intense physical activity compared with inactivity, showed a protective effect on total stroke for both occupational (RR = 0.64, 95% CI: 0.48-0.87) and leisure time physical activity (RR = 0.85, 95% CI: 0.78-0.93). High level occupational physical activity protected against ischaemic stroke compared with both moderate (RR = 0.77, 95% CI: 0.60-0.98) and inactive occupational levels (RR = 0.57, 95% CI: 0.43-0.77). High level compared with low level leisure time physical activity protected against total stroke (RR = 0.78, 95% CI: 0.71-0.85), haemorrhagic stroke (RR = 0.74, 95% CI: 0.57-0.96) as well as ischaemic stroke (RR = 0.79, 95% CI: 0.69-0.91). Studies conducted in Europe showed a stronger protective effect (RR = 0.47, 95% CI: 0.33-0.66) than studies conducted in the US (RR = 0.82, 95% CI: 0.75-0.90).
Lack of physical activity is a modifiable risk factor for both total stroke and stroke subtypes. Moderately intense physical activity is sufficient to achieve risk reduction.
A core question for policy-makers will be the extent to which investments
in preventive actions that address some of the social determinants of health
represent an effi cient option to help promote and protect population health.
Can they reduce the level of ill health in the population? How strong is the
evidence base on their effectiveness and, from an economic perspective,
how do they stack up against investment in the treatment of health problems?
Are there potential gains to be made by reducing or delaying the need for the
consumption of future health care resources? Will they limit some of the wider
costs of poor health to society, such as absenteeism from work, poorer levels of
educational attainment, higher rates of violence and crime and early retirement
from the labour force due to sickness and disability?
This policy summary provides an overview of what is known about the economic
case for investing in a number of different areas of health promotion and
non-communicable disease prevention. It focuses predominantly on addressing
some of the risk factors for health: tobacco and alcohol consumption, impacts
of dietary behaviour and patterns of physical activity, exposure to environmental
harm, risks to mental health and well-being, as well as risks of injury on
our roads.
It highlights that there is an evidence base from controlled trials and welldesigned
observational studies on the effectiveness of a wide range of health
promotion and disease prevention interventions that address risk factors to
health. Moreover, the cost–effectiveness of a number of health promotion and
disease prevention interventions has been shown in multiple studies. Some of
these interventions will be cost-saving, but most will generate additional health
(and other) benefi ts for additional costs.
In many cases combinations of actions, for example in the areas of tobacco,
alcohol and road injury prevention, are often more cost-effective than
relying on one action alone. In terms of individual actions the use of taxes to
infl uence individual choices on the use of tobacco and alcohol, as well as the
consumption of food, is consistently seen as a cost-effective intervention to
promote better lifestyle choices. Media-based campaigns, in contrast, are not
always effective or cost-effective. Interventions targeted at children often have
the most potential to be cost-effective because of the longer time-frame over
which health benefi ts can be realized.
While some interventions may take several decades to be seen to be costeffective,
for example impacts on the risk of obesity, there are some health
promotion and disease prevention actions that are cost-effective in the
short term, for instance related to the protection of mental health in the
workplace. There are opportunities to invest in cost-effective health promoting
interventions that can be delivered universally as well as to target population
groups, for instance in schools or workplaces.
However, this evidence base must be treated with caution, given that many
interventions have only been assessed in a small number of settings, and
different economic methods and assumptions are made in different studies.
Most of the economic evidence identifi ed has been undertaken in highincome
countries, with very few studies applied to other settings in the
WHO European Region.
Moreover, much of the evidence on the long-term costs and benefi ts of
interventions has been estimated using simulation modelling approaches
synthesizing data on effectiveness, epidemiology and costs. This refl ects the
lack of long-term observed effectiveness data for many public health and health
promoting interventions. It also means that policy-makers need to be cautious
on assumptions made about the persistence of effect of health promoting
interventions, for example the likelihood of long-term behaviour change.
The issue of equity is also a particularly important consideration. If the uptake
of a public health intervention is higher in more affl uent groups in society then
one unintended consequence of investment in a public health programme
could be to inadvertently widen health inequalities. We have little data from
our review on the impact of interventions on health inequalities. Finally there
are also challenges to be met to in order to help encourage the implementation
of cost-effective health promotion and disease prevention actions.
Notwithstanding these caveats, it is clear that there is an economics evidence
base for health promotion and disease prevention. The challenge now is to
strengthen this evidence base further and look at ways in which it may be used
to translate evidence-based knowledge into routine everyday practice across all
of the WHO European Region. For instance, given that these actions are often
delivered outside of the health system it is helpful to speak the same language
and highlight the economic benefi ts of most interest to the sectors that are
responsible for funding each action.
In 2008, 2·45 million people were diagnosed with cancer and 1·23 million died because of cancer in the 27 countries of the European Union (EU). We aimed to estimate the economic burden of cancer in the EU.
In a population-based cost analysis, we evaluated the cost of all cancers and also those associated with breast, colorectal, lung, and prostate cancers. We obtained country-specific aggregate data for morbidity, mortality, and health-care resource use from international and national sources. We estimated health-care costs from expenditure on care in the primary, outpatient, emergency, and inpatient settings, and also drugs. Additionally, we estimated the costs of unpaid care provided by relatives or friends of patients (ie, informal care), lost earnings after premature death, and costs associated with individuals who temporarily or permanently left employment because of illness.
Cancer cost the EU €126 billion in 2009, with health care accounting for €51·0 billion (40%). Across the EU, the health-care costs of cancer were equivalent to €102 per citizen, but varied substantially from €16 per person in Bulgaria to €184 per person in Luxembourg. Productivity losses because of early death cost €42·6 billion and lost working days €9·43 billion. Informal care cost €23·2 billion. Lung cancer had the highest economic cost (€18·8 billion, 15% of overall cancer costs), followed by breast cancer (€15·0 billion, 12%), colorectal cancer (€13·1 billion, 10%), and prostate cancer (€8·43 billion, 7%).
Our results show wide differences between countries, the reasons for which need further investigation. These data contribute to public health and policy intelligence, which is required to deliver affordable cancer care systems and inform effective public research funds allocation.
Pfizer.
To implement effective non-communicable disease prevention programmes, policy makers need data for physical activity levels and trends. In this report, we describe physical activity levels worldwide with data for adults (15 years or older) from 122 countries and for adolescents (13-15-years-old) from 105 countries. Worldwide, 31·1% (95% CI 30·9-31·2) of adults are physically inactive, with proportions ranging from 17·0% (16·8-17·2) in southeast Asia to about 43% in the Americas and the eastern Mediterranean. Inactivity rises with age, is higher in women than in men, and is increased in high-income countries. The proportion of 13-15-year-olds doing fewer than 60 min of physical activity of moderate to vigorous intensity per day is 80·3% (80·1-80·5); boys are more active than are girls. Continued improvement in monitoring of physical activity would help to guide development of policies and programmes to increase activity levels and to reduce the burden of non-communicable diseases.
Strong evidence shows that physical inactivity increases the risk of many adverse health conditions, including major non-communicable diseases such as coronary heart disease, type 2 diabetes, and breast and colon cancers, and shortens life expectancy. Because much of the world's population is inactive, this link presents a major public health issue. We aimed to quantify the eff ect of physical inactivity on these major non-communicable diseases by estimating how much disease could be averted if inactive people were to become active and to estimate gain in life expectancy at the population level.
For our analysis of burden of disease, we calculated population attributable fractions (PAFs) associated with physical inactivity using conservative assumptions for each of the major non-communicable diseases, by country, to estimate how much disease could be averted if physical inactivity were eliminated. We used life-table analysis to estimate gains in life expectancy of the population.
Worldwide, we estimate that physical inactivity causes 6% (ranging from 3·2% in southeast Asia to 7·8% in the eastern Mediterranean region) of the burden of disease from coronary heart disease, 7% (3·9-9·6) of type 2 diabetes, 10% (5·6-14·1) of breast cancer, and 10% (5·7-13·8) of colon cancer. Inactivity causes 9% (range 5·1-12·5) of premature mortality, or more than 5·3 million of the 57 million deaths that occurred worldwide in 2008. If inactivity were not eliminated, but decreased instead by 10% or 25%, more than 533 000 and more than 1·3 million deaths, respectively, could be averted every year. We estimated that elimination of physical inactivity would increase the life expectancy of the world's population by 0·68 (range 0·41-0·95) years.
Physical inactivity has a major health eff ect worldwide. Decrease in or removal of this unhealthy behaviour could improve health substantially.
None.
To estimate the global health expenditure on diabetes among people aged 20-79 years for the years 2010 and 2030.
Country-by-country expenditures for 193 countries, expressed in United States Dollars (USD) and in International Dollars (ID), were estimated based on the country's age-sex specific diabetes prevalence and population estimates, per capita health expenditures, and health expenditure ratios per person with and without diabetes. Diabetes prevalence was estimated from studies in 91 countries. Population estimates and health expenditures were from the United Nations and the World Health Organization. The health expenditure ratios were estimated based on utilization and cost data of a large health plan in the U.S. Diabetes expenditures for the year 2030 were projected by considering future changes in demographics and urbanization.
The global health expenditure on diabetes is expected to total at least USD 376 billion or ID 418 billion in 2010 and USD 490 billion or ID 561 billion in 2030. Globally, 12% of the health expenditures and USD 1330 (ID 1478) per person are anticipated to be spent on diabetes in 2010. The expenditure varies by region, age group, gender, and country's income level.
Diabetes imposes an increasing economic burden on national health care systems worldwide. More prevention efforts are needed to reduce this burden. Meanwhile, the very low expenditures per capita in poor countries indicate that more resources are required to provide basic diabetes care in such settings.
A new approach for estimating the indirect costs of disease, which explicitly considers economic circumstances that limit production losses due to disease, is presented (the friction cost method). For the Netherlands the short-term friction costs in 1990 amount to 1.5-2.5% of net national income (NNI), depending on the extent to which short-term absence from work induces production loss and costs. The medium-term macro-economic consequences of absence from work and disability reduce NNI by an additional 0.8%. These estimates are considerably lower than estimates based on the traditional human capital approach, but they better reflect the economic impact of illness.
Type 1 diabetes accounts for only about 5-10% of all cases of diabetes; however, its incidence continues to increase worldwide and it has serious short-term and long-term implications. The disorder has a strong genetic component, inherited mainly through the HLA complex, but the factors that trigger onset of clinical disease remain largely unknown. Management of type 1 diabetes is best undertaken in the context of a multidisciplinary health team and requires continuing attention to many aspects, including insulin administration, blood glucose monitoring, meal planning, and screening for comorbid conditions and diabetes-related complications. These complications consist of microvascular and macrovascular disease, which account for the major morbidity and mortality associated with type 1 diabetes. Newer treatment approaches have facilitated improved outcomes in terms of both glycaemic control and reduced risks for development of complications. Nonetheless, major challenges remain in the development of approaches to the prevention and management of type 1 diabetes and its complications.
This paper estimates the disease burden and loss of economic output associated with chronic diseases-mainly cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes-in 23 selected countries which account for around 80% of the total burden of chronic disease mortality in developing countries. In these 23 selected low-income and middle-income countries, chronic diseases were responsible for 50% of the total disease burden in 2005. For 15 of the selected countries where death registration data are available, the estimated age-standardised death rates for chronic diseases in 2005 were 54% higher for men and 86% higher for women than those for men and women in high-income countries. If nothing is done to reduce the risk of chronic diseases, an estimated US8 billion, which is almost 10% of the projected loss in national income over the next 10 years.
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Global Burden of Disease Study Collaborators. Global, regional, and
national incidence, prevalence, and years lived with disability for
301 acute and chronic diseases and injuries in 188 countries,
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Eff ect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy
Eff ect of physical inactivity on major non-communicable diseases
worldwide: an analysis of burden of disease and life expectancy.
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