The Basic Paradigm of the Conference and Key Definitions The Paradigm The subject matter has been approached on the as- sumption that there are complex relationships be- tween the levels of habitual physical activity, physical and physiological fitness, and health. In a simplified manner, these relationships are illus- trated in Figure 1.1. The ecifies thi ‘bitual physical activity can influence fitne hhich in turn is correlated with the level of habit physical activity. For instance, the fittest dividuals tend to be the most active and, with increasing fitness, people tend to become tive. The model also specifies that fitness is relat Thatis, health status influences both habitual physical activity level and fitness level. The Consensus Statement 5 In reality, the relationships between the level of habitual physical activity, fitness and health are ‘more complex than suggested by Figure 1.1. Other factors are associated with individual differences in health conditions, personal attributes, and gene! laracteristics also affect the major factors of t asic model and determine their interrelation: A more complex model describing the relation- ships between habitual physical activity, fitness, and health is suggested by Figure 1.2. Both the Program content of the Conference and the con- tent of the Consensus Statement were planned in the context of the relationships specified in this figure. PHYSICAL ACTIVITY ra 7 — WELLNESS — work ESS EALTH $ — MORBIDITY — LEISURE <¢_ 70 >50 >28 Maximm 100131074 energy expenditure. Physical activity is clearly th most variable component of total daily ener expends FF + Phy Physiological Fitness: Fitness “Sayer cp the purpose of this conf ence, a distinction is drawn ical fitness and physiological fines: Pgs is 5 defined by the World Health Organization, is tis generally thought that physic: comprises cardiorespiratory endurance, muscular strength and endurance, and flexibility) is deter- mined by several variables including habitu: physical activity level, diet, and heredity. shich are influence: e level jitual physical ac~ tivity. In that sense, one may talk about physio- logical fitness. Variables to consider include blood pressure, glucose tolerance and insulin sensitivi- ty, blood lipid levels and the lipoprotein profile, body composition and fat distribution, and stress tolerance. Some clinical values for these various characteristics are more desirable than others from. the viewpoints of both health and performance In the context of fitnes processes of adjustment, to variations inthe level ty. Adaptation is therefore defined in terms of the responses to such activity including training and a lack of adequate physical activity. Healt Positive health is associated with a capacity to enjoy life and to withstand chal- lenges; it is not merely the absence of disease.Negative health is associated with morbidity and, in the extreme, with mortality. + Wellness: Wellness is a holistic concept, describing a state of positive health in the individu- al and comprising biological and psychological well-being. + Morbidity and Mortality: Morbidity is a state of ill health, generally resulting from a specific pathology. Mortality is usually defined in terms of an age and sex-specific death rate. + Heredity: Inherited factors contribute \uman variation in physical and physiological fit ess and in health. The concept of heredity al cludes the effects of genes determining the phi jotypic response to lifestyle and environment: ctors. + Lifestyle: Lifestyle comprises the aggregate of an individual's behaviors, actions, and habits which can affect personal health (e.g., smoking, diet, habitual physical activity). SQEEEID ne crore has physical and social characteristics (temperature, humidity, altitude, quality of air, place of residence, social network, characteristics of workplace, gross na- tional product, etc.) which affect habitual physi- aS Personal attributes in- ‘clude such enduring sociodemographic and ps chological characteristics as: —— Assessment of Physical Activity, Fitness, and Health Assessment of Physical Activity Level and ‘Overali Energy Expenditure Physical activity is almost universally accepted as being relevant to health, although the pattern of activity (nature, intensity, frequency and duration of individual exercise bouts, cumulative years of participation) required to induce maximum healt benefits remains uncertain. One obstacle to more lefinitive studies is the considerable interaction. hysical activity with fitness, nutritional status, ind other sociocultural variables. Isolating the specific health effects of physical activity is thus very difficult. ‘More conclusive investigations of the relation- ship between health and physical activity will de- ‘The Consensus Statement 7 assessing both overall energy expenditure and pat tems of physical activity at work and during leisu hours. Existing procedures also need more careful validation. A prime epidemiological requirement is to in- crease our information pend upon the development of better methods a (preferably prospective) and/or a questionnaire are the only current methods capa- ble of providing such information on large num- bers of individuals. Careful validation of both wrocedures is necessary t such te: niques cannot be applied to children younger than ten years of age; used when validating ques- tionnaire assessments of habitual activity remains a problem. Doubly labeled water} been used sucvessfully to monitor energy \ditures in sinall animals. The development of new ratio mass spectrometers with greater precision has reduced the dose of the isotope needed and hence the cost, so that the method has potential application to human assessments made over periods of 1 to 2 weeks, provided that the number of subjects is not large. Personal monitoring devices hold most promise for small-scale experimental validation of self- reports and for future epidemiological studies. ‘Techniques will, in all probability, include single- or multiple-plane accelerometers, perhaps in com- bination with the monitoring of heart rate and/or the use of computerized activity records. The tradi- tional approach of measuring oxygen consumption has the disadvantage of modifying the subject's movements, but a further potential approach would be a technique for accumulating information obtained from a thoracic respiration recorder. Rapid developments in technology may soon provide suitable low-cost instrumentation for epidemiological studies. Future monitoring devices should incorporate a time base and be able to mea- sure and store data on movement patterns or physiological responses at intervals of about one minute for a total period of 12 to 24 hours. For the immediate future, we shall probably con: tinue to rely very largely on diary records or ques. tionnaires, possibly supplemented by selecte measurements of movement patterns and/or hi rates, when assessing relationships betweer habitual physical activity and health.8 Exercise, Fitness, and Health Assessment of Physical and Physiological Fitness In the assessment of physical and physiological fi ness, it is important to identify whether the mation relates to performance- and/or healt related fitness. Performance-related fitness ref to those components of fitness that contribute optimal work or sport performance, where health-related fitness involves those component that relate to health status. When evaluating physical fitness, the following components should be considered: Flexibility is relatively easy to assess. Standard procedures are required for more reliable joint- specific measures, From a health-related perspec- tive, additional measurements which correlate well with the risk of back disorders are needed, A range of techniques is presently available, but none is completely accurate or valid and all need improvement. 1 health-related fitness, the concern ie nt on the amount of fat, but also with fat dtbue since the presence of a high waist-to-hip cir- cumference ratio and excessive trunk or abdominal fat places the individual more at risk of diabetes and cardiovascular diseases, this information should be included in the evaluation of body cor position. impler and more accurate indirect methods of assessing body composition and fat distribution are also needed. Imaging techniques appear promising but continued development is needed to make such methods simpler and more practical. Finally, there is a need to study the ef- fects of such factors as age, gender, heredity, health status, level of fitness, and type of training upon the various body components Muscle Strength and Endurance gh can be assessed using sme iti Each has inherent limita- tions. While isometric tests are easy to administer, information is limited to the specific joint angles measured, and the direct applicability of data to ‘most types of movement is questionable. Tests of isotonic strength provide more information about performance, but better standardization of mea- surement technique is needed. Isokinetic testing is promising, but further validation is required, Age- and gender-specific norms should be devel yped, describing the strength and endurance inge-muscle groups at varying speeds of contr tion. Some tests of muscular strength and endur- ance can be dangerous, and alternative methods of measurement should be developed. Anaerobic Abilities There remains a need to develop standardized tests, reflecting the ability to undertake different types and durations of brief, Aerobic Ability The direct measurement of maximal aerobic power (VO,max) is the most satisfactory method for as- sessing aerobic ability and there are definite crite- ria for its measurement. Submaximal tests have often been used to predict VOsmax where maxi- mal tests are contraindicated or prevented by tech- nical difficulties, but there are serious limitations with these methodologies. lity to sustain endurance exercise. \smax, endurance capacity, and participation in physical activity, while usually associated with each other, cannot be used interchangeably. During a routine medical or health examination, selected physiological and biochemical variables are of considerable importance. A normal blood. pressure and concentrations of plasma lipids, in- sulin, and blood glucose in the low-to-normal range are signs of physiological fitness and are associated with alow body-fat content and low ab- dominal fat, both also characteristics of physio- logical fitness. Proper interpretation of physical fitness and physiological fitness data has to take into account such characteristics of the individual as age, gender, years of education, and personal lifestyle, including inventories of tobacco use, alcohol use, diet, and leisure-time and occupational activity. In addition, any family history of hypertension, blood. lipid disorders, diabetes, obesity, ischemic heart disease, or early death of relatives should be con- sidered,Assessment of Health The assessment of health status has evolved considerably since the concept of positive health was first articulated. Nevertheless, traditional in- dices of morbidity (e.g., hospital admissions, bed- days by cause, case-fatality ratios) and of mortality (c.g. life expectancy at specified ages) continue to dominate descriptions of population health status. ‘A major limitation in this class of indicators is their origin in administrative data. For morbidity, their application is often limited to a small and un- representative fraction of the total population. Mortality statistics are also of limite: ees status, Nevertheless the prevalence of certain diseases possibly related to activity should be measured. ‘More importantly, in prospective or longitudinal =: the incidence rate for these diseases could sve as Both short- and long-term cross-sectional and longitudinal studies are needed to better understand the relationship between habitual physical activity, fitness, and health. In consequence, population-based measures such as two-week disability days and measures of functional status (e.g., ability to undertake the activities of daily living) have been developed. Such measures, while more comprehensive in the population covered, are fragile because of their re- liance upon survey data which are not usually col- lected on a routine basis. Data from administrative sources, on the other hand, suffer from incon- sistencies in recording, classification, or process- ing, and are often focused on events rather than individuals. With all such measures, it is impor- tant to distinguish between disease events (e.g., prevalence of a condition) and proxy measures based on the consequences of illness (e.g., hospi- tal days). The assessment of positive health has been hin- dered by difficulties in its conceptualization, while conceptual developments have been retarded by a paucity of data. Disability-free life expectancy and psychological well-being are two measures ‘commonly used to describe positive dimensions of sopulation health. Measures of health are also needed for crater le intervention studies on the effects of exercis and physical activity. For such purposes, certain “surrogates” for health have proved useful. For example, the effects of exercise regimens can be related to known risk factors for the development ‘The Consensus Statement 9 of atherosclerotic complications (serum lipids, glu- cose tolerance, blood pressure), even though these variables serve only as proxies for health itself. In studies involving larger numbers of individuals and lasting for long enough periods of time, the incidence rates for specific diseases may also serve as relevant end-points (coronary artery disease, diabetes mellitus, os Thus, scientists should, when possible, use more global ‘measures, such as healthy life expectancy or dis- ability-free life expectancy. These variables will al- low more meaningful comparisons across cultures and nations of the impact of habitual physical ov fitness. Determinants of Participation in Physical Activity Personal attributes can classify people as likely to be responsive or nonresponsive to interventions that are designed to increase their level of habitual physical activity. Available evidence from devel- oped countries suggests many categories of in- dividuals who are’ particularly inactive in their leisure time and who, to date, have been un- responsive to supervised programmes. Such target groups include blue-collar workers, low-income, less-educated individuals, ethnic minorities, housewives, middle-aged individuals, the physi- cally disabled, smokers, and those with a Type A behavior pattern, While resistant to an increase of physical activity, such groups are of interest to public health, since they are the people most like- ly to benefit from an increase in their personal activity. Those who are active tend to be self-motivated and possess self-regulatory skills: setting personal physical activity goals, planning to reach them, minimizing environmental barriers to implemen tation, and monitoring and reinforcing their ac- tions. Those promoting physical activity must thus seek to develop behavioral skills and environments t will enable and reinforce participation. ere is a need to identify and rank dete ‘minants of participation in physical activity. In ation and maintenance of physical activity must be considered separately. Interventions focused upon knowledge, attitudes, intentions, health be- liefs, self-efficacy, and expectancies about activity