Chapter 01

1. Chapter 01 Origins of Physical Activity Epidemiology

2. What is Epidemiology? • Physical activity epidemiology has emerged as a new field of study and intervention during the past 25 years as its scientific undergirding has grown. • However, the ideas that underlie the field are not new but are based in antiquity, dating to the use of structured exercise for health promotion in China around 2500 B.C. Origins of Physical Activity Epidemiology

3. Ancient History of Physical Activity and Health • The Code of Hammurabi, king of Babylon, had laws about health practices and physicians as early as 2080 BC. • In Greek Culture: • Panacea, goddess of healing, gave medicines to the sick, while Hygeia, goddess of health, taught people to protect their bodies by prudent living • In Modern Medicine “panacea” refers to a healing agent and “hygiene” refers to healthy practices. Origins of Physical Activity Epidemiology

4. Ancient History of Physical Activity and Health • Hippocrates (460-377 BC), known as the “father of medicine,” has also been described as the first epidemiologist. • He kept records of associations between diseases and climate, living conditions, and habits such as diet and exercise. He distinguished endemic diseases that differ in prevalence between places from epidemic diseases that vary in prevalence across time Origins of Physical Activity Epidemiology

5. Ancient History of Physical Activity and Health • In Class Task… Read the quote from Hippocrates on page 4. • What ideas from Hippocrates can be substantiated from modern research? • What ideas, if followed in modern day lifestyle behavioral practice would reduce the health burden in The United States? Origins of Physical Activity Epidemiology

6. Ayurveda System of Medicine, 9thCentury India • (Sanskrit for “the knowledge of living”),which recommended exercise and massage for the treatment of rheumatism • The Indian physician Sushruta prescribed moderate daily exercise as early as 600 BC for the treatment of diabetes. • Sushrutaalso recognized physical activity as preventive medicine, viewing sedentary living as a cause of obesity, diabetes, and early death Exercise as Medicine Origins of Physical Activity Epidemiology

7. Gymnastics, 5th century Greece • Around 480 BC, the Greek physician Herodicus specialized in therapeutic gymnastics (one of three classes of medical practice at that time). He based his therapies mainly on vigorous exercise. • Herophilus and Eristratus of Alexandria, Egypt, in the fourth century BC recommended moderate exercise, and, • Asclepiades of Bithynia, a Greek reformer of Hippocratic therapy in the first century BC, recommended walking and running for his patients Exercise as Medicine Origins of Physical Activity Epidemiology

8. Alexander the Great in the court of Macedonia, extended those views, stating, • “The following are examples of the results of action: bodily health is the result of a fondness for gymnastics; a man falls into ill health as a result of not caring for exercise” Exercise as Medicine Origins of Physical Activity Epidemiology

9. Middle Ages • Even during the Middle Ages in Europe, when the influence of Greek writings was obscured awaiting their rediscovery in the Renaissance, the Greek medical tradition of using exercise was preserved by the Arabs and later translated from Arabic into Latin medical manuals • The Canon of Medicine, written by the Persian physician Ibn Sine (a.k.a. Avicenna) in 1025, was the most influential medical text in Europe during the 15th and 16th centuries. Exercise as Medicine Origins of Physical Activity Epidemiology

10. Middle Ages Exercise as Medicine The work Sirr al-asrar, reportedly written by Aristotle, is believed to be the basis of the famous poem of medicine, Regimen SanitatisSalernitanum, which was published at the medical school at Salerno, Italy, in the 12th century and which mentioned the healthful benefits of walking after a meal and the use of exercise as a purgative. Origins of Physical Activity Epidemiology

11. Revival of Physical Education, Renaissance Period • During the Renaissance, scholars in Italy renewed interest in classical Greek gymnastics and recommended it as a fundamental part of education. • The 14th-century Italian poet laureate, Francesco Petrarca, encouraged exercise as a natural remedy to replace medicines that “poison the body” in his 1354 work, Invective Contra Medicum (Protest Against the Doctor) Exercise as Medicine Origins of Physical Activity Epidemiology

12. Revival of Physical Education, Renaissance Period • Leon Battista Albertirecommended physical exercise beginning in early infancy for strengthening the muscles, stimulating the circulation, and adapting the nervous system. He also stated that exercise for those purposes became even more important with increasing age. Exercise as Medicine Origins of Physical Activity Epidemiology

13. Revival of Physical Education, Renaissance Period Exercise as Medicine • MaffeusVegius, in his 15th-century Education of Children and Their Good Habits, distinguished between light recreational exercises and heavy exercise designed to strengthen the body, advising moderation in all physical activity. • Although the great educators of the 15th century recommended exercise as a lifelong habit, contemporary physicians did notembrace exercise. This was changed during the Renaissance by the Italian physician Hieronymus Mercurialis. (see next slide) Origins of Physical Activity Epidemiology

14. Think About It… • Discuss how some of the early beliefs and observations in health and exercise are now considered science fact (review the slides) Origins of Physical Activity Epidemiology

15. Revival of Physical Education, Renaissance Period His Six Books on the Art of Gymnastics, printed in 1569, laid the foundation for modern rehabilitative medicine by recommending that convalescents and weakened older people do special exercises, based on specific diagnoses, that should not worsen their infirmities. Hieronymus Mercurialis Origins of Physical Activity Epidemiology

16. Revival of Physical Education, Renaissance Period For the purpose of health, Mercurialis replaced passive exercises, which had been recommended by early Renaissance experts, with vigorous exercise involving heavy breathing and physical effort, including mountain climbing among three types of walking. He considered running, jumping, rope climbing, and wrestling healthy forms of exercise and suggested ball games to strengthen the upper body. Origins of Physical Activity Epidemiology

17. Revival of Physical Education, Renaissance Period Exercise as Medicine One of the first physicians since the classical Greeks to attempt to explain the benefits of exercise was the Frenchborn Swiss pharmacologist Joseph Duchesne, who in 1648 wrote in ArsMedicaHermetica, “The essential purpose of gymnastics for the body is its deliverance from superfluous humors, the regulation of digestion, the strengthening of the heart and joints, the opening of the pores of the skin, and the stronger circulation of blood in the lungs by strenuous breathing.” Origins of Physical Activity Epidemiology

18. Age of Enlightenment to the Modern Era Exercise as Medicine In 1772, Benjamin Rush, Philadelphia physician and father of American psychiatry, delivered a “Sermon on Exercise,” in which he recommended sports and exercises for young and old alike. His “Plan of a Federal University” included exercises to improve the body’s strength and health Sports Illustrated Article November 19, 1979 Benjamin Franklin Was An Athlete Whose Ideas Were Ahead Of His Time Origins of Physical Activity Epidemiology

19. Age of Enlightenment to the Modern Era Exercise as Medicine In 1802, the British physician William Heberden reported a case history of heart disease in which he concluded, “I know one who set himself a task of sawing wood half an hour every day, and was nearly cured” Origins of Physical Activity Epidemiology

20. Age of Enlightenment to the Modern Era Exercise as Medicine It was not until the years between the U.S. Civil War and World War I that physicians became the main proponents of exercise to promote good health. Their influence was the basis for our present-day acceptance of the relationship between exercise and a more rewarding and healthier life, and for our contemporary knowledge about the developing science of exercise as a form of preventive medicine. Origins of Physical Activity Epidemiology

21. Age of Enlightenment to the Modern Era Exercise as Medicine Edward Hitchcock Jr. (1828-1911) graduated from Harvard Medical School in 1853, then he and his father published a discussion of the relationship between exercise and health for boys and girls, which argued that gymnastics was as important to schools and colleges as were academic libraries In 1861 He began a teaching career promoting physical activity at Amherst College In 1885 he was elected the first president of the Association for the Advancement of Physical Education. Origins of Physical Activity Epidemiology

22. Age of Enlightenment to the Modern Era • The role of physical fitness in preventive medicine was advocated further by Dudley Sargent, an 1878 graduate of Yale Medical School who was the first director of the Hemenway Gymnasium at Harvard in 1880. Exercise as Medicine Sargent published Health, Strength, and Power in 1904, in which he argued for the importance of regular vigorous exercise for health and presented exercises for children and men of all ages designed to increase fitness. Origins of Physical Activity Epidemiology

23. Exercise as Medicine • Age of Enlightenment to the Modern Era 1909 – R. Tait McKenzie publishes “Exercise in Education and Medicine” • Emphasizes physiology of exercise, and the use of exercise to treat disease. This publication provides the foundation of modern physical medicine and rehabilitation. Origins of Physical Activity Epidemiology

24. Age of Enlightenment to the Modern Era Exercise as Medicine The impetus provided by those early physician-educators continued in the United States and Europe during the first half of the 20th century and culminated in the founding of The American College of Sports Medicine in 1954. Note Founding Fathers in ACSM Origins of Physical Activity Epidemiology

25. Exercise as Medicine – Physical Activity Epidemiology Landmark Research • Epidemiologist Dr. Jeremy Morris begins to study the relationships between physical activity and coronary heart disease. (late 1940’s –early 1950’s) Morris observed what appeared to be a protective effect of occupational physical activity against CHD Origins of Physical Activity Epidemiology

26. Morris hypothesized that those men with more active jobs would have a protective effect against heart disease. 1953 – Morris finds that highly active bus conductors on double-decker buses were at lower risk that the drivers Morris later reports similar findings in postal workers who walk deliver mail when compared to office clerks and telephone operators. Origins of Physical Activity Epidemiology

27. Other Supporting Studies had similar findings as Morris, including the community study of Framingham, MA. • Framingham Study: • Began in 1948 • 5000 + men / women • 30 to 62 yrs. of age • Study continues • Findings = physical activity reduces the risk of heart disease, and that high blood pressure , cigarette smoking, and cholesterol increases risk. Origins of Physical Activity Epidemiology

28. Other Studies • Tecumseh Community Health Study • Longshoremen and College Alumni Studies • Recent Developments • 1980: U.S. Public Health Service identifies physical fitness and exercise as one of 15 areas of focus for improving health • CDC created “Behavioral Epidemiology and Evaluation Branch”. In 1990, this branch begins to monitor national goals for physical fitness. Origins of Physical Activity Epidemiology

29. Recent Developments • 1988 First International Conference on Exercise held in Toronto, Canada. • 1992 Second International Consensus Symposium on Physical Activity, Fitness, and Health in Toronto, Canada. • Conference publication “Physical Activity, Fitness, and Health: International Proceedings and Consensus Statement”, lays the foundation for “Physical Activity and Health: A Report of the U.S. Surgeon General”, 1996. Origins of Physical Activity Epidemiology

30. Recent Developments • Government Reports • 1992: American Heart Association Position Statement on Physical Inactivity and Coronary Heart Disease • 1996: Physical Activity and Health: A Report of the Surgeon General. • National Health Goals • Healthy People 2000 • Healthy People 2010 • Healthy People 2020 (see Physical Activity in Objectives and Topics) Origins of Physical Activity Epidemiology

31. Physical Activity /Health Promotion for U.S. and World At the May 2002 World Health Assembly, member nations mandated that the World Health Organization (WHO) create a Global Strategy on Diet, Physical Activity and Health. In 2003, the WHO and the Food and Agriculture Organization of the United Nations published the technical report “Diet, Nutrition, and the Prevention of Chronic Diseases,” Origins of Physical Activity Epidemiology

32. Physical Activity /Health Promotion for U.S. and World • In 1995 the CDC and the Prevention Research Center at the University of South Carolina started offering widely renowned postgraduate training courses for physical activity and public health researchers and practitioners, which continue today. • Largely as an outgrowth of those courses, the U.S. National Society of Physical Activity Practitioners in Public Health was formed in 2006. Origins of Physical Activity Epidemiology

33. Physical Activity /Health Promotion for U.S. and World In May 2004, the WHO adopted the Global Strategy on Diet, Physical Activity and Health, which has four main objectives: • Reduce risk factors for chronic diseases that stem from unhealthy diets and physical inactivity through public health actions. • Increase awareness and understanding of the influences of diet and physical activity on health and the positive impact of preventive interventions. Origins of Physical Activity Epidemiology

34. Physical Activity /Health Promotion for U.S. and World 3) Develop, strengthen, and implement global, regional, national policies and action plans to improve diets and increase physical activity that are sustainable and comprehensive and that actively engage all sectors. 4) Monitor science and promote research on diet and physical Activity Consistent with those goals, the International Congress on Physical Activity and Public Health met first in Atlanta in 2006 and then in Amsterdam in 2008 and Toronto in 2010. Origins of Physical Activity Epidemiology

35. In Class Review • Read through the section “Health Goals for the Nation” (pp 11-13) • Discuss and compare the goals verses the outcomes of the health objectives • How does the level of activity reflect our nation’s priorities in preventing disease through physical activity? Origins of Physical Activity Epidemiology

36. Additional Reading (FYI) A history of physical activity, cardiovascular health and longevity: the scientific contributions of Jeremy N Morris, DSc, DPH, FRCP By: Ralph S Paffenbarger Jr, Steven N Blair, and I-Min Lee. END OF PRESENTATION Origins of Physical Activity Epidemiology