Exercise and Nutrition for Healthcare Michael T. Cunningham for: S.C. HAM Inc. January 5, 2009 Is exercise and nutrition Amusement, Recreation, Entertainment, or is it Healthcare? Where do we begin? Looking at recent nationwide trends and statistics, currently the frequency of regular leisure-time physical activity among adults age 18 and older is around 30 percent. According to recent CDC (Center for Disease Control) data, 49.5 percent of adults age 18 and older engage in 30 or more minutes of moderate physical activity five or more days per week. As of January 2009 there were approximately 30,022 U.S. Health Clubs; 45.5 million U.S. Health Club Members; and total U.S. Industry Revenues for 2008 was around $19.1 billion. On the flip side regarding our nation's health profile more than one third of U.S. adults (more than 72 million people) and 16% of U.S. children are obese. Since 1980, obesity rates for adults have doubled and rates for children have tripled. Obesity rates among all groups in society irrespective of age, sex, race, ethnicity, socioeconomic status, education level, or geographic region have increased markedly. Obesity has psychological, physical, and social consequences in adults and children. Children are developing obesity-related diseases, such as type 2 diabetes, that were once seen only in adults. Obese children are more likely to have risk factors for cardiovascular disease, including high cholesterol levels and high blood pressure. Recently reported obesity-related health care costs totaled an estimated $117 billion. Between 1987 and 2001, diseases associated with obesity accounted for 27% of the increases in medical costs. Medical expenditures for obese workers, depending on severity of obesity and sex, were between 29%-117% greater than expenditures for workers with optimal weight. From 1979-1981 to 1997-1999, annual hospital costs related to obesity among children and adolescents increased, rising from $35 million to $127 million, it is still increasing. Nearly 10 million children and adolescents ages 6-19 are classified as overweight, recent statistics report just over 12 percent of preschool children ages 2-5 were also considered overweight. Among infants and children 6-23 months of age, the prevalence of overweight (high weight for age) increased from 7.2 percent in 1976-80 to 11.5 percent in 2003-06. Overweight adolescents have a 70 percent chance of becoming overweight adults, the chance increases to 80 percent if one or both parents are overweight or obese. Another recent study show ed an estimated 66.7 percent of the adult population (age 20 and older) was overweight or obese. The WHO (world health organization) estimates that by 2015, the number of overweight people worldwide will increase to 2.3 billion, and more than 700 million will be obese. According to one study, annual medical spending on overweight and obesity could be as high as $92.6 billion. According to another estimate, the annual cost might reach $117 billion. Based on projections from NHANES/NCHS studies between 1984 and 2004, the total prevalence of diabetes in the United States was expected to more than double from 2005 to 2050 (from 5.6 percent to 12.0 percent) in all age, sex and race/ethnicity groups. An estimated 80 million American adults (one in three) have one or more types of cardiovascular disease (CVD). High blood pressure (HBP) impacted 73.6 million. Coronary heart disease (CHD) affected approximately 16.8 million. Myocardial infarction (MI, or heart attack) hit around 7.9 million. Angina pectoris (AP, or chest pain) affected 9.8 million. Heart failure (HF) was at 5.7 million. Stroke accounted for 6.5 million. More than 2,500 Americans die from heart disease each day. Almost 6 million hospitalizations each year (in the United States) are due to cardiovascular disease. Since 1900, Cardio Vascular Disease has been the number 1 killer in the United States for every year but 1918. Every 33 seconds, a person dies from Cardio Vascular Disease in the United States. Do these numbers grab your attention? Should we still be focused on Exercise and Nutrition as amusement, recreation or even entertainment? As we explore known risk factors; according to a case-control study of 52 countries (INTERHEART), nine easily measured and potentially modifiable risk factors account for over 90 percent of the risk of an initial acute MI. These nine risk factors include cigarette smoking, abnormal blood lipid levels, hypertension, diabetes, abdominal obesity, a lack of physical activity, low daily fruit and vegetable consumption, alcohol over-consumption and psychosocial index. The relative risk of coronary heart disease associated with physical inactivity ranges from 1.5-2.4; That increase in risk is directly comparable to the risk observed for high blood cholesterol, high blood pressure or cigarette smoking. A study of over 72,000 female nurses indicates that moderate intensity physical activity, such as walking, is associated with a substantial reduction in risk of total and ischemic stroke. Physical inactivity is responsible for approximately 12.2 percent of the worldwide trouble with heart attack. Given these enlightening and in some cases alarming statistics, now more than ever a clear need exists to heighten the discussion of Exercise and Nutrition as prevention and treatment; exercise as a prescription; and to lobby the request to move accredited exercise and nutrition, facilities and business services into the discussion of healthcare. Exercise prescription is health care. The recent Washington discussions for healthcare reform needs to include moving regulated, accredited exercise and nutrition services; accredited exercise and nutrition facilities and accredited professionals from the current SIC (standard industrial classification) and NAILS (North American Industry Classification System) classification of (SIC)799 Miscellaneous Amusement And Recreation or the (NAICS)7139 Other Amusement and Recreation Industries groupings. The U.S. Department of Labor can help lead the effort to change the classifications. The Exercise and Nutrition Industry can lead the effort to impact health issues worldwide. We would also argue to include the accredited facilities, accredited program participation agreements, and exercise prescriptions as qualified recipients of applicable entitlement programs (Medicaid, Medicare, etc.) coverage dollars. The discussion should include reductions in healthcare premiums, and treatment costs as related to participation. It has been reported that thirty-three percent of adults under age 65 who had Medicaid health care coverage were obese compared with 25% of those who had private health insurance and 26% of those who were uninsured. Among adults age 65 and over, 33% of those who were covered by Medicare and Medicaid were obese compared with 22% of those with private health insurance and 23% of those with Medicare alone. Education, guidance, and affordable programs are needed in all communities. A great majority of physicians (worldwide) regardless if it be for treatment or prevention today will recommend some amount of exercise activity within their patient's health care guidelines. According to recent reports, the American Medical Association (AMA) and the American College of Sports Medicine (ACSM) have partnered to create the Exercise Is Medicine program. This program encourages physical activity to be a standard part of the discussion in patient visits. Recognized professionals and specialist exist in all areas pertaining to exercise prescription and nutrition. Physical Therapy already addresses one area the exercise specialist to patient, physician or medical professional integration takes place regarding exercise guidance. Physical therapy as defined is a health care profession which provides services to individuals and populations to develop, maintain, and restore maximum movement and functional ability. In the United States, training in physical therapy culminates in a doctor of physical therapy (DPT) degree. Exercise physiology is the study of the function of the human body during various acute and chronic exercise conditions. Kinesiology, also known as Human Kinetics, is the science of human movement. It focuses on how the body functions and moves. A kinesiological approach applies scientific based medical principles towards the analysis, preservation and enhancement of human movement. Nutritionist interface directly with appropriate medical professionals in clinical settings when applicable also. Human physiology, human anatomy, exercise physiology, kinesiology/biomechanics, nutrition, acute care of injury and illness, statistics and research design, and strength training and reconditioning. There is clinical science supporting all of these exercise and nutrition specialties. Is the Industry to blame for perceptions in the public and private sectors regarding exercise and nutrition? That would be a resounding yes! Some blame needs to be acknowledged by the current Health and Fitness industry itself. We are guilty of marketing extremes. Major weight reduction for cosmetic reasons, hard core enthusiasts with boot camps and specialty classes, and crash course programs get all of the attention. Too many of these exercise products focus on a one- size fits all approach? Extreme specialty diets encouraging extreme results, or the highly under- regulated and over promising supplement and dietary products industry that again boast a one size fits all promise. Many of these specialized sport or activity specific products serve their functions but these are specialty areas geared to specific focus groups, or high-end amateur athletes, weekend warriors, and people seeking extreme results, not the main stream. Many varieties of body movement programs and nutrition options exist; not all are based on scientific evidence or research. Some fitness programs and activity were designed just for fun and recreation. Fitness and good health is a by product of proper exercise and proper nutrition. Our bodies are limited on the range of movement capable (there are only so many ways to twist and turn, push and pull) and we all recognize the truth in "you are what you eat"? There are far more individual body types, combinations, lifestyles, and different fitness levels then one program can address. Just as the Medical Profession has a range of professionals and specialists from General Practitioners to Surgeons so too should the Exercise and Nutrition industry approach to products and services be presented? Exercise prescription and Nutrition as Healthcare will address a national need to move toward better preventive health measures and lifestyle recommendations. The partnership with all Health Services industries is vital. Exercise Science by one definition is a theory-based, research- led discipline that seeks applied solutions to health problems related to physical inactivity, and which aims to understand and promote individual and public health and wellbeing through evidence-based physical activity interventions. Proper exercise and nutrition affects all of our lives. When I look into the eyes of my 5 year old daughter I envision a world where all children should have access to the clear benefits of a healthy lifestyle which must include some form of body movement (proper exercise) and good nutrition. I smile, feel empowered and feel much more engaged knowing I can lift her to the swing set at the playground when she ask or I can actively play games during a family get together. Fun, amusement, recreation, and entertainment are by products of being fit. Fitness is the result of exercise and proper nutrition. Exercise and Nutrition guidance is Health Care.